Alberta Program Research Articles

Factors influencing human papillomavirus school-based immunization in Alberta: A mixed-methods study protocol.

More than 1,300 Canadians are diagnosed with cervical cancer annually, which is nearly preventable through human papillomavirus (HPV) immunization. Across Canada, coverage rates remain below the 90% target set out by the Action Plan for the Elimination of Cervical Cancer in Canada (2020-2030). To support this Plan, the Canadian Partnership Against Cancer has commissioned the Urban Public Health Network (UPHN) to coordinate a quality improvement project with Canada's school-based HPV immunization programs. In Alberta, the UPHN partnered with Alberta Health Services (AHS) for this work. This study has one overarching research question: what are parent/guardian and program stakeholder perceived barriers, enablers and opportunities to immunization for youth as part of the school-based HPV immunization program in Alberta? This study uses a mixed-methods sequential explanatory design. A survey will be emailed to a sample of Albertans with children aged 11-17 years. Questions will be based on a Conceptual Framework of Access to Health Care. Subsequent qualitative work will explore the survey's findings. Parents/guardians identifying as vaccine hesitant in the survey will be invited to participate in virtual, semi-structured, in-depth interviews. Stakeholders of the school-based immunization program will be purposively sampled from AHS' five health zones for virtual focus groups. Quantitative data will be analyzed using SAS Studio 3.6 to carry out descriptive statistics and, using logistic regression, investigate if Framework constructs are associated with parents'/guardians' decision to immunize their children. Qualitative data will be analyzed using NVivo 12 to conduct template thematic analysis guided by the Framework. Study results will provide insights for Alberta's public health practitioners to make evidence-informed decisions when tailoring the school-based HPV immunization program to increase uptake in vaccine hesitant populations. Findings will contribute to the national study, which will culminate in recommendations to increase HPV immunization uptake nationally and progress towards the 90% coverage target.

Retrospective audit of a convenience cohort of individuals on HIV pre-exposure prophylaxis in Alberta, Canada.

We undertook an audit of a province-wide HIV pre-exposure prophylaxis (PrEP) program in Alberta (Canada). A retrospective record review of individuals accessing PrEP in Alberta included demographics, PrEP indication(s), and reported non-prescription drug and alcohol use from March 2016 to June 2019. Hepatitis A, B, C, HIV and syphilis serology, serum creatinine, and nucleic acid amplification tests testing for chlamydia and gonorrhea were collected. Descriptive statistics, incidence, and prevalence were calculated. A total of 511 participants were seen at STI, sexual, and reproductive health clinics and private family practitioner (FP) offices; 98.4% (503) were men, median age was 34 years (IQR 28-43 years), and 89.8% (459) were gay or bisexual men who have sex with men. Non-prescription drug use was reported by 39.3% (201) and alcohol use by 55.4% (283). 94.3% (482) reported condomless anal sex in the past 6 months. Testing rates were high (>95%) for all tests except for chlamydia and gonorrhea at the first follow-up visit 89.6%; (3-4 months). There was one HIV seroconversion. The incidence of new bacterial STIs was high: chlamydia 17 cases per 100 person-years (95% CI 13.5% to 21.4%), gonorrhea 11.14 cases per 100 person-years (95% CI 8.3% to 15.0%), and syphilis 1.94 cases per 100 person-years (95% CI 0.73% to 5.12%). Following implementation of a provincial program for PrEP in Alberta, PrEP initiation and continuation was feasible in a range of settings and by both specialists and FPs.

