The impact of funding models on the integration of registered nurses in primary health care teams: protocol for a multi-phase mixed-methods study in Canada.

BACKGROUND: Family practice registered nurses co-managing patient care as healthcare professionals in interdisciplinary primary care teams have been shown to improve access, continuity of care, patient satisfaction, and clinical outcomes for patients with chronic diseases while being cost-effective. Currently, however, it is unclear how different funding models support or hinder the integration of family practice nurses into existing primary health care systems and interdisciplinary practices. This has resulted in the underutilisation of family practice nurses in contributing to high-quality patient care. METHODS: This mixed-methods project is comprised of three studies: (1) a funding model analysis; (2) case studies; and (3) an online survey with family practice nurses. The funding model analysis will employ policy scans to identify, describe, and compare the various funding models used in Canada to integrate family practice nurses in primary care. Case studies involving qualitative interviews with clinic teams (family practice nurses, physicians, and administrators) and family practice nurse activity logs will explore the variation of nursing professional practice, training, skill set, and team functioning in British Columbia, Nova Scotia, Ontario, and Quebec. Interview transcripts will be analysed thematically and comparisons will be made across funding models. Activity log responses will be analysed to represent nurses\u27 time spent on independent, dependent, interdependent, or non-nursing work in each funding model. Finally, a cross-sectional online survey of family practice nurses in Canada will examine the relationships between funding models, nursing professional practice, training, skill set, team functioning, and patient care co-management in primary care. We will employ bivariate tests and multivariable regression to examine these relationships in the survey results. DISCUSSION: This project aims to address a gap in the literature on funding models for family practice nurses. In particular, findings will support provincial and territorial governments in structuring funding models that optimise the roles of family practice nurses while establishing evidence about the benefits of interdisciplinary team-based care. Overall, the findings may contribute to the integration and optimisation of family practice nursing within primary health care, to the benefit of patients, primary healthcare providers, and health care systems nationally

Primary health care services for patients with chronic disease in Newfoundland and Labrador: a descriptive analysis

Background: Newfoundland and Labrador has a rapidly aging population, much of which is rural, with poor health behaviours and high rates of chronic disease. These factors contribute to a unique challenge in health care delivery. Our aim was to describe the availability of publicly funded primary health care programs and services delivered by regional health authorities across the province. Methods: We performed a descriptive analysis using data from a cross-sectional provincial primary health care survey deployed across Newfoundland and Labrador. Survey data included location, disease-specific chronic disease prevention programming, types of routine primary care, allied health prevention and promotion, chronic disease prevention and management services, and team-based care. The mode of service delivery was identified for most programs and services. Results: Surveys were returned by 153 sites (99.4% response rate). Family physician services were available at 66% of sites (95/145) and nurse practitioner services were available at 51% (74/144) of sites. Many sites offered screening for cervical (60%, 86/144), colon (42%, 59/142) and prostate cancers (43%, 60/141), in addition to various self-management and education services. Allied health services, such as clinical nutrition counselling (47%, 68/46) and occupational therapy (46%, 68/147), were available at many sites. Available health care services were most often offered by on-site staff, and few sites provided primary health care services through telehealth. Overall, rural sites offered a greater variety of services than urban sites. Interpretation: Considerable variability exists in the range of primary health care services available across Newfoundland and Labrador, with limited delivery of some programs and services. Future research should examine how availability of programs and services affects health outcomes and costs

Family physicians’ roles in long-term care homes and other congregate residential care settings during the COVID-19 pandemic: a qualitative study

Context: The COVID-19 pandemic disproportionally affected long-term care (LTC) homes and other community-based congregate residential care settings. Although family physicians (FPs) play important roles in the care of residents in LTC homes, provincial pandemic plans make few references to their specific roles in LTC. Objective: To examine the experiences of FPs providing care in LTC homes and other congregate care settings in Canada during the first year of the COVID-19 pandemic (2020–2021). Methods: As part of a multiple case study, we conducted semi-structured qualitative interviews with FPs across four Canadian regions. Interviews were transcribed, and a thematic analysis approach was employed. Findings: Twenty-one of the 68 FPs interviewed discussed providing care in congregate residential settings, including LTC. We identified three major themes: 1) the roles of FPs in community-based congregate residential care settings during a pandemic, 2) modification of the delivery of routine care, and 3) special workforce considerations in pandemic response for community-based congregate residential care settings. Limitations: We interviewed FPs in four Canadian jurisdictions between October 2020 and June 2021; findings may not be generalisable to later pandemic stages or to other provinces. Our recruitment strategy did not specifically target FPs who worked in different types of congregate residential care facilities; further research is needed to examine these settings in greater depth. Implications: FPs have a unique understanding of the populations they serve and are well suited to plan and implement community-adaptive procedures. Future pandemic plans should implement LTC-related FP roles during the pre-pandemic stage of a pandemic response

Family physicians\u27 responses to personal protective equipment shortages in four regions in Canada: a qualitative study.

