Understanding frostbite presentation and distribution of care in Ontario 2010-2018.

ENVIRONMENTAL SCAN OF SELF-IDENTIFIED HEART FAILURE CLINICS IN ONTARIO

The lack of effective systems to appropriately manage the health and social care of frail older adults - especially among those who become homebound - is becoming all the more apparent. Home-based primary care (HBPC) is increasingly being promoted as a promising model that takes into account the accessibility needs of frail older adults, ensuring that they receive more appropriate primary and community care. There remains a paucity of literature exploring patients' experiences with HBPC programmes. The purpose of this study was to explore the experiences of patients accessing HBPC delivered by interprofessional teams, and their perspectives on the facilitators and barriers to this model of care in Ontario, Canada. Using certain grounded theory principles, we conducted an inductive qualitative content analysis of in-depth patient interviews (n=26) undertaken in the winter of 2013 across seven programme sites exploring the lived experiences and perspectives of participants receiving HBPC. Themes emerged in relation to patients' perceptions regarding the preference for and necessity of HBPC, the promotion of better patient care afforded by the model in comparison to office-based care, and the benefits of and barriers to HBPC service provision. Underlying patterns also surfaced related to patients' feelings and emotions about their quality of life and satisfaction with HBPC services. We argue that HBPC is well positioned to serve frail homebound older adults, ensuring that patients receive appropriate primary and community care - which the office-based alternative provides little guarantee - and that they will be cared for, pointing to a model that may not only lead to greater patient satisfaction but also likely contributes to bettering the quality of life of a highly vulnerable population.

Introduction: Antipsychotic use in Long-Term Care (LTC) in Ontario, Canada continues to pose a challenge in the care of older adult patients living in these institutions. The dangers and patterns of inappropriate prescribing have been documented frequently. Most of the current literature focuses on dementia and behavioral and psychological symptoms of dementia, the role of prescribers, or on interprofessional interventions with person-centered care to address the behavior. Very little discussion has focused on the role of nurse practitioners and other frontline long-term care staff in the assessment and interactions with residents that may result in prescriptions of antipsychotics. Objectives: The purpose of this population based retrospective study of data from all LTC facilities in Ontario, Canada in 2019-2020 was to determine the extent to which antipsychotic medications were used in and the factors associated with this use. Reflections about the NP role are discussed. Results: The results demonstrate that over thirty percent of residents in LTC continue to receive antipsychotics and those with the responsive behaviours are significantly more likely to be prescribed antipsychotics. Conclusions: The findings identify a potential link between over-burdened front-line staff and increased antipsychotic prescriptions, as well as continued use of antipsychotics in attempts to prevent harm to residents and staff at long-term care homes. Recommendations are made that include changes to legislation that will ensure optimal front-line care and time for care, increased training for front line staff and, in particular, how the role of the nurse practitioner in LTC can be utilized to optimize the appropriate use of antipsychotics, and the support of discontinuing or decreasing the dose of antipsychotics when required.

These two mixed method studies are among the first to focus on resilience among Canadian Aboriginal (i.e., First Nations, Metis, and Inuit) youth living in out-of-home care. The first study was quantitative and consisted of cross-sectional and longitudinal components. For the cross-sectional investigation, the participants consisted of 510 First Nations (237 females, 273 males aged 10-16 years), 39 Metis (15 females, 24 males aged 10-16 years), and 10 Inuit young people (2 females, 8 males aged 10-16 years) who were drawn from an ongoing study of young people in out-of-home care in Ontario collected during 2007-2008. The second Canadian adaptation of the Assessment and Action Record (AAR-C2-2006; Flynn, Ghazal, & Legault, 2006) from the ongoing Ontario Looking After Children (OnLAC) project was used to collect data. The criterion variables were the young person’s self-esteem, score on a suicidality index, educational performance, pro-social behaviour, and positive emotional and behavioural development. The predictor variables included the young person’s gender, ethnicity, age, behavioural difficulties, cognitive impairments, attainment of LAC goals, and number of developmental assets. The longitudinal investigation used the same design as study one, but examined the OnLAC data for year eight (2008-2009) in following 260 young people from the sample in study one. The second study was qualitative and involved interviewing 21 First Nations children and adolescents residing in out-of-home care in northern Ontario to obtain their views about resilience and the factors related to the presence or absence of resilient outcomes. The results provided some support for the hypothesis, in that a greater number of developmental assets were related to more positive outcomes on four of the five criterion variables. The results of the focus groups and in-depth interviews suggested that family members, members of the community (coaches), teachers, and child welfare workers, all play important roles in fostering the youths’ success.

