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Petrusevski C, MacDermid JC, Wilson MG, Richardson J. Framing Physical Literacy for Adults Through a Rehabilitation Lens: An Expert Consensus Study. J Aging Phys Act 2024:1-8. [PMID: 38417423 DOI: 10.1123/japa.2023-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 11/29/2023] [Accepted: 01/13/2024] [Indexed: 03/01/2024]
Abstract
Research indicates a positive relationship between physical literacy and healthy aging; however, there is no consensus on the components required to become a physically literate adult. The objective of this study was to understand how physical literacy for adults with chronic conditions is characterized from the perspective of healthcare professionals. Physiotherapy leaders and physical literacy researchers within North America were invited to an online consensus panel and presented with questions related to physical literacy and rehabilitation. A nominal group technique was used for idea generation, clarification, and ranking. Confidence and safety with movements, motivation and commitment to physical activity, the ability to self-monitor changes in function, and understanding the benefits of physical activity were key components when defining physical literacy. There is a need to reconceptualize physical literacy to include the rehabilitation needs of adults living with chronic conditions, and to design programs that promote physical literacy to enhance function and mobility.
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Affiliation(s)
| | - Joy C MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- Physical Therapy and Surgery, Western University, London, ON, Canada
- Hand and Upper Limb Centre, St. Joseph's Health Centre, London, ON, Canada
| | - Michael G Wilson
- Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada
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Gauvreau CL, Wight L, Subasri M, Palmer A, Hayeems R, Croker A, Abelson J, Fraser B, Bombard Y, Moore Hepburn C, Wilson MG, Denburg A. Access to novel drugs and therapeutics for children and youth: Eliciting citizens' values to inform public funding decisions. Health Expect 2023; 26:715-727. [PMID: 36639959 PMCID: PMC10010086 DOI: 10.1111/hex.13697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/08/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION The unique evidentiary, economic and ethical challenges associated with health technology assessment (HTA) of precision therapies limit access to novel drugs and therapeutics for children and youth, for whom such challenges are amplified. We elicited citizens' perspectives about values-based criteria relevant to the assessment of paediatric precision therapies to inform the development of a child-tailored HTA framework. METHODS We held four citizen panels virtually in May-June 2021, informed by a plain-language citizen brief summarizing global and local evidence about the challenges, policy and programmatic options and implementation strategies related to enhancing access to precision therapies for Canadian children and youth. Panellists were recruited through a nationally representative database, medical/patient networks and social media. We inductively coded and thematically analysed panel transcripts to generate themes and identify priority values. RESULTS The perspectives of panellists (n = 45) coalesced into four overlapping themes, with attendant subthemes, relevant to a child-tailored HTA framework: (1) Childhood Distinctions: vulnerability, 'fair innings', future potential, family impacts; (2) Voice: agency of children and youth; lived versus no lived experience; (3) One versus Many: disease severity, rarity, equity, unmet need and (4) Health System Governance: funding, implementation inequities, effectiveness and safety. Participants broadly agreed that childhood distinctions, particularly family impacts, justify child-tailored HTA. Dissent arose over whose voice should inform HTA and how such perspectives are best incorporated. CONCLUSIONS Citizens can offer unique insights into criteria relevant to the development or revision of HTA frameworks to capture holistic, societally responsive dimensions of value attached to unique contexts or populations, including children. Balancing the hopes and expectations of patients and caregivers for access to expensive but potential life-altering therapies against the opportunity costs borne by encompassing health systems is a fundamental challenge that will require rigorous methods to elicit, weigh and reconcile varied views. PATIENT OR PUBLIC CONTRIBUTION A patient advocate served on the steering committee of this study and co-authored this article. Key informants for the Citizen Brief included patient advocates and caregivers; a separate patient advocate reviewed the Brief before dissemination. Qualitative and quantitative data were collected from the general public and caregivers of children, with written consent.
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Affiliation(s)
- Cindy L Gauvreau
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Lisa Wight
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Mathushan Subasri
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Antonia Palmer
- Ac2orn: Advocacy for Canadian Childhood Oncology Research, Toronto, Ontario, Canada
| | - Robin Hayeems
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Alysha Croker
- Centre for Policy, Pediatrics and International Collaboration, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Julia Abelson
- Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Brent Fraser
- Pharmaceutical Reviews, CADTH, Ottawa, Ontario, Canada
| | - Yvonne Bombard
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Ontario Institute of Cancer Research, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
| | - Charlotte Moore Hepburn
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael G Wilson
- McMaster Health Forum, Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Avram Denburg
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Abstract
The time has come to develop and implement a Canadian strategy on equitable access to Assistive Technology (AT). AT use has significant health, social, and economic benefits for people with disabilities and older people, and benefits society by assisting to mitigate the most prominent health and social challenges of our time. Our research with citizens (with/without experiences of disabilities or AT use) and system leaders across Canada determined that access is variable and inequitable, with unmet needs, restricted funding, and inefficiencies. Collaboratively, we devised a blueprint, comprising a policy vision, three priority issues to address, principles to underpin policy actions, and short- and long-term priorities, from which to build a strategy. We hope the blueprint sparks action among citizens and health leaders, especially those working across governments, sectors, and communities to promote leadership and create a cross-jurisdictional coalition to elaborate on a national strategy and action plans for moving forward.
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Wang Q, Zhu Y, Xie S, Kibria MG, Guo Q, Belal AA, Li Y, Zhang J, Chen Y, Schünemann HJ, Wilson MG, Yang K, Lavis JN. Facilitators, barriers and strategies for health-system guidance implementation: a critical interpretive synthesis protocol. Health Res Policy Syst 2022; 20:105. [PMID: 36175897 PMCID: PMC9523963 DOI: 10.1186/s12961-022-00908-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/09/2022] [Indexed: 12/01/2022] Open
Abstract
Background As systematically developed statements regarding possible courses of action, health system guidance (HSG) can assist with making decisions about addressing problems or achieving goals in health systems. However, there are conceptual and methodological challenges in HSG implementation due to the complexity of health-system policy-making, the diversity of available evidence and vast differences in contexts. To address these gaps, we aim to develop a theoretical framework for supporting HSG implementation as part of a broader effort to promote evidence-informed policy-making in health systems. Methods To develop a theoretical framework about facilitators, barriers and strategies for HSG implementation, we will apply a critical interpretive synthesis (CIS) approach to synthesize the findings from a range of relevant literature. We will search 11 electronic databases and seven organizational websites to identify relevant published and grey literature. We will check the references of included studies and contact experts to identify additional eligible papers. Finally, we will conduct purposively sampling of the literature to fill any identified conceptual gaps. We will use relevance and five quality criteria to assess included papers. A standardized form will be developed for extracting information. We will use an interpretive analytic approach to synthesize the findings, including a constant comparative method throughout the analysis. Two independent reviewers will conduct the literature screening and relevance assessment, and disagreements will be resolved through discussion. The principal investigator will conduct data extraction and synthesis, and a second reviewer will check the sample of extracted data for consistency and accuracy. Discussion A new theoretical framework about facilitators, barriers and strategies for HSG implementation will be developed using a CIS approach. The HSG implementation framework could be widely used for supporting the implementation of HSG covering varied topics and in different contexts (including low-, middle- and high-income countries). In later work, we will develop a tool for supporting HSG implementation based on the theoretical framework. Registration PROSPERO CRD42020214072. Date of Registration: 14 December 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00908-0.
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Affiliation(s)
- Qi Wang
- Health Policy Ph.D. Program, McMaster University, Hamilton, ON, Canada.,Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.,McMaster Health Forum, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Ying Zhu
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Shitong Xie
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | | | - Qiangqiang Guo
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Ahmed Atef Belal
- Health Policy Ph.D. Program, McMaster University, Hamilton, ON, Canada.,McMaster Health Forum, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Yanfei Li
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Jingyi Zhang
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yaolong Chen
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, China
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada.,Michael G DeGroote Cochrane Canada and GRADE Centres, Hamilton, ON, Canada
| | - Michael G Wilson
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Kehu Yang
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China. .,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China. .,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
| | - John N Lavis
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
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Al Sabahi S, Wilson MG, Lavis JN, El-Jardali F, Moat K. Examining and Contextualizing Approaches to Establish Policy Support Organizations - A Mixed Method Study. Int J Health Policy Manag 2022; 11:1788-1800. [PMID: 34380206 PMCID: PMC9808249 DOI: 10.34172/ijhpm.2021.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 07/13/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There has been an increase in the number of policy support organizations (PSOs) that have been created to foster the systematic use of evidence in health system policymaking. Our aim was to identify approaches for establishing a PSO or similar entities by soliciting insights from those with practical experience with developing and operationalizing PSOs in real-world contexts. METHODS We used a sequential mixed method approached. We first conducted a survey to identify the views and experiences of those who were directly involved in the establishment of PSOs that have been developed and implemented across a variety of political-, health- and research-system contexts. The survey findings were then used to develop a purposive sample of PSO leaders and refine an interview guide for interviews with them. RESULTS We received 19 completed surveys from leaders of PSOs in countries across the WHO regions and that operate in different settings (eg, as independent organization or within a university or government department) and conducted interviews with 15 senior managers from nine PSOs. Our findings provide in-depth insights about approaches and strategies across four stages for establishing a PSO, which include: (i) building awareness for the PSO; (ii) developing the PSO; (iii) assessing the PSO to identify potential areas for enhancement; and (iv) supporting maturation to build sustainability in the long-term. Our findings provide rich insights about the process of establishing a PSO from leaders who have undertaken the process. CONCLUSION While all PSOs share the same objective in supporting evidence-informed policy-making (EIPM), there is no single approach that can be considered to be the most successful in establishing a PSO, and each country should identify the approach based on its context.
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Affiliation(s)
| | - Michael G. Wilson
- Health Policy PhD Program, McMaster University, Hamilton, ON, Canada
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
- Department of Health Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - John N. Lavis
- Health Policy PhD Program, McMaster University, Hamilton, ON, Canada
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
- Department of Health Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
- Department of Political Science, McMaster University, Hamilton, ON, Canada
- Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
| | - Fadi El-Jardali
- Knowledge to Policy Center, American University of Beirut, Beirut, Lebanon
| | - Kaelan Moat
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
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Miregwa BN, Holbrook A, Law MR, Lavis JN, Thabane L, Dolovich L, Wilson MG. The impact of OHIP+ pharmacare on use and costs of public drug plans among children and youth in Ontario: a time-series analysis. CMAJ Open 2022; 10:E848-E855. [PMID: 36167420 PMCID: PMC9578752 DOI: 10.9778/cmajo.20210295] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In 2018, Ontario implemented a pharmacare program (Ontario Health Insurance Plan Plus [OHIP+]) to provide children and youth younger than 25 years with full coverage for prescription medications in the provincial formulary. We aimed to assess the use of public drug plans and costs of publicly covered prescriptions before and after the program's implementation and modification. METHODS We conducted a population-based, interrupted time-series analysis using data on prescription drug claims, from the Canadian Institute for Health Information's National Prescription Drug Utilization Information System, for people younger than 25 years from January 2016 to October 2019 in Ontario, using British Columbia as the control. We assessed changes in the level and trend of publicly covered prescriptions and expenditures after the introduction of OHIP+ in January 2018 and after program modifications in April 2019. We also assessed plan use and expenditures for publicly covered prescriptions for diabetes and asthma. RESULTS Publicly covered prescriptions in Ontario increased by 290%, from 756 per 1000 people before OHIP+ to 2952 per 1000 (p < 0.001) after its implementation. After program modification, prescriptions decreased by 52% to 1421 per 1000 (p < 0.001). Similarly, total public drug expenditures increased by 254%, from $379 million in 2017 to $839 million in 2018, then reduced by 49% to $204 million in 2019. Monthly public plan expenditures increased by $115.94 (95% confidence interval [CI] $100.93 to $130.94) post-OHIP+ implementation and decreased by $99.97 (95% CI -$119.79 to -$80.15) per person per month after April 2019. INTERPRETATION Adopting OHIP+ increased use of public drug plans and expenditures for publicly funded prescription medicines, and the program modification was associated with decreases in both outcomes. This study's findings can inform the national pharmacare debate; future research should investigate associations with health outcomes.
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Affiliation(s)
- Benard N Miregwa
- Health Policy PhD Program (Miregwa), and Division of Clinical Pharmacology & Toxicology (Holbrook), and Department of Health Evidence and Impact (Holbrook, Lavis, Thabane, Dolovich, Wilson), McMaster University, Hamilton, Ont.; Centre for Health Services and Policy Research (Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; McMaster Health Forum (Lavis, Wilson), McMaster University, Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich), University of Toronto, Toronto, Ont.; Centre for Health Economics and Policy Analysis (Wilson), McMaster University, Hamilton, Ont.
