Objective: Evaluate The Ottawa Hospital Viral Hepatitis Program (TOHVHP) telemedicine (TM) program for patient retention, treatment initiation and sustained virologic response (SVR) rates. Methods: Retrospective analysis of TOHVHP cohort data for patients entering HCV care between 2012 and 2016. Logistic regression modeling was used to assess characteristics associated with patient retention, treatment initiation, and achieving SVR. TM outcomes were compared to the standard outpatient clinic and mixed delivery outcomes. Results: Treatment initiation rates were comparable between TM and the outpatient clinic. TM delivered Direct Acting Antiviral treatments achieved high SVR outcomes across all patient populations. Patient retention was lower among TM patients. Conclusion: TOHVHP TM program engaged patients facing barriers to traditional HCV care models. Efforts to improve TM retention are needed.

The disproportionate burden of disease in the Aboriginal population in Canada has become so great that it is now being referred to as a health ‘crisis’. Evidence suggests that the answer to these ills lies not in the western biomedical model of heath care, but within the Aboriginal traditions of self-determination and holism (RCAP, 1996; O’Neil, Lemckuk-Favel, Allard & Postl, 1999; Romanow, 2002; CIHI, 2004; Maar, 2004; First Nations & Inuit Regional Health Survey, 2004). To this end, First Nations communities have been negotiating with the federal government and transferring responsibility for their community-based health services since 1986, despite the limitations of the federal Health Transfer Policy (Gregory, Russell, Hurd, Tyance & Sloan, 1992; Lavoie, et al, 2005; RCAP, Vol 3, Chp 3, 1996; Speck, 1989). These self-determination initiatives in health attempt to improve the health status of community members. Thus, determining an approach to health service delivery that contributes to positive health outcomes is of particular significance. Examining Island Lake’s evolving model of health service delivery indicates the success of the intergovernmental, interdepartmental, and intersectoral partnership approach they have taken; as evidenced by the Regional Renal Health Program, with dialysis treatment services, that has been established, perhaps for the first time in the country, in a remote First Nations community without existing hospital services. There remains work to be done in creating a holistic system of health service delivery that reflects their unique worldview within a context of health promotion and self-determination; however, their accomplishments to date, established processes, willingness to put their dreams into action and build what has not been built before demonstrate a potential to improve community health and well-being. / October 2006

The disproportionate burden of disease in the Aboriginal population in Canada has become so great that it is now being referred to as a health ‘crisis’. Evidence suggests that the answer to these ills lies not in the western biomedical model of heath care, but within the Aboriginal traditions of self-determination and holism (RCAP, 1996; O’Neil, Lemckuk-Favel, Allard & Postl, 1999; Romanow, 2002; CIHI, 2004; Maar, 2004; First Nations & Inuit Regional Health Survey, 2004). To this end, First Nations communities have been negotiating with the federal government and transferring responsibility for their community-based health services since 1986, despite the limitations of the federal Health Transfer Policy (Gregory, Russell, Hurd, Tyance & Sloan, 1992; Lavoie, et al, 2005; RCAP, Vol 3, Chp 3, 1996; Speck, 1989). These self-determination initiatives in health attempt to improve the health status of community members. Thus, determining an approach to health service delivery that contributes to positive health outcomes is of particular significance. Examining Island Lake’s evolving model of health service delivery indicates the success of the intergovernmental, interdepartmental, and intersectoral partnership approach they have taken; as evidenced by the Regional Renal Health Program, with dialysis treatment services, that has been established, perhaps for the first time in the country, in a remote First Nations community without existing hospital services. There remains work to be done in creating a holistic system of health service delivery that reflects their unique worldview within a context of health promotion and self-determination; however, their accomplishments to date, established processes, willingness to put their dreams into action and build what has not been built before demonstrate a potential to improve community health and well-being.

