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Pascale Lehoux

Publications and source records attributed to Pascale Lehoux.

At least 19 recordsLinked to original sources
PubMed2006

Bringing 'the public' into health technology assessment and coverage policy decisions: from principles to practice.

Those making health care coverage decisions rely on health technology assessment (HTA) for crucial technical information. But coverage decision-making, and the HTA that informs it, are also inherently political. They involve the values and judgments of a range of stakeholders as well as the public. Moreover, governments are politically accountable for their resource allocation decisions. Canadian policy makers are at an early stage in the design of legitimate mechanisms for the public to contribute to, and to be apprised of, HTA and coverage decisions. As they consider the options, questions arise about whom to involve (e.g., which publics), how to engage them (e.g., through what public involvement or accountability mechanisms), and for what purpose (e.g., to inform the public of decisions and their rationales, or to have the public directly affect those decisions). Often key concepts, such as the difference between public accountability and public participation, are not well articulated or distinguished in these debates. Guidance is needed regarding both rationales and methods for involving the public in HTA and technology coverage decisions. We offer a framework that clearly distinguishes specific roles for the public, and relates them to several layers of policy analysis and policy making where 'the public' may engage in different tasks. The framework offers a menu of choices for policy makers contemplating changes to public involvement, as well as a model that can be used to characterize and analyze different approaches across jurisdictions.

Community Participation↗
PubMed2006

Focus group research and "the patient's view".

A clear emphasis on the patient's view is discernible in the health services research literature of the past decades. Such a switch to patients' perspectives has been greatly facilitated by a wider acceptance and use of qualitative methods. In particular, focus groups are often used to uncover the range and depth of experiences of health services users and chronically ill individuals. Although this method contributes to a better understanding of patients' perspectives and practices, a number of analytical considerations have been overlooked. The aim of this paper is to consider how to conceptualise and analyse interactions in focus group research. We argue that focus groups are social spaces in which participants co-construct the "patient's view" by sharing, contesting and acquiring knowledge. Focus groups conducted with home care patients in Quebec, Canada (on antibiotic intravenous therapy, parenteral nutrition, peritoneal dialysis and oxygen therapy) are used to illustrate three interactive processes at work in focus groups: (1) establishing oneself as experienced and knowledgeable; (2) establishing oneself as in search of information and advice; and (3) validating or challenging one another's knowledge claims. We develop an analytical template focused on the subtle dynamics underpinning the various and at times competing claims of patients. This template acknowledges the processes through which participants attribute authority to the claims of others, including the focus group moderator. We find that focus group research does not derive epistemological authority simply from the identity of its participants. Rather, an emerging consensus about what constitutes the patient's view is the result of context-dependent social interactions that need to be scrutinised.

Adult↗
PubMed2006

Working off the record: physicians' and nurses' transformations of electronic patient record-based patient information.

BACKGROUND: Electronic patient records (EPRs) are increasingly being used in health care, but little is known about how EPR-based patient information is used in daily care activities, nor about its potential influence on novice training. METHOD: Seventy-two physicians and nurses participated in an eight-month study on a single pediatric ward. Eighty hours of nonparticipant observations and 20 interviews were conducted. Data were analyzed using constructivist grounded theory and visual rhetoric. RESULTS: Three main features of participant interactions with EPR-based information were identified: (1) EPR-based information was routinely transformed into paper documents; (2) these transformations were organized by profession-specific guiding principles; and (3) transformation strategies were learned through an informal curriculum. CONCLUSIONS: This study describes how and why health care professionals work around EPR-based patient information, and suggests that an EPR's visual organization may be incompatible with professional activities. The study addresses the socializing implications of these activities, and highlights their educational potential.

Canada↗
PubMed2006

Delivery of high-tech home care by hospital-based nursing units in Quebec: clinical and technical challenges.

BACKGROUND: The role that hospital-based nurses should play in the delivery of high-tech home care, and how they should be supported in that role, are topics that remain understudied. Our research objective was to document how hospital-based nursing teams perceive and deal with the clinical and technical challenges associated with the provision of high-tech home care. METHODS: Four home care interventions were selected: antibiotic intravenous therapy, parenteral nutrition, peritoneal dialysis and oxygen therapy. A self-administered survey was sent to all hospital-based units providing these interventions in the province of Quebec, Canada (n = 154; response rate: 70.8%). We used descriptive statistical analyses to derive mean values for scores on either a five- or a six-level Likert scale. RESULTS: Despite variation across the four interventions, our results indicate that while nursing teams believe these interventions increase patients' autonomy, they also recognize that they generate anxiety and impose constraints on patients' lives. Nurses must increase efforts to deal with both clinical and technical challenges and help patients overcome the barriers to appropriate use of home care technologies. CONCLUSIONS: While nursing teams generally perceive high-tech home care as beneficial, they still experience significant technical and clinical challenges. Some of these challenges could be addressed by strengthening professional training initiatives, while others require broader home care policy interventions.

