Ontario Experience Research Articles

The relationship between patient experience and real-world digital health access in primary care: A population-based cross-sectional study.

Implementing digital health technologies in primary care is anticipated to improve patient experience. We examined the relationships between patient experience and digital health access in primary care settings in Ontario, Canada. We conducted a retrospective cross-sectional study using patient responses to the Health Care Experience Survey linked to health and administrative data between April 2019-February 2020. We measured patient experience by summarizing HCES questions. We used multivariable logistic regression stratified by the number of primary care visits to investigate associations between patient experience with digital health access and moderating variables. Our cohort included 2,692 Ontario adults, of which 63.0% accessed telehealth, 2.6% viewed medical records online, and 3.6% booked appointments online. Although patients reported overwhelmingly positive experiences, we found no consistent relationship with digital health access. Online appointment booking access was associated with lower odds of poor experience for patients with three or more primary care visits in the past 12 months (adjusted odds ratio 0.16, 95% CI 0.02-0.56). Younger age, tight financial circumstances, English as a second language, and knowing their primary care provider for fewer years had greater odds of poor patient experience. In 2019/2020, we found limited uptake of digital health in primary care and no clear association between real-world digital health adoption and patient experience in Ontario. Our findings provide an essential context for ensuing rapid shifts in digital health adoption during the COVID-19 pandemic, serving as a baseline to reexamine subsequent improvements in patient experience.

A typology of undergraduate biology research experiences in Ontario

Undergraduate research experiences (UREs) have long been integrated into the landscape of undergraduate education, and the typical, one-on-one model has been associated with several positive student outcomes. Newer models of URE, aimed at improving scalability and promoting access for larger cohorts of students, have proliferated. However, due to the absence of a systematic classification of the models of UREs, comparisons across model types are limited, particularly in Canada. Therefore, it is unclear if these scalable models have achieved the aim of providing a more accessible, but equally impactful URE. We used principal component analyses of key variables derived from the course syllabi of 76 UREs to generate a typology of curriculum-based biology UREs, categorized into the following: Type A (apprenticeship-style research), Type B (field courses), and Type C (high enrollment, course-based research). Analysis of the course characteristics of these three course types revealed that Type C courses were the best positioned to provide an accessible learning environment and to include students who would otherwise not participate in research. The development of a typology of UREs provides a foundation to extend previous research on undergraduate research courses—which primarily focuses on the apprenticeship model—to include the other course types characterized in this study.

LUNG CANCER SCREENING- THE ONTARIO? CANADA EXPERIENCE

Lung cancer remains the most significant cause of cancer death, accounting for about 20% of all cancer-related mortality. A significant reason for this is delayed diagnosis mostly related to lack of symptoms in early-stage disease. Low-dose computed tomography screening of high-risk, asymptomatic populations has been shown to reduce lung cancer mortality. Various approaches have been taken on the implementation of lung cancer screening programs. Ontario Health Cancer Care Ontario OHCCO believes that screening that is delivered through organized programs is more likely to reduce cancer incidence and mortality, minimize the potential harms of screening and be cost effective when compared to screening that happens outside of organized programs. Based on lessons learned from a pilot project the province has now transitioned to a full provincial Ontario Lung Cancer Screening program. The key objectives of this presentation are to: discuss the need for early lung cancer detection; to clarify the use of the word Screening; to outline the essential components or the foundations of a screening program; and to summarize the Ontario experience on implementation of a population-based lung cancer screening program.

Choreographed expansion of services results in decreased patient burden without compromise of outcomes: An assessment of the Ontario experience.

