The Medical Access to Service project was initiated to broadly engage participants in the health system to collectively improve service integration and patient access to primary care and specialist medical services. The Conference Model® (the Axelrod Group, Willmette, IL) was used as a change vehicle. The ideal design was translated into the creation of central access and triage (CAT) processes across medical specialties, development of prioritization tools and implementation of access and efficiency through Alberta AIM (access improvement measures) collaboratives for process re-engineering. The ultimate goal for all Albertans who need care is one point-of-access-one standardized process to ensure equal access for all regardless of where they live.
People with lived experience are individuals who have first-hand experience of the medical condition(s) being considered. The value of including the viewpoints of people with lived experience in health policy, health care, and health care and systems research has been recognized at many levels, including by funding agencies. However, there is little guidance or established best practices on how to include non-academic reviewers in the grant review process. Here we describe our approach to the inclusion of people with lived experience in every stage of the grant review process. After a budget was created for a specific call, a steering committee was created. This group included researchers, people with lived experience, and health systems administrators. This group developed and issued the call. After receiving proposals, stage one was scientific review by researchers. Grants were ranked by this score and a short list then reviewed by people with lived experience as stage two. Finally, for stage three, the Steering Committee convened and achieved consensus based on information drawn from stages one and two. Our approach to engage people with lived experience in the grant review process was positively reviewed by everyone involved, as it allowed for patient perspectives to be truly integrated. However, it does lengthen the review process. The proposed model offers further practical insight into including people with lived experience in the review process.
Depression is a major public health problem, with a lifetime and 12-month prevalence estimated at 18 and 6% of adults. Depression is costly in terms of treatment and lost productivity and is the main burden of mental illness across the globe. Existing pharmacological and psychological treatments for depression result in clinically meaningful improvements in <60% of patients. An emerging treatment approach is non-invasive brain stimulation of depression-related brain targets through transcranial magnetic stimulation (TMS). In this perspective, we detail our efforts on bringing TMS to clinical populations in Alberta by utilizing a novel organizational structure that bridges the gap between academia and the health care system. The Addictions and Mental Health Strategic Clinical Network worked with stakeholders to (1) examine the evidence, (2) develop clinical tools for patient selection and protocol application, (3) create overall implementation and evaluation plans to aid in further scale and spread, and even (4) fund the purchase and deployment of devices. Through this work, five publicly supported clinics now exist in Alberta.
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