Patient and Clinician Perspectives on Shared Decision Making in Vascular Access Selection: A Qualitative Study

Collaborative approaches to vascular access selection are being increasingly encouraged to elicit patients' preferences and priorities where no unequivocally superior choice exists. We explored how patients, their caregivers, and clinicians integrate principles of shared decision making when engaging in vascular access discussions. Qualitative description. Semistructured interviews with a purposive sample of patients, their caregivers, and clinicians from outpatient hemodialysis programs in Alberta, Canada. We used a thematic analysis approach to inductively code transcripts and generate themes to capture key concepts related to vascular access shared decision making across participant roles. 42 individuals (19 patients, 2 caregivers, 21 clinicians) participated in this study. Participants identified how access-related decisions follow a series of major decisions about kidney replacement therapy and care goals that influence vascular access preferences and choice. Vascular access shared decision making was strengthened through integration of vascular access selection with dialysis-related decisions and timely, tailored, and balanced exchange of information between patients and their care team. Participants described how opportunities to revisit the vascular access decision before and after dialysis initiation helped prepare patients for their access and encouraged ongoing alignment between patients' care priorities and treatment plans. Where shared decision making was undermined, hemodialysis via a catheter ensued as the most readily available vascular access option. Our study was limited to patients and clinicians from hemodialysis care settings and included few caregiver participants. Findings suggest that earlier, or upstream, decisions about kidney replacement therapies influence how and when vascular access decisions are made. Repeated vascular access discussions that are integrated with other higher-level decisions are needed to promote vascular access shared decision making and preparedness.

PHYSICAL ASSESSMENT OF THE CANADIAN STEWARDSHIP PROGRAMS ON EMPTY PLASTIC BEVERAGE CONTAINERS IN SASKATCHEWAN AND ALBERTA PROVINCES

Stewardship programs are gradually being phased out in favor of Extended Producer Responsibility (EPR) schemes, which are used in various forms in different Canadian provinces. An example is the British Columbia province's EPR program on empty plastic beverage containers. Provinces like Saskatchewan and Alberta, on the other hand, continue to rely on stewardship programs and are in the process of incorporating the EPR policy as a program into their waste management regulations. Therefore, this study will discuss how stewardship program policies have helped to solve a portion of the plastic waste problem; however, negotiations to fully integrate the EPR program into Saskatchewan and Alberta waste management policies are still ongoing. The significance of this study has demonstrated how stewardship programs in Saskatchewan and Alberta have promoted the reuse and recycling economy of plastic management to a limited extent in these respective provinces. A case study method was used to analyze and investigate the stewardship program, with a focus on plastic bottle management. Field observations were conducted at selected recycling companies (Sarcan recycling and Alberta beverage container recycling corporation) in Saskatchewan and Alberta to correlate the data gathered during the investigation, as presented in this research outcome. Implementing the EPR program, according to the study's findings, may be the most effective way for Canada to achieve a circular economy of plastic waste management.

A Healthy Food Prescription Incentive Program for Adults With Type 2 Diabetes Who Are Experiencing Food Insecurity: Protocol for a Longitudinal Qualitative Study

Abstract Objectives Food insecurity is inadequate or insecure access to food due to financial constraints. Individuals experiencing food insecurity tend to have poorer diet quality compared to their food secure peers. Given the importance of maintaining healthful dietary patterns for optimal glycemic control, food insecurity is a considerable barrier to managing type 2 diabetes (T2DM). Healthy food prescription incentive programs aim to reduce such barriers by providing financial incentives to purchase healthy foods. The purpose of this study is to conduct longitudinal qualitative shop-along interviews among adults with T2DM who are experiencing food insecurity. We will explore experiences of redeeming healthy food incentives and factors influencing food purchasing patterns during participation in a healthy food prescription program in Alberta, Canada. Methods The healthy food prescription incentive program consists of two core elements: 1) A one-time healthy food prescription pamphlet outlining an evidence-based healthy dietary pattern; and 2) A healthy food incentive of $1.50/day/household member to purchase healthy foods in participating supermarkets for 6 months. Thirty participants aged 18–85 years will be purposefully recruited from primary care clinics. At baseline and 6-month follow-up, participants will take part in supermarket-based shop-along qualitative interviews. Participants will be asked to complete a usual grocery shop alongside a researcher. Using think-aloud principles, they will be asked to verbalize their thought processes for the shop's duration. Researchers will also collect naturalistic observations of participants, such as consulting nutrition labels. A post-shop interview will be completed to discuss experiences, decision-making rationale, and potential barriers and facilitators to food purchasing. Data will be analyzed iteratively and inductively at each time point. Further, a longitudinal analysis will compare emerging themes and identify changes occurring over time. Results N/A Conclusions This study will generate key data regarding if, how, and why such programs may address barriers to maintaining healthful dietary patterns. These findings will help to understand experiences of participating in healthy food incentive programs that can be used to improve future programs. Funding Sources Alberta Innovates.