| | - Anne Holbrook
- Health Policy PhD Program (Miregwa), and Division of Clinical Pharmacology & Toxicology (Holbrook), and Department of Health Evidence and Impact (Holbrook, Lavis, Thabane, Dolovich, Wilson), McMaster University, Hamilton, Ont.; Centre for Health Services and Policy Research (Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; McMaster Health Forum (Lavis, Wilson), McMaster University, Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich), University of Toronto, Toronto, Ont.; Centre for Health Economics and Policy Analysis (Wilson), McMaster University, Hamilton, Ont
| | - Michael R Law
- Health Policy PhD Program (Miregwa), and Division of Clinical Pharmacology & Toxicology (Holbrook), and Department of Health Evidence and Impact (Holbrook, Lavis, Thabane, Dolovich, Wilson), McMaster University, Hamilton, Ont.; Centre for Health Services and Policy Research (Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; McMaster Health Forum (Lavis, Wilson), McMaster University, Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich), University of Toronto, Toronto, Ont.; Centre for Health Economics and Policy Analysis (Wilson), McMaster University, Hamilton, Ont
| | - John N Lavis
- Health Policy PhD Program (Miregwa), and Division of Clinical Pharmacology & Toxicology (Holbrook), and Department of Health Evidence and Impact (Holbrook, Lavis, Thabane, Dolovich, Wilson), McMaster University, Hamilton, Ont.; Centre for Health Services and Policy Research (Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; McMaster Health Forum (Lavis, Wilson), McMaster University, Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich), University of Toronto, Toronto, Ont.; Centre for Health Economics and Policy Analysis (Wilson), McMaster University, Hamilton, Ont
| | - Lehana Thabane
- Health Policy PhD Program (Miregwa), and Division of Clinical Pharmacology & Toxicology (Holbrook), and Department of Health Evidence and Impact (Holbrook, Lavis, Thabane, Dolovich, Wilson), McMaster University, Hamilton, Ont.; Centre for Health Services and Policy Research (Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; McMaster Health Forum (Lavis, Wilson), McMaster University, Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich), University of Toronto, Toronto, Ont.; Centre for Health Economics and Policy Analysis (Wilson), McMaster University, Hamilton, Ont
| | - Lisa Dolovich
- Health Policy PhD Program (Miregwa), and Division of Clinical Pharmacology & Toxicology (Holbrook), and Department of Health Evidence and Impact (Holbrook, Lavis, Thabane, Dolovich, Wilson), McMaster University, Hamilton, Ont.; Centre for Health Services and Policy Research (Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; McMaster Health Forum (Lavis, Wilson), McMaster University, Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich), University of Toronto, Toronto, Ont.; Centre for Health Economics and Policy Analysis (Wilson), McMaster University, Hamilton, Ont
| | - Michael G Wilson
- Health Policy PhD Program (Miregwa), and Division of Clinical Pharmacology & Toxicology (Holbrook), and Department of Health Evidence and Impact (Holbrook, Lavis, Thabane, Dolovich, Wilson), McMaster University, Hamilton, Ont.; Centre for Health Services and Policy Research (Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; McMaster Health Forum (Lavis, Wilson), McMaster University, Hamilton, Ont.; Leslie Dan Faculty of Pharmacy (Dolovich), University of Toronto, Toronto, Ont.; Centre for Health Economics and Policy Analysis (Wilson), McMaster University, Hamilton, Ont
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Wilson MG, Gauvin FP, DeMaio P, Alam S, Drakos A, Soueidan S, Costa A, Reid R, Simeonov D, Sixsmith A, Sveistrup H, Lavis JN. Enhancing the use of technology in the long-term care sector in Canada: Insights from citizen panels and a national stakeholder dialogue. Healthc Manage Forum 2022; 35:310-317. [PMID: 35830436 PMCID: PMC9425718 DOI: 10.1177/08404704221108466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Enhancing the use of technology in long-term care has been identified as a key part of broader efforts to strengthen the sector in the wake of the COVID-19 pandemic. To inform such efforts, we convened a series of citizen panels, followed by a national stakeholder dialogue with system leaders focused on reimagining the long-term care sector using technology. Key actions prioritized through the deliberations convened included: developing an innovation roadmap/agenda (including national standards and guidelines); using co-design approaches for the strengthening the long-term care sector and for technological innovation; identifying and coordinating existing innovation projects to support scale and spread; enabling rapid-learning and improvement cycles to support the development, evaluation, and implementation of new technologies; and using funding models that enable the flexibility needed for such rapid-learning cycles.
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Affiliation(s)
| | | | - Peter DeMaio
- 3710McMaster University, Hamilton, Ontario, Canada
| | - Saif Alam
- 3710McMaster University, Hamilton, Ontario, Canada
| | | | | | - Andrew Costa
- 3710McMaster University, Hamilton, Ontario, Canada
| | - Rob Reid
- 5543Trillium Health Partners, Mississauga, Ontario, Canada
| | | | - Andrew Sixsmith
- 1763Simon Fraser University, Vancouver, British Columbia, Canada
| | | | - John N Lavis
- 3710McMaster University, Hamilton, Ontario, Canada.,University of Johannesburg, Johannesburg, South Africa
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Jarvis T, Mah AML, Wang RH, Wilson MG. Usability of an Online System Navigation Database to Support Equitable Access to Assistive Technology in Canada: Usability Testing Study (Preprint). JMIR Form Res 2022; 6:e36949. [DOI: 10.2196/36949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
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Macaulay B, Reinap M, Wilson MG, Kuchenmüller T. Integrating citizen engagement into evidence-informed health policy-making in eastern Europe and central Asia: scoping study and future research priorities. Health Res Policy Syst 2022; 20:11. [PMID: 35042516 PMCID: PMC8764649 DOI: 10.1186/s12961-021-00808-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/16/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The perspectives of citizens are an important and often overlooked source of evidence for informing health policy. Despite growing encouragement for its adoption, little is known regarding how citizen engagement may be integrated into evidence-informed health policy-making in low- and middle-income counties (LMICs) and newly democratic states (NDSs). We aimed to identify the factors and variables affecting the potential integration of citizen engagement into evidence-informed health policy-making in LMICs and NDSs and understand whether its implementation may require a different approach outside of high-income western democracies. Further, we assessed the context-specific considerations for the practical implementation of citizen engagement in one focus region-eastern Europe and central Asia. METHODS First, adopting a scoping review methodology, we conducted and updated searches of six electronic databases, as well as a comprehensive grey literature search, on citizen engagement in LMICs and NDSs, published before December 2019. We extracted insights about the approaches to citizen engagement, as well as implementation considerations (facilitators and barriers) and additional political factors, in developing an analysis framework. Second, we undertook exploratory methods to identify relevant literature on the socio-political environment of the focus region, before subjecting these sources to the same analysis framework. RESULTS Our searches identified 479 unique sources, of which 28 were adjudged to be relevant. The effective integration of citizen engagement within policy-making processes in LMICs and NDSs was found to be predominantly dependent upon the willingness and capacity of citizens and policy-makers. In the focus region, the implementation of citizen engagement within evidence-informed health policy-making is constrained by a lack of mutual trust between citizens and policy-makers. This is exacerbated by inadequate incentives and capacity for either side to engage. CONCLUSIONS This research found no reason why citizen engagement could not adopt the same form in LMICs and NDSs as it does in high-income western democracies. However, it is recognized that certain political contexts may require additional support in developing and implementing citizen engagement, such as through trialling mechanisms at subnational scales. While specifically outlining the potential for citizen engagement, this study highlights the need for further research on its practical implementation.
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Affiliation(s)
- Bobby Macaulay
- World Health Organization Regional Office for Europe, Copenhagen, Denmark.
| | - Marge Reinap
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Michael G Wilson
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
| | - Tanja Kuchenmüller
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
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Wilson MG, Oliver S, Melendez-Torres GJ, Lavis JN, Waddell K, Dickson K. Paper 3: Selecting rapid review methods for complex questions related to health policy and system issues. Syst Rev 2021; 10:286. [PMID: 34717777 PMCID: PMC8556903 DOI: 10.1186/s13643-021-01834-y] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/08/2021] [Indexed: 11/11/2022] Open
Abstract
Approaches for rapid reviews that focus on streamlining systematic review methods are not always suitable for exploring complex policy questions, as developing and testing theories to explain these complexities requires configuring diverse qualitative, quantitative, and mixed methods studies. Our objective was therefore to provide a guide to selecting approaches for rapidly (i.e., within days to months) addressing complex questions related to health policy and system issues.We provide a two-stage, transdisciplinary collaborative process to select a rapid review approach to address complex policy questions, which consists of scoping the breadth and depth of the literature and then selecting an optimal approach to synthesis. The first stage (scoping the literature) begins with a discussion with the stakeholders requesting evidence to identify and refine the question for the review, which is then used to conduct preliminary searches and conceptually map the documents identified. In the second stage (selection of an optimal approach), further stakeholder consultation is required to refine and tailor the question and approach to identifying relevant documents to include. The approach to synthesizing the included documents is then guided by the final question, the breadth and depth of the literature, and the time available and can include a static or evolving conceptual framework to code and analyze a range of evidence. For areas already covered extensively by existing systematic reviews, the focus can be on summarizing and integrating the review findings, resynthesizing the primary studies, or updating the search and reanalyzing one or more of the systematic reviews.The choice of approaches for conducting rapid reviews is intertwined with decisions about how to manage projects, the amount of work to be done, and the knowledge already available, and our guide offers support to help make these strategic decisions.
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Affiliation(s)
- Michael G. Wilson
- McMaster Health Forum, McMaster University, Hamilton, Canada
- Department of Health Evidence and Impact, McMaster University, Hamilton, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada
| | - Sandy Oliver
- EPPI-Centre, University College London, London, UK
- Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
| | | | - John N. Lavis
- McMaster Health Forum, McMaster University, Hamilton, Canada
- Department of Health Evidence and Impact, McMaster University, Hamilton, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada
- Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
- Department of Political Science, McMaster University, Hamilton, Canada
| | - Kerry Waddell
- McMaster Health Forum, McMaster University, Hamilton, Canada
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11
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Peters MDJ, Marnie C, Colquhoun H, Garritty CM, Hempel S, Horsley T, Langlois EV, Lillie E, O'Brien KK, Tunçalp Ӧ, Wilson MG, Zarin W, Tricco AC. Scoping reviews: reinforcing and advancing the methodology and application. Syst Rev 2021; 10:263. [PMID: 34625095 PMCID: PMC8499488 DOI: 10.1186/s13643-021-01821-3] [Citation(s) in RCA: 129] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022] Open
Abstract
Scoping reviews are an increasingly common approach to evidence synthesis with a growing suite of methodological guidance and resources to assist review authors with their planning, conduct and reporting. The latest guidance for scoping reviews includes the JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews. This paper provides readers with a brief update regarding ongoing work to enhance and improve the conduct and reporting of scoping reviews as well as information regarding the future steps in scoping review methods development. The purpose of this paper is to provide readers with a concise source of information regarding the difference between scoping reviews and other review types, the reasons for undertaking scoping reviews, and an update on methodological guidance for the conduct and reporting of scoping reviews.Despite available guidance, some publications use the term 'scoping review' without clear consideration of available reporting and methodological tools. Selection of the most appropriate review type for the stated research objectives or questions, standardised use of methodological approaches and terminology in scoping reviews, clarity and consistency of reporting and ensuring that the reporting and presentation of the results clearly addresses the review's objective(s) and question(s) are critical components for improving the rigour of scoping reviews.Rigourous, high-quality scoping reviews should clearly follow up to date methodological guidance and reporting criteria. Stakeholder engagement is one area where further work could occur to enhance integration of consultation with the results of evidence syntheses and to support effective knowledge translation. Scoping review methodology is evolving as a policy and decision-making tool. Ensuring the integrity of scoping reviews by adherence to up-to-date reporting standards is integral to supporting well-informed decision-making.
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Affiliation(s)
- Micah D J Peters
- University of South Australia, UniSA Clinical and Health Sciences, Rosemary Bryant AO Research Centre, Playford Building P4-27, City East Campus, North Terrace, Adelaide, 5000, South Australia.,Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, 101 Currie St, Adelaide, 5001, South Australia.,The Centre for Evidence-based Practice South Australia (CEPSA): a Joanna Briggs Institute Centre of Excellence, Faculty of Health and Medical Sciences, The University of Adelaide, 5006, Adelaide, South Australia
| | - Casey Marnie
- University of South Australia, UniSA Clinical and Health Sciences, Rosemary Bryant AO Research Centre, Playford Building P4-27, City East Campus, North Terrace, Adelaide, 5000, South Australia
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, Terrence Donnelly Health Sciences Complex, 3359 Mississauga Rd, Toronto, Ontario, L5L 1C6, Canada.,Rehabilitation Sciences Institute (RSI), University of Toronto, St. George Campus, 160-500 University Avenue, Toronto, Ontario, M5G 1V7, Canada
| | - Chantelle M Garritty
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada
| | - Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, CA, 90007, USA
| | - Tanya Horsley
- Royal College of Physicians and Surgeons of Canada, 774 Echo Drive, Ottawa, Ontario, K1S 5N8, Canada
| | - Etienne V Langlois
- Partnership for Maternal, Newborn and Child Health (PMNCH), World Health Organisation, Avenue Appia 20, 1211, Geneva, Switzerland
| | - Erin Lillie
- Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada
| | - Kelly K O'Brien
- Rehabilitation Sciences Institute (RSI), University of Toronto, St. George Campus, 160-500 University Avenue, Toronto, Ontario, M5G 1V7, Canada.,Department of Physical Therapy, University of Toronto, St. George Campus, 160-500 University Avenue, Toronto, Ontario, M5G 1V7, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, St. George Campus, 155 College Street 4th Floor, Toronto, Ontario, M5T 3M6, Canada
| | - Ӧzge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organisation, Avenue Appia 20, 1211, Geneva, Switzerland
| | - Michael G Wilson
- McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada.,Department of Health Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Wasifa Zarin
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1T8, Canada
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1T8, Canada. .,Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St, Room 500, Toronto, Ontario, M5T 3M7, Canada. .,Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, School of Nursing, Queen's University, 99 University Ave, Kingston, Ontario, K7L 3N6, Canada.
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Bullock HL, Lavis JN, Wilson MG, Mulvale G, Miatello A. Understanding the implementation of evidence-informed policies and practices from a policy perspective: a critical interpretive synthesis. Implement Sci 2021. [PMID: 33588878 DOI: 10.1186/s13012‐021‐01082‐7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The fields of implementation science and knowledge translation have evolved somewhat independently from the field of policy implementation research, despite calls for better integration. As a result, implementation theory and empirical work do not often reflect the implementation experience from a policy lens nor benefit from the scholarship in all three fields. This means policymakers, researchers, and practitioners may find it challenging to draw from theory that adequately reflects their implementation efforts. METHODS We developed an integrated theoretical framework of the implementation process from a policy perspective by combining findings from these fields using the critical interpretive synthesis method. We began with the compass question: How is policy currently described in implementation theory and processes and what aspects of policy are important for implementation success? We then searched 12 databases as well as gray literature and supplemented these documents with other sources to fill conceptual gaps. Using a grounded and interpretive approach to analysis, we built the framework constructs, drawing largely from the theoretical literature and then tested and refined the framework using empirical literature. RESULTS A total of 11,434 documents were retrieved and assessed for eligibility and 35 additional documents were identified through other sources. Eighty-six unique documents were ultimately included in the analysis. Our findings indicate that policy is described as (1) the context, (2) a focusing lens, (3) the innovation itself, (4) a lever of influence, (5) an enabler/facilitator or barrier, or (6) an outcome. Policy actors were also identified as important participants or leaders of implementation. Our analysis led to the development of a two-part conceptual framework, including process and determinant components. CONCLUSIONS This framework begins to bridge the divide between disciplines and provides a new perspective about implementation processes at the systems level. It offers researchers, policymakers, and implementers a new way of thinking about implementation that better integrates policy considerations and can be used for planning or evaluating implementation efforts.
