Browsing by Author "Zarzeczny, Amy"

Now showing 1 - 14 of 14

Open Access
Assessing Value in Upstream Health Interventions: A Case Study of the Dr. Paul Schwann Centre Cardiac Rehabilitation Program
(Faculty of Graduate Studies and Research, University of Regina, 2015-07) Beck, Caroline Anna; Marchildon, Gregory; Zhang, Lihui; Zarzeczny, Amy; Mou, Haizhen; Daschuk, James
In the past several decades, a major ideological shift has occurred regarding the relative importance of broad socioeconomic factors as determinants of health over access to conventional health services. During this time, public health experts have continually re-emphasized the need to focus attention further “upstream” of disease, in order to prevent populations from developing poor health. While provincial health systems currently integrate some population and public health programming within the basket of services they offer, upstream health interventions represent only a very small proportion. While many factors can explain this pattern, one explanation is key; upstream health interventions must compete against conventional “downstream” services for a single funding pool, and in this evaluation process, three unique challenges arise. First, there must be a convincing argument that governments should intervene in these private markets to produce a socially optimal outcome. Second, there are unique challenges that arise in measuring the outcomes of upstream interventions, as upstream interventions tend to relate to broader social values that occur over the long-term rather than immediate, quantifiable improvements in health. Third, there have been structural challenges within the system of healthcare administration in Canada. As a result of these three challenges, upstream health interventions are often undervalued and can become subject to great financial instability. This is demonstrated by one upstream program in the Regina Qu’Appelle Health Region – the Dr. Paul Schwann Centre Cardiac Rehabilitation Program. This research investigates the policy problem of assessing value in upstream interventions through a case study of this upstream health intervention. Through a three-pronged analysis of program-level data, this thesis explores the question of how evidence in preventative health interventions can be synthesized with greater policy relevance to inform the reallocation of scarce healthcare dollars from downstream illness care interventions to the upstream. To explore these policy-relevant dimensions – effectiveness, client experience, and cost-effectiveness – three methodologies were used: (1) a quantitative analysis of available client health data to assess changes in health status throughout the program’s duration; (2) qualitative interviews with clients and staff to assess perceptions of experience, health impact, and overall value for money in the program; and (3) quantitative assessment of cost-effectiveness using economic evaluation techniques to allow for comparison to other health interventions. By comparing the results of these assessments to other studies from the literature, lessons were drawn regarding the potential health system value of such a program for the regional health system. While various methodological and data-related limitations must be recognized, this study demonstrates the ability to overcome some traditional challenges in the evaluation of upstream health interventions. As one example of this type of evaluation, this research acts as a guiding example for future studies examining health systems value of upstream interventions. By using multiple dimensions of relevance to policy and decision-making, findings of this research suggest that the use of mixed method research and evaluation methodologies may best illuminate the broader social and health-related outcomes of prevention-oriented programs in addition to their quantifiable outcomes.
Open Access
Exploring factors that influence trust in non-standard stem cell therapies among patients with musculoskeletal conditions
(Faculty of Graduate Studies and Research, University of Regina, 2024-06) Shaker, Marina; Zarzeczny, Amy; Longo, Justin; Yang, Yang
Although stem cell interventions (SCIs) may offer some therapeutic potential, the development of regulatory frameworks for their safe clinical application remains a significant challenge. As the regulation of these innovative therapies is still being developed, it is crucial to examine the factors that shape patients’ trust in these interventions that lack clear oversight. The purpose of this study is to explore the factors that influence the trust in nonstandard SCIs among patients with musculoskeletal disorders as well as their understanding of the role regulatory bodies play in ensuring safe and effective treatments. This understanding will be relevant to policy development and regulatory reform for innovative regenerative medicine therapies, potentially addressing the role that professional regulation plays in providing oversight of this developing field. This study employed a qualitative approach, using constructivist grounded theory. The data were obtained through in-depth, semi-structured one-on-one interviews with eight participants lasting from 45 to 75 minutes. The interview transcripts were analyzed initially with line-by-line coding, then focused coding. The codes were later collapsed and organized into categories, which guided theory construction. The findings unveiled a range of factors involving the patients, their knowledge of the intervention, and their practitioners that influence their trust in non-standard SCIs. The results also suggest that health practitioners play a central role in guiding participants' consideration of non-standard SCIs. This role also extends beyond medical doctors and includes allied healthcare professionals, as patients with musculoskeletal conditions often seek their services to manage their symptoms. Lastly, the results indicate a strong and implicit trust that patients place in regulatory bodies; suggesting that patients hold expectations of these bodies without a full understanding of how they meet them.
