Jalila Jbilou

Research-Based-Decision-Making in Canadian Health Organizations: A Behavioural Approach

Decision making in Health sector is affected by a several elements such as economic constraints, political agendas, epidemiologic events, managers’ values and environment … These competing elements create a complex environment for decision making. Research-Based-Decision-Making (RBDM) offers an opportunity to reduce the generated uncertainty and to ensure efficacy and efficiency in health administrations. We assume that RBDM is dependant on decision makers’ behaviour and the identification of the determinants of this behaviour can help to enhance research results utilization in health sector decision making. This paper explores the determinants of RBDM as a personal behaviour among managers and professionals in health administrations in Canada. From the behavioural theories and the existing literature, we build a model measuring “RBDM” as an index based on five items. These items refer to the steps accomplished by a decision maker while developing a decision which is based on evidence. The determinants of RBDM behaviour are identified using data collected from 942 health care decision makers in Canadian health organizations. Linear regression is used to model the behaviour RBDM. Determinants of this behaviour are derived from Triandis Theory and Banduras construct “self-efficacy.” The results suggest that to improve research use among managers in Canadian governmental health organizations, strategies should focus on enhancing exposition to evidence through facilitating communication networks, partnerships and links between researchers and decision makers, with the key long-term objective of developing a culture that supports and values the contribution that research can make to decision making in governmental health organizations. Nevertheless, depending on the organizational level, determinants of RBDM are different. This difference has to be taken into account if RBDM adoption is desired. Decision makers in Canadian health organizations (CHO) can help to build networks, develop partnerships between professionals locally, regionally and nationally, and also act as change agents in the dissemination and adoption of knowledge and innovations in health services. However, the research focused on knowledge use as a support to decision-making, further research is needed to identify and evaluate effective incentives and strategies to implement so as to enhance RBDM adoption among health decision makers and more theoretical development are to complete in this perspective.

Combining Communication Technology Utilization and Organizational Innovation: Evidence from Canadian Healthcare Decision Makers

Information and Communication Technology (ICT) and Organizational Innovation (OI) are seen as the miracle of post-modernity in organizations. In this way, they are supposed to resolve most organizational problems, efficiently and rapidly. OI is highly dependent on the capacity and the investment in knowledge management (internal and external) to support decision making process and to implement significant changes. We know what explains ICT utilization (ICTU) and what determines OI development (OID) in healthcare services. Moreover, the literature tends to link ICTU to OID and vice versa. However, this dependency has never been explored empirically through the lens of roles combination. To identify the existing combined roles profiles of ICTU and OID among healthcare decision makers and determine factors of the shift from a profile to another. We did the following: (1) a structured review of the literature on healthcare management by focusing on ICTU and OID which allowed us to build two indexes and a comprehensive framework; (2) a copula methodology to identify with high precision the thresholds for ICTU and OID; and (3) a cross-sectional study based on a survey done with a sample of 942 decision makers from Canadian healthcare organizations through a multinomial logit model to identify determinants of the shift. ICTU and OID are correlated at 22% (Kendal’s Tau). The joint distribution (combination) of ICTU and OID shows that four major profiles exist among decision makers in Canadian healthcare organizations: the traditional decision maker, the innovative decision maker, the technologic decision maker and the contemporary decision maker. We found out that classic factors act as barriers to the shift from one profile to the desired profile (from 1 to 4, from 2 to 4 and from 3 to 4). We have identified that the attitude toward research and relational capital are transversal barriers of shift. We have also found that some factors have a specific impact such as engaging in activities of research acquisition, the administrative position (being a manager), the preference for applied research results as source of information, the degree of novelty of research results, and the gender. Modern Canadian healthcare organizations need contemporary decision makers who use ICT and develop OI, if performance is the target. Our results let us suggest that the isolated administrative agents profile is no more effective in a dynamic and changing world. Contemporary decision makers need to be more active intellectually and to take risks in their decisions. Relying exclusively on research results and on their social network is no more helpful for a real shift. Moreover, the traditional factors, i.e. organization size, time, experience…are no more effective, especially when we consider combined roles. We propose some practical and theoretical recommendations to support these changes.

