Portrait des Canadiens réticents à la vaccination

"Nous voulons, dans ce chapitre, décrire les caractéristiques des Canadiens qui sont réticents à la vaccination ou s’y opposent1 à différents stades du processus de vaccination (c’est-àdire à l’enfance, à l’adolescence et à l’âge adulte). Nous commencerons par une description des parents canadiens qui hésitent à faire vacciner leurs nourrissons, leurs enfants et leurs adolescents, puis nous passerons aux adolescentes réticentes et conclurons avec les adultes qui éprouvent les mêmes doutes à leur propre sujet. Nous terminerons par un examen de certaines caractéristiques sociodémographiques, ainsi que de certaines tendances religieuses et culturelles que partagent les groupes réticents à la vaccination. […]

A cost comparison of electronic and hybrid data collection systems in Ontario during pandemic and seasonal influenza vaccination campaigns

<p>Abstract</p> <p>Background</p> <p>During the pandemic (H1N1) 2009 influenza vaccination campaign, health regions in Canada collected client-level immunization data using fully electronic or hybrid systems, with the latter comprising both electronic and paper-based elements. The objective of our evaluation was to compare projected five-year costs associated with implementing these systems in Ontario public health units (PHUs) during pandemic and seasonal influenza vaccination campaigns.</p> <p>Methods</p> <p>Six PHUs provided equipment and staffing costs during the pandemic (H1N1) 2009 influenza vaccination campaign and staffing algorithms for seasonal campaigns. We standardized resources to population sizes 100,000, 500,000 and 1,000,000, assuming equipment lifetime of five years and public health vaccine administration rates of 18% and 2.5% for H1N1 and seasonal campaigns, respectively. Two scenarios were considered: Year 1 pandemic and Year 1 seasonal campaigns, each followed by four regular influenza seasons. Costs were discounted at 5%.</p> <p>Results</p> <p>Assuming a Year 1 pandemic, the five-year costs per capita for the electronic system decrease as PHU population size increases, becoming increasingly less costly than hybrid systems ($4.33 vs.$4.34 [100,000], $4.17 vs.$4.34 [500,000], $4.12 vs.$4.34 [1,000, 000]). The same trend is observed for the scenario reflecting five seasonal campaigns, with the electronic system being less expensive per capita than the hybrid system for all population sizes ($1.93 vs.$1.95 [100,000], $1.91 vs.$1.94 [500,000], $1.87 vs.$1.94 [1,000, 000]). Sensitivity analyses identified factors related to nurse hours as affecting the direction and magnitude of the results.</p> <p>Conclusions</p> <p>Five-year cost projections for electronic systems were comparable or less expensive than for hybrid systems, at all PHU population sizes. An intangible benefit of the electronic system is having data rapidly available for reporting.</p

The prevention and management of chronic disease in primary care: recommendations from a knowledge translation meeting

BACKGROUND: Seven chronic disease prevention and management programs were implemented across Quebec with funding support from a provincial-private industry funding initiative. Given the complexity of implementing integrated primary care chronic disease management programs, a knowledge transfer meeting was held to share experiences across programs and synthesize common challenges and success factors for implementation. METHODS: The knowledge translation meeting was held in February 2014 in Montreal, Canada. Seventy-five participants consisting of 15 clinicians, 14 researchers, 31 knowledge users, and 15 representatives from the funding agencies were broken up into groups of 10 or 11 and conducted a strengths, weaknesses, opportunities, and threats analysis on either the implementation or the evaluation of these chronic disease management programs. Results were reported back to the larger group during a plenary and recorded. Audiotapes were transcribed and summarized using pragmatic thematic analysis. RESULTS AND DISCUSSION: Strengths to leverage for the implementation of the seven programs include: (1) synergy between clinical and research teams; (2) stakeholders working together; (3) motivation of clinicians; and (4) the fact that the programs are evidence-based. Weaknesses to address include: (1) insufficient resources; (2) organizational change within the clinical sites; (3) lack of referrals from primary care physicians; and (4) lack of access to programs. Strengths to leverage for the evaluation of these programs include: (1) engagement of stakeholders and (2) sharing of knowledge between clinical sites. Weaknesses to address include: (1) lack of referrals; (2) difficulties with data collection; and (3) difficulties in identifying indicators and control groups. Opportunities for both themes include: (1) fostering new and existing partnerships and stakeholder relations; (2) seizing funding opportunities; (3) knowledge transfer; (4) supporting the transformation of professional roles; (5) expand the use of health information technology; and (6) conduct cost evaluations. Fifteen recommendations related to mobilisation of primary care physicians, support for the transformation of professional roles, and strategies aimed at facilitating the implementation and evaluation of chronic disease management programs were formulated based on the discussions at this knowledge translation event. CONCLUSION: The results from this knowledge translation day will help inform the sustainability of these seven chronic disease management programs in Quebec and the implementation and evaluation of similar programs elsewhere

Promoting advance planning for health care and research among older adults: A randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making.</p> <p>Methods/Design</p> <p>Dyads (<it>n </it>= 240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled <it>My Preferences </it>that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about <it>My Preferences</it>. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the end of the intervention and 6 months later to assess improvement in predictive accuracy and cost savings, if any. Copies of completed guides are made at the time of these assessments.</p> <p>Discussion</p> <p>This study will determine whether the tested intervention guides proxies in making decisions that concur with those of older adults, motivates the latter to record their wishes in writing, and yields savings for the healthcare system.</p> <p>Trial Registration</p> <p><a href="http://www.controlled-trials.com/ISRCTN89993391">ISRCTN89993391</a></p

