ABSTRACT
BACKGROUND: Understanding the epidemiology of Coronavirus Disease of 2019 (COVID-19) in a local context is valuable for both future pandemic preparedness and potential increases in COVID-19 case volume, particularly due to variant strains. METHODS: Our work allowed us to complete a population-based study on patients who tested positive for COVID-19 in Alberta from March 1, 2020 to December 15, 2021. We completed a multi-centre, retrospective population-based descriptive study using secondary data sources in Alberta, Canada. We identified all adult patients (≥ 18 years of age) tested and subsequently positive for COVID-19 (including only the first incident case of COVID-19) on a laboratory test. We determined positive COVID-19 tests, gender, age, comorbidities, residency in a long-term care (LTC) facility, time to hospitalization, length of stay (LOS) in hospital, and mortality. Patients were followed for 60 days from a COVID-19 positive test. RESULTS: Between March 1, 2020 and December 15, 2021, 255,037 adults were identified with COVID-19 in Alberta. Most confirmed cases occurred among those less than 60 years of age (84.3%); however, most deaths (89.3%) occurred among those older than 60 years. Overall hospitalization rate among those who tested positive was 5.9%. Being a resident of LTC was associated with substantial mortality of 24.6% within 60 days of a positive COVID-19 test. The most common comorbidity among those with COVID-19 was depression. Across all patients 17.3% of males and 18.6% of females had an unplanned ambulatory visit subsequent to their positive COVID-19 test. CONCLUSIONS: COVID-19 is associated with extensive healthcare utilization. Residents of LTC were substantially impacted during the COVID-19 pandemic with high associated mortality. Further work should be done to better understand the economic burden associated with related healthcare utilization following a COVID-19 infection to inform healthcare system resource allocation, planning, and forecasting.
Subject(s)
COVID-19 , Internship and Residency , Male , Adult , Female , Humans , COVID-19/epidemiology , Long-Term Care , Retrospective Studies , Alberta/epidemiology , Pandemics , Patient Acceptance of Health CareABSTRACT
OBJECTIVE: Older Muslim immigrants experience multiple vulnerabilities living in Canada. This study explores the experiences of Muslim older adults during the COVID-19 pandemic to identify ways to build community resilience as part of a community-based participatory research partnership with a mosque in Edmonton, Alberta. METHODS: Using a mixed-methods approach, check-in surveys (n = 88) followed by semi-structured interviews (n = 16) were conducted to assess the impact of COVID-19 on older adults from the mosque congregation. Quantitative findings were reported through descriptive statistics, and thematic analysis guided the identification of key findings from the interviews using the socio-ecological model. RESULTS: Three major themes were identified in consultation with a Muslim community advisory committee: (a) triple jeopardy leading to loneliness, (b) decreased access to resources for connectivity, and (c) organizational struggles to provide support during the pandemic. The findings from the survey and interviews highlight various supports that were missing during the pandemic for this population. CONCLUSION: The COVID-19 pandemic exacerbated the challenges associated with aging in the Muslim population and contributed to further marginalization, with mosques being sites of support during times of crises. Policymakers and service providers must explore ways of engaging mosque-based support systems in meeting the needs of older Muslim adults during pandemics.
RéSUMé: OBJECTIF: Les immigrants musulmans âgés vivant au Canada sont confrontés à des vulnérabilités multiples. Cette étude explore les expériences des personnes âgées musulmanes durant la pandémie de COVID-19 afin d'identifier des moyens pour renforcer la résilience communautaire dans le cadre d'un partenariat de recherche participative communautaire (CBPR) avec une mosquée à Edmonton, en Alberta. MéTHODES: À l'aide d'une approche à méthodes mixtes, des enquêtes de contrôle (n = 88) suivies d'entretiens semi-dirigés (n = 16) ont été menés pour évaluer l'impact du COVID-19 sur les personnes âgées de la congrégation de la mosquée. Les résultats quantitatifs ont été rapportés au moyen de statistiques descriptives, tandis que l'analyse thématique a guidé l'identification des principaux résultats des entretiens à l'aide du modèle socio-écologique. RéSULTATS: Trois thèmes majeurs ont été identifiés en concertation avec un comité consultatif de la communauté musulmane : a) triple péril menant à la solitude, b) accès réduit aux ressources pour la connectivité, et c) luttes organisationnelles pour fournir un soutien pendant la pandémie. Les résultats de l'enquête et des entretiens mettent en évidence le manque d'aides diverses à cette population durant la pandémie. CONCLUSION: La pandémie de COVID-19 a exacerbé les défis associés au vieillissement de cette population et a contribué à une marginalisation supplémentaire, les mosquées étant des sites de soutien en temps de crise. Les décideurs politiques et les prestataires de services doivent explorer les moyens d'engager les systèmes d'aide basés dans les mosquées pour répondre aux besoins des adultes musulmans âgés pendant les pandémies.
