Opioid use in pregnancy and parenting: An Indigenous-based, collaborative framework for Northwestern Ontario.

Opioid use affects up to 30% of pregnancies in Northwestern Ontario. Health care providers in Northwestern Ontario have varying comfort levels providing care to substance-involved pregnant women. Furthermore, health care practitioners, social service agencies and community groups in Northwestern Ontario often work in isolation with little multidisciplinary communication and collaboration. This article describes two workshops that brought together health and social service providers, community organizations, as well as academic institutions and professional organizations involved in the care of substance-involved pregnant and parenting women. The initial workshop presented best practices and local experience in the management of opioid dependence in pregnancy while the second workshop asked participants to apply a local Indigenous worldview to the implementation of clinical, research and program priorities that were identified in the first workshop. Consensus statements developed by workshop participants identified improved transitions in care, facilitated access to buprenorphine treatment, stable funding models for addiction programs and a focus on Indigenous-led programming. Participants identified a critical need for a national strategy to address the effects of opioid use in pregnancy from a culturally safe, trauma-informed perspective that takes into account the health and well-being of the woman, her infant, her family and her community.

Patients and families experiences with video telehealth in rural/remote communities in Northern Canada.

AIM: To explore patients' and families' experiences with video telehealth consultations as a method of health care delivery in rural/ remote communities in Northern Canada. BACKGROUND: Accessing health services in isolated populations where human resources and infrastructure are constrained by vast geographical landmasses poses challenges and opportunities for nurses, health care providers, patients and families. DESIGN: A qualitative approach was adopted with a purposeful sample of 10 patients and four family members representative of nine communities. METHOD: Selection criteria included patients receiving telehealth visits for a minimum of a year and willing to share their experiences. Data were collected during the winter of 2006 using semi-structured video taped interviews and analysed using a qualitative thematic content analysis. RESULTS: Patients and families experiences of their telehealth visits centered on three key themes: lessening the burden (costs of travel, accommodations, lost wages, lost time and physical limitations), maximising supports (access to family, friends, familiar home environment, nurses and other care providers), tailoring specific e-health systems to enhance patient and family needs. CONCLUSION: The benefits of telehealth extend not only to patients and families but are linked to benefits for providers as well as the health care system. RELEVANCE TO CLINICAL PRACTICE: This study indicates that video telehealth is an effective mechanism for delivering nursing and other health services to rural/remote communities and can impact positively on the quality of health care. The integration of telehealth practice can enhance the coordination, organisation and implementation of health care services.

Bridging the distance: educating nurses for telehealth practice.

BACKGROUND: The aim of this research project was to explore the impact of telehealth technology on health assessments performed by nurses delivering health services to isolated populations. METHOD: Nurses performing preoperative and oncology assessments for clients in remote communities via telehealth received training. Education workshops were delivered to nurses (N = 37) in 13 communities across Northwestern Ontario. RESULTS/CONCLUSION: Presurveys and postsurveys indicated that the nurses were receptive to the mode of delivery and the content was relevant to their telehealth practice.

A survey of recipient client physician satisfaction with teleoncology services originating from thunder bay regional health sciences centre.

The objective of this work was to investigate end user satisfaction and perceived efficacy on the part of client physicians for teleoncology services in Northwestern Ontario. A survey of 98 referring physicians from 17 remote communities in Northwestern Ontario was undertaken primarily to determine overall client physician satisfaction with the teleoncology process. The survey also investigated perceived problems and explored potential solutions. Overall client physician satisfaction was high for the majority of response fields. However, more than 50% of surveyed physicians felt that some aspects of the teleoncology process could be improved with an emphasis on more timely communication of interview results, continuity of care, and improving patients comfort level with the technologies involved. The success of this service is evidenced by its exponential growth since the original introduction in 2001. Ninety-eight percent of referring physicians would continue to use the teleoncology service process.

Estimating per patient funding for cancer clinical trials: an Ontario based survey.

The financial implications of conducting clinical trials in oncology have not been well researched from a perspective that would facilitate the negotiation of appropriate reimbursement. A better understanding of the resources required to conduct clinical trials is central to this process. Summaries of two hypothetical clinical trials were circulated to the clinical trials departments of the nine regional cancer centres of Cancer Care Ontario (CCO), in the Province of Ontario, Canada. The centres were asked to produce itemized budgets with per patient charges detailed for each trial. Additionally, each trial was to be separately considered as if sponsored by a federally funded cooperative group, and then as if sponsored by industry. Six of the centres reported experience generating clinical trial budgets. Specific charges by the local Institutional Review or Research Ethics Boards (REB) were not included. The total of all per patient charges for the first trial ranged from 1352 dollars to 3082 dollars when considered as a cooperative group trial, and from 1700 dollars to 7217 dollars when considered as an industry sponsored trial. Similar charges for the second trial ranged from 2251 dollars to 5826 dollars and from 2251 dollars to 11,304 dollars respectively. Despite the similarities of the regional cancer centres across the province of Ontario, there were surprisingly large differences in the submitted budgets. No centre consistently produced the highest or lowest estimates. The majority of the differences appeared to be based on the range in estimates for professional support (nurse and physician), and the required radiology investigations. For centres that negotiate specific per patient funding amounts with industry, this data would suggest a need to better understand the budgeting process and its link to appropriate resource identification to ensure appropriate funding is obtained. These issues are likely not unique to oncology.