Browsing by Author "Ronksley, Paul"
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Item Open Access A Scoping Review of Self-Report Measures Used to Assess Individual and Contextual Determinants of COVID-19 Vaccination in General Population Samples(2023-08-24) Moran, Chelsea Véronique; Campbell, Tavis; Ronksley, Paul; McDonough, Meghan; Boucher, Jean-Christophe; Kennedy, EricIntroduction: Understanding vaccine refusal is crucial for enhancing COVID-19 vaccination rates. There has been a surge in survey-based research using self-report measures to identify predictors of COVID-19 vaccination uptake. The validity of research findings greatly depends on the use of appropriate and rigorous measurement practices. This dissertation aims to describe constructs and evaluate measurement practices in peer-reviewed studies on determinants of COVID-19 uptake in general population samples. Methods: A scoping review adhering to PRISMA-ScR guidelines was conducted (Study 1, Chapter 2). This review focused on construct definition and theoretical representation, based on the Capability, Opportunity, Motivation, Behavior (COM-B) model, and examined the characteristics of self-report measures. A secondary analysis of data from this scoping review, supplemented by a targeted search strategy, identified validated self-report measures and critically appraised the quality of their measurement properties using the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance (Study 2, Chapter 3). Results: The comprehensive literature search identified 157 unique studies which reported on 425 constructs. Constructs representing the motivation dimension of the COM-B model were prominent, while capability and opportunity factors were often neglected. Frequently assessed constructs included positive and negative attitudes, intentions, beliefs, willingness, and hesitancy. The results revealed conceptual overlap in construct definitions and inconsistent use of construct labels. Most self-report measures were developed by study authors, used in only one study retrieved, and lacked reporting of psychometric properties. Study 2 identified ten validated self-report measures assessing COVID-19 vaccine attitudes, beliefs, hesitancy, and anxiety, with generally inadequate quality of psychometric evidence examined and limited reporting of methods used to ascertain content validity. Although the Vaccination Concerns in COVID-19 Scale (VaCCS) demonstrated the highest quality evidence for measurement properties, none of the measures retrieved in Study 2 could be recommended without further research to further quantify their measurement properties. Conclusion: This dissertation offers guidance on construct definition and measure selection for future research on COVID-19 vaccination determinants. Further research is needed to standardize construct definitions, confirm the measurement properties of existing measures, and develop measures to assess social and environmental factors. Recommendations for improving measurement practices are discussed.Item Open Access Assessing Changes in Relational Continuity of Care Among Adults with Vulnerable Housing in a Transitional Case Management Program(2022-06-17) Chiew, Alexandra; McBrien, Kerry; Fabreau, Gabriel; Ronksley, PaulBackground: Individuals with vulnerable housing commonly experience barriers to health and social care. Connect 2 Care (C2C) is a case management intervention that connects people with vulnerable housing and high acute care use to community-based care. Relational continuity of care, a proxy for stable patient-provider relationships, is associated with improved patient outcomes in the general population. We assessed whether adults with vulnerable housing experience improved primary care use and relational continuity following C2C engagement, and evaluated predictors of improved continuity. Methods: We used practitioner claims data to conduct a pre-post cohort study with 390 adults engaged with C2C. Participants must have been homeless or vulnerably housed, had ≥3 emergency department presentations or ≥2 hospitalizations within the past year, and ≥3 primary care visits pre- and post-C2C for continuity analyses. We examined changes in the proportion of low primary care users (<3 visits/year) using McNemar’s test. Relational continuity was measured at the provider and site level using the Usual Provider of Care (UPC) and Continuity of Care (COCI) indices. We performed paired t-tests to compare continuity within the year pre- and post-C2C and multivariable logistic regression to identify characteristics associated with improved continuity. Results: Of 390 participants, 220 had ≥3 primary