Strengthening collaborations at the public health system-academic interface: a call to action.

In Canada and globally, the COVID-19 pandemic has highlighted the importance of reliable and responsive public health systems. The pandemic has required decisive leadership and collaboration across all sectors of society informed by the best available evidence. In this commentary, we argue that in order to create a robust public health system equipped to address current and future public health challenges, we must prioritize and invest in stronger relationships between public health practice and academia.

Theoretical analysis of policies to improve the recruitment and retention of rural physicians.

The lack of success in resolving the shortage of rural physicians in Organisation for Economic Cooperation and Development countries has been attributed to the weakness of implemented policies. This research examines the theoretical plausibility of policies to improve the recruitment and retention of rural physicians, first, by modelling the policies; and then, by describing how they might achieve their intended outcome based on a theoretical analysis. A theory-driven method relying on published research and expert analysis is used.

Strategic analysis of interventions to reduce physician shortages in rural regions.

Introduction: Physician shortages in rural regions of OECD countries has led to the development of regulatory, financial, educational and tailored interventions designed to reduce physician shortages. Studies evaluating these interventions report weak or inconclusive results. The objective of this research is to examine the strategic relevance of the interventions by identifying and prioritizing the determinants of physician shortages and analyzing the interventions based on their ability to target the determinants.

Developing key performance indicators for prescription medication systems.

Objective: To develop key performance indicators that evaluate the effectiveness of a prescription medication system.

Methods: A modified RAND/UCLA appropriateness method was used to develop key performance indicators (KPIs) for a prescription medication system. A broad list of potential KPIs was compiled.

Contributing causes to adverse events in home care and potential interventions to reduce their incidence.

The increasing complexity of home care services, pressures to discharge patients quicker, and the growing vulnerabilities of home care clients all contribute to adverse events in home care. In this article, home care staff in six programs analyzed 27 fall- and medication-related events. Classification of contributing causes indicates that patient and environmental factors were common in fall events, while organization and management factors along with patient, task, team, and individual factors were common in medication-related events.

Scope of Nursing Practice in a Tertiary Pediatric Setting: Associations With Nurse and Job Characteristics and Job Satisfaction.

Purpose: While professional nursing, like other health professions, has a recognized educational base and a legal scope of practice that is remarkably consistent across societies, there are important variations even within the same institution or organization in the extent to which professional nurses engage in the full range of activities for which they are qualified. There has been limited study of enacted (actual) scope of nursing practice (ESOP) or of its impacts on nurse job outcomes, such as job satisfaction. The aim of this study is to measure ESOP, as well as its predictors and impact on job satisfaction, in a specialty university-affiliated tertiary referral center in one of the few remaining jurisdictions outside the United States that continue to educate registered nurses at multiple educational levels.

Associations between patient factors and adverse events in the home care setting: a secondary data analysis of two canadian adverse event studies.

Background: Early identification of patients at who have a higher risk for the occurrence of harm can provide patient safety improvement opportunities. Patient factors contribute to adverse event occurrence. The study aim was to identify a single, parsimonious model of home care patient factors that, regardless of location and differences in home care program management and design factors, could provide a means of locating patients at higher and lower risk of harm.

Association of Nursing Overtime, Nurse Staffing, and Unit Occupancy with Health Care-Associated Infections in the NICU.

 This study aims to assess the association of nursing overtime, nurse staffing, and unit occupancy with health care-associated infections (HCAIs) in the neonatal intensive care unit (NICU).  A 2-year retrospective cohort study was conducted for 2,236 infants admitted in a Canadian tertiary care, 51-bed NICU. Daily administrative data were obtained from the database "Logibec" and combined to the patient outcomes database.

Education and Role Title as Predictors of Enacted (Actual) Scope of Practice in Generalist Nurses in a Pediatric Academic Health Sciences Center.

Objective: The aim of this study is to document the enacted (actual) scope of practice (SOP) of nurses in pediatric settings in relation to education level and position.

Background: Baccalaureate-prepared staff nurses routinely carry out only a fraction of the activities essential for quality of care and patient safety they have been educated for. A direct care nurse clinician role exists for nurses with bachelor's degrees in Quebec, Canada.

Influences on and outcomes of enacted scope of nursing practice: a new model.

Enacted scope of practice is a major issue for nursing administrators, given the potentially negative effect on accessibility, continuity, safety and quality of care, job satisfaction, and organizational costs of nurses working at reduced scope. Optimal deployment of nurses to a fuller enacted scope of nursing practice holds much promise for addressing all of these larger challenges. In this sense, new model of the Enacted Scope of Nursing Practice presented in this article provides a number of directions for interventions that could improve health system functioning.

The safety at home study: an evidence base for policy and practice change.

This paper explores the policies and practices that are needed to improve the safety of home care in light of the most recent evidence about home care safety in Canada. Four areas for policy and practice change are addressed: 1) the promotion of effective communication processes in home care through cross-sector collaboration, case management and technology innovations; 2) screening for safety risk factors; 3) standardizing care processes, packaging and equipment; and 4) supporting family/caregivers and strengthening clients' ability to engage in therapeutic self-care. Evidence-based strategies for change are presented within the context of the evidence about home care safety issues.

