Development of an online tool to support financial and legal planning in dementia.

Objective: To develop, assess, and refine an online educational tool, Plan for Clarity, to support financial and legal planning in dementia. Methods: A Delphi mixed-method study with three rounds of anonymous review by lay and professional stakeholders was designed to reach consensus about the content of the online tool and explore the socio-cultural and behavioral factors that could affect access and use. Results: Consensus showed that the online tool covered key information, knowledge, and communication skills for financial and legal planning. Study themes: 1) the online tool had to be easy to navigate with relevant, easily understood information; 2) people with early signs of memory difficulties would be able to use the tool; 3) a referral from a trusted source is a primary way to facilitate access and use of the tool; and 4) discussions about financial and legal issues should be held early, ahead of barriers that can block discussion. Conclusion: These data suggest this online tool is relevant and feasible for dementia care and support as well as aging more generally. Innovation: Plan for Clarity is innovative as an evidence and theory-driven online education tool to address financial and legal planning for dementia care, particularly among underserved older adults.

Descriptive analysis and evaluation of Health Link referrals to the emergency department before and during the COVID-19 pandemic.

BACKGROUND: In Alberta, Health Link (HL) provides a 24-h, nurse-staffed, phone resource to the public for health-care advice. HL directs callers to either seek care in the emergency department (ED), with a primary care provider or provide self-care at home. This work aims to describe HL ED referrals prior to and during the COVID-19 pandemic. METHODS: Data from January 1, 2018-December 31, 2019, and July 1, 2020-June 30, 2022, were selected. HL calls were categorized as likely appropriate if the patient was referred and presented to the ED within 24 h and had a Canadian Triage and Acuity Scale (CTAS) of 1-3; or a CTAS of 4-5 and the patient was admitted, specialist consulted, or diagnostic imaging or laboratory tests were completed. The primary outcome was the percentage of likely appropriate referrals among all HL ED referrals. RESULTS: In the 2018-2019 and 2020-2022 samples, respectively, there were 845,372 and 832,730 calls. Of the 211,723 and 213,486 ED referrals, only 140,614 (66.4%) and 143,322 (67.1%) presented to an ED. Of these, 84.3 and 86.7 per 100 patient visits were categorized as likely appropriate referrals. Health Link referrals account for 3.2% and 3.8% of all ED visits. IMPACT: HL referrals to the ED represent only a small percentage of all ED visits. Based on our definition, most referrals by HL are likely appropriate. The COVID-19 pandemic does not appear to have altered the rates of calls to HL, the number of HL calls referred to the ED, nor the likely appropriateness of those referrals.

Impact of Health Link utilization on emergency department visits.

OBJECTIVES: Our aim was to compare Health Link utilization in urban and rural Alberta by metrics relevant to the ED. METHODS: Data on Health Link callers from January 1, 2018-December 31, 2019 was extracted from the National Ambulatory Care Reporting System, including postal code, location of ED attended, Canadian Triage Acuity Scale (CTAS) assigned at ED, age, and self-identified gender. Usage density (presentations/100/year), patient demographics (age, self-identified gender), and ED metrics (CTAS, investigations, admission) were compared for Health Link ED referrals and direct ED visits. RESULTS: In this period, 900,196 individuals called Health Link, 241,103 were referred to the ED, 58% (140,614) of which presented to the ED within 24 h of their call. These referrals constituted 3.4% of the total ED visit population (4,194,735). Looking at the density of ED utilization, this is greater in rural than urban settings with respect to patients who present directly to the ED (90.9 vs. 36.5 presentations/100/year). There is a sparser density of Health Link ED visits in rural settings than in urban centres (1.5 vs. 1.6). Urban ED presentations were more often triaged as a CTAS 1-3 than a CTAS 4-5 if they had presented after a Health Link referral (76.0% CTAS 1-3) than a direct ED visit (63.0% CTAS 1-3). This effect is greater for rural patients, who also more likely to present as a CTAS 1-3 than a CTAS 4-5 if they were referred through Health Link (61.1% CTAS 1-3) compared to those who directly went to the ED (39.0% CTAS 1-3). CONCLUSIONS: This study on Health Link describes how tele-health can often triage higher acuity patients to appropriately receive ED level care, which may be important for future development of health care and ED infrastructure.

RéSUMé: OBJECTIFS: Notre objectif était de comparer l'utilisation de Health Link dans les zones urbaines et rurales de l'Alberta en fonction de paramètres pertinents pour l'urgence. MéTHODES: Les données sur les appelants de Health Link du 1er janvier 2018 au 31 décembre 2019 ont été extraites du Système national d'information sur les soins ambulatoires, y compris le code postal, le lieu de l'urgence fréquentée, l'échelle canadienne de triage et de gravité (ETG) attribuée à l'urgence, l'âge et le sexe auto-identifié. La densité d'utilisation (présentations/100/an), les caractéristiques démographiques des patients (âge, sexe déclaré) et les paramètres des urgences (ETG, investigations, admission) ont été comparés pour les orientations vers les urgences de Health Link et les visites directes aux urgences. RéSULTATS: Au cours de cette période, 900 196 personnes ont appelé Health Link, 241 103 ont été dirigées vers les urgences, dont 58 % (140 614) se sont présentées aux urgences dans les 24 heures suivant leur appel. Ces renvois représentaient 3,4 % du nombre total de visites aux urgences (4 194 735). La densité d'utilisation des urgences est plus élevée dans les zones rurales que dans les zones urbaines en ce qui concerne les patients qui se présentent directement aux urgences (90,9 contre 36,5 présentations/100/an). La densité des visites aux urgences de Health Link est plus faible dans les zones rurales que dans les centres urbains (1,5 contre 1,6). Les patients qui se présentaient aux urgences en milieu urbain étaient plus souvent classés dans l'ETG 1-3 que dans l'ETG 4-5 s'ils avaient été orientés par Health Link (76,0 % ETG 1-3) que s'ils s'étaient rendus directement aux urgences (63,0 % ETG 1-3). Cet effet est plus important pour les patients des zones rurales, qui sont également plus susceptibles de présenter un ÉTG 1-3 qu'un ÉTG 4-5 s'ils ont été orientés par Health Link (61,1 % d'ÉTG 1-3) que s'ils se sont rendus directement aux urgences (39,0 % d'ÉTG 1-3). CONCLUSIONS: Cette étude sur Health Link décrit comment la télésanté permet souvent de trier les patients les plus graves pour qu'ils reçoivent les soins appropriés au niveau des urgences, ce qui peut être important pour le développement futur des infrastructures de soins de santé et des urgences.

