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Accelerating client-driven care: pilot study for a social interaction approach to knowledge translation.

https://arctichealth.org/en/permalink/ahliterature155589
Source
Can J Nurs Res. 2008 Jun;40(2):58-74
Publication Type
Article
Date
Jun-2008
Author
Carol L McWilliam
Anita Kothari
Beverly Leipert
Catherine Ward-Griffin
Dorothy Forbes
Mary Lou King
Marita Kloseck
Karen Ferguson
Abram Oudshoorn
Author Affiliation
School of Nursing, University of Western Ontario, London, Canada. cmcwill@uwo.ca
Source
Can J Nurs Res. 2008 Jun;40(2):58-74
Date
Jun-2008
Language
English
Publication Type
Article
Keywords
Adult
Consumer Participation
Diffusion of Innovation
Evidence-Based Medicine
Female
Group Processes
Health Planning Councils
Home Care Services - organization & administration
Humans
Interprofessional Relations
Middle Aged
Ontario
Pilot Projects
Abstract
This study piloted a knowledge translation (KT) intervention promoting evidence-based home care through social interaction. A total of 33 providers organized into 5 heterogeneous, geographically defined action groups participated in 5 researcher-facilitated meetings based on the participatory action model. The KT evidence reflects an empowering partnership approach to service delivery. Exploratory investigation included quantitative pre-post measurement of outcomes and qualitative description of data, presented herein. The critical reflections of the groups reveal macro-, meso-, and micro-level barriers to and facilitators of KT as well as recommendations for achieving KT. Insights gleaned from the findings have informed the evolution of the KT intervention to engage all 3 levels in addressing barriers and facilitators, with a conscious effort to transcend "push" and "pull" tendencies and enact transformative leadership. The findings suggest the merit of a more prolonged longitudinal investigation with expanded participation.
PubMed ID
18714898 View in PubMed
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Flexible client-driven in-home case management: an option to consider.

https://arctichealth.org/en/permalink/ahliterature173614
Source
Care Manag J. 2004;5(2):73-86
Publication Type
Article
Date
2004
Author
Carol L McWilliam
Moira Stewart
Evelyn Vingilis
Jeffrey S Hoch
Jeffrey Hoch
Catherine Ward-Griffin
Allan Donner
Gina Browne
Peter Coyte
Karen Anderson
Author Affiliation
Faculty of Health Sciences, University of Western Ontario, London, Canada. cmcwill@uwo.ca
Source
Care Manag J. 2004;5(2):73-86
Date
2004
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Canada
Case Management
Community Health Nursing - methods
Female
Home Care Services
Humans
Male
Middle Aged
Models, Nursing
Patient Participation
Patient-Centered Care
Questionnaires
Abstract
Changes in health services and care needs have created high demand for case management of in-home services. To address this challenge, several models of case management have been used. Evaluations to date suggest that clients need different approaches for different circumstances at different times to optimize cost-effectiveness. Accordingly, one Canadian home care program adopted flexible client-driven case management engaging clients as partners in flexibly selecting either an integrated team, consumer-managed or brokerage model of case management in keeping with their preferences and abilities. Using an exploratory, multimeasure quasi-experimental design, a generic model of program evaluation, and both quantitative and qualitative methods, researchers identified challenges in implementing this intervention, policy impediments the clients characteristically in each of the three case management models, and client, provider, and caregiver outcomes of flexible, client-driven care. While further longitudinal investigation is needed findings suggest several important considerations for those interested in this option for care management. Alternative case management models do attract different client groups, and having a choice does not alter care costs or outcomes. Flexible client-driven case management may be experienced positively by case managers and other providers.
Notes
Erratum In: Care Manag J. 2008;9(2):table of contentsHoch, Jeffrey [corrected to Hoch, Jeffrey S]
PubMed ID
16047912 View in PubMed
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Health professionals' enactment of their accountability obligations: doing the best they can.

