Diane E. Allan

Examining Distance Effects on Hospitalizations Using GIS: A Study of Three Health Regions in British Columbia, Canada

We examine travel distance and its effect on total and on avoidable hospitalizations, using data from three health regions in British Columbia, Canada. We conceptualize distance to hospital in geographic and socioeconomic contexts from the care seekers perspective, and develop a GIS procedure to generate variables for these contexts. The procedure includes geocoding hospital locations and patient locations to determine travel distance for each hospitalization, generating several geographic barriers such as mountain crossings, and linking patient-neighborhood locations to socioeconomic variables. The findings reveal that overall, hospitalization rates are inversely related to distance to hospital. Even though low-income patients are more likely to be hospitalized for avoidable conditions, the income effect influences different dimensions from those affected by the distance effect. A balanced approach may be needed to address issues appropriately at both the low and the high ends of physical accessibility.

Short Report: Preferences for location of death of seriously ill hospitalized patients: perspectives from Canadian patients and their family caregivers

Previous studies involving palliative patients suggest a preference for dying at home. The purpose of this paper is to examine, prospectively, patient and family caregiver preferences for, and congruence with, location of death for hospitalized patients with cancer and end-stage medical conditions. Questionnaires were administered to 440 eligible in-patients and 160 family caregivers in five hospitals across Canada. This paper reports results of 138 patient/family caregiver dyads who answered a question about preference for location of death. The results suggest that only half of all patients and family caregivers report a preference for a home death. Furthermore, half of the patient/family caregiver dyads disagree on preferred location of death. If one of the primary goals of end of life care is to enhance the quality of life of dying patients and their family caregivers, policies directed towards ensuring that patients die in their location of choice ought to be a priority and resources should be allocated to promote the development of excellent care, not only in the home, but also within our institutional settings. Palliative Medicine 2008; 22: 85—88

The uses of provincial administrative health databases for research on palliative care: Insights from British Columbia, Canada

BackgroundResearch indicating that people increasingly prefer to die at home suggests that palliative care is likely to play a more prominent role in the future of Canadas health care system. Unfortunately, at a time when research evidence should be informing policy and service delivery, little is known about health service utilization by Canadians at the end of life. One existing mechanism that can help address this gap is provincial administrative health data. The purpose of this study was to explore the potential of administrative health data to identify characteristics of palliative care users, patterns of formal service utilization and predictors of palliative care use.MethodsBivariate and multivariate analyses were used to examine data from the Capital Health Region, British Columbia Linked Health Databases for the period 1992/93 to 1998/99. The databases examined include continuing care, physician claims, hospital separations, and vital statistics. As the name implies, these databases can be linked at the individual level using unique identifiers so that health services utilization can be tracked across sectors.ResultsGeneral patterns of service use among palliative care patients suggest that general practitioner and medical specialist visits have decreased over time and the utilization of hospital beds has increased. Utilization of community-based services (i.e. home support and home nursing care) shows an overall pattern of decline. However, when compared to non-palliative care patients, palliative care patients spent fewer nights in hospital, used fewer hours of home support, and had a greater number of home nursing care visits.ConclusionsAdministrative health databases can provide valuable information for examining service utilization patterns over time. However, given that decisions surrounding the designation of palliative care include factors beyond the scope of administrative databases (such as quality of life, personal preferences, social support), these databases should only be seen as one source of information to inform service delivery and policy decision making.

Canada's Compassionate Care Benefit: Is it an adequate public health response to addressing the issue of caregiver burden in end-of-life care?

