Publications by authors named "Nicole Bobbette"

8 Publications

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Virtual health care for adult patients with intellectual and developmental disabilities: A scoping review.

Disabil Health J 2021 Jun 6:101132. Epub 2021 Jun 6.

University of Toronto, 27 King's College Cir, Toronto, ON, M5S 3K1, Canada; Centre for Addiction and Mental Health, 1001 Queen St, Toronto, ON, M6J 1H1, Canada.

Background: The COVID-19 pandemic led to an abrupt shift to virtual health care for many patients, including adults with intellectual and developmental disabilities (IDD). Approaches to virtual care that are successful for people without IDD may need to be adapted for adults with IDD.

Objective: The aim of this scoping review was to examine what is known about virtual health care for adults with IDD and in particular, the impact of virtual delivery on access to care for this population.

Methods: A comprehensive search was conducted of the academic and grey literature. A two-stage screening process was conducted by two independent reviewers and a structured data extraction template was populated for each included study. Findings were analyzed thematically using Access to Care Framework domains.

Results: In total, 22 studies met inclusion criteria. The majority were published in the past three years and focused on specialized IDD services. A subset of 12 studies reported findings on access to care for adults with IDD. Participants generally reported high acceptability of virtual care, though some preferred face-to-face encounters. Initial results on effectiveness were positive, though limited by small sample sizes. Challenges included internet quality and technical skill or comfort.

Conclusions: This review suggests that it is possible to deliver accessible, high quality virtual care for adults with IDD, however, relatively little research has been conducted on this topic. Due to COVID-19 there is currently a unique opportunity and urgency to learn when and for whom virtual care can be successful and how it can be supported.
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http://dx.doi.org/10.1016/j.dhjo.2021.101132DOI Listing
June 2021

Predictors of worker mental health in intellectual disability services during COVID-19.

J Appl Res Intellect Disabil 2021 May 16. Epub 2021 May 16.

Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada.

Background: Workers supporting adults with intellectual disabilities experience significant stress in their essential role during COVID-19. The purpose of this study was to describe the experience of these workers and determine predictors of emotional distress.

Methods: Eight hundred and thirty-eight workers supporting adults with intellectual disabilities completed an online survey about their work during COVID-19 and their mental health in July 2020.

Results: One in four workers reported moderate to severe emotional distress. Being older and more experienced, having counselling services available through one's agency, and engaging in regular exercise or hobbies outside work were associated with less distress. Workers who reported increased stress in the workplace, stigma towards their families because of their job, personal fears about spreading COVID-19, and receipt of medications for mental health conditions or therapy reported greater distress.

Conclusions: More attention is needed to address the mental health of workers supporting adults with intellectual disabilities as they continue their essential work during the pandemic.
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http://dx.doi.org/10.1111/jar.12892DOI Listing
May 2021

Interprofessional primary care during COVID-19: a survey of the provider perspective.

BMC Fam Pract 2021 02 3;22(1):31. Epub 2021 Feb 3.

Queen's University, 31 George Street, Kingston, Ontario, K7L 3N6, Canada.

Background: Interprofessional primary care (IPC) teams provide comprehensive and coordinated care and are ideally equipped to support those populations most at risk of adverse health outcomes during the COVID-19 pandemic, including older adults, and patients with chronic physical and mental health conditions. There has been little focus on the experiences of healthcare teams and no studies have examined IPC practice during the early phase of the COVID-19 pandemic. The objective of the study was to describe the state of interprofessional health provider practice within IPC teams during the COVID-19 pandemic.

Methods: Observational cross-sectional design. A web-based survey was deployed to IPC providers working in team-based primary care clinics in the province of Ontario, Canada. The survey included 26 close-ended and six open-ended questions. Close-ended questions were analyzed using descriptive statistics. Content analysis was used to analyze the open-ended questions.

Results: 445 surveys were included in the final analysis. Service delivery shifted from in-person care (77% pre-COVID-19) to telephone (76.5% during the COVID-19 pandemic). Less than half of the respondents (40%) reported receiving any training for virtual delivery. Wait times to access team members were reported to have decreased. There has also been a shift in what IPC providers report as the most commonly seen conditions, with increases in visits related to mental health concerns, acute infections (including COVID-19), social isolation, and resource navigation. Respondents also reported a reduction in healthcare provision for multiple chronic conditions including diabetes, cardiovascular disease, and chronic pain.