Predator control alters wolf interactions with prey and competitor species over the diel cycle

Predator control remains one of the most common strategies for the conservation of threatened prey species. Despite significant and ongoing efforts to reduce predator populations, little is known about the impacts on the behaviour and interactions of target and non‐target species following numerical and potentially behavioural suppression of predators. We used camera‐trap data collected before and after an intensive wolf control program in northeastern Alberta's boreal forest to evaluate changes in activity patterns and overlap in wolves, competitors and prey. We hypothesized wolves would shift their activity toward increased nocturnality to avoid diurnal control efforts, and thereby cause a behavioural cascade where other species shift activity to maintain temporal segregation from wolves. Wolves shifted activity into the nighttime following predator control, reducing temporal overlap with the other, mostly diurnal, members of the community. Decreases in activity overlap between wolves and other species indicates reduced potential for wolf interactions with ungulate prey and large competitor species. Predator control may therefore not only release species from top to down regulation and competition following numerical suppression of top predators, but also through de‐coupling of temporal overlap, with potential effects on species interactions. Understanding the indirect impacts of conservation strategies such as predator control on both target and non‐target species provides insight into potential disruptions to top–down regulation and the associated species interactions that shape community structure.

A Qualitative Description of Resident Physicians' Understanding of Child Maltreatment: Impacts, Recognition, and Response.

Child maltreatment (CM) is a public health problem with devastating effects on individuals, families, and communities. Resident physicians have varied formal education in CM, and report feeling inadequately trained in identifying and responding to CM. The purpose of this study is to explore residents’ understanding of the impacts of CM, and their perceptions of their role in recognizing and responding to CM to better understand their educational needs. This study analyzed qualitative data obtained from a larger project on family violence education. Twenty-nine resident physicians enrolled in pediatric, family medicine, emergency medicine, obstetrics and gynecology, and psychiatry training programs in Alberta, Ontario, and Québec participated in semi-structured interviews to elicit their ideas, experiences, and educational needs relating to CM. Conventional (inductive) content analysis guided the development of codes and categories. Residents had thorough knowledge about the impacts of CM and their duty to recognize CM, but there was less consistency in how residents understood their role in responding to CM. Residents identified the need for more education about recognizing and responding to CM, and the need for educational content to be responsive to training, patient and family factors, and systemic issues. Despite knowledge about the impacts of CM and laws pertaining to mandated reporting, residents reported challenges with responding to concerns of CM. Findings of this study emphasize the need for better training in response to CM. Future educational interventions should consider a multidisciplinary, experiential approach.

Aligning Goals for Certification and Professional Growth: Building Cooperation Among Bachelor of Education Programs in Alberta

This article chronicles a provincial collaboration between ten Bachelor of Education degree-granting universities in Alberta, Canada. This collaboration focused on the newly implemented Teaching Quality Standard (2018) in Alberta and its impact on preservice teacher practicums. Data were collected through curriculum mapping and interviews at each institution. Each institution analyzed their own data and shared themes at a number of group meetings. Two common themes arose: (a) the interconnectedness of practicum and teacher education courses and (b) the role of the Teaching Quality Standard as a development tool within practicum. Key words: teacher education, practicum, teaching quality standard, postsecondary collaboration Cet article relate une collaboration provinciale entre dix universités de l'Alberta, au Canada, qui décernent des baccalauréats en éducation. Cette collaboration s'est concentrée sur la nouvelle norme de qualité de l'enseignement (2018) en Alberta et son impact sur les stages des enseignants en formation initiale. Les données ont été recueillies par le biais de la cartographie des programmes d'études et d'entretiens dans chaque établissement. Chaque établissement a analysé ses propres données et a partagé les thèmes lors de plusieurs réunions de groupe. Deux thèmes communs sont apparus : (a) l'interconnexion des stages et des cours de formation des enseignants et (b) le rôle de la norme de qualité de l'enseignement comme outil de développement dans le cadre des stages. Mots clés: formation des enseignants, stage, norme de qualité de l'enseignement, collaboration postsecondaire

