Patients in long-term care (LTC) homes face barriers to accessing specialist advice. Electronic consultation (eConsult) has the potential to improve access for these patients. We used a multi-method approach to evaluate adoption of the Champlain BASE eConsult service in LTC homes across Eastern Ontario, Canada. We conducted a cross-sectional study of all eConsults submitted by primary care providers (PCPs) working at LTC homes between January 1, 2018 and December 31, 2018. Service use data were collected and descriptive statistics were calculated. We completed a thematic analysis of 4 focus groups with PCPs, senior leadership, and a nurse champion working in LTC homes where eConsult is used. Sixty-four cases were submitted to 23 specialty and subspecialty groups by LTC PCPs, most frequently dermatology (19%), geriatric medicine (11%), and infectious disease (9%). Specialists responded in a median of 0.6 days, and 70% of cases were resolved without the resident needing a face-to-face specialist visit. In 60% of cases, PCPs received advice for a new or additional course of action. Participants described complexities in the LTC context, the value of eConsult in LTC, and considerations for implementation. PCPs with experience using the service described increased access to specialist advice, ease of use, and benefits to themselves, residents, and families. eConsult is feasible in LTC and should continue to be used in this region and beyond to improve equity of access to specialist advice. Resolving the identified limitations in LTC, which hinder access to specialists and adoption of eConsult and similar innovations, should be of high priority to researchers and policy makers.
When the first wave of COVID-19 hit in March 2020, health care professionals across Canada were challenged to quickly and efficiently adapt to change their work practices in these unprecedented times. Pharmacy professionals, being some of the very few front-line health care workers who remained accessible in person for patients, had to rapidly adopt critical changes in their pharmacies to respond in the best interest of their patients and their pharmacy staff. As challenging and demanding as such changes were, they provided pharmacists with invaluable lessons that would be imperative as the country enters a potentially more dangerous second wave. This article seeks to identify and summarize opportunities for improvement in pharmacy as learnt from the pandemic’s first wave. Such areas include but are not limited to handling of drug shortage and addressing drug hoarding and stockpiling, providing physical and mental support for staff, timing of flu vaccine and COVID-19 screening/testing, collaboration between different health care sites as well as collaboration with patients and with other health care professionals, telemedicine and willingness to adopt innovative ideas, need for more staff training and more precise research to provide accurate information and finally the need for more organizational and workplace support. Learning from what went well and what did not work in the early stages of the pandemic is integral to ensure pharmacy professionals are better prepared to protect themselves and their patients amidst a second and possibly subsequent waves.
Introduction A urinary catheter constitutes a one-point patient restraint, can induce deconditioning and may lead to patient mortality. An audit performed at Winchester District Memorial Hospital revealed that 20% of patients had a urinary catheter, of whom 31% did not meet the criteria for catheterisation. The main objective of this study was to use the Influencer Change Model and the Choosing Wisely Canada toolkit to create a bundle of interventions that would reduce the unnecessary use of urinary catheters in hospitalised patients. Methods In a rural teaching hospital, a time-series quasiexperiment was employed to decrease inappropriate use of urinary catheters. Both the Choosing Wisely Canada toolkit for appropriate use of urinary catheters and the Influencer change management approach were used to create effective interventions. Results This study revealed that there was no improvement in appropriate urinary catheter use during Plan-Do-Study-Act (PDSA) cycle 1. There was gradual improvement during PDSA cycle 2, with the percentage of inappropriate urinary catheter use dropping from an initial 31% before any interventions to less than 5% by the end of this study. Discussion/conclusion This study aimed to reduce the inappropriate use of urinary catheters in a rural hospital with limited resources. The findings indicate that by using a change model, such as the Influencer Change Model, it is possible to promote better patient care through empowering healthcare staff to implement accepted protocols more stringently and thereby to decrease the inappropriate use of urinary catheters to 0%.
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