Examining the impact of the COVID-19 pandemic on homecare services among individuals with traumatic and non-traumatic spinal cord injuries.

STUDY DESIGN: Descriptive repeated-cross sectional retrospective longitudinal cohort study. OBJECTIVE: To investigate the impact of the COVID-19 pandemic on homecare services in individuals with traumatic or non-traumatic Spinal Cord Injury (SCI). SETTING: Health administrative database in Ontario, Canada. METHODS: A repeated cross-sectional study using linked health administrative databases from March 2015 to June 2022. Monthly homecare utilization was assessed in 3381 adults with SCI using Autoregressive Integrated Moving Average (ARIMA) models. RESULTS: Compared to pre-pandemic levels, between March 2020 to June 2022, the traumatic group experienced a decrease in personal and/or homemaking services, as well as an increase in nursing visits from April 2020-March 2022 and June 2022. Case management increased at various times for the traumatic group, however therapies decreased in May 2020 only. The non-traumatic group experienced a decrease in personal and/or homemaking services in July 2020, as well as an increase in nursing visits from March 2020 to February 2021 and sporadically throughout 2020. Case management also increased at certain points for the non-traumatic group, but therapies decreased in April 2020, July 2020, and September 2021. CONCLUSION: The traumatic group had decreases in personal and/or homemaking services. Both groups had increases in nursing services, increases in case management, and minimal decreases in therapies at varying times during the pandemic. Investigation is warranted to understand the root cause of these changes, and if they resulted in adverse outcomes.

Pelvic Health Content in Canadian Entry-To-Practice Physiotherapy Programs: An Online Survey.

Purpose: Pelvic health physiotherapy is an emerging and sensitive area of practice that offers effective conservative treatment for pelvic health conditions. Canadian entry-to-practice curriculum guidelines accord programs considerable flexibility regarding incorporating pelvic health content, which may lead to differences between programs and diverse levels of competence among new graduates. The purpose of this study was to determine the nature and extent to which pelvic health content is incorporated in entry-to-practice physiotherapy programs in Canada. Method: We conducted a descriptive cross-sectional e-survey of representatives from Canadian entry-to-practice physiotherapy programs. Results: Ten out of 15 Canadian programs participated. Programs incorporated pelvic health content throughout the required curriculum (n = 9) and in optional courses (n = 6). All participating programs covered musculoskeletal-related conditions, urinary incontinence, and pelvic pain conditions, and included anatomy and physiology, clinical reasoning, subjective assessment and pelvic floor muscle training topics. Three programs trained students in internal pelvic floor techniques in elective courses. All programs covered cisgender women populations, however, transgender populations were seldom covered. Conclusions: This study provides an understanding of pelvic health curricular content that can serve as a first step towards standardizing and improving entry-level pelvic health training in Canada.

Objectif: la physiothérapie pelvienne est un domaine de pratique émergent et sensible qui propose des traitements conservateurs efficaces pour les affections pelviennes. Les directives canadiennes sur le cursus d'entrée en pratique prévoient une grande souplesse quant à l'intégration de la matière sur la santé pelvienne, qui peut se solder par des différences entre les programmes et les divers niveaux de compétence chez les nouveaux diplômés. La présente étude visait à déterminer la nature et l'importance du contenu en santé pelvienne intégré aux programmes d'entrée en pratique en physiothérapie au Canada. Méthodologie: les chercheurs ont effectué un sondage descriptif transversal en ligne auprès de représentants des programmes d'entrée en pratique en physiothérapie au Canada. Résultats: dix des 15 programmes canadiens ont participé. Ils intégraient le contenu sur la santé pelvienne tout au long du cursus obligatoire (n = 9) et dans des cours à option. Tous les programmes participants traitaient des affections musculosquelettiques, de l'incontinence urinaire et des douleurs pelviennes et incluaient l'anatomie et la physiologie, le raisonnement clinique, l'évaluation subjective et l'entraînement musculaire du plancher pelvien. Trois programmes formaient les étudiants aux techniques internes du plancher pelvien dans le cadre de cours à option. Tous les programmes couvraient les populations de femmes cisgenres, mais les populations transgenres y étaient rarement intégrées. Conclusions: la présente étude permet de comprendre le cursus en santé pelvienne et peut représenter une première étape vers la standardisation et l'amélioration de la formation en santé pelvienne à l'entrée en pratique au Canada.

