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Aggarwal M, Hutchison BG, Kokorelias KM, Ramsden VR, Ivers NM, Pinto A, Uphsur REG, Wong ST, Pimlott N, Slade S. The Conceptualization and Measurement of Research Impact in Primary Health Care: Protocol for a Rapid Scoping Review. JMIR Res Protoc 2024; 13:e55860. [PMID: 38652900 DOI: 10.2196/55860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The generation of research evidence and knowledge in primary health care (PHC) is crucial for informing the development and implementation of interventions and innovations and driving health policy, health service improvements, and potential societal changes. PHC research has broad effects on patients, practices, services, population health, community, and policy formulation. The in-depth exploration of the definition and measures of research impact within PHC is essential for broadening our understanding of research impact in the discipline and how it compares to other health services research. OBJECTIVE The objectives of the study are (1) to understand the conceptualizations and measures of research impact within the realm of PHC and (2) to identify methodological frameworks for evaluation and research impact and the benefits and challenges of using these approaches. The forthcoming review seeks to guide future research endeavors and enhance methodologies used in assessing research impact within PHC. METHODS The protocol outlines the rapid review and environmental scan approach that will be used to explore research impact in PHC and will be guided by established frameworks such as the Canadian Academy of Health Sciences Impact Framework and the Canadian Health Services and Policy Research Alliance. The rapid review follows scoping review guidelines (PRISMA-ScR; Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews). The environmental scan will be done by consulting with professional organizations, academic institutions, information science, and PHC experts. The search strategy will involve multiple databases, citation and forward citation searching, and manual searches of gray literature databases, think tank websites, and relevant catalogs. We will include gray and scientific literature focusing explicitly on research impact in PHC from high-income countries using the World Bank classification. Publications published in English from 1978 will be considered. The collected papers will undergo a 2-stage independent review process based on predetermined inclusion criteria. The research team will extract data from selected studies based on the research questions and the CRISP (Consensus Reporting Items for Studies in Primary Care) protocol statement. The team will discuss the extracted data, enabling the identification and categorization of key themes regarding research impact conceptualization and measurement in PHC. The narrative synthesis will evolve iteratively based on the identified literature. RESULTS The results of this study are expected at the end of 2024. CONCLUSIONS The forthcoming review will explore the conceptualization and measurement of research impact in PHC. The synthesis will offer crucial insights that will guide subsequent research, emphasizing the need for a standardized approach that incorporates diverse perspectives to comprehensively gauge the true impact of PHC research. Furthermore, trends and gaps in current methodologies will set the stage for future studies aimed at enhancing our understanding and measurement of research impact in PHC. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/55860.
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Affiliation(s)
- Monica Aggarwal
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Brian G Hutchison
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Kristina M Kokorelias
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Section of Geriatrics, Sinai Health, Toronto, ON, Canada
| | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Noah M Ivers
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
| | - Andrew Pinto
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Ross E G Uphsur
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sabrina T Wong
- School of Nursing and Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Nick Pimlott
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Steve Slade
- Research Department, College of Family Physicians of Canada, Mississuaga, ON, Canada
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Aggarwal M, Hutchison B, Wong ST, Katz A, Slade S, Snelgrove D. What factors are associated with the research productivity of primary care researchers in Canada? A qualitative study. BMC Health Serv Res 2024; 24:263. [PMID: 38429708 PMCID: PMC10908166 DOI: 10.1186/s12913-024-10644-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/26/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Research evidence to inform primary care policy and practice is essential for building high-performing primary care systems. Nevertheless, research output relating to primary care remains low worldwide. This study describes the factors associated with the research productivity of primary care researchers. METHODS A qualitative, descriptive key informant study approach was used to conduct semi-structured interviews with twenty-three primary care researchers across Canada. Qualitative data were analyzed using reflexive thematic analysis. RESULTS Twenty-three primary care researchers participated in the study. An interplay of personal (psychological characteristics, gender, race, parenthood, education, spousal occupation, and support), professional (mentorship before appointment, national collaborations, type of research, career length), institutional (leadership, culture, resources, protected time, mentorship, type), and system (funding, systematic bias, environment, international collaborations, research data infrastructure) factors were perceived to be associated with research productivity. Research institutes and mentors facilitated collaborations, and mentors and type of research enabled funding success. Jurisdictions with fewer primary care researchers had more national collaborations but fewer funding opportunities. The combination of institutional, professional, and system factors were barriers to the research productivity of female and/or racialized researchers. CONCLUSIONS This study illuminates the intersecting and multifaceted influences on the research productivity of primary care researchers. By exploring individual, professional, institutional, and systemic factors, we underscore the pivotal role of diverse elements in shaping RP. Understanding these intricate influencers is imperative for tailored, evidence-based interventions and policies at the level of academic institutions and funding agencies to optimize resources, promote fair evaluation metrics, and cultivate inclusive environments conducive to diverse research pursuits within the PC discipline in Canada.
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Affiliation(s)
- Monica Aggarwal
- University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada.
| | - Brian Hutchison
- McMaster University, Departments of Family Medicine and Health Research Methods, Evidence and Impact and the Centre for Health Economics and Policy Analysis, Hamilton, Ontario, Canada
| | - Sabrina T Wong
- University of British Columbia, School of Nursing, Centre for Health Services and Policy Research, Vancouver, British Columbia, Canada
| | - Alan Katz
- University of Manitoba, Departments of Community Health Sciences and Family Medicine Rady Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Steve Slade
- The College of Family Physicians of Canada, Mississauga, Canada
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Barnes K, Hall Dykgraaf S, O'Brien K, Douglas K, Eggleton K, Bui N, Wong ST, Etz RS, Goodyear-Smith F. A novel methodological approach to participant engagement and policy relevance for community-based primary medical care research during the COVID-19 pandemic in Australia and New Zealand. Health Res Policy Syst 2024; 22:13. [PMID: 38254197 PMCID: PMC10802036 DOI: 10.1186/s12961-023-01100-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 12/25/2023] [Indexed: 01/24/2024] Open
Abstract
Community-based primary care, such as general practice (GP) or urgent care, serves as the primary point of access to healthcare for most Australians and New Zealanders. Coronavirus disease 2019 (COVID-19) has created significant and ongoing disruptions to primary care. Traditional research methods have contributed to gaps in understanding the experiences of primary care workers during the pandemic. This paper describes a novel research design and method that intended to capture the evolving impact of the COVID-19 pandemic on primary care workers in Australia and New Zealand. Recurrent, rapid cycle surveys were fielded from May 2020 through December 2021 in Australia, and May 2020 through February 2021 in New Zealand. Rapid survey development, fielding, triangulated analysis and dissemination of results allowed close to real-time communication of relevant issues among general practice workers, researchers and policy-makers. A conceptual model is presented to support longitudinal analysis of primary care worker experiences during the COVID-19 pandemic in Australia and New Zealand, and key learnings from applying this novel method are discussed. This paper will assist future research teams in development and execution of policy-relevant research in times of change and may inform further areas of interest for COVID-19 research in primary care.
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Affiliation(s)
- Katelyn Barnes
- Academic Unit of General Practice, ACT Health Directorate, Canberra, ACT, Australia.
- Academic Unit of General Practice, School of Medicine and Psychology, the Australian National University, Canberra, ACT, Australia.
| | - Sally Hall Dykgraaf
- Rural Clinical School, School of Medicine and Psychology, the Australian National University, Canberra, ACT, Australia
| | - Kathleen O'Brien
- Academic Unit of General Practice, School of Medicine and Psychology, the Australian National University, Canberra, ACT, Australia
| | - Kirsty Douglas
- Academic Unit of General Practice, ACT Health Directorate, Canberra, ACT, Australia
- Academic Unit of General Practice, School of Medicine and Psychology, the Australian National University, Canberra, ACT, Australia
| | - Kyle Eggleton
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Nam Bui
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Sabrina T Wong
- School of Nursing and Centre for Health Services and Policy Research, University of British Columbia, 2211 Westbrook Mall, Vancouver, BC, V6T2B5, Canada
| | - Rebecca S Etz
- Larry A. Green Center for the Advancement of Primary Health Care for the Public Good, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Felicity Goodyear-Smith
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
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Li V, Alibhai SMH, Noel K, Fazelzad R, Haase K, Mariano C, Durbano S, Sattar S, Newton L, Dawe D, Bell JA, Hsu T, Wong ST, Lofters A, Bender JL, Manthorne J, Puts MTE. Access to cancer clinical trials for racialised older adults: an equity-focused rapid scoping review protocol. BMJ Open 2024; 14:e074191. [PMID: 38245013 PMCID: PMC10807002 DOI: 10.1136/bmjopen-2023-074191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The intersection of race and older age compounds existing health disparities experienced by historically marginalised communities. Therefore, racialised older adults with cancer are more disadvantaged in their access to cancer clinical trials compared with age-matched counterparts. To determine what has already been published in this area, the rapid scoping review question are: what are the barriers, facilitators and potential solutions for enhancing access to cancer clinical trials among racialised older adults? METHODS We will use a rapid scoping review methodology in which we follow the six-step framework of Arksey and O'Malley, including a systematic search of the literature with abstract and full-text screening to be conducted by two independent reviewers, data abstraction by one reviewer and verification by a second reviewer using an Excel data abstraction sheet. Articles focusing on persons aged 18 and over who identify as a racialised person with cancer, that describe therapies/therapeutic interventions/prevention/outcomes related to barriers, facilitators and solutions to enhancing access to and equity in cancer clinical trials will be eligible for inclusion in this rapid scoping review. ETHICS AND DISSEMINATION All data will be extracted from published literature. Hence, ethical approval and patient informed consent are not required. The findings of the scoping review will be submitted for publication in a peer-reviewed journal and presentation at international conferences.
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Affiliation(s)
- Vivian Li
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine and Dalla Lana School of Public Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Rouhi Fazelzad
- Library and Information Services, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Kristin Haase
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Caroline Mariano
- BC Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada
| | - Sara Durbano
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Schroder Sattar
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lorelei Newton
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - David Dawe
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer A Bell
- Clinical and Organizational Ethics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Tina Hsu
- Department of Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Sabrina T Wong
- Division of Intramural Research, National Institute of Nursing Research, Bethesda, Maryland, USA
| | - Aisha Lofters
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Ontario, Canada
| | - Jacqueline L Bender
- Department of Supportive Care, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- Dalla Lana School of Public Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Martine T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Zeitouny S, McGrail K, Tadrous M, Wong ST, Cheng L, Law M. Impact of the COVID-19 pandemic on prescription drug use and costs in British Columbia: a retrospective interrupted time series study. BMJ Open 2024; 14:e070031. [PMID: 38176877 PMCID: PMC10773331 DOI: 10.1136/bmjopen-2022-070031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/06/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVES To assess the impact of the COVID-19 pandemic on prescription drug use and costs. DESIGN Interrupted time series analysis of comprehensive administrative health data linkages in British Columbia, Canada, from 1 January 2018 to 28 March 2021. SETTING Retrospective population-based analysis of all prescription drugs dispensed in community pharmacies and outpatient hospital pharmacies and irrespective of the drug insurance payer. PARTICIPANTS Between 4.30 and 4.37 million individuals (52% women) actively registered with the publicly funded medical services plan. INTERVENTION COVID-19 pandemic and associated mitigation measures. MAIN OUTCOME MEASURES Weekly dispensing rates and costs, both overall and stratified by therapeutic groups and pharmacological subgroups, before and after the declaration of the public health emergency related to the COVID-19 pandemic. Relative changes in post-COVID-19 outcomes were expressed as ratios of observed to expected rates. RESULTS After the onset of the pandemic and subsequent COVID-19 mitigation measures, overall medication dispensing rates dropped by 2.4% (p<0.01), followed by a sustained weekly increase to return to predicted levels by the end of January 2021. We observed abrupt level decreases in antibacterials (30.3%, p<0.01) and antivirals (22.4%, p<0.01) that remained below counterfactuals over the first year of the pandemic. In contrast, there was a week-to-week trend increase in nervous system drugs, yielding an overall increase of 7.3% (p<0.01). No trend changes in the dispensing of respiratory system agents, ACE inhibitors, antidiabetic drugs and antidepressants were detected. CONCLUSION The COVID-19 pandemic impact on prescription drug dispensing was heterogeneous across medication subgroups. As data become available, dispensing trends in nervous system agents, antibiotics and antivirals warrant further monitoring and investigation.
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Affiliation(s)
- Seraphine Zeitouny
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mina Tadrous
- University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lucy Cheng
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
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Thandi M, Wong ST, Price M, Baumbusch J. Perspectives on the representation of frailty in the electronic frailty index. BMC Prim Care 2024; 25:4. [PMID: 38166753 PMCID: PMC10759446 DOI: 10.1186/s12875-023-02225-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Frailty is a state of increased vulnerability from physical, social, and cognitive factors resulting in greater risk of negative health-related outcomes and increased healthcare expenditure. A 36-factor electronic frailty index (eFI) developed in the United Kingdom calculates frailty scores using electronic medical record data. There is currently no standardization of frailty screening in Canadian primary care. In order to implement the eFI in a Canadian context, adaptation of the tool is necessary because frailty is represented by different clinical terminologies in the UK and Canada. In considering the promise of implementing an eFI in British Columbia, Canada, we first looked at the content validation of the 36-factor eFI. Our research question was: Does the eFI represent frailty from the perspectives of primary care clinicians and older adults in British Columbia? METHODS A modified Delphi using three rounds of questionnaires with a panel of 23 experts (five family physicians, five nurse practitioners, five nurses, four allied health professionals, four older adults) reviewed and provided feedback on the 36-factor eFI. These professional groups were chosen because they closely work as interprofessional teams within primary care settings with older adults. Older adults provide real life context and experiences. Questionnaires involved rating the importance of each frailty factor on a 0-10 scale and providing rationale for ratings. Panelists were also given the opportunity to suggest additional factors that ought to be included in the screening tool. Suggested factors were similarly rated in two Delphi rounds. RESULTS Thirty-three of the 36 eFI factors achieved consensus (> 80% of panelists provided a rating of ≥ 8). Factors that did not achieve consensus were hypertension, thyroid disorder and peptic ulcer. These factors were perceived as easily treatable or manageable and/or not considered reflective of frailty on their own. Additional factors suggested by panelists that achieved consensus included: cancer, challenges to healthcare access, chronic pain, communication challenges, fecal incontinence, food insecurity, liver failure/cirrhosis, mental health challenges, medication noncompliance, poverty/financial difficulties, race/ethnic disparity, sedentary/low activity levels, and substance use/misuse. There was a 100% retention rate in each of the three Delphi rounds. CONCLUSIONS AND NEXT STEPS Three key findings emerged from this study: the conceptualization of frailty varied across participants, identification of frailty in community/primary care remains challenging, and social determinants of health affect clinicians' assessments and perceptions of frailty status. This study will inform the next phase of a broader mixed-method sequential study to build a frailty screening tool that could ultimately become a standard of practice for frailty screening in Canadian primary care. Early detection of frailty can help tailor decision making, frame discussions about goals of care, prevent advancement on the frailty trajectory, and ultimately decrease health expenditures, leading to improved patient and system level outcomes.