Participant Exercise-Session Attendance in Community-Based, Bridging, and Hospital-Based Cardiac Rehabilitation: A Retrospective Case-Control Study

BackgroundA paucity of studies have investigated participant attendance in community-based and hybrid cardiac rehabilitation programs in the Canadian setting. We compared exercise-session attendance of community-based, bridging (hospital plus community-based), and hospital-based participants who attended a high-volume cardiac rehabilitation program in Alberta, Canada. MethodsExercise sessions attended and participant characteristics were collected and analyzed from 230 records of patients who attended cardiac rehabilitation between 2016 and 2019. Community-based (n = 74) and bridging (n = 41) program participants were age- and sex-matched in a 1:1 ratio to hospital-based participants. The number of exercise sessions attended was compared among program groups, between female and male patients, and for patients with vs without cardiac surgery. The percentage of exercise sessions attended was also compared among program groups. ResultsBridging participants attended the greatest number of exercise sessions (median = 10.0 sessions) and demonstrated a significantly higher percentage of sessions attended (91%, 25th and 75th percentile interquartile range [IQR] = 64, 100%) than matched hospital participants (median = 6.0 sessions; 63%, 25, 75 IQR = 13, 94%; P = 0.01). Percentage of sessions attended did not differ for bridging and community-based participants (P = 0.30). Exercise-session attendance was similar for community-based participants (median = 6.0 sessions; 75%, 25, 75 IQR = 38%, 88%) vs their hospital matches (median = 6.0 sessions; 81%, 25, 75 IQR = 38%, 100%; P ≥ 0.37), as well as for female vs male patients (median = 7.0 sessions for both sexes; P = 0.66), and for surgical vs nonsurgical patients (median = 7.0 sessions; P = 0.48). Female patients in the bridging program attended significantly more exercise sessions in the community, compared with male patients in the bridging program (P = 0.02). ConclusionsBridging participants attended the most exercise sessions overall and demonstrated a higher percentage attendance than hospital-based participants. These results suggest that a hybrid program consisting of hospital and community-based exercise was favourable for exercise-session attendance. Given modern approaches to de-medicalize cardiac rehabilitation, our findings further support the provision of community program offerings, without detriment to patient session attendance.

COVID-19 Pandemic: Stress, Anxiety, and Depression Levels Highest amongst Indigenous Peoples in Alberta.

This study explores differences in stress, anxiety, and depression experienced by different ethnic groups during the COVID-19 pandemic. This was a cross-sectional online survey of subscribers of the COVID-19 Text4Hope text messaging program in Alberta. Stress, anxiety, and depression were measured among Caucasian, Indigenous, Asian, and other ethnic groups using the Perceived Stress Scale (PSS)-10, Generalized Anxiety Disorder (GAD)-7, and Patient Health Questionnaire (PHQ)-9 scales, respectively. The burden of depression and stress were significantly higher in Indigenous populations than in both Caucasian and Asian ethnic groups. The mean difference between Indigenous and Caucasian for PHQ-9 scores was 1.79, 95% CI of 0.74 to 2.84, p < 0.01 and for PSS-10 it was 1.92, 95% CI of 0.86 to 2.98, p < 0.01). The mean difference between Indigenous and Asian for PHQ-9 scores was 1.76, 95% CI of 0.34 to 3.19, p = 0.01 and for PSS-10 it was 2.02, 95% CI of 0.63 to 3.41, p < 0.01. However, Indigenous participant burden of anxiety was only significantly higher than Asian participants’ (mean difference for GAD-7 was 1.91, 95% CI of 0.65 to 3.18, p < 0.01). Indigenous people in Alberta have higher burden of mental illnesses during the COVID-19 pandemic. These findings are helpful for service planning and delivery.