Development of an activity-based therapy tracking tool: Item generation and reduction using the Delphi method.

CONTEXT/OBJECTIVE: Activity-based therapies (ABT) are increasingly used in rehabilitation after spinal cord injury or disease (SCI/D). However, the absence of standardized tools to track the details of an ABT program hinders the collection of data needed for client-tailored programming and resource allocation. The objective of this study is to determine the content to include in an ABT tracking tool for people living with SCI/D. DESIGN: Cross-sectional e-survey. SETTING: Community. PARTICIPANTS: The 60 participants from Canada and the United States who had knowledge and/or experience with ABT included: individuals with SCI/D; hospital clinicians (i.e. physical and occupational therapists/assistants); community-based clinicians; hospital or community clinic administrators; researchers; and funders, advocates and policy makers. INTERVENTIONS: None. OUTCOME MEASURES: A Delphi e-survey comprised 16 types of ABT (e.g. treadmill training) and 4 types of technology (e.g. virtual reality). Participants rated the importance of including each item on a tracking tool and the feasibility to track each item using a 9-point Likert scale. RESULTS: After two survey rounds, nine types of ABT and one technology were identified as important to include in a tracking tool. All items rated as important were considered feasible for clinicians and people with SCI/D to track, except crawling. CONCLUSION: This study identified the types of ABT and technology to include in an ABT tracking tool. Such a tool may provide details of an ABT program that can support decision-making at the individual, program and health system levels and aid the development of best practice guidelines.

Outcomes following hip fracture surgery in adults with schizophrenia in Ontario, Canada: A 10-year population-based retrospective cohort study.

OBJECTIVE: To understand immediate and long-term outcomes following hip fracture surgery in adults with schizophrenia. METHODS: Retrospective population-based cohort study leveraging health administrative databases from Ontario, Canada. Individuals aged 40-105 years with hip fracture surgery between April 1, 2009 and March 31, 2019 were included. Schizophrenia was ascertained using a validated algorithm. Outcomes were: 30-day mortality; 30-day readmission; 1-year survival; and subsequent hip fracture within 2 years. Analyses incorporated Generalized Estimating Equation models, Kaplan-Meier curves, and Fine-Gray competing risk models. RESULTS: In this cohort study of 98,126 surgically managed hip fracture patients, the median [IQR] age was 83[75-89] years, 69.2% were women, and 3700(3.8%) had schizophrenia. In Fine-Gray models, schizophrenia was associated with subsequent hip fracture (sdRH, 1.29; 95% CI, 1.09-1.53), with male patients with schizophrenia sustaining a refracture 50 days earlier. In age- and sex-adjusted GEE models, schizophrenia was associated with 30-day mortality (OR, 1.31; 95% CI, 1.12-1.54) and readmissions (OR, 1.40; 95% CI, 1.25-1.56). Kaplan-Meier survival curves suggested that patients with schizophrenia were less likely to be alive at 1-year. CONCLUSIONS: Study highlights the susceptibility of hip fracture patients with schizophrenia to worse outcomes, including refracture, with implications for understanding modifiable processes of care to optimize their recovery.

The impact of the COVID-19 virus and pandemic on healthcare utilization, access, delivery, experiences, and outcomes in the spinal cord injuries/dysfunction population: A scoping review study.

