Objective Living labs represent a user-centric approach to solving real-world challenges by encouraging active participation of external stakeholders in co-designing the research and innovation process. Highlighted by contextual research and user co-creation, living labs are ideal for addressing the challenges of providing optimal healthcare to patients living in rural and remote regions. Our objective was to synthesise the existing research on the living lab approach in co-designing, developing or implementing a rural healthcare service, clinical intervention or health-related technology.Design Scoping review.Data sources A search was conducted on 10 May 2025, to identify articles from three electronic databases (MEDLINE, EMBASE and CINAHL).Eligibility criteria We included published literature that presented a living lab approach to improve the provision of healthcare services in a rural environment. We excluded articles examining social determinants of health (eg, physical activity and general health promotion) without a direct link to clinical service innovation or healthcare delivery.Data extraction and synthesis We collected data on study methodologies, settings, stakeholders and innovation types. Data extraction was performed by two independent reviewers using a standardised form. We used frequencies and a narrative synthesis to map characteristics, methods and contexts of living lab applications in rural healthcare.Results The search identified a total of 1080 articles and ultimately included 11 articles. Studies were published between 2016 and 2025 and conducted in Canada (n=3), the USA (n=3), Australia (n=2), Guatemala (n=1), Uganda (n=1) and France/Portugal (n=1). Study settings included rural hospitals, regional health networks, Indigenous communities, farming and fishing communities and underserved rural regions. Health issues targeted included cardiovascular disease, diabetes, musculoskeletal conditions, perinatal care, palliative care and infectious disease management. Study methodologies included formalised, theory-driven frameworks (n=4), community-based participatory research (n=4), user- or human-centred design (n=3) and co-design workshops and interviews (n=3). Only one study explicitly used the term ‘living lab’ to describe their innovation.Conclusions Relatively few living lab approaches have been meaningfully applied in rural health. There is a need for greater global diversification, expanded domains of focus and more robust evaluation to fully understand the potential and impact of living labs in rural healthcare.

Background: Almost twenty percent of BC population live in rural settings; yet accessing healthcare, particularly emergency health services (EHSs), is challenging for rural and remote populations as they continue to experience systemic inequities, higher incidence of chronic illnesses, and lower access to healthcare services. Access to EHSs is essential for integrated health services for these populations. Despite the challenges, healthcare providers have demonstrated resiliency in delivering EHSs in rural and remote communities through innovative approaches such as Real-time Virtual Support (RTVS). Additionally, the BC government has made significant efforts to improve EHSs by increasing the budget for innovation (e.g., virtual care and broadband technology) and emergency transport services, however, there is limited information on these innovations in the literature. This study aims to explore and understand how current innovations emerged and evolved in rural and remote EHSs to identify what works, for whom, and in which contexts, and to develop recommendations for policymakers and decision-makers to leverage innovation in rural and remote EHSs. Approach: The case study methodology, with a focus on narrative inquiry, was employed to study three rural and remote cases: two in northern BC and one in interior BC. Mixed methods were used to collect data over two phases. Phase I involved descriptive data collection and community visits. Phase II involved: semi-structured interviews with policymakers, decision-makers, managers, health providers, and administrative staff (n=3); focus groups with patients and community members (n=4); and aggregate administrative data collection from various relevant organizations (e.g., health authorities). Thematic analysis was conducted to identify common themes in the qualitative data. Quantitative data analysis, using descriptive statistics, is in process. A preliminary report was developed and shared with each case study participants through an in-person follow-up dialogue (n=20) to discuss the results and co-create actions moving EHSs innovations forward. Final individual case study reports and cross-case reports will be shared with the communities. Results: Qualitative data showed that various innovations such as Real Time Virtual Support ( pathways, virtual care, emergency physician online support, mechanical CPR devices, translation apps, and electronic triage and transfer systems were being used to provide EHSs. These innovations, particularly RTVS, equipped health providers with additional support, increased community membersaccess to EHSs, and reduced unnecessary transfer of patients out of the community. However, barriers to innovations such as limited resources (e.g., funding, digital health inequities, innovations for mental health services and support), cross-jurisdictional policies, and staff shortages were highlighted. Recommendations to enhance innovations in EHSs such as increasing funding for rural infrastructures, expanding RTVS services, exploring the alignment of policies, planning proactively, and collaborating with the local government were identified. Quantitative data analysis is currently in progress and will be included in the presentation. Implications: Recent innovations in EHSs have improved access to integrated care in rural and remote communities. Results of this study will guide policymakers and decision-makers to advance, adapt, and scale innovation and facilitate equitable access to EHSs for rural, remote, and Indigenous communities.

