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Déry J, de Guise É, Lamontagne ME. Identifying prioritization criteria for patients with mtbi waiting for multidisciplinary rehabilitation services: A Delphi study. Brain Inj 2023; 37:563-571. [PMID: 37114975 DOI: 10.1080/02699052.2023.2205662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Rehabilitation service providers must take into account prognostic factors when making clinical decisions, which includes using these factors as prioritization criteria. The goal of this study was to establish consensus on patient prioritization criteria based on prognostic factors related to persistent symptoms for patients with mild traumatic brain injury (mTBI) waiting for outpatient specialized rehabilitation services. MATERIALS AND METHODS We conducted a Delphi survey involving clinicians, researchers, decision makers, and patients. Before the survey, we presented the results of an overview of systematic reviews summarizing the evidence on prognostic factors related to post-concussion symptoms. RESULTS After two rounds, the 17 experts reached consensus on the inclusion of 12 prioritization criteria: acute stress disorder, anxiety and depression, baseline mental and physical health, functional impacts and difficulties in performing daily habits after the trauma, motivation to receive services, multiple concussions, prior neurological problems, PTSD, quality of sleep, return to work failures, somatic complaints, suicidal ideation. CONCLUSION Healthcare stakeholders must consider a wide range of factors to guide clinical decision-making, including about access to care and patient prioritization. This study shows that the Delphi technique can be used to reach consensus on such decisions regarding patients with mTBI who are waiting for outpatient specialized rehabilitation services.
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Affiliation(s)
- Julien Déry
- Department of Rehabilitation, Université Laval, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale,Québec, Canada
| | - Élaine de Guise
- Department of Psychology, Université de Montréal, Montréal, Canada
- Research Institute of the McGill University Health Centre (RI-MUHC), Montréal, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montréal, Canada
| | - Marie-Eve Lamontagne
- Department of Rehabilitation, Université Laval, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale,Québec, Canada
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Dupuis F, Déry J, Lucas de Oliveira FC, Pecora AT, Gagnon R, Harding K, Camden C, Roy JS, Lettre J, Hudon A, Beauséjour M, Pinard AM, Bath B, Deslauriers S, Lamontagne MÈ, Feldman D, Routhier F, Desmeules F, Hébert LJ, Miller J, Ruiz A, Perreault K. Strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities: A systematic literature review. J Health Serv Res Policy 2022; 27:157-167. [DOI: 10.1177/13558196211065707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Identifying effective strategies to reduce waiting times is a crucial issue in many areas of health services. Long waiting times for rehabilitation services have been associated with numerous adverse effects in people with disabilities. The main objective of this study was to conduct a systematic literature review to assess the effectiveness of service redesign strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities. Methods We conducted a systematic review, searching three databases (MEDLINE, CINAHL and EMBASE) from their inception until May 2021. We identified studies with comparative data evaluating the effect of rehabilitation services redesign strategies on reducing waiting times. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. A narrative synthesis was conducted. Results Nineteen articles including various settings and populations met the selection criteria. They covered physiotherapy ( n = 11), occupational therapy ( n = 2), prosthetics ( n = 1), exercise physiology ( n = 1) and multidisciplinary ( n = 4) services. The methodological quality varied ( n = 10 high quality, n = 6 medium, n = 3 low); common flaws being missing information on the pre-redesign setting and characteristics of the populations. Seven articles assessed access processes or referral management strategies (e.g. self-referral), four focused on extending/modifying the roles of service providers (e.g. to triage) and eight changed the model of care delivery (e.g. mode of intervention). The different redesign strategies had positive effects on waiting times in outpatient rehabilitation services. Conclusions This review highlights the positive effects of many service redesign strategies. These findings suggest that there are several effective strategies to choose from to reduce waiting times and help better respond to the needs of persons experiencing physical disabilities.
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Affiliation(s)
- Frédérique Dupuis
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Julien Déry
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Fabio Carlos Lucas de Oliveira
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Ana Tereza Pecora
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Rose Gagnon
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Katherine Harding
- Allied Health Clinical Research Office, Eastern Health, Victoria, Australia
| | - Chantal Camden
- École de réadaptation, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Josiane Lettre
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Anne Hudon
- École de Réadaptation, Université de Montréal, Montreal, QC, Canada
| | - Marie Beauséjour
- Département des Sciences de la santé communautaire, Université de Sherbrooke, Longueuil, QC, Canada
| | - Anne-Marie Pinard
- Département D’anesthésiologie et de Soins Intensifs, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Brenna Bath
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Simon Deslauriers
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Marie-Ève Lamontagne
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Debbie Feldman
- École de Réadaptation, Université de Montréal, Montreal, QC, Canada
| | - François Routhier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | | | - Luc J. Hébert
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Physical Therapy Program, Queen’s University, Kingston, ON, Canada
| | - Angel Ruiz
- Département d’opérations et systèmes de décision, Faculté des sciences de l’administration, Université Laval, Québec, QC, Canada
| | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
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Missen K, Mills A, McDonald G, Di Corleto E, Telling L, Davey A. Evaluation of an assessment model to reduce waitlist times for occupational therapy in a rural community health setting. Aust J Rural Health 2021; 29:987-992. [PMID: 34757648 DOI: 10.1111/ajr.12806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 08/19/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Community occupational therapy services have seen an increase in demand over the last three years, resulting in longer waitlist times for service provision, particularly in rural areas where it is difficult to recruit experienced occupational therapists. Utilising a demand management model, the Basic Assessment Model Pre-Screening Tool was developed by a team of Occupational Therapists and allied health assistants to decrease client waitlist times at one rural community health service. DESIGN An evaluation of the implementation of an assessment model with comparison of quantitative data pre and post intervention. SETTING Rural Community Health Service in Victoria, Australia PARTICIPANTS: 456 clients that were registered as community-based clients requiring occupational therapy services. MAIN OUTCOME MEASURE Following the implementation of the newly developed Basic Assessment Model the number of occupational therapy assessments increased and there was a decrease in the median wait time that clients were on the waitlist in comparison to pre implementation. RESULTS There was a statistically significant decrease (p<0.001) in the median number of days spent on the waitlist for the post intervention group (80 days) compared to the pre intervention group (105 days). CONCLUSION The results of this study suggest that waiting lists for community occupational therapy services can be reduced by implementing this basic assessment model ultimately improving the health outcomes of clients.
