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Lüchau EC, Atherton H, Olesen F, Søndergaard J, Assing Hvidt E. Interpreting technology: Use and non-use of doctor-patient video consultations in Danish general practice. Soc Sci Med 2023; 334:116215. [PMID: 37690154 DOI: 10.1016/j.socscimed.2023.116215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/15/2023] [Accepted: 09/01/2023] [Indexed: 09/12/2023]
Abstract
This study uses socio-cognitive theory on technological frames to understand how and why general practitioners in Denmark use or choose not to use video consultations. Video consultations play a vital role in the digitalisation of the Danish healthcare system. Whilst political decision-makers continuously push for increased use of video consultations, uptake accounts for less than 2% of all consultations. Research is needed that explores the actual circumstances and conditions of video consultation use. Our data corpus consists of 30 semi-structured interviews conducted from August 2021 to August 2022 with 27 Danish general practitioners. Interviews were analysed following reflexive thematic analysis. Our findings show that video consultations are interpreted as 1) compromising occupational values, 2) a crisis tool, 3) the future, and 4) a tool to improve work conditions. Video consultations are differently adopted across clinics due to different interpretations of the technology and its relative advantage in specific clinical contexts. We argue that the concept of technological frames offers a useful analytic perspective for elucidating and anticipating attitudes and actions towards a technology. It increases our understanding of the uptake and rejection of video consultations. This knowledge is valuable for clinicians and politicians working with technological innovation in general practice.
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Affiliation(s)
- Elle Christine Lüchau
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark; Warwick Medical School, Unit of Academic Primary Care, University of Warwick, Coventry, CV4 7AL, United Kingdom.
| | - Helen Atherton
- Warwick Medical School, Unit of Academic Primary Care, University of Warwick, Coventry, CV4 7AL, United Kingdom.
| | - Finn Olesen
- School of Communication and Culture, Department of Digital Design and Information Studies, Aarhus University, Helsingforsgade 14, 8200, Århus N, Denmark.
| | - Jens Søndergaard
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Elisabeth Assing Hvidt
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
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Assing Hvidt E, Christensen NP, Grønning A, Jepsen C, Lüchau EC. What are patients' first-time experiences with video consulting? A qualitative interview study in Danish general practice in times of COVID-19. BMJ Open 2022; 12:e054415. [PMID: 35428624 PMCID: PMC9013986 DOI: 10.1136/bmjopen-2021-054415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore the experiences of Danish patients using video consultation (VC) to consult their general practitioner (GP) during COVID-19 lockdown and their attitudes towards continued use beyond COVID-19. DESIGN A qualitative design was employed, consisting of individual semi-structured interviews where participants were asked to retrospectively describe their experiences and reflections. Data were analysed using thematic analysis. SETTING Capital and Southern Regions of Denmark. PARTICIPANTS 27 patients (17 women and 10 men) aged between 23 and 76 years who had used VC once or more during the COVID-19 pandemic participated. The data were collected from February to October 2020. We used a convenience sampling technique and sample size was based on the principle of information power. RESULTS Three overarching themes, each containing subthemes, were developed. Participants described pre-use reactions and concerns relating to VC as being 'better than nothing' given the COVID-19 circumstances, and preferred VC over a telephone consultation. Salient pre-use concerns related to whether the technology 'would work' and whether VC would influence consultation length and GP behaviour. Overall, participants reported positive experiences of VC use and communication attributing these mainly to 'knowing the GP' and 'feeling seen and heard'. Participants were interested in future VC use for many needs as a natural consequence of an increasingly digitalised society, not least due to COVID-19. CONCLUSIONS Our findings contribute with knowledge about first-user experiences of VC against the background of COVID-19. Participants showed positive attitudes towards future use of VC as either a supplementary or alternative consultation form in general practice.