Adaptation, Psychological↗
PubMed2005

International Master's Program in health technology assessment and management: assessment of the first edition (2001--2003).

BACKGROUND: Despite a clear call for greater input from health technology assessment (HTA) in the areas of clinical practice and policy making, there are currently very few formal training programs. The objectives of our Consortium were to (i) develop a master's level program in HTA, (ii) test its content with a group of Canadian and European students, and (iii) evaluate the Program's strengths and weaknesses. OBJECTIVES: This study presents the results of our evaluation of the first edition of the Master's Program (2001--2003). METHODS: The evaluation relied on (i) a self-administered student questionnaire for each course (n = 142), (ii) interviews with students (n = 10), and (iii) interviews with internship supervisors (n = 5). RESULTS: A vast majority of students were satisfied with the course content and particularly appreciated the exercises and materials presented in an intensive format. However, they needed more systematic feedback from faculty members and recommended increasing the methodology content. The six key characteristics of the program are (i) flexible format adapted to the needs of skilled professionals, (ii) continuous interaction between HTA users and producers, (iii) international academic and professional collaboration, (iv) partnership with HTA agencies, (v) global approach to evidence-based methods and practices, and (vi) multidisciplinary approach. CONCLUSIONS: Despite the numerous organizational barriers inherent to creating an international program and several areas for improvement in the Program itself, the Ulysses Project was successful in attaining its objectives. Because there is a growing need for human resources with special training in HTA, further efforts need to be devoted to strengthening the international research capacity in HTA.

Canada↗
PubMed2005

'Airplanes are flying nursing homes': geographies in the concepts and locales of gerontological nursing practice.

With the geographical literatures and issues outlined in the first paper very much in mind, this paper focuses specifically on the places in the concepts and locales of gerontological nursing practice. Particular attention is paid to the role of nurses in the making of long-term care institutions and to some fundamental priorities of care. Consideration is also given to some broader impacts of neighbourhood and community as an important spatial context to nursing practice based both in institutions and the community. In the final section, the paper makes some observations on how place-sensitive practice and research might contribute to the uptake of evidence for practice. These discussions set the scene for the final paper in this special section focused on the future research agenda for place and older people nursing.

Aged↗
PubMed2005

Dissemination of health technology assessments: identifying the visions guiding an evolving policy innovation in Canada.

Health technology assessment (HTA) has received increasing support over the past twenty years in both North America and Europe. The justification for this field of policy-oriented research is that evidence about the efficacy, safety, and cost-effectiveness of technology should contribute to decision and policy making. However, concerns about the ability of HTA producers to increase the use of their findings by decision makers have been expressed. Although HTA practitioners have recognized that dissemination activities need to be intensified, why and how particular approaches should be adopted is still under debate. Using an institutional theory perspective, this article examines HTA as a means of implementing knowledge-based change within health care systems. It presents the results of a case study on the dissemination strategies of six Canadian HTA agencies. Chief executive officers and executives (n = 11), evaluators (n = 19), and communications staff (n = 10) from these agencies were interviewed. Our results indicate that the target audience of HTA is frequently limited to policy makers, that three conflicting visions of HTA dissemination coexist, that active dissemination strategies have only occasionally been applied, and that little attention has been paid to the management of diverging views about the value of health technology. Our discussion explores the strengths, limitations, and trade-offs associated with the three visions. Further efforts should be deployed within agencies to better articulate a shared vision and to devise dissemination strategies that are consistent with this vision.

Canada↗
PubMed2005

Use of health technology assessment in decision making: coresponsibility of users and producers?

OBJECTIVES: Health technology assessment (HTA) is a policy-oriented form of research designed to inform decision-makers on the introduction, use, and dissemination of health technology. Whereas research on knowledge transfer has focused on knowledge producers, little attention has been given to the user's perspective. This study examines how health-care provider, administrator, and patient associations across Canada use HTA reports and the limitations they encounter when accessing and using scientific knowledge. METHODS: This study draws from semistructured interviews (n=42) conducted with three types of user, located in British Columbia, Alberta, Saskatchewan, Ontario, and Quebec. Applying well-established conceptual categories in knowledge utilization research, our qualitative analyses sought to define more precisely how HTA is used by interviewees as well as the most significant barriers they encounter. RESULTS: The vast majority of users recognize the usefulness and credibility of HTA reports. Of interest, the way they use HTA takes different forms. Although administrators and health-care providers are in a better position than patient associations to act directly on HTA messages--making an instrumental use of HTA--we also found conceptual and symbolic uses across all groups. Our results also indicate that significant organizational, scientific, and material limitations hinder the use of scientific evidence. Overcoming such barriers requires a greater commitment from both HTA producers and users. CONCLUSIONS: This study argues that, to ensure better uptake of HTA, it should become a shared responsibility between HTA producers and various types of user.

