Browsing by Author "Hazlewood, Glen S."

Now showing 1 - 6 of 6
  • Thumbnail Image
    ItemOpen Access
    Development of an interdisciplinary early rheumatoid arthritis care pathway
    (2022-06-25) Gukova, Xenia; Hazlewood, Glen S.; Arbillaga, Hector; MacMullan, Paul; Zimmermann, Gabrielle L.; Barnabe, Cheryl; Choi, May Y.; Barber, Megan R. W.; Charlton, Alexandra; Job, Becky; Osinski, Kelly; Hartfeld, Nicole M. S.; Knott, Marlene W.; Pirani, Paris; Barber, Claire E. H.
    Abstract Background To develop an interdisciplinary care pathway for early rheumatoid arthritis (RA) including referral triage, diagnosis, and management. Methods Our process was a four-phase approach. In Phase 1, an anonymous survey was electronically distributed to division rheumatologists. This provided data to a small interprofessional working group of rheumatology team members who drafted an initial care pathway informed by evidence-based practice in Phase 2. In Phase 3, an education day was held with approximately 40 physicians (rheumatologists and rheumatology residents), members of our interprofessional team, and two clinic managers to review the proposed care elements through presentations and small group discussions. The care pathway was revised for content and implementation considerations based on feedback received. Implementation of the care pathway and development of strategies for evaluation is ongoing across multiple practice sites (Phase 4). Results Our care pathway promotes an approach to patient-centered early RA care using an interdisciplinary approach. Care pathway elements include triage processes, critical diagnostics, pre-treatment screening and vaccinations, and uptake of suggested RA pharmacologic treatment using shared decision-making strategies. Pathway implementation has been facilitated by nursing protocols and evaluation includes continuous monitoring of key indicators. Conclusion The ‘Calgary Early RA Care Pathway’ emphasizes a patient-centered and interdisciplinary approach to early RA identification and treatment. Implementation and evaluation of this care pathway is ongoing to support, highest quality care for patients.
  • Thumbnail Image
    ItemOpen Access
    Forecasting the Future: A Trek through the Changing Landscape of Inflammatory Bowel Disease
    (2019-06-06) Coward, Stephanie; Kaplan, Gilaad G.; Clement, Fiona M.; McBrien, Kerry Alison; Hazlewood, Glen S.; Congly, Stephen E.
    Inflammatory bowel disease (IBD) is an immune-mediated disease of the gastrointestinal tract. It imparts a lifelong burden once diagnosed, which can lead to medication reliance, hospitalizations, and surgeries. Previous research has elucidated the current state of knowledge on IBD, but what is missing from the field are analyses of IBD-related outcomes within a specific population, and analyses of what these outcomes mean for the future of IBD in that population.1,2 Therefore, the aim of this thesis is to give an overarching understanding of the current burden of IBD; forecast the future burden; and, illustrate what these findings mean for the future of Canadians and our healthcare systems. Administrative data were used to identify prevalent cases from seven provinces (95% of the Canadian population). In Alberta specifically, prevalent and incident cases were isolated and data on hospitalizations, surgeries, medications, and all-cause mortality data were obtained. Using regression analyses, temporal trends of prevalence, incidence, hospitalization (total, IBD-related, and IBD-specific), surgery, biologics (an expensive medication increasing in popularity for the treatment of IBD), and mortality were analyzed. Data on prevalence from all seven provinces were analyzed and forecasted to 2030. Alberta-specific data were used to forecast incidence to 2030, and hospitalizations and surgeries to 2021. Overall, the prevalence of IBD in Canada is significantly increasing. By 2030, an estimated 402,853 Canadians will be living with IBD. In Alberta, incidence is forecasted to continue to significantly decrease from 2015 through to 2030. Hospitalizations and surgeries have also been significantly decreasing in Alberta and are forecasted to continue decreasing through to 2021. The proportion of patients dispensed biologics has been significantly increasing, which is indicative of an increasing utilization of this medication. Finally, the mortality rate has remained stable. While the decrease of adverse IBD-related outcomes (e.g., hospitalization and surgery) prove to be beneficial for patients with IBD and healthcare systems, the significant increase in the number of people with the disease may still overwhelm the system and inhibit patients from receiving necessary care.
