Services In Ontario Research Articles

Mental Disorder Symptoms and the Relationship with Resilience among Paramedics in a Single Canadian Site.

There is growing recognition in research and policy of a mental health crisis among Canada’s paramedics; however, despite this, epidemiological surveillance of the problem is in its infancy. Just weeks before the emergence of the COVID-19 pandemic, we surveyed paramedics from a single, large, urban paramedic service in Ontario, Canada to assess for symptom clusters consistent with post-traumatic stress disorder (PTSD), major depressive disorder, and generalized anxiety disorder and to identify potential risk factors for each. In total, we received 589 completed surveys (97% completion rate) and found that 11% screened positive for PTSD, 15% screened positive for major depressive disorder, and 15% screened positive for generalized anxiety disorder, with one in four active-duty paramedics screening positive for any of the three as recently as February 2020. In adjusted analyses, the risk of a positive screen varied as a function of employment classification, gender, self-reported resilience, and previous experience as a member of the service’s peer support team. Our findings support the position that paramedics screen positive for mental disorders at high rates—a problem likely to have worsened since the onset of the COVID-19 pandemic. We echo the calls of researchers and policymakers for urgent action to support paramedic mental health in Canada.

Integrating community paramedicine with primary health care: a qualitative study of community paramedic views.

Background:Community paramedicine (CP) is an emerging model of care that addresses local health needs through programs led by community paramedics; however, CP remains poorly defined and appears to lack systematic integration with the broader health system, specifically primary care, within which it is seated. The purpose of the study was to elucidate the views of community paramedics and their stakeholders in Ontario, Canada, on the topic of integrating CP with the broader health system.Methods:This was a retrospective qualitative analysis of a public recording of a CP provincial forum held in Ontario, Canada, in 2017. Forum attendees (paramedics and stakeholders) were invited by email if they had attended a similar provincial forum in the past (no exclusion criteria for attendance). In small- and large-group discussions, attendees discussed their views on how CP could fit into primary care and what medical oversight and acceptance for the profession could involve. A recording of the large-group discussion, which is publicly available, was transcribed and thematically analyzed.Results:The 89 participants varied in professional affiliation (66% from a paramedic service, n = 59). Among those from paramedic services, 33% were community paramedics (n = 14). Five major themes emerged: defining the role of community paramedics, how CP may integrate with other services, how to garner support for CP, where standardization is needed and possible oversight structures.Interpretation:Community paramedics and their stakeholders have insights into barriers and facilitators for integration with the health system. These study findings could help inform the integration of health and social services in Ontario with a consideration for the unique position and potential of community paramedics.

Role Identity, Dissonance, and Distress among Paramedics.

Role identity theory describes the purpose and meaning in life that comes, in part, from occupying social roles. While robustly linked to health and wellbeing, this may become unideal when an individual is unable to fulfill the perceived requirements of an especially salient role in the manner that they believe they should. Amid high rates of mental illness among public safety personnel, we interviewed a purposely selected sample of 21 paramedics from a single service in Ontario, Canada, to explore incongruence between an espoused and able-to-enact paramedic role identity. Situated in an interpretivist epistemology and using successive rounds of thematic analysis, we developed a framework for role identity dissonance wherein chronic, identity-relevant disruptive events cause emotional and psychological distress. While some participants were able to recalibrate their sense of self and understanding of the role, for others, this dissonance was irreconcilable, contributing to disability and lost time from work. In addition to contributing a novel perspective on paramedic mental health and wellbeing, our work also offers a modest contribution to the theory in using the paramedic context as an example to consider identity disruption through chronic workplace stress.