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Affiliation(s)
- Heather L Bullock
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada.
| | - John N Lavis
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada.,McMaster Health Forum, Hamilton, Canada
| | - Michael G Wilson
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada.,McMaster Health Forum, Hamilton, Canada
| | - Gillian Mulvale
- DeGroote School of Business, McMaster University, Burlington, Canada
| | - Ashleigh Miatello
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada
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13
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Bullock HL, Lavis JN, Wilson MG, Mulvale G, Miatello A. Understanding the implementation of evidence-informed policies and practices from a policy perspective: a critical interpretive synthesis. Implement Sci 2021; 16:18. [PMID: 33588878 PMCID: PMC7885555 DOI: 10.1186/s13012-021-01082-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 08/08/2020] [Accepted: 01/07/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The fields of implementation science and knowledge translation have evolved somewhat independently from the field of policy implementation research, despite calls for better integration. As a result, implementation theory and empirical work do not often reflect the implementation experience from a policy lens nor benefit from the scholarship in all three fields. This means policymakers, researchers, and practitioners may find it challenging to draw from theory that adequately reflects their implementation efforts. METHODS We developed an integrated theoretical framework of the implementation process from a policy perspective by combining findings from these fields using the critical interpretive synthesis method. We began with the compass question: How is policy currently described in implementation theory and processes and what aspects of policy are important for implementation success? We then searched 12 databases as well as gray literature and supplemented these documents with other sources to fill conceptual gaps. Using a grounded and interpretive approach to analysis, we built the framework constructs, drawing largely from the theoretical literature and then tested and refined the framework using empirical literature. RESULTS A total of 11,434 documents were retrieved and assessed for eligibility and 35 additional documents were identified through other sources. Eighty-six unique documents were ultimately included in the analysis. Our findings indicate that policy is described as (1) the context, (2) a focusing lens, (3) the innovation itself, (4) a lever of influence, (5) an enabler/facilitator or barrier, or (6) an outcome. Policy actors were also identified as important participants or leaders of implementation. Our analysis led to the development of a two-part conceptual framework, including process and determinant components. CONCLUSIONS This framework begins to bridge the divide between disciplines and provides a new perspective about implementation processes at the systems level. It offers researchers, policymakers, and implementers a new way of thinking about implementation that better integrates policy considerations and can be used for planning or evaluating implementation efforts.
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Affiliation(s)
- Heather L Bullock
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada.
| | - John N Lavis
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada.,McMaster Health Forum, Hamilton, Canada
| | - Michael G Wilson
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada.,McMaster Health Forum, Hamilton, Canada
| | - Gillian Mulvale
- DeGroote School of Business, McMaster University, Burlington, Canada
| | - Ashleigh Miatello
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L6, Canada
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Bisnauth MA, Coovadia A, Mbuagbaw L, Wilson MG, Birch S. Option B+ Program for the Prevention of Vertical Transmission of HIV: A Case Study in Johannesburg, South Africa. Front Public Health 2020; 8:533534. [PMID: 33194942 PMCID: PMC7656053 DOI: 10.3389/fpubh.2020.533534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/08/2020] [Accepted: 08/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background: South Africa's National Department of Health adopted WHO's 2013 consolidated guidelines on ARVs for HIV treatment and prevention in 2015, including changes for Prevention from Mother-to-Child Transmission (PMTCT) through Option B+, aimed to reduce the HIV prevalence rate amongst women by placing them on lifelong treatment, irrespective of their CD4 count. As a result, these guidelines were implemented for the PMTCT program at Rahima Moosa Hospital. Little is known about the impact of these guidelines on the work of healthcare workers (HCWs) and no research had focused on how these changes have affected adherence for the patients. Objectives: The purpose of this research project was (1) to explore the impact of the Option B+ PMTCT program on the work of healthcare professionals, and (2) to understand pregnant HIV-positive women views and experiences with ART for life, as a way to better manage the Option B+ PMTCT program. Design: Qualitative semi-structured interviews with a phenomenological approach was used. Setting: Data collection at the antenatal/postnatal clinics/wards, OBGYN and Department of Pediatrics at RMMCH in Johannesburg. Method: A qualitative study design is used with a phenomenological approach. The methodology used semi-structured interviews with healthcare professionals and patients. The thematic analysis was used within an Accessibility Framework to guide the identification of domains that emerged from all transcribed data. A convenience sample in the antenatal clinic, postnatal clinic, antenatal ward, OBGYN, and Department of Pediatrics and Child Health at RMMCH. The study is situated in Johannesburg, South Africa. Results: The findings demonstrated that work has become difficult to manage for all healthcare professionals because of (1) the need for strengthening indicators for tracking to decrease loss to follow-up (LTFU); (2) inconsistency in delivery of counseling and support services and the need for communication across clinical departments; and (3) the lack of compassion and understanding by service providers. The difficult healthcare environment has affected overall views and experiences of pregnant HIV-positive women going on ART for life. All patient participants (n = 55) responded that they chose to take the fixed-dose combination (FDC) for life to protect the health of the baby and felt ART for life can be stopped after giving birth, unaware of the long-term benefits to the mother. Conclusion: The Option B+ program emphasized a need for the provision of continuous counseling and support services for women with same day initiation of ART. There is a need for better internal communication and collaboration amongst HCWs across all units of RMMCH for attainment in treatment outcomes. HCWs communication to patients is essential in helping patients build trust in service delivery, decreasing the LTFU and promoting adherence. The ability to understand functions of the work environment in which a PMTCT program operates in is essential in addressing policy implementation and program issues for ease of adaptability of Option B+ programming on a larger scale across all units of RMMCH. Implications for future research include the need to address changes within the healthcare system at both clinical and management levels. It is crucial to incorporate the perspective of patients in policy implementation; uptake and adherence are key indicators in informing whether the Option B+ PMTCT program is being adapted into state hospitals effectively. There needs to be extensive research on how to strengthen indicators for long term scalability and sustainability of the program. Future evaluations need to address how interdisciplinary collaboration within healthcare facilities improves the management and understanding of Option B+ program.
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Affiliation(s)
- Melanie A Bisnauth
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,Empilweni Services and Research Unit, Department of Pediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa.,School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Ashraf Coovadia
- Empilweni Services and Research Unit, Department of Pediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa.,School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Lawrence Mbuagbaw
- Biostatistics Unit, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Michael G Wilson
- Department of Clinical Epidemiology and Biostatistics, University of Toronto, Toronto, ON, Canada
| | - Stephen Birch
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,Taylor Chair and Centre Director, Centre for the Business and Economics of Health, University of Queensland, Brisbane, QLD, Australia
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15
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Al Sabahi S, Wilson MG, Lavis JN, El-Jardali F, Moat K, Vélez M. Examining and Contextualizing Approaches to Establish Policy Support Organizations - A Critical Interpretive Synthesis. Int J Health Policy Manag 2020; 11:551-566. [PMID: 33008260 PMCID: PMC9309922 DOI: 10.34172/ijhpm.2020.181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 03/17/2020] [Accepted: 09/15/2020] [Indexed: 11/24/2022] Open
Abstract
Background: In response to worldwide calls for the need to support evidence-informed policy-making (EIPM), more countries are increasingly interested in enhancing their efforts to use research to inform policy-making. In order to inform the efforts of those asked to lead the support of EIPM, our aim is to develop a conceptual framework to guide the process of establishing a policy support organization (PSO). Methods: We conducted a critical interpretive synthesis (CIS). We conducted a two steps literature review. In the second step, we systematically searched OVID EMBASE, PsychInfo, HealthStar, CINAHL, Web of Science, Social Science Abstract, Health Systems Evidence, and ProQuest Dissertations and Theses Global databases for documents reporting the establishment of PSOs and the contextual factors influencing the process of establishing these organizations. We assessed the eligibility of the retrieved articles and synthesized the findings iteratively. Results: We included 52 documents in the synthesis. Our findings suggest that a PSO establishment process has four interconnected stages: awareness, development, assessment, and maturation. The process of establishing a PSO is iterative and influenced by political, research and health systems contextual factors, which determine the availability of the resources and the trust between researchers and policy-makers. The contextual factors have an impact on each other, and the challenges that arise from one factor can be mitigated by other factors. Conclusion: For those interested in establishing a PSO, our framework provides a road map for identifying the most appropriate starting point and the factors that might influence the establishment process. Leaders of such PSOs can use our findings to expand or refine their scope of work. Given that this framework focuses only on PSOs in the health sector, an important next step for research would be to include other sectors from social systems and identify any additional insight that can enhance our framework.
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Affiliation(s)
- Sultana Al Sabahi
- Health Policy PhD Program, McMaster University, Hamilton, ON, Canada
| | - Michael G Wilson
- Health Policy PhD Program, McMaster University, Hamilton, ON, Canada.,McMaster Health Forum, McMaster University, Hamilton, ON, Canada.,Department of Health Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - John N Lavis
- Health Policy PhD Program, McMaster University, Hamilton, ON, Canada.,McMaster Health Forum, McMaster University, Hamilton, ON, Canada.,Department of Health Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,Department of Political Science, McMaster University, Hamilton, ON, Canada.,Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
| | - Fadi El-Jardali
- Knowledge to Policy Center, American University of Beirut, Beirut, Lebanon
| | - Kaelan Moat
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
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16
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Vélez CM, Wilson MG, Lavis JN, Abelson J, Florez ID. A framework for explaining the role of values in health policy decision-making in Latin America: a critical interpretive synthesis. Health Res Policy Syst 2020; 18:100. [PMID: 32894131 PMCID: PMC7487839 DOI: 10.1186/s12961-020-00584-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 05/31/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although values underpin the goals pursued in health systems, including how health systems benefit the population, it is often not clear how values are incorporated into policy decision-making about health systems. The challenge is to encompass social/citizen values, health system goals, and financial realities and to incorporate them into the policy-making process. This is a challenge for all health systems and of particular importance for Latin American (LA) countries. Our objective was to understand how and under what conditions societal values inform decisions about health system financing in LA countries. METHODS A critical interpretive synthesis approach was utilised for this work. We searched 17 databases in December 2016 to identify articles written in English, Spanish or Portuguese that focus on values that inform the policy process for health system financing in LA countries at the macro and meso levels. Two reviewers independently screened records and assessed them for inclusion. One researcher conceptually mapped the included articles, created structured summaries of key findings from each, and selected a purposive sample of articles to thematically synthesise the results across the domains of agenda-setting/prioritisation, policy development and implementation. RESULTS We identified 5925 references, included 199 papers, and synthesised 68 papers. We identified 116 values and developed a framework to explain how values have been used to inform policy decisions about financing in LA countries. This framework has four categories - (1) goal-related values (i.e. guiding principles of the health system); (2) technical values (those incorporated into the instruments adopted by policy-makers to ensure a sustainable and efficient health system); (3) governance values (those applied in the policy process to ensure a transparent and accountable process of decision-making); and (4) situational values (a broad category of values that represent competing strategies to make decisions in the health systems, their influence varying according to the four factors). CONCLUSIONS It is an effort to consolidate and explain how different social values are considered and how they support policy decision-making about health system financing. This can help policy-makers to explicitly incorporate values into the policy process and understand how values are supporting the achievement of policy goals in health system financing. TRIAL REGISTRATION The protocol was registered with PROSPERO, ID=CRD42017057049 .
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Affiliation(s)
- C Marcela Vélez
- McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L6, Canada.
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.
- Health Policy PhD Program, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.
- Department of Paediatrics, Faculty of Medicine, University of Antioquia, Cl. 67 #53 - 108, Medellín, Antioquia, Colombia.
| | - Michael G Wilson
- McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L6, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
- Health Policy PhD Program, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - John N Lavis
- McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L6, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
- Health Policy PhD Program, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
- Department of Political Science, McMaster University, Hamilton, Canada
- Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
| | - Julia Abelson
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
- Health Policy PhD Program, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Ivan D Florez
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
- Department of Paediatrics, Faculty of Medicine, University of Antioquia, Cl. 67 #53 - 108, Medellín, Antioquia, Colombia
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Mattison CA, Lavis JN, Wilson MG, Hutton EK, Dion ML. A critical interpretive synthesis of the roles of midwives in health systems. Health Res Policy Syst 2020; 18:77. [PMID: 32641053 PMCID: PMC7346500 DOI: 10.1186/s12961-020-00590-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Midwives' roles in sexual and reproductive health and rights continues to evolve. Understanding the profession's role and how midwives can be integrated into health systems is essential in creating evidence-informed policies. Our objective was to develop a theoretical framework of how political system factors and health systems arrangements influence the roles of midwives within the health system. METHODS A critical interpretive synthesis was used to develop the theoretical framework. A range of electronic bibliographic databases (CINAHL, EMBASE, Global Health database, HealthSTAR, Health Systems Evidence, MEDLINE and Web of Science) was searched through to 14 May 2020 as were policy and health systems-related and midwifery organisation websites. A coding structure was created to guide the data extraction. RESULTS A total of 4533 unique documents were retrieved through electronic searches, of which 4132 were excluded using explicit criteria, leaving 401 potentially relevant records, in addition to the 29 records that were purposively sampled through grey literature. A total of 100 documents were included in the critical interpretive synthesis. The resulting theoretical framework identified the range of political and health system components that can work together to facilitate the integration of midwifery into health systems or act as barriers that restrict the roles of the profession. CONCLUSIONS Any changes to the roles of midwives in health systems need to take into account the political system where decisions about their integration will be made as well as the nature of the health system in which they are being integrated. The theoretical framework, which can be thought of as a heuristic, identifies the core contextual factors that governments can use to best leverage their position when working to improve sexual and reproductive health and rights.
