Enhancing the delivery of comprehensive care for people living with HIV in Canada: insights from citizen panels and a national stakeholder dialogue.

BACKGROUND: People living with human immunodeficiency virus (HIV) are living longer with health-related disability associated with ageing, including complex conditions. However, health systems in Canada have not adapted to meet these comprehensive care needs. METHODS: We convened three citizen panels and a national stakeholder dialogue. The panels were informed by a plain-language citizen brief that outlined data and evidence about the challenge/problem, elements of an approach for addressing it and implementation considerations. The national dialogue was informed by a more detailed version of the same brief that included a thematic analysis of the findings from the panels. RESULTS: The 31 citizen panel participants emphasized the need for more prevention, testing and social supports, increased public education to address stigma and access to more timely data to inform system changes. The 21 system leaders emphasized the need to enhance person-centred care and for implementing learning and improvement across provinces, territories and Indigenous communities. Citizens and system leaders highlighted that policy actions need to acknowledge that HIV remains unique among conditions faced by Canadians. CONCLUSIONS: Action will require a national learning collaborative to support spread and scale of successful prevention, care and support initiatives. Such a collaborative should be grounded in a rapid-learning and improvement approach that is anchored on the needs, perspectives and aspirations of people living with HIV; driven by timely data and evidence; supported by appropriate decision supports and aligned governance, financial and delivery arrangements; and enabled with a culture of and competencies for rapid learning and improvement.

The role of civil society organizations in alcohol control during the COVID-19 pandemic across six countries in Africa.

Background: The differing global trends in alcohol consumption and policy measures implemented during the COVID-19 pandemic warrant a closer look at the actions taken by civil society organisations (CSOs) and community-led efforts to describe how they may influence and accelerate action for change in alcohol control measures. This paper analyses actions undertaken by CSOs at the national and local levels to safeguard communities and improve alcohol control policies during the COVID-19 pandemic in six African countries. Methods: A cross-sectional survey was distributed via email to CSOs involved in alcohol prevention, outreach and policy development in Kenya, Lesotho, Namibia, South Africa, Tanzania and Zimbabwe. Individuals (n = 19) working at CSOs responded to the questionnaire from February to March 2022. Questions related to the role of CSOs during the pandemic are analysed and synthesised in this paper. 19 CSOs respondents representing the six countries were included in the study. Results: Action areas led by CSOs during the COVID-19 pandemic included: (i) direct lobbying advocacy, (ii) conducting public awareness media campaigns and (iii) legal and regulatory interventions linked to the pandemic. Conclusions: Given the size of the challenges governments faced during the COVID-19 pandemic, the role of CSOs, during the ongoing pandemic and beyond, has become even more relevant to strengthen advocacy and public health interventions for alcohol control in Southern Africa. For this, CSOs should have a "seat at the table" when public health policies are designed, discussed and enforced.

Paper 3: Selecting rapid review methods for complex questions related to health policy and system issues.

Approaches for rapid reviews that focus on streamlining systematic review methods are not always suitable for exploring complex policy questions, as developing and testing theories to explain these complexities requires configuring diverse qualitative, quantitative, and mixed methods studies. Our objective was therefore to provide a guide to selecting approaches for rapidly (i.e., within days to months) addressing complex questions related to health policy and system issues.We provide a two-stage, transdisciplinary collaborative process to select a rapid review approach to address complex policy questions, which consists of scoping the breadth and depth of the literature and then selecting an optimal approach to synthesis. The first stage (scoping the literature) begins with a discussion with the stakeholders requesting evidence to identify and refine the question for the review, which is then used to conduct preliminary searches and conceptually map the documents identified. In the second stage (selection of an optimal approach), further stakeholder consultation is required to refine and tailor the question and approach to identifying relevant documents to include. The approach to synthesizing the included documents is then guided by the final question, the breadth and depth of the literature, and the time available and can include a static or evolving conceptual framework to code and analyze a range of evidence. For areas already covered extensively by existing systematic reviews, the focus can be on summarizing and integrating the review findings, resynthesizing the primary studies, or updating the search and reanalyzing one or more of the systematic reviews.The choice of approaches for conducting rapid reviews is intertwined with decisions about how to manage projects, the amount of work to be done, and the knowledge already available, and our guide offers support to help make these strategic decisions.

