The Impact of Primary Care Practice Models on Indicators of Unplanned Health Care Utilization for Ontario Adults Newly Diagnosed With Chronic Obstructive Pulmonary Disease: A Retrospective Cohort Study.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a highly prevalent chronic disease. Most of the care for this population occurs within the primary care setting; however, the extent to which different primary care practice models influence the outcomes of patients with COPD remains unclear. OBJECTIVE: The study aimed to compare and analyze the influence of different primary care practice models on indicators of unplanned health care utilization among newly diagnosed COPD patients in Ontario. DESIGN: A retrospective cohort study was conducted using health administrative database within the Institute for Clinical Evaluative Sciences. The cohort included persons who were 35 years and older with physician-diagnosed COPD between January 1, 2014 and December 31, 2019. Patients were assigned into 3 practice models: team-based, traditional, and no enrolment. The primary outcomes examined was unplanned health care utilization, specifically emergency department (ED) visits and hospitalizations. To account for excessive zero values, the zero inflated negative binomial (ZINB) models were used to analyze the association between different practice models and unplanned health care utilization. RESULTS: Among 57,145 individuals who met the inclusion criteria, 55,994 were included in the regression analysis. Of the included participants, 62.8% of patients were in the traditional group, 30.3% were in the team-based group, and 6.9% were in the no enrolment group. Between 2014 and 2019, 70.7% of the cohort had at least 1 all-cause ED visit without hospitalization. The adjusted ZINB models showed no significant difference in risks of experiencing an unplanned health care utilization between the team-based and traditional groups. However, patients in the no enrolment group had a significantly higher risk of ED visit without hospitalization regardless of cause, ED visit with hospitalization regardless of cause, and 30-day readmissions regardless of cause. CONCLUSIONS: Primary care practice models are complex, influenced by remuneration and organizational structures, reinforcing the need for further research to enhance our understanding of primary care reforms. Furthermore, given the growing shortage of primary care providers, patients with COPD and other chronic conditions are particularly vulnerable.

Evaluating student perceptions of a multi-platform classroom response system in undergraduate nursing.

BACKGROUND: Classroom response systems (CRSs) support interactive learning in undergraduate nursing education. Simple "clicker" hardware has evolved into more sophisticated multi-platform software allowing multiple operating systems and devices including smartphones, tablets and laptops to enhance in-class, proximate student engagement. However, student perspectives of multi-platform mobile CRSs have not been assessed among undergraduate nursing students. OBJECTIVES: To evaluate undergraduate nursing student perceptions of usability, engagement, and learning associated with Top Hat™ CRS software. METHODS: This descriptive study utilized a cross sectional survey of undergraduate Bachelor of Nursing Science (BNSc) students enrolled in a four-year (n = 160) and a two-year (n = 75) accelerated program. Descriptive statistics were used to evaluate learner perceptions of usability, engagement, and learning, measured using the Classroom Response System Perceptions (CRiSP) questionnaire. Thematic analysis was used to examine data from open-ended questions designed to capture qualitative feedback related to the perceived benefits, limitations and the technology's impact on learning. RESULTS: Students perceived the use of the CRS, TopHat™, as a positive influence on classroom learning. The mean CRiSP scores for all subscales [usability 16.51 (SD 2.7), engagement 40.97 (SD 7.2), learning 43.96 (SD 6.8)] correlated with "agree" or "strongly agree". There was no statistical difference among CRiSP scores between the two programs. Students reported that CRS in the classroom improved learning, enhanced formative assessment and increased participation. Perceived limitations include practical drawbacks such as redundant features, technical difficulties, limited access and cost. Moreover, some students felt that it did not add value to teaching as it was disruptive to classroom time. CONCLUSIONS: This study addresses a gap in the nursing education literature and contributes to the growing body of scientific knowledge related to using technology in proximal classroom teaching. One multi-platform CRS, TopHat™, did enhance learning but important recommendations and limitations should be considered before implementing this technology.