1
|
Johnston JC, Strain KL, Dribnenki C, Devolin M. Meeting case investigation and contact tracing needs during COVID-19 in Alberta: the development and implementation of the Alberta Health Services Pod Partnership Model. Can J Public Health 2022; 113:87-95. [PMID: 35006591 PMCID: PMC8744387 DOI: 10.17269/s41997-021-00604-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022]
Abstract
Setting In Alberta, a small team of specialized public health experts typically complete case investigation and contact tracing. High COVID-19 case counts and a shortage of trained public health professionals required a rapid and significant adaptation of staffing models to meet the population’s needs. Intervention A tiered, interdisciplinary staffing model, based on those in critical care, was developed, piloted, and implemented in the Alberta Health Services’ Communicable Disease Control department in late 2020 to complete case investigation and contact tracing. The final model included novice, non-regulated professionals divided into pods of four to six investigators, led by an experienced regulated investigator. Team leads oversaw five pods. Communicable disease nurses provided an additional tier of clinical expertise. During the model development, roles and responsibilities of team members were delineated, ratios for supervision were tested, and rapid training was provided. Outcomes The tiered staffing model began in November 2020 with staff members in two pods. At its peak in early May 2021, 72 pods of 502 non-regulated members, 134 regulated investigators, and 4 communicable disease nurses completed 780–973 case investigations daily, or 40–45% of all positive cases in Alberta. In comparison, the same number of regulated investigators working independently in the traditional staffing model without non-regulated pods completed, on average, 249 case investigations daily. Implications A tiered staffing model can be effective at maximizing the skills of the experienced members of the case investigation team to maintain case investigation and contact tracing activities during a pandemic.
Collapse
Affiliation(s)
- J Cyne Johnston
- Communicable Disease Control COVID-19 Response, Provincial Population & Public Health, Alberta Health Services, 10101 Southport Rd. SW, Calgary, AB, T2W 3N2, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Keri-Lynn Strain
- Communicable Disease Control COVID-19 Response, Provincial Population & Public Health, Alberta Health Services, 10101 Southport Rd. SW, Calgary, AB, T2W 3N2, Canada
| | - Cindy Dribnenki
- Communicable Disease Control COVID-19 Response, Provincial Population & Public Health, Alberta Health Services, Edmonton, AB, Canada
| | - Maureen Devolin
- Communicable Disease Control COVID-19 Response, Provincial Population & Public Health, Alberta Health Services, 10101 Southport Rd. SW, Calgary, AB, T2W 3N2, Canada
| |
Collapse
|
2
|
Taddio A, Coldham J, Logeman C, McMurtry CM, Little C, Samborn T, Bucci LM, MacDonald NE, Shah V, Dribnenki C, Snider J, Stephens D. Feasibility of implementation of CARD™ for school-based immunizations in Calgary, Alberta: a cluster trial. BMC Public Health 2021; 21:260. [PMID: 33526030 PMCID: PMC7849968 DOI: 10.1186/s12889-021-10247-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 01/14/2021] [Indexed: 01/23/2023] Open
Abstract
Background Negative experiences with school-based immunizations can contribute to vaccine hesitancy in youth and adulthood. We developed an evidence-based, multifaceted and customizable intervention to improve the immunization experience at school called the CARD™ (C-Comfort, A-Ask, R-Relax, D-Distract) system. We evaluated the feasibility of CARD™ implementation for school-based immunizations in Calgary, Canada. Methods In a mixed methods study, two Community Health Centres providing immunization services, including 5 schools each with grade 9 students (aged approximately 14 years), were randomized to CARD™ or control (usual care). In the CARD™ group, public health staff and students were educated about coping strategies prior to immunization clinics. Clinics were organized to reduce fear and to support student’s choices for coping strategies. Public health staff in the CARD™ group participated in a focus group discussion afterwards. We sought a recruitment rate of 80% for eligible schools, an external stakeholder focus group (e.g., school staff) with 6 or more individuals, 85% of individual injection-related data acquisition (student and immunizer surveys), and 80% absolute agreement between raters for a subset of data that were double-coded. Across focus groups, we examined perceptions of acceptability, appropriateness, feasibility and fidelity of CARD™. Results Nine (90%) of eligible schools participated. Of 219 students immunized, injection-related student and immunizer data forms were acquired for 195 (89.0%) and 196 (89.5%), respectively. Reliability of data collection was high. Fifteen public health and 5 school staff participated in separate focus groups. Overall, attitudes towards CARD™ were positive and compliance with individual components of CARD™ was high. Public health staff expressed skepticism regarding the value of student participation in the CARD™ system. Suggestions were made regarding processes to refine implementation. Conclusion While most outcome criteria were satisfied and overall perceptions of implementation outcomes were positive, some important challenges and opportunities were identified. Feedback is being used to inform a large cluster trial that will evaluate the impact of CARD™ during school-based immunizations. Trial registration The trial is registered at ClinicalTrials.gov (NCT03948633); Submitted April 24, 2019.