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Affiliation(s)
- Manpreet Thandi
- School of Nursing, University of British Columbia, T201 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Sabrina T Wong
- School of Nursing, University of British Columbia, T201 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
- Centre for Health Services and Policy Research, University of British Columbia, 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Morgan Price
- Department of Family Practice, University of British Columbia, David Strangway Building, Suite 300, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Jennifer Baumbusch
- School of Nursing, University of British Columbia, T201 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
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Karunananthan S, Rahgozar A, Hakimjavadi R, Yan H, Dalsania KA, Bergman H, Ghose B, LaPlante J, McCutcheon T, McIsaac DI, Abbasgholizadeh Rahimi S, Sourial N, Thandi M, Wong ST, Liddy C. Use of Artificial Intelligence in the Identification and Management of Frailty: A Scoping Review Protocol. BMJ Open 2023; 13:e076918. [PMID: 38154888 PMCID: PMC10759108 DOI: 10.1136/bmjopen-2023-076918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
INTRODUCTION Rapid population ageing and associated health issues such as frailty are a growing public health concern. While early identification and management of frailty may limit adverse health outcomes, the complex presentations of frailty pose challenges for clinicians. Artificial intelligence (AI) has emerged as a potential solution to support the early identification and management of frailty. In order to provide a comprehensive overview of current evidence regarding the development and use of AI technologies including machine learning and deep learning for the identification and management of frailty, this protocol outlines a scoping review aiming to identify and present available information in this area. Specifically, this protocol describes a review that will focus on the clinical tools and frameworks used to assess frailty, the outcomes that have been evaluated and the involvement of knowledge users in the development, implementation and evaluation of AI methods and tools for frailty care in clinical settings. METHODS AND ANALYSIS This scoping review protocol details a systematic search of eight major academic databases, including Medline, Embase, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Ageline, Web of Science, Scopus and Institute of Electrical and Electronics Engineers (IEEE) Xplore using the framework developed by Arksey and O'Malley and enhanced by Levac et al and the Joanna Briggs Institute. The search strategy has been designed in consultation with a librarian. Two independent reviewers will screen titles and abstracts, followed by full texts, for eligibility and then chart the data using a piloted data charting form. Results will be collated and presented through a narrative summary, tables and figures. ETHICS AND DISSEMINATION Since this study is based on publicly available information, ethics approval is not required. Findings will be communicated with healthcare providers, caregivers, patients and research and health programme funders through peer-reviewed publications, presentations and an infographic. REGISTRATION DETAILS OSF Registries (https://doi.org/10.17605/OSF.IO/T54G8).
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Affiliation(s)
- Sathya Karunananthan
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Arya Rahgozar
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ramtin Hakimjavadi
- Bruyere Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Hui Yan
- Bruyere Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kunal A Dalsania
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Howard Bergman
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Bishwajit Ghose
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Tess McCutcheon
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Daniel I McIsaac
- Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Nadia Sourial
- Department of Health Management, Evaluation & Policy, Université de Montréal, Montreal, Québec, Canada
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Manpreet Thandi
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
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Hawkins NM, Peterson S, Salimian S, Demers C, Keshavjee K, Virani SA, Mancini GJ, Wong ST. Epidemiology and treatment of heart failure with chronic obstructive pulmonary disease in Canadian primary care. ESC Heart Fail 2023; 10:3612-3621. [PMID: 37786365 PMCID: PMC10682874 DOI: 10.1002/ehf2.14497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 07/24/2023] [Indexed: 10/04/2023] Open
Abstract
AIMS Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are largely managed in primary care, but their intersection in terms of disease burden, healthcare utilization, and treatment is ill-defined. METHODS AND RESULTS We examined a retrospective cohort including all patients with HF or COPD in the Canadian Primary Care Sentinel Surveillance Network from 2010 to 2018. The population size in 2018 with HF, COPD, and HF with COPD was 15 778, 27 927, and 4768 patients, respectively. While disease incidence declined, age-sex-standardized prevalence per 100 population increased for HF alone from 2.33 to 3.63, COPD alone from 3.44 to 5.96, and COPD with HF from 12.70 to 15.67. Annual visit rates were high and stable around 8 for COPD alone but declined significantly over time for HF alone (9.3-8.1, P = 0.04) or for patients with both conditions (14.3-11.9, P = 0.006). For HF alone, cardiovascular visits were common (29.4%), while respiratory visits were infrequent (3.5%), with the majority of visits being non-cardiorespiratory. For COPD alone, respiratory and cardiovascular visits were common (16.4% and 11.3%) and the majority were again non-cardiorespiratory. For concurrent disease, 39.0% of visits were cardiorespiratory. The commonest non-cardiorespiratory visit reasons were non-specific symptoms or signs, endocrine, musculoskeletal, and mental health. In patients with HF with and without COPD, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor use was similar, while mineralocorticoid receptor antagonist use was marginally higher with concurrent COPD. Beta-blocker use was initially lower with concurrent COPD compared with HF alone (69.3% vs. 74.0%), but this progressively declined by 2018 (74.5% vs. 73.5%). CONCLUSIONS The prevalence of HF and COPD continues to rise. Although patients with either or both conditions are high utilizers of primary care, the majority of visits relate to non-cardiorespiratory comorbidities. Medical therapy for HF was similar and the initially lower beta-blocker utilization disappeared over time.
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Affiliation(s)
- Nathaniel M. Hawkins
- Division of Cardiology, Centre for Cardiovascular InnovationUniversity of British ColumbiaVancouverCanada
- Centre for Health Services and Policy ResearchUniversity of British ColumbiaVancouverCanada
| | - Sandra Peterson
- Centre for Health Services and Policy ResearchUniversity of British ColumbiaVancouverCanada
| | - Samaneh Salimian
- Division of Cardiology, Centre for Cardiovascular InnovationUniversity of British ColumbiaVancouverCanada
| | | | - Karim Keshavjee
- Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
| | - Sean A. Virani
- Division of Cardiology, Centre for Cardiovascular InnovationUniversity of British ColumbiaVancouverCanada
| | - G.B. John Mancini
- Division of Cardiology, Centre for Cardiovascular InnovationUniversity of British ColumbiaVancouverCanada
| | - Sabrina T. Wong
- Centre for Health Services and Policy ResearchUniversity of British ColumbiaVancouverCanada
- Division of Intramural ResearchNational Institute of Nursing Research, National Institutes of HealthBethesdaMDUSA
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Siew ZY, Lai ZJ, Ho QY, Ter HC, Ho SH, Wong ST, Gani M, Leong PP, Voon K. Bat coronavirus was detected positive from insectivorous bats in Krau Wildlife Reserve Forest. Trop Biomed 2023; 40:462-470. [PMID: 38308834 DOI: 10.47665/tb.40.4.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
Bats are flying mammals with unique immune systems that allow them to hold many pathogens. Hence, they are recognised as the reservoir of many zoonotic pathogens. In this study, we performed molecular detection to detect coronaviruses, paramyxoviruses, pteropine orthoreoviruses and dengue viruses from samples collected from insectivorous bats in Krau Reserve Forest. One faecal sample from Rhinolophus spp. was detected positive for coronavirus. Based on BLASTN, phylogenetic analysis and pairwise alignment-based sequence identity calculation, the detected bat coronavirus is most likely to be a bat betacoronavirus lineage slightly different from coronavirus from China, Philippines, Thailand and Luxembourg. In summary, continuous surveillance of bat virome should be encouraged, as Krau Reserve Forest reported a wide spectrum of biodiversity of insectivorous and fruit bats. Moreover, the usage of primers for the broad detection of viruses should be reconsidered because geographical variations might possibly affect the sensitivity of primers in a molecular approach.
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Affiliation(s)
- Z Y Siew
- University of Nottingham Malaysia, 43500 Semenyih, Selangor, Malaysia
| | - Z J Lai
- International Medical University, 57000 Kuala Lumpur, Malaysia
| | - Q Y Ho
- International Medical University, 57000 Kuala Lumpur, Malaysia
| | - H C Ter
- International Medical University, 57000 Kuala Lumpur, Malaysia
| | - S H Ho
- International Medical University, 57000 Kuala Lumpur, Malaysia
| | - S T Wong
- International Medical University, 57000 Kuala Lumpur, Malaysia
| | - M Gani
- Department of Wildlife and National Parks Peninsular Malaysia, 56100, Kuala Lumpur, Malaysia
| | - P P Leong
- University of Tunku Abdul Rahman, 43000 Sg. Long, Selangor, Malaysia
| | - K Voon
- University of Nottingham Malaysia, 43500 Semenyih, Selangor, Malaysia
- International Medical University, 57000 Kuala Lumpur, Malaysia
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Wong ST. Une initiative internationale recueille la voix collective du milieu des soins primaires. Can Fam Physician 2023; 69:e236-e238. [PMID: 38092458 PMCID: PMC10949263 DOI: 10.46747/cfp.6912e236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Sabrina T. Wong
- Professeure à l’École des sciences infirmières et membre du corps professoral de base du Centre de recherche sur les services et les politiques de la santé de l’Université de la Colombie-Britannique à Vancouver
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11
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Wong ST. International effort harnessing the collective voice of primary care: Patient-Reported Indicator Surveys (PaRIS) initiative includes Canadian involvement. Can Fam Physician 2023; 69:827-828. [PMID: 38092448 PMCID: PMC10949255 DOI: 10.46747/cfp.6912827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Sabrina T. Wong
- Professor in the School of Nursing and a core faculty member of the Centre for Health Services and Policy Research at the University of British Columbia in Vancouver
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Aggarwal M, Katz A, Kokorelias KM, Wong ST, Aghajafari F, Ivers NM, Martin-Misener R, Aubrey-Bassler K, Breton M, Upshur REG, Kwong JC. What are effective vaccine distribution approaches for equity-deserving and high-risk populations during COVID-19? Exploring best practices and recommendations in Canada: protocol for a mixed-methods multiple case codesign study. BMJ Open 2023; 13:e072238. [PMID: 37940159 PMCID: PMC10632871 DOI: 10.1136/bmjopen-2023-072238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 10/18/2023] [Indexed: 11/10/2023] Open
Abstract
INTRODUCTION The WHO has stated that vaccine hesitancy is a serious threat to overcoming COVID-19. Vaccine hesitancy among underserved and at-risk communities is an ongoing challenge in Canada. Public confidence in vaccine safety and effectiveness and the principles of equity need to be considered in vaccine distribution. In Canada, governments of each province or territory manage their own healthcare system, providing an opportunity to compare and contrast distribution strategies. The overarching objective of this study is to identify effective vaccine distribution approaches and advance knowledge on how to design and implement various strategies to meet the different needs of underserved communities. METHODS AND ANALYSIS Multiple case studies in seven Canadian provinces will be conducted using a mixed-methods design. The study will be informed by Experience-Based CoDesign techniques and theoretically guided by the Socio-Ecological Model and the Vaccine Hesitancy Matrix frameworks. Phase 1 will involve a policy document review to systematically explore the vaccine distribution strategy over time in each jurisdiction. This will inform the second phase, which will involve (2a) semistructured, in-depth interviews with policymakers, public health officials, researchers, providers, groups representing patients, researchers and stakeholders and (2b) an analysis of population-based administrative health data of vaccine administration. Integration of qualitative and quantitative data will inform the identification of effective vaccine distribution approaches for various populations. Informed by this evidence, phase 3 of the study will involve conducting focus groups with multiple stakeholders to codesign recommendations for the design and implementation of effective vaccine delivery strategies for equity-deserving and at-risk populations. ETHICS AND DISSEMINATION This study is approved by the University of Toronto's Health Sciences Research Ethics Board (#42643), University of British Columbia Behavioural Research Ethics Board (#H22-01750-A002), Research Ethics Board of the Nova Scotia Health Authority (#48272), Newfoundland and Labrador Health Research Ethics Board (#2022.126), Conjoint Health Research Ethics Board, University of Calgary (REB22-0207), and University of Manitoba Health Research Board (H2022-239). The outcome of this study will be to produce a series of recommendations for implementing future vaccine distribution approaches from the perspective of various stakeholders, including equity-deserving and at-risk populations.
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Affiliation(s)
- Monica Aggarwal
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alan Katz
- Department of Community Health Sciences, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Family Medicine, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kristina Marie Kokorelias
- Rehabiliation Sciences Institute, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Noah M Ivers
- Department of Family and Community Medicine, Women's College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University, St. John's, Newfoundland, Canada
| | - Mylaine Breton
- Department of Community Health Sciences, University of Sherbrooke, Longueuil, Quebec, Canada
| | - Ross E G Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
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Grudniewicz A, Randall E, Lavergne MR, Marshall EG, Jones L, Rudoler D, Horrey K, Mathews M, McKay M, Mitra G, Scott I, Snadden D, Wong ST, Goldsmith LJ. Factors influencing practice choices of early-career family physicians in Canada: a qualitative interview study. Hum Resour Health 2023; 21:84. [PMID: 37884968 PMCID: PMC10605974 DOI: 10.1186/s12960-023-00867-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/02/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Comprehensiveness of primary care has been declining, and much of the blame has been placed on early-career family physicians and their practice choices. To better understand early-career family physicians' practice choices in Canada, we sought to identify the factors that most influence their decisions about how to practice. METHODS We conducted a qualitative study using framework analysis. Family physicians in their first 10 years of practice were recruited from three Canadian provinces: British Columbia, Ontario, and Nova Scotia. Interview data were coded inductively and then charted onto a matrix in which each participant's data were summarized by code. RESULTS Of the 63 participants that were interviewed, 24 worked solely in community-based practice, 7 worked solely in focused practice, and 32 worked in both settings. We identified four practice characteristics that were influenced (scope of practice, practice type and model, location of practice, and practice schedule and work volume) and three categories of influential factors (training, professional, and personal). CONCLUSIONS This study demonstrates the complex set of factors that influence practice choices by early-career physicians, some of which may be modifiable by policymakers (e.g., policies and regulations) while others are less so (e.g., family responsibilities). Participants described individual influences from family considerations to payment models to meeting community needs. These findings have implications for both educators and policymakers who seek to support and expand comprehensive care.
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Affiliation(s)
- Agnes Grudniewicz
- Telfer School of Management, University of Ottawa, 55 Laurier Avenue East, Ottawa, ON, K1N 6N5, Canada.
| | - Ellen Randall
- Telfer School of Management, University of Ottawa, 55 Laurier Avenue East, Ottawa, ON, K1N 6N5, Canada
| | - M Ruth Lavergne
- Department of Family Medicine, Dalhousie University, 402-1465 Brenton St., Halifax, NS, B3J 3T4, Canada
| | - Emily Gard Marshall
- Department of Family Medicine, Dalhousie University, 402-1465 Brenton St., Halifax, NS, B3J 3T4, Canada
| | - Lori Jones
- Telfer School of Management, University of Ottawa, 55 Laurier Avenue East, Ottawa, ON, K1N 6N5, Canada
| | - David Rudoler
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street N, Oshawa, ON, L1G 0C5, Canada
- Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, ON, L1N 5S9, Canada
| | - Kathleen Horrey
- Department of Family Medicine, Dalhousie University, 402-1465 Brenton St., Halifax, NS, B3J 3T4, Canada
| | - Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western Centre for Public Health and Family Medicine, Western University, 1465 Richmond St, Second Floor, London, ON, N6G 2M1, Canada
| | - Madeleine McKay
- Department of Family Medicine, Dalhousie University, 402-1465 Brenton St., Halifax, NS, B3J 3T4, Canada
| | - Goldis Mitra
- Department of Family Practice, Faculty of Medicine, University of British Columbia, 5950 University Blvd #310, Vancouver, BC, V6T 1Z3, Canada
| | - Ian Scott
- Department of Family Practice, Faculty of Medicine, University of British Columbia, 5950 University Blvd #310, Vancouver, BC, V6T 1Z3, Canada
| | - David Snadden
- University of British Columbia Northern Medical Program, Prince George, BC, Canada
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Laurie J Goldsmith
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- GoldQual Consulting, Richmond Hill, ON, Canada
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Htet H, Win TT, Wong ST, Shamsudin NH, Kandasami P. Clinicopathological study of gastric cancer in a Malaysian tertiary public health care centre. Med J Malaysia 2023; 78:616-620. [PMID: 37775488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
INTRODUCTION Gastric cancer (GC) is one of the leading causes of all new cancer cases globally. Although it is no longer reported in the top 10th most common cancer in Malaysia, geographical distribution and ethnic influences still obviously exist. MATERIALS AND METHODS This is a retrospective analysis of histopathological records in a public tertiary health care centre in Malaysia. The computerised laboratory information system from the histopathology department of the hospital was retrieved for the period of 2005-2018. Descriptive analysis was done using Microsoft Excel. RESULTS There was a total of 233 histologically confirmed GC cases. The burden of GC was observed to be an increasing trend from 2016 onwards. Among them, 64% were male and 36% were female. The youngest age of diagnosis was 19, while the oldest one was 93. Malaysian Chinese were found to have the highest incidences (41.63%), followed by Malays (32.19%) and Malaysian Indians (23.61%). All cases were of adenocarcinoma cell types and were found to have poorly differentiated in majority at the time of diagnosis. CONCLUSION Although this report only represents one tertiary health care centre in Malaysia, the Indian Enigma was still observed, as stated in other literatures. Over time, the incidence of GC in Malays has increased. Consideration of lifestyle modifications, health education and Helicobacter pylori eradication in various nations' National Health Insurance plans, are encouraged as prevention is always better than treatment or cure, including the cost load.