BACKGROUND: Individuals with spinal cord injuries or disease (SCI/D) require frequent healthcare services. The COVID-19 pandemic may have impacted healthcare. Furthermore, due to secondary health conditions and comorbidities persons with SCI/D are at increased risk of experiencing severe symptoms or outcomes if infected with the COVID-19 virus. It is unclear to what extent research has investigated the pandemic and virus impacts on the SCI/D population. OBJECTIVE: To identify and summarize what is reported in the literature on the impact the COVID-19 virus and pandemic had on healthcare, health outcomes, and experiences in the adult SCI/D population. METHODS: Electronic databases and grey literature were searched for articles that included an adult population with a SCI/D and investigated the impact the COVID-19 virus and pandemic had on healthcare-related outcomes and experiences. Articles were double screened, and data were extracted, and synthesized to provide a descriptive summary of the findings. RESULTS: Twenty-four studies were included in this review with eight qualitative, fifteen quantitative, and one mixed methods study. Sixteen studies investigated healthcare utilization/access; nine investigated care delivery, nine investigated patient outcomes, and eight investigated patient experiences, with multiple studies spanning different categories of investigation. The pandemic was detrimental to healthcare utilization, access, and outcomes, but no studies quantified these changes. Virtual care was well-received by the SCI/D population to maintain continuity of care. The SCI/D population had issues with maintaining caregiving support. It was unclear if the COVID-19 virus infection impacted individuals with SCI/D differently than the general population. CONCLUSIONS: This scoping review found the pandemic negatively impacted multiple aspects of healthcare in individuals with SCI/D, however further investigation on health outcomes is required. More research, particularly large-scale quantitative studies, investigating healthcare access, utilization, and delivery, as well as patient outcomes and experiences is needed to improve care in the SCI/D population post-pandemic onset.

Identifying prescribers of antibiotics in a primary care spinal cord injury cohort.

STUDY DESIGN: A retrospective cross-sectional study. OBJECTIVE: To identify who prescribes outpatient antibiotics among a primary care spinal cord injury (SCI) cohort. SETTING: ICES databases in Ontario, Canada. METHODS: A cohort of individuals with SCI were retrospectively identified using a tested-algorithm and chart reviews in a primary care electronic medical records database. The cohort was linked to a drug dispensing database to obtain outpatient antibiotic prescribing information, and prescriber details were obtained from a physician database. RESULTS: Final cohort included three hundred and twenty individuals with SCI. The average annual number of antibiotic courses dispensed for the SCI cohort was 2.0 ± 6.2. For dispensed antibiotics, 58.9% were prescribed by rostered-primary care practice physicians, compared to 17.9% by emergency and non-rostered primary care physicians, 17.4% by specialists and 6.1% by non-physician prescribers. Those who lived in urban areas and rural areas, compared to those who lived in suburban areas, were more likely to receive antibiotics from emergency and non-rostered primary care physicians than from rostered-primary care practice physicians. CONCLUSION: Although individuals with SCI received outpatient antibiotic prescriptions from multiple sources, physicians from an individual's rostered-primary care practice were the main antibiotic prescribers. As such, interventions to optimize antibiotics use in the SCI population should target the primary care practice.

Development of an Algorithm to Screen for Frailty Using the Clinical Frailty Scale with Postoperative Patients Entering Cardiac Rehabilitation.

Purpose: Frailty is not commonly assessed on intake to cardiac rehabilitation (CR), but screening could enable targeted interventions and potentially reduce secondary complications. This study aimed to develop and retrospectively examine the feasibility of utilizing a CR-specific algorithm based on the Clinical Frailty Scale (CFS). Our CFS-CR algorithm endeavoured to screen for frailty in older adults (> 65 y) entering CR following cardiac surgery/procedure. Method: The charts of 30 former patients (mean age: 74.0 ± 6.9 y) were examined by a clinician working in CR. Results: The clinician was unable to score any of the patients based on their medical charts using the CFS-CR due to insufficient data. Documentation was typically limited in the areas of instrumental and basic activities of daily living whereas exercise data were readily available. Conclusions: Current intake documentation in CR limited the ability to retrospectively screen for frailty. This finding suggests a need for a frailty-specific tool to support routine clinical screening. Prospective evaluation of the CFS-CR is warranted to further examine the clinical utility of the algorithm during CR intake assessments.

Objectif: la fragilité est peu évaluée à l'admission en réadaptation cardiaque (RC), mais le dépistage pourrait permettre de cibler des interventions et peutêtre de réduire les complications secondaires. La présente étude visait à créer un algorithme de RC d'après l'échelle de fragilité clinique (ÉFC) et à procéder à une analyse rétrospective pour déterminer la faisabilité de l'utiliser. L'algorithme ÉFC-RC était conçu pour dépister la fragilité chez les personnes âgées (de 65 ans ou plus) qui arrivaient en RC après une opération ou une intervention cardiaque. Méthodologie: une clinicienne qui travaillait en RC a examiné les dossiers de 30 anciens patients (âge moyen de 74,0 ± 6,9 ans). Résultats: la clinicienne n'a pu mesurer les résultats d'aucun patient d'après leur dossier médical au moyen de l'ÉFC-RC en raison de données insuffisantes. Les éléments du dossier se limitaient généralement aux activités déterminantes et courantes de la vie quotidienne, tandis que les données sur les exercices étaient facilement accessibles. Conclusions: l'information contenue dans les dossiers d'admission actuels en RC limitait la possibilité de procéder à l'analyse rétrospective de la fragilité. Cette observation laisse croire à la nécessité de concevoir un outil axé sur la fragilité pour contribuer au dépistage clinique systématique. Une évaluation prospective de l'ÉFC-RC s'impose pour mieux analyser l'utilité clinique de l'algorithme lors des évaluations à l'admission en RC.