Building Families Through Healthcare: Experiences of Lesbians Using Reproductive Services

The use of assisted human reproduction (AHR) represents a meaningful and important life event for lesbians wishing to create biologically related families. Despite increasing numbers of lesbians utilizing AHR services, barriers to access persist. This qualitative study investigated the experiences of lesbians and their interactions with reproductive services in Ontario, Canada, where limited public funding is available for all AHR patients and where the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community makes up to 30% of clientele. Eleven semi-structured interviews were conducted, and findings revealed a wide range of experiences. Lesbian patients expressed a desire for more support from their care providers in navigating a complex and costly medical journey through a system largely designed for the needs of heterosexual patients. Additionally, private fertility clinics, as the environment for accessing publicly funded services, were felt to contribute pressure to pay out-of-pocket for add-on medical procedures. To improve the quality of care, participants recommended providing more high-level information on the medical journey and taking an individual approach with lesbian patients, in particular, assuming a patient has sufficient fertility until proven otherwise.

Impact of COVID-19 pandemic on foot care services in Ontario, Canada

BackgroundThe COVID-19 pandemic has directly affected the delivery of health care services in Canada, including foot care. The goal of this descriptive study was to understand the impact of the early COVID-19 pandemic (March 2020 to April 2021) on chiropodists’ and podiatrists’ clinical practices and foot care service delivery in Ontario, Canada.MethodsA web-survey was completed by participating chiropodists and podiatrists registered with the College of Chiropodists of Ontario. The survey consisted of 31 multiple choice and open-ended items on clinical practice characteristics, foot care service delivery changes, perceived barriers during the pandemic, and its impact on clinicians. Descriptive statistics were used to characterize the sample and examine clinicians’ responses, and qualitative content analysis was used to explore opened-ended items.ResultsOf the 773 eligible clinicians, 279 participated for a response rate of 36.1%. Most respondents reported a decline in patient volume, an increase in urgent foot health problems, a financial impact on their clinical practices, an emotional impact, and substantial changes to how they provided foot care services, such as incorporating telehealth/virtual care into patient care. Factors that impact clinicians’ perception of future pandemic preparedness are identified.ConclusionThis study describes foot care service delivery in Ontario, Canada during the COVID-19 pandemic. The COVID-19 pandemic saw an increase in urgent foot health problems, decline in patient volume, and impacted clinicians’ mental health and emotional well-being. Future studies should examine patients’ experiences of foot care service delivery and maintaining their foot health during the pandemic, and further examination of factors that impact clinicians’ perception of pandemic preparedness.

The role of organizational culture in normalizing paramedic exposure to violence

PurposeViolence against paramedics is a complex – but underreported – problem. Extant research suggests organizational culture may play a role in sustaining cultural norms that downplay the significance and limit reporting. The purpose of this paper is to qualitatively explore paramedics’ experience with violence, with particular emphasis on understanding how organizational culture contributes to under-reporting.Design/methodology/approachThe authors surveyed paramedics from a single, large, urban service in Ontario, Canada, asking participants to describe their experiences with violence, including whether – and why or why not – the incidents were reported. Within a constructivist epistemology, we used inductive thematic analysis with successive rounds of coding to identify and then define features of organizational culture that limit reporting.FindingsA total of 196 (33% of eligible) paramedics completed the survey. Fully 98% of participants disclosed having experienced some form of violence; however, only a minority (40%) reported the incidents to management, or the police (21%). The authors defined a framework within which a lack of support from management, and consequences for offenders, implicitly positions the ability of paramedics to “brush off” violent encounters as an expected professional competency. Disclosing emotional or psychological distress in response to violent encounters invited questions as to whether the individual is personally suited to paramedic work.Originality/valueWhile the extant research has indicated that underreporting is a problem, the findings shed light on why – a critical first step in addressing what has been described as a serious public health problem.