Virtual Cancer Care During the COVID-19 Pandemic in Alberta: Evidence From a Mixed Methods Evaluation and Key Learnings.

This study reports on a mixed methods evaluation conducted within a provincial cancer program in Alberta, Canada. The purpose was to capture key learnings from a rapid virtual care implementation because of the COVID-19 pandemic and to understand the impact on patient and staff experiences. Administrative data were collected for 21,362 patients who had at least one virtual or in-person visit to any provincial cancer center from April 1, 2020, to June 10, 2020. Patient surveys were conducted with 397 randomly selected patients who had received a virtual visit. Surveys were also conducted with 396 Cancer Care Alberta staff. 14,906 virtual visits took place in this period, and about 40% of weekly visits were virtual. Significant differences were observed in both patient-reported symptom questionnaire completion rates and referrals to supportive care services between patients seen in-person and virtually. Patients receiving active treatments reported significantly lower levels of satisfaction with virtual visits than those seen for follow-up, but overall 90% of patients indicated interest in receiving virtual care in the future. Staff thought virtual visits increased patients' access to care but less than one third (31.5%) felt confident meeting patients' emotional needs and having conversations about disease progression and/or end of life virtually. The COVID-19 pandemic has driven the rapid implementation of virtual visits for cancer care delivery in health care settings. The findings from this mixed methods evaluation provide a concrete set of considerations for organizations looking to develop a large-scale, enduring virtual care strategy.

Exploring the impact of pharmacist comprehensive annual care plans on perceived quality of chronic illness care by patients in Alberta, Canada.

Background:In 2012, the Government of Alberta introduced a funding program to remunerate pharmacists to develop a comprehensive annual care plan (CACP) for patients with complex needs. The objective of this study is to explore patients’ perceptions of the care they received through the pharmacist CACP program in Alberta.Methods:We invited 3442 patients who received a pharmacist-billed CACP within the previous 3 months and 6888 matched controls across Alberta to complete an online questionnaire. The questionnaire consisted of the short version Patient Assessment of Chronic Illness Care (PACIC-11), with 3 additional pharmacy-specific assessment questions added. Additional questions related to health status and demographics were also included.Results:Overall, most patients indicated a low level of chronic illness care by pharmacists, with few differences noted between CACP patients and non-CACP controls. Of note, controls reported higher quality of care for 5 domains within the adapted PACIC-like tool compared with CACP patients (p < 0.05 for all). Interestingly, only 79 (44%) of CACP patients reported that they had received a CACP, whereas only 192 (66%) of control patients reported that they did not receive a care plan. In a sensitivity analysis including only these respondents, individuals who received a CACP perceived a significantly higher quality of chronic illness care across all PACIC domains.Conclusion:Overall, chronic illness care incentivized by the pharmacist CACP program in Alberta is perceived to be moderate to low. When limited to respondents who explicitly recognized receiving the service or not, the perceptions of quality of care were more positive. This suggests that better implementation of CACP by pharmacists may be associated with improved quality of care and that some redesign is needed to engage patients more. Can Pharm J (Ott) 2021;154:xx-xx.

Patient navigation programs in Alberta, Canada: an environmental scan.

