Projected Outcomes of an Expanded Role for Pharmacists in Publicly Funded Immunization Services in New Brunswick
by Dr. Chris Folkins, Clark Brewster, Rebecca Foster, Adrienne Gulliver & Emily Thomson
Abstract: In New Brunswick, pharmacy professionals can provide a range of immunizations to the public. However, only the provision of the influenza and COVID-19 vaccines are currently reimbursed by the government. Patients seeking other vaccines at pharmacies must pay out of pocket or use private insurance to cover both service fees and drug costs. Many vaccines are publicly-funded by the province and are available through physicians at no personal cost, yet thousands of residents are without family doctors and instead seek the convenience of pharmacies for this service, despite the price. Administrative data accessed through NB-IRDT was used to investigate how the expansion of publicly-funded vaccines administered by pharmacy professionals could impact health care costs, access to care, and health outcomes for New Brunswick. Linear regressions were performed to forecast pharmacist-administered vaccine counts and cost estimates for the year 2023 with the addition of two vaccines in pharmacists’ publicly-funded immunization scope. Based on eligibility criteria and ease of patient assessment, vaccines protecting against pneumonia, tetanus, diphtheria, and pertussis were included in our model. Our results suggest that by joining physicians in the administration of two additional vaccines, pharmacists could improve vaccine uptake in New Brunswick while reducing provincial health care costs. Expanding the scope of pharmacy professionals may also benefit the physician workforce; increasing pharmacists’ capacity to provide additional publicly-funded vaccines resulted in physician time savings. This translates into greater availability for family doctors to roster new patients. The application of our findings could result in health system savings, higher vaccine uptake rates, better access to primary care, and government investment in pharmacy services in New Brunswick.
Transitioning from Pediatric to Adult Healthcare: Exploring the Practices and Experiences of Care Providers
by Jennifer Splane, Dr. Shelley Doucet, Dr. Alison Luke
Abstract: Youth with complex care needs (CCN) experience complex health conditions, many of which were once seen as fatal and are now increasingly associated with survival into adulthood. As a result, more youth are transitioning from pediatric to adult healthcare as they approach adulthood. Current transition practices, when present, are disorganized, resulting in health status deterioration and complications due to unmet needs. The purpose of this qualitative descriptive study is to develop a broader understanding of the current transition practices and experiences, as well as recommendations of primary care providers, specialists, and subspecialists in the support of youth with CCN as they transition from pediatric to adult healthcare. A purposeful sample of 15 care providers from two Eastern Canadian provinces who support youth in the transition from pediatric to adult healthcare were interviewed using a semi-structured interview guide. The data collected was analyzed using inductive thematic analysis following the six phases outlined by Braun and Clarke (2006). The findings from this research demonstrate a shortage of care providers and lack of community services available for youth with CCN who move into adult health services. Moreover, participants indicated that a designated transition coordinator can enhance the transition process for the youth and stakeholders involved in their care. The results of this study can potentially improve transition practices and policies and guide future research in this area.
Improving the Pediatric to Adult Care Transition Experience: Recommendations from Young Adults with Complex Care Needs
by Monique Cassidy, Dr. Shelley Doucet and Dr. Alison Luke
Abstract: With advancements in modern medicine, an increasing number of youth with complex care needs (CCN) now survive into adulthood1. As service demands increase for this group, healthcare providers must determine the best way to meet their high resource needs. The process of transition to adult healthcare is a critical time for their overall life course and health outcomes for these youth with chronic conditions (e.g., T1 diabetes and anxiety)2. Following the transition to adult healthcare, youth are vulnerable to deteriorating outcomes (e.g., increased stress and costly ER visits)3. Seeking input from youth on their experiences with health services is a key step towards improving service delivery. This study aims to better understand the experiences of young adults with CCN who have transitioned from pediatric to adult healthcare services in New Brunswick. A qualitative descriptive design was used to describe the experiences of transitioning from pediatric to adult care. Semi-structured interviews were conducted with 23 young adults (aged 19-30). Maximum variation sampling was used. Interview questions were designed to identify specific gaps in transition services while providing recommendations to address these gaps. The analysis is ongoing. The following recommendation themes are emerging from the data: (a) proactive and personalized communications on ‘what to expect’ during transition; (b) peer support to facilitate transition; and (c) access to detailed information on health-related resources and services (e.g., insurance). Results from this study will inform policy in NB and lead to the development of necessary service delivery improvement strategies.
by Alison Balcom
Abstract: The long-term health consequences of COVID-19 school closures and associated learning losses remain largely unexplored. Researchers estimate that up to 90 percent of health outcomes are attributable to non-medial lifestyle factors known as social determinants of health. Heart disease, obesity, mental health complications, and life expectancy are all associated with education. Education is particularly important because it impacts other determinants, including employment, social support, healthcare access, and housing. New Brunswick students were out of school for nearly six months due to COVID-19 closures beginning in March of 2020. Evidence suggests that students' lost learning is equivalent to or even greater than the duration of school closures and remote learning implementation. School closures also exacerbate pre-existing inequities within populations.