BACKGROUND: Despite well-documented increased demands and shortages of personal protective equipment (PPE) during previous disease outbreaks, health systems in Canada were poorly prepared to meet the need for PPE during the COVID-19 pandemic. In the primary care sector, PPE shortages impacted the delivery of health services and contributed to increased workload, fear, and anxiety among primary care providers. This study examines family physicians\u27 (FPs) response to PPE shortages during the first year of the COVID-19 pandemic to inform future pandemic planning. METHODS: As part of a multiple case study, we conducted semi-structured qualitative interviews with FPs across four regions in Canada. During the interviews, FPs were asked to describe the pandemic-related roles they performed over different stages of the pandemic, facilitators and barriers they experienced in performing these roles, and potential roles they could have filled. Interviews were transcribed and a thematic analysis approach was employed to identify recurring themes. For the current study, we examined themes related to PPE. RESULTS: A total of 68 FPs were interviewed across the four regions. Four overarching themes were identified: 1) factors associated with good PPE access, 2) managing PPE shortages, 3) impact of PPE shortages on practice and providers, and 4) symbolism of PPE in primary care. There was a wide discrepancy in access to PPE both within and across regions, and integration with hospital or regional health authorities often resulted in better access than community-based practices. When PPE was limited, FPs described rationing and reusing these resources in an effort to conserve, which often resulted in anxiety and personal safety concerns. Many FPs expressed that PPE shortages had come to symbolize neglect and a lack of concern for the primary care sector in the pandemic response. CONCLUSIONS: During the COVID-19 pandemic response, hospital-centric plans and a lack of prioritization for primary care led to shortages of PPE for family physicians. This study highlights the need to consider primary care in PPE conservation and allocation strategies and to examine the influence of the underlying organization of primary care on PPE distribution during the pandemic

Development of a primary care pandemic plan informed by in-depth policy analysis and interviews with family physicians across Canada during COVID-19: A qualitative case study protocol

Introduction Given the recurrent risk of respiratory illness-based pandemics, and the important roles family physicians play during public health emergencies, the development of pandemic plans for primary care is imperative. Existing pandemic plans in Canada, however, do not adequately incorporate family physicians\u27 roles and perspectives. This policy and planning oversight has become increasingly evident with the emergence of the novel coronavirus disease, COVID-19, pandemic. This study is designed to inform the development of pandemic plans for primary care through evidence from four provinces in Canada: British Columbia, Newfoundland and Labrador, Nova Scotia, and Ontario. Methods and analysis We will employ a multiple-case study of regions in four provinces. Each case consists of a mixed methods design which comprises: (1) a chronology of family physician roles in the COVID-19 pandemic response; (2) a provincial policy analysis; and (3) qualitative interviews with family physicians. Relevant policy and guidance documents will be identified through targeted, snowball and general search strategies. Additionally, these policy documents will be analysed to identify gaps and/or emphases in existing policies and policy responses. Interviews will explore family physicians\u27 proposed, actual and potential roles during the pandemic, the facilitators and barriers they have encountered throughout and the influence of gender on their professional roles. Data will be thematically analysed using a content analysis framework, first at the regional level and then through cross-case analyses. Ethics and dissemination Approval for this study has been granted by the Research Ethics of British Columbia, the Health Research Ethics Board of Newfoundland and Labrador, the Nova Scotia Health Authority Research Ethics Board and the Western University Research Ethics Board. Findings will be disseminated via conferences and peer-reviewed publications. Evidence and lessons learnt will be used to develop tools for government ministries, public health units and family physicians for improved pandemic response plans for primary care

Family physician leadership during the COVID-19 pandemic: roles, functions and key supports.

PURPOSE: Strong leadership in primary care is necessary to coordinate an effective pandemic response; however, descriptions of leadership roles for family physicians are absent from previous pandemic plans. This study aims to describe the leadership roles and functions family physicians played during the COVID-19 pandemic in Canada and identify supports and barriers to formalizing these roles in future pandemic plans. DESIGN/METHODOLOGY/APPROACH: This study conducted semi-structured qualitative interviews with family physicians across four regions in Canada as part of a multiple case study. During the interviews, participants were asked about their roles during each pandemic stage and the facilitators and barriers they experienced. Interviews were transcribed and a thematic analysis approach was used to identify recurring themes. FINDINGS: Sixty-eight family physicians completed interviews. Three key functions of family physician leadership during the pandemic were identified: conveying knowledge, developing and adapting protocols for primary care practices and advocacy. Each function involved curating and synthesizing information, tailoring communications based on individual needs and building upon established relationships. PRACTICAL IMPLICATIONS: Findings demonstrate the need for future pandemic plans to incorporate formal family physician leadership appointments, as well as supports such as training, communication aides and compensation to allow family physicians to enact these key roles. ORIGINALITY/VALUE: The COVID-19 pandemic presents a unique opportunity to examine the leadership roles of family physicians, which have been largely overlooked in past pandemic plans. This study\u27s findings highlight the importance of these roles toward delivering an effective and coordinated pandemic response with uninterrupted and safe access to primary care

