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Manalili K, Scott CM, Hemmelgarn B, O'Beirne M, Bailey AL, Haener MK, Banerjee C, Peters SP, Chiodo M, Aghajafari F, Santana MJ. Co-designing person-centred quality indicator implementation for primary care in Alberta: a consensus study. Res Involv Engagem 2022; 8:59. [PMID: 36348406 PMCID: PMC9641306 DOI: 10.1186/s40900-022-00397-z] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND We aimed to contribute to developing practical guidance for implementing person-centred quality indicators (PC-QIs) for primary care in Alberta, Canada. As a first step in this process, we conducted stakeholder-guided prioritization of PC-QIs and implementation strategies. Stakeholder engagement is necessary to ensure PC-QI implementation is adapted to the context and local needs. METHODS We used an adapted nominal group technique (NGT) consensus process. Panelists were presented with 26 PC-QIs, and implementation strategies. Both PC-QIs and strategies were identified from our extensive previous engagement of patients, caregivers, healthcare providers, and quality improvement leaders. The NGT objectives were to: 1. Prioritize PC-QIs and implementation strategies; and 2. Facilitate the participation of diverse primary care stakeholders in Alberta, including patients, healthcare providers, and quality improvement staff. Panelists participated in three rounds of activities. In the first, panelists individually ranked and commented on the PC-QIs and strategies. The summarized results were discussed in the second-round face-to-face group meeting. For the last round, panelists provided their final individual rankings, informed by the group discussion. Finally, we conducted an evaluation of the consensus process from the panelists' perspectives. RESULTS Eleven primary care providers, patient partners, and quality improvement staff from across Alberta participated. The panelists prioritized the following PC-QIs: 'Patient and caregiver involvement in decisions about their care and treatment'; 'Trusting relationship with healthcare provider'; 'Health information technology to support person-centred care'; 'Co-designing care in partnership with communities'; and 'Overall experience'. Implementation strategies prioritized included: 'Develop partnerships'; 'Obtain quality improvement resources'; 'Needs assessment (stakeholders are engaged about their needs/priorities for person-centred measurement)'; 'Align measurement efforts'; and 'Engage champions'. Our evaluation suggests that panelists felt that the process was valuable for planning the implementation and obtaining feedback, that their input was valued, and that most would continue to collaborate with other stakeholders to implement the PC-QIs. CONCLUSIONS Our study demonstrates the value of co-design and participatory approaches for engaging stakeholders in adapting PC-QI implementation for the primary care context in Alberta, Canada. Collaboration with stakeholders can promote buy-in for ongoing engagement and ensure implementation will lead to meaningful improvements that matter to patients and providers.
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Affiliation(s)
- Kimberly Manalili
- Department of Community Health Sciences, Cumming School of Medicine, 3D10, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
- Patient Engagement Platform - Alberta Strategy for Patient Oriented Research, University of Calgary, 3280 Hospital Drive NW, Cal Wenzel Precision Health Building, Calgary, AB, Canada.