Medical Genetic Counseling for Breast Cancer in Primary Care: A Synthesis of Major Determinants of Physicians' Practices in Primary Care Settings

Objectives: This paper aims to identify relevant potential predictors of medical genetic counseling for breast cancer (MGC-BC) in primary care and to develop a comprehensive questionnaire to study MGC-BC. Methods: A scoping review was conducted to identify the predictors of MGC-BC among primary care physicians. Relevant articles were identified in selected databases (PubMed, Embase, CINAHL, ISI Web of Science, PsycINFO, and Cochrane CENTRAL) and 4 selected relevant electronic journals. Results: An inductive analysis of the 193 quantitatively tested variables, conducted by 3 researchers, showed that 6 conceptual categories of determinants, namely (1) demographic, (2) organizational, (3) experiential, (4) professional, (5) psychological, and (6) cognitive, influence MGC-BC practices. Conclusion: There is a scarcity of literature addressing the medical behavior determinants of MGC-BC. Future research is needed to identify effective strategies put into action to support the integration of MGC-BC in primary care medical practices and routines. However, our results shed light on 2 levels of actions that could improve genetic counseling services in primary care: (1) medical training and educational efforts emphasizing family history collection (individual level), and (2) clarification of roles and responsibilities in ordering and referral practices in genetic counseling and genetic testing for better healthcare management (organizational level).

Generalized Additive Models in Environmental Health: A Literature Review

Time series regression models are especially suitable in epidemiology for evaluating shortterm effects of time-varying exposures. Typically, a single population is assessed with reference to its change over the time in the rate of any health outcome and the corresponding changes in the exposure factors during the same period. In time series regression dependent and independent variables are measured over time, and the purpose is to model the existing relationship between these variables through regression methods. Various applications of these models have been reported in literature exploring relationship between mortality and air pollution (Katsouyanni et al. 2009; Wong et al. 2010; Balakrishnan et al. 2011); hospital admissions and air pollution (Peng et al. 2008; Zanobetti et Schwartz 2009; Lall et al. 2011); pollution plumes and breast cancer (Vieira et a. 2005); diet and cancer (Harnack et al. 1997); and mortality and drinking water (Braga et al. 2001). Different time series methods have been used in these studies, i.e. the linear models (Hatzakis et al. 1986) the log-linear models (Mackenbach et al. 1992), the Poisson regression models (Schwartz et al. 2004), and Generalized Additive Models (Dominici 2002; Wood, 2006). The Generalized Additive Models represent a method of fitting a smooth relationship between two or more variables and are useful for complex correlations, that not easily fitted by standard linear or non-linear models.

Men-centered Approaches for Primary and Secondary Prevention of HIV/ AIDS: A Scoping Review of Effective Interventions

Approximately 65,000 people live with HIV/AIDS (PLWHA) in Canada and around 82% of declared cases (52,932 cases) of HIV and AIDS are men. Without evidence-based specific interventions, HIV will continue to spread. This scoping review aims to identify evidence on best practice programs for sexual and reproductive health promotion (i.e. HIV/AIDS) targeting men, and to document the best channels for reaching men. English and French language literature indexed in relevant electronic databases was systematically searched. This was complemented by a manual search through five periodicals specializing in mens health. A total of 6608 articles were identified and 39 articles that met all inclusion and exclusion criteria were retained in the synthesis. Three reviewers independently extracted information on: health topic (i.e. HIV/AIDS), design of services (structure and resources), modes of delivery, content of intervention and main outcomes. The preventive practices with the strongest supportive evidence included, just in time information available through electronic channels (website or cell phone). Interventions designed for men only, showed significantly greater effectiveness compared to interventions targeting both men and women. We derived practical recommendations to design an integrated evidence-based preventive intervention targeting men.