Subject(s)
COVID-19 , Emigrants and Immigrants , Humans , Aged , Islam , Pandemics , Alberta/epidemiology , Community-Based Participatory Research , COVID-19/epidemiologyABSTRACT
OBJECTIVES: To examine the prevalence of coping behaviors during the first 2 waves of the COVID-19 pandemic among caregivers of assisted living residents and variation in these behaviors by caregiver gender and mental health. DESIGN: Cross-sectional and longitudinal survey. SETTING AND PARTICIPANTS: Family/friend caregivers of assisted living residents in Alberta and British Columbia. METHODS: A web-based survey, conducted twice (October 28, 2020 to March 31, 2021 and July 12, 2021 to September 7, 2021) on the same cohort obtained data on caregiver sociodemographic characteristics, anxiety and depressive symptoms, and coping behaviors [seeking counselling, starting a psychotropic drug (sedative, anxiolytic, antidepressant), starting or increasing alcohol, tobacco and/or cannabis consumption] during pandemic waves 1 and 2. Descriptive analyses and multivariable (modified) Poisson regression models identified caregiver correlates of each coping behavior. RESULTS: Among the 673 caregivers surveyed at baseline, most were women (77%), White (90%) and age ≥55 years (81%). Alcohol (16.5%) and psychotropic drug (13.3%) use were the most prevalent coping behaviors reported during the initial wave, followed by smoking and/or cannabis use (8.0%), and counseling (7.4%). Among the longitudinal sample (n = 386), only alcohol use showed a significantly lower prevalence during the second wave (11.7% vs 15.1%, P = .02). During both waves, coping behaviors did not vary significantly by gender, however, psychotropic drug and substance use were significantly more prevalent among caregivers with baseline anxiety and depressive symptoms, including in models adjusted for confounders [eg, anxiety: adjusted risk ratio = 3.87 (95% CI 2.50-6.00] for psychotropic use, 1.87 (1.28-2.73) for alcohol use, 2.21 (1.26-3.88) for smoking/cannabis use). CONCLUSIONS AND IMPLICATIONS: Assisted living caregivers experiencing anxiety or depressive symptoms during the pandemic were more likely to engage in drug and substance use, potentially maladaptive responses. Public health and assisted living home initiatives that identify caregiver mental health needs and provide targeted support during crises are required to mitigate declines in their health.
Subject(s)
COVID-19 , Substance-Related Disorders , Humans , Female , Middle Aged , Male , Caregivers/psychology , Pandemics , Depression/diagnosis , Cross-Sectional Studies , Adaptation, Psychological , Substance-Related Disorders/epidemiology , Health Status , Psychotropic Drugs , AlbertaABSTRACT
BACKGROUND: Community pharmacists were the face of the health response to the unprecedented COVID-19 pandemic. Their pivotal role during the pandemic has been widely recognized, as they adapted to continue to provide a higher level of care to their patients. OBJECTIVE: The objective of this study was to gain a deeper understanding of frontline pharmacists' lived experiences of the COVID-19 pandemic and its impact on their roles. METHODS: Photovoice, a visual research method that uses participant-generated photographs to articulate their experiences, was used with semi-structured interviews to explore pharmacists' lived experiences. Frontline community pharmacists who provided direct patient care during the COVID-19 pandemic in Alberta, Canada were recruited. Participants were asked to provide 3-5 photos that reflected on how they see themselves as a pharmacist and/or represents what they do as a pharmacist. Data analysis incorporated content, thematic and visual analysis and was facilitated using NVivo software. A published conceptual framework model was used as the foundation of the analysis with care taken to include new concepts. Ethics approval was obtained from the University of Alberta health research ethics board. RESULTS: Interviews were conducted with 21 participants and they 71 photos. This study advanced the conceptual framework model presented in a scoping review, of what was made visible (pharmacists' information, public health, and medication management roles) and what was invisible but made visible by the pandemic (pharmacists' leadership roles). It was revealed through the reflective nature of this study the important leadership role pharmacists have in their communities. CONCLUSIONS: This study highlighted the work of community pharmacists responding to the COVID-19 pandemic through their information, public health, medication management, and leadership roles. Their experiences also made visible the cost their work had on them as they did more to adapt and continually respond as the pandemic evolved. Pharmacists recognized their role as leaders in their practice and communities.
Subject(s)
COVID-19 , Community Pharmacy Services , Humans , COVID-19/epidemiology , Pharmacists , Pandemics , Patient Care , Alberta , Professional RoleABSTRACT
BACKGROUND: Measurement of SARS-CoV-2 antibody seropositivity is important to accurately understand exposure to infection and/or vaccination in specific populations. This study aimed to estimate the serologic response to SARS-CoV-2 virus infection and vaccination in children in Calgary, Alberta over a two-year period. METHODS: Children with or without prior SARS-CoV-2 infections, were enrolled in Calgary, Canada in 2020. Venous blood was sampled 4 times from July 2020 to April 2022 for SARS-CoV-2 nucleocapsid and spike antibodies. Demographic and clinical information was obtained including SARS-CoV-2 testing results and vaccination records. RESULTS: 1035 children were enrolled and 88.9% completed all 4 visits; median age 9 years (IQR: 5,13); 519 (50.1%) female; and 815 (78.7%) Caucasian. Before enrolment, 118 (11.4%) had confirmed or probable SARS-CoV-2. By April 2022, 39.5% of previously uninfected participants had a SARS-CoV-2 infection. Nucleocapsid antibody seropositivity declined to 16.4% of all infected children after more than 200 days post diagnosis. Spike antibodies remained elevated in 93.6% of unvaccinated infected children after more than 200 days post diagnosis. By April 2022, 408 (95.6%) children 12 years and older had received 2 or more vaccine doses, and 241 (61.6%) 5 to 11 year-old children had received 2 vaccine doses. At that time, all 685 vaccinated children had spike antibodies, compared with 94/176 (53.4%) of unvaccinated children. CONCLUSIONS: In our population, after the first peak of Omicron variant infections and introduction of COVID-19 vaccines for children, all vaccinated children, but just over one-half of unvaccinated children, had SARS-CoV-2 spike antibodies indicating infection and/or vaccination, highlighting the benefit of vaccination. It is not yet known whether a high proportion of seropositivity at the present time predicts sustained population-level protection against future SARS-CoV-2 transmission, infection or severe COVID-19 outcomes in children.
