Assuntos

Assuntos

RESUMO

BACKGROUND: It has been suggested that up to 40% of dementia cases worldwide are associated with modifiable risk factors; however, these estimates are not known in Canada. Furthermore, sleep disturbances, an emerging factor, has not been incorporated into the life-course model of dementia prevention. OBJECTIVE: To estimate the population impact of 12 modifiable risk factors in Canadian adults including sleep disturbances, by sex and age groups, and to compare with other countries. DESIGN: Cross-sectional analysis of Canadian Longitudinal Study on Aging baseline data. SETTING: Community. PARTICIPANTS: 30,097 adults aged 45 years and older. MEASUREMMENTS: Prevalence and Population Attributable Fractions (PAFs) associated with less education, hearing loss, traumatic brain injury, hypertension, excessive alcohol, obesity, smoking, depression, social isolation, physical inactivity, diabetes, and sleep disturbances. RESULTS: The risk factors with the largest PAF were later life physical inactivity (10.2%; 95% CI, 6.8% to 13%), midlife hearing loss (6.5%; 3.7% to 9.3%), midlife obesity (6.4%; 4.1% to 7.7%), and midlife hypertension (6.2%; 2.7% to 9.3%). The PAF of later life sleep disturbances was 3.0% (95% CI, 1.8% to 3.8%). The 12 risk factors accounted for 51.9% (32.2% to 68.0%) of dementia among men and 52.4% (32.5% to 68.7%) among women. Overall, the combined PAF of all risk factors was 49.2% (31.1% to 64.9%), and it increased with age. CONCLUSION: Nearly up to 50% of dementia cases in Canada are attributable to 12 modifiable risk factors across the lifespan. Canadian risk reduction strategies should prioritize targeting physical inactivity, hearing loss, obesity, and hypertension.

Assuntos

Assuntos

Assuntos

Assuntos

Assuntos

Assuntos

RESUMO

Most participants reported a positive perception of bone active medication despite sustaining a fracture while taking the medication, reporting medication side effects, or having a healthcare provider stop the prescription. Participants did not appear to connect the medication to fracture risk, suggesting this connection should be emphasized by healthcare providers. OBJECTIVE: Our purpose was to examine perceptions about bone active medication from individuals with a fragility fracture and a prescription for bone active medication. METHODS: In this qualitative description study, eligible participants were those who attended an Osteoporosis Canada education session, and reported sustaining a previous fragility fracture and receiving a prescription for bone active medication. We conducted one-on-one interviews and analyzed the data using the analytic hierarchy approach. RESULTS: We interviewed 32 female participants (age range 58-89 years). Based on our analysis, two themes were developed: (1) most participants spoke positively about bone active medication, indicating they were willing to start, or continue to take, their medication. Positive perceptions were held by participants who sustained a fracture while taking bone active medication, participants whose healthcare provider had stopped the prescription, and participants who reported side effects from the medication; (2) most participants did not discuss bone active medication in relation to their fracture and did not appear to connect the medication to the concept of fracture risk. Instead, participants talked about the medication in relation to bone health in general, or to bone density. CONCLUSION: Participants appeared to have positive perceptions of bone active medication, despite sustaining a fracture while taking the medication, reporting medication side effects, or having a healthcare provider stop the prescription. Participants did not connect bone active medication to the concept of fracture risk, illustrating the need for healthcare providers to emphasize the connection between fracture risk and bone active medication.

Assuntos

RESUMO

BACKGROUND: Despite primary care being largely free at the point of delivery, many Canadians experience challenges in accessing the services they need. A systematic review was conducted to summarize the evidence on the level of unmet need for primary care in Canada and its social determinants. METHODS: MEDLINE, Embase, Cochrane, and Web of Science databases were screened from inception to December 2023 using relevant search terms for primary care and unmet healthcare needs. Quantitative observational studies in the English language that included Canadian adults aged 18 years and older and focused on unmet needs for primary care were included. The risk of bias in the studies was assessed using either the Joanna Briggs Institute (JBI) critical appraisal checklist or the Newcastle-Ottawa Scale. The included studies were synthesized narratively. RESULTS: Forty-six studies met the inclusion criteria for this review. Of the included studies, 96% were cross-sectional in design and 91% had low risk of bias. The prevalence of unmet need, mostly self-reported, varied between 6.6% and 25.2% in national studies. Social determinants of unmet needs were heterogeneous across studies. Findings suggest that unmet need for primary care is related to having low income, mental health diagnoses, and chronic conditions, and negatively associated with older age, having better-perceived health, and having a family physician. CONCLUSIONS: Universal access to primary care is the founding principle of the Canadian healthcare system. However, we found evidence suggesting that the extent to which primary care needs are met is influenced by social determinants of health. Further research is needed to improve our understanding of the mechanisms of unmet primary care needs in Canada. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021285074.