  • Thumbnail Image
    ItemOpen Access
    Identifying strategies that support equitable person-centred osteoarthritis care for diverse women: content analysis of guidelines
    (2023-09-14) Abuwa, Chidinma; Abbaticchio, Angelina; Theodorlis, Madeline; Marshall, Deborah; MacKay, Crystal; Borkhoff, Cornelia M.; Hazlewood, Glen S.; Battistella, Marisa; Lofters, Aisha; Ahluwalia, Vandana; Gagliardi, Anna R.
    Abstract Introduction Women are disproportionately impacted by osteoarthritis (OA) but less likely than men to access early diagnosis and management, or experience OA care tailored through person-centred approaches to their needs and preferences, particularly racialized women. One way to support clinicians in optimizing OA care is through clinical guidelines. We aimed to examine the content of OA guidelines for guidance on providing equitable, person-centred care to disadvantaged groups including women. Methods We searched indexed databases and websites for English-language OA-relevant guidelines published in 2000 or later by non-profit organizations. We used manifest content analysis to extract data, and summary statistics and text to describe guideline characteristics, person-centred care (PCC) using a six-domain PCC framework, OA prevalence or barriers by intersectional factors, and strategies to improve equitable access to OA care. Results We included 36 OA guidelines published from 2003 to 2021 in 8 regions or countries. Few (39%) development panels included patients. While most (81%) guidelines included at least one PCC domain, guidance was often brief or vague, few addressed exchange information, respond to emotions and manage uncertainty, and none referred to fostering a healing relationship. Few (39%) guidelines acknowledged or described greater prevalence of OA among particular groups; only 3 (8%) noted that socioeconomic status was a barrier to OA care, and only 2 (6%) offered guidance to clinicians on how to improve equitable access to OA care: assess acceptability, availability, accessibility, and affordability of self-management interventions; and employ risk assessment tools to identify patients without means to cope well at home after surgery. Conclusions This study revealed that OA guidelines do not support clinicians in caring for diverse persons with OA who face disadvantages due to intersectional factors that influence access to and quality of care. Developers could strengthen OA guidelines by incorporating guidance for PCC and for equity that could be drawn from existing frameworks and tools, and by including diverse persons with OA on guideline development panels. Future research is needed to identify multi-level (patient, clinician, system) strategies that could be implemented via guidelines or in other ways to improve equitable, person-centred OA care. Patient or public contribution This study was informed by a team of researchers, collaborators, and thirteen diverse women with lived experience, who contributed to planning, and data collection, analysis and interpretation by reviewing study materials and providing verbal (during meetings) and written (via email) feedback.
  • Thumbnail Image
    ItemOpen Access
    Multi-level strategies to improve equitable timely person-centred osteoarthritis care for diverse women: qualitative interviews with women and healthcare professionals
    (2023-10-07) Gagliardi, Anna R.; Abbaticchio, Angelina; Theodorlis, Madeline; Marshall, Deborah; MacKay, Crystal; Borkhoff, Cornelia M.; Hazlewood, Glen S.; Battistella, Marisa; Lofters, Aisha; Ahluwalia, Vandana
    Abstract Background Women are more likely to develop osteoarthritis (OA), and have greater OA pain and disability compared with men, but are less likely to receive guideline-recommended management, particularly racialized women. OA care of diverse women, and strategies to improve the quality of their OA care is understudied. The purpose of this study was to explore strategies to overcome barriers of access to OA care for diverse women. Methods We conducted qualitative interviews with key informants and used content analysis to identify themes regarding what constitutes person-centred OA care, barriers of OA care, and strategies to support equitable timely access to person-centred OA care. Results We interviewed 27 women who varied by ethno-cultural group (e.g. African or Caribbean Black, Chinese, Filipino, Indian, Pakistani, Caucasian), age, region of Canada, level of education, location of OA and years with OA; and 31 healthcare professionals who varied by profession (e.g. family physician, nurse practitioner, community pharmacist, physio- and occupational therapists, chiropractors, healthcare executives, policy-makers), career stage, region of Canada and type of organization. Participants within and across groups largely agreed on approaches for person-centred OA care across six domains: foster a healing relationship, exchange information, address emotions, manage uncertainty, share decisions and enable self-management. Participants identified 22 barriers of access and 18 strategies to overcome barriers at the patient- (e.g. educational sessions and materials that accommodate cultural norms offered in different languages and formats for persons affected by OA), healthcare professional- (e.g. medical and continuing education on OA and on providing OA care tailored to intersectional factors) and system- (e.g. public health campaigns to raise awareness of OA, and how to prevent and manage it; self-referral to and public funding for therapy, greater number and ethno-cultural diversity of healthcare professionals, healthcare policies that address the needs of diverse women, dedicated inter-professional OA clinics, and a national strategy to coordinate OA care) levels. Conclusions This research contributes to a gap in knowledge of how to optimize OA care for disadvantaged groups including diverse women. Ongoing efforts are needed to examine how best to implement these strategies, which will require multi-sector collaboration and must engage diverse women.