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Affiliation(s)
- Cristina A Mattison
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, 1280 Main St. West, HSC-4H26, Hamilton, ON, L8S 4K1, Canada.
| | - John N Lavis
- McMaster Health Forum, 1280 Main St West, MML-417, Hamilton, ON, L8S 4L6, Canada
| | - Michael G Wilson
- McMaster Health Forum, 1280 Main St West, MML-417, Hamilton, ON, L8S 4L6, Canada
| | - Eileen K Hutton
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, 1280 Main St. West, HSC-4H26, Hamilton, ON, L8S 4K1, Canada
| | - Michelle L Dion
- Department of Political Science, McMaster University, 1280 Main St. West, KTH-533, Hamilton, ON, L8S 4M4, Canada
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Wang RH, Zdaniuk N, Durocher E, Wilson MG. Policymaker and stakeholder perspectives on access to assistive technologies in Canada: challenges and proposed solutions for enhancing equitable access. Disabil Rehabil Assist Technol 2020; 17:61-73. [PMID: 32489125 DOI: 10.1080/17483107.2020.1765033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: Unmet needs for assistive technologies (ATs) exist and the need for ATs is growing owing to demographic changes worldwide. Little comprehensive research has examined equity of access to ATs in Canada. Our study elucidates perspectives of policymakers and stakeholders on challenges and solutions for enhancing equitable access to ATs to advance policy discussions.Methods: We conducted a qualitative interview study with a purposive sample of policymakers and stakeholders. Stakeholders were from non-profit organisations; private insurance companies; ageing or technology industries; and advocacy, consumer, and support groups. We used thematic analysis to develop themes that summarised and facilitated data interpretation.Results: We conducted 24 interviews involving 32 participants. We present three themes: (1) User experiences, detailing challenges experienced by AT system users; (2) System characteristics: Challenges and solutions, outlining governance, financial, and delivery arrangements that create challenges for accessing AT, as well as participants' proposed solutions; and (3) Shifts in models and principles, for approaches that may foster equitable access to ATs. We consolidate results into a set of valued qualities of a system that can enhance equitable AT access, and relate results to relevant national and international activities.Conclusions: This is the most comprehensive study of Canadian policymaker and stakeholder views on AT access to date. Identified challenges and solutions point to opportunities for policy action and to support work to create a national vision for AT access that strengthens the potential for ATs to enable daily activity participation, independence, and societal inclusion of seniors and people with disabilities.IMPLICATIONS FOR REHABILITATIONAT use supports daily activity participation, independence, and societal inclusion of seniors and people with disabilities.There is an urgent need to ensure that those who need ATs have access to them, considering the benefits of their use, current unmet needs for ATs, and the anticipated demand for ATs because of the ageing population and increased prevalence of chronic disease and disability.A comprehensive understanding of policymakers' and stakeholders' perspectives on challenges and potential solutions for enhancing equitable access to ATs is critical to support development of evidence- and values-informed policies.Understanding challenges and solutions identified by diverse policymakers and stakeholders can lead to national and local opportunities for policy action and support work to create a national vision for enhancing equitable access to AT.
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Affiliation(s)
- Rosalie H Wang
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Natalia Zdaniuk
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Evelyne Durocher
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Michael G Wilson
- McMaster Health Forum, McMaster University, Hamilton, Canada.,Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
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Vélez M, Wilson MG, Abelson J, Lavis JN, Paraje G. Understanding the Role of Values in Health Policy Decision-Making From the Perspective of Policy-Makers and Stakeholders: A Multiple-Case Embedded Study in Chile and Colombia. Int J Health Policy Manag 2020; 9:185-197. [PMID: 32563219 PMCID: PMC7306109 DOI: 10.15171/ijhpm.2019.94] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 10/15/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Chile and Colombia are examples of Latin American countries with health systems shaped by similar values. Recently, both countries have crafted policies to regulate the participation of private for-profit insurance companies in their health systems, but through very different mechanisms. This study asks: what values are important in the decision-making processes that crafted these policies? And how and why are they used? METHODS An embedded multiple-case study design was carried out for 2 specific decisions in each country: (1) in Chile, the development of the Universal Plan of Explicit Entitlements -AUGE/GES - and mandating universal coverage of treatments for high-cost diseases; and (2) in Colombia, the declaration of health as a fundamental right and a mechanism to explicitly exclude technologies that cannot be publicly funded. We interviewed key informants involved in one or more of the decisions and/or in the policy analysis and development process that contributed to the eventual decision. The data analysis involved a constant comparative approach and thematic analysis for each case study. RESULTS From the 40 individuals who were invited, 28 key informants participated. A tension between 2 important values was identified for each decision (eg, solidarity vs. individualism for the AUGE/GES plan in Chile; human dignity vs. sustainability for the declaration of the right to health in Colombia). Policy-makers used values in the decisionmaking process to frame problems in meaningful ways, to guide policy development, as a pragmatic instrument to make decisions, and as a way to legitimize decisions. In Chile, values such as individualism and free choice were incorporated in decision-making because attaining private health insurance was seen as an indicator of improved personal economic status. In Colombia, human dignity was incorporated as the core value because the Constitutional Court asserted its importance in its use of judicial activism as a check on the power of the executive and legislative branches. CONCLUSION There is an opportunity to open further exploration of the role of values in different health decisions, political sectors besides health, and even other jurisdictions.
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Affiliation(s)
- Marcela Vélez
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,Health Policy Ph.D. Program, McMaster University, Hamilton, ON, Canada.,Department of Paediatrics, Faculty of Medicine, University of Antioquia, Antioquia, Colombia
| | - Michael G Wilson
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,Health Policy Ph.D. Program, McMaster University, Hamilton, ON, Canada
| | - Julia Abelson
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,Health Policy Ph.D. Program, McMaster University, Hamilton, ON, Canada
| | - John N Lavis
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,Health Policy Ph.D. Program, McMaster University, Hamilton, ON, Canada.,Department of Political Science, McMaster University, Hamilton, ON, Canada.,Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
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Mattison CA, Lavis JN, Hutton EK, Dion ML, Wilson MG. Understanding the conditions that influence the roles of midwives in Ontario, Canada's health system: an embedded single-case study. BMC Health Serv Res 2020; 20:197. [PMID: 32164698 PMCID: PMC7068956 DOI: 10.1186/s12913-020-5033-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/18/2019] [Accepted: 02/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the significant variability in the role and integration of midwifery across provincial and territorial health systems, there has been limited scholarly inquiry into whether, how and under what conditions midwifery has been assigned roles and integrated into Canada's health systems. METHODS We use Yin's (2014) embedded single-case study design, which allows for an in-depth exploration to qualitatively assess how, since the regulation of midwives in 1994, the Ontario health system has assigned roles to and integrated midwives as a service delivery option. Kingdon's agenda setting and 3i + E theoretical frameworks are used to analyze two recent key policy directions (decision to fund freestanding midwifery-led birth centres and the Patients First primary care reform) that presented opportunities for the integration of midwives into the health system. Data were collected from key informant interviews and documents. RESULTS Nineteen key informant interviews were conducted, and 50 documents were reviewed in addition to field notes taken during the interviews. Our findings suggest that while midwifery was created as a self-regulated profession in 1994, health-system transformation initiatives have restricted the profession's integration into Ontario's health system. The policy legacies of how past decisions influence the decisions possible today have the most explanatory power to understand why midwives have had limited integration into interprofessional maternity care. The most important policy legacies to emerge from the analyses were related to payment mechanisms. In the medical model, payment mechanisms privilege physician-provided and hospital-based services, while payment mechanisms in the midwifery model have imposed unintended restrictions on the profession's ability to practice in interprofessional environments. CONCLUSIONS This is the first study to explain why midwives have not been fully integrated into the Ontario health system, as well as the limitations placed on their roles and scope of practice. The study also builds a theoretical understanding of the integration process of healthcare professions within health systems and how policy legacies shape service delivery options.
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Affiliation(s)
- Cristina A Mattison
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, 1280 Main St. West, HSC-4H26, Hamilton, ON, L8S 4K1, Canada.
| | - John N Lavis
- McMaster Health Forum, 1280 Main St West, MML-417, Hamilton, ON, L8S 4L6, Canada
| | - Eileen K Hutton
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, 1280 Main St. West, HSC-4H26, Hamilton, ON, L8S 4K1, Canada
| | - Michelle L Dion
- Department of Political Science, McMaster University, 1280 Main St. West, KTH-533, Hamilton, ON, L8S 4M4, Canada
| | - Michael G Wilson
- McMaster Health Forum, 1280 Main St West, MML-417, Hamilton, ON, L8S 4L6, Canada
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21
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Wilson MG, Nidumolu A, Berditchevskaia I, Gauvin FP, Abelson J, Lavis JN. Identifying approaches for synthesizing and summarizing information to support informed citizen deliberations in health policy: a scoping review. J Health Serv Res Policy 2019; 25:59-66. [PMID: 31523997 DOI: 10.1177/1355819619872221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective Public deliberations are an increasingly popular tool to engage citizens in the development of health policies and programmes. However, limited research has been conducted on how to best synthesize and summarize information on health policy issues for citizens. To begin to address this gap, our aim was to map the literature on the preparation of information to support informed citizen deliberations related to health policy issues. Methods We conducted a scoping review where two reviewers screened the results of electronic database searches, grey literature searches and hand searches of organizational websites to identify empirical studies, scholarly commentaries, and publicly available organizational documents focused on synthesizing and summarizing information to inform citizen deliberation about health policy issues. Two reviewers categorized each included document according to themes/topics of deliberation, purpose of deliberation and the form of deliberation, and developed a summary of the key findings related to synthesizing and summarizing information to support informed citizen deliberations. Results There was limited reporting about whether and how information was synthesized. Evidence was typically organized based on the source used (e.g. by comparing the views of stakeholders or experts) or according to the areas that policymakers need to consider when making decisions (e.g. benefits, harms, costs and stakeholder perspectives related to policy options). Information was presented primarily through written materials (e.g. briefs and brochures), audiovisual resources (e.g. videos or presentations from stakeholders), but some interactive presentation approaches were also identified (e.g. through interactive arts-based approaches). Conclusions The choice and framing of information to inform citizen deliberations about health policy can strongly influence their understanding of a policy issue, and has the potential to impact the discussions and recommendations that emerge from deliberations. Our review confirmed that there remains a dearth of literature describing methods of the preparation of information to inform citizen deliberations about health policy issues. This highlights the need for further exploration of optimal strategies for citizen-friendly approaches to synthesizing and summarizing information for deliberations.
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Affiliation(s)
- Michael G Wilson
- Assistant Director, McMaster Health Forum, McMaster University, Canada.,Associate Professor, Department of Health Evidence and Impact, McMaster University, Canada.,Member, Centre for Health Economics and Policy Analysis, McMaster University, Canada
| | - Aditya Nidumolu
- Resident Physician, Department of Psychiatry, Dalhousie University, Canada
| | | | - Francois-Pierre Gauvin
- Senior Scientific Lead, Citizen Engagement and Evidence Curation, McMaster Health Forum, McMaster University, Canada
| | - Julia Abelson
- Associate Professor, Department of Health Evidence and Impact, McMaster University, Canada.,Professor, Department of Health Evidence and Impact, McMaster University, Canada
| | - John N Lavis
- Member, Centre for Health Economics and Policy Analysis, McMaster University, Canada.,Professor, Department of Health Evidence and Impact, McMaster University, Canada.,Director, McMaster Health Forum, McMaster University, Canada.,Associate Member, Department of Political Science, McMaster University, Canada
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22
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Bentley C, Peacock S, Abelson J, Burgess MM, Demers-Payette O, Longstaff H, Tripp L, Lavis JN, Wilson MG. Addressing the affordability of cancer drugs: using deliberative public engagement to inform health policy. Health Res Policy Syst 2019; 17:17. [PMID: 30732616 PMCID: PMC6367823 DOI: 10.1186/s12961-019-0411-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 08/17/2018] [Accepted: 01/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health system expenditure on cancer drugs is rising rapidly in many OECD countries given the costly new treatments and increased rates of use due to a growing and ageing population. These factors put considerable strain on the sustainability of health systems worldwide, sparking public debate among clinicians, pharmaceutical companies, policy-makers and citizens on issues of affordability and equity. We engaged Canadians through a series of deliberative public engagement events to determine their priorities for making cancer drug funding decisions fair and sustainable in Canada's publicly financed health system. METHODS An approach to deliberation was developed based on the McMaster Health Forum's citizen panels and the established Burgess and O'Doherty model of deliberative public engagement. Six deliberations were held across Canada in 2016. Transcripts were coded in NVivo and analysed to determine where participants' views converged and diverged. Recommendations were grouped thematically. RESULTS A total of 115 Canadians participated in the deliberative events and developed 86 recommendations. Recommendations included the review and regular re-review of approved drugs using 'real-world' evidence on effectiveness and cost-effectiveness; prioritisation of treatments that restore patients' independence, mental health and general well-being; ensuring that decision processes, results and their rationales are transparent; and commitment to people with similar needs receiving the same care regardless of where in Canada they live. CONCLUSIONS The next steps for policy-makers should be to develop mechanisms for (1) re-reviewing effectiveness and cost-effectiveness data for all cancer drugs; (2) making disinvestments in cancer drugs that satisfy requirements relating to grandfathering and compassionate access; (3) ensuring fair and equitable access to cancer drugs for all Canadians; and (4) fostering a pan-Canadian approach to cancer drug funding decisions.
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Affiliation(s)
- Colene Bentley
- Canadian Centre for Applied Research in Cancer Control (ARCC), 675 West 10th Avenue, Vancouver, British Columbia, V5Z 1L3, Canada.
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control (ARCC), 675 West 10th Avenue, Vancouver, British Columbia, V5Z 1L3, Canada
| | - Julia Abelson
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West (CRL 203), Hamilton, Ontario, L8S 4K1, Canada
| | - Michael M Burgess
- School of Population and Public Health, University of British Columbia, 239 RHS, 1088 Discovery Avenue, Kelowna, British Columbia, V1V 1V7, Canada
| | - Olivier Demers-Payette
- Institute National d'Excellence en Santé et en Services Sociaux (INESSS), 2021 avenue Union, 12th Floor, bureau 1200, Montreal, Quebec, H3A 2S9, Canada
| | - Holly Longstaff
- Engage Associates Consulting Firm, Vancouver, British Columbia, Canada
| | - Laura Tripp
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West (CRL 203), Hamilton, Ontario, L8S 4K1, Canada
| | - John N Lavis
- McMaster Health Forum, 1280 Main Street West, MML-417, Ontario, Hamilton, L8S 4L6, Canada
| | - Michael G Wilson
- McMaster Health Forum, 1280 Main Street West, MML-417, Ontario, Hamilton, L8S 4L6, Canada
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Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, Moher D, Peters MDJ, Horsley T, Weeks L, Hempel S, Akl EA, Chang C, McGowan J, Stewart L, Hartling L, Aldcroft A, Wilson MG, Garritty C, Lewin S, Godfrey CM, Macdonald MT, Langlois EV, Soares-Weiser K, Moriarty J, Clifford T, Tunçalp Ö, Straus SE. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med 2018. [PMID: 30178033 DOI: 10.7326/m18-0850/suppl_file/m18-0850_supplement.pdf] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Scoping reviews, a type of knowledge synthesis, follow a systematic approach to map evidence on a topic and identify main concepts, theories, sources, and knowledge gaps. Although more scoping reviews are being done, their methodological and reporting quality need improvement. This document presents the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist and explanation. The checklist was developed by a 24-member expert panel and 2 research leads following published guidance from the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network. The final checklist contains 20 essential reporting items and 2 optional items. The authors provide a rationale and an example of good reporting for each item. The intent of the PRISMA-ScR is to help readers (including researchers, publishers, commissioners, policymakers, health care providers, guideline developers, and patients or consumers) develop a greater understanding of relevant terminology, core concepts, and key items to report for scoping reviews.
