Primary Care

CCAPNR involves a group of multi-disciplinary, university-based researchers dedicated to creating new solutions for problems that challenge health and social services through the use of new models of care and evaluation. The team engages in research and professional education activities to address CCAPNR goals.

CCAPNR goals include:1. To provide a national forum to identify, discuss, consult and debate on important issues relevant to the education, development, and utilization of generalist, specialized and advanced nursing roles in Canada.2. To conduct timely, responsive and meaningful interdisciplinary and cross-jurisdictional research that informs decision-making about the education, development and utilization of generalist, specialized and advanced nursing roles in Canada.3. To lead a broad range of knowledge translation activities that support the design, conduct, dissemination and utilization of high quality research about nursing roles and models of care delivery in Canada.4. To support the development of advanced nursing roles and related research through consultation with key stakeholders and the education and mentorship of undergraduate and graduate students, advanced practice nurse

Faculty Member:

Denise Bryant-Lukosius and Ruth Martin-Misener (Co-Directors), Nancy Carter, Faith Donald, Patti Harbman, Kelly Kilpatrick, Diana Sherifali, Joan Trammer, Ruta Valaitis

Students:

1. Linda Brousseau
2. Erin Ziegler
3. Lindsay Yuille

Research Funding:

More Information:

• Canadian Centre for Advanced Practice Nursing (CCAPNR)

Since 2009, Dr. Ruta Valaitis has been a Deputy Director, World health Organization (WHO) Collaborating Centre (McMaster University, Hamilton, Ontario) for Primary Care and Health Human Resources. Dr. Valaitis was elected Secretary to the Pan American Nursing and Midwifery Collaborating Centres Network (PANNMCC) and served in that role from 2011 to 2013.

A PAHO/WHO Collaborating Center is an institution designated by the Director General to form part of an international network that develops activities in support of the programs of the World Health Organization. Currently the Region of the Americas has 18 Collaborating Centers in Nursing and Midwifery.  Our Collaborating Centre was recently redesignated (see http://fhs.mcmaster.ca/globalhealthoffice/McMaster_redesignated_paho_who_collaborating_centre.html) 

PANMCC/WHO :

Collaborating Centres

Research Funding:

More Information:

• WHO Collaborating Centre for Primary Care and Health Human Resources

WHO Collaborating Centers are designated by the Director-General, WHO, as part of an inter-institutional collaborative network of centers worldwide. They are established to provide concrete activities at the national, regional, and global levels, in support of the strategic plans of specific WHO areas of work.

All WHO Collaborating Centers in the Region of the Americas are known as PAHO/WHO Collaborating Centers since the Pan American Health Organization also serves as a WHO regional office.  Currently there are over 180 Centers in 15 countries in the Americas.

Lead:

Valaitis, R.

Research Funding:

More Information:

• PAHO Advanced Practice Nursing Webinar Series 2016 English with Spanish translation
• PAHO Website

EU-GENIE is an online tool that volunteers can use with clients. It can help them describe their support network and can link them to relevant local community resources that are tailored to the interests of the client.

EU-GENIE is a UK-developed, evidence-based online intervention aimed to support self-management for adults living with long-term health and social conditions. It was adapted for use in Canada. It is currently being tested in a sub-group of TAPESTRY clients who are enroled in Health Links. Study Objectives include: 1.      To assess the usability, acceptability, and normalization of the EU-GENIE tool in a primary care environment that is used by providers, clients and volunteers. 2.      To explore if and how EU-GENIE can function as a collaborative practice tool to improve providers’ and clients’ understanding of personal support networks, as well as linkages among primary care team members and between primary care and community-based health and social services (team-based care), within the context of Health TAPESTRY and Health Links programs. 3.      To explore if and how clients perceive the use of EU-GENIE as a tool to support attainment of their health and life goals. 4.      To explore how the size, composition and function of clients’ social networks support attainment of self-identified health goals.    Our Canadian adatped version of EU-GENIE was presented at the EU-WISE Conference, Southhampton, England. November 23, 2015. (http://eu-wise.com/wp-content/uploads/2012/12/EU-WISE-Conference-Southampton-9-R.-Valaitis-21-Nov.pdf) 

Lead:

Ruta Valaitis, Cathy Risdon, Jenny Ploeg, Anita Kothari, Lisa Dolovich, Laura Cleghorn, Anne Kennedy, Anne Rogers, Ivo Vassilev, Dale Guenter, and James Gillett

Research Funding:

• Exploring the Use of Personal Network Mapping as a Component of the TAPESTRY Program

More Information:

• Website
• Conference

The objective of this study is to evaluate the implementation and effectiveness of the Health Teams Advancing Patient Experience: Strengthening Quality (Health TAPESTRY) approach in older adults.

In our program, trained volunteers visit people where they live . In these visits, they learn about what matters most to that person and their health. They also learn more about a person’s health needs. The stories people tell our volunteers are recorded and sent to their health care team using special technology. This helps the team learn more about that person’s life, health needs, goals and how they can better work together to achieve goals and meet needs.

Co-author:

Dolovich, L., Oliver, D., Lamarche, L., Agarwal, G., Carr, T., Chan, D., Cleghorn, L., Griffith, L., Javadi, D., Kastner, M., Longaphy, J., Mangin, D., Richardson, J., Papaioannou, A., Ploeg, J., Raina, P., Risdon, C., Santaguida, P.L., Straus, S., Thabane, L., Valaitis, R., Price, D.

Research Funding:

• TAPESTRY: Teams Advancing Patient Experience: Strengthening Quality

More Information:

• Publication
• Health Tapestry Website

This article reports on the development and psychometric testing of a learning needs assessment questionnaire related to the Canadian community health nursing Standards of practice.

Professional competencies have been widely used as a basis for the development of learning needs assessment. The Canadian Community Health Nursing Standards of Practices (CCHN Standards) were released in 2003. However, it is not known whether community health nurses (CHNs) have the educational background to enable them to meet these standards. This article reports on the development of a learning needs assessment questionnaire for CHNs. Exploratory and confirmatory factor analyses were conducted to examine the consistency of factors underpinning the CCHN Standards. Also, validity and reliability of the questionnaire were evaluated using appropriate techniques. This process resulted in a valid and reliable CHN learning needs assessment questionnaire to measure learning needs of large groups of practitioners, where other forms of measurement cannot be feasibly conducted.

Co-author:

Akhtar-Danesh, N., Valaitis, R., Schofield, R., Underwood, J., Martin-Misener, R., Baumann, A., Kolotylo, C.

Research Funding:

• A Pan-Canadian Survey of Community Health Nurses’ Learning Needs

More Information:

• Publication

The purpose of this scoping literature review was to determine what is known about: 1) structures and processes required to build successful collaborations between primary care (PC) and public health (PH); 2) outcomes of such collaborations; and 3) markers of their success.

