Canadian Health Services Research Articles

Community capacity to acquire, assess, adapt, and apply research evidence: a survey of Ontario's HIV/AIDS sector

BackgroundCommunity-based organizations (CBOs) are important stakeholders in health systems and are increasingly called upon to use research evidence to inform their advocacy, program planning, and service delivery. To better support CBOs to find and use research evidence, we sought to assess the capacity of CBOs in the HIV/AIDS sector to acquire, assess, adapt, and apply research evidence in their work.MethodsWe invited executive directors of HIV/AIDS CBOs in Ontario, Canada (n = 51) to complete the Canadian Health Services Research Foundation's "Is Research Working for You?" survey.FindingsBased on responses from 25 organizations that collectively provide services to approximately 32,000 clients per year with 290 full-time equivalent staff, we found organizational capacity to acquire, assess, adapt, and apply research evidence to be low. CBO strengths include supporting a culture that rewards flexibility and quality improvement, exchanging information within their organization, and ensuring that their decision-making processes have a place for research. However, CBO Executive Directors indicated that they lacked the skills, time, resources, incentives, and links with experts to acquire research, assess its quality and reliability, and summarize it in a user-friendly way.ConclusionGiven the limited capacity to find and use research evidence, we recommend a capacity-building strategy for HIV/AIDS CBOs that focuses on providing the tools, resources, and skills needed to more consistently acquire, assess, adapt, and apply research evidence. Such a strategy may be appropriate in other sectors and jurisdictions as well given that CBO Executive Directors in the HIV/AIDS sector in Ontario report low capacity despite being in the enviable position of having stable government infrastructure in place to support them, benefiting from long-standing investment in capacity building, and being part of an active provincial network. CBOs in other sectors and jurisdictions that have fewer supports may have comparable or lower capacity. Future research should examine a larger sample of CBO Executive Directors from a range of sectors and jurisdictions.

A review of Canadian health care and cancer care systems

Canada is a westernized, market-economy nation with a publicly funded health care and cancer control system and has health indices reflective of a high-resource economy. Provision of health services is in accord with the Canada Health Act and is implemented through federal, provincial, and territorial relations wherein federal funding partly provides support for the provincial/territorial delivery of health services. Cancer services are provided within the acute health care system with dedicated entities existing in parallel in most provinces to provide services specific to the diagnosis, treatment, and support of cancer patients. Interprovincial and territorial collaboration to enhance and facilitate optimal cancer system performance is enabled through the Canadian Partnership Against Cancer (the Canadian national cancer control initiative). Adolescent and young adult (AYA) cancer patients use both the pediatric and adult cancer systems. There is recognition, however, that although AYA patients are numerically a small portion of all cancer patients, the negative personal, societal, and socioeconomic impacts of potential years of life lost are substantial and can be lessened through attention to awareness, education, redesign of care and care pathways, quality of life, developmental aspects related to adolescent-teen-adult transitions, continuity of care, and surveillance across pediatric and adult settings. Appropriate solutions need to be established within the framework of the Canadian Health Service by innovative rethinking and realignment of system capacity and performance to the special needs of AYA cancer patients.

Book Review: Epidemiology Mental Disorders in Canada: An Epidemiological Perspective

Mental Disorders in Canada: An Epidemiological Perspective John Cairney, David L Streiner, editors. Toronto (ON): University of Toronto Press; 2010. 432 p. CanS37.95 Reviewer rating: Good Epidemiology This edited volume was produced to celebrate contributions of late Alexander Leighton to field of psychiatric epidemiology in Canada. Leighton carried out Stirling County Study, initiating our modem approach to psychiatric epidemiology through community surveys. The aim of book is to provide a of research in psychiatric epidemiology in Canada1'5 and editors contend that no such review currently exists. This work certainly provides a single source for interested readers to capture major epidemiologic research that has been carried out over last 3 decades in Canada. These experts discuss both breakthroughs and blemishes of these previous works. For example, in terms of blemishes, 2002 Canadian Community Health Survey, Cycle 1.2: Mental Health and Weil-Being (CCHS 1 .2) is criticized for choosing to only partially code mental disorders from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, making it difficult to compare these results with other major surveys. Regarding breakthroughs, same CCHS 1.2 provides first pan-Canadian data on co-occurring mental disorders and substance use problems; specifically, 1 .7% or 435 000 people in Canada suffered from mood or anxiety disorders and substance use problems during 2002, year of survey. The contributors to volume are who's who of Canadian psychiatric epidemiology, including John Cairney, current president of Canadian Academy of Psychiatric Epidemiology; David Streiner, our Canadian guru on measurement and statistics; Roger Bland, executive medical director at Alberta Health Board; Paula Goering, Canadian Institutes of Health Research and Canadian Health Services Research Foundation Chair in health services research; and Isaac Sakinofsky, Canadian expert in epidemiology of suicide, to name but a few of distinguished contributors. The book is organized into 6 parts: context and theory; methodological issues; epidemiology of disorders; special topics, including prevalence of disorders in migrants and among criminal offenders; mental health care services, policy; and final thoughts. Several important issues are raised from this work. The first chapter by Streiner and Cairney gives an interesting brief history of psychiatric epidemiology; I was reading this as country was debating Conservative Government's decision to abolish mandatory long-form census. Streiner and Cairney recall sixth US census conducted in 1840 that attempted to count the insane at a national level. …

