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  1. Article ; Online: Facilitating continuity of care at a health system level to support integration

    Richard Lewanczuk

    International Journal of Integrated Care, Vol 19, Iss

    2019  Volume 4

    Abstract: Introduction: Continuity of care – relational, informational and management – is a defining characteristic of integrated care. With input from all stakeholders, we developed and implemented a data-supported, system-wide change management strategy in ... ...

    Abstract Introduction: Continuity of care – relational, informational and management – is a defining characteristic of integrated care. With input from all stakeholders, we developed and implemented a data-supported, system-wide change management strategy in support of continuity. Policy context and objective: The province of Alberta, Canada has a single publically funded healthcare system. While the health system is largely structurally integrated, primary care is provided in a joint partnership between the health system and networks of primary care physicians and their teams. Specialists are independent and paid on a fee-for-service basis. People are free to choose and move between primary care providers. The purpose of this initiative was to facilitate continuity of care, in all its forms, across the broad health care system. Approach and Stakeholders: This initiative was started by collection and analysis of provincial data. This demonstrated the critical role of relational continuity in improving patient and population health. Analysis demonstrated that relational continuity of 75% or more reduced mortality, after adjustment, by approximately 50%. In addition, there was an incremental benefit of continuity with increasing patient complexity. These findings, plus literature data, were used, in accordance with change management principles, to create a compelling case for change. Importantly, patient input was also used to support change. Data was shared with our formal patient advisory councils representing both geography and specific patient groups such as seniors. Results of these meetings revealed 88% “strong support” for continuity. Patient experience and public focus group input was also used to create the next stage of the change management strategy. Highlights: After all input, including that from providers and community organizations was collected, leaders in the health system met and agreed on a collective strategy. The health system agreed to establish informational and management continuity (transitions) as ...
    Keywords continuity ; transitions ; policy ; Medicine (General) ; R5-920
    Subject code 360
    Language English
    Publishing date 2019-08-01T00:00:00Z
    Publisher Ubiquity Press
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Value in Healthcare: Designing an Integrated Value-Based Healthcare System.

    Lewanczuk, Richard / Chuck, Anderson / Todd, Kathryn / Yiu, Verna

    HealthcarePapers

    2020  Volume 19, Issue 1, Page(s) 59–64

    Abstract: Value-based healthcare (VBHC) can be interpreted in many ways depending on one's jurisdiction. Often it is used synonymously with cost-effectiveness. In Alberta, VBHC might more appropriately be termed "values-based healthcare." This reflects our belief ... ...

    Abstract Value-based healthcare (VBHC) can be interpreted in many ways depending on one's jurisdiction. Often it is used synonymously with cost-effectiveness. In Alberta, VBHC might more appropriately be termed "values-based healthcare." This reflects our belief that a healthcare system should meet the needs and desires of its population and contribute to overall wellness. We therefore developed a framework based on the dimensions of quality, the Quadruple Aim and feasibility considerations, which enables us to assess and measure our system activities and initiatives to determine if they are in keeping with VBHC in the Alberta context.
    MeSH term(s) Alberta ; Community Health Planning ; Delivery of Health Care, Integrated/organization & administration ; Health Services Needs and Demand/organization & administration ; Humans ; Population Health ; Social Determinants of Health ; Stakeholder Participation
    Language English
    Publishing date 2020-05-01
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 2141700-3
    ISSN 1929-6339 ; 1488-917X
    ISSN (online) 1929-6339
    ISSN 1488-917X
    DOI 10.12927/hcpap.2020.26154
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Treating patients and treating populations: the value of population data in controlling hypertension.

    Lewanczuk, Richard Z

    The Canadian journal of cardiology

    2013  Volume 29, Issue 5, Page(s) 524–525

    MeSH term(s) Female ; Heart Failure/mortality ; Humans ; Hypertension/mortality ; Male ; Myocardial Infarction/mortality ; Stroke/mortality
    Language English
    Publishing date 2013-05
    Publishing country England
    Document type Comment ; Editorial
    ZDB-ID 632813-1
    ISSN 1916-7075 ; 0828-282X
    ISSN (online) 1916-7075
    ISSN 0828-282X
    DOI 10.1016/j.cjca.2013.02.002
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Preexisting mental health disorders and risk of opioid use disorder in young people: A case-control study.