The combined search strategy yielded 6125 articles of which 114 were included. Systemic-level factors influencing collaboration included: government involvement, policy and fit with local needs; funding and resource factors, power and control issues; and education and training. Lack of a common agenda; knowledge and resource limitations; leadership, management and accountability issues; geographic proximity of partners; and shared protocols, tools and information sharing were influential at the organizational level. Interpersonal factors included having a shared purpose; philosophy and beliefs; clear roles and positive relationships; and effective communication and decision-making strategies. Reported benefits of collaboration included: improved chronic disease management; communicable disease control; and maternal child health. More research is needed to explore the conditions and contexts in which collaboration between PC and PH makes most sense and potential gains outweigh the associated risks and costs.

Co-author:

Martin-Misener, R., Valaitis, R., Wong, S.T., MacDonald, M., Meagher-Stewart, D., Austin, P., Kaczorowski, J., O’Mara, L., Savage, R., & the Strengthening Primary Health Care through Public Health and Primary Care Collaborations Team.

Research Funding:

• Building Primary Health Care Nursing Leadership to Enhance Collaboration between Primary Health Care and Public Health

More Information:

• Publication

his study aimed to explore the nature of Canadian primary care - public health collaborations, their aims, motivations, activities, collaboration barriers and enablers, and perceived outcomes.

Health systems in Canada and elsewhere are at a crossroads of reform in response to rising economic and societal pressures. The Quadruple Aim advocates for: improving patient experience, reducing cost, advancing population health and improving the provider experience. It is at the forefront of Canadian reform debates aimed to improve a complex and often-fragmented health care system. Concurrently, collaboration between primary care and public health has been the focus of current research, looking for integrated community-based primary health care models that best suit the health needs of communities and address health equity. This study aimed to explore the nature of Canadian primary care - public health collaborations, their aims, motivations, activities, collaboration barriers and enablers, and perceived outcomes. Ten case studies were conducted in three provinces (Nova Scotia, Ontario, and British Columbia) to elucidate experiences of primary care and public health collaboration in different settings, contexts, populations and forms. Data sources included a survey using the Partnership Self-Assessment Tool, focus groups, and document analysis. This provided an opportunity to explore how primary care and public health collaboration could serve in transforming community-based primary health care with the potential to address the Quadruple Aims. Aims of collaborations included: provider capacity building, regional vaccine/immunization management, community-based health promotion programming, and, outreach to increase access to care. Common precipitators were having a shared vision and/or community concern. Barriers and enablers differed among cases. Perceived barriers included ineffective communication processes, inadequate time for collaboration, geographic challenges, lack of resources, and varying organizational goals and mandates. Enablers included clear goals, trusting and inclusive relationships, role clarity, strong leadership, strong coordination and communication, and optimal use of resources. Cases achieved outcomes addressing the Q-Aims such as improving access to services, addressing population health through outreach to at-risk populations, reducing costs through efficiencies, and improving provider experience through capacity building. Primary care and public health collaborations can strengthen community-based primary health care while addressing the Quadruple Aims with an emphasis on reducing health inequities but requires attention to collaboration barriers and enablers.

Primary Author:

Ruta Valaitis, Sabrina Wong, Marjorie MacDonald, Ruth Martin-Misener, Linda O’Mara, Donna Meagher-Stewart, Sandy Isaacs, Nancy Murray, Andrea Baumann, Fred Burge, Michael Green, Janusz Kaczorowski & Rachel Savage

Students:

1. Sandra Isaacs

Research Funding:

More Information:

• Link to article

This paper examines advanced practice nursing (APN) roles internationally to inform role development in Latin America and the Caribbean to support universal health coverage and universal access to health.

We examined literature related to APN roles, their global deployment, and APN effectiveness in relation to universal health coverage and access to health. Results: given evidence of their effectiveness in many countries, APN roles are ideally suited as part of a primary health care workforce strategy in Latin America to enhance universal health coverage and access to health. Brazil, Chile, Colombia, and Mexico are well positioned to build this workforce. Role implementation barriers include lack of role clarity, legislation/regulation, education, funding, and physician resistance. Strong nursing leadership to align APN roles with policy priorities, and to work in partnership with primary care providers and policy makers is needed for successful role implementation. Conclusions: given the diversity of contexts across nations, it is important to systematically assess country and population health needs to introduce the most appropriate complement and mix of APN roles and inform implementation. Successful APN role introduction in Latin America and the Caribbean could provide a roadmap for similar roles in other low/middle income countries. 

Co-Author:

Denise Bryant-Lukosius; Ruta Valaitis; Ruth Martin-Misener; Faith Donald; Laura Morán Peña; Linda Brousseau

Students:

1. Linda Brousseau

Research Funding:

More Information:

• Link to paper

A technical report commissioned by the Canadian Nurses Association, 1-116, 2014. This report summarizes the issues and policy options and will inform CNA’s future role and strategies for advancing a pan-Canadian primary care framework that optimizes the role of registered nurses (RNs) and advanced practice nurses in primary care interprofessional teams.

Research, practice, education and policy information and input from key stakeholders relevant to nursing roles in the delivery of primary care services from national, provincial and territorial perspectives were synthesized to provide policy guidance and actionable recommendations. The key components of this project included a scoping literature review and key informant interviews with nurses and other stakeholders.

Co-author:

Martin-Misener R, Bryant-Lukosius D, Bullard C, Campbell D, Carter N, Donald F, Kilpatrick K, McKinlay J, Parks C, Sherifali D, Tranmer, J, Valaitis, R. Viscardi V., Yuille L.P.

Research Funding:

• Advancing a pan-Canadian primary care framework: optimizing the role of Registered Nurses and Nurse Practitioners.

More Information:

• Final Report

In 2010 -2015, Dr. Ruta Valaitis became an Affiliate Network Member, Primary Health Care System (PHCS).

The lead for the Primary Health Care System (PHCS) Network was the Dr. Moira Stewart, University of Western Ontario.

Primary Health Care System :

Primary Health Care System (PHCS) Network

Research Funding:

More Information:

• System Integration & Innovation Research Network

Systems navigation services provided by a designated provider or team have the potential to address health and social disparities. We conducted an environmental scan of navigation activities in a large urban Canadian community to identify and describe: service providers who engage in systems navigation; the clients who require systems navigation support and the issues they face; activities involved; and barriers and facilitators in providing systems navigation support to clients.

 Using an online survey and convenience sampling, we recruited individuals who self-identified as community navigators or practiced systems navigation activities as part of their role. The majority of respondents (n¼145) were social workers, social services workers, or nurses. Clients of navigators struggled with mental health or addictions issues, disabilities, chronic diseases, and history of trauma or abuse. The most frequently reported activities of navigators were building professional relationships, managing paperwork, and communicating with relevant agencies or organizations. Barriers and facilitators are reported. 

