Rhonda Cockerill

Emotional stress and coping in multiple sclerosis (MS) exacerbations

Ninety-five pairs of MS patients in exacerbation and remission were compared on emotional stress in the previous three months. Patients in exacerbation scored higher on emotional disturbance and intensity of stressful events than patients in remission, but lower on frequency of compensating uplifts. There was also a tendency for more patients in exacerbation than remission to favour emotion-focused coping techniques over problem-solving or social support. Whether patients building to an exacerbation over-react to various events or unresolved emotional stress precipitates exacerbations, MS patients might benefit from counselling in stress reduction techniques.

Factors affecting the utilization of systematic reviews. A study of public health decision makers.

OBJECTIVE To determine the extent to which public health decision makers used five systematic reviews to make policy decisions, and to determine which characteristics predict their use. METHODS This cross-sectional follow-up study of public health decision makers in Ontario collected primary data using a telephone survey and a short, self-administered organizational demographics questionnaire completed by the administrative assistant for each Medical Officer of Health. Independent variables included characteristics of the innovation, organization, environment, and individual. Data were entered into a computerized database developed specifically for this study, and multiple logistic regression analysis was conducted. RESULTS The participation rate was very high, with 85% of public health units and 96% of available decision makers completing the survey. In addition, 63% of respondents stated they had used at least one of the systematic reviews in the previous 2 years to make a decision. The most important predictors of use were ones position, expecting to use a review in the future, and perceptions that the reviews were easy to use and that they overcame the barrier of limited critical appraisal skills. CONCLUSIONS Utilization of the systematic reviews in Ontario was very high. The utilization rates found in this study were significantly higher than those reported in previous utilization studies. Ones position was found to be the strongest predictor of use, identifying program managers and directors as the most appropriate audience for systematic reviews.

Job satisfaction and intentions to leave of new nurses

Turnover of newly graduated nurses is of significant concern. There are continuing reports that new graduates struggle during the transition to the work setting. The purpose of this study was to examine the effects of perceived demands, control, social support and self-efficacy on the job satisfaction and intention to leave of new nurses utilising Karaseks Job Demands-Control-Support model. A cross-sectional mailed survey was used to gather data. The sample comprised 232 new nurses working in acute care in Canada. Job demands, social support from both supervisors and coworkers and self-efficacy were significantly related to job dissatisfaction, while demands and support from coworkers were related to intention to leave the job. Identifying factors that contribute to the job satisfaction and intentions to leave of new nurses is a first step in developing interventions to assist nurses who are just beginning their careers.

Increasing access to chronic disease self-management programs in rural and remote communities using telehealth.

OBJECTIVE This study examined whether a telehealth chronic disease self-management program (CDSMP) would lead to improvements in self-efficacy, health behaviors, and health status for chronically ill adults living in Northern Ontario, Canada. Two telehealth models were used: (1) single site, groups formed by participants at one telehealth site; and (2) multi-site, participants linked from multiple sites to form one telehealth group, as a strategy to increase access to the intervention for individuals living in rural and remote communities. SUBJECTS AND METHODS Two hundred thirteen participants diagnosed with heart disease, stroke, lung disease, or arthritis attended the CDSMP at a preexisting Ontario Telemedicine Network studio from September 2007 to June 2008. The program includes six weekly, peer-facilitated sessions designed to help participants develop important self-management skills to improve their health and quality of life. Baseline and 4-month follow-up surveys were administered to assess self-efficacy beliefs, health behaviors, and health status information. Results were compared between single- and multi-site delivery models. RESULTS Statistically significant improvements from baseline to 4-month follow-up were found for self-efficacy (6.6±1.8 to 7.0±1.8; p<0.001), exercise behavior, cognitive symptom management, communication with physicians, role function, psychological well-being, energy, health distress, and self-rated health. There were no statistically significant differences in outcomes between single- and multi-site groups. CONCLUSIONS Improvements in self-efficacy, health status, and health behaviors were equally effective in single- and multi-site groups. Access to self-management programs could be greatly increased with telehealth using single- and multi-site groups in rural and remote communities.

The reliability and validity of two health status measures for evaluating outcomes of home care nursing

The reliability, validity, and sensitivity of the Medical Outcome Study Short Form (SF-36) and the Quality of Life Profile: Senior Version (QOLPSV) for measuring outcomes of home care nursing were evaluated. Data were collected from 50 clients receiving home care nursing services. Twenty-two registered nurses and six registered practical nurses collected client and nursing data on each home visit. Client baseline and outcome measures were collected by two independent evaluators at admission and discharge from the home care service. Internal consistency reliability ranged from.76 to.94 for the eight subscales of the SF-36. Internal consistency reliability ranged from.47 to.82 for the nine subscales of the QOLPSV. The subscales of both instruments had minimal problems with missing responses. The SF-36 was found to be more sensitive than the QOLPSV to change over time. In addition, the subscales of the SF-36 were found to be more sensitive than the subscales of the QOLPSV to several of the nursing variables, such as intensity of the clients nursing condition and skill mix.

Evaluation of a diabetes management program in China demonstrated association of improved continuity of care with clinical outcomes.