  • Thumbnail Image
    ItemOpen Access
    Policies in Canada fail to address disparities in access to person-centred osteoarthritis care: a content analysis
    (2024-04-25) Abbaticchio, Angelina; Theodorlis, Madeline; Marshall, Deborah; MacKay, Crystal; Borkhoff, Cornelia M.; Hazlewood, Glen S.; Battistella, Marisa; Lofters, Aisha; Ahluwalia, Vandana; Gagliardi, Anna R.
    Abstract Background Women are disproportionately impacted by osteoarthritis (OA) but less likely than men to access OA care, particularly racialized women. One way to reduce inequities is through policies that can influence healthcare services. We examined how OA-relevant policies in Canada address equitable, person-centred OA care for women. Methods We used content analysis to extract data from English-language OA-relevant documents referred to as policies or other synonymous terms published in 2000 or later identified by searching governmental and other web sites. We used summary statistics to describe policy characteristics, person-centred care using McCormack’s six-domain framework, and mention of OA prevalence, barriers and strategies to improve equitable access to OA care among women. Results We included 14 policies developed from 2004 to 2021. None comprehensively addressed all person-centred care domains, and few addressed individual domains: enable self-management (50%), share decisions (43%), exchange information (29%), respond to emotions (14%), foster a healing relationship (0%) and manage uncertainty (0%). Even when mentioned, content offered little guidance for how to achieve person-centred OA care. Few policies acknowledged greater prevalence of OA among women (36%), older (29%) or Indigenous persons (29%) and those of lower socioeconomic status (14%); or barriers to OA care among those of lower socioeconomic status (50%), in rural areas (43%), of older age (37%) or ethno-cultural groups (21%), or women (21%). Four (29%) policies recommended strategies for improving access to OA care at the patient (self-management education material in different languages and tailored to cultural norms), clinician (healthcare professional education) and system level (evaluate OA service equity, engage lay health leaders in delivering self-management programs, and offer self-management programs in a variety of formats). Five (36%) policies recommended research on how to improve OA care for equity-seeking groups. Conclusions Canadian OA-relevant policies lack guidance to overcome disparities in access to person-centred OA care for equity-seeking groups including women. This study identified several ways to strengthen policies. Ongoing research must identify the needs and preferences of equity-seeking persons with OA, and evaluate the impact of various models of service delivery, knowledge needed to influence OA-relevant policy.
  • Thumbnail Image
    ItemOpen Access
    Psoriatic Arthritis Screening: A Systematic Review, Meta-Analysis, and Economic Evaluation
    (2018-09-13) Iragorri Amaya, Nicolas; Spackman, Eldon; Manns, Braden; Hazlewood, Glen S.
    Psoriatic arthritis (PsA) is an autoimmune disease that affects the skin and the musculoskeletal system. It causes joint damage and psoriasis of the skin. Untreated disease is usually related to a delayed diagnosis and has been associated with physical disability and high treatment costs later on. Although expensive biologic therapy has proven to slow disease progression and improve health outcomes, rheumatologists have suggested initiating treatment with less expensive Disease Modifying Anti-Rheumatic Drugs (DMARDs). Identifying early PsA is expected to improve health outcomes through early treatment with DMARDs. It is also expected to reduce the proportion of severe disease and biologic treatment. Given that the prevalence of PsA among psoriasis patients is relatively high, dermatologists are well-positioned to screen for arthritis symptoms with already validated self-administered screening questionnaires for patients with psoriasis. The goal of this thesis is to systematically review the characteristics and accuracy estimates of the validated PsA screening tools (chapter 2). It also seeks to evaluate the cost-effectiveness of implementing a PsA screening program in Canada relative to the current practice where psoriasis patients are not systematically screened (chapter 3). The National Institute of Health Research is currently developing a randomized controlled trial for PsA screening in the United Kingdom that will inform the cost-effectiveness model presented in this thesis.