In Quebec, several primary care physicians have made the transition to the advanced access model to address the crisis of limited access to primary care. The objectives are to describe the implementation of the advanced access model, as perceived by the first family physicians; to analyze the factors influencing the implementation of its principles; and to document the physicians' perceptions of its effects on their practice, colleagues and patients. Qualitative methods were used to explore, through semi-structured interviews, the experiences of 21 family physicians who had made the transition to advanced access. Of the 21 physicians, 16 succeeded in adopting all five advanced access principles to varying degrees. Core implementation issues revolved around the dynamics of collaboration between physicians, nurses and other colleagues. Secretaries' functions, in particular, had to be expanded. Facilitating factors were mainly related to the physicians' leadership and the professional resources available in the organizations. Impediments related to resource availability and team functioning were also encountered. This is the first exploratory study to examine the factors influencing the adoption of the advanced access model conducted with early-adopter family physicians. The lessons drawn will inform discussions on scaling up to other settings experiencing the same problems. Copyright © 2016 John Wiley & Sons, Ltd.
Background Children’s ability to engage in meaningful occupations is positively influenced by their ability to move independently. Preliminary evidence in children suggests that wheelchair skills training improves wheelchair skills, which are critical for wheelchair mobility. The Wheelchair Skills Training Program is a standardized program to teach wheelchair skills. However, it is underutilized in pediatric rehabilitation settings. To address perceived barriers to training, three pediatric-specific Wheelchair Skills Training Program tools for indoor skills were developed (i.e., a storybook, four instructional posters, and a workbook). This study aimed to document occupational therapists’ and pediatric manual wheelchair users’ satisfaction and perspectives on the usability, relevance, and feasibility of these tools. Method A descriptive qualitative research design was used. A focus group was conducted with occupational therapists and interviews were conducted pediatric manual wheelchair users to obtain their feedback on the tool prototypes to facilitate refinement and to ensure they meet users’ needs. Results Eight occupational therapists and five pediatric manual wheelchair users expressed general satisfaction with the tools, describing them as usable, relevant and feasible to integrate into wheelchair skills training with novice wheelchair users and younger children. All occupational therapists and three pediatric manual wheelchair users expressed the desire to use the tools for wheelchair skills training. Two children expressed that the tools were more relevant for beginner wheelchair users only. The participants suggested minor modifications to make the tools more accessible for children (e.g., more action in the story, increased precision of illustrations related to the characters’ position in the wheelchair). Conclusion Occupational therapists and pediatric manual wheelchair users perceived the tools to have high potential to facilitate the use of the Wheelchair Skills Training Program in pediatric rehabilitation settings. After making the recommended modifications, the tools will be ready for pilot testing in pediatric rehabilitation settings.
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