Understanding vaccine hesitancy in Canada: Results of a consultation study by the Canadian Immunization Research Network

"Vaccine hesitancy" is a concept now frequently used in vaccination discourse. The increased popularity of this concept in both academic and public health circles is challenging previously held perspectives that individual vaccination attitudes and behaviours are a simple dichotomy of accept or reject. A consultation study was designed to assess the opinions of experts and health professionals concerning the definition, scope, and causes of vaccine hesitancy in Canada. We sent online surveys to two panels (1- vaccination experts and 2- front-line vaccine providers). Two questionnaires were completed by each panel, with data from the first questionnaire informing the development of questions for the second. Our participants defined vaccine hesitancy as an attitude (doubts, concerns) as well as a behaviour (refusing some / many vaccines, delaying vaccination). Our findings also indicate that both vaccine experts and front-line vaccine providers have the perception that vaccine rates have been declining and consider vaccine hesitancy an important issue to address in Canada. Diffusion of negative information online and lack of knowledge about vaccines were identified as the key causes of vaccine hesitancy by the participants. A common understanding of vaccine hesitancy among researchers, public health experts, policy-makers and health care providers will better guide interventions that can more effectively address vaccine hesitancy within Canada

Étude des modes d’organisation des équipes de première ligne en santé mentale jeunesse en Montérégie

Cette étude qualitative s’intéresse aux modes d’organisation des équipes de première ligne en santé mentale jeunesse de la Montérégie. Cette région compte onze de ces équipes qui disposent de modalités de fonctionnement différentes et oeuvrant au sein de contextes diversifiés. La collecte des données a été effectuée en 2010 et 2011. L’étude décrit les pratiques actuelles selon la perspective des membres de ces équipes et les modalités de collaboration qu’elles ont préconisées avec leurs différents partenaires, un enjeu majeur lorsqu’une équipe oeuvre au sein d’un réseau intégré de services. Une taxonomie fut élaborée afin de mieux apprécier le potentiel d’amélioration et de faire ressortir des pistes tangibles tant pour les gestionnaires que pour les professionnels de ces équipes.This qualitative study examines the organizational models of a primary mental health care team for youths in the Montérégie region. This region includes eleven teams working according to different modalities of functioning and within varied contexts. Data was collected in 2010 and 2011. The study describes current practices according to the perspective of members of these teams and modes of collaboration advocated by their different partners, a major issue when a team works within an integrated network of services. A taxonomy was elaborated in order to better appreciate the potential for improvement, and to highlight tangible avenues as much for management as for professionals of these teams

Étude des modes d’organisation des équipes de première ligne en santé mentale jeunesse en Montérégie

Cette étude qualitative s’intéresse aux modes d’organisation des équipes de première ligne en santé mentale jeunesse de la Montérégie. Cette région compte onze de ces équipes qui disposent de modalités de fonctionnement différentes et oeuvrant au sein de contextes diversifiés. La collecte des données a été effectuée en 2010 et 2011. L’étude décrit les pratiques actuelles selon la perspective des membres de ces équipes et les modalités de collaboration qu’elles ont préconisées avec leurs différents partenaires, un enjeu majeur lorsqu’une équipe oeuvre au sein d’un réseau intégré de services. Une taxonomie fut élaborée afin de mieux apprécier le potentiel d’amélioration et de faire ressortir des pistes tangibles tant pour les gestionnaires que pour les professionnels de ces équipes.This qualitative study examines the organizational models of a primary mental health care team for youths in the Montérégie region. This region includes eleven teams working according to different modalities of functioning and within varied contexts. Data was collected in 2010 and 2011. The study describes current practices according to the perspective of members of these teams and modes of collaboration advocated by their different partners, a major issue when a team works within an integrated network of services. A taxonomy was elaborated in order to better appreciate the potential for improvement, and to highlight tangible avenues as much for management as for professionals of these teams

Determinants of influenza vaccination among a large adult population in Quebec

Objectives: Very low uptake has been noted for influenza vaccination in the province of Quebec. This study aimed to identify the determinants of influenza vaccination among a large regional population. Methods: A telephone survey was administered to a random digit sample in the Eastern Townships region (Quebec, Canada). Respondents were asked questions on several health topics such as perceived knowledge and beliefs about influenza immunization, medical consultations, perceived health status and life habits. Significant variables in the univariate analysis were introduced into a multivariate logistic regression model to determine independent factors for having received the influenza vaccine (aOR and 95% CI) among adults aged ≥60 years and younger adults with ≥1 chronic condition. Results: A total of 4,620 interviews were analyzed. Among the target groups, 55.4% of adults aged ≥60 and 32.2% of adults aged 18–59 with at least one chronic disease had received the influenza vaccine during the 2013–2014 season. Several determinants were significantly associated with influenza vaccination in both groups such as having received a recommendation from a healthcare professional. Among adults aged ≥60, not having consulted a chiropractor over the last 12 months (aOR = 2.37; 1.09-5.19), non-smokers (aOR = 1.78; 1.22-2.59) and self-perceived poor health status (aOR = 1.45; 1.01-2.06) were significantly linked to flu vaccination. In the younger group, influenza vaccination was independently associated to low alcohol consumption (aOR = 2.14; 1.13-4.05) and being overweight (aOR = 1.63; 1.12-2.38). Conclusions: Many determinants influence the decision to get vaccinated against influenza. Specific messages should be tailored for high-risk groups to effectively increase influenza vaccine coverage