BackgroundAmong Indigenous peoples in Canada, access to high-quality healthcare remains an important determinant of health. The shift to virtual and remote-based approaches, expedited during the COVID-19 pandemic, influenced the ways in which individuals accessed care and the quality of care received. This study sought to determine which elements are required for effective and sustainable virtual care approaches for delivery of primary care to Indigenous patients and develop quality indicators grounded in Indigenous community and experience. We share a conceptual framework to understand how Indigenous patients access and define high-quality virtual care, grounded in Indigenous patient experiences and worldviews.MethodsUsing principles of patient-oriented research, we grounded this work in social justice and participatory action research. We sought to gain an in-depth understanding of the Indigenous experiences of virtual care and specifically of primary care. This was developed through semistructured interviews with Indigenous patients and Indigenous virtual primary care providers.ResultsThirteen participants were interviewed between 5 August 2021 and 25 October 2021. Using Framework Analysis, we constructed four domains including access, relationships, quality and safety as being primary facets of defining high-quality Indigenous virtual primary care.DiscussionThe results presented here indicate that the shift to virtual care, largely seen in response to the COVID-19 pandemic, does not compromise quality of care, nor does it lead to negative patient experiences. Optimal care is possible in virtual settings for some care needs and types of appointments and has the potential to decrease barriers to access and improve patient experiences of safety and quality while facilitating patient/provider relationships.ConclusionIn summary, high-quality Indigenous virtual care benefits from attention to patients’ experiences of access, relationships, safety and quality with their service providers and healthcare teams.
Introduction In Canada, people experiencing socioeconomic inequities have higher rates of late diagnosis and lower survival rates than the general population. Palliative care services focussed on this population are scarce. We developed a community-based nursing intervention to improve access to palliative care for people experiencing socioeconomic inequities and living with life-limiting illnesses in an urban Canadian setting. Methods This community-based, qualitative research study combined critical and participatory research methodologies. The study was conducted in partnership with the Palliative Care Outreach Advocacy Team (PCOAT) based in Edmonton, Alberta, a team dedicated to serving populations experiencing socioeconomic inequities who require palliative care. Following an exploratory phase that served to delineate the intervention, we undertook a one-year pilot implementation during which a part-time registered nurse (RN) joined PCOAT. The RN engaged in trust building, resolution of health and practical needs and complex care coordination. Twenty-five patients participated in the intervention. Participants were interviewed at least once to explore their experiences with the intervention. Data were analyzed through thematic analysis. Results Most participants were men, were Indigenous and had advanced cancer. Participants had significant financial concerns, lived or had lived in precarious housing situations and had previously faced serious challenges accessing health care. Participants reported social and health needs including housing, finances, transportation, symptom control, harm reduction and end-of-life care. Participants reported improved access to health and social services and expressed satisfaction with the study intervention. Conclusion Study findings suggest the study intervention may have contributed to improved access to palliative care, improved experiences for participants and increased equity in the delivery of care.
Introduction Au Canada, les personnes confrontées à des iniquités socioéconomiques présentent des taux supérieurs de diagnostics tardifs et des taux inférieurs de survie par rapport à la population générale. Peu de services de soins palliatifs sont destinés à ces personnes en particulier. Nous avons mis au point une intervention infirmière en milieu communautaire et en contexte urbain au Canada afin d’améliorer l’accès aux soins palliatifs pour les personnes confrontées à des iniquités socioéconomiques et atteintes d’une maladie limitant leur espérance de vie. Méthodologie Cette étude de recherche qualitative communautaire combine des méthodes de recherche critiques et participatives. Elle a été réalisée en partenariat avec l’équipe PCOAT (Palliative Care Outreach Advocacy Team), basée à Edmonton (Alberta), qui offre des services de proximité aux populations désavantagées sur le plan socioéconomique ayant besoin de soins palliatifs. Après une phase exploratoire nous ayant permis de définir l’intervention, nous avons mis en oeuvre une phase pilote d’un an, durant laquelle une infirmière s’est jointe à l’équipe PCOAT. Cette infirmière a eu pour tâche d’établir des liens de confiance, de coordonner les soins complexes et de répondre aux besoins à la fois en matière de santé et sur le plan pratique. Vingt-cinq participants ont pris part à cette intervention. Ils ont été interviewés chacun au moins une fois afin de décrire leurs expériences en lien avec l’intervention. Nous avons ensuite effectué une analyse thématique des données. Résultats La plupart des participants étaient des hommes, étaient autochtones et étaient atteints d’un cancer à un stade avancé. Les participants avaient d’importantes difficultés financières, se trouvaient ou s’étaient déjà trouvés en situation de logement précaire et avaient précédemment connu de sérieuses difficultés d’accès à des soins de santé. Ils ont décrit leurs besoins sur le plan social et sur le plan de la santé, en matière notamment de logement, de finances, de transport, de soulagement des symptômes, de réduction des méfaits et de soins de fin de vie. Ils ont également déclaré que leur accès aux services sociaux et de santé s’était amélioré et se sont dits satisfaits de l’intervention liée à l’étude. Conclusion D’après les données recueillies, l’intervention liée à l’étude semble avoir favorisé un meilleur accès aux soins palliatifs, de meilleures expériences pour les participants et une prestation de soins plus équitable.
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