Background: Centralized referral mechanisms anchored in primary care have been implemented to facilitate timely and appropriate access to health care in Quebec, Canada, like via Centre de répartition des demandes de services (CRDS), a regionally centralized referral system used by family physicians (FPs) for new requests to specialty care, including psychiatric services. CRDS for psychiatry was implemented in 2019, where local centralized referral systems to psychosocial or psychiatric services (Guichets d'accès en santé mentale adulte (GASMA)) were already operating. We aimed to: 1) explore FPs' use of CRDS for psychiatry; 2) better understand the functioning and potential complementarity of CRDS and GASMA, including by visually mapping these pathways; and 3) identify factors that may influence their use and functioning. Methods: A qualitative descriptive study with 20 participants working in the healthcare sector was conducted. Thematic analysis was employed. Results: Mental health referral pathways were mapped, with FPs as focal points. Factors identified as influencing referral mechanisms' use and functioning included: 1) challenges related to the communication of ministerial directives on the use/functioning of centralized referral systems; 2) stakeholders' perceptions on the regionally centralized system's objectives for service access; 3) collaborations between clinicians and the regionally centralized system; 4) perceived added value of the regionally centralized system compared to pre-existing centralized local referral systems; and 5) key organizational/system-level mental health challenges and facilitators. Recommendations to improve these pathways' use, functioning, and complementarity included clarifying directives and roles within trajectories, and improving communication between the regionally centralized and local systems already in place, as well as addressing organizational/system-level challenges to mental health care. Conclusions: Findings inform on improvements for mental health service access, delivery, and continuity via centralized referral systems anchored in primary care and used by FPs; and access challenges via pathways and solutions to optimize mental health service trajectories.

The COVID-19 pandemic did not create but rather exposed and exacerbated long-standing vulnerabilities, marginalities, and inequalities deeply embedded in our societies. Moving beyond strictly medical and epidemiological explanations, this article offers a novel perspective on the disproportionate impacts of COVID-19 on dependent elderly people living in Residential and Long-Term Care Centres (CHSLDs) in the Province of Quebec, Canada. To achieve this, we draw on the concept of necropolitics, which refers to the mechanisms through which socio-political power is exercised to control life, death, and the conditions of existence. It reflects the State’s power to determine who is allowed to live and who is left to die. Through this lens, we argue that the high rates of infection and mortality in CHSLDs were not merely attributable to age or comorbidities but were instead the inevitable outcomes of numerous austerity and privatisation reforms that reflect systemic discrimination against the elderly. These reforms chronically underfunded long-term care, commodified essential services, deteriorated working conditions for healthcare professionals and support staff, reduced the quality and quantity of care, and weakened care facility infrastructures. By implicitly determining which lives were to be protected and prioritised, these reform policies had already sealed the fate of dependent elderly individuals long before the pandemic. Using necropolitics as an analytical framework, this article elucidates the structural causes (“the causes of the causes”) of these inequalities, marginalities, and vulnerabilities. It calls for a transformative approach to long-term care policies that can address these systemic issues and prevent such tragedies in the future.

Background Public healthcare systems are increasingly relying on artificial intelligence (AI) technologies to meet growing healthcare needs. Because AI technologies are complex and costly to develop, public-private partnerships (PPPs) between digital companies and university hospital centres are being promoted as a key for the successful development and implementation of AI solutions. This article aims to shed light on stakeholders’ perspectives on the intellectual property (IP) and value sharing of AI technologies developed by PPPs and how their practical experiences can affect the success or failure of such PPPs. Methods Semi-structured interviews were conducted with 29 stakeholders concerned with and/or involved in digital health technologies in a large Canadian university hospital centre. Data were collected and analysed through a mixed deductive-inductive approach. Results The analysis revealed three key themes highlighting AI IP issues of concern for PPP stakeholders. First, the collaborations and contributions required from all stakeholders to develop AI technologies of clinical and commercial value are highly complex and often unclear. Second, the lack of institutional and commercial recognition of clinicians’ essential contributions to AI solution development results in competing academic and business imperatives that hinder their engagement in PPPs. Finally, public healthcare systems’ strategic use of AI requires new policies adapted to the digital economy where IP plays a central role in value generation and sharing. Conclusion For PPPs developing AI healthcare technologies to be successful, updated policies clarifying public healthcare systems’ strategic use of AI are required as well as clear value-sharing frameworks between stakeholders.