Subject(s)
COVID-19 , SARS-CoV-2 , Child , Female , Humans , Child, Preschool , Male , Alberta/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Antibody Formation , COVID-19 Testing , Seroepidemiologic Studies , Vaccination , Antibodies, ViralABSTRACT
INTRODUCTION: Very little is known about how the COVID-19 pandemic has affected the health of residents and the healthcare system in Alberta, Canada. The purpose of this study is to establish an observational study to characterise the health of residents in Alberta, Canada, over time, covering a population that tested negative or positive for COVID-19 during the pandemic. The primary outcome is to characterise 'long COVID-19' and the health status of residents during the COVID-19 pandemic. Secondary outcomes include the estimation of the risk of and risk factors associated with adverse health outcomes and healthcare utilisation and burdens. METHODS AND ANALYSIS: This is a population-level provincial observational study which will follow-up with Alberta residents who underwent testing for COVID-19 and completed surveys adapted from the ISARIC COVID-19 long-term follow-up survey. The survey data will be linked with medical records. Statistical analyses will be carried out to characterise 'long COVID-19' and the health status of residents during the pandemic. The outcomes of this study will inform strategies for primary care and rehabilitation services to prevent chronic consequences; contribute to healthcare management, interventional studies, rehabilitation and health management to reduce overall morbidity and improve long-term outcomes of COVID-19 and the COVID-19 pandemic and potentially guide a self-evaluation of a remote monitoring system to manage individuals' health. ETHICS AND DISSEMINATION: This study was reviewed and approved by the University of Alberta ethics committee (Study ID: Pro00112053 & Pro00113039) on 13 August 2021 and adheres to the Alberta Health Services research information management policy. Study results will be used to manage clinical care, published in peer-reviewed journals and presented at local, national and international conferences. PROTOCOL VERSION: 6 June 2022 EUROQOL ID: 161 015.
Subject(s)
COVID-19 , Pandemics , Humans , Alberta/epidemiology , Follow-Up Studies , COVID-19 Testing , Post-Acute COVID-19 Syndrome , COVID-19/epidemiology , Patient Acceptance of Health CareABSTRACT
BACKGROUND: For the care need of older adults, long-term care (LTC) and assisted living (AL) facilities are expanding in Alberta, but little is known about the caregivers' well-being. The purpose of the study was to investigate the physical health conditions, mental and emotional health (MEH), health behaviour, stress levels, quality of life (QOL), and turnover and absenteeism (TAA) among professional caregivers in Alberta's LTC and AL facilities. METHODS: This cross-sectional survey involved 933 conveniently selected caregivers working in Alberta's LTC and AL facilities. Standardised questions were selected from the Canadian Community Health Survey, Patient Health Questionnaire-9, and Short Form-36 QOL survey revalidated and administered to the participants. The new questionnaire was used to assess the caregivers' general health condition (GHC), physical health, health behaviour, stress level, QOL, and TAA. Data were analysed using descriptive statistics, Cronbach alpha, Pearson's correlation, one-way analysis of variance, and multiple linear regression. RESULTS: Of 1385 surveys sent to 39 facilities, 933 valid responses were received (response rate = 67.4%). The majority of the caregivers were females (90.8%) who were ≥ 35 years (73.6%), worked between 20 to 40 h weekly (67.3%), and were satisfied with their GHC (68.1%). The Registered Nurses had better GHC (mean difference [MD] = 0.18, p = 0.004) and higher TAA than the Health Care Aides (MD = 0.24, p = 0.005). There were correlations between caregivers' TAA and each of MEH (r = 0.398), QOL (r = 0.308), and stress (r = 0.251); p < 0.001. The most significant predictors of TAA were the propensity to quit a workplace or the profession, illness, job stress, and work-related injury, F (5, 551) = 76.62, p < 0.001, adjusted R2 = 0.998. CONCLUSION: Reducing the caregivers' job stressors such as work overload, inflexible schedule, and poor remuneration, and improving their quality of life, health behaviour, and mental, emotional, and physical health conditions may increase their job satisfaction and reduce turnover and absenteeism.
Subject(s)
Caregivers , Quality of Life , Female , Humans , Aged , Male , Quality of Life/psychology , Caregivers/psychology , Cross-Sectional Studies , Long-Term Care , Alberta/epidemiology , Surveys and QuestionnairesABSTRACT
SETTING: In Alberta, polymerase chain reaction (PCR) COVID-19 tests were an important step in detecting and isolating contagious individuals throughout the pandemic. Initially, a staff member provided results to all PCR COVID-19 test clients by phone. As the number of tests increased, new approaches were essential for timely result notification. INTERVENTION: An innovative automated IT system was introduced during the pandemic to reduce workloads and support timely result notification. At the time of the COVID-19 test booking and again following swabbing, clients had an option to consent to receive their test results via an automated text or voice message. Prior to implementation, a privacy impact assessment was approved, a pilot was undertaken, and changes to lab information systems were made. OUTCOMES: Health administration data were used in a cost analysis to compare the unique costs associated with the novel automated IT practice (e.g., administration, integration, messages, staffing costs) and a hypothetical staff caller practice (e.g., administration, staffing costs) for negative test results. The costs of sharing 2,161,605 negative test results in 2021 were assessed. The automated IT practice demonstrated a cost savings of $6,272,495 over the staff caller practice. A follow-up analysis determined the cost savings threshold of 46,463 negative tests to break even. IMPLICATIONS: Using an automated IT practice for consenting clients can be a cost-effective approach to reach clients in a timely manner during a pandemic or other instances warranting direct notification. This approach is being explored for test result notification of other communicable diseases in other contexts.