Assuntos

Assuntos

RESUMO

OBJECTIVES: Widespread health service disruptions resulting from the COVID-19 pandemic coincided with a dramatic increase in overdose deaths among people who use drugs (PWUD) in Vancouver, Canada. Those with a history of injection drug use are known to be at heightened risk of substance-associated harms. Drug use patterns and associated sociodemographic and health care utilization trends have been understudied in this population since the pandemic onset. We sought to understand patterns of drug use initiation and/or re-initiation among people with a history of injection drug use (IVDU). METHODS: Data were obtained from three harmonized prospective cohort studies of PWUD in Vancouver. Participants with a lifetime history of IVDU who responded to a survey between June 2021 and May 2022 were included. The primary outcome variable was a composite of substance use initiation and re-initiation over the study period, labelled as drug (re)-initiation. A multivariable generalized linear mixed-effects model was used to examine factors associated with self-reported (re)-initiation of substance use over the past six months. RESULTS: Among 1061 participants, the median age was 47 years at baseline and 589 (55.5%) identified as men. In total, 183 (17.2%) participants reported initiating and/or re-initiating a drug, with 44 (4.1%) reporting new drug initiation and 148 (14.0%) reporting drug re-initiation (9 participants responded 'yes' to both). Overall, unregulated stimulants (e.g., crystal methamphetamine and cocaine) were the most common drug class (re-)initiated (n = 101; 55.2%), followed by opioids (n = 74; 40.4%) and psychedelics (n = 36; 19.7%). In the multivariable analysis, (re-)initiation of drug use was independently associated with recent IVDU (adjusted odds ratio [AOR] 2.62, 95% confidence interval [CI] 1.02, 6.76), incarceration (AOR 3.36, CI 1.12, 10.14) and inability to access addiction treatment (AOR 4.91, 95% CI 1.22, 19.75). CONCLUSIONS: In an era impacted by the intersecting effects of the COVID-19 pandemic and the overdose crisis, nearly one in five PWUD with a history of IVDU began using a new drug and/or re-started use of a previous drug. Those who reported drug (re-)initiation exhibited riskier substance use behaviours and reported difficulty accessing treatment services. Our findings underscore the need to provide additional resources to support this high-risk population.

Assuntos

RESUMO

BACKGROUND: Health Advocacy is considered one of the most difficult skills to teach. Many medical learners feel ill-equipped in social competencies and identify it as a significant gap in their medical training. Experiential learning has recently been emerging as a more effective method to teach health advocacy. The Post Graduate Medical Education (PGME) Health Advocacy Day is a new experiential learning curriculum designed to teach important competencies of health advocacy and social accountability to post-graduate medical residents at the University of Ottawa in Ottawa, Canada. The objective of this mixed-methods study was to assess resident experiences. METHODS: Second-year trainees from all adult residency programs attended the Advocacy Day as part of a mandatory academic day. All participants completed a mandatory pre-and post-session quiz to assess knowledge of key topics before and after the course. We also distributed a voluntary survey to all participants and invited residents to participate in semi-structured interviews to provide feedback on the course. We used descriptive statistics to analyze quiz scores and survey results and conducted a paired t-test of pre and post-test quiz scores. We also performed a thematic analysis of qualitative feedback, specifically survey comments and semi-structured interviews. RESULTS: One hundred and eighty-three residents participated in the Advocacy Day and 112 (61.2%) completed the post-course survey. Ten residents volunteered to be interviewed. Respondents were generally satisfied by the session and felt it was of good quality. Most residents felt the course enhanced their ability to advocate for individual patients or communities (N = 80; 71.5%) and understand patients and families' lived experience with illness (N = 87; 77.5%). Most residents also felt the course improved their knowledge of the impact of social determinants of health (N = 91; 81.2%) and increased their awareness of local resources that can support patients and their families (N = 88; 78.3%). Visiting community sites in-person and meeting persons with lived experiences were highlighted as the most valuable components of the course. CONCLUSION: Experiential learning can be integrated within post-graduate medical curricula to teach health advocacy competencies. Future studies should examine the longitudinal impact of the curricula, to determine whether shifts in perspectives persist over time.