Open Access
Exploring the Adoption and Implementation of Healthcare Innovation: Case Studies of Two Antimicrobial Stewardship Programs in Saskatchewan
(Faculty of Graduate Studies and Research, University of Regina, 2019-08) Tambalo, Dinah; Zarzeczny, Amy; Katapally, Tarun; Phillips, Peter; Neudorf, Cordell; Domm, Elizabeth
Health innovations can play an important role in improving quality of care and in reducing healthcare costs. However, even promising innovations are not always successfully implemented because the process can be challenging. Thus, there is a significant gap between healthcare innovations and their application in routine practice. In this study, I explored determinants that influence adoption and implementation of a healthcare innovation, using the Regina Qu’Appelle Health Region (RQHR) and the Saskatoon Health Region (SHR) Antimicrobial Stewardship Programs (ASPs) as case studies. Considering the increasing risks of antimicrobial resistance, international bodies such as the World Health Organization, United Nations, the World Economic Forum and the Government of Canada have called for antimicrobial stewardship. Accreditation Canada has also required acute care facilities, inpatient cancer, inpatient rehabilitation and complex continuing care facilities to implement an ASP. Antimicrobial stewardship activities are focused on appropriate selection, dosing, route, and duration of antimicrobial therapy. I initiated this study prior to the amalgamation of the province’s health regional authorities into the Saskatchewan Health Authority (SHA). Understanding potential challenges and strategies adopted for the two health regions may help inform the development of a provincial antimicrobial stewardship approach as well as other healthcare institutions that are in the process of adopting or implementing their own ASP. I utilized a qualitative case study approach and conducted semi-structured interviews of eight stakeholders involved in the adoption and/or implementation of the RQHR and SHR ASPs. I included a prescribing physician, ASP implementing team members and organizational champions as study participants. I obtained additional information from the health regions’ websites, publicly available documents and the ASP teams. The RQHR and the SHR ASPs demonstrated a complex innovation process. The decision to adopt an ASP required multiple years, and various factors and stakeholders. Accreditation Canada’s requirement appeared to be the key determinant for the decision to adopt a formal ASP for both health regions. There were additional enabling factors for the RQHR: “policy push” from key healthcare institutions (e.g., the World Health Organization, United Nations and the Public Health Agency of Canada) and innovation champions. In terms of implementation, the majority of determinants that I identified for the health regions are shared: (1) dedicated resources and time for the ASP team; (2) data infrastructure; (3) availability of tools and information for prescribing physicians; (4) competencies of the ASP implementing team; (5) fit of the innovation to health professional’s values and goals; and (6) collegial conversations of the ASP team with prescribers. Most of these factors are consistent with published studies suggesting that these commonalities transcend different contexts. Thus, it may be helpful for healthcare organizations, including the newly established SHA, to pay attention to these factors when planning and/or implementing their ASPs. This study adds to the limited information on the adoption and implementation of ASPs in Canada and internationally. Despite Accreditation Canada’s ASP requirement, there appears to be limited ASP implementation in Canadian healthcare facilities. My study offers lessons and strategies that could facilitate planning and implementation of ASPs. Also, this research contributes to the growing area of implementation research and demonstrates the utility of using a theoretical framework to guide analysis of results.
