Using data to explore vulnerable women's utilization of maternity health care

Introduction Inequitable access to appropriate maternity health care is an issue for vulnerable women that negatively impacts health outcomes. As part of a feasibility study on midwifery services for vulnerable women, we used administrative data to further our understanding of socially disadvantaged women’s use of the primary care system during pregnancy. Objectives and Approach To better understand maternity health service utilization and social vulnerability of women in Calgary Alberta, a research partnership was formed between Alberta Health Services and a social service agency that serves clients experiencing, poverty, and food insecurity and were at risk for homelessness. This multi-phase study linked postal code data to data from provincial databases. Variables included socioeconomic characteristics, prenatal health care utilization and maternal and birth outcomes for the years 2013 to 2015. Results Databases accessed included the Alberta Perinatal Health Program (APHP), Alberta Health Practitioner Claims Database, AHS Admission Discharge Transfer Database, Discharge Abstracts Database, National Ambulatory Care Reporting, and Provincial Registry Database. Data linkages yielded a total sample size of 7493 women, with 15.5% of women qualifying as ‘socially vulnerable’. Women receiving social assistance are relatively younger, experience more pregnancies, have higher antenatal risk scores and accessed maternal and emergency care more often and later in their pregnancy than those women who are not accessing social services. Our results suggest women living in vulnerable circumstances experience higher risk pregnancies that those not living in vulnerable circumstances. Therefore a maternity care model such as midwifery, which uses a holistic approach to care may be beneficial for vulnerable women. Conclusion/Implications Findings from our study confirm that women experiencing poor social circumstances are at increased risk for complications during pregnancy and birth. Therefore, we need to further investigate utilizing maternity models of care that serve both the maternal health needs and the social needs of this population

Specialist LINK and primary care network clinical pathways - a new approach to patient referral: a cross-sectional survey of awareness, utilization and usability among family physicians in Calgary

Abstract Background Specialist LINK is a real-time, non-urgent telephone collaboration line designed to link family doctors and specialists. The purpose was to reduce wait times, improve efficiency and enhance the coordination of patient care through enhanced communication between primary and specialty care. The aim of this study was to determine the awareness and utilization of Specialist LINK and Primary Care Network (PCN) Clinical Pathways among family physicians. Methods A family physician experience cross-sectional survey was conducted from March to May 2018 in Calgary and Area. The survey was designed to assess family physicians’ awareness and utilization of Specialist LINK and PCN Clinical Pathways. We also used a 1–10 scale for respondents to rate the utility of Specialist LINK (1 was least useful and 10 represented highly useful). To obtain a true representative sample, family physicians were selected through a random sampling method. We applied multiple approaches to ensure a high response rate: paper survey, telephone reminders, and an on-site survey for non-responders. Results A total of 251 participants completed the survey of the 650 randomly selected family physicians (Response rate≈39%). Eighty-nine percent of the family physicians were aware of Specialist LINK [95% Confidence Interval (84–92%)]. The average rating was 8.1 (on a scale of 1–10) for the usefulness of Specialist LINK. We found that the odds of being aware of Specialist LINK were two times higher in female family physicians compared to male physicians. Also, those with less than 5 years of experience, the odds of being aware of Specialist LINK were around five times higher compared to those with 5 or more years of experience. Fifty-five percent of family physicians were aware of PCN Clinical Pathways (95% CI = 48–60%); of those, 82% were accessing and following PCN Clinical Pathways in their clinical practice. The average rating was 7.9 (on a scale of 1–10) for the usefulness of PCN Clinical Pathways. Conclusion Most of the respondents in Calgary and area were aware of Specialist LINK and a large proportion of them were using it to access advice for their patients

Should Health Care Aides Assist With Medications in Long-Term Care?

Objective: The objective of the study was to determine whether health care aides (HCAs) could safely assist in medication administration in long-term care (LTC). Method: We obtained medication error reports from LTC facilities that involve HCAs in oral medication assistance and we analyzed Resident Assessment Instrument (RAI) data from these facilities. Standard ratings of error severity were “no apparent harm,” “minimum harm,” and “moderate harm.” Results: We retrieved error reports from two LTC facilities with 220 errors reported by all health care providers including HCAs. HCAs were involved in 137 (63%) errors, licensed practical nurses (LPNs)/registered nurses (RNs) in 77 (35%), and pharmacy in four (2%). The analysis of error severity showed that HCAs were significantly less likely to cause errors of moderate severity than other nursing staff (2% vs. 7%, chi-square = 5.1, p value = .04). Conclusion: HCAs’ assistance in oral medications in LTC facilities appears to be safe when provided under the medication assistance guidelines

Specialist LINK and primary care network clinical pathways - a new approach to patient referral: a cross-sectional survey of awareness, utilization and usability among family physicians in Calgary

Background Specialist LINK is a real-time, non-urgent telephone collaboration line designed to link family doctors and specialists. The purpose was to reduce wait times, improve efficiency and enhance the coordination of patient care through enhanced communication between primary and specialty care. The aim of this study was to determine the awareness and utilization of Specialist LINK and Primary Care Network (PCN) Clinical Pathways among family physicians. Methods A family physician experience cross-sectional survey was conducted from March to May 2018 in Calgary and Area. The survey was designed to assess family physicians’ awareness and utilization of Specialist LINK and PCN Clinical Pathways. We also used a 1–10 scale for respondents to rate the utility of Specialist LINK (1 was least useful and 10 represented highly useful). To obtain a true representative sample, family physicians were selected through a random sampling method. We applied multiple approaches to ensure a high response rate: paper survey, telephone reminders, and an on-site survey for non-responders. Results A total of 251 participants completed the survey of the 650 randomly selected family physicians (Response rate≈39%). Eighty-nine percent of the family physicians were aware of Specialist LINK [95% Confidence Interval (84–92%)]. The average rating was 8.1 (on a scale of 1–10) for the usefulness of Specialist LINK. We found that the odds of being aware of Specialist LINK were two times higher in female family physicians compared to male physicians. Also, those with less than 5 years of experience, the odds of being aware of Specialist LINK were around five times higher compared to those with 5 or more years of experience. Fifty-five percent of family physicians were aware of PCN Clinical Pathways (95% CI = 48–60%); of those, 82% were accessing and following PCN Clinical Pathways in their clinical practice. The average rating was 7.9 (on a scale of 1–10) for the usefulness of PCN Clinical Pathways. Conclusion Most of the respondents in Calgary and area were aware of Specialist LINK and a large proportion of them were using it to access advice for their patients.Other Information Published in: BMC Family Practice License: https://creativecommons.org/licenses/by/4.0See article on publisher's website: http://dx.doi.org/10.1186/s12875-020-01159-0</p