Assuntos

RESUMO

BACKGROUND: Digital health technologies are increasingly used by healthcare professionals working in pediatric hospital and rehabilitation settings. Multiple factors may affect the implementation and use of digital health technologies in these settings. However, such factors have not been identified in a multidisciplinary, pediatric context. The objective of this study was to describe actual use and to identify the factors that promote or hinder the intention to use digital health technologies (mobile learning applications, virtual/augmented reality, serious games, robotic devices, telehealth applications, computerized assessment tools, and wearables) among pediatric healthcare professionals. METHODS: An online survey evaluating opinions, current use, and future intentions to use digital health technologies was completed by 108 professionals at one of Canada's largest pediatric institutes. Mann-Whitney U tests were used to compare the attitudes of healthcare professionals who intend to increase their use of digital health technologies and those who do not. Linear regression analyses were used to determine predictors of usage success. RESULTS: Healthcare professionals reported mostly using mobile and tablet learning applications (n = 43, 38.1%), telehealth applications (n = 49, 43.4%), and computerized assessment tools (n = 33, 29.2%). Attitudes promoting the intention to increase the use of digital health technologies varied according to technology type. Healthcare professionals who wished to increase their use of digital health technologies reported a more positive attitude regarding benefits in clinical practice and patient care, but were also more critical of potential negative impacts on patient-professional relationships. Ease of use (ß = 0.374; p = 0.020) was a significant predictor of more favorable usage success. The range of obstacles encountered was also a significant predictor (ß = 0.342; p = 0.032) of less favorable evaluation of usage success. Specific factors that hinder successful usage are lack of training (ß = 0.303; p = 0.033) and inadequate infrastructure (ß = 0.342; p = 0.032). CONCLUSIONS: When working with children, incorporating digital health technologies can be effective for motivation and adherence. However, it is crucial to ensure these tools are implemented properly. The findings of this study underscore the importance of addressing training and infrastructure needs when elaborating technology-specific strategies for multidisciplinary adoption of digital health technologies in pediatric settings.

Assuntos

RESUMO

While there is growing literature on experiences of healthcare workers and those providing unpaid care during COVID-19, little research considers the relationships between paid and unpaid care burdens and contributions. We administered a moral distress survey to healthcare workers in Canada, in 2022, collecting data on both paid and unpaid care. There were no significant differences in the proportion of participants providing unpaid care by gender, with both genders equally affected by certain responsibilities such as reduced contact with family/loved ones. However, men were significantly more distressed about specific unpaid care responsibilities. Unpaid care was not significantly associated with differences in intention to leave work. At work, women were significantly more concerned about patients unable to see family, while men were distressed by others mistreating COVID patients. This study enhances understanding of paid and unpaid care relationships, particularly during crises, and proposes an innovative method for assessing unpaid care burdens.

Assuntos

RESUMO

INTRODUCTION: Social prescribing (SP) is a holistic and collaborative approach to help individuals access community-based supports and services for their nonmedical social needs. The aim of this study was to assess the needs and priorities of Canadian older adults (aged 55 years and older), with a focus on optimizing SP programs for those who are systemically disadvantaged and socially marginalized. METHODS: Semistructured focus groups (N = 10 groups, 43 participants) were conducted online via Zoom with participants from across Canada. Data transcription and thematic analysis were completed in NVivo. Analyses were informed by self-determination theory. RESULTS: Our results suggest that older adults desire SP programs that respect their ability to maintain their autonomy and independence, aid and facilitate the development of connectedness and belonging, are built on a foundation of trust and relationship-building in interactions with providers and link workers, and prioritize the person and thus personalize SP to the unique needs of each individual. CONCLUSION: SP programs should be informed by the values of older adults. As work is currently underway to formalize and scale SP in Canada, personalizing these programs to the unique circumstances, needs and priorities of participants should be a top priority.