Schulich students for emergency childcare: Results of a community initiative during COVID-19

The coronavirus disease (COVID-19) pandemic led to the abrupt suspension of many businesses and services in Ontario including schools and childcare centres. This resulted in many parents struggling to identify options for childcare, including frontline healthcare workers (HCWs). A volunteer initiative composed of medical and dental students was developed to provide emergency childcare support to HCWs in Southwestern Ontario. Experts in areas of public health, law, and bioethics were consulted to minimize the risks associated with participation and develop a clear policy to prioritize the health and safety of all participants. Social media was utilized to recruit volunteers and HCWs who were matched on a first-come, first-served basis. 59 medical and dental students were recruited to provide emergency support for 21 HCWs within the unique safety and ethical conditions posed by COVID-19. By reflecting on the strengths of this initiative and the challenges faced during its completion, key areas of improvement were identified that should be addressed in future initiatives of a similar nature.

Relevance of assessment items in community paramedicine home visit programmes: results of a modified Delphi study

ObjectiveGuidelines for a structured assessment in community paramedicine home visit programmes have not been established and evidence to inform their creation is lacking. We sought to investigate the relevance of...

Demographic and Clinical Characteristics of Diabetic Patients With and Without a History of Homelessness

People experiencing homelessness face numerous challenges to diabetes management that can contribute to chronic hyperglycemia and adverse outcomes. The aim of this study was to compare the clinical and demographic characteristics between those with and without a history of homelessness in a cohort of people with diabetes who have received acute care services in Ontario.

Socioeconomic Status and Vision Care Services in Ontario, Canada: A Population-Based Cohort Study

To test the association of material deprivation and the utilization of vision care services for young children. We conducted a population-based, repeated measures cohort study using linked health and administrative datasets. All children born in Ontario in 2010 eligible for provincial health insurance were followed from birth until their seventh birthday. The main exposure was neighborhood-level material deprivation quintile, a proxy for socioeconomic status. The primary outcome was receipt of a comprehensive eye examination (not to include a vision screening) by age 7years from an eye care professional, or family physician. Of 128 091 children included, female children represented 48.7% of the cohort, 74.4% lived in major urban areas, and 16.2% lived in families receiving income assistance. Only 65% (n=82 833) had at least 1 comprehensive eye examination, with the lowest uptake (56.9%; n=31 911) in the most deprived and the highest uptake (70.5%; n =19 860) in the least deprived quintiles. After adjusting for clinical and demographic variables, children living in the least materially deprived quintile had a higher odds of receiving a comprehensive eye examination (aOR 1.43; 95% CI 1.36, 1.51) compared with children in the most materially deprived areas. Uptake of comprehensive eye examinations is poor, especially for children living in the most materially deprived neighborhoods. Strategies to improve uptake and reduce inequities are warranted.

Health System-Level Evaluation of Tele-Mental Health Services Among Children and Adolescents in Ontario, Canada.

ObjectiveTo describe the characteristics of children and adolescents receiving tele-mental health services in Ontario, Canada and examine access to a psychiatrist, in-person or via tele-mental health services, following a mental health and addictions (MHA)-related emergency department (ED) visit or hospitalization.MethodUsing linked health and administrative data, we described two cohorts: (1) children and adolescents (1–18 years) who used a provincial tele-mental health programme from January 1, 2013 to March 31, 2017, comparing their MHA-related service use (outpatient, ED, hospitalization) in the 1 year prior to and the 1 year following initial consultation; (2) children and adolescents with high mental health service needs, defined as those with an incident MHA-related ED visit or hospitalization between January 1, 2013 and December 31, 2016, examining their 1-year follow-up with telemedicine and other health care utilization.ResultsIn the first cohort, 7,216 children and adolescents (mean age 11.8 [±3.8] years) received tele-mental health services. The proportion of MHA-related ED visits [15.1% pre vs. 12.6% post (test statistic 23.57, P < 0.001)] or hospitalizations [10.2% pre vs. 8.7% post (test statistic 11.96, P < 0.001)] declined in the year following tele-mental health consultation, while local psychiatry visits increased [8.4% pre vs. 17.0% post (test statistic 298.69, P < 0.001)]. In the second cohort (n = 84,033), only 1.5% received tele-mental health services, 40.7% saw a psychiatrist in-person, and 32.5% received no MHA-related outpatient care in follow-up.ConclusionsTele-mental health services were rarely used in Ontario, even among high-needs children and adolescents, despite their association with increased access to care and less need for acute mental health care.