This research utilizes secondary data from the Programme for International Student Assessment (PISA) to illustrate the troubling educational landscape for New Brunswick prior to COVID-19, project long-term health consequences of learning loss within New Brunswick, and emphasize that education must be a foremost public health priority moving forward. New Brunswick has the largest proportion of students who do not meet the literacy standard necessary for full societal participation among provinces. Interventions to mitigate learning losses may help minimize long-term health consequences for New Brunswickers. International authorities have emphasized the need for inter-sectoral collaboration to prioritize public health. As New Brunswick transitions to recovery, we need prompt consideration of the potentially devastating long-term health consequences of COVID-19 associated learning losses.
by Fareeha Quayyum, Dr. Shelley Doucet, Dr. Alison Luke and Amy Reid
Abstract: The purpose of this study is to explore barriers and facilitators to dementia diagnosis and post-diagnostic support from the perspective of persons with dementia (PWD) and their care partners (CP) such as family members or friends, as well as health and social care providers (HSCP) in New Brunswick. Semi-structured individual interviews and focus groups were conducted with CP, PWD, and HSCP. Qualitative interview data were analyzed in NVivo using Braun and Clarke’s (2006) six phases of thematic analysis. Key barriers that have emerged related to diagnostic and post-diagnostic care include: lack of access and support, ‘no continuity of care’, stigma, and burnout. Facilitators included: education, compassionate care, establishing a network of support, ‘upholding personhood’ of PWD, and support to navigate the system. Participants called for greater integration of dementia care and system navigation supports to fill in current gaps of dementia care. Ensuring that CP and PWD have consistent and regular access to formal emotional, practical, and medical support is crucial in eliminating barriers to dementia care in New Brunswick.
Exploring Patient Navigation for People with Dementia, Their Caregivers, and the Care Team in Canada
by Matt Douglas, Dr. Shelley Doucet, Dr. Allison Luke, Grailing Anthonisen and Hannah Trites
Abstract: Persons with dementia, their caregivers, and the care team face many barriers, such as a lack of knowledge about dementia services and caregiver burnout. These challenges are worsened by uncoordinated dementia care and a fragmented health system. Patient navigation (PN) is a cost-effective approach to address the care needs of this population by helping them navigate the complex range of services. An environmental scan was undertaken to identify existing PN programs in Canada and describe their structure and functions. Organizations were included in the scan if they provided a PN service for persons with dementia, their caregivers, and the care team; had a specific position designated to perform the navigation roles; and were based in Canada. A survey was created using the web-based Qualtrics software and was sent to previously identified key contacts. Eleven responses were received across six provinces. The data collected included information on demographics, service characteristics, navigator role characteristics, caseloads, and evaluations. All PN programs provided emotional support, facilitated linkages to other community supports, and built caregiver capacity through advice and support. The findings provide contextual information to support organizations in developing and implementing PN programs for people with dementia, their caregivers, and the care team. The consensus gathered by this scan can help streamline the design of future and existing PN programs, which may lead to improved experience with health and social care systems for this population, increased access to resources and support, and improved health outcomes.
Assessment of Community Resources and Services for People with Cancer and their Families in New Brunswick: An Environmental Scan
by Emma Lynch, Danie A. Beaulieu, Dr. Shelley Doucet, Dr. Alison Luke, Dr. Julie Easley, Stephanie McIntosh Lawrence and Charlotte Schwarz
Abstract: Cancer is one of the most frequent diagnoses of chronic illnesses and the main cause of death among New Brunswickers. Supportive care services can help address the physical, emotional, mental, social, and spiritual needs of those who have received a cancer diagnosis and their families. The availability of supportive care services can improve the quality of life, and lead to higher survival rates among cancer patients. The primary objective of this environmental scan is to identify supportive care programs and community resources currently available in New Brunswick. The environmental scan consisted of a review of grey literature for health and supportive care services for individuals with cancer, cancer survivors, their families, and caregivers in New Brunswick. A data extraction sheet was used to ensure we were extracting consistent information. Additional services were found after verifying services with oncology centres, cancer navigation program coordinators, and support groups. All services included were validated by contacting the organizations. Supportive care services were organized into active cancer support groups, active cancer general health services, and active cancer specific health services in New Brunswick. The service type, location of services, population targeted/eligibility, type of service, delivery method, and language of service are identified in the results. The environmental scan offers an overview of supportive care services available in New Brunswick. The results highlight that while some supportive care services are available in New Brunswick, they are often difficult to identify, and are not accessible to all. A gap in services exists, particularly for individuals who are no longer receiving cancer treatment, family members, and caregivers.