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Affiliation(s)
- Andrea C Tricco
- St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada (A.C.T., S.E.S.)
| | - Erin Lillie
- St. Michael's Hospital, Toronto, Ontario, Canada (E.L., W.Z.)
| | - Wasifa Zarin
- St. Michael's Hospital, Toronto, Ontario, Canada (E.L., W.Z.)
| | - Kelly K O'Brien
- University of Toronto, Toronto, Ontario, Canada (K.K.O., H.C.)
| | | | | | - David Moher
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.M., C.G.)
| | - Micah D J Peters
- University of South Australia and University of Adelaide, Adelaide, South Australia, Australia (M.D.P.)
| | - Tanya Horsley
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada (T.H.)
| | - Laura Weeks
- Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada (L.W., T.C.)
| | | | - Elie A Akl
- American University of Beirut, Beirut, Lebanon (E.A.A.)
| | - Christine Chang
- Agency for Healthcare Research and Quality, Rockville, Maryland (C.C.)
| | | | | | - Lisa Hartling
- University of Alberta, Edmonton, Alberta, Canada (L.H.)
| | | | | | - Chantelle Garritty
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.M., C.G.)
| | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway, and South African Medical Research Council, Cape Town, South Africa (S.L.)
| | | | | | | | | | - Jo Moriarty
- King's College London, London, United Kingdom (J.M.)
| | - Tammy Clifford
- Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada (L.W., T.C.)
| | - Özge Tunçalp
- World Health Organization, Geneva, Switzerland (E.V.L., Ö.T.)
| | - Sharon E Straus
- St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada (A.C.T., S.E.S.)
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Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, Moher D, Peters MDJ, Horsley T, Weeks L, Hempel S, Akl EA, Chang C, McGowan J, Stewart L, Hartling L, Aldcroft A, Wilson MG, Garritty C, Lewin S, Godfrey CM, Macdonald MT, Langlois EV, Soares-Weiser K, Moriarty J, Clifford T, Tunçalp Ö, Straus SE. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med 2018; 169:467-473. [PMID: 30178033 DOI: 10.7326/m18-0850] [Citation(s) in RCA: 11978] [Impact Index Per Article: 1996.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Scoping reviews, a type of knowledge synthesis, follow a systematic approach to map evidence on a topic and identify main concepts, theories, sources, and knowledge gaps. Although more scoping reviews are being done, their methodological and reporting quality need improvement. This document presents the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist and explanation. The checklist was developed by a 24-member expert panel and 2 research leads following published guidance from the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network. The final checklist contains 20 essential reporting items and 2 optional items. The authors provide a rationale and an example of good reporting for each item. The intent of the PRISMA-ScR is to help readers (including researchers, publishers, commissioners, policymakers, health care providers, guideline developers, and patients or consumers) develop a greater understanding of relevant terminology, core concepts, and key items to report for scoping reviews.
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Affiliation(s)
- Andrea C Tricco
- St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada (A.C.T., S.E.S.)
| | - Erin Lillie
- St. Michael's Hospital, Toronto, Ontario, Canada (E.L., W.Z.)
| | - Wasifa Zarin
- St. Michael's Hospital, Toronto, Ontario, Canada (E.L., W.Z.)
| | - Kelly K O'Brien
- University of Toronto, Toronto, Ontario, Canada (K.K.O., H.C.)
| | | | | | - David Moher
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.M., C.G.)
| | - Micah D J Peters
- University of South Australia and University of Adelaide, Adelaide, South Australia, Australia (M.D.P.)
| | - Tanya Horsley
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada (T.H.)
| | - Laura Weeks
- Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada (L.W., T.C.)
| | | | - Elie A Akl
- American University of Beirut, Beirut, Lebanon (E.A.A.)
| | - Christine Chang
- Agency for Healthcare Research and Quality, Rockville, Maryland (C.C.)
| | | | | | - Lisa Hartling
- University of Alberta, Edmonton, Alberta, Canada (L.H.)
| | | | | | - Chantelle Garritty
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.M., C.G.)
| | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway, and South African Medical Research Council, Cape Town, South Africa (S.L.)
| | | | | | | | | | - Jo Moriarty
- King's College London, London, United Kingdom (J.M.)
| | - Tammy Clifford
- Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada (L.W., T.C.)
| | - Özge Tunçalp
- World Health Organization, Geneva, Switzerland (E.V.L., Ö.T.)
| | - Sharon E Straus
- St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada (A.C.T., S.E.S.)
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25
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Mattison CA, Dion ML, Lavis JN, Hutton EK, Wilson MG. Midwifery and obstetrics: Factors influencing mothers' satisfaction with the birth experience. Birth 2018; 45:322-327. [PMID: 29687481 DOI: 10.1111/birt.12352] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/05/2018] [Accepted: 03/07/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Satisfaction is a key component of the care experience and part of the health system "triple aim," along with improving population health and reducing per capita health care costs, the other two parts of the "triple aim." The objectives of the study were to examine birth-experience satisfaction among women in Ontario, Canada, who received care from midwives, family physicians, and obstetricians. METHODS We used Statistics Canada's 2006 national Maternity Experiences Survey. The sample includes 1900 Ontario women and is, with appropriate weighting, representative of an estimated population of 29 700 women who gave birth in Ontario to a singleton baby during the study period. Information was collected on respondents' satisfaction with their health care providers, demographic characteristics, and a range of pregnancy, labor, birth, and postpartum experiences. We used logistic regression analysis to assess differences in patient/client satisfaction by type of health care provider. RESULTS Women cared for by midwives were three times more likely to be satisfied with their care (OR 3.32 [95% CI 2.26-4.86]) when compared with obstetrician-led care. Depression symptoms, having to travel outside the respondents' community to give birth, and being born in an East Asian country were associated with lower levels of satisfaction. CONCLUSION Given recent health system reforms emphasizing the importance of shifting from expensive acute hospital-based care to community-based care, our findings support empirically the importance of supporting women's access to midwifery services within their communities. Findings of ethnocultural differences in satisfaction with care can inform policy makers as health systems move to provide culturally appropriate care to increasingly diverse populations.
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Affiliation(s)
| | - Michelle L Dion
- Department of Political Science, McMaster University, Hamilton, ON, Canada
| | - John N Lavis
- Department of Political Science, McMaster University, Hamilton, ON, Canada.,Department of Health Evidence and Impact, McMaster Health Forum, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Eileen K Hutton
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Michael G Wilson
- Department of Health Evidence and Impact, McMaster Health Forum, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
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Ellen ME, Wilson MG, Vélez M, Shach R, Lavis JN, Grimshaw JM, Moat KA. Addressing overuse of health services in health systems: a critical interpretive synthesis. Health Res Policy Syst 2018; 16:48. [PMID: 29907158 PMCID: PMC6003114 DOI: 10.1186/s12961-018-0325-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 12/11/2017] [Accepted: 05/08/2018] [Indexed: 01/08/2023] Open
Abstract
Background Health systems are increasingly focusing on the issue of ‘overuse’ of health services and how to address it. We developed a framework focused on (1) the rationale and context for health systems prioritising addressing overuse, (2) elements of a comprehensive process and approach to reduce overuse and (3) implementation considerations for addressing overuse. Methods We conducted a critical interpretive synthesis informed by a stakeholder-engagement process. The synthesis identified relevant empirical and non-empirical articles about system-level overuse. Two reviewers independently screened records, assessed for inclusion and conceptually mapped included articles. From these, we selected a purposive sample, created structured summaries of key findings and thematically synthesised the results. Results Our search identified 3545 references, from which we included 251. Most articles (76%; n = 192) were published within 5 years of conducting the review and addressed processes for addressing overuse (63%; n = 158) or political and health system context (60%; n = 151). Besides negative outcomes at the patient, system and global level, there were various contextual factors to addressing service overuse that seem to be key issue drivers. Processes for addressing overuse can be grouped into three elements comprising a comprehensive approach, including (1) approaches to identify overused health services, (2) stakeholder- or patient-led approaches and (3) government-led initiatives. Key implementation considerations include the need to develop ‘buy in’ from stakeholders and citizens. Conclusions Health systems want to ensure the use of high-value services to keep citizens healthy and avoid harm. Our synthesis can be used by policy-makers, stakeholders and researchers to understand how the issue has been prioritised, what approaches have been used to address it and implementation considerations. Systematic review registration PROSPERO CRD42014013204.
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Affiliation(s)
- Moriah E Ellen
- Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 653, 84105, Beer-Sheva, Israel.,Institute for Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada.,McMaster Health Forum, McMaster University, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada
| | - Michael G Wilson
- McMaster Health Forum, McMaster University, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada. .,Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada. .,Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.
| | - Marcela Vélez
- McMaster Health Forum, McMaster University, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada.,Health Policy PhD Program, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.,Faculty of Medicine, University of Antioquia, Cra. 51d #62-29, Medellín, Antioquia, Colombia
| | - Ruth Shach
- Brown School of Social Work, Washington University in St Louis, 1 Brookings Dr, St Louis, MO, 63130, United States of America
| | - John N Lavis
- McMaster Health Forum, McMaster University, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.,Department of Political Science, McMaster University, Hamilton, Canada.,Department of Global Health and Population, Harvard School of Public Health, Cambridge, MA, United States of America
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Kaelan A Moat
- McMaster Health Forum, McMaster University, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
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Wang SK, Green LA, Gutwein AR, Drucker NA, Babbey CM, Gupta AK, Fajardo A, Motaganahalli RL, Wilson MG, Murphy MP. Ethnic minorities with critical limb ischemia derive equal amputation risk reduction from autologous cell therapy compared with whites. J Vasc Surg 2018; 68:560-566. [PMID: 29503004 DOI: 10.1016/j.jvs.2017.11.088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/28/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Ethnic minorities (nonwhites) with critical limb ischemia (CLI) have historically performed worse compared with whites with regard to major amputation risk reduction and amputation-free survival (AFS) after peripheral vascular intervention. This post hoc analysis was completed to determine whether this precedent also extended to treatment of CLI without a suitable revascularization option with intramuscular injections of concentrated bone marrow aspirate (cBMA). METHODS The treatment arm of the randomized, double-blind, multicenter MarrowStim PAD Kit for the Treatment of Critical Limb Ischemia in Subjects with Severe Peripheral Arterial Disease (MOBILE) trial was stratified by ethnicity and evaluated for demographics, comorbidities, and outcomes. The primary and therapeutic end point was 1-year AFS and major amputation, respectively. Noninferiority analysis was performed with the margin set at historically reported hazard ratios. RESULTS Thirty-seven minority (African American, Hispanic, other) CLI patients (9 placebo, 28 cBMA) with no suitable revascularization option were randomized to cBMA or placebo at a 3:1 ratio during the MOBILE trial. At 1-year follow-up for the treatment group, overall AFS was 80%. Of the 28 minority patients randomized to cBMA intervention, an 89% AFS rate was observed compared with 77% in whites. Specifically, 22 of 24 (92%) African Americans survived amputation free at 1-year follow-up. Noninferiority testing confirmed no difference between whites and the ethnic minority treated with cBMA with respect to major amputation reduction; however, noninferiority could not be confirmed with regard to AFS. No significant differences favoring whites treated with cBMA were noted in the secondary end points of vascular quality of life, limb pain, ankle-brachial index, toe-brachial index, transcutaneous oximetry, and 6-minute walk testing. CONCLUSIONS This post hoc analysis of the MOBILE trial demonstrates noninferiority of cBMA intervention in minorities with no-option CLI for the therapeutic end point of major amputation prevention. cBMA represents a novel treatment paradigm and should be explored for minorities with poor revascularization options who face impending amputation secondary to progressive CLI.
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Affiliation(s)
- S Keisin Wang
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Linden A Green
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Ashley R Gutwein
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Natalie A Drucker
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Clifford M Babbey
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Alok K Gupta
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Andres Fajardo
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Raghu L Motaganahalli
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Michael G Wilson
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Ind
| | - Michael P Murphy
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind.
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Affiliation(s)
- Evelyne Durocher
- Department of Occupational Science and Occupational Therapy, University of Toronto
| | - Rosalie H. Wang
- Department of Occupational Science and Occupational Therapy, University of Toronto
| | - Jerome Bickenbach
- Department of Health Sciences and Health Policy, University of Lucerne Swiss Paraplegic Research, Nottwil
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Loyola-Sanchez A, Richardson J, Pelaez-Ballestas I, Alvarez-Nemegyei J, Lavis JN, Wilson MG, Wilkins S. Physical Function Assessment of a Mayan Population Living With Osteoarthritis: The Importance of Considering Different Aspects of Functioning. Rehabil Process Outcome 2017. [DOI: 10.1177/1179572717715433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives: To assess the physical function of people living with osteoarthritis in a Maya-Yucateco rural community from 3 perspectives and explore factors associated with the presence of disability. Design: Physical function and social, physical, psychological, and behavioral factors were evaluated in all adults detected with hand, hip, and/or knee osteoarthritis (n = 144) through a Community-Oriented Program for the Control of Rheumatic Diseases–based census in the Mayan community of Chankom, Yucatán. All cases fulfilled the American College of Rheumatology criteria. Physical function was assessed from 3 perspectives: hypothetical or “what people think they can do” (Health Assessment Questionnaire-Disability Index [HAQ-DI]), experimental or “what people could do in standardized conditions” (6-minute walk test [6MWT] + the Functional Dexterity Test) and enacted or “what people actually do” (personal care, work, and leisure activities’ self-report). Results: About 80% of participants reported “mild” disability (HAQ-DI ≤ 1) in the hypothetical function perspective, whereas average experimental function scores were low (6MWT: 206 m, Functional Dexterity Test: 64 seconds), and 78% of participants reported problems with enacted function (ie, work). Pain was significantly associated with disability in the hypothetical perspective (odds ratio [OR] = 3 [95% confidence interval [CI]: 1-4]); levels of wealth (β = 5 [95% CI: 1-9]) and muscle strength (β = 54 [95% CI: 20-87]) were significantly associated with functioning in the experimental perspective; and lower levels of self-efficacy (OR = 12 [95% CI: 6-27]) and physical activity (OR = 12 [95% CI: 6-27]) were significantly associated with work disability in the enacted function perspective. Conclusions: People living with osteoarthritis in Chankom show important issues when assessing physical function at the experimental and enacted perspectives, which could have been overlooked if only the hypothetical perspective was considered. Different factors were associated with different physical function perspectives and all should be addressed to decrease disability in this community.