Open Access
The Indian solution to the policy problem: Articulating Indigenous and colonial policymaking models using an Indigenous lens
(Faculty of Graduate Studies and Research, University of Regina, 2022-07) Opikokew Wajuntah, Cassandra Joy; McNutt, Kathleen; Boyer, Yvonne; Zarzeczny, Amy; Schneider, Bettina; Gunn, Brenda
A defining feature of the post-contact policymaking era between Western colonial governments and Indigenous communities was the creation of the so-called “Indian problem” as an actual phrase used within colonial governments (Satzewich 1997; Episkenew 2009; Erasmus 2003). More than a phrase though, the “Indian problem: was the misidentification of an issue that defined the relationship between Indigenous people and the colonial government from that point forward and it is the basic premise of all the paternalistic policies Indigenous people are still subject to in Canada, such as the Indian Act (1985). Though often referred to, the concept of the “Indian problem” has yet to be properly unpacked from a theoretical policy perspective. For the purposes of this study, the phrase “Western policymaking process” is used to denote the present-day policymaking process that evolved over time from the historical experience of European nations expanding into and colonizing Indigenous territories. The phrase encompasses more than a political history, but a policy tradition whereby colonial governments implemented their own forms of policymaking, such as the British during the colonization of Indigenous territories in the parts of the world now known as Canada, New Zealand, Australia and the United States. This policymaking process fails to create effective policies for closing the education, income and health gaps between Indigenous and non-Indigenous peoples in these countries. The resulting policy failures have led scholars to call for an examination of the policy process that looks at “systemic and foundational rather than attitudinal and incidental” solutions (Maaka and Fleras 2005). In this new era of espoused reconciliation, we see that both Indigenous communities and the colonial government are calling for the same thing – a new relationship. How do we capitalize on this emerging rhetorical opening? Why do policies and programs continue to fall short of truly improving Indigenous health, education and socio-economic outcomes? It is within this new intellectual space that the disconnect starts to become clearer – we may have begun to change the rhetoric but the way policies and programs continue to be delivered has remained largely unchanged. This paper unpacks the concept of the “Indian problem” utilizing western colonial policy theories to explain its permeance and endurance in modern day policies that continue to negatively impact Indigenous people. The western colonial policymaking model is also examined at its ontological, epistemological, and methodological levels via an Indigenous lens to expose its inherent limitations when applied in Indigenous contexts. An Indigenous research methodology is used to gather knowledge (collect data), make meaning (data analysis) and share stories (results) collected from ten participants affiliated with two Indigenous community partners – the All Nations Healing Hospital in Fort Qu’Appelle, Saskatchewan and Papa Ola Lokahi, a health service/advocacy organization with locations throughout the Hawaiian Islands. Through a combination of “talking story” sessions, archival research, and a review of Indigenous methodologies, an Indigenous policymaking model is articulated from its ontological and epistemological roots to its methodological approach. This model is presented as an experiential, multi-media art installation featuring the Indigenous policymaking model painted on a moose hide.
Open Access
‘My spirit is fed’: Exploring land-based, culturally appropriate active living strategies to facilitate holistic well-being among on-reserved youth: A Smart Platform study
(Faculty of Graduate Studies and Research, University of Regina, 2025-04) Walker, Susannah Lynn; Zarzeczny, Amy; Katapally, Tarun; Dupeyron, Bruno; Coates, Ken; Klest, Bridget; Green, Jacquie
A constructivist grounded theory approach with an Indigenous lens was used for a qualitative analysis of questions on culture, mental health, physical activity, and land-based activities. This analysis was undertaken as a part of the Smart Platform: Smart Indigenous Youth (SIY) project. The goals of the SIY were to increase physical activity using a cultural land-based active living intervention along with a technological component through an app. This thesis focused on the impact of the intervention on the mental health of on-reserve Indigenous youth in southern Saskatchewan; eleven on-reserve Indigenous youth shared their perceptions in focus groups before and after participating in the land-based intervention and thematic data analysis was performed. Themes included keeping culture going, community and cultural aspects of physical activity, and the importance of schools as key locations for reconnecting with culture. A theory of Indigenous identity was developed to provide insight into the complicated aspects in reconnecting with culture, especially the pressure, obligation, and responsibility that Indigenous youth feel towards passing on Indigenous culture. A notable finding was the improvement in mental health reported by participants after participating in the land-based intervention. Policy recommendations include the importance of early childhood access to cultural programs, the necessity of a mental health component as a part of land-based programs, and the need for inclusivity in land-based program teachings.
Open Access
Physician-assisted dying in Canada: Where do we stand after the Supreme Court's Decision in Carter v. Canada?
(2015-08) Zarzeczny, Amy
On February 6, 2015, the Supreme Court of Canada (SCC) released its judgment in Carter v. Canada, 2015 SCC 5 [Carter]. This much-anticipated decision changed the law relating to physician-assisted dying in Canada for individuals whose circumstances meet a list of conditions enumerated by the court, including a grievous and irremediable medical condition that causes enduring and intolerable suffering.
