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Examination of the British Columbia influenza prevention policy for healthcare workers: Phase 1 qualitative case study.

ABSTRACT: In August 2012, British Columbia became the first Canadian province to implement a province-wide Influenza Prevention Policy requiring all healthcare workers (HCWs) in residential and acute care facilities to either be immunized against influenza, or wear masks in patient care areas during the influenza season. This qualitative case study sought to understand the key facilitators and barriers involved in developing and implementing British Columbia's Influenza Prevention Policy. An explanatory qualitative case study approach was selected for this project. Data were collected through the review of 110 documents (policy and planning documents, implementation tools, press releases, communication materials, etc.), and through 7 focus groups with policy implementation team members (n = 48). Focus group interview transcripts were analyzed using Framework Analysis methods, and Prior's approach guided document analysis. Four themes were identified: (1) Clashing paradigms, (2) Policy implementation gaps, (3) Pathways of power, and (4) Personal impacts. Issues embedded in macro-, meso-, and micro-level contexts, and planning across the province, were identified as critical to policy implementation. A province-wide approach with senior-level engagement and dedicated resources is critical in a province-wide influenza prevention policy for HCW. Recommendations to improve large-scale implementation of condition-of-service influenza policies include: engaging stakeholders early, considering the complexity of political contexts, allotting time to plan appropriately, developing 'enforcement' plans, and providing education and skills to frontline providers.

SUBMITTER: McPherson CM

PROVIDER: S-EPMC6149879 | biostudies-other | 2018

REPOSITORIES: biostudies-other

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Examination of the British Columbia influenza prevention policy for healthcare workers: Phase 1 qualitative case study.

McPherson Charmaine M CM Halperin Donna M DM Henry Bonnie B Di Castri Antonia M AM Kwong Jeffrey C JC

Human vaccines & immunotherapeutics 20180510 8

In August 2012, British Columbia became the first Canadian province to implement a province-wide Influenza Prevention Policy requiring all healthcare workers (HCWs) in residential and acute care facilities to either be immunized against influenza, or wear masks in patient care areas during the influenza season. This qualitative case study sought to understand the key facilitators and barriers involved in developing and implementing British Columbia's Influenza Prevention Policy. An explanatory q ...[more]

PMID: 29617181

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Project description:BackgroundPublic health strategies that focus on legislative and policy change involving chronic disease risk factors such as unhealthy diet and physical inactivity have the potential to prevent chronic diseases and improve quality of life as a whole. However, many public health policies introduced as part of public health reform have not yet been analyzed, such as in British Columbia and Ontario. The purpose of this paper is to present the results of a descriptive, comparative analysis of public health policies related to the Healthy Living Core Program in British Columbia and Chronic Disease Prevention Standard in Ontario that are intended to prevent a range of chronic diseases by promoting healthy eating and physical activity, among other things.MethodsPolicy documents were found through Internet search engines and Ministry websites, at the guidance of policy experts. These included government documents as well as documents from non-governmental organizations that were implementing policies and programs at a provincial level. Documents (n = 31) were then analysed using thematic content analysis to classify, describe and compare policies in a systematic fashion, using the software NVivo.ResultsThree main categories emerged from the analysis of documents: 1) goals for chronic disease prevention in British Columbia and Ontario, 2) components of chronic disease prevention policies, and 3) expected outputs of chronic disease prevention interventions. Although there were many similarities between the two provinces, they differed somewhat in terms of their approach to issues such as evidence, equity, and policy components. Some expected outputs were adoption of healthy behaviours, use of information, healthy environments and increased public awareness.ConclusionsThe two provincial policies present different approaches to support the implementation of related programs. Differences may be related to contextual factors such as program delivery structures and different philosophical approaches underlying the two frameworks. These differences and possible explanations for them are important to understand because they serve to contextualize the differences in health outcomes across the two provinces that might eventually be observed. This analysis informs future public health policy directions as the two provinces can learn from each other.

