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Background Frailty is associated with multi-system deterioration, and typically increases susceptibility to adverse events such as falls. Frailty can be better managed with early screening and intervention, ideally conducted in primary health care (PHC) settings. This study used the Consolidated Framework for Implementation Research (CFIR) as an evaluation framework during the second stage piloting of a novel web-based tool called the Frailty Portal, developed to aid in the screening, identification, and care planning of frail patients in community PHC. Methods This qualitative study conducted semi-structured key informant interviews with a purposive sample of PHC providers (family physicians, nurse practitioners) and key PHC stakeholders who were administrators, decision makers and staff. The CFIR was used to guide data collection and analysis. Framework Analysis was used to determine the relevance of the CFIR constructs to implementing the Frailty Portal. Results A total of 17 interviews were conducted. The CFIR-inspired interview questions helped clarify critical aspects of implementation that need to be addressed at multiple levels if the Frailty Portal is to be successfully implemented in PHC. Finding were organized into three themes 1) PHC Practice Context, 2) Intervention attributes affecting implementation, and 3) Targeting providers with frail patients. At the intervention level the Frailty Portal was viewed positively, despite the multi-level challenges to implementing it in PHC practice settings. Provider participants perceived high opportunity costs to using the Frailty Portal due to changes they needed to make to their practice routines. However, those who had older patients, took the time to learn how to use the Frailty Portal, and created processes for sharing tasks with other PHC personnel become proficient at using the Frailty Portal. Conclusions Structuring our evaluation around the CFIR was instrumental in identifying multi-level factors that will affect large-scale adoption of the Frailty Portal in PHC practices. Incorporating CFIR constructs into evaluation instruments can flag factors likely to impede future implementation and impact the effectiveness of innovative practices. Future research is encouraged to identify how best to facilitate changes in PHC practices to address frailty and to use implementation frameworks that honor the complexity of implementing innovations in PHC.

IntroductionThe COVID-19 pandemic has made long-standing nursing workforce challenges apparent on an international scale. Decision-makers must develop multi-pronged approaches to foster the development and maintenance of a strong nursing workforce to support health systems. These approaches require attendance to recruitment and retention initiatives that show promise for stabilising the nursing workforce now and into the future.Methods and analysisSearches were conducted across MEDLINE, Embase, CINAHL and Scopus from January 2014 up to 11 March 2024. This rapid umbrella review protocol is guided by the Joanna Briggs Institute scoping review methodology and adheres to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. The research question guiding this review is: what structures have healthcare systems put in place to stabilise, support and sustain the nursing workforce? This review will include existing reviews of nursing workforce initiatives with outcomes that impact nursing recruitment and retention. Results will support local health transformation including the development of a jurisdictional nursing workforce stabilisation strategy. Findings from this review will be relevant for the design, refinement and implementation of nursing workforce sustainability strategies in countries around the globe and may apply to strategies for other healthcare workers.Ethics and disseminationInstitutional research ethics board exemption was received. The research team is supported by an advisory group that includes provider and patient partners. The results from this study will inform the Nursing Workforce Strategy for the province of Nova Scotia as part of a larger Canadian Institutes of Health Research-funded project. They will also inform broader planning and strategy in Canada through integration with other evidence-generation activities such as comparative policy analyses and workforce planning exercises. Finally, the results will be published in a peer-reviewed journal.Review registration numberRegistered through Open Science Framework: https://doi.org/10.17605/OSF.IO/CUJYK

