Annals of family medicine
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Annals of family medicine · Apr 2022
Implementation analysis of case management interventions for frequent users of healthcare services: A multiple-case study.
Context. Case management interventions (CMIs) are recognized to improve patients' experience of integrated care, to promote better utilization of healthcare resources, and to reduce emergency department visits, hospitalizations and health care costs. However, contextual factors influencing implementation of CMIs in primary care settings in Canada still need to be studied. ⋯ On the other hand, a culture of patient-centredness and collaboration; managerial and clinical leadership and support; and a positive perception of the CMI alongside provider engagement helps to overcome these barriers. Conclusions. This study may help researchers, decision-makers and clinicians plan the implementation of CMIs in primary care settings for frequent users of healthcare services with chronic diseases and complex care needs.
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Annals of family medicine · Apr 2022
The positive impact of a telemedicine education program on healthcare workers during the COVID-19 pandemic in Ontario, Canada.
Context The impact of the COVID-19 pandemic on health care service and delivery has been profound. In addition to shifting and expanding clinical responsibilities, rapidly evolving information and guidelines during the COVID-19 pandemic has made it difficult for healthcare workers (HCWs) to synthesize and translate COVID-19 information into practice. Objective The objectives of this study are 1) to examine the impact of a telemedicine education program on HCW's self-efficacy and satisfaction and 2) to explore HCWs' experience in the program and context of practice during the COVID-19 pandemic. ⋯ Median self-efficacy scores increased from 5 (IQR 4 - 6) to 6 (IQR 6 - 6) (p < 0.0001), independent of profession, years in practice, age group, or type of practice environment. Participants were highly satisfied with the ECHO sessions with a median score of 4 (IQR 4 - 5). FGD data indicated that HCWs gained knowledge through ECHO, established the context of their practice, and revealed facilitators for ECHO program success, including the transition to virtual care, the practicability of knowledge provided, and a "perspective from the trenches." Conclusions This study demonstrated that a telemedicine education program aimed to support HCWs in managing patients with COVID-19 had a positive impact on self-efficacy and satisfaction, and that this impact was specifically mediated through the ECHO program.
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Annals of family medicine · Apr 2022
Choosing active surveillance versus curative treatment in a population-based survey of men with low-risk prostate cancer.
Context: Active Surveillance (AS) is a preferred treatment option for low-risk prostate cancer (LPC) in current practice guidelines. Limited data as to factors influencing men's decision to choose AS. Objective: To identify determinants of initial treatment choice and whether race and geographical location influence the AS decision. ⋯ When "curing cancer" was highly influential, White men were less likely than Black men to choose AS (OR 0.5, 95%CI 0.2-0.9). Conclusions: In this population-based sample, more than half of patients with LPC chose AS. Many factors influenced patient's AS decision with Urologist's AS recommendation being the strongest predictor of patient's AS decision.
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Annals of family medicine · Apr 2022
Rapid adaptation of cancer screening practices during COVID-19: A multi-state qualitative study.
Context: The COVID-19 pandemic required primary care practices to rapidly adapt cancer screening procedures to comply with changing guidelines and policies. Objective: This study sought to: 1) identify cancer screening barriers and facilitators during the COVID-19 pandemic; 2) describe cancer screening adaptations; and 3) provide recommendations. Study design: A qualitative study was conducted (n= 42) with primary care staff. ⋯ Recommendations included more public health education about the importance of cancer screening during COVID-19, more mail-home testing, and expanded healthcare access (e.g., weekend clinic) to address patient backlogs for cancer screening. Conclusions: Primary care staff developed innovative strategies to adapt cancer screening during the COVID-19 pandemic. Unresolved challenges (e.g., patient backlogs) will require additional implementation stra.
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Annals of family medicine · Apr 2022
Evaluating student food selections after a nutrition education intervention in a montessori community school.
Context: Schools are unique sites for nutrition education interventions due to their ability to provide educational activities as well as meals, allowing for observation of behavior change. Nutrition education and physical activity awareness programs implemented in the school setting have the potential to positively impact students' eating habits. Eating habits are developed at a young age, but few efforts have been made to deliver and assess education interventions in the pre-K through grade 3 age group. ⋯ This analysis of production records showed a decline in acceptability of foods over the three years. It is unclear if these changes are directly related to the instructional program, due to the presence of confounding factors. Future studies should attempt to reevaluate nutrition education and subsequently conduct a plate-waste study for a more accurate representation of food consumption before and after an intervention.