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IntroductionWhile much of the literature on homelessness is centred on the experience of men, women make up over one-quarter of Canada’s homeless population. Research has shown that women experiencing homelessness are often hidden (i.e. provisionally housed) and have different pathways into homelessness and different needs as compared to men. The objective of this research is to identify evidence-based interventions and best practices to better support women experiencing or at risk of homelessness. MethodsWe conducted a scoping review with a gender and equity analysis. This involved searching MEDLINE, CINAHL, PsycINFO and other databases for systematic reviews and randomized trials, supplementing our search through reference scanning and grey literature, followed by a qualitative synthesis of the evidence that examined gender and equity considerations. ResultsOf the 4102 articles identified on homelessness interventions, only 4 systematic reviews and 9 randomized trials were exclusively conducted on women or published disaggregated data enabling a gender analysis. Interventions with the strongest evidence included post-shelter advocacy counselling for women experiencing homelessness due to intimate partner violence, as well as case management and permanent housing subsidies (e.g. tenant-based rental assistance vouchers), which were shown to reduce homelessness, food insecurity, exposure to violence and psychosocial distress, as well as promote school stability and child well-being. ConclusionMuch of the evidence on interventions to better support women experiencing homelessness focusses on those accessing domestic violence or family shelters. Since many more women are experiencing or at risk of hidden homelessness, population-based strategies are also needed to reduce gender inequity and exposure to violence, which are among the main structural drivers of homelessness among women.

IntroductionBien qu’une grande partie de la littérature sur l’itinérance porte principalement sur l’expérience des hommes, les femmes forment plus du quart de la populationdes sans-abri au Canada. Des études ont montré que les femmes en situation d’itinérance sont souvent cachées (c. à.-d. qu’elles sont logées provisoirement) et qu’à la fois le parcours qui les a menées à l’itinérance et leurs besoins sont différents de ceux des hommes. Cette recherche vise à cibler des interventions fondées sur des données probantes et des pratiques exemplaires aptes à mieux soutenir les femmes en situation ou à risque d’itinérance. MéthodologieNous avons effectué un examen de la portée accompagné d’une analyse fondée sur le sexe et l’équité. Pour ce faire, nous avons effectué des recherches dans MEDLINE, CINAHL, PsycINFO et d’autres bases de données afin de sélectionner les revues systématiques et les essais randomisés. Nous avons complété ces recherches par un passage en revue des références et de la littérature grise puis nous avons effectué une synthèse qualitative des données probantes portant sur les éléments liés au genre et à l’équité. RésultatsDes 4102 articles axés sur les interventions auprès de sans-abri que nous avons recensés, seuls 4 revues systématiques et 9 essais randomisés portaient exclusivement sur des femmes ou contenaient des données désagrégées permettant d’effectuer une analyse comparative entre les sexes. Parmi les interventions comportant les données les plus solides, mentionnons le counseling sur la défense des intérêts des femmes qui, après un passage en refuge, se retrouvent en situation d’itinérance pour cause de violence familiale, ainsi que la gestion de cas et les subventions pour un logement fixe (comme des bons d’aide au logement pour les locataires). Chacune de ces interventions a permis non seulement de réduire l’itinérance, l’insécurité alimentaire, l’exposition à la violence, aux refuges, l’insécurité alimentaire et la détresse psychosociale mais aussi de promouvoir la stabilité scolaire et le bien-être des enfants. ConclusionDes 4102 articles axés sur les interventions auprès de sans-abri que nous avons recensés, seuls 4 revues systématiques et 9 essais randomisés portaient exclusivement sur des femmes ou contenaient des données désagrégées permettant d’effectuer une analyse comparative entre les sexes. Parmi les interventions comportant les données les plus solides, mentionnons le counseling sur la défense des intérêts des femmes qui, après un passage en refuge, se retrouvent en situation d’itinérance pour cause de violence familiale, ainsi que la gestion de cas et les subventions pour un logement fixe (comme des bons d’aide au logement pour les locataires). Chacune de ces interventions a permis non seulement de réduire l’itinérance, l’insécurité alimentaire, l’exposition à la violence, aux refuges, l’insécurité alimentaire et la détresse psychosociale mais aussi de promouvoir la stabilité scolaire et le bien-être des enfants.

Background: Health equity concerns the absence of avoidable and unfair differences in health. Randomized controlled trials (RCTs) can provide evidence about the impact of an intervention on health equity for specific disadvantaged populations or in general populations; this is important for equity-focused decision-making. Previous work has identified a lack of adequate reporting guidelines for assessing health equity in RCTs. The objective of this study is to develop guidelines to improve the reporting of health equity considerations in RCTs, as an extension of the Consolidated Standards of Reporting Trials (CONSORT).Methods/design: A six-phase study using integrated knowledge translation governed by a study executive and advisory board will assemble empirical evidence to inform the CONSORT-equity extension. To create the guideline, the following steps are proposed: (1) develop a conceptual framework for identifying "equity-relevant trials," (2) assess empirical evidence regarding reporting of equity-relevant trials, (3) consult with global methods and content experts on how to improve reporting of health equity in RCTs, (4) collect broad feedback and prioritize items needed to improve reporting of health equity in RCTs, (5) establish consensus on the CONSORT-equity extension: the guideline for equity-relevant trials, and (6) broadly disseminate and implement the CONSORT-equity extension.Discussion: This work will be relevant to a broad range of RCTs addressing questions of effectiveness for strategies to improve practice and policy in the areas of social determinants of health, clinical care, health systems, public health, and international development, where health and/or access to health care is a primary outcome. The outcomes include a reporting guideline (CONSORT-equity extension) for equity-relevant RCTs and a knowledge translation strategy to broadly encourage its uptake and use by journal editors, authors, and funding agencies. [ABSTRACT FROM AUTHOR]