Conclusions: IPC teams are rapidly shifting their practice to supporting their patients during the pandemic. A surge in mental health issues has been seen and is expected to continue to increase in response to COVID-19. Understanding early experiences can help plan for future pandemic waves.
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http://dx.doi.org/10.1186/s12875-020-01366-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857097PMC
February 2021

Adults with intellectual and developmental disabilities and interprofessional, team-based primary health care: a scoping review.

JBI Evid Synth 2020 07;18(7):1470-1514

1School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada 2Department of Public Health Sciences & Psychiatry (Division of Developmental Disabilities), Faculty of Health Sciences, Queen's University, Kingston, Canada 3School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, Canada 4Health Learning, Research & Practice, Wolters Kluwer Health, Toronto, Canada.

Objective: This scoping review aimed to examine the state of the evidence for interprofessional, team-based primary health care for adults with intellectual and developmental disabilities.

Introduction: Adults with intellectual and developmental disabilities are a complex, vulnerable population known to experience health inequities. Interprofessional primary health care teams are recommended to improve access to comprehensive and coordinated health care for these individuals. Limited information is available regarding what services interprofessional primary health care teams provide and how services are evaluated specific to the care of this population.

Inclusion Criteria: This scoping review considered all studies that referenced individuals with intellectual and/or developmental disabilities who were 18 years or older. It considered all studies that referred to health care provision within a primary health care context. All studies that discussed the provision of interprofessional primary health care services were included. "Interprofessional primary health care team" was the term used to describe services provided by health providers (e.g. physicians, nurse practitioners, nurses, dietitians, social workers, mental health workers, occupational therapists, physical therapists) working in a team-based model of care.

Methods: This scoping review was conducted in accordance with JBI methodology for scoping reviews. Quantitative, qualitative, and mixed methods study designs were considered for inclusion. In addition, systematic reviews, program descriptions, clinical reviews, and opinion papers were considered. Studies published in English and French were included. The period considered was from 2000 to the date of the searches (July and August 2018 for bibliographic databases and January 2019 for the final searches of unpublished studies and selected papers from key authors).

Results: The search identified 2761 records. Despite the global search strategy, only 20 records were included in the final review, mainly consisting of work based in the United States and Canada. Results were heterogeneous and descriptive in nature, consisting of cross-sectional designs, program descriptions, and clinical reviews. The findings represent only a few distinct interprofessional primary health care team models of care and multiple contributions from a small pool of researchers. Roles for physicians, nurse practitioners, nurses, social workers, and mental health providers were identified. Ten studies identified either patient-reported outcomes or health-utilization outcomes. Overall, there was no consistent reporting of outcomes across studies, and outcomes specifically related to many interprofessional services were not captured. Although interprofessional, team-based approaches are supported at a policy and practice level, the concept of interprofessional primary health care for this population remains understudied and is challenged by differences in primary health care provision across the world, complexity in how the field is defined, as well as a lack of consistent reporting of the organizational attributes and processes that support interprofessional primary health care provision.

Conclusions: To fully realize the potential of interprofessional primary health care teams, health services research is needed to describe organizational attributes and processes, and evaluate interventions for this population. Engaging in this work will ultimately provide a more fulsome evidence base to support high-quality, interprofessional primary health care provision for adults with intellectual and developmental disabilities.
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http://dx.doi.org/10.11124/JBISRIR-D-19-00200DOI Listing
July 2020

Critical considerations for engaging in inclusive health research with individuals with intellectual disability.

Evid Based Nurs 2021 01 7;24(1):11. Epub 2020 Feb 7.

Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.

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http://dx.doi.org/10.1136/ebnurs-2019-103210DOI Listing
January 2021

Measuring the performance of interprofessional primary health care teams: understanding the teams perspective.

Prim Health Care Res Dev 2019 08 28;20:e125. Epub 2019 Aug 28.

Quality Improvement Decision Support Program, Provincial Lead, Association of Family Health Teams of Ontario, Toronto, ONCanada.

