A formative evaluation of a nurse practitioner-led interprofessional geriatric outpatient clinic.

The number of older adults with multiple complex comorbidities and frailty is expected to increase dramatically in the coming decades, which will necessitate a concomitant increase in the need for skilled clinicians who are able to manage complex geriatric needs. Many physicians, however, lack the required formal training, often leading to long wait-lists for specialist clinics. Yet, clinics led by non-physician professionals specialising in geriatric care could decrease these delays. This article describes the development and evaluation of a nurse practitioner-led interprofessional geriatric outpatient clinic (Inter-D Clinic). A combination of semi-structured clinician interviews, post-clinic follow-up phone calls, satisfaction surveys, and information from the hospital workload management system served as data sources for this formative programme evaluation. Between January 2013 and December 2014, 293 patients were seen in the clinic with the majority being referred for either memory issues (49%) or functional decline (35%). The clinic assessment frequently uncovered other issues, which led to guidance around falls prevention, improved nutrition, medication management, and referrals to available community supports. Both patients and referring physicians were very satisfied with this model of care, which is likely transferable to other locations provided the needed clinical expertise and community support services are available.

Why physicians and nurses ask (or don't) about partner violence: a qualitative analysis.

BACKGROUND: Intimate partner violence (IPV) against women is a serious public health issue and is associated with significant adverse health outcomes. The current study was undertaken to: 1) explore physicians' and nurses' experiences, both professional and personal, when asking about IPV; 2) determine the variations by discipline; and 3) identify implications for practice, workplace policy and curriculum development. METHODS: Physicians and nurses working in Ontario, Canada were randomly selected from recognized discipline-specific professional directories to complete a 43-item mailed survey about IPV, which included two open-ended questions about barriers and facilitators to asking about IPV. Text from the open-ended questions was transcribed and analyzed using inductive content analysis. In addition, frequencies were calculated for commonly described categories and the Fisher's Exact Test was performed to determine statistical significance when examining nurse/physician differences. RESULTS: Of the 931 respondents who completed the survey, 769 (527 nurses, 238 physicians, four whose discipline was not stated) provided written responses to the open-ended questions. Overall, the top barriers to asking about IPV were lack of time, behaviours attributed to women living with abuse, lack of training, language/cultural practices and partner presence. The most frequently reported facilitators were training, community resources and professional tools/protocols/policies. The need for additional training was a concern described by both groups, yet more so by nurses. There were statistically significant differences between nurses and physicians regarding both barriers and facilitators, most likely related to differences in role expectations and work environments. CONCLUSIONS: This research provides new insights into the complexities of IPV inquiry and the inter-relationships among barriers and facilitators faced by physicians and nurses. The experiences of these nurses and physicians suggest that more supports (e.g., supportive work environments, training, mentors, consultations, community resources, etc.) are needed by practitioners. These findings reflect the results of previous research yet offer perspectives on why barriers persist. Multifaceted and intersectoral approaches that address individual, interpersonal, workplace and systemic issues faced by nurses and physicians when inquiring about IPV are required. Comprehensive frameworks are needed to further explore the many issues associated with IPV inquiry and the interplay across these issues.

Collaborative Development of an Older Adult Experience Survey for Specialized Geriatric Services.

BACKGROUND: While generic, site, and disease-specific patient experience surveys exist, such surveys have limited relevance to frail, medically complex older adults attending appointment-based specialized geriatric services (SGS). The study objective was to develop and evaluate a patient experience survey specific to this population. METHODS: Using established survey research methods, this study was conducted collaboratively with older adults (patients and family members/friends) at three Ontario sites offering SGS. The study was done in three phases: Phase One-literature review, evidence alignment, and operationalization of core survey items; Phase Two-cognitive interviews and refinement; and Phase Three-pilot testing, survey item analysis, and refinement. RESULTS: Based on an evidence-informed framework, the "Older Adult Experience Survey" includes 12 core items, two global rating items, two open-ended questions, and two demographic questions. The summed 12 core items demonstrated acceptable internal consistency (Cronbach's alpha: 0.83), and the correlation between the summed score and a global question was 0.59, providing evidence of construct validity. The survey also demonstrated face and content validity. CONCLUSION: This open access, collaboratively developed, psychometrically sound patient experience survey can be used to assess, then improve, the clinical experience and quality of care of older adults attending appointment-based SGS clinics/programs.