Informal Caregiving: Implications for Healthcare Expenditures

Introduction: Informal caregivers are family, friends, and neighbors who provide assistance to people in need of care without pay. Caregivers play a critical role in patients’ care. Care provided by informal caregivers is often seen as a lower cost substitute to formal care and their contributions are assumed to take strain off the care system. Caregivers, however, report significant consequences such as a decline in their health and a higher use of healthcare services due to their caregiving responsibilities. While many studies have explored these outcomes using self-reported measures, use of administrative databases to substantiate such claims is rare. The objective of this study was to examine the impact of caregiving on healthcare utilization amongst informal caregivers.Methods: The outcome was total healthcare expenditures for publicly funded healthcare services in Ontario, Canada. The population consists of Ontarians who a) participated in the 2008/09 Canadian Community Health Survey – Health Aging Supplement Survey (CCHS-HAS) and b) provided consent to link their survey results to health administrative databases. The exposure was measured as self-reported role as a primary caregiver that started within 5 years of the date that the survey was completed; the comparison group was those who did not self-identify as caregivers in CCHS-HAS. Total healthcare costs of caregivers and non-caregivers were compared pre versus post reported caregiving start date using a difference-in-differences design. Both one and two-year periods of healthcare utilization were examined. The study period was 2002 to 2011. Generalized Linear Models is used to model the total healthcare costs. Sensitivity analyses were conducted to test the robustness of the results.Results: The sample consists of 1265 caregivers and 3010 non-caregivers. The average age was 62.6 and 67.7 for caregivers and non-caregivers, respectively. Nearly 60% of caregivers and 54% of the non-caregivers were female. After adjusting for confounders, it was found that while caregivers’ costs associated with use of publicly funded services increased over time, caregiving had a negative impact on total costs in comparison to non-caregivers. Caregivers used the healthcare services less than non-caregivers. In the first year after caregiving this difference was 3% but not statistically significant. This, however, changed with time; the difference increased by 8% to 11% and became statistically significant. Discussion: Despite overwhelming self-reported evidence of caregivers’ declining health and increased use of health services due to caregiving, we found that use of healthcare services increased by a lesser amount amongst caregivers than for non-caregivers. If caregivers’ health has not similarly improved relative to non-caregivers, this suggests that caregivers may not have time to ensure their own medical needs are addressed.Conclusions: Our findings suggest the need for careful consideration of caregivers and their needs when designing and implementing healthcare interventions such as integrated care models.Lessons learned: By providing an estimation of healthcare expenditure implications of caregiving, we offer an alternative method to be considered in economic evaluations of the healthcare system, evaluation studies, health economics, and caregiving studies. Limitations: The main limitation is that caregiver status and timing is based on survey self-report which could incorrectly classify the exposure and bias estimates of cost. Lack of specific data on caregiving characteristics (e.g. hours of care provided) could have introduced bias in our results.Future research: More research in different jurisdictions and on different caregiver populations are required to substantiate our findings.

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.

ORAL AND OROPHARYNGEAL SQUAMOUS CELL CARCINOMA ASSOCIATED WITH PRECURSOR LESIONS: A STUDY OF CANCER DATA IN ONTARIO, CANADA