BackgroundAn increasingly significant public health issue in Canada, and elsewhere throughout the developed world, pertains to the provision of adequate palliative/end-of-life (P/EOL) care. Informal caregivers who take on the responsibility of providing P/EOL care often experience negative physical, mental, emotional, social and economic consequences. In this article, we specifically examine how Canadas Compassionate Care Benefit (CCB) - a contributory benefits social program aimed at informal P/EOL caregivers - operates as a public health response in sustaining informal caregivers providing P/EOL care, and whether or not it adequately addresses known aspects of caregiver burden that are addressed within the population health promotion (PHP) model.MethodsAs part of a national evaluation of Canadas Compassionate Care Benefit, 57 telephone interviews were conducted with Canadian informal P/EOL caregivers in 5 different provinces, pertaining to the strengths and weaknesses of the CCB and the general caregiving experience. Interview data was coded with Nvivo software and emerging themes were identified by the research team, with such findings published elsewhere. The purpose of the present analysis was identified after comparing the findings to the literature specific to caregiver burden and public health, after which data was analyzed using the PHP model as a guiding framework.ResultsInformal caregivers spoke to several of the determinants of health outlined in the PHP model that are implicated in their burden experience: gender, income and social status, working conditions, health and social services, social support network, and personal health practises and coping strategies. They recognized the need for improving the CCB to better address these determinants.ConclusionsThis study, from the perspective of family caregivers, demonstrates that the CCB is not living up to its full potential in sustaining informal P/EOL caregivers. Effort is required to transform the CCB so that it may fulfill the potential it holds for serving as one public health response to caregiver burden that forms part of a healthy public policy that addresses the determinants of this burden.

Defining community boundaries in health promotion research.

Purpose. A means for integrating subjective experience in the operationalization of community boundaries is described and examined, and a community typology incorporating both psychosocial and structural resources is developed and applied. Design. Small-area sense of belonging was used to delineate broader community boundaries, which were compared with administrative boundaries. Community differences on participation and health were analyzed by using analysis of variance and post hoc tests. Setting. Data were from face-to-face interviews with residents of a relatively disadvantaged area of a medium-sized Canadian city. Subjects. A sample of 910 individuals was drawn from a population listing of those aged 35 to 65 years in the project area (44% response rate). Measures. Measures include sense of belonging; income; community participation; and mental, physical, and perceived health. Results. Data revealed the similarity of community boundaries based on sense of belonging with administrative boundaries. The communities differed significantly in income, community activities attended, and two health measures. The typology indicated the community rich in both income and sense of belonging had higher participation and health than did communities low in both or with mixed resources. Conclusions. Psychosocial indicators can be used to delineate community boundaries, which may be similar to administrative boundaries. A typology including both psychosocial and structural components can be a helpful preliminary step in interpreting area differences.

Testing the Relationship Between Involvement and Perceived Neighborhood Safety A Multinomial Logit Approach

This article examines the association between social and community involvement and perceived neighborhood safety for residents of a relatively disadvantaged area of a medium-sized Canadian city. Data are from a survey of 918 local residents who are in midlife (35 to 64 years of age). A specialized regression technique for categorical dependent variables is used that is sensitive to variations. Even using this technique and in contrast to some of the existing literature (with the exception of length of residence and trust in neighbors), our findings do not support an association between involvement and perceived safety. Rather, attention is drawn to the roles of perceived health and perceived stress as well as local area perceptions. The absence of significant relationships with most measures of involvement challenges the idea that involvement in ones community decreases fear and increases feelings of safety.

Public health human resources: a comparative analysis of policy documents in two Canadian provinces

BackgroundAmidst concerns regarding the capacity of the public health system to respond rapidly and appropriately to threats such as pandemics and terrorism, along with changing population health needs, governments have focused on strengthening public health systems. A key factor in a robust public health system is its workforce. As part of a nationally funded study of public health renewal in Canada, a policy analysis was conducted to compare public health human resources-relevant documents in two Canadian provinces, British Columbia (BC) and Ontario (ON), as they each implement public health renewal activities.MethodsA content analysis of policy and planning documents from government and public health-related organizations was conducted by a research team comprised of academics and government decision-makers. Documents published between 2003 and 2011 were accessed (BC = 27; ON = 20); documents were either publicly available or internal to government and excerpted with permission. Documentary texts were deductively coded using a coding template developed by the researchers based on key health human resources concepts derived from two national policy documents.ResultsDocuments in both provinces highlighted the importance of public health human resources planning and policies; this was particularly evident in early post-SARS documents. Key thematic areas of public health human resources identified were: education, training, and competencies; capacity; supply; intersectoral collaboration; leadership; public health planning context; and priority populations. Policy documents in both provinces discussed the importance of an educated, competent public health workforce with the appropriate skills and competencies for the effective and efficient delivery of public health services.ConclusionThis policy analysis identified progressive work on public health human resources policy and planning with early documents providing an inventory of issues to be addressed and later documents providing evidence of beginning policy development and implementation. While many similarities exist between the provinces, the context distinctive to each province has influenced and shaped how they have focused their public health human resources policies.