Open Access
Playing the (Policy) Fields: The Lesbian and Gay Movement and the Development of the Modernization of Benefits and Obligations Bill
(Faculty of Graduate Studies and Research, University of Regina, 2016-12) Boiteau, Meaghen Johanna; Dupeyron, Bruno; Carter, Claire; Zarzeczny, Amy; Beland, Daniel
The lesbian and gay rights movement in Canada has a rich history comprised of numerous groups and individuals that worked tirelessly for decades to promote lesbian and gay rights and champion for protections to the community at a number of levels. One of the primary challenges that occurred was in relation to relationship recognition. Throughout the 1970s, 80s, and 90s in Canada, the lesbian and gay movement worked to achieve relationship recognition, challenging the criminal code, human rights protections, and finally full relationship recognition through the Modernization of Benefits and Obligations Act in 2000. Using the theory of fields as outlined by Fligstein and McAdam (2012), this thesis will provide a comprehensive view to understanding select challenges that occurred to key policy fields in order to create the conditions which allowed for the passing of Bill C- 23 in Canada. I address the question of how the lesbian and gay community worked to challenge the policies that supported the Criminal Code and Human Rights frameworks – both of which inform understandings of ‘relationship politics’ – in order to re-define the underlying logic within the strategic action field of ‘relationship politics’, leading to a reconceptualization of it through the passing of Bill C-23 in 2000. In Chapter One, I introduce the lesbian and gay movement in Canada, presenting key achievements the movement made throughout the late-20th century. In Chapter Two, I provide a comprehensive overview of the ‘theory of fields’ as conceptualized by Fligstein and McAdam (2012), specifically how I will utilize their theory in order to explain the ways in which challenger groups and incumbent groups worked to effect change, or maintain the status quo, in relation to the various policy fields that were impacted leading to Bill C-23. In Chapter Three I introduce the field of ‘relationship politics’ that will provide the overview of my primary analysis, situating it in the context of the lesbian and gay movement. In Chapter Four I explore the lesbian and gay movement as a challenger group to ‘relationship politics’, paying close attention to the community mobilization and specific ‘shocks’ to ‘relationship politics’ that the movement was able to take advantage of, which opened up both the policy fields of the criminal code and human rights to lead to Bill C- 23. Finally, in Chapter Five I will focus on the incumbent group, Members of Parliament who were most in control of those policy fields that served to reinforce ‘relationship politics’. I will look at how the incumbent group worked to assert their views of ‘relationship politics’ when debating challenges that came forward, providing a deeper analysis around the specific episodes of contention to the main fields within my analysis. This analysis, while being somewhat unique to the lesbian and gay movement, will provide a framework for understanding how other social movement groups, through collective action and understanding the logic and composition of a variety of policy and public fields, may be able to affect change on a broad scale. The challenge for relationship recognition is somewhat unique in terms of the relative speed with which it came to be implemented, happening within a period of about 30 years. Understanding the numerous spaces through which change occurred, where challenges emerged, and how both challengers and incumbents worked to assert their relative positions, can allow for an understanding as to how other social movements may succeed – or, alternatively, fail – to achieve substantive social and policy change.
