Biomedical subjects

Evelyn Vingilis

Publications and source records attributed to Evelyn Vingilis.

9 recordsLinked to original sources

PubMed2007

Predictors of adolescent health care utilization.

This study, using Andersen's health care utilization model, examined how predisposing characteristics, enabling resources, need, personal health practices, and psychological factors influence health care utilization using a nationally representative, longitudinal sample of Canadian adolescents. Second, this study examined whether this process varies across physicians, non-physicians, and dentists. The results indicate that need and psychological factors were strong determinants of utilization. Predisposing factors were associated with utilization, although there were few enabling resources. Differences were found for utilization of different services. Females, adolescents who were older, from single parent families, with lower self-rated health, lower health status, higher disability, higher distress and involved in health compromizing practices were more likely to visit physicians and non-physicians. Higher dentist utilization was related to higher income, single parent status, being younger, having lower health status, and higher disability. Predisposing and enabling factors were not mediators of utilization. The findings suggest that health care providers could be an important source of counselling on psychological, lifestyle issues, and physical concerns.

Adolescent↗

PubMed2006

What do practitioners think? A qualitative study of a shared care mental health and nutrition primary care program.

OBJECTIVE: To develop an in-depth understanding of a shared care model from primary mental health and nutrition care practitioners with a focus on program goals, strengths, challenges and target population benefits. DESIGN: Qualitative method of focus groups. SETTING/PARTICIPANTS: The study involved fifty-three practitioners from the Hamilton Health Service Organization Mental Health and Nutrition Program located in Hamilton, Ontario, Canada. METHOD: Six focus groups were conducted to obtain the perspective of practitioners belonging to various disciplines or health care teams. A qualitative approach using both an editing and template organization styles was taken followed by a basic content analysis. MAIN FINDINGS: Themes revealed accessibility, interdisciplinary care, and complex care as the main goals of the program. Major program strengths included flexibility, communication/collaboration, educational opportunities, access to patient information, continuity of care, and maintenance of practitioner and patient satisfaction. Shared care was described as highly dependent on communication style, skill and expertise, availability, and attitudes toward shared care. Time constraint with respect to collaboration was noted as the main challenge. CONCLUSION: Despite some challenges and variability among practices, the program was perceived as providing better patient care by the most appropriate practitioner in an accessible and comfortable setting.

Journal Article↗

PubMed2006

Process and outcome evaluation of an emergency department intervention for persons with mental health concerns using a population health approach.

PURPOSE: To evaluate an emergency department's use of a mental health triage and mental health crisis counsellor for persons presenting with mental health concerns. METHOD: Mixed method (qualitative and quantitative), multiple measures. RESULTS: Significant pre- and post-intervention reductions for wait time, security incidents and hospital admissions were found. Follow ups with a community agency, medications and a psychiatrist increased post-intervention, while follow ups with detox decreased post-intervention. CONCLUSIONS: The qualitative and quantitative findings are congruent with other studies supporting the use of properly implemented mental health triage and crisis counsellors to improve the care of persons with mental health concerns.

Adolescent↗

PubMed2005

The effect of problem-based learning on nursing students' perceptions of empowerment.

This study tested Kanter's structural empowerment theory within a university nursing student population. Differences in perceptions of empowerment among nursing students enrolled in either a problem-based learning (PBL) or a conventional lecture learning (CLL) program were examined, as well as the relationship between perceptions of structural empowerment in the learning environment and feelings of psychological empowerment. Participants completed measures of structural and psychological empowerment adapted to educational settings, as well as measures related to exposure to various learning strategies in their programs and clinical problem-solving abilities. Students in the PBL program (n = 41) had significantly higher perceptions of structural and psychological empowerment than students in the CLL program (n = 67). Regardless of academic program, structural empowerment was strongly positively related to psychological empowerment. The results of this study are the first to support the applicability of Kanter's theory to nursing education settings.

Adult↗

PubMed2004

Flexible client-driven in-home case management: an option to consider.

Changes in health services and care needs have created high demand for case management of in-home services. To address this challenge, several models of case management have been used. Evaluations to date suggest that clients need different approaches for different circumstances at different times to optimize cost-effectiveness. Accordingly, one Canadian home care program adopted flexible client-driven case management engaging clients as partners in flexibly selecting either an integrated team, consumer-managed or brokerage model of case management in keeping with their preferences and abilities. Using an exploratory, multimeasure quasi-experimental design, a generic model of program evaluation, and both quantitative and qualitative methods, researchers identified challenges in implementing this intervention, policy impediments the clients characteristically in each of the three case management models, and client, provider, and caregiver outcomes of flexible, client-driven care. While further longitudinal investigation is needed findings suggest several important considerations for those interested in this option for care management. Alternative case management models do attract different client groups, and having a choice does not alter care costs or outcomes. Flexible client-driven case management may be experienced positively by case managers and other providers.

Aged↗

PubMed2003

The effects of drinking-driving laws: a test of the differential deterrence hypothesis.