Co-author:

Nancy Carter, Ruta Valaitis, Janice Feather, Laura Cleghorn, and Annie Lam

Students:

1. Janice Feather

Research Funding:

• Evaluation of a Community Nurse Navigator in a Priority Hamilton Neighbourhood

More Information:

• Link to paper

This report describes an environmental scan that was completed in May 2009 of primary care and public health in the province of British Columbia (BC) as one of a series of steps in a larger program of research: Strengthening Primary Health Care through Primary Care and Public Health Collaboration Study (Strengthening PHC Study).

It is one of three scans being completed for provincial health care systems, which include: British Columbia, Ontario and Nova Scotia. The purpose of the environmental scans is to provide current information about the provincial context of primary care and public health that may be contributing, either positively or negatively, towards integration and collaboration between these two health sectors. Vancouver: Centre for Health Services and Policy Research, University of British Columbia. ISBN 978-0-88865-879-1. 

Co-author:

Wong, S.T., MacDonald, M., Valaitis, R.K., Kaczorowski, J. Munroe, V., Blatherwick, J.

Research Funding:

• Building Primary Health Care Nursing Leadership to Enhance Collaboration between Primary Health Care and Public Health

More Information:

• Report

This report describes an environmental scan that was completed in July 2009 of primary care and public health in the province of Nova Scotia (NS) as one of a series of steps in a larger program of research: Strengthening Primary Health Care through Primary Care and Public Health Collaboration Study (Strengthening PHC Study).

It is one of three scans being completed of provincial health care systems; the others are British Columbia and Ontario. The purpose of the environmental scans is to provide current information about the provincial context of primary care and public health that may be contributing, either positively or negatively, towards integration and collaboration between these two health sectors. Halifax, NS: School of Nursing, Dalhousie University. ISBN PDF: 978-0-7703-1887-1. 

Co-author:

Meagher-Stewart, D., Martin-Misener, R., Valaitis, R.K.

Research Funding:

More Information:

• Report

This report describes an environmental scan, which includes information up to May 2009, related to primary care (PC) and public health (PH) in the province of Ontario (ON). It is one of a series of steps in a larger program of research entitled: Strengthening Primary Health Care through Primary Care and Public Health Collaboration Study (Strengthening PHC Study).

This is also one of a series of three scans being completed for provincial health care systems, including those of British Columbia, Ontario and Nova Scotia. The purpose of the environmental scans is to provide current information about the provincial context of PC and PH that may be contributing, either positively or negatively, towards integration and collaboration between these two health sectors. Hamilton: School of Nursing, McMaster University. ISBN PDF 978-1-894088-19-0. 

First Author:

Valaitis, R.K., Ehrlich, A., O’Mara, L.M, Brauer, P.M.

Research Funding:

More Information:

• Report

The aim of this toolkit is to develop knowledge, skills, and attitudes that support the development and maintenance of successful collaborations between primary care and public health. This toolkit is for practitioners, managers, policy makers, and students from a variety of disciplines working in primary care and public health.

This toolkit was developed based on results from a 4-1/2 year program of research supported by the Canadian Health Services Research Foundation completed in 2012. It was developed with multiple co-authors including Francophone and Aboriginal communities. It was officially launched in July 2016.

Lead:

Valaitis, R., Murray, N., Brauer, P., Green, M., MacDonald, M., Martin-Misener, R., Meagher-Stewart, D., O'Mara, l., Savage, R., Wong, S., Gendron, S.

Research Funding:

More Information:

• Website

We conducted a scoping review of the international literature on patient panel size for NPs in primary healthcare from 2000 to 2013 and updated the review in 2014

Some important gaps in determining NP patient panel size for primary healthcare are identified in this scoping review. These gaps include the lack of validated tools to measure NP activities and workload and the lack of observational studies to determine actual rather than perceived NP practice. A pan-Canadian initiative to develop standardized tools and benchmarks for NP panels in primary healthcare, facilitate annual reviews, and to monitor and document trends in NP practice and workload would accelerate our understanding of best practice models for determining patient panels and optimal models of primary healthcare delivery that include NP roles. Final Report submitted to Health Care Programs & Policy Directorate, Health Canada. May 31, 2013.

Co-author:

Martin-Misener, R., Kilpatrick, K., Bryant-Lukosius, D., Valaitis, R., Carter, N., Miller, P., Flanigan, K., Harbman, P., Charbonneau-Smith, R., Donald, F., McKinlay, R.J., Boesveld, S., Lamb, A., DiCenso, A.

Research Funding:

This case study describes how broker organizations supported a network of community-based services to work together to address the primary healthcare needs of recent immigrant families with young children.

Broker organizations were identified as pivotal for ensuring connections among network members, for supporting immigrant family access to services through their involvement with multiple providers, and for developing cultural competence capacities in the system overall. Network cohesiveness differed depending on the type of need being addressed, as did the organizations playing the role of broker. Service providers were able to extend their reach through the co-location of services in local centres and schools attended by immigrant families and their children. The study demonstrates the value of ties across service sectors facilitated by broker organizations to ensure the delivery of comprehensive services to young immigrant families challenged by an unfamiliar system of care.

Co-author:

Isaacs, S., Valaitis, R., Newbold, K.B., Black, M., & Sargeant, J.

Students:

1. Sandra Isaacs

Research Funding:

More Information:

• Publication

The Aging, Community and Health Research Unit at McMaster University has purposefully employed a capacity building model for interdisciplinary trainee development. This paper describes the processes and outcomes of the model, outlining how the provision of funding, mentorship, and a unique learning environment enables capacity building in networking, collaboration, leadership development, and knowledge mobilization among its early career interdisciplinary PHC trainees. The reciprocal advancement of the research unit through the knowledge and productivity of trainees will also be detailed.

Health care system capacity and sustainability to address the needs of an aging population are a challenge worldwide. An aging population has brought attention to the limitations associated with existing health systems, specifically the heavy emphasis on costly acute care and insufficient investments in comprehensive primary health care (PHC). Health system reform demands capacity building of academic trainees in PHC research to meet this challenge. Many ACHRU trainees have now completed their training programs; some are pursuing additional academic training, several have initiated careers in academia with early grant success, while others contribute to the health care system through leadership roles in policy and practice. ACHRU’s scientific leads, in turn, experienced reciprocity and a return on investment from capacity development efforts through mutual learning, enhanced academic outputs, and expertise brought by interdisciplinary PHC trainees.

Co-author:

Ganann, R., Peacock, S., Garnett, A., Northwood, M., Hyde, A., Bookey-Bassett, S., Kennedy, L., Markle-Reid, M., Ploeg, J., Valaitis, R.

Research Funding:

More Information:

• Publication

The Health TAPESTRY (Health Teams Advancing Patient Experience: STRengthening qualitY) intervention was designed to improve primary care teamwork and promote optimal aging. We evaluated the effectiveness of Health TAPESTRY in attaining goals of older adults (e.g., physical activity, productivity, social connection, medical status) and other outcomes.

