Integrating paramedics into primary care to optimize patient time in the community at end of life

Health Research BC is providing match funds for this research project, which is funded by CIHR’s Strategy for Patient Oriented Research (SPOR) Primary and Integrated Health Care Innovations (PIHCI) Network – Comparative Program and Policy Analysis Grant.

 

Many Canadians wish to spend their dying days at home. Despite this, 70 percent of deaths occur in hospital, the majority after a visit to the emergency department (ED). Paramedics, also known as emergency medical services (EMS), facilitate more than half of ED visits for patients receiving palliative care for a chronic condition.

 

One of the goals of British Columbia’s provincial palliative care strategies is to help enable people to stay at home as long as possible during their end of life. Currently, BC does not have a palliative care program within its Emergency Health Services (EHS).

 

Drs. Sabrina Wong and Jennifer Kryworuchko, faculty in the School of Nursing and Centre for Health Services and Policy Research at the University of British Columbia (UBC) are leading a team of researchers investigating innovative ways to deliver integrated emergency health services that support palliative care. The BC team collaborate with counterpart research team members in Nova Scotia who are examining the impact of the Nova Scotia EHS Special Patient Program on provincially funded health services and the ability to enable palliative patients to stay at home. Researchers will compare administrative health data from the two provinces on patients who received EHS paramedic services and died non-suddenly from chronic disease.

 

Since 2015, paramedics in Nova Scotia have received specialized clinical training on pain and symptom management and other care and support services for palliative patients as part of the Paramedics Providing Palliative Care at Home Project (PPPCHP). The PPPCHP is intended to enhance existing palliative care resources and the end-of-life experience for patients and their families/caregivers by bridging palliative care until their usual care team can take over. Researchers will identify the core elements of the PPPCHP essential for the program to be modified for rollout in BC.

 

In addition to improving end-of-life care and strengthening community-based care, the adoption of the Nova Scotia model in BC and other jurisdictions has the potential to reduce transport to the ED and avoid or reduce unwanted medical treatments, interventions and hospitalizations, contributing to reduced health care system costs.

Validation of administrative and primary care electronic medical record derived frailty algorithms

Health Research BC is providing match funds for this research project, which is funded by CIHR’s Strategy for Patient-Oriented Research (SPOR) Network in Primary and Integrated Health Care Innovation (PIHCI) – Quick Strikes initiative.

 

Frailty is a significant and growing issue in Canada. By 2025, two million Canadians will be living with frailty and 3.75 million Canadians will be caregivers. Characterized by reduced strength, endurance and physiological function, those who are frail or at risk of becoming increasingly frail are less resilient to recover from significant life events and respond to acute care treatments, and are vulnerable to further decline, dependence and death.

 

Dr. Sabrina Wong of the University of British Columbia’s School of Nursing and Centre for Health Services and Policy Research worked with Dr. Tyler Williamson from the University of Calgary and Dr. Alan Katz from the University of Manitoba on the development of tools to aid in the early detection and accurate identification of frailty in seniors, to supporting healthy aging and the needs of older adults.

 

Using data from seniors 65 years of age and older in British Columbia, Alberta, and Manitoba, they developed an algorithm for use with administrative health data and another for use with electronic medical record data. Researchers also engaged primary care clinicians and patients in developing ways to identify frailty and to detect the range of frailty in patients to be used as part of the algorithms.

 

Finally, they sought to implement the electronic medical record algorithm in the Canadian Primary Care Sentinel Surveillance Network’s (CPCSSN) web-based reporting tool, InQUIRE (Interactive Quality Improvement Reporting Environment) to provide timely feedback on frailty back to primary care clinicians.

 

The results of Wong’s study will provide new knowledge that could inform both clinical care and jurisdictional level health services planning across Canada in order to improve patient care, patients’ and caregivers’ quality of life and better use of the healthcare system.