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Affiliation(s)
- Karen Missen
- Federation University, Churchill, Vic., Australia
| | - Alyssa Mills
- Latrobe Community Health Service, Morwell, Vic., Australia
| | | | | | - Laura Telling
- Latrobe Community Health Service, Morwell, Vic., Australia
| | - Alice Davey
- Latrobe Community Health Service, Morwell, Vic., Australia
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Barriers and facilitators for implementation of a patient prioritization tool in two specialized rehabilitation programs. JBI Evid Implement 2021; 19:149-161. [PMID: 33843768 DOI: 10.1097/xeb.0000000000000281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND AIMS Prioritization tools aim to manage access to care by ranking patients equitably in waiting lists based on determined criteria. Patient prioritization has been studied in a wide variety of clinical health services, including rehabilitation contexts. We created a web-based patient prioritization tool (PPT) with the participation of stakeholders in two rehabilitation programs, which we aim to implement into clinical practice. Successful implementation of such innovation can be influenced by a variety of determinants. The goal of this study was to explore facilitators and barriers to the implementation of a PPT in rehabilitation programs. METHODS We used two questionnaires and conducted two focus groups among service providers from two rehabilitation programs. We used descriptive statistics to report results of the questionnaires and qualitative content analysis based on the Consolidated Framework for Implementation Research. RESULTS Key facilitators are the flexibility and relative advantage of the tool to improve clinical practices and produce beneficial outcomes for patients. Main barriers are the lack of training, financial support and human resources to sustain the implementation process. CONCLUSION This is the first study that highlights organizational, individual and innovation levels facilitators and barriers for the implementation of a prioritization tool from service providers' perspective.
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Auger C, Mortenson WB, Jutai JW, Seguin-Tremblay N, Chenel V, Guay M. Older adults' use of an online decision support system: Usability and stability of assistive technology recommendations. Assist Technol 2020; 34:316-325. [PMID: 32865488 DOI: 10.1080/10400435.2020.1815251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Online decision support systems (DSS) may help older adults self-select assistive technology (AT) by offering recommendations. User interactions with DSSs may change the recommendations they receive. OBJECTIVE We evaluated recommendations stability and usability of an online DSS. METHODS Middle-aged and older adults (n = 43) were observed while using the DSS. The stability of DSS recommendations (ATs and advice) was compared between two time points, using a three-point scale: no, partial, or full agreement. Usability was coded, referencing ISO standards. RESULTS Half (51%) of participants received AT recommendations from the DSS in both sessions, with full (14%) or partial (12%) agreement. All but one participant received advice, and almost all of them had full (40%) or partial (56%) agreement between sessions. Many of the usability issues appear to be the result of the users inaccurately measuring their environment, challenges in understanding the questions being asked, and improperly making selections from the system. DISCUSSION Strict AT matching rules versus generic advice, and usability issues, likely reduced the matching rate and stability of AT recommendations. CONCLUSION It appears that some users may require assistance with the system, and we suggest changes to the DSS format and content to improve stability and usability.
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Affiliation(s)
- Claudine Auger
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montréal, Canada.,School of Rehabilitation, Université de Montréal, Montréal, Canada
| | - W Ben Mortenson
- Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Jeffrey W Jutai
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada.,LIFE Research Institute, Ottawa, Canada
| | | | - Vanessa Chenel
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montréal, Canada.,School of Rehabilitation, Université de Montréal, Montréal, Canada
| | - Manon Guay
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada
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Rahimi SA, Dery J, Lamontagne ME, Jamshidi A, Lacroix E, Ruiz A, Ait-Kadi D, Routhier F. Prioritization of patients access to outpatient augmentative and alternative communication services in Quebec: a decision tool. Disabil Rehabil Assist Technol 2020; 17:8-15. [PMID: 32501741 DOI: 10.1080/17483107.2020.1751314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: A large number of people living with a chronic disability wait a long time to access publicly funded rehabilitation services such as Augmentative and Alternative Communication (AAC) services, and there is no standardized tool to prioritize these patients. We aimed to develop a prioritization tool to improve the organization and access to the care for this population.Methods: In this sequential mixed methods study, we began with a qualitative phase in which we conducted semi-structured interviews with 14 stakeholders including patients, their caregivers, and AAC service providers in Quebec City, Canada to gather their ideas about prioritization criteria. Then, during a half-day consensus group meeting with stakeholders, using a consensus-seeking technique (i.e. Technique for Research of Information by Animation of a Group of Experts), we reached consensus on the most important prioritization criteria. These criteria informed the quantitative phase in which used an electronic questionnaire to collect stakeholders' views regarding the relative weights for each of the selected criteria. We analyzed these data using a hybrid quantitative method called group based fuzzy analytical hierarchy process, to obtain the importance weights of the selected eight criteria.Results: Analyses of the interviews revealed 48 criteria. Collectively, the stakeholders reached consensus on eight criteria, and through the electronic questionnaire they defined the selected criteria's importance weights. The selected eight prioritization criteria and their importance weights are: person's safety (weight: 0.274), risks development potential (weight: 0.144), psychological well-being (weight: 0.140), physical well-being (weight: 0.124), life prognosis (weight: 0.106), possible impact on social environment (weight: 0.085), interpersonal relationships (weight: 0.073), and responsibilities and social role (weight: 0.054).Conclusion: In this study, we co-developed a prioritization decision tool with the key stakeholders for prioritization of patients who are referred to AAC services in rehabilitation settings.IMPLICATIONS FOR REHABILIATIONStudies in Canada have shown that people in Canada with a need for rehabilitation services are not receiving publicly available services in a timely manner.There is no standardized tool for the prioritization of AAC patients.In this mixed methods study, we co-developed a prioritization tool with key stakeholders for prioritization of patients who are referred to AAC services in a rehabilitation center in Quebec, Canada.