METHODS: We conducted a pragmatic randomized controlled trial between January and October 2015 in a primary care practice in Hamilton, Ontario. Older adults were randomized (1:1) to Health TAPESTRY (n = 158) or control (n = 154). Trained community volunteers gathered information on people’s goals, needs and risks in their homes, using electronic forms. Interprofessional primary care teams reviewed summaries and addressed issues. Participants reported goal attainment (primary outcome), self-efficacy, quality of life, optimal aging, social support, empowerment, physical activity, falls, and access to and comprehensiveness of the health system. We determined use of health care resources through chart audit. RESULTS: There were no differences between groups in goal attainment or many other patient-reported outcome and experience assessments at 6 months. More primary care visits took place in the intervention versus control group over 6 months (mean ± standard deviation [SD] 4.93 ± 3.86 v. 3.50 ± 3.53; difference of 1.52 [95% confidence interval (CI) 0.84 to 2.19]). The odds of having 1 or more hospital admission were lower for the intervention group (odds ratio [OR] 0.44 [95% CI 0.20 to 0.95]). INTERPRETATION: Health TAPESTRY did not improve the primary outcome of goal attainment but showed signals of shifting care from reactive to active preventive care. Further evaluation will help in understanding effective components, costs and consequences of the intervention.

Co-author:

Dolovich, L., Oliver, D., Lamarche, L., Thabane, L., Valaitis, R., Agarwal, G., Carr, T., Foster, G., Griffith, L., Javadi, D., Kastner, M., Mangin, D., Papaioannou, A., Ploeg, J., Raina, P., Richardson, J., Risdon, C., Santaguida, P., Straus, S., Price, D.

Research Funding:

More Information:

• Publication

Canadian Community health nurses (CHNs) work in diverse urban, rural, and remote settings such as: public health units/departments, home health, community health facilities, family practices, and other community-based settings.

Research into specific learning needs of practicing CHNs is sparsely reported. This paper examines Canadian CHNs learning needs in relation to the 2008 Canadian Community Health Nursing Standards of Practice (CCHN Standards). It answers: What are the learning needs of CHNs in Canada in relation to the CCHN Standards? What are differences in CHNs’ learning needs by: province and territory in Canada, work setting (home health, public health and other community health settings) and years of nursing practice? CHN educators and practice leaders need to consider these results in determining where to strengthen content in graduate and undergraduate nursing programs, as well as professional development programs. For practicing CHNs educational content should be tailored based on learner’s years of experience in the community and their employment sector.

First Author:

Valaitis, R.K., Schofield, R., Akhtar-Danesh, N., Baumann, A., Martin-Misener, R., Underwood, J., Isaacs, S.

Research Funding:

More Information:

• Publication
• Community Health Nurses of Canada (CHNC)

The aim was to explore how an organization's trust in the cultural competency of other service providers (competence trust) can influence the effectiveness of a services network in meeting the needs of recent immigrant families.

Perceived cultural competency affected the degree of trust and collaboration within the services network when addressing the needs of recent immigrant families. Competence trust toward other providers increased the desire and commitment to work together, while lack of competence trust created avoidance. Non-government organizations were identified among the most culturally competent. The perceived positive and negative experiences of families with different providers influenced the level of trust among network members. The development of systemic cultural competences within a services network is needed in order to improve collaborations and access to services for immigrant families.

Co-author:

Isaacs, S., Valaitis, R., Newbold, K.B., Black, M., & Sargeant, J.

Students:

1. Sandra Isaacs

Research Funding:

More Information:

• Publication

Addressing complex primary health care (PHC) questions requires the knowledge, skills, and effective collaboration of interdisciplinary research teams. The Transdisciplinary Understanding and Training on Research–Primary Health Care (TUTOR-PHC) program, which is unique in Canada because of its size and reach across the country, was developed for interdisciplinary PHC research capacity building. As this year marks the program’s 15th anniversary, this article will describe this one-of-a-kind training program’s evolution and effect.

Background: The goals of the TUTOR-PHC program are to train a cadre of PHC researchers, clinicians, and decision makers in interdisciplinary research to tackle current and future challenges in PHC, lead collaborative interdisciplinary research teams, and increase the number and quality of interdisciplinary and transdisciplinary research projects and publications at national and international levels. Conclusion: Enhancing capacity for conducting effective interdisciplinary PHC research has become ever more important given the complexity of research questions that need to be answered and the critical role of PHC in Canada’s health care system. The TUTOR-PHC program has responded by addressing current issues and trends in PHC in its curriculum, while retaining its core focus on interdisciplinary research training, thus filling an important niche in developing PHC research capacity in Canada.

Co-author:

Terry AL, Brown JB, Van Hoorn R, Stewart M, Ashcroft R, Beaulieu MD, Bhattacharyya O, Breton M, Burge F, Dahrouge S, Dolovich L, Donnelly C, Farrales L, Fortin M, Haggerty J, Kothari A, Loignon C, Marshall EG, Martin-Misener R, Ramsden VR, Regan S, Reid GJ, Ryan BL, Sampalli T, Thomas R, Valaitis, R

Research Funding:

More Information:

• Publication

This study describes the effectiveness, feasibility and effects of a volunteer program evaluation framework in primary care.

<p><span style="color: #1c1d1e; font-family: 'Open Sans', icomoon, sans-serif; font-size: 16px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: #ffffff; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;">Volunteers support health and social care worldwide, yet there is little research on integrating these unpaid community members into primary care. ‘Health Teams Advancing Patient Experience, Strengthening Quality through Health Connectors for Diabetes Management’ (Health TAPESTRY‐HC‐DM) integrates volunteer ‘health connectors’ into a community‐ and primary care‐based program supporting client self‐management in Hamilton, Canada. Volunteers supported clients through goal setting, motivation, education and connections to community resources and primary care. This study aimed to create and apply a volunteer program evaluation framework to explore: (a) volunteer training effectiveness (learning online content, in‐person training, self‐efficacy in role tasks, training overall); (b) feasibility of program implementation (process measures, reflections on client encounters, understanding of volunteer roles/responsibilities, client perspectives on volunteer program); and (c) effects of volunteering on volunteers (health outcomes, self‐efficacy, value of volunteering). A concurrent triangulation, mixed‐methods design was used. Data were collected in 2016, sources included: volunteer online training quizzes, focus groups, self‐efficacy survey, Veterans RAND 12‐Item (VR‐12) survey, in‐person training feedback forms and narratives of client visits; client interviews; and quantitative implementation data. Quantitative data analysis included descriptive statistics, paired samples<span>&nbsp;</span></span><em style="box-sizing: border-box; color: #1c1d1e; font-family: 'Open Sans', icomoon, sans-serif; font-size: 16px; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: #ffffff; text-decoration-style: initial; text-decoration-color: initial;">t</em><span style="color: #1c1d1e; font-family: 'Open Sans', icomoon, sans-serif; font-size: 16px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: #ffffff; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;"><span>&nbsp;</span>tests, and effect size (Cohen's<span>&nbsp;</span></span><em style="box-sizing: border-box; color: #1c1d1e; font-family: 'Open Sans', icomoon, sans-serif; font-size: 16px; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: #ffffff; text-decoration-style: initial; text-decoration-color: initial;">d</em><span style="color: #1c1d1e; font-family: 'Open Sans', icomoon, sans-serif; font-size: 16px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: #ffffff; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;">). Qualitative data used descriptive thematic analysis. Nineteen volunteers and 12 clients participated in this evaluation. Findings demonstrate the volunteer program evaluation framework in action. Online training increased knowledge. In‐person training received largely positive evaluations. Self‐efficacy was high post‐training and higher after volunteering. VR‐12 sub‐scale means increased descriptively. Volunteers understood themselves as healthcare system connectors, feeling fulfilled with their contributions and learning new skills. They identified barriers including not having the resources and skills of healthcare professionals. Clients found volunteers were a major program strength, appreciating their company and regular goals follow‐up. Using a volunteer program evaluation framework generated rich and comprehensive data demonstrating the feasibility of bringing volunteers into primary care.</span></p>