Project description:BackgroundIn 2011, the province of British Columbia (BC) moved to allow patients with complex rheumatic disease to be seen by nurses along with their rheumatologist by introducing a 'Multidisciplinary Care Assessments' (MCA) billing code (G31060).ObjectiveTo describe multidisciplinary care introduced as part of MCAs across BC and investigate the perceived impact of this intervention, the addition of nurses to the care team, on patient care from the perspective of patients, nurses, and rheumatologists.MethodsWe conducted semi-structured interviews, informed by a qualitative evaluation approach with patients, nurses, and rheumatologists from September 2019 - August 2020. Interviews investigated 1) the experiences of all stakeholders with adopting the multidisciplinary care billing code, 2) the perceived role of the nurse in the care team, and 3) the perceived impact of multidisciplinary care on patient experience and outcomes. We purposefully sampled practices for maximum variation of geographical location (rural vs. urban), size of practice (i.e., patient caseload), and number of nurses employed.ResultsWe interviewed 21 patients, 13 nurses, and 12 rheumatologists from across BC. Our analysis identified variation in the way rheumatologists adopted multidisciplinary care across BC. Our analysis showed some heterogeneity in the way the MCA was delivered in rheumatology practices; however, patient education was identified as the core role of nurses across practices. We identified six core themes describing the impact of this model of care, all representing improvements in the way practices functioned, from improved efficiency to access, patient experience, time management, clinician experience, and patient health outcomes. Contextual factors that influenced the presence of these themes were related to the time the nurses spent with patients and the professional roles they performed.ConclusionOur results suggest nurse care can complement physician care by extending contact time for patients and promoting the efficient use of health care professionals' skills, time, and resources. These data may encourage future uptake of the billing code to help ensure the policy delivers maximum benefits to patients given the wide range of perceived benefits described by clinicians and patients.

Project description:BackgroundBritish Columbia falls short in uptake of recommended clinical prevention services, with even lower rates among immigrant populations. This study explored facilitators of and barriers to uptake of clinical prevention services among people from South Asia, who represent 31% of the population in Surrey, British Columbia.MethodsWe used a qualitative descriptive approach and employed vignettes in a focus group setting to elicit perspectives of South Asian people on accessing clinical prevention services. Participants aged 40 years or more were recruited between October 2014 and February 2015 from health care and community settings such as older-adult housing, day programs and health education events. Letters of introduction to the study were provided in English or Punjabi or both to all potential participants. We conducted qualitative content analysis of the results.ResultsSixty-two South Asian adults (36 women and 26 men) aged 40-87 years participated in 1 of 8 focus groups in health care or community settings. Facilitators of and barriers to accessing clinical prevention services were noted at the patient, primary care provider and health care system levels. Facilitators at the patient level included taking ownership over one's health, health literacy and respecting the provider's advice; barriers included fear of the diagnosis, death and/or procedures, perceived low risk of disease or utility of the intervention, and side effects of procedures. Provider factors centred on a trust-based patient-provider relationship, strong communication and adequate time during visits. Health care system factors included such facilitators as processes to routinely offer prevention services as part of other health care or social services, systems that encourage prevention-oriented family practice and services at low or no cost to the patient.InterpretationOur findings validate previously identified facilitators of and barriers to accessing preventive care for immigrant populations. However, the results suggest that system-level factors influencing the duration of primary care visits may have a more salient impact on uptake of clinical prevention services in this population.

Project description:BackgroundThe province of British Columbia (BC), Canada, was among the first jurisdictions to scale up HIV Treatment as Prevention (TasP) to the population level, including funding and policy commitments that enhanced HIV testing efforts (e.g., expansion of routine, opt-out testing), while also making antiretroviral therapy universally available to all people living with HIV. As such, BC represents a critical context within which to identify factors that influenced the scalability of TasP (e.g., acceptability, adoption, fidelity, equitable reach, sustainability), including key opportunities and challenges.MethodsWe draw on in-depth, semi-structured interviews with 10 key stakeholders, comprised policymakers at the local and provincial levels and representatives from community-based organizations. Using the Consolidated Framework for Implementation Research (CFIR) to guide data collection, coding, and analysis, we identified key factors that influenced practice transformation and scale up.ResultsKey factors that contributed to the successful scale up of TasP included: (i) opportunities that enhanced stakeholder buy-in based on features of the intervention characteristics, including with regard to assessments about the quality and strength of evidence supporting TasP; (ii) an inner setting implementation climate that was, in part, shaped by the large and highly symbolic government investments into TasP; (iii) features of the outer setting such as external policies (e.g., harm reduction) that cultivated opportunities to implement new "systems-level" approaches to HIV intervention; (iv) the personal attributes of some "middle-level" influencers, including a team that was comprised of some highly motivated and social justice-oriented individuals (e.g., folks who were deeply committed to serving marginalized populations); and (v) the capacity to develop various implementation processes that could maintain "nimble and evidence-informed" adaptations across a highly decentralized service delivery system, while also creating opportunities to adapt features of TasP programming based on "real time" program data.ConclusionConstructs across all five domains of CFIR (intervention characteristics, outer setting, inner setting, characteristics of individuals, and process) were identified to influence the success of TasP in BC. Our findings provide important insights into how BC can successfully implement and scale up other systems-level interventions that have demonstrated efficacy, while also offering insights for other jurisdictions that are currently or planning to scale up TasP.

Dataset Information

Examination of the British Columbia influenza prevention policy for healthcare workers: Phase 1 qualitative case study.

Publications

Examination of the British Columbia influenza prevention policy for healthcare workers: Phase 1 qualitative case study.

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