<h3>Background</h3> Oral and oropharyngeal squamous cell carcinoma (OSCC) is commonly preceded by preinvasive lesions. These are collectively described as oral potentially malignant disorders (OPMDs). We hypothesized that OSCCs that are associated with a previously diagnosed OPMD have better clinical outcomes. <h3>Objective</h3> To determine the clinical characteristics and outcomes of OSCC diagnosed in Ontario and compare cases with or without previous biopsy-proven OPMD. <h3>Methods</h3> We searched for OPMD diagnosed from 2001 to 2015 in the databases of 4 pathology services in Ontario: Oral Pathology Diagnostic Services at University of Toronto, Western University, Mt. Sinai Hospital, and Sunnybrook Health Sciences Centre. The database was linked to the Cancer Care Ontario database (2005-2015) to identify OSCC cases with a preceding OPMD. Variables included age at cancer diagnosis, sex, geographic location of the patient's residence, cancer site, stage, and outcome. <h3>Results</h3> There were 11,213 patients diagnosed with OSCC between 2005 and 2015 and 390 of these patients had a preceding diagnosis of OPMD (3.48%). In addition, 17.12% of patients with OSCC with precursor lesions died of disease, compared with 31.87% of those without a precursor (<i>P</i> < .0001). Stage I disease predominated in patients with precursor lesions (46.71%) and Stage IV disease was more frequent in patients without precursor lesions (56.73%). The proportion of patients with cancer with previously diagnosed OPMD was influenced by the location of patients' residence (<i>P</i> < .0001), suggesting that differences in access to care play an important role. <h3>Conclusions</h3> Clinical and histopathologic diagnosis of OPMD is critical for early cancer detection and leads to improved clinical outcome.

The impact of the COVID-19 pandemic on the Ontario Cervical Screening Program, colposcopy and treatment services in Ontario, Canada: a population-based study.

ObjectiveTo describe the immediate impact of the COVID‐19 pandemic on cervical screening, colposcopy and treatment volumes in Ontario, Canada.DesignPopulation‐based retrospective observational study.SettingOntario, Canada.PopulationPeople with a cervix age of 21–69 years who completed at least one cervical screening cytology test, colposcopy or treatment procedure for cervical dysplasia between January 2019 and August 2020.MethodsAdministrative databases were used to compare cervical screening cytology, colposcopy and treatment procedure volumes before (historical comparator) and during the first 6 months of the COVID‐19 pandemic (March–August 2020).Main outcome measuresChanges in cervical screening cytology, colposcopy and treatment volumes; individuals with high‐grade cytology awaiting colposcopy.ResultsDuring the first 6 months of the COVID‐19 pandemic, the monthly average number of cervical screening cytology tests, colposcopies and treatments decreased by 63.8% (range: −92.3 to −41.0%), 39.7% (range: −75.1 to −14.3%) and 31.1% (range: −43.5 to −23.6%), respectively, when compared with the corresponding months in 2019. Between March and August 2020, on average 292 (−51.0%) fewer high‐grade cytological abnormalities were detected through screening each month. As of August 2020, 1159 (29.2%) individuals with high‐grade screening cytology were awaiting follow‐up colposcopy.ConclusionsThe COVID‐19 pandemic has had a substantial impact on key cervical screening and follow‐up services in Ontario. As the pandemic continues, ongoing monitoring of service utilisation to inform system response and recovery is required. Future efforts to understand the impact of COVID‐19‐related disruptions on cervical cancer outcomes will be needed.Tweetable abstractCOVID‐19 has had a substantial impact on cervical screening and follow‐up services in Ontario, Canada.

Strategies to Locate Lost Persons with Dementia: A Case Study of Ontario First Responders.

Information on strategies and practices in the search of missing persons with dementia is inconsistent which creates challenges for first responders, such as police, when they choose appropriate search and rescue approaches. The purpose of this study was to describe current strategies among police services in Ontario. Telephone interviews with police were conducted. Questions included what strategies were used for locating missing persons living with dementia, and what gaps exist in search practices. Participants described they used high- and low-tech solutions in search and rescue. They identified gaps in education and awareness, proactive strategies, resources, and funding. Information collected from the interviews was used to develop a practice guideline for police in partnership with the Alzheimer Society of Ontario.

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.

Advancing Trans-Affirming Practice to Recognize, Account for, and Address the Unique Experiences and Needs of Transgender Sexual Assault Survivors.