Importance:Caregivers of community-dwelling older adults play a protective role in emergency department (ED) care transitions. When the demands of caregiving result in caregiver burden, ED returns can ensue. Objective:To develop models describing whether caregiver burden is associated with ED revisits and hospital admissions up to 30 days after discharge from an initial ED visit. Design, Setting, and Participants:This prospective cohort study nested within the LEARNING WISDOM longitudinal cohort study included dyads of community-dwelling patients aged 65 years or older and their caregivers. Included patients were triaged to an observation unit stretcher on their index visit to 1 of 4 EDs within an integrated health multisite organization of 4 acute care hospitals in Québec, Canada, between January 1, 2019, and December 21, 2021, and underwent a transition of care when discharged back to the community. Analyses were conducted in May 2024. Exposure:Caregiver burden, collected using the brief 12-item Quebec French version of the Zarit Burden Interview (ZBI; score range, 0-48, with higher scores indicating higher burden). Main Outcomes and Measures:Revisits to the ED, defined as a return to any ED in the 4-hospital network, within 3, 7, or 30 days of the index visit and return visits to the ED resulting in hospitalization within 30 days of the index visit. Moderation of outcomes by wave of the COVID-19 pandemic at the index visit was also assessed. Results:Among 1409 caregiver-patient dyads, 711 patients (50.5%) and 980 caregivers (69.6%) were women; mean (SD) age was 77.06 (7.39) years for patients and 63.87 (12.04) years for caregivers. The mean (SD) ZBI score was 7.33 (7.11). Caregivers were most often spouses of patients (667 [48.0%]) or children of patients (534 [37.9%]). Among all patients, 75 (5.3%) returned to the ED within 3 days, 133 (9.4%) returned within 7 days, 292 (20.7%) returned within 30 days, and 88 (6.2%) were admitted to the hospital within 30 days. Each point increase on the ZBI scale was associated with an increase in the odds of a 30-day revisit to the ED (odds ratio [OR], 1.03; 95% CI, 1.00-1.05; P = .03), but associations were not found in models with shorter time windows (3 days: OR, 1.01; 95% CI, 0.98-1.04; P = .69; 7 days: OR, 1.01; 95% CI, 0.98-1.03; P = .55) or for revisits with hospital admissions (OR, 1.02; 95% CI, 0.99-1.05; P = .24). Associations between ZBI scores and 30-day ED revisits may have been moderated by the COVID-19 pandemic waves: the first interwave period (between waves 1 and 2) reversed the association (OR, 0.89; 95% CI, 0.78-0.97). Conclusions and Relevance:The findings suggest caregiver burden may be associated with ED revisits within 30 days of discharge from an initial ED visit among community-dwelling older adults. Future studies could enhance the management of ED revisits by demonstrating the longitudinal impact of caregiver burden on ED use in older adults.

Objective Improving care transitions for older adults can reduce emergency department (ED) visits, adverse events, and empower community autonomy. We conducted an inductive qualitative content analysis to identify themes emerging from comments to better understand ED care transitions. Methods The LEARNING WISDOM prospective longitudinal observational cohort includes older adults (≥ 65 years) who experienced a care transition after an ED visit from both before and during COVID-19. Their comments on this transition were collected via phone interview and transcribed. We conducted an inductive qualitative content analysis with randomly selected comments until saturation. Themes that arose from comments were coded and organized into frequencies and proportions. We followed the Standards for Reporting Qualitative Research (SRQR). Results Comments from 690 patients (339 pre-COVID, 351 during COVID) composed of 351 women (50.9%) and 339 men (49.1%) were analyzed. Patients were satisfied with acute emergency care, and the proportion of patients with positive acute care experiences increased with the COVID-19 pandemic. Negative patient comments were most often related to communication between health providers across the care continuum and the professionalism of personnel in the ED. Comments concerning home care became more neutral with the COVID-19 pandemic. Conclusion Patients were satisfied overall with acute care but reported gaps in professionalism and follow-up communication between providers. Comments may have changed in tone from positive to neutral regarding home care over the COVID-19 pandemic due to service slowdowns. Addressing these concerns may improve the quality of care transitions and provide future pandemic mitigation strategies.

