Dataset Information

Health System Enablers and Barriers to Continuity of Care for First Nations Peoples Living with Chronic Disease.

ABSTRACT:

Introduction

Failings in providing continuity of care following an acute event for a chronic disease contribute to care inequities for First Nations Peoples in Australia, Canada, and Aotearoa (New Zealand).

Methods

A rapid narrative review, including primary studies published in English from Medline, Embase, PsycINFO, and Cochrane Central, concerning chronic diseases (cancer, cardiovascular disease, chronic kidney disease, diabetes, and related complications), was conducted. Barriers and enablers to continuity of care for First Nations Peoples were explored considering an empirical lens from the World Health Organization framework on integrated person-centred health services.

Results

Barriers included a need for more community initiatives, health and social care networks, and coaching and peer support. Enabling strategies included care adapted to patients' cultural beliefs and behavioural, personal, and family influences; continued and trusting relationships among providers, patients, and caregivers; and provision of flexible, consistent, adaptable care along the continuum.

Discussion

The support and co-creation of care solutions must be a dialogical participatory process adapted to each community.

Conclusions

Health and social care should be harmonised with First Nations Peoples' cultural beliefs and family influences. Sustainable strategies require a co-design commitment for well-funded flexible care plans considering coaching and peer support across the lifespan.

SUBMITTER: Pinero de Plaza MA

PROVIDER: S-EPMC10723014 | biostudies-literature | 2023 Oct-Dec

REPOSITORIES: biostudies-literature

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Publications

Health System Enablers and Barriers to Continuity of Care for First Nations Peoples Living with Chronic Disease.

Pinero de Plaza Maria Alejandra MA Gebremichael Lemlem L Brown Shannon S Wu Chiung-Jung CJ Clark Robyn A RA McBride Katharine K Hines Sonia S Pearson Odette O Morey Kim K

International journal of integrated care 20231001 4

<h4>Introduction</h4>Failings in providing continuity of care following an acute event for a chronic disease contribute to care inequities for First Nations Peoples in Australia, Canada, and Aotearoa (New Zealand).<h4>Methods</h4>A rapid narrative review, including primary studies published in English from Medline, Embase, PsycINFO, and Cochrane Central, concerning chronic diseases (cancer, cardiovascular disease, chronic kidney disease, diabetes, and related complications), was conducted. Barri ...[more]

PMID: 38107834

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Project description:Background: As First Nations Peoples are a priority focus of Canada’s commitment to eliminating hepatitis C virus (HCV) as a public health threat, understanding individuals’ progression from diagnosis to cure can guide prioritization of elimination efforts. We sought to characterize and identify gaps in the HCV care cascade for Status First Nations peoples in Ontario. Methods: In this retrospective cohort study, a partnership between the Ontario First Nations HIV/AIDS Education Circle and academic researchers, HCV testing records (1999–2018) for Status First Nations peoples in Ontario were linked to health administrative data. We defined the cascade of care as 6 stages, as follows: tested positive for HCV antibody, tested for HCV RNA, tested positive for HCV RNA, HCV genotyped, initiated treatment and achieved sustained viral response (SVR). We mapped the care cascade from 1999 to 2018, and estimated the number and proportion of people at each stage. We stratified analyses by sex, diagnosis date and location of residence. We used Cox regression to analyze the secondary outcomes, namely the associations between undergoing HCV RNA testing and initiating treatment, and demographic and clinical predictors. Results: By Dec. 31, 2018, 4962 people tested positive for HCV antibody. Of those testing positive, 4118 (83.0%) were tested for HCV RNA, with 2480 (60.2%) testing positive. Genotyping was completed in 2374 (95.7%) of those who tested positive for HCV RNA, with 1002 (42.2%) initiating treatment. Nearly 80% (n = 801, 79.9%) of treated people achieved SVR, with 34 (4.2%) experiencing reinfection or relapse. Undergoing testing for HCV RNA was more likely among people in older age categories (within 1 yr of antibody test; adjusted hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.19–1.41, among people aged 41–60 yr; adjusted HR 1.47, 95% CI 1.18–1.81, among people aged > 60 yr), those living in rural areas (adjusted HR 1.20, 95% CI 1.10–1.30), those with an index date after Dec. 31, 2013 (era of treatment with direct-acting antiviral regimens) (adjusted HR 1.99, 95% CI 1.85–2.15) and those with a record of substance use or addictive disorders (> 1 yr after antibody test; adjusted HR 1.38, 95% CI 1.18–1.60). Treatment initiation was more likely among people in older age categories at index date (adjusted HR 1.32, 95% CI 1.15–1.50, among people aged 41–60 yr; adjusted HR 2.62, 95% CI 1.80–3.82, among people aged > 60 yr) and those with a later diagnosis year (adjusted HR 2.71, 95% CI 2.29–3.22). Interpretation: In comparison with HCV testing and diagnosis, a substantial gap in treatment initiation remains among Status First Nations populations in Ontario. Elimination efforts that prioritize linkage to care and integration with harm reduction and substance use services are needed to close gaps in HCV care among First Nations populations in Ontario.

Dataset Information

Health System Enablers and Barriers to Continuity of Care for First Nations Peoples Living with Chronic Disease.

Introduction

Methods

Results

Discussion

Conclusions

Publications

Health System Enablers and Barriers to Continuity of Care for First Nations Peoples Living with Chronic Disease.

Similar Datasets

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