Structural determinants of health workforce burnout.

COVID-19 has exposed the grim underbelly of a fragmented, regionalized, costly, and inefficient approach to health service that is an engine for health workforce burnout. A matrix framework that defines the nature of system-level structural determinants of burnout and their relationship to service-level wellness can serve as a useful tool to understand workforce burnout causality, and guide meaningful intervention. This could inform a constructive system-level approach to health workforce burnout through the establishment of harmonized principle-based interventions across health sector jurisdictions and stakeholders.

How long are Canadians waiting to access specialty care? Retrospective study from a primary care perspective.

OBJECTIVE: To calculate patient wait times for specialist care using data from primary care clinics across Canada. DESIGN: Retrospective chart audit. SETTING: Primary care clinics. PARTICIPANTS: A total of 22 primary care clinics across 7 provinces and 1 territory. MAIN OUTCOME MEASURES: Wait time 1, defined as the period between a patient's referral by a family physician to a specialist and the visit with said specialist. RESULTS: Overall, 2060 referrals initiated between January 2014 and December 2016 were included in the analysis. The median national wait time 1 was 78 days (interquartile range [IQR] of 34 to 175 days). The shortest waits were observed in Saskatchewan (51 days; IQR = 23 to 101 days) and British Columbia (59 days; IQR = 29 to 131 days), whereas the longest were in New Brunswick (105 days; IQR = 43 to 242 days) and Quebec (104 days; IQR = 36 to 239 days). Median wait time 1 varied substantially among different specialty groups, with the longest wait time for plastic surgery (159 days; IQR = 59 to 365 days) and the shortest for infectious diseases (14 days; IQR = 6 to 271 days). CONCLUSION: This is the first national examination of wait time 1 from the primary care perspective. It provides a picture of patient access to specialists across provinces and specialty groups. This research provides decision makers with important context for developing programs and policies aimed at addressing the largely ignored stage of the wait time continuum from the time of referral to eventual appointment time with the specialist.

Human Factor Health Data Interoperability.

Comprehensive health data interoperability is recognized as an essential element of high-functioning and accountable health service. Canada is lagging in health data interoperability compared to international comparators, and lacks a comprehensive approach to human factor interoperability, defined as system-level relationships that impact the capacity of health sector stakeholders to adopt harmonized health data standards and technology. Without addressing these system-level relationships, the adoption of harmonized health data standards and technology will be obstructed and Canadians will be underserved. The proposed health data interoperability framework articulates the factors that Canada needs to address to optimize health data design to support quality health programs and services.

The Impact of Secure Messaging in the Treatment of Patients With Diabetes Within a Primary Care Setting: Protocol for a Scoping Review.

BACKGROUND: Diabetes-a high-burden chronic disease-requires lifetime active management involving the use of different tools and health care resources to improve patient health outcomes. Recent studies have demonstrated promising results regarding the impact of the use of virtual care technology on the treatment of chronic diseases, such as diabetes. However, it is unclear whether the use of technologies, such as secure messaging, improves the quality of care and reduces diabetes-related costs to the health care system. OBJECTIVE: The purpose of our scoping review is to explore what is known about the use of secure messaging in the treatment of diabetes within the primary care setting and how its impact has been assessed from the patient and health system perspectives. Our review aims to understand to what extent secure messaging improves the quality of diabetes care. METHODS: Our scoping review will follow the 6-step Arksey and O'Malley methodological framework, as well as the Joanna Briggs Institute methodology for scoping reviews and their recommended tools. The tools to guide the development and reporting of the review in a structured way will include the Population, Concept, and Context framework and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines and checklist. The search strategy was developed iteratively in collaboration with a professional information specialist. Furthermore, a peer review of electronic search strategies was also conducted by an independent, third-party, professional information specialist. A systematic literature search will be conducted against databases, including Ovid MEDLINE ALL, Embase, APA PsycINFO, Cochrane Library on Wiley, CINAHL on EBSCO, and PubMed. Grey literature sources will also be searched for relevant literature. Literature on the use of secure messaging in the treatment of diabetes (types 1 and 2) within a primary care setting will be included. Two reviewers will review the literature based on the inclusion criteria in the following two steps: (1) title and abstract review and (2) full-text review. Discrepancies will be discussed to reach consensus where possible; otherwise, a third reviewer will resolve the dispute. RESULTS: The results and a final report are expected to be completed and submitted to a peer-reviewed journal in 6 months. CONCLUSIONS: The review will examine existing literature to identify the impact of secure messaging in diabetes treatment within primary care settings. Research gaps will also be identified to determine if there is a need for further studies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/42339.

Inequity in Digital Health Planning in Canada.

An evaluation of the paper by Falk (2022) in this issue using a word count method found that it omits consideration of substantial efforts, inherent data rights and experiences with virtual care from certain jurisdictions, professions and Indigenous groups. Although equity is positioned as a core policy pillar of virtual care, it is not defined, nor are factors underlying digital health inequity described. Deficits in health informatics training, regulation, pedagogy and research in Canada likely contribute to an inequitable approach to health informatics planning. A commitment to definitional rigour, taxonomic clarity and evidence-informed informatics will help promote digital health equity.

Content of physical activity documentation in Canadian family physicians' electronic medical records.

The purpose of this study was to examine the content of physical activity inputs in Canadian family physician electronic medical records. Of 1 225 948 patients aged 18-64 years, a sample of 1535 patients' charts were reviewed. A minority (n = 148; 9.6%) of patients had at least 1 mention of physical activity at any time. Insufficient information existed to determine physical activity domain (21.6%), purpose (50.0%), or meeting of guidelines (98.1%). Novelty: This study examines the physical activity content of what Canadian family physicians document in their electronic medical records.

A Combined Collaborative Information Behaviour (CIB) and Continuity of Care Framework for Modeling Complexity in Colorectal Cancer Screening Access.

Colorectal cancer screening access within a rural and remote health care environment represents a complex systems problem. Existing modeling approaches are inadequate in their representation of health system complexity. A combined Collaborative Information Behavior (CIB) and Continuity of Care framework was developed to model the health care processes involved in screening access over time. This framework highlighted necessary information behavior supports and system gaps in screening access, supporting development of targeted informatics solutions to improve screening access and cancer outcomes.

The Culture of Care.

The obstacle to achieving meaningful healthcare transformation may not be a function of the integrity of reform models such as Triple Aim, but rather a by-product of the nature of healthcare stewardship. Classical definitions of health stewardship - as a governmental mandate - may be more aspirational than a reflection of reality in Canada. In Canada, healthcare is not organized as an intelligible system, but it is a disjoint matrix of services, that is governed by actions of a variety of "stewards" or power brokers - professional, governmental, non-governmental and corporate interests - that are often at odds. The complex relationships between the power brokers form the organizational culture of healthcare and informs the dynamic interplay of the power brokers that jockey for control, resulting in system disintegration that is an anathema to any healthcare reform. As a macro-level reform tool, Triple Aim is unlikely to succeed because the fundamental problem with healthcare has not yet been addressed: healthcare is ungoverned. Perhaps in the context of grassroots reform projects, the nascent principles of Triple Aim could grow, be replicated and be gently disseminated, and, by a process of reverse engineering, a model of health stewardship that is best suited to sound principles of quality care can evolve.