Objectives To evaluate the feasibility of the Bali Yoga Programme for Residents (PYB-R), an 8-week virtual yoga-based intervention and determine its impact on the mental health of resident physicians.Design Single-group repeated measures study.Setting Associations from the four postgraduate medical education programmes in Québec, Canada.Participants Overall, 55 resident physicians were recruited to participate of which 53 (96.4%) completed the assessment pre-PYB-R. The postintervention assessment was completed by 43 residents (78.2%) and 39 (70.9%) completed all phases (including 3-month follow-up). Most were in their first year (43.4%) or second year (32.1%) of residency. The majority were female (81.1%) with a mean age of 28±3.6 years.Primary and secondary outcome measures The primary outcome measure was feasibility as measured by participation in the PYB-R. Secondary outcome measures were psychological variables (anxiety, depression, burn-out, emotional exhaustion, compassion fatigue and compassion satisfaction) and satisfaction with the PYB-R. Residents were further subgrouped based on the quality of work life and a number of PYB-R sessions attended.Results The attrition rate for programme completion was 19%. Of the 43 residents who completed the PYB-R, 90.6% attended between 6 and 8 sessions. Repeated-measures analysis of variances (ANOVAs) at three time points (baseline, PYB-R completion and 3-month follow-up) confirmed a decrease in scores for depression and anxiety, and an increase in scores for compassion satisfaction. No changes were observed in the other psychological variables evaluated. ANOVAs also confirmed that a better quality of life at work helps develop compassion satisfaction, a protective factor to compassion fatigue. Most participants (92.9%) indicated they were satisfied or very satisfied with the quality of the programme.Conclusions A virtual yoga-based programme is feasible and has lasting positive effects for up to 3 months on the mental health of resident physicians. Further research is warranted to validate these findings using a larger sample of residents with a control group.

OBJECTIVES:This study sought to describe the 2-year evolution of the intensity and frequency of noncardiac chest pain (NCCP), NCCP-related disability and health-related quality of life in a cohort of emergency department (ED) patients. It also aimed to identify and characterize subgroups of patients who share similar NCCP trajectories. METHODS:672 consecutive patients with NCCP were prospectively recruited in two EDs. NCCP, physical and mental health-related quality of life and pain-related impairment were assessed at baseline and 6 months, 1 year and 2 years after the index ED visit. RESULTS:Significant reductions in the intensity and frequency of NCCP and in NCCP-related disability were observed over time, with 58.1% of patients being considered NCCP-free at the 2-year follow-up. Four trajectories of NCCP intensity were identified through latent class growth mixture modelling: Worsening Trajectory (6.8%), Persistence Trajectory (20.5%), Limited Improvement Trajectory (13.1%) and Remission Trajectory (59.5%). Physical quality of life was significantly higher in the latter two trajectories at all assessment points. Patients in the Remission Trajectory reported a better mental quality of life and a greater decrease in NCCP-related disability over time than those in the other trajectories. CONCLUSIONS:Over 40% of ED patients with NCCP experienced persistent biopsychosocial morbidity that warrants further clinical attention.

BackgroundThe conventional methods and strategies used for knowledge translation (KT) in academic research often fall short in effectively reaching stakeholders, such as citizens, practitioners, and decision makers, especially concerning complex healthcare issues. In response, a growing number of scholars have been embracing arts-based knowledge translation (ABKT) to target a more diverse audience with varying backgrounds and expectations. Despite the increased interest, utilization, and literature on arts-based knowledge translation over the past three decades, no studies have directly compared traditional knowledge translation with arts-based knowledge translation methods. Thus, our study aimed to evaluate and compare the impact of an arts-based knowledge translation intervention-a circus show-with two traditional knowledge translation interventions (webinar and research report) in terms of awareness, accessibility, engagement, advocacy/policy influence, and enjoyment.MethodsTo conduct this exploratory convergent mixed method study, we randomly assigned 162 participants to one of the three interventions. All three knowledge translation methods were used to translate the same research project: "Rural Emergency 360: Mobilization of decision-makers, healthcare professionals, patients, and citizens to improve healthcare and services in Quebec's rural emergency departments (UR360)."ResultsThe findings revealed that the circus show outperformed the webinar and research report in terms of accessibility and enjoyment, while being equally effective in raising awareness, increasing engagement, and influencing advocacy/policy. Each intervention strategy demonstrates its unique array of strengths and weaknesses, with the circus show catering to a diverse audience, while the webinar and research report target more informed participants. These outcomes underscore the innovative and inclusive attributes of Arts-Based Knowledge translation, showcasing its capacity to facilitate researchers' engagement with a wider array of stakeholders across diverse contexts.ConclusionAs a relevant first step and a complementary asset, arts-based knowledge translation holds immense potential in increasing awareness and mobilization around crucial health issues.