care visits pre- and post-C2C and 116 were low primary care users. Following C2C engagement, the proportion of low primary care users significantly decreased by 15% in absolute terms and continuity of care significantly increased. Pre- to post-C2C, there was a mean increase of 0.04 in provider- and site-UPC. Similar increases were observed for the COCI, though only the increase in site-COCI was significant. Stratified analyses demonstrated no differences in effect on care continuity in subgroups across 11 patient characteristics and we did not identify characteristics associated with increased continuity following C2C engagement. Significance: Our results suggest that Connect 2 Care was associated with improved primary care use and relational continuity of care among individuals with vulnerable housing. These findings add to our understanding of how primary care access may be improved using case management interventions in this population.Item Open Access Correction to: Methods for identifying 30 chronic conditions: application to administrative data(2019-09-04) Tonelli, Marcello; Wiebe, Natasha; Fortin, Martin; Guthrie, Bruce; Hemmelgarn, Brenda R; James, Matthew T; Klarenbach, Scott W; Lewanczuk, Richard; Manns, Braden J; Ronksley, Paul; Sargious, Peter; Straus, Sharon; Quan, HudeFollowing publication of the original manuscript [1], the authors noted several errors in Table 1. Details of the requested corrections are shown below:Item Open Access Creating a Frailty Case Definition for Primary Care EMR Using Machine Learning(2021-05-04) Aponte-Hao, Zhi Yun (Sylvia); Williamson, Tyler; Lee, Joon; McBrien, Kerry; Ronksley, PaulBackground: Frailty is a geriatric syndrome characterized by increased vulnerability and increased risk of adverse events. The Clinical Frailty Scale (CFS) is a judgement-based scale used to identify frailty in senior populations (over the age of 65). Primary care electronic medical records (EMRs) contain routinely collected medical data and can be used for frailty screening. There is currently no method to detect frailty automatically using primary care electronic medical records that aligns with the CFS definition. Purpose: To create a machine learning based algorithm for the identification of frailty in routinely collected primary care electronic medical records. Methods: Primary care physicians within the Canadian Primary Care Sentinel Surveillance Network retrospectively identified frailty in 5466 senior patients from their own practice using the CFS, and the corresponding patient EMR data were extracted and processed as features. The patient data were split 30-70, with 30% being the hold-out set used for final testing and 70% for the training set. A collection of machine learning algorithms was created using the training dataset, including regularized logistic regression models, support vector machines, random forests, k-nearest neighbours, classification and regression trees, feedforward neural networks, Naïve Bayes, and XGBoost. A balanced training dataset was also created by oversampling. Sensitivity analyses were also performed using two alternative dichotomization cut-offs of frailty. Final model performance was assessed using the hold-out dataset, and reported using ROC, accuracy, F1-score, sensitivity, specificity, positive and negative predictive values. Results: 18.4% of patients were classified as frail based on a CFS score of 5 and above. Of the 8 models developed, an XGBoost model had the best classification performance, with sensitivity of 78.14% and specificity of 74.41%. Neither the balanced training dataset, nor the sensitivity analyses using two alternative cut-offs resulted in improved performance. Conclusion: Supervised machine learning was able to distinguish between frail and non-frail patients with good performance. Future work may wish to develop a protocol for standardized assignment of the CFS, use all available unstructured and structured data, and supplement with additional geriatric-specific data.Item Open Access Decade of Turmoil: A Characterization of a Specialized Refugee Health Clinic 2011-2020(2023-05-03) Norrie, Eric Culham; Fabreau, Gabriel; McBrien, Kerry; Ronksley, Paul; Montesanti, StephanieBackground: Canadian refugee healthcare has been impacted by periodic upheavals including federal funding cuts, Syrian and Yazidi resettlement programs, and COVID-19. These upheavals may have led to changes in clinic use, demographics, clinic policy, or may impact provider wellness. Refugees are a vulnerable population with specific biopsychosocial health needs. One model of care that can address these needs is a specialized refugee health