What are the impacts of being formally enrolled with a GP on continuity and integration of care? Evidence from a comparison of Quebec and British Columbia

Health Research BC is providing match funds for this research project, which is funded by CIHR’s Strategy for Patient Oriented Research (SPOR) Primary and Integrated Health Care Innovations (PIHCI) Network – Comparative Program and Policy Analysis Grant. Additional support is provided by the University of British Columbia and several Quebec-based institutions and organizations.

 

The idea behind patient enrolment with a general practitioner (GP) — also called rostering or registration — is that all patients have a family doctor responsible for their care. For some provinces, patient enrolment is a foundation of efforts to make primary health care more accessible, continuous, and of higher quality. Many jurisdictions either have or are considering implementing such programs, with the belief that this can ensure accessible, timely health care for Canadians. To date, little is known about the actual benefits of patient enrolment policies in Canada.

 

Researchers in two provinces with patient enrolment programs — British Columbia and Quebec — have teamed up to investigate and compare the impact of different approaches to enrollment with a GP on the continuity and integration of care for patients in each province.

 

Dr. Kimberlyn McGrail, associate professor at the University of British Columbia (UBC) in the School of Population and Public Health, and the Centre for Health Services and Policy Research, is leading the BC team of researchers. The Quebec-based research is led by the project’s overall principal investigator Dr. Erin Strumpf, associate professor in the Department of Economics and the Department of Epidemiology, Biostatistics and Occupational Health at Montreal’s McGill University.

 

The two-year project brings together patients, health care providers, decision makers and researchers. Researchers will interview patients and family doctors on their experiences and priorities regarding enrolment and will analyze health care data to assess the effects of enrolment policies on health care services use.

 

The research results will provide insights on the effects of enrolment, including whether it is more effective for some patients than others, with special attention paid to those Canadians who use and need the health care systems most. The resulting evidence will support decision makers in designing and tailoring policies to build patient-oriented, integrated health care and social services systems.

Knowledge dissemination efforts of peer engagement research: Reframing the language of the opioid crisis

Co-leads:

  • Jane Buxton
    University of British Columbia
  • Travis Lupick
    Georgia Straight

Trainee:

  • Lindsay Shaw
    University of Victoria

The media can greatly influence how the public perceives people who use drugs (PWUDs). With the escalating opioid epidemic in British Columbia, reframing how one thinks about and describes PWUDs is key to reducing the stigma of drug use, and the subsequent reluctance of PWUDs in accessing health services. While stigma surrounding drug use has traditionally served as a deterrent, it is becoming increasingly recognized that the stigmatization, discrimination and isolation of PWUDs has led to poorer health outcomes and further marginalization. Hence, a need to address the language surrounding substance use disorders and drug addiction and those who use drugs has emerged.

Co-developing with local and regional journalists in BC (knowledge users), Dr. Jane Buxton (research co-lead; BC Centre for Disease Control and University of British Columbia) and her team will attempt to translate innovative peer engagement research to optimize uptake by journalists, and reframe the language used to describe PWUDs. Peer engagement can be defined as the active participation of people with lived experience of substance use in research and policy decision-making processes. Key elements and potential outcomes of knowledge transfer activities include:

  • Organization of a knowledge symposia with local and regional knowledge users (i.e. key media) to share, contextualize and harmonize the research with existing practice norms.
  • Development of a news release and media availability with a peer spokesperson, researchers, and research users (based on synthesized knowledge from the symposia).
  • Creation of a one-page infographic document for BC newsrooms.
  • Creation of original photography that accurately shows different views of the opioid crisis, which would then be provided to the media as stock images.
  • Submission of an editorial on behalf of the research team that contextualizes the role language plays in reducing stigma among people who use drugs.
  • Creation of a brief educational module offered to BC’s five schools/departments of journalism to share the synthesized findings among journalism and broadcast trainees.
  • Outreach campaign to editors of The Canadian Press Stylebook (popular reference book providing guidelines to journalists; published annually).