Objective: This study aimed to prospectively document the association between panic disorder (PD) or generalized anxiety disorder (GAD) and noncardiac chest pain (NCCP)-related disability. Its second objective was to validate an explanatory model of these associations. Methods: This was a prospective cohort study of 124 emergency department patients with NCCP and comorbid PD or GAD. Anxiety sensitivity, heart -focused anxiety, and alexithymia were assessed at baseline. NCCP-related disability was assessed at baseline and at the 6 -month follow-up. Mediation analysis was used to validate the explanatory model. Results: The rate of NCCP-related disability was 54.8% (n = 68) at baseline and 34.7% (n = 43) at the 6 -month followup. Patients with PD were significantly more likely to report NCCP-related disability at the 6 -month follow-up than those with GAD alone (P = 0.021). A simplified model containing a causal chain between anxiety, anxiety sensitivity, heart -focused anxiety, and NCCP-related disability at the 6 -month followup was a good fit for the data. Conclusions: PD appears to be more closely associated with NCCPrelated disability than GAD. Among patients with NCCP and comorbid PD or GAD, heart -focused anxiety was the main psychological determinant of the development or maintenance of NCCP-related disability in the 6 months following an emergency department visit.

BACKGROUND:Artificial intelligence (AI) technologies are expected to "revolutionise" healthcare. However, despite their promises, their integration within healthcare organisations and systems remains limited. The objective of this study is to explore and understand the systemic challenges and implications of their integration in a leading Canadian academic hospital.METHODS:Semi-structured interviews were conducted with 29 stakeholders concerned by the integration of a large set of AI technologies within the organisation (e.g., managers, clinicians, researchers, patients, technology providers). Data were collected and analysed using the Non-Adoption, Abandonment, Scale-up, Spread, Sustainability (NASSS) framework.RESULTS:Among enabling factors and conditions, our findings highlight: a supportive organisational culture and leadership leading to a coherent organisational innovation narrative; mutual trust and transparent communication between senior management and frontline teams; the presence of champions, translators, and boundary spanners for AI able to build bridges and trust; and the capacity to attract technical and clinical talents and expertise. Constraints and barriers include: contrasting definitions of the value of AI technologies and ways to measure such value; lack of real-life and context-based evidence; varying patients' digital and health literacy capacities; misalignments between organisational dynamics, clinical and administrative processes, infrastructures, and AI technologies; lack of funding mechanisms covering the implementation, adaptation, and expertise required; challenges arising from practice change, new expertise development, and professional identities; lack of official professional, reimbursement, and insurance guidelines; lack of pre- and post-market approval legal and governance frameworks; diversity of the business and financing models for AI technologies; and misalignments between investors' priorities and the needs and expectations of healthcare organisations and systems.CONCLUSION:Thanks to the multidimensional NASSS framework, this study provides original insights and a detailed learning base for analysing AI technologies in healthcare from a thorough socio-technical perspective. Our findings highlight the importance of considering the complexity characterising healthcare organisations and systems in current efforts to introduce AI technologies within clinical routines. This study adds to the existing literature and can inform decision-making towards a judicious, responsible, and sustainable integration of these technologies in healthcare organisations and systems.

Importance: Caregivers play a protective role in emergency department (ED) care transitions. When the demands of caregiving result in caregiver burden, ED returns can ensue. Objective: We developed models describing how caregiver burden may predict ED revisits and admissions up to thirty days after discharge. Design: This prospective cohort study nested within the LEARNING WISDOM clinical trial included older adults and their caregivers who underwent a transition of care from one of four EDs in Quebec, Canada between January 1st, 2019, and December 21st, 2021. Setting: This study occurred within an integrated health multi-site organization consisting of four acute care hospitals. Participants: Patients aged 65 years or older who were discharged back to the community from the ED observation unit after being triaged to a stretcher on their index visit. Exposure: Caregiver burden, as collected using the brief twelve-item Quebec French version of the Zarit Brief Burden Interview (ZBI). Main Outcomes and Measure: Revisits to the ED were defined as a return to any ED in the 4-hospital network within 3, 7, or 30 days of the index visit. Admissions were return visits to the ED within 30 days resulting in hospitalization. Results: Among 1,409 caregiver-patient dyads, ZBI scores averaged 7.33 (SD = 7.11). Most caregivers were women (69%). Caregivers were most often spouses (48%) of patients or children of patients (38%). Among all patients, 5.3% returned to the ED within 3 days, 9.4% returned within 7 days, 20.7% returned within 30 days and 6.2% were admitted within 30 days. Each point increase on the ZBI scale was associated with a 2.8% increase in the odds of a 30-day revisit to the ED (p = 0.03), but not in models with shorter time windows, nor for admissions. ZBI scores on 30-day ED revisits were moderated by the COVID-19 pandemic waves: the first inter-wave period attenuated the association. Conclusions and Relevance: Caregiver burden may modestly predict ED revisits over 30 days. Future studies may enhance the management of ED revisits by predicting the longitudinal impact of caregiver burden on ED use in older adults. Trial Registration: https://clinicaltrials.gov/ct2/show/[NCT04093245][1] ### Competing Interest Statement The LEARNING WISDOM clinical trial was funded by an Embedded Clinician Salary Award (ECRA) awarded to PMA from the Canadian Institutes for Health Research (CIHR) (#201603), a Fonds de recherche du Québec - Santé (FRQS) Senior Clinical Scholar Award (#283211), and a CIHR Project Grant (#378616). Work on this article was supported by a Master's Award: Canada Graduate Scholarships Award (CIHR) awarded to NG (#202112). The funding bodies had no role in the design of the study, collection, or analysis of the data, interpretation of the results, or writing of the manuscript. The authors do not have any conflicts of interest to declare. ### Clinical Trial NCT04093245 ### Clinical Protocols ### Funding Statement The LEARNING WISDOM clinical trial was funded by an Embedded Clinician Salary Award (ECRA) awarded to PMA from the Canadian Institutes for Health Research (CIHR) (#201603), a Fonds de recherche du Québec - Santé (FRQS) Senior Clinical Scholar Award (#283211), and a CIHR Project Grant (#378616). Work on this article was supported by a Master's Award: Canada Graduate Scholarships Award (CIHR) awarded to NG (#202112). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The protocol for this study was approved by the Centre intégré de santé et de services sociaux - Chaudière Appalaches (CISSS-CA, Québec, Canada) Ethics Review Committee (project #2018-462, 2018-007). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Analysis code is consultable in a public repository on GitHub. Please contact the corresponding author for a link to the repository. Anonymized data are available from the corresponding author on reasonable request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04093245&atom=%2Fmedrxiv%2Fearly%2F2024%2F11%2F13%2F2024.09.25.24314385.atom