Sense of Community Belonging and Health in Canada: A Regional Analysis

This article investigates the association between sense of community belonging and health among settlements of different size and across the urban to rural continuum in Canada. Using data from the recent 2007/08 Canadian Community Health Survey (CCHS), the objective is to identify the major health, social and geographic determinants of sense of community belonging and to consider policy options aimed at improving sense of belonging among certain segments of the population. The research found a significant and consistent association between sense of belonging and health, particularly mental health, even when controlling for geography and socio-economic status. At the same time, sense of community belonging improved progressively across the urban to rural continuum with remarkably high levels of belonging evident in the outer most regions of Canada. Despite the health deficit that exists in rural and small-town Canada, the paper postulates that these communities are able to overcome health challenges to create conditions conducive to a positive sense of belonging. Overall, sense of belonging was also found to be highest among seniors, people residing in single-detached homes and among couples with children and was lowest among youth, residents of high-rise apartments and among single-parents. Finally, in the context of addressing deficiencies in sense of belonging, the paper examines several recent policy developments aimed at improving mental health services in Canada.

Nurse Executives’ Perceptions of the Executive Training for Research Application (EXTRA) Program

To improve the overall quality and effectiveness of the Canadian health care system through better decisions supported by research-based evidence (RBE), the Canadian Health Services Research Foundation (CHSRF) and partners have created the Executive Training for Research Application (EXTRA) program. To evaluate how nurse executive fellows perceive changes in their levels of knowledge of RBE and in their level of use of RBE following participation in the EXTRA program. Nurse executives in the first four cohorts of the program (2004-2007) completed a survey during their 2-year fellowship period. Statistically significant improvements were observed regarding nurse executives' perceived knowledge and use of RBE. According to the participants, the EXTRA fellowship contributes to their role and function in their organization by providing tools, learning, and access to resources and networking, which contributes to their credibility, leadership, and knowledge transfer skills. The EXTRA program has been structured to reduce barriers and to enhance the facilitators found in the literature on the implementation of evidence-based practices (EBP) in health care settings. Overall, nurse executives perceived that the benefits of participating in the EXTRA program were both individual and organizational.

Inequity in access to cancer care: a review of the Canadian literature

Despite the policy and research attention on ensuring equitable access--equal access for equal need--to health care, research continues to identify inequities in access to cancer services. We conducted a literature review to identify the current state of knowledge about inequity in access to cancer health services in Canada in terms of the continuum of care, disease sites, and dimensions of inequity (e.g., income). We searched MEDLINE, CINAHL, and Embase for studies published between 1990 and 2009. We retrieved 51 studies, which examine inequity in access to cancer services from screening to end-of-life care, for multiple cancer types, and a variety of socioeconomic, geographic, and demographic factors that may cause concern for inequity in Canada. This review demonstrates that income has the most consistent influence on inequity in access to screening, while age and geography are most influential for treatment services and end-of-life care, even after adjusting for patient need. Our review also reports on methods used in the literature and new techniques to explore. Equitable access to cancer care is vitally important in all health systems. Obtaining information on the current status of inequities in access to cancer care is a critical first step toward action.

A decade of knowledge translation research—what has changed?