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Affiliation(s)
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | | | - Jose Alvarez-Nemegyei
- Research Unit, Hospital Regional de Alta Especialidad de la Península de Yucatán, Mérida, Mexico
| | - John N Lavis
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Department of Political Science, McMaster University, Hamilton, ON, Canada
- Program in Policy Decision-Making, McMaster University, Hamilton, ON, Canada
- Centre for Health Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Michael G Wilson
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Seanne Wilkins
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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Wang SK, Green LA, Motaganahalli RL, Wilson MG, Fajardo A, Murphy MP. Rationale and design of the MarrowStim PAD Kit for the Treatment of Critical Limb Ischemia in Subjects with Severe Peripheral Arterial Disease (MOBILE) trial investigating autologous bone marrow cell therapy for critical limb ischemia. J Vasc Surg 2017; 65:1850-1857.e2. [PMID: 28390770 DOI: 10.1016/j.jvs.2017.01.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/28/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Critical limb ischemia (CLI) continues to place a significant encumbrance on patients and the health care system as it progresses to limb loss and long-term disability. Traditional methods of revascularization offer a significant benefit; however, for one-third of CLI patients, these surgical options are not technically possible or patency is severely limited by disease burden (deemed "poor-option" for revascularization). In a previous phase I trial, we demonstrated intramuscular injection of concentrated bone marrow aspirate (cBMA) via MarrowStim (Zimmer Biomet, Warsaw, Ind) harvest is safe and may decrease major amputation in patients with CLI unfit for surgical revascularization. Therefore, we describe and rationalize the MarrowStim PAD Kit for the Treatment of Critical Limb Ischemia in Subjects with Severe Peripheral Arterial Disease (MOBILE) trial, a study geared to provide the pivotal proof of efficacy of cBMA in CLI. METHODS MOBILE is a multicenter, randomized, double-blind, placebo-controlled trial designed to assess the efficacy of intramuscular injections of cBMA in promoting amputation-free survival in patients with poor-option CLI. Patients (aged >21 years) with rest pain or tissue loss resulting from advanced peripheral arterial disease, as characterized by ankle-brachial index (<0.6), toe-brachial index (<0.4), or transcutaneous pressure of oxygen (<50 mm Hg), were eligible for inclusion if surgical revascularization was not possible secondary to advanced disease. RESULTS Treatment and 1-year follow-up of 152 patients enrolled in MOBILE are completed. Long-term follow-up is ongoing. Currently, we are in the process of unblinding the initial results for preliminary data analysis. CONCLUSIONS If successful, MOBILE could add definitive, high-quality evidence in support of cBMA for the treatment of poor-option CLI patients and provide an additional modality for patients who face amputation secondary to advanced limb ischemia.
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Affiliation(s)
- S Keisin Wang
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Linden A Green
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Raghu L Motaganahalli
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Michael G Wilson
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Ind
| | - Andres Fajardo
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Michael P Murphy
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind.
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Ellen ME, Demaio P, Lange A, Wilson MG. Adult Day Center Programs and Their Associated Outcomes on Clients, Caregivers, and the Health System: A Scoping Review. The Gerontologist 2017; 57:e85-e94. [DOI: 10.1093/geront/gnw165] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 10/19/2016] [Indexed: 11/14/2022] Open
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Sun W, Wilson MG, Schreiber D, Wang RH. Ethical challenges related to assistive product access for older adults and adults living with a disability: a scoping review protocol. Syst Rev 2017; 6:24. [PMID: 28143554 PMCID: PMC5286736 DOI: 10.1186/s13643-017-0419-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the surge of research and development in assistive products for older adults and/or people living with disabilities, policies on access and procurement have lagged in responding to the growing demand from users. Developing policies to address these concerns require an understanding of the ethical challenges underlying approaches for providing assistive products. The purpose of this scoping review is to identify and map the literature pertaining to ethical challenges related to assistive product access and procurement to inform policy development. METHODS/DESIGN We will use established approaches to conducting scoping reviews which include five stages: (1) conducting broad searches to identify potentially relevant literature, (2) refining selection criteria, (3) reviewing search results, (4) mapping literature according to conceptual areas of interest, and (5) summarizing results. We will analyze data by thematically grouping the descriptions of assistive products identified in the included articles and conducting a content analysis to iteratively develop a targeted synthesis of literature focused on ethical challenges in relation to assistive product access and procurement by older adults and/or adults living with disabilities. DISCUSSION Our scoping review findings will focus on and provide insight about the models, frameworks, and principles that have been used to understand ethical challenges related to technology access and procurement. We will use the findings to help inform a series of citizen panels in Canada to identify Canadians' values and preferences for enhancing equitable access to assistive products.
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Affiliation(s)
- Winnie Sun
- Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe St. N., Oshawa, ON, L1H 7K4, Canada
| | - Michael G Wilson
- McMaster Health Forum, McMaster University, 1280 Main St W, MML-417, Hamilton, ON, L8S 4K1, Canada. .,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada. .,Department of Health Evidence and Impact, McMaster University, Hamilton, Canada.
| | - Daphne Schreiber
- March of Dimes Canada, 10 Overlea Blvd, Toronto, ON, M4H 1A4, Canada
| | - Rosalie H Wang
- Department of Occupational Science and Occupational Therapy, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
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Mattison CA, Waddell K, Wang RH, Wilson MG. Citizen and Stakeholder Perspectives About Approaches to Enhance Equitable Access to Assistive Technologies for Older Adults. Stud Health Technol Inform 2017; 242:48-51. [PMID: 28873775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Assistive technologies play an important role in promoting healthy aging, independent living and aging-in-place, yet many experience unmet needs. This project reports on three citizen panels and a stakeholder dialogue convened in Canada to spark action towards enhancing equitable access to assistive technologies for older adults.
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Affiliation(s)
| | - Kerry Waddell
- McMaster Health Forum, McMaster University, Hamilton, Canada
| | - Rosalie H Wang
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
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Wilson MG, Lavis JN, Gauvin FP. Designing Integrated Approaches to Support People with Multimorbidity: Key Messages from Systematic Reviews, Health System Leaders and Citizens. Healthc Policy 2016; 12:91-104. [PMID: 28032827 PMCID: PMC5221714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Living with multiple chronic conditions (multimorbidity) - and facing complex, uncoordinated and fragmented care - is part of the daily life of a growing number of Canadians. METHODS We undertook: a knowledge synthesis; a "gap analysis" of existing systematic reviews; an issue brief that synthesized the available evidence about the problem, three options for addressing it and implementation considerations; a stakeholder dialogue involving key health-system leaders; and a citizen panel. RESULTS We identified several recommendations for actions that can be taken, including: developing evidence-based guidance that providers can use to help achieve goals set by patients; embracing approaches to supporting self-management; supporting greater communication and collaboration across healthcare providers as well as between healthcare providers and patients; and investing more efforts in health promotion and disease prevention. CONCLUSIONS Our results point to the need for health system decision-makers to support bottom-up, person-centred approaches to developing models of care that are tailored for people with multimorbidity and support a research agenda to address the identified priorities.
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Affiliation(s)
- Michael G. Wilson
- McMaster Health Forum, McMaster University, Centre for Health Economics and Policy Analysis, McMaster University, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON
| | - John N. Lavis
- McMaster Health Forum, McMaster University, Centre for Health Economics and Policy Analysis, McMaster University, Department of Clinical Epidemiology and Biostatistics, McMaster University, Department of Political Science, McMaster University, Hamilton, ON, Department of Global Health and Population, Harvard School of Public Health, Cambridge, MA
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Affiliation(s)
- Gregory G. Enas
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana
| | - Nathan H. Enas
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana
| | - C. Thomas Spradlin
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana
| | - Michael G. Wilson
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana
| | - Curtis G. Wiltse
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana
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Affiliation(s)
- David J. Goldstein
- Lilly Research Laboratories, Eli Lilly and Company, Department of Pharmacology and Toxicology, Indiana University School of Medicine, and Department of Pediatrics, Methodist Hospital of Indiana, Indianapolis, Indiana
| | - Michael G. Wilson
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana
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Abstract
PURPOSE This patient study was designed to measure the validity of both the horizontal and Camper's planes, which are used as benchmarks to reestablish the sagittal orientation of the occlusal plane angles in dental rehabilitation. MATERIALS AND METHODS Profile digital photographs were made of the first 100 consenting dentate patients as they closed on an occlusal plane analyzer while maintaining natural head posture. Using a digital screen protractor, three angles were measured: the occlusal plane angle relative to the horizontal plane, and the angle between the occlusal plane and Camper's plane from both the superior and inferior borders of the tragus of the ear. RESULTS The angle between the occlusal plane and the horizontal reference plane for the 100 patients ranged from -8.72° to +18.08° (mean +3.25°); the angle between the occlusal plane and Camper's plane, from the superior border of the tragus to the ala of the nose demonstrated a range from -8.49° to +15.16° (mean +3.03°); and the angle between Camper's plane, from the inferior border of the tragus to the ala of the nose and the occlusal plane demonstrated a range from -15.57° to +9.15° (mean -4.09°). CONCLUSIONS Occlusal plane angles measured in this patient population with natural dentitions demonstrated a relatively small mean deviation from both the horizontal plane and Camper's plane when using the superior border of the tragus as the distal reference point, but the range was quite broad and could result in unacceptable occlusal plane angles in many patients undergoing dental rehabilitation. CLINICAL IMPLICATIONS Both Camper's plane and the horizontal reference plane may be acceptable initial reference planes for oral rehabilitation, but additional anatomic and esthetic parameters are required for verification of an esthetically pleasing occlusal plane angle.
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Affiliation(s)
- George Priest
- Private practice in prosthodontics, Hilton Head Island, SC
| | - Michael G Wilson
- Adjunct Faculty, Department of Clinical Pharmacology, Indiana University School of Medicine, Clinical Pharmacology, Indianapolis, IN
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Liang TW, Jester A, Motaganahalli RL, Wilson MG, G'Sell P, Akingba GA, Fajardo A, Murphy MP. Autologous bone marrow mononuclear cell therapy for critical limb ischemia is effective and durable. J Vasc Surg 2016; 63:1541-5. [PMID: 27021379 DOI: 10.1016/j.jvs.2016.01.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We have previously shown that autologous bone marrow mononuclear cell (ABMNC) therapy improves measures of limb perfusion, rest pain, wound healing, and amputation-free survival (AFS) at 1 year in patients with critical limb ischemia (CLI). Long-term durability of ABMNC therapy for CLI remains unknown. The objective of the current study was to evaluate long-term clinical outcomes 5 years after treatment. METHODS Data were retrospectively gathered from a database and via a patient survey and review of medical records of patients previously enrolled in this phase I/II trial. AFS, freedom from major amputation, and freedom from major adverse limb events (MALE) were calculated using the product-limit estimate. The incidence of cardiac, malignant, and other medical events relevant to the safety of cell therapy were tabulated during the time from treatment to follow-up. RESULTS Twenty-one of the 24 patients (88%) who completed the initial 1-year phase I/II trial were available for the 5-year analysis; AFS was 74% (95% confidence interval [CI], 0.53-0.87), freedom from major amputation was 78% (95% CI, 0.58-0.90), and freedom from MALE was 65% (95% CI, 0.45-0.80). Three patients (14%) had major cardiac events. There were no incidences of malignancies or diagnoses of clinically significant proliferative retinopathy. Fifteen patients (71%) report continued improvement in pain-free walking. Nineteen (90%) patients believed that the study was of significant medical value and would participate again. CONCLUSIONS ABMNC therapy provides long-term freedom from AFS, major amputation, and MALE that are comparable with other reports of patients who underwent surgical and endovascular interventions for CLI. Furthermore, no patients developed tumorigenesis or clinically significant retinopathy. Because of the limited number of patients studied, our findings will need to be followed up in a larger phase III trial.
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Affiliation(s)
- Tiffany W Liang
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Andrea Jester
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Raghu L Motaganahalli
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Michael G Wilson
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Ind
| | - Patricia G'Sell
- Indiana Center for Vascular Biology and Medicine, Indiana University School of Medicine, Indianapolis, Ind
| | - George A Akingba
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Andres Fajardo
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Michael P Murphy
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind.
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Aidala AA, Wilson MG, Shubert V, Gogolishvili D, Globerman J, Rueda S, Bozack AK, Caban M, Rourke SB. Housing Status, Medical Care, and Health Outcomes Among People Living With HIV/AIDS: A Systematic Review. Am J Public Health 2016. [DOI: 10.2105/ajph.2015.302905a] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wilson MG, Grimshaw JM, Haynes RB, Hanna SE, Raina P, Gruen R, Ouimet M, Lavis JN. A process evaluation accompanying an attempted randomized controlled trial of an evidence service for health system policymakers. Health Res Policy Syst 2015; 13:78. [PMID: 26652277 PMCID: PMC4677046 DOI: 10.1186/s12961-015-0066-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 11/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We developed an evidence service that draws inputs from Health Systems Evidence (HSE), which is a comprehensive database of research evidence about governance, financial and delivery arrangements within health systems and about implementation strategies relevant to health systems. Our goal was to evaluate whether, how and why a 'full-serve' evidence service increases the use of synthesized research evidence by policy analysts and advisors in the Ontario Ministry of Health and Long-Term Care as compared to a 'self-serve' evidence service. METHODS We attempted to conduct a two-arm, 10-month randomized controlled trial (RCT), along with a follow-up qualitative process evaluation, but we terminated the RCT when we failed to reach our recruitment target. For the qualitative process evaluation we modified the original interview guide to allow us to explore the (1) factors influencing participation in the trial; (2) usage of HSE, factors explaining usage patterns, and strategies to increase usage; (3) participation in training workshops and use of other supports; and (4) views about and experiences with key HSE features. RESULTS We terminated the RCT given our 15% recruitment rate. Six factors were identified by those who had agreed to participate in the trial as encouraging their participation: relevance of the study to participants' own work; familiarity with the researchers; personal view of the importance of using research evidence in policymaking; academic background; support from supervisors; and participation of colleagues. Most reported that they never, infrequently or inconsistently used HSE and suggested strategies to increase its use, including regular email reminders and employee training. However, only two participants indicated that employee training, in the form of a workshop about finding and using research evidence, had influenced their use of HSE. Most participants found HSE features to be intuitive and helpful, although registration/sign-in and some page formats (particularly the advanced search page and detailed search results page) discouraged their use or did not optimize the user experience. CONCLUSIONS The qualitative findings informed a re-design of HSE, which allows users to more efficiently find and use research evidence about how to strengthen or reform health systems or in how to get cost-effective programs, services and drugs to those who need them. Our experience with RCT recruitment suggests the need to consider changing the unit of allocation to divisions instead of individuals within divisions, among other lessons. TRIAL REGISTRATION This protocol for this study is published in Implementation Science and registered with ClinicalTrials.gov ( HHS/FHS REB 10-267 ).