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Affiliation(s)
- H Htet
- International Medical University, School of Medicine, Kuala Lumpur, Malaysia.
| | - T T Win
- International Medical University, School of Medicine, Kuala Lumpur, Malaysia
| | - S T Wong
- International Medical University, School of Medicine, Kuala Lumpur, Malaysia
| | - N H Shamsudin
- Hospital Tuanku Ja'afar, Department of Histopathology, Seremban, Ministry of Health, Malaysia
| | - P Kandasami
- International Medical University, School of Medicine, Kuala Lumpur, Malaysia
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Zeitouny S, Cheng L, Wong ST, Tadrous M, McGrail K, Law MR. Prevalence and predictors of primary nonadherence to medications prescribed in primary care. CMAJ 2023; 195:E1000-E1009. [PMID: 37553145 PMCID: PMC10446155 DOI: 10.1503/cmaj.221018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Most research on medication adherence has focused on secondary nonadherence and persistence to therapy. Medication prescriptions that are never filled by patients (primary nonadherence) remain understudied in the general population. METHODS We linked prescribing data from primary care electronic medical records to comprehensive pharmacy dispensing claims between January 2013 and April 2019 in British Columbia (BC) to estimate primary nonadherence, defined as failure to dispense a new medication or its equivalent within 6 months of the prescription date. We used hierarchical multivariable logistic regression to determine prescriber, patient and medication factors associated with primary nonadherence among community-dwelling patients in primary care. RESULTS Among 150 565 new prescriptions to 34 243 patients, 17% of prescriptions were never filled. Primary nonadherence was highest for drugs prescribed mostly on an as-needed basis, including topical corticosteroids (35.1%) and antihistamines (23.4%). In multivariable analysis, primary nonadherence was lower for prescriptions issued by male prescribers (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.50-0.88). Primary nonadherence decreased with patient age (OR 0.91, 95% CI 0.90-0.92 for each additional 10 years) but increased with polypharmacy among patients aged 65 years or older. Patients filled more than 82% of their medication prescriptions within 2 weeks after their primary care provider visit. INTERPRETATION The prevalence of primary nonadherence to new prescriptions was 17%. Interventions to address primary nonadherence could target older patients with multiple medication use and within the first 2 weeks of the prescription issue date.
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Affiliation(s)
- Seraphine Zeitouny
- Centre for Health Services and Policy Research, School of Population and Public Health (Zeitouny, Cheng, Wong, McGrail, Law), University of British Columbia, Vancouver, BC; Leslie Dan Faculty of Pharmacy (Tadrous), University of Toronto; Women's College Research Institute (Tadrous), Women's College Hospital, Toronto, Ont.
| | - Lucy Cheng
- Centre for Health Services and Policy Research, School of Population and Public Health (Zeitouny, Cheng, Wong, McGrail, Law), University of British Columbia, Vancouver, BC; Leslie Dan Faculty of Pharmacy (Tadrous), University of Toronto; Women's College Research Institute (Tadrous), Women's College Hospital, Toronto, Ont
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, School of Population and Public Health (Zeitouny, Cheng, Wong, McGrail, Law), University of British Columbia, Vancouver, BC; Leslie Dan Faculty of Pharmacy (Tadrous), University of Toronto; Women's College Research Institute (Tadrous), Women's College Hospital, Toronto, Ont
| | - Mina Tadrous
- Centre for Health Services and Policy Research, School of Population and Public Health (Zeitouny, Cheng, Wong, McGrail, Law), University of British Columbia, Vancouver, BC; Leslie Dan Faculty of Pharmacy (Tadrous), University of Toronto; Women's College Research Institute (Tadrous), Women's College Hospital, Toronto, Ont
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health (Zeitouny, Cheng, Wong, McGrail, Law), University of British Columbia, Vancouver, BC; Leslie Dan Faculty of Pharmacy (Tadrous), University of Toronto; Women's College Research Institute (Tadrous), Women's College Hospital, Toronto, Ont
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health (Zeitouny, Cheng, Wong, McGrail, Law), University of British Columbia, Vancouver, BC; Leslie Dan Faculty of Pharmacy (Tadrous), University of Toronto; Women's College Research Institute (Tadrous), Women's College Hospital, Toronto, Ont
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Lavergne MR, Rudoler D, Peterson S, Stock D, Taylor C, Wilton AS, Wong ST, Scott I, McGrail KM, McCracken RK, Marshall EG, MacKenzie A, Katz A, Jamieson M, Hedden L, Grudniewicz A, Goldsmith LJ, Glazier RH, Burge F, Blackie D. Changes in comprehensiveness of services delivered by Canadian family physicians: Analysis of population-based linked data in 4 provinces. Can Fam Physician 2023; 69:550-556. [PMID: 37582603 PMCID: PMC10426375 DOI: 10.46747/cfp.6908550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
OBJECTIVE To describe changes in the comprehensiveness of services delivered by family physicians across service settings and service areas in 4 Canadian provinces, to identify which settings and areas have changed the most, and to compare the magnitude of changes by physician characteristics. DESIGN Descriptive analysis of province-wide, population-based billing data linked to population and physician registries. SETTING British Columbia, Manitoba, Ontario, and Nova Scotia. PARTICIPANTS Family physicians registered to practise in the 1999-2000 and 2017-2018 fiscal years. MAIN OUTCOME MEASURES Comprehensiveness was measured across 7 service settings (home care, long-term care, emergency departments, hospitals, obstetric care, surgical assistance, anesthesiology) and in 7 service areas consistent with office-based practice (prenatal and postnatal care, Papanicolaou testing, mental health, substance use, cancer care, minor surgery, palliative home visits). The proportion of physicians with activity in each setting and area are reported and the average number of service settings and areas by physician characteristics is described (years in practice, sex, urban or rural practice setting, and location of medical degree training). RESULTS Declines in comprehensiveness were observed across all provinces studied. Declines were greater for comprehensiveness of settings than for areas consistent with office-based practice. Changes were observed across all physician characteristics. On average across provinces, declines in the number of service settings and service areas were highest among physicians in practice 20 years or longer, male physicians, and physicians practising in urban areas. CONCLUSION Declining comprehensiveness was observed across all physician characteristics, pointing to changes in the practice and policy contexts in which all family physicians work.
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Affiliation(s)
- M Ruth Lavergne
- Associate Professor in the Department of Family Medicine at Dalhousie University in Halifax, NS, and holds a Tier II Canada Research Chair in Primary Care.
| | - David Rudoler
- Assistant Professor in the Faculty of Health Sciences at Ontario Tech University in Oshawa and Research Chair at the Ontario Shores Centre for Mental Health Sciences in Whitby
| | - Sandra Peterson
- Research analyst in the Centre for Health Services and Policy Research at the University of British Columbia in Vancouver
| | - David Stock
- Senior health services researcher in the Department of Family Medicine at Dalhousie University
| | - Carole Taylor
- Data analyst in the Manitoba Centre for Health Policy at the University of Manitoba in Winnipeg
| | | | - Sabrina T Wong
- Senior investigator with the Division of Intramural Research of the National Institute of Nursing Research
| | - Ian Scott
- Associate Professor in the Department of Family Practice and Director of the Centre for Health Education Scholarship at the University of British Columbia
| | - Kimberlyn M McGrail
- Professor in the Centre for Health Services and Policy Research at the University of British Columbia
| | - Rita K McCracken
- Assistant Professor in the Department of Family Practice at the University of British Columbia
| | - Emily Gard Marshall
- Professor in the Department of Family Medicine and the Primary Care Research Unit at Dalhousie University and with the Nova Scotia Health Authority
| | - Adrian MacKenzie
- Project executive for Health Workforce Planning with the Nova Scotia Department of Health and Wellness, co-Investigator with the WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Adjunct Faculty in the Department of Community Health and Epidemiology at Dalhousie University, and an affiliate scientist with Nova Scotia Health
| | - Alan Katz
- Professor in the Department of Family Medicine and the Department of Community Health Sciences at the University of Manitoba
| | - Margaret Jamieson
- Doctoral candidate in the Institute of Health Policy Management and Evaluation at the University of Toronto
| | - Lindsay Hedden
- Assistant Professor in the Faculty of Health Sciences at Simon Fraser University in Burnaby, BC
| | - Agnes Grudniewicz
- Associate Professor in the Telfer School of Management at the University of Ottawa
| | - Laurie J Goldsmith
- Adjunct Professor in the Faculty of Health Sciences at Simon Fraser and the founder and Principal of GoldQual Consulting
| | - Richard H Glazier
- Senior core scientist with ICES, a Professor of Family and Community Medicine at the University of Toronto, and a family physician and scientist at St Michael's Hospital
| | - Fred Burge
- Professor and a faculty researcher in the Department of Family Medicine at Dalhousie University
| | - Doug Blackie
- Associate Faculty member at the School of Leadership Studies, Royal Roads University, Victoria, BC and a certified health care consultant
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17
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Garrison SR, Kelmer M, Korownyk T, Kolber MR, Allan GM, Bakal J, Singer A, Katz A, Mcalister F, Padwal RS, Lewanczuk R, Hill MD, McGrail K, O'Neill B, Greiver M, Manca DP, Mangin D, Wong ST, Kirkwood JEM, McCormack JP, Yeung JMS, Green L. Tolerability of bedtime diuretics: a prospective cohort analysis. BMJ Open 2023; 13:e068188. [PMID: 37280022 DOI: 10.1136/bmjopen-2022-068188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVES We sought to validate, or refute, the common belief that bedtime diuretics are poorly tolerated due to nocturia. DESIGN Prespecified prospective cohort analysis embedded within the randomised BedMed trial, in which hypertensive participants are randomised to morning versus bedtime antihypertensive administration. SETTING 352 community family practices across 4 Canadian provinces between March 2017 and September 2020. PARTICIPANTS 552 hypertensive patients (65.6 years old, 57.4% female) already established on a single once-daily morning antihypertensive and randomised to switch that antihypertensive to bedtime. Of these, 203 used diuretics (27.1% thiazide alone, 70.0% thiazide/non-diuretic combinations) and 349 used non-diuretics. INTERVENTION Switching the established antihypertensive from morning to bedtime, and comparing the experience of diuretic and non-diuretic users. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome: Adherence to bedtime allocation time at 6 months (defined as the willingness to continue with bedtime use, not an assessment of missed doses). Secondary 6-month outcomes: (1) nocturia considered to be a major burden and (2) increase in overnight urinations/week. All outcomes were self-reported and additionally collected at 6 weeks. RESULTS At 6 months: Adherence to bedtime allocation time was lower in diuretic users than non-diuretic users (77.3% vs 89.8%; difference 12.6%; 95% CI 5.8% to 19.8%; p<0.0001; NNH 8.0), and more diuretic users considered nocturia a major burden (15.6% vs 1.3%; difference 14.2%; 95% CI 8.9% to 20.6%; p<0.0001; NNH 7.0). Compared with baseline, diuretic users experienced 1.0 more overnight urinations/week (95% CI 0.0 to 1.75; p=0.01). Results did not differ between sexes. CONCLUSIONS Switching diuretics to bedtime did promote nocturia, but only 15.6% found nocturia a major burden. At 6 months, 77.3% of diuretic users were adherent to bedtime dosing. Bedtime diuretic use is viable for many hypertensive patients, should it ever become clinically indicated. TRIAL REGISTRATION NUMBER NCT02990663.
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Affiliation(s)
- Scott R Garrison
- Family Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
- Pragmatic Trials Collaborative, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Kelmer
- Pragmatic Trials Collaborative, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Tina Korownyk
- Family Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
- Pragmatic Trials Collaborative, University of Alberta, Edmonton, Alberta, Canada
| | - Michael R Kolber
- Family Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
- Pragmatic Trials Collaborative, University of Alberta, Edmonton, Alberta, Canada
| | - Gary Michael Allan
- Pragmatic Trials Collaborative, University of Alberta, Edmonton, Alberta, Canada
- Programs and Practice Support, College of Family Physicians, Mississauga, Ontario, Canada
| | - Jeffrey Bakal
- Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Alexander Singer
- Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alan Katz
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Finlay Mcalister
- Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Raj S Padwal
- Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Richard Lewanczuk
- Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Michael D Hill
- Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kimberlyn McGrail
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Braden O'Neill
- Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Greiver
- Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Donna P Manca
- Family Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Dee Mangin
- Family Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Sabrina T Wong
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica E M Kirkwood
- Family Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
- Pragmatic Trials Collaborative, University of Alberta, Edmonton, Alberta, Canada
| | - James P McCormack
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jack M S Yeung
- Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Lee Green
- Family Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
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Ngan JST, Chan WC, Wong ST, Wong CSM, Cheng CPW. Reward System in Late-Life Depression: a Cross-Sectional Case-Control Study. East Asian Arch Psychiatry 2023; 33:71-76. [PMID: 37400229 DOI: 10.12809/eaap2309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
OBJECTIVE Anhedonia, commonly defined as a reduced ability to feel pleasure, is a core clinical symptom of late-life depression (LLD). Deficits in reward processing are hypothesised to be associated with anhedonia. We examined differences in reward sensitivity between patients with LLD and healthy controls and explored the associations between LLD-related symptomatology, global cognition, and the reward system. METHODS The reward responsiveness of 63 patients with LLD and 58 healthy controls aged ≥60 years was assessed using the probabilistic reward learning task with an asymmetric reward schedule. RESULTS Compared with healthy controls, patients with LLD displayed lower response bias and reward learning. Global cognition of all participants was positively correlated with response bias. In patients with LLD, anhedonia severity explained impaired reward learning. CONCLUSION A deficit in reward processing is implicated in patients with LLD. Our findings suggest that executive dysfunction and anhedonia contribute to lower sensitivity to reward learning in patients with LLD.
