Martin-Misener, Ruth
Permanent URI for this collectionhttps://hdl.handle.net/10222/43990
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Item Open Access The impact of transitional care programs on health services utilization in community-dwelling older adults: A systematic review(Wolters Kluwer, 2018-02) Weeks, Lori E.; Macdonald, Marilyn; Martin-Misener, Ruth; Helwig, Melissa; Bishop, Andrea C.; Iduye, Damilola; Moody, ElaineObjective: The objective was to identify and synthesize the best available evidence on the impact of transitional care programs on various forms of health services utilization in community-dwelling older adults. Introduction: There is growing evidence that transitional care programs can help address important challenges facing health care systems and our increasing older adult population in many countries by reducing unnecessary health service utilization. There is a need for a systematic review of the research evaluating the impact of transitional care programs on hospital and other health service usage. Inclusion criteria: The review included studies on community-dwelling adults age 60 and over with at least one medical diagnosis, and which evaluated the outcomes of transitional care programs on health system utilization of older adults. The outcomes for this review were hospital usage including admissions and readmissions, emergency department usage, primary care/physician usage, nursing home usage, and home health care usage. The review considered experimental and epidemiological study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental studies, before and after studies, prospective and retrospective cohort studies, and case-control studies. Methods: A three-step search was utilized to find published and unpublished studies conducted in any country but reported in English. Six electronic databases were searched from inception of the database to May, 2016. A search for unpublished studies was also conducted. Methodological quality was assessed independently by two reviewers using the Joanna Briggs Institute critical appraisal checklist for systematic reviews and research synthesis. Quantitative data were extracted from included studies independently by the two reviewers using the standardized Joanna Briggs Institute data extraction tools. Due to the methodological heterogeneity of the included studies, a comprehensive meta-analysis for all outcomes was not possible. Meta-analysis was conducted for rehospitalization at 30, 90 and 180 days. A narrative summary of other quantitative findings was conducted. Results: Twenty-three studies met the inclusion criteria and were included in the review. Nineteen of the studies were randomized controlled trials and four were case control studies, involving 20,997 participants in total with a mean age of 76. Meta-analysis found that transitional care significantly reduced hospital readmission rates at 30 days (odds ratio [OR] 0.75, 95% confidence intervals [CIs] 0.62-0.91, p < 0.01), 90 days (OR 0.77, 95% CIs 0.59-1.02, p = 0.04), and 180 days (OR 0.67, 95% CIs 0.46-0.99, p < 0.01). Narrative synthesis indicated little impact of transitional care on emergency department and nursing home usage, increased use of primary care/physician usage, and decreased home health care usage. Conclusions: Based on a review of 23 studies conducted in the USA, Hong Kong, Canada, Germany, the Netherlands, Sweden and Switzerland, we identified four major conclusions. First, transitional care reduces rehospitalization rates over time, with the largest effects seen at 30 days. Second, transitional care may increase the utilization of primary care services and thus have a favourable impact on preventative care. Third, transitional care may reduce home health usage. Fourth, transitional care interventions of one month or less appear to be as effective as longer interventions in reducing hospital usage.Item Open Access Key Priorities to Implement Deprescribing in Primary Health Care in Nova Scotia: Results from the Deprescribing in Primary Health Care in Nova Scotia Knowledge Exchange Event (June 20, 2019)(2020-03-03) Isenor, Jennifer; Kennie-Kaulbach, Natalie; Kehoe, Sarah; Bai, Isaac; Reeve, Emily; Whelan, Anne Marie; Burgess, Sarah; Kits, Olga; Burge, Frederick; Martin-Misener, Ruth; Helwig, Melissa; Sampalli, TaraInappropriate medication use and polypharmacy are associated with increased adverse drug reactions, hospitalizations and mortality. Deprescribing has been found to decrease the use of medications and medication costs and is expected to improve clinical outcomes. An interactive in-person knowledge exchange event using World Café and Nominal Group Technique was held with stakeholders including patient advisors, representatives from nursing, pharmacy, family medicine, and members of advocacy/regulatory bodies and government/policy representatives. Six themes were identified with accompanying key priorities that need to be addressed to implement deprescribing strategies in Nova Scotia. These included: Communication (including public awareness and communication between providers and patients, families and caregivers), Compensation (for all providers), Education (for the