RéSUMé: LIEU: En Alberta, les tests de réaction de polymérisation en chaîne (PCR) pour la COVID-19 ont représenté une étape importante dans la détection et l'isolement des personnes contagieuses tout au long de la pandémie. Au début, un membre du personnel communiquait par téléphone les résultats de tous les tests PCR de la COVID-19 aux usagers et usagères. Avec l'augmentation du nombre de tests, il a absolument fallu trouver de nouvelles façons de communiquer les résultats rapidement. INTERVENTION: Un système de TI automatisé novateur a été introduit durant la pandémie pour alléger la charge de travail et favoriser la communication rapide des résultats des tests. Au moment de la réservation d'un test de dépistage de la COVID-19 et après l'écouvillonnage, les usagers et usagères pouvaient consentir à recevoir leurs résultats via un message texte automatisé ou un message vocal. Avant la mise en Åuvre, une évaluation des facteurs relatifs à la vie privée a été approuvée, un projet pilote a été mené, et des changements ont été apportés aux systèmes d'information des laboratoires. RéSULTATS: Les données administratives sanitaires ont servi à effectuer une analyse des coûts visant à comparer les coûts spécifiquement associés à la nouvelle pratique de TI automatisée (p. ex. frais d'administration, d'intégration, de messages, de personnel) et ceux d'une hypothétique pratique d'appel par un membre du personnel (p. ex. frais d'administration, de personnel) pour les tests négatifs. Les coûts de communication des résultats de 2 161 605 tests négatifs en 2021 ont été évalués. La pratique de TI automatisée a représenté des économies de 6 272 495 $ par rapport à la pratique d'appel par un membre du personnel. Selon une analyse de suivi, le seuil de rentabilité était atteint après 46 463 tests négatifs. CONSéQUENCES: L'utilisation d'une pratique de TI automatisée pour les usagers et usagères ayant consenti à cette option peut être une méthode efficace par rapport au coût pour joindre rapidement les usagères et usagers lors d'une pandémie ou dans d'autres cas où une notification directe est justifiée. Cette méthode est explorée pour la communication des résultats de tests d'autres maladies transmissibles dans d'autres contextes.
Subject(s)
COVID-19 , Text Messaging , Humans , COVID-19/diagnosis , COVID-19/epidemiology , Alberta , Costs and Cost Analysis , Cost-Effectiveness AnalysisABSTRACT
BACKGROUND: Risk factors for nosocomial COVID-19 outbreaks continue to evolve. The aim of this study was to investigate a multi-ward nosocomial outbreak of COVID-19 between 1st September and 15th November 2020, occurring in a setting without vaccination for any healthcare workers or patients. METHODS: Outbreak report and retrospective, matched case-control study using incidence density sampling in three cardiac wards in an 1100-bed tertiary teaching hospital in Calgary, Alberta, Canada. Patients were confirmed/probable COVID-19 cases and contemporaneous control patients without COVID-19. COVID-19 outbreak definitions were based on Public Health guidelines. Clinical and environmental specimens were tested by RT-PCR and as applicable quantitative viral cultures and whole genome sequencing were conducted. Controls were inpatients on the cardiac wards during the study period confirmed to be without COVID-19, matched to outbreak cases by time of symptom onset dates, age within ± 15 years and were admitted in hospital for at least 2 days. Demographics, Braden Score, baseline medications, laboratory measures, co-morbidities, and hospitalization characteristics were collected on cases and controls. Univariate and multivariate conditional logistical regression was used to identify independent risk factors for nosocomial COVID-19. RESULTS: The outbreak involved 42 healthcare workers and 39 patients. The strongest independent risk factor for nosocomial COVID-19 (IRR 3.21, 95% CI 1.47-7.02) was exposure in a multi-bedded room. Of 45 strains successfully sequenced, 44 (97.8%) were B.1.128 and differed from the most common circulating community lineages. SARS-CoV-2 positive cultures were detected in 56.7% (34/60) of clinical and environmental specimens. The multidisciplinary outbreak team observed eleven contributing events to transmission during the outbreak. CONCLUSIONS: Transmission routes of SARS-CoV-2 in hospital outbreaks are complex; however multi-bedded rooms play a significant role in the transmission of SARS-CoV-2.
Subject(s)
COVID-19 , Cross Infection , Humans , COVID-19/epidemiology , SARS-CoV-2/genetics , Cross Infection/epidemiology , Cross Infection/prevention & control , Case-Control Studies , Retrospective Studies , Disease Outbreaks , Risk Factors , Tertiary Care Centers , AlbertaABSTRACT
SETTING: On March 17, 2020, a state of public health emergency was declared in Alberta under the Public Health Act in response to the COVID-19 pandemic. Congregate and communal living sites were environments with a high risk of exposure to and transmission of COVID-19. Consequently, provincial efforts to prevent and manage COVID-19 were required and prioritized. INTERVENTION: During the first 9 months of the pandemic, vaccines were unavailable and alternate strategies were used to prevent and manage COVID-19 (e.g., physical distancing, masking, symptom screening, testing, isolating cases). Alberta Health Services worked with local, provincial, and First Nations and Inuit Health Branch stakeholders to deliver interventions to support congregate and communal living sites. Interventions included resources and site visits to support prevention and preparedness, and the creation of a coordinated response line to serve as a single point of contact to access information and services in the event of an outbreak (e.g., guidance, testing, personal protective equipment, reporting). OUTCOMES: Data from an internal monitoring dashboard informed intervention uptake and use. Online survey results found high levels of awareness, acceptability, appropriateness, and use of the interventions among congregate and communal living site administrators (n = 550). Recommendations were developed from reported experiences, challenges, and facilitators, and processes were improved. IMPLICATIONS: Provincially coordinated prevention, preparedness, and outbreak management interventions supported congregate and communal living sites. Efforts to further develop adaptive system-level approaches for prevention and preparedness, in addition to communication and information sharing in complex rapidly changing contexts, could benefit future public health emergencies.