    Marshall, Tyler / Olson, Karin / Youngson, Erik / Abba-Aji, Adam / Li, Xin-Min / Vohra, Sunita / Lewanczuk, Richard

    Early intervention in psychiatry

    2023  Volume 17, Issue 10, Page(s) 963–973

    Abstract: Aim: Opioid use disorder (OUD) is a leading cause of preventable mortality amongst young people worldwide. Early identification and intervention of modifiable risk factors may reduce future OUD risk. The aim of this study was to explore whether the ... ...

    Abstract Aim: Opioid use disorder (OUD) is a leading cause of preventable mortality amongst young people worldwide. Early identification and intervention of modifiable risk factors may reduce future OUD risk. The aim of this study was to explore whether the onset of OUD is associated with preexisting mental health conditions such as anxiety and depressive disorders in young people.
    Methods: A retrospective, population-based case-control study was conducted from 31 March 2018 until 01 January 2002. Provincial administrative health data were collected from Alberta, Canada.
    Cases: Individuals 18-25 years on 01 April 2018, with a previous record of OUD.
    Controls: Individuals without OUD were matched to cases, on age/sex/index date. Conditional logistic regression analysis was used to control for additional covariates (e.g., alcohol-related disorders, psychotropic medications, opioid analgesics, and social/material deprivation).
    Results: We identified N = 1848 cases and N = 7392 matched controls. After adjustment, OUD was associated with the following preexisting mental health conditions: Anxiety disorders, aOR = 2.53 (95% CI = 2.16-2.96); depressive disorders, aOR = 2.20 (95% CI = 1.80-2.70); alcohol-related disorders, aOR = 6.08 (95% CI, 4.86-7.61); anxiety and depressive disorders, aOR = 1.94 (95% CI = 1.56-2.40); anxiety and alcohol-related disorders, aOR = 5.22 (95% CI = 4.03-6.77); depressive and alcohol-related disorders, aOR = 6.47 (95% CI = 4.73-8.84); anxiety, depressive and alcohol-related disorders, aOR = 6.09 (95% CI = 4.41-8.42).
    Discussion: Preexisting mental health conditions such as anxiety and depressive disorders are risk factors for future OUD in young people. Preexisting alcohol-related disorders showed the strongest association with future OUD and demonstrated an additive risk when concurrent with anxiety/depression. As not all plausible risk factors could be examined, more research is still needed.
    MeSH term(s) Humans ; Adolescent ; Mental Health ; Case-Control Studies ; Retrospective Studies ; Opioid-Related Disorders/complications ; Opioid-Related Disorders/epidemiology ; Opioid-Related Disorders/drug therapy ; Alcohol-Related Disorders ; Alberta/epidemiology
    Language English
    Publishing date 2023-02-15
    Publishing country Australia
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2272425-4
    ISSN 1751-7893 ; 1751-7885
    ISSN (online) 1751-7893
    ISSN 1751-7885
    DOI 10.1111/eip.13385
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Cardiac rehabilitation and primary care: bridging the two solitudes.

    Lewanczuk, Richard

    The Canadian journal of cardiology

    2009  Volume 25, Issue 6, Page(s) e193–4

    MeSH term(s) Continuity of Patient Care ; Humans ; Myocardial Infarction/rehabilitation ; Primary Health Care
    Language English
    Publishing date 2009-06-12
    Publishing country England
    Document type Comment ; Editorial
    ZDB-ID 632813-1
    ISSN 1916-7075 ; 0828-282X
    ISSN (online) 1916-7075
    ISSN 0828-282X
    DOI 10.1016/s0828-282x(09)70097-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Hypertension as a chronic disease: what can be done at a regional level?