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Affiliation(s)
- Samira Abbasgholizadeh Rahimi
- Department of Family Medicine, McGill University, Montreal, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Julien Dery
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Marie-Eve Lamontagne
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Afshin Jamshidi
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Mechanical Engineering, Faculty of Science and Engineering, Université Laval, Quebec City, Canada
| | - Emilie Lacroix
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada
| | - Angel Ruiz
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Operations and Decision Systems, Faculty of Administration Sciences, Université Laval, Quebec City, Canada
| | - Daoud Ait-Kadi
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Mechanical Engineering, Faculty of Science and Engineering, Université Laval, Quebec City, Canada
| | - François Routhier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
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Breton M, Smithman MA, Sasseville M, Kreindler SA, Sutherland JM, Beauséjour M, Green M, Marshall EG, Jbilou J, Shaw J, Brousselle A, Contandriopoulos D, Crooks VA, Wong ST. How the design and implementation of centralized waiting lists influence their use and effect on access to healthcare - A realist review. Health Policy 2020; 124:787-795. [PMID: 32553740 DOI: 10.1016/j.healthpol.2020.05.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/02/2020] [Accepted: 05/19/2020] [Indexed: 12/11/2022]
Abstract
CONTEXT Many health systems have centralized waiting lists (CWLs), but there is limited evidence on CWL effectiveness and how to design and implement them. AIM To understand how CWLs' design and implementation influence their use and effect on access to healthcare. METHODS We conducted a realist review (n = 21 articles), extracting context-intervention-mechanism-outcome configurations to identify demi-regularities (i.e., recurring patterns of how CWLs work). RESULTS In implementing non-mandatory CWLs, acceptability to providers influences their uptake of the CWL. CWL eligibility criteria that are unclear or conflict with providers' role or judgement may result in inequities in patient registration. In CWLs that prioritize patients, providers must perceive the criteria as clear and appropriate to assess patients' level of need; otherwise, prioritization may be inconsistent. During patients' assignment to service providers, providers may select less-complex patients to obtain CWLs rewards or avoid penalties; or may select patients for other policies with stronger incentives, disregarding the established patient order and leading to inequities and limited effectiveness. CONCLUSION These findings highlight the need to consider provider behaviours in the four sequential CWL design components: CWL implementation, patient registration, patient prioritization and patient assignment to providers. Otherwise, CWLs may result in limited effects on access or lead to inequities in access to services.
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Affiliation(s)
- Mylaine Breton
- Department of Community Health Sciences, Université de Sherbrooke, Canadian Research Chair in Clinical Governance on Primary Health Care, Longueuil, QC, Canada.
| | | | - Martin Sasseville
- Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé - Université de Sherbrooke, Longueuil, QC, Canada
| | - Sara A Kreindler
- Department of Community Health Sciences, and Manitoba Research Chair in Health System Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Jason M Sutherland
- Centre for Health Services and Policy Research, University of British Columbia, Michael Smith Foundation for Health Research, Vancouver, BC, Canada
| | - Marie Beauséjour
- Department of Community Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
| | - Michael Green
- Departments of Family Medicine and Public Health Sciences, Queen's University, Centre for Health Services and Policy Research, Centre for Studies in Primary Care, Institute for Clinical Evaluative Sciences, Kingston, ON, Canada
| | | | - Jalila Jbilou
- Centre de formation médicale du Nouveau-Brunswick and École de psychologie, Université de Moncton, Moncton, NB, Canada
| | - Jay Shaw
- Institute for Health System Solutions and Virtual Care, Women's College Research Institute, Women's College Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Astrid Brousselle
- School of Public Administration, University of Victoria, Victoria, BC, Canada
| | - Damien Contandriopoulos
- School of Nursing, University of Victoria, Research Chair Policies, Knowledge and Health (Pocosa/Politiques, Connaissances, Santé), Victoria, BC, Canada
| | - Valorie A Crooks
- Department of Geography, Simon Fraser University, Michael Smith Foundation for Health Research, Canada Research Chair in Health Service Geographies, Burnaby, BC, Canada
| | - Sabrina T Wong
- School of Nursing and Centre for Health Services and Policy Research, University of British Columbia, BC Primary Care Sentinel Surveillance Network, Vancouver, BC, Canada
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Raymond MH, Feldman DE, Demers L. Referral Prioritization in Home Care Occupational Therapy: A Matter of Perspective. Can J Occup Ther 2020; 87:182-191. [PMID: 32292056 PMCID: PMC7298351 DOI: 10.1177/0008417420917500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Prioritizing referrals for home care occupational therapy is somewhat
subjective, and public and patient perspectives on waiting list priorities
are unknown. Purpose. To explore the views of home care occupational therapists (OTs), older
persons (OPs) and adults with disabilities on waiting list priorities, as
well as issues and challenges underlying these priorities. Method. We conducted in-depth interviews with 11 OTs, 10 OPs and 9 adults with
disabilities. Participants were asked to prioritize referral scenarios while
explaining their choices. Directed and conventional content analysis allowed
the identification of themes for each group of participants. Findings. OTs experienced conflicts of values but mainly prioritized referrals based on
client safety. OPs sought to maximize client’s independence, and persons
with disabilities aimed to improve clients’ social participation. Implications. OTs should seek the perspectives of their target clientele on referral
prioritization criteria and strive to adjust prioritization practices
accordingly.