Open Access
Policy Implications of Smartphone Usage and Holistic Wellbeing Among Youth in Urban Saskatchewan: A Smart Platform Study
(Faculty of Graduate Studies and Research, University of Regina, 2021-12) Brodersen, Kayla Dawn; Katapally, Tarun; Hammami, Nour; Zarzeczny, Amy; Hirani, Shela
Background: Screen time on multiple digital devices has become an integral part of population behavior. Globally, populations have access to a variety of digital devices and engage in high levels of screen time activities starting in early childhood. It is well established that increased levels of screen time-based sedentary behaviours have significant negative impacts on health, however, the relationship between screen time behaviours, types of devices, and holistic wellbeing remains complicated and not well understood. In particular, smartphone technology has become increasingly popular and almost all age cohorts engage in smartphone usage for a wide variety of activities. Objectives: This study aims to investigate the relationship between screen time accumulated on smartphones and holistic wellbeing among youth and young adults (13 to 21 years) in Saskatchewan urban centres. This thesis will address the following questions: 1) Is there an association between smartphone usage (internet surfing, video gaming, texting, etc.) and mental health outcomes such as anxiety and depression?; 2) Is there an association between smartphone usage and physical health outcomes such as weight status?; and 3) Is there an association between smartphone usage and perceived health such as self-rated health and self-rated mental health? Methods: This study is part of the Smart Platform, a digital epidemiological and citizen science initiative for ethical population health surveillance, integrated knowledge translation, and policy interventions. Citizen science engages all participants throughout the research process either for contribution, collaboration, or co-creation of knowledge. Citizen scientists provided all data via their smartphones using a custom-built smartphone application, including a baseline questionnaire that combines validated self-report surveys to record physical activity, sedentary behaviours, screen time behaviours, demographic characteristics, and health outcomes such as mental wellbeing, weight status, and self-rated health. Results: 808 youth and young adult citizen scientists (aged 13 to 21) were recruited through Regina Public and Catholic School engagement sessions held in various high schools throughout Regina, Saskatchewan in 2018. Binomial Regression analyses were conducted to determine how quantitative measures inform the relationship between smartphone usage and holistic wellbeing in youth populations in Saskatchewan. Policy Implications: To our knowledge, this is the first digital epidemiological study to understand the association of smartphone usage with holistic health outcomes across youth and young adult populations. The findings of this study will have several policy implications, including: 1) Development of age-appropriate policy interventions to address smartphone usage; 2) Inform and influence ethical population health surveillance; 3) Advance recommendations for smartphone usage to deploy mHealth interventions to monitor, mitigate, and manage communicable and non-communicable diseases.
Open Access
Population Aging and Long-Term Care Policy Change in Canada: A Comparison of British Columbia, Manitoba, and Ontario
(Faculty of Graduate Studies and Research, University of Regina, 2014-11) Harris, Jonathan Brody; Marchildon, Gregory; Zarzeczny, Amy; Mou, Haizhen; Genoe, Rebecca
Introduction: Residential long-term care (LTC) is an important component of the care continuum for older adults in Canada. Three factors related to population aging are contributing to an increased demand for LTC services: 1) an increased prevalence of age-related health disorders; 2) reduced societal capacity to provide unpaid care; and 3) a lack of available substitutes for LTC. LTC is not one of Medicare’s insured services and as such great variation in the provision of LTC services exists across provinces. Provincial governments are currently grappling with how best to provide and pay for quality LTC services while also weighing investment in other aspects of the care continuum to delay or prevent LTC admission. Purpose: The purpose of this thesis is to examine LTC policy changes since 1990 and the impact these have had on LTC spending and quality in three provinces that represent natural policy experiments: British Columbia, where a disinvestment in LTC and concurrent investment in assisted living has taken place; Manitoba, one of the largest per capita spenders on both LTC and home care; and Ontario, which has essentially maintained the status quo. Methods: A retrospective comparative case study approach adapted from the work of Richard Rose (2005) is used to compare provincial experiences. Evidence was drawn from a comprehensive literature review of not only peer-reviewed literature but also grey literature, including policy and planning documents and advocacy group and think-tank reports. Descriptive analysis was performed on spending data obtained from the Canadian Institute for Health Information’s National Health Expenditures Database, and Quality data obtained from the Canadian Institute for Health Information’s Continuing Care Reporting System. Results: British Columbia’s strategy of investment in assisted living in lieu of LTC resulted in substantial cost savings since the early 2000s. LTC quality was best in Manitoba, where the per capita spend on LTC is highest, although resident populations varied slightly between provinces. Conclusions and Recommendations: While British Columbia has successfully reduced costs in the LTC sector by substituting assisted living, there is some evidence to suggest that this approach may create barriers to access and lead to downward pressures in other parts of the health system, particularly acute care. Investment in a robust continuum of care that includes support for informal carers, home care, respite care, assisted living, and LTC where appropriate seems the best way to meet the needs of the aging population while providing affordable and high quality LTC. Additionally, paradigms such as aging in place, although well-intentioned, may be misused by governments to achieve policy ends and can be a barrier to effective reform in the LTC sector. Keywords: Long-term care, continuing care, aging, health policy, health services.