    Lewanczuk, Richard

    The Canadian journal of cardiology

    2008  Volume 24, Issue 6, Page(s) 483–484

    Abstract: Historically, management of chronic diseases such as hypertension has tended to be reactive, with patients being passive recipients of care. In recent years, the chronic care model has been developed and implemented in many jurisdictions to ensure ... ...

    Abstract Historically, management of chronic diseases such as hypertension has tended to be reactive, with patients being passive recipients of care. In recent years, the chronic care model has been developed and implemented in many jurisdictions to ensure optimal, proactive care of people with chronic conditions. The model and its principles address the infrastructure and support that is necessary to enable this high-quality care. The role of the patient, primary care team, system and community are all addressed in this model. Experience suggests that application of chronic disease management principles to hypertension can result in significant benefits to all concerned.
    MeSH term(s) Canada ; Chronic Disease ; Delivery of Health Care/standards ; Disease Management ; Humans ; Hypertension/therapy ; Models, Theoretical ; Outcome Assessment, Health Care/organization & administration ; Practice Guidelines as Topic
    Language English
    Publishing date 2008-06-12
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 632813-1
    ISSN 1916-7075 ; 0828-282X
    ISSN (online) 1916-7075
    ISSN 0828-282X
    DOI 10.1016/s0828-282x(08)70622-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: The impact of shared decision-making on the treatment of anxiety and depressive disorders: systematic review - CORRIGENDUM.

    Marshall, Tyler / Stellick, Chelsea / Abba-Aji, Adam / Lewanczuk, Richard / Li, Xin-Min / Olson, Karin / Vohra, Sunita

    BJPsych open

    2021  Volume 7, Issue 6, Page(s) e212

    Language English
    Publishing date 2021-11-17
    Publishing country England
    Document type Journal Article
    ZDB-ID 2829557-2
    ISSN 2056-4724
    ISSN 2056-4724
    DOI 10.1192/bjo.2021.1050
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Effect of a vitamin and mineral supplementation on glycemic status: Results from a community-based program.

    Kimball, Samantha M / Emery, J C Herbert / Lewanczuk, Richard Z

    Journal of clinical & translational endocrinology

    2017  Volume 10, Page(s) 28–35

    Abstract: Aims: Diet is a major risk factor for type 2 diabetes mellitus. As cofactors necessary for enzyme function of all metabolic pathways, vitamins and minerals have the potential to improve glucose metabolism. We investigated the effects of a nutrient ... ...

    Abstract Aims: Diet is a major risk factor for type 2 diabetes mellitus. As cofactors necessary for enzyme function of all metabolic pathways, vitamins and minerals have the potential to improve glucose metabolism. We investigated the effects of a nutrient intervention program on glycemic status.
    Methods: We used a form of natural experiment to compare Pure North program participants (n = 1018) that received vitamin D alone (Vital 1) or vitamin D in combination with other nutrients (Vital 2) during two different time periods. Changes in 25-hydroxyvitamin D [25(OH)D], high-sensitivity C reactive protein (hs-CRP), glycated hemoglobin (HbA1c) and glycemic status were characterized over one and two years.
    Results: Serum 25(OH)D concentrations increased significantly in both Vital 1 (to 111  ±  49 nmol/L) and Vital 2 (to 119  ±  52 nmol/L) over one year. HbA1c and hs-CRP were significantly reduced over time in Vital 2. Higher 25(OH)D levels after one year were associated with larger decreases in HbA1c and hs-CRP in Vital 2. At one year, 8% of Vital 2 and 16% of Vital 1 participants progressed from normoglycemia to prediabetes/diabetes, whereas 44% of Vital 2 and 8% of Vital prediabetes/diabetes subjects regressed to normoglycemia.
    Conclusions: Vitamin D combined with other nutrients was associated with a reduced risk of progression to diabetes and with an increased rate of reversion to normoglycemia in high risk participants. The results suggest that nutrient supplementation regimes may provide a safe, economical and effective means for lowering diabetes risk. Further examination of this potential via randomized controlled trials is warranted.
    Language English
    Publishing date 2017-11-07
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2834222-7
    ISSN 2214-6237 ; 2214-6237
    ISSN (online) 2214-6237
    ISSN 2214-6237
    DOI 10.1016/j.jcte.2017.11.002
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Using Concept Maps to compare obesity knowledge between policy makers and primary care researchers in Canada.

