Publications (2)0.97 Total impact
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ABSTRACT: The management of mentally ill people committing minor criminal offences has been a social concern in Canada for more than thirty years. Processing of these individuals through the Justice system results in a well-known 'revolving door' syndrome. One approach to this problem is the diversion of these offenders from the Justice system to the network of health and social services that can address their overall well-being. A lack of empirical evidence on diversion programs has been identified as a main roadblock to their acceptance. To describe outcomes and service utilization of clients using the Calgary Diversion Program, a community-based alternative to incarceration for persons with serious mental disorders who commit minor offences. The study employed mixed quantitative and qualitative methods, and used a quasi-experimental design with the clients serving as their own controls. The Calgary Diversion Program was formed in 2002, with this study spanning client enrollment (n=179) from 2002-2003. Before to after program enrolment comparisons found justice system complaints, charges and court appearances to have been reduced between 84% and 91% in those clients that participated successfully in the program, while at the same time found reductions of between 25% and 48% of acute services. Both quantitative and qualitative results indicated a high degree of satisfaction on the part of both providers and clients. Statistically significant improvement in the Brief Psychiatric Rating Scale values between baseline and three months after program entry were observed, while quality of life measurement showed statistically significant improvements in six of nine indicators. Acute health care and justice system costs were compared for the nine months prior to referral and the nine months following referral, with an average reduction in total costs of CAD 1,721 per client. The findings presented in this paper are the first significant contribution to empirical research on diversion programs in Canada. The study suggests improved outcomes, support from clients and providers, and reduced overall costs. However, the nature of the study design limits firm conclusions to be made. Longer term follow-up is a key area for future research. IMPLICATION FOR HEALTH POLICIES: This results identified through the study, as well as the accompanying information on the Calgary program's implementation and functioning, are an important building block in moving towards a strategy to address a long-standing social concern. In an era of cost-consciousness, policy makers need to consider programs that not only have the opportunity to improve patient outcomes, but as well show promise in reducing health and other social service costs.
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ABSTRACT: Accessibility and quality of primary health care services in rural areas are challenging issues, particularly for the elderly and those with chronic or complex medical conditions. The objective of the Nurse-Physician Collaborative Partnership was to implement and evaluate a collaborative partnership between homecare nurses and family physicians in the rural Trochu-Delburne-Elnora area of Alberta. Overall, 37 patients were enrolled in a shared care plan, which included comprehensive biopsychosocial assessment, early intervention, health education and self-management. Patient and provider outcomes were assessed using quantitative and qualitative data collected at baseline, 6 months and 12 months. Results showed that patients made improvements in activities of daily living and robust cognitive status. In interviews, patients reported improvements in psychological well-being, knowledge of disease processes and confidence to manage health issues. Patients' use of acute health care services decreased, showing a 51% reduction in the number of days in hospital, a 32% reduction in emergency department visits and a 25% reduction in hospital admissions. Total acute service costs, excluding program costs, decreased by 40% from an average of $15,485 to $9,313 per person (p < or = 0.05). Based on these results, policy initiatives that incorporate the shared care model developed in this project may be considered. To our knowledge, this type of evaluation has not previously been conducted in a rural Canadian setting.
University of British Columbia - OkanaganKelowna, British Columbia, Canada