https://arctichealth.org/en/permalink/ahliterature149226
Source
Soc Sci Med. 2009 Oct;69(7):1063-71
Publication Type
Article
Date
Oct-2009
Author
Andrew R Freeman
Carol L McWilliam
Joyce R MacKinnon
Sandra DeLuca
Susan G Rappolt
Author Affiliation
Universite Laval, Pavillon Ferdinand-Vandry, 1050 avenue de la Medecine, Quebec City, Quebec, Canada. andrew.freeman@rea.ulaval.ca
Source
Soc Sci Med. 2009 Oct;69(7):1063-71
Date
Oct-2009
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Decision Making
Female
Humans
Interviews as Topic
Male
Occupational Therapy - psychology
Ontario
Personal Autonomy
Professional Practice
Professional Role
Professional-Patient Relations
Quality Assurance, Health Care
Social Responsibility
Abstract
In the current context of health care, health professionals' accountability obligations may be more extensive than the degree of autonomy that they are permitted to exercise. To date, how professionals fulfil their obligations with regard to this potential for dissonance has not been investigated. The purpose of this Grounded Theory study was to examine how one professional group, occupational therapists, enacted their accountability obligations within their current practice context. Interviews with 21 therapists across three practice sectors in one Canadian province elicited a detailed portrait of the contextual elements within which accountability enactment took place, and a view of the dynamic interplay of these elements with the decision-making involved in fulfilling professional accountabilities. Practitioners moved back and forth between conscious juggling of accountability expectations and more automatically applying tacit practice knowledge. Beyond non-negotiable bottom line commitments to their formal ethical obligations and to retaining autonomy for their clinical recommendations, practitioners' decisions reflected the goal of doing their best. However, participants' efforts to find a balance between satisfactorily fulfilling their obligations and acknowledging the frequently unavoidable reality of contextual constraints elicited inconsistent patterns. The study findings raise concerns about ensuring quality of services and the impact on professionals. Although practitioners have an important role to play in addressing these challenges, other stakeholders, for example, the professional regulatory bodies, also must play a role in creating a coherent accountability framework. Further research is needed to obtain greater understanding of professional accountability enactment across health professions, practice sectors and health jurisdictions, and to explore managerial and professional regulatory bodies' perspectives, roles and responsibilities.
PubMed ID
19666206 View in PubMed
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Integrating Physician Services in the Home: evaluation of an innovative program.

https://arctichealth.org/en/permalink/ahliterature139318
Source
Can Fam Physician. 2010 Nov;56(11):1166-74
Publication Type
Article
Date
Nov-2010
Author
Moira Stewart
John F Sangster
Bridget L Ryan
Jeffrey S Hoch
Irene Cohen
Carol L McWilliam
Joan Mitchell
Evelyn Vingilis
Christine Tyrrell
Ian R McWhinney
Author Affiliation
University of Western Ontario, Family Medicine, Suite 245, 100 Collip Circle, London, ON N6G 4X8. moira@uwo.ca
Source
Can Fam Physician. 2010 Nov;56(11):1166-74
Date
Nov-2010
Language
English
Publication Type
Article
Keywords
Acute Disease - therapy
Aged
Aged, 80 and over
Attitude of Health Personnel
Caregivers - statistics & numerical data
Delivery of Health Care, Integrated
Emergency Service, Hospital - utilization
Family Practice - statistics & numerical data
Female
Home Care Services - utilization
Humans
Male
Middle Aged
Nurse Practitioners - utilization
Ontario
Outcome and Process Assessment (Health Care)
Patient care team
Patient satisfaction
Physicians, Family - statistics & numerical data - utilization
Program Evaluation
Social Class
Abstract
To evaluate a new program, Integrating Physician Services in the Home (IPSITH), to integrate family practice and home care for acutely ill patients.
Causal model, mixed-method, multi-measures design including comparison of IPSITH and non-IPSITH patients. Data were collected through chart reviews and through surveys of IPSITH and non-IPSITH patients, caregivers, family physicians, and community nurses.
London, Ont, and surrounding communities, where home care is coordinated through the Community Care Access Centre.
A total of 82 patients receiving the new IPSITH program of care (including 29 family physicians and 1 nurse practitioner), 82 non-randomized matched patients receiving usual care (and their physicians), community nurses, and caregivers.
Emergency department (ED) visits and satisfaction with care. Analysis included a process evaluation of the IPSITH program and an outcomes evaluation comparing IPSITH and non-IPSITH patients.
Patients and family physicians were very satisfied with the addition of a nurse practitioner to the IPSITH team. Controlling for symptom severity, a significantly smaller proportion of IPSITH patients had ED visits (3.7% versus 20.7%; P = .002), and IPSITH patients and their caregivers, family physicians, and community nurses had significantly higher levels of satisfaction (P
Notes
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Comment In: Can Fam Physician. 2011 Jan;57(1):2121252125
Comment In: Can Fam Physician. 2011 Jan;57(1):2221252127
PubMed ID
21076000 View in PubMed
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Interdiscplinary team processes within an in-home service delivery organization.

