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Application of the RE-AIM Framework to Evaluate Electronic, Mobile and Telehealth Interventions and Inform Design of a Real-world Intervention

PHCRIS Conference, Sydney

November 07, 2017

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Presentations

Pragmatic strategies supporting multi-site community-based research: responding to local context while ensuring methodological coherence across contexts

CAHSPR Conference, Halifax

May 30, 2019

Importance and Relevance: Many attempts have been made to facilitate team-based, collaborative service delivery models to address the access needs of vulnerable populations. These approaches are often designed and implemented by health service authorities for application in communities. Increasingly, it is recognized that community must be engaged in designing sustainable solutions to overcome barriers to access. The IMPACT research intentionally designed strategies to ensure interventions across six sites were tailored to local context while ensuring consistency in overall implementation approach across sites. The lessons learned from this research will inform future scale and spread of sustainable interventions through linking research, policy and practice innovation.

Objectives: Through this panel we aim to:

  • Familiarize participants with the approaches and tools that supported cross-case coherence and integration of intervention design, implementation and evaluation

  • Share concrete examples of tools and approaches for continuous improvement interventions throughout implementation

  • Share tips for developing partnerships among researchers, decision-makers and patients to facilitate community-based design and implementation of interventions

  • Stimulate discussion regarding balancing the need for contextual relevant interventions with the desire to achieve common outcomes across contexts

 

Approach: Following a brief overview of the approaches and tools used throughout the IMPACT program of research, each panelist describes the innovation implemented in their region and the strategies for designing interventions with communities so that they are responsive to context while measuring common outcomes and adhering to the overarching research design. The presentation wraps up with a summary of the elements the panel proposes are essential to effective, acceptable, and potentially scalable interventions. The presentation is followed by a facilitated discussion with the audience members; seeking the input about the panelists’ experiences.  

 

Invited Experts: The three panelists have worked together over the past six years under an international program to address gaps in access to PHC funded $5 million under the CIHR SPOR initiative, and each have successfully implemented an innovative approach that responded to the needs of a population in a Including someone from policy

Properties of a provider questionnaire of acces to primary health care by vulnerable groups

NAPCRG conference, Chicago

November 12, 2018

The objective of this study was to assess the psychometric properties of a provider questionnaire on access to primary health care by vulnerable groups in Australia, an instrument that may be useful in measuring provider confidence in managing vulnerable populations and their referral practices.

How Family Physicians Perceive Access Needs of Vulnerable Populations and Act to Address These Needs

NAPCRG Conference, Chicago

November 12, 2019

This study sought to understand family physicians' perspectives on barriers for vulnerable people to access primary care and on strategies that family physicians have explored to address these barriers.

How policy changes influenced the design of an organizational innovation to improve access to primary care for vulnerable populations: a participatory action research

CAHSPR Conference, Montreal

May 29, 2018

The objective of this presentation was to describe how policy changes influenced the design of an organizational innovation to improve access to primary care for vulnerable populations. Results show that policy changes in Quebec heavily influenced the intervention’s design. 

The feasibility of integrating a non-clinical patient navigator in primary care practices to enhance Access to Resources in the Community (ARC) – the ARC study

CAHSPR Conference, Montreal

May 29, 2018

No standard process exists to facilitate “referrals” to health enabling community resources (CR) by primary care providers (PCP), or to support their patients to access these resources. This is especially problematic for individuals with social complexities. We studied the feasibility of a multipronged approach to improve equitable access to CRs. 

The integration of a non-clinical patient navigator in primary care practices is feasible on many levels. A randomized controlled trial of this model is starting in March 2018. This model of navigation offers many advantages and may help mitigate inequities for individuals with social complexities. 

Access to Resources in the Community (ARC): Provider and Patient Perspectives of a Non-Clinical Patient Navigator in Primary Care.

CAHSPR Conference, Montreal

May 29, 2018

Through this presentation our objective is to determine the effectiveness of a non-clinical patient navigator in optimizing access to community resource from the perspective of primary care providers and patients. 

Access to Resources in the Community: Patient Profile, Resource Referrals, and Social Barriers to Access

CAHSPR Conference, Montreal

May 29, 2018

This presentation describes 1) the socio-demographic characteristics of patients referred to a non-clinical navigator for support as part of the Access to Resources in the Community (ARC) feasibility study 2) the type of community resources recommended to patients and 3) the access barriers reported to the Navigator. 

Pattern of Patients' Experience of Primary Care Access in Australia, Canada, New Zealand, and Switzerland: A Comparative Study

NAPCRG Conference, Montreal

November 18, 2017

This presentation focuses on patient's experience of primary care access in a complex and multifactorial matter. It can be both assessed through the accessibility of care (supply side factors: e.g. density of GPs, hours of openings) and the ability for patients to get the required care (demand side factors: e.g. patient mobility, ability and willingness to pay). 