Evaluations of virtual exercise programmes for adults with mobility limitations: a scoping review protocol incorporating an equity lens to inform the development of strategies to optimise participation of under-represented groups.

INTRODUCTION: For individuals with mobility limitations, virtual exercise programmes can address the challenges of in-person participation in community exercise programmes. A synthesis of studies of virtual exercise programmes targeting mobility limitations provided outside of conventional rehabilitation services and strategies used to optimise equitable access and inclusivity in these programmes is lacking. We aim to characterise evaluations of virtual exercise programmes for adults with mobility limitations, and the nature of and extent to which equity, diversity and inclusion considerations are integrated in the research process. METHODS AND ANALYSIS: A scoping review following a six-stage methodological framework, including a consultation exercise, is proposed. A comprehensive strategy will be used to search Medline, Embase, PEDro, CINAHL and Scopus to identify peer-reviewed studies evaluating virtual exercise programmes for adults with mobility limitations living in the community. Three trained reviewers will select studies independently. Data (eg, study methodology, programme structure and content, participant characteristics) will be extracted using a standardised form, and collated and summarised using quantitative and qualitative methods. The PROGRESS-Plus and International Classification of Functioning, Disability and Health frameworks will be used to classify participant characteristics and study outcomes, respectively. During the consultation exercise, key knowledge users, including exercise participants, programme providers and coordinators, and members of community organisations for persons living with disabilities and under-represented groups, will be asked to provide insights regarding the applicability of review findings. A directed content analysis of data from the consultation exercise will be performed. ETHICS AND DISSEMINATION: The research ethics board at the University of Toronto approved the consultation exercise. Findings will be disseminated through peer-reviewed publications and conference presentations. Findings will enhance understanding of current research evaluating virtual exercise programmes and inform future research and strategies for promoting equitable access and outcomes for individuals with mobility limitations. REGISTRATION DETAILS: https://doi.org/10.17605/OSF.IO/X5JMA.

Hip fracture rate and osteoporosis treatment in Ontario: A population-based retrospective cohort study.

This population-based study analyzes hip fracture and osteoporosis treatment rates among older adults, stratified by place of residence prior to fracture. Hip fracture rates were higher among older adults living in the community and discharged to long-term care (LTC) after fracture, compared to LTC residents and older adults living in the community. Only 23% of LTC residents at high fracture risk received osteoporosis treatment. PURPOSE: This population-based study examines hip fracture rate and osteoporosis management among long-term care (LTC) residents > 65 years of age compared to community-dwelling older adults at the time of fracture and admitted to LTC after fracture, in Ontario, Canada. METHODS: Healthcare utilization and administrative databases were linked using unique, encoded identifiers from the ICES Data Repository to estimate hip fractures (identified using the Public Health Agency of Canada algorithm and International Classification of Diseases (ICD)-10 codes) and osteoporosis management (pharmacotherapy) among adults > 66 years from April 1, 2014 to March 31, 2018. Sex-specific and age-standardized rates were compared by pre-fracture residency and discharge location (i.e., LTC to LTC, community to LTC, or community to community). Fracture risk was determined using the Fracture Risk Scale (FRS). RESULTS: At baseline (2014/15), the overall age-standardized hip fracture rate among LTC residents was 223 per 10,000 person-years (173 per 10,000 females and 157 per 10,000 males), 509 per 10,000 person-years (468 per 10,000 females and 320 per 10,000 males) among the community to LTC cohort, and 31.5 per 10,000 person-years (43.1 per 10,000 females and 25.6 per 10,000 males). During the 5-year observation period, the overall annual average percent change (APC) for hip fracture increased significantly in LTC (AAPC = + 8.6 (95% CI 5.0 to 12.3; p = 0.004) compared to the community to LTC group (AAPC = + 2.5 (95% CI - 3.0 to 8.2; p = 0.248)) and the community-to-community cohort (AAPC - 3.8 (95% CI - 6.7 to - 0.7; p = 030)). However, hip fracture rate remained higher in the community to LTC group over the study period. There were 33,594 LTC residents identified as high risk of fracture (FRS score 4 +), of which 7777 were on treatment (23.3%). CONCLUSION: Overall, hip fracture rates have increased in LTC and among community-dwelling adults admitted to LTC after fracture. However, hip fracture rates among community-dwelling adults have decreased over time. A non-significant increase in osteoporosis treatment rates was observed among LTC residents at high risk of fracture (FRS4 +). Residents in LTC are at very high risk for fracture and require individualized based on goals of care and life expectancy.