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Affiliation(s)
| | | | - Louise Demers
- Louise Demers, OT, Ph.D., School of
Rehabilitation, Faculty of Medicine, Université de Montréal, C.P. 6128,
succursale Centre-ville, Montreal (Quebec), H3C 3J7 Canada, Telephone:
1-514-343-5780. E-mail:
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Jean-Gagnon K, Brousseau M. Appliquer un procédé argumentaire pour revendiquer une attribution des services en ergothérapie basée sur l’habilitation aux occupations. CANADIAN JOURNAL OF BIOETHICS 2020. [DOI: 10.7202/1070235ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Problématique : L’attribution actuelle des services en ergothérapie en CLSC permet difficilement aux ergothérapeutes d’intervenir selon leur expertise première d’habilitation aux occupations. Pour revendiquer cette situation, les professionnels sont appelés à agir comme agent de changement et idéalement avoir recours à un procédé argumentaire. Objectif : Appliquer un procédé argumentaire à une situation professionnelle problématique en ergothérapie, soit revendiquer une attribution des services en ergothérapie en CLSC basée sur l’habilitation aux occupations. Méthode : Le procédé argumentaire est basé sur le cadre argumentaire Convictions-Réel-Actions-Fondements (CRAF) nécessitant une recherche d’arguments provenant d’une recension critique des écrits. Résultats : Les études recensées font valoir des arguments basés sur les valeurs et les fondements théoriques de la profession. Les arguments issus des résultats probants proviennent d’études dont le niveau d’évidence scientifique est élevé. Ils montrent que des interventions basées sur l’habilitation aux occupations ont des retombées sur la participation et le fonctionnement dans les occupations, le bien-être et la santé physique et mentale, la perception d’efficacité personnelle, la satisfaction de vie, les interactions sociales, l’apprentissage de connaissances et l’espérance de vie. Discussion : L’habilitation aux occupations dans une approche de prévention et de promotion de la santé est efficace et rentable, et ce, pour une clientèle plus vaste que celle actuellement desservie. Les ergothérapeutes, désireux d’être agent de changement dans leur milieu, pourraient reproduire le procédé argumentaire pour l’appliquer à une situation clinique problématique.
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Affiliation(s)
- Kim Jean-Gagnon
- Département d’ergothérapie, Université du Québec à Trois-Rivières, Québec, Canada
| | - Martine Brousseau
- Département d’ergothérapie, Université du Québec à Trois-Rivières, Québec, Canada
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Déry J, Ruiz A, Routhier F, Gagnon MP, Côté A, Ait-Kadi D, Bélanger V, Deslauriers S, Lamontagne ME. Patient prioritization tools and their effectiveness in non-emergency healthcare services: a systematic review protocol. Syst Rev 2019; 8:78. [PMID: 30927927 PMCID: PMC6441215 DOI: 10.1186/s13643-019-0992-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 03/19/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Waiting lists should be managed as fairly as possible to ensure that patients with greater or more urgent needs receive services first. Patient prioritization refers to the process of ranking referrals in a certain order based on various criteria with the aim of improving fairness and equity in the delivery of care. Despite the widespread use of patient prioritization tools (PPTs) in healthcare services, the existing literature on this subject has mainly focused on emergency settings. Evidence has not been synthesized with respect to all the non-emergency services. METHODS This review aims to perform a systematic synthesis of published evidence concerning (1) prioritization tools' characteristics, (2) their metrological properties, and (3) their effect measures across non-emergency services. Five electronic databases will be searched (Cochrane Library, Ovid/MEDLINE, Embase, Web of Science, and CINAHL). Eligibility criteria guiding data selection will be (1) qualitative, quantitative, or mixed methods empirical studies; (2) patient prioritization in any non-emergency setting; and (3) discussing characteristic, metrological properties, or effect measures. Data will be sought to report tool's format, description, population, setting, purpose, criteria, developer, metrological properties, and outcome measures. Two reviewers will independently screen, select, and extract data. Data will be synthesized with sequential exploratory design method. We will use the Mixed Methods Appraisal Tool (MMAT) to assess the quality of articles included in the review. DISCUSSION This systematic review will provide much-needed knowledge regarding patient prioritization tools. The results will benefit clinicians, decision-makers, and researchers by giving them a better understanding of the methods used to prioritize patients in clinical settings. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018107205.
