Based on the 2017 Canadian Survey on Disability, more than two million Canadians 15 years of age or older are living with a mental health-related disability. Subsequently, access and delivery of mental health services in Canada, more specifically in Ontario, have shifted to a shared responsibility between healthcare providers and the individual client's informal caregivers. Unfortunately, the role of the caregiver has been historically underappreciated and undervalued, leaving caregivers with few supports to help them manage and cope with caregiving responsibilities. This paper reports the results of a qualitative descriptive study that explored the lived experiences of caregivers who are providing care to an adult family member who is living with a mental illness in Windsor-Essex County, Ontario. Twenty-one participants volunteered to be interviewed for this study via telephone or online on Microsoft Teams. All interviews were audio-recorded and transcribed verbatim. Data analysis followed Braun and Clarke's framework for reflexive thematic analysis. Four themes were identified from the 21 interviews: 1) personal impact of being a caregiver, 2) stress associated with navigating the system, 3) complexity of the caregiving burden, and 4) caregivers as buffers of the failings of the system. Results demonstrate that caregiving is a stressful responsibility and, without sufficient supports, can impair the wellbeing of both the caregiver and the care recipient. As such, apart from recognizing informal caregivers as partners in the care of persons living with mental illness in the community, there is also a need to acknowledge that they, too, require supports to ensure that their health and well-being are not compromised in providing care to their loved one(s).
This study examined whether a telehealth chronic disease self-management program (CDSMP) would lead to improvements in self-efficacy, health behaviors, and health status for chronically ill adults living in Northern Ontario, Canada. Two telehealth models were used: (1) single site, groups formed by participants at one telehealth site; and (2) multi-site, participants linked from multiple sites to form one telehealth group, as a strategy to increase access to the intervention for individuals living in rural and remote communities.Two hundred thirteen participants diagnosed with heart disease, stroke, lung disease, or arthritis attended the CDSMP at a preexisting Ontario Telemedicine Network studio from September 2007 to June 2008. The program includes six weekly, peer-facilitated sessions designed to help participants develop important self-management skills to improve their health and quality of life. Baseline and 4-month follow-up surveys were administered to assess self-efficacy beliefs, health behaviors, and health status information. Results were compared between single- and multi-site delivery models.Statistically significant improvements from baseline to 4-month follow-up were found for self-efficacy (6.6±1.8 to 7.0±1.8; p<0.001), exercise behavior, cognitive symptom management, communication with physicians, role function, psychological well-being, energy, health distress, and self-rated health. There were no statistically significant differences in outcomes between single- and multi-site groups.Improvements in self-efficacy, health status, and health behaviors were equally effective in single- and multi-site groups. Access to self-management programs could be greatly increased with telehealth using single- and multi-site groups in rural and remote communities.
People with disability, multiple chronic conditions or both may experience challenges in accessing primary care. We aimed to determine the association between appropriate cervical cancer screening and level of disability among women eligible for screening in Ontario and the influence of relevant sociodemographic and health-related variables, including level of morbidity (measured by number of chronic conditions), on screening.
Methods
We used multiple linked databases, including 2 waves of the Canadian Community Health Survey (2005 and 2007/08). Of the 22 824 women included in the study, 7600 reported some level of disability. We used Ontario Health Insurance Plan fee codes to identify appropriate cervical cancer screening.
Results
Compared with women without disability, women with disability were older, less educated, had lower income and had more chronic conditions (36.2% had at least 2 conditions v. 8.4% of women without disability). Women with no disability and no chronic conditions were more frequently screened appropriately than those with severe disability and 2 or more chronic conditions (64.5% v. 39.8%). In multivariable logistic regression analysis, age, rurality, education, marital status and household income were each independently associated with cervical cancer screening. There was a significant interaction between level of morbidity and level of disability. Women with a higher level of disability were less likely to be screened than women with lower level of disability as their level of morbidity increased.
Conclusion
The rate of screening for cervical cancer is low among women with both disability and multimorbidity. Policymakers should note these results as they work toward improving cancer screening rates for an aging population with complex medical needs.
In rural and remote settings, providing education programs for chronic conditions can be challenging because of the limited access and availability of healthcare services. The purpose of this study was to explore the experiences of participants in a chronic disease self-management program via telehealth (tele-CDSMP) and to identify facilitators and barriers to inform future tele-CDSMP delivery models.Nineteen tele-CDSMP courses were delivered to 13 Northern Ontario (Canada) communities. Two types of group were delivered: (1) single telehealth site (one community formed a self-management group linked to program leaders via telehealth) and (2) multiple telehealth sites (several remote communities were linked to each other and program leaders via telehealth). Following the completion of the courses, participants were invited to partake in a focus group.Overall, 44 people participated in the focus groups. Four main themes were identified by tele-CDSMP participants related to the overall experience of the program: (1) bridging the access gap, (2) importance of group dynamics, (3) importance of strong leaders, and (4) preference for extended session time. Key barriers were related to transportation, lack of session time, and access to Internet-based resources. The main facilitators were having strong program leaders, encouraging the development of group identity, and providing enough time to be comfortable with technology.Our findings suggest overall the tele-CDSMP was a positive experience for participants and that tele-CDSMPs are an effective option to increasing access to more geographically isolated communities.