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Affiliation(s)
- J S T Ngan
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - W C Chan
- Department of Psychiatry, Queen Mary Hospital, Hong Kong SAR, China
| | - S T Wong
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - C S M Wong
- Division of Community Medicine and Public Health Practice, School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - C P W Cheng
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
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Ezzat AM, Esculier JF, Ferguson SL, Napier C, Wong ST. Canadian Physiotherapists Integrate Virtual Care during the COVID-19 Pandemic. Physiother Can 2023; 75:134-145. [PMID: 37736382 PMCID: PMC10510558 DOI: 10.3138/ptc-2022-0092] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/24/2021] [Accepted: 01/07/2022] [Indexed: 09/23/2023]
Abstract
Purpose To examine Canadian physiotherapists' experiences in adapting their delivery of patient care during the COVID-19 pandemic. We examine the level of strain on the profession and barriers and enablers to virtual care and provide strategies to support future virtual care implementation. Methods From May to October 2020, a series of eight cross-sectional survey cycles were distributed every 2-4 weeks through branches and divisions of the Canadian Physiotherapy Association, social media, and personal networks. Descriptive statistics summarized the main findings. Open ended questions were first analyzed inductively using thematic analysis, then deductively mapped to the Capability-Opportunity-Motivation Behavioural (COM-B) Model. Results Between 1,820 (cycle 1) and 334 (cycle 7) physiotherapists responded. Median strain level was 5/5 (cycle 1) and dropped to median 3/5 (cycles 5-8). In cycle 1, 55% of physiotherapists had ceased in-person care, while 41% were providing modified in-person care. Of these physiotherapists, 79% were offering virtual care. As modified in-person care increased, virtual care continued as a substantial aspect of practice. Physiotherapists identified barriers (e.g., lack of hands-on care) and enabling factors (e.g., greater accessibility to patients) for virtual care. In-depth examination of the barriers and enablers through the COM-B lens identified potential interventions to support future virtual care implementation, including education and training resources for physiotherapists and communication and advocacy to patients and the public on the value of virtual care. Conclusions Canadian physiotherapists exhibited high adaptability in response to COVID-19 through the rapid and widespread use of virtual care. By creating an in-depth understanding of the barriers and enablers to virtual care, along with potential interventions, this work will facilitate future opportunities to support and enhance physiotherapists' delivery of virtual care.
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Affiliation(s)
- Allison M. Ezzat
- From the:
La Trobe Sports Medicine Research Centre, La Trobe University, Melbourne, Australia
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- School of Nursing, University of British Columbia, Vancouver, Canada
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | - Jean-Francois Esculier
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- The Running Clinic, Lac Beauport, Quebec, Canada
| | | | - Christopher Napier
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Metro Vancouver, Canada
| | - Sabrina T. Wong
- School of Nursing, University of British Columbia, Vancouver, Canada
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
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20
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Wong ST, Morkem R, Salman A, Barber D, Leis JA. Value in Primary Care: Evidence from the Canadian Primary Care Sentinel Surveillance Network. Healthc Policy 2023; 18:57-71. [PMID: 37486813 PMCID: PMC10370397 DOI: 10.12927/hcpol.2023.27093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
Primary care antimicrobial stewardship programs are virtually non-existent. Using electronic medical record (EMR) data for an interrupted time series study, the authors examined the relationship between antibiotic prescriptions for acute respiratory tract infections (RTIs) and the COVID-19 pandemic. The main outcome of the study was to gauge the proportion of RTI encounters with an antibiotic prescription. The pre-pandemic RTI antibiotic prescribing rate was 27.8%. During the COVID-19 pandemic, prescribing dropped significantly by 9.4% (p < 0.001). Almost 750,000 fewer patients could potentially avoid receiving an antibiotic prescription for RTI. The authors also discuss the value of EMR data; their use can help develop insights for health system improvement.
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Affiliation(s)
- Sabrina T Wong
- Scientific Director and Senior Investigator, Division of Intramural Research, National Institute of Nursing Research, Bethesda, MD
| | - Rachael Morkem
- Data Analyst, Canadian Primary Care Sentinel Surveillance Network, Department of Family Medicine, Queen's University, Kingston, ON
| | - Ayat Salman
- Operations Director and Postdoctoral Fellow, Department of Family Medicine, Queen's University, Kingston, ON
| | - David Barber
- Canadian Primary Care Sentinel Surveillance Network, Associate Professor, Department of Family Medicine, Queen's University, Kingston, ON
| | - Jerome A Leis
- Staff Physician, Division of Infectious Diseases, Associate Scientist, Sunnybrook Health Sciences Centre, Associate Professor, Adjunct Faculty, Department of Medicine and Centre for Quality Improvement and Patient Safety, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
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21
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Cronin S, Li A, Bai YQ, Ammi M, Hogg W, Wong ST, Wodchis WP. How do respondents of primary care surveys compare to typical users of primary care? A comparison of two surveys. BMC Prim Care 2023; 24:80. [PMID: 36959533 PMCID: PMC10037805 DOI: 10.1186/s12875-023-02029-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 03/06/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Primary care surveys are a key source of evaluative data; understanding how survey respondents compare to the intended population is important to understand results in context. The objective of this study was to examine the physician and patient representativeness of two primary care surveys (TRANSFORMATION and QUALICOPC) that each used different sampling and recruitment techniques. METHODS We linked the physician and patient participants of the two surveys to health administrative databases. Patients were compared to other patients visiting the practice on the same day and other randomly selected dates using sociodemographic data, chronic disease diagnosis, and health system utilization. Physicians were compared to other physicians in the same practice, and other physicians in the intended geographic area using sociodemographic and practice characteristics. RESULTS Physician respondents of the TRANSFORMATION survey included more males compared to their practice groups, but not to other physicians in the area. TRANSFORMATION physicians cared for a larger roster of patients than other physicians in the area. Patient respondents of the QUALICOPC survey did not have meaningful differences from other patients who visit the practice. Patient respondents of the TRANSFORMATION survey resided in more rural areas, had less chronic disease, and had lower use of health services than other patients visiting the practice. CONCLUSION Differences in survey recruitment methods at the physician and patient level may help to explain some of the differences in representativeness. When conducting primary care surveys, investigators should consider diverse methods of ensuring representativeness to limit the potential for nonresponse bias.
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Affiliation(s)
- Shawna Cronin
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Unit 425, Toronto, Canada.
| | - Allanah Li
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Unit 425, Toronto, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
| | - Yu Qing Bai
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Unit 425, Toronto, Canada
- ICES, Toronto, Canada
| | - Mehdi Ammi
- School of Public Policy & Administration, Carleton University, Ottawa, Canada
| | - William Hogg
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
- Institut du Savoir Montfort, Ottawa, Canada
| | - Sabrina T Wong
- School of Nursing, University of British Columbia, Vancouver, Canada
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Unit 425, Toronto, Canada
- ICES, Toronto, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
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22
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Mangin D, Lawson J, Risdon C, Siu HYH, Packer T, Wong ST, Howard M. Association between frailty, chronic conditions and socioeconomic status in community-dwelling older adults attending primary care: a cross-sectional study using practice-based research network data. BMJ Open 2023; 13:e066269. [PMID: 36810183 PMCID: PMC9944661 DOI: 10.1136/bmjopen-2022-066269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVES Frailty is a multidimensional syndrome of loss of reserves in energy, physical ability, cognition and general health. Primary care is key in preventing and managing frailty, mindful of the social dimensions that contribute to its risk, prognosis and appropriate patient support. We studied associations between frailty levels and both chronic conditions and socioeconomic status (SES). DESIGN Cross-sectional cohort study SETTING: A practice-based research network (PBRN) in Ontario, Canada, providing primary care to 38 000 patients. The PBRN hosts a regularly updated database containing deidentified, longitudinal, primary care practice data. PARTICIPANTS Patients aged 65 years or older, with a recent encounter, rostered to family physicians at the PBRN. INTERVENTION Physicians assigned a frailty score to patients using the 9-point Clinical Frailty Scale. We linked frailty scores to chronic conditions and neighbourhood-level SES to examine associations between these three domains. RESULTS Among 2043 patients assessed, the prevalence of low (scoring 1-3), medium (scoring 4-6) and high (scoring 7-9) frailty was 55.8%, 40.3%, and 3.8%, respectively. The prevalence of five or more chronic diseases was 11% among low-frailty, 26% among medium-frailty and 44% among high-frailty groups (χ2=137.92, df 2, p<0.001). More disabling conditions appeared in the top 50% of conditions in the highest-frailty group compared with the low and medium groups. Increasing frailty was significantly associated with lower neighbourhood income (χ2=61.42, df 8, p<0.001) and higher neighbourhood material deprivation (χ2=55.24, df 8, p<0.001). CONCLUSION This study demonstrates the triple disadvantage of frailty, disease burden and socioeconomic disadvantage. Frailty care needs a health equity approach: we demonstrate the utility and feasibility of collecting patient-level data within primary care. Such data can relate social risk factors, frailty and chronic disease towards flagging patients with the greatest need and creating targeted interventions.
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Affiliation(s)
- Dee Mangin
- Department of Family Medicine, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Jennifer Lawson
- Department of Family Medicine, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Cathy Risdon
- Department of Family Medicine, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Henry Yu-Hin Siu
- Department of Family Medicine, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Tamar Packer
- Hamilton Health Sciences and St. Joseph's Health Care, Hamilton, Ontario, Canada
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
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23
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Lavergne MR, Rudoler D, Peterson S, Stock D, Taylor C, Wilton AS, Wong ST, Scott I, McGrail KM, McCracken R, Marshall EG, MacKenzie A, Katz A, Jamieson M, Hedden L, Grudniewicz A, Goldsmith LJ, Glazier RH, Burge F, Blackie D. Declining Comprehensiveness of Services Delivered by Canadian Family Physicians Is Not Driven by Early-Career Physicians. Ann Fam Med 2023; 21:151-156. [PMID: 36973051 PMCID: PMC10042570 DOI: 10.1370/afm.2945] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 03/29/2023] Open
Abstract
We describe changes in the comprehensiveness of services delivered by family physicians in 4 Canadian provinces (British Columbia, Manitoba, Ontario, Nova Scotia) during the periods 1999-2000 and 2017-2018 and explore if changes differ by years in practice. We measured comprehensiveness using province-wide billing data across 7 settings (home, long-term care, emergency department, hospital, obstetrics, surgical assistance, anesthesiology) and 7 service areas (pre/postnatal care, Papanicolaou [Pap] testing, mental health, substance use, cancer care, minor surgery, palliative home visits). Comprehensiveness declined in all provinces, with greater changes in number of service settings than service areas. Decreases were no greater among new-to-practice physicians.
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Affiliation(s)
- M. Ruth Lavergne
- Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (M. R. L., F. B.)
- Canada Research Chairs Program, Tier II Primary Care, Ottawa, Ontario, Canada (M. R. L.)
- CORRESPONDING AUTHOR: M. Ruth Lavergne Department of Family Medicine, Dalhousie University 402-1465 Brenton St Halifax, NS, B3J 3T4
| | - David Rudoler
- Ontario Tech University, Faculty of Health Sciences, Oshawa, Ontario, Canada (D. R.)
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada (D. R.)
| | - Sandra Peterson
- The University of British Columbia, Centre for Health Services and Policy Research, Vancouver, British Columbia, Canada (S. P., S. T. W., K. M. M.)
| | - David Stock
- Dalhousie University, Department of Community Health and Epidemiology, Halifax, Nova Scotia, Canada (D. S., A. M.)
| | - Carole Taylor
- University of Manitoba, Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada (C. T.)
| | - Andrew S. Wilton
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (A. S. W., R. H. G.)
| | - Sabrina T. Wong
- The University of British Columbia, Centre for Health Services and Policy Research, Vancouver, British Columbia, Canada (S. P., S. T. W., K. M. M.)
- National Institute of Nursing Research, Division of Intramural Research (this work was completed while at the University of British Columbia, School of Nursing, Vancouver, British Columbia, Canada) (S. T. W.)
| | - Ian Scott
- The University of British Columbia, Department of Family Practice, Vancouver, British Columbia, Canada (I. S., R. M.)
- The University of British Columbia, Centre for Health Education Scholarship, Vancouver, British Columbia, Canada (I. S.)
| | - Kimberlyn M. McGrail
- The University of British Columbia, Centre for Health Services and Policy Research, Vancouver, British Columbia, Canada (S. P., S. T. W., K. M. M.)
| | - Rita McCracken
- The University of British Columbia, Department of Family Practice, Vancouver, British Columbia, Canada (I. S., R. M.)
| | - Emily G. Marshall
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada (E. G. M., A. M.)
- Dalhousie University, Primary Care Research Unit, Department of Family Medicine, Halifax, Nova Scotia, Canada (E. G. M.)
| | - Adrian MacKenzie
- Dalhousie University, Department of Community Health and Epidemiology, Halifax, Nova Scotia, Canada (D. S., A. M.)
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada (E. G. M., A. M.)
| | - Alan Katz
- University of Manitoba, Department of Family Medicine, Winnipeg, Manitoba, Canada (A.K.)
- University of Manitoba, Department of Community Health Sciences, Winnipeg, Manitoba, Canada (A. K.)
| | - Margaret Jamieson
- University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada (M. J., R. H. G.)
| | - Lindsay Hedden
- Simon Fraser University, Faculty of Health Sciences, Burnaby, British Columbia, Canada (L. H., L. J. G.)
| | - Agnes Grudniewicz
- University of Ottawa, Telfer School of Management, Ottawa, Ontario, Canada (A. G.)
| | - Laurie J. Goldsmith
- Simon Fraser University, Faculty of Health Sciences, Burnaby, British Columbia, Canada (L. H., L. J. G.)
- GoldQual Consulting, Ontario, Canada (L. J. G.)
| | - Richard H. Glazier
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (A. S. W., R. H. G.)
- University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada (M. J., R. H. G.)
- St Michael’s Hospital, Toronto, Ontario, Canada (R. H. G.)
- University of Toronto, Department of Family and Community Medicine, Toronto, Ontario, Canada (R. H. G.)
| | - Fred Burge
- Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (M. R. L., F. B.)
| | - Doug Blackie
- Royal Roads University, School of Leadership Studies, Victoria, British Columbia, Canada (D. B.)
- Doug Blackie Consulting, Inc, Edmonton, Alberta, Canada (D. B.)
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24
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Rudoler D, Peterson S, Stock D, Taylor C, Wilton D, Blackie D, Burge F, Glazier RH, Goldsmith L, Grudniewicz A, Hedden L, Jamieson M, Katz A, MacKenzie A, Marshall E, McCracken R, McGrail K, Scott I, Wong ST, Lavergne MR. Changes over time in patient visits and continuity of care among graduating cohorts of family physicians in 4 Canadian provinces. CMAJ 2022; 194:E1639-E1646. [PMID: 36511867 PMCID: PMC9828986 DOI: 10.1503/cmaj.220439] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Lack of patient access to family physicians in Canada is a concern. The role of recent physician graduates in this problem of supply of primary care services has not been established. We sought to establish whether career stage or graduation cohort were related to family physician practice volume and continuity of care over time. METHODS We conducted a retrospective cohort study of family physician practice from 1997/98 to 2017/18. We collected administrative health and physician claims data in British Columbia, Manitoba, Ontario and Nova Scotia. We included all physicians who registered with their respective provincial regulatory colleges as having a medical specialty of family practice or who had billed the provincial health insurance system for patient care as family physicians, or both. We used regression models to isolate the effects of 3-year categories of years in practice (at all career stages), time period and cohort on patient contacts and physician-level continuity of care. RESULTS Between 1997/98 and 2017/18, the median number of patient contacts per provider per year fell by between 515 and 1736 contacts in the 4 provinces examined. Median contacts peaked at 27-29 years in practice in all provinces, and median physician-level continuity of care increased until 30 or more years in practice. We found no association between graduation cohort and patient contacts or physician-level continuity of care. INTERPRETATION Recent cohorts of family physicians practise similarly to their predecessors in terms of practice volumes and continuity of care. Because family physicians of all career stages showed declining patient contacts, we suggest that system-wide solutions to recent challenges in the accessibility of primary care in Canada are needed.