The occurrence of adverse events potentially attributable to nursing care in medical units: cross sectional record review.

Background: Ensuring the safety of hospitalized patients remains a major challenge for healthcare systems, and nursing services are at the center of hospital care. Yet our knowledge about safety of nursing care is quite limited. In fact, most earlier studies examined one, or at most two, indicators, thus presenting an incomplete picture of safety at an institutional or broader level.

Adverse events associated with hospitalization or detected through the RAI-HC assessment among Canadian home care clients.

Background: The occurrence of adverse events (AEs) in care settings is a patient safety concern that has significant consequences across healthcare systems. Patient safety problems have been well documented in acute care settings; however, similar data for clients in home care (HC) settings in Canada are limited. The purpose of this Canadian study was to investigate AEs in HC, specifically those associated with hospitalization or detected through the Resident Assessment Instrument for Home Care (RAI-HC).

Assessing adverse events among home care clients in three Canadian provinces using chart review.

Objectives: The objectives of this study were to document the incidence rate and types of adverse events (AEs) among home care (HC) clients in Canada; identify factors contributing to these AEs; and determine to what extent evidence of completion of incident reports were documented in charts where AEs were found.

Methods: This was a retrospective cohort study based on expert chart review of a random sample of 1200 charts of clients discharged in fiscal year 2009-2010 from publicly funded HC programmes in Manitoba, Quebec and Nova Scotia, Canada.

Results: The results show that 4.

Polypharmacy meets polyherbacy: pharmaceutical, over-the-counter, and natural health product use among Canadian adults.

Objectives: Natural health products (NHP) are increasingly being used to supplement prescription medications (PM) and over-the-counter (OTC) products. The objective of this study was to examine patterns of overall health product use and how these patterns are associated with social and health factors.

Methods: We used direct health measures data from the Canada Health Measures Survey (CHMS) Cycle 1.

Adverse events among Ontario home care clients associated with emergency room visit or hospitalization: a retrospective cohort study.

Background: Home care (HC) is a critical component of the ongoing restructuring of healthcare in Canada. It impacts three dimensions of healthcare delivery: primary healthcare, chronic disease management, and aging at home strategies. The purpose of our study is to investigate a significant safety dimension of HC, the occurrence of adverse events and their related outcomes.

Associations of patient safety outcomes with models of nursing care organization at unit level in hospitals.

Objective: To examine the associations of four distinct nursing care organizational models with patient safety outcomes.

Design: Cross-sectional correlational study. Using a standardized protocol, patients' records were screened retrospectively to detect occurrences of patient safety-related events.

Measuring actual scope of nursing practice: a new tool for nurse leaders.

Objective: : This project describes the development and testing of the actual scope of nursing practice questionnaire.

Background: : Underutilization of the skill sets of registered nurses (RNs) is a widespread concern. Cost-effective, safe, and efficient care requires support by management to facilitate the implementation of nursing practice at the full scope.

Impact of a multipronged education strategy on antibiotic prescribing in Quebec, Canada.

Background: Antibiotic overuse and resistance have become a major threat in the last 2 decades. Many programs tried to optimize antibiotic consumption in the inpatient setting, but the outpatient environment that represents the bulk of antibiotic use has been challenging. Following a significant rise of Clostridium difficile infections, all the health care stakeholders in the province of Quebec, Canada initiated a global education program targeting physicians and pharmacists.

Physician, heal thyself: Survey of users of the Quebec Physicians Health Program.

Objective: To document the opinions of the users of the Quebec Physicians Health Program (QPHP) about the services they received.

Design: Mailed questionnaire.

Setting: Quebec.

Breadth, Depth and Agreement among Provincial Formularies in Canada.

Background: Previous studies have concluded that there is significant variation in drug coverage across Canadian provinces because conventional measures of inter-rater reliability for formulary listings are low. We sought to investigate whether conventional methods are appropriate for formulary concordance measurement by testing the hypotheses that (a) conventionally measured variations in provincial formularies are driven by disagreement over large numbers of drugs that represent very small segments of the market and (b) patterns in coverage levels and agreement across therapeutic categories might provide evidence of "potentially legitimate" variation in provincial formularies.

Methods: We studied December 2006 formulary listings for general pharmacare programs in all but the smallest Canadian province.

TOCSIN: a proposed dashboard of indicators to control healthcare-associated infections.

Healthcare-associated infections (HAIs) constitute a major safety problem. Healthcare managers need complete and valid information to fight against these infections. The purpose of this study was to develop a dashboard of indicators to help healthcare managers monitor HAIs.

Identification of safety outcomes for Canadian home care clients: evidence from the resident assessment instrument--home care reporting system concerning emergency room visits.

Problems of patient safety have been well documented in hospitals. However, we have very limited data about patient safety problems among home care clients. The purpose of this study was to assess the burden of safety problems among Canadian home care clients using data collected through the Resident Assessment Instrument - Home Care (RAI HC), and to explore the role of age and patient safety risk factors in explaining variations in adverse outcomes, with a particular focus on emergency room visits.