The objective of this study was to measure how primary care family physicians perceived their own and pharmacists' contributions to medication processes as pharmacists become integrated into primary care group family practices. The 22- item Family Medicine Medication Use Processes Matrix was mailed to physicians in seven sites at the 3rd, 12th and 19th month of pharmacist integration. Paired sample t-tests for the third month results were conducted to compare perceptions between pharmacist and physician contributions. One way repeated measure ANOVA test was conducted to determine significant changes over time. Physicians initially perceived their own contributions to be significantly higher than pharmacists in three subscales: Diagnosis & Prescribing, Monitoring and Administration/Documentation and their own contributions to be significantly lower than the pharmacists in the Education subscale. Over time, physicians perceived increases in the pharmacists' contribution to the Diagnosis & Prescribing, Monitoring and Medication Review subscales and decreases in their own contribution to the Diagnosis & Prescribing and Education subscales. Changes in family physicians' perceptions of pharmacists' contribution demonstrate an initial underestimate of pharmacists' role in primary care family practice and a gradual recognition of expertise and competence. This may have led to increased comfort in sharing aspects of contribution to medication use processes. [ABSTRACT FROM AUTHOR]

Purpose: Narratives can capture unfolding events and negotiation of roles and thus can help to evaluate interventions in interdisciplinary health care teams. We describe a practical qualitative method, the narrative report, and its role in evaluating implementation research.Methods: We used narrative reports as a means to evaluate an intervention to integrate pharmacists into group family practices. The pharmacists submitted 63 written narrative reports during a 1-year period. Our interdisciplinary research team analyzed these reports to monitor the progress of the implementation, to identify pharmacists' needs, and to capture elements of the integration process.Results: The monthly narrative reports allowed the research team to document early learning and calibrate the program in terms of clinical support, adapting roles, and realigning expectations. The reports helped the research team stay in tune with practice-related implementation challenges, and the preliminary summary of narrative findings provided a forum for sharing innovations among the integrating pharmacists.Conclusion: The narrative report can be a successful qualitative tool to track and evaluate the early stages of an intervention in the context of evolving primary health care teams. [ABSTRACT FROM AUTHOR]

Objective: To discover the prevalence of 4 preventable and treatable diseases among newly arriving refugees.Design: Retrospective cohort study.Setting: An immigrant-friendly family medicine centre in Ottawa, Ont, that offers newly arriving refugees a clinical preventive program following a specially designed protocol.Participants: A total of 112 adult government-assisted refugees seen during 2004 and 2005 within 6 months of arrival.Main Outcome Measures: Demographic information and prevalence of HIV infection, latent tuberculosis (TB), chronic hepatitis B surface antigen-positive status, and intestinal parasites.Results: Descriptive analysis revealed that 71% of the adults were younger than 35 years and 83% of them had come from sub-Saharan Africa. Disease prevalence rates were 6.3% for HIV (95% confidence interval [CI] 1.8 to 10.8), 49.5% for latent TB (95% CI 39.5 to 49.8), 5.4% for chronic hepatitis B surface antigen-positive status (95% CI 1.2 to 9.5), and 13.6% for intestinal parasites (95% CI 7.2 to 20.0). Most refugees (83%) successfully completed the preventive care program. Performing chi(2) analysis revealed a statistically significant higher risk of latent TB among the men (P < .032). Most of the women had never had a Papanicolaou test.Conclusion: Refugees are a vulnerable population with unique, but often preventable or treatable, health issues. This study demonstrated substantial differences in the prevalence of HIV, TB, chronic hepatitis B, and intestinal parasites between government-assisted refugees and Canadian residents. These health disparities and the emerging field of health settlement are new challenges for family physicians and other primary health care providers. [ABSTRACT FROM AUTHOR]

Problem Being Addressed: Canadian family physicians serve a patient population that is increasingly diverse, both culturally and linguistically. Family medicine needs to take a leadership role in developing social accountability and cultural sensitivity among physicians.Objective Of Program: To train medical students to work with newly arriving refugees, to foster competence in handling cultural issues, to raise awareness of global health, and to engage medical students in work with underserviced populations in primary care.Program Description: The program is composed of an Internet-based training module and a self-assessment quiz focused on global and refugee health, a workshop to increase competence in cultural matters, an experience working with at least 1 refugee family at a shelter for newly arriving refugees, family physician mentorship, and a debriefing workshop at the end of the experience. Students who complete this program are eligible for further electives at a refugee health clinic.Conclusion: The program has been received enthusiastically by students, refugees, and family physicians. Working with refugees provides a powerful introduction to issues related to global health and competence in cultural matters. The program also provides an opportunity for medical students to work alongside family physicians and nurtures their interest in working with disadvantaged populations. [ABSTRACT FROM AUTHOR]