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Affiliation(s)
- Julien Déry
- Department of Rehabilitation, Université Laval, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre Intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Angel Ruiz
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre Intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
- Faculty of Business Administration, Université Laval, Québec, Canada
- Centre interuniversitaire de recherche sur les réseaux d’entreprise, la logistique et le transport (CIRRELT), Montréal, Canada
| | - François Routhier
- Department of Rehabilitation, Université Laval, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre Intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Marie-Pierre Gagnon
- Faculty of Nursing, Université Laval, Québec, Canada
- Centre de recherche du CHU de Québec, Québec, Canada
| | - André Côté
- Faculty of Business Administration, Université Laval, Québec, Canada
- Centre de recherche du CHU de Québec, Québec, Canada
- Centre de recherche en gestion des services de santé, Université Laval, Québec, Canada
| | - Daoud Ait-Kadi
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre Intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
- Centre interuniversitaire de recherche sur les réseaux d’entreprise, la logistique et le transport (CIRRELT), Montréal, Canada
- Department of Mechanical Engineering, Université Laval, Québec, Canada
| | - Valérie Bélanger
- Centre interuniversitaire de recherche sur les réseaux d’entreprise, la logistique et le transport (CIRRELT), Montréal, Canada
- Department of Logistics and Operations Management, HEC Montréal, Montréal, Canada
| | - Simon Deslauriers
- Department of Rehabilitation, Université Laval, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre Intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Marie-Eve Lamontagne
- Department of Rehabilitation, Université Laval, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre Intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
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11
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Community-based participatory research remodelling occupational therapy to foster older adults’ social participation. The Canadian Journal of Occupational Therapy 2019; 86:262-276. [DOI: 10.1177/0008417419832338] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Occupational therapists who provide community-based services are well positioned to foster older adults’ social participation. However, community occupational therapists rarely address social participation and require support to change their practice. Purpose. This study initiated a remodelling of community occupational therapy services by (a) selecting practices fostering older adults’ social participation and (b) identifying factors that could affect their integration. Method. A community-based participatory research study was conducted in a large Canadian city. Four focus group meetings and seven individual interviews were held with 28 key informants. Findings. A continuum of emerging practices was identified, including personalized, group-based, and community-based interventions. Potential enablers of these practices included clinical support, better communication, and user involvement. Organizational and systemic barriers were related to the institutional culture and performance indicators. Implications. These results point to innovative ways to foster older adults’ social participation and identify potential enablers and barriers affecting their integration.
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Smithman MA, Brousselle A, Touati N, Boivin A, Nour K, Dubois CA, Loignon C, Berbiche D, Breton M. Area deprivation and attachment to a general practitioner through centralized waiting lists: a cross-sectional study in Quebec, Canada. Int J Equity Health 2018; 17:176. [PMID: 30509274 PMCID: PMC6277998 DOI: 10.1186/s12939-018-0887-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 11/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Access to primary healthcare is an important social determinant of health and having a regular general practitioner (GP) has been shown to improve access. In Canada, socio-economically disadvantaged patients are more likely to be unattached (i.e. not have a regular GP). In the province of Quebec, where over 30% of the population is unattached, centralized waiting lists were implemented to help patients find a GP. Our objectives were to examine the association between social and material deprivation and 1) likelihood of attachment, and 2) wait time for attachment to a GP through centralized waiting lists. METHODS A cross-sectional study was conducted in five local health networks in Quebec, Canada, using clinical administrative data of patients attached to a GP between June 2013 and May 2015 (n = 24, 958 patients) and patients remaining on the waiting list as of May 2015 (n = 49, 901), using clinical administrative data. Social and material area deprivation indexes were used as proxies for patients' socio-economic status. Multiple regressions were carried out to assess the association between deprivation indexes and 1) likelihood of attachment to a GP and 2) wait time for attachment. Analyses controlled for sex, age, local health network and variables related to health needs. RESULTS Patients from materially medium, disadvantaged and very disadvantaged areas were underrepresented on the centralized waiting lists, while patients from socially disadvantaged and very disadvantaged areas were overrepresented. Patients from very materially advantaged and advantaged areas were less likely to be attached to a GP than patients from very disadvantaged areas. With the exception of patients from socially disadvantaged areas, all other categories of social deprivation were more likely to be attached to a GP compared to patients from very disadvantaged areas. We found a pro-rich gradient in wait time for attachment to a GP, with patients from more materially advantaged areas waiting less than those from disadvantaged areas. CONCLUSION Our findings suggest that there are socio-economic inequities in attachment to a GP through centralized waiting lists. Policy makers should take these findings into consideration to adjust centralized waiting list processes to avoid further exacerbation of health inequities.