Transgender (trans) persons are sexually assaulted at high rates and often encounter barriers to equitable services and supports. The receipt of timely and appropriate postassault care, provided increasingly by specialized forensic nurses around the world, is critical in ameliorating the harms that accompany sexual assault. In order to adequately respond to the acute health care needs of trans clients and attend to longer term psychosocial difficulties that some experience, forensic nurses not only require specialized training but must also cultivate collaborative relationships with trans-positive health and social services in their communities. To meet this need, we describe our strategy to advance trans-affirming practice in the sexual assault context. We outline the design and evaluation of a trans-affirming care curriculum for forensic nurses. We also discuss the planning, formation, and maturation of an intersectoral network through which to disseminate our curriculum, foster collaboration, and promote trans-affirming practice across health care and social services in Ontario, Canada. Our approach to advancing trans-affirming practice holds the potential to address systemic barriers experienced by trans survivors and transform the response to sexual assault across other sectors and jurisdictions.

The Transformation of Soil Advisory Services in Ontario

The past several decades has witnessed a marked transformation of Ontario’s agricultural extension services from being a provincial government run service to one that’s is marked by a diverse network of public and private information service providers. This presentation reports a preliminary analysis of the contemporarysoil advisory services, especially looking at how different actors are organised, methods used and emerging challenges. The data were collected using key informant interviews with a purposively selectedadvisor. The findings highlight a variety of service providers at play within the soil advisory services which comprised of numerous commodity marketing boards, producer organisations, input and equipmentsuppliers, OMAFRA and the University of Guelph. These actors are organised through various formal andinformal networks, although respondents expressed their concerns on coordination and communication within the network, with an attendant negative impact on network efficiency in advisory service provision. Although most respondents yearn for an individual approach, mainly represented by the public sector, the current service delivery is dominated by groups and mass methods. The findings also indicate a move fromadvisory roles as generalist knowledge brokers to specialist knowledge brokers. The advisory service isgoverned by a ‘hands off’ approach because of withdrawal of public service support that creates significant gaps for coordination and collaboration among different players. The gaps need to be filled in—eitherchampioned by public or private sector actors—but it is not possible without significant changes in existingpolicy and public supports.

Prevalence of winter migration to warmer destinations among Ontarians ("snowbirds") and patterns of their use of health care services: a population-based analysis.

Background:Older Canadians frequently migrate to warmer destinations for the winter season (snowbirds). Our aim was to examine the prevalence of migration to warmer destinations among Ontarians, and to compare the characteristics and use of health care services of snowbirds to those of older Ontarians who did not migrate for the winter.Methods:We conducted a population-based analysis using health administrative databases from Ontario. We compiled 10 seasonal cohorts (2009/10 to 2018/19) of adults aged 65 or more who filled a travel supply of medications under the Ontario Drug Benefits program (snowbirds) between September and January (snowbird season). We calculated the seasonal prevalence of snowbirds per 100 Ontarians aged 65 or more. We matched each snowbird in the 2018/19 season to 2 nonsnowbirds on age and sex, and compared their characteristics and patterns of use of government-funded health care services.Results:Over the 10-year period, 53 431 to 70 863 Ontarians aged 65 or more were identified as snowbirds (seasonal prevalence 2.6%–3.3%). Compared to nonsnowbirds, snowbirds were more likely to be recent migrants, live in higher-income neighbourhoods, have fewer comorbidities and make more visits to primary care physicians. From January to March 2019, snowbirds accessed government-funded health care services for a median of 0 days (interquartile range [IQR] 0–1 d), compared to 4 days (IQR 2–8 d) among nonsnowbirds.Interpretation:About 3% of older Ontarians migrate to warmer destinations for the winter each season. Since few access health care services in Ontario from January to March, researchers are encouraged to consider the snowbird population and the impact of their absence on evaluations that assume continuous observation.