Examining the role of coaching in health-system transformations

OHTs are being introduced to provide a new way of organizing and delivering care that is more integrated from the perspective of the patients in their local communities, and that achieves measurable improvements in key quadruple-aim metrics of improving care experiences and health outcomes at manageable per capita costs and with positive provider experiences. This change requires significant adjustments to the way in which care is organized and provided, as well as the ways in which organizations and providers across the system interact with one another.

Enhancing Equitable Access to Assistive Technologies in Canada: Insights from Citizens and Stakeholders.

Les besoins en technologies d'assistance augmentent au Canada, mais l'accès à ces technologies est inégal et fragmentaire, ce qui ferait en sorte que des besoins demeureraient non comblés. Cette étude visait à identifier les valeurs et préférences des citoyens concernant les moyens à utiliser pour favoriser un accès équitable aux technologies d'assistance. Elle visait également à impliquer les décideurs politiques, les parties prenantes et les chercheurs dans des discussions afin d'élaborer des actions dans ce domaine. Au printemps 2017, nous avons organisé trois panels de citoyens et un dialogue avec les parties prenantes. Les principales conclusions des panels ont été incluses dans une synthèse qui a été partagée avec les participants du dialogue. Trente-sept citoyens ont participé aux panels et ont souligné l'importance de l'accès à de l'information fiable, d'un accès équitable aux technologies d'assistance (et ce, quelle que soit la capacité de payer), et de la collaboration. Les vingt-deux participants au dialogue ont fait valoir la nécessité d'un cadre d'orientation pour appuyer l'évolution des pratiques dans l'ensemble au pays. Le cadre d'orientation proposé combinerait des politiques et programmes simplifiés incluant la collecte et l'évaluation de données robustes pour appuyer l'innovation et l'imputabilité à travers le pays.The need for assistive technologies in Canada is increasing, but access is inconsistent and fragmented which can result in unmet needs. We aimed to identify citizens' values and preferences for how to enhance equitable access to assistive technologies and to engage policymakers, stakeholders, and researchers in deliberations to spark action. In spring 2017, we convened three citizen panels and a stakeholder dialogue. Key panel findings were included in an evidence brief that informed dialogue participants. Thirty-seven citizens participated in panels and emphasized the need for access to reliable information, equitable access to assistive technologies regardless of ability to pay, and the need for collaboration. Twenty-two dialogue participants focused on the need for a guiding framework that supports fundamental change across the country. The proposed policy framework can enhance access to assistive technologies through enabling simplified policies and programs, along with fostering robust data collection and evaluation to support countrywide innovation and accountability.

Review of 128 quality of care mechanisms: A framework and mapping for health system stewards.

Health system stewards have the critical task to identify quality of care deficiencies and resolve underlying system limitations. Despite a growing evidence-base on the effectiveness of certain mechanisms for improving quality of care, frameworks to facilitate the oversight function of stewards and the use of mechanisms to improve outcomes remain underdeveloped. This review set out to catalogue a wide range of quality of care mechanisms and evidence on their effectiveness, and to map these in a framework along two dimensions: (i) governance subfunctions; and (ii) targets of quality of care mechanisms. To identify quality of care mechanisms, a series of searches were run in Health Systems Evidence and PubMed. Additional grey literature was reviewed. A total of 128 quality of care mechanisms were identified. For each mechanism, searches were carried out for systematic reviews on their effectiveness. These findings were mapped in the framework defined. The mapping illustrates the range and evidence for mechanisms varies and is more developed for some target areas such as the health workforce. Across the governance sub-functions, more mechanisms and with evidence of effectiveness are found for setting priorities and standards and organizing and monitoring for action. This framework can support system stewards to map the quality of care mechanisms used in their systems and to uncover opportunities for optimization backed by systems thinking.

