Collaborating With Service Users to Select Psychiatry Residents Committed to Health Equity and Social Justice.

PROBLEM: Advocates have called for health services to be delivered equitably to all. Academic psychiatry must play a role in this work, given its history of creating and perpetuating the marginalization of people experiencing mental health issues. While medical educators have started teaching concepts such as structural competency and cultural safety, careful consideration of who enters the medical workforce and what values they bring is also important. APPROACH: The authors report on the first 5 years (2016-2021) of a collaboration with individuals who have used mental health or addiction services or identify as having lived experiences of mental health and/or substance use issues (i.e., service users) to select residents to the general adult psychiatry residency program at the University of Toronto who are committed to working toward health equity and social justice and who bring diverse personal, academic, and community-based experiences. Starting in 2016, a working group of service users and faculty iteratively refined the selection process to add personal letter and interview day writing sample prompts centered on social justice and advocacy. OUTCOMES: The working group, coled by service users since 2019, defined the problem (lack of attention to health equity and social justice in resident selection) and codesigned the solution by revising writing prompts used in the selection process and their assessment rubrics to emphasize these missing areas. Further, service users directly participated in the implementation by reviewing candidates' personal letters and interview day writing samples alongside faculty and residents. This work serves as an example of meaningful service user engagement in action. NEXT STEPS: To ensure the needs of service users are prioritized, future work must aim for long-term institutional commitment to strengthen service user involvement and power sharing with service user communities in resident selection and at other points along the medical education pathway.

Telephone versus In-Person Pharmacist-Led Medication Reviews in Home Dialysis Patients: Evaluating Quality of Care and Patient Satisfaction.

The COVID-19 pandemic required pharmacists in a provincial Home Dialysis Clinic to adapt from in-person to telephone-based medication reviews. Studies have shown that in-person pharmacist interventions in patients with chronic kidney disease (CKD) lead to a reduction of drug therapy problems (DTPs), however, it's unknown if telephone interventions provide similar outcomes. The purpose of this study was to evaluate whether differences in quality of care exist between in-person vs. telephone medication reviews in home dialysis patients and to evaluate patient satisfaction with telephone medication reviews. Data from the two most recent in-person medication reviews was compared with the two most recent telephone medication reviews for each patient (n = 46). There were no statistically significant differences in DTPs identified between in-person and telephone medication reviews (p = 0.431). Physician acceptance of pharmacist recommendations was higher for in-person medication reviews (p = 0.009). Patients were satisfied with the care they received with pharmacist-led telephone medication reviews, however, 29% (n = 7) would prefer an in-person medication review once per year with telephone medication reviews the rest of the time. Overall, patients were satisfied with the care they received from telephone medication reviews.

Clinical pharmacy services in an ambulatory oncology clinic: Patient perception and satisfaction.

INTRODUCTION: Studies have shown that patients rate pharmacists more favourably when the pharmacist expresses interest in the patient and attends to patients' perspectives. There is limited available evidence evaluating both patient perception and satisfaction regarding clinical pharmacy services provided in an ambulatory oncology clinic. METHODS: This was a prospective mixed methods study involving surveys and patient interviews. Consenting participants completed a survey at their first visit evaluating their perceptions of the importance of the clinical pharmacy services offered in the ambulatory oncology clinic. They completed a second survey 6-8 weeks later to re-evaluate their perceptions and to measure satisfaction ratings. The final component of this study involved semi-structured one-on-one telephone interviews to gather qualitative data regarding the study objectives. RESULTS: A total of 35 participants completed the survey, of which eleven completed one-on-one patient telephone interviews. Patients perceived the clinical pharmacy services assessed as important to their care before receiving treatment. The ratings of the importance of the pharmacist in managing patients' nausea/vomiting significantly decreased when remeasured, whereas the importance of meeting the pharmacist in the clinic significantly increased. The importance of the role of the pharmacist was highlighted in patient interviews as well: patients particularly valued the pharmacist's initiative to meet them in the clinic, the education provided by pharmacist, and the pharmacist's accessibility throughout treatment. CONCLUSIONS: Overall, patients in the ambulatory oncology clinic perceived the services offered as important to their care and they were highly satisfied.

Overlooked and Invisible: Everyday Experiences of Microaggressions for LGBTQ Adolescents.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) adolescents face a number of challenges in their lives related to heterosexism and cissexism. Drawing on the microaggressions framework, we conducted two focus groups with LGBTQ adolescents (n = 11; ages 14-18, six trans/genderfluid, one person of color) to (1) explore the type and nature of microaggressions experienced by LGBTQ adolescents; (2) assess the relevance of existing LGBTQ microaggression taxonomies for this group; and (3) understand the impact of microaggressions on LGBTQ adolescents. Participants' experiences of microaggressions reflected complex forms of discrimination emerging from the intersections of sexual and gender identity.

(Dis)integrated Care: Barriers to Health Care Utilization for Trans Women Living With HIV.

Transgender (trans) women have been particularly impacted by HIV. To seek insights into the dynamics of health service utilization, interviews were conducted with trans women living with HIV (n = 14) as part of the Trans PULSE community-based research project in Ontario, Canada. Service providers (n = 10) were also interviewed to provide additional details about communication between trans women, social service providers, and clinicians. Results highlight how both problematic interactions with individuals and health systems navigation challenges affect access to services and impede the development of trans-specific HIV supports. Participants described discrimination, identified strategies for navigating a dysfunctional system, and outlined specific ways in which health and social services may be failing trans women living with HIV. Findings support the importance of coordinating HIV services and transition-related care, and providing training for service providers.