public and providers), Prompts (electronic and social), Resources (technology supports and resources) and Roles (providers, patients, families and caregivers). The key priorities will be shared with stakeholders to help inform future sustainable deprescribing strategies in Nova Scotia.Item Open Access Formation of a Collaborative Interprofessional Primary Healthcare Deprescribing Research Team in Nova Scotia(2019-06) Whelan, Anne Marie; Kennie-Kaulbach, Natalie; Isenor, Jennifer; Martin-Misener, Ruth; Burge, Fred; Burgess, Sarah; Reeve, Emily; Salsbury, Lauren E.; Cormier, Rachel; Bai, Isaac; MacLean, Heather; Helwig, Melissa; Kits, OlgaStudy objective: To describe the development of a collaborative interprofessional primary health care deprescribing research team in Nova Scotia. Methods: Initiated by two College of Pharmacy faculty members, a core group of 6 health care researchers with an interest in forming an interprofessional primary health care deprescribing research team met in 2016. Based on positive feedback, the next steps involved building the team which included 1) creating the team (determination of needed expertise; description of roles and responsibilities); 2) establishing goals/objectives; 3) determining team functioning (leadership, ascertainment of common mission, determining communication strategies and delineating decision-making approaches); and 4) monitoring team outputs (e.g. presentations, publications, grants); and team functioning (e.g. discussions at team meetings, team assessment survey, social network analysis). Results: The first team meeting was in April 2017, and as of January 2019 the team had expanded to 9 core members with research assistants/students added to the team as necessary. At initial team meetings, the two College of Pharmacy faculty members assumed a co-leadership role, established the overarching goal of the team, set specific objectives and reached a consensus on various aspects of team functioning. The team has received five grants. Eight posters/oral presentations have been presented and two manuscripts are in preparation. A team assessment survey was completed in the spring of 2018 which resulted in changes to communication strategies. A social network analysis is underway. Conclusions: An interprofessional deprescribing primary health care research team was successfully formed in Nova Scotia. This success has hinged on a team committed to working well together, sharing common goals, effective communication, positivity towards the research and celebrating successes.Item Open Access Resident and family perceptions of the nurse practitioner role in long term care settings: a qualitative descriptive study(2013) Ploeg, Jenny; Kaasalainen, Sharon; McAiney, Carrie; Martin-Misener, Ruth; Donald, Faith; Wickson-Griffiths, Abigail; Carter, Nancy; Sangster-Gormley, Esther; Schindel Martin, Lori; Brazil, Kevin; Taniguchi, AlanNo abstract available.Item Open Access A case study of nurse practitioner role implementation in primary care: what happens when new roles are introduced?(2013) Sangster-Gormley, Esther; Martin-Misener, Ruth; Burge, FredBackground: At the time of this study (2009) the role of the nurse practitioner was new to the province of British Columbia. The provincial government gave the responsibility for implementing the role to health authorities. Managers of health authorities, many of whom were unfamiliar with the role, were responsible for identifying the need for the NP role, determining how the NP would function, and gaining team members' acceptance for the new role. Method: The purpose of the study was to explain the process of nurse practitioner role implementation as it was occurring and to identify factors that could enhance the implementation process. An explanatory, single case study with embedded units of analysis was used. The technique of explanation building was used in data analysis. Three primary health care settings in one health authority in British Columbia were purposively selected. Data sources included semi-structured interviews with participants (n=16) and key documents. Results: The results demonstrate the complexity of implementing a new role in settings unfamiliar with it. The findings suggest that early in the implementation process and after the nurse practitioner was hired, team members needed to clarify intentions for the role and they looked to senior health authority managers for assistance. Acceptance of the nurse practitioner was facilitated by team members' prior knowledge of either the role or the individual nurse practitioner. Community health care providers needed to be involved in the implementation process and their acceptance developed as they gained knowledge and understanding of the role. Conclusion: The findings suggest that the interconnectedness of the concepts of intention, involvement and acceptance influences the implementation process and how the nurse practitioner is able to function in the setting. Without any one of the three concepts not only is implementation difficult, but it is also challenging for the nurse practitioner to fulfill role expectations. Implications for research, policy, practice and education are discussed.