Typology of Primary Care Practices: Analysis of the Qualicopc Data of Canada, New-Zealand, Australia and Switzerland

NAPCRG Conference, Montreal

November 19, 2017

This presentation is focused on the definition of a general typology of PC practices using data from the QualicoPC study from four countries: Australia, Canada, New-Zealand and Switzerland. 

Effective Teamwork for Collaborative Primary Health Care Research: Coordination Strategies to Achieve Shared Goals and Outcomes in Multi-Sites, 5-Year International Participatory Research Programme

NAPCRG Conference, Montreal

November 18, 2017

The goals of this workshop was to learn useful strategies to coordinate activities in complex research programs and gain simulated experience using these strategies to face challenges of multi-components and multi-sites, international participatory research programme.

Why Do Nations Differ in Their Ability to Provide Equitable Access to Primary Care for People Living With a Mental Health Condition?

NAPCRG Conference, Montreal

November 20, 2017

The goal of this presentation is to examine how–and why nations vary in the provision of access to primary care for people with mental health problems. We generate hypotheses explaining international variations in access to PC for individuals with MH conditions.

Multiple Barriers to Access to Primary Care for Vulnerable Groups: An International Analysis

NAPCRG Conference. Montreal

November 18, 2017

In this presentation, we try to understand more about concentration of multiple barriers to access to PC across countries. Using a reanalysis of surveys we analysed ten questions related to barriers to access to PC before reaching care (no regular provider, long waits for appointments or for response to a call, difficult access after-hours or foregoing care due to cost), and after reaching care (feeling that the doctor did not know their history, explain things clearly, coordinate their care or spend enough time with them) were selected.

Do Patients and Providers Agree on How Healthcare Systems Perform? Comparing Healthcare Performance Assessment in International Surveys of Patients and Providers

NAPCRG Conference, Montreal

November 21, 2017

This study aims to assess the agreement between patient and provider perspectives. Methods: Using 16 pairs of questions from the 2014 commonwealth fund international health policy survey of older adults and the 2015 survey of primary care physicians, patients and providers' responses were compared across 11 participating countries.

Data Sharing in Multi-Site, Multi-Country Trials

NAPCRG Conference, Montreal

November 21, 2017

This presentation describes the data-sharing issues managed by IMPACT. Each site used a common protocol to design and evaluate its own intervention, with the aim of pooling data across the sites. Ethics applications were submitted in each site. Sharing data across the sites proved a challenge. 

Marching to the Beat of the Same Drum(s). An Insight into the Real World Challenges of Participatory Action Research

PHCRIS Conference, Sydney

August 07, 2017

This workshop gave participants skills in dealing with some of the problems faced in implementation research conducted with clinicians, policy makers and members of vulnerable communities.
 

Developing Qualitative Data Collection Tools to Evaluate a Participatory Intervention in Primary Care

PHCRIS Conference, Sydney

August 07, 2017

This paper presents our approach for developing qualitative tools and collection of qualitative data across the six sites.

The challenge to the IMPACT intervention evaluation rests in the manifold expressions taken by interventions in each region. The evaluation tools had to be flexible yet rigorous to account for the local variability. To learn about the impact of the intervention on patient and provider experience, we use semi-structured interviews with patients, PHC providers, research committees and intervention staff. To study the interventions' fidelity to their local logic models and potential scalability, we perform document analysis of intervention staff diaries, meeting minutes, and other documents that allow to understand decisions made by the local implementation team. IMPACT Logic Map provides an overarching framework for the intervention and supported the design of common qualitative tools to be used in all regions. To ensure quality and consistency of qualitative data, two national qualitative researchers oversee data collection.

Our approach to the development of qualitative tools highlights challenges and opportunities in evaluation of a participatory intervention in PHC.

Improving Research Outcomes on an International PHC Participatory Action Research Program using a Project Management Approach

PHCRIS Conference, Sydney

August 07, 2017

To maximize outcomes, IMPACT contextualizes standard project management tools to a participatory, patient-oriented research setting. Interactive and formative in its design, this approach includes: activity and study plans, productivity tools such as staff diaries and status reports, and embedded evaluation procedures.

 

Status reports and study plans provided greater accountability and contributed to uniformity and common terminology across sites. Activity plans help kept the study on schedule, facilitated the monitoring of its multifaceted components and ensured communication flows. Our project relies on the creation of working groups and thematic committees, which spread the work load. Online video-conferencing increased the quality and clarity of communication, while annual face-to-face meetings built momentum and contributed to the quality and meaningfulness of engagement. Our project management approach provides an opportunity to balance management with research creativity, PAR and formative evaluation processes. It also has the potential to improve the quality of partnerships, and works toward sustainable relationships and scalability.

Multi-site Research and Data Sharing

PHCRIS Conference, Sydney

August 07, 2017

This paper outlines the data-sharing issues managed by IMPACT, a 6-site Canadian-Australian collaborative research program designed to improve access to primary health care for vulnerable individuals. Each site used a common protocol to evaluate its own intervention, with the aim of pooling data across the sites. Ethics applications were submitted in each site.