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Affiliation(s)
- Elisabeth Assing Hvidt
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | | | - Anette Grønning
- Department for the Study of Culture, University of Southern Denmark, Odense, Denmark
| | - Carole Jepsen
- Department for the Study of Culture, University of Southern Denmark, Odense, Denmark
| | - Elle Christine Lüchau
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
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Trimarchi F, Arvat E, Bartalena L, Colao A. L’ambulatorio di Endocrinologia durante e dopo la pandemia da COVID-19: opinioni e riflessioni. L'ENDOCRINOLOGO 2022. [PMCID: PMC8864458 DOI: 10.1007/s40619-022-01036-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Francesco Trimarchi
- Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Messina, Messina, Italia
- Accademia Peloritana dei Pericolanti, Messina, Italia
| | - Emanuela Arvat
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, Torino, Italia
| | - Luigi Bartalena
- E-i-C, Journal of Endocrinological Investigation, Dipartimento di Medicina e Chirurgia, Università dell’Insubria, Varese, Italia
| | - Annamaria Colao
- Presidente SIE, Dipartimento di Medicina Clinica e Chirurgia, Unesco Chair Health Education and Sustainable Development, Università di Napoli Federico II, Napoli, Italia
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Barriers and Benefits of the Scheduled Telephone Referral Model (DETELPROG): A Qualitative Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105280. [PMID: 34065624 PMCID: PMC8156098 DOI: 10.3390/ijerph18105280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/09/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022]
Abstract
The recently developed scheduled mobile-telephone referral model (DETELPROG) has achieved especially important results in reducing waiting days for patients, but it has been decided to explore what barriers and positive aspects were detected by both primary care physicians (PCPs) and hospital attending physicians (HAPs) regarding its use. For this, a qualitative descriptive study was carried out through six semi-structured interviews and two focus groups in a sample of eleven PCPs and five HAPs. Interviews were carried out from September 2019 to February 2020. Data were analysed by creating the initial categories, recording the sessions, transcribing the information, by doing a comprehensive reading of the texts obtained, and analysing the contents. The results show that DETELPROG gives the PCP greater prominence as a patient’s health coordinator by improving their relationship and patient safety; it also improves the relationship between PCP and HAP, avoiding unnecessary face-to-face referrals and providing safety to the PCP when making decisions. The barriers for DETELPROG to be used by PCP were defensive medicine, patients’ skepticism in DETELPROG, healthcare burden, and inability to focus on the patient or interpret a sign, symptom, or diagnostic test. For HAP, the barriers were lack of confidence in the PCP and complexity of the patient. As a conclusion, DETELPROG referral model provides a lot of advantages and does not pose any new barrier to face-to-face referral or other non-face-to-face referral models, so it should be implemented in primary care.
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Lüchau EC, Jepsen C, Grønning A, Hvidt EA. Reciprocal dynamics between patients' choice of place and how they experience video consultations: A qualitative study. Digit Health 2021; 7:20552076211052158. [PMID: 34733540 PMCID: PMC8559177 DOI: 10.1177/20552076211052158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/22/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To analyse the reciprocal dynamics between patients' choice of place and how they experience video consultations (VCs) with the general practitioner. METHODS Qualitative, semi-structured interviews with 27 Danish patients were conducted over a period of 9 months, from February to October 2020. Interviews were analysed using thematic analysis. The analysis was guided by Nelly Oudshoorn's concept of technogeography of care. RESULTS The following three themes were identified in the data: VC-home dynamics: balancing boundaries; VC-workplace dynamics: logistical considerations; and VC-body image dynamics: on-screen exposure. CONCLUSIONS Taking human geography and science and technology studies as our analytical point of departure, we used the concept of technogeography of care and demonstrated how the reciprocal dynamics between patients' choice of place and how they experience VC made boundaries fluid and complex between different contexts and places, such as the home, the workplace and the clinic. These boundaries were negotiated differently by the patients depending on their need for privacy, convenience and support. Additionally, VC reconfigured patients' and general practitioners' roles, increasing patients' responsibility in securing an appropriate health care setting.
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Affiliation(s)
- Elle C. Lüchau
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Carole Jepsen
- Department for the Study of Culture, University of Southern Denmark, Odense, Denmark
| | - Anette Grønning
- Department for the Study of Culture, University of Southern Denmark, Odense, Denmark
| | - Elisabeth Assing Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department for the Study of Culture, University of Southern Denmark, Odense, Denmark
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Baines R, Tredinnick-Rowe J, Jones R, Chatterjee A. Barriers and Enablers in Implementing Electronic Consultations in Primary Care: Scoping Review. J Med Internet Res 2020; 22:e19375. [PMID: 33035177 PMCID: PMC7674136 DOI: 10.2196/19375] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/26/2020] [Accepted: 07/26/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Often promoted as a way to address increasing demands, improve patient accessibility, and improve overall efficiency, electronic consultations are becoming increasingly common in primary care, particularly in light of the current COVID-19 pandemic. However, despite their increasing use, a theoretically informed understanding of the factors that support and inhibit their effective implementation is severely limited. OBJECTIVE With this scoping review, we sought to identify the factors that support and inhibit the implementation of electronic consultations in primary care. METHODS In total, 5 electronic databases (PubMed, Medline, Embase, CINAHL, and PsycINFO) were systematically searched for studies published in 2009-2019 that explored the impact and/or implementation of electronic consultations in primary care. Database searches were supplemented by reference list and grey literature searches. Data were analyzed using inductive thematic analysis and synthesized using Normalization Process Theory (NPT). RESULTS In total, 227 articles were initially identified and 13 were included in this review. The main factors found to hinder implementation included awareness and expectations; low levels of engagement; perceived suitability for all patient groups, conditions, and demographics; cost; and other contextual factors. Reports of information technology reliability and clinical workload duplication (as opposed to reduction) also appeared detrimental. Conversely, the development of protocols and guidance; patient and staff education; strategic marketing; and patient and public involvement were all identified as beneficial in facilitating electronic consultation implementation. CONCLUSIONS This review highlights the need for proactive engagement with patients and staff to facilitate understanding and awareness, process optimization, and delivery of coherent training and education that maximizes impact and success. Although the necessity to use online methods during the COVID-19 pandemic may have accelerated awareness, concerns over workload duplication and inequality of access may remain. Future research should explore health inequalities in electronic consultations and their economic impacts from multiple perspectives (eg, patient, professional, and commissioner) to determine their potential value. Further work to identify the role of meaningful patient involvement in digital innovation, implementation, and evaluation is also required following the rapid digitization of health and social care.