RéSUMé: LIEU: Le 17 mars 2020, un état d'urgence sanitaire a été déclaré en Alberta en vertu de la Loi sur la santé publique pour riposter à la pandémie de COVID-19. Les habitations collectives étaient des environnements qui présentaient un risque élevé d'exposition à la COVID-19 et de transmission du virus. Des efforts provinciaux pour prévenir et gérer la COVID-19 ont donc été nécessaires et se sont vu accorder la priorité. INTERVENTION: Comme des vaccins n'étaient pas disponibles au cours des neuf premiers mois de la pandémie, d'autres stratégies ont été utilisées pour prévenir et gérer la COVID-19 (p. ex. distanciation physique, port du masque, dépistage des symptômes, tests, isolation des cas). Les Services de santé de l'Alberta ont travaillé avec les acteurs locaux et provinciaux et les fonctionnaires de la Direction générale de la santé des Premières nations et des Inuits pour mener des interventions à l'appui des habitations collectives. Ces interventions ont compris des ressources et des visites sur place pour appuyer la prévention et la préparation, et la création d'une ligne d'intervention coordonnée qui a servi de guichet unique d'accès à l'information et aux services en cas d'éclosion (p. ex. conseils, tests, équipement de protection individuelle, déclaration des cas). RéSULTATS: Les données d'un tableau de bord interne ont permis d'en savoir plus sur la popularité et l'utilisation de ces interventions. Les résultats d'un sondage en ligne ont fait état de niveaux élevés de connaissance, d'acceptabilité, de pertinence et d'utilisation des interventions chez les administrateurs d'habitations collectives (n = 550). Des recommandations ont été élaborées à partir des expériences signalées et des éléments positifs et négatifs, et les processus ont été améliorés. CONSéQUENCES: Des interventions de prévention, de préparation et de gestion des éclosions coordonnées à l'échelle provinciale ont soutenu les habitations collectives. Il pourrait être utile pour les futures urgences sanitaires de développer ces approches d'adaptation systémiques pour la prévention et la préparation, en plus des communications et de l'échange d'informations dans des contextes en évolution rapide.
Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , COVID-19/prevention & control , Public Health , Pandemics/prevention & control , Alberta/epidemiology , Disease Outbreaks/prevention & control , Health ServicesABSTRACT
Background Because the impact of changes in how outpatient care was delivered during the COVID-19 pandemic is uncertain, we designed this study to examine the frequency and type of outpatient visits between March 1, 2019 to February 29, 2020 (prepandemic) and from March 1, 2020 to February 28, 2021 (pandemic) and specifically compared outcomes after virtual versus in-person outpatient visits during the pandemic. Methods and Results Population-based retrospective cohort study of all 3.8 million adults in Alberta, Canada. We examined all physician visits and 30- and 90-day outcomes, with a focus on those adults with the cardiovascular ambulatory-care sensitive conditions heart failure, hypertension, and diabetes. Our primary outcome was emergency department visit or hospitalization, evaluated using survival analysis accounting for competing risk of death. Although in-person outpatient visits decreased by 38.9% in the year after March 1, 2020 (10 142 184 versus 16 592 599 in the prior year), the introduction of virtual visits (7 152 147; 41.4% of total) meant that total outpatient visits increased by 4.1% in the first year of the pandemic for Albertan adults. Outpatient visit frequency (albeit 41.4% virtual, 58.6% in-person) and prescribing patterns were stable in the first year after pandemic onset for patients with the cardiovascular ambulatory-care sensitive conditions we examined, but laboratory test frequency declined by 20% (serum creatinine) to 47% (glycosylated hemoglobin). In the first year of the pandemic, virtual outpatient visits were associated with fewer subsequent emergency department visits or hospitalizations (compared with in-person visits) for patients with heart failure (adjusted hazard ratio [aHR], 0.90 [95% CI, 0.85-0.96] at 30 days and 0.96 [95% CI, 0.92-1.00] at 90 days), hypertension (aHR, 0.88 [95% CI, 0.85-0.91] and 0.93 [95% CI, 0.91-0.95] at 30 and 90 days), or diabetes (aHR, 0.90 [95% CI, 0.87-0.93] and 0.93 [95% CI, 0.91-0.95] at 30 and 90 days). Conclusions The adoption and rapid uptake of virtual outpatient care during the COVID-19 pandemic did not negatively impact frequency of follow-up, prescribing, or short-term outcomes, and could have potentially positively impacted some of these for adults with heart failure, diabetes, or hypertension in a setting where there was an active reimbursement policy for virtual visits. Given declines in laboratory monitoring and screening activities, further research is needed to evaluate whether long-term outcomes will differ.