A framework of research priorities in COVID rehabilitation from the Rehabilitation Science Research Network for COVID: an international consultation involving qualitative and quantitative research.

PURPOSE: To identify research priorities related to COVID rehabilitation from the perspectives of persons with lived experiences, clinicians, researchers, community organization and policy representatives. MATERIALS & METHODS: We conducted five international consultations to identify key issues and research priorities in COVID rehabilitation using (i) web-based questionnaires, (ii) synchronous discussions, and (iii) content analysis of COVID rehabilitation research conference presentations. We collated responses and notes and then analyzed data using content analytical techniques. RESULTS: The Framework of Research Priorities in COVID Rehabilitation includes five priorities that span health and disability across COVID-19 and Long COVID illness trajectories: (1) understanding experiences of episodic disability; (2) assessing episodic disability; (3) identifying and examining safe approaches to rehabilitation; (4) examining the role, implementation, and impact of models of rehabilitation care; and (5) examining access to safe, timely and appropriate rehabilitation and other health care provider services. The Framework identifies target populations, methodological considerations, and highlights the importance of integrated knowledge translation and exchange in advancing scientific evidence, clinical education, practice, and COVID rehabilitation policy. CONCLUSIONS: This Framework provides a foundation to advance COVID, disability and rehabilitation research to advance the health and well-being of persons with COVID-19, Long COVID, and their caregivers.Implications for rehabilitationPersons with COVID-19 or Long COVID and their caregivers may experience multi-dimensional forms of disability spanning physical, cognitive, emotional health challenges, difficulties with daily function, and social inclusion, which individually and/or collectively may be unpredictable, episodic and/or chronic in nature.Rehabilitation has a role in preventing or mitigating disability and enhancing health outcomes for persons with COVID-19, Long COVID and their caregivers.The Framework of Research Priorities COVID Rehabilitation includes five overlapping research priorities spanning health and disability across COVID trajectories: (1) understanding experiences of episodic disability; (2) assessing episodic disability; (3) identifying and examining safe approaches to rehabilitation; (4) examining the role, implementation, and impact of models of rehabilitation care; and (5) examining access to safe, timely and appropriate rehabilitation and other health care provider services.The research priorities in the Framework represent a comprehensive approach to examine disability and rehabilitation across COVID illness trajectories and the broad continuums of rehabilitation care to provide a coordinated and collaborative approach to advancing evidence in COVID disability and rehabilitation.This Framework provides a foundation for international and interdisciplinary collaborations, to advance COVID disability and rehabilitation research to enhance health outcomes of persons with COVID-19, Long COVID, and their caregivers.

Identifying Patterns of Primary Care Antibiotic Prescribing for a Spinal Cord Injury (SCI) Cohort Using an Electronic Medical Records (EMR) Database.

