Transformation of primary care settings implementing a co-located team-based care model: a scoping review.

BACKGROUND: In Canada, primary care reforms led to the implementation of various team-based care models to improve access and provide more comprehensive care for patients. Despite these advances, ongoing challenges remain. The aim of this scoping review is to explore current understanding of the functioning of these care models as well as the contexts in which they have emerged and their impact on the population, providers and healthcare costs. METHODS: The Medline and CINAHL databases were consulted. To be included, team-based care models had to be co-located, involve a family physician, specify the other professionals included, and provide information about their organization, their relevance and their impact within a primary care context. Models based on inter-professional intervention programs were excluded. The organization and coordination of services, the emerging contexts and the impact on the population, providers and healthcare costs were analysed. RESULTS: A total of 5952 studies were screened after removing duplicates; 15 articles were selected for final analysis. There was considerable variation in the information available as well as the terms used to describe the models. They are operationalized in various ways, generally consistent with the Patient's Medical Home vision. Except for nurses, the inclusion of other types of professionals is variable and tends to be associated with the specific nature of the services offered. The models primarily focus on individuals with mental health conditions and chronic diseases. They appear to generally satisfy the expectations of the overarching framework of a high-performing team-based primary care model at patient and provider levels. However, economic factors are seldom integrated in their evaluations. CONCLUSIONS: The studies rarely provide an overarching view that permits an understanding of the specific contexts, service organization, their impacts, and the broader context of implementation, making it difficult to establish universal guidelines for the operationalization of effective models. Negotiating the inherent complexity associated with implementing models requires a collaborative approach between various stakeholders, including patients, to tailor the models to the specific needs and characteristics of populations in given areas, and reflection about the professionals to be included in delivering these services.

Creating synergies among education/research, practice, and policy environments to build capacity for the scholar role in occupational therapy and physiotherapy in the Canadian context.

Scholarly practice (SP) is considered a key competency of occupational therapy and physiotherapy. To date, the three sectors-education/research, practice, and policy/regulation-that support SP have been working relatively independently. The goals of this project were to (a) understand how representatives of the three sectors conceptualize SP; (b) define each sector's individual and collective roles in supporting SP; (c) identify factors influencing the enactment of SP and the specific needs of how best to support SP; and (d) co-develop goals and strategies to support SP across all sectors. We used interpretive description methodology. Consistent with an integrated knowledge translation approach, partners representing the three sectors across Canada recruited individuals from each sector, developed the content and questions for three focus groups, and collected and analyzed the data. Inspired by the Consolidated Framework for Implementation Research, we developed the questions for the second focus group. We analyzed the data using an inductive thematic analysis method. Thirty-nine participants from the three sectors participated. Themes related to participants' conceptualization of SP included (a) ongoing process, (b) reflective process, (c) broad concept, and (d) collective effort. Themes describing factors influencing and supporting SP were (a) recognition, (b) appropriate conceptualization, (c) social network, (d) accessibility to resources, and (e) forces outside of practitioners' effort. Goals to support SP included (a) further recognizing SP, (b) sustaining SP competency, and (c) ensuring access to information. SP requires collaborative and integrated intersectoral support and further recognition of its importance through the collaboration of multiple stakeholders.

Enabling integration in sports for adolescents with intellectual disabilities.

BACKGROUND: Promoting the health and social participation of adolescents with intellectual disability is important as they are particularly vulnerable to encountering difficulties in those areas. Integration of these individuals in integrated sports is one strategy to address this issue. METHODS: The main objective of this study was to gain a better understanding of the factors associated with the integration of adolescents with intellectual disability in sports alongside their non-disabled peers. Individual interviews were completed with 40 adolescents with intellectual disability and their parents, while 39 rehabilitation staff participated via either a discussion group or self-administered questionnaires. The Disability Creation Process (DCP) theoretical model was used to frame the analysis and the presentation of the findings (The Quebec Classification: Disability Creation Process. International Network on the Disability Creation Process/CSICIDH, Québec, QC, 1998). RESULTS: Various personal and environmental factors that have an impact on integration in sports were identified by participants. For example, attitudes, practical support, individuals' experiences in sports and in integrated settings as well as behaviour control emerged as important elements to consider. CONCLUSIONS: Integration in integrated sports can engender a lot of benefits for individuals with intellectual disability, their parents and non-disabled athletes. However, many barriers need to be removed before such benefits can be more widely realized.

Health professionals' enactment of their accountability obligations: doing the best they can.

In the current context of health care, health professionals' accountability obligations may be more extensive than the degree of autonomy that they are permitted to exercise. To date, how professionals fulfil their obligations with regard to this potential for dissonance has not been investigated. The purpose of this Grounded Theory study was to examine how one professional group, occupational therapists, enacted their accountability obligations within their current practice context. Interviews with 21 therapists across three practice sectors in one Canadian province elicited a detailed portrait of the contextual elements within which accountability enactment took place, and a view of the dynamic interplay of these elements with the decision-making involved in fulfilling professional accountabilities. Practitioners moved back and forth between conscious juggling of accountability expectations and more automatically applying tacit practice knowledge. Beyond non-negotiable bottom line commitments to their formal ethical obligations and to retaining autonomy for their clinical recommendations, practitioners' decisions reflected the goal of doing their best. However, participants' efforts to find a balance between satisfactorily fulfilling their obligations and acknowledging the frequently unavoidable reality of contextual constraints elicited inconsistent patterns. The study findings raise concerns about ensuring quality of services and the impact on professionals. Although practitioners have an important role to play in addressing these challenges, other stakeholders, for example, the professional regulatory bodies, also must play a role in creating a coherent accountability framework. Further research is needed to obtain greater understanding of professional accountability enactment across health professions, practice sectors and health jurisdictions, and to explore managerial and professional regulatory bodies' perspectives, roles and responsibilities.

Keyboarding for students with handwriting problems: a literature review.

A literature review is presented regarding keyboarding for school students experiencing handwriting difficulties. Despite the overall dearth of research, some general conclusions appear warranted. Students need to be able to keyboard at least as fast as they can handwrite and should learn the touch-keyboarding method if possible. Appropriate instruction appears critical for the development of keyboarding competency. The upper elementary age is an appropriate time to start teaching keyboarding, with students possibly requiring 25-30 total hours of instruction. Students experiencing handwriting difficulties might need customized goals and strategies. Although the existing literature regarding the role of performance components in keyboarding provides some direction to clinicians, further investigation is required.

Assistive technology and handwriting problems: what do occupational therapists recommend?

BACKGROUND: Handwriting difficulties for students are a common reason for referral to occupational therapy. Little research evidence is available concerning the factors guiding technology recommendations for these children. PURPOSE: The objective of this survey research was to describe the technology-related recommendations and factors involved in the decisions made by Canadian occupational therapists for these students. RESULTS: More therapists recommended the use of keyboard-based strategies (93%) than dictation-based strategies (72%). Experienced therapists were more likely to prescribe technology tools. Dictation to a scribe (93%) and desktop computers (89%) were the strategies most frequently recommended. Equipment cost and availability of funding, and the availability of support in the school for the student were the most influential factors, respectively, on the keyboard and dictation strategy type prescribed. PRACTICE IMPLICATIONS: The results confirmed that occupational therapists prescribe a range of technology solutions. Factors influencing these recommendations differ depending on the nature of the technology, the person, environment or occupation. Knowing the factors guiding occupational therapist technology recommendations will help provide valuable information about the practical implications of the available technologies.