Background The post-pandemic expansion of virtual care in Nova Scotia aimed to improve access for patients without primary care providers. Virtual Care Nova Scotia, launched in 2021, and increased access, but equitable reach remained a concern. The Virtual Care @ Your Library (VC@YL) initiative addressed this gap by offering virtual healthcare access through public libraries in collaboration with government and health organizations. Methods This descriptive observational study applied the RE-AIM framework. Reach was assessed by the number of participants. Effectiveness was evaluated through service utilization and satisfaction. Adoption examined staff burden and role integration. Implementation fidelity and access barriers were documented. Maintenance was assessed via cost analysis and potential savings from avoiding emergency department (ED) and walk-in clinic visits under different utilization and cost scenarios. Results VC@YL engaged 518 unique users across 1,073 visits. Most users were aged 65+ (64.2%), citing technological barriers (75.4%) and support needs (77.6%) as primary reasons for use. All users successfully completed virtual care appointments, with 98% reporting positive experiences. Among library staff, 83% felt well-supported, and 65% of patron interactions required less than 15 min. Digital literacy assistance was the most common service (75.4%). The total project cost for VC@YL was $93,061, incorporating both one-time implementation and recurring staff costs. The cost per VC@YL utilization was $87. Avoided ED visits resulted in net savings of up to $63,614, though higher virtual care costs reduced savings in certain scenarios. Walk-in clinic diversions yielded negative cost savings due to the cost structure. Total savings ranged from $15,708 to $61,541, with per-person savings from $30 to $57, depending on virtual care consultation costs and utilization levels. Conclusions The VC@YL initiative demonstrated how community-based programs can effectively enhance access to virtual care, particularly for individuals facing technological barriers. This pilot project showed strong potential for improving healthcare access through practical support and leveraging existing community infrastructure. Its scalability and cost-effectiveness make it a promising model for broader implementation in similar settings.

Introduction Improving healthcare for people with multiple chronic or ongoing conditions is receiving increased attention, particularly due to the growing number of people experiencing multimorbidity (MM) and concerns about the sustainability of the healthcare system. Primary care has been promoted as an important resource for supporting people with MM to live well with their conditions and to prevent unnecessary use of health care services. However, traditional primary care has been criticized for not centring the needs and preferences of people with MM themselves. Our aim was to conduct a review that centred on the perspective of people with MM in multiple ways, including having patient partners co‐lead the design, conduct and reporting of findings, and focusing on literature that reported the perspective of people with MM, irrespective of it being experimental or nonexperimental. Methods We searched for published literature in CINAHL with Full Text (EBSCOhost) and MEDLINE All (Ovid). Findings from experimental and nonexperimental studies were integrated into collaboration with patient partners. Results Twenty‐nine articles were included in the review. Findings are described in five categories: (1) Care that is tailored to my unique situation; (2) meaningful inclusion in the team; (3) a healthcare team that is ready and able to address my complex needs; (4) supportive relationships and (5) access when and where I need it. Conclusion This review supports a reorientation of primary care systems to better reflect the experiences and perspectives of people with MM. This can be accomplished by involving patient partners in the design and evaluation of primary care services and incentivizing collaboration among health and social supports and services for people with MM. Patient or Public Contribution Patient partners were involved in the design and conduct of this review, and in the preparation of the manuscript. Their involvement is further elucidated in the manuscript text.

Objective The COVID-19 pandemic accelerated the use of virtual health care in Canada. Nova Scotia launched VirtualCareNS—a hybrid model integrating virtual and in-person primary care—to address access gaps. This rapid evaluation assesses its feasibility, preliminary economic outcomes, and stakeholder experiences. Methods A mixed-methods rapid evaluation design was employed, incorporating utilization and economic analyses. Surveys were completed by key informants, including users (N = 74,159), non-users (N = 3130), and implementation team members (N = 31). Interviews were conducted with providers (N = 8), implementation team members (N = 11), and platform users (N = 28). Results Over 101,000 virtual primary care visits were completed, with 76,054 unique profiles created. The cost per consultation was $123 (95% CI: $99–$149), and the net cost-savings per consultation was $85 (95% CI: $62–$111), primarily driven by reduced travel time and avoidance of emergency department and walk-in clinic visits. Patient satisfaction was high (91%), and providers reported improved access, especially for patients without a regular primary care provider. Conclusion Our rapid evaluation suggests that a hybrid model of virtual and in-person care can effectively address non-urgent care needs, generate cost savings, and improve access for both unattached and attached patients. VirtualCareNS benefits from dedicated leadership structures and integration with Nova Scotia's broader primary care services, positioning it as a scalable and sustainable approach to primary care delivery. Ongoing refinement—guided by user, provider, and implementation feedback—will be critical to realizing its full potential within the publicly funded health system.

