Comparison of in-person and telegeriatric follow-up consultations.

INTRODUCTION: Telehealth has the potential to support the care of older adults and their desire to age at home by providing a videoconferencing connection to specialist geriatric care. However, more information is needed to determine how telehealth services affect the care of older adults, and how telehealth services for older adults compare to traditional in-person methods of care provision. The aim of this study was to compare telegeriatric and in-person geriatric consultation methods with respect to outcomes and costs. METHODS: This was a retrospective chart analysis of consultation letters from patients' first follow-up appointment with a geriatric specialist during the 2017/2018 fiscal year (N = 95) in a health jurisdiction of a Western Canadian province. RESULTS: Patients seen through telehealth and in person were similar in mean age (M = 79.1 and 78.1 years, respectively) and were predominately female. Telegeriatric consultations resulted in more requests for further testing and screening (p = 0.003), new diagnoses (p = 0.002), medication changes (p = 0.009) and requests for follow-up (p = 0.03) compared to in-person consultations. An average one-day clinic with one geriatric specialist providing consultations through telehealth cost Can$1684-$1859 less than an equivalent in-person clinic. DISCUSSION: Although additional research is needed to explain the differences in outcomes further between telehealth and in-person consultations found in this work, telehealth consultations cost substantially less than in-person consultations and are a promising way to improve access to geriatric care for older adults in underserved areas.

"I see beauty, I see art, I see design, I see love." Findings from a resident-driven, co-designed gardening program in a long-term care facility. / « Je vois de la beauté, je vois de l'art, je vois de l'intention, je vois de l'amour. ¼ Résultats d'un programme de jardinage de conception collaborative à l'intention des résidents d'un établissement de soins de longue durée.

BACKGROUND: Engagement with the natural environment is a meaningful activity for many people. People living in long-term care facilities can face barriers to going outdoors and engaging in nature-based activities. In response to needs expressed by our long-term care facility resident partners, we examined the feasibility and benefits of a co-designed hydroponic and raised-bed gardening program. METHODS: Our team of long-term care facility residents, staff and researchers co-designed and piloted a four-month hydroponic and raised-bed gardening program along with an activity and educational program, in 2019. Feedback was gathered from long-term care facility residents and staff through surveys (N = 23 at baseline; N = 23 at follow-up), through five focus groups (N = 19: n = 10 staff; n = 9 residents) and through photovoice (N = 5). A qualitative descriptive approach was applied to focus group transcripts to capture a rich account of participant experiences within the naturalistic context, and descriptive statistics were calculated. RESULTS: While most residents preferred to go outside (91%), few reported going outside every day (30%). Program participants expressed their joy about interacting with nature and watching plants grow. Analyses of focus group data generated the following themes: finding meaning; building connections with others through lifelong learning; impacts on mental health and well-being; opportunities to reminisce; reflection of self in gardening activities; benefits for staff; and enthusiasm for the program to continue. CONCLUSION: Active and passive engagement in gardening activities benefitted residents with diverse abilities. This fostered opportunity for discussions, connections and increased interactions with others, which can help reduce social isolation. Gardening programs should be considered a feasible and important option that can support socialization, health and well-being.

Addressing rural and Indigenous health inequities in Canada through socially accountable health partnerships.

BACKGROUND: There are few examples of the practical application of the concepts of social accountability, as defined by the World Bank and WHO, to health system change. This paper describes a robust approach led by First Nations Health Authority and the Rural Coordination Centre of British Columbia. This was achieved using partnerships in British Columbia, Canada, where the health system features inequities in service and outcomes for rural and Indigenous populations. Social accountability is achieved when all stakeholders come together simultaneously as partners and agree on a path forward. This approach has enabled socially accountable healthcare, effecting change in the healthcare system by addressing the needs of the population. INNOVATION: Our innovative approach uses social accountability engagement to counteract persistent health inequities. This involves an adaptation of the Boelen Health Partnership model (policymakers, health administrators, health professionals, academics and community members) extended by addition of linked sectors (eg, industry and not-for-profits) to the 'Partnership Pentagram Plus'. We used appreciative inquiry and deliberative dialogue focused on the rural scale and integrating Indigenous ways of knowing along with western scientific traditions ('two-eyed seeing'). Using this approach, partners are brought together to identify common interests and direction as a learning community. Equitable engagement and provision of space as 'peers' and 'partners' were key to this process. Groups with varying perspectives came together to create solutions, building on existing strengths and new collaborative approaches to address specific issues in the community and health services delivery. A resulting provincial table reflecting the Pentagram Plus model has fostered policies and practices over the last 3 years that have resulted in meaningful collaborations for health service change. CONCLUSION: This paper presents the application of the 'Partnership Pentagram Plus' approach and uses appreciative inquiry and deliberative dialogue to bring about practical and positive change to rural and Indigenous communities.