Examining the effects of prenatal education

Prenatal education has expanded significantly over the past two decades, from its initial conception as an opportunity to teach pain management in labour and preparation for birth in the hospital environment to including broader public-health principles of preparing women and their families for pregnancy, labour and birth, care of the newborn and the adjustments to life as a family.(1) It also provides an opportunity to assist women in detecting warning signs in pregnancy, build confidence in self-care, and can act as an opportunity for early intervention in high-risk pregnancies.

Learning from the Experience of Accountable Care Organizations in the US

In February 2019, the Government of Ontario revealed its plans to reform the Ontario health system. The plans include the amalgamation of the province's six provincial agencies (i.e., Cancer Care Ontario, Health Quality Ontario, eHealth Ontario, Trillium Gift of Life Network, Health Shared Services Ontario and HealthForceOntario Marketing and Recruitment Agency) and its 14 Local Health Integration Networks into one central agency responsible for planning, delivering and improving the quality of care in Ontario.(1) In addition, the province announced its intention to support the development of a number of Ontario Health Teams (OHTs), which would have providers and organizations work together in networks to deliver the

Exploring models for health workforce planning

The health of British Columbians has continued to improve over the past decade, with gains in healthadjusted life expectancy and a gradual decrease in the gap between the life expectancy of women and men.(1) These gains in health status have come, in part, as a result of provincial efforts to strengthen health systems and ensure that programs, services and technologies get to those who need them. Essential to these efforts is ensuring that the right mix of health workers are equipped with the right skills to provide British Columbians with high-quality care when and where they need it.

Examining the effects of youth skills-development programs

Improving labour-market participation of youth is a common objective across most advanced economies. Achieving this goal is critical to developing a strong economy, as well as for ensuring the social cohesion and inclusion of youth in society.(1) However, countries around the world face the significant challenge of ensuring youth have the skills they need to enter the labour market and to get fulfilling jobs that make use of their education.

Examining the efficiency and effectiveness of ontario's health workforce regulatory system

The regulation and oversight of the health professionals responsible for providing care to patients in Ontario is an important mechanism to ensure patients receive the highest-quality care possible (e.g., by setting the standards that professionals need to meet in their practice) while mitigating, to the extent that is possible, the risks of harm that may be associated with the provision of healthcare services (e.g., by ensuring health professionals are fit to practice, and that those who are licensed to practice have the competencies to provide the services patients need safely). There are currently 261 regulatory colleges in Ontario that provide oversight for the 292 health professions that are regulated in the province, which collectively include over 300,000 healthcare professionals Additionally, there are several organizations providing oversight and guiding the practice of the many health workers who are not currently regulated, such as personal-support workers (PSWs) ­ of which there are many ­ as well as assistants of many kinds (e.g., dental, medical laboratory, physiotherapy and osteopath), athletic therapists, hearing-instrument practitioners, lactation consultants, marriage and family therapists, medical geneticists, paramedics, pedorthists, phlebotomists, and personalservice workers of many kinds (e.g., ear piercers, tattoo artists).

Using multi-source feedback and other practice assessments for quality assurance in nursing

Under the Regulated Health Professions Act, 1991 every regulatory college in Ontario is expected to establish a quality-assurance program to ensure the ongoing quality of each profession's practice.

Creating rapid-learning health systems in Canada / Créer des systèmes de santé apprenant rapidement au Canada

The 14 jurisdictions include one federal/national/panCanadian jurisdiction, 10 provincial jurisdictions, and three territorial jurisdictions. The first of these jurisdictions includes both areas of federal government responsibility for providing healthcare ­ most notably for Indigenous peoples, military personnel and veterans, and prisoners in federal correctional facilities ­ and areas where national or panCanadian initiatives have been developed to support provincial and territorial health systems.

Les 14 juridictions incluent la juridiction fédérale/nationale/pancanadienne, les dix juridictions provinciales et les trois juridictions territoriales. La première juridiction englobe tant la responsabilité fédérale de fournir des soins de santé ­ particulièrement aux Autochtones, aux militaires et aux anciens combattants, ainsi qu'aux personnes détenues dans les établissements fédéraux ­ que les domaines où des initiatives nationales ou pancanadiennes ont été instaurées pour soutenir les systèmes de santé provinciaux et territoriaux.

