COMMUNITY IMPACT OF THETOWARDS PATIENT CENTEREDADDICTION CARE PROJECTAlberta Harm Reduction ConferenceMay 23, 2013Ginetta Salvalaggio MD MSc CCFP FCFPAssistant Professor, Department of Family Medicine, University of AlbertaKaren Turner, Outreach Worker, Streetworks Harm Reduction Program
No conflicts of interest to declare.Support provided by:
Team Members Lauren Girard Kathryn Dong MD MSc FRCP Christine Vandenberghe MEd Scott Kirkland MSc Les Umpherville Marliss Taylor RN Cameron Wild PhD Greta Cummings PhD Bob McKim MSc Kelsey Ross RN Taryn Brown MD Ben Chu
A special thank you to the community members whoshared their talents and their stories and made thisproject worthwhile… the project would not be thesame without you. This talk is dedicated to the memory of those in thecommunity who gave to this project and have nowgone.
Role of health care in addiction SBIRT helps people towards health Screening Brief Intervention Referral for Treatment The right care at the right time? LOTS of barriers Time Training System Social issues Past experiences Patient Engagement Matters
What was the Towards Patient-CenteredAddiction Care project?Developed and tested a set of addiction assessmentand patient engagement knowledge transfermaterials and activities designed to: Enhance the ability of Edmonton-area physicians toeffectively intervene with low-socioeconomic positionpatients living with addiction Improve the target population’s satisfaction with healthcare encounters
Some Definitions: Knowledge Translation Evidence to practice aka Knowledge Transfer / Exchange / Sharing Occurs at several points in knowledge generation Uses several strategies Relevant to local needs Multiple stakeholders Evaluated Sustained
Graham ID, Logan J, Harrison MB, et al. Lost in knowledge translation: time for a map? J Contin Ed Health Prof2006 Winter;26:13-24http://ktclearinghouse.ca/knowledgebase/knowledgetoaction
Some Definitions: Action Research Practice to Evidence! aka Community-Based ParticipatoryResearch, Participatory Research Community co-drives and co-owns the process Access to a hard-to-reach population Research credibility Research relevance Research program continuity Community capacity building Knowledge transfer (two-way!) Facilitation of sociopolitical changehttp://pram.mcgill.ca/“Nothing about us Without us.” Available at http://www.aidslaw.ca/publications/publicationsdocEN.php?ref=85Guide for Working with Agencies. Available at http://www.uofaweb.ualberta.ca/amhrl/pdf/Wild_et_al_2003_Injection_Drug_Use.pdf
We wanted to do things a bit differently! Formation of partnerships Evidence review Development of patient-centered KT Development of physician-centered KT Evaluation End-of-project KT
Partnerships Multidisciplinary core team Hiring of a community consultant Advisory board End users (patient and clinician) KT experts Policy makers Researchers Community collaborators Streetworks Harm Reduction program As It Is user advocacy group
Patient-Centered KT:Health Care Navigation Booklet Authors: 8 inner city communitymembers with livedexperience interacting withthe health care system Methods: Focus groups facilitated byRN and medical student Legal and health careexpert content review Street-friendly languageand illustrations Literature, past localresearch, and livedexperience as informationsources
Patient-Centered KT:Health Care Navigation Booklet Themes Where and when to seek care What to expect during a visit How to negotiate with a health careteam Local list of resources for patients“Try to be patient and answer asmany questions as you can, asbest as you can! The doctorneeds to gather as muchinformation as possible in order tofind a solution to your healthproblems. Sometimes the doctormight ask a lot of questions orsend you for tests. Be patient andknow that he/she is trying theirvery best to help you get healthyagain!”“Joe woke up after a roughnight on the town and couldn’tremember what happened! Fortwo days his body hurt sobad, he was sick and had ahigh fever. He needed to see adoctor but didn’t know where togo or what to tell them!
