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Access to adult liver transplantation in Canada: a survey and ethical analysis.

https://arctichealth.org/en/permalink/ahliterature212821
Source
CMAJ. 1996 Feb 1;154(3):337-42
Publication Type
Article
Date
Feb-1-1996
Author
M A Mullen
N. Kohut
M. Sam
L. Blendis
P A Singer
Author Affiliation
University of Toronto Joint Centre for Bioethics, Ont.
Source
CMAJ. 1996 Feb 1;154(3):337-42
Date
Feb-1-1996
Language
English
Publication Type
Article
Keywords
Adult
Canada
Data Collection
Health Care Rationing - organization & administration
Health Services Accessibility - organization & administration
Humans
Liver Transplantation
Organizational Policy
Patient Selection
Resource Allocation
Waiting Lists
Abstract
To describe the substantive and procedural criteria used for placing patients on the waiting list for liver transplantation and for allocating available livers to patients on the waiting list; to identify principal decision-makers and the main factors limiting liver transplantation in Canada; and to examine how closely cadaveric liver allocation resembles theoretic models of source allocation.
Mailed survey.
Medical directors of all seven Canadian adult liver transplantation centres, or their designates. Six of the questionnaires were completed.
Relative importance of substantive and procedural criteria used to place patients in the waiting list for liver transplantation and to allocate available livers. Identification of principal decision-makers and main limiting factors to adult liver transplantation.
Alcoholism, drug addiction, HIV positivity, primary liver cancer, noncompliance and hepatitis B were the most important criteria that had a negative influence on decisions to place patients on the waiting list for liver transplantation. Severity of disease and urgency were the most important criteria used for selecting patients on the waiting list for transplantation. Criteria that were inconsistent across the centres included social support (for deciding who is placed on the waiting list) and length of time on the waiting list (for deciding who is selected from the list). Although a variety of people were reported as being involved in these decisions, virtually all were reported to be health to be health care professionals. Thirty-seven patients died while waiting for liver transplantation in 1991; the scarcity of cadaveric livers was the main limiting factor.
Criteria for resource allocation decisions regarding liver transplantation are generally consistent among the centres across Canada, although some important inconsistencies remain. Because patients die while on the waiting list and because the primary limiting factor is organ supply, increased organ acquisition efforts are needed.
Notes
Cites: Psychosomatics. 1993 Jul-Aug;34(4):314-238351306
Cites: Arch Intern Med. 1990 Mar;150(3):523-72178581
Cites: BMJ. 1990 Jul 7;301(6742):15-72383700
Cites: N Engl J Med. 1991 Oct 24;325(17):1243-61845039
PubMed ID
8564903 View in PubMed
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Air ambulance nurses as expert supplement to local emergency services.

https://arctichealth.org/en/permalink/ahliterature261647
Source
Air Med J. 2014 Jan-Feb;33(1):40-3
Publication Type
Article
Author
Torben Wisborg
Bjørn Bjerkan
Source
Air Med J. 2014 Jan-Feb;33(1):40-3
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Air Ambulances - organization & administration
Child
Child, Preschool
Critical Care Nursing
Health Services Accessibility - organization & administration
Humans
Infant
Infant, Newborn
Norway
Nurse Anesthetists
Prospective Studies
Abstract
Flight nurses in the Norwegian National Air Ambulance Service are specialist nurse anesthetists or intensive care nursing specialists. For air ambulance bases far from hospitals, these nurses present otherwise unavailable competencies. This study reports a 6-year experience with flight nurse participation in local emergencies beyond the transportation phase.
The fixed-wing air ambulance base in Alta, Northern Norway (20,000 inhabitants), with 2 aircraft and 2 on-call teams is 150 km by road from the nearest hospital. We did a prospective registration of all emergency nonflight missions near the air ambulance base from January 1, 2005, to December 31, 2010.
The 217 completed missions corresponded to 3 missions per month, half during daytime. Twenty-three percent of patients were under age 18, injury rate was high (36%), 63% had potentially or manifest life-threatening conditions, and 11% died during treatment. One third of all missions (67/217) resulted in an air ambulance flight to the hospital.
Mission frequency did not significantly reduce flight availability, and precision in case selection for this special service was good. The use of flight nurses in the local community promotes equal access to advanced medical services for populations far from hospitals.
PubMed ID
24373476 View in PubMed
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An Evaluation of In-Person and Online Engagement in Central Newfoundland.