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Affiliation(s)
- David Rudoler
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Sandra Peterson
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - David Stock
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont.
| | - Carole Taylor
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Drew Wilton
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Doug Blackie
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Fred Burge
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Richard H Glazier
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Laurie Goldsmith
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Agnes Grudniewicz
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Lindsay Hedden
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Margaret Jamieson
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Alan Katz
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Adrian MacKenzie
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Emily Marshall
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Rita McCracken
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Kim McGrail
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Ian Scott
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Sabrina T Wong
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - M Ruth Lavergne
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
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Singer A, Kosowan L, LaBine L, Shenoda D, Katz A, Abrams EM, Halas G, Wong ST, Talpade S, Kirby S, Baldwin A, Francois J. Characterizing the use of virtual care in primary care settings during the COVID-19 pandemic: a retrospective cohort study. BMC Prim Care 2022; 23:320. [PMID: 36496379 PMCID: PMC9736717 DOI: 10.1186/s12875-022-01890-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 10/26/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND In March 2020, Canada implemented restrictions to curb viral transmission of COVID-19, which resulted in abrupt disruptions to conventional (in-person) clinical care. To retain continuity of care the delivery of primary care services shifted to virtual care. This study examined the nature of virtual visits, characterizing the use and users of virtual care in primary care settings from March 14/20 to June 30/20 of the COVID-19 pandemic. METHODS: Retrospective cohort study of primary care providers in Manitoba, Canada that participate in the Manitoba Primary Care Research Network (MaPCReN) and offered ≥ 1 virtual care visit between 03/14/20 and 06/30/20 representing 142,616 patients. Tariff codes from billing records determined the visit type (clinic visit, virtual care). Between 03/14/20, and 06/30/20, we assessed each visit for a follow-up visit between the same patient and provider for the same diagnosis code. Patient (sex, age, comorbidities, visit frequency, prescriptions) and provider (sex, age, clinic location, provider type, remuneration, country of graduation, return visit rate) characteristics describe the study population by visit type. Generalized estimating equation models describe factors associated with virtual care. RESULTS: There were 146,372 visits provided by 154 primary care providers between 03/14/20 and 06/30/20, of which 33.6% were virtual care. Female patients (OR 1.16, CI 1.09-1.22), patients with ≥ 3 comorbidities (OR 1.71, CI 1.44-2.02), and patients with ≥ 10 prescriptions (OR 2.71, 2.2-1.53) had higher odds of receiving at least one virtual care visit compared to male patients, patients with no comorbidities and patients with no prescriptions. There was no significant difference between the number of follow-up visits that were provided as a clinic visit compared to a virtual care visit (8.7% vs. 5.8%) (p = 0.6496). CONCLUSION Early in the pandemic restrictions, approximately one-third of visits were virtual. Virtual care was utilized by patients with more comorbidities and prescriptions, suggesting that patients with chronic disease requiring ongoing care utilized virtual care. Virtual care as a primary care visit type continues to evolve. Ongoing provision of virtual care can enhance quality, patient-centered care moving forward.
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Affiliation(s)
- Alexander Singer
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Leanne Kosowan
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Lisa LaBine
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Daniel Shenoda
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Alan Katz
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada ,grid.21613.370000 0004 1936 9609Departments of Community Health Science and Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, MB Winnipeg, Canada ,grid.21613.370000 0004 1936 9609Manitoba Centre for Health Policy, Winnipeg, MB Canada
| | - Elissa M Abrams
- grid.21613.370000 0004 1936 9609Department of Pediatrics, Section of Allergy and Clinical Immunology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada ,grid.17091.3e0000 0001 2288 9830Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, BC Canada
| | - Gayle Halas
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Sabrina T. Wong
- grid.17091.3e0000 0001 2288 9830School of Nursing and Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC Canada
| | - Siddhesh Talpade
- grid.416388.00000 0001 1245 5369Planning and Knowledge Management, Manitoba Health and Seniors Care, Winnipeg, MB Canada
| | - Sarah Kirby
- grid.21613.370000 0004 1936 9609George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, MB Winnipeg, Canada
| | - Alanna Baldwin
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Jose Francois
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
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Dhari R, Haase K, Ranger M, Tan E, Affleck F, Bailey E, Wong ST. Engaging nursing students in a COVID-19 Point-of-Care rapid screening clinic. Nurs Open 2022; 9:2518-2524. [PMID: 35686659 PMCID: PMC9348001 DOI: 10.1002/nop2.1272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 04/26/2022] [Accepted: 05/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background The COVID‐19 pandemic has globally impacted nursing education, particularly clinical learning opportunities for undergraduate nursing students. Purpose In this paper, we report on an educational activity wherein students participated in a COVID‐19 Rapid Antigen Testing (RAT) clinic on a Canadian university campus. Methods Between February–April 2021, in the second term of a five‐term accelerated program, nursing students (n = 60) participated in a nurse‐led COVID‐19 RAT clinic for students and staff living or working in congregate housing. Students participated in education activities which exposed nursing students to the full range of community health nursing roles in a pandemic. Results From clinical, research, policy, and public health, this educational activity acted as a microcosm of the critical roles that nurses employ in the health ecosystem. Conclusion We offer lessons learned about implementing this activity, and how these lessons can be applied to routine and exceptional nursing curriculum.
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Affiliation(s)
- Ranjit Dhari
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kristen Haase
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Manon Ranger
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Elsie Tan
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Frances Affleck
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elisabeth Bailey
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sabrina T Wong
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Services and Policy Research, Vancouver, British Columbia, Canada
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Liaw W, Wong ST. Supporting the Primary Care Research Infrastructure Through Advocacy: A Reflection from the NAPCRG Research Advocacy Committee. Ann Fam Med 2022; 20:488-490. [PMID: 36228079 PMCID: PMC9512547 DOI: 10.1370/afm.2877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Winston Liaw
- Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine;
| | - Sabrina T Wong
- University of British Columbia, School of Nursing and Centre for Health Services and Policy Research;
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Ndateba I, Wong ST, Beaumier J, Burge F, Martin-Misener R, Hogg W, Wodchis W, McGrail K, Johnston S. Primary care practice characteristics associated with team functioning in primary care settings in Canada: A practice-based cross-sectional survey. J Interprof Care 2022; 37:352-361. [PMID: 35880781 DOI: 10.1080/13561820.2022.2099359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Team-based care is recognized as a foundational building block of high-performing primary care. The purpose of this study was to identify primary care practice characteristics associated with team functioning and examine whether there is relationship between team composition or size and team functioning. We sought to answer the following research questions: (1) are primary care practice characteristics associated with team functioning; and (2) does team composition or size influence team functioning. This cross-sectional correlational study was conducted in Fraser East, British Columbia, Eastern Ontario Health Unit, Ontario and Central Zone, Nova Scotia in Canada. Data were collected from primary care practices using an organization survey and the Team Climate Inventory (TCI) as a measure team functioning. The independent variables of interest were: physicians' payment model, internal clinic meetings to discuss clinical issues, care coordination through informal and ad hoc exchange, care coordination through electronic medical records and sharing clinic mission, values and objectives among health professionals. Potentially confounding variables were as follows: team size, composition, and practice panel size. A total of 63 practices were included in these analyses. The overall mean score of team climate was 73 (SD: 10.75) out of 100. Regression analyses showed that care coordination through human interaction and sharing the practice's mission, values, and objectives among health professionals were positively associated with higher functioning teams. Care coordination through electronic medical records and larger team size were negatively associated with team climate. This study provides baseline data on what practice characteristics are associated with highly functioning teams in Canada.
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Affiliation(s)
- Innocent Ndateba
- School of Nursing, University of British Columbia, Vancouver, Canada.,Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | - Sabrina T Wong
- School of Nursing, University of British Columbia, Vancouver, Canada.,Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | - Jonathan Beaumier
- School of Nursing, University of British Columbia, Vancouver, Canada.,Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | | | | | - William Hogg
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Walter Wodchis
- University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Sharon Johnston
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
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Terry AL, Stewart M, Ashcroft R, Brown JB, Burge F, Haggerty J, McWilliam C, Meredith L, Reid GJ, Thomas R, Wong ST. Complex skills are required for new primary health care researchers: a training program responds. BMC Med Educ 2022; 22:565. [PMID: 35869518 PMCID: PMC9306239 DOI: 10.1186/s12909-022-03620-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Current dimensions of the primary health care research (PHC) context, including the need for contextualized research methods to address complex questions, and the co-creation of knowledge through partnerships with stakeholders - require PHC researchers to have a comprehensive set of skills for engaging effectively in high impact research. MAIN BODY In 2002 we developed a unique program to respond to these needs - Transdisciplinary Understanding and Training on Research - Primary Health Care (TUTOR-PHC). The program's goals are to train a cadre of PHC researchers, clinicians, and decision makers in interdisciplinary research to aid them in tackling current and future challenges in PHC and in leading collaborative interdisciplinary research teams. Seven essential educational approaches employed by TUTOR-PHC are described, as well as the principles underlying the curriculum. This program is unique because of its pan-Canadian nature, longevity, and the multiplicity of disciplines represented. Program evaluation results indicate: 1) overall program experiences are very positive; 2) TUTOR-PHC increases trainee interdisciplinary research understanding and activity; and 3) this training assists in developing their interdisciplinary research careers. Taken together, the structure of the program, its content, educational approaches, and principles, represent a complex whole. This complexity parallels that of the PHC research context - a context that requires researchers who are able to respond to multiple challenges. CONCLUSION We present this description of ways to teach and learn the advanced complex skills necessary for successful PHC researchers with a view to supporting the potential uptake of program components in other settings.
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Affiliation(s)
- Amanda L. Terry
- Centre for Studies in Family Medicine, Department of Family Medicine, Department of Epidemiology & Biostatistics, Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, The University of Western Ontario, Western Centre for Public Health and Family Medicine, 1151 Richmond Street, London, Ontario N6A 3K7 Canada
| | - Moira Stewart
- Centre for Studies in Family Medicine, Department of Family Medicine; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario Canada
| | - Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario Canada
| | - Judith Belle Brown
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia Canada
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montréal, Québec Canada
| | - Carol McWilliam
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, The University of Western Ontario, London, Ontario Canada
| | - Leslie Meredith
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario Canada
| | - Graham J. Reid
- Centre for Studies in Family Medicine, Department of Family Medicine, Department of Psychology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario Canada
| | - Roanne Thomas
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Sabrina T. Wong
- School of Nursing, Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia Canada
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Carter AJE, Harrison M, Kryworuchko J, Kekwaletswe T, Wong ST, Goldstein J, Warner G. Essential Elements to Implementing a Paramedic Palliative Model of Care: An Application of the Consolidated Framework for Implementation Research. J Palliat Med 2022; 25:1345-1354. [PMID: 35727113 DOI: 10.1089/jpm.2021.0459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Comfort care without transport to hospital was not traditionally a paramedic practice. The novel Paramedics Providing Palliative Care at Home Program includes a new clinical practice guideline, medications, a database to manage and share goals of care, and palliative care training. This study determined essential elements for implementation, scale, and spread of this Program. Methods: Deliberative dialogs, a qualitative method, were held with diverse stakeholders/experts in one province with the Program (Nova Scotia, March 2018) and one without (British Columbia, July 2018). The Consolidated Framework for Implementation Research (CFIR) informed the discussion guide and was used in a framework analysis. Four team members analyzed the data independently; themes were derived by consensus with the broader research team. Results: CFIR constructs framed several key elements. Inter-sectoral communication is critical but challenged by privacy concerns and the siloed structure of the health system. Locally adapted training is an essential characteristic of the intervention; cost is a factor. A shift in mindset away from traditional paramedic roles is required; this can be facilitated by paramedic champions and a positive implementation climate. Early engagement of diverse stakeholders and planning for sustainability is key. Conclusion: This framework analysis using CFIR constructs can guide successful scale and spread of the program. The constructs of Outer setting: Cosmopolitanism; Characteristics of the intervention: Adaptability; Inner Setting: Implementation climate; and Processes: Engagement, and Planning, emerged as essential.
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Affiliation(s)
- Alix J E Carter
- Emergency Health Services Nova Scotia, Halifax, Nova Scotia, Canada.,Division of EMS, Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michelle Harrison
- Division of EMS, Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Nova Scotia Health Halifax, Nova Scotia, Canada
| | - Jennifer Kryworuchko
- Center for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada.,School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tjingaita Kekwaletswe
- Center for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sabrina T Wong
- Center for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada.,School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Judah Goldstein
- Emergency Health Services Nova Scotia, Halifax, Nova Scotia, Canada.,Division of EMS, Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada
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31
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Marshall EG, Breton M, Green M, Edwards L, Ayn C, Smithman MA, Ryan Carson S, Ashcroft R, Bayoumi I, Burge F, Deslauriers V, Lawson B, Mathews M, McPherson C, Moritz LR, Nesto S, Stock D, Wong ST, Andrew M. CUP study: protocol for a comparative analysis of centralised waitlist effectiveness, policies and innovations for connecting unattached patients to primary care providers. BMJ Open 2022; 12:e049686. [PMID: 35256440 PMCID: PMC8905966 DOI: 10.1136/bmjopen-2021-049686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Access to a primary care provider is a key component of high-functioning healthcare systems. In Canada, 15% of patients do not have a regular primary care provider and are classified as 'unattached'. In an effort to link unattached patients with a provider, seven Canadian provinces implemented centralised waitlists (CWLs). The effectiveness of CWLs in attaching patients to regular primary care providers is unknown. Factors influencing CWLs effectiveness, particularly across jurisdictional contexts, have yet to be confirmed. METHODS AND ANALYSIS A mixed methods case study will be conducted across three Canadian provinces: Ontario, Québec and Nova Scotia. Quantitatively, CWL data will be linked to administrative and provider billing data to assess the rates of patient attachment over time and delay of attachment, stratified by demographics and compared with select indicators of health service utilisation. Qualitative interviews will be conducted with policymakers, patients, and primary care providers to elicit narratives regarding the administration, use, and access of CWLs. An analysis of policy documents will be used to identify contextual factors affecting CWL effectiveness. Stakeholder dialogues will be facilitated to uncover causal pathways and identify strategies for improving patient attachment to primary care. ETHICS AND DISSEMINATION Approval to conduct this study has been granted in Ontario (Queens University Health Sciences and Affiliated Teaching Hospitals Research Ethics Board, file number 6028052; Western University Health Sciences Research Ethics Board, project 116591; University of Toronto Health Sciences Research Ethics Board, protocol number 40335), Québec (Centre intégré universitaire de santé et de services sociaux de l'Estrie, project number 2020-3446) and Nova Scotia (Nova Scotia Health Research Ethics Board, file number 1024979).