OBJECTIVE: The objective of this study was to assess the accuracy of procedure, diagnosis and physician billing code algorithms to identify cases of spinal cord injured persons having undergone surgical flap closure of pelvic pressure injuries in a provincial administrative data base. Hospital medical records with confirmed cases (true positive) and controls (true negative) were used as reference standard. METHODS: Following research ethics approval, 111 patients were included with 136 cases of pressure injury (PI) reconstruction procedures from the billing codes of one plastic/reconstructive surgeon from the years 2002–2015, at one tertiary care hospital in Toronto, Ontario. 38 controls were further identified through medical record review. Ontario Health Insurance Plan (OHIP) billing codes, ICD-10-CA and Canadian Classification of Health Interventions codes (CCI) were recorded for each of the cases. Spinal cord diagnosis, the index surgery codes and billing codes were use to build several algorithms tested for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS: The final and best algorithm displayed a sensitivity of 69.1%, specificity of 97.37%; PPV of 98.95% and NPV of 46.84%. In other words, 30.9% of the true positives in this cohort were missed using the algorithm while 97.37% of the true negatives were identified using the same algorithm. CONCLUSION: Use of retrospective observational study employing administrative algorithms to identify SCI patients who have undergoing pressure injury reconstruction is currently insufficient to proceed with population based study in Ontario. This study emphasizes the importance of evaluating accuracy and completeness of codes in administrative databases in order to reduce the risk of misclassification and subsequent reduction of power and generalizability.
Epidemiology and resource indicators for all health regions in Ontario, fiscal 2008â 2013. Table S2. Demographic and clinical characteristics of persons admitted to acute care for surgical repair of hip fracture in Ontario, by health region, fiscal 2008â 2013. Table S3. Epidemiology and resource indicators for High IPR LHINs and all other LHINs, Ontario, fiscal 2008-2013. (XLSX 29Â kb)
Introduction Inadequate knowledge and training of healthcare providers are obstacles to effective chronic pain management. ECHO (extension for community healthcare outcomes) uses case-based learning and videoconferencing to connect specialists with providers in underserved areas. ECHO aims to increase capacity in managing complex cases in areas with poor access to specialists. Methods A pre-post study was conducted to evaluate the impact of ECHO on healthcare providers’ self-efficacy, knowledge and satisfaction. Type of profession, presenting a case, and number of sessions attended were examined as potential factors that may influence the outcomes Results From June 2014 to March 2017, 296 primary care healthcare providers attended ECHO, 264 were eligible for the study, 170 (64%) completed the pre-ECHO questionnaire and 119 completed post-ECHO questionnaires. Participants were physicians (34%), nurse practitioners (21%), pharmacists (13%) and allied health professionals (32%). Participants attended a mean of 15 ± 9.19 sessions. There was a significant increase in self-efficacy ( p < 0.0001) and knowledge ( p < 0.0001). Self-efficacy improvement was significantly higher among physicians, physician assistants and nurse practitioners than the non-prescribers group ( p = 0.03). On average, 96% of participants were satisfied with ECHO. Satisfaction was higher among those who presented cases and attended more sessions. Discussion This study shows that ECHO improved providers’ self-efficacy and knowledge. We evaluated outcomes from a multidisciplinary group of providers practicing in Ontario. This diversity supports the generalisability of our findings. Therefore, we suggest that this project may be used as a template for creating other educational programs on other medical topics.
Though preclinical models of type 1 diabetes (T1D) exhibit impaired muscle regeneration, this has yet to be investigated in humans with T1D. Here, we investigated the impact of damaging exercise (eccentric quadriceps contractions) in 18 physically active young adults with and without T1D. Pre- and postexercise (48 h and 96 h), the participants provided blood samples, vastus lateralis biopsies, and performed maximal voluntary quadriceps contractions (MVCs). Skeletal muscle sarcolemmal integrity, extracellular matrix (ECM) content, and satellite cell (SC) content/proliferation were assessed by immunofluorescence. Transmission electron microscopy was used to quantify ultrastructural damage. MVC was comparable between T1D and controls before exercise. Postexercise, MVC was decreased in both groups, but subjects with T1D exhibited moderately lower strength recovery at both 48 h and 96 h. Serum creatine kinase, an indicator of muscle damage, was moderately higher in participants with T1D at rest and exhibited a small elevation 96 h postexercise. Participants with T1D showed lower SC content at all timepoints and demonstrated a moderate delay in SC proliferation after exercise. A greater number of myofibers exhibited sarcolemmal damage (disrupted dystrophin) and increased ECM (laminin) content in participants with T1D despite no differences between groups in ultrastructural damage as assessed by electron microscopy. Finally, transcriptomic analyses revealed dysregulated gene networks involving RNA translation and mitochondrial respiration, providing potential explanations for previous observations of mitochondrial dysfunction in similar cohorts with T1D. Our findings indicate that skeletal muscle in young adults with moderately controlled T1D is altered after damaging exercise, suggesting that longer recovery times following intense exercise may be necessary.