https://onlinelibrary.wiley.com/doi/abs/10.1111/hs:

Lisa Dolovich, Jessica Gaber, Ruta Valaitis, Jenny PLoeg, Doug Oliver, Julie Richardson, Dee Mangin, Fiona Paeascandalo, & Gina Agarwal

Research Funding:

• TAPESTRY: Teams Advancing Patient Experience: Strengthening Quality

More Information:

• Link to paper

The purpose of this paper is to explore how a modified approach to the persona-scenario method was used to co-design a complex primary health care intervention (Health TAPESTRY) by and for older adults and providers and the value added of this approach.

The persona-scenario method drew out feasible novel ideas from stakeholders, which expanded on the research team’s original ideas and highlighted interactions among components and stakeholder groups. Many ideas were integrated into the Health TAPESTRY program’s design and implementation. Persona-scenario method added significant value worthy of the added time it required. This method presents a promising alternative to active engagement of multiple stakeholders in the co-design of complex interventions.

First Author:

Ruta Valaitis, Jennifer Longaphy, Jenny Ploeg, Gina Agarwal, Doug Oliver, Kalpana Nair, Monika Kastner, Ernie Avilla, Lisa Dolovich

Research Funding:

More Information:

• Publication

This paper fills a gap in knowledge to reveal what is known about motivators and factors influencing implementation and maintenance of patient navigation programs in primary care that link patients to community-based health and social services. It also reports on outcomes from these studies to help identify gaps in research that can inform future studies.

This scoping literature review involved: i) electronic database searches; ii) a web site search; iii) a search of reference lists from literature reviews; and, iv) author follow up. It included papers from Canada, the United States, the United Kingdom, Australia, New Zealand, and/or Western Europe published between January 1990 and June 2013 if they discussed navigators or navigation programs in primary care settings that linked patients to community-based health and social services.   Of 34 papers, most originated in the United States (n = 29) while the remainder were from the United Kingdom, Canada and Australia. Motivators for initiating navigation programs were to: a) improve delivery of health and social care services; b) support and manage specific health needs or specific population needs, and; c) improve quality of life and wellbeing of patients. Eleven factors were found to influence implementation and maintenance of these patient navigation programs. These factors closely aligned with the Diffusion of Innovation in Service Organizations model, thus providing a theoretical foundation to support them. Various positive outcomes were reported for patients, providers and navigators, as well as the health and social care system, although they need to be considered with caution since the majority of studies were descriptive.

First Author:

Ruta K. Valaitis; Nancy Carter; Annie Lam; Jennifer Nicholl; Janice Feather; Laura Cleghorn

Students:

1. Jennifer Nicholl
2. Janice Feather

Research Funding:

• Evaluation of a Community Nurse Navigator in a Priority Hamilton Neighbourhood

More Information:

• Link to paper

Advanced practice nursing (APN) is a term used to describe a variety of possible nursing roles operating at an advanced level of practice. The introduction of APN roles is expected to advance primary health care throughout Latin America and the Caribbean, where few such roles exist. The purpose of the paper is to outline an implementation strategy to guide and support the introduction of primary health care APN roles in Latin America and the Caribbean.

This paper outlined an implementation strategy to help guide implementation of APN roles in Latin America and the Caribbean, based on an existing framework that strategically organizes the key points identified by nursing leaders at the April 2015 summit. Countries can use this strategy as a tool to guide the implementation of APN roles that are relevant to their unique health care needs and system contexts. The ultimate aim is to contribute to the advancement of universal health by strengthening the contribution of nursing through the introduction of advanced practice nursing.

Co-author:

Oldenburger, D., Cassiani, S., Bryant-Lukosius, D., Valaitis, R., Baumann, A., Pulcini, J., & Martin-Misener, R.

Research Funding:

More Information:

• Link to paper

Dr. Ingrid Tyler's, Public Health Ontario, presentation on 'The Social Pediatrics Realist Review' focussed interest on child and maternal health and related social pediatrics, as well as, advancing primary care/public health collaboration in this area. Dr. Ruta Valaitis was an invited advisor on this presentation.

The Public Health Physicians' of Canada: Continuing Professional Development Symposium 2014: 'Practice, Evidence, and Research - Public Health Physicians' Persepctive' The presentation was titled 'Social Networks and Social Media'

The Social Pediatrics Realist Review:

Tyler, I

Research Funding:

More Information:

• Public Health Phsicians' of Canada Symposium 2014 - Brochure

The Summer Institute is aimed at graduate students from across Canada.

In 2010, Dr. Ruta Valaitis was an invited Faculty for Canadian Institutes of Health Research - IHSPR-IPPH Primary Health Care Summer Institute.

Summer Institute for Graduate Students:

Canadian Institutes of Health Research

Research Funding:

More Information:

• Canadian Institutes of Health Research

Dr. Ruta Valaitis was an invited member of Ontario’s Ministry of Health and Long-term Care’s Primary Care Advisory Group providing advice on primary care reform for Ontario.

A report on behalf of the Primary Health Care Expert Advisory Committee was prepared on behalf by the Patient Care Groups presenting a new model of population based primary health care for Ontario, May 2015.

Patient Care Groups:

Price, D., Golden, B., Hannam, R.,

Research Funding:

More Information:

• A report on behalf of the Primary Health Care Expert Advisory Committee

During 2006 - 2007, Dr. Ruta Valaitis served as an invited member of the Ministry of health and Long Term care (MOHLTC) Family Health Team (FHT) Action Group Sub-committee on Health Promotion and Disease Prevention (HPDP).

The discussion report ‘Enhancing Disease prevention and Health promotion in Ontario’s Family Health Teams: The Public Health/Primary Health Connection’ (May 2006) served to make practical recommendations based on a review of the literature, other information and practices regarding the integration of public health services into primary care settings.

