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The values of NAPCRG have been built upon participatory processes. The document, 'Responsible Research with Communities: Participatory Research in Primary Care,' (1) together with the recommendations for NAPCRG, was adopted [...]

Participatory research has been foundational to the values of NAPCRG. The document, 'Responsible Research with Communities: Participatory Research in Primary Care,' (1) together with the recommendations for NAPCRG, was adopted [...]

Context: When environmental tobacco smoke (ETS) is combined with other home-based exposures, such as mold, the risks to respiratory health are dramatically increased. Objective: To understand the relationships between the house, ETS and respiratory health outcomes of those living in the house. Design: The overall design was informed by the integration of community- based participatory research and transformative action research. This approach facilitated the process of co-creation, identifying issues of concern to the community, and utilizing the strengths and contributions of the community. Setting and Participants: One adult from each of the 238 homes in Sturgeon Lake First Nation, Saskatchewan, Canada. Intervention(s): Co-created community-based survey and house assessments. Results: The participation rate was 100% with 238 of 238 houses participating in both the survey and the house assessment. Almost half (47%) of the houses were smoke-free. Crowding was present in 67% of the houses with 19% having more than two persons/bedroom. House assessments revealed: 58% of homes had visible mold; 74% reported dampness in the house; 39% of houses reported a moldy/musty smell with 65% always having the smell present. Residents in the houses were treated for: wheeze (34.3%); bronchitis (27.9%); ear infection (23%); asthma (19.6%); tonsillitis (15.7%); pneumonia (13.2%); croup (9.4%); and respiratory viruses (8.0%). In the last five years hospitalizations for respiratory conditions were: pneumonia (14.8%); bronchitis (11.9%); asthma (9.4%); ear infection (8.0%); and tonsillitis (4.8%). Analysis reveals that when crowding was present in the house, the home was more frequently smoke-free. Moldy smell and visible mold in the house were significantly associated with respiratory health including tonsillitis, bronchitis, pneumonia, respiratory viruses, asthma, croup, ear infections, and wheeze. Having a moldy smell was strongly associated with both treatment and hospitalization for these conditions. Conclusions: Although smoke-free homes were important; mold in homes was more strongly associated with both treatment and hospitalization for respiratory conditions., Presenters Shelley Kirychuk, PhD, BSN, MBA, MSc, Vivian Ramsden, PhD, RN, MCFP (Hon.), Chandima Karunanayake, PhD, BSc, MSc, Brooke Thompson, Nicole Jacobson, MA, Larkin Lamarche, PhD, Norma Rabbitskin, [...]

PURPOSE Case management (CM) is a promising intervention for frequent users of health care services. Our research question was how and under what circumstances does CM in primary care work to improve outcomes among frequent users with chronic conditions? METHODS We conducted a realist synthesis, searching MEDLINE, CINAHL, Embase, and PsycINFO (1996 to September 2017) for articles meeting the following criteria: (1) population: adult frequent users with chronic disease, (2) intervention: CM in a primary care setting with a postintervention evaluation, and (3) primary outcomes: integration of services, health care system use, cost, and patient outcome measures. Academic and gray literature were evaluated for relevance and robustness. Independent reviewers extracted data to identify context, mechanism, and outcome (CMO) configurations. Analysis of CMO configurations allowed for the modification of an initial program theory toward a refined program theory. RESULTS Of the 9,295 records retrieved, 21 peer-reviewed articles and an additional 89 documents were retained. We evaluated 19 CM interventions and identified 11 CMO configurations. The development of a trusting relationship fostering patient and clinician engagement in the CM intervention was recurrent in many CMO configurations. CONCLUSION Our refined program theory proposes that in the context of easy access to an experienced and trusted case manager who provides comprehensive care while maintaining positive interactions with patients, the development of this relationship fosters the engagement of both individuals and yields positive outcomes when the following mechanisms are triggered: patients and clinicians feel supported, respected, accepted, engaged, and committed; and patients feel less anxious, more secure, and empowered to self-manage., INTRODUCTION Frequent users of health care services are a small proportion of the population who account for a disproportionate number of visits to emergency departments, thereby placing a heavy strain [...]

Background Clinical medicine saves lives only by advancing new knowledge and its implementation. Family Medicine is a clinical discipline. Ergo, family medicine must evolve based on new knowledge and its [...]

