Barriers to Implementing Patient-Centred Care: An Exploration of Guidance Provided by Ontario's Health Regulatory Colleges.

The philosophy of patient-centred care has become widely embraced but its implementation is dependent on interrelated factors. A factor that has received limited attention is the role of policy tools. In Ontario, one method government can use to promote healthcare priorities is through health regulatory colleges, which set the standard of practice for health professionals. The degree to which government policy in support of patient-centered care has influenced the direction provided by health regulatory colleges to their members, and ultimately impacted actual patient care, remains unclear. This study investigates the extent to which Ontario's health regulatory colleges have provided explicit written guidance to members related to the importance of patient-centred care. It also explores applied and theoretical explanations that may further our understanding of why patient-centred care has not been more fully embraced. Findings reveal that guidance provided by Ontario's health regulatory colleges varies widely. Institutional barriers and the choice of policy tools for disseminating government preferences may hinder full implementation of the principles of patient-centred care. More fully understanding the role health regulatory colleges' play in facilitating the implementation of health policy will contribute positively to dialogue and to efforts to achieve positive health system reforms.

Lost in transition or translation? Care philosophies and transitions between child and youth and adult mental health services: a systematic review.

Background: Differences in care philosophies may influence transitions from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). Aims: To review literature about CAMHS and AMHS care philosophies and their influence on transitions. Method: MEDLINE, PsycINFO, Embase and CINAHL databases were searched electronically using keywords related to transitions, youth and mental disorders. Content relating to philosophies of care was searched manually. Descriptive themes were extracted and the analysis suggested four hypotheses of how care philosophies influence transitions. Results: Of the 1897 identified articles, 12 met eligibility criteria. Findings reveal consistent differences in care philosophies between CAMHS (developmental approach, involving families and nurturing) and AMHS (clinical/diagnosis-focus, emphasis on client autonomy and individual responsibility). Conclusions: Better understanding of philosophical differences and collaborative planning and service delivery may foster shared approaches in CAMHS and AMHS to better meet the needs of transitioning youth.

Fidelity to assertive community treatment program standards: a regional survey of adherence to standards.

In 2004, the Ontario government approved revised program standards for the operation of Assertive Community Treatment (ACT) programs in the province. This paper reports on results from The 2005 Survey of ACT Programs in Ontario. We provide a profile of ACT programs in the province and identify respondents' perceptions of the extent to which the revised program standards have been complied with and are thought to be essential for the effective operation of an ACT program. Program Coordinators completed surveys for 56 (85%) of the 66 ACT programs in existence at the time. None of the Program Coordinators reported that their ACT program was fully compliant with all program standards and only 4% of ACT programs were identified as being fully compliant with more than 75% of the program standards. Conclusions are provided and the broader implications of lower fidelity to program standards are discussed.

Competing for Referrals for Cardiac Diagnostic Tests: What Do Family Physicians Really Want?

In recent years, there has been a substantial shift in where many cardiac diagnostic tests are performed. Not-for-profit hospitals now have to compete with for-profit private clinics for referrals from family physicians. This study aims to evaluate the key factors that family physicians consider when deciding where to refer their patients for several cardiac diagnostic services. Ninety-one family physicians were recruited from one of Ontario's 14 regional local health integration networks (LHINs). These physicians reported on 1,262 referrals made in the previous month for echocardiography, cardiac stress testing, cardiac nuclear imaging, and arrhythmia management. Family physician referrals were almost evenly split between not-for-profit hospitals and for-profit private clinics. The primary criteria influencing the location of referrals were: (1) speed of notification of test date; (2) short wait time for patients; and (3) speed of obtaining test results. Study findings also revealed that 23% of participating family physicians referred 25% or more of all patients needing cardiac diagnostic tests outside of their local LHIN, even though 80% of participants indicated that it is "important" or "somewhat important" to have their patients access cardiac diagnostic services within their local LHIN. Knowledge of the criteria that influence family physician decisions on where to refer patients for cardiac diagnostic testing may be used to assist both hospitals and private laboratories in better meeting the needs of physicians and patients. In particular, failure to meet physicians' expectations regarding fast access and communication of results can be expected to have a negative impact on referrals for cardiac diagnostic testing to a particular facility.

Identifying barriers to mental health system improvements: an examination of community participation in assertive community treatment programs.

BACKGROUND: Integrating the best available evidence into program standards is essential if system-wide improvements in the delivery of community-based mental health services are to be achieved. Since the beginning of the Assertive Community Treatment (ACT) program movement, program standards have included a role for the community. In particular, ACT program standards have sought to ensure that members of the local community are involved in governance and that former clients participate in service delivery as "Peer Support Specialists". This paper reports on the extent to which ACT program standards related to community participation have been implemented and identifies barriers to full compliance. METHODS: Qualitative and quantitative data were collected through a telephone survey of ACT Program Coordinators in Ontario, Canada, using a census sample of the existing 66 ACT programs. A thematic approach to content analysis was used to analyze respondents' qualitative comments. Quantitative data were analyzed using SPSS 16.0 and included means, frequencies, independent t-tests and Pearson Correlations. RESULTS: An 85% response rate was achieved. Of the 33 program standards, the two that received the lowest perceived compliance ratings were the two standards directly concerning community participation. Specifically, the standard to have a functioning Community Advisory Body and the standard requiring the inclusion of a Peer Support Specialist. The three major themes that emerged from the survey data with respect to the barriers to fully implementing the Community Advisory Body were: external issues; standard related issues; and, organizational/structural related issues. The three major themes concerning barriers to implementing the Peer Support Specialist role were: human resource related issues; organizational/structural related issues; and, standard related issues. CONCLUSIONS: The reasons for low compliance of ACT programs with community participation standards are complex and are tied to structural and human resources barriers (both internal and external to the ACT programs) as well as to the requirements of the standards themselves. In order for improvements to the mental health system to be achieved there is a need to identify and address these barriers. Failure to do so will result in less than optimal client, family and economic efficiency outcomes.

Achieving full compliance with standards for assertive community treatment programs in Ontario: does sponsoring agency type matter?

Assertive Community Treatment (ACT) programs provide community-based services for individuals with severe mental illness. In Ontario, these programs are funded by the Ministry of Health and Long-Term Care and administered through sponsoring agencies (hospitals, mental health facilities, and "other" community-based organizations). This article reports on the results of a survey of ACT programs and investigates the relationship between sponsoring agency type and ACT program operations. Findings and implications for policy makers and administrators are discussed.