Quels liens entre les caractéristiques des médecins et leur cadre de pratique dans le contexte canadien : une étude de la portée

Background: Physician characteristics such as education and sociodemographic attributes are associated with particular practice patterns, such as practice in rural settings. Understanding the Canadian context of such associations can inform medical school recruitment and health workforce decision-making. Objective: The objective of this scoping review was to report the nature and extent of the literature on associations between characteristics of physicians in Canada and physicians’ practice patterns. Eligibility criteria: We included studies reporting associations between 1) the education or sociodemographic attributes of practicing physicians or residents in Canada and 2) practice patterns, including career choice, practice setting, and populations served. Methods: We searched five electronic databases (MEDLINE (R) ALL, Embase, ERIC, Education Source and Scopus) for quantitative primary studies and reviewed reference lists of included studies for additional studies. Data were extracted using a standardized data charting form. Results: Our search yielded 80 studies. Sixty-two examined education, evenly divided between undergraduate and postgraduate. Fifty-eight examined physicians’ attributes, most focusing on sex/gender. The majority of studies focused on the outcome of practice setting. We found no studies examining race/ethnicity or socioeconomic status. Conclusion: Many studies in our review found positive associations between (i) rural training or rural background and rural practice setting and (ii) location of training or physicians’ origin and practice in that location, consistent with previous literature. Associations for sex/gender were mixed, suggesting it may be a less useful target for workforce planning or recruitment aiming to address gaps in health care provision. More research is needed on the association of characteristics, particularly race/ethnicity and socioeconomic status, with career choice and populations served.Contexte : Il existe un lien entre les caractéristiques des médecins, comme leur formation et leur profil sociodémographique, et des cadres de pratique particuliers, comme la pratique en milieu rural. La compréhension de ces liens dans le contexte canadien peut éclairer les stratégies d’admission dans les facultés de médecine et la planification de la main-d’œuvre dans le secteur de la santé. Objectif : L’objectif de cette étude de la portée était de faire état de la nature et de l’étendue de la littérature sur les liens entre les caractéristiques des médecins au Canada et leurs cadres de pratique. Critères de sélection : Nous avons inclus les études établissant des liens entre 1) la formation ou le profil sociodémographique des médecins ou des résidents en exercice au Canada et 2) les cadres de pratique, y compris le choix de carrière, le milieu de pratique et les populations desservies. Méthodes : Nous avons effectué des recherches dans cinq bases de données électroniques (MEDLINE (R) ALL, Embase, ERIC, Education Source et Scopus) pour trouver des études quantitatives primaires et avons examiné les listes de références bibliographiques des articles inclus pour repérer d’autres études. Les données ont été extraites à l’aide d’un formulaire normalisé. Résultats : Notre recherche a permis de recenser 80 études. Soixante-deux d’entre elles portaient sur l’éducation, réparties de manière égale entre le premier cycle et le cycle de spécialisation. Cinquante-huit examinaient les caractéristiques des médecins, la plupart portant sur le sexe/genre. La majorité des études étaient focalisées sur le résultat lié au milieu de pratique. Nous n’avons trouvé aucune étude portant sur la race/ethnicité ou le statut socio-économique. Conclusion : Conformément à la littérature antérieure, de nombreuses études de notre revue trouvent des associations positives entre (i) la formation en milieu rural ou l’origine rurale et le cadre de pratique rurale et entre (ii) le lieu de formation ou l’origine des médecins et la pratique dans ce lieu. Les associations relatives au sexe/genre étaient mitigées, ce qui suggère qu’il s’agit peut-être d’une cible moins utile pour la planification ou le recrutement de la main-d’œuvre visant à combler les lacunes dans la prestation des soins de santé. Des recherches supplémentaires sont nécessaires sur les liens entre le profil des médecins, en particulier la race/ethnie, et le statut socio-économique, et leur choix de carrière et les populations desservies

Characteristics of Canadian physicians and their associations with practice patterns: a scoping review