Assuntos

RESUMO

Social prescribing offers a practical mechanism by which public health and health care systems can work together toward a future in which well-being is prioritized, health equity is addressed and people and communities thrive. The articles in this second part of the Health Promotion and Chronic Disease Prevention in Canada special issue on social prescribing explore how social prescribing in Canada supports action on two frameworks important to public health and health care communities: the Ottawa Charter for Health Promotion, which emphasizes building healthy public policy, creating supportive environments, strengthening community action, developing personal skills and reorienting health services, and the Quintuple Aim for health care improvement, which focusses on improved population health, health equity, patient experience, care team well-being and reduced costs.

Social prescribing supports collaboration between public health and health care services by providing a mechanism for action on both the Ottawa Charter for Health Promotion and the Quintuple Aim for health care improvement. At the individual level, people develop personal skills (Ottawa Charter), and care experiences improve for participants, patients and health care workers (Quintuple Aim). At the community level, health service reorientation strengthens community action, builds supportive environments and reduces acute care costs by moving care upstream. At the population level, precision data on health and social care support prioritization and decision making for healthy public policy and health equity.

La prescription sociale renforce la collaboration entre la santé publique et les services de soins de santé en leur fournissant un mécanisme par lequel agir en respectant la Charte d'Ottawa pour la promotion de la santé et l'Objectif quintuple pour l'amélioration des soins de santé. À l'échelle individuelle, les personnes développent des compétences personnelles (Charte d'Ottawa) et les expériences en matière de soins sont meilleures pour les participants, les patients et les travailleurs de la santé (Objectif quintuple). À l'échelle locale, la réorientation des services de santé renforce l'action des collectivités, crée des environnements favorables et réduit les coûts des soins aigus en déplaçant les soins en amont. À l'échelle de la population, la présence de données précises sur les soins de santé et les soins sociaux favorise l'établissement des priorités et la prise de décision, ce qui conduit à des politiques publiques favorisant davantage la santé et à une meilleure équité en matière de santé.

Assuntos

RESUMO

INTRODUCTION: Social prescribing (SP) is a rapidly growing health and social model of care. The concept of social prescribing is based on well-known clinical practices such as community referrals, integrated health and social care, and navigator models. Although SP began in the United Kingdom's mental health and social care field, there are many examples of different models of SP foci and pathways. Here in Canada, SP is emerging at several provincial locations, with differences in its delivery reflecting the local context of people and places.

British Columbia (BC) has developed a province-wide social prescribing model supporting older adults through close partnerships between health care and community organizations. A regional health authority, Fraser Health, has a specific regional team focussing on integrating social prescribing into the health system through meaningful engagement and continuous co-creation with multisectoral partners, using strategies such as change management and Plan-Do-Study-Act cycles. Environmental and organizational support are big facilitators that have supported the continuation of the designated integration effort. Long-term funding and more partnerships between health care and community organizations will be critical to sustaining the social prescribing model in BC.

La Colombie-Britannique a élaboré un modèle de prescription sociale à l'échelle de la province pour soutenir les aînés grâce à des partenariats étroits entre les établissements de soins de santé et les organismes communautaires. Une régie régionale de santé, Fraser Health, a une équipe régionale spécialisée qui travaille à intégrer la prescription sociale au système de santé par des interactions significatives avec des partenaires multisectoriels et l'élaboration conjointe continue de programmes, au moyen de stratégies comme la gestion du changement et les cycles de planification, d'exécution, d'étude et d'action (de Plan-Do-Study-Act, soit Planification-Exécution-Étude-Action). Les ressources du milieu et le soutien des organismes sont des facteurs importants qui ont facilité la poursuite de ces travaux d'intégration. Un financement à long terme et une hausse des partenariats entre les établissements de soins de santé et les organismes communautaires seront essentiels à la pérennisation du modèle de prescription sociale en Colombie-Britannique.