Background: Individuals with a spinal cord injury (SCI) are considered higher users of antibiotics. However, to date there have been no detailed studies investigating outpatient antibiotic use in this population. Objectives: (1) To describe primary care antibiotic prescribing patterns in adults with SCI rostered to a primary care physician (PCP), and (2) to identify patient or PCP factors associated with number of antibiotics prescribed and antibiotic prescription duration. Methods: A retrospective cohort study using linked health administrative and electronic medical records (EMR) databases from January 1, 2013 to December 31, 2015 among 432 adults with SCI in Ontario, Canada. Negative binomial regression analyses were conducted to identify patient or physician factors associated with number of antibiotics prescribed and prescription duration. Results: During the study period, 61.1% of the SCI cohort received an antibiotic prescription from their PCP. There were 59.8% of prescriptions for urinary tract infections (UTI) and 24.6% of prescriptions for fluoroquinolones. Regression analysis found catheter use was associated with increased number of antibiotics prescribed (relative risk [RR] = 3.1; 95% CI, 2.3-4.1; p < .001) and late career PCPs, compared to early-career PCPs, prescribed a significantly longer duration (RR = 1.8; 95% CI, 1.1-3.1; p = .02). Conclusion: UTIs were the number one prescription indication, and fluoroquinolones were the most prescribed antibiotic. Catheter use was associated with number of antibiotics, and PCP's years of practice was associated with duration. The study provided important information about primary care antibiotic prescribing in the SCI population and found that not all individuals received frequent antibiotics prescriptions.

Barriers and facilitators to establishing a national public health observatory / Barreras y facilitadores para el establecimiento de un observatorio de salud pública nacional

Objective. To determine what stakeholders perceive as barriers and facilitators to creating a national public health observatory (PHO) in Trinidad and Tobago. Methods. A descriptive study was conducted based on 15 key informant interviews carried out from April to September 2013. The key informants worked within the health care sector in Trinidad and Tobago. Using a semi-structured interview guide, information was collected on knowledge, attitudes, and beliefs about creating a PHO; barriers and facilitators to creating and sustaining a PHO; legal considerations; and human resource and information technology requirements. Common themes of the responses were identified. Results. The majority of participants supported the development of a national PHO, recognized its value in informing their work, and indicated that a national PHO could 1) provide information to support evidence-informed decision-making for health policy and strategic planning; 2) facilitate data management by establishing data policies, procedures, and standards; 3) increase the use of data by synthesizing and disseminating information; and 4) provide data for benchmarking. However, a number of barriers were identified, including 1) the perception that data collection is not valued; 2) untimely availability of data; 3) limited data synthesis, dissemination, and utilization to inform decision-making; and 4) challenges related to the allocation of human resources and existing information technology. Conclusions. Key informants support the development of a national PHO in Trinidad and Tobago. The findings align well within the components of the conceptual framework for establishing national health observatories. A stepwise approach to establishing a national PHO in Trinidad and Tobago, beginning with structural components and followed by functional components, is recommended. A national PHO in Trinidad and Tobago could serve as a model for other countries in the Caribbean.

Objetivo. Determinar las barreras y los facilitadores percibidos por los interesados directos para crear un observatorio de salud pública (OSP) nacional en Trinidad y Tabago. Métodos. Se realizó un estudio descriptivo basado en 15 entrevistas a informants clave llevadas a cabo de abril a septiembre del 2013. Los informantes clave trabajaban en el sector de la atención de la salud en Trinidad y Tabago. Mediante el empleo de una guía de entrevista semiestructurada, se recopiló información sobre conocimientos, actitudes y creencias acerca de la creación de un OSP; barreras y facilitadores para crear y mantener un OSP; consideraciones legales; y necesidades en cuanto a recursos humanos y tecnología de la información. Se determinaron los temas comunes de las respuestas. Resultados. La mayor parte de los participantes brindaron apoyo a la creación de un OSP nacional, reconocieron su valor para fundamentar su trabajo e indicaron que un OSP nacional podría 1) suministrar información para brindar apoyo a la toma de decisiones basada en la evidencia a efectos de política sanitaria y planificación estratégica; 2) facilitar el manejo de datos mediante el establecimiento de políticas, procedimientos y estándares de datos; 3) incrementar la utilización de los datos mediante la síntesis y la difusión de la información; y 4) proporcionar datos para la evaluación comparativa. Sin embargo, se indicaron varias barreras, incluidas 1) la percepción de que la recopilación de datos no se evalúa; 2) la inoportunidad de la disponibilidad de los datos; 3) las limitaciones en la síntesis, difusión y utilización de los datos para fundamentar la toma de decisiones; y 4) las dificultades relacionadas con la asignación de recursos humanos y de la tecnología de la información existente. Conclusiones. Los informantes clave brindan apoyo al desarrollo de un OSP nacional en Trinidad y Tabago. Los resultados se alinean bien dentro de los componentes del marco conceptual para establecer observatorios de salud nacionales. Se recomienda un método progresivo para establecer un OSP nacional en Trinidad y Tabago, empezando por los componentes estructurales y siguiendo con los componentes funcionales. Un OSP nacional en Trinidad y Tabago podría servir de modelo para otros países del Caribe.