clinic. Understanding the impacts of recent upheavals on a specialized refugee health clinic’s utilization, its staff and clinicians is critical. Methods: We used a mixed methods sequential explanatory case study design to investigate changes (including patient demographic characteristics, clinic utilization, and care adaptations), at a specialized refugee health clinic in Calgary from 2011 to 2020, across five time periods: Pre-Interim Federal Health Program (IFHP) Cuts, IFHP Cuts, Syrian Surge, Yazidi Period, and COVID-19. We used segmented linear regression (SLR), Kruskal-Wallis, and chi-square analyses to assess quantitative changes to utilization and demographics across these time periods. Then we conducted semi-structured interviews with clinic leadership which we analyzed thematically. Finally, we merged our quantitative and qualitative findings, by assessing which of our qualitative themes converged with our quantitative findings during each time period. Results: We included 10,661 patients in our quantitative analysis; 48.2% were female and the mean age was 24.4 years (SD: 17.0). The most common region of origin was first East Africa, and then West Asia after the Syrian period. Total monthly appointments increased 576% from 478/month to 2752/month over 10 years. The mean appointments/month increased significantly (p<0.05) during each time period, but the rate of increase varied. Our qualitative and merged results converged with and expanded upon these quantitative results, especially by emphasizing the impact of health system upheavals on provider wellness. Conclusion: Utilization increased greatly over different policy changes and a pandemic, at a specialized refugee clinic over ten years. These upheavals challenged clinic leadership and providers to adapt. Qualitative participants consistently indicated that the stress of these upheavals negatively impacted staff wellness and patient care. Canada and other countries of resettlement should consider how health policies and other upheavals may have downstream consequences.Item Open Access Determining the Association between Continuity of Primary Care and Acute Care Use among Adult Patients with Chronic Kidney Disease in Alberta(2021-06-22) Chong, Christy C.E.; Ronksley, Paul; Elliott, Meghan; Campbell, David; Aghajafari, FaribaBackground: Acute care use is high among individuals with chronic kidney disease (CKD). It is unclear how relational continuity of primary care influences downstream acute care use. Aim: To determine if poor relational continuity of primary care is associated with higher rates of all-cause and potentially preventable acute care use among adults with CKD. This project had two objectives:1) To describe the relational continuity of primary care received among adults with CKD in Alberta over a 2-year period and,2) To determine if poor relational continuity of care is associated with higher rates of all-cause and CKD-related ACSC hospitalization and ED visits among adults with CKD.Design and Setting: A population-based retrospective cohort study of adults with stages 3 and 4 CKD and at least three visits to a primary care provider between April 1, 2011 to March 31, 2014 in Alberta, Canada.Method: Relational continuity was calculated using the Usual Provider Continuity index and descriptive statistics were used to summarize patient and acute care encounter characteristics. Adjusted rates (per 1,000 person-years) and incidence rate ratios for all-cause and CKD-related ambulatory care-sensitive condition (ACSC) hospitalizations and emergency department (ED) visits were estimated using negative binomial regression modelling. Results: Among 86,475 individuals with CKD, 51.3%, 30.0%, and 18.7% of patients had high, moderate, and poor continuity of primary care, respectively. There were 77,988 all-cause hospitalizations, 204,615 all-cause ED visits, 6,489 (8.3% of all hospitalizations) CKD-related ACSC hospitalizations, and 8,461 (4.1% of all ED visits) CKD-related ACSC ED visits during a median follow-up of 2.3 years. Rates of all-cause hospitalization and ED use increased with poorer continuity of primary care in a stepwise fashion across CKD stages. Poor continuity of primary care was also associated with higher rates of CKD-related ACSC hospitalization and ED visits, particularly among individuals with stage 3 CKD. Conclusion: Poor continuity of care is associated with increased acute care use and targeted strategies are needed to strengthen patient-provider relationships within primary care among those with CKD.Item Open Access Exploring Transitions in Care Among Patients with Head and Neck Cancer: A Multimethod Study(2023-12-20) Kersen, Jaling