Practicing During the COVID-19 Pandemic: Experiences of Canadian Hospital-Based Occupational Therapists

Background. The COVID-19 pandemic disrupted hospital operations worldwide, including services delivered by occupational therapists (OTs). Purpose. This study aimed to understand the experiences of OTs at one Canadian, tertiary care hospital during the 2021-2022 period of the pandemic. Method. We used a qualitative descriptive approach to describe the experiences of OTs during the pandemic. Findings. While there were similarities in the 10 participating OTs' experiences, salient differences were largely linked to the method of service delivery. Inpatient OTs benefitted from the support of colleagues and developed coping strategies in response to high levels of workplace stress and anxiety and a perceived lack of support from many levels of society. Clinically, they spent more time on discharge planning with fewer resources. OTs providing virtual/hybrid services experienced unique challenges related to adapting their practice to a virtual platform, including challenges assessing patients. They described benefits associated with virtual/hybrid service delivery and brought up concerns around equity of service provision. Conclusion. OTs in this hospital setting faced challenges in providing patient care and supporting their own wellness during the pandemic. Future research could explore the role of leadership in supporting occupational therapy practice during public health emergencies.

Transition of Youth With Type 2 Diabetes: Predictors of Health-Care Utilization After Transition to Adult Care From Population-Based Administrative Data

OBJECTIVES

In this study, we aimed to compare health-care visits pre- and posttransition from pediatric to adult care between youth with type 2 and type 1 diabetes.

METHODS

We linked a clinical database with the Manitoba Population Research Data Repository to compare health-care visits 2 years before and after transition, and investigated baseline factors influencing health-care engagement.

RESULTS

Youth with type 2 diabetes (n=196) vs type 1 diabetes (n=456) were more likely to be female (61% vs 44%), older at diagnosis (13.6 vs 10.6 years), live in northern regions and to be in the lowest socioeconomic status quartile (53% vs 5.4%). Seventy-six percent of youth with type 2 diabetes attended a follow-up visit within 2 years of transition compared to 97% of youth with type 1 diabetes. Youth with type 2 diabetes had higher rates of hospitalization pretransition (19.6 vs 11.6 admissions/100 patient years) and posttransition (24.7 vs 11.7 admissions/100 patient years) and fewer medical visits (pretransition: 2.4 vs 3.0 visits/person year [p<0.01]; posttransition: 1.6 vs 2.1 visits/person year [p<0.01]). Accounting for sex, geography, age, education, socioeconomic status and diabetes type, achieving 4 visits in 2 years posttransition was predicted by the number of visits pretransition (odds ratio, 1.35; 95% confidence interval, 1.23 to 1.49) and diabetes type (type 2 diabetes: odds ratio, 0.57; 95% confidence interval, 0.34 to 0.98).

CONCLUSIONS

Youth with type 2 diabetes attend fewer medical follow-up visits pre- and posttransition to adult care compared to youth with type 1 diabetes. Focused, informed, specific transition planning is needed that addresses the unique characteristics of this population.

Profiles of Depressive Symptoms and Diabetes Distress in Preadolescents With Type 1 Diabetes

OBJECTIVES

Diabetes distress and depressive symptoms are common psychosocial concerns for people with diabetes. These are related, yet distinct, mood states, which have each been related to diabetes management and glycated hemoglobin (A1C) among adolescents and adults with diabetes. However, they have not been examined concurrently in preadolescents with type 1 diabetes. Understanding the overlaps and distinctions between diabetes distress and depressive symptoms in youth would help guide decisions about psychosocial screening in diabetes clinical practice. In this study, we aimed to categorize preadolescents based on clinical cutoffs of concurrently administered measures of depressive symptoms and diabetes distress, and identify clinical and demographic characteristics of each group.

METHODS

One hundred eighty youth (age range, 9 to 13 years; age [mean ± standard deviation], 11.3±1.3 years; 55% female; 56% Caucasian; mean A1C, 8.4±1.6% [68 mmol/mol]) completed measures of diabetes distress, depressive symptoms and quality of life. Daily blood glucose monitoring frequency was calculated from meter download. A1C values were obtained from electronic medical records.

RESULTS

Depressive symptoms and diabetes distress each significantly correlated with A1C and quality of life. Although most (69%) participants had no clinically significant elevations in either diabetes distress or depressive symptoms, 14% had elevated depressive symptoms only and 17% had elevated distress without concurrent elevated depressive symptoms. Groups differed based on A1C, quality of life and insurance status.

CONCLUSIONS

Routine assessment of both depressive symptoms and diabetes distress may help to identify preadolescents with type 1 diabetes who require psychosocial support.

Time to Treatment Intensification in Newly Treated Adult Type 2 Diabetes Patients: Comparison of Canada and the United States

OBJECTIVES

Our aim in this study was to determine whether differences exist in time to treatment intensification in newly treated type 2 diabetes patients in Canada and the United States (US).

METHODS

Two separate retrospective cohorts of diabetes patients were used from Canada and the US. Time to treatment intensification (i.e. addition of a second antihyperglycemic agent after initial metformin use) was determined using multivariate Cox proportional hazard models.

RESULTS

Among new metformin users in 2004‒2007 (2,116 Canadians and 2,631 Americans) >65 years of age, the median time to treatment intensification was 362 days for Canadians and 170 days for Americans (adjusted hazard ratio, 1.99; 95% confidence interval, 1.69 to 2.36). In a second cohort of all adult ages with clinical data between 2008 and 2010 (23,022 Canadians and 19,318 Americans), the median time to treatment intensification was 197 days for Canadians and 119 days for Americans (adjusted hazard ratio, 5.62; 95% confidence interval, 5.246 to 6.029). At treatment intensification, the mean glycated hemoglobin was 9.0% (standard deviation, 2.0) in Canada and 8.6% (standard deviation, 2.2) in the US (p<0.01).

CONCLUSIONS

Although clinical practice guidelines are similar between Canada and the US, Canadian clinicians have historically demonstrated more clinical inertia compared with their US counterparts with respect to intensifying antihyperglycemic therapy. It is relatively unknown whether these differences currently exist or whether Canadian clinicians have closed the gap.