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Affiliation(s)
- Emily Gard Marshall
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mylaine Breton
- Department of Community Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
| | | | - Lynn Edwards
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Caitlyn Ayn
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mélanie Ann Smithman
- Centre de recherche Charles-LeMoyne, Université de Sherbrooke, Longueuil, Québec, Canada
| | | | | | | | - Frederick Burge
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Véronique Deslauriers
- Centre de recherche Charles-LeMoyne, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Beverley Lawson
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Lauren R Moritz
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sue Nesto
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David Stock
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sabrina T Wong
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Melissa Andrew
- Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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32
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Garrison SR, Kolber MR, Allan GM, Bakal J, Green L, Singer A, Trueman DR, McAlister FA, Padwal RS, Hill MD, Manns B, McGrail K, O'Neill B, Greiver M, Froentjes LS, Manca DP, Mangin D, Wong ST, MacLean C, Kirkwood JE, McCracken R, McCormack JP, Norris C, Korownyk T. Bedtime versus morning use of antihypertensives for cardiovascular risk reduction (BedMed): protocol for a prospective, randomised, open-label, blinded end-point pragmatic trial. BMJ Open 2022; 12:e059711. [PMID: 35210352 PMCID: PMC8883279 DOI: 10.1136/bmjopen-2021-059711] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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
INTRODUCTION Sleep-time blood pressure correlates more strongly with adverse cardiovascular events than does daytime blood pressure. The BedMed trial evaluates whether bedtime antihypertensive administration, as compared with conventional morning use, reduces major adverse cardiovascular events. METHODS AND ANALYSIS: DesignProspective randomised, open-label, blinded end-point trial.ParticipantsHypertensive primary care patients using blood pressure lowering medication and free from glaucoma.SettingCommunity primary care providers in 5 Canadian provinces (British Columbia, Alberta, Saskatchewan, Manitoba and Ontario) are mailing invitations to their eligible patients. Social media campaigns (Google, Facebook) are additionally running in the same provinces.InterventionConsenting participants are allocated via central randomisation to bedtime vs morning use of all antihypertensives.Follow-up(1) Telephone or email questionnaire at 1 week, 6 weeks, 6 months and every 6 months thereafter, and (2) accessing linked governmental healthcare databases tracking hospital and community medical services.Primary outcomeComposite of all-cause death, or hospitalisation for myocardial infarction/acute-coronary syndrome, stroke or congestive heart failure.Secondary outcomesEach primary outcome element on its own, all-cause hospitalisation or emergency department visit, long-term care admission, non-vertebral fracture, new glaucoma diagnosis, 18-month cognitive decline from baseline (via Short Blessed Test).Select other outcomesSelf-reported nocturia burden at 6 weeks and 6 months (no, minor or major burden), 1-year self-reported overall health score (EQ-5D-5L), self-reported falls, total cost of care (acute and community over study duration) and mean sleep-time systolic blood pressure after 6 months (via 24-hour monitor in a subset of 302 sequential participants).Primary outcome analysisCox proportional hazards survival analysis.Sample sizeThe trial will continue until a projected 254 primary outcome events have occurred.Current statusEnrolment ongoing (3227 randomised to date). ETHICS AND DISSEMINATION BedMed has ethics approval from six research ethics review boards and will publish results in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT02990663.
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Affiliation(s)
- Scott R Garrison
- Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Michael R Kolber
- Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - G Michael Allan
- Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey Bakal
- Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Lee Green
- Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Alexander Singer
- Family Medicine, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
| | | | | | - Raj S Padwal
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Michael D Hill
- Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Braden Manns
- Nephrology, University of Calgary, Calgary, Alberta, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Braden O'Neill
- Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Greiver
- Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Donna P Manca
- Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Dee Mangin
- Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cathy MacLean
- Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Rita McCracken
- Family Medicine, Providence Health Care, Vancouver, British Columbia, Canada
- Family Practice, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - James P McCormack
- Faculty of Pharmaceutical Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colleen Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Tina Korownyk
- Family Medicine, University of Alberta, Edmonton, Alberta, Canada
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Mathews M, Ryan D, Randall E, Marshall EG, Goldsmith LJ, Jones L, Lavergne MR, Snadden D, Scott I, Wong ST, Stringer K, Horrey K, Grudniewicz A. "At the mercy of some of the regulations": the impact of the residency match and return of service requirement on the early-career decisions of international medical graduates in Canada. Hum Resour Health 2022; 20:15. [PMID: 35120549 PMCID: PMC8817606 DOI: 10.1186/s12960-022-00709-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/11/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND Return-of-service (ROS) agreements require international medical graduates (IMGs) who accept medical residency positions in Canada to practice in specified geographic areas following completion of training. However, few studies have examined how ROS agreements influence career decisions. We examined IMG resident and early-career family physicians' perceptions of the residency matching process, ROS requirements, and how these factors shaped their early career decisions. METHODS As part of a larger project, we conducted semi-structured qualitative interviews with early-career family physicians and family medicine residents in British Columbia, Ontario and Nova Scotia. We asked participants about their actual or intended practice characteristics (e.g., payment model, practice location) and factors shaping actual or intended practice (e.g., personal/professional influences, training experiences, policy environments). Interviews were transcribed verbatim and a thematic analysis approach was employed to identify recurring patterns and themes. RESULTS For this study, we examined interview data from nine residents and 15 early-career physicians with ROS agreements. We identified three themes: IMGs strategically chose family medicine to increase the likelihood of obtaining a residency position; ROS agreements limited career choices; and ROS agreements delayed preferred practice choice (e.g., scope of practice and location) of an IMGs' early-career practice. CONCLUSIONS The obligatory nature of ROS agreements influences IMG early-career choices, as they necessitate strategically tailoring practice intentions towards available residency positions. Existing analyses of IMGs' early-career practice choices neglect to distinguish between ROS and practice choices made independently of ROS requirements. Further research is needed to understand how ROS influences longer term practice patterns of IMGs in Canada.
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Affiliation(s)
- Maria Mathews
- Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 5C1, United Kingdom.
| | - Dana Ryan
- Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 5C1, United Kingdom
| | - Ellen Randall
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Emily Gard Marshall
- Department of Family Medicine Primary Care Unit, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3J 3T4, Canada
| | - Laurie J Goldsmith
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Clinical Sciences Building (Novena), 11 Mandalay Road, Singapore, 308232, Singapore
| | - Lori Jones
- Department of History, University of Ottawa, 55 Laurier Ave E, Ottawa, ON, K1N 6N5, Canada
| | - M Ruth Lavergne
- Department of Family Medicine, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3J 3T4, Canada
| | - David Snadden
- Department of Family Practice, University of British Columbia, Northern Medical Program, UNBC, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Ian Scott
- Department of Family Practice, University of British Columbia, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Sabrina T Wong
- UBC Centre for Health Services and Policy Research and School of Nursing, University of British Columbia, 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Katherine Stringer
- Department of Family Medicine, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3J 3T4, Canada
| | - Kathleen Horrey
- Department of Family Medicine, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3J 3T4, Canada
| | - Agnes Grudniewicz
- Telfer School of Management, University of Ottawa, Desmarais Building, 55 Laurier Ave East, Ottawa, ON, K1N 6N5, Canada
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Block LJ, Ronquillo C, Hardiker NR, Wong ST, Currie LM. Mapping of Wound Infection Concepts. Stud Health Technol Inform 2021; 284:431-435. [PMID: 34920564 DOI: 10.3233/shti210764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Wound infection is a serious health care complication. Standardized clinical terminologies could be leveraged to support the early identification of wound infection. The purpose of this study was to evaluate the representation of wound infection assessment and diagnosis concepts (N=26) in SNOMED CT and ICNP, using a synthesized procedural framework. A total of 13/26 (50%) assessment and diagnosis concepts had exact matches in SNOMED CT and 2/7 (29%) diagnosis concepts had exact matches in ICNP. This study demonstrated that the source concepts were moderately well represented in SNOMED CT and ICNP; however, further work is necessary to increase the representation of diagnostic infection types. The use of the framework facilitated a systematic, transparent, and repeatable mapping process, with opportunity to extend.
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Affiliation(s)
- Lorraine J Block
- School of Nursing, University of British Columbia, Vancouver, Canada
| | | | - Nicholas R Hardiker
- School of Human and Health Sciences, University of Huddersfield, United Kingdom
| | - Sabrina T Wong
- School of Nursing, University of British Columbia, Vancouver, Canada.,University of British Columbia, Centre for Health Services and Policy Research
| | - Leanne M Currie
- School of Nursing, University of British Columbia, Vancouver, Canada
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35
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Wong ST, Johnston S, Burge F, Ammi M, Campbell JL, Katz A, Martin-Misener R, Peterson S, Thandi M, Haggerty J, Hogg W. Comparing the Attainment of the Patient's Medical Home Model across Regions in Three Canadian Provinces: A Cross-Sectional Study. Healthc Policy 2021; 17:19-37. [PMID: 34895408 PMCID: PMC8665731 DOI: 10.12927/hcpol.2021.26659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: The aim of this work was to show the feasibility of providing a comprehensive portrait of regional primary care performance. Methods: The TRANSFORMATION study used a mixed-methods concurrent study design where we analyzed survey data and case studies. Data were collected in British Columbia, Ontario and Nova Scotia. Patient's Medical Home (PMH) pillar scores were created by calculating mean clinic-level scores across regions. Scores and qualitative themes were compared. Results: Participation included 86 practices (n = 1,929 patients; n = 117 clinicians). Regions had differential attainment towards PMH orientation with respect to infrastructure; community adaptiveness and accountability; and patient and family partnered care. The lowest PMH attainment for all regions were observed in connected care; accessible care; measurement, continuous quality improvement and research; and training, education and continuing professional development. Conclusions: Comprehensive performance reporting that draws on multiple data sources in primary care is possible. Regional portraits highlighting many of the key pillars of a PMH approach to primary care show that despite differences in policy contexts, achieving a PMH remains elusive.
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Affiliation(s)
- Sabrina T Wong
- Professor, Centre for Health Services and Health Research, University of British Columbia, School of Nursing, University of British Columbia, Vancouver, BC
| | - Sharon Johnston
- Associate Professor, Department of Family Medicine, University of Ottawa, Ottawa, ON
| | - Fred Burge
- Professor, Department of Family Medicine, Dalhousie University, Halifax, NS
| | - Mehdi Ammi
- Associate Professor, School of Public Policy and Administration, Carleton University, Ottawa, ON
| | - John L Campbell
- Professor, Primary Care Research Group, University of Exeter College of Medicine and Health, Exeter, England
| | - Alan Katz
- Professor, Departments of Community Health Sciences and Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
| | | | - Sandra Peterson
- Research Analyst, Centre for Health Services and Health Research, University of British Columbia Vancouver, BC
| | - Manpreet Thandi
- Doctoral Student, Centre for Health Services and Health Research, School of Nursing, University of British Columbia, Vancouver, BC
| | - Jeannie Haggerty
- Professor, Department of Family Medicine, McGill University, Montreal, QC
| | - William Hogg
- Co-Investigator, TRANSFORMATION Study, Professor, Department of Family Medicine, University of Ottawa; Vice-président associé recherche et Directeur scientifique, Institut du Savoir Montfort, Ottawa, ON
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Breton M, Smithman MA, Kreindler SA, Jbilou J, Wong ST, Gard Marshall E, Sasseville M, Sutherland JM, Crooks VA, Shaw J, Contandriopoulos D, Brousselle A, Green M. Designing centralized waiting lists for attachment to a primary care provider: Considerations from a logic analysis. Eval Program Plann 2021; 89:101962. [PMID: 34127272 DOI: 10.1016/j.evalprogplan.2021.101962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/22/2021] [Accepted: 05/08/2021] [Indexed: 06/12/2023]
Abstract
Access to a regular primary care provider is essential to quality care. In Canada, where 15 % of patients are unattached (i.e., without a regular provider), centralized waiting lists (CWLs) help attach patients to a primary care provider (family physician or nurse practitioner). Previous studies reveal mechanisms needed for CWLs to work, but focus mostly on CWLs for specialized health care. We aim to better understand how to design CWLs for unattached patients in primary care. In this study, a logic analysis compares empirical evidence from a qualitative case study of CWLs for unattached patients in seven Canadian provinces to programme theory derived from a realist review on CWLs. Data is analyzed using context-intervention-mechanism-outcome configurations. Results identify mechanisms involved in three components of CWL design: patient registration, patient prioritization, and patient assignment to a provider for attachment. CWL programme theory is revised to integrate mechanisms specific to primary care, where patients, rather than referring providers, are responsible for registering on the CWL, where prioritization must consider a broad range of conditions and characteristics, and where long-term acceptability of attachment is important. The study provides new insight into mechanisms that enable CWLs for unattached patients to work.
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Affiliation(s)
- Mylaine Breton
- Department of Community Health Sciences, Université de Sherbrooke, Canadian Research Chair in Clinical Governance on Primary Health Care, Longueuil, QC, Canada
| | | | - Sara A Kreindler
- Department of Community Health Sciences, Manitoba Research Chair in Health System Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Jalila Jbilou
- Centre de formation médicale du Nouveau-Brunswick and École de psychologie, Université de Moncton, Moncton, NB, Canada
| | - Sabrina T Wong
- School of Nursing and Centre for Health Services and Policy Research, University of British Columbia, BC Primary Care Sentinel Surveillance Network, Vancouver, BC, Canada
| | | | | | - Jason M Sutherland
- Centre for Health Services and Policy Research, University of British Columbia, Michael Smith Foundation for Health Research, Vancouver, BC, Canada
| | - Valorie A Crooks
- Department of Geography, Simon Fraser University, Michael Smith Foundation for Health Research, Canada Research Chair in Health Service Geographies, Burnaby, BC, Canada
| | - Jay Shaw
- Institute for Health System Solutions and Virtual Care, Women's College Research Institute, Women's College Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Damien Contandriopoulos
- School of Nursing, University of Victoria, Research Chair Policies, Knowledge and Health (Pocosa/Politiques, Connaissances, Santé), Victoria, BC, Canada
| | - Astrid Brousselle
- School of Public Administration, University of Victoria, Victoria, BC, Canada
| | - Michael Green
- Departments of Family Medicine and Public Health Sciences, Queen's University, CTAQ Chair in Applied Health Economics/Health Policy, Centre for Health Services and Policy Research, Centre for Studies in Primary Care, Institute for Clinical Evaluative Sciences, Kingston, ON, Canada
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Fortin M, Stewart M, Almirall J, Berbiche D, Bélanger M, Katz A, Ryan BL, Wong ST, Zwarenstein M. One year follow-up and exploratory analysis of a patient-centered interdisciplinary care intervention for multimorbidity. J Comorb 2021; 11:26335565211039780. [PMID: 34820337 PMCID: PMC8606917 DOI: 10.1177/26335565211039780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/16/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022]
Abstract
Context Interventions for people with multimorbidity have obtained mixed results. We aimed to document the long-term effect of an intervention for people with multimorbidity. Methods 284 patients (18-80 years) presenting three or more chronic conditions were recruited from seven family medicine groups in the Saguenay-Lac St-Jean region, Quebec, Canada. The patient-centered intervention was based on motivational approach and self-management support. Outcomes were evaluated in a one-year pre-post study design with questionnaires that included the Health Education Questionnaire (heiQ), the Self-Efficacy for Managing Chronic Diseases, the Veteran RAND-12 Health Survey (VR-12), the EuroQoL 5-Domains questionnaire, the Kessler six item Psychological Stress Scale, and measures of smoking habit, physical activity, healthy eating and alcohol consumption. Subgroup analyses by age, number of conditions, sex, and income were also conducted. Results The heiQ domain of emotional wellbeing improved significantly. Improvement was also observed for the VR-12 and the K6. Among the health behaviours, only healthy eating was improved. Subgroup analyses in this exploratory study suggest that younger patients, those with lower number of chronic conditions or higher incomes may respond better in relation to self-management, health status and health behaviours. Conclusion One year after the intervention, participants significantly improved a variety of outcomes. Subgroup analyses suggest that younger patients, those with lower number of chronic conditions or higher incomes may respond better in relation to self-management, health status and health behaviours. This suggests that future interventions should be tailored to patients' characteristics including age, sex, income and number of conditions.