Case management (CM) is an intervention for improving integrated care for patients with complex care needs. The implementation of this complex intervention often raises opportunities for change and collective leadership has the potential to optimize the implementation. However, the application of collective leadership in real-world is not often described in the literature. This commentary highlights challenges faced during the implantation of a CM intervention in primary care for people with complex care needs, including stakeholders' buy-in and providers' willingness to change their practice, selection of the best person for the case manager position and staff turnover. Based on lessons learned from PriCARE research program, this paper encourages researchers to adopt collective leadership strategies for the implementation of complex interventions, including promoting a collaborative approach, fostering stakeholders' engagement in a trusting and fair environment, providing a high level of communication, and enhancing collective leadership attitudes and skills. The learnings from the PriCARE program may help guide researchers for implementing complex healthcare interventions. [ABSTRACT FROM AUTHOR]

On this, the 50th Anniversary of NAPCRG, we want to extend our thanks to those who have been members of NAPCRG over the past 50 years. Change in an organization [...]

OBJECTIVES: To determine among rural-dwelling on-reserve Saskatchewan First Nations people whether racial discrimination is associated with depression, and in turn, if this relationship is moderated by gender. METHODS: As a component of a community-based participatory research project, a cross-sectional, interviewer-administered survey of 874 adults living on 2 Cree First Nation reserves in rural north-central Saskatchewan was conducted during May-August in 2012 and 2013. Self-reported, health-provider diagnosis of depression was the dependent variable and experiences of interpersonal racial discrimination was the primary exposure. Chi-square and multiple logistic regression were the main analytic techniques. Generalized estimating equations were applied to account for clustering within households. RESULTS: Overall, 64% of participants reported being treated unfairly in 1 or more situations because of their ethnicity; 38% indicated discrimination occurring in 3 or more situations. Nineteen percent reported a diagnosis of depression. Adjusted analyses indicated that compared to those with no experience of racial discrimination, those reporting 1-2 and 3 or more situations were 1.77 times (95% CI: 1.06-2.95) and 1.91 times (95% CI: 1.19- 3.04) more likely to have diagnosed depression respectively. The relationship between racial discrimination and depression was not modified by gender, although women were 1.85 times (95% CI: 1.24-2.76) more likely to report depression than men. CONCLUSION: Interpersonal racial discrimination was associated with depression among First Nations women and men in rural Saskatchewan. Research directed at identifying the most efficacious interventions, programs and policies to combat racism is required to advance the goal of health equity. KEY WORDS: Racial discrimination; First Nations; depression OBJECTIFS : Determiner, chez les membres des Premieres Nations de la Saskatchewan vivant dans des reserves en zone rurale, si la discrimination raciale est associee a la depression et si, en retour, cette relation est modulee par le sexe. METHODE : Dans le cadre d'un projet de recherche participative communautaire, nous avons mene une enquete transversale administree par un intervieweur aupres de 874 adultes vivant dans deux reserves de la Premiere Nation crie dans le centre-nord rural de la Saskatchewan entre mai et aout en 2012 et en 2013. La variable dependante etait un diagnostic de depression autodeclare pose par un dispensateur de soins de sante, et l'exposition directe etait l'experience de la discrimination raciale interpersonnelle. Nos principales techniques etaient l'analyse du khi-carre et l'analyse de regression logistique multiple. Nous avons applique des equations d'estimation generalisees pour tenir compte des regroupements au sein des menages. RESULTATS : Dans l'ensemble, 64% des participants ont declare avoir ete traites injustement dans une situation ou plus en raison de leur ethnicite; 38% ont fait etat de discrimination dans trois situations ou plus. Dix-neuf p. cent ont dit avoir un diagnostic de depression. Les analyses ajustees ont indique que comparativement aux repondants n'ayant aucune experience de discrimination raciale, ceux qui ont declare une ou deux situations et trois situations ou plus etaient 1,77 fois (IC de 95% : 1,06-2,95) et 1,91 fois (IC de 95% : 1,19-3,04) plus susceptibles d'avoir un diagnostic de depression, respectivement. La relation entre la discrimination raciale et la depression n'etait pas modulee par le sexe, mais les femmes etaient 1,85 fois (IC de 95% : 1,24-2,76) plus susceptibles de declarer un diagnostic de depression que les hommes. CONCLUSION : La discrimination raciale interpersonnelle etait associee a la depression chez les femmes et les hommes des Premieres nations vivant en zone rurale en Saskatchewan. Pour atteindre l'objectif de l'equite en sante, il faut faire de la recherche pour determiner quels sont les interventions, les programmes et les politiques les plus efficaces pour combattre le racisme. MOTS CLES : discrimination raciale; Premieres Nations; depression, Racial discrimination is increasingly recognized within the population health literature as an important determinant of health inequities. Different levels of racial discrimination exist, ranging from structural to interpersonal, the latter [...]