Background:Patient navigation is a complex intervention that has garnered substantial interest and investment across Canada. We conducted an environmental scan to understand the landscape of patient navigation programs within the health care system in Alberta, Canada.Methods:We included patient navigation programs within Alberta Health Services (AHS) and Alberta’s Primary Care Networks (PCNs). Key informants were asked in October 2016 to identify existing programs and their corresponding program contacts. These program contacts were invited to complete a telephone-based survey from October 2016 to July 2017, to provide program descriptions and eligibility criteria, and to identify gaps in navigation. Programs were included if they engaged patients on an individual basis, and either facilitated continuity of care or promoted patient and family empowerment. We tabulated results and calculated summary statistics for program characteristics.Results:Ninety-five potentially eligible programs were identified by key informants. The response rate to the study survey was 73% (n = 69). After excluding programs not meeting inclusion criteria, we included a total of 58 programs in the study: 43 AHS programs and 15 PCN programs. Nearly all programs (93%, n = 54) delivered navigation via an individual acting as a navigator. A minority of programs also included nonnavigator components, such as Web-based resources (7%, n = 4) and process or structural changes to facilitate navigation (22%, n = 13). Certain patient subgroups were particularly well-served by patient navigation; these included patients with cancer, substance use disorders or mental health concerns, and pediatric patients. Gaps identified in navigation fell under 4 domains: awareness, resources, geographic distribution and integration.Interpretation:Patient navigation programs are common and have extended beyond cancer care, from which the construct originated; however, gaps include a lack of awareness and inequitable access to the programs. These findings will be of interest to those developing and implementing patient navigation interventions in Alberta and other jurisdictions.

The Evolving Impact on Survival Outcomes in Multiple Myeloma with Greater Access to Novel Treatment Regimens: Experience in a Real-World Cohort

The Evolving Impact on Survival Outcomes in Multiple Myeloma with Greater Access to Novel Treatment Regimens: Experience in a Real-World Cohort

A survey of Alberta pharmacists' attitudes, comfort and perceived barriers to a community-based naloxone program.

Community pharmacists play an important role in the wellness of patients, families and friends affected by prescription and illicit opioid drugs. They are key partners of the Community Based Naloxone (CBN) Program in Alberta and similar programs across other Canadian jurisdictions. This publicly funded program is an evidence-based response to the opioid overdose crisis, facilitating access to and distribution of naloxone kits through pharmacies. The study aimed to describe Alberta community pharmacists' practices, training, comfort levels and views in dispensing naloxone kits through the CBN program and detail potential perceived barriers to program participation. The study was conducted as a cross-sectional online survey of Alberta pharmacists. Data collected from the survey were descriptive and evaluated using Microsoft Excel. Fisher exact tests were used to study the associations in responses among several demographic characteristics and related to dispensing practices, pharmacists' beliefs and perceived barriers. A total of 255 responses were included in the final analysis, with 89.8% of pharmacists replying "yes" to CBN program participation. Pharmacists on average were "comfortable" dispensing naloxone to patients for varying indications, with 85% reporting always providing education when dispensing naloxone to an individual for the first time. About 41% of pharmacists reported no barriers to the program, with the most common perceived barriers being lack of time (29%), demand (20%) and funding (19%). Most community pharmacists who responded to the survey participate in the CBN program in Alberta. They held positive beliefs about their role in screening patients for the risk of opioid overdose and are confident in their abilities to recommend and educate on naloxone kits. Proactive screening appeared lower, however, and dispensing kits were potentially variable. Addressing factors such as time, funding for services and demand may help further pharmacist uptake and success of the program. Can Pharm J (Ott) 2021;154:xx-xx.

A comparison of surgical site infections following total hip replacement and total knee replacement surgeries identified by Infection Prevention and Control and the National Surgical Quality Improvement Program in Alberta, Canada.

To understand how the different data collections methods of the Alberta Health Services Infection Prevention and Control Program (IPC) and the National Surgical Quality Improvement Program (NSQIP) are affecting reported rates of surgical site infections (SSIs) following total hip replacements (THRs) and total knee replacements (TKRs). Retrospective cohort study. Four hospitals in Alberta, Canada. Those with THR or TKR surgeries between September 1, 2015, and March 31, 2018. Demographic information, complex SSIs reported by IPC and NSQIP were compared and then IPC and NSQIP data were matched with percent agreement and Cohen's κ calculated. Statistical analysis was performed for age, gender and complex SSIs. A P value <.05 was considered significant. In total, 7,549 IPC and 2,037 NSQIP patients were compared. The complex SSI rate for NSQIP was higher compared to IPC (THR: 1.19 vs 0.68 [P = .147]; TKR: 0.92 vs 0.80 [P = .682]). After matching, 7 SSIs were identified by both IPC and NSQIP; 3 were identified only by IPC, and 12 were identified only by NSQIP (positive agreement, 0.48; negative agreement, 1.0; κ = 0.48). Different approaches to monitor SSIs may lead to different results and trending patterns. NSQIP reports total SSI rates that are consistently higher than IPC. If systems are compared at any point in time, confidence on the data may be eroded. Stakeholders need to be aware of these variations and education provided to facilitate an understanding of differences and a consistent approach to SSI surveillance monitoring over time.