Open Access
Professional Regulation: A Potentially Valuable Tool in Responding to ‘‘Stem Cell Tourism’’
(Elsevier, 2014-09-09) Zarzeczny, Amy; Caulfield, Timothy; Ogbogu, Ubaka; Bell, Peter; Crooks, Valorie A.; Kamenova, Kalina; Master, Zubin; Rachul, Christen; Snyder, Jeremy; Toews, Maeghan; Zoeller, Sonja
The growing international market for unproven stem cell-based interventions advertised on a direct-to-consumer basis over the internet (‘‘stem cell tourism’’) is a source of concern because of the risks it presents to patients as well as their supporters, domestic health care systems, and the stem cell research field. Emerging responses such as public and health provider-focused education and national regulatory efforts are encouraging, but the market continues to grow. Physicians play a number of roles in the stem cell tourism market and, in many jurisdictions, are members of a regulated profession. In this article, we consider the use of professional regulation to address physician involvement in stem cell tourism. Although it is not without its limitations, professional regulation is a potentially valuable tool that can be employed in response to problematic types of physician involvement in the stem cell tourism market.
Open Access
The hidden triad of cannabis influence
(Faculty of Graduate Studies and Research, University of Regina, 2024-07) Bojkovsky, Cynthia Dawn; Dupeyron, Bruno; Zarzeczny, Amy; Camillo, Cheryl; Mou, Haizhen; Novotna, Gabriela; Bear, Daniel
Description of the Problem In October 2018, the Government of Canada became the second country in the world to legalize non-medical cannabis, with the goal to promote better health and well-being amongst Canadians. To date, the ways in which young adults in Canada perceive and experience cannabis in this new legal context have been minimally explored and are not well understood. This research contributes important insights into how young adults in Saskatchewan perceive and understand their own health and well-being in relation to cannabis in a context of legal non-medical use. These findings are relevant for future policy and program developments in this area. Methods The objective of this study was to answer the primary research question “How do young adults perceive and experience cannabis use, in particular from a health perspective, in the context of Canada’s current policy frameworks?” This study applies constructivist grounded theory data collection and analysis techniques, guided by the work of Kathy Charmaz (2014). Data was collected through 10 in-depth interviews with young adults in Saskatchewan. The information was transcribed and thoroughly analyzed to transition from analytical findings to theoretical understanding. Secondary research questions addressed the relationship between cannabis related perceptions and experiences, influences shaping those perceptions and experiences, and the policy implications. Findings The main outcome from this study is entitled “The Hidden Triad of Cannabis Influence”, a grounded theory that explains how young adults perceive and experience cannabis within a legal non-medical and medical cannabis policy framework and an illicit market. Although the young adults who participated in this research tended not to outwardly identify policy and market factors as influencing their health and well-being, this theory substantiates the presence of these influences. The four main policy considerations emerging from this study include: • evaluate the short-term outcomes of non-medical cannabis legalization, including but not limited to input from young adults and qualitative research findings • develop a robust health literacy approach to promote public health objectives related to non- medical and medical cannabis use by young adults • improve supports in the health care system for medical use and misuse of cannabis to promote harm reduction • take additional measures to mitigate the illicit market for cannabis The results of this study offer preliminary evidence about how young adults perceive and experience their own health and well-being within a context of legal non-medical cannabis. Keywords Cannabis; marijuana; legalization; young adults; grounded theory; health policy; perceptions
Open Access
Unproven stem cell-based interventions & physicians’ professional obligations; a qualitative study with medical regulatory authorities in Canada
(BMC Medical Ethics, 2014-10) Zarzeczny, Amy; Clark, Marianne
Background - The pursuit of unproven stem cell-based interventions (“stem cell tourism”) is an emerging issue that raises various concerns. Physicians play different roles in this market, many of which engage their legal, ethical and professional obligations. In Canada, physicians are members of a self-regulated profession and their professional regulatory bodies are responsible for regulating the practice of medicine and protecting the public interest. They also provide policy guidance to their members and discipline members for unprofessional conduct. Methods - We conducted semi-structured telephone interviews with representatives from six different provincial Colleges of Physicians and Surgeons in Canada to discuss their experiences and perspectives regarding stem cell tourism. Our focus was on exploring how different types of physician involvement in this market would be viewed by physicians’ professional regulatory bodies in Canada. Results - When considering physicians’ professional obligations, participants drew analogies between stem cell tourism and other areas of medical tourism as well as with some aspects of complementary alternative medicine where existing policies, codes of ethics and regulations provide some guidance. Canadian physicians are required to act in the best interests of their patients, respect patient autonomy, avoid conflicts of interest and pursue evidence-based practice in accordance with accepted standards of care. Physicians who provide unproven treatments falling outside the standard of care, not in the context of an approved research protocol, could be subject to professional discipline. Other types of problematic conduct include referrals involving financial conflict of interest and failure to provide urgent medically necessary care. Areas of ambiguity include physicians’ obligations when asked for information and advice about seeking unproven medical treatments, in terms of providing non-urgent follow-up care, and when asked to support efforts to go abroad by providing tests or procedures in advance that would not otherwise be medically indicated. Conclusions - Specific policy guidance regarding the identified areas of tension or ambiguity may prove helpful for physicians struggling with these issues. Further consideration of the complex interplay of factors at issue in how physicians may (should) respond to patient demands related to unproven medical interventions while meeting their professional, legal and ethical obligations, is warranted.