Knowledge translation (KT) is perhaps an overused term. It reportedly has around 90 synonyms and a wide range of definitions [ 1 Straus S.E. Tetroe J. Graham I. Defining knowledge translation. CMAJ. 2009; 181: 165-168 Crossref PubMed Scopus (507) Google Scholar , 2 Kitson A. Phil D. Straus S.E. The knowledge-to-action cycle: identifying the gaps. CMAJ. 2010; 182: E73-E77 Crossref PubMed Scopus (62) Google Scholar , 3 Gagliardi A. Perrier L. Webster F. Leslie K. Bell M. Levinson W. et al. Exploring mentorship as a strategy to build capacity for knowledge translation research and practice: protocol for a qualitative study. Implement Sci. 2009; 4: 55 Crossref PubMed Scopus (35) Google Scholar , 4 Straus S. Haynes R.B. Managing evidence-based knowledge: the need for reliable, relevant and readable resources. CMAJ. 2009; 180: 942-945 Crossref PubMed Scopus (74) Google Scholar ]. The Canadian Institutes of Health Research (CIHR) define KT as “the exchange, synthesis and ethically sound application of knowledge—within a complex system of interactions among researchers and users—to accelerate the capture of the benefits of research for society through improved health, more effective services and products, and a strengthened health care system” [ [5] Canadian Institutes of Health Research Canadian Institutes of Health Research knowledge translation strategy 2004–2009. http://www.cihr-irsc.gc.ca/e/26574.html#defining Google Scholar ]. Straus et al. [ [1] Straus S.E. Tetroe J. Graham I. Defining knowledge translation. CMAJ. 2009; 181: 165-168 Crossref PubMed Scopus (507) Google Scholar ] prefer to describe KT as “the methods for closing the gaps from knowledge to practice.” This has an appealing directness. In the United Kingdom, and in other jurisdictions, the investigation of KT is rather prosaically known as “implementation research” [ [1] Straus S.E. Tetroe J. Graham I. Defining knowledge translation. CMAJ. 2009; 181: 165-168 Crossref PubMed Scopus (507) Google Scholar ]. This nicely captures the intent of most KT—to ensure that research findings are implemented appropriately and for the net benefit of patients and the public. KT has been the subject of a great deal of investment in several countries. Research funding agencies, such as the UK National Health Service have created new expectations of researchers, such as the recent trend to require lodgment of publications in digital repositories. This has led to a number of national governments have supported free access to the Cochrane Library. In Canada, the federal government has wavered on the latter; however, the CIHR has provided funding for the Canadian Cochrane Center, supported a number of integrated KT activities (for instance, the partnerships for Health System Improvement competition), provided required specification of end-of-grant KT, and has sponsored a number of policy development forums [ 6 Canadian Institutes of Health Research. About knowledge translation 2009. Google Scholar , 7 Canadian Health Services Research Foundation Summary of the article from research to practice: a knowledge transfer planning guide. Insight and Action. 2007; Google Scholar ].

Advanced Practice Nursing in Canada: Overview of a Decision Support Synthesis

The objective of this decision support synthesis was to identify and review published and grey literature and to conduct stakeholder interviews to (1) describe the distinguishing characteristics of clinical nurse specialist (CNS) and nurse practitioner (NP) role definitions and competencies relevant to Canadian contexts, (2) identify the key barriers and facilitators for the effective development and utilization of CNS and NP roles and (3) inform the development of evidence-based recommendations for the individual, organizational and system supports required to better integrate CNS and NP roles into the Canadian healthcare system and advance the delivery of nursing and patient care services in Canada. Four types of advanced practice nurses (APNs) were the focus: CNSs, primary healthcare nurse practitioners (PHCNPs), acute care nurse practitioners (ACNPs) and a blended CNS/NP role. We worked with a multidisciplinary, multijurisdictional advisory board that helped identify documents and key informant interviewees, develop interview questions and formulate implications from our findings. We included 468 published and unpublished English- and French-language papers in a scoping review of the literature. We conducted interviews in English and French with 62 Canadian and international key informants (APNs, healthcare administrators, policy makers, nursing regulators, educators, physicians and other team members). We conducted four focus groups with a total of 19 APNs, educators, administrators and policy makers. A multidisciplinary roundtable convened by the Canadian Health Services Research Foundation formulated evidence-informed policy and practice recommendations based on the synthesis findings. This paper forms the foundation for this special issue, which contains 10 papers summarizing different dimensions of our synthesis. Here, we summarize the synthesis methods and the recommendations formulated at the roundtable.