by Wanqin Yu and Jonathan Wilbiks
Abstract: Studies conducted in several countries found that university students tended to have high risk perceptions of the coronavirus disease (COVID-19) infection, to worry a lot about the pandemic, and to perceive the COVID-19 pandemic as having negative impacts on their everyday life and academic studies. Therefore, the purpose of the present study is to examine the interrelationships between the beliefs and worries university students in Canada have about the COVID-19 pandemic and its perceived impacts on successfully completing their academic studies. It is hypothesized that students who perceive higher risks of COVID-19 infection and who are more worried about contracting COVID-19 will also perceive the impacts of the pandemic on their academic studies more negatively. The participants in this study were undergraduate students currently enrolled at the University of New Brunswick, who were asked to fill out an online survey consisting of demographic questions and scales assessing their risk perceptions, anxiety, and perceived impacts regarding the COVID-19 pandemic. The collected data were analyzed using JASP Statistics to conduct correlation and multiple regression tests. Results showed that students who perceived higher risks of COVID-19 infection also worried more about the COVID-19 pandemic, and that higher risk perceptions, more COVID-19-related worries, and higher generalized anxiety levels all predicted more negative perceived impacts of the pandemic on their academic studies. These results suggest the importance of monitoring the mental health of university students during global pandemics.
by Taylor Hill, Sophie Keddy, Alanna Kaser, Lindsay Heyland
Abstract: Positive mental health promotion is an emerging field within community mental health, as programming and policy efforts devoted to promoting mental health are beginning to surface. These efforts are varied in scope and nature, and there is little consensus across theoretical background or evidence base, program best practices, and alignment with provincial mental health policy. This study protocol outlines a scoping review of peer-reviewed and grey literature, to map positive mental health promotion by identifying the characteristics and participants of such programs and the contexts of their implementation. We will also document the current offerings in a Canadian province to provide insight into the types, scope, and nature of the programs currently and previously available to community residents and assess fit with the best available evidence identified from the peer-reviewed literature. To be included, peer-reviewed literature must be relevant to community mental health promotion, and grey literature must contain details of relevant programs accessible to the general community. Papers published after 2000 in English, on primary studies evaluating or documenting positive mental health promotion programs, will be included. Grey literature from an environmental scan of existing local programs will be included. Data to be extracted includes program scope, content, materials and methods, evaluation methodology, and outcomes. The results of this review will be synthesized evidence on best practices and promising indicators of community-embedded mental health promotion programs, which seek to promote positive mental health in the general population, and an application these findings to an environmental scan of existing programs in Nova Scotia.
by Julia Besner, Dr. Shelley Doucet, Dr. Alison Luke, Julia Besner, Grailing Anthonisen, Lillian MacNeill, Luke MacNeil, Matt Douglas and Hannah Trites
Abstract: Dementia in Canada is increasing. It is a complex disease with varying needs throughout different stages, resulting in fragmented and uncoordinated care. This results in barriers from diagnosis through end-of-life care. Patient navigation has been shown to support people with dementia and their caregivers across various care settings. The aim of this study was to explore how dementia patient navigation can be implemented in New Brunswick (NB). The study used a qualitative descriptive design. Participants were recruited through health, social, and community organizations focused on dementia/senior care in NB. Interviews were conducted via zoom over a four-month period. Additional data from a related project was utilized for data from people with dementia. Twenty-seven participants were interviewed including geriatricians, nurses, social workers, administrators, decision makers, and caregivers. Challenges to dementia care navigation included lack of education and navigational support among care providers, people with dementia, and caregivers. Additionally, siloed systems prevent a common entry point to dementia care. People with dementia and caregivers also identified a lack of peer and emotional support. Care coordination; patient-centred care; connecting services and resources; timely diagnosis; and education were identified needs. In-person care navigation was prioritized by most participants. The findings recognize challenges of dementia care navigation, and the need for improved dementia care coordination in NB. They support previous findings from other studies showing that dementia care is often uncoordinated and lacking support, and that in-person patient navigation is a valued tool to improve the quality of dementia care.