Implementing physical activity programs in communities for children with neuro-disabilities

Co-leads:

  • William McKellin
    UBC
  • Lois McNary
    Special Olympics BC
  • Jean-Paul Collet
    UBC

Executive sponsor:

  • Matt Herman
    BC Ministry of Health

Parents of up to 60,000 children with neurodevelopmental disabilities (NDD) in BC are searching desperately for interventions that could improve their child’s condition with the profound desire to reach normal communication and integration. Previous work has found that attending community-based physical activity programs (PAPs) improves motor performance, cognitive functioning, social integration, emotional well-being and daily functioning for children with NDD. Families also became more resilient by developing social PAP-related networks. The same studies, however, also showed huge variations in coaching practice and gaps with regard to best practice.

This project will involve the implementation of an evidence-informed, goal-oriented coaching approach to optimize the health benefits of community-based PAPs for children with NDD. The development of the coaching intervention is funded by Kids Brain Health Network.

The community-based PAP sites for children and their families provide contexts in which to tailor coaching supports, examine community implementation and KT processes and support long-term sustainability.

The implementation intervention for this project will involve coach and parent training, the development of a community of practice for coaches and parents to support sustainability, and the establishment of an evaluation process related to both implementation and its proposed outcomes.

Over three years, this research will examine PAP implementation at over 80 sites in BC, including rural and Indigenous communities. Employing the CIHR iKT framework, strengths and barriers for PAP implementation will be assessed, and research will be conducted on the best ways to involve stakeholders, educate coaches and parents, and develop efficient communication processes. An analysis of cost-effectiveness will provide insight into the benefits of different approaches.

If successful, this project will lead directly to:

  1. A PAP implementation model with precise methodology, processes and tools to guide future implementation in other settings.
  2. A community of practice to support a PAP provincial network.
  3. Capacity building in the communities in which the PAP intervention is implemented.
  4. More equitable services to remote communities, including Indigenous communities.
  5. Better engagement of Indigenous communities around a neglected problem.
  6. Improved health and educational outcomes for both children with NDD and their parents.

Reducing diabetes distress in the type 1 community: A peer-delivered intervention using an interactive social media platform

Co-leads:

  • Tricia Tang
    UBC
  • Alan Ruddiman
    Rural Coordination Centre of BC
  • Deanne Taylor
    Interior Health
  • Marshall Dahl
    UBC
  • Ramya Hosak & Danielle Hessler University of California, San Francisco
  • Lawrence Fisher
    University of California, San Francisco
  • William Polonsky
    University of California, San Diego

Executive sponsor:

  • Marshall Dahl
    VCH

Psychological distress is often overlooked in diabetes care. In fact, British Columbia’s medical services plan fails to cover this patient-identified health care priority, allowing only those with means or extended health care access to these services.  

Among the different emotional struggles that patients with diabetes experience, it is diabetes distress that is most strongly associated with poor glycemic control and worse diabetes-related health outcomes.

Diabetes distress refers to the unique and often hidden emotional burdens, relentless worries, and ongoing concerns that are part of the spectrum of patients’ experience while managing this demanding disease. In 2027, it is estimated there will be 69,700 British Columbians diagnosed with type 1 diabetes (T1D), of which almost 50% will likely experience clinically significant levels of diabetes distress.

Research shows that in the absence of any type of targeted intervention, elevated distress levels will continue to persist. Given the shortage of diabetes-trained physicians and psychologists in rural and remote settings, T1D patients living in these communities have the least access to specialized health and psychological care. Accordingly, BC has identified mental health and rural and remote health care services as two of the five provincial health care priorities.

This project will seek to address three major gaps in BC’s diabetes care: the availability, affordability, and accessibility of psychosocial support for T1D patients living in low-resource settings. Specifically, this study will adapt an evidence-based, low-cost peer support model using an interactive social media platform to reduce diabetes distress among T1D adults living in the Interior Health region.