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Affiliation(s)
- Michael G Wilson
- McMaster Health Forum, McMaster University, Hamilton, Canada. .,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada. .,Department of Medicine, University of Ottawa, Ottawa, Canada.
| | - R Brian Haynes
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada. .,Health Information Research Unit, McMaster University, Hamilton, Canada.
| | - Steven E Hanna
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada. .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. .,Department of Political Science, Université Laval, Québec, Canada. .,Centre de Recherche du Centre Hospitalier Universitaire de Québec, Québec, Canada.
| | - Parminder Raina
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada. .,McMaster Evidence Review and Synthesis Centre, McMaster University, Hamilton, Canada.
| | - Russell Gruen
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
| | - Mathieu Ouimet
- Department of Political Science, Université Laval, Québec, Canada. .,Centre de Recherche du Centre Hospitalier Universitaire de Québec, Québec, Canada.
| | - John N Lavis
- McMaster Health Forum, McMaster University, Hamilton, Canada. .,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada. .,Department of Political Science, McMaster University, Hamilton, Canada. .,Department of Global Health and Population, Harvard School of Public Health, Cambridge, USA.
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Aidala AA, Wilson MG, Shubert V, Gogolishvili D, Globerman J, Rueda S, Bozack AK, Caban M, Rourke SB. Housing Status, Medical Care, and Health Outcomes Among People Living With HIV/AIDS: A Systematic Review. Am J Public Health 2015; 106:e1-e23. [PMID: 26562123 DOI: 10.2105/ajph.2015.302905] [Citation(s) in RCA: 235] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Accumulating evidence suggests responses to HIV that combine individual-level interventions with those that address structural or contextual factors that influence risks and health outcomes of infection. Housing is such a factor. Housing occupies a strategic position as an intermediate structural factor, linking "upstream" economic, social, and cultural determinants to the more immediate physical and social environments in which everyday life is lived. The importance of housing status for HIV prevention and care has been recognized, but much of this attention has focused on homeless individuals as a special risk group. Analyses have less often addressed community housing availability and conditions as factors influencing population health or unstable, inadequate, or unaffordable housing as a situation or temporary state. A focus on individual-level characteristics associated with literal homelessness glosses over social, economic, and policy drivers operating largely outside any specific individual's control that affect housing and residential environments and the health resources or risk exposures such contexts provide. OBJECTIVES We examined the available empirical evidence on the association between housing status (broadly defined), medical care, and health outcomes among people with HIV and analyzed results to inform future research, program development, and policy implementation. SEARCH METHODS We searched 8 electronic health and social science databases from January 1, 1996, through March 31, 2014, using search terms related to housing, dwelling, and living arrangements and HIV and AIDS. We contacted experts for additional literature. SELECTION CRITERIA We selected articles if they were quantitative analyses published in English, French, or Spanish that included at least 1 measure of housing status as an independent variable and at least 1 health status, health care, treatment adherence, or risk behavior outcome among people with HIV in high-income countries. We defined housing status to include consideration of material or social dimensions of housing adequacy, stability, and security of tenure. DATA COLLECTION AND ANALYSIS Two independent reviewers performed data extraction and quality appraisal. We used the Cochrane Risk of Bias Tool for randomized controlled trials and a modified version of the Newcastle Ottawa Quality Appraisal Tool for nonintervention studies. In our quality appraisal, we focused on issues of quality for observational studies: appropriate methods for determining exposure and measuring outcomes and methods to control confounding. RESULTS Searches yielded 5528 references from which we included 152 studies, representing 139,757 HIV-positive participants. Most studies were conducted in the United States and Canada. Studies examined access and utilization of HIV medical care, adherence to antiretroviral medications, HIV clinical outcomes, other health outcomes, emergency department and inpatient utilization, and sex and drug risk behaviors. With rare exceptions, across studies in all domains, worse housing status was independently associated with worse outcomes, controlling for a range of individual patient and care system characteristics. CONCLUSIONS Lack of stable, secure, adequate housing is a significant barrier to consistent and appropriate HIV medical care, access and adherence to antiretroviral medications, sustained viral suppression, and risk of forward transmission. Studies that examined the history of homelessness or problematic housing years before outcome assessment were least likely to find negative outcomes, homelessness being a potentially modifiable contextual factor. Randomized controlled trials and observational studies indicate an independent effect of housing assistance on improved outcomes for formerly homeless or inadequately housed people with HIV. Housing challenges result from complex interactions between individual vulnerabilities and broader economic, political, and legal structural determinants of health. The broad structural processes sustaining social exclusion and inequality seem beyond the immediate reach of HIV interventions, but changing housing and residential environments is both possible and promising.
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Affiliation(s)
- Angela A Aidala
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Michael G Wilson
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Virginia Shubert
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - David Gogolishvili
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Jason Globerman
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Sergio Rueda
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Anne K Bozack
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Maria Caban
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Sean B Rourke
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
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Loyola-Sanchez A, Richardson J, Pelaez-Ballestas I, Alvarez-Nemegyei J, Lavis JN, Wilson MG, Wilkins S. The impact of arthritis on the physical function of a rural Maya-Yucateco community and factors associated with its prevalence: a cross sectional, community-based study. Clin Rheumatol 2015; 35 Suppl 1:25-34. [PMID: 26445940 PMCID: PMC4957744 DOI: 10.1007/s10067-015-3084-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/22/2015] [Accepted: 09/27/2015] [Indexed: 11/26/2022]
Abstract
This study aims to evaluate the impact of arthritis on the physical function of people living in a Maya-Yucateco rural community and to assess the association of known modifiable risk factors with the prevalence of overall arthritis and its main types (osteoarthritis and rheumatoid arthritis). Using a cross-sectional, community-based census design, data collected from the adult population (≥18 years) of the Municipality of Chankom, Yucatán, México, were analyzed (n = 1523). Participants’ physical function was assessed using a culturized version of the health assessment questionnaire disability index. Social, physical, and behavioral factors linked to overall arthritis, osteoarthritis, and rheumatoid arthritis, were assessed through the “Community-Oriented-Program-for-the-Control-of-Rheumatic-Diseases [COPCORD]” questionnaire. A physiatrist and a rheumatologist confirmed all osteoarthritis and rheumatoid arthritis cases using the American College of Rheumatology criteria. Arthritis was confirmed in 169 cases (22 %, 95 % confidence interval (CI) 19–25) of those assessed for musculoskeletal symptoms (n = 779): osteoarthritis = 144, rheumatoid arthritis = 17, and non-specific arthritis = 8. Arthritis was associated with a higher prevalence of disability after controlling for age, gender, and number of comorbidities (odds ratio = 4.0, 95 % CI 3.0–6.0). Higher level of wealth was associated with lower arthritis prevalence (odds ratio = 0.9, 95% CI 0.8–0.9). Higher body mass index was associated with higher hip and/or knee osteoarthritis prevalence (odds ratio = 1.1, 95 % CI 1.03–1.1). Arthritis is highly associated with disability in the Mayan people living in Chankom. The prevalence of arthritis in Chankom is associated with social factors, such as people’s level of wealth, while the prevalence of low-extremity osteoarthritis is associated with people’s body mass index.
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Affiliation(s)
- Adalberto Loyola-Sanchez
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
- Institute for Applied Health Sciences, Room 403, 1400 Main St. W., Hamilton, ON, L8S 1C7, USA.
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | | | - José Alvarez-Nemegyei
- Research Unit, Hospital Regional de Alta Especialidad de la Península de Yucatán, Mérida, Mexico
| | - John N Lavis
- Centre for Health Policy Analysis, McMaster University, Hamilton, ON, Canada
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Department of Political Science, McMaster University, Hamilton, ON, Canada
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
| | - Michael G Wilson
- Centre for Health Policy Analysis, McMaster University, Hamilton, ON, Canada
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Seanne Wilkins
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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Wilson MG, Béland F, Julien D, Gauvin L, Guindon GE, Roy D, Campbell K, Comeau DG, Davidson H, Raina P, Sattler D, Vrkljan B. Interventions for preventing, delaying the onset, or decreasing the burden of frailty: an overview of systematic reviews. Syst Rev 2015; 4:128. [PMID: 26419226 PMCID: PMC4589080 DOI: 10.1186/s13643-015-0110-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 09/07/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Many systematic reviews have evaluated the effectiveness of interventions to prevent, delay, or decrease frailty symptoms, but no effort has been made to identify, map, and synthesize the findings from reviews across the full spectrum of interventions. Our objectives are to (1) synthesize findings from all existing systematic reviews evaluating interventions for preventing, delaying the onset, or decreasing the burden of frailty symptoms; (2) examine different conceptualizations of frailty that have been used in the development and implementation of interventions; and (3) inform policy by convening a stakeholder dialogue with Canadian health-system leaders. METHODS/DESIGN We will conduct an overview of systematic reviews to identify and synthesize all of the systematic reviews addressing interventions to preventing, delaying the onset, or decreasing the burden of frailty symptoms. To identify relevant systematic reviews, we will conduct database searches for published and grey literature as well as contact key experts and search reference lists of included reviews. Two reviewers will independently review all search results for inclusion and then conceptually map, extract key findings (including the conceptualization/definition of frailty used) and assess the methodological quality of all included reviews. We will then synthesize the findings by producing a 'gap map' (i.e. mapping reviews in a matrix according to the interventions and outcomes assessed), and narratively synthesize the key messages across reviews related to type of interventions. DISCUSSION Following the completion of the synthesis, we will use the findings to develop an evidence brief that mobilizes the best available evidence about the problem related to preventing, delaying the onset, or decreasing the burden of frailty symptoms in older adults, policy and programmatic options to address the problem and implementation considerations. The evidence brief will then be used as the input into a stakeholder dialogue, which will engage 18-22 Canadian health-system leaders (including policymakers, health providers, researchers, and other stakeholders) in 'off-the-record' deliberations to inform future actions and policymaking. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015022082.
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Affiliation(s)
- Michael G Wilson
- McMaster Health Forum, McMaster University, Hamilton, Canada. .,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
| | - François Béland
- Département d'administration de la santé, École de santé publique, Université de Montréal, Montréal, Canada. .,Institut Lady Davis, Hôpital général juif, Montréal, Canada.
| | - Dominic Julien
- Institut Lady Davis, Hôpital général juif, Montréal, Canada. .,Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Université de Montréal, Montréal, Canada. .,Département de psychologie, Université de Montréal, Montréal, Canada.
| | - Lise Gauvin
- Department of Social and Preventive Medicine at the Université de Montréal, Montréal, Canada.
| | - G Emmanuel Guindon
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
| | - Denis Roy
- l'Institut National d'Excellence en Santé et en Services Sociaux, Québec, Canada.
| | - Kaitryn Campbell
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada. .,Programs for Assessment of Technology in Health (PATH), McMaster University, Hamilton, Canada.
| | | | | | - Parminder Raina
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada. .,McMaster Evidence Review and Synthesis Centre, McMaster University, Hamilton, Canada.
| | - Deborah Sattler
- Erie St. Clair Local Health Integration Network, Chatham, Canada.
| | - Brenda Vrkljan
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.
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Loyola-Sanchez A, Richardson J, Wilkins S, Lavis JN, Wilson MG, Alvarez-Nemegyei J, Pelaez-Ballestas I. Barriers to accessing the culturally sensitive healthcare that could decrease the disabling effects of arthritis in a rural Mayan community: a qualitative inquiry. Clin Rheumatol 2015; 35:1287-98. [PMID: 26334916 DOI: 10.1007/s10067-015-3061-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 08/10/2015] [Accepted: 08/18/2015] [Indexed: 10/23/2022]
Abstract
The impact of living with arthritis in a rural Mexican Mayan community along with the barriers encountered by people living with this chronic condition were investigated in this study. The community needs around this health issue were investigated by conducting an ethnographic study using data obtained during two time periods (August 2012-April 2013 and December 2013-December 2014). During the first period, fieldwork observations and interviews with 65 individuals, which included people with arthritis, health professionals, traditional health providers, and community leaders were undertaken. During the second period, 46 community meetings were conducted to identify the needs associated with arthritis in the municipality. Data were analyzed following a modified version of the Framework approach. The results show that arthritis reduces the health-related quality of life of the people in Chankom through a process of disablement, conditioning a need to access culturally sensitive healthcare. Availability, attainability, and acceptability barriers prevent access to this type of healthcare and result from power imbalance between indigenous and non-indigenous people. There is a need to develop culturally sensitive rehabilitation services for people living with arthritis in Chankom. Mayan people should be involved in the design and implementation of these services. Moreover, it is important to improve our understanding of the processes behind the healthcare access inequities identified in this study by attending to the historical generation of current social, economical, cultural, and political structures.
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Affiliation(s)
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Seanne Wilkins
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - John N Lavis
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Canada, Hamilton, ON, Canada.,Department of Political Science, McMaster University, Canada, Hamilton, ON, Canada.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Michael G Wilson
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Canada, Hamilton, ON, Canada
| | - Jose Alvarez-Nemegyei
- Research Unit, Hospital Regional de Alta Especialidad de la Península de Yucatán, Mérida, Mexico
| | - Ingris Pelaez-Ballestas
- Rheumatology Department, Hospital General de Mexico, Dr. Balmis No. 148, Col. Doctores, Delg. Cuauhtémoc, Mexico City, C.P. 06726, Mexico.