Kathleen; Sauro, Khara; Ronksley, Paul; Roach, Pamela; Chandarana, ShamirIntroduction: Head and Neck Cancers (HNC) are the 6th most common cancer worldwide. Due to the complex nature of HNC, treatments are multifaceted and focus on diverse anatomical structures. As such, patients with HNC experience many Transitions in Care (TiC), which occur when patients transfer between healthcare providers, institutions, and settings. Although a necessary component of patient care, TiC represent a vulnerable point in the journey and are associated with compromised patient safety, decreased patient satisfaction, and increased healthcare costs. However, our understanding of TiC among patients with HNC is lacking. The objective of this multimethod study was to understand TiC among patients with HNC and identify opportunities to improve care for patients with HNC. Methods: This multimethod study consisted of two phases: a retrospective cohort study and qualitative description. Phase I was a retrospective population-based cohort study that characterized the number and type of TiC that patients with HNC experienced using routinely collected populations-based administrative health databases including the Alberta Cancer Registry, Discharge Abstract Database, the National Ambulatory Care Reporting System, and Physician Claims between January 1, 2012, to December 1, 2019. Both patient demographic and TiC variables were dichotomously coded and described using descriptive statistics. In Phase II, semi-structured interviews were used to explore the lived experiences of patients with HNC and their healthcare providers during TiC. Two independent reviewers used an inductive approach to thematically analyze the semi-structured interview transcripts. Results: In Phase I, there were 2,208 patients with HNC who were mostly male (71.1%), classified as Stage IV HNC at diagnosis (62.4%) and had two or more tumours (91.3%). Patients with HNC often underwent multiple treatment modalities (average: 1.5), with the most common treatment transitions being from surgery to radiotherapy (29.7%). Many patients with HNC were admitted to the hospital and emergency department during the study period, averaging 2.0 hospital admissions and 13.2 emergency departments per patient during the study period. Patients with HNC also experienced many TiC between healthcare providers, with the highest number of physician visits being to general practitioners (average= 62.24 per patient). In Phase II, there were 16 semi-structured interviews conducted with ten patients with HNC and six healthcare providers. The experiences of patients with HNC and their healthcare providers revealed three interconnected themes related to TiC: 1) Navigating the Healthcare System (subthemes include: Head and Neck Cancer Care Complexities, Disrupted Continuity of Head and Neck Cancer Care, and Healthcare System Pressures), 2) Relational Head and Neck Cancer Care (subthemes include: Patient Expectations during Transitions in Care, Feeling Valued as a Head and Neck Cancer Patient and Healthcare Provider Roles and Responsibilities) and 3) System and Individual Impact of Transitions in Care (subthemes include: Impact of Resource-intensive Nature of TiC and the Impact of Transitions in Care on Quality of Care). Conclusions: In sum, this study identifies the challenges faced by both patients with HNC and their healthcare providers amidst the frequent TiC within HNC. This study suggests TiC may have an impact on the quality of care and provides crucial insights that can inform and guide future research or the development of health interventions aiming to improve the quality of care during TiC within this patient population. These findings also identified potentially feasible interventions for further exploration, such as shared decision-making, telehealth, or a patient navigator within HNC care.Item Open Access Exploring transitions in care among patients with head and neck CANCER: a multimethod study(2024-09-05) Kersen, Jaling; Roach, Pamela; Chandarana, Shamir; Ronksley, Paul; Sauro, KharaAbstract Background Patients with head and neck cancers (HNC) experience many transitions in care (TiC), occurring when patients are transferred between healthcare providers and/or settings. TiC can compromise patient safety, decrease patient satisfaction, and increase healthcare costs. The evidence around TiC among patients with HNC is sparse. The objective of this study was to improve our understanding of TiC among patients with HNC to identify ways to improve care. Methods This multimethod study consisted of two phases: Phase I (retrospective population-based cohort study) characterized