Innovations in health service organization and delivery in northern rural and remote regions: a review of the literature

Mitton, Craig; Dionne, François; Masucci, Lisa; Wong, Sabrina T.; Law, Susan

doi:10.3402/ijch.v70i5.17859

Cited by 51 publications

(45 citation statements)

References 44 publications

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“…In Canada, geographic location may also present a significant barrier to healthcare services 14 . Residents of rural communities usually have access to a limited range of services and often have to travel long distances to reach urban clinics for specialized care 15 .…”

Section: Rheumatologymentioning

confidence: 99%

Treating Rheumatoid Arthritis to Target: A Canadian Physician Survey

Haraoui

Bensen²,

Bessette³

et al. 2012

J Rheumatol

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Objective.To assess agreement and application of Treat to Target (T2T) recommendations in Canadian practice.Methods.A survey of Canadian rheumatologists was conducted on the recommendations of T2T, an international initiative toward reaching specific therapeutic goals in rheumatoid arthritis. Agreement with each recommendation was measured on a 10-point Likert scale (1 = fully disagree, 10 = fully agree). A 4-point Likert scale (never, not very often, very often, always) assessed application of each recommendation in current practice. Responders who answered “never” or “not very often” were asked whether they were willing to change their practice according to the particular recommendation.Results.Seventy-eight rheumatologists responded (24% of the 330 who were contacted). The average agreement scores ranged from 6.92 for recommendation #5 (the frequency of measures of disease activity) to 9.10 for recommendation #10 (the patient needs to be involved in the decision-making process). A majority of participants indicated that they apply the T2T recommendations in their practice. Recommendations dealing with frequency of visits and the use of composite measures received the highest number of “never” or “not very often” responses. Busy practices and lack of confidence in composite outcome measures were the main reasons for objections to certain components of the recommendations.Conclusion.Although a majority of Canadian rheumatologists agreed with and supported the T2T recommendations, there was resistance toward specific aspects of these recommendations. Efforts are needed to better understand the reasons behind identified disagreements. Action plans to encourage the application of T2T recommendations in Canada are in development.

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Section: Rheumatologymentioning

confidence: 99%

Treating Rheumatoid Arthritis to Target: A Canadian Physician Survey

Haraoui

Bensen²,

Bessette³

et al. 2012

J Rheumatol

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“…The study’s findings reveal that participant interviews about the potential for mental health initiatives in Nunavut’s criminal courts focused primarily on 3 of 18 objectives of TJ principles, namely (1) identification, screening and assessment of people with mental illness; (2) treatment and (3) collaboration. Participants discussed these objectives and the role of remote geography in responding to people affected by mental illness in ways that align with the general view of Canadian rural and remote healthcare that “[t]he farther away the community is, the worse the health status of the population” [36]. Generally, scarce and often inaccessible mental health resources in Nunavut have been described as a key reason the justice system is “too often the first stop for troubled people who do not have access to care” [7].…”

Section: Discussionmentioning

confidence: 99%

Remoteness and its impact on the potential for mental health initiatives in criminal courts in Nunavut, Canada

Ferrazzi

Krupa

2018

International Journal of Circumpolar Health

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Remoteness in the isolated communities of Nunavut, Canada adversely affects access to mental health services. Mental health initiatives in criminal courts exist in many cities to offer healthcare alternatives to regular criminal court processing for people affected by mental illness. These initiatives do not exist in Nunavut. A qualitative multiple-case study in 3 Nunavut communities involving 55 semi-structured interviews and 3 focus groups explored perceptions by health, justice and community stakeholders of the potential for criminal court mental health initiatives in the territory. Findings suggest remoteness is perceived to hinder mental healthcare support for court responses to people affected by mental illness, creating delay in psychiatric assessments and treatment. While communication technologies, such as tele-mental health, are considered an effective solution by most health professionals, many justice-sector participants are sceptical because of perceived limits to accessibility, reliability and therapeutic value. These perceptions suggest remoteness is a significant hurdle facing future criminal court mental health initiatives in Nunavut. Additionally, remoteness is viewed as affecting decisions by lawyers to bypass legislated mental health avenues, possibly resulting in more people with mental illness facing criminal justice sanctions without assessment and treatment.

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“…Além disso, em regiões de difícil acesso aos serviços de saúde, como áreas remotas e rurais, foram encontradas inovações na organização e prestação de serviços de saúde, com a expansão dos papéis profissionais de enfermeiros e clínicos gerais para atender as necessidades daquelas populações 10 .…”

Section: Introductionunclassified