Background The ongoing impacts of the COVID-19 pandemic on Canada’s healthcare workforce and service delivery necessitate focused health system planning and delivery that prioritizes coordination, collaboration, and evidence-based strategies. A rapid evidence synthesis was commissioned by Health Canada to determine the impacts of the pandemic on the healthcare workforce and to identify promising strategies and innovations that mitigate these challenges. Methods Two, sequential rapid evidence syntheses were conducted between October 2022 and March 2023 using methodologies aligned with Preferred Reporting Items for Systematic reviews and Meta-Analyses literature search extension (PRISMA-S) guidelines. The first review (October–November 2022) focused on the impacts of COVID-19 on Canadian healthcare workers and mitigation strategies, while the second (November 2022–March 2023) broadened the scope to international interventions. Findings were organized by impact level (individual, organizational, system). Quality assessment of sources was not performed. Results We included 176 and 31 sources, respectively in the analysis. Sources identifying impacts of the COVID-19 pandemic described significant mental health impacts on healthcare workers, alongside changes in demand and supply of services, physical health challenges, and shifts in scopes of practice or care models. Interventions were primarily targeted at the individual or organizational level and included mental health support, training and upskilling, enhanced organizational communication and workforce planning initiatives. System-level interventions were less common, and most interventions lacked robust evaluation or evidence-informed design. Conclusions This review highlights a significant gap in literature regarding evaluated interventions to address healthcare workforce challenges during the pandemic. While numerous sources document the adverse impacts on healthcare workers, detailed reports on specific interventions are scarce. Most interventions focus on workforce planning, education, practice scopes, recruitment and technology integration. The research underscores the need for comprehensive recommendations addressing social and mental health support, workplace safety, organizational communication and pandemic preparedness. These recommendations are vital for developing future workforce strategies, thus enabling policymakers and healthcare leaders to effectively respond to current and future healthcare challenges. This strategic approach will enhance system resilience and improve healthcare delivery across Canada.

Background Interprofessional primary care teams have been introduced across Canada to improve access (e.g., a regular primary care provider, timely access to care when needed) to and quality of primary care. However, the quality and speed of team implementation has not kept pace with increasing access issues. The aim of this research was to use an implementation framework to categorize and describe barriers and enablers to team implementation in primary care. Methods A narrative review that prioritized systematic reviews and evidence syntheses was conducted. A search using pre-defined terms was conducted using Ovid MEDLINE, and potentially relevant grey literature was identified through ad hoc Google searches and hand searching of health organization websites. The Consolidated Framework for Implementation Research (CFIR) was used to categorize barriers and enablers into five domains: (1) Features of Team Implementation; (2) Government, Health Authorities and Health Organizations; (3) Characteristics of the Team; (4) Characteristics of Team Members; and (5) Process of Implementation. Results Data were extracted from 19 of 435 articles that met inclusion/exclusion criteria. Most barriers and enablers were categorized into two domains of the CFIR: Characteristics of the Team and Government, Health Authorities, and Health Organizations. Key themes identified within the Characteristics of the Team domain were team-leadership, including designating a manager responsible for day-to-day activities and facilitating collaboration; clear governance structures, and technology supports and tools that facilitate information sharing and communication. Key themes within the Government, Health Authorities, and Health Organizations domain were professional remuneration plans, regulatory policy, and interprofessional education. Other key themes identified in the Features of Team Implementation included the importance of good data and research on the status of teams, as well as sufficient and stable funding models. Positive perspectives, flexibility, and feeling supported were identified in the Characteristics of Team Members domain. Within the Process of Implementation domain, shared leadership and human resources planning were discussed. Conclusions Barriers and enablers to implementing interprofessional primary care teams using the CFIR were identified, which enables stakeholders and teams to tailor implementation of teams at the local level to impact the accessibility and quality of primary care.