https://arctichealth.org/en/permalink/ahliterature277010
Source
Healthc Policy. 2015 Nov;11(2):72-85
Publication Type
Article
Date
Nov-2015
Author
Peter Wilton
Doreen Neville
Rick Audas
Heather Brown
Roger Chafe
Source
Healthc Policy. 2015 Nov;11(2):72-85
Date
Nov-2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Consumer Participation - psychology - statistics & numerical data
Female
Focus Groups
Health Services Accessibility - organization & administration - statistics & numerical data
Humans
Internet - utilization
Male
Middle Aged
Newfoundland and Labrador
Rural Population - statistics & numerical data
Socioeconomic Factors
Surveys and Questionnaires
Telemedicine - organization & administration - statistics & numerical data
Therapy, Computer-Assisted - organization & administration - statistics & numerical data
Young Adult
Abstract
This study evaluates the use of in-person focus groups and online engagement within the context of a large public engagement initiative conducted in rural Newfoundland.
Participants were surveyed about their engagement experience and demographic information. Pre and post key informant interviews were also conducted with organizers of the initiative.
Of the 111 participants in the focus groups, 97 (87%) completed evaluation surveys; as did 23 (88%) out of 26 online engagement participants. Overall, focus group participants were positive about their involvement, with 87.4% reporting that they would participate in a similar initiative. Online participation was below expectations and these participants viewed their experience less positively than in-person participants. Organizers viewed the engagement initiative and the combined use of online and in-person engagement positively.
This study presents a real-world example of the use of two methods of engagement. It also highlights the importance of the successful execution of whatever engagement mechanism is selected.
Notes
Cites: Med Teach. 2009 Feb;31(2):e36-919330662
Cites: Healthc Manage Forum. 2008 Winter;21(4):6-2119363962
Cites: Health Policy. 2009 Aug;91(3):219-2819261347
Cites: Healthc Q. 2010;13(3):86-9020523159
PubMed ID
26742117 View in PubMed
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Assessing the dimensionality of YFHS-Swe: a questionnaire to assess youth-friendliness in differentiated health services.

https://arctichealth.org/en/permalink/ahliterature295034
Source
Glob Health Action. 2017; 10(1):1380399
Publication Type
Journal Article
Validation Studies
Date
2017
Author
Mazen Baroudi
Anna-Karin Waenerlund
Miguel San Sebastian
Isabel Goicolea
Author Affiliation
a Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden.
Source
Glob Health Action. 2017; 10(1):1380399
Date
2017
Language
English
Publication Type
Journal Article
Validation Studies
Keywords
Adolescent
Adolescent Health Services - organization & administration
Adult
Attitude to Health
Female
Health Services Accessibility - organization & administration
Humans
Male
Middle Aged
Patient Acceptance of Health Care - psychology
Professional-Patient Relations
Psychology, Adolescent
Psychometrics
Reproducibility of Results
Surveys and Questionnaires
Sweden
Young Adult
Abstract
The aim of this study was to assess the dimensionality of YFHS-Swe and identify possible unique factors in the evaluation of youth-friendliness. YFHS-Swe was answered by 1110 youths aged 16 to 25 years visiting youth clinics in Northern Sweden. Thirteen factors were identified by exploratory factor analysis and except for one factor they all proved to fit well and have good reliability when assessed by the confirmatory factor analysis. The YFHS-Swe proved to be credible and suitable for assessing youth-friendliness of differentiated health services in Sweden. With cultural and linguistic adaptations, it can be used in similar settings internationally.
Notes
Cites: Psychometrika. 1965 Jun;30:179-85 PMID 14306381
Cites: Lancet. 2007 May 5;369(9572):1565-73 PMID 17482988
Cites: J Adolesc Health. 2012 Nov;51(5):422-30 PMID 23084162
Cites: World Health Organ Tech Rep Ser. 2006;938:151-204; discussion 317-41 PMID 16921920
Cites: Scand J Public Health. 2012 Dec;40(9 Suppl):42-71 PMID 23238401
Cites: Reprod Health. 2016 Dec 21;13(1):147 PMID 28003025
Cites: Scand J Public Health. 2017 Jun;45(4):366-372 PMID 28385109
Cites: Med Care. 2006 Nov;44(11 Suppl 3):S50-9 PMID 17060836
PubMed ID
29043946 View in PubMed
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Care of the secondary patient in family practice. A report from the Ambulatory Sentinel Practice Network.