Neuro-oncology care in Ontario, Canada has been historically centralized, at times requiring significant travel on the part of patients. Toward observing the goal of patient-centered care and reducing patient burden, 2 additional regional cancer centres (RCC) capable of neuro-oncology care delivery were introduced in 2016. This study evaluates the impact of increased regionalization of neuro-oncology services, from 11 to 13 oncology centers, on healthcare utilization and travel burden for glioblastoma (GBM) patients in Ontario. We present a cohort of GBM patients diagnosed between 2010 and 2019. Incidence of GBM and treatment modalities were identified using provincial health administrative databases. A geographic information system and spatial analysis were used to estimate travel time from patient residences to neuro-oncology RCCs. Among the 5242 GBM patients, 79% received radiation as part of treatment. Median travel time to the closest RCC was higher for patients who did not receive radiation as part of treatment than for patients who did (P = .03). After 2016, the volume of patients receiving radiation at their local RCC increased from 62% to 69% and the median travel time to treatment RCCs decreased (P = .0072). The 2 new RCCs treated 35% and 41% of patients within their respective catchment areas. Receipt of standard of care, surgery, and chemoradiation (CRT), increased by 11%. Regionalization resulted in changes in the healthcare utilization patterns in Ontario consistent with decreased patient travel burden for patients with GBM. Focused regionalization did not come at the cost of decreased quality of care, as determined by the delivery of a standard of care.

Classroom assessment fairness inventory: a new instrument to support perceived fairness in classroom assessment

ABSTRACT Fair assessment in the classroom is a concern from student, teacher, principal and public perspectives. Standards and policies also underscore fairness as a key underpinning for assessments. Perceptions of fairness impact students’ socio-emotional and learning outcomes, and build confidence, trust and legitimacy for the assessment outcomes. However, a direct inquiry into students’ perceptions of what a fair assessment means has received scant attention. Without appreciating students’ perceptions, we lack insights into how students’ perceptions of fairness impact their responses to assessment outcomes for learning and grading purposes. Therefore, this study leveraged the Classroom Assessment Fairness Inventory to investigate first-year undergraduate students’ perceptions of fairness about their secondary school experiences in Ontario, Canada. The results present initial validity evidence for the inventory to support a fairness theory and practice in classroom assessment contexts.

Impact of safer supply programs on injection practices: client and provider experiences in Ontario, Canada

ObjectivesFentanyl has contributed to a sharp rise in the toxicity of the unregulated drug supply and fatal overdoses in Canada. It has also changed injection practices. Injection frequency has increased as a result and so has equipment sharing and health-related risks. The aim of this analysis was to explore the impact of safer supply programs on injection practices from the perspective of clients and providers in Ontario, Canada.MethodsThe data set included qualitative interviews with 52 clients and 21 providers that were conducted between February and October 2021 across four safer supply programs. Interview excerpts discussing injection practices were extracted, screened, coded and then grouped into themes.ResultsWe identified three themes, each theme corresponding to a change in injection practices. The first change was a decrease in the amount of fentanyl used and a decrease in injection frequency. The second change involved switching to injecting hydromorphone tablets instead of fentanyl. Finally, the third change was stopping injecting altogether and taking safer supply medications orally.ConclusionSafer supply programs can contribute to reducing injection-related health risks in addition to overdose risks. More specifically, they have the potential to address disease prevention and health promotion gaps that stand-alone downstream harm reduction interventions cannot address, by working upstream and providing a safer alternative to fentanyl.

“I can’t remember the last time I was comfortable about being home”: lived experience perspectives on thriving following homelessness

ABSTRACT Purpose Strategies for preventing and ending homelessness are frequently measured by their effectiveness on indices of tenancy sustainment. To shift this narrative, we conducted research to identify what is needed to “thrive” following homelessness from the perspectives of persons with lived experience in Ontario, Canada. Methods Conducted in the context of a community-based participatory research study aimed at informing the development of intervention strategies, we interviewed 46 persons living with mental illness and/or substance use disorder [n = 25 (54.3%) unhoused; n = 21 (45.7%) housed following homelessness] using qualitative interviews. A subsample of 14 participants agreed to engage in photovoice interviews. We analysed these data abductively using thematic analysis informed by health equity and social justice. Results Participants described experiences of “living in a state of lack” following homelessness. This essence was expressed through four themes: 1) housing as part one of the journey to home; 2) finding and keeping “my people”; 3) meaningful activity as critical for thriving following homelessness; and 4) struggling to access mental health supports in the context of challenging circumstances. Conclusions Individuals struggle to thrive following homelessness in the context of insufficient resources. There is a need to build on existing interventions to address outcomes beyond tenancy sustainment.

From Recruitment to Retention: Evaluating the Experiences of Internationally Educated Nurses in the Supervised Practice Experience Partnership.