Open Access
Using Data to Inform Appropriateness in Saskatchewan's Health Care System: A Snapshot of Low Acuity Emergency Department Use
(Faculty of Graduate Studies and Research, University of Regina, 2017-06) Todd, Tara Nicole; Marchildon, Gregory; Katapally, Tarun; Zarzeczny, Amy; Carleton, R. Nicholas; Pohler, Dionne
Background Emergency department (ED) use for low acuity medical conditions is widely regarded as a contributor to health system inefficiency. Low acuity conditions are semi-urgent or non-urgent conditions that can safely withstand 60 to 120 minutes prior to physician initial assessment. Low acuity ED attendance diverts limited resources away from patients with urgent conditions and creates increased demand for ED services. Low acuity conditions can also accrue higher costs at EDs than alternative primary care centres due to greater resource consumption and higher specialist fees. Continuity of care is compromised when patients consult EDs for low acuity conditions that have complex or chronic attributes. The objective of this study is to analyse ED utilization data to inform policies that support appropriate use of health care services. Methods A sample of 69,782 Regina and Saskatoon ED visits in 2012-13 were analyzed using descriptive analyses. Demographic and socioeconomic characteristics of patients, availability of existing primary care services, main medical problems, time of ED registration, and service provider for ED visit was analyzed. A macro-level comparative analysis was applied to Regina and Saskatoon and a meso-level comparative analysis was applied to communities within Regina and Saskatoon. Results In 2012-13, in urban Saskatchewan, 48.5% of ED visits were for low acuity conditions. Males and females used EDs in nearly equal proportions. Patients aged 18-44 constituted the highest proportion of ED use, at 42% of total visits. Patients using EDs at the highest rate reside in the S7M postal code area in Saskatoon and S4P area in Regina. These areas obtained the lowest median income in each municipality. S7M and S4P also showed the highest rate of existing primary care services in their immediate postal code area. Seventy-three percent of visits occurred during daytime hours (9:00 am to 10:00 pm). Medical conditions presented were largely due to chronic ailments or other family practice sensitive conditions. In Regina EDs, emergency specialists served the majority of patients (76.8%), while in Saskatoon, service was distributed as follows: emergency specialists (34.5%), GPs (25.6%), pediatrics (11.8%), RNs (10.3%), and internal medicine (9.4%). Discussion The greatest proportion of patients seeking low acuity ED care reside in low-income neighbourhoods and the presence of existing primary care centres near a patient’s residence may not avert the use of EDs. As such, adding primary care services in low-income neighbourhoods may not reduce low acuity ED use. Innovative strategies are required to meet primary care needs outside of the walls of EDs. Policy options are presented that empower patients through health literacy, promote sustainability through economic efficiency by replacing high-cost ED care with lower-cost primary care, and ensure quality and continuity of care for patients who require services beyond the biomedical model observed in EDs.
Open Access
Western Policy Analyst Quarterly Volume 4 Issue 1
(2012-10) Zarzeczny, Amy; Zhang, Lihui; Judge, Rahatjan; Whyte, John D.; Elliott, Doug
The CCSVI Wave Sweeps Saskatchewan – 1; Youth Bullying Victimization – 5; First Nation Education: Policy and Political Legitmacy – 7; Households, Families, and Living Arrangements – 10