A Unique Model and Workforce to Address Health-Related Social Needs and Health Equity: Regional Health Connectors in Colorado.

Unmet health-related social needs contribute to high morbidity and poor population health. Improving social conditions are likely to reduce health disparities and improve the health of the overall U.S. population. The primary objective of this article is to describe an innovative workforce model, called Regional Health Connectors (RHCs), and how they address health-related social needs in Colorado. This is a program evaluation that analyzed field notes and interview data from 2021-2022. We applied our findings to the framework developed by the National Academies of Sciences, Engineering, and Medicine's (NASEM's) report on strengthening social care integration into health care (2019). We found that RHCs address the following health-related social needs most commonly: food insecurity (n = 18 of 21 regions or 85% of all regions), housing (n = 17 or 81% of all regions), transportation (n = 11 or 52% of all regions), employment opportunities (n = 10 or 48% of all regions), and income/financial assistance (n = 11 or 52% of all regions). RHCs interacted across many sectors to address health-related social needs and provided multiple types of support to primary care practices at the organizational level. Examples of emerging impact of RHCs are described and mapped onto the NASEM framework. Findings from this program evaluation add to the growing landscape of knowledge and importance of detecting and addressing health-related social needs. We conclude that RHCs are a unique and emerging workforce that addresses multiple domains needed to integrate social care into health care.

Using live stream technology to conduct workplace observation assessment of trainee dental nurses: an evaluation of effectiveness and user experience.

AIM/OBJECTIVE: This study evaluates the effectiveness and users' experience of using live stream technology to conduct workplace observation assessments of trainee dental nurses. Information on the usability, accessibility, and general satisfaction of this technological technique were collected. MATERIALS AND METHODS: This nationwide cross-sectional survey was conducted in Scotland and included one focus group and three online questionnaires with qualitative and quantitative questions. The quantitative responses were described using standard descriptive analysis, while the quantitative data were investigated using thematic analysis. RESULTS: Eighty-one trainee dental nurses, 35 clinicians and 19 assessors participated in this study. Live stream observation was generally well received by the trainee dental nurses and clinicians, who thought that it had helped increase their confidence to perform practical skills. The assessors also stated that overall satisfaction was high, and that live stream observation met their expectations for efficacy. However, several technical challenges, such as network issues were brought up by responders. CONCLUSION: This study provides evidence that workplace observation assessments can be performed in the future by using live stream technology. However, additional investigation and comparison will aid in determining the most effective way of using this approach and providing feedback to promote learning among dental trainees.

Virtual care exercise interventions in multidisciplinary chronic pain clinics: a qualitative study of perspectives of adults living with chronic pain.

PURPOSE: Chronic pain affects 1 in 4 Canadians and is a leading contributor of disability. Although virtual care has become more prevalent, it is unclear how adults living with chronic pain perceive virtual delivery of exercise interventions within multidisciplinary chronic pain clinics (MCPC). This study explores the perspectives of adults living with chronic pain regarding their perceived barriers and facilitators and recommendations when implementing virtual care exercise interventions within MCPCs. METHODS: We conducted an interpretive description qualitative study based on semi-structured interviews with adults (age ≥18 years) living with chronic pain from a MCPC in Toronto, Canada, between March 1 and April 30, 2021. RESULTS: We completed fifteen (N = 15) interviews of adults living with chronic pain. We identified eight themes that addressed the study objectives: 1) virtual care supplements in-person care, 2) virtual care improves accessibility, 3) impact of technology on participation, 4) navigating the home environment, 5) impact of pain on participation, 6) impact of supervision and feedback, 7) the need for tailored care, and 8) the need for preparation and additional support. CONCLUSION: Our results reveal that adults living with chronic pain view virtual care exercise interventions positively however, the implementation of these interventions must be carefully considered within MCPCs. Specifically, virtual care was considered an excellent adjunct to in-person care but should not replace it completely.Implications for RehabilitationChronic pain is a leading contributor of disability.Exercise interventions are recommended component of comprehensive pain management.Virtual delivery of exercise interventions are becoming more prevalent.Adults living with chronic pain view virtual care exercise interventions positively as they can supplement in-person care and improve access to this type of care.

Exploring physiotherapy practice within hospital-based interprofessional chronic pain clinics in Ontario.

Background: Chronic pain affects one in five persons and is a leading contributor to years lived with disability and high health care costs. In 2016, the government of Ontario increased public funding for pediatric and adult hospital-based interprofessional chronic pain clinics (HICPCs) in Ontario, Canada, expanding the role of physiotherapy in chronic pain management in the province. This role has yet to be described in the literature. Aim: The aim of this study was to explore physiotherapy practice within HICPCs in Ontario. Methods: We conducted an interpretive description qualitative study based on semistructured interviews with physiotherapists employed in pediatric and adult HICPCs in Ontario. Interviews were audio recorded, transcribed verbatim, and reviewed for accuracy. We analyzed interview data using thematic analysis. Results: Ten physiotherapists who practiced in pediatric and adult HICPCs (n = 4 pediatric; n = 6 adult) in Ontario were interviewed between February and April 2020. We constructed five themes related to physiotherapy practice in this setting. Themes included (1) contributing a functional lens to care; (2) empowering through pain education; (3) facilitating participation in physical activity and exercise; (4) supporting engagement in self-management strategies; and (5) implementing a collaborative approach to whole-person care. Conclusions: Our results illuminate how physiotherapy practice within HICPCs in Ontario focuses on providing a collaborative and whole-person approach to care, with an emphasis on supporting patients to increase their functional capacity by promoting engagement in active chronic pain management strategies.

