Policy and practices in primary care that supported the provision and receipt of care for older persons during the COVID-19 pandemic: a qualitative case study in three Canadian provinces

Abstract Background The effects of the COVID-19 pandemic on older adults were felt throughout the health care system, from intensive care units through to long-term care homes. Although much attention has been paid to hospitals and long-term care homes throughout the pandemic, less attention has been paid to the impact on primary care clinics, which had to rapidly change their approach to deliver timely and effective care to older adult patients. This study examines how primary care clinics, in three Canadian provinces, cared for their older adult patients during the pandemic, while also navigating the rapidly changing health policy landscape. Methods A qualitative case study approach was used to gather information from nine primary care clinics, across three Canadian provinces. Interviews were conducted with primary care providers (n = 17) and older adult patients (n = 47) from October 2020 to September 2021. Analyses of the interviews were completed in the language of data collection (English or French), and then summarized in English using a coding framework. All responses that related to COVID-19 policies at any level were also examined. Results Two main themes emerged from the data: (1) navigating the noise: understanding and responding to public health orders and policies affecting health and health care, and (2) receiving and delivering care to older persons during the pandemic: policy-driven challenges & responses. Providers discussed their experiences wading through the health policy directives, while trying to provide good quality care. Older adults found the public health information overwhelming, but appreciated the approaches adapted by primary care clinics to continue providing care, even if it looked different. Conclusions COVID-19 policy and guideline complexities obliged primary care providers to take an important role in understanding, implementing and adapting to them, and in explaining them, especially to older adults and their care partners

Caregivers as a proxy for responses of dementia clients in a GPS technology acceptance study

The objective of this study was to examine the extent to which caregivers can be used to provide proxy responses for dementia clients in a study on the acceptance of GPS technology. Methods: Forty-five client–caregiver dyads used one of three GPS devices. The Unified Theory of Acceptance and Use of Technology (UTAUT) was used to create two questionnaires, one for dementia clients and one for caregivers, as proxies. Spearman rho bivariate correlations of responses for each UTAUT construct were used to compare the client and caregiver responses post-usage of the GPS devices. Results: The mean age of the clients was 76.02 years (SD = 11.5). Overall, after using the GPS devices, the responses of the clients and caregivers were correlated and statistically significant (rxy Overall summative scale = 0.550). In addition, 4 out of 6 constructs of the UTAUT were correlated and statistically significant (p < 0.05) (rxy Performance Expectancy = 0.160; rxy Social Influence = 0.478; rxy Behavioural Intention to Use = 0.347; and rxy Actual Use = 0.570). Conclusion: The degree of agreement between the caregivers and clients, especially for the constructs intention to use and actual use of the GPS technology, suggested that caregivers can respond on behalf of dementia clients on technology acceptance questionnaires.El objetivo de este estudio fue examinar hasta qué punto se puede utilizar a los cuidadores para que proporcionen respuestas proxy para los clientes con demencia en un estudio sobre la aceptación de la tecnología GPS. Métodos: Cuarenta y cinco díadas cliente-cuidador utilizaron uno de los tres dispositivos GPS. Se utilizó la Teoría Unificada de Aceptación y Uso de la Tecnología (UTAUT) para crear dos cuestionarios, uno para los clientes con demencia y otro para los cuidadores, como sustitutos. Se utilizaron correlaciones bivariadas de Spearman rho de las respuestas para cada constructo de la UTAUT para comparar las respuestas de los clientes y los cuidadores tras el uso de los dispositivos GPS. Resultados: La edad media de los clientes era de 76,02 años (SD = 11,5). En general, tras el uso de los dispositivos GPS, las respuestas de los clientes y los cuidadores estaban correlacionadas y eran estadísticamente significativas (rxy escala sumativa global = 0,550). Además, 4 de los 6 constructos de la UTAUT estaban correlacionados y eran estadísticamente significativos (p < 0,05) (rxy Expectativa de rendimiento = 0,160; rxy Influencia social = 0,478; rxy Intención de comportamiento de uso = 0,347; y rxy Uso real = 0,570). Conclusiones: El grado de acuerdo entre los cuidadores y los clientes, especialmente para los constructos intención de uso y uso real de la tecnología GPS, sugiere que los cuidadores pueden responder en nombre de los clientes con demencia en los cuestionarios de aceptación de la tecnología