the number and type of TiC that patients with HNC experienced using deterministically linked, population-based administrative health data in Alberta, Canada (January 1, 2012, to September 1, 2020), and Phase II (qualitative descriptive study) used semi-structured interviews to explore the lived experiences of patients with HNC and their healthcare providers during TiC. Results There were 3,752 patients with HNC; most were male (70.8%) with a mean age at diagnosis of 63.3 years (SD 13.1). Patients underwent an average of 1.6 (SD 0.7) treatments, commonly transitioning from surgery to radiotherapy (21.2%). Many patients with HNC were admitted to the hospital during the study period, averaging 3.3 (SD 3.0) hospital admissions and 7.8 (SD 12.6) emergency department visits per patient over the study period. Visits to healthcare providers were also frequent, with the highest number of physician visits being to general practitioners (average = 70.51 per patient). Analysis of sixteen semi-structured interviews (ten patients with HNC and six healthcare providers) revealed three themes: (1) Navigating the healthcare system including challenges with the complexity of HNC care amongst healthcare system pressures, (2) Relational head and neck cancer care which encompasses patient expectations and relationships, and (3) System and individual impact of transitions in care. Conclusions This study identified challenges faced by both patients with HNC and their healthcare providers amidst the frequent TiC within cancer care, which was perceived to have an impact on quality of care. These findings provide crucial insights that can inform and guide future research or the development of health interventions aiming to improve the quality of TiC within this patient population.Item Open Access Healthcare Utilization Among Young Adult Survivors of Childhood Cancer in Canada: The Role of Patient-Level Factors(2024-09-20) Drummond, Rachelle Marie; Schulte, Fiona; Campbell, Tavis; Reynolds, Kathleen; Ronksley, PaulBackground: Survivors of childhood cancer (SCC) face substantive risks for developing late effects (LE) from their cancer treatments due to disruptions in crucial periods of physical and social development while undergoing cancer treatment (Tonorezos et al., 2022; Baker & Syrjala, 2018). The inappropriate use of healthcare services, whether underutilization or overutilization, may jeopardize the effective risk-based prevention and management of LE among SCC. In addition, inappropriate healthcare utilization (HCU) may contribute to unsustainability and inefficiency in the healthcare system, creating challenges for supporting the growing population of survivors in Canada. Despite existing knowledge that young adult (YA) SCC are at a heightened high risk for the development of LE and life-long complications from their treatments, limited research exists that describes HCU among this population. The two aims of this study were to 1) identify and explore the associations of survivor’s demographics (i.e., sex, gender, age, race, geographic location, SES), knowledge of cancer history and risks, and psychological factors (i.e., anxiety, depression) and perceived vulnerability with healthcare utilization; and 2) examine the relationships among demographic, clinical, and psychological patient-level factors with HCU among YA SCC. Methods: Canadian YA SCC (n=123; 31% male; mean age=28.19yrs, mean time post treatment= 16.56yrs) diagnosed <18 years of age; and >5 years from diagnosis and/or >2 years from treatment completed the Self-Report Survey of Cancer Knowledge (Kunin-Batson et al., 2016), and the Self-Report Survey of Core Health Beliefs (Tercyak et al., 2004), to assess knowledge of cancer history and risks and perceived vulnerability, respectively. Survivors completed the Patient-Reported Outcomes Measurement Information System (PROMIS) SF v1.0 Anxiety 8a and the PROMIS SF v1.0 Depression 8a to assess levels of anxiety and depression respectively. To assess HCU, survivors reported the number of times that they saw a doctor within the last 2 years, in relation to their cancer diagnosis. A bivariate logistic regression model examined associations between YA SCC’s demographics, knowledge of cancer history, and psychological factors with HCU. Results: Survivors reported a wide range of HCU rates over the past 2 years (median= 3-4 visits). The number of reported visits ranged from 0-20+ visits. Despite 45.5% of reported health problems being attributed to mental health, psychiatrists and psychologists/counselors were the third and fourth least utilized types of providers, respectively. A logistic regression model was conducted