The disproportionate burden of disease in the Aboriginal population in Canada has become so great that it is now being referred to as a health ‘crisis’. Evidence suggests that the answer to these ills lies not in the western biomedical model of heath care, but within the Aboriginal traditions of self-determination and holism (RCAP, 1996; O’Neil, Lemckuk-Favel, Allard & Postl, 1999; Romanow, 2002; CIHI, 2004; Maar, 2004; First Nations & Inuit Regional Health Survey, 2004). To this end, First Nations communities have been negotiating with the federal government and transferring responsibility for their community-based health services since 1986, despite the limitations of the federal Health Transfer Policy (Gregory, Russell, Hurd, Tyance & Sloan, 1992; Lavoie, et al, 2005; RCAP, Vol 3, Chp 3, 1996; Speck, 1989). These self-determination initiatives in health attempt to improve the health status of community members. Thus, determining an approach to health service delivery that contributes to positive health outcomes is of particular significance. Examining Island Lake’s evolving model of health service delivery indicates the success of the intergovernmental, interdepartmental, and intersectoral partnership approach they have taken; as evidenced by the Regional Renal Health Program, with dialysis treatment services, that has been established, perhaps for the first time in the country, in a remote First Nations community without existing hospital services. There remains work to be done in creating a holistic system of health service delivery that reflects their unique worldview within a context of health promotion and self-determination; however, their accomplishments to date, established processes, willingness to put their dreams into action and build what has not been built before demonstrate a potential to improve community health and well-being.

Philosophiae Doctor - PhD / Since the advent of South Africa‘s democracy in 1994 there have been several changes in the policy and legislative arena specifically promoting public-private-partnerships in the health sector. These initiatives have given rise to opportunities for inter-sectoral policy transfer under the rubric of ―best practices‖. This exploratory study examines the character, obstacles and contested nature of a selection of policy transfers between private and public health institutions in a single province of South Africa. The study looks at the dynamics at play around envisaged, current and past transfers of policies and organisational practices in relation to administrative systems and technologies used in four different hospital settings – two public and two private hospitals in the Eastern Cape Province of South Africa. This thesis explores the views of managers and labour organisations about policy transfer focusing on local contexts, and how various parties construct policy transfer, hence providing a perspective of policy at the ―plant‖ level. In this research, special focus is placed on different agents‘ role and understandings of their contexts and how and why policies move and contradictions of these developments. In-depth interviews were conducted at four major Eastern Cape hospitals. The thesis argues that in practice, policy transfer is messy, politicized and traversed by power and vested interests and that organised labour plays a key role in policy transfer process. The thesis focuses on the different philosophical/ideological underpinnings, socio-political values and operational environments in each sector. This study is designed to contribute to existing knowledge on practices particularly between the public and private sectors in order to widen the understanding of the complexity of transferability.

Philosophiae Doctor - PhD / Since the advent of South Africa's democracy in 1994 there have been several changes in the policy and legislative arena specifically promoting public-private-partnerships in the health sector. These initiatives have given rise to opportunities for inter-sectoral policy transfer under the rubric of ―best practices‖. This exploratory study examines the character, obstacles and contested nature of a selection of policy transfers between private and public health institutions in a single province of South Africa. The study looks at the dynamics at play around envisaged, current and past transfers of policies and organisational practices in relation to administrative systems and technologies used in four different hospital settings – two public and two private hospitals in the Eastern Cape Province of South Africa. This thesis explores the views of managers and labour organisations about policy transfer focusing on local contexts, and how various parties construct policy transfer, hence providing a perspective of policy at the ―plant‖ level. In this research, special focus is placed on different agents' role and understandings of their contexts and how and why policies move and contradictions of these developments. In-depth interviews were conducted at four major Eastern Cape hospitals. The thesis argues that in practice, policy transfer is messy, politicized and traversed by power and vested interests and that organised labour plays a key role in policy transfer process. The thesis focuses on the different philosophical/ideological underpinnings, socio-political values and operational environments in each sector. This study is designed to contribute to existing knowledge on practices particularly between the public and private sectors in order to widen the understanding of the complexity of transferability.