Assuntos

RESUMO

Social prescribing (SP) embodies a comprehensive approach to addressing the social determinants of health. Access to Resources in the Community (ARC) is an innovative SP program offering bilingual services that involves a single point of entry for health and social needs and introduces practice changes to assist primary care providers in engaging patients, along with a nonclinical lay navigator who supports patients in accessing relevant community resources. The ARC team has created a SP toolkit offering practical guidance for setting up, implementing, monitoring the progress of and evaluating SP programs. The four ARC guides can be easily customized for application in diverse practice and research settings.

We developed a set of guides for use in "Access to Resources in the Community" (ARC), one of the first social prescribing (SP) programs established and evaluated in Ontario, Canada. The four guides are: (1) PC Practice Set Up, (2) Navigator Training, (3) Navigation Processes and (4) Evaluation. The guides provide practical guidance for establishing, conducting and monitoring progress, and evaluating SP programs; they form the basis of a toolkit we created to support organizations and researchers in establishing and evaluating SP programs. The guides and toolkit are currently being adopted for the ARC/211- Ontario program that we are cocreating through a nonprofit research partnership with Community Connections, an innovative hub of 211 Ontario in Collingwood. The program will help generate evidence on the feasibility, effectiveness, impact on health inequities and cost-effectiveness of adapting and scaling up SP programs in Canada.

Nous avons mis au point quatre guides à utiliser dans le cadre du programme « Accès aux ressources communautaires ¼ (ARC), l'un des premiers programmes de prescription sociale reconnus et évalués en Ontario (Canada). Les quatre guides sont 1) Préparation du cabinet de soins primaires, 2) Formation des intervenants pivots, 3) Processus d'intervention pivot et 4) Évaluation. Ces guides fournissent des conseils pratiques sur l'établissement, la tenue et l'évaluation de programmes de prescription sociale ainsi que sur le suivi des progrès, constituant ansi la base d'une trousse d'outils créée pour aider les organisations et les chercheurs à établir et à évaluer des programmes de prescription sociale. Les guides et la trousse d'outils sont en cours d'adoption dans le cadre du programme ARC/211-Ontario que nous sommes en train de cocréer grâce à un partenariat de recherche sans but lucratif avec Community Connection, un carrefour novateur situé à Collingwood et qui relève de 211 Ontario. Ce programme contribuera à générer des données probantes sur la faisabilité, l'efficacité, la rentabilité et l'incidence (du point de vue des inégalités en matière de santé) de l'adaptation et de l'application à grande échelle des programmes de prescription sociale au Canada.

Assuntos

RESUMO

Background: Insomnia is a common sleep disorder, associated with multiple health concerns. Current medications for insomnia are associated with higher safety risks if clinical practice guidelines or monograph recommendations are not followed. This study aims to understand real-world prescribing practices among patients with insomnia in Canada, including medication utilization, potentially inappropriate medication use, cost incurred, and lines of treatment.Methods: This retrospective observational study utilized longitudinal drug claims data from 2018 to 2020 from the Canadian IQVIA National Private Drug Plan and Ontario Drug Benefit databases. Patients with any claims for medications approved for insomnia in Canada were identified. Four types of inappropriate medication usage were defined: (1) elevated daily dose; (2) extended duration of use for benzodiazepines (BZD) and/or Z-drugs; (3) combination use; and (4) opioid overlap with BZD and/or Z-drugs.Results: In 2019, 597,222 patients with insomnia were identified; 64% were female, with an average age of 55 years. Inappropriate medication use was noted in 52.5% of adult patients (aged 18-65 years) and 69.5% of senior patients (aged >65 years). Extended duration was the most common inappropriate medication usage category. The annual cost of medications for insomnia was $54.8 million, and $30.3 million (55.2%) met inappropriate medication use criteria.Conclusion: High prevalence of inappropriate medications usage in insomnia raises serious safety concerns for patients suffering from insomnia, particularly seniors, while also placing a substantial burden on the Canadian public and private health systems. This highlights an unmet need for better education regarding current guidelines and more effective and safer treatment options.

Assuntos