to assess the associations between HCU and patient-related factors. The model was significant X2(8) =23.68, p=0.003, and accounted for 29.3% of variance in healthcare utilization among YA SCC (NagelKerke R2= 0.293). Anxiety was the only independent variable that contributed significantly to the model (p<0.001), and higher anxiety scores were associated with increased odds of HCU. Conclusion: Anxiety levels were a significant predictor of HCU rates within this population, whereby higher anxiety scores were associated with higher HCU rates. Based on the findings of this study, behavioral interventions could be beneficial in reducing anxiety among YA SCC and promoting appropriate risk based HCU that support the long-term well-being of survivors, and the sustainability of the healthcare system.Item Open Access Identifying Chronic Kidney Disease in the Community: The See Kidney Disease Targeted Screening Program(2015-09-30) Galbraith, Lauren; Hemmelgarn, Brenda; Ronksley, PaulBackground: Guidelines recommend early identification of chronic kidney disease (CKD), with targeted screening as a potential method. Methods: The See Kidney Disease (SeeKD) targeted screening program screened 5,194 participants for CKD across Canada. Participant characteristics and clinical measures, including point-of-care creatinine testing for at-risk participants to determine unrecognized CKD (estimated glomerular filtration rate < 60 mL/min/1.73m2), were obtained. Individual counselling sessions were provided to participants as a behaviour change intervention. Results: The majority of participants (88.9%) had at least one risk factor for CKD, amongst whom the prevalence of unrecognized CKD was 18.8%. The majority of respondents to the post-screening survey (89.8%) self-reported a health behaviour change 2-4 weeks after their individual counselling session. Conclusion: The SeeKD program was able to identify a high prevalence of unrecognized CKD. Individual counselling may be an important component in facilitating health behaviour change among participants at risk of CKD.Item Open Access New ileostomy formation and subsequent community-onset acute and chronic kidney disease: A population-based cohort study(2017) Smith, Stephen; James, Matthew; Dixon, Elijah; Ronksley, Paul; Buie, W. DonaldIleostomy formation results in a loss of colonic absorptive capacity, which may cause volume depletion and kidney disease; however, associations with acute kidney injury (AKI) and chronic kidney disease (CKD) are uncertain. This thesis reports a population-based cohort study that characterizes the relationships between ileostomy formation and subsequent community-onset AKI and CKD. A total of 19,889 patients that underwent surgery in Alberta, Canada between May 2002 and January 2015 were included; 4136 patients that underwent ileostomy formation were compared to 15,753 patients that underwent bowel resection without ileostomy formation. After statistical adjustment using logistic regression, ileostomy formation was associated with subsequent community-onset AKI (OR=4.08; 95% CI=3.62-4.61) and CKD (OR=4.71; 95% CI=3.84-5.77). A series of risk prediction models of these outcomes after ileostomy formation were subsequently developed and evaluated. Clinicians should be vigilant for kidney disease following ileostomy formation and future studies should focus on developing preventative strategies.Item Open Access Prevalence of polypharmacy and associated adverse health outcomes in adult patients with chronic kidney disease: protocol for a systematic review and meta-analysis(2021-07-04) Okpechi, Ikechi G.; Tinwala, Mohammed M.; Muneer, Shezel; Zaidi, Deenaz; Ye, Feng; Hamonic, Laura N.; Khan, Maryam; Sultana, Naima; Brimble, Scott; Grill, Allan; Klarenbach, Scott; Lindeman, Cliff; Molnar, Amber; Nitsch, Dorothea; Ronksley, Paul; Shojai, Soroush; Soos, Boglarka; Tangri, Navdeep; Thompson, Stephanie; Tuot, Delphine; Drummond, Neil; Mangin, Dee; Bello, Aminu K.Abstract Background Polypharmacy, often defined as the concomitant use of ≥ 5 medications, has been identified as a significant global public health threat. Aging and multimorbidity are key drivers of polypharmacy and have been linked to a broad range of adverse health outcomes and mortality. Patients with chronic kidney disease (CKD) are particularly at high risk of polypharmacy and use of potentially inappropriate medications given the numerous risk factors and complications associated with CKD. The aim of this systematic review will be to assess the prevalence of polypharmacy among adult patients with CKD, and the potential association between polypharmacy and adverse health outcomes within this