Economic evaluations of eHealth technologies: A systematic review

<div><p>Background</p><p>Innovations in eHealth technologies have the potential to help older adults live independently, maintain their quality of life, and to reduce their health system dependency and health care expenditure. The objective of this study was to systematically review and appraise the quality of cost-effectiveness or utility studies assessing eHealth technologies in study populations involving older adults.</p><p>Methods</p><p>We systematically searched multiple databases (MEDLINE, EMBASE, CINAHL, NHS EED, and PsycINFO) for peer-reviewed studies published in English from 2000 to 2016 that examined cost-effectiveness (or utility) of eHealth technologies. The reporting quality of included studies was appraised using the Consolidated Health Economic Evaluation Reporting Standards statement.</p><p>Results</p><p>Eleven full text articles met the inclusion criteria representing public and private health care systems. eHealth technologies evaluated by these studies includes computerized decision support system, a web-based physical activity intervention, internet-delivered cognitive behavioral therapy, telecare, and telehealth. Overall, the reporting quality of the studies included in the review was varied. Most studies demonstrated efficacy and cost-effectiveness of an intervention using a randomized control trial and statistical modeling, respectively. This review found limited information on the feasibility of adopting these technologies based on economic and organizational factors.</p><p>Conclusions</p><p>This review identified few economic evaluations of eHealth technologies that included older adults. The quality of the current evidence is limited and further research is warranted to clearly demonstrate the long-term cost-effectiveness of eHealth technologies from the health care system and societal perspectives.</p></div

CHEERS statement quality results.

<p>Items: (1) Title, (2) Abstract, (3) Background and Objectives, (4) Target population and subgroups, (5) Setting and Location, (6) Study perspective, (7) Comparators, (8) Time horizon, (9) Discount rate, (10) Choice of health outcomes, (11) Effectiveness, (12) Preference valuation, (13) Estimate resources and costs, (14) Currency, price date, conversion, (15) Choice of model, (16) Assumptions, (17) Analytical methods, (18) Study parameters, (19) Incremental costs and outcomes, (20) Uncertainty—single study or model based, (21) Heterogeneity, (22) Study findings/limitations/generalizability/current knowledge, (23) Source of funding, (24) Conflict of interest.</p

Mentoring a health technology assessment initiative in Kazakhstan

Objectives: The aim of this study was to assist in the development of a health technology assessment (HTA) program for the Ministry of Health (MOH) of the Republic of Kazakhstan. Methods: Mentoring of an initial HTA program in Kazakhstan was provided by the Canadian Society for International Health (CSIH) by means of a partnership with the Kazakhstan MOH. HTA materials, courses, and one-on-one support for the preparation of a series of initial HTA reports by MOH HTA staff were provided by a seven-member CSIH team over a 2.5-year project. Results: Guidance documents on HTA and institutional strengthening were prepared in response to an extensive set of deliverables developed by the MOH and the World Bank. Introductory and train-the-trainer workshops in HTA and economic evaluation were provided for MOH staff members, experts from Kazakhstan research institutes and physicians. Five short HTA reports were successfully developed by staff in the Ministry\u27s HTA Unit with assistance from the CSIH team. Challenges that may be relevant to other emerging HTA programs included lack of familiarity with some essential underlying concepts, organization culture, and limited time for MOH staff to do HTA work. Conclusions: The project helped to define the need for HTA and mentored MOH staff in taking the first steps to establish a program to support health policy decision making in Kazakhstan. This experience offers practical lessons for other emerging HTA programs, although these should be tailored to the specific context

Quality assessment of included studies using CHEERS statement.

<p>Quality assessment of included studies using CHEERS statement.</p