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What Are The Roles Involved In Establishing And Maintaining Informational Continuity Of Care Within Family Practice? A Systematic Review

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2008
Abstract: 

Background: Central to establishing continuity of care is the development of a relationshipbetween doctor and patient/caregiver. Transfer of information between these parties facilitates thedevelopment of continuity in general; and specifically informational continuity of care. Weconducted a systematic review of published literature to gain a better understanding of the rolesthat different parties – specifically doctors, patients, family caregivers, and technology – play inestablishing and maintaining informational continuity of care within family practice.Methods: Relevant published articles were sought from five databases. Accepted articles werereviewed and appraised in a consistent way. Fifty-six articles were retained following title andabstract reviews. Of these, 28 were accepted for this review.Results: No articles focused explicitly on the roles involved in establishing or maintaininginformational continuity of care within family practice. Most informational continuity of careliterature focused on the transfer of information between settings and not at the first point ofcontact. Numerous roles were, however, were interpreted using the data extracted from reviewedarticles. Doctors are responsible for record keeping, knowing patients' histories, recallingaccumulated knowledge, and maintaining confidentiality. Patients are responsible for disclosingpersonal and health details, transferring information to other practitioners (including new familydoctors), and establishing trust. Both are responsible for developing a relationship of trust.Technology is an important tool of informational continuity of care through holding importantinformation, providing search functions, and providing a space for recorded information. There isa significant gap in our knowledge about the roles that family caregivers play.Conclusion: The number of roles identified and the interrelationships between them indicatesthat establishing and maintaining informational continuity of care within family practice is a complexand multifaceted process. This synthesis of roles provided serves as an important resource forcontinuity of care researchers in general, for the development of continuity of care qualityindicators, and for the practice of family medicine.

Document type: 
Article

A Method to Determine Spatial Access to Specialized Palliative Care Services Using GIS

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2008
Abstract: 

Background: Providing palliative care is a growing priority for health service administratorsworldwide as the populations of many nations continue to age rapidly. In many countries, palliativecare services are presently inadequate and this problem will be exacerbated in the coming years.The provision of palliative care, moreover, has been piecemeal in many jurisdictions and there islittle distinction made at present between levels of service provision. There is a pressing need todetermine which populations do not enjoy access to specialized palliative care services in particular.Methods: Catchments around existing specialized palliative care services in the Canadian provinceof British Columbia were calculated based on real road travel time. Census block face populationcounts were linked to postal codes associated with road segments in order to determine thepercentage of the total population more than one hour road travel time from specialized palliativecare.Results: Whilst 81% of the province's population resides within one hour from at least onespecialized palliative care service, spatial access varies greatly by regional health authority. Based onthe definition of specialized palliative care adopted for the study, the Northern Health Authorityhas, for instance, just two such service locations, and well over half of its population do not havereasonable spatial access to such care.Conclusion: Strategic location analysis methods must be developed and used to accurately locatefuture palliative services in order to provide spatial access to the greatest number of people, andto ensure that limited health resources are allocated wisely. Improved spatial access has thepotential to reduce travel-times for patients, for palliative care workers making home visits, and fortravelling practitioners. These methods are particularly useful for health service planners – andprovide a means to rationalize their decision-making. Moreover, they are extendable to a numberof health service allocation problems.

Document type: 
Article

Injury Surveillance in Low-Resource Settings Using Geospatial and Social Web Technologies

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2010
Abstract: 

Background: Extensive public health gains have benefited high-income countries in recent decades, however, citizensof low and middle-income countries (LMIC) have largely not enjoyed the same advancements. This is in part due to thefact that public health data - the foundation for public health advances - are rarely collected in many LMIC. Injury dataare particularly scarce in many low-resource settings, despite the huge associated burden of morbidity and mortality.Advances in freely-accessible and easy-to-use information and communication (ICT) technology may provide theimpetus for increased public health data collection in settings with limited financial and personnel resources.Methods and Results: A pilot study was conducted at a hospital in Cape Town, South Africa to assess the utility andfeasibility of using free (non-licensed), and easy-to-use Social Web and GeoWeb tools for injury surveillance in lowresourcesettings. Data entry, geocoding, data exploration, and data visualization were successfully conducted usingthese technologies, including Google Spreadsheet, Mapalist, BatchGeocode, and Google Earth.Conclusion: This study examined the potential for Social Web and GeoWeb technologies to contribute to publichealth data collection and analysis in low-resource settings through an injury surveillance pilot study conducted inCape Town, South Africa. The success of this study illustrates the great potential for these technologies to be leveragedfor public health surveillance in resource-constrained environments, given their ease-of-use and low-cost, and thesharing and collaboration capabilities they afford. The possibilities and potential limitations of these technologies arediscussed in relation to the study, and to the field of public health in general.