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Affiliation(s)
- Mélanie Ann Smithman
- Centre de recherche Charles-Le Moyne - Saguenay Lac-St-Jean sur les innovations en santé, Université de Sherbrooke, Longueuil Campus, 150 Place Charles-Le Moyne, Suite 200, Longueuil, Quebec, J4K 0A8, Canada
| | - Astrid Brousselle
- School of Public Administration, University of Victoria, 3800 Finnerty Rd, Suite A302, Victoria, British Columbia, V8P 5C2, Canada
| | - Nassera Touati
- Centre de recherche sur la gouvernance, École nationale d'administration publique, 4750, Avenue Henri-Julien, Office 5117, Montreal, Quebec, H2T 3E5, Canada
| | - Antoine Boivin
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, 900 Rue Saint-Denis, Montreal, Quebec, H2X 0A9, Canada
| | - Kareen Nour
- Direction de santé publique, Centre intégré de santé et des services sociaux - Montérégie-Centre, 1255 rue Beauregard, Longueuil, Quebec, J4K 2M3, Canada
| | - Carl-Ardy Dubois
- Faculty of Nursing, Université de Montréal, 2375, chemin de la Côte Ste-Catherine, Office 5103, Montreal, Quebec, H3T 1A8, Canada
| | - Christine Loignon
- Centre de recherche Charles-Le Moyne - Saguenay Lac-St-Jean sur les innovations en santé, Université de Sherbrooke, Longueuil Campus, 150 Place Charles-Le Moyne, Suite 200, Longueuil, Quebec, J4K 0A8, Canada
| | - Djamal Berbiche
- Centre de recherche Charles-Le Moyne - Saguenay Lac-St-Jean sur les innovations en santé, Université de Sherbrooke, Longueuil Campus, 150 Place Charles-Le Moyne, Suite 200, Longueuil, Quebec, J4K 0A8, Canada
| | - Mylaine Breton
- Centre de recherche Charles-Le Moyne - Saguenay Lac-St-Jean sur les innovations en santé, Université de Sherbrooke, Longueuil Campus, 150 Place Charles-Le Moyne, Suite 200, Longueuil, Quebec, J4K 0A8, Canada.
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13
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Laliberté M. Facteurs influençant la multiplication de traitements en physiothérapie : une analyse thématique de la jurisprudence québécoise. BIOÉTHIQUEONLINE 2018. [DOI: 10.7202/1044610ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
La physiothérapie est touchée par un problème de multiplication de traitements; la fréquence des traitements ou leur durée peuvent être inappropriées ou disproportionnées face aux besoins du patient. La multiplication de traitements peut avoir des conséquences financières, physiques, psychologiques et sociales. Pour explorer les facteurs influençant la fréquence et la durée des traitements dans les situations de multiplication de traitements, une analyse thématique de la jurisprudence a été réalisée. Certains facteurs cliniques et non cliniques influençant la fréquence et la durée des traitements ont pu être identifiés par cette analyse thématique de la jurisprudence. Les facteurs cliniques impliquent que l’allocation des ressources soit guidée par la condition et l’évolution du patient. Les facteurs non cliniques peuvent inclure la pression des employeurs, les demandes des autres professionnels de la santé ou les conflits d’intérêts de type financier. Cette analyse thématique de la jurisprudence est une première étape pour comprendre ce qui motive les décisions cliniques d’allocation des ressources des professionnels de la physiothérapie. Cette démarche est essentielle pour mettre en place des politiques et des normes de pratique soucieuses du contexte de pratique et des normes éthiques, déontologiques et légales qui animent la profession.
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Affiliation(s)
- Maude Laliberté
- École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, Canada
- Programmes de bioéthique, Département de médecine sociale et préventive, École de santé publique de l’Université de Montréal
- Membre étudiant de l’Institut de recherche en santé publique de l’Université de Montréal (IRSPUM)
- Membre étudiant du Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR)
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Raymond MH, Demers L, Feldman DE. Differences in Waiting List Prioritization Preferences of Occupational Therapists, Elderly People, and Persons With Disabilities: A Discrete Choice Experiment. Arch Phys Med Rehabil 2017; 99:35-42.e1. [PMID: 28797617 DOI: 10.1016/j.apmr.2017.06.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/31/2017] [Accepted: 06/20/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare the preferences of occupational therapists, elderly people, and adults with disabilities regarding prioritization criteria for occupational therapy waiting lists in home care. DESIGN Discrete choice experiment survey. SETTING Survey mailed to occupational therapists working in home care and community-dwelling elderly or disabled persons. PARTICIPANTS A sample (N=714) of home-based occupational therapists (n=241), elderly persons from a bank of research participants (n=226), and adults with physical disabilities recruited through community organizations (n=247). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The dependent variable was whether the referral scenario was prioritized or not in each question. The results were analyzed through logistic regression using conditional logit models. RESULTS Prioritization preferences differed between groups (P<.001). Occupational therapists most strongly prioritized people who had a few falls (odds ratio vs no falls, 48.7), whereas elderly people and adults with disabilities most strongly prioritized people who were unable to enter and exit the home (odds ratio vs no difficulty entering and exiting the home, 30.8 for elderly people and 16.8 for persons with disabilities.) CONCLUSIONS: Our results highlight the gap between the priorities of home-based occupational therapists and their target clientele. Although further inquiry is needed to inform priority setting, the findings emphasize the importance of public or patient involvement in decisions on waiting list prioritization.
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Affiliation(s)
- Marie-Hélène Raymond
- School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada; Research Center, Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada; Greater Montreal Interdisciplinary Rehabilitation Research Centre (CRIR), Montreal, Quebec, Canada.
| | - Louise Demers
- School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada; Research Center, Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada
| | - Debbie Ehrmann Feldman
- School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada; Greater Montreal Interdisciplinary Rehabilitation Research Centre (CRIR), Montreal, Quebec, Canada
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15
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Ruest M, Bourget A, Delli-Colli N, Guay M. Algo Used by Homecare Nonoccupational Therapists Selecting Bathing Assistive Technology: Enhancing Standardization by Exploring Clinical Reasoning. Occup Ther Health Care 2017; 31:20-33. [PMID: 28094591 DOI: 10.1080/07380577.2016.1270481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Algo is a clinical decision algorithm developed to support nonoccupational therapists in establishing assistive technology recommendations to enable physically disabled adults to perform their hygiene at home. This study aimed to explore the in-depth clinical reasoning of nonoccupational therapists using Algo to pinpoint the items leading to disagreements regarding recommendations. A multiple-case study was conducted with eight nonoccupational therapists trained to use Algo and filmed while using it with six standardized clients. Explicitation interviews were conducted for the conflicting recommendations. Identifying the key reasoning skills to develop in Algo users has led to three recommendations to enhance standardization with seniors.
