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OBJECTIVE: Patients may use emergency departments (EDs) to meet their health needs when ambulatory care systems are not sufficient. We aim to describe contributing factors to the decision made by persons with inflammatory arthritis (IA) to present to the ED, as well as their experiences of ED care and postdischarge follow-up. METHODS: An embedded mixed-methods approach was taken to contextualize quantitative data with associated free-text responses from an online survey distributed to residents of Alberta with a known IA condition and an ED visit. RESULTS: Eighty-two persons (63% aged 16-55 years, 48% female, 50% urban residents) with rheumatoid arthritis (48%), psoriatic arthritis (12%), spondyloarthritis (6%), or gout (34%) completed the survey. Presenting concerns were arthritis flare (37%), chest pain (15%), injury (12%), and infection (11%). Of all visits, 29% proceeded directly to the ED, 35% attempted accessing ambulatory care first, and 32% arrived for a return visit. In presentations for arthritis flare, patients were aware of the rheumatology service being contacted by the ED provider for advice in just 9% of events. Challenges in healthcare system coordination and system pressures resulted in patients requiring ED attendance to assess their concern. The quality of communication and relationality developed between patients with IA and healthcare providers informed experiences of ED care. CONCLUSION: Modifying rheumatology ambulatory care models could better meet patient needs and ultimately reduce avoidable ED use by patients with IA.
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Some emergency department (ED) visits by persons with rheumatoid arthritis (RA) may be avoidable. This study aims to describe ED use by persons with RA in Alberta, Canada over a 10-year period. Using linked population-based administrative datasets, the annual frequency of ED visits, timing of visits, acuity at presentation assessed (Canadian Triage Acuity Scale (CTAS)), return visits within 72 h, and final disposition were assessed. Most responsible diagnoses assessed by the ED provider were categorized. Between 2008 and 2017, a total of 48,633 persons with RA had 416,964 unique ED visits. There was a 41% relative increase in visits over the study period and within a fiscal year 37% of persons with RA on average attended an ED. Half of the visits were assessed as CTAS 4 'Less Urgent' (31%) and CTAS 5 'Non-Urgent' (19%). No specific diagnosis could be assigned in 36% of visits and RA was listed as the most responsible diagnosis in 2.5% of all visits. Hospital admissions, occurring on average for 14% of ED visits, increased by 15% over the 10 years, and were rare for CTAS 4 (6.4%) and CTAS 5 (1.4%) presentations. Male patients (difference to female 1.2%, 95%CI 0.6, 1.7) and urban patients (difference to rural 8.4%, 95%CI 7.7, 9.2) were more frequently admitted to hospital. Persons with RA have increased ED utilization over time, with a significant volume of less urgent and non-urgent visits. Opportunities for appropriate ambulatory care provision to reduce acute care use should be identified.
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Action research provides fertile grounds for co-generation of knowledge in complex contexts and to be present in the becoming of the process. Time and temporality warrant explanation and distinction, and in retrospective a process can be described with temporal phases, such as planning, observation, action, reflection, evaluation, and modification. Such a description may appear rational, sequential, and linear. However, an action research process is not that! This paper explores the various positionalities of the action researcher, as an insider in a process of becoming, showing how time and temporality can be made explicit in the evolution of an action research process. Our contributions to the action research literature concerning co-generation of knowledge when addressing territorial complexity are: (1) an explicit awareness of temporality provides the opportunity for research on evolvement of processes from the inside, (2) presence in the becoming of a process means there is a unique possibility for reflection and iteration, (3) research in the present tense allows for insight into unexpected developments that create the foundation for future action, as an alternative to retrospective process evaluation, and (4) modelling the process creates a narrative which tells the story of evolution of the process over time.
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OBJECTIVE: To determine the information and support needs among parents of young children in a region of Canada. DESIGN AND SAMPLE: A cross-sectional survey was mailed to a stratified random sample of 1,064 parents of children aged 6 years and under. Of the 359 respondents, the majority were Caucasian, female, married, and well educated. MEASURES: An investigator designed questionnaire measured preferred sources of parenting information and support, sources and modes of program delivery, and perceived barriers to accessing information and programs. RESULTS: Breastfeeding, car seat safety, caring for a new baby, supporting their child's development, and sleep issues were considered "somewhat" or "very" important by 95.8% of respondents. Informal sources of support were rated as more important and more valuable than formal supports. The internet, drop-in programs for parents and children, books, organized play groups, classes and information sessions were identified as the most preferred modes to access parenting information. Respondents reported a lack of knowledge and awareness of programs, lack of time, lack of child care, and inconvenient scheduling as the top barriers to accessing information and programs. CONCLUSIONS: Parents want information to support their parenting. These results have implications for planning and implementation of future parenting information and support programs and services.