Chronic disease prevention policy in British Columbia and Ontario in light of public health renewal: a comparative policy analysis

BackgroundPublic health strategies that focus on legislative and policy change involving chronic disease risk factors such as unhealthy diet and physical inactivity have the potential to prevent chronic diseases and improve quality of life as a whole. However, many public health policies introduced as part of public health reform have not yet been analyzed, such as in British Columbia and Ontario. The purpose of this paper is to present the results of a descriptive, comparative analysis of public health policies related to the Healthy Living Core Program in British Columbia and Chronic Disease Prevention Standard in Ontario that are intended to prevent a range of chronic diseases by promoting healthy eating and physical activity, among other things.MethodsPolicy documents were found through Internet search engines and Ministry websites, at the guidance of policy experts. These included government documents as well as documents from non-governmental organizations that were implementing policies and programs at a provincial level. Documents (n = 31) were then analysed using thematic content analysis to classify, describe and compare policies in a systematic fashion, using the software NVivo.ResultsThree main categories emerged from the analysis of documents: 1) goals for chronic disease prevention in British Columbia and Ontario, 2) components of chronic disease prevention policies, and 3) expected outputs of chronic disease prevention interventions. Although there were many similarities between the two provinces, they differed somewhat in terms of their approach to issues such as evidence, equity, and policy components. Some expected outputs were adoption of healthy behaviours, use of information, healthy environments and increased public awareness.ConclusionsThe two provincial policies present different approaches to support the implementation of related programs. Differences may be related to contextual factors such as program delivery structures and different philosophical approaches underlying the two frameworks. These differences and possible explanations for them are important to understand because they serve to contextualize the differences in health outcomes across the two provinces that might eventually be observed. This analysis informs future public health policy directions as the two provinces can learn from each other.

Using Quality Improvement to Enhance Research Readiness in Palliative Care

&NA; Quality improvement is an essential feature of the ongoing development of palliative care programs. Little has been written, however, about using quality improvement as a strategy to introduce research concepts to staff and administrators for the purpose of enhancing research readiness in healthcare settings. This article describes such an endeavor. The authors discuss two quality improvement initiatives undertaken by a palliative care program in Canada. These two examples demonstrate how the quality improvement process acted as a catalyst to enhance research readiness.

Bereaved family members’ perceptions of the quality of end-of-life care across four types of inpatient care settings

BackgroundThe aims of this study were to gain a better understanding of how bereaved family members perceive the quality of EOL care by comparing their satisfaction with quality of end-of-life care across four different settings and by additionally examining the extent to which demographic characteristics and psychological variables (resilience, optimism, grief) explain variation in satisfaction.MethodsA cross-sectional mail-out survey was conducted of bereaved family members of patients who had died in extended care units (n = 63), intensive care units (n = 30), medical care units (n = 140) and palliative care units (n = 155). 1254 death records were screened and 712 bereaved family caregivers were identified as eligible, of which 558 (who were initially contacted by mail and then followed up by phone) agreed to receive a questionnaire and 388 returned a completed questionnaire (response rate of 70%). Measures included satisfaction with end-of-life care (CANHELP- Canadian Health Care Evaluation Project - family caregiver bereavement version; scores range from 0 = not at all satisfied to 5 = completely satisfied), grief (Texas Revised Inventory of Grief (TRIG)), optimism (Life Orientation Test – Revised) and resilience (The Resilience Scale). ANCOVA and multivariate linear regression were used to analyze the data.ResultsFamily members experienced significantly lower satisfaction in MCU (mean = 3.69) relative to other settings (means of 3.90 [MCU], 4.14 [ICU], and 4.00 [PCU]; F (3371) = 8.30, p = .000). Statistically significant differences were also observed for CANHELP subscales of “doctor and nurse care”, “illness management”, “health services” and “communication”. The regression model explained 18.9% of the variance in the CANHELP total scale, and between 11.8% and 27.8% of the variance in the subscales. Explained variance in the CANHELP total score was attributable to the setting of care and psychological characteristics of family members (44%), in particular resilience.ConclusionFindings suggest room for improvement across all settings of care, but improving quality in acute care and palliative care should be a priority. Resiliency appears to be an important psychological characteristic in influencing how family members appraise care quality and point to possible sites for targeted intervention.