Adolescents' low-carbohydrate-density diets are related to poorer dietary intakes.

This study was undertaken to assess how low-carbohydrate-density diets below the acceptable macronutrient distribution range relate to food and micronutrient intake and sociodemographic and health-related characteristics. The multistage stratified cluster design in the 1990 Ontario Health Survey was used. There were 5,194 subjects, 12 to 18 years of age, in sampled households. Dietary data were collected via a food frequency questionnaire. Low-carbohydrate-density diets were consumed by 27.6% of males and 24.1% of females. Low-carbohydrate-density diets were related (P < .05) to reduced sufficiency of vegetables and fruit and higher consumption of meat and alternatives and added fats. The low-carbohydrate-density diet resulted in intakes lower in vitamin C and fiber and higher in cholesterol and total fat. The low-carbohydrate-density diet was directly associated with being Canadian-born (odds ratio [OR] = 1.78, 95% confidence interval [CI] = 1.27 to 2.50), overweight status (OR = 1.27, 95% CI = 1.02 to 1.57), smoking (OR = 1.53, 95% CI = 1.23 to 1.90), alcohol use (OR = 1.46, 95% CI = 1.21 to 1.75), and poorer self-rated health (OR = 1.47, 95% CI = 1.01 to 2.14). Use of the acceptable macronutrient distribution range identified adolescents with low-carbohydrate-density diets whose food choices and nutrient intake may impact negatively on short- and long-term health.

Socioeconomic status and non-fatal injuries among Canadian adolescents: variations across SES and injury measures.

BACKGROUND: While research to date has consistently demonstrated that socioeconomic status (SES) is inversely associated with injury mortality in both children and adults, findings have been less consistent for non-fatal injuries. The literature addressing SES and injury morbidity among adolescents has been particularly inconclusive. To explore potential explanations for these discrepant research findings, this study uniquely compared the relationship across different measures of SES and different causes of injury (recreation versus non-recreation injuries) within a sample of Canadian adolescents. METHODS: The sample included adolescent participants (aged 12 to 19 years) in the Canadian 1996-1997 cross-sectional National Population Health Survey (n = 6967). Five SES measures (household income, two neighbourhood-level proxy measures, two parental indicators) were examined in relation to three injury outcomes (total, recreation, and non-recreation injuries) using multivariable logistic regression. RESULTS: Among males, a clear relationship with injury was observed only for a parental SES index, which was positively associated with total and recreation injuries (odds ratios for the highest versus lowest SES category of 1.9 for total and 2.5 for recreation injuries). Among females, there was some evidence of a positive relationship between SES and injuries, particularly for a neighbourhood-level education measure with total and recreation injuries (odds ratios of 1.7 for total and 2.0 for recreation injuries). CONCLUSION: The results suggest that differences related to the measures of SES chosen and the causes of injury under study may both contribute to discrepancies in past research on SES and non-fatal injuries among adolescents. To clarify the potential SES-injury relationship among youth, the findings emphasize a need for a greater understanding of the meaning and relevance of different SES measures for adolescents, and for an exploration of the pathways through which SES may be related to injury risk.

Is there value in using physician billing claims along with other administrative health care data to document the burden of adolescent injury? An exploratory investigation with comparison to self-reports in Ontario, Canada.