Cancer Screening Interventions in Indigenous Populations: A Rapid Review.

Cancer screening is an important component of a cancer control strategy. Indigenous people in Canada have higher incidence rates for many types of cancer, including those that can be detected early or prevented through organized screening programs. Increased participation and retention in cancer screening is critical to improved population health outcomes amongst Indigenous people. This rapid review evaluates cancer screening interventions published in the last six years. Included studies demonstrated increased participation in breast, colorectal, or cervical cancer screening programs in Indigenous populations or showed promise of increased participation based on the factors that influence people’s screening practices, such as knowledge, attitude, or intent to screen. The Preferred Reporting Items for Systematic Reviews guided the search strategy. The review identified 85 articles with 12 meeting the specified criteria: seven studies reported an increase in cancer screening participation and five studies reported improved knowledge, attitude, or intent to screen. The use of multiple culturally appropriate strategies in co-designed studies were the most effective. This review will be used to inform First Nations (FN) populations and Screening Programs in Alberta of potential strategies to address disparities identified through a recent data analysis comparing cancer screening and outcomes between FN and non-FN people.

Community paramedicine to support palliative care

Objective This commentary describes community paramedicine (CP) and the potentiality of an expanded scope of practice to provide home-based palliative care. Background The prevalence of individuals desiring palliative care within their home is growing, requiring the provision of high-quality care. CP is a novel approach to delivering care, allowing paramedics to provide community-based, non-urgent care as well as crisis and symptom management within the home. The need for home-based palliative care at earlier stages of the disease trajectory will be essential for the growing older adult population. Community-based models of care are essential in alleviating health systems burden by reducing emergency department visits and over-reliance on primary care. Methods A rapid review was conducted to determine current scope of practice and geographical coverage of CP programming, as well as a broader literature search describing current roles. Discussion An expanded scope of CP practice that provides palliative care has immense potential in alleviating health system burden while simultaneously improving patient health outcomes. Pilot CP palliative care programs in Alberta, Nova Scotia and Prince Edward Island have demonstrated the benefits of community paramedics providing palliative care through reduced emergency department visits and improved patient satisfaction. Community paramedics are well equipped to provide high-quality palliative care earlier within the patient’s disease trajectory and support the patient and caregiver through remote patient monitoring.

Characteristics and Outcomes of Physician-to-Physician Telephone Consultation Programs: Environmental Scan

BackgroundTelephone consultations between physicians provide quick access to medical advice, allowing patients to be cared for by calling physicians in their local settings.ObjectiveAs part of a quality assurance study of a physician-to-physician consultation program in Alberta, Canada, this environmental scan aims to identify the characteristics and outcomes of physician-to-physician telephone consultation programs across several countries.MethodsWe searched 7 databases to identify English publications in 2007-2017 describing physician-to-physician consultations using telephones as the main technology. To identify Canadian programs, the literature search was supplemented with an additional internet search.ResultsThe literature search yielded 2336 citations, of which 17 publications were included. Across 7 countries, 14 telephone consultation programs provided primary care providers with access to various specialists through hotlines, paging systems, or call centers. The programs reported on the avoidance of hospitalizations, emergency department visits and specialty visits, caller satisfaction with the telephone consultation, and cost avoidance.ConclusionsTelephone consultation programs between health care providers have facilitated access to specialist care and prevented acute care use.

Implementing the Med Wise Program in rural Alberta: A feasibility study to support seniors.

Implementing the Med Wise Program in rural Alberta: A feasibility study to support seniors.