Background. Rural Canadian hospitals are increasingly vulnerable to service reductions and emergency department closures, compromising the emergency care access for the 6 million residents (20% of the population) living in these areas. Current standards for rural emergency care in Canada are outdated, necessitating innovative, locally adapted solutions. The Living Lab concept, a collaborative, real-world innovation ecosystem involving patients, citizens, healthcare professionals, learners and researchers, may address this gap. In 2020, we initiated a rural Living Lab hospital project in Charlevoix, Québec, where no prior studies on such hospitals existed. Our research aims to assess the current state of literature on rural Living Lab hospitals. Objectives. Our specific goal was to examine and characterize the existing research on Living Lab Hospitals in rural settings while precisely identifying areas where further research is required. Methodology. Our scoping review was conducted through a structured five-stage process: [1] problem formulation, [2] literature search, across five databases: PubMed, MEDLINE, EMBASE, CINAHL, and Web of Sciences, [3] data evaluation and analysis, [4] data collection and summary, and [5] presentation. Results. A total of 212 studies from Embase, 134 from MEDLINE, 91 from CINAHL, 10 from Web of Science, and 4 from PubMed were initially part of our analysis. After eliminating 169 duplicate entries, our team scrutinized 282 titles and abstracts. Given our primary aim of identifying living labs based in rural hospital settings, only our original publication, “A Canadian Rural Living Lab Hospital: Implementing solutions for improving rural emergency care”, was found. Conclusion: This scoping review indicates a stark research deficit on Living Lab hospitals in rural contexts, with only one relevant study identified. This highlights a critical need for further investigation into the adoption and impact of Living Lab models in rural healthcare. Given the risks faced by rural emergency services, it is vital to prioritize research in this area to improve and innovate care for vulnerable populations.

The COVID-19 pandemic has accelerated the deployment of telehealth services in many countries around the world. It also revealed many barriers and challenges to the use of digital health technologies in health organisations and systems that have persisted for decades. One of these barriers is what is known as the ‘wrong pocket’ problem – where an organisation or sector makes expenditures and investments to address a given problem, but the benefits (return on investment) are captured by another organisation or sector (the wrong pocket). This problem is the origin of many difficulties in public policies and programmes (e.g. education, environment, justice and public health), especially in terms of sustainability and scaling-up of technology and innovation. In this essay/perspective, we address the wrong pocket problem in the context of a major telehealth project in Canada. We show how the problem of sharing investments and expenses, as well as the redistribution of economies among the different stakeholders involved, may have threatened the sustainability and scaling-up of this project, even though it has demonstrated the clinical utility and contributed to improving the health of populations. In conclusion, the wrong pocket problem may be decisive in the reduced take-up, and potential failure, of certain telehealth programmes and policies. It is not enough for a telehealth service to be clinically relevant and ‘efficient’, it must also be mutually beneficial to the various stakeholders involved, particularly in terms of the equitable sharing of costs and benefits (return on investment) associated with the implementation of this new service model. Finally, the wrong pocket concept offers a helpful lens for studying the success, sustainability, and scale-up of digital transformations in health organisations and systems. This needs to be considered in future research and evaluations in the field.