Contexte: La douleur chronique touche une personne sur cinq et est l'un des principaux contributeurs au nombre d'années vécues avec un handicap, ainsi qu'aux coûts de soins de santé élevés. En 2016, le gouvernement de l'Ontario a augmenté le financement public des cliniques interprofessionnelles de la douleur chronique (HICPC) pédiatriques et pour adultes en milieu hospitalier en Ontario, Canada, élargissant le rôle de la physiothérapie dans la prise en charge de la douleur chronique dans la province. Ce rôle n'a pas encore été décrit dans la littérature.Objectif: Le but de cette étude est d'examiner la pratique de la physiothérapie au sein des HICPC en Ontario.Méthodes: Nous avons mené une étude qualitative descriptive interprétative fondée sur des entrevues avec des physiothérapeutes employés dans des HICPC pédiatriques et pour adultes en Ontario. Les entrevues ont fait l'objet d'un enregistrement audio, puis elles ont été transcrites textuellement et vérifiées pour assurer leur exactitude. Nous avons analysé les données des entrevues en ayant recours à une analyse thématique.Résultats: Dix physiothérapeutes qui ont exercé dans des HICPC pédiatriques et pour adultes (n = 4 pédiatriques; n = 6 pour adultes) en Ontario ont été interviewés entre février et avril 2020. Nous avons construit cinq thèmes liés à la pratique de la physiothérapie dans ce contexte. Les thèmes comprenaient (1) l'apport de l'angle fonctionnel aux soins; (2) l'autonomisation grâce à l'éducation sur la douleur; (3) faciliter la participation à une activité physique et à l'exercice; (4) soutenir l'engagement dans des stratégies d'autogestion; et (5) la mise en œuvre d'une approche collaborative des soins à la personne globale.Conclusions: Nos résultats illustrent la façon dont la pratique de la physiothérapie au sein des HICPC en Ontario se concentre sur une approche de soins collaborative et globale, qui met l'accent sur le soutien aux patients pour augmenter leur capacité fonctionnelle en favorisant l'engagement dans les stratégies actives de prise en charge de la douleur chronique.

"A little bit of a guidance and a little bit of group support": a qualitative study of preferences, barriers, and facilitators to participating in community-based exercise opportunities among adults living with chronic pain.

PURPOSE: To understand preferences, barriers, and facilitators to participating in community-based exercise opportunities among adults living with chronic pain. MATERIALS AND METHODS: An interpretive description methodology based on semi-structured interviews was conducted. Adults (age>18 years) living with chronic pain (pain >3 months in duration) were recruited from a multidisciplinary chronic pain clinic in Toronto, Canada. Thematic analysis was used to conceptualize interview data. RESULTS: Fifteen adults living with chronic pain (11/15 women) were interviewed. Four themes regarding preferences, barriers, and facilitators to participation in community-based exercise are described: (1) accessibility (e.g., cost, location, scheduling, and access to program information from healthcare providers); (2) intrinsic factors (e.g., pain, mental health, and motivation); (3) social factors (e.g., isolation, participation with people with similar capabilities, and safe environment); and (4) program factors (e.g., tailored to adults living with chronic pain, gentle exercise, group-based, and delivered by an instructor knowledgeable about chronic pain). CONCLUSIONS: Participation in community-based exercise opportunities among adults living with chronic pain may be influenced by accessibility, intrinsic factors, social factors, and program factors. Results provide a foundation of understanding to develop person-centered community-based exercise opportunities that are tailored to meet the preferences of this population.Implications for RehabilitationAlthough community-based exercise is commonly recommended as part of ongoing self-management of chronic pain, there is limited research exploring perspectives towards community-based exercise opportunities from the perspective of adults living with chronic pain.Adults living with chronic pain reported specific preferences, barriers, and facilitators to participating in community-based exercise opportunities, including accessibility, instrinsic factors, social factors, and program factors.Most adults living with chronic pain reported a preference for community-based exercise opportunities that: (1) are delivered by an instructor who is knowledgeable about chronic pain; (2) involve gentle exercise; (3) are group-based; and (4) include other individuals with similar physical capabilities.Healthcare providers, community-based organizations, and researchers should develop, implement, and evaluate person-centered community-based exercise opportunities for adults living with chronic pain that consider their unique preferences, barriers, and facilitators to participation.

University women's and men's mindsets surrounding postcesarean birth: Findings and implications for practice and policy.

BACKGROUND: Nearly twice as many women report preferring vaginal birth after cesarean (VBAC) than actually undergo it. It is unknown whether the preference pattern would hold in childbearing-aged individuals who had not yet been directly influenced by care experiences. We therefore examined postcesarean birth preferences in nulliparous university women and men to provide additional evidence to help advance related policy and practice. METHODS: An online study of 558 university women and 164 men who read a hypothetical postcesarean birth scenario was conducted. Students selected the option they would prefer for themselves or a partner in a similar situation; these data were analyzed descriptively and for gender differences. Students' written rationales were analyzed qualitatively. RESULTS: Of women, 38.2% reported preference for VBAC compared with 47.6% of men (P < .05). Thematic analysis revealed that women and men based their preferences on safety, quality of experience, and other concerns similar to those reported among pregnant women making the decision. Assumptions and misinformation were also noted. CONCLUSION: Given the current primary cesarean rate of ~20%, the current childbearing generation will be facing cesarean and postcesarean birth decisions in appreciable numbers. The relatively high VBAC preference rate reported by our participants, particularly men, is useful in advocating for expanded access and practice. From a constructivist perspective, evidence of young adults' mindsets and misconceptions surrounding postcesarean birth is valuable for developing effective educational interventions.