Effectiveness of registered nurses on system outcomes in primary care: a systematic review

Background Internationally, policy-makers and health administrators are seeking evidence to inform further integration and optimal utilization of registered nurses (RNs) within primary care teams. Although existing literature provides some information regarding RN contributions, further evidence on the impact of RNs towards quality and cost of care is necessary to demonstrate the contribution of this role on health system outcomes. In this study we synthesize international evidence on the effectiveness of RNs on care delivery and system-level outcomes in primary care. Methods A systematic review was conducted in accordance with Joanna Briggs Institute methodology. Searches were conducted in CINAHL, MEDLINE Complete, PsycINFO, and Embase for published literature and ProQuest Dissertations and Theses and MedNar for unpublished literature between 2019 and 2022 using relevant subject headings and keywords. Additional literature was identified through Google Scholar, websites, and reference lists of included articles. Studies were included if they measured effectiveness of a RN-led intervention (i.e., any care/activity performed by a primary care RN within the context of an independent or interdependent role) and reported outcomes of these interventions. Included studies were published in English; no date or location restrictions were applied. Risk of bias was assessed using the Integrated Quality Criteria for Review of Multiple Study Designs tool. Due to the heterogeneity of included studies, a narrative synthesis was undertaken. Results Seventeen articles were eligible for inclusion, with 11 examining system outcomes (e.g., cost, workload) and 15 reporting on outcomes related to care delivery (e.g., illness management, quality of smoking cessation support). The studies suggest that RN-led care may have an impact on outcomes, specifically in relation to the provision of medication management, patient triage, chronic disease management, sexual health, routine preventative care, health promotion/education, and self-management interventions (e.g. smoking cessation support). Conclusions The findings suggest that primary care RNs impact the delivery of quality primary care, and that RN-led care may complement and potentially enhance primary care delivered by other primary care providers. Ongoing evaluation in this area is important to further refine nursing scope of practice policy, determine the impact of RN-led care on outcomes, and inform improvements to primary care infrastructure and systems management to meet care needs. Protocol registration ID PROSPERO: International prospective register of systematic reviews. 2018. ID= CRD42018090767

The effects of patient-professional partnerships on the self-management and health outcomes for patients with chronic back pain: a quasi-experimental study

Background: Self-management may be a lifelong task for patients with chronic back pain. Research suggests that chronic pain self-management programmes have beneficial effects on patients’ health outcome. Contemporary pain management theories and models also suggest that a good patient-professional partnership enhances patients’ ability to self-manage their condition. Objectives: 1) To investigate whether there is a reciprocal relationship between self-management of chronic back pain and health-related quality of life (HRQoL); 2) to examine the impact of a good patient-professional partnership on HRQoL, either directly, or indirectly via change in the ability to self-manage pain. Design and setting: This quasi-experimental study was designed to take place during routine service appointments and conducted in a community-based pain management service in the United Kingdom. A patient-professional partnership was established in which patients were actively involved in setting up goals and developing individualised care plans. Through this, health professionals undertook patients’ health needs assessment, collaborated with patients to identify specific problems, provided written materials and delivered individualised exercise based on patients’ life situation. Patients were recruited following initial consultation and followed up three months later. Participants: A total of 147 patients (65% female) with a mean age of 48 years (SD: 14 years) were enrolled in the study. Of these, 103 subjects completed the study. Patients were included if they were aged 18 and over, suffered from chronic back pain, had opted in to the clinic and had sufficient ability to read and understand English. Patients were excluded if they opted out this service after the initial assessment, suffered from malignant pain or required acute medical interventions for their pain relief. Methods: Self-reported measures of HRQoL, patient-professional partnerships and self- management ability were collected at baseline and three months later. Pathways proposed were depicted using structural equation modelling. Results: There was no association between patients’ self-management ability and HRQoL at baseline. However, a positive direct effect was detected at three months (-0.38, p<0.01). A patient-professional partnership was not found to be beneficial for patients’ HRQoL through a direct pathway, but via an indirect pathway where self-management was a mediator (- 19.09, p<0.01). Conclusions: This study suggests that the increase in patients’ self-management ability may lead to improvement in HRQoL after pain management support provided in a partnership with health professionals. A good patient-professional partnership appears to be beneficial as an augmentation to self-management practice for patients with chronic back pain

University of Toronto Medical Journal (UTMJ): Best Practices for Successful and Sustainable Journals

The presentation was given at the Fourth Annual Student Journal Forum organized by the University of Toronto Libraries in January 2019.The University of Toronto Medical Journal (UTMJ) was established in 1923 and is Canada’s oldest student-run medical journal. It published articles from universities, institutes, organizations, and medical professionals from around the world. In this presentation UTMJ editors talk about the journal's operations and share best practices for a sustainable and successful production. This is an updated version of the presentation given at the Student Journal Forum 2018