The intended outcomes are to:

  1. Demonstrate reductions in diabetes distress in rural and remote populations using a social media-delivered peer support intervention.
  2. Establish a recruitment and training infrastructure to support a sustainable peer supporter “workforce”.
  3. Engage key stakeholders including Interior Health, Diabetes Canada, Young and Type 1, Joint Standing Committee on Rural Issues, and BC Rural Coordination Centre.

If successful, this innovative approach to reaching the “hard to reach” can be adopted across Canada, targeting and improving quality of life for the most vulnerable, high-risk, and geographically marginalized patients.

Promoting positive sexual health and protective factors for East Asian LGBTQ youth in BC

Co-leads:

Trainee:

  • Andrea Polonijo
    SARAVYC

The Stigma and Resilience Among Vulnerable Youth Centre (SARAVYC) has identified lesbian, gay, bisexual, trans, and queer (LGBTQ) health disparities for a range of physical and mental health outcomes. This work has also documented lower levels of family- and school-connectedness –– two key social supports that are protective factors for youth. East Asian LGBTQ youth are nearly 30 times more likely to face harassment and discrimination than their heterosexual peers, and are at higher risk of problematic drug and alcohol use. It may be especially difficult for these youth to find support within their families and communities, as LGBTQ topics can be stigmatizing for East Asian families.

Therefore, SARAVYC and Options for Sexual Health (Opt) will create and present culturally relevant materials to East Asian parents, youth and families, on youth sexual health and create supportive environments for LGBTQ youth. This team will work with SARAVYC’s East Asian advisory group to develop and present two evening events in English with simultaneous interpretation in Cantonese and Mandarin, an online slide deck, and education materials, translated into Cantonese-traditional Chinese, Mandarin-Simplified Chinese, Japanese, and Korean, which can be circulated in Opt offices and online. These knowledge translation activities will help East Asian parents support their adolescents' successful development of healthy relationships and sexual health overall, with information about LGBTQ youth integrated into the content.

There are three key objectives:

  1. Provide information in culturally appropriate and sensitive formats accessible to non-English speakers/readers.
  2. Create opportunities for parents to engage with experts in their own language.
  3. Develop awareness about LGBTQ health disparities among East Asian youth and increase knowledge of how parents can support their LGBTQ children.

To achieve these objectives, advisory meetings will be held in September and December to develop the content and format of the events and materials, and finalize the materials for translation. Event details will be confirmed in February and then advertising begins. Events are tentatively planned for April and May.

The event and materials will create a common vocabulary for parents to better speak with their youth about their sexual health and help support LGBTQ inclusivity. Materials will bridge language and cultural barriers often experienced by East Asians seeking advice and health care, and promote greater inclusivity and support in Opt clinics.

Knowledge translation for a new understanding of sexual pain in endometriosis

Co-leads:

  • Paul Yong
    University of British Columbia
  • Jessica Sutherland
    BC Women's Hospital + Health Centre

Trainee:

  • Natasha Orr
    University of British Columbia

One in 10 reproductive-aged women have endometriosis (where endometrial cells abnormally grow outside the uterus). This can lead to menstrual cramps and pain during bowel movements, pelvic movements, and vaginal penetration. This project focuses on deep penetration pain during sexual activity, which profoundly affects relationships and the sexual quality of life of women with endometriosis.

The interdisciplinary team at the BC Women’s Centre for Pelvic Pain and Endometriosis uses surgical-medical treatments, cognitive behavioural and mindfulness based therapies, and physiotherapy to treat women with endometriosis and sexual pain. The centre also has an active CIHR-funded clinical and translational research program, with a focus on sexual pain. Endometriosis-associated sexual pain may be due to endometriosis lesions and/or central nervous system sensitization and treatment efficacy may depend on the specific cause of the pain. The concept that pain may be due to central nervous system changes, and not directly to the endometriosis, may be difficult for some patients to understand. Therefore, there will be a one-day workshop explaining the multifactorial causes of sexual pain and patients will be provided with tools to manage their pain. The aim is to include women from the centre and women from the community along with their partners. This workshop will be created in collaboration with patient partners from start to finish, ensuring the learning objectives are patient-informed and the event is appropriate for the target audience.