This study explores interprofessional team members’ perspectives and experiences providing home-based primary care (HBPC) in Ontario, Canada. Employing an inductive qualitative methodology using procedures informed by grounded theory, themes emerged in the data in relation to the benefits of the HBPC model, and the barriers associated with its provision, as well as the key components that enable or hinder interprofessional collaboration in the HBPC environment. This research deepens our understanding of the key features and processes of interprofessional teams providing high-quality care in the home.

The demand for home care services is increasing, yet the literature describing the clinical characteristics of community-dwelling individuals with a history of stroke who receive home care is limited. In this retrospective, cross-sectional, population-level study, data were sourced from home care recipients aged 65+ who had a routine assessment using the Resident Assessment Instrument for Home Care (RAI-HC) in Ontario between January 2007 and December 2011. The RAI-HC contains several health status indicators and validated health index scales. The association of a history of stroke on health status was assessed through a series of logistic regression models, adjusted for age, sex, and number of comorbidities. Sex differences were also explored. A change in odds of ≥25% was considered to indicate a clinically important finding. From the home care data ( N = 319,694), 56,909 individuals had a stroke diagnosis, with approximately 86% diagnosed with ≥3 chronic conditions. A stroke diagnosis was associated with a higher risk of limitations or impairments with communication, locomotion, continence, activities of daily living, and cognitive performance. A clinically meaningful difference was not observed for symptoms of depression. Few sex differences were observed. In an effort to support the development of effective home and community-based care programs, research is needed to understand differences in community-dwelling versus institutional populations. Community-dwelling individuals with a history of stroke show higher levels of impairment and limitations compared with those without, suggesting areas where home care resources could be improved to help manage the chronic effects of stroke.

From 0-50 in Pandemic, and Then Back? A Case Study of Virtual Care in Ontario Pre–COVID-19, During, and Post–COVID-19

109 Background: Disease Pathway Management (DPM) is used by Cancer Care Ontario (CCO) to set priorities for cancer control, plan cancer services, and improve the quality of care in Ontario by promoting standardization. The DPM approach applies a framework to examine the performance of the entire system from prevention to end of life care, and to identify any gaps within the system. In 2014, DPM began its breast cancer pathway initiative by mapping the patient journey, depicting evidence-based best practice along the breast cancer care continuum, identifying where further guidance is needed for clinical decision making, and identifying gaps in quality of care and performance measurement indicators. Objective: To evaluate the impact of DPM on quality assessment of breast cancer care in Ontario. Methods: DPM convened a multidisciplinary breast cancer working group (WG) of 40 experts from across Ontario. The WG held 12 meetings and used guidelines developed by CCO’s Program in Evidence Based Care (or other sources as needed) to generate pathways for the prevention, screening and diagnosis, treatment, and follow-up care for breast cancer. The pathways were used as a framework to review the existing inventory of provincial breast cancer quality indicators, and to identify areas where evidence based guidance is needed. The pathways were subjected to an extensive review process before publication. Results: The expert WG identified 28 priority areas, including opportunities to develop guidance in areas where it is lacking (e.g. role of perioperative breast MRI; indications for contralateral prophylactic mastectomy) and system barriers that may hinder optimal care (e.g. biomarker assessment). The WG also used the pathways as a framework for evaluating performance measurement indicators by mapping 48 existing quality indicators for breast cancer to the pathway. Conclusions: The CCO DPM Breast Cancer pathways facilitated a province-wide, multidisciplinary process to promote quality standards, to identify gaps and overlaps in performance and quality measurement, and to recommend additional indicators more relevant to the quality of breast cancer care in Ontario.