Paper 1 - Consultation is a widely used model of practice amongst Educational Psychology Services (EPS) in the United Kingdom (UK) as evidenced in the amount of research carried out on this practice (Leadbetter, 2006, p. 246). This paper attempts to supplement the limited evidence on how and why consultation is used. This paper provides an account of Educational Psychologists (EPs) perceptions of using consultation in a Welsh Educational Psychology Service (EPS). The study uses a thematic analysis of interviews with EPs and 3 accounts of the practice of consultation are provided as examples of how consultation is used. Data analysis revealed that EPs’ practice is dominated by the influence of Wagner’s model of consultation, which is a result of both university, and service based training and not because they feel it is necessarily the best way of working and were vague about their reasons for using this approach. Evidence emerged to suggest EPs were only aware of one model of consultation, which is the Wagner model. Evidence also emerged to suggest that EPs confused service delivery models with models of consultation and that EPs are unclear about their unique skills and role when using consultation and feel that schools do not understand the work they are trying to achieve when working in this way. EPs also considered that schools want more time with them, but burdensome bureaucracy hinders this. These findings are discussed in more detail at the end of Paper 2 where the overall findings suggest there is a systemic problem in Pantysgawn EPS, where the dominance of the EP role to provide statutory assessments prevents EPs from working in a truly consultative way. The paper ends by discussing the key element of the EP’s role, whether a consistent and rigid adherence to one practice model is practicable or desirable, and the various ways that EP services can monitor outcomes to alleviate some of the bureaucratic processes. Paper 2 - Paper 1 of this study looked at EPs’ perceptions of using consultation. Very few studies have looked at service users experiences in consultation based EP services. Paper 2 therefore looks at schools’ perceptions of the EP service and considers the benefits and barriers to effective service delivery using a thematic analysis of interviews with staff from 5 primary and 3 secondary schools. Findings suggest that schools continue to regard the expertise of the EP as being a provider of individual assessments, but they also revealed an awareness of the wider systemic role that EPs can provide. This traditional view of the role of the EP is discussed in terms of a wider systemic pressure for schools to seek this kind of EP intervention due to the Local Authority’s (LA) focus on statutory assessments. Schools appreciated a greater continuity of EPS staff as this helped them to develop more productive working relationships and they wanted more time with the EP. The findings suggest that the level of bureaucracy and the statutory assessment requirements to gain access to targeted resources were a barrier to working more effectively with schools. The paper ends by integrating these findings with the paper 1 findings and discussing the key element of the EP’s role, whether a consistent and rigid adherence to one practice model is practicable or desirable, and the various ways that EP services can monitor outcomes to alleviate some of the bureaucratic processes.

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Chronic disease is rising globally, but LMICs may require novel approaches to management suited to a low-resource setting. Private health care providers in LMICs have experimented and developed new models for organizing, financing, and delivering care. This thesis examines some of the innovations that have emerged in LMICs to manage chronic disease. Using a common performance measurement framework and drawing from a database of over 1200 innovative health programs, I identify and evaluate 46 programs addressing chronic disease in LMICs. I then go on to identify, innovative practices used by the subset of 19 diabetes focussed programs and catalogue them according to the Chronic Care Model (CCM). Delivery system design is the most commonly used domain of the CCM, which even earlier has shown to have great potential to impact health outcomes. Few of the identified innovations may also have the potential for ‘Reverse innovation’ in high income countries.

Chronic disease is rising globally, but LMICs may require novel approaches to management suited to a low-resource setting. Private health care providers in LMICs have experimented and developed new models for organizing, financing, and delivering care. This thesis examines some of the innovations that have emerged in LMICs to manage chronic disease. Using a common performance measurement framework and drawing from a database of over 1200 innovative health programs, I identify and evaluate 46 programs addressing chronic disease in LMICs. I then go on to identify, innovative practices used by the subset of 19 diabetes focussed programs and catalogue them according to the Chronic Care Model (CCM). Delivery system design is the most commonly used domain of the CCM, which even earlier has shown to have great potential to impact health outcomes. Few of the identified innovations may also have the potential for ‘Reverse innovation’ in high income countries.