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Affiliation(s)
| | | | - Ray Jones
- University of Plymouth, Plymouth, United Kingdom
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Hoffman JD, Shayegani R, Spoutz PM, Hillman AD, Smith JP, Wells DL, Popish SJ, Himstreet JE, Manning JM, Bounthavong M, Christopher MLD. Virtual academic detailing (e-Detailing): A vital tool during the COVID-19 pandemic. J Am Pharm Assoc (2003) 2020; 60:e95-e99. [PMID: 32747164 PMCID: PMC7833607 DOI: 10.1016/j.japh.2020.06.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/19/2020] [Accepted: 06/28/2020] [Indexed: 12/11/2022]
Abstract
As the coronavirus disease (COVID-19) pandemic continues its course in 2020, telehealth technology provides opportunities to connect patients and providers. Health policies have been amended to allow easy access to virtual health care, highlighting the field's dynamic ability to adapt to a public health crisis. Academic detailing, a peer-to-peer collaborative outreach designed to improve clinical decision-making, has traditionally relied on in-person encounters for effectiveness. A growth in the adoption of telehealth technology translates to increases in academic detailing reach for providers unable to meet with academic detailers in person. The U.S. Department of Veterans Affairs (VA) has used academic detailing to promote and reinforce evidence-based practices and has encouraged more virtual academic detailing (e-Detailing). Moreover, VA academic detailers are primarily clinical pharmacy specialists who provide clinical services and education and have made meaningful contributions to improving health care at VA. Amid the COVID-19 pandemic and physical isolation orders, VA academic detailers have continued to meet with providers to disseminate critical health care information in a timely fashion by using video-based telehealth. When working through the adoption of virtual technology for the delivery of medical care, providers may need time and nontraditional delivery of "evidence" before eliciting signals for change. Academic detailers are well suited for this role and can develop plans to help address provider discomfort surrounding the use of telehealth technology. By using e-Detailing as a method for both familiarizing and normalizing health professionals with video-based telehealth technology, pharmacists are uniquely poised to deliver consultation and direct-care services. Moreover, academic detailing pharmacists are ambassadors of change, serving an important role navigating the evolution of health care in response to emergent public health crises and helping define the norms of care delivery to follow.
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Boom VE, van der Kamp LT, van Zuilen AD, De Ranitz WL, Bos WJ, Jellema WT, Mui KW, Later AF, Prinssen M, Kaasjager K. Ongoing effects of eConsultation in nephrology on hospital referral rates: An observational study. J Telemed Telecare 2020; 28:423-428. [PMID: 32746760 DOI: 10.1177/1357633x20942037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION eConsultation in nephrology is an innovative way for general practitioners (GPs) to consult a nephrologist. Studies have shown that questions from GPs can be answered and intended referrals can be avoided by eConsultation. However, follow-up data are lacking. The primary aim of this study was therefore to assess whether patients for whom a referral to the outpatient clinic of a medical specialist was avoided in the short term were not then referred for the same problem within one year after the eConsultation. METHODS All eConsultations sent between June 2017 and April 2018 to seven nephrologists in three different hospitals in The Netherlands were included. Exclusion criteria were duplications and missing data on follow-up. Data were obtained from the eConsultation application forms and from GP medical records. RESULTS A total of 173 eConsultations were included. Of the 32 patients for whom a referral was initially prevented, 91% (95% confidence interval 75-98) had not been referred to a specialist for the same problem within one year after the eConsultation. DISCUSSION eConsultation in the field of nephrology can prevent referrals in the long term. It can therefore contribute to a more modern and efficient health-care system in which chronic care is provided by GPs in close proximity to patients, while specialist support is easily available and accessible through eConsultation when necessary.
