Browsing by Author "Crowshoe, Lynden"

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    A Retrospective Cohort Study of Health Service Utilization and Costs of People Experiencing Homelessness Following Community Paramedic Care
    (2021-09-22) Taplin, John G; Clement, Fiona; Barnabe, Cheryl; Cipriano, Lauren; Blanchard, Ian; Crowshoe, Lynden
    The City Centre Team (CCT) is a community paramedic program that delivers care to people experiencing homelessness in Calgary, Canada. This study compares the rates and characteristics of health service utilization and the associated costs of patients interacting with the service by linking multiple administrative databases (including hospitalizations, emergency department and urgent care centre visits, emergency medical services (EMS) events, physician claims, and pharmaceutical dispensations) in a pre-post retrospective cohort study. The primary outcome is the difference in ambulatory care sensitive condition-related hospitalizations in the year preceding the initial CCT visit and in the following year. Secondary outcomes are the differences between periods of all-cause hospitalizations, emergency department and urgent care centre visits, EMS events, physician claims, pharmaceutical dispensations, and costs. In the post-period, CCT patients had increased ambulatory care sensitive condition-related hospitalizations and associated costs compared to the pre-period. Except for all-cause hospitalizations, there was increased utilization and costs of health services between periods, with significant increases in community-based care in those that were previously underserved. The study characterizes and shows the impact on health service utilization in the initial 18-months of a community paramedic program directed at people experiencing homelessness. These findings inform decision-makers of a health service that can be developed in response to the complex health needs of an underserved population using community paramedics.
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    Participant-reported effect of an Indigenous health continuing professional development initiative for specialists
    (2021-02-18) Barnabe, Cheryl; Kherani, Raheem B; Appleton, Tom; Umaefulam, Valerie; Henderson, Rita; Crowshoe, Lynden
    Abstract Background Health outcomes of Indigenous patients are impacted by culturally unsafe specialty care environments. The ‘Educating for Equity (E4E)’ program is a continuing professional development (CPD) intervention which incorporates skill-based teaching to improve Indigenous patient experiences and outcomes in healthcare interactions. Methods The E4E program was delivered to rheumatologists in two phases, each delivered as experiential learning workshops where participants engaged with and applied course content within an interactive format focusing on real-time feedback. The phase 1 workshop focused on skill development of E4E Framework concepts and principles. Phase 2 concentrated on building capacity for teaching of E4E content. Evaluation of the program’s effectiveness was through longitudinal responses to the Social Cultural Confidence in Care Survey (SCCCS), self-reported strategies employed to address social issues and improve therapeutic relationships, engagement with teaching others, and satisfaction with the program. Results Two cohorts of participants have participated in the program (n = 24 Phase 1, n = 10 Phase 2). For participants completing both phases of training, statistically significant improvements were observed in exploring social factors with patients, gaining knowledge and skills related to cultural aspects of care, improved communication and relationship building, and reflections on held stereotypes. Strategies to address social issues and build therapeutic relationships remained consistent throughout participation, while the training enhanced exploration and confidence to ask about cultural and traditional practices, and stronger communication strategies for exploring beliefs, expectations, social barriers, and residential school impacts on health. Participants reported feeling prepared to teach Indigenous health concepts to others and subsequently lead teaching with residents, fellows, and allied health professionals. Satisfaction with the delivery and content of the workshops was high, and participants valued interactions with peers in learning. Conclusions This CPD intervention had a beneficial impact on self-reported confidence and enhanced practice strategies to engage with Indigenous patients.
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    “There are still a lot of things that I need”: a qualitative study exploring opportunities to improve the health services of First Nations People with arthritis seen at an on-reserve outreach rheumatology clinic
    (2020-11-25) Loyola-Sanchez, Adalberto; Pelaez-Ballestas, Ingris; Crowshoe, Lynden; Lacaille, Diane; Henderson, Rita; Rame, Ana; Linkert, Tessa; White, Tyler; Barnabe, Cheryl
    Abstract Background Arthritis is a highly prevalent disease and leading cause of disability in the Indigenous population. A novel model of care consisting of a rheumatology outreach clinic in an on-reserve primary healthcare center has provided service to an Indigenous community in Southern Alberta since 2010. Despite quality assessments suggesting this model of care improves accessibility and is effective in meeting treatment targets, substantial improvements in patient-reported outcomes have not been realized. Therefore, the objective of this study was to explore the experiences of Indigenous persons with arthritis and healthcare providers involved in this model of care to inform the development of health service improvements that enhance patient outcomes. Methods This was a narrative-based qualitative study involving a purposeful sample of 32 individuals involved in the Indigenous rheumatology model of care. In-depth interviews were conducted to elicit experiences with the existing model of care and to encourage reflections on opportunities to improve it. A two-stage analysis was conducted. The first stage aimed to produce a narrative synthesis of concepts through a dialogical method comparing people with arthritis and health providers’ narratives. The second stage involved a collective effort to synthesize concepts and propose specific recommendations to improve the quality of the current model of care. Triangulation, through participant checking and discussion among researchers, was used to increase the validity of the final recommendations. Results Ten Indigenous people with arthritis lived experience, 14 health providers and 8 administrative staff were interviewed. One main overarching theme was identified, which reflected the need to provide services that improve people’s physical and mental functioning. Further, the following specific recommendations were identified: 1) enhancing patient-provider communication, 2) improving the continuity of the healthcare service, 3) increasing community awareness about the presence and negative impact of arthritis, and 4) increasing peer connections and support among people living with arthritis. Conclusions Improving the quality of the current Indigenous rheumatology model of care requires implementing strategies that improve functioning, patient-provider communication, continuity of care, community awareness and peer support. A community-based provider who supports people while navigating health services could facilitate the implementation of these strategies.
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    Understanding virtual primary healthcare with Indigenous populations: a rapid evidence review
    (2023-03-29) Fitzpatrick, Kayla M.; Ody, Meagan; Goveas, Danika; Montesanti, Stephanie; Campbell, Paige; MacDonald, Kathryn; Crowshoe, Lynden; Campbell, Sandra; Roach, Pamela
    Abstract Background Virtual care has become an increasingly useful tool for the virtual delivery of care across the globe. With the unexpected emergence of COVID-19 and ongoing public health restrictions, it has become evident that the delivery of high-quality telemedicine is critical to ensuring the health and wellbeing of Indigenous peoples, especially those living in rural and remote communities. Methods We conducted a rapid evidence review from August to December 2021 to understand how high quality Indigenous primary healthcare is defined in virtual modalities. After completing data extraction and quality appraisal, a total of 20 articles were selected for inclusion. The following question was used to guide the rapid review: How is high quality Indigenous primary healthcare defined in virtual modalities? Results We discuss key limitations to the delivery of virtual care, including the increasing cost of technology, lack of accessibility, challenges with digital literacy, and language barriers. This review further yielded four main themes that highlight Indigenous virtual primary healthcare quality: (1) limitations and barriers of virtual primary healthcare, (2) Indigenous-centred virtual primary healthcare, (3) virtual Indigenous relationality, (4) collaborative approaches to ensuring holistic virtual care. Discussion: For virtual care to be Indigenous-centred, Indigenous leadership and users need to be partners in the development, implementation and evaluation of the intervention, service or program. In terms of virtual models of care, time must be allocated to educate Indigenous partners on digital literacy, virtual care infrastructure, benefits and limitations. Relationality and culture must be prioritized as well as digital health equity. Conclusion These findings highlight important considerations for strengthening virtual primary healthcare approaches to meet the needs of Indigenous peoples worldwide.