This qualitative study examined the delivery of Assertive Community Treatment from the perspective of service providers of 4 ACT teams in southeastern Ontario. Overall, providers were positive about their involvement with ACT. Eight tensions experienced in the context of delivering services emerged: negotiating governance structures; providing 24-hour coverage; balancing the clinical-administrative responsibilities of team leaders; accessing hospital beds; meeting local population needs; integrating treatment and rehabilitation; changing services to meet changes in the population being served; and implementing ambiguous ACT standards. Framing these challenges in the context of ACT structures and the broader community mental health system, the study suggests possibilities for the ongoing development of the model to facilitate the realization of the ACT vision.
This study provides evidence that a number of frailty-related characteristics (older age, de novo admission to long-term care (LTC), comorbidities [Charlson Index, osteoporosis, osteoporosis risk factors, sarcopenia risk factors, and dementia]) have increased in the hip fracture population from 2001-2008. This will have significant impact on community resources, as the number of people discharged to the community is also increasing.
The aim of this study is to estimate secular changes in the prevalence of selected frailty-related characteristics among the hip fracture population in the Canadian province of Quebec (2001-2008) and the potential impact of these changes on healthcare services.
The Quebec hospitalization database was used to identify nontraumatic hip fractures for the purposes of calculating age- and sex-specific rates. Also estimated were time trends for selected frailty-related characteristics and discharge destinations.
A significant decline in fracture rates was evident for all age groups except for those
A cross-sectional and multidisciplinary study on the situation of the elderly in Denmark at the beginning of the next century was undertaken in the late 1980s. The intention was to give a picture of the future cohorts of elderly, and their expectations for old age. The study also looked into the ways in which future societal developments might affect the situation of the elderly. In order to test a number of hypotheses on the future elderly and their preferences for life when they grow older, 1200 persons in the age groups 40-44, 50-54, and 60-64 years old were interviewed. Further, a number of studies were commissioned on developments which may affect the elderly with regard to health, housing, family, work and retirement, financial conditions, leisure activities and political participation. A main conclusion is that the future elderly in most areas--be it financial conditions, health, housing education--will be in a more favourable position than their predecessors after retirement. But there will still be a minority who suffer a hard life. They are the people whose finances are weak, whose health is impaired, and who lack social contacts.
The following article presents an overall picture of child health care delivery in Finland. The history and priorities of the Finnish Child Care Services are discussed with statistical data regarding birth rate, mortality and immunization.
The Citizen's Reference Panel was created to engage the people of Ontario in a dialogue about the directions for the future sustainability of healthcare. The primary concerns raised during the course of the panellists' deliberations included the need to (1) create a much closer integration of the health system's many providers and institutions, (2) accelerate the deployment of e-health solutions across the health system and (3) continue to focus on improving access to care, especially primary care and expanded community care services to reduce the pressure on institutional care.
Nurse leaders, educators and employers work to address the challenges of providing optimal care to Indigenous people and communities in Canada, which is often further complicated by geography and isolation. The Canadian Indigenous Nurses Association (CINA) has responded to the Calls to Action of the Truth and Reconciliation Commission of Canada through partnerships with various levels of government, including the First Nations and Inuit Health Branch of the new federal department of Indigenous Services Canada, to increase and better support Indigenous nurses in the healthcare system. Grounding nursing practice with the wisdom and strength of Indigenous knowledge, balanced with the perspectives of western ways of knowing is further facilitated when nursing students can be educated and supported closer to home. Learning in a supportive way, closer to where one lives, can allow for important family ties, cultural supports and practices to improve experiences and outcomes for students.
This article reports on a successful community-based psychiatric treatment program in Philadelphia, Pennsylvania and describes subsequent experiences seeking approval of similar programs in Philadelphia and in Oslo, Norway. Previous studies have shown that the Philadelphia community-based program, which used patient social networks and indigenous community workers assisted by psychological and psychiatric professionals, provided better treatment outcomes than traditional hospital programs and socioenvironmental treatment programs. On the basis of these experiences a new service delivery system was proposed which integrates patient social networks, community workers, and lay community organizations with mental health center professionals. Examination of differences in official responses to the proposal shows the importance of several factors, including the mental health bureaucracy's perception of patient potential, their openness to social psychological therapy, and the power struggles within the bureaucracy and the professional community.