Targeted Neonatal Echocardiography Performed by Nurse Practitioners in the NICU: Attitudes and Perceptions of the Healthcare Team.

Background: Targeted neonatal echocardiography (TNE) and hemodynamic consultation have typically been performed by physicians. The Stollery Children's Hospital neonatal intensive care unit (NICU) expanded their TNE training program to include neonatal nurse practitioners (NNPs), the first in North America.

Purpose: This study examines the thoughts and perceptions of clinicians about the incorporation of NNPs providing TNE and hemodynamic consultation and investigates key facilitators and challenges for consideration when planning future training, expansion of service in Edmonton, or beyond.

Policy and practices in primary care that supported the provision and receipt of care for older persons during the COVID-19 pandemic: a qualitative case study in three Canadian provinces.

Background: The effects of the COVID-19 pandemic on older adults were felt throughout the health care system, from intensive care units through to long-term care homes. Although much attention has been paid to hospitals and long-term care homes throughout the pandemic, less attention has been paid to the impact on primary care clinics, which had to rapidly change their approach to deliver timely and effective care to older adult patients. This study examines how primary care clinics, in three Canadian provinces, cared for their older adult patients during the pandemic, while also navigating the rapidly changing health policy landscape.

Feasibility of Goal Attainment Scaling as a patient-reported outcome measure for older patients in primary care.

Background: Goal Attainment Scaling (GAS) is an outcome measure that reflects the perspectives and experiences of patients, consistent with patient-centred care approaches and with the aims of patient-reported outcome measures (PROMs). GAS has been used in a variety of clinical settings, including in geriatric care, but research on its feasibility in primary care practice has been limited. The time required to complete GAS is a barrier to its use by busy primary care clinicians.

Facilitating Integration Through Team-Based Primary Healthcare: A Cross-Case Policy Analysis of Four Canadian Provinces.

Introduction: Team-based care can improve integrated health services by increasing comprehensiveness and continuity of care in primary healthcare (PHC) settings. Collaborative models involving providers from different professions can help to achieve coordinated, high-quality person-centred care. In Canada, there has been variation in both the timing/pace of adoption and approach to interprofessional PHC (IPHC) policy.

The "hard, relentless, never-ending" work of focusing on discharge: a qualitative study of managers' perspectives.

Purpose: Interventions to hasten patient discharge continue to proliferate despite evidence that they may be achieving diminishing returns. To better understand what such interventions can be expected to accomplish, the authors aim to critically examine their underlying program theory.

Design/methodology/approach: Within a broader study on patient flow, spanning 10 jurisdictions across Western Canada, the authors conducted in-depth interviews with 300 senior, middle and frontline managers; 174 discussed discharge initiatives.

A national intervention to support frail older adults in primary care: a protocol for an adapted implementation framework.

Background: Older Canadians are high users of health care services, however the health care system is not well-designed to meet the complex needs of many older adults. Older persons often look to their primary care practitioners to assess their needs and coordinate their care. The intervention seeks to improve primary care for older persons living with frailty and will be implemented in six primary care clinics in three Canadian provinces.

Transforming primary care for older Canadians living with frailty: mixed methods study protocol for a complex primary care intervention.

Introduction: Older Canadians living with frailty are high users of healthcare services; however, the healthcare system is not well designed to meet the complex needs of many older adults. Older persons look to their primary care practitioners to assess their needs and coordinate their care. They may need care from a variety of providers and services, but often this care is not well coordinated.

How Do Health Systems Address Patient Flow When Services Are Misaligned With Population Needs? A Qualitative Study.

Background: Patient flow through health services is increasingly recognized as a system issue, yet the flow literature has focused overwhelmingly on localized interventions, with limited examination of system-level causes or remedies. Research suggests that intractable flow problems may reflect a basic misalignment between service offerings and population needs, requiring fundamental system redesign. However, little is known about health systems' approaches to population-capacity misalignment, and guidance for system redesign remains underdeveloped.

Can facility-based transitional care improve patient flow? Lessons from four Canadian regions.

Units providing transitional, subacute, or restorative care represent a common intervention to facilitate patient flow and improve outcomes for lower acuity (often older) inpatients; however, little is known about Canadian health systems' experiences with such "transition units." This comparative case study of diverse units in four health regions (48 interviews) identified important success factors and pitfalls. A fundamental requirement for success is to clearly define the unit's intended population and design the model around its needs.

Managing intergroup silos to improve patient flow.

Background: Health care managers face the critical challenge of overcoming divisions among the many groups involved in patient care, a problem intensified when patients must flow across multiple settings. Surprisingly, however, the patient flow literature rarely engages with its intergroup dimension.

Purpose: This study explored how managers with responsibility for patient flow understand and approach intergroup divisions and "silo-ing" in health care.

"Working Against Gravity": The Uphill Task of Overcapacity Management.

While most health systems have implemented interventions to manage situations in which patient demand exceeds capacity, little is known about the long-term sustainability or effectiveness of such interventions. A large multi-jurisdictional study on patient flow in Western Canada provided the opportunity to explore experiences with overcapacity management strategies across 10 diverse health regions. Four categories of interventions were employed by all or most regions: overcapacity protocols, alternative locations for emergency patients, locations for discharge-ready inpatients, and meetings to guide redistribution of patients.