Accompanied by an unparalleled nursing shortage, the COVID-19 pandemic has prompted a nationwide health human resource recruitment drive focused on internationally educated nurses (IENs). The Supervised Practice Experience Partnership (SPEP) is a provincial strategy that provides IENs the opportunity to attain their supervised practice experience in Ontario. In order to sustain the nursing workforce, there is a need to go beyond recruitment strategies and implement evidence-informed approaches that retain IENs after meeting their registration requirements. Mixed-methods surveys and focus groups were used to evaluate the experiences of IENs, their preceptors and nurse leaders working with the SPEP. The findings highlight the value of mentorship and support from nurse leaders in developing communication skills, building connections with teams, fostering cultural integration and establishing support networks for IENs. This paper enhances nurse leaders' understanding of the experiences of IENs and establishes a foundation for innovative ideas that facilitates their integration and retention.

Barriers and facilitators to opioid agonist treatment (OAT) engagement among individuals released from federal incarceration into the community in Ontario, Canada

ABSTRACT Introduction Correctional populations with opioid use disorder experience increased health risks during community transition periods. Opioid Agonist Treatment (OAT) can reduce these risks, but retention is a key challenge. This study addresses a knowledge gap by describing facilitators and barriers to OAT engagement among federal correctional populations released into the community in Ontario, Canada. Methods This article describes results from a longitudinal mixed-methods study examining OAT transition experiences among thirty-five individuals released from federal incarceration in Ontario, Canada. Assessments were completed within one year of participants’ release. Data were thematically analyzed. Results The majority (77%) of participants remained engaged in OAT, however, 69% had their release suspended and 49% returned to custody. Key facilitators for OAT engagement included flexibility, positive staff rapport, and structure. Fragmented OAT transitions, financial OAT coverage, balancing reintegration requirements, logistical challenges, and inaccessibility of ‘take-home’ OAT medications were common barriers. Conclusions Post-incarceration transition periods are critical for OAT retention, yet individuals in Ontario experience barriers to OAT engagement that contribute to treatment disruptions and related risks such as relapse and/or re-incarceration. Additional measures to support community OAT transitions are required, including improved discharge planning, amendments to OAT and financial coverage policies, and an expansion of OAT options.

Acknowledgements

This special edition of Healthcare Quarterly, entitled "Engaging Patients in Research Evidence Uptake: The Ontario Experience," was prepared on behalf of the Ontario Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit (OSSU) and would not have been possible without the enormous efforts and support of many individuals across the province.

At the Intersections: Supporting Equity, Diversity, and Inclusion on Campus—A Northern Ontario Experience

At the Intersections: Supporting Equity, Diversity, and Inclusion on Campus—A Northern Ontario Experience

Risk-based lung cancer screening eligibility criteria: towards implementation.

Retrospective studies have consistently shown that risk-prediction models are superior at identifying individuals eligible for lung cancer screening compared with criteria based on combinations of age accumulated pack-years and years since smoking cessation (ie, pack-year criteria). 1 ten Haaf K Jeon J Tammemägi MC et al. Risk prediction models for selection of lung cancer screening candidates: a retrospective validation study. PLOS Med. 2017; 14e1002277 Crossref Scopus (149) Google Scholar Although some studies advocate the use of risk-prediction models in existing and future screening programmes, others have been reserved in advocating their use because of the absence of evidence from prospective studies. 2 Force USPSTScreening for lung cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021; 325: 962-970 Crossref PubMed Scopus (228) Google Scholar , 3 Tammemägi MC Darling GE Schmidt H et al. Selection of individuals for lung cancer screening based on risk prediction model performance and economic factors—the Ontario experience. Lung Cancer. 2021; 156: 31-40 Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar In The Lancet Oncology, Martin Tammemägi and colleagues 4 Tammemägi MC Ruparel M Tremblay A et al. USPSTF2013 versus PLCOm2012 lung cancer screening eligibility criteria (International Lung Screening Trial): interim analysis of a prospective cohort study. Lancet Oncol. 2021; (published online Dec 10.)https://doi.org/10.1016/S1470-2045(21)00590-8 Summary Full Text Full Text PDF PubMed Google Scholar report an interim analysis of the International Lung Screening Trial (ILST), a large prospective multinational trial that compares a risk-prediction model with pack-year criteria. The ILST compared the sensitivity of the US Preventive Services Task Force (USPSTF) 2013 eligibility criteria (aged 55–80 years, ≥30 pack-years smoking history, and ≤15 years since smoking cessation) with the PLCOm2012 risk model when selecting a similar number of eligible individuals (aged 55–80 years with a PLCOm2012 risk threshold ≥1·7%). The sensitivity of the PLCOm2012 model to identify individuals who develop lung cancer was 15·8 percentage points higher than that of the USPSTF2013 criteria (162 [94·7%; 95% CI 90·2–97·6] of 171 individuals vs 135 [78·9%; 72·1–84·8] of 171 individuals; p=0·0001). Analyses that included individuals not meeting either the PLCOm2012 risk threshold of at least 1·7% or USPSTF2013-positive criteria also showed superior sensitivity (162 [85·3%; 79·4–90·0] of 190 individuals vs 135 [71·1%; 64·0–77·4] of 190 individuals; p=0·0001) and both criteria had similar specificities (8357 [65·6%; 64·7–66·4] of 12 735 vs 8330 [65·4%; 64·5–66·2] of 12 735 individuals; p=0·72). Thus, the ILST demonstrated that the superiority of risk-prediction models over pack-year criteria is maintained in a prospective analysis. USPSTF2013 versus PLCOm2012 lung cancer screening eligibility criteria (International Lung Screening Trial): interim analysis of a prospective cohort studyPLCOm2012 appears to be more efficient than the USPSTF2013 criteria for selecting individuals to enrol into lung cancer screening programmes and should be used for identifying high-risk individuals who benefit from the inclusion in these programmes. Full-Text PDF Open Access

