Prioritization of patients access to outpatient augmentative and alternative communication services in Quebec: a decision tool

Abstract

Purpose

A large number of people living with a chronic disability wait a long time to access publicly funded rehabilitation services such as Augmentative and Alternative Communication (AAC) services, and there is no standardized tool to prioritize these patients. We aimed to develop a prioritization tool to improve the organization and access to the care for this population.

Methods

In this sequential mixed methods study, we began with a qualitative phase in which we conducted semi-structured interviews with 14 stakeholders including patients, their caregivers, and AAC service providers in Quebec City, Canada to gather their ideas about prioritization criteria. Then, during a half-day consensus group meeting with stakeholders, using a consensus-seeking technique (i.e. Technique for Research of Information by Animation of a Group of Experts), we reached consensus on the most important prioritization criteria. These criteria informed the quantitative phase in which used an electronic questionnaire to collect stakeholders’ views regarding the relative weights for each of the selected criteria. We analyzed these data using a hybrid quantitative method called group based fuzzy analytical hierarchy process, to obtain the importance weights of the selected eight criteria.

Results

Analyses of the interviews revealed 48 criteria. Collectively, the stakeholders reached consensus on eight criteria, and through the electronic questionnaire they defined the selected criteria’s importance weights. The selected eight prioritization criteria and their importance weights are: person’s safety (weight: 0.274), risks development potential (weight: 0.144), psychological well-being (weight: 0.140), physical well-being (weight: 0.124), life prognosis (weight: 0.106), possible impact on social environment (weight: 0.085), interpersonal relationships (weight: 0.073), and responsibilities and social role (weight: 0.054).

Conclusion

In this study, we co-developed a prioritization decision tool with the key stakeholders for prioritization of patients who are referred to AAC services in rehabilitation settings.

IMPLICATIONS FOR REHABILIATION

• Studies in Canada have shown that people in Canada with a need for rehabilitation services are not receiving publicly available services in a timely manner.

• There is no standardized tool for the prioritization of AAC patients.

• In this mixed methods study, we co-developed a prioritization tool with key stakeholders for prioritization of patients who are referred to AAC services in a rehabilitation center in Quebec, Canada.

Keywords:

• Outpatient rehabilitation services
• augmentative and alternative communication
• waiting list
• access to care
• prioritization
• publicly funded health sector

Acknowledgments

This work is financed by Natural Sciences and Engineering Research Council (NSERC) discovery grants [OPG 0293307 and OPG 0118062]. This support is gratefully acknowledged. SAR, FR and MEL hold salary award from the Fonds de la recherche du Quebec–Sante (FRQS) (respectively J1 and J2). SAR, AJ and JD have been supported by a competitive scholarship from CIRRIS during this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).