Community impact of the towards patient centered addiction care project
1. COMMUNITY IMPACT OF THE
TOWARDS PATIENT CENTERED
ADDICTION CARE PROJECT
Alberta Harm Reduction Conference
May 23, 2013
Ginetta Salvalaggio MD MSc CCFP FCFP
Assistant Professor, Department of Family Medicine, University of Alberta
Karen Turner, Outreach Worker, Streetworks Harm Reduction Program
3. 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
4. A special thank you to the community members who
shared their talents and their stories and made this
project worthwhile… the project would not be the
same without you.
This talk is dedicated to the memory of those in the
community who gave to this project and have now
gone.
5. 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
6. What was the Towards Patient-Centered
Addiction Care project?
Developed and tested a set of addiction assessment
and patient engagement knowledge transfer
materials and activities designed to:
Enhance the ability of Edmonton-area physicians to
effectively intervene with low-socioeconomic position
patients living with addiction
Improve the target population’s satisfaction with health
care encounters
7. 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
8. Graham ID, Logan J, Harrison MB, et al. Lost in knowledge translation: time for a map? J Contin Ed Health Prof
2006 Winter;26[1]:13-24
http://ktclearinghouse.ca/knowledgebase/knowledgetoaction
9. Some Definitions: Action Research
Practice to Evidence!
aka Community-Based Participatory
Research, 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 change
http://pram.mcgill.ca/
“Nothing about us Without us.” Available at http://www.aidslaw.ca/publications/publicationsdocEN.php?ref=85
Guide for Working with Agencies. Available at http://www.uofaweb.ualberta.ca/amhrl/pdf/Wild_et_al_2003_Injection_Drug_Use.pdf
10. 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
11. 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
12. Patient-Centered KT:
Health Care Navigation Booklet
Authors:
8 inner city community
members with lived
experience interacting with
the health care system
Methods:
Focus groups facilitated by
RN and medical student
Legal and health care
expert content review
Street-friendly language
and illustrations
Literature, past local
research, and lived
experience as information
sources
13. 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 care
team
Local list of resources for patients
“Try to be patient and answer as
many questions as you can, as
best as you can! The doctor
needs to gather as much
information as possible in order to
find a solution to your health
problems. Sometimes the doctor
might ask a lot of questions or
send you for tests. Be patient and
know that he/she is trying their
very best to help you get healthy
again!”
“Joe woke up after a rough
night on the town and couldn’t
remember what happened! For
two days his body hurt so
bad, he was sick and had a
high fever. He needed to see a
doctor but didn’t know where to
go or what to tell them!
14. Community Consultant
Member of advisory
board
Community-research
team liaison
Patient engagement
“champion”
Community
reinforcement of booklet
messages
Booklet insert with
contact info
Participated in physician
workshops
18. Evaluation
Numbers, numbers, numbers
Nonrandomized 2-group pre-post quasi-experimental
intervention design in family medicine and emergency
medicine settings
Outcomes: resource uptake and relevance, patient
satisfaction with care, health care and addiction
behaviour changes, physician attitudes and comfort
Stories
End-of-Project Community Consultation / Impact
Assessment
Qualitative focus groups
19. Community Consultation Objectives
Understand the community impact of and experience
with the TPCAC project
Share project findings with the community and seek
community help with interpretation of findings
Seek recommendations from the community on what
project content to emphasize, and how and with
whom to share this content
20. Community Consultation Methods
Semi-structured, qualitative, focus group sessions
with a minimum of 2 moderators, audio-recorded and
transcribed
Thematic analysis using a combination of
paraphrasing and coding, independent analysis by 2
individuals
Constant comparison, Field notes maintained
throughout analysis
Member checking (themes verified by participants)
21. 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
22. What was your experience with this
project?
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 to
talk to.
There were some barriers to participation.
23. Giving back…
A: How I got involved, it was actually through
[name], being you know, being a user you
know, alcoholic, and I guess that’d be my point of
view from the addict’s point of view from being on the
streets, and what I’ve seen and you know, my
experiences that’s who I’ve been able to put in my
input on this, on the project. With not being able to
be discriminated against, but no it’s I find it’s a very
[good] way of you know, being able to find out what
is out there for me as a, as an addict. Um, like yeah
it’s, everything’s been on the up and up so far. Like
with these surveys, like I’m honoured to be able to sit
here amongst you guys, and you know, give my
experiences and you know, my information what I
24. Booklet…
D: I think for me too, and it’s the same anytime that a
resource is created with the community, is that, it’s
usually pretty honest, pretty rooted in reality. I think
it’s good for the people who are writing it, um, and I
think it’s good for people who read it, because it’s
written in a way that speaks the truth. And so I think
having some sort of, and I don’t think the world
should live and die on a brochure by any means, but
I think sometimes that being able to write things
differently, is really helpful (2,39,37).
25. Community consultant…
E: It would have a nice impact, but you got to
remember too, community members trust community
members. Like if you’re there you’re there, like it’s
hard if, you know, like all these different to come
in, and all these different agencies that are here.
Like they’re trust is limited, it’s always like what can
you do for me. Right, not what I can tell you and
direct you what I really need. Right. Different, like
[community consultant’s] been around since Jesus
was a baby, so you know, we all have our opinion or
our trusts, and whatever with [community
consultant]. So we know what we say to him, we
either going to get bullshit or we’re going to get the
truth. Like that’s the bottom line, like he’s one of us
26. What do the project results mean?
Change takes time.
Change depends on many other issues that also
need to be addressed.
The community is self-reliant.
27. Addressing other issues…
E: Like I say, I’ve been lucky so far, I just talked to some of
my friends and asked them some questions, and just I
know a few off by heart, and then just things that I would
repeat, of course they’re talking about the outreach. Just
like you know, like my friend said, the doors get shut in
people’s faces, and they just say heck it. You
know, they’d rather put a tent up than go and apply for a
little cheque, or apply for housing, you know. There’s a lot
of people in the this, a lot of people gave up, you know.
Cause maybe they’re not educated enough, or they don’t
know the right question, or they don’t have the
confidence enough to jump through the hoops. You
know, cause even just applying for welfare, like I
said, you need ID to get ID, you need an address to get
assistance. Well how can you get assistance if you don’t
28. What is the best way to share this
project?
More investments need to be made in outreach supports
like the community consultant.
More investments need to be made in social work
supports to address other barriers.
Messaging needs to be a sustained partnership between
community members and professional champions.
The messages in the booklet need to be shared not only
with the community, but also with professionals.
The messages should be a mandatory part of
professional development.
Modeling and field experience are a necessary part of
professional training.
Incentives could help to reinforce the messages.
29. 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 seriously
they can, you noticed us, [name] notices us, she notices us.
And like you guys are doing, trying to do something about
it, but we need that next step.
[Facilitator] Is it a [professional]’s role to help the community get
noticed.
E: No but he can like inadvertently direct us in a direction. Like I
don’t have to borrow his car, but he can tell me if there’s a car
down 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).
30. Conclusion
Overall the TPCAC project was a positive experience
for the community and has helped build academic-
community bridges for future collaboration.
On-site research assistant, Scott Kirkland, one day per week until all patients are recruited.Likely starting next week.May need your assistance to introduce Scott to patientWill not increase LOS, nursing workload or delay patient careWill be using the quiet room to interview patientsPatients can complete the survey themselves or Scott can help to administer itPatients are followed up at 6-12 months and their health care utilization is tracked