A qualitative examination of substance use service needs among people who use drugs (PWUD) with treatment and service experience in Ontario, Canada

BackgroundPeople who use drugs (PWUD) often have complex health and social support needs related to substance use, yet face numerous barriers to service access, resulting in unmet treatment needs and a corresponding gap in treatment. While initiatives to scale up substance use services for PWUD in Canada - and Ontario - have been undertaken, these have excluded PWUD’ perspectives, and their needs have largely been defined by other actors. As end-users of services, PWUD’ perspectives are vital to understanding what services are required, and whether existent services are adequate, appropriate and effective. Thus, the present study aimed to elicit in-depth knowledge from PWUD with lived experience of accessing services to better understand their unmet treatment and service needs, towards closing the service and treatment gap in Ontario.MethodsThis qualitative study included one-on-one interviews conducted with a cohort of n = 45 adult PWUD with substance use and treatment experience in Ontario, Canada. Participants were recruited from substance use services based on ConnexOntario’s directory of all provincial addiction services, as well as by word-of-mouth. Questions focused on participants’ experiences and perspectives on substance use services towards understanding their service needs. Data underwent an inductive thematic analysis based on key themes that emerged.ResultsParticipants commonly engaged in polysubstance use, and identified a number of unmet substance use service needs including complex factors within the current service system that influenced access to available programs. Specifically, participants suggested the need to address stigmatization and system fragmentation, increase service provision and capacity, and scale up specific services and related supports such as harm reduction, counseling, treatment, and housing.ConclusionsThis study identified PWUD’ needs in relation to substance use service provision in Ontario, Canada, and highlighted important areas for policy change and program planning and implementation. Concrete recommendations include the development of a government-funded, low-barrier, comprehensive and integrated service delivery and referral models that include PWUD as collaborators and program facilitators to ensure that services are as accessible, effective, and cohesive as possible. Results from this study can be used to enhance provincial substance use treatment and service provision.

“I Just Want to Belong Somewhere”: Latinx Youth’s Experiences in the Education System in Ontario, Canada

ABSTRACT Latino Critical Theory (LatCrit) posits that the invisibility of the Latinx identity in conversations surrounding race and ethnicity leads to an inability for Latinxs to identify, conceptualize, and verbalize their unique experience. This article explores Latinx youth’s experiences in Ontario’s education system and their invisibility throughout their educational journey. Based on qualitative interviews and focus groups with a total of 60 Latinx youth (aged 16 to 26), this study found that Latinx students do not see themselves represented by teachers and peers. Latinx youth struggled with situating their sense of community within the education system and the broader Canadian context, which impacted their identity as Latinx-Canadians. The findings also showed that a lack of exposure and widespread recognition of the Latinx community by peers, teachers, and other stakeholders in positions of power create racially insensitive environments for students. Youth shared that they experienced a sense of placelessness, wherein they could not fully belong in a single space.