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Affiliation(s)
- Victor Ea Boom
- Department of Internal Medicine, University Medical Centre Utrecht, The Netherlands
| | - Laura T van der Kamp
- Department of Internal Medicine, University Medical Centre Utrecht, The Netherlands
| | - Arjan D van Zuilen
- Department of Internal Medicine, University Medical Centre Utrecht, The Netherlands
| | - Wendela L De Ranitz
- Department of Internal Medicine, University Medical Centre Utrecht, The Netherlands
| | - Willem Jan Bos
- Department of Internal Medicine, St Antonius Ziekenhuis Nieuwegein, The Netherlands.,Department of Internal Medicine, Leiden University Medical Centre, The Netherlands
| | - Wilbert T Jellema
- Department of Internal Medicine, St Antonius Ziekenhuis Nieuwegein, The Netherlands
| | - Kwok Wai Mui
- Department of Internal Medicine, Ziekenhuis St Jansdal, The Netherlands
| | - Alexander F Later
- Department of Internal Medicine, Ziekenhuis St Jansdal, The Netherlands
| | | | - Karin Kaasjager
- Department of Internal Medicine, University Medical Centre Utrecht, The Netherlands
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Helmer-Smith M, Fung C, Afkham A, Crowe L, Gazarin M, Keely E, Moroz I, Liddy C. The Feasibility of Using Electronic Consultation in Long-Term Care Homes. J Am Med Dir Assoc 2020; 21:1166-1170.e2. [DOI: 10.1016/j.jamda.2020.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/03/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
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Osman MA, Schick-Makaroff K, Thompson S, Bialy L, Featherstone R, Kurzawa J, Zaidi D, Okpechi I, Habib S, Shojai S, Jindal K, Braam B, Keely E, Liddy C, Manns B, Tonelli M, Hemmelgarn B, Klarenbach S, Bello AK. Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review. BMJ Glob Health 2019; 4:e001629. [PMID: 31565409 PMCID: PMC6747903 DOI: 10.1136/bmjgh-2019-001629] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/04/2019] [Accepted: 08/10/2019] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Electronic consultation (eConsult)-provider-to-provider electronic asynchronous exchanges of patient health information at a distance-is emerging as a potential tool to improve the interface between primary care providers and specialists. Despite growing evidence that eConsult has clinical benefits, it is not widely adopted. We investigated factors influencing the adoption and implementation of eConsult services. METHODS We applied established methods to guide the review, and the recently published Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews to report our findings. We searched five electronic databases and the grey literature for relevant studies. Two reviewers independently screened titles and full texts to identify studies that reported barriers to and/or facilitators of eConsult (asynchronous (store-and-forward) use of telemedicine to exchange patient health information between two providers (primary and secondary) at a distance using secure infrastructure). We extracted data on study characteristics and key barriers and facilitators were analysed thematically and classified using the Quadruple Aim framework taxonomy. No date or language restrictions were applied. RESULTS Among the 2579 publications retrieved, 130 studies met eligibility for the review. We identified and summarised key barriers to and facilitators of eConsult adoption and implementation across four domains: provider, patient, healthcare system and cost. Key barriers were increased workload for providers, privacy concerns and insufficient reimbursement for providers. Main facilitators were remote residence location, timely responses from specialists, utilisation of referral coordinators, addressing medicolegal concerns and incentives for providers to use eConsult. CONCLUSION There are multiple barriers to and facilitators of eConsult adoption across the domains of Quadruple Aim framework. Our findings will inform the development of practice tools to support the wider adoption and scalability of eConsult implementation.
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Affiliation(s)
- Mohamed A Osman
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Stephanie Thompson
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Liza Bialy
- Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
- Alberta SPOR SUPPORT Unit, Knowledge Translation platform, Edmonton, Alberta, Canada
| | - Robin Featherstone
- Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
- Alberta SPOR SUPPORT Unit, Knowledge Translation platform, Edmonton, Alberta, Canada
| | - Julia Kurzawa
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Deenaz Zaidi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ikechi Okpechi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Syed Habib
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Soroush Shojai
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kailash Jindal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Branko Braam
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Erin Keely
- Departments of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Research Institute, Ottawa, Ontario, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- CT Lamont Primary Healthcare Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Braden Manns
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brenda Hemmelgarn
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Scott Klarenbach
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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