The goals of this project are to:

  1. Develop a one-day workshop targeted to patients with endometriosis and their partners.
  2. Measure the impact of the workshop on patient understanding by using a short self-reported questionnaire created with patient partners.

The long-term goal is to effectively translate research findings on central nervous sensitization to patients with endometriosis so they gain a better understanding of the causes of their sexual pain.

  • Primary audience: women (patients).
  • Secondary audience members: patient partners/families, hospital foundation, researchers, physicians.

Co-creation of a resource toolkit for Indigenous community health representatives

Co-leads:

  • Shannon Bredin
    University of British Columbia
  • Rosalin Miles
    Indigenous Physical Activity & Cultural Circle

Trainee:

  • Erin Shellington
    University of British Columbia

Community Health Representatives (CHRs) are the contacts between community members and health care practitioners in BC’s Indigenous communities. CHRs play an important role in the health care system for Indigenous health; they provide cultural support and health education within these communities.

Improving lifestyle behaviours is an effective way to reduce the burden caused by obesity, diabetes, cardiovascular disease, and conditions that affect mental wellbeing within Indigenous peoples. However, there is limited accessibility to effective, culturally appropriate, Indigenous-led and community-based health and wellness resources for CHRs. Therefore, this project will create a resource toolkit for CHRs in BC’s rural Indigenous communities, which is Indigenous-led and integrates and respects the language, culture, and traditions of Indigenous communities.

The toolkit will be developed through co-creation activities with CHRs and Indigenous communities in partnership with Indigenous Studies in Kinesiology (School of Kinesiology, UBC) and the Indigenous Physical Activity and Cultural Circle.

ACCEss-SCI: Adapting community centres to enhance exercise in spinal cord injury

Co-leads:

  • Tania Lam
    University of British Columbia
  • Ross MacDonald
    City of Surrey
  • Jaine Priest 
    City of Vancouver

Trainee:

  • Alison Williams
    University of British Columbia
  • Sharon Jang
    University of British Columbia

There is overwhelming evidence that regular physical activity is critical for reducing secondary health complications and improving quality of life for people with spinal cord injury (SCI). However, individuals with SCI face many barriers to exercising; the most common is accessing appropriate fitness facilities and fitness professionals with specialized knowledge in adaptive physical activity.

Since 2013, the Physical Activity Research Centre (PARC) at the International Collaboration on Repair Discoveries (ICORD) has provided adaptive physical activity opportunities to over 300 individuals with SCI. PARC previously created professional development workshops about physical activity for individuals with SCI. These workshops were conducted for UBC students, SCI peers, and local community fitness leaders; they were well received and there is interest for more continuing education programming. Research was also conducted to show the feasibility, acceptance, and health benefits of adaptive group exercises programs such as arm “spin” classes, circuit training, and boxercise. The goal is to extend these initiatives to local settings.

The City of Surrey Parks, Recreation, and Culture department (CoS) and the Vancouver Board of Parks and Recreation (VPB) share a common vision with PARC — to make physical activity opportunities across the Lower Mainland universal and accessible to all. Both VPB and CoS have identified multiple community centres to expand adaptive physical activity programming, but need support to train fitness staff to advance this programming. This Reach award will facilitate the translation of PARC-created adaptive fitness programs to VPB and CoS community centres. PARC will support this translation by providing on-site training to community fitness leaders, professional development workshops, staff in-services, and an adaptive physical activity mentorship program. The benefits of these translational initiatives will be measured by the success in changing attitudes about physical disability and perceived barriers to implementing adaptive programs among community programmers and fitness instructors, and successful implementation of inclusive and integrated fitness class programs in VPB and CoS community centers.