Interventions to improve cancer survivorship among Indigenous Peoples and communities: a systematic review with a narrative synthesis.

Purpose: The purpose of this systematic review is to synthesize the evidence on the types of interventions that have been utilized by Indigenous Peoples living with cancer, and report on their relevance to Indigenous communities and how they align with holistic wellness.

Methods: A systematic review with narrative synthesis was conducted.

Results: The search yielded 7995 unique records; 27 studies evaluating 20 interventions were included.

Patient Perspectives on Managing Type 1 Diabetes During High-Performance Exercise: What Resources Do They Want?

Objective: Athletes with type 1 diabetes face unique challenges that make it difficult for health care providers to offer concise recommendations for diabetes management. Moreover, little is known about patient preferences for diabetes management during high-level and competitive exercise. We undertook a qualitative study to understand patient perspectives on managing type 1 diabetes during exercise.

Experiences of practice facilitators working on the Improved Delivery of Cardiovascular Care project: Retrospective case study.

Objective: To examine the barriers to and facilitators of practice facilitation experienced by participants in the Improving Delivery of Cardiovascular Care (IDOCC) project.

Design: Case studies of practice facilitators' narrative reports.

Setting: Eastern Ontario.

Improved Delivery of Cardiovascular Care (IDOCC): Findings from Narrative Reports by Practice Facilitators.

Practice facilitation can help family physicians adopt evidence-based guidelines. However, many practices struggle to effectively implement practice changes that result in meaningful improvement. Building on our previous research, we examined the barriers to and enablers of implementation perceived by practice facilitators (PF) in helping practices to adopt the Improved Delivery of Cardiovascular Care (IDOCC) program, which took place at 84 primary care practices in Ottawa, Canada between April 2008 and March 2012.

Honoring Indigenous culture-as-intervention: Development and validity of the Native Wellness Assessment.

There is a need for Indigenous-centered research to appraise culture's role in wellness. Researchers described the development and validity of the Native Wellness Assessment (NWA). The NWA has culture-as-intervention at its apex.

A scoping study of cultural interventions to treat addictions in Indigenous populations: methods, strategies and insights from a Two-Eyed Seeing approach.

Background: This paper describes the methods, strategies and insights gained from a scoping study using a "Two-Eyed Seeing" approach. An evolving technique, Two-Eyed Seeing respects and integrates the strengths of Indigenous knowledge and Western sciences, often "weaving back and forth" between the two worldviews. The scoping study was used to inform a tool for measuring the impact of culturally based addictions treatment services on wellness in Indigenous populations.

Patient perspectives on discharge from specialist type 2 diabetes care back to primary care: a qualitative study.

Background: Timely access to specialist care remains a barrier for both patients with type 2 diabetes and their primary care physicians. To improve access to specialists for new patients, an efficient and appropriate discharge process is required. Consideration of patient perspectives is central to developing a smooth care transition, and currently, research in this area is limited.

An innovative medical and dental hygiene clinic for street youth: results of a process evaluation.

Canada has a noteworthy reputation for high quality health care. Nonetheless, street youth are one of our most vulnerable yet underserved populations. Consequently, a medical and dental clinic was created in downtown Ottawa, Ontario to respond to their needs.

Building access to specialist care through e-consultation.

Background: Limited access to specialist care remains a major barrier to health care in Canada, affecting patients and primary care providers alike, in terms of both long wait times and inequitable availability. We developed an electronic consultation system, based on a secure web-based tool, as an alternative to face-to-face consultations, and ran a pilot study to evaluate its effectiveness and acceptability to practitioners.

Methods: In a pilot program conducted over 15 months starting in January 2010, the e-consultation system was tested with primary care providers and specialists in a large health region in Eastern Ontario, Canada.

Cultural competence and cultural safety in Canadian schools of nursing: a mixed methods study.

Cultural competence and cultural safety are essential knowledge in contemporary nursing care. Using a three-phase, mixed methods sequential triangulation design, this study examines the extent to which Anglophone Schools of Nursing in Canada have integrated cultural competence and/or cultural safety into the undergraduate nursing curricula. Factors that influence successful integration are identified through the lens of Donabedian's structure, process, and outcome model.

The patient's voice: an exploratory study of the impact of a group self-management support program.