BACKGROUND: Administrative health care databases may be particularly useful for injury surveillance, given that they are population-based, readily available, and relatively complete. Surveillance based on administrative data, though, is often restricted to injuries that result in hospitalization. Adding physician billing data to administrative data-based surveillance efforts may improve comprehensiveness, but the feasibility of such an approach has rarely been examined. It is also not clear how injury surveillance information obtained using administrative health care databases compares with that obtained using self-report surveys. This study explored the value of using physician billing data along with hospitalization data for the surveillance of adolescent injuries in Ontario, Canada. We aimed i) to document the burden of adolescent injury using administrative health care data, focusing on the relative contribution of physician billing information; and ii) to explore data quality issues by directly comparing adolescent injuries identified in administrative and self-report data. METHODS: The sample included adolescents aged 12 to 19 years who participated in the 1996-1997 cross-sectional Ontario Health Survey, and whose survey responses were linked to administrative health care datasets (N = 2067). Descriptive analysis was used to document the burden of injuries as a proportion of all physician care by gender and location of care, and to examine the distribution of both administratively-defined and self-reported activity-limiting injuries according to demographic characteristics. Administratively-defined and self-reported injuries were also directly compared at the individual level. RESULTS: Approximately 10% of physician care for the sample was identified as injury-related. While 18.8% of adolescents had self-reported injury in the previous year, 25.0% had documented administratively-defined injury. The distribution of injuries according to demographic characteristics was similar across data sources, but congruence was low at the individual level. Possible reasons for discrepancies between the data sources included recall errors in the survey data and errors in the physician billing data algorithm. CONCLUSION: If further validated, physician billing data could be used along with hospital inpatient data to make an important and unique contribution to adolescent injury surveillance. The limitations inherent in different datasets highlight the need to continue rely on multiple information sources for complete injury surveillance information.

Dietary intake among young adolescents in Ontario: associations with vegetarian status and attitude toward health.

BACKGROUND: This study aimed to describe the dietary intakes of adolescent vegetarians and omnivores and determine if, and how, attitude toward personal health related to food consumption. METHODS: Among grade 9 students in Ontario, Canada (n = 630), vegetarian status and estimated consumption of foods and food groups were determined by food frequency questionnaire. Personal health was self-categorized as very important (the "health conscious") or somewhat/not important (the "non-health conscious"). RESULTS: The prevalence of vegetarianism was 6.5% (CI = 4.6-8.4%) among females and 1.0% (CI = 0.2-1.8%) among males. Health-conscious omnivores consumed more grain, vegetables and fruit, and milk product than non-health-conscious omnivores (P < 0.05). Health-conscious vegetarians ingested more grain products, vegetables and fruit, and meat and alternatives than non-health-conscious vegetarians (P < 0.05). Among non-health-conscious vegetarians, none consumed two daily servings of meat and alternatives compared to 60.5% of non-health-conscious omnivores (P < 0.001). Among health-conscious vegetarians, milk product consumption was lower than that of health-conscious omnivores (P = 0.015). CONCLUSIONS: Large proportions of both vegetarian and omnivore adolescents consumed suboptimal diets. Health consciousness had value as an indicator of dietary adequacy and may be useful as a rudimentary screen for problematic dietary consumption patterns.

A comparison of measures of socioeconomic status for adolescents in a Canadian national health survey.

The purpose of this study was to explore and compare measures of socioeconomic status (SES) in a national sample of Canadian adolescents. Issues of missing data and interrelationships among the measures were addressed. Measures of SES included household income, parental education, two parental occupation-based measures, and four neighbourhood proxy indicators. The proportion of adolescents with missing data was largest for household income (21.1 percent). Data were not missing at random, as adolescents missing household income information were less likely to reside in a high income neighbourhood. Pair-wise Spearman correlations ranged from: 0.40-0.79 between neighbourhood SES measures; 0.12-0.37 between household/parental and neighbourhood indicators; and 0.36-0.87 between household/parental measures. Correlations were lower among rural adolescents, particularly for the neighbourhood SES measures. The results highlight both measurement and conceptual challenges for researchers who wish to gain insight into SES-health relationships for adolescents. In particular, the findings emphasize the importance of incorporating multiple measures of SES and suggest a need to further explore the meaning of socioeconomic position for this population.