Canada↗
PubMed2004

Patients' perspectives on high-tech home care: a qualitative inquiry into the user-friendliness of four technologies.

BACKGROUND: The delivery of technology-enhanced home care is growing in most industrialized countries. The objective of our study was to document, from the patient's perspective, how the level of user-friendliness of medical technology influences its integration into the private and social lives of patients. Understanding what makes a technology user-friendly should help improve the design of home care services. METHODS: Four home care interventions that are frequently used and vary in their technical and clinical features were selected: Antibiotic intravenous therapy, parenteral nutrition, peritoneal dialysis and oxygen therapy. Our qualitative study relied on the triangulation of three sources of data: 1) interviews with patients (n = 16); 2) interviews with carers (n = 6); and 3) direct observation of nursing visits of a different set of patients (n = 16). Participants of varying socioeconomic status were recruited through primary care organizations and hospitals that deliver home care within 100 km of Montreal, the largest urban area in the province of Quebec, Canada. RESULTS: The four interventions have both a negative and positive effect on patients' lives. These technologies were rarely perceived as user-friendly, and user-acceptance was closely linked to user-competence. Compared with acute I.V. patients, who tended to be passive, chronic patients seemed keener to master technical aspects. While some of the technical and human barriers were managed well in the home setting, engaging in the social world was more problematic. Most patients found it difficult to maintain a regular job because of the high frequency of treatment, while some carers found their autonomy and social lives restricted. Patients also tended to withdraw from social activities because of social stigmatization and technical barriers. CONCLUSIONS: While technology contributes to improving the patients' health, it also imposes significant constraints on their lives. Policies aimed at developing home care must clearly integrate principles and resources supporting the appropriate use of technology. Close monitoring of patients should be part of all technology-enhanced home care programs.

Adult↗
PubMed2004

Redefining health technology assessment in Canada: diversification of products and contextualization of findings.

OBJECTIVES: While strategies for enhancing the dissemination and impact of Health Technology Assessment (HTA) are now being increasingly examined, the characteristics of HTA production have received less attention. METHODS: This study presents the results of a content analysis of the HTA documents (n = 187) produced by six Canadian agencies from 1995 to 2001, supplemented by interviews with chief executive officers and researchers (n = 40). The goal of this analysis was to characterize the agencies' portfolios and to analyze the challenges these agencies face in responding to the increased demand for HTA. RESULTS: On average, thirty HTA products were issued annually by the agencies. While the bulk of documents produced were full HTA reports (76 percent), two agencies showed significant diversification in their products. Three agencies in particular actively supported the publication of results in scientific journals. Three agencies showed evidence of adapting to different institutional environments by specializing in certain areas (drugs, health services). Overall, a significant portion of the agencies' HTAs contained data on costs (37 percent) and effectiveness (48 percent), whereas ethical and social issues were rarely addressed (17 percent). Most agencies addressed issues and outcomes that did not strictly fall under the typical definition of HTA but that increased the "contextualization" of their findings. CONCLUSIONS: Our discussion highlights four paradoxes and reflects further on challenges raised by the coordination of HTA within large countries and among European states. This study concludes that HTA is being redefined in Canada as HTA agencies offer a more contextualized informational basis, an approach that may prove more compatible with the increased demand for HTA.

Canada↗
PubMed2004

The use of technology at home: what patient manuals say and sell vs. what patients face and fear.

Over the past 15 years, the use of specialised medical equipment by patients at home has increased in most industrialised countries. Adopting a conceptual framework that brings together two research perspectives, i.e. the sociology of technology and the sociology of illness, this paper empirically examines why and how patients use health technology at home and in the broader social world. Our study compares and contrasts the use of four interventions: antibiotic intravenous therapy, parenteral nutrition, peritoneal dialysis and oxygen therapy. We conducted interviews with patients (n = 16) and caregivers (n = 6), and made direct observations of home visits by nurses (n = 16). The content and structure of patient manuals distributed by major manufacturers and hospitals were analysed (n = 26). The aim of our study was to determine how technology was supposed to be used versus how it was actually used. This study shows that patients are deeply ambivalent about the benefits and drawbacks of technology, and that these advantages and disadvantages are shaped by the various places in which the technology is used. While technology can be pivotal in making patients autonomous and able to participate in the social world, it also imposes heavy restrictions that are intimately interwoven with the nature of the particular disease and with the patient's personal life trajectory.