The AFCC‐Ontario Parenting Plan Guide and Template: Jurisdictionally‐Specific Resources for Family Justice Professionals and Parents

This article discusses the development of the concept of parenting plans and the different approaches to providing materials that can help parents and professionals to make individualized, future‐oriented plans for children post‐separation. More than a quarter century after American states began to enact laws to encourage the use of parenting plans, Canada amended its legislation to abandon the proprietary concepts of “custody” and “access,” and encourage the use of parenting plans rather than “custody orders”. To support the making and use of individualized, child‐focused parenting plans, the Ontario Chapter of the Association of Family and Conciliation Courts (AFCC‐O) prepared its Parenting Plan Guide and Parenting Plan Template. These web‐based materials are available without charge to parents and their professional advisors. The Guide discusses the value of parental co‐operation and planning, while recognizing that in cases where there are serious issues of abuse, violence or parental mental health, a protective judicial role and court orders may be needed. The Guide offers advice on the making of developmentally‐appropriate parenting plans, and the Template provides possible alternatives for the wording of specific clauses. While the available parenting plan materials from different jurisdictions have broadly similar content, there is value in having family justice organizations, including chapters of the AFCC, develop their own materials, that are consistent with the laws, justice processes and resources of their jurisdiction. The Ontario experience suggests that judges, lawyers and parents may be more likely to use jurisdictionally‐specific materials rather than more generic resources.

Exploring the perspectives and strategies of Ontario community pharmacists to improve routine follow-up for patients with diabetes: A qualitative study.

Background:Medication reviews are a fundamental activity carried out as part of comprehensive care delivered by pharmacists. Varying programs that reimburse pharmacists for conduct of medication reviews are in place in different jurisdictions in Canada and other countries around the world. The MedsCheck Diabetes (MCD) program is a publicly funded service in Ontario, Canada, offered to patients with type 1 or type 2 diabetes. Through this service, pharmacists can complete a focused medication review with advice, training, monitoring and follow-up diabetes education. Although pharmacists can be reimbursed for patient follow-up activities, a low number of follow-up medication reviews are billed through this program.Methods:The study explores the barriers and facilitators that community pharmacists in Ontario experience in conducting routine monitoring and follow-up of patients with diabetes. Using a descriptive content analysis approach study, semistructured interviews were conducted with a convenience sample of 8 community pharmacists working in Ontario.Results:Three main themes emerged: the design of the MCD program, the state of community pharmacy and collaboration and relationships. These themes demonstrate challenges and potential strategies recognized by community pharmacists to conduct routine diabetes follow-up through the MCD program.Conclusion:This study found that the design of the MedsCheck Diabetes program, the community pharmacy environment and the relationships between pharmacists, patients and prescribers can pose a challenge in the conduct of routine monitoring and follow-up through the MedsCheck Diabetes program.

Pharmacist Prescribing for Minor Ailments Service Development: The Experience in Ontario.

To date, eight of ten Canadian provinces have authorized pharmacists to prescribe for minor ailments. Prompted by a request by the Ontario Minister of Health, draft regulations were submitted to enable this pharmacy service in Ontario. Differences exist in how jurisdictions have approached development and delivery of these programs. This paper will summarize key differences and similarities among existing programs while highlighting the multi-pronged approach utilized by Ontario. Such an approach involved broad stakeholder engagement, implementation science, and an evaluations framework to guide an assessment of the impact of this new service. These insights can be leveraged by other jurisdictions planning to initiate or evolve their minor ailment prescribing services.