Barriers and facilitators to establishing a national public health observatory / Barreras y facilitadores para el establecimiento de un observatorio de salud pública nacional

OBJECTIVE: To determine what stakeholders perceive as barriers and facilitators to creating a national public health observatory (PHO) in Trinidad and Tobago. METHODS: A descriptive study was conducted based on 15 key informant interviews carried out from April to September 2013. The key informants worked within the health care sector in Trinidad and Tobago. Using a semi-structured interview guide, information was collected on knowledge, attitudes, and beliefs about creating a PHO; barriers and facilitators to creating and sustaining a PHO; legal considerations; and human resource and information technology requirements. Common themes of the responses were identified. RESULTS: The majority of participants supported the development of a national PHO, recognized its value in informing their work, and indicated that a national PHO could 1) provide information to support evidence-informed decision-making for health policy and strategic planning; 2) facilitate data management by establishing data policies, procedures, and standards; 3) increase the use of data by synthesizing and disseminating information; and 4) provide data for benchmarking. However, a number of barriers were identified, including 1) the perception that data collection is not valued; 2) untimely availability of data; 3) limited data synthesis, dissemination, and utilization to inform decision-making; and 4) challenges related to the allocation of human resources and existing information technology. CONCLUSIONS: Key informants support the development of a national PHO in Trinidad and Tobago. The findings align well within the components of the conceptual framework for establishing national health observatories. A stepwise approach to establishing a national PHO in Trinidad and Tobago, beginning with structural components and followed by functional components, is recommended. A national PHO in Trinidad and Tobago could serve as a model for other countries in the Caribbean.

OBJETIVO:Determinar las barreras y los facilitadores percibidos por los interesados directos para crear un observatorio de salud pública (OSP) nacional en Trinidad y Tabago. MÉTODOS: Se realizó un estudio descriptivo basado en 15 entrevistas a informantes clave llevadas a cabo de abril a septiembre del 2013. Los informantes clave trabajaban en el sector de la atención de la salud en Trinidad y Tabago. Mediante el empleo de una guía de entrevista semiestructurada, se recopiló información sobre conocimientos, actitudes y creencias acerca de la creación de un OSP; barreras y facilitadores para crear y mantener un OSP; consideraciones legales; y necesidades en cuanto a recursos humanos y tecnología de la información. Se determinaron los temas comunes de las respuestas. RESULTADOS: La mayor parte de los participantes brindaron apoyo a la creación de un OSP nacional, reconocieron su valor para fundamentar su trabajo e indicaron que un OSP nacional podría 1) suministrar información para brindar apoyo a la toma de decisiones basada en la evidencia a efectos de política sanitaria y planificación estratégica; 2) facilitar el manejo de datos mediante el establecimiento de políticas, procedimientos y estándares de datos; 3) incrementar la utilización de los datos mediante la síntesis y la difusión de la información; y 4) proporcionar datos para la evaluación comparativa. Sin embargo, se indicaron varias barreras, incluidas 1) la percepción de que la recopilación de datos no se evalúa; 2) la inoportunidad de la disponibilidad de los datos; 3) las limitaciones en la síntesis, difusión y utilización de los datos para fundamentar la toma de decisiones; y 4) las dificultades relacionadas con la asignación de recursos humanos y de la tecnología de la información existente. CONCLUSIONES: Los informantes clave brindan apoyo al desarrollo de un OSP nacional en Trinidad y Tabago. Los resultados se alinean bien dentro de los componentes del marco conceptual para establecer observatorios de salud nacionales. Se recomienda un método progresivo para establecer un OSP nacional en Trinidad y Tabago, empezando por los componentes estructurales y siguiendo con los componentes funcionales. Un OSP nacional en Trinidad y Tabago podría servir de modelo para otros países del Caribe.