Clinical Nurse Specialists and Nurse Practitioners: Title Confusion and Lack of Role Clarity

Title confusion and lack of role clarity pose barriers to the integration of advanced practice nursing roles (i.e., clinical nurse specialist [CNS] and nurse practitioner [NP]). Lack of awareness and understanding about NP and CNS roles among the healthcare team and the public contributes to ambiguous role expectations, confusion about NP and CNS scopes of practice and turf protection. This paper draws on the results of a scoping review of the literature and qualitative key informant interviews conducted for a decision support synthesis commissioned by the Canadian Health Services Research Foundation and the Office of Nursing Policy in Health Canada. The goal of this synthesis was to develop a better understanding of advanced practice nursing roles and the factors that influence their effective development and integration in the Canadian healthcare system. Specific recommendations from interview participants and the literature to enhance title and role clarity included the use of consistent titles for NP and CNS roles; the creation of a vision statement to articulate the role of CNSs and NPs across settings; the use of a systematic planning process to guide role development and implementation; the development of a communication strategy to educate healthcare professionals, the public and employers about the roles; attention to inter-professional team dynamics when introducing these new roles; and addressing inter-professionalism in all health professional education program curricula.

Understanding Advanced Practice Nursing

The Canadian Health Services Research Foundation (CHSRF) is proud to be one of the supporters of this special issue on advanced practice nursing, which represents several decades of research and programming related to the role of nurses in the health system.

Mapping Health Services and Policy Research Settings in Canada: Following the Money, the Publications and the Interest

While health services and policy research (HSPR) has an established footing in traditional research settings (e.g., universities, hospitals, research institutes) in Canada, its presence in other research settings (e.g., government agencies, regional health authorities, charitable organizations) is emergent and less well understood. Drawing on data from the Canadian Institutes of Health Research, the Canadian Health Services Research Foundation, two Canadian HSPR-focused journals (Healthcare Policy and Healthcare Management Forum) and the Canadian Association of Health Services and Policy Research, we mapped HSPR settings based on three different measures: (1) HSPR-related funding, (2) authorship in Canadian HSPR-focused journals and (3) membership in a professional HSPR association. Our findings suggest that while a significant proportion of HSPR is directly linked to non-traditional research settings, the nature and extent of HSPR activity in those settings are unclear.

The use of psychotropic medication for the management of problem behaviours in adults with intellectual disabilities living in Canada

The paper provides a Canadian perspective on the use of psychotropic medication in the management of problem behaviours in adults with intellectual disabilities in Canada. Psychotropic medication and intellectual disabilities were explored in the context of Canadian health and social services, clinical practices, medical training and factors that have shaped these over the past few decades. Informal physician intellectual disabilities networks and the newly formed Canadian Network of the National Coalition on Dual Diagnosis provided the opportunity to survey the use of psychotropic medication for problem behaviours across the country. Geographic, political, cultural and other influences on the development of health and social services are described, as well as training requirements for physicians. Survey responses were received from all provinces and represented clinicians in mental health multidisciplinary teams, health and social services ministry representatives, agency staff (up to executive director level) and family members of individuals with intellectual disabilities. Psychiatry and family medicine perspectives of the authors from working in Canada and the UK with people with intellectual disabilities presenting with problem behaviours are described. In Canada there are no national, provincial or territorial policies or guidelines on use of psychotropic medication for the management of such behaviours. There are no requirements for physicians prescribing these medications to have training in the care of people with intellectual disabilities. Services for people with intellectual disabilities and behaviour problems in Canada appear to be more crisis‐reactive than those in the UK.

Doctors' groups a roadblock to reform, researchers say

Medical associations often pose a powerful barrier to health care reform in Canada, according to researchers participating in a web seminar hosted by the Canadian Health Services Research Foundation. Organizations representing the medical profession have played a key role in preventing or

Increasing initial appointment attendance in paediatric mental health clinics: A call for theory-driven interventions

Initial appointment nonattendance is a serious problem for paediatric mental health services in Canada. In this paper, we report on a study protocol that uses an empirically validated theory of behavior to increase first-time attendance rates in paediatric mental health clinics. A mixed method approach is proposed to understand beliefs about initial appointments and nonattendance. We propose semi-structured interviews with parents/guardians, focus groups with children and youth, and a postal survey of parents and children in order to administer our intervention. The intervention is theoretically guided by the idea of Implementation Intentions, or ‘if-then’ plans. It is expected that the use of a theory-based, cost effective intervention will increase attendance at initial child mental health appointments. We aim to encourage researchers and clinicians to consider the use of theory-driven interventions in their work in mental health. Theoretically-guided research may allow us to prospectively identify children and youth at greater risk of missing their initial appointment and thereby target them with measures to improve attendance.