Enhancing health promotion and disease prevention in networked primary care

Health systems are moving away from traditional primary care (e.g., by increasingly shifting to group practice and interprofessional teams rather than solo practice primary-care providers), which is often siloed and results in barriers to timely access to care.(1) The Ministry of Health of British Columbia, which requested this rapid synthesis, is undergoing system transformation to better coordinate and potentially integrate primary care with some and community care and public-health services.(2) The transformation presents an important opportunity to improve primary care and preventive care services through improved management of clinical conditions coupled with health promotion and diseaseprevention services.

Identifying effective approaches to support parents and caregivers of children with fetal alcohol spectrum disorder

Fetal Alcohol Spectrum Disorder (FASD) is used "to describe a broader spectrum of presentations and disabilities resulting from alcohol exposure in utero."(1) FASD affects fetal and brain development and may result in limitations to any of an individual's: memory; sensory integration; social communication; language processing; emotional regulation; adaptive functioning; and other executive functions that may make conforming to social, behavioural and cognitive expectations difficult.(2; 3) These effects may mean that individuals affected by FASD are unable to live independently, have difficulty securing employment, and experience behavioural challenges that increase their risk of being in conflict with the law.

Supporting parents in making informed decisions in relation to their children's health needs

Momentum for patient and caregiver engagement in health and social care is growing across Ontario.(1) This is evidenced by a number of recently released strategies and frameworks highlighting the importance of involving Ontarians in their own care as informed consumers of health and social services. One such notable example was the Patients First Act 2016, for which a key pillar was informing and educating patients to make informed decisions about their health in efforts to improve their experiences and health outcomes.

Examining compensation models for walk-in clinics

Positioning primary care as the cornerstone of the health system and establishing primary-care providers as the gatekeepers and coordinators of care has been a long-sought aim of health systems around the world. Further, a main aim of this goal in Canada has been to have a primary-care provider that is responsible for the health and well-being for each insured patient. However, ensuring that all citizens in a province are registered with a primary-care provider who is responsible for their care and can provide timely access to care when needed has proven difficult to achieve. This is not surprising given that primary-care providers in Canada are confronted with many challenges in their practices, including one or more of having to serve large geographical areas, providing care to uninsured populations, and managing high workloads as well as a mismatch between provider availability and the need for timely access to services (particularly after-hours and weekend care). When coupled with the policy legacies of how physicians in Canada have traditionally delivered care and been remunerated (e.g., as private business owners with public fee-for-service payment), the result is a patchwork of primary-care models.

Understanding the use of and compensation for virtual-care services in primary care

Provincial and territorial health systems across Canada continue to struggle with delivering timely access to primary-care services. In 2016, 74% of Canadians reported in the Commonwealth International Health Policy Survey that they received excellent or very good care from their regular doctor, which is above the 11-country average of 65%. However, Canadians also reported the longest wait times to see a primary-care provider across the 10 countries, with one in five reporting a wait of over seven days the last time they needed medical attention. To address this challenge, policymakers across the country have been increasingly exploring options to improve the delivery of patient-centred health services through the introduction and evolution of virtual care to enhance accessibility and efficiency.

Identifying performance measures, indicators and targets to monitor and evaluate dementia strategies

Dementia is a complex condition and refers to "progressive brain syndromes which affect memory, thinking, behavior and emotion."(1) While the experience of dementia is different for each person, it eventually progresses to an individual not being able to care for themselves and requiring assistance with all aspects of their daily life.(1) Accounting for approximately 50% to 60% of all cases of dementia, Alzheimer's disease is the most common of the more than 100 known forms of dementia. Common symptoms of all forms of dementia include memory loss (e.g., inability to recall details of recent events or conversations, not recognizing or knowing family members' names), frequent difficulty in finding words (e.g., with pauses or substitutions when finding words) or understanding what others are saying, not being to perform routine tasks, and changes in personality or mood