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Chambers LA, Rueda S, Baker DN, Wilson MG, Deutsch R, Raeifar E, Rourke SB. Stigma, HIV and health: a qualitative synthesis. BMC Public Health 2015; 15:848. [PMID: 26334626 PMCID: PMC4557823 DOI: 10.1186/s12889-015-2197-0] [Citation(s) in RCA: 193] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 08/27/2015] [Indexed: 11/10/2022] Open
Abstract
Background HIV-related stigma continues to negatively impact the health and well-being of people living with HIV, with deleterious effects on their care, treatment and quality of life. A growing body of qualitative research has documented the relationship between HIV-related stigma and health. This review aims to synthesize qualitative evidence that explored the intersections of stigma and health for people with HIV. Methods A thematic summary was conducted that was guided by the qualitative metasummary technique developed by Sandelowski and Barraso. Literature searches yielded 8,622 references of which 55 qualitative studies were identified that illustrated HIV-related stigma in the context of health. Results The metasummary classified qualitative findings into three overarching categories: conceptualizing stigma which identified key dimensions of HIV-related stigma; experiencing stigma which highlighted experiences of stigma in the health context, and managing stigma which described ways in which stigma is avoided or addressed. To better illustrate these connections, the qualitative literature was summarized into the following themes: stigma within health care settings, the role of stigma in caring for one’s health, and strategies to address HIV-related stigma in the health context. A number of health care practices were identified – some rooted in institutional practices, others shaped by personal perceptions held by practitioners – that could be stigmatizing or discriminatory towards people with HIV. There existed interconnections between enacted stigma and felt stigma that influenced health care utilization, treatment adherence, and overall health and well-being of people with HIV. Intersectional stigma also emerged as instrumental in the stigma experiences of people living with HIV. A number of strategies to address stigma were identified including social support, education, self-efficacy, resilience activities, and advocacy. Conclusion This review of the qualitative evidence indicates that HIV-related stigma within health contexts is a broad social phenomenon that manifests within multiple social spheres, including health care environments. Findings from this review indicate that future stigma research should consider the social structures and societal practices – within and outside of health care environments – that perpetuate and reinforce stigma and discrimination towards people with HIV. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2197-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lori A Chambers
- School of Social Work, McMaster University, Kenneth Taylor Hall, KTH-319, 1280 Main St. West, Hamilton, ON, L8S 4M4, Canada.
| | - Sergio Rueda
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, c/o Research Services Office, 33 Russell St., T100, Toronto, ON, M5S 2S1, Canada. .,Department of Psychiatry, University of Toronto, 250 College St., 8th floor, Toronto, ON, M5T 1R8, Canada. .,Institute for Work & Health, 481 University Ave., Suite 800, Toronto, ON, M5G 2E9, Canada.
| | - D Nico Baker
- Ontario HIV Treatment Network, 1300 Yonge St., Suite 600, Toronto, ON, M4T 1X3, Canada.
| | - Michael G Wilson
- Ontario HIV Treatment Network, 1300 Yonge St., Suite 600, Toronto, ON, M4T 1X3, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, Communications Research Laboratory, CRL-209, 1280 Main St. West, Hamilton, ON, L8S 4M4, Canada. .,Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4M4, Canada. .,McMaster Health Forum, McMaster University, Mills Memorial Library, MML-417, 1280 Main St. West, Hamilton, ON, L8S 4M4, Canada.
| | - Rachel Deutsch
- Ontario HIV Treatment Network, 1300 Yonge St., Suite 600, Toronto, ON, M4T 1X3, Canada.
| | - Elmira Raeifar
- Department of Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Rd., White Plains, NY, 10605, USA.
| | - Sean B Rourke
- Department of Psychiatry, University of Toronto, 250 College St., 8th floor, Toronto, ON, M5T 1R8, Canada. .,Ontario HIV Treatment Network, 1300 Yonge St., Suite 600, Toronto, ON, M4T 1X3, Canada. .,Centre for Research on Inner City Health, The Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1 T8, Canada.
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- Ontario HIV Treatment Network, 1300 Yonge St., Suite 600, Toronto, ON, M4T 1X3, Canada
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Wilson MG, Lavis JN, Gauvin FP. Developing a rapid-response program for health system decision-makers in Canada: findings from an issue brief and stakeholder dialogue. Syst Rev 2015; 4:25. [PMID: 25875495 PMCID: PMC4373100 DOI: 10.1186/s13643-015-0009-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 01/28/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is currently no mechanism in place outside of government to provide rapid syntheses of the best available research evidence about problems, options and/or implementation considerations related to a specific health system challenge that Canadian health system decision-makers need to address in a timely manner. A 'rapid-response' program could address this gap by providing access to optimally packaged, relevant and high-quality research evidence over short periods of time (i.e. days or weeks). METHODS We prepared an issue brief that describes the best available research evidence related to the problem, three broad features of a program that addresses the problem and implementation considerations. We identified systematic reviews by searching for organization-targeted implementation strategies in Health Systems Evidence ( www.healthsystemsevidence.org ) and drew on an existing analytical framework for how knowledge-brokering organizations can organize themselves to operationalize the program features. The issue brief was then used to inform a half-day stakeholder dialogue about whether and how to develop a rapid-response program for health system decision-makers in Canada. We thematically synthesized the deliberations. RESULTS We found very few relevant systematic reviews but used frameworks and examples from existing programs to 1) outline key considerations for organizing a rapid-response program,, 2) determine what can be done in timelines ranging from 3 to 10 and 30 business days, and 3) define success and measure it. The 11 dialogue participants from across Canada largely agreed with the content presented in the brief, but noted two key challenges to consider: securing stable, long-term funding and finding a way to effectively and equitably manage the expected demand. Recommendations and suggestions for next steps from dialogue participants included taking an 'organic' approach to developing a pan-Canadian network and including jurisdictional scans as a type of product to deliver through the program (rather than only syntheses of research evidence). CONCLUSIONS Dialogue participants clearly signalled that there is an appetite for a rapid-response program for health system decision-makers in Canada. To 'organically' build such a program, we are currently engaging in efforts to build partnerships and secure funding to support the creation of a pan-Canadian network for conducting rapid syntheses for health system decision-makers in Canada.
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Affiliation(s)
- Michael G Wilson
- McMaster Health Forum, McMaster University, Hamilton, Canada. .,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
| | - John N Lavis
- McMaster Health Forum, McMaster University, Hamilton, Canada. .,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada. .,Department of Political Science, McMaster University, Hamilton, Canada. .,Department of Global Health and Population, Harvard School of Public Health, Cambridge, USA.
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Lavis JN, Wilson MG, Moat KA, Hammill AC, Boyko JA, Grimshaw JM, Flottorp S. Developing and refining the methods for a 'one-stop shop' for research evidence about health systems. Health Res Policy Syst 2015; 13:10. [PMID: 25971248 PMCID: PMC4429608 DOI: 10.1186/1478-4505-13-10] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 01/09/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Policymakers, stakeholders and researchers have not been able to find research evidence about health systems using an easily understood taxonomy of topics, know when they have conducted a comprehensive search of the many types of research evidence relevant to them, or rapidly identify decision-relevant information in their search results. METHODS To address these gaps, we developed an approach to building a 'one-stop shop' for research evidence about health systems. We developed a taxonomy of health system topics and iteratively refined it by drawing on existing categorization schemes and by using it to categorize progressively larger bundles of research evidence. We identified systematic reviews, systematic review protocols, and review-derived products through searches of Medline, hand searches of several databases indexing systematic reviews, hand searches of journals, and continuous scanning of listservs and websites. We developed an approach to providing 'added value' to existing content (e.g., coding systematic reviews according to the countries in which included studies were conducted) and to expanding the types of evidence eligible for inclusion (e.g., economic evaluations and health system descriptions). Lastly, we developed an approach to continuously updating the online one-stop shop in seven supported languages. RESULTS The taxonomy is organized by governance, financial, and delivery arrangements and by implementation strategies. The 'one-stop shop', called Health Systems Evidence, contains a comprehensive inventory of evidence briefs, overviews of systematic reviews, systematic reviews, systematic review protocols, registered systematic review titles, economic evaluations and costing studies, health reform descriptions and health system descriptions, and many types of added-value coding. It is continuously updated and new content is regularly translated into Arabic, Chinese, English, French, Portuguese, Russian, and Spanish. CONCLUSIONS Policymakers and stakeholders can now easily access and use a wide variety of types of research evidence about health systems to inform decision-making and advocacy. Researchers and research funding agencies can use Health Systems Evidence to identify gaps in the current stock of research evidence and domains that could benefit from primary research, systematic reviews, and review overviews.
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Affiliation(s)
- John N Lavis
- McMaster Health Forum, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada. .,Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, CRL-209, Hamilton, ON, L8S 4K1, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. West, CRL-209, Hamilton, ON, L8S 4 K1, Canada. .,Department of Political Science, McMaster University, 1280 Main St. West, CRL-209, Hamilton, ON, L8S 4 K1, Canada. .,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Cambridge, MA, 02115, USA.
| | - Michael G Wilson
- McMaster Health Forum, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada. .,Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, CRL-209, Hamilton, ON, L8S 4K1, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. West, CRL-209, Hamilton, ON, L8S 4 K1, Canada.
| | - Kaelan A Moat
- McMaster Health Forum, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada. .,Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, CRL-209, Hamilton, ON, L8S 4K1, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. West, CRL-209, Hamilton, ON, L8S 4 K1, Canada.
| | - Amanda C Hammill
- McMaster Health Forum, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada. .,Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, CRL-209, Hamilton, ON, L8S 4K1, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. West, CRL-209, Hamilton, ON, L8S 4 K1, Canada.
| | - Jennifer A Boyko
- School of Health Studies, Western University, Arthur and Sonia Labatt Health Sciences Building, Room 403, London, ON, N6A 5B9, Canada.
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Rd., Box 711, Ottawa, ON, K1H 8 L6, Canada. .,Department of Medicine, University of Ottawa, 451 Smyth Rd., Ottawa, ON, K1H 8 M5, Canada.
| | - Signe Flottorp
- Norwegian Knowledge Centre for the Health Services, Boks 7004, St., Olavsplass, Oslo, N-0130, Norway.
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Colquhoun H, Leeman J, Michie S, Lokker C, Bragge P, Hempel S, McKibbon KA, Peters GJY, Stevens K, Wilson MG, Grimshaw J. Erratum to: Towards a common terminology: a simplified framework of interventions to promote and integrate evidence into health practices, systems, and policies. Implement Sci 2014. [PMCID: PMC4272786 DOI: 10.1186/s13012-014-0154-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Wilson MG, Ellen ME, Lavis JN, Grimshaw JM, Moat KA, Shemer J, Sullivan T, Garner S, Goeree R, Grilli R, Peffer J, Samra K. Processes, contexts, and rationale for disinvestment: a protocol for a critical interpretive synthesis. Syst Rev 2014; 3:143. [PMID: 25495034 PMCID: PMC4273322 DOI: 10.1186/2046-4053-3-143] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 11/12/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Practical solutions are needed to support the appropriate use of available health system resources as countries are continually pressured to 'do more with less' in health care. Increasingly, health systems and organizations are exploring the reassessment of possibly obsolete, inefficient, or ineffective health system resources and potentially redirecting funds to those that are more effective and efficient. Such processes are often referred to as 'disinvestment'. Our objective is to gain further understanding about: 1) whether how and under what conditions health systems decide to pursue disinvestment; 2) how health systems have chosen to undertake disinvestment; and 3) how health systems have implemented their disinvestment approach. METHODS/DESIGN We will use a critical interpretive synthesis (CIS) approach, to develop a theoretical framework based on insights drawn from a range of relevant sources. We will conduct systematic searches of databases as well as purposive searches to identify literature to fill conceptual gaps that may emerge during our inductive process of synthesis and analysis. Two independent reviewers will assess search results for relevance and conceptually map included references. We will include all empirical and non-empirical articles that focus on disinvestment at a system level. We will then extract key findings from a purposive sample of articles using frameworks related to government agendas, policy development and implementation, and health system contextual factors and then synthesize and integrate the findings to develop a framework about our core areas of interest. Lastly, we will convene a stakeholder dialogue with Canadian and international policymakers and other stakeholders to solicit targeted feedback about the framework (e.g., by identifying any gaps in the literature that we may want to revisit before finalizing it) and deliberating about barriers for developing and implementing approaches to disinvestment, strategies to address these barriers and about next steps that could be taken by different constituencies. DISCUSSION Disinvestment is an emerging field and there is a need for evidence to inform the prioritization, development, and implementation of strategies in different contexts. Our CIS and the framework developed through it will support the actions of those involved in the prioritization, development, and implementation of disinvestment initiatives. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014013204.
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Loyola Sánchez A, Richardson J, Peláez-Ballestas I, Lavis JN, Wilkins S, Wilson MG, Rodríguez-Amado J, Alvarez-Nemegyei J, Martínez-Villarreal RT, Onofre-Rodríguez DJ, Benavides-Torres R. Developing Community-Based Rehabilitation Programs for Musculoskeletal Diseases in Low-Income Areas of Mexico: The Community-Based Rehabilitation for Low-Income Communities Living With Rheumatic Diseases (CONCORD) Protocol. JMIR Res Protoc 2014; 3:e57. [PMID: 25474820 PMCID: PMC4260078 DOI: 10.2196/resprot.3604] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 09/02/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The negative impact of musculoskeletal diseases on the physical function and quality of life of people living in developing countries is considerable. This disabling effect is even more marked in low-socioeconomic communities within developing countries. In Mexico, there is a need to create community-based rehabilitation programs for people living with musculoskeletal diseases in low-socioeconomic areas. These programs should be directed to prevent and decrease disability, accommodating the specific local culture of communities. OBJECTIVE The objective of this paper is to describe a research protocol designed to develop, implement, and evaluate culturally sensitive community-based rehabilitation programs aiming to decrease disability of people living with musculoskeletal diseases in two low-income Mexican communities. METHODS A community-based participatory research approach is proposed, including multi and transdisciplinary efforts among the community, medical anthropology, and the health sciences. The project is structured in 4 main stages: (1) situation analysis, (2) program development, (3) program implementation, and (4) program evaluation. Each stage includes the use of quantitative and qualitative methods (mixed method program). RESULTS So far, we obtained resources from a Mexican federal agency and completed stage one of the project at Chankom, Yucatán. We are currently receiving funding from an international agency to complete stage two at this same location. We expect that the project at Chankom will be concluded by December of 2017. On the other hand, we just started the execution of stage one at Nuevo León with funding from a Mexican federal agency. We expect to conclude the project at this site by September of 2018. CONCLUSIONS Using a community-based participatory research approach and a mixed method program could result in the creation of culturally sensitive community-based rehabilitation programs that promote community development and decrease the disabling effects of musculoskeletal diseases within two low-income Mexican communities.
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Affiliation(s)
- Adalberto Loyola Sánchez
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
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