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Affiliation(s)
| | | | | | | | | | - Alan Katz
- University of Manitoba, Winnipeg, MB, Canada
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Thandi M, Wong ST, Aponte-Hao S, Grandy M, Mangin D, Singer A, Williamson T. Strategies for working across Canadian practice-based research and learning networks (PBRLNs) in primary care: focus on frailty. BMC Fam Pract 2021; 22:220. [PMID: 34772356 PMCID: PMC8590340 DOI: 10.1186/s12875-021-01573-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 10/29/2021] [Indexed: 01/17/2023]
Abstract
Background Practice based research and learning networks (PBRLNs) are groups of learning communities that focus on improving delivery and quality of care. Accurate data from primary care electronic medical records (EMRs) is crucial in forming the backbone for PBRLNs. The purpose of this work is to: (1) report on descriptive findings from recent frailty work, (2) describe strategies for working across PBRLNs in primary care, and (3) provide lessons learned for engaging PBRLNs. Methods We carried out a participatory based descriptive study that engaged five different PBRLNs. We collected Clinical Frailty Scale scores from a sample of participating physicians within each PBRLN. Descriptive statistics were used to analyze frailty scores and patients’ associated risk factors and demographics. We used the Consolidated Framework for Implementation Research to inform thematic analysis of qualitative data (meeting minutes, notes, and conversations with co-investigators of each network) in recognizing challenges of working across networks. Results One hundred nine physicians participated in collecting CFS scores across the five provinces (n = 5466). Percentages of frail (11-17%) and not frail (82-91%) patients were similar in all networks, except Ontario who had a higher percentage of frail patients (25%). The majority of frail patients were female (65%) and had a significantly higher prevalence of hypertension, dementia, and depression. Frail patients had more prescribed medications and numbers of healthcare encounters. There were several noteworthy challenges experienced throughout the research process related to differences across provinces in the areas of: numbers of stakeholders/staff involved and thus levels of burden, recruitment strategies, data collection strategies, enhancing engagement, and timelines. Discussion Lessons learned throughout this multi-jurisdictional work included: the need for continuity in ethics, regular team meetings, enhancing levels of engagement with stakeholders, the need for structural support and recognizing differences in data sharing across provinces. Conclusion The differences noted across CPCSSN networks in our frailty study highlight the challenges of multi-jurisdictional work across provinces and the need for consistent and collaborative healthcare planning efforts.
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Affiliation(s)
- Manpreet Thandi
- Centre for Health Services and Policy Research & School of Nursing, University of British Columbia, 201-2206 East Mall, Vancouver, BC, V6T IZ3, Canada.
| | - Sabrina T Wong
- Centre for Health Services and Policy Research & School of Nursing, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Sylvia Aponte-Hao
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 2Z6, Canada
| | - Mathew Grandy
- Department of Family Medicine, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, Nova Scotia, B3J 3T4, Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Alexander Singer
- Department of Family Medicine, University of Manitoba, D009-780 Bannatyne Ave, Winnipeg, MB, R3E 0W2, Canada
| | - Tyler Williamson
- Centre for Health Informatics & Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 2Z6, Canada
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Aponte-Hao S, Wong ST, Thandi M, Ronksley P, McBrien K, Lee J, Grandy M, Mangin D, Katz A, Singer A, Manca D, Williamson T. Machine learning for identification of frailty in Canadian primary care practices. Int J Popul Data Sci 2021; 6:1650. [PMID: 34541337 PMCID: PMC8431345 DOI: 10.23889/ijpds.v6i1.1650] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Frailty is a medical syndrome, commonly affecting people aged 65 years and over and is characterized by a greater risk of adverse outcomes following illness or injury. Electronic medical records contain a large amount of longitudinal data that can be used for primary care research. Machine learning can fully utilize this wide breadth of data for the detection of diseases and syndromes. The creation of a frailty case definition using machine learning may facilitate early intervention, inform advanced screening tests, and allow for surveillance. Objectives The objective of this study was to develop a validated case definition of frailty for the primary care context, using machine learning. Methods Physicians participating in the Canadian Primary Care Sentinel Surveillance Network across Canada were asked to retrospectively identify the level of frailty present in a sample of their own patients (total n = 5,466), collected from 2015–2019. Frailty levels were dichotomized using a cut-off of 5. Extracted features included previously prescribed medications, billing codes, and other routinely collected primary care data. We used eight supervised machine learning algorithms, with performance assessed using a hold-out test set. A balanced training dataset was also created by oversampling. Sensitivity analyses considered two alternative dichotomization cut-offs. Model performance was evaluated using area under the receiver-operating characteristic curve, F1, accuracy, sensitivity, specificity, negative predictive value and positive predictive value. Results The prevalence of frailty within our sample was 18.4%. Of the eight models developed to identify frail patients, an XGBoost model achieved the highest sensitivity (78.14%) and specificity (74.41%). The balanced training dataset did not improve classification performance. Sensitivity analyses did not show improved performance for cut-offs other than 5. Conclusion Supervised machine learning was able to create well performing classification models for frailty. Future research is needed to assess frailty inter-rater reliability, and link multiple data sources for frailty identification.
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Affiliation(s)
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia.,School of Nursing, University of British Columbia
| | - Manpreet Thandi
- Centre for Health Services and Policy Research, University of British Columbia.,School of Nursing, University of British Columbia
| | | | | | - Joon Lee
- Cumming School of Medicine, University of Calgary
| | | | - Dee Mangin
- Department of Family Medicine, McMaster University
| | - Alan Katz
- Manitoba Centre for Health Policy, University of Manitoba.,College of Medicine Faculty of Health Sciences, University of Manitoba
| | | | - Donna Manca
- Department of Family Medicine, University of Alberta
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Abbasgholizadeh Rahimi S, Légaré F, Sharma G, Archambault P, Zomahoun HTV, Chandavong S, Rheault N, T Wong S, Langlois L, Couturier Y, Salmeron JL, Gagnon MP, Légaré J. Application of Artificial Intelligence in Community-Based Primary Health Care: Systematic Scoping Review and Critical Appraisal. J Med Internet Res 2021; 23:e29839. [PMID: 34477556 PMCID: PMC8449300 DOI: 10.2196/29839] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Research on the integration of artificial intelligence (AI) into community-based primary health care (CBPHC) has highlighted several advantages and disadvantages in practice regarding, for example, facilitating diagnosis and disease management, as well as doubts concerning the unintended harmful effects of this integration. However, there is a lack of evidence about a comprehensive knowledge synthesis that could shed light on AI systems tested or implemented in CBPHC. OBJECTIVE We intended to identify and evaluate published studies that have tested or implemented AI in CBPHC settings. METHODS We conducted a systematic scoping review informed by an earlier study and the Joanna Briggs Institute (JBI) scoping review framework and reported the findings according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Scoping Reviews) reporting guidelines. An information specialist performed a comprehensive search from the date of inception until February 2020, in seven bibliographic databases: Cochrane Library, MEDLINE, EMBASE, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ScienceDirect, and IEEE Xplore. The selected studies considered all populations who provide and receive care in CBPHC settings, AI interventions that had been implemented, tested, or both, and assessed outcomes related to patients, health care providers, or CBPHC systems. Risk of bias was assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Two authors independently screened the titles and abstracts of the identified records, read the selected full texts, and extracted data from the included studies using a validated extraction form. Disagreements were resolved by consensus, and if this was not possible, the opinion of a third reviewer was sought. A third reviewer also validated all the extracted data. RESULTS We retrieved 22,113 documents. After the removal of duplicates, 16,870 documents were screened, and 90 peer-reviewed publications met our inclusion criteria. Machine learning (ML) (41/90, 45%), natural language processing (NLP) (24/90, 27%), and expert systems (17/90, 19%) were the most commonly studied AI interventions. These were primarily implemented for diagnosis, detection, or surveillance purposes. Neural networks (ie, convolutional neural networks and abductive networks) demonstrated the highest accuracy, considering the given database for the given clinical task. The risk of bias in diagnosis or prognosis studies was the lowest in the participant category (4/49, 4%) and the highest in the outcome category (22/49, 45%). CONCLUSIONS We observed variabilities in reporting the participants, types of AI methods, analyses, and outcomes, and highlighted the large gap in the effective development and implementation of AI in CBPHC. Further studies are needed to efficiently guide the development and implementation of AI interventions in CBPHC settings.
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Affiliation(s)
- Samira Abbasgholizadeh Rahimi
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Mila-Quebec AI Institute, Montreal, QC, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada.,VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada
| | - Gauri Sharma
- Faculty of Engineering, Dayalbagh Educational Institute, Agra, India
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada.,VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada
| | - Herve Tchala Vignon Zomahoun
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada.,Quebec SPOR-Support Unit, Quebec City, QC, Canada
| | - Sam Chandavong
- Faculty of Science and Engineering, Université Laval, Quebec City, QC, Canada
| | - Nathalie Rheault
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada.,Quebec SPOR-Support Unit, Quebec City, QC, Canada
| | - Sabrina T Wong
- School of Nursing, University of British Columbia, Vancouver, BC, Canada.,Center for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Lyse Langlois
- Department of Industrial Relations, Université Laval, Quebec City, QC, Canada.,OBVIA - Quebec International Observatory on the social impacts of AI and digital technology, Quebec City, QC, Canada
| | - Yves Couturier
- School of Social Work, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Jose L Salmeron
- Department of Data Science, University Pablo de Olavide, Seville, Spain
| | | | - Jean Légaré
- Arthritis Alliance of Canada, Montreal, QC, Canada
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Block LJ, Wong ST, Handfield S, Hart R, Currie LM. Comparison of terminology mapping methods for nursing wound care knowledge representation. Int J Med Inform 2021; 153:104539. [PMID: 34358804 DOI: 10.1016/j.ijmedinf.2021.104539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/25/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Standardized clinical terminologies are increasingly used to design and support advanced information systems. In order to examine the representativeness of these terminologies for different professional groups or clinical areas, researchers may perform different methods of terminology mapping. OBJECTIVE The purpose of this study was to evaluate the ability of four mapping methods to identify concepts related to wound care in SNOMED CT. METHODS A class diagram of 107 concepts was developed to represent the nursing context of wound assessment, wound diagnosis, and goal of care for wound management. All concepts were mapped to SNOMED CT and identified as a direct match, a one-to-many match, or no match using four mapping methods (manual, automated, comparison, and concordance). The manual, automated and comparison methods produced candidate lists of SNOMED CT concepts, which were then used by two nursing wound care experts. The experts completed concordance mapping, which produced the final list. The SNOMED CT concepts from the manual, automated and comparison mappings were compared to the concordance mapping to generate a proportion of representation by each mapping method. RESULTS The manual, automated and comparison mappings produced partial lists of unique candidate concept matches not found in the other mapping methods. The concordance mapping produced a final list which included: 43 terms (40%) that had direct matches, 2 terms (2%) that had one-to-many matches, and 62 terms (58%) that had no matches to SNOMED CT. All mapping methods were necessary to achieve the representativeness captured in the final list. CONCLUSION To increase the representativeness of candidate mapping lists, multiple mapping methods and considerations may be necessary.
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Affiliation(s)
- Lorraine J Block
- University of British Columbia, School of Nursing, Vancouver, BC, Canada. https://twitter.com/lori_block1
| | - Sabrina T Wong
- University of British Columbia, School of Nursing and Centre for Health Services and Policy Research, Vancouver, BC, Canada
| | - Shannon Handfield
- Provincial Professional Practice Stream Lead Wound Ostomy Continence, Vancouver, BC, Canada
| | - Rosa Hart
- Regional Director Clinical Informatics, Acute Vancouver Coastal Health Authority, Vancouver, BC, Canada
| | - Leanne M Currie
- University of British Columbia, School of Nursing Vancouver, BC, Canada
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Vijh R, Wong ST, Grandy M, Peterson S, Ezzat AM, Gibb AG, Hawkins NM. Identifying heart failure in patients with chronic obstructive lung disease through the Canadian Primary Care Sentinel Surveillance Network in British Columbia: a case derivation study. CMAJ Open 2021; 9:E376-E383. [PMID: 33863795 PMCID: PMC8084551 DOI: 10.9778/cmajo.20200183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Heart failure (HF) poses a substantial global health burden, particularly in patients with chronic obstructive pulmonary disease (COPD). The objective of this study was to validate an electronic medical record-based definition of HF in patients with COPD in primary care practices in the province of British Columbia, Canada. METHODS We conducted a cross-sectional retrospective chart review from Sept. 1, 2018, to Dec. 31, 2018, for a cohort of patients from primary care practices in BC whose physicians were recruited through the BC node of the Canadian Primary Care Sentinel Surveillance Network. Heart failure case definitions were developed by combining diagnostic codes, medication information and laboratory values available in primary care electronic medical records. These were compared with HF diagnoses identified through detailed chart review as the gold standard. Sensitivity, specificity, negative (NPV) and positive predictive values (PPV) were calculated for each definition. RESULTS Charts of 311 patients with COPD were reviewed, of whom 72 (23.2%) had HF. Five categories of definitions were constructed, all of which had appropriate sensitivity, specificity and NPV. The optimal case definition consisted of 1 HF billing code or a specific combination of medications for HF. This definition had an excellent specificity (93.3%, 95% confidence interval [CI] 89.4%-96.1%), sensitivity (90.3%, 95% CI 81.0%-96.0%), PPV (80.2%, 95% CI 69.9%-88.3%) and NPV (97.0%, 95% CI 93.8%-98.8%). INTERPRETATION This comprehensive case definition improves upon previous primary care HF definitions to include medication codes and laboratory data, along with previously used billing codes. A case definition for HF was derived and validated and can be used with data from electronic medical records to identify HF in patients with COPD in primary care accurately.