Centralized Waiting Lists for Unattached Patients in Primary Care: Learning from an Intervention Implemented in Seven Canadian Provinces

Introduction: Centralized waiting lists (CWLs) are one solution to reduce the problematic number of patients without a regular primary care provider. This article describes different models of CWLs for unattached patients implemented in seven Canadian provinces and identifies common issues in the implementation of these CWLs. Methods: Logic models of each provinces intervention were built after a grey literature review, 42 semi-structured interviews and a validation process with key stakeholders were performed. Results: Our analysis across provinces showed variability and common features in the design of CWLs such as same main objective to attach patients to a primary care provider; implementation as a province-wide program with the exception of British Columbia; management at a regional level in most provinces; voluntary participation for providers except in two provinces where it was mandatory for providers to attach CWL patients; fairly similar registration process across the provinces; some forms of prioritization of patients either using simple criteria or assessing for vulnerability was performed in most provinces except New Brunswick. Conclusion: Despite their differences in design, CWLs implemented in seven Canadian provinces face common issues and challenges regarding provider capacity to address the demand for attachment, barriers to the attachment of more vulnerable and complex patients as well as non-standardized approaches to evaluating their effectiveness. Sharing experiences across provinces as CWLs were being implemented would have fostered learning and could have helped avoid facing similar challenges.

A comparative analysis of centralized waiting lists for patients without a primary care provider implemented in six Canadian provinces: study protocol

BackgroundHaving a regular primary care provider (i.e., family physician or nurse practitioner) is widely considered to be a prerequisite for obtaining healthcare that is timely, accessible, continuous, comprehensive, and well-coordinated with other parts of the healthcare system. Yet, 4.6 million Canadians, approximately 15% of Canada’s population, are unattached; that is, they do not have a regular primary care provider. To address the critical need for attachment, especially for more vulnerable patients, six Canadian provinces have implemented centralized waiting lists for unattached patients. These waiting lists centralize unattached patients’ requests for a primary care provider in a given territory and match patients with providers. From the little information we have on each province’s centralized waiting list, we know the way they work varies significantly from province to province. The main objective of this study is to compare the different models of centralized waiting lists for unattached patients implemented in six provinces of Canada to each other and to available scientific knowledge to make recommendations on ways to improve their design in an effort to increase attachment of patients to a primary care provider.MethodsA logic analysis approach developed in three steps will be used. Step 1: build logic models that describe each province’s centralized waiting list through interviews with key stakeholders in each province; step 2: develop a conceptual framework, separate from the provincially informed logic models, that identifies key characteristics of centralized waiting lists for unattached patients and factors influencing their implementation through a literature review and interviews with experts; step 3: compare the logic models to the conceptual framework to make recommendations to improve centralized waiting lists in different provinces during a pan Canadian face-to-face exchange with decision-makers, clinicians and researchers.DiscussionThis study is based on an inter-provincial learning exchange approach where we propose to compare centralized waiting lists and analyze variations in strategies used to increase attachment to a regular primary care provider. Fostering inter-provincial healthcare systems connectivity to improve centralized waiting lists’ practices across Canada can lever attachment to a regular provider for timely access to continuous, comprehensive and coordinated healthcare for all Canadians and particular for those who are vulnerable.

Accès au diagnostic précoce de démence au Nouveau-Brunswick : perceptions d’usagers potentiels de services selon la langue et le milieu de vie

