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Overcoming Care Access Barriers Project #4 (Years 2-3.5)

Overcoming Care Access Barriers Project #4 (Years 2-3.5). Trainee: Linda Reade (Doctoral Candidate, SGES, McMaster) Co-PIs: Williams & Leipert Co-I: Duggleby; Coll: Berry. Overview of the Project.

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Overcoming Care Access Barriers Project #4 (Years 2-3.5)

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  1. Overcoming Care Access BarriersProject #4 (Years 2-3.5) Trainee: Linda Reade (Doctoral Candidate, SGES, McMaster) Co-PIs: Williams & Leipert Co-I: Duggleby; Coll: Berry

  2. Overview of the Project • Significance: several studies have described barriers to PC, however there is a lack of research which has explored the ways that patients, informal active and bereaved caregivers, and health care professionals have overcome access barriers.

  3. Research Purpose • This research aims to identify and describe factors that contribute to the existence of P/EOL care access barriers in rural settings. • Access levels to care are defined in terms of: • primary(i.e. when the patient enters the health care system) • secondary ( i.e. systemic problems such as delays in service such as admission to inpatient palliative care when needed)and • tertiary(i.e. addressing specific patient needs).

  4. Objectives • describe P/EOL care access barriers for P/EOL informal caregivers in a rural community, • identify factors in rural settings that contribute to the development of barriers, or the prevention and minimization of barriers, • describe ways informal palliative caregivers manage these barriers or not, and • generate a theoretical analysis of rural caregivers managing the barriers to palliative care.

  5. Palliative care trajectory model

  6. Methodology (1) • I will be taking the graduate course , “Qualitative Research Methods” (NUR 745) which specifically focuses on Grounded Theory • Using a qualitative grounded theory approach, semi-structured interviews will be conducted with approximately 15 family caregivers/site, 6 months post-bereavement, to explore the ways in which they overcame access barriers such as mentioned in the three access levels to care

  7. Methodology (2) • Further data will be collected from rural health service providers via interviews (physicians) and focus group interviews (front-line practitioners and case managers) to gain their perspective on specific barriers that inhibit the referral process • recruitment strategy for caregivers will be facilitated thorough CCAC and developed in conjunction with site partners • The sampling frame will be strategic in order to capture the most rural & most isolated CGs

  8. Ontario Sites (2) • First/Initial Site: Haliburton County • Access and approval will be established via phone and personal contact with key gatekeepers: • Gena Robertson, E.D. of “So It Really Can Happen” (S.I.R.C.H) Community Services & Consulting ( non-profit organization) • Primary resource for Palliative and Hospice Care services in Haliburton County • CCAC located outside of town of Haliburton • both org. work together to service EOL care

  9. Map of CCAC catch man area for Haliburton-Northumberland-Victoria County • Total population 15+ Yrs 12,510 • One of the largest senior populations in Ontario based on percentage of total population • markers north and northwest of Peterborough:

  10. London Site: • Second site is in London • Dr. Leipert from the University of Western Ontario, will co-supervise • Paul Cavanaugh, Director of Southwest EOL Care Network, ( a “mini-site” of key resources) will be the principal contact • Access will be established by attending the Local Health Integration Network (LHIN) (representing 7 CCACs) meetings

  11. Map of the boundaries of the South West LHIN Which comprises seven CCACs Serves 50,000 each year with rural areas comprising approximately 60% of clients

  12. Time-Line • YEAR 1 • coursework, literature review, prepare qualitative interview schedule, ethics application & approval ( Sept 07-March 08) • Pre-test and finalize interview schedule • Gain access to participants in Haliburton County site & begin primary data collection • ( April-August 08)

  13. Time-Line continued • YEAR 2- Data collection in both Haliburton and London sites completed • YEARS 3,4 Interpret/analyse data: • Write first draft of dissertation • Revise and defend dissertation • Write lay reports and begin writing for publication • Plan for operating grant for other sites outside of Ontario (possible PDF)

  14. Results • The results of this study will contribute to minimizing access barriers which in turn will ease access to P/EOL care services • Work with our community partners to inform services provided based upon research results

  15. Dissemination Plan • Dissertation • Lay Reports • Conferences (Meetings of the Canadian Assoc. of Geographers, CAG Ontario Division Meetings, CHPCA Meetings • Peer-reviewed publications (Health and Place, Social Science & Medicine, Canadian Journal of Palliative Care)

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