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Affiliation(s)
- Mélanie Ruest
- a Health Sciences Research Programs, Faculty of Medicine And Health Sciences , Université de Sherbrooke , Sherbrooke, Quebec , Canada.,b Research Centre on Aging , Health and Social Services Centre - University Institute of Geriatrics of Sherbrooke , Sherbrooke, Quebec , Canada
| | - Annick Bourget
- c School of Rehabilitation , Faculty of Medicine and Health Sciences, Université de Sherbrooke , Sherbrooke, Quebec , Canada
| | - Nathalie Delli-Colli
- d School of Social Work , Faculty of Arts, Humanities and Social Sciences, Université de Sherbrooke , Sherbrooke, Quebec , Canada
| | - Manon Guay
- b Research Centre on Aging , Health and Social Services Centre - University Institute of Geriatrics of Sherbrooke , Sherbrooke, Quebec , Canada.,c School of Rehabilitation , Faculty of Medicine and Health Sciences, Université de Sherbrooke , Sherbrooke, Quebec , Canada
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16
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Deslauriers S, Raymond MH, Laliberté M, Lavoie A, Desmeules F, Feldman DE, Perreault K. Access to publicly funded outpatient physiotherapy services in Quebec: waiting lists and management strategies. Disabil Rehabil 2016; 39:2648-2656. [PMID: 27758150 DOI: 10.1080/09638288.2016.1238967] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Problems with access to outpatient physiotherapy services have been reported in publicly funded healthcare systems worldwide. A few studies have reported management strategies aimed at reducing extensive waiting lists, but their association with waiting times is not fully understood. The purpose of this study was to document access to public outpatient physiotherapy services for persons with musculoskeletal disorders in hospitals and explore organizational factors associated with waiting time. METHODS We surveyed outpatient physiotherapy services in publicly funded hospitals in the province of Quebec (Canada). RESULTS A total of 97 sites responded (99%) to the survey. The median waiting time was more than six months for 41% of outpatient physiotherapy services. The waiting time management strategies most frequently used were attendance and cancelation policies (99.0%) and referral prioritization (95.9%). Based on multivariate analyses, the use of a prioritization process with an initial evaluation and intervention was associated with shorter waiting times (p = 0.008). CONCLUSIONS Our findings provide evidence that a large number of persons wait a long time for publicly funded physiotherapy services in Quebec. Based on our results, implementation of a prioritization process with an initial evaluation and intervention could help improve timely access to outpatient physiotherapy services. Implications for Rehabilitation Access to publicly funded outpatient physiotherapy services is limited by long waiting times in a great proportion of Quebec's hospitals. The use of a specific prioritization process that combines an evaluation and an intervention could possibly help improve timely access to services. Policy-makers, managers, and other stakeholders should work together to address the issue of limited access to publicly funded outpatient physiotherapy services.
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Affiliation(s)
- Simon Deslauriers
- a Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) , Quebec City , Quebec , Canada.,b Department of Rehabilitation, Faculty of Medicine , Université Laval , Quebec City , Quebec , Canada
| | - Marie-Hélène Raymond
- c School of Rehabilitation, Faculty of Medicine , Université de Montréal , Montreal , Quebec , Canada.,d Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Quebec , Canada
| | - Maude Laliberté
- c School of Rehabilitation, Faculty of Medicine , Université de Montréal , Montreal , Quebec , Canada.,d Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Quebec , Canada
| | - Amélie Lavoie
- a Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) , Quebec City , Quebec , Canada.,b Department of Rehabilitation, Faculty of Medicine , Université Laval , Quebec City , Quebec , Canada
| | - François Desmeules
- c School of Rehabilitation, Faculty of Medicine , Université de Montréal , Montreal , Quebec , Canada.,e Maisonneuve-Rosemont Hospital Research Centre , Montreal , Quebec , Canada
| | - Debbie E Feldman
- c School of Rehabilitation, Faculty of Medicine , Université de Montréal , Montreal , Quebec , Canada.,d Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Quebec , Canada.,f Direction of Public Health of the Centre intégré universitaire de santé et de services sociaux du Centre-Est-de-l'ḽle-de-Montréal , Montreal , Quebec , Canada
| | - Kadija Perreault
- a Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) , Quebec City , Quebec , Canada.,b Department of Rehabilitation, Faculty of Medicine , Université Laval , Quebec City , Quebec , Canada
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Guay M, Gagnon M, Ruest M, Bourget A. Interrater reliability of Algo used by non-occupational therapist members of homecare interdisciplinary teams. Disabil Rehabil 2016; 39:883-888. [PMID: 27111712 DOI: 10.3109/09638288.2016.1168488] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine if non-occupational therapists (non-OTs) with different job titles using Algo, a clinical algorithm for recommending bathroom modifications (e.g., bath seat) for community-dwelling elders in "straightforward" situations, will make clinically equivalent recommendations for standardized clients. METHOD Eight non-OTs (three social workers, two physical rehabilitation therapists, two homecare aides and one auxiliary nurse) were trained on Algo and used it with six standardized clients. Bathroom adaptations recommended (one of nine options) by non-OTs were compared to assess interrater agreement using Fleiss adapted kappa. RESULTS Estimated kappa was 0.43 [0.36; 0.49] qualified as a moderate agreement, according to Landis and Koch's arbitrary divisions, among the recommendations of non-OTs. However, clinical equivalence is reached, since safety and client needs were met when raters selected two different options (e.g., with or without a seat back). CONCLUSIONS Non-OTs using Algo in the same simulated clinical scenarios recommend clinically equivalent bathroom adaptations, increasing the confidence regarding the interrater reliability of Algo used by non-OT members of homecare interdisciplinary teams Implications for Rehabilitation In homecare services, non-occupational therapists from different health care disciplines (e.g., homecare aides, social workers, physical rehabilitation therapists) may be asked to select assistive devices for the hygiene care of clients living at home. Algo was designed to guide non-occupational therapists in the selection of assistive devices when performed with clients in straightforward cases. This study indicates that non-occupational therapists using Algo recommend similar and acceptable bathroom adaptations to enhance client safety.