Background: Given the potential value of self-management support programs for people with chronic diseases, it is vital to understand how they influence participants' health attitudes and behaviours. The Stanford Chronic Disease Self-Management Program (CDSMP), the most well-known and widely studied such program, is funded in many provinces and jurisdictions throughout Canada. However, there is little published evidence on its impact in the Canadian health-care system.

Understanding whole systems change in health care: the case of nurse practitioners in Canada.

Nurse practitioners (NPs) were introduced into the Canadian health system almost half a century ago. Despite early evidence of their effectiveness, it took decades to establish a substantial critical mass of NPs. Using the NP as a case study exemplar, we adopted a whole system change perspective to understand what else besides evidence was needed to ensure the success of desirable health systems innovations.

The role of nursing best practice champions in diffusing practice guidelines: a mixed methods study.

Background: While the importance of nursing best practice champions has been widely promoted in the diffusion of evidence-based practice, there has been little research about their role. By learning more about what champions do in guideline diffusion, the nursing profession can more proactively manage and facilitate the role of champions while capitalizing on their potential to be effective leaders of the health care system.

Aim: To determine how nursing best practice champions influence the diffusion of Best Practice Guideline recommendations.

A rapid evidence-based service by librarians provided information to answer primary care clinical questions.

Background: A librarian consultation service was offered to 88 primary care clinicians during office hours. This included a streamlined evidence-based process to answer questions in fewer than 20 min. This included a contact centre accessed through a Web-based platform and using hand-held devices and computers with Web access.

Transition from specialist to primary diabetes care: a qualitative study of perspectives of primary care physicians.

Background: The growing prevalence of diabetes and heightened awareness of the benefits of early and intensive disease management have increased service demands and expectations not only of primary care physicians but also of diabetes specialists. While research has addressed issues related to referral into specialist care, much less has been published about the transition from diabetes specialists back to primary care. Understanding the concerns of family physicians related to discharge of diabetes care from specialist centers can support the development of strategies that facilitate this transition and result in broader access to limited specialist services.

Just-in-time information improved decision-making in primary care: a randomized controlled trial.

Background: The "Just-in-time Information" (JIT) librarian consultation service was designed to provide rapid information to answer primary care clinical questions during patient hours. This study evaluated whether information provided by librarians to answer clinical questions positively impacted time, decision-making, cost savings and satisfaction.

Methods And Finding: A randomized controlled trial (RCT) was conducted between October 2005 and April 2006.

Framework for primary care organizations: the importance of a structural domain.

Purpose: Conceptual frameworks for primary care have evolved over the last 40 years, yet little attention has been paid to the environmental, structural and organizational factors that facilitate or moderate service delivery. Since primary care is now of more interest to policy makers, it is important that they have a comprehensive and balanced conceptual framework to facilitate their understanding and appreciation. We present a conceptual framework for primary care originally developed to guide the measurement of the performance of primary care organizations within the context of a large mixed-method evaluation of four types of models of primary care in Ontario, Canada.

Models of primary care service delivery in Ontario: why such diversity?

A surprisingly large and ever-growing number of alternative models of primary care service delivery have been developed in Ontario. The models are relatively poorly understood, and it is unclear why there are so many of them. What needs of providers and of government as payer are they attempting to address? Through a literature review and interviews with key informants, we sought to explain why there are so many models.

Family physicians' reactions to performance assessment feedback.

Objective: To explore and describe family physicians' personal and professional responses to performance assessment feedback.

Design: Qualitative study using one-on-one semistructured interviews after feedback on performance.

Setting: Fee-for-service family practices in eastern Ontario.

Why do family physicians fail to detect renal impairment?

Objective: To investigate why many patients with renal impairment (30.7%) were not recognized by their family physicians despite an earlier educational intervention on detecting renal impairment; and to determine whether certain factors related to physicians, patients, or the intervention itself were associated with whether renal impairment was detected.

Design: Qualitative approach using grounded theory.

Upholding the principles of primary care in preceptors' practices.

Background And Objectives: Family medicine preceptorships are crucial to educating future physicians, but there is a lack of research on how well preceptors are following the principles of primary care. This study used the Primary Care Assessment Tool (PCAT)-Provider Edition to determine how well medical preceptors provide quality medical care.

Methods: A total of 134 family medicine preceptors in the Maritime provinces of Canada answered questions about their practice behaviors, along with background information about themselves, their practice, and their practice population.