Addressing Provider-Shortage and Collaborative Practice in Rural/Remote Areas... (March 2012)

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Title: Addressing Provider-Shortage and Collaborative Practice in Rural/Remote Areas: The Role of TCAM Practitioners in Rural/Remote Communities in Ontario
Principal ApplicantTitle(s)Institutional AffiliationFunding AmountAnticipated CIHR Submission Date
Dr. Daniel Hollenberg Senior Policy Analyst Human Resources for Health at Royal College of Physicians and Surgeons of Canada $13,900 March 2012
Co-Applicant(s)Titles(s)Institutional Affiliation(s)
Dr. Rishma Walji Post Doctoral Fellow McMaster University
Dr. Millennia Lytle Independent Researcher N/A
Dr. Kieran Cooley Associate Director, Research and Clinical Epidemiology Canadian College of Naturopathic Medicine

 Hollenberg 2014Biography of the Principal Investigator: Daniel Hollenberg is a Senior Policy Analyst, Health Human Resources for Heatlh at the Royal College of Physicians and Surgeons of Canada who brings eight years of qualitative ethnographic research and writing on diverse forms of TCAM and IM healthcare providers and settings, both nationall and internationally.

Description of Proposed Project Submitted to CIHR

This project will examine the role of traditional, complementary and alternative medicine ("TCAM") health care providers in rural/remote communities of Ontario that may be providing care in provider--‐ Shortage areas and/or collaborating with biomedical healthcare providers to provide "integrative" care or medicine (IM). The main research question to be addressed is: Are TCAM providers providing care to rural/remote communities in Ontario, and if so, what roles are they playing in biomedical provider--‐ shortage areas, and what specific areas may TCAM providers be complementing in lieu of a biomedical provider? This study will also examine the effect of wider provincial recognition of TCAM in specific rural/remote communities, and thus, will cut across two related themes related to HHR distribution in rural/remote communities of Ontario

Research Design and Methodology for CIHR Grant

The Submission to CIHR will draw extensively on the capacity building activities, pilot data collection and grant preparation activities between October 2011 and February 2012. The CIHR grant is viewed as an extension of the research planning activities, however, with an expanded methodology and scope within rural/remote areas of Ontario. It should also be noted that as the specific TCAM groups in rural/remote regions of Ontario are to be identified as part of the planned activities, the rural areas to be examined will be identified by the end of October 2011 and further expanded for the CIHR grant. The larger CIHR grand will expanded into a mixed-method, quantitative/qualitative research design to examine the main research question noted above.

Survey of Rural Physicians in Ontario

Informed by the research-planning phase, we intend to conduct a large survey of approximately 2000 rural family and specialist physicians in Canada, facilitated by the Society of Rural Physicians of Canada (SRPC) with specific focus on Ontario. The main goal of the survey will b to collect as yet unknown data on the views, opinions and collaborative practice patterns of rural Ontario physicians toward and with TCAM providers in rural/remote areas of Ontario. The survey will provide crucial comparative data to be analyzed alongside interviews with TCAM providers, and will outline key rural/remote areas in Ontario where TCAM providers are practicing. The survey will further clarify the awareness of rural physicians of TCAM providers and specific rural/remote areas of Ontario "in need".

In-Depth Interviews with Expanded Group of TCAM Providers

Partially led by analysis of survey data and the initial pilot data collection, we intend to conduct continued in-depth interviews (approx 50) with a larger group of TCAM providers in addition to those already included, and within multiple rural localities in Ontario (to be determined by January, 2011, and through survey data). TCAM providers for the CIHR grant will also include massage therapists (MTs), traditional Chinese medicine (TCM) practitioners and Western herbalists (WH), alongside naturopathic doctors (NDs), doctors of chiropractic (DC), registered midwives (RMs) and traditional First Nations healers (TH), in addition to those TCAM professions deemed of interest by rural physicians as presented in survey data.

Focus Groups with Select "Communities of Practice"

Pending analysis of survey data and in-depth interviews, select TCAM provider groups within certain rural/remote areas and "communities of practice" will be identified as key case studies or exemplars of integrated rural care, combining both TCAM and biomedical approaches. We intend to conduct select focus groups with identified groups of collaborative and/or integrative rural practice. The main goal of these focus groups will be to document key case studies that will inform future research and policy making for rural/remote care in Ontario.

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