IntroductionAssessing and measuring patients’ chronic condition self-management needs are critical to quality health care and to related research. One in three adults around the world live with multiple chronic conditions. While many patient-reported measures of self-management have been developed, none has emerged as the gold standard, and all have one or more of the following limitations: (1) they fail to measure the different domains of self-management important to patients, (2) they lack sufficient specificity to support patient-centred care or identify the specific components of self-management interventions that work and/or (3) they lack suitability for patients with multiple chronic conditions.Methods and analysisThe Patient-Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC) is being developed to overcome these shortcomings. It will measure respondents’ perceived success (or difficulty) in self-managing seven domains important to patients. The protocol has three phases. Phase 1 is conceptual model development and item generation. Phase 2 is assessment of the relevance and understanding of items by people with chronic conditions. Phase 3 is item analysis, dimensionality assessment, scaling and preliminary validation of the PRISM-CC using an online survey of people with chronic conditions (n~750). The expected completion date is early 2021.Ethics and disseminationThis study will adhere to the Canadian Tri-Council Policy Statement on Ethical Conduct for Research Involving Humans. Ethics approval for all phases has been obtained from the Nova Scotia Health Authority Research Ethics Board. Once completed, the PRISM-CC will be made available for research and healthcare at minimal to no cost.

Background Respiratory viral illness (RVI)—e.g., influenza, COVID-19—is a serious threat in long-term care (LTC) facilities. Standard infection control measures are suboptimal in LTC facilities because of residents’ cognitive impairments, care needs, and susceptibility to loneliness and mental illness. Further, LTC residents living with high degrees of frailty who contract RVIs often develop the so-called atypical symptoms (e.g., delirium, worse mobility) instead of typical cough and fever, delaying infection diagnosis and treatment. Although far-UVC (222 nm) light devices have shown potent antiviral activity in vitro, clinical efficacy remains unproven. Methods Following a study to assay acceptability at each site, this multicenter, double-blinded, cluster-randomized, placebo-controlled trial aims to assess whether far-UVC light devices impact the incidence of RVIs in LTC facilities. Neighborhoods within LTC facilities are randomized to receive far-UVC light devices (222 nm) or identical placebo light devices that emit only visible spectrum light (400–700 nm) in common areas. All residents are monitored for RVIs using both a standard screening protocol and a novel screening protocol that target atypical symptoms. The 3-year incidence of RVIs will be compared using intention-to-treat analysis. A cost-consequence analysis will follow. Discussion This trial aims to inform decisions about whether to implement far-UVC light in LTC facilities for RVI prevention. The trial design features align with this pragmatic intent. Appropriate additional ethical protections have been implemented to mitigate participant vulnerabilities that arise from conducting this study. Knowledge dissemination will be supported through media engagement, peer-reviewed presentations, and publications. Trial registration ClinicalTrials.gov NCT05084898. October 20, 2021.

IntroductionCanadians report persistent problems accessing primary care despite an increasing per-capita supply of primary care physicians (PCPs). There is speculation that PCPs, especially those early in their careers, may now be working less and/or choosing to practice in focused clinical areas rather than comprehensive family medicine, but little evidence to support or refute this. The goal of this study is to inform primary care planning by: (1) identifying values and preferences shaping the practice intentions and choices of family medicine residents and early career PCPs, (2) comparing practice patterns of early-career and established PCPs to determine if changes over time reflect cohort effects (attributes unique to the most recent cohort of PCPs) or period effects (changes over time across all PCPs) and (3) integrating findings to understand the dynamics among practice intentions, practice choices and practice patterns and to identify policy implications.Methods and analysisWe plan a mixed-methods study in the Canadian provinces of British Columbia, Ontario and Nova Scotia. We will conduct semi-structured in-depth interviews with family medicine residents and early-career PCPs and analyse survey data collected by the College of Family Physicians of Canada. We will also analyse linked administrative health data within each province. Mixed methods integration both within the study and as an end-of-study step will inform how practice intentions, choices and patterns are interrelated and inform policy recommendations.Ethics and disseminationThis study was approved by the Simon Fraser University Research Ethics Board with harmonised approval from partner institutions. This study will produce a framework to understand practice choices, new measures for comparing practice patterns across jurisdictions and information necessary for planners to ensure adequate provider supply and patient access to primary care.