Background:Injury severity scales have traditionally been used to assess the performance of prehospital trauma triage protocols, but they correlate weakly with the urgent needs of specialized trauma care interventions. This study aimed to develop a list of in-hospital urgent and specialized trauma care interventions that require direct transport to the highest-level trauma centre within the catchment area. Methods:Based on a list of potential participants we obtained using data on training, experience, geographic location, affiliations and role within key trauma organizations, we recruited multidisciplinary trauma experts (including prehospital, emergency, surgery and intensive care clinicians, epidemiologists and clinician/decision-makers) from across Canada to complete a 3-round modified Delphi survey. We conducted a literature review of the criteria used to define urgent and specialized trauma care, and included all diagnostic and therapeutic interventions presented in previously published studies in the list of interventions to present to the panellists. The final list was determined by our advisory committee, 5 clinicians with experience in trauma care. Participants were asked to rate their level of agreement for potentially including the 38 items as urgent and specialized trauma care interventions on a 9-point Likert scale. Interventions were retained if more than 67% of participants moderately or strongly agreed (7-9 on the Likert scale). Interventions that did not reach consensus were presented again in the subsequent round. Results:Twenty-three panellists were recruited. The response rate was 91%, 96% and 83% for the 3 rounds. After the Delphi process, 30 of the 38 interventions, including endotracheal intubation, blood product administration and angioembolization, and abdominal, thoracic, neurosurgical, spinal and/or orthopedic operations (excluding hip or limb surgery, and toe or finger amputation), were selected. Hospital admission to the intensive care unit and/or for observation of brain, spinal, thoracic or abdominal injuries were also retained. Conclusion:We developed a Canadian consensus-based list of urgent and specialized in-hospital trauma care interventions requiring direct transportation to a major trauma centre. This list should help standardize assessments of current protocols and derive new triage tools.

This study explores the barriers and facilitators to point-of-care ultrasound (POCUS) use and adoption in rural healthcare since POCUS is a useful resource for rural clinicians to overcome the challenges associated with limited on-site clinical support, such as limited diagnostic imaging services and infrastructure. A qualitative descriptive study was employed, interviews with ten rural clinicians were conducted, and the data were analysed using the Walt and Gilson health policy framework to guide interpretation. Barriers include a lack of standardised training requirements, the cost of the devices and challenges recouping the costs of purchase and training, difficulty with the maintenance of skills, and a lack of an effective method to achieve quality assurance. Coupling POCUS with telemedicine could address the issues of the maintenance of skills and quality assurance to facilitate increased POCUS use, leading to positive patient safety and social and economic implications.

Background Digital health technologies (DHTs) are promoted as means to reduce the environmental impact of healthcare systems. However, a growing literature is shedding light on the highly polluting nature of the digital industry and how it exacerbates health inequalities. Thus, the environmental footprint of DHTs should be considered when assessing their overall value to healthcare systems. The objectives of this article are to: (1) explore stakeholders’ perspectives on integrating the environmental impacts of DHTs in assessment and procurement practices; (2) identify the factors enabling or constraining the operationalisation of such a change; and (3) encourage a constructive dialogue on how environmental issues fit within healthcare systems’ push for more DHTs. Methods Semi-structured interviews were conducted with 29 stakeholders involved in DHTs in a large Canadian academic healthcare centre. Data were collected and analysed through a mixed deductive-inductive process using a framework derived from diffusion of innovations theories. Results The integration of the environmental impact of DHTs in assessment and procurement is contingent upon key micro-meso-macrosystemic factors that either enable or constrain changes in practices and processes. Innovation (micro) factors include stakeholders’ recognition of the environmental issue and the extent to which it is feasible for them to address the environmental impact of DHTs. Organisational (meso) factors include the organisation's culture, leadership, policies, and practices, as well as the expertise and professional skillsets available. Finally, external (macro) factors include political and regulatory (e.g., national strategy, laws, standards, norms), economic (e.g., business models, public procurement), and professional and scientific factors (e.g., evidence, methodologies, clinical guidelines). Conclusion Considering the environmental impact of DHTs depends on micro-meso-macrosystemic factors involving a variety of stakeholders and levels of governance, sometimes with divergent or even antagonistic objectives and expectations. It highlights the importance of better understanding the complexity inherent in the environmental shift in healthcare.