Subject(s)
COVID-19 , Diabetes Mellitus , Heart Failure , Hypertension , Telemedicine , Adult , Humans , COVID-19/epidemiology , Retrospective Studies , Pandemics , Outpatients , Heart Failure/diagnosis , Heart Failure/epidemiology , Heart Failure/therapy , Hypertension/epidemiology , Alberta/epidemiology , Telemedicine/methodsABSTRACT
BACKGROUND: The COVID-19 pandemic overwhelmed health care systems, leading many jurisdictions to reduce surgeries to create capacity (beds and staff) to care for the surge of patients with COVID-19; little is known about the impact of this on patients whose surgery was delayed. The objective of this study was to understand the patient and family/caregiver perspective of having a surgery delayed during the COVID-19 pandemic. METHODS: Using an interpretative descriptive approach, we conducted interviews between Sept. 20 and Oct. 8, 2021. Adult patients who had their surgery delayed or cancelled during the COVID-19 pandemic in Alberta, Canada, and their family/caregivers were eligible to participate. Trained interviewers conducted semistructured interviews, which were iteratively analyzed by 2 independent reviewers using an inductive approach to thematic content analysis. RESULTS: We conducted 16 interviews with 15 patients and 1 family member/caregiver, ranging from 27 to 75 years of age, with a variety of surgical procedures delayed. We identified 4 interconnected themes: individual-level impacts on physical and mental health, family and friends, work and quality of life; system-level factors related to health care resources, communication and perceived accountability within the system; unique issues related to COVID-19 (maintaining health and isolation); and uncertainty about health and timing of surgery. INTERPRETATION: Although the decision to delay nonurgent surgeries was made to manage the strain on health care systems, our study illustrates the consequences of these decisions, which were diffuse and consequential. The findings of this study highlight the need to develop and adopt strategies to mitigate the burden of waiting for surgery during and after the COVID-19 pandemic.
Subject(s)
COVID-19 , Adult , Humans , Alberta/epidemiology , COVID-19/epidemiology , Pandemics , Quality of Life , Qualitative ResearchABSTRACT
OBJECTIVE: To develop a set of patient and family engagement indicators (PFE-Is) for measuring engagement in health system improvement for a Canadian provincial health delivery system through an evidence-based consensus approach. DESIGN: This mixed-method, multiphase project included: (1) identification of existing measures of patient and family engagement through a review of the literature and consultations with a diverse provincial council of patients, caregivers, community members and researchers. The Public and Patient Engagement Evaluation Tool (PPEET) was selected; (2) consultations on relevance, acceptability and importance with patient and family advisors, and staff members of Alberta Health Services' Strategic Clinical Networks. This phase included surveys and one-on-one semi-structured interviews aimed to further explore the use of PPEET in this context. Findings from the survey and interviews informed the development of PFE-Is; (3) a Delphi consensus process using a modified RAND/UCLA Appropriateness Method to identify and refine a core set of PFE-Is. PARTICIPANTS: The consensus panel consisted of patients, family members, community representatives, clinicians, researchers and healthcare leadership. RESULTS: From an initial list of 33 evidence-based PFE-Is identified, the consensus process yielded 18 final indicators. These PFE-Is were grouped into seven themes: communication, comfort to contribute, support needed for engagement, impact and influence of engagement initiative, diversity of perspectives, respectful engagement, and working together indicators. CONCLUSIONS: This group of final patient, family and health system leaders informed indicators can be used to measure and evaluate meaningful engagement in health research and system transformation. The use of these metrics can help to improve the quality of patient and family engagement to drive health research and system transformation.
Subject(s)
Patient Participation , Humans , Consensus , AlbertaABSTRACT
BACKGROUND: The COVID-19 pandemic challenged healthcare systems worldwide and disrupted primary care, particularly prevention, screening, and lifestyle counselling. BETTER WISE is a comprehensive and structured approach that proactively addresses cancer and chronic disease prevention and screening (CCDPS), including cancer survivorship and screening for poverty and lifestyle risks for patients aged 40 to 65. Patients from 13 primary care clinics (urban, rural, and remote) in Alberta, Ontario, and Newfoundland & Labrador, Canada were invited for a 1-hour visit with a prevention practitioner (PP), a member of the primary care team with specialized training in CCDPS to provide patients an overview of eligible screening and assist with lifestyle counselling. This qualitative sub-study describes how the COVID-19 pandemic impacted BETTER WISE in a constantly changing medical landscape. METHODS: We conducted 17 focus groups and 48 key informant interviews with a total of 132 primary care providers (PPs, physicians, allied health professionals, and clinic staff) over three different time points to better understand their perspectives on the BETTER WISE project. We also received 585 patient feedback forms of the 1005 patients who agreed to participate in the study. We also collected field notes and memos and employed thematic analysis using a constant comparative method focused on the impact of the pandemic on BETTER WISE. RESULTS: We identified four themes related to how the COVID-19 pandemic impacted the BETTER WISE study: 1) Switch of in-person visits to visits over the phone; 2) Lack of access to preventive care and delays of screening tests; 3) Changes in primary care providers' availability and priorities; 4) Mental health impacts of the pandemic on patients and primary care providers. CONCLUSIONS: The COVID-19 pandemic had and, at the time of writing, continues to have an impact on primary care, particularly on prevention, screening, and lifestyle counselling. Despite structural, procedural, and personal challenges throughout different waves of the pandemic, the primary care clinics participating in BETTER WISE were able to complete the study. Our results underscore the importance of the role of primary care providers in adapting to changing circumstances and support of patients in these challenging times. TRIAL REGISTRATION: This qualitative study is a sub-component of the BETTER WISE pragmatic, cRCT, trial registration ISRCTN21333761 (date of registration 19/12/2016).