Users' experiences of an online intervention for bipolar disorder: important lessons for design and evaluation.

Background: The evidence base for digital interventions for physical and mental health, including severe and enduring mental health difficulties, is increasing. In a feasibility trial, web-based Enhanced Relapse Prevention (ERPonline) for bipolar disorder demonstrated high recruitment and retention rates. Relative to participants in the waitlist control group, those who received ERPonline showed increased monitoring for early warning signs of relapse and had developed more positive illness models.

Exploring Context and the Factors Shaping Team-Based Primary Healthcare Policies in Three Canadian Provinces: A Comparative Analysis.

This paper discusses findings from a high-level scan of the contextual factors and actors that influenced policies on team-based primary healthcare in three Canadian provinces: British Columbia, Alberta and Saskatchewan. The team searched diverse sources (e.g.

Advancing team-based primary health care: a comparative analysis of policies in western Canada.

Background: We analyzed and compared primary health care (PHC) policies in British Columbia, Alberta and Saskatchewan to understand how they inform the design and implementation of team-based primary health care service delivery. The goal was to develop policy imperatives that can advance team-based PHC in Canada.

Methods: We conducted comparative case studies (n = 3).

Interprofessional education for internationally educated health professionals: an environmental scan.

Objective: The objective of this environmental scan was to identify Western Canadian interprofessional education (IPE) resources that currently exist for internationally educated health professionals (IEHPs).

Methodology: A web-based search was conducted to identify learning resources meeting defined inclusion criteria with a particular focus on the resources available in the Western Canadian provinces. Information was extracted using a standardized template, and we contacted IEHP programs for additional information if necessary.

Mind the gap: governance mechanisms and health workforce outcomes.

Attempts at health system reform have not been as successful as governments and health authorities had hoped. Working from the premise that health system governance and changes to the workforce are at the heart of health system performance, we conducted a systematic review examining how they are linked. Key messages from the report are that: (1) leadership, communication and engagement are crucial to workforce change; (2) workforce outcomes need to be considered in conjunction with patient outcomes; and (3) decision-makers and researchers need to work together to develop an evidence base to inform future reform planning.

Exploring the relationship between governance mechanisms in healthcare and health workforce outcomes: a systematic review.

Background: The objective of this systematic review of diverse evidence was to examine the relationship between health system governance and workforce outcomes. Particular attention was paid to how governance mechanisms facilitate change in the workforce to ensure the effective use of all health providers.

Methods: In accordance with standard systematic review procedures, the research team independently screened over 4300 abstracts found in database searches, website searches, and bibliographies.

Factors that dentists use to decide whether or not to render a patient edentulous. Part 1. A qualitative study of East Lancashire general dental practitioners' views.

Aims: To identify the factors that dentists use to decide whether to render a patient edentulous, prior to developing a questionnaire to investigate the factors that dentists use when making this decision.

Method: This was a qualitative study involving two groups of seven dentists practising in primary care in East Lancashire who were given scenarios involving patients of different types to facilitate discussion and identify all factors. Audio recordings were used during the focus groups and were subsequently fully transcribed.

Understanding factors influencing substance use in people with recent onset psychosis: A qualitative study.

This qualitative study identifies factors influencing the use of substances in young people with recent onset psychosis. A purposive sample of 19 people aged between 16 and 35 years from an Early Intervention Service in the English National Health Service (NHS) was interviewed using a semi-structured guide. All had experienced a psychotic episode and were within 3 years of first contact with the service.

Describing depression: ethnicity and the use of somatic imagery in accounts of mental distress.

Past research has suggested that there are significant differences in the prevalence and progress of anxiety and depression in different ethnic groups in England and that patterns of help seeking also differ. In parallel, research has also reported distinctive differences in the language and representations of mental distress across different ethnic groups. Differences both in the expression of depression and underlying conceptual models of mental health and illness may be part of the explanation for different patterns of help seeking, as the accounts people give of their experience of health and illness, including the meaning they attach to symptoms and signs for example, have been shown to be an important mediator of the action they take to protect their health or to respond to ill health.

Social problems, primary care and pathways to help and support: addressing health inequalities at the individual level. Part II: lay perspectives.

Objectives: This study aimed to describe social problems presented to general practitioners (GPs) in UK inner cities and GPs' responses; describe patients help-seeking pathways; and consider how these pathways can be improved.

Methods: The study involved a pilot survey and follow-up qualitative interviews with patients in two inner city areas in London and Salford in 2001-2. The pilot survey involved five practices in each locality.

Social problems, primary care and pathways to help and support: addressing health inequalities at the individual level. Part I: the GP perspective.

Objectives: This study aimed to describe social problems presented to general practitioners (GPs) in UK inner cities and GPs' responses; describe patients' help-seeking pathways; and consider how these pathways can be improved.

Methods: The study involved a pilot survey and follow-up qualitative interviews with patients in two inner city areas in London and Salford in 2001-2. The pilot survey involved five practices in each locality.

Listening to respondents: a qualitative assessment of the Short-Form 36 Health Status Questionnaire.

Standardised health status questionnaires are widely used to obtain subjective assessments of health. However, little research has investigated the meaning of the data they produce. Statistical tests will highlight some problems with the structure and wording of a questionnaire but they cannot shed any light on the way in which respondents interpret questions or their intended meaning when they select a response.