BACKGROUND:There was an increase in self-reported mental health needs during the COVID-19 pandemic in Canada, with research showing reduced access to mental health services in comparison to pre-pandemic levels. This paper explores 1) barriers and facilitating factors associated with mental health service delivery via primary care settings during the first two pandemic waves in Quebec, Canada, and 2) recommendations to addressing these barriers.METHODS:A qualitative descriptive study design was used. Semi-structured interviews with 20 participants (health managers, family physicians, mental health clinicians) were conducted and coded using a thematic analysis approach.RESULTS:Barriers and facilitating factors were organized according to Chaudoir et al. (2013)'s framework of structural, organizational, provider- and patient-related, as well as innovation (technological modalities for service delivery) categories. Barriers included relocation of mental health staff to non-mental health related COVID-19 tasks (structural); mental health service interruption (organizational); mental health staff on preventive/medical leave (provider); the pandemic's effect on consultations (i.e., perceptions of increased demand) (patients); and challenges with the use of technological modalities (innovation). Facilitating factors included reinforcements to mental health care teams (structural); perceptions of reductions in wait times for mental health evaluations during the second wave due to diminished FP referrals in the first wave, as well as supports (i.e., management, private sector, mental health trained staff) for mental health service delivery (organizational); staff's mental health consultation practices (provider); and advantages in increasing the use of technological modalities in practice (innovation).CONCLUSIONS:To our knowledge, this is the first study to explore barriers and facilitating factors to mental health service delivery during the pandemic in Quebec, Canada. Some barriers identified were caused by the pandemic, such as the relocation of staff to non-mental health services and mental health service interruption. Offering services virtually seemed to facilitate mental health service delivery only for certain population groups. Recommendations related to building and strengthening human and technological capacity during the pandemic can inform mental health practices and policies to improve mental health service delivery in primary care settings and access to mental health services via access points.

Psychiatry and Clinical NeurosciencesVolume 76, Issue 8 p. 404-405 Letter to the Editor Rethinking the organizational culture of the health system to address burnout Kouadio Ibrahime Sinan PhD, Corresponding Author Kouadio Ibrahime Sinan PhD sinankouadio@gmail.com orcid.org/0000-0002-6168-5707 Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada Research Chair in Emergency Medicine, Laval University, CHAU Hôtel-Dieu de Lévis, Quebec, CanadaSearch for more papers by this authorMarie-Philippe Tremblay MPH, Corresponding Author Marie-Philippe Tremblay MPH marie-philippetremblay@ssss.gouv.qc.ca orcid.org/0000-0003-2698-7651 Research Chair in Emergency Medicine, Laval University, CHAU Hôtel-Dieu de Lévis, Quebec, Canada Faculty of Nursing, Laval University, Quebec City, Quebec, CanadaSearch for more papers by this authorFatoumata Korika Tounkara PhD, Fatoumata Korika Tounkara PhD Research Chair in Emergency Medicine, Laval University, CHAU Hôtel-Dieu de Lévis, Quebec, CanadaSearch for more papers by this authorRichard Fleet MD, PhD, Richard Fleet MD, PhD Research Chair in Emergency Medicine, Laval University, CHAU Hôtel-Dieu de Lévis, Quebec, Canada Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Quebec, CanadaSearch for more papers by this author Kouadio Ibrahime Sinan PhD, Corresponding Author Kouadio Ibrahime Sinan PhD sinankouadio@gmail.com orcid.org/0000-0002-6168-5707 Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada Research Chair in Emergency Medicine, Laval University, CHAU Hôtel-Dieu de Lévis, Quebec, CanadaSearch for more papers by this authorMarie-Philippe Tremblay MPH, Corresponding Author Marie-Philippe Tremblay MPH marie-philippetremblay@ssss.gouv.qc.ca orcid.org/0000-0003-2698-7651 Research Chair in Emergency Medicine, Laval University, CHAU Hôtel-Dieu de Lévis, Quebec, Canada Faculty of Nursing, Laval University, Quebec City, Quebec, CanadaSearch for more papers by this authorFatoumata Korika Tounkara PhD, Fatoumata Korika Tounkara PhD Research Chair in Emergency Medicine, Laval University, CHAU Hôtel-Dieu de Lévis, Quebec, CanadaSearch for more papers by this authorRichard Fleet MD, PhD, Richard Fleet MD, PhD Research Chair in Emergency Medicine, Laval University, CHAU Hôtel-Dieu de Lévis, Quebec, Canada Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Quebec, CanadaSearch for more papers by this author First published: 10 May 2022 https://doi.org/10.1111/pcn.13371Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume76, Issue8August 2022Pages 404-405 RelatedInformation