Collapse
Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario, M5S 3M2, Canada.
| | - Joanne Coldham
- Alberta Health Services, 10101 Southport Road SW, Calgary, Alberta, T2W 3N2, Canada
| | - Charlotte Logeman
- The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, 4003 Mackinnon Building (Mackinnon Extension), Guelph, Ontario, N1G 2W1, Canada
| | - Cheri Little
- Alberta Health Services, 10101 Southport Road SW, Calgary, Alberta, T2W 3N2, Canada
| | - Tracy Samborn
- Cochrane Community Health Centre, Alberta Health Services, 60 Grande Blvd, Cochrane, Alberta, T4C 0S4, Canada
| | - Lucie M Bucci
- Immunize Canada, 404-1525 Carling Avenue, Ottawa, Ontario, K1Z 8R9, Canada
| | - Noni E MacDonald
- IWK Health Centre, Dalhousie University, 5850/5980 University Avenue, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Vibhuti Shah
- Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada
| | - Cindy Dribnenki
- Alberta Health Services, Suite 104 Main Floor West Tower, 14310-111 Avenue, Edmonton, Alberta, T5M 3Z7, Canada
| | - Joanne Snider
- Alberta Health Services, Suite 104 Main Floor West Tower, 14310-111 Avenue, Edmonton, Alberta, T5M 3Z7, Canada
| | - Derek Stephens
- The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| |
Collapse
|
3
|
Logeman C, Taddio A, McMurtry CM, Bucci L, MacDonald N, Chalmers G, Gudzak V, Shah V, Coldham J, Little C, Samborn T, Dribnenki C, Snider J. Student Feedback to Tailor the CARD™ System for Improving the Immunization Experience at School. Children (Basel) 2020; 7:E126. [PMID: 32899632 PMCID: PMC7552616 DOI: 10.3390/children7090126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 02/07/2023]
Abstract
Increasing the comfort of vaccine delivery at school is needed to improve the immunization experience for students. We created the CARD™ (C-Comfort, A-Ask, R-Relax and D-Distract) system to address this clinical care gap. Originally designed for grade 7 students, this study examined the perceptions of grade 9 students of CARD™. Grade 9 students who had experience with school-based immunizations, either as recipients or onlookers (n = 7; 100% females 14 years old) participated. Students answered pre-post surveys, reviewed CARD™ educational materials and participated in a semi-structured focus group discussion. The Consolidated Framework for Implementation Research (CFIR) was used as the framework for analysis of qualitative data. Participants reported positive perceptions of CARD™ educational materials and that CARD™ could fit into the school immunization process. CARD™ improved knowledge about effective coping interventions and was recommended for education of both nurses and students. The results provide preliminary evidence that CARD™ is acceptable and appropriate for implementation in grade 9 school-based immunizations.
Collapse
Affiliation(s)
- Charlotte Logeman
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada; (C.L.); (V.G.)
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada; (C.L.); (V.G.)
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - C. Meghan McMurtry
- Department of Psychology, The University of Guelph, Guelph, ON N1G 2W1, Canada;
- McMaster Children’s Hospital, Hamilton, ON L8N 3Z5, Canada
| | - Lucie Bucci
- Immunize Canada, Canadian Public Health Association, Ottawa, ON K1Z 8R9, Canada;
| | - Noni MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, NS B3K 6R8, Canada;
| | - Garth Chalmers
- University of Toronto Schools, Toronto, ON M5S 2R7, Canada;
| | - Victoria Gudzak
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada; (C.L.); (V.G.)
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Vibhuti Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada;
| | - Joanne Coldham
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
| | - Cheri Little
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
| | - Tracy Samborn
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
| | - Cindy Dribnenki
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
| | - Joanne Snider
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
| |
Collapse
|