https://arctichealth.org/en/permalink/ahliterature178200
Source
Home Health Care Serv Q. 2004;23(3):1-17
Publication Type
Article
Date
2004
Author
Thomas W Gantert
Carol L McWilliam
Author Affiliation
School of Nursing, Faculty of Health Sciences, The University of Western Ontario, London, Canada. twganter@uwo.ca
Source
Home Health Care Serv Q. 2004;23(3):1-17
Date
2004
Language
English
Publication Type
Article
Keywords
Canada
Health Services Research
Home Care Services - organization & administration
Humans
Patient care team
Abstract
Interdisciplinary teamwork is particularly difficult to achieve in the community context where geographical separateness and solo practices impede face to face contact and collaborative practice. Understanding the processes that occur within interdisciplinary teams is imperative, since client outcomes are influenced by interdisciplinary teamwork. The purpose of this exploratory study was to describe the processes that occur within interdisciplinary teams that deliver in-home care. Applying grounded theory methodology, the researcher conducted unstructured in-depth interviews with a purposeful sample of healthcare providers and used constant comparative analysis to elicit the findings. Findings revealed three key team processes: networking, navigating, and aligning. The descriptions afford several insights that are applicable to in-home healthcare agencies attempting to achieve effective interdisciplinary team functioning.
PubMed ID
15451713 View in PubMed
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Living with the health and social inequities of a disability: a critical feminist study.

https://arctichealth.org/en/permalink/ahliterature170345
Source
Health Care Women Int. 2006 Mar;27(3):204-22
Publication Type
Article
Date
Mar-2006
Author
Patricia Bethune-Davies
Carol L McWilliam
Helene Berman
Author Affiliation
Fanshawe College, London, Ontario, Canada. pbethune-davies@fanshawec.on.ca
Source
Health Care Women Int. 2006 Mar;27(3):204-22
Date
Mar-2006
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Adult
Aged
Aged, 80 and over
Caregivers - organization & administration
Disabled Persons - psychology - rehabilitation
Female
Health status
Home Care Services - organization & administration
Humans
Middle Aged
Narration
Ontario
Quality of Life
Questionnaires
Social Support
Socioeconomic Factors
Women's health
Abstract
Clients living at home with chronic disabling conditions together with their caregivers, service providers, and policymakers face major challenges in optimizing health care. In this critical feminist interpretive study we examined the experiences of women receiving home care for chronic disabling conditions. Five themes emerged: struggling with the embodied limitations of disabling chronic conditions; actively seeking health; struggling with service limitations; seeking ways to manage; and living with isolation and marginalization. Having done this study, we learned that home care services do not always contribute sufficiently to the overall health and well-being of women living with chronic disabling conditions and, in fact, may negatively impact upon their health.
PubMed ID
16524852 View in PubMed
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7 records – page 1 of 1.