MOHLTC Family Health Teams :

Perth District Health Unit

Research Funding:

More Information:

• Enhancing DPHP Ontario`s FHTs

Invited Working Group Member: Ontario’s Ministry of Health and Long-term Care Primary Health Care Planning Group: Working Group 2: Strengthening Primary Care Access. The report was completed August 2011.

The membership of the working group was diverse and reflective of the many stakeholders and jurisdictions involved in primary care access in Ontario. Experts were drawn from across the province of Ontario including healthcare practitioners, Aboriginal health experts, researchers, administrators and policymakers participated in the Improving Access in Primary Care Working Group.

Strengthening Primary Care Access:

Primary Health Care Working Group

Research Funding:

More Information:

• Strengthening Primary Care Access

Invited Member: Canadian Nurses Association (CNA) Reference Group on Primary Health Care (2011-2014)

Primary Health Care Summit was held January 25-26 2012 in Ottawa and was hosted by the Canadian Nurses Association and the Canadian Medical Association. A summary of the event was prepared in a brief report.  

Primary Health Care Summit Report: January 2012:

Canadian Nurses Association and the Canadian Medical Association

Research Funding:

More Information:

• Primary Health Care Summit: Report

This paper describes the methods, strategies and technologies used to conduct a scoping literature review examining primary care (PC) and public health (PH) collaboration. It presents challenges encountered as well as recommendations and 'lessons learned' from conducting the review with a large geographically distributed team comprised of researchers and decision-makers using an integrated knowledge translation approach.

Of 6125 papers identified, 114 were retained as relevant. Most papers originated in the United Kingdom (38%), the United States (34%) and Canada (19%). Of 80 papers that reported on specific collaborations, most were descriptive reports (51.3%). Research studies represented 34 papers: 31% were program evaluations, 9% were literature reviews and 9% were discussion papers. Key strategies to ensure rigor in conducting a scoping literature review while engaging a large geographically dispersed team are presented for each stage. The use of enabling technologies was essential to managing the process. Leadership in championing the use of technologies and a clear governance structure were necessary for their successful uptake.

First Author:

Valaitis, R., Martin-Misener, R., Wong, S.T., MacDonald, M., Meagher-Stewart, D., Austin, P., Kaczorowski, J., O’Mara, L., Savage, R.

Research Funding:

• Building Primary Health Care Nursing Leadership to Enhance Collaboration between Primary Health Care and Public Health

More Information:

• Publication

We conducted a scoping literature review following established methods to explore the existing evidence on system navigation in primary care. To be included, studies had to be published in English between 1990 and 2013, and include a navigator or navigation process in a primary care setting that involves the community- based social services beyond the health care system. We make an important contribution to the literature by highlighting navigation models that address both health and social service navigation. T

Co-Author:

Nancy Carter, Ruta K. Valaitis, Annie Lam, Janice Feather, Jennifer Nicholl and Laura Cleghorn

Students:

1. Jennifer Nicholl
2. Janice Feather

Research Funding:

• Evaluation of a Community Nurse Navigator in a Priority Hamilton Neighbourhood

More Information:

• Link to paper

To identify recommendations for determining patient panel/caseload size for nurse practitioners in community-based primary health care settings. There are few systems in place to track and measure community-based primary health care nurse practitioner activities. The development of such mechanisms is an important next step to assess community-based primary health care nurse practitioner productivity and determine patient panel/caseload size.

We identified 111 peer-reviewed articles and grey literature documents. Most of the papers were published in Canada and the United States after 2010. Current methods to determine panel/caseload size use large administrative databases, provider work hours and the average number of patient visits. Most of the papers addressing the topic of patient panel/caseload size in community-based primary health care were descriptive. The average number of patients seen by nurse practitioners per day varied considerably within and between countries; an average of 9–15 patients per day was common. Patient characteristics (e.g., age, gender) and health conditions (e.g., multiple chronic conditions) appear to influence patient panel/caseload size. Very few studies used validated tools to classify patient acuity levels or disease burden scores. Decisions about panel/caseload size must take into account the effects of nurse practitioner activities on outcomes of care.

Co-Author:

R. Martin-Misener, K. Kilpatrick, F. Donald, D. Bryant-Lukosius, J. Rayner, R. Valaitis, N. Carter, P.A. Miller, V. Landry, P. Harbman , R.Charbonneau-Smith, J. McKinlay , E. Ziegler, S. Boesveld , A. Lamb

Students:

1. Erin Ziegler

Research Funding:

More Information:

• Publication

To address increasing pressures for cancer survivorship care, provincial cancer agencies have introduced new models of post-treatment follow-up involving earlier transition of cancer survivors back to primary care (PC) providers. It is unknown how nurses in PC settings have responded to this practice change. The purpose of this qualitative descriptive study was to examine registered nurses' (RNs) perspectives of the strengths, gaps, barriers and opportunities for optimizing nursing roles in the delivery of cancer survivorship care within PC settings.

Participants completed a demographical questionnaire and semi-structured, in-depth telephone interview. Data collection and analysis were conducted concurrently. Data were analyzed using content analysis approaches. The sample included 18 RNs working in diverse PC settings across Ontario. Participants' involvement in cancer survivorship care was limited, but it could be categorized into the following three themes: care coordination and system navigation, emotional support and facilitating access to community resources. Individual, practice setting and PC team factors influenced nurses' involvement in cancer survivorship care. To the best of our knowledge, this is the first Canadian study to examine RN roles in PC settings related to cancer survivorship care. There is wide variability and opportunity to enhance RNs' roles and involvement in cancer survivorship care.

Co-Author:

Lindsay Yuille, Denise Bryant-Lukosius, Ruta Valaitis & Lisa Dolovich

Students:

1. Lindsay Yuille

Research Funding:

More Information:

• Link to publication

Building on a scoping literature review, our study aimed to identify the influencing factors within these organizations that affect the ability of these health care sectors to collaborate with one another in the Canadian context. Relationships between these factors were also explored.

Seven major organizational influencing factors on collaboration were identified: 1) Clear Mandates, Vision, and Goals; 2) Strategic Coordination and Communication Mechanisms between Partners; 3) Formal Organizational Leaders as Collaborative Champions; 4) Collaborative Organizational Culture; 5) Optimal Use of Resources; 6) Optimal Use of Human Resources; and 7) Collaborative Approaches to Programs and Services Delivery.

First Author:

Ruta ValaitisEmail authorView ORCID ID profile, Donna Meagher-Stewart, Ruth Martin-Misener, Sabrina T. Wong, Marjorie MacDonald, Linda O’Mara and

Research Funding:

• Building Primary Health Care Nursing Leadership to Enhance Collaboration between Primary Health Care and Public Health

More Information:

• Link to paper

Building on a scoping literature review, our study aimed to identify the influencing factors within these organizations that affect the ability of these health care sectors to collaborate with one another in the Canadian context. Relationships between these factors were also explored.