population. Methods/design We will search empirical databases such as MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, and PsycINFO and grey literature from inception onwards (with no language restrictions) for observational studies (e.g., cross-sectional or cohort studies) reporting the prevalence of polypharmacy in adult patients with CKD (all stages including dialysis). Two reviewers will independently screen all citations, full-text articles, and extract data. Potential conflicts will be resolved through discussion. The study methodological quality will be appraised using an appropriate tool. The primary outcome will be the prevalence of polypharmacy. Secondary outcomes will include any adverse health outcomes (e.g., worsening kidney function) in association with polypharmacy. If appropriate, we will conduct random effects meta-analysis of observational data to summarize the pooled prevalence of polypharmacy and the associations between polypharmacy and adverse outcomes. Statistical heterogeneity will be estimated using Cochran’s Q and I2 index. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., sex, kidney replacement therapy, multimorbidity). Discussion Given that polypharmacy is a major and a growing public health issue, our findings will highlight the prevalence of polypharmacy, hazards associated with it, and medication thresholds associated with adverse outcomes in patients with CKD. Our study will also draw attention to the prognostic importance of improving medication practices as a key priority area to help minimize the use of inappropriate medications in patients with CKD. Systematic review registration PROSPERO registration number: [ CRD42020206514 ].Item Open Access The role of Community Health Navigators in the creation of plans to support patients with chronic conditions: A sub study of the ENCOMPASS trial(2022-07-05) Leong, Michelle; McBrien, Kerry; Campbell, David; Ronksley, PaulBackground: Patients with chronic conditions implement care plans in the community but barriers to care, such as financial constraints, may hinder their abilities to do so. Support from patient navigators has been shown to improve health disparities associated with socioeconomic barriers and increase patient adherence with care plans. However, the role of patient navigators in providing individualized support to address unique patient needs is not well defined in the literature. The ENhancing COMmunity health through Patient navigation, Advocacy and Social Support (ENCOMPASS) research program in Calgary is testing a patient navigation program to address patient barriers and build self-efficacy. Non-clinically trained Community Health Navigators (CHNs) are paired with patients diagnosed with two or more (of a set of six) common chronic conditions and provide support by helping patients set and meet priorities. Purpose: To explore if and how CHNs tailor their plans of support to address patient social and/or health-related needs in the ENCOMPASS program of research. Methods: A multimethod qualitative description approach was used. Case notes completed by CHNs documenting information on patient barriers, priorities, and the CHN’s support plan for each patient priority were analyzed. Two reviewers subjectively assessed Priority-CHN plans to determine the appropriateness of the plan. Patient priorities and CHN plans of support were coded separately using thematic codebook analysis, with codes being subsequently linked and quantitized to show percent correlation. Descriptive statistics was used to summarize findings. Results: 86 patients were included in the analysis. A total of 179 patient priorities were evaluated and 157 priorities (88%) were assessed as having CHN support plans that had a reasonable link to addressing the priority. The strongest correlations between a priority and support plan were found for: medication adherence and CHN verifying adherence to care plan (100%); transportation and CHN facilitating transportation (90%); increasing knowledge about medical information and CHN gathering and sharing information (60%). Conclusion: CHNs planned diverse and appropriate supports to help address patient priorities. Future work should consider linking the supports provided by CHNs during the intervention to patient priorities and barriers to further understand how CHNs provide tailored support.Item Open Access Teaching Mental Health in the Classroom: A Mixed-Methods Investigation of a Mental Health Literacy Program in Elementary Schools(2023-06) Sadler, Daniel; Ronksley, Paul; McCaughey, Deirdre; Metcalfe, Amy; Milaney, KatrinaBackground: Mental illnesses are the largest disease burden for