https://arctichealth.org/en/permalink/ahliterature195641
Source
J Fam Pract. 2001 Feb;50(2):113-6
Publication Type
Article
Date
Feb-2001
Author
A J Orzano
P M Gregory
P A Nutting
J J Werner
S A Flocke
K C Stange
Author Affiliation
Department of Family Medicine, Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903-0019, USA. orzanoaj@umdnj.edu
Source
J Fam Pract. 2001 Feb;50(2):113-6
Date
Feb-2001
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Ambulatory Care - organization & administration
Canada
Cross-Sectional Studies
Family
Family Health
Family Practice - organization & administration
Female
Health Services Accessibility - organization & administration
Health Services Research
Humans
Male
Middle Aged
Physician's Practice Patterns - organization & administration
Questionnaires
Referral and Consultation - organization & administration
Reimbursement Mechanisms - statistics & numerical data
Time Factors
United States
Workload
Abstract
Care of a secondary patient (an individual other than the primary patient for an outpatient visit) is common in family practice, but the content of care of this type of patient has not been described.
In a cross-sectional study, 170 volunteer primary care clinicians in 50 practices in the Ambulatory Sentinel Practice Network reported all occurrences of care of a secondary patient during 1 week of practice. These clinicians reported the characteristics of the primary patient and the secondary patient and the content of care provided to the secondary patient. Content of care was placed in 6 categories (advice, providing a prescription, assessment or explanation of symptoms, follow-up of a previous episode of care, making or authorizing a referral, and general discussion of a health condition).
Physicians reported providing care to secondary patients during 6% of their office visits. This care involved more than one category of service for the majority of visits involving care of a secondary patient. Advice was provided during more than half the visits. A prescription, assessment or explanation of symptoms, or a general discussion of condition were provided during approximately 30% of the secondary care visits. Secondary care was judged to have substituted for a separate visit 60% of the time, added an average of 5 minutes to the visit, and yielded no reimbursement for 95% of visits.
Care of a secondary patient reflects the provision of potentially intensive and complex services that require additional time and are largely not reimbursed or recognized by current measures of primary care. This provision of secondary care may facilitate access to care and represent an added value provided by family physicians.
PubMed ID
11219557 View in PubMed
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Client perceptions of the performance of public and independent not-for-profit primary healthcare.

https://arctichealth.org/en/permalink/ahliterature166329
Source
Scand J Public Health. 2006;34(6):598-608
Publication Type
Article
Date
2006
Author
Ritva Laamanen
John Ovretveit
Jari Sundell
Nina Simonsen-Rehn
Sakari Suominen
Mats Brommels
Author Affiliation
Department of Public Health, University of Helsinki, Finland. ritva.laamanen@kolumbus.fi
Source
Scand J Public Health. 2006;34(6):598-608
Date
2006
Language
English
Publication Type
Article
Keywords
Adult
Aged
Community Health Centers - organization & administration - standards
Female
Finland
Health Maintenance Organizations - organization & administration - standards
Health Services Accessibility - organization & administration - standards
Humans
Male
Middle Aged
Organizations, Nonprofit
Patient Acceptance of Health Care
Patient satisfaction
Primary Health Care - organization & administration - standards
Private Sector
Public Sector
Questionnaires
Trust
Abstract
To compare primary healthcare (PHC) provided by an independent not-for-profit organization (INPO) with that provided by two public municipal organizations (MO1 and MO2), in terms of clients' perceptions of performance, acceptance, and trust.
A survey using a pre-tested questionnaire to all clients visiting a health centre (HC) doctor or nurse during one week in 2000 (n = 511, 51% response rate) and 2002 (n = 275, 47%). The data were analysed by descriptive statistics and cumulative logistic regression analysis.
The INPO differed from both publicly provided services in accessibility, consistency of service, and outcomes. Clients reported lower trust in HC provided by public organizations compared with the INPO. Trust was higher if clients also reported experiencing "very good" or "moderate" organizational access--or if general satisfaction was "very high" or "moderate" or if they experienced outcomes as "very good" or "moderate" compared with the "very poor or low" situation. Women reported lower trust in HC than men. When the family doctor was included in the same logistic regression model with the service provider, only the family doctor was a significant explanatory variable. Reported acceptance of private alternative service providers among clients was similar between the study organizations.
Clients of the INPO generally rated the service more positively than clients of publicly provided services. The results indicate that trust in HC depends more on a family doctor system than a service provider.
PubMed ID
17132593 View in PubMed
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Directly observed therapy programmes for anti-retroviral treatment amongst injection drug users in Vancouver: access, adherence and outcomes.