AIMS: Ontario introduced an Administrative Driver's Licence Suspension (ADLS) law in 1996, whereby a person with a blood alcohol level over the legal limit of 80 mg%, or who refused to provide a breath sample, would have his or her driver's licence suspended immediately for a period of 90 days. We test the differential deterrence hypothesis which would predict that social or lighter drinkers would be more affected by the Administrative Driver's License Suspension law than heavier drinkers. DESIGN: Data from the 1996 and 1997 cycles of the Ontario Drug Monitor, a general population survey of Ontario adults (monthly cross-sectional surveys), were employed (response rate 64-67%). Analyses were restricted to drivers who reported at least some drinking during the last year (n = 3827). The total number of drinks consumed during the past 12 months was analysed with analysis of variance. FINDINGS: We found that the mean alcohol consumption of those who reported drinking-driving increased significantly after the ADLS was introduced, whereas the alcohol consumption of those who did not drive after drinking remained the same. CONCLUSIONS: The limits of this study include a lack of comparison data from regions without ADLS, a reliance on self-report measures, possible age restrictions of the findings and the fact that only an inferential test of the differential deterrence hypothesis is permitted by the data. Despite these limitations, these findings are consistent with the prediction that lighter or more moderate drinkers will tend to stop driving after drinking completely, and thus drop out of the drinking-driving population when the ADLS law was introduced, leaving heavier drinkers in this population. It will be important to continue to examine the dynamics of differential deterrence over a longer interval.

Adult↗

PubMed2002

Who provides walk-in services? Survey of primary care practice in Ontario.

OBJECTIVE: To compare walk-in clinics with other primary care settings on characteristics associated with best practices in primary care. DESIGN: A mailed self-administered questionnaire asked about organizational and clinical characteristics of primary care practices located in major urban and suburban areas in Ontario. SETTING: Four types of fee-for-service group practices: walk-in and urgent-care clinics (WICs), mixed practices (MPs), after-hours clinics (AHCs), and group family practices (GFPs). PARTICIPANTS: A physician or a staff member involved in practice administration. MAIN OUTCOME MEASURES: The four practice types were compared on organizational characteristics and measures of access, continuing care, comprehensiveness, coordination, and mechanisms for monitoring quality of care. RESULTS: Walk-in clinics, MPs, and AHCs were open more hours during evenings and weekends and were more likely to see patients without appointments; GFPs were more likely to have on-call arrangements. Group family practices saw a larger proportion of patients for whom they provided ongoing care; WICs and MPs reported that more than 60% of their visits were with "regular" patients. Walk-in clinics were less likely to provide preventive services and psychological counseling than were GFPs and MPs. A few WICs, MPs, and GFPs had procedures to support coordination of care or to monitor quality of care. CONCLUSION: Although WICs, MPs, and AHCs provided walk-in services to Ontario patients, WICs and MPs also provided a substantial amount of ongoing care and preventive services. Independent AHCs appeared to most closely fit the "walk-in clinic" stereotype.

Adolescent↗

PubMedDate not supplied

The early effects of Ontario's Administrative Driver's Licence Suspension law on driver fatalities with a BAC > 80 mg%.

BACKGROUND: On November 29, 1996, Ontario introduced an Administrative Driver's Licence Suspension (ADLS) law, which required that anyone charged with driving with a blood alcohol concentration (BAC) over the legal limit of 80 mg% or failing to provide a breath sample would have their licence suspended for a period of 90 days at the time the charge was laid. This study evaluates the early effects of Ontario's ADLS law on alcohol-involved driver fatalities. METHODS: Interrupted time series analysis with ARIMA modelling was applied to the monthly proportion of drivers killed in Ontario with a BAC over 80 mg% for the period Jan. 1, 1988 to Dec. 31, 1997. RESULTS: A significant intervention effect was found, with ADLS being associated with an estimated reduction of 17.3% in the proportion of fatally injured drivers who were over the legal limit. CONCLUSION: These data provide an early indication that the law resulted in some success in reducing alcohol-related driver fatalities.

Accidents, Traffic↗

PubMedDate not supplied

Integrating knowledge generation with knowledge diffusion and utilization: a case study analysis of the Consortium for Applied Research and Evaluation in Mental Health.

OBJECTIVE: Knowledge diffusion and utilization (KDU) have become a key focus in the health research community because of the limited success to date of research findings to inform health policies, programs and services. Yet, evidence indicates that successful KDU is often predicated on the early involvement of potential knowledge users in the conceptualization and conduct of the research and on the development of a "partnership culture". This study describes the integration of KDU theory with practice via a case study analysis of the Consortium for Applied Research and Evaluation in Mental Health (CAREMH). METHODS: This qualitative study, using a single-case design, included a number of data sources: proposals, meeting minutes, presentations, publications, reports and curricula vitae of CAREMH members. RESULTS: CAREMH has adopted the following operational strategies to increase KDU capacity: 1) viewing research as a means and not as an end; 2) bringing the university and researcher to the community; 3) using participatory research methods; 4) embracing transdisciplinary research and interactions; and 5) using connectors. Examples of the iterative process between researchers and potential knowledge users in their contribution to knowledge generation, diffusion and utilization are provided. CONCLUSIONS: This case study supports the importance of early and ongoing involvement of relevant potential knowledge users in research to enhance its utilization potential. It also highlights the need for re-thinking research funding approaches.

Humans↗