Background: Physician characteristics such as education and sociodemographic attributes are associated with particular practice patterns, such as practice in rural settings. Understanding the Canadian context of such associations can inform medical school recruitment and health workforce decision-making. Objective: The objective of this scoping review was to report the nature and extent of the literature on associations between characteristics of physicians in Canada and physicians’ practice patterns. Eligibility criteria: We included studies reporting associations between 1) the education or sociodemographic attributes of practicing physicians or residents in Canada and 2) practice patterns, including career choice, practice setting, and populations served. Methods: We searched five electronic databases (MEDLINE (R) ALL, Embase, ERIC, Education Source and Scopus) for quantitative primary studies and reviewed reference lists of included studies for additional studies. Data were extracted using a standardized data charting form. Results: Our search yielded 80 studies. Sixty-two examined education, evenly divided between undergraduate and postgraduate. Fifty-eight examined physicians’ attributes, most focusing on sex/gender. The majority of studies focused on the outcome of practice setting. We found no studies examining race/ethnicity or socioeconomic status. Conclusion: Many studies in our review found positive associations between (i) rural training or rural background and rural practice setting and (ii) location of training or physicians’ origin and practice in that location, consistent with previous literature. Associations for sex/gender were mixed, suggesting it may be a less useful target for workforce planning or recruitment aiming to address gaps in health care provision. More research is needed on the association of characteristics, particularly race/ethnicity and socioeconomic status, with career choice and populations served

Neighborhood-Level Influences and Adolescent Health Risk Behaviors in Rural and Urban Sub-Saharan Africa: A Systematic Review

The impact of neighborhoods on adolescent engagement in health-risk behaviors (HRBs), such as substance use and sexual activity, has been well documented in high-income countries; however, evidence from low and middle-income country settings is limited, particularly in sub-Saharan African (SSA) countries. Neighborhoods and communities in SSA continue to experience urbanization, epidemiologic transition, and the simultaneous presence of large populations living in rurality and urbanicity. This is a dynamic context for exploring adolescent health challenges. This review seeks to identify and summarize existing literature that investigates adolescent engagement in HRBs when compared across rural and urban neighborhoods across SSA. We performed searches using three electronic databases, targeted grey literature searches and scanned reference lists of included studies. Following dual-screening, our search yielded 23 relevant studies that met all inclusion criteria. These were categorized into six broad themes including studies on: (1) sexual risk taking, (2) injury-related, (3) violence, (4) eating and/or exercise-related, (5) substance use, and (6) personal hygiene. We found that neighborhood factors relating to accessibility and availability of health information and care impacted adolescent engagement in HRBs in rural and urban areas. Urbanization of areas of SSA plays a role in differences in engagement in HRBs between rural and urban dwelling adolescents

Key factors for national spread and scale-up of an eConsult innovation.

BackgroundExpanding healthcare innovations from the local to national level is a complex pursuit requiring careful assessment of all relevant factors. In this study (a component of a larger eConsult programme of research), we aimed to identify the key factors involved in the spread and scale-up of a successful regional eConsult model across Canada.MethodsWe conducted a constant comparative thematic analysis of stakeholder discussions captured during a full-day National eConsult Forum meeting held in Ottawa, Canada, on 11 December 2017. Sixty-four participants attended, representing provincial and territorial governments, national organisations, healthcare providers, researchers and patients. Proceedings were recorded, transcribed and underwent qualitative analysis using the Framework for Applied Policy Research.ResultsThis study identified four main themes that were critical to support the intentional efforts to spread and scale-up eConsult across Canada, namely (1) identifying population care needs and access problems, (2) engaging stakeholders who were willing to roll up their sleeves and take action, (3) building on current strategies and policies, and (4) measuring and communicating outcomes.ConclusionsEfforts to promote innovation in healthcare are more likely to succeed if they are based on an understanding of the forces that drive the spread and scale-up of innovation. Further research is needed to develop and strengthen the conceptual and applied foundations of the spread and scale-up of healthcare innovations, especially in the context of emergent learning health systems across Canada and beyond

Key factors for national spread and scale-up of an eConsult innovation.

BackgroundExpanding healthcare innovations from the local to national level is a complex pursuit requiring careful assessment of all relevant factors. In this study (a component of a larger eConsult programme of research), we aimed to identify the key factors involved in the spread and scale-up of a successful regional eConsult model across Canada.MethodsWe conducted a constant comparative thematic analysis of stakeholder discussions captured during a full-day National eConsult Forum meeting held in Ottawa, Canada, on 11 December 2017. Sixty-four participants attended, representing provincial and territorial governments, national organisations, healthcare providers, researchers and patients. Proceedings were recorded, transcribed and underwent qualitative analysis using the Framework for Applied Policy Research.ResultsThis study identified four main themes that were critical to support the intentional efforts to spread and scale-up eConsult across Canada, namely (1) identifying population care needs and access problems, (2) engaging stakeholders who were willing to roll up their sleeves and take action, (3) building on current strategies and policies, and (4) measuring and communicating outcomes.ConclusionsEfforts to promote innovation in healthcare are more likely to succeed if they are based on an understanding of the forces that drive the spread and scale-up of innovation. Further research is needed to develop and strengthen the conceptual and applied foundations of the spread and scale-up of healthcare innovations, especially in the context of emergent learning health systems across Canada and beyond