    Sturgiss, Elizabeth / Luig, Thea / Campbell-Scherer, Denise L / Lewanczuk, Richard / Green, Lee A

    BMC research notes

    2019  Volume 12, Issue 1, Page(s) 23

    Abstract: ... to each of the participants.: Results: All participants had mental models with rich details on the complexity of obesity ...

    Abstract Objective: Knowledge transfer is the process of information sharing between researchers, knowledge users and policy makers. Globally, public policies about obesity do not reflect the complexity of what is known about the cause and effects of obesity. We used Concept Maps, a qualitative method that represents mental models, to compare the understanding of obesity between policy makers in a Canadian province and local primary care researchers. Eight participants were interviewed during which a Concept Map was developed using "C-map Tools" software. Maps were then colour-coded to identify themes and concepts in the maps. Finally, the team synthesised the findings from each of the maps and presented them back to each of the participants.
    Results: All participants had mental models with rich details on the complexity of obesity for individuals, community, and at the policy level. Clinician-researchers had more focus on medical management than policy makers although most participants lacked concepts on the role of primary care in obesity management. A shared understanding of obesity could assist researchers and policy makers in developing a relevant and effective strategy. Concept Mapping provides a novel and creative way to visually compare different understandings of health-related topics.
    MeSH term(s) Administrative Personnel ; Adult ; Canada ; Health Knowledge, Attitudes, Practice ; Health Policy ; Health Services Research ; Humans ; Obesity ; Primary Health Care ; Research Personnel ; Translational Medical Research
    Language English
    Publishing date 2019-01-14
    Publishing country England
    Document type Journal Article
    ZDB-ID 2413336-X
    ISSN 1756-0500 ; 1756-0500
    ISSN (online) 1756-0500
    ISSN 1756-0500
    DOI 10.1186/s13104-018-4042-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: The effect of provider affiliation with a primary care network on emergency department visits and hospital admissions.

    McAlister, Finlay A / Bakal, Jeffrey A / Green, Lee / Bahler, Brad / Lewanczuk, Richard

    CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne

    2018  Volume 190, Issue 10, Page(s) E276–E284

    Abstract: Background: Primary care networks are designed to facilitate access to inter-professional, team-based care. We compared health outcomes associated with primary care networks versus conventional primary care.: Methods: We obtained data on all adult ... ...

    Abstract Background: Primary care networks are designed to facilitate access to inter-professional, team-based care. We compared health outcomes associated with primary care networks versus conventional primary care.
    Methods: We obtained data on all adult residents of Alberta who visited a primary care physician during fiscal years 2008 and 2009 and classified them as affiliated with a primary care network or not, based on the physician most involved in their care. The primary outcome was an emergency department visit or nonelective hospital admission for a Patient Medical Home indicator condition (asthma, chronic obstructive pulmonary disease, heart failure, coronary disease, hypertension and diabetes) within 12 months.
    Results: Adults receiving care within a primary care network (
    Interpretation: Care within a primary care network was associated with fewer emergency department visits and fewer hospital days.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Alberta ; Community Networks/standards ; Community Networks/statistics & numerical data ; Crowding ; Emergency Service, Hospital/organization & administration ; Emergency Service, Hospital/statistics & numerical data ; Female ; Hospitalization/statistics & numerical data ; Humans ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Poisson Distribution ; Primary Health Care/methods ; Primary Health Care/statistics & numerical data
    Language English
    Publishing date 2018-03-09
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 215506-0
    ISSN 1488-2329 ; 0008-4409 ; 0820-3946
    ISSN (online) 1488-2329
    ISSN 0008-4409 ; 0820-3946
    DOI 10.1503/cmaj.170385
    Database MEDical Literature Analysis and Retrieval System OnLINE

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