Podium Presentations

Practice Changes and Challenges

Evaluating change in mental health symptoms over time using the interRAI Community Mental Health instrument

Jerrica Little*, John P. Hirdes

University of Waterloo

Community mental health services can be an important resource for individuals living with mental illness. Through the provision of various types of treatments, individuals should be enabled to manage their symptoms and live safely in the community. However, the extent to which symptoms change over time after receiving community services needs to be assessed, allowing interventions to be better tailored to individual needs. The interRAI community mental health (CMH) assessment instrument is designed for clinicians providing mental health services in the community, and tracks information in several areas. By analyzing change in symptoms between assessments, an individual's progress can be reviewed, and adjustments to treatment plans can be made if necessary. CMH data was collected in the provinces of Ontario and Newfoundland from participating organizations. 881 individuals who had been assessed at least twice were included in the study sample. Time intervals between the first and second CMH assessments were separated into three groups: 0-3 months, 3-6 months, and 6-12 months. Change in various outcome areas were examined, such as symptoms of psychosis, depression, activities of daily living, cognition. Risk scales (harm to self, harm to others, and ability to care for self) were also assessed between assessments. The majority of scales demonstrated significant change for each time interval, with more positive than negative changes. However, instances where change did not occur were also observed, and are concerning for risk scales especially. By examining change in many symptoms over time, a holistic view of an individual's progress can be evaluated.

Investigation into the vision needs of refugee patients settling in the Waterloo Region             

Sarah MacIver*, Aysha Hassan OD; Alexander Hynes

University of Waterloo

Purpose: Impaired vision in Refugee populations can impact integration into a new Country.  In 2016, a referral process between Center for Family Medicine (CFFM), Reception House (RH), and WOVS was initiated to improve access to vision care for Refugees settling in the Waterloo Region. The purpose of this review is to investigate the scope of vision issues that were seen at WOVS and reflect on the benefits and barriers identified following new initiative.

Method: A review of the vision exam records from the refugee patients seen at WOVS will be done to investigate the number of patients seen as well as the scope of vision issues seen. The scope of vision issues will be divided further into refractive (spectacle) issues and eye health issues as well as the varying levels of visual impairment.

Results: 168 refugee patients were seen at WOVS between Jan 1, 2016 and Dec. 31, 2016.  The majority seen were school and working age. 1 in 4 needed glasses specifically to address reading issues yet presented with good distance vision. 1 in 3 had another eye condition that required further investigation. Data on the scope of visual impairment, as well as, barriers and successes will be presented.

Conclusions: Collaboration between CFFM, Reception House and UW Optometry facilitated referrals for f eye exams in Refugee patients. The majority of patients seen required glasses and/or additional treatment for unidentified eye conditions. Identifying vision issues early can help facilitate learning English and integration into society.

Ready or not? Pharmacist perceptions of a changing injection scope of practice before it happens

Ai-Leng Foong*, David J Edwards, Sherilyn Houle, Kelly A Grindrod          

University of Waterloo

Background: Since 2012, Ontario pharmacists have been authorized to administer the influenza vaccine. In April 2016, the Ontario College of Pharmacists (OCP) proposed to expand the Pharmacy Act to allow pharmacists to vaccinate against 13 additional conditions. The OCP held an online public consultation and invited pharmacists, members of the public, and organizations to weigh in on the proposed changes. Our objective was to explore the factors influencing how Ontario pharmacists may adopt or reject an expanding scope of practice using data from the public consultation.

Methods: We coded the responses to the public consultation in two ways: 1) sentiment analysis and 2) an integrative approach to coding using Roger's Diffusion of Innovations theory across five domains: Relative advantage, compatibility, complexity, trialability, and observability.

Results: On average, responses were moderately positive. Pharmacists most commonly mentioned relative advantages, including benefits for patients, pharmacists, physicians, and the health system. Positive responses focused on accessibility for patients, improved vaccine coverage, lower healthcare spending, and freed physician time, but cited lack of prescribing rights as a barrier to the proposed changes. Negative responses focused on increased workload, patient safety concerns, and the complexity of travel medicine.

Conclusions: The expanded immunization services are likely to be well-received by most pharmacists. Convenience and accessibility for patients were commonly cited benefits, but the changes will be only a slight improvement over the current system unless pharmacists can prescribe these vaccines. Although employers responded positively, the question remains if they will support pharmacists in a way that aligns with pharmacists' values and expectations. Decision makers must pay close attention to the pharmacy infrastructure and how this will impact uptake of these services. Recognition of this, combined with pharmacists' positive perceptions of the expanded scope, will facilitate smooth integration of this legislation into Ontario pharmacy practice.

Measuring functional change following outpatient rehabilitation using the interRAI Community Rehabilitation Assessment

Luke Turcotte*, Dr. John Hirdes

University of Waterloo

The Rehabilitative Care Alliance recently sought to develop a Minimum Data Set for outpatient/ambulatory rehabilitative care that would support evaluation and capacity planning at the organizational, regional and system levels. In response to an identified need for a comprehensive and non-population specific measure of functional change, the interRAI Community Rehabilitation Assessment (CRA) was developed. This new instrument based on validated interRAI items consists of an in-clinic assessment and a patient self-report tool to reduce assessment burden and gain the client's perspective of their own functional status and wellbeing before and after participation in a rehabilitation program. In the Fall of 2016, a pilot of the CRA was conducted with 212 patients across 10 outpatient/ambulatory clinics in Ontario. Using information collected with the CRA, this presentation will characterize the functional change achieved by pilot program participants. This presentation will also describe the psychometric properties of self-report items used to identify difficulty in the completion of instrumental activities of daily living such as meal preparation, ordinary housework, shopping, and transportation. Results from this pilot study indicate that the CRA detected significant improvement in clients' capacity to complete basic and instrumental activities of daily living. Measures of inter-rater reliability also indicate that patient self-appraisals of activity difficulty could be used in place of clinician ratings to streamline the assessment process to focus only on domains where impairment is present. Results from this work will be used to refine this new instrument and inform the development of self-report models of assessment for other patient populations.