Document type: 
Article

Using GIS-Based Methods of Multicriteria Analysis to Construct Socio-Economic Deprivation Indices

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2007
Abstract: 

Background:

Over the past several decades researchers have produced substantial evidence of asocial gradient in a variety of health outcomes, rising from systematic differences in income,education, employment conditions, and family dynamics within the population. Social gradients inhealth are measured using deprivation indices, which are typically constructed from aggregatedsocio-economic data taken from the national census – a technique which dates back at least untilthe early 1970's. The primary method of index construction over the last decade has been aPrincipal Component Analysis. Seldom are the indices constructed from survey-based data sourcesdue to the inherent difficulty in validating the subjectivity of the response scores. We argue thatthis very subjectivity can uncover spatial distributions of local health outcomes. Moreover,indication of neighbourhood socio-economic status may go underrepresented when weightedwithout expert opinion. In this paper we propose the use of geographic information science (GIS)for constructing the index. We employ a GIS-based Order Weighted Average (OWA) MulticriteriaAnalysis (MCA) as a technique to validate deprivation indices that are constructed using morequalitative data sources. Both OWA and traditional MCA are well known and used methodologiesin spatial analysis but have had little application in social epidemiology.

Results:

A survey of British Columbia's Medical Health Officers (MHOs) was used to populate theMCA-based index. Seven variables were selected and weighted based on the survey results. OWAvariable weights assign both local and global weights to the index variables using a sliding scale,producing a range of variable scenarios. The local weights also provide leverage for controlling thelevel of uncertainty in the MHO response scores. This is distinct from traditional deprivationindices in that the weighting is simultaneously dictated by the original respondent scores and thevalue of the variables in the dataset.

Conclusion:

OWA-based MCA is a sensitive instrument that permits incorporation of expertopinion in quantifying socio-economic gradients in health status. OWA applies both subjective andobjective weights to the index variables, thus providing a more rational means of incorporatingsurvey results into spatial analysis.

Document type: 
Article

Mass Casualty Modelling: A Spatial Tool to Support Triage Decision Making

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2011
Abstract: 

BACKGROUND:During a mass casualty incident, evacuation of patients to the appropriate health care facility is critical to survival. Despite this, no existing system provides the evidence required to make informed evacuation decisions from the scene of the incident. To mitigate this absence and enable more informed decision making, a web based spatial decision support system (SDSS) was developed. This system supports decision making by providing data regarding hospital proximity, capacity, and treatment specializations to decision makers at the scene of the incident.METHODS:This web-based SDSS utilizes pre-calculated driving times to estimate the actual driving time to each hospital within the inclusive trauma system of the large metropolitan region within which it is situated. In calculating and displaying its results, the model incorporates both road network and hospital data (e.g. capacity, treatment specialties, etc.), and produces results in a matter of seconds, as is required in a MCI situation. In addition, its application interface allows the user to map the incident location and assists in the execution of triage decisions.RESULTS:Upon running the model, driving time from the MCI location to the surrounding hospitals is quickly displayed alongside information regarding hospital capacity and capability, thereby assisting the user in the decision-making process.CONCLUSIONS:The use of SDSS in the prioritization of MCI evacuation decision making is potentially valuable in cases of mass casualty. The key to this model is the utilization of pre-calculated driving times from each hospital in the region to each point on the road network. The incorporation of real-time traffic and hospital capacity data would further improve this model.

Document type: 
Article

Proximity of Public Elementary Schools to Major Roads in Canadian Urban Areas

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2011
Abstract: 

BACKGROUND:

Epidemiologic studies have linked exposure to traffic-generated air and noise pollution with a wide range of adverse health effects in children. Children spend a large portion of time at school, and both air pollution and noise are elevated in close proximity to roads, so school location may be an important determinant of exposure. No studies have yet examined the proximity of schools to major roads in Canadian cities.

METHODS:

Data on public elementary schools in Canada's 10 most populous cities were obtained from online databases. School addresses were geocoded and proximity to the nearest major road, defined using a standardized national road classification scheme, was calculated for each school. Based on measurements of nitrogen oxide concentrations, ultrafine particle counts, and noise levels in three Canadian cities we conservatively defined distances < 75 m from major roads as the zone of primary interest. Census data at the city and neighborhood levels were used to evaluate relationships between school proximity to major roads, urban density, and indicators of socioeconomic status.

RESULTS:

Addresses were obtained for 1,556 public elementary schools, 95% of which were successfully geocoded. Across all 10 cities, 16.3% of schools were located within 75 m of a major road, with wide variability between cities. Schools in neighborhoods with higher median income were less likely to be near major roads (OR per $20,000 increase: 0.81; 95% CI: 0.65, 1.00), while schools in densely populated neighborhoods were more frequently close to major roads (OR per 1,000 dwellings/km2: 1.07; 95% CI: 1.00, 1.16). Over 22% of schools in the lowest neighborhood income quintile were close to major roads, compared to 13% of schools in the highest income quintile.

CONCLUSIONS:

A substantial fraction of students at public elementary schools in Canada, particularly students attending schools in low income neighborhoods, may be exposed to elevated levels of air pollution and noise while at school. As a result, the locations of schools may negatively impact the healthy development and academic performance of a large number of Canadian children.

 

Document type: 
Article