adolescents, affecting 20% of youth in Canada. As mental health needs arise earlier and with greater prevalence it is essential to work upstream and prepare youth before psychological distress emerges. When implemented in the classroom as part of the educational curriculum, Mental Health Literacy (MHL) fulfills these goals as a universal response to the myriad of societal and development stressors experienced by youth. Aim: The overall aim of this program evaluation was to investigate the experience of educators in delivering the Elementary Mental Health Literacy Resources (EMHLR) program during a 4-month trial. The specific objectives were to identify the individual (educator) and organizational (district) level barriers and facilitators to delivery of the EMHLR to improve future implementation of the program. Design and Setting: An explanatory sequential design collected educator experience through a feedback survey which informed group interviews. Participants were elementary school educators primarily from the provinces of British Columbia and New Brunswick. Methods: The feedback survey collected demographics and feedback on each module taught using five-point Likert scales. The feedback survey also included multiple solicitations for qualitative feedback. Group interviews were held to further explore survey responses. Findings were integrated using the RE-AIM framework to identify barriers and facilitators and develop considerations for implementation. Results: System level barriers included preexisting stigma around mental health, competing priorities for classroom time and access, and cultivating buy-in from educational leadership. Individual level barriers included the time required to teach the EMHLR curriculum and to develop the skills and knowledge to teach MHL. The flexible design of the EMHLR curriculum alongside key implementation strategies of advocacy, practice champions, and professional development were seen as facilitators. Conclusion: Adolescents are ready to engage in their mental health. Mental Health Literacy offers the language to communicate about their experience clearly and accurately. The EMHLR curriculum offers an evidence-based and adaptable means to build the MHL of youth across Canada. This could result in significant improvements in adolescent mental health but requires intentional implementation strategies to be successful.Item Open Access Transitions in Care and Healthcare Resource Use in Critically Ill Patients Living in Urban and Rural Settings: A Retrospective Cohort Study(2023-09-21) Thomas, Abigail; Sauro, Khara; Fiest, Kirsten; Ronksley, Paul; Parhar, KenObjective: To examine healthcare resource use and patient outcomes among critically ill patients who live in urban versus rural settings. Design: Retrospective cohort study. Setting: Medical, medical-surgical, and cardiovascular intensive care units (ICUs) in Alberta, Canada between January 1, 2014, and April 30, 2018. Patients: Those who survived their index ICU stay, remained in ICU for ≥24 hours before ICU discharge, and had 1-year of follow-up post-index ICU admission. Interventions: None. Measurements and Main Results: Of 20,659 patients, 25.0% lived in a rural setting at the time of their index ICU admission. Urban and rural ICU patients had similar baseline demographic characteristics, with differences in admitting location and discharge destination. Rural ICU patients were admitted to ICU from inpatient units less than urban patients (76.3%, 84.2%). Differences in discharge destination were also apparent, with rural ICU patients seeing a general practitioner as their first provider after hospital discharge (53.3%), while urban patients saw specialists (59.7%). Rural and urban ICU patients did not differ in their use of continuous renal replacement therapy, though rural ICU patients in the lowest quintile of material deprivation had lower odds of requiring mechanical ventilation during their ICU stay than their urban counterparts (OR: 0.87, 95% CI: 0.76-0.99). Rural ICU patients had greater odds of adverse events while in hospital (OR: 1.39, 95% CI: 1.09-1.78) and 30-day ICU readmission after hospital discharge compared to urban patients, regardless of social deprivation and sex. Conclusions: While critically ill patients living in urban and rural settings are similar at the time of ICU admission and have similar clinical courses in ICU, their care and outcomes differ after ICU discharge. Lack of access to care in rural areas may be related to these differences. Strategies to improve healthcare access in these areas are needed to ensure high-quality care for critically ill patients living in rural settings.