Seven major organizational influencing factors on collaboration were identified: 1) Clear Mandates, Vision, and Goals; 2) Strategic Coordination and Communication Mechanisms between Partners; 3) Formal Organizational Leaders as Collaborative Champions; 4) Collaborative Organizational Culture; 5) Optimal Use of Resources; 6) Optimal Use of Human Resources; and 7) Collaborative Approaches to Programs and Services Delivery.

First Author:

Ruta Valaitis, Donna Meagher-Stewart, Ruth Martin-Misener, Sabrina T. Wong, Marjorie MacDonald, Linda O’Mara and The Strengthening Primary Health Care through Primary Care and Public Health Collaboration Team

Research Funding:

More Information:

• Link to paper

A report on behalf of the Primary Health Care Expert Advisory Committee. In late 2013 the Ministry of Health and Long-Term Care (the “ministry”) convened the Expert Advisory Committee on Strengthening Primary Health Care in Ontario to address current challenges in Ontario’s primary care system. The ministry identified four policy questions of particular interest which are addressed in this report, May 2015.

In response, the Committee has proposed a vision for an integrated primary health care system for Ontario, based on a redesign of the province’s existing primary care sector. The foundation of the redesign is a population-based model of integrated primary health care delivery, designed around Patient Care Groups (PCGs); which are fund-holding organizations that are accountable to the ministry through the Local Health Integration Networks (LHINs).

Expert Advisory Committee Member:

David Price, Elizabeth Baker, Brian Golden, and Rosemary Hannam

Research Funding:

More Information:

• Report

The aim of the study was to explore the perceptions of older adults on the implementation and impact of Health Teams Advancing Patient Experience: Strengthening Quality (Health TAPESTRY), a multicomponent primary care programme that seeks to improve care coordination for individuals through health-related goal-setting supported by trained lay volunteers who are an extension of an interprofessional team, and the use of technology to support communication among the team.

Older adults' perceptions about the Health TAPESTRY programme included (1) the lack of a clear purpose and understanding of how information was shared among providers, (2) mixed positive and negative perceptions of goal-setting and provider follow-up after inhome visits by volunteers, (3) positive impacts such as satisfaction with the primary care team, and (4) the potential for the programme to become a regular programme and applied to other communities and groups. Older adults living in the community may benefit from greater primary care support provided through enhanced team-based approaches. Programmes such as Health TAPESTRY facilitate opportunities for older adults to work with primary care providers to meet their self-identified needs. By exploring perceptions of clients, primary care programmes can be further refined and expanded for various populations.

Co-author:

Jenny Ploeg, Ruta Valaitis, Laura Cleghorn, Marie-Lee Yous, Jessica Gaber, Gina Agarwal, Monika Kastner, Derelie Mangin, Doug Oliver, Fiona Parascandalo, Cathy Risdon, Lisa Dolovich

Research Funding:

More Information:

• Publication

The persona-scenario exercise, an alternative to traditional strategies, originated from the field of human computer interface design. This project used this methodology adapted by Dr. Valaitis from participatory approaches used in eHealth. This article describes how persona-scenario exercises were applied in the codesign of the complex primary health care intervention TAPESTRY (Teams Advancing Patient Experiences: Strengthening Quality).

The goal of the TAPESTRY program is to determine how health care teams can be more responsive to the needs of our aging population. The program involves trained community volunteers reaching out to older adults in their homes to assess their health needs. Volunteers will be linked to patients’ health care teams using technology, which will improve communication with providers and will also maximize engagement with community service providers. For more information on TAPESTRY, visit http://healthtapestry.ca

First Author:

Valaitis, R., Longaphy, J., Nair, K., Agarwal, G., Griffith, L., Kastner, M., Oliver, D., Ploeg, J., Strauss, S., Dolovich, L.

Research Funding:

• TAPESTRY: Teams Advancing Patient Experience: Strengthening Quality

More Information:

• Publication
• Health Tapestry

Most health care for people with diabetes occurs in family practice, yet balancing the time and resources to help these patients can be difficult. An intervention empowering patients, leveraging community resources, and assisting self-management could benefit patients and providers. Thus, the feasibility and potential for effectiveness of “Health Teams Advancing Patient Experience, Strengthening Quality through Health Connectors for Diabetes Management” (Health TAPESTRY-HC-DM) as an approach supporting diabetes self-management was explored to inform development of a future large-scale trial.

This study of Health TAPESTRY-HC-DM, a complex intervention to help people with diabetes self-management, indicated feasibility and potential clinical benefit. Patient-reported outcome measures showed change in the hypothesized direction, notably with physical activity, which was also seen as a primary goal set by clients. However, we need a greater understanding of who this approach helped the most and more efficient recruitment processes in order to offer it on a larger scale to the most appropriate patient population.

Co-author:

Agarwal, G., Gaber, J., Richardson, J., Mangin, D., Ploeg, J., Valaitis, R., Reid, G.J., Lamarche, L., Parascandalo, F., Javadi, D., O’Reilly, D., Dolovich, L.

Research Funding:

More Information:

• Publication

Report to the WHO, Series Number 16, March 2009. Primary health care (PHC) is a philosophy and an educational practice approach. Nursing is one of the key services for the delivery of PHC. The purpose of this background paper is to examine PHC education for nurses in the globalized world.

A case study approach is used to provide information about PHC education. The paper will define and describe PHC, nursing education in Canada and curriculum development. Challenges will be discussed and a policy framework will be provided. In addition, recommendations specific to PHC nursing education will be made.

Co-author:

Baumann, A., Valaitis, R., Kaba, A.

Research Funding:

More Information:

• Report

The goal of the Aging, Community and Health Research Unit (ACHRU) is to promote optimal aging at home for older adults with multimorbidity (≥2 chronic conditions) and to support their family/friend caregivers. This protocol paper reports the rationale and plan for this patient-oriented, cross-jurisdictional research program.

BACKGROUND: The goal of the Aging, Community and Health Research Unit (ACHRU) is to promote optimal aging at home for older adults with multimorbidity (≥2 chronic conditions) and to support their family/friend caregivers. This protocol paper reports the rationale and plan for this patient-oriented, cross-jurisdictional research program. OBJECTIVES: The objectives of the ACHRU research program are (i) to codesign integrated and person-centered interventions with older adults, family/friend caregivers, and providers; (ii) to examine the feasibility of newly designed interventions; (iii) to determine the intervention effectiveness on Triple Aim outcomes: health, patient/caregiver experience, and cost; (iv) to examine intervention context and implementation barriers and facilitators; (v) to use diverse integrated knowledge translation (IKT) strategies to engage knowledge users to support scalability and sustainability of effective interventions; and (vi) to build patient-oriented research capacity. DESIGN: The research program was informed by the Knowledge-to-Action Framework and the Complexity Model. Six individual studies were conceptualized as integrated pieces of work. The results of the three initial descriptive studies will inform and be followed by three pragmatic randomized controlled trials. IKT and capacity building activities will be embedded in all six studies and tailored to the unique focus of each study. CONCLUSIONS: This research program will inform the development of effective and scalable person-centered interventions that are sustainable through interagency and intersectoral partnerships with community-based agencies, policy makers, and other health and social service agencies. Implementation of these interventions has the potential to transform health-care services and systems and improve the quality of life for older adults with multimorbidity and their caregivers.