Adaptation, Psychological↗
PubMed2004

A cost-effectiveness analysis of interactive paediatric telecardiology.

We analysed the cost-effectiveness of a teleconsultation service after five years of operation. The service provides diagnostic consultation at a distance for children suffering from cardiac pathologies. A retrospective study was performed with all 78 infants who had received a paediatric cardiology teleconsultation over a four-year period from January 1998. The cost-effectiveness of telecardiology was compared with that of the conventional means of providing services. Teleconsultation proved to be an effective and reliable method of enhancing access to tertiary care. The number of patient journeys (both emergency transfers and semi-urgent or elective visits to the tertiary care centre) was reduced by 42%. However, the cost analysis demonstrated that teleconsultation did not result in overall cost savings: the total cost of telecardiology was C dollars 272,327 and the total cost of conventional care would have been C dollars 157,212. There were direct savings for patients but not for the health-care system, because of the high cost of the equipment and telecommunication fees. Telemedicine therefore represented a supplementary cost of C dollars 1500 per patient. In summary, telemedicine added to cost but increased effectiveness. The incremental cost-effectiveness ratio of teleconsultation was estimated to C dollars 3488 per patient journey avoided.

Cardiology↗
PubMed2003

The great escape? Prospects for regulating access to technology through health technology assessment.

OBJECTIVE: Health technology assessment (HTA) can be used both to promote access to safe, efficacious, and cost-effective technologies, and to discourage access to undesirable ones. Yet HTA has had less success than might be hoped in pursuing the latter goal. This paper examines the scope of HTA as currently practiced to contribute to regulation of access to undesirable technologies. DESIGN: The study design is a critical analysis of HTA's methods, based on an exposition of the normative issues involved in restriction of access to health technologies. The paper classifies technologies that might figure as potential candidates for exclusion into five categories and underscores the key social and ethical dilemmas associated with limiting their use. RESULTS: For four of the five categories of technology outlined, limitation of access necessarily involves denial of benefit. Limitation of access thus inevitably raises difficult normative issues. We show that these are ill-addressed by the range of "evidence" typically considered in technology assessments, which centers predominantly on clinical and technical features such as efficacy, safety, and costs. CONCLUSIONS: If HTA is to enhance our ability to make reasonable decisions concerning the use and diffusion of health technologies, it must better integrate consideration of the social, political, and ethical dimensions of health technologies into the process of technology assessment. We suggest a framework within which to approach this goal.

Canada↗
PubMed2003

Creating a new articulation between research and practice through policy? The views and experiences of researchers and practitioners.

OBJECTIVES: In 1990, the Quebec Social Research Council - a body financing social research in Quebec, Canada - launched a new policy encouraging the development of social research units within health care organizations. Through financial incentives, it encouraged the implementation of long-term collaborations between researchers and practitioners with the purpose of transforming both scientific knowledge production and professional practices. This paper examines the perceptions of researchers and practitioners regarding the attributes and the usefulness of this collaborative research policy. METHODS: A self-administered survey was sent to all the researchers (n = 146; response rate 78.1%) and practitioners (n = 204; response rate 44.1%) involved in the 21 collaborative research teams funded in 1998. T-tests were performed in order to assess the difference between the perceptions of researchers and practitioners in five key dimensions of collaborative research. RESULTS: The results showed that, contrary to expectations, researchers and practitioners shared fairly similar views regarding the various dimensions of collaborative research. They both agreed that their involvement within collaborative research teams had contributed to the development of new skills and practices but had not facilitated their participation in external activities nor their involvement in networks and organizations that influence environments in which public policies and practices are deployed. They also both encountered some difficulties in putting the dimensions that they highly valued into practice. CONCLUSIONS: Collaborative research within health care organizations succeeded in fostering the implementation of new modes of knowledge production and intervention. Nevertheless, special attention needs to be given to the development of strategies to reduce the discrepancies between values and practices.

Cooperative Behavior↗
PubMed2003

Feasibility and outcome evaluation of a telemedicine application in speech-language pathology.

This evaluative study assessed the feasibility and outcome of delivering speech-language services from a distance to children and adolescents who stutter. All six patients who formed the first cohort seen in the telespeech programme were included in the study. The results demonstrated that interactive videoconferencing can provide a feasible and effective care delivery model. Patient attendance was maintained throughout the intervention. All participants showed improved fluency. Stuttering ranged from 13% to 36% before treatment and 2% to 26% after treatment. All participants maintained at least part of their improved fluency during the six-month follow-up, when stuttering ranged from 4% to 32%. The study demonstrates that full assessment and treatment of stuttering in children and adolescents can be accomplished successfully via telemedicine.

Adolescent↗