RésuméObjectifsLe diagnostic précoce de la démence (DPD) est crucial autant pour l’identification des causes réversibles que pour la mise en place rapide d’interventions de prévention secondaire et de prise en charge thérapeutique. Cette étude explore la perception d’aînés du Nouveau-Brunswick concernant l’accessibilité, la disponibilité et la satisfaction des services de DPD, en tenant compte de leur langue d’usage et de leur milieu de vie (urbain ou rural).MéthodeQuestionnaire auto-administré explorant les perceptions d’aînés francophones et anglophones de régions rurales et urbaines du Nouveau-Brunswick concernant les services de DPD. Des analyses univariées et bivariées ont été réalisées.RésultatsParmi les 157 participants âgés de 65 ans et plus ayant répondu au questionnaire et dont les données ont été analysées, 84 déclarent être principalement francophones et 72 parmi eux vivent en milieu rural. Les analyses bivariées suggèrent que les groupes linguistiques étudiés sont comparables en ce qui concerne leurs perceptions de la disponibilité, l’accès et la satisfaction des services de DPD. Toutefois, l’introduction de la dimension géographique montre des disparités intragroupes et intergroupes linguistiques, notamment en ce qui a trait à l’information relative au type de services disponibles dans la région.ConclusionCes résultats suggèrent que les aînés vivant en milieu rural au Nouveau-Brunswick représentent un groupe particulièrement vulnérable ayant une perception d’accès limité aux services de DPD dans leur région.AbstractObjectivesThe early diagnosis of dementia (EDD) enables the identification of reversible causes of dementia and allows the timely implementation of secondary preventive and therapeutic interventions. This study explores New Brunswick seniors’ perceptions of the accessibility and availability of EDD services as well as their satisfaction with them while taking into account their language of use and place of residence (urban or rural).MethodSelf-administered survey exploring perceptions of EDD services in Francophone and Anglophone seniors from rural and urban areas of New Brunswick. Univariate and bivariate analyses were carried out.ResultsOf the 157 participants aged 65 years and over who filled out the survey and whose data were analyzed, 84 identified as Francophone, 72 of whom lived in rural areas. Bivariate analyses showed that linguistic groups were comparable with regard to their perceptions of the availability, access to, and satisfaction with EDD services. However, when taking the geographic dimension into account, linguistic intergroup and intragroup disparities were observed, notably in the areas pertaining to the type of services available in the area.ConclusionsThese results suggest that seniors who live in rural areas of New Brunswick are a particularly vulnerable group with perceived limited access to EDD services in their area.

A strategic initiative to foster interprofessional collaboration: A case report using a men’s healthy living programme

Abstract Interprofessional collaboration (IPC) can be challenging, yet it has shown benefits for providers and patients. We examined the existing enablers and barriers to IPC at a local Community Health Center (CHC) and report on the existing types of IPC practice. We also report how implementing a men-sensitive healthy living programme united a team of health professionals/managers in attending to the needs of a population that to date had been largely underserved. A total of 16 employees were interviewed at the CHC. All respondents spoke positively of existing IPC and provided examples of existing collaborative practices. These CHC professionals (clinicians and managers) experienced greater intra- and extra-organisational collaborations as a result of experiencing a community-delivered programme. It also allowed the CHC professionals/managers to rethink the management and structure of collaborative practices and understand the needs and challenges of working with non-traditional partners (men and workplace-based managers). While our findings are context sensitive (case study design), they shed light on how uniting health professionals/managers around a challenging and non-traditional health issue (i.e., improving health in a hard-to-reach population subgroup) can strategically reduce resistance to collaborative practice development by strengthening team cohesion and fostering innovative interactions.

Knowledge Management in Canadian Healthcare Organizations: How Do Knowledge Brokers Perform?

Under the Canada’s health Act, the health sector is administered and operated on a nonprofit basis by the public authority. The sustainability of Canada’s public health-care system depends in large part on its ability to implement strategies to improve its perform‐ ance in terms of social, economic, organizational and professional. Knowledge-brokering is an emerging function in the healthcare systems worldwide. Championed as a corner‐ stone role for knowledge translation by the Canadian Health Services Research Founda‐ tion, the implications of understanding this function and those who undertake it are important for improving knowledge management in the healthcare sector where there is a spread of the evidence informed/based decision making (EI/BDM) movement. Knowl‐ edge brokering is defined, by the Canadian Health Services Research Foundation, through a set of basic skills that are the ability to bring people together and facilitate their interaction; the ability to find academic research and other evidence to shape decisions; the ability to assess evidence, interpret it and adapt it to circumstance; a knowledge of marketing, communication and Canadian healthcare; and the ability to identify emerging management and policy issues which research could help to resolve. Its mandate is to support in the organization, management and delivery of health services and its main strategy for doing so is to link decision makers and researchers to ensure effective knowledge transfer.