Improving chronic illness care: Implementation and evaluation of interdisciplinary and patient-centred care
Notice bibliographique
Résumé
The prevalence of chronic diseases and conditions is steadily increasing in Canada and globally. Despite the availability of effective therapies, the management of chronic diseases remains far from optimal. Several reports and practice guidelines recommend that care should be patient-centred and delivered by health care teams as means to empower patients to engage in their own care decisions, enhance coordination of care, and make more efficient use of resources, ultimately leading to improved patient outcomes and safety. However, many challenges remain in implementing these approaches, including assessing and accumulating evidence on their effectiveness. The overall aim of this thesis is to contribute to evidence-informed patient-centred and interdisciplinary team (IDT) care in the context of quality chronic illness care through two interrelated research projects. Using a population-based survey, the first project assessed the level of support for patient-centred care (PCC) amongst the Canadian public and among health professionals. Significant associations were identified between support for PCC and support for both team-based care and the use of health information technology. These associations were identified from both the public and health professionals' perspectives. The second project used a convergent mixed methods design to investigate experiences of primary interdisciplinary care for low back pain. For the qualitative component, I employed a phenomenological approach to better understand the delivery and perceived impact of IDT care. The quantitative component used the Patient Assessment of Chronic Illness Care (PACIC) questionnaire to evaluate change in patient experience and to estimate the impact of patient and process variables on patient experience. The findings from the two components were reviewed for convergence, complementarity and discrepancy. Findings from project 1 suggest that implementation of health care teams supported by information and communication technologies are needed to deliver PCC. From the perspective of the participants in the qualitative inquiry of project 2, IDT care contributed to effective and patient-centred primary care. The quantitative component showed improved experience of care for the majority of the participants but did not demonstrate significant associations between change in experience of care and patient and process outcomes. Overall, implementing an IDT appears to be an appropriate approach to deliver PCC and improve the quality of chronic illness care. Based on these analyses, I propose strategies to help improve the implementation of IDT programs for low back pain. These recommendations can also inform similar primary care programs for other chronic conditions. Directions for future research include further evaluation of the structure and construct validity of the PACIC, and continued investigation of the relationships between PCC, patient experience, patient factors, and outcomes.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,155 | 0,174 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,004 |
| Bibliométrie | 0,003 | 0,004 |
| Études des sciences et des technologies | 0,004 | 0,004 |
| Communication savante | 0,007 | 0,005 |
| Science ouverte | 0,004 | 0,008 |
| Intégrité de la recherche | 0,002 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».