Co-author:

Markle-Reid, M., Ploeg, J., Valaitis, R., Duggleby, W., Fisher, K., Fraser, K., Ganann, R., Griffith, L., Gruneir, A., McAiney, C., and Williams, A. for the Aging, Community and Health Research Unit Team

Research Funding:

More Information:

• Link to paper

A full day think tank on strengthening collaboration between public health and primary care was held at Public Health Ontario in Toronto in 2012.

Participants included policy makers, decision-makers, front line practitioners and academics from PC and PH. They represented Ontario Ministry of Health and Long-Term Care (MoHLTC) staff, as well as PC, PH, medical, nursing, and nurse practitioner associations, and national organizations. Dr. Valaitis presented an overview of findings from a program of research on PC and PH collaboration in Ontario, Nova Scotia and British Columbia. MOHLTC PC and PH leaders presented overviews of current ministry directions in relation to PC and PH. Based on the presentations, participants brainstormed actions to increase collaboration. These were separated into high impact actions and short term quick wins. Key messages were developed for policy makers and directors, managers and providers for high impact items.

Lead and Chair:

Valaitis, R.

Research Funding:

• Building Primary Health Care Nursing Leadership to Enhance Collaboration between Primary Health Care and Public Health

More Information:

• Website

The aim of this paper is to examine Canadian key informants’ perceptions of intrapersonal (within an individual) and interpersonal (among individuals) factors that influence successful primary care and public health collaboration

A total of 74 participants [from the provinces of British Columbia (n=20); Ontario (n=19); Nova Scotia (n=21), and representatives from other provinces or national organizations (n=14)] participated. Five interpersonal factors were found that influenced public health and primary care collaborations including: (1) trusting and inclusive relationships; (2) shared values, beliefs and attitudes; (3) role clarity; (4) effective communication; and (5) decision processes. There were two influencing factors found at the intrapersonal level: (1) personal qualities, skills and knowledge; and (2) personal values, beliefs, and attitudes. A few differences were found across the three core provinces involved. There were several complex interactions identified among all inter and intra personal influencing factors: One key factor – effective communication – interacted with all of them. Results support and extend our understanding of what influences successful primary care and public health collaboration at these levels and are important considerations in building and sustaining primary care and public health collaborations.

First Author:

Ruta K Valaitis; Linda O'Mara; Sabrina T. Wong; Marjorie MacDonald; Nancy Murray; Ruth Martin-Misener; Donna Meagher-Stewart

Research Funding:

• Building Primary Health Care Nursing Leadership to Enhance Collaboration between Primary Health Care and Public Health

More Information:

• Link to paper

Final Report to Canadian Health Services Research Foundation (CHSRF), 2012. ISBN 978-1-927565-02-5.

First Author:

Valaitis, R., MacDonald, M., Martin-Misener, R., Meagher-Stewart, D., O’Mara, L., Wong, S., Akhtar-Danesh, N., Baumann, A., Brauer, P., Burge, F., Green, M., Kaczorowski, J., Savage, R., & the Strengthening Primary Health Care through Public Health and Primary Care Collaboration Team.

Students:

1. Sandra Isaacs
2. Jennifer Nicholl
3. Sally Binks
4. Dr. Judy Burgess

Research Funding:

• Building Primary Health Care Nursing Leadership to Enhance Collaboration between Primary Health Care and Public Health

More Information:

• Link to final report
• Link to program of research website

Although there is a global movement toward health system integration and collaboration, little is known about values, beliefs, and attitudes towards collaboration between stakeholders in public health (i.e. promotion, protection, and prevention with vulnerable groups and/or at the population level) and primary care (i.e., family practices, nurse-led clinics).

Different viewpoints are held by stakeholders around PC and PH collaboration which have the potential to influence the success of collaborations. Understanding and managing these differences is important to assist change management processes required to build and maintain strong PC and PH collaborations.

Co-author:

Akhtar-Danesh, A., Valaitis, R., O’Mara, L., Austin, P., Munroe, V

Research Funding:

• Primary Care and Public Health Collaboration: Synergies, Research Capacity & Knowledge Translation Among Three Teams

More Information:

• Publication

The purpose of this paper is to report: 1) what systemic factors influence collaborations between PC and PH; and 2) how systemic factors interact and could influence collaboration.

We conducted a total of 70 in-depth interviews with 74 participants working in either PC (n = 33) or PH (n = 32), both PC and PH (n = 7), or neither sector (n = 2). Seven systemic factors for collaboration were identified: 1) health service structures that promote collaboration; 2) funding models and financial incentives supporting collaboration; 3) governmental and regulatory policies and mandates for collaboration; 4) power relations; 5) harmonized information and communication infrastructure; 6) targeted professional education; and 7) formal systems leaders as collaborative champions.

Senior Author:

Sabrina T. Wong, Marjorie MacDonald, Ruth Martin-Misener, Donna Meagher-Stewart, Linda O’Mara, and Ruta K. Valaitis

Research Funding:

• Building Primary Health Care Nursing Leadership to Enhance Collaboration between Primary Health Care and Public Health

More Information:

• Link to Paper

The purpose of this study is to understand how the implementation of primary care services for transgender individuals compares across various models of primary care delivery in Ontario.

BACKGROUND: In Ontario, Canada, healthcare for transgender individuals is accessed through primary care; however, there are a limited number of practitioners providing transgender care, and patients are often on waiting lists and/or traveling great distances to receive care. Understanding how primary care is implemented and delivered to transgender individuals is key to improving access and eliminating healthcare barriers. METHODS: A qualitative, exploratory, multiple-case study guided by Normalization Process Theory (NPT) was used to compare transgender care delivery and implementation across three primary care models. Three cases known to provide transgender primary care and represent different primary care models in Ontario, Canada (i.e., family health team, community health centre, fee-for service physician) were explored. The NoMAD survey, a tool to measure implementation processes, and qualitative interviews with primary care practitioners and allied healthcare staff were administered. RESULTS: Using the NPT framework to guide analysis, key themes emerged about successful implementation of primary care services for transgender individuals. These themes include creating a safe space for patients, identifying gaps in services, understanding practitioners' roles, and the need for more training and education in transgender care for practitioners. CONCLUSIONS: Primary care services for transgender individuals can and should be delivered in all models of primary care. Training and awareness for healthcare practitioners are needed to develop capacity in providing primary care to transgender individuals. A greater number of practitioners and organizations are needed to take on this work, embedding and normalizing transgender care into routine practice to address barriers to access and improve quality of care for transgender individuals.

Senior Author:

Ziegler, E., Valaitis, R., Yost, J., Carter, N., & Risdon, C.

Students:

1. Erin Ziegler

Research Funding:

More Information:

• Publication