(IN) ACCESS TO ARTIFICIAL LIMBS: THE PATIENT’S PERSPECTIVE ACCORDING TO THE WAR AMPS OF CANADA

Funding agencies, both public and private, do not adequately meet the needs of Canadian amputees. This often leaves amputees without access to appropriate prosthetic care due to outstanding balances that are to be paid out of pocket, or by charitable organizations. There are several factors that result in these inadequacies. As healthcare is a provincial responsibility in Canada, provinces and territories have the authority to create individual public regimes, each with their own weaknesses. In fact, there are a few provincial regimes which do not include prosthetic funding at all. Private healthcare is meant to offset the remaining balance; however, their lack of knowledge regarding amputation has resulted in the creation of policies with ambiguous language, limiting the funding available for prosthetic care. Attitudinal barriers and missed legislative opportunities further exacerbate the shortcomings of prosthetic funding provided by public and private funding agencies, requiring action. Article PDF Link:https://jps.library.utoronto.ca/index.php/cpoj/article/view/35972/28331 How To Cite: Petlock A, DiMario K. (In) Access to artificial limbs: the patient’s perspective according to the WAR AMPS of Canada. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.13. https://doi.org/10.33137/cpoj.v4i2.35972 Corresponding Author: Annelise PetlockThe War Amps Advocacy Program/ 2827 Riverside Drive Ottawa, Ontario, Canada.E-Mail: [email protected] ID: https://orcid.org/0000-0002-7273-4527

Acceptability of a Mobile-Health Living Kidney Donor Advocacy Program for Black Wait-Listed Patients

Marked racial disparities exist in rates of living donor kidney transplantation (LDKT). The Living Organ Video Educated Donors (LOVED) program is a distance-based, mobile health program designed to help Black kidney transplant wait-list patients advocate for a living donor. This study reported on the acceptability outcomes to aid in future refinements. Participants were randomized to LOVED (n = 24, mean age = 50.9 SD (9.2) years), male = 50%) and usual care groups (n = 24 (mean age 47.9 SD (10.0), male 50%). Four LOVED groups completed an eight-week intervention that consisted of six online video education modules and eight group video chat sessions led by a Black navigator. Qualitative analysis from post-study focus groups resulted in six themes: (1) video chat sessions provided essential support and encouragement, (2) videos motivated and made participants more knowledgeable, (3) connectivity with tablets was acceptable in most areas, (4) material was culturally sensitive, (5) participation was overall a positive experience and (6) participants were more willing to ask for a kidney now. The video chat sessions were pertinent in participant satisfaction, though technology concerns limited program implementation. Results showed that the LOVED program was acceptable to engage minorities in health behavior changes for living donor advocacy but barriers exist that require future refinement.

Engaging older adults as advocates for age-friendly, walkable communities: The Senior Change Makers Pilot Study

As the U.S. population ages, communities must adapt to help older adults thrive. Built environment features, like safe sidewalks and crosswalks, provide the foundation for age- and physical activity-friendly communities. Controlled studies are needed to evaluate advocacy training programs that instruct and support seniors to advocate for more walkable neighborhoods. The Senior Change Makers Pilot Study evaluated an advocacy program that taught seniors to evaluate pedestrian environments using the validated MAPS-Mini audit tool, identify barriers, and advocate for improvements. Participants (n = 50) were recruited from four low-income senior housing sites in San Diego, CA, which were randomly assigned to an 8-week advocacy program or physical activity (PA) comparison intervention. Evaluation included surveys, accelerometers to assess PA, and direct observation. Primary outcomes were seniors’ advocacy confidence and skills. Main analyses used repeated measures ANOVAs. Seniors in the advocacy condition (n = 17) increased their advocacy outcome efficacy (p = .03) and knowledge of resources (p = .04) more than seniors in the PA condition (n = 33). Most seniors in the advocacy condition completed a street audit (84%), submitted an advocacy request (79%), or made an advocacy presentation to city staff (58%). Environmental changes included repairs to sidewalks and crosswalks. City staff approved requests for lighting, curb cuts, and crosswalk markings. Seniors’ accelerometer-measured PA did not significantly increase, but self-reported transportation activity increased in the PA condition (p = .04). This study showed the potential of advocacy training to empower seniors to make communities more age- and activity-friendly.