Subject(s)
COVID-19 , Humans , Pandemics , Qualitative Research , Focus Groups , Chronic Disease , AlbertaABSTRACT
INTRODUCTION: Few studies have assessed the impact of the coronavirus disease 2019 (COVID-19) pandemic on immunization coverage for adolescents, and little is known about how coverage has changed throughout the pandemic. We aimed to: (1) assess the change in coverage for school-based vaccines in Alberta, Canada resulting from the pandemic; (2) determine whether coverage differed by geographic health zone and school type; and (3) ascertain whether coverage has returned to pre-pandemic levels. METHODS: Using a retrospective cohort design, we used administrative health data to compare coverage for human papillomavirus (HPV) and meningococcal conjugate A, C, Y, W-135 (MenC-ACYW) vaccines between pre-pandemic (2017-2018 school year) and pandemic (2019-2020 and 2020-2021 school years) cohorts (N = 289,420). Coverage was also compared by health zone and authority type. The 2019-2020 cohort was followed over one year to assess catch-up. RESULTS: Compared to 2017-2018, immunization coverage for HPV was significantly lower in the 2019-2020 (absolute difference: 60.8%; 95% CI: 60.4-61.3%) and 2020-2021 cohorts (absolute difference: 59.9%; 95% CI: 59.4-60.3%). There was a smaller, significant decline in MenC-ACYW coverage comparing 2017-2018 to 2019-2020 (absolute difference: 6.1%; 95% CI: 5.6-6.5%) and 2020-2021 (absolute difference: 32.2%; 95% CI: 31.6-32.7%). Private schools had low coverage overall, while coverage fluctuated by zone. During follow-up of the 2019-2020 cohort, coverage for HPV and MenC-ACYW increased from 5.6% to 50.2%, and 80.7% to 83.0%, respectively. CONCLUSION: There was a substantial decrease in school-based immunization coverage during the COVID-19 pandemic, and coverage has not returned to pre-pandemic levels, suggesting further catch-up is needed.
Subject(s)
COVID-19 , Meningococcal Vaccines , Papillomavirus Infections , Papillomavirus Vaccines , Humans , Adolescent , Vaccination Coverage , Retrospective Studies , Pandemics/prevention & control , COVID-19/prevention & control , Human Papillomavirus Viruses , Alberta , Immunization Programs , VaccinationABSTRACT
BACKGROUND: Colonially imposed jurisdictional boundaries that have little meaning to Indigenous peoples in Canada may confound tuberculosis (TB) prevention and care activities. This study explores how inter-jurisdictional mobility and the current accommodation of mobility through policies and programming sustain a regional TB epidemic in northwestern Saskatchewan, and northeastern Alberta. METHODS: A qualitative instrumental case study was performed using a community based participatory approach. Semi-structured interviews were conducted with First Nations peoples from a high-incidence community in Canada including community-based healthcare workers. These interview data are presented in the context of a multi-level document analysis of TB program guidelines. RESULTS: The location of the community, and related lack of access to employment, services and care, necessitates mobility across jurisdictional boundaries. There are currently no formal federal or provincial guidelines in place to accommodate highly mobile patients and clients within and across provincial TB prevention and care programs. As a result, locally developed community-based protocols, and related ad-hoc strategies ensure continuity of care. CONCLUSION: Indigenous peoples living in remote communities face unique push/pull factors that motivate mobility. When these motivations exist in communities with increased risk of contagion by communicable infectious diseases such as TB, public health risks extend into increasingly large areas with competing jurisdictional authority. Such mobility poses several threats to TB elimination. We have identified a gap in TB services to systematically accommodate mobility, with specific implications for Indigenous peoples and reconciliation. We recommend clearly defined communication paths and inter-jurisdictional coordination to ensure maintenance of care for mobile populations.
Subject(s)
Community Health Services , Population Groups , Humans , Canada , Alberta/epidemiology , Community Participation , Public HealthABSTRACT
INTRODUCTION: The PLAYshop programme is a novel, brief, theory-based, parent-focused physical literacy intervention in early childhood designed to address the major public health issue of childhood physical inactivity. The primary objective of this study is to examine the efficacy of the virtually delivered PLAYshop programme in increasing preschool-aged children's physical literacy, including fundamental movement skills and motivation and enjoyment. METHODS AND ANALYSIS: This study aims to recruit 130 families with preschool-aged children (3-5 years) from Alberta and British Columbia, Canada who will be randomised to an intervention or control group. The PLAYshop programme is informed by the Capability, Opportunity, Motivation, Behavior (COM-B) model and includes four intervention strategies: (1) educational training via a 60 min virtual synchronous workshop, (2) educational resources via handouts, (3) material resources via a goody bag of basic active play equipment and (4) follow-up support via access to a digital app with an online toolkit and four biweekly booster lessons (1-week, 3-week, 5-week and 7-week follow-up). To assess the primary outcome of physical literacy, five fundamental movement skills (overhand throw, underhand throw, horizontal jump, hop, one leg balance) will be measured virtually at baseline and 2-month follow-up using the Test of Gross Motor Development (TGMD) and the Movement Assessment Battery for Children-Second Edition (MABC-2) tools. Additionally, children's motivation and enjoyment will also be assessed at baseline and 2-month follow-up by: (1) parental-report using items from the Preschool Physical Literacy Assessment (PrePLAy) and (2) self-report using an adapted Five Degrees of Happiness Likert scale for children. The control group will receive the PLAYshop programme after the 2-month follow-up. ETHICS AND DISSEMINATION: The protocol was approved by the University of Alberta (00093764) and University of Victoria (16-444) Research Ethics Boards. Findings will be disseminated through peer-reviewed publications, conference presentations, social and traditional media and a circulated infographic. TRIAL REGISTRATION NUMBER: NCT05255250.