| | - Catherine M Scott
- Department of Community Health Sciences, Cumming School of Medicine, 3D10, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Sociology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Brenda Hemmelgarn
- Faculty of Medicine and Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada
| | - Maeve O'Beirne
- Department of Community Health Sciences, Cumming School of Medicine, 3D10, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Family Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Allan L Bailey
- Department of Family Medicine, University of Alberta, 5-16 University Terrace, 8303 112 St., Edmonton, AB, T6G 1K4, Canada
| | - Michel K Haener
- Grande Prairie Primary Care Network, 11745 105 St #104, Grande Prairie, AB, T8V 8L1, Canada
| | - Cyrene Banerjee
- Patient and Community Engagement Research Program (PaCER), University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Sue P Peters
- Health Quality Council of Alberta, 210, 811 14 St NW, Calgary, AB, T2N 2A4, Canada
| | - Mirella Chiodo
- Department of Family Medicine, University of Alberta, 5-16 University Terrace, 8303 112 St., Edmonton, AB, T6G 1K4, Canada
| | - Fariba Aghajafari
- Department of Community Health Sciences, Cumming School of Medicine, 3D10, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Family Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Maria J Santana
- Department of Community Health Sciences, Cumming School of Medicine, 3D10, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department Paediatrics, Alberta Children's Hospital, University of Calgary, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
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Ravina A, Ficarra G, Chiodo M, Mazzetti M, Romagnani S. Relationship of circulating CD4+ T-lymphocytes and p24 antigenemia to the risk of developing AIDS in HIV-infected subjects with oral hairy leukoplakia. J Oral Pathol Med 1996; 25:108-11. [PMID: 9148036 DOI: 10.1111/j.1600-0714.1996.tb00203.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
To investigate the relationship of circulating CD4+ T-lymphocytes and p24 antigenemia to the development of AIDS in HIV-infected subjects with hairy leukoplakia (HL), we have followed over eight years 173 HIV-positive patients, all asymptomatic at the start of the study, and compared those who developed HL (n=55) to those who did not (n=118). Both groups included injection drug users (IDUs), homosexual men, and hemophiliacs. At the time of their first visit, both HL+ and HL- patients had a normal value of CD4+ cells and a low frequency of p24 antigenemia. During the years of follow-up, patients in the HL+ group showed a greater reduction in CD4+ cells, a significant increase in p24 antigenemia, and a higher rate of progression to AIDS. Our study demonstrates that in HIV-positive patients, HL is associated with more compromised immunological parameters and a higher viral replication and that its appearance has a negative prognostic value in relation to AIDS progression.
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Affiliation(s)
- A Ravina
- Division of Allergy and Clinical Immunology, Polyclinic of Careggi, Florence, Italy
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Ficarra G, Chiodo M, Morfini M, Longo G, Orsi A, Piluso S, Rafanelli D. Oral lesions among HIV-infected hemophiliacs. A study of 54 patients. Haematologica 1994; 79:148-53. [PMID: 8063262] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND HIV-infected individuals develop a large variety of oral manifestations. This study was designed to assess the prevalence and types of oral lesions among HIV-positive hemophiliacs. MATERIALS AND METHODS A study population of 54 hemophiliacs was evaluated from February, 1987 to March, 1992 in order to analyze types, prevalence and relationships to clinical stages of HIV-related oral lesions. Thirty-six (67%) of the group of patients were HIV seropositive. The remaining 18 tested negative to HIV during the observation period. RESULTS The majority of patients suffered from hemophilia A. One patient was also bisexual and two were also intravenous drug abusers. Analysis of patient stage revealed that half had a CD4+ T-lymphocyte count over 0.5 x 10(9)/L cells, 10 between 0.2 and 0.499 x 10(9)/L and 8 showed a count lower than 200 x 10(9)/L. Oral lesions were recorded in 18 (50%) HIV-seropositive hemophiliacs. No oral lesions were observed among the HIV-seronegative hemophiliacs. Advanced stage of immunosuppression and presence of oral lesions were significantly associated (p = 0.040). Candidiasis was the most common disturbance, followed by hairy leukoplakia. Oral herpes simplex infection, necrotizing gingivitis and facial herpes zoster were found in a small number of patients. Those with oral lesions showed a lower median CD4+ T lymphocyte count (0.209 x 10(9)/L cells; range 0.008 to 0.615) when compared to the ones without oral lesions (median CD4+ count was 0.539 x 10(9)/L cells; range 0.042 to 1.180; p = 0.002). CONCLUSIONS HIV-seropositive hemophiliacs may develop oral lesions during the course of their disease. Candidiasis and hairy leukoplakia are among the most common manifestations. A careful oral examination should be included in the clinical evaluation of all HIV-infected hemophiliacs.
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Affiliation(s)
- G Ficarra
- Institute of Odontology and Stomatology, University of Florence, Italy
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