This paper details a revolutionary approach to schizophrenia care in Ontario, emphasizing a collaborative, multi-agency partnership and an integrated care model. Central to this transformation is the introduction of new care coordinator roles, seamlessly integrating care across acute, tertiary, and community settings, with a focus on patient-centered approaches. A key innovation in our model is the mapping of care pathways and activities, based on best practices and quality standards, across the care continuum. Schizophrenia is a complex mental health disorder requiring a comprehensive and multifaceted treatment approach. Traditional care models have been plagued by fragmentation, leading to less than optimal patient outcomes. In response, our model offers an integrated approach to care coordination, crucial for bridging gaps between different healthcare settings. Care coordinators, equipped with specialized training in schizophrenia and mental health, are responsible for coordinating evidence-based, personalized care plans. A groundbreaking aspect of our model is the development and utilization of mapped care pathways, designed in accordance with the highest standards of best practice in schizophrenia treatment. These pathways guide the delivery of a shared, coordinated care plan, ensuring that every step in the patient's journey is aligned with proven standards for managing schizophrenia. This methodical approach has resulted in increased coordination of care activities and significant reductions in delays in treatment initiation and continuation. Patient-centered care remains a cornerstone of our model. By placing patients at the heart of the care process, we ensure their needs and preferences are prioritized. This strategy is underpinned by the latest evidence-based practices in schizophrenia care, guaranteeing the delivery of the most effective treatments available. Active involvement of patients and their families in care planning and decision-making processes is central to our approach, enhancing the responsiveness and personalization of the care provided. The integration of services across healthcare agencies is another critical component of our model. By eliminating the traditional barriers between acute, tertiary, and community care settings, we enable a more comprehensive approach to patient care. This inter-agency collaboration is essential for addressing the diverse needs of schizophrenia patients, who often require a combination of medical treatment, psychosocial support, rehabilitation, and community integration services. Preliminary outcomes of this model are promising, showing not only increased coordination of care activities but also a marked improvement in the management of psychosis symptoms. This enhancement in symptom control is a direct result of the timely and effective implementation of treatment plans. Additionally, the integrated care model offers the potential to improve overall health outcomes and reduce healthcare costs by decreasing the frequency of crisis situations and hospital readmissions. The transformation of schizophrenia care in Ontario through this innovative care model is a significant advancement in mental health treatment. The introduction of care coordinators, combined with the strategic mapping of care pathways and the emphasis on patient-centered care, represents a forward-thinking approach to managing schizophrenia. This model is already demonstrating tangible results in improving patient care and has the potential to serve as a benchmark for treating other complex health conditions.

The affordability of dental care continues to receive attention in Canada. Since most dental care is privately financed, the use of dental care is largely influenced by insurance coverage and the ability to pay-out-of pocket. i) to explore trends in self-reported cost barriers to dental care in Ontario; ii) to assess trends in the socio-demographic characteristics of Ontarians reporting cost barriers to dental care; and iii) to identify the trend in what attributes predicts reporting cost barriers to dental care in Ontario. A secondary data analysis of five cycles (2003, 2005, 2009-10, 2013-14 and 2017-18) of the Canadian Community Health Survey (CCHS) was undertaken. The CCHS is a cross-sectional survey that collects information related to health status, health care utilization, and health determinants for the Canadian population. Univariate and bivariate analyses were conducted to determine the characteristics of Ontarians who reported cost barriers to dental care. Poisson regression was used to calculate unadjusted and adjusted prevalence ratios to determine the predictors of reporting a cost barrier to dental care. In 2014, 34% of Ontarians avoided visiting a dental professional in the past three years due to cost, up from 22% in 2003. Having no insurance was the strongest predictor for reporting cost barriers to dental care, followed by being 20-39 years of age and having a lower income. Self-reported cost barriers to dental care have generally increased in Ontario but more so for those with no insurance, low income, and aged 20-39 years.