https://arctichealth.org/en/permalink/ahliterature161968
Source
Int J Drug Policy. 2007 Aug;18(4):281-7
Publication Type
Article
Date
Aug-2007
Author
Mark W Tyndall
Maggi McNally
Calvin Lai
Ruth Zhang
Evan Wood
Thomas Kerr
Julio G Montaner
Author Affiliation
Department of Medicine, University of British Columbia, Canada. mtyndall@cfenet.ubc.ca
Source
Int J Drug Policy. 2007 Aug;18(4):281-7
Date
Aug-2007
Language
English
Publication Type
Article
Keywords
Adult
Aged
Anti-HIV Agents - therapeutic use
British Columbia
CD4 Lymphocyte Count
Directly Observed Therapy
Efficiency, Organizational
Female
HIV Infections - complications - drug therapy - virology
Health Services Accessibility - organization & administration
Humans
Male
Middle Aged
Patient Compliance - statistics & numerical data
Retrospective Studies
Substance Abuse, Intravenous - complications
Treatment Outcome
Viral Load
Abstract
The introduction of highly active anti-retroviral therapy (HAART) has produced dramatic reductions in HIV associated morbidity and mortality. However, this success has not been replicated amongst injection drug users (IDUs) and other marginalised groups largely due to reduced uptake and lower rates of access and adherence to anti-retrovirals (ARVs). Multi-disciplinary programmes have been developed to help support ARV treatment and HIV care amongst IDUs. We retrospectively analysed the rates of adherence and plasma viral load suppression amongst participants in two clinic-based programmes that began enrollment in 1998. Of the 297 clients, the mean age was 40.5 years, 73% were males, 44% were of Aboriginal ethnicity, and 85% were Hepatitis C co-infected. One hundred and forty-two (47%) started therapy with a CD4 count below 200 mm(-3), and baseline plasma viral load was over 100,000 copies/ml in 73 (25%). Treatment interruptions of greater than 2 weeks occurred in 41% of the participants during follow-up. The overall rate of adherence to treatment was 84.5% during periods when known interruptions were not considered. Plasma viral load suppression was attained by 29% during the first ARV regimen, although 83% had at least one fully suppressed plasma viral load recorded during follow-up. All cause mortality was 21% during the period of observation. The programmes initiated in Vancouver demonstrate the positive impact that a comprehensive DOT programme can have on ARV adherence, as well as highlight the challenges that remain.
PubMed ID
17689376 View in PubMed
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Does team-based primary health care improve patients' perception of outcomes? Evidence from the 2007-08 Canadian Survey of Experiences with Primary Health.

https://arctichealth.org/en/permalink/ahliterature127140
Source
Health Policy. 2012 Apr;105(1):71-83
Publication Type
Article
Date
Apr-2012
Author
Shammima Jesmin
Amardeep Thind
Sisira Sarma
Author Affiliation
Department of Epidemiology and Biostatistics, University of Western Ontario, Canada. shjesmin@gmail.com
Source
Health Policy. 2012 Apr;105(1):71-83
Date
Apr-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Canada
Continuity of Patient Care - organization & administration - statistics & numerical data
Cost-Benefit Analysis - organization & administration - statistics & numerical data
Female
Health Care Surveys
Health Services Accessibility - organization & administration - statistics & numerical data
Humans
Male
Middle Aged
Patient Care Team - organization & administration - standards
Patient satisfaction
Primary Health Care - organization & administration - standards
Quality Indicators, Health Care - organization & administration - statistics & numerical data
Quality of Health Care - organization & administration - statistics & numerical data
Sex Factors
Treatment Outcome
Young Adult
Abstract
Team-based practice in primary care has been advocated for improved access, quality, effectiveness, and cost-efficiency of primary health care services, but there is limited empirical evidence supporting it.
To examine the impact of team-based practice on patients' perception of several process and outcome indicators from patients' perspective.
Micro data from the 2007-08 Canadian Survey of Experiences with Primary Health Care conducted by Statistics Canada were utilized. Regression techniques and propensity score matching method were used to examine the impact of team-based primary care on several process and outcome indicators of primary care.
The estimated average treatment effect of team-based care was positively significant and robust for access to after-hours care, quality of care, confidence in the system, overall coordination of care, and patient centeredness. Although the estimated average treatment effects for the two dimensions of follow-up coordination, continuity of care, health promotion and disease prevention initiatives, and utilization of physician and nurse services were statistically significant, sensitivity test results showed that these results were unreliable.
Team-based primary care improves patients' perception of process and outcome indicators in the area of access to after-hours care, quality of care, confidence in the system, overall coordination and patient centeredness. Future research needs to establish the causal link between team-based primary care and health outcomes of patients.
PubMed ID
22321527 View in PubMed
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Drop-in access to specialist services for eating disorders: a qualitative study of patient experiences.

