Browsing by Author "Metcalfe, Amy Lynn"

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    Choosing the Right Model of Care Together: Informing an Equitable, Patient-Oriented Decision Aid for In-Person vs Virtual Care of Pediatric Chronic Pain
    (2024-09-17) Marbil, Mica Gabrielle Aragon; Birnie, Kathryn Ann Manson; Noel, Melanie Elizabeth; McArthur, Brae Anne; Metcalfe, Amy Lynn
    Background. Pediatric chronic pain management can occur virtually or in-person, but youth with chronic pain and their families may not be involved in decisions about treatment delivery. Decision aids can supplement shared decision-making, a collaborative decision-making approach between patients and health professionals, and promote patient involvement. To inform the development of a decision aid for in-person versus virtual pediatric chronic pain care, this study sought to understand decision-making practices for in-person versus virtual care (part A) and glean desired decision aid features (part B) from patients’ (youth and caregivers) and health professionals’ experiences. Methods. In part A, an online survey on virtual care and decision-making practices was sent to international pediatric pain clinics. Main findings were descriptively summarized. In part B, patients and health professionals completed an online demographics survey and a semi-structured interview on virtual care decision-making experiences to inform decision aid features. Reflexive thematic analysis described common themes. Results. In part A, 67 clinic responses were included. Virtual care constituted <25% of overall pediatric chronic pain management. Families were reported to play the largest role in decisions. Top factors influencing decision-making included new referrals, patient demographics and location, and patient values and preferences. Most clinics did not evaluate in-person versus virtual care decisions. In part B, 11 patients (5 youth, 6 caregivers) and 15 health professionals participated. Four main themes were generated from health professionals, suggesting that the decision aid should: 1) contextualize the individual patient; 2) promote patient engagement and adherence to care; 3) support clinician characteristics and values; and 4) contextualize the decision-making encounter. Three themes created from patient perspectives guide the decision aid to: 1) communicate patient needs and preferences; 2) facilitate navigation of the healthcare system; and 3) build partnership in a paternalistic system. Discussion. Decision-making for in-person versus virtual pediatric chronic pain management is not always shared. Patients and health professionals have individual preferences for decision-making processes. The future decision aid prototype should consider the unique contexts surrounding health professionals and patients to best support decision-making needs.
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    Does the Amount of Gestational Weight Gain Modify the Risk of Adverse Maternal and Neonatal Outcomes for Obese Women?
    (2017) Salmon, Charleen Nicole; Metcalfe, Amy Lynn; Sauve, Reg; LeJour, Caroline; Fenton, Tanis
    Background: Obesity during pregnancy is growing in prevalence. There has been a significant linear increase in the prevalence of obesity in American women from 35% (95% CI: 32 – 38) in 2005 to 40.5% (95% CI: 37.6 – 43.4) in 2014 (1). The increase in prevalence of obesity (body mass index (BMI) ≥ 30 kg/m2) is also seen in women of reproductive age (2). Previous studies suggested that the Institute of Medicine (IOM) gestational weight gain (GWG) guidelines needed modification by obesity severity. Objectives: The present study investigated whether the IOM guidelines for obese women needed modification for obesity severity by determining the risk of maternal, obstetric, and neonatal outcomes for class I, II and III obese pregnant women who either: lost weight during pregnancy, gained below the IOM guidelines, or gained above the IOM guidelines, compared to women who gained within the IOM guidelines (11-20 lbs). Methods: A cross-sectional study using 2014 U.S. birth certificate data (N=646,642). Chi-square tests examined associations between GWG categories and adverse outcomes. Log-binomial regression models were built to examine relative risks of adverse maternal, obstetric, and neonatal outcomes following adjustment for maternal age, education, marital status, race, insurance status, and parity. Results: The observed pattern of association was the same between all 3 obese classes indicating evidence for a single GWG recommendation for all 3 classes of obesity. Obese women who lost weight during pregnancy or gained below the IOM recommendations were at a significantly decreased risk for caesarean delivery (RR, 95% CI class I: 0.92, 0.90-0.94; II: 0.91, 0.89-0.93; III: 0.92, 0.90-0.93) and large-for-gestational age (LGA) births (class I: 0.80, 0.77-0.83; II: 0.76, 0.73-0.78; III: 0.73, 0.70-0.75) but had a significantly increased risk of small-for-gestational age (SGA) births (class I: 1.34, 1.26-1.43; II: 1.381.28-1.49; III: 1.35, 1.24-1.46) compared to women who had GWG within IOM guidelines. Obese women who gained above IOM guidelines were at an increased risk for caesarean delivery and LGA births but are at a decreased risk for SGA births. Conclusion: A single GWG recommendation for all obese women is possible, but 2009 IOM guidelines may need to be updated as current recommendations may be too high.
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    Impact of prenatal screening on future resource utilization in pregnancy
    (2012-09-26) Metcalfe, Amy Lynn; Tough, Suzanne
    In 2007, the Society of Obstetricians and Gynaecologists of Canada first recommended that prenatal screening for fetal aneuploidy be offered to all pregnant women. This is an important change in clinical obstetrics as previously these services had only been routinely offered to women who would be 35 or older at the time of delivery; however, maternal age alone is a poor predictor of fetal aneuploidy. Obtaining reliable data on prenatal screening utilization is problematic in Canada as these data are not collected in a systematic way nationally and, in many cases, not even provincially. This study aimed to understand utilization of prenatal screening in an Albertan context; to examine the impact of different prenatal screening strategies on health care utilization in pregnancy; and to estimate the incremental cost of prenatal screening when accounting for all of direct medical costs of this procedure including ancillary service use. Data on health resource utilization that occurred in the three months prior to pregnancy, during pregnancy and three months post-partum were collected from twelve unique clinical and administrative databases. Using deterministic linkage, participants from multiple databases were linked based on personal health number, gender and date of birth. This study found that utilization of prenatal screening tends to impact utilization of prenatal diagnostic services but not overall health resource utilization, and that there is a cost for prenatal screening but this cost may be less than what is suggested in the literature due to differences between hypothetical utilization patterns and actual resource utilization. It also suggests that current techniques used to identify women who have an increased risk of carrying a fetus with aneuploidy, may also be useful for identifying women who are at an increased risk of a variety of adverse pregnancy outcomes. With the rapid development of non-invasive prenatal testing, additional clinical changes in prenatal screening and diagnosis are likely to occur in the next few years. However, prior to abandoning screening in favour of non-invasive prenatal testing, the results of this work suggest that a more thorough evaluation of the impact of prenatal screening on non-aneuploidy outcomes may be warranted.