BackgroundHome care is integral to enabling older adults to delay or avoid long-term care (LTC) admission. To date, there is little population-based data about gender differences in home care users and their subsequent outcomes. Our objectives were to quantify differences between women and men who used home care in Ontario, Canada and to determine if there were subsequent differences in LTC admission.MethodsThis is a population-based retrospective cohort study. We identified all adults aged 76+ years living in Ontario and receiving home care on April 1, 2007 (baseline). Using the Resident Assessment Instrument – Home Care (RAI-HC) linked to other databases, we characterized the cohort by living condition, health and functioning, and identified all acute care and LTC use in the year following baseline.ResultsThe cohort consisted of 51,201 women and 20,102 men. Women were older, more likely to live alone, and more likely to rely on a child or child-in-law for caregiver support. Men most frequently identified a spouse as caregiver and their caregivers reported distress twice as often as women’s caregivers. Men had higher rates of most chronic conditions and were more likely to experience impairment. Men were more likely to be admitted to hospital, to have longer stays in hospital, and to be admitted to LTC.ConclusionsUnderstanding who uses home care and why is critical to ensuring that these programs effectively reduce LTC use. We found that women outnumbered men but that men presented with higher levels of need. This detailed gender analysis highlights how needs differ between older women, men, and their respective caregivers.

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Background:Despite its relative rarity, glomerulonephritis (GN) accounts for 20% ofprevalent end-stage renal disease patients in Ontario. Early identificationand appropriate management of GN to delay progression of disease can reducepatient morbidity and health system costs. As such, a provincial GN needsassessment was conducted to inform on the development of the provincial GNstrategic framework in Ontario.Objective:To understand the current state of GN care in Ontario from nephrologist,hospital administrator, and patient and family perspectives.Design:Cross-sectional.Settings:26 regional renal programs in Ontario.Patients:23 patients and family members living with GN who do not require renalreplacement therapy.Measurements:Patient and family member interviews as well as a survey ofnephrologists.Methods:The study included 3 components: (1) interviews with patients and familymembers, (2) a survey of nephrologists, and (3) interviews with regionalrenal programs. The Ontario Renal Network provincial office developed theneeds assessment questions and the physician survey questions afterconsultation with practicing nephrologists and hospital administrators.Thematic analysis was used to assess interview data and descriptivestatistics to assess survey data.Results:Interviews with patients and family members (n = 23) identified gaps in carerelated to diagnosis and referral to nephrology care, education anddecision-making, and psychosocial supports. The survey of nephrologists (n =74) identified various issues that contribute to unstandardized GN careacross Ontario, including a lack of provincial expertise in providingcomplex GN care, access to medication, multidisciplinary team support aswell as patient education, and psychosocial supports. Interviews withregional renal programs aligned with interview and survey findings (n =11).Limitations:Interviews with patients and family members were facilitated by 1 interviewerand limited to 20 interviews due to resource limitations. All nephrologists,patients, and family members who participated in the survey and interviewswere volunteers and English-speaking, which may have resulted inself-selection bias.Conclusions:The provincial GN needs assessment emphasized the necessity to develop andimplement a provincial GN strategy. The strategic framework includes 4objectives: (1) ensure patients are supported to make informed decisions,(2) establish a provincial model of care, (3) leverage data to enableplanning, decision-making, and monitoring of outcomes, and (4) ensureappropriate access to medication. This is the first Ontario strategy toaddress provincial gaps in GN care.

This article looks at home care in Ontario and its role as a foundation for a sustainable healthcare system in the future. Beginning with the history and evolution of the service delivery model, it examines current challenges and opportunities to unleash the potential of home care within a more integrated model for patient-centred care for the future. An in-depth look at how to better coordinate, integrate, and fund care for patients is highlighted.

ABSTRACTTo understand the impact of ongoing reform of mental health and dementia care in Ontario, an examination of prevalence and health services utilization rates is needed. However, there exists a gap in current prevalence and health services research specific to dementia care in Ontario. The objective of this study was to address these concerns using linked administrative databases to determine the incremental use of health services by elderly Ontarians with dementia. Overall, study results demonstrated that individuals with dementia used services in a pattern similar to non-demented persons, albeit at a higher level. Exceptions were women's use of hospital and home care services, where the most elderly women received significantly fewer services. Thus, the study provided important insight regarding the relative levels of health services used by demented Ontarians. Research in this area will become increasingly important as the population ages and the settings integral to dementia care and management shift and evolve.