Browsing by Author "Finlay, Juli"

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    Elephants on a Flatbed Truck: Ethnography of an Integrated Applied Health Services Research Collaboration
    (2014-09-23) Finlay, Juli; Mather, Charles
    Previous studies of science reveal that research collaborations require negotiations as researchers form themselves into a project team that confronts a research question, collects data, and transforms the data into agreed-upon facts. Collaborations that span geographic, institutional, and epistemic borders are increasing in frequency. Funding agencies like Canada’s health research grant agency, CIHR, are encouraging collaborations that span multiple academic disciplines and include research users throughout the research process. This change from the traditional research model has the potential to affect the academic and health services landscapes through its emphasis on non-traditional research products and CIHR’s expectation that research users will allocate portions of their limited time budget to areas of knowledge production that may not be of interest to non-researchers. Erevna is the pseudonym for a five-year CIHR-funded multidisciplinary applied health services research project examining new knowledge uptake by health care aides in seniors’ long-term care facilities across Canada’s Prairie Provinces. Erevna’s project team included investigators from several universities and decision makers from provincial health authorities, and urban and rural elder care facilities. The team’s varied membership, specifically the inclusion of research users in the project’s formative stages, provided an opportunity to document a boundary-spanning research collaboration as it unfolded. Existing studies of science have focused on laboratory and natural scientists. Erevna, as an applied health services research project, took place firmly in the “real world” of Canada’s long-term care sector. This setting’s inherent heterogeneity brought with it complexities not found in controlled laboratory settings, or in studies that do not involve human beings interacting naturally. Through long-term ethnographic fieldwork spread over more than two years, I used actor-network theory to explore how people spanning institutional, organizational, provincial, and national boundaries formed into an actor-network that pursued a common goal and how Erevna’s actor-network persisted over five-years. I also documented the challenges to Erevna’s stability. In this dissertation, I compare Erevna’s public and behind-the-curtain narratives revealing the complexities of science-in-the-making that published accounts generally omit. I examine how membership in Erevna’s component social worlds and epistemic cultures influenced the collaboration. Finally, I explore the construction of Erevna’s actor-network, and examine effective and ineffective strategies for its maintenance.
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    Patient and provider experience and perspectives of a risk-based approach to multidisciplinary chronic kidney disease care: a mixed methods study
    (2019-03-29) Smekal, Michelle D; Tam-Tham, Helen; Finlay, Juli; Donald, Maoliosa; Thomas, Chandra; Weaver, Robert G; Quinn, Robert R; Tam, Kin; Manns, Braden J; Tonelli, Marcello; Bello, Aminu; Tangri, Navdeep; Hemmelgarn, Brenda R
    Abstract Background The Kidney Failure Risk Equation (KFRE) predicts risk of progression to kidney failure and is used to guide clinical decisions for patients with chronic kidney disease (CKD). Methods The KFRE was implemented to guide access to multidisciplinary care for CKD patients in Alberta, Canada, based on their 2-year risk of kidney failure. We used a mixed methods approach to investigate patients’ and providers’ perspectives and experiences 1 year following KFRE implementation. We conducted post-implementation interviews with multidisciplinary clinic providers and with low-risk patients who transitioned from multidisciplinary to general nephrology care. We also administered pre- and post-implementation patient care experience surveys, targeting both low-risk patients discharged to general nephrology and high-risk patients who remained in the multidisciplinary clinic, and provider job satisfaction surveys. Results Twenty-seven interviews were conducted (9 patients, 1 family member, 17 providers). Five categories were identified among patients and providers: targeted care; access to resources outside the multidisciplinary clinics; self-efficacy; patient reassurance and reduced stress; and transition process for low-risk patients Two additional categories were identified among providers only: anticipated concerns and job satisfaction. Patients and providers reported that the risk-based approach allowed the clinic to target care to those most likely to experience kidney failure and most likely to benefit from multidisciplinary care. While some participants indicated the risk-based model enhanced the sustainability of the clinics, others expressed concern that care for low-risk patients discharged from multidisciplinary care, or those now considered ineligible, may be inadequate. Overall, 413 patients completed the care experience survey and 73 providers completed the workplace satisfaction survey. The majority of patients were satisfied with their care in both periods with no overall differences. When considering the responses “Always” and “Often” together versus not, there were statistically significant improvements in domains of access to care, caring staff, and safety of care. There were no differences in healthcare providers’ job satisfaction following KFRE implementation. Conclusions Patients and healthcare providers reported that the risk-based approach improved the focus of the multidisciplinary CKD clinics by targeting patients at highest risk, with survey results suggesting no difference in patient care experience or healthcare provider job satisfaction.
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    “You need a team”: perspectives on interdisciplinary symptom management using patient-reported outcome measures in hemodialysis care—a qualitative study
    (2023-01-20) Baragar, Brigitte; Schick-Makaroff, Kara; Manns, Braden; Love, Shannan; Donald, Maoliosa; Santana, Maria; Corradetti, Bonnie; Finlay, Juli; Johnson, Jeffrey A.; Walsh, Michael; Elliott, Meghan J.
    Abstract Background Patient-reported outcome measures (PROMs) are standardized instruments used for assessing patients’ perspectives on their health status at a point in time, including their health-related quality of life, symptoms, functionality, and physical, mental, and social wellbeing. For people with kidney failure receiving hemodialysis, addressing high symptom burden and complexity relies on care team members integrating their expertise to achieve common management goals. In the context of a program-wide initiative integrating PROMs into routine hemodialysis care, we aimed to explore patients’ and clinicians’ perspectives on the role of PROMs in supporting interdisciplinary symptom management. Methods We employed a qualitative descriptive approach using semi-structured interviews and observations. Eligible participants included adult patients receiving intermittent, outpatient hemodialysis for > 3 months, their informal caregivers, and hemodialysis clinicians (i.e., nurses, nephrologists, and allied health professionals) in Southern Alberta, Canada. Guided by thematic analysis, team members coded transcripts in duplicate and developed themes iteratively through review, refinement, and discussion. Results Thirty-three clinicians (22 nurses, 6 nephrologists, 5 allied health professionals), 20 patients, and one caregiver participated in this study. Clinicians described using PROMs to coordinate care across provider types using the resources available in their units, whereas patients tended to focus on the perceived impact of this concerted care on symptom trajectory and care experience. We identified 3 overarching themes with subthemes related to the role of PROMs in interdisciplinary symptom management in this setting: (1) Integrating care for interrelated symptoms (“You need a team”, conducive setting, role clarity and collaboration); (2) Streamlining information sharing and access (symptom data repository, common language for coordinated care); (3) Reshaping expectations (expectations for follow-up, managing symptom persistence). Conclusions We found that use of PROMs in routine hemodialysis care highlighted symptom interrelatedness and complexity and helped to streamline involvement of the interdisciplinary care team. Issues such as role flexibility and resource constraints may influence sustainability of routine PROM use in the outpatient hemodialysis setting.