Patient expectations of emergency department care: phase II--a cross-sectional survey.

OBJECTIVES: To explore emergency department (ED) patient expectations regarding staff communication with patients, wait times, the triage process and information management. METHODS: We conducted a cross-sectional English-language telephone survey among patients aged 18 years or older who visited the EDs in the Calgary Health Region in 2002. Survey items were based on a preceding qualitative study. RESULTS: Of the 941 surveys, 837 were analyzed. Patients placed the highest importance on the explanation of test results (96.5%), a description of circumstances that would require the patient to return to the ED (94.4%), the use of plain language (92.1%) and the reason for the tests (90.8%). Seventy-six percent of patients felt that ED staff should update patients every 30 minutes or less, 51.3% expected patients with non-life threatening problems should wait <1 hour, and 58.3% expected that the tests should be done within 1 hour. Almost two-thirds of the patients (64.4%) believed that the most serious patients should be seen first; 59.3% felt that the seriousness of medical concern should be determined by a triage nurse, and 63.9% thought that their personal health records should be immediately available to the emergency physician without their consent. The actual length of stay was significantly longer than expected length of stay for all patient groups, with Canadian Emergency Department Triage and Acuity Scale Levels IV and V patients expecting a shorter wait than patients in more urgent triage groups. Triage level effects on other expectations were not observed. CONCLUSIONS: ED patient expectations appear to be similar across all triage levels. Patients value effective communication and short wait times over many other aspects of care. They have expectations for short wait times that are met infrequently and are currently unattainable in many Canadian EDs. Although it may be neither feasible nor desirable to meet all patient expectations, increased focus on wait times and staff communication may increase both ED efficiency and patient satisfaction.

A quality control method enhancement concept-Continual improvement of regulatory approved QC methods.

Quality Control methods (QC-methods) play an important role in the overall control strategy for drug manufacturing. However, efficient life-cycle management and continual improvement are hindered due to a variety of post-approval variation legislations across territories and a lack of harmonization of the requirements. As a result, many QC-methods fall behind the technical development. Developing the QC-method in accordance with the Quality by Design guidelines gives the possibility to do continual improvements inside the original Method Operable Design Region (MODR). However, often it is necessary to do changes outside the MODR, e.g. to incorporate new technology that was not available at the time the original method was development. Here, we present a method enhancement concept which allows minor adjustments, within the same measuring principle, outside the original MODR without interaction with regulatory agencies. The feasibility of the concept is illustrated by a case study of a QC-method based on HPLC, assumed to be developed before the introduction of UHPLC, where the switch from HPLC to UHPLC is necessary as a continual improvement strategy. The concept relies on the assumption that the System Suitability Test (SST) and failure modes are relevant for other conditions outside the MODR as well when the same measuring principle is used. It follows that it should be possible to move outside the MODR as long as the SST has passed. All minor modifications of the original, approved QC-method must be re-validated according to a template given in the original submission and a statistical equivalence should be shown between the original and modified QC-methods. To summarize, revalidation is handled within the pharmaceutical quality control system according to internal change control procedures, but without interaction with regulating agencies.

Patient expectations of emergency department care: phase I--a focus group study.

OBJECTIVES: To assess patient comprehension of emergency department discharge instructions and to describe other predictors of patient compliance with discharge instructions. METHODS: Patients departing from the emergency department of an inner-city teaching hospital were invited to undergo a structured interview and reading test, and to participate in a follow-up telephone interview 2 weeks later. Two physicians, blinded to the other's data, scored patient comprehension of discharge information and compliance with discharge instructions. Inter-rater reliability was assessed using a kappa-weighted statistic, and correlations were assessed using Spearman's rank correlation coefficient and Fisher's exact test. RESULTS: Of 106 patients approached, 88 (83%) were enrolled. The inter-rater reliability of physician rating scores was high (kappa = 0.66). Approximately 60% of subjects demonstrated reading ability at or below a Grade 7 level. Comprehension was positively associated with reading ability (r = 0.29, p = 0.01) and English as first language (r = 0.27, p = 0.01). Reading ability was positively associated with years of education (r = 0.43, p < 0.0001) and first language (r = 0.24, p = 0.03), and inversely associated with age (r = -0.21, p = 0.05). Non-English first language and need for translator were associated with poorer comprehension of discharge instructions but not related to compliance. Compliance with discharge instructions was correlated with comprehension (r = 0.31, p = 0.01) but not associated with age, language, education, years in anglophone country, reading ability, format of discharge instructions, follow-up modality or association with a family physician. CONCLUSIONS: Emergency department patients demonstrated poor reading skills. Comprehension was the only factor significantly related to compliance; therefore, future interventions to improve compliance with emergency department instructions will be most effective if they focus on improving comprehension.