Future Challenges to Health and Public Health Services in Canada

Future Challenges to Health and Public Health Services in Canada

Future Challenges to Health and Public Health Services in Canada

Future Challenges to Health and Public Health Services in Canada

Indian Hospitals and Aboriginal Nurses: Canada and Alaska

Between 1945 and the early 1970s, both Indian Health Services in Canada (IHS), and the Alaska Native Health Service (ANS) initiated programs and activities aimed at recruiting and training nurses/nurses aides from Canadian and Alaskan Native communities. In Alaska, the Mt. Edgecumbe Hospital in Sitka acted as a training facility for Alaska Native nurses' aides, while in Canada, the Charles Camsell Hospital served a similar function. These initiatives occurred prior to the devolution of health care to Aboriginal communities. The histories of these two hospitals provide a comparative opportunity to reveal themes related to the history of Aboriginal nurse training and Aboriginal health policies in the north. The paper outlines the structure and function of two main hospitals within the Indian Health and Alaska Native Health Services, discusses the historic training, and role of Aboriginal nurses and caregivers within those systems using both archival and oral history sources.

Aligning the stars and shrinking the gap between health services decision making and research in Canada

AbstractCanada is internationally known for its universal healthcare system. Like other nations, Canada's publicly funded healthcare system struggles with challenges related to escalating costs, complexity of care and sustainability. The Canadian Health Services Research Foundation (CHSRF), through its flagship programmes — Capacity for Applied and Developmental Research and Evaluation (CADRE) and Executive Training for Research Application (EXTRA) — strives to meet those challenges by improving the capacity of researchers and decision makers to make evidence-informed health service decisions. This paper showcases the significant strides being made by the programmes in adapting the linkage and exchange approach, through national-level data and narrative accounts from key stakeholders. The paper concludes with remarks on potential future directions for CADRE and EXTRA, and their alignment with CHSRF's strategic priorities.

Conceptual and Methodological Challenges in Producing Research Syntheses for Decision-and Policy-Making: An Illustrative Case in Primary Healthcare

This article presents and discusses five challenges encountered in conducting a knowledge synthesis on primary healthcare, commissioned by the Canadian Health Services Research Foundation. These challenges are (1) conceptualizing, defining and operationalizing complex interventions; (2) integrating quantitative and qualitative studies and assessing strength of evidence; (3) incorporating expert opinions and decision-makers’ viewpoints; (4) producing timely results; and (5) presenting the results in a concise yet understandable form. We also propose methods and operational tools to deal with these issues, particularly regarding integration of qualitative and quantitative evidence and incorporation of expert opinions into syntheses. The major challenge of the synthesis was to provide pertinent and useful information for decision- and policy-makers, while maintaining an acceptable level of scientific rigour. This approach seems promising for knowledge syntheses, which sustain a deliberative process that leads to more enlightened decision and policy-making.

Canadian Cardiovascular Society 2009 Consensus Conference on the management of adults with congenital heart disease: Introduction

With advances in pediatric cardiology and cardiac surgery, the population of adults with congenital heart disease (CHD) has increased. In the current era, there are more adults with CHD than children. This population has many unique issues and needs. Since the 2001 Canadian Cardiovascular Society consensus conference report on the management of adults with CHD, there have been significant advances in the field of adult CHD. Therefore, new clinical guidelines have been written by Canadian adult CHD physicians in collaboration with an international panel of experts in the field. The present introductory section is a summary of the epidemiology and scope of adult CHD in Canada, the structure of the Canadian health care system and adult congenital cardiac health services in Canada. The recommendations for antibiotic prophylaxis and genetic evaluation in this population are included. The complete document consists of four manuscripts, which are published online in the present issue of The Canadian Journal of Cardiology, including sections on genetics, outcomes, diagnostic workups, surgical and interventional options, treatment of arrhythmias, assessment of pregnancy and contraception risks, and follow-up recommendations. The complete document and references can also be found at www.ccs.ca or www.cachnet.org.