OBJECTIVE The aim of the study was to evaluate a community-based diabetes management program in Shanghai, China and to examine the association between continuity of care and clinical outcomes. STUDY DESIGN AND SETTING The diabetes management program was implemented in downtown Shanghai. One hundred fifty-six patients participated in the intervention group and 182 patients were in the control group. Participants were elders without severe diabetic complications. Patient weight, body mass index, blood pressures, and fasting blood glucose were collected from outpatient records at baseline and the end of the study in both groups. Fructosamine level was measured to monitor glycemic control for patients in the intervention group. Continuity of care was measured based on our broad definition. RESULTS Improved patient health outcomes were observed in the diabetes management program: patients in the intervention group significantly reduced their weight, systolic blood pressure, and fasting blood glucose compared with those in the control group (P<0.05). In hierarchical regression models, continuity of care scales had a significant association with weight loss and fasting blood glucose reduction. CONCLUSION This study suggested that continuity based on broad terms can act as an important management tool to improve the quality of primary care in similar urban settings.

Pharmacy Provision of Emergency Contraception: The Ontario Emergency Contraception Pilot Project

OBJECTIVES To develop and evaluate a program to provide emergency contraception (EC) directly in pharmacies that would recruit and train pharmacists and physician partners, and inform women about the availability of EC in pharmacies. METHODS Pharmacists and physicians working in the Scarborough, Rexdale, and North York regions of Toronto were recruited to receive a training program on EC. The pharmacists in each pharmacy were linked with a designated physician who retrospectively authorized prescriptions provided under the protocol. Client eligibility for EC was determined using a self-administered questionnaire that was reviewed by the pharmacist. A poster and radio campaign advertised the service, and a telephone hotline informed users of their nearest participating pharmacy. Data on the clients age, reasons for requesting EC, time elapsed from intercourse until presentation, and requests for follow-up referral were analyzed using descriptive methodology. User satisfaction was determined through a mail-back questionnaire. RESULTS A total of 146 pharmacists practising in 40 pharmacies were linked with 34 physicians. In the 1 year of the project, 6931 prescriptions for EC were provided. Fifty-four percent of the women accessed EC within 24 hours of intercourse. The majority of women were very satisfied with the service, and 21.1% indicated that had they not obtained EC in this way, they would not have obtained it elsewhere. More information about birth control was desired by 10.2% of the women. CONCLUSION Direct pharmacist provision of EC is an effective pregnancy-prevention strategy that is well accepted by the women who access it.

Gender, social change, and the professions : The case of pharmacy

This paper examines the nature of increasing female entry into the profession of pharmacy. Using data from a survey of Ontario pharmacists, it compares the work experiences and career paths of 668 men and women in the profession. In terms of hours worked, where they work, and the nature of the work that they do, we found considerable differences between males and females that are becoming increasingly pronounced as more women enter the profession. These findings are then discussed in terms of available theories of gender, professions and social change.

Expanding the lens of HIV services provision in Canada: results of a national survey of HIV health professionals

Abstract Those living with HIV may experience a range of disabilities, including body impairments, activity limitations, and social participation restrictions. The aim of this study was to examine HIV services provision in Canada by exploring practices, referrals, and service delivery challenges from the perspective of HIV health professionals (including nurses, physicians, social workers, pharmacists, psychologists, and dieticians), and to explore differences in referrals and perceived service delivery challenges by professional group, jurisdiction, community size, and practice in a Northern region. We conducted a nationwide mail survey with the population of selected HIV health professionals in Canada using the Dillman tailored design survey method. Of the 731 deliverable mailings, we received 462 (63%) responses, with 36% of eligible respondents completing the survey (n=214). The large majority (90%) of HIV professionals were located in metropolitan or urban communities and worked predominantly in hospital in-patient (42%), out-patient (50%), and HIV specialty clinic (46%) settings in one of the three provinces (Ontario, Quebec, and British Columbia) with the highest HIV prevalence. HIV health professionals referred primarily, and at relatively high levels, to AIDS service organizations (79%) and social workers (84%) to address participation restrictions and social issues; a lower percentage referred to rehabilitation professionals and other service providers to address impairments, activity limitations, or participation restrictions. Of respondents, 74% perceived barriers to care specific to HIV. Our results suggest that there is little difference in referral patterns by profession, jurisdiction, community size, or northern region of practice. There is a need for increased information and education of HIV health professionals that may refer to rehabilitation and other health services. In addition, new approaches are needed to coordinate multisectoral care and enhance the access and delivery of HIV rehabilitation health services to better meet the disablement needs of people living with HIV in Canada.

FLIGHT PATHS AND REVOLVING DOORS: A CASE STUDY OF GENDER DESEGREGATION IN PHARMACY

This paper examines practitioner reactions to occupational desegregation in pharmacy-the effects, for women and men, of a rapid female entry into the profession. The topic is documented in terms of processes of integration, ghettoisation, and re-segregation. With data collected from licensed pharmacists in Ontario, Canada, we find little evidence of either genuine gender integration in the profession or gender re-segregation precipitated by collective male discontent. While female practitioners are more positive in their evaluation of their jobs and their profession, there is no indication that current satisfaction and dissatisfaction is a harbinger of male-or female-flight from pharmacy. We discuss these findings in the light of arguments about a job and gender queue in the labour market.