Factors Influencing Uptake of Breastfeeding: The Role of Early Promotion in the Maternity Hospital

Background: This study aimed to explore the prevalence of breastfeeding at birth points in Sicily and the relevance of the factors influencing the adoption of exclusive breastfeeding during hospitalization linked to childbirth. Methods: A survey was conducted to monitor the prevalence of breastfeeding in seven out of nine facilities providing maternity services in the province of Catania (Sicily, Southern Italy) in the years 2016–2018. An online questionnaire was administered using an electronic tablet by the midwife to the mother after discharge. Results: Women who had a higher educational qualification breastfed in a greater proportion (59.6%; odds ratio OR 0.60 for abandoning breastfeeding). Having had a caesarean section moderately impaired breastfeeding uptake, with an almost double chance of declining exclusive breastfeeding (OR = 1.74). Starting breastfeeding within 1 h from delivery showed a significant facilitating effect (OR = 0.58). Rooming-in had a strong facilitating effect on exclusive breastfeeding. A breastfeeding advocacy program was shown to protect from abandoning breastfeeding. Conclusions: It is important to offer in all hospitals the possibility and support for breastfeeding in the first moments after childbirth to increase the number of those who will then continue with exclusive breastfeeding.

The Effect of a Customized Advocacy Product on Downstream Medical Expenditures and Utilization

Background: The complexity of today’s healthcare system has led to the growth of an emerging healthcare function known as healthcare advocacy. A telephonic healthcare advocate or advisor can play an essential role in care coordination, a better understanding of health benefits, and ease in navigating the healthcare system. A healthcare advocate’s role may be filled by clinical staff (i.e., registered nurses), non-clinical staff, or both, with varying levels of training depending on the intended scope of service. Objective: With a higher number of employers seeking customized health advocacy programing, this study serves to determine if more favorable healthcare outcomes offset the additional operating costs associated with a more dedicated delivery system. Therefore, this study’s primary objective was to evaluate the impact of patient access to a customized health advocacy program on downstream medical costs and healthcare utilization compared to a control (CON) group without access to this service. The secondary aim was to provide information to employers on whether a higher investment in a more complex customized delivery model provides significant value compared to a less customized program. Methods: The study treatment (TRT) group included 89,372 individuals with access to a customized advocacy program for employees, while the CON group of 115,465 had access to a non-customized program. Key outcomes included total healthcare expenditures, hospital admissions, emergency room visits, and physician office visits 12 months after the advocacy start date compared to 6 months before the start date. Researchers evaluated the impact the customized advocacy intervention had on expenditures by comparing differences in pre- and post-expenditures between customized health advisor and non-customized health advisor groups after controlling for various demographic, socioeconomic, and health status characteristics. Inverse propensity score weighting helped minimize differences in characteristics between the TRT and CON groups. Results: With the customized advocacy product, healthcare expenditures increased by only $2.03 per member per month (PMPM) compared with a $26.35 PMPM larger increase for controls with a non-customized product. Also, customized health advisor participants experienced reduced hospital admissions and ER visits compared with the CON group. Conclusions: Study participants with access to customized healthcare advocacy services experienced significant healthcare cost savings, along with fewer ER visits, and reduced inpatient admissions compared with the CON group. Thus, these findings suggest that healthcare advocacy programs justify the increased delivery cost and can lead to reduced healthcare costs and utilization, along with the potential to improve health outcomes and quality of life.

Factors Predicting Family Violence Revictimization Among Army Families With Child Maltreatment

The Army Family Advocacy Program (Army FAP) strives to prevent family violence and intervene to reduce the deleterious effects of exposure to family violence. This paper examines the individual, family, community, and treatment factors associated with family violence revictimization. Case files of 134 families with substantiated child maltreatment and associated Army FAP interventions that closed in 2013 were coded across risk and protective factors and intervention characteristics and were matched to Army Central Registry files to identify revictimization rates through 2017. Revictimization, experienced by 23% of families, was predicted by community risk and reduced by intervention dose. With the high rates of relocations, housing or neighborhood issues, and the isolation military families experience and the relationship of these concerns to repeated family violence, identifying the impact of community risk is particularly important. Similarly, research that elucidates the effective treatment components is needed.