College of Medicine - Master of Physician Assistant Studies Capstone Projects

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    Inequities in acute stroke care and outcomes among rural versus urban populations in Canada: a literature review
    (2022-05-15) Betcher, Charnae
    In acute stroke evaluation, rapid intervention and rehabilitation is critical. Canada’s vast geography innately creates barriers for efficient transport to stroke centres, thus delaying treatment. The purpose of this literature review is to investigate potential inequities in acute stroke care and outcomes, and to understand the causes and consequences of inequities in access to diagnostic investigations, acute stroke care management, and overall post stroke mortality in rural versus urban populations in Canada. A literature search using PubMed database was performed using keywords ischemic stroke, hemorrhagic stroke, Canada, and rural or urban. Three articles met the inclusion criteria and were included in the review. One additional related report was included by consulting primary sources in reference lists of relevant articles. Literature suggests that rural residence is associated with limited access to stroke centres and rehabilitation services, decreased acquisition of neuroimaging, increased hesitancy to treat with tPA, and impeded access to timely revascularization intervention via EVT. These disparities may in part be explained by time required to access appropriate healthcare facilities, variations in resource allocation and level of expertise of treating health care providers. There is contrasting findings regarding usage of tPA and 30-day post stroke mortality rates. Acute stroke care management is substandard in rural compared to urban populations in Canada. This gap in care may be addressed by focusing on minimizing existing barriers including access to stroke centres and rehabilitation services, neuroimaging, comfort administering tPA and timely revascularization intervention. Implementing telestroke and regionalization of stroke care may be of value.
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    Current Management of Opioid Use Disorder and Barriers to Prescribing Opioid Agonist Therapy by Primary Care Providers in the Interlake-Eastern Health Region
    (2022-08-26) Devaney, Brittany
    Background: Opioid agonist therapy (OAT) is the first-line treatment for opioid use disorder. It has traditionally been provided through specialized addictions clinics, but more recently, there has been a push for primary care providers (PCPs) to take on this service. This has been met with reluctance by providers who cite a lack of adequate time, knowledge, and remuneration, among other barriers. Objective: The primary objective of this study was to explore provider-reported attitudes on and barriers to integrating OAT into primary care, specifically within the Interlake-Eastern Health Region (IERHA). The aim was to improve regional access by generating actionable recommendations to address these barriers. A secondary objective was to explore how PCPs currently manage opioid use disorder. Methods: This study employed a quality improvement design. Participants were purposively sampled from PCPs in the IERHA who did not have licensure to prescribe OAT. Structured individual interviews were conducted from May to June 2022. Transcripts were analyzed for overarching themes as they related to the study objectives. Results: Fourteen participants were included in the study. Fee-for-service providers were largely unwilling to prescribe OAT in the primary care setting and cited a multitude of factors for this such as lack of adequate remuneration, time, and perceived need. Notably, many providers were frustrated with the limited nature of mental health resources and expressed a sense of futility in providing OAT without these supports. Conclusion: Overall, fee-for-service providers in the IERHA expressed a myriad of barriers with respect to their unwillingness to prescribe OAT. At present, priority should be placed on contracted providers in expanding primary care access. Fee-for-service providers would be best utilized for maintenance prescriptions or OAT induction in a small number of less complex patients.
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    A literature review: Cervical Cancer Screening Among Immigrant Women in Canada
    (2022-05-15) Wagner, Camille
    Introduction: The introduction of Pap test screening programs in Canada has resulted in a decrease in the incidence of cervical cancer and cervical cancer-related deaths (1). Despite screening programs and a universally available health care program, immigrant women in Canada are at a higher risk of being under-screened for cervical cancer compared to Canadian-born women (2). Objective: The purpose of this literature review is to understand the factors related to Canadian immigrant women’s lower participation in cervical cancer screening programs, with the aim to develop recommendations to increase immigrant women’s cervical cancer screening rate. Methods: A literature search using PubMed, Scopus, and CINAHL databases were performed using key terms pertaining to cervical cancer screening among immigrant women in Canada. Six primary research articles were found to meet the inclusion criteria and were analyzed in this literature review. Results: Six studies explored the factors related to Canadian immigrant women’s participation in cervical cancer screening programs through multivariate regression analysis. These studies identified that decreased screening rates were related to factors in four main areas: socioeconomic status, access to a primary care physician, age, and country of origin. Conclusion: The four main factors identified as relating to Canadian immigrant women’s participation in cervical cancer screening include having access to a primary care physician, lower socioeconomic status, older age, and being a visible minority or originating from South Asian, Middle Eastern or North African regions. Interventions to improve screening program participation may include ensuring immigrant women have access to a primary care provider, with consideration that this access could be extended to more women through the utilization of physician assistants. Additionally, efforts to make women more aware of screening guidelines and make screening more readily accessible may target those immigrant women who have been identified as being under-screened, namely those of lower socioeconomic status, and older age.
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    Straight until proven otherwise; improving sexual orientation and gender identity disclosure in healthcare, and its application in Manitoba.
    (2022-05-15) Chasse, Kelsie
    Background: The 2SLGBTQIA+ community experiences disproportionately poor healthcare outcomes when compared to their cisgender-heterosexual counterparts. This disparity is thought to be primarily due to a lack of disclosure of sexual orientation and gender identity (SOGI) to healthcare providers. Failure of providers to ask patients’ their SOGI is thought to be the greatest barrier to disclosure. Objective: Discuss the best methods to collect SOGI data from a logistical standpoint, and from a patient and provider perspective. Method: Narrative literature review using PubMed and Scopus databases Results: Nine articles were reviewed and their results categorized into four outcome measures: SOGI fields in electronic medical records, data collection method, patient perspectives on SOGI data collection, provider perspectives on SOGI data collection. Conclusions: Adding SOGI to electronic medical records is an important step in improving disclosure. Both patients and providers prefer an indirect method of data collection such as survey format. Patients want to know why their SOGI is being collected. Provider education in delivering queer-competent care is required. Many of these findings could be implemented in the existing healthcare infrastructure in Manitoba.
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    Views, self-rated competency, and perceived barriers in practicing trauma-informed care: A survey of Physician Assistants in Canada
    (2022-05-15) Murray, Madelaine
    Psychological trauma has a widespread impact on individuals and the healthcare system, with it being estimated that over 70% of Canadians have experienced a traumatic event in their lives (1). Trauma-informed care (TIC) acknowledges the impact that trauma can have on an individual, works to understand the effects of trauma, recognizes the signs and symptoms of traumatic stress, and works to actively resist re-traumatization. The purpose of this study was to assess the opinions, self-rated competency, and perceived barriers of Canadian Physician Assistants (PAs) towards their practice of trauma-informed care. A survey study was distributed via email and various social media groups with a total of 66 respondents. The majority of participants had positive opinions towards TIC, feel somewhat confident in their practice of TIC and expressed a desire to learn more about it. Participants also acknowledged various barriers to the implementation of TIC, including a lack of training and education on the topic. In conclusion, there appears to be a knowledge gap between Canadian PAs and the practice of TIC, but the positive reception and interest towards the topic suggests this is a promising area for future growth and education for PAs in Canada.