Community Consultant Member of advisoryboard Community-researchteam liaison Patient engagement“champion” Communityreinforcement of bookletmessages Booklet insert withcontact info Participated in physicianworkshops
Physician-centered KT Intro workshop Inner city orientation E-modules Video clips Opinion leaders Point-of-care reminders CPD incentives
Evaluation Numbers, numbers, numbers Nonrandomized 2-group pre-post quasi-experimentalintervention design in family medicine and emergencymedicine settings Outcomes: resource uptake and relevance, patientsatisfaction with care, health care and addictionbehaviour changes, physician attitudes and comfort Stories End-of-Project Community Consultation / ImpactAssessment Qualitative focus groups
Community Consultation Objectives Understand the community impact of and experiencewith the TPCAC project Share project findings with the community and seekcommunity help with interpretation of findings Seek recommendations from the community on whatproject content to emphasize, and how and withwhom to share this content
Community Consultation Methods Semi-structured, qualitative, focus group sessionswith a minimum of 2 moderators, audio-recorded andtranscribed Thematic analysis using a combination ofparaphrasing and coding, independent analysis by 2individuals Constant comparison, Field notes maintainedthroughout analysis Member checking (themes verified by participants)
Who gave feedback? Booklet authors Community members involved in other KT activities(e.g. videos, workshops) Community KT recipients Health care workers from participating agencies Program managers from participating agencies Project facilitators and content experts
What was your experience with thisproject? The project was a chance to learn. The project was a chance to give back. The project was a chance to be heard. The project gave hope. The resources were relevant and accurate. The community consultant was trusted and easy totalk to. There were some barriers to participation.
Giving back…A: How I got involved, it was actually through[name], being you know, being a user youknow, alcoholic, and I guess that’d be my point ofview from the addict’s point of view from being on thestreets, and what I’ve seen and you know, myexperiences that’s who I’ve been able to put in myinput on this, on the project. With not being able tobe discriminated against, but no it’s I find it’s a very[good] way of you know, being able to find out whatis out there for me as a, as an addict. Um, like yeahit’s, everything’s been on the up and up so far. Likewith these surveys, like I’m honoured to be able to sithere amongst you guys, and you know, give myexperiences and you know, my information what I
Booklet…D: I think for me too, and it’s the same anytime that aresource is created with the community, is that, it’susually pretty honest, pretty rooted in reality. I thinkit’s good for the people who are writing it, um, and Ithink it’s good for people who read it, because it’swritten in a way that speaks the truth. And so I thinkhaving some sort of, and I don’t think the worldshould live and die on a brochure by any means, butI think sometimes that being able to write thingsdifferently, is really helpful (2,39,37).
Community consultant…E: It would have a nice impact, but you got toremember too, community members trust communitymembers. Like if you’re there you’re there, like it’shard if, you know, like all these different to comein, and all these different agencies that are here.Like they’re trust is limited, it’s always like what canyou do for me. Right, not what I can tell you anddirect you what I really need. Right. Different, like[community consultant’s] been around since Jesuswas a baby, so you know, we all have our opinion orour trusts, and whatever with [communityconsultant]. So we know what we say to him, weeither going to get bullshit or we’re going to get thetruth. Like that’s the bottom line, like he’s one of us
What do the project results mean? Change takes time. Change depends on many other issues that alsoneed to be addressed. The community is self-reliant.
Addressing other issues…E: Like I say, I’ve been lucky so far, I just talked to some ofmy friends and asked them some questions, and just Iknow a few off by heart, and then just things that I wouldrepeat, of course they’re talking about the outreach. Justlike you know, like my friend said, the doors get shut inpeople’s faces, and they just say heck it. Youknow, they’d rather put a tent up than go and apply for alittle cheque, or apply for housing, you know. There’s a lotof people in the this, a lot of people gave up, you know.Cause maybe they’re not educated enough, or they don’tknow the right question, or they don’t have theconfidence enough to jump through the hoops. Youknow, cause even just applying for welfare, like Isaid, you need ID to get ID, you need an address to getassistance. Well how can you get assistance if you don’t
What is the best way to share thisproject? More investments need to be made in outreach supportslike the community consultant. More investments need to be made in social worksupports to address other barriers. Messaging needs to be a sustained partnership betweencommunity members and professional champions. The messages in the booklet need to be shared not onlywith the community, but also with professionals. The messages should be a mandatory part ofprofessional development. Modeling and field experience are a necessary part ofprofessional training. Incentives could help to reinforce the messages.
Sustained partnership…E: But we need a vehicle. You know.C: You can borrow my car.[Facilitator] Okay what’s the vehicle, how do we do it.E: A person can get us in that door, get us noticed, like seriouslythey can, you noticed us, [name] notices us, she notices us.And like you guys are doing, trying to do something aboutit, but we need that next step.[Facilitator] Is it a [professional]’s role to help the community getnoticed.E: No but he can like inadvertently direct us in a direction. Like Idon’t have to borrow his car, but he can tell me if there’s a cardown the street from you.A: The keys are in it, the engine’s running.E: Yeah, seriously.B: Lots of gas, of gas. (1,31,14).
Conclusion Overall the TPCAC project was a positive experiencefor the community and has helped build academic-community bridges for future collaboration.