Aim: The aim of the study was to describe practices that support collaboration in interprofessional primary health care teams, and identify performance indicators perceived to measure the impact of this collaboration from the perspective of interprofessional health providers.

Background: Despite the surge of interprofessional primary health care models implemented across Canada, there is little evidence as to whether or not the intended outcomes of primary health care teams have been achieved. Part of the challenge is determining the most appropriate measures that can demonstrate the value of collaborative care. To date, little remains known about performance measurement from the providers contributing to the collaborative care process in interprofessional primary care teams. Having providers from a range of disciplinary backgrounds assist in the development of performance measures can help identify measures most relevant to demonstrate the value of collaborative care on the intended outcomes of interprofessional primary care models.

Methods: A qualitative study; part of a larger mixed methods developmental evaluation to examine performance measurement in interprofessional primary health care teams. A stakeholder workshop was conducted at an annual association meeting of interprofessional primary health care teams in the province of Ontario, Canada. Six questions guided the workshop groups and participant responses were documented on worksheets and flip charts. All responses were collected and entered verbatim into a word document. Qualitative analytic strategies were applied to each question.

Findings: A total of 283 primary health care providers from 14 health professions working in interprofessional primary health care teams participated. Top three elements of interprofessional collaboration (total n = 628) were communication (n = 146), co-treatment (n = 112) and patient-based conferences (n = 81). Top three performance indicators currently used to demonstrate the value of interprofessional collaboration (total n = 241) were patient experience (n = 71), patient health status (n = 35) and within team referrals (n = 30).
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http://dx.doi.org/10.1017/S1463423619000409DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6719251PMC
August 2019

Interprofessional team-based primary health care for adults with intellectual and developmental disabilities: a scoping review protocol.

JBI Database System Rev Implement Rep 2019 12;17(12):2506-2516

School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada.

Objective: This review aims to examine the state of the evidence for interprofessional team-based primary health care for adults with intellectual and developmental disabilities.

Introduction: Adults with intellectual and developmental disabilities have complex health needs, as well as experience health service inequities. Interprofessional primary healthcare teams offer access to comprehensive primary health care and are recommended as an approach to improve the health of this population. At present, limited information is available regarding what services interprofessional primary healthcare teams provide and how services are evaluated specific to the care of adults with intellectual and developmental disabilities.

Inclusion Criteria: This review will consider all studies that reference individuals with intellectual and developmental disabilities who are 18 years and over. It will consider all studies that refer to interprofessional healthcare provision within a primary healthcare team context. Interprofessional care is the term that will be used to describe services provided by interprofessional health providers (e.g. nurses, dietitians, social workers) in these teams. Work completed by physicians and nurses within traditional general practices will be excluded.

Methods: This review will be conducted according to the JBI methodology for scoping reviews. It will consider quantitative, qualitative and mixed methods study designs for inclusion. In addition, systematic reviews, program descriptions, clinical reviews and opinion papers will be considered. The review will consider all studies published since 2000 in English or French. All duplicates will be removed from identified citations. A data extraction tool will assist reviewers to identify and synthesize findings from selected papers.
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http://dx.doi.org/10.11124/JBISRIR-2017-003999DOI Listing
December 2019

Implementation of Health Links coordinated care plans for adults with intellectual and developmental disabilities: Cross-sectoral pilot program.

Can Fam Physician 2019 Apr;65(Suppl 1):S41-S46

Epidemiologist and Professor in the Department of Public Health Sciences and with ICES at Queen's University.

Problem Addressed: Adults with intellectual and developmental disabilities (IDD) are a complex population that could benefit from improved care coordination across health and social sectors, as they experience poorer health and have higher rates of emergency department use and hospitalization due to ambulatory care-sensitive conditions.

Objective Of Program: To pilot a novel, enhanced model of care coordination for complex patients with IDD.

Program Description: Health Links is a provincial care-coordination program for patients with complex health care needs. This pilot program adapted Health Links to include a guide and training specific to adults with IDD to ensure that these patients' needs were met and high-quality, efficient care was provided.

Conclusion: A tailored care-coordination approach for adults with IDD was able to identify complex patients in need and successfully bridge cross-sectoral care.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6501720PMC
April 2019