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Affiliation(s)
- Rohit Vijh
- School of Population and Public Health (Vijh), Centre for Health Services and Policy Research (Wong, Peterson, Ezzat, Gibb) and School of Nursing (Wong, Ezzat), University of British Columbia, Vancouver, BC; Primary Care Research Unit (Grandy) and Department of Family Medicine (Grandy), Dalhousie University, Halifax, NS; Division of Cardiology (Hawkins), University of British Columbia, Vancouver, BC
| | - Sabrina T Wong
- School of Population and Public Health (Vijh), Centre for Health Services and Policy Research (Wong, Peterson, Ezzat, Gibb) and School of Nursing (Wong, Ezzat), University of British Columbia, Vancouver, BC; Primary Care Research Unit (Grandy) and Department of Family Medicine (Grandy), Dalhousie University, Halifax, NS; Division of Cardiology (Hawkins), University of British Columbia, Vancouver, BC
| | - Matthew Grandy
- School of Population and Public Health (Vijh), Centre for Health Services and Policy Research (Wong, Peterson, Ezzat, Gibb) and School of Nursing (Wong, Ezzat), University of British Columbia, Vancouver, BC; Primary Care Research Unit (Grandy) and Department of Family Medicine (Grandy), Dalhousie University, Halifax, NS; Division of Cardiology (Hawkins), University of British Columbia, Vancouver, BC
| | - Sandra Peterson
- School of Population and Public Health (Vijh), Centre for Health Services and Policy Research (Wong, Peterson, Ezzat, Gibb) and School of Nursing (Wong, Ezzat), University of British Columbia, Vancouver, BC; Primary Care Research Unit (Grandy) and Department of Family Medicine (Grandy), Dalhousie University, Halifax, NS; Division of Cardiology (Hawkins), University of British Columbia, Vancouver, BC
| | - Allison M Ezzat
- School of Population and Public Health (Vijh), Centre for Health Services and Policy Research (Wong, Peterson, Ezzat, Gibb) and School of Nursing (Wong, Ezzat), University of British Columbia, Vancouver, BC; Primary Care Research Unit (Grandy) and Department of Family Medicine (Grandy), Dalhousie University, Halifax, NS; Division of Cardiology (Hawkins), University of British Columbia, Vancouver, BC
| | - Andrew G Gibb
- School of Population and Public Health (Vijh), Centre for Health Services and Policy Research (Wong, Peterson, Ezzat, Gibb) and School of Nursing (Wong, Ezzat), University of British Columbia, Vancouver, BC; Primary Care Research Unit (Grandy) and Department of Family Medicine (Grandy), Dalhousie University, Halifax, NS; Division of Cardiology (Hawkins), University of British Columbia, Vancouver, BC
| | - Nathaniel M Hawkins
- School of Population and Public Health (Vijh), Centre for Health Services and Policy Research (Wong, Peterson, Ezzat, Gibb) and School of Nursing (Wong, Ezzat), University of British Columbia, Vancouver, BC; Primary Care Research Unit (Grandy) and Department of Family Medicine (Grandy), Dalhousie University, Halifax, NS; Division of Cardiology (Hawkins), University of British Columbia, Vancouver, BC
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Fortin M, Stewart M, Ngangue P, Almirall J, Bélanger M, Brown JB, Couture M, Gallagher F, Katz A, Loignon C, Ryan BL, Sampalli T, Wong ST, Zwarenstein M. Scaling Up Patient-Centered Interdisciplinary Care for Multimorbidity: A Pragmatic Mixed-Methods Randomized Controlled Trial. Ann Fam Med 2021; 19:126-134. [PMID: 33685874 PMCID: PMC7939717 DOI: 10.1370/afm.2650] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To measure the effectiveness of a 4-month interdisciplinary multifaceted intervention based on a change in care delivery for patients with multimorbidity in primary care practices. METHODS A pragmatic randomized controlled trial with a mixed-methods design in patients aged 18 to 80 years with 3 or more chronic conditions from 7 family medicine groups (FMGs) in Quebec, Canada. Health care professionals (nurses, nutritionists, kinesiologists) from the FMGs were trained to deliver the patient-centered intervention based on a motivational approach and self-management support. Primary outcomes: self-management (Health Education Impact Questionnaire); and self-efficacy. SECONDARY OUTCOMES health status, quality of life, and health behaviors. Quantitative analyses used multi-level mixed effects and generalized linear mixed models controlling for clustering within FMGs. We also conducted in-depth interviews with patients, family members, and health care professionals. RESULTS The trial randomized 284 patients (144 in intervention group, 140 in control group). The groups were comparable. After 4 months, the intervention showed a neutral effect for the primary outcomes. There was significant improvement in 2 health behaviors (healthy eating with odds ratios [OR] 4.36; P = .006, and physical activity with OR 3.43; P = .023). The descriptive qualitative evaluation revealed that the patients reinforced their self-efficacy and improved their self-management which was divergent from the quantitative results. CONCLUSIONS Quantitatively, this intervention showed a neutral effect on the primary outcomes and substantial improvement in 2 health behaviors as secondary outcomes. Qualitatively, the intervention was evaluated as positive. The combination of qualitative and quantitative designs proved to be a good design for evaluating this complex intervention.
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Affiliation(s)
- Martin Fortin
- CORRESPONDING AUTHOR Martin Fortin Department of Family Medicine and Emergency Medicine Université de Sherbrooke 3001 12e Ave N Quebec, Canada, J1H 5N4
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Abstract
BACKGROUND Frailty is considered an emerging syndrome characterized by a decrease in physiological ability to respond to stressors, leading to increased morbidity and mortality rates. Frailty is distinguished from normal age-associated decline because it is a sharp and often rapid decline rather than a gradual slowing down of general functioning. The comprehensive geriatric assessment is currently considered the gold standard for identifying frailty in older adults. The electronic version of this tool is called the eCGA and is commonly included in electronic medical records (EMR) in primary care settings. OBJECTIVES We explored the adequacy of SNOMED CT to represent frailty concepts by addressing three research questions: 1) What are the defining characteristics of frailty most commonly used in frailty assessment tools? 2) Are these characteristics captured within one or many frailty assessment tools? 3) Which data elements from existing tool(s) can be reliably mapped to existing SNOMED CT terms? METHODS We conducted a literature search to explore the defining characteristics of frailty and the most commonly used assessment tools. We compared these findings to the components of frailty captured within the eCGA. We then used a descriptive study design to manually map concepts from the eCGA to SNOMED CT. RESULTS Our literature review demonstrated that the eCGA contains all common defining characteristics of frailty. Unique assessment questions from the eCGA (n = 133) were manually mapped to SNOMED CT, using expert consensus. Of these, 72 % were direct matches, 17 % were one-to-many matches, and the remaining 11 % were non-matches. Two rounds of expert clinician mapping occurred; inter-rater reliability between the two clinicians was 0.75 (kappa). CONCLUSIONS/IMPLICATIONS The resulting list of mapped eCGA elements to SNOMED CT terms can inform revisions to existing chronic disease databases to include frailty monitoring and surveillance.
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Affiliation(s)
- M Thandi
- University of British Columbia, School of Nursing, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - S Brown
- University of British Columbia, School of Nursing, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - S T Wong
- University of British Columbia, Centre for Health Services and Policy Research and School of Nursing, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
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Johnston S, Hogg W, Wong ST, Burge F, Peterson S. Differences in Mode Preferences, Response Rates, and Mode Effect Between Automated Email and Phone Survey Systems for Patients of Primary Care Practices: Cross-Sectional Study. J Med Internet Res 2021; 23:e21240. [PMID: 33427675 PMCID: PMC7834947 DOI: 10.2196/21240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/23/2020] [Accepted: 10/28/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A growing number of health care practices are adopting software systems that link with their existing electronic medical records to generate outgoing phone calls, emails, or text notifications to patients for appointment reminders or practice updates. While practices are adopting this software technology for service notifications to patients, its use for collection of patient-reported measures is still nascent. OBJECTIVE This study assessed the mode preferences, response rates, and mode effect for a practice-based automated patient survey using phone and email modalities to patients of primary care practices. METHODS This cross-sectional study analyzed responses and respondent demographics for a short, fully automated, telephone or email patient survey sent to individuals within 72 hours of a visit to their regular primary care practice. Each survey consisted of 5 questions drawn from a larger study's patient survey that all respondents completed in the waiting room at the time of their visit. Automated patient survey responses were linked to self-reported sociodemographic information provided on the waiting room survey including age, sex, reported income, and health status. RESULTS A total of 871 patients from 87 primary care practices in British Columbia, Ontario, and Nova Scotia, Canada, agreed to the automated patient survey and 470 patients (45.2%) completed all 5 questions on the automated survey. Email administration of the follow-up survey was preferred over phone-based administration, except among patients aged 75 years and older (P<.001). Overall, response rates for those who selected an emailed survey (369/606, 60.9%) were higher (P<.001) than those who selected the phone survey (101/265, 38.1%). This held true irrespective of age, sex, or chronic disease status of individuals. Response rates were also higher for email (range 57.4% [58/101] to 66.3% [108/163]) compared with phone surveys (range 36% [23/64] to 43% [10/23]) for all income groups except the lowest income quintile, which had similar response rates (email: 29/63, 46%; phone: 23/50, 46%) for phone and email modes. We observed moderate (range 64.6% [62/96] to 78.8% [282/358]) agreement between waiting room survey responses and those obtained in the follow-up automated survey. However, overall agreement in responses was poor (range 45.3% [43/95] to 46.2% [43/93]) for 2 questions relating to care coordination. CONCLUSIONS An automated practice-based patient experience survey achieved significantly different response rates between phone and email and increased response rates for email as income group rose. Potential mode effects for the different survey modalities may limit multimodal survey approaches. An automated minimal burden patient survey could facilitate the integration of patient-reported outcomes into care planning and service organization, supporting the move of our primary care practices toward a more responsive, patient-centered, continual learning system. However, practices must be attentive to furthering inequities in health care by underrepresenting the experience of certain groups in decision making based on the reach of different survey modes.
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Affiliation(s)
- Sharon Johnston
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Family Medicine, Institu du Savoir, Hôpital Montfort, University of Ottawa, Ottawa, ON, Canada
| | - William Hogg
- Department of Family Medicine, Institu du Savoir, Hôpital Montfort, University of Ottawa, Ottawa, ON, Canada
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Sandra Peterson
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
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Ezzat AM, McCracken R, Wong ST. A team-based approach in primary care can alleviate the burden created by the COVID-19 surgical backlog for people with hip and knee osteoarthritis. CMAJ 2020; 192:E1471. [PMID: 33199455 DOI: 10.1503/cmaj.76844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Allison M Ezzat
- Postdoctoral fellow and physiotherapist, School of Nursing, University of British Columbia, Vancouver, BC
| | - Rita McCracken
- Assistant professor and family physician, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - Sabrina T Wong
- Professor, School of Nursing, University of British Columbia, Vancouver, BC
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Abstract
High-performing and equitable healthcare systems are influenced by the strength of primary healthcare (PHC), which means that there should be special attention on this sector because we are changing how we monitor and improve overall care. Comprehensive data are the foundation for actionable information and are urgently needed in PHC because of the heterogeneity in both the demographics and the healthcare needs of the populations served. An ideal information system would combine multiple data sources such as electronic medical records (EMRs), administrative data and patient-reported information, drawing on the strengths of each to develop a comprehensive view of PHC. The purpose of this commentary is to draw attention to data gaps and offer suggestions about where and how this information could be obtained. Linked patient experience, EMRs and administrative data could be used in a learning health system to support decisions at the practice level and the jurisdictional level, where resources (financial and human) can be deployed to improve the quality of care, particularly when care is needed across sectors. The information gained from the analysis of these data are of high value for clinician/practice quality improvement efforts and for regional and jurisdictional health system planning and resource allocation.
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Affiliation(s)
- Sabrina T Wong
- Professor, Centre for Health Services Research, University of British Columbia, Vancouver, BC, School of Nursing, University of British Columbia, Vancouver, BC
| | - Sharon Johnston
- Associate Professor, Department of Family Medicine, University of Ottawa, Bruyère Research Institute and Institut du Savoir Montfort, Ottawa, ON
| | - Fred Burge
- Professor, Faculty of Medicine, Dalhousie University, Halifax, NS
| | - Kim McGrail
- Professor, Centre for Health Services Research and School of Population and Public Health, University of British Columbia, Vancouver, BC
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Tyler Williamson P, Aponte-Hao S, Mele B, Lethebe BC, Leduc C, Thandi M, Katz A, Wong ST. Developing and Validating a Primary Care EMR-based Frailty Definition using Machine Learning. Int J Popul Data Sci 2020; 5:1344. [PMID: 32935059 PMCID: PMC7477778 DOI: 10.23889/ijpds.v5i1.1344] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction Individuals who have been identified as frail have an increased state of vulnerability, often leading to adverse health events, increased health spending, and potentially detrimental outcomes. Objective The objective of this work is to develop and validate a case definition for frailty that can be used in a primary care electronic medical record database. Methods This is a cross-sectional validation study using data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) in Southern Alberta. 52 CPCSSN sentinels assessed a random sample of their own patients using the Rockwood Clinical Frailty scale, resulting in a total of 875 patients to be used as reference standard. Patients must be over the age of 65 and have had a clinic visit within the last 24 months. The case definition for frailty was developed using machine learning methods using CPCSSN records for the 875 patients. Results Of the 875 patients, 155 (17.7%) were frail and 720 (84.2%) were not frail. Validation metrics of the case definition were: sensitivity and specificity of 0.28, 95% CI (0.21 to 0.36) and 0.94, 95% CI (0.93 to 0.96), respectively; PPV and NPV of 0.53, 95% CI (0.42 to 0.64) and 0.86, 95% CI (0.83 to 0.88), respectively. Conclusions The low sensitivity and specificity results could be because frailty as a construct remains under-developed and relatively poorly understood due to its complex nature. These results contribute to the literature by demonstrating that case definitions for frailty require expert consensus and potentially more sophisticated algorithms to be successful.
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Affiliation(s)
- PhD Tyler Williamson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary.,O'Brien Institute for Public Health and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary.,Centre for Health Informatics, Cumming School of Medicine, University of Calgary
| | - Sylvia Aponte-Hao
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Bria Mele
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Brendan Cord Lethebe
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary.,Clinical Research Unit, Cumming School of Medicine, University of Calgary
| | - Charles Leduc
- Department of Family Medicine, Cumming School of Medicine, University of Calgary
| | - Manpreet Thandi
- School of Nursing, University of British Columba.,Centre for Health Services and Policy Research, University of British Columbia
| | - Alan Katz
- Departments of Family Medicine and Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba
| | - Sabrina T Wong
- School of Nursing, University of British Columba.,Centre for Health Services and Policy Research, University of British Columbia
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Wong ST, Katz A, Williamson T, Singer A, Peterson S, Taylor C, Price M, McCracken R, Thandi M. Can Linked Electronic Medical Record and Administrative Data Help Us Identify Those Living with Frailty? Int J Popul Data Sci 2020; 5:1343. [PMID: 33644409 PMCID: PMC7893852 DOI: 10.23889/ijpds.v5i1.1343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Introduction Frailty is a complex condition that affects many aspects of patients’ wellbeing and health outcomes. Objectives We used available Electronic Medical Record (EMR) and administrative data to determine definitions of frailty. We also examined whether there were differences in demographics or health conditions among those identified as frail in either the EMR or administrative data. Methods EMR and administrative data were linked in British Columbia (BC) and Manitoba (MB) to identify those aged 65 years and older who were frail. The EMR data were obtained from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) and the administrative data (e.g. billing, hospitalizations) was obtained from Population Data BC and the Manitoba Population Research Data Repository. Sociodemographic characteristics, risk factors, prescribed medications, use and costs of healthcare are described for those identified as frail. Results Sociodemographic and utilization differences were found among those identified as frail from the EMR compared to those in the administrative data. Among those who were >65 years, who had a record in both EMR and administrative data, 5%-8% (n=191 of 3,553, BC; n=2,396 of 29,382, MB) were identified as frail. There was a higher likelihood of being frail with increasing age and being a woman. In BC and MB, those identified as frail in both data sources have approximately twice the number of contacts with primary care (n=20 vs. n=10) and more days in hospital (n=7.2 vs. n=1.9 in BC; n=9.8 vs. n=2.8 in MB) compared to those who are not frail; 27% (BC) and 14% (MB) of those identified as frail in 2014 died in 2015. Conclusions Identifying frailty using EMR data is particularly challenging because many functional deficits are not routinely recorded in structured data fields. Our results suggest frailty can be captured along a continuum using both EMR and administrative data.
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Affiliation(s)
- S T Wong
- University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5
| | - A Katz
- University of Manitoba, 408-727 McDermot Ave, Winnipeg, Mb, R3E 3P5
| | - T Williamson
- University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1
| | - A Singer
- University of Manitoba, 408-727 McDermot Ave, Winnipeg, Mb, R3E 3P5
| | - S Peterson
- University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5
| | - C Taylor
- University of Manitoba, 408-727 McDermot Ave, Winnipeg, Mb, R3E 3P5
| | - M Price
- University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5
| | - R McCracken
- University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5
| | - M Thandi
- University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5
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Alsabbagh MW, Kueper JK, Wong ST, Burge F, Johnston S, Peterson S, Lawson B, Chung H, Bennett M, Blackman S, McGrail K, Campbell J, Hogg W, Glazier R. Development of comparable algorithms to measure primary care indicators using administrative health data across three Canadian provinces. Int J Popul Data Sci 2020; 5:1340. [PMID: 33644408 PMCID: PMC7893851 DOI: 10.23889/ijpds.v5i1.1340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Performance measurement has been recognized as key to transforming primary