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Affiliation(s)
- Manon Guay
- a Faculty of Medicine and Health Sciences , School of Rehabilitation, Université de Sherbrooke , Sherbrooke , Quebec , Canada.,b Research Center on Aging , Sherbrooke , Quebec , Canada
| | - Marilyn Gagnon
- c Centre intégré universitaires de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke , Sherbrooke , Quebec , Canada
| | - Mélanie Ruest
- b Research Center on Aging , Sherbrooke , Quebec , Canada
| | - Annick Bourget
- a Faculty of Medicine and Health Sciences , School of Rehabilitation, Université de Sherbrooke , Sherbrooke , Quebec , Canada
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Raymond MH, Demers L, Feldman DE. Waiting list management practices for home-care occupational therapy in the province of Quebec, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:154-164. [PMID: 25684435 DOI: 10.1111/hsc.12195] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/07/2014] [Indexed: 06/04/2023]
Abstract
Referral prioritisation is commonly used in home-based occupational therapy to minimise the negative impacts of waiting, but this practice is not standardised. This may lead to inequities in access to care, especially for clients considered as low priority, who tend to bear the brunt of lengthy waiting lists. This cross-sectional study aimed to describe waiting list management practices targeting low-priority clients in home-based occupational therapy in the province of Quebec, Canada, and to investigate the association between these practices and the length of the waiting list. A structured telephone interview was conducted in 2012-2013 with the person who manages the occupational therapy waiting list in 55 home care programmes across Quebec. Questions pertained to strategies aimed at servicing low-priority clients, the date of the oldest referral and the number of clients waiting. Results were analysed using descriptive statistics and non-parametric tests. The median wait time for the oldest referral was 18 months (range: 2-108 months). A variety of strategies were used to service low-priority clients. Programmes that used no strategies to service low-priority clients (n = 16) had longer wait times (P < 0.0001) and a greater number of people on the waiting list (P = 0.006) compared with programmes that applied a maximum wait time target (n = 12). In conclusion, diverse strategies exist to allocate services to low-priority clients in home-based occupational therapy programmes. However, in programmes where none of these strategies are used, low-priority clients may be denied access to services indefinitely.
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Affiliation(s)
| | - Louise Demers
- School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada
- Research Center, Institut Universitaire de gératrie de Montréal, Montreal, Quebec, Canada
| | - Debbie E Feldman
- School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada
- Direction of Public Health of Montreal, Health Services and Population Health Team, Montreal, Quebec, Canada
- Greater Montreal Interdisciplinary Rehabilitation Research Centre (CRIR), Montreal, Quebec, Canada
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Turcotte PL, Carrier A, Desrosiers J, Levasseur M. Are health promotion and prevention interventions integrated into occupational therapy practice with older adults having disabilities? Insights from six community health settings in Québec, Canada. Aust Occup Ther J 2015; 62:56-67. [PMID: 25649035 DOI: 10.1111/1440-1630.12174] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM Increasingly, health-care systems should promote seniors' health and prevent disability. As they enable engagement in meaningful activities within the individuals' living environment, community occupational therapists have great potential to contribute to health promotion and prevention. Despite this potential, little is known about current health promotion and prevention activities in occupational therapy community practice. This study thus aimed to: (1) identify health promotion and prevention interventions used with seniors having disabilities, and (2) explore barriers to integrating such interventions into practice. METHODS Secondary data analysis of a qualitative study was carried out using thematic saliency analysis. Eleven community occupational therapists working with seniors having disabilities were recruited in six community health settings in Québec, Canada. Observations of 12 home visits, followed by 12 semi-structured interviews, were conducted with occupational therapists. RESULTS Most interventions involved optimising independence in personal care and mobility. Explicit health promotion interventions were limited and included enabling healthy lifestyles by increasing health literacy and empowerment. Meaningful activities (leisure, community participation) were not targeted. Barriers to integrating health promotion into practice were clients' complex health conditions and limited openness to change combined with organisational and professional obstacles, such as a misunderstanding of occupational therapists' role in health promotion. CONCLUSIONS Health promotion and prevention interventions are not intentionally integrated into community occupational therapy practice with seniors having disabilities. As a result, seniors' needs to engage in meaningful activities might remain unmet. Overcoming barriers to integrating health promotion and prevention in practice could help improve population health and wellbeing.
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Affiliation(s)
- Pier-Luc Turcotte
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Québec, Canada; Research Centre on Aging, Health and Social Services Centre, University Institute of Geriatrics of Sherbrooke (CSSS-IUGS), Sherbrooke, Québec, Canada
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