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

Dialogue and Dissemination: The Social Practices of Medical Illustrators in the Pharmaceutical Context

This dissertation investigates the social practices of North American medical illustrators in the creation of images for their pharmaceutical sponsors. It tells a contemporary story of the relational attributes that support these visual science messages, using theories of social practice and research on communities of practice. Ethnographic interviews conducted with 28 medical illustrators reveal that visual accuracy is the result of a process of negotiation influenced by transitioning community interests. Medical illustrators face increased complexity in the communities of practice responsible to professional representations of science bridging research science, marketing, regulatory, legal, and health advertising interests. Medical illustrators invoke accuracy in challenging negotiations through relationships with beauty, technology and science story, in order to engage in traditional dialogues with medical science practitioners despite a commercial pharmaceutical context of dissemination. The accuracy of images is not a singular, uncomplicated entity, but a fertile area of active creation, a social construction through negotiated meaning. Medical illustrators transition to working contexts that allow them to engage in production processes that bridge dialogue and dissemination, in smaller biotech companies, not-for-profit educational contexts, or their own research science studies. This research contributes to the disparate literatures of medical illustration, practice theory, the social studies of scientific imaging and visualization, and visual culture where the material world is a complex socio-material space

Feasibility of Goal Attainment Scaling as a patient-reported outcome measure for older patients in primary care

Abstract Background Goal Attainment Scaling (GAS) is an outcome measure that reflects the perspectives and experiences of patients, consistent with patient-centred care approaches and with the aims of patient-reported outcome measures (PROMs). GAS has been used in a variety of clinical settings, including in geriatric care, but research on its feasibility in primary care practice has been limited. The time required to complete GAS is a barrier to its use by busy primary care clinicians. In this study, we explored the feasibility of lay interviewers completing GAS with older primary care patients. Methods Older adults were recruited from participants of a larger study in five primary care clinics in Alberta and Ontario, Canada. GAS guides were developed based on semi-structured telephone interviews completed by a non-clinician lay interviewer; goals were reviewed in a follow-up interview after six months. Results Goal-setting interviews were conducted with 41 participants. GAS follow-up guides could be developed for 40 patients (mean of two goals/patient); follow-up interviews were completed with 29 patients. Mobility-focused goals were the most common goal areas identified. Conclusions Study results suggest that it is feasible for lay interviewers to conduct GAS over the telephone with older primary care patients. This study yielded an inventory of patient goal areas that could be used as a starting point for future goal-setting interviews in primary care. Recommendations are made for use of GAS and for future research in the primary care context