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Academic Alternate Relationship Plans for internal medicine: a lever for health care transformation.

https://arctichealth.org/en/permalink/ahliterature129973
Source
Open Med. 2011;5(1):e28-32
Publication Type
Article
Date
2011
Author
Allison Bichel
Maria Bacchus
Jon Meddings
John Conly
Author Affiliation
Department of Medicine, Calgary Health Region, and University of Calgary, Calgary, Alberta.
Source
Open Med. 2011;5(1):e28-32
Date
2011
Language
English
Publication Type
Article
Keywords
Alberta
Diffusion of Innovation
Health Care Reform - methods
Health Care Surveys
Health Services Accessibility - organization & administration
Health services needs and demand
Humans
Internal Medicine - education
Poisson Distribution
Program Development
Schools, Medical - organization & administration - trends
Notes
Cites: Can Fam Physician. 2000 Jul;46:1438-4410925758
Cites: Can Respir J. 2009 Mar-Apr;16(2):49-5419399308
Cites: Can J Cardiol. 2008 Mar;24(3):195-818340388
Cites: CMAJ. 1999 Jun 15;160(12):1710-410410632
PubMed ID
22046217 View in PubMed
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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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The Alberta Cardiac Access Collaborative: improving the cardiac patient journey.

https://arctichealth.org/en/permalink/ahliterature146165
Source
Healthc Q. 2009;13 Spec No:85-90
Publication Type
Article
Date
2009
Author
Robyn Blackadar
Mishaela Houle
Author Affiliation
Alberta Cardiac Access Collaborative.
Source
Healthc Q. 2009;13 Spec No:85-90
Date
2009
Language
English
Publication Type
Article
Keywords
Alberta
Angioplasty, Balloon, Coronary
Benchmarking - organization & administration
Continuity of Patient Care - organization & administration
Coronary Artery Bypass
Evidence-Based Practice
Health Care Reform - organization & administration
Health Plan Implementation
Health Services Accessibility - organization & administration
Heart Diseases - therapy
Humans
National health programs - organization & administration
Organizational Case Studies
Program Development
Program Evaluation
Regional Health Planning - organization & administration
Systems Integration
Total Quality Management - organization & administration
Waiting Lists
Abstract
The Alberta Cardiac Access Collaborative (ACAC) is a joint initiative of Alberta's health system to improve access to adult cardiac services across the patient journey. ACAC has created new care delivery models and implemented best practices across Alberta in four streams across the continuum: heart attack, patient navigation, heart failure and arrhythmia. Emergency medical providers, nurses, primary care physicians, hospitals, cardiac specialists and clinicians are all working together to integrate services, bridge jurisdictions and geography with one aim--improving the patient journey for adults in need of cardiac care.
PubMed ID
20057256 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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Building access to specialist care through e-consultation.