 

Application of the RE-AIM Framework to Evaluate Electronic, Mobile and Telehealth Interventions and Inform Design of a Real-world Intervention

PHCRIS Conference, Sydney

August 07, 2017

This review highlights some major considerations when developing e/m/telehealth interventions for vulnerable groups. Within South-Western Sydney, pragmatism limits the ability to conduct recruitment in a way to measure or enhance reach. However, the intervention will be low intensity to enhance sustainable implementation and fidelity will be assessed using the Template for Intervention Description and Replication (TIDieR) framework.

Les soins de santé et les populations vulnérables

Présentation du PLI-Québec auprès des cliniques participantes

December 05, 2016

This presentation [in French only] was given by the PLI-Quebec research team, led to Christine Loignon, to present IMPACT and its intervention in one of their participant Groupes de Médecins de Famille (GMFs). It also includes a 'cultural sensitive training' that explores the health challenges that vulnerable patients face.

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Cette présentation, donnée par l'équipe de recherche du PLI-Québec lors de la presentation d'IMPACT et de l'intervention dans l'un des Groupes de Médecins de Famille (GFM) au Québec, apporte les enjeux de santé que rencontrent les patients issus de populations vulnérables.

Piecing together ways to improve access to primary care for vulnerable populations at a local level: A typology of components of organizational interventions

Haggerty et al.: NAPCRG 2016, Colorado Springs

November 14, 2016

Despite many national primary healthcare (PHC) reforms in OECD countries, meaningful gaps in equitable access remain. These gaps particularly affect vulnerable populations, such as the poor, refugees and indigenous communities. While current classifications of healthcare interventions exist, they are not specific to access to PHC, often include macro or meso level interventions that cannot be implemented at a primary care level and/or are not tailored for vulnerable populations. This paper presents a typology of components of interventions that can inform organizations seeking to improve access to PHC for vulnerable populations.

Marching to the beat of the same drum(s). An insight into the real world challenges of Participatory Action Research.

NAPCRG Annual Meeting, Colorado Springs

November 14, 2016

IMPACT is a 5 year Canadian-Australian research program based on the principles of Participatory Action Research. Our team is working with 6 regional communities to help vulnerable individuals gain access to needed primary care. Now, on the threshold of program implementation, we are confronting the realities of: competing regional interests, diverse (and sometimes conflicting) research skills, limited local resources, and the need to keep everyone “on the same page”. This workshop gave participants an increased awareness, and new skills, in dealing with some of the challenges inherent in conducting Participatory Action Research within vulnerable communities.

Copy Of -"Does this seem surprising to you?" Learning how to contextualise international survey data with a mixed methods knowledge exchange approach

PHC Research Conference, Canberra

June 08, 2016

This workshop has introduced participants to the mixed methods approach used to explore the influence of context on equitable access to primary care. Attendees gained insights into innovative approaches to the interpretation and translation of comparative primary care performance data (i.e. 2013 and 2014 Commonwealth Fund International Health Policy Survey) on health services and health systems to engage policy makers and health service managers.

Context, needs & opportunities: Co-creating an intervention to improve primary health care access for vulnerable commu

PHC Research Conference, Canberra

June 08, 2016

This presentation focuses on lessons from one Australian region’s experience of designing an intervention in partnership with academic and community based stakeholders.

The partnership settled on an intervention that would a) identify vulnerable clients of large social welfare organisations who lacked access to enduring primary care; and b) use a health broker to support linkage with appropriate primary care. We secured in-kind commitment from two of six potential implementation partners and will commence implementation in May 2016. We learned lessons about partner engagement, how to be flexible to changes in the local context, working with organisational priorities, and, developing sustainable interventions.

Cultural Sensivity Training

A presentation by the Alberta-LIP for their Pop-Up Intervention

January 01, 2020

This presentation was developed by the Alberta LIP team to promote awareness about vulnerable populations' and patients' needs and realities. We are proud to their amazing work and happy to share with the wider team. All comments are welcome!

Access to primary care: Cumulative barriers and disparities across 11 countries.

Canadian Association for Health Services and Policy Research

May 11, 2016

As part of the Innovative Models Promoting Access-to-Care Transformation (IMPACT) research program — a Canadian–Australian collaboration to improve access to primary care for vulnerable populations, we did a secondary analysis of the 2013 and 2014 Commonwealth Fund International Health Policy Surveys to highlight patterns of disparities in access to primary care across 11 countries, including Canada and Australia. This analysis discusses incremental barriers to access in different countries. Results may inform innovations aimed at improving access for vulnerable populations

International variation in access to care for chronic conditions: patient and provider perspectives

International Primary Health Care Reform Conference, Brisbane

March 15, 2016

Using recent international health policy surveys from the Commonwealth fund on patients and from primary care physicians, we analysed the international variation in access to PHC through a recognised conceptual framework of access to care and by triangulating patient and provider perspectives.