Subject(s)
Literacy , Parents , Humans , Child, Preschool , Parents/education , Schools , Motivation , Alberta , Randomized Controlled Trials as TopicABSTRACT
We compared the seroprevalence of SARS-CoV-2 anti-nucleocapsid antibodies in blood donors across Canadian regions in 2021. The seroprevalence was the highest in Alberta and the Prairies, and it was so low in Atlantic Canada that few correlates were observed. Being male and of young age were predictive of seropositivity. Racialization was associated with higher seroprevalence in British Columbia and Ontario but not in Alberta and the Prairies. Living in a materially deprived neighborhood predicted higher seroprevalence, but it was more linear across quintiles in Alberta and the Prairies, whereas in British Columbia and Ontario, the most affluent 60% were similarly low and the most deprived 40% similarly elevated. Living in a more socially deprived neighborhood (more single individuals and one parent families) was associated with lower seroprevalence in British Columbia and Ontario but not in Alberta and the Prairies. These data show striking variability in SARS-CoV-2 seroprevalence across regions by social determinants of health. IMPORTANCE Canadian blood donors are a healthy adult population that shows clear disparities associated with racialization and material deprivation. This underscores the pervasiveness of the socioeconomic gradient on SARS-CoV-2 infections in Canada. We identify regional differences in the relationship between SARS-CoV-2 seroprevalence and social determinants of health. Cross-Canada studies, such as ours, are rare because health information is under provincial jurisdiction and is not available in sufficient detail in national data sets, whereas other national seroprevalence studies have insufficient sample sizes for regional comparisons. Ours is the largest seroprevalence study in Canada. An important strength of our study is the interpretation input from a public health team that represented multiple Canadian provinces. Our blood donor seroprevalence study has informed Canadian public health policy at national and provincial levels since the start of the SARS-CoV-2 pandemic.
Subject(s)
COVID-19 , SARS-CoV-2 , Adult , Male , Humans , Female , Blood Donors , Seroepidemiologic Studies , Social Determinants of Health , COVID-19/epidemiology , Alberta/epidemiology , Antibodies, ViralABSTRACT
Background: Active and recent coronavirus disease 2019 (COVID-19) infections are associated with morbidity and mortality after surgery in adults. Current recommendations suggest delaying elective surgery in survivors for four to 12 weeks, depending on initial illness severity. Recently, the predominant causes of COVID-19 are the highly transmissible/less virulent Omicron variant/subvariants. Moreover, increased survivability of primary infections has engendered the long-COVID syndrome, with protean manifestations that may persist for months. Considering the more than 600,000,000 COVID-19 survivors, surgeons will likely be consulted by recovered patients seeking elective operations. Knowledge gaps of the aftermath of Omicron infections raise questions whether extant guidance for timing of surgery still applies to adults or should apply to the pediatric population. Methods: Scoping review of relevant English-language literature. Results: Most supporting data derive from early in the pandemic when the Alpha variant of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) predominated. The Omicron variant/subvariants generally cause milder infections with less organ dysfunction; many infections are asymptomatic, especially in children. Data are scant with respect to adult surgical outcomes after Omicron infection, and especially so for pediatric surgical outcomes at any stage of the pandemic. Conclusions: Numerous knowledge gaps persist with respect to the disease, the recovered pre-operative patient, the nature of the proposed procedure, and supporting data. For example, should the waiting period for all but urgent elective surgery be extended beyond 12 weeks, e.g., after serious/critical illness, or for patients with long-COVID and organ dysfunction? Conversely, can the waiting periods for asymptomatic patients or vaccinated patients be shortened? How shall children be risk-stratified, considering the distinctiveness of pediatric COVID-19 and the paucity of data? Forthcoming guidelines will hopefully answer these questions but may require ongoing modifications based on additional new data and the epidemiology of emerging strains.
Subject(s)
COVID-19 , Post-Acute COVID-19 Syndrome , Adult , Child , Humans , Alberta , Multiple Organ Failure , COVID-19/epidemiology , SARS-CoV-2 , Health ServicesABSTRACT
OBJECTIVE: To evaluate changes in mental health and well-being (eg, quality of work life, health, intention to leave) among nursing home managers from a February 2020 prepandemic baseline to December 2021 in Alberta, Canada. DESIGN: Repeated cross-sectional survey. SETTING AND PARTICIPANTS: A random sample of nursing homes (n = 35) in urban areas of Alberta was selected on 3 strata (region, size, ownership). Care managers were invited to participate if they (1) managed a unit, (2) worked there for at least 3 months, and (3) worked at least 6 shifts per month. METHODS: We measured various mental health and well-being outcomes, including job satisfaction (Michigan Organizational Assessment Questionnaire Job Satisfaction Subscale), burnout (Maslach Burnout Inventory-exhaustion, cynicism, efficacy), organizational citizenship behaviors (constructive efforts by individuals to implement changes to improve performance), mental and physical health (Short Form-8 Health Survey), burden of worry, and intention to leave. We use mixed effects regression to examine changes at the survey time points, controlling for staffing and resident acuity. RESULTS: The final sample included 181 care managers (87 in the pre-COVID survey; 94 in the COVID survey). Response rates were 66.9% and 82.5% for the pre-COVID and COVID surveys, respectively. In the regression analysis, we found statistically significant negative changes in job satisfaction (mean difference -0.26, 95% CI -0.47 to -0.06; P = .011), cynicism (mean difference 0.43, 95% CI 0.02-0.84; P = .041), exhaustion (mean difference 0.84, 95% CI 0.41-1.27; P < .001), and SF-8 mental health (mean difference -6.49, 95% CI -9.60 to -3.39; P < .001). CONCLUSIONS AND IMPLICATIONS: Mental health and well-being of nursing home managers worsened during the pandemic, potentially placing them at risk for leaving their jobs and in need of improved support. These findings should be a major concern for policy makers, particularly given serious prepandemic workforce shortages. Ongoing assessment and support of this understudied group are needed.