https://arctichealth.org/en/permalink/ahliterature113781
Source
Open Med. 2013;7(1):e1-8
Publication Type
Article
Date
2013
Author
Clare Liddy
Margo S Rowan
Amir Afkham
Julie Maranger
Erin Keely
Author Affiliation
Department of Family Medicine, University of Ottawa, Ontario, Canada. CLiddy@bruyere.org
Source
Open Med. 2013;7(1):e1-8
Date
2013
Language
English
Publication Type
Article
Keywords
Focus Groups
Health Personnel - psychology
Health Services Accessibility - organization & administration
Humans
Internet
Ontario
Pilot Projects
Primary Health Care
Program Development
Remote Consultation - methods
Specialization
Abstract
Limited access to specialist care remains a major barrier to health care in Canada, affecting patients and primary care providers alike, in terms of both long wait times and inequitable availability. We developed an electronic consultation system, based on a secure web-based tool, as an alternative to face-to-face consultations, and ran a pilot study to evaluate its effectiveness and acceptability to practitioners.
In a pilot program conducted over 15 months starting in January 2010, the e-consultation system was tested with primary care providers and specialists in a large health region in Eastern Ontario, Canada. We collected utilization data from the electronic system itself (including quantitative data from satisfaction surveys) and qualitative information from focus groups and interviews with providers.
Of 18 primary care providers in the pilot program, 13 participated in focus groups and 9 were interviewed; in addition, 10 of the 11 specialists in the program were interviewed. Results of our evaluation showed good uptake, high levels of satisfaction, improvement in the integration of referrals and consultations, and avoidance of unnecessary specialist visits. A total of 77 e-consultation requests were processed from 1 Jan. 2010 to 1 Apr. 2011. Less than 10% of the referrals required face-to-face follow-up. The most frequently noted benefits for patients (as perceived by providers) included improved access to specialist care and reduced wait times. Primary care providers valued the ability to assist with patient assessment and management by having access to a rapid response to clinical questions, clarifying the need for diagnostic tests or treatments, and confirming the need for a formal consultation. Specialists enjoyed the improved interaction with primary care providers, as well as having some control in the decision on which patients should be referred.
This low-cost referral system has potential for broader implementation, once payment models for physicians are adapted to cover e-consultation.
Notes
Cites: Psychosomatics. 2007 Mar-Apr;48(2):135-4117329607
Cites: CMAJ. 2002 Feb 19;166(4):429-3411876170
Cites: Milbank Q. 2004;82(4):581-62915595944
Cites: Postgrad Med J. 1998 Dec;74(878):721-810320886
Cites: J Fam Pract. 1998 Nov;47(5):357-609834770
Cites: JAMA. 1998 Oct 21;280(15):1321-49794310
Cites: JAMA. 1998 Sep 9;280(10):905-99739975
Cites: JAMA. 1996 Jan 10;275(2):145-78531311
Cites: BMJ. 2003 Jul 12;327(7406):8412855528
Cites: J Telemed Telecare. 2002;8(2):102-611972945
Cites: Mil Med. 2002 Mar;167(3):200-411901566
Cites: Issue Brief (Commonw Fund). 2011 Oct;23:1-1422059281
Cites: Qual Saf Health Care. 2010 Oct;19(5):e5420554576
Cites: Stud Health Technol Inform. 2010;160(Pt 2):821-520841800
Cites: Health Care Manag (Frederick). 2009 Jan-Mar;28(1):14-819225331
Cites: J Telemed Telecare. 2005;11(2):60-7015829049
PubMed ID
23687533 View in PubMed
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Cardiac EASE (Ensuring Access and Speedy Evaluation)--design of a single point of entry and a multidisciplinary team to reduce waiting times in the Canadian health care system.

https://arctichealth.org/en/permalink/ahliterature153640
Source
Healthc Manage Forum. 2008;21(3):35-40
Publication Type
Article
Date
2008
Author
Tammy J Bungard
Marcie J Smigorowsky
Lucille D Lalonde
Terry Hogan
Evelyn Maier
Stephen L Archer
Author Affiliation
Division of Cardiology, Department of Medicine, University of Alberta, Canada.
Source
Healthc Manage Forum. 2008;21(3):35-40
Date
2008
Language
English
Publication Type
Article
Keywords
Alberta - epidemiology
Cardiology Service, Hospital - organization & administration - utilization
Cardiovascular Diseases - diagnosis - epidemiology - therapy
Efficiency, Organizational
Health Services Accessibility - organization & administration
Hospitals, University - utilization
Humans
Models, organizational
National Health Programs
Organizational Case Studies
Patient care team
Program Development
Referral and Consultation - organization & administration - utilization
Remote Consultation - organization & administration
Time Management
Triage
Waiting Lists
Abstract
Out-patient cardiac consultation in academic group practices often lacks a coordinated intake process, making it difficult to perform prospective testing or to direct undifferentiated consultations to the cardiologist with the shortest waiting list. We created a programmatic approach, with a single point of entry to improve the efficiency of cardiology consultation, without departing from the Canada Health Act. The purpose of this paper is to describe the design of Cardiac EASE.
PubMed ID
19086484 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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68 records – page 1 of 7.