https://arctichealth.org/en/permalink/ahliterature259897
Source
Eat Disord. 2014;22(4):279-91
Publication Type
Article
Date
2014
Author
David Clinton
Linn Almlöf
Sofia Lindström
Moa Manneberg
Lena Vestin
Source
Eat Disord. 2014;22(4):279-91
Date
2014
Language
English
Publication Type
Article
Keywords
Adult
Ambulatory Care - methods - organization & administration
Eating Disorders - therapy
Female
Health Services Accessibility - organization & administration
Humans
Mental Health Services - organization & administration
Motivation
Patient Acceptance of Health Care
Patient Dropouts
Patient satisfaction
Professional-Patient Relations
Qualitative Research
Sweden
Young Adult
Abstract
Lack of patient motivation and dropout are common problems in the treatment of eating disorders. The present study explored patient experiences with open access to specialist eating disorder services through a drop-in program aiming to enable early identification of eating disorders, address motivational problems, and strengthen the therapeutic alliance. Semi-structured qualitative interviews were used to explore the experiences of 11 individuals attending the program. Results suggest that drop-in access may strengthen the therapeutic alliance, motivate engagement in treatment, and reduce dropout. Strengths and weaknesses of the program are discussed and the need for more systematic research is elaborated.
PubMed ID
24809992 View in PubMed
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Forcing the system: a configuration analysis of a regionalized neonatal-perinatal health network.

https://arctichealth.org/en/permalink/ahliterature133917
Source
Health Care Manage Rev. 2011 Jul-Sep;36(3):241-51
Publication Type
Article
Author
Christian M Rochefort
Lise Lamothe
Author Affiliation
Clinical and Health Informatics Research Group, McGill University Health Centre, Montreal, Quebec, Canada. Christian.Rochefort@mcgill.ca
Source
Health Care Manage Rev. 2011 Jul-Sep;36(3):241-51
Language
English
Publication Type
Article
Keywords
Adult
Community Networks - organization & administration
Evidence-Based Practice - methods
Female
Health Services Accessibility - organization & administration
Health services needs and demand
Hospital Administration
Humans
Infant
Infant, Newborn
Intensive Care Units, Neonatal - organization & administration
Models, organizational
Organizational Case Studies
Patient Admission
Patient Transfer - organization & administration
Perinatal Care - organization & administration
Pregnancy
Quality Assurance, Health Care
Quebec
Abstract
: Health care transformations often involve the development of networks to ensure smooth and safe patient flows throughout the care continuum. However, more empirical information is needed on the workings of health networks and on how their structures, processes, and systems influence access to high-quality patient care.
: Using Miller's concept of configuration, we describe the workings of a health network specialized in the provision of neonatal-perinatal care, a specialty where accessibility issues are quite problematic. We aimed to generate evidence that will assist policy makers, network managers, and clinicians in facilitating access to high-quality neonatal-perinatal care.
: From late 2007 to early 2008, we conducted a case study of all (N = 7) neonatal intensive care units (NICUs) in the province of Quebec (Canada). We performed field work into two purposefully selected NICUs. This involved 450 hours of nonparticipant observation and 56 semistructured interviews with various actors. Data from these sources were triangulated with data collected during informal interviews with key actors from the other five NICUs in the province and from administrative databases.
: We found that the elements of this health network are pulled together by a core orchestrating theme: "Forcing the system." Indeed, in attempting to fulfill the network mission of providing access to high-quality neonatal-perinatal care, clinicians and managers must implement various strategies to compensate for the misfit of the configuration. Although these strategies are successful in providing access to neonatal-perinatal care, they, however, have adverse effects that are paradoxically in contradiction with the network's core mission.
: This configuration analysis enabled us to identify a set of modifiable elements that contribute to the misfit of the configuration and its suboptimal functioning. The comprehensiveness of the configuration approach was proven useful for the analysis of such a complex organizational form.
PubMed ID
21646883 View in PubMed
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57 records – page 1 of 6.