Selection of individuals for lung cancer screening based on risk prediction model performance and economic factors – The Ontario experience

IntroductionRandomized controlled trials have shown that screening with computed tomography reduces lung cancer mortality but is most effective when applied to high-risk individuals. Accurate lung cancer risk prediction models effectively select individuals for screening. Few pilots or programs have implemented risk models for enrolling individuals for screening in real-world, population-based settings. This report describes implementation of the PLCOm2012 risk prediction model in the Ontario Health (Cancer Care Ontario) lung cancer screening Pilot. MethodsIn the Pilot’s Health Technology Assessment, 576 categorical age/pack-years/quit-years scenarios were evaluated using MISCAN microsimulation modeling and cost-effectiveness analyses. A preferred model was selected which provided the most life-years gained per cost. The PLCOm2012 was compared to the preferred MISCAN scenario at a threshold that yielded the same number eligible (risk ≥2.0 %/6-years). ResultsThe PLCOm2012 had significantly higher sensitivity and predictive value (68.1 % vs 59.6 %, p < 0.0001; 4.90 % vs 4.29 %, p = 0.044), and an Expert Panel selected it for use in the Pilot. The Pilot cancer detection rate was significantly higher than in the NLST (p = 0.009) or NELSON (p = 0.003) and there was a significant shift to early stage compared to historical Ontario Cancer Registry statistics (p < 0.0001). Pre- and post-Pilot evaluations found that conducting quality risk assessments were not excessively time consuming or difficult, and participants’ satisfaction was high. ConclusionsThe PLCOm2012 was efficiently implemented in the Pilot in a real-world setting and is being used to transition into a provincial program. Compared to categorical age/pack-years/quit-years criteria, risk assessment using the PLCOm2012 can lead to effective and efficient screening.

Evidence and politics of patient experience in Ontario: The perspective of healthcare providers and administrators.

Patient experience has a direct impact on patients' engagement in healthcare, their commitment to treatment plans, and their relationship with their healthcare providers, all of which can impact their health outcomes. The complexity of the healthcare system, the increasing health needs of the population, and the priority and knowledge differences among healthcare stakeholders impact how they conceptualize and seek to achieve the ideal patient experience and the weights that they give to different elements of this experience. This study sought to understand the perspectives of healthcare providers and administrators in Ontario regarding the factors affecting the patient experience. Qualitative data were collected between April 2018 and May 2019. Twenty-one semi-structured interviews were conducted. Interviewees included physicians, nurses, optometrists, dietitians, quality managers, and policymakers. Thematic analysis was used to analyse the data, utilizing and extending a previously developed patient experience framework. Several themes emerged in the data, and they represent two perspectives on patient experience: the biomedical perspective, which prioritizes health outcomes and gives high weights to healthcare experience factors that can be controlled by healthcare providers, while ignoring other factors, and the sociopolitical perspective, which recognizes the impacts ofhealthcare politics and the social context of health on patient experience in Ontario. The study is timely in light of the current changes in the Ontario healthcare system and the healthcare reform started by the new government, as it sheds light on the possible negative impact of healthcare policy and politics on patient experience.

Liver transplantation in adult polycystic liver disease: the Ontario experience

BackgroundLiver transplantation (LT) remains the curative treatment for symptomatic Polycystic Liver Disease (PCLD) patients and is associated with excellent survival rates. The aim of the study is to review the Ontario experience in LT for PCLD.MethodsA retrospective study was performed from pre-existing LT databases from the LT Units at Toronto General Hospital and London Health Sciences Center, which are the two LT programs in Ontario, Canada. This database contains demographic, clinical parameters and follow-up of all patients transplanted for PCLD. Data was extracted for patients who underwent LT between January 2000–April 2017 and included follow up until December 31st, 2018.ResultsA total of 3560 patients underwent LT, of whom 51 (1.4%) had PCLD and met inclusion criteria. 43 (84%) of these patients were female. The median physiologic Model for End Stage Liver Disease (MELD-Na) score at time of referral was 13 (IQR = 7–22), however all patients required MELD-Na exception points to receive LT. The median age of transplant was 62 years (IQR = 59–64) for male vs. 52 (IQR = 45–56) for female patients. 33 (65%) of our cohort had PCLD while 9 (17.5%) had ADPKD and 9 (17.5%) had both diseases. 39 (76%) had LT due to symptoms of mass effect, while 8 (16%) had portal hypertensive complications. After a median follow-up of 6.3 (IQR = 2.9–12.5) years, the probability of survival was 96% (95% CI: 90%, 100%). Log-rank test, comparing survival analysis between males and females did not show a statistically significant difference (p = 0.26).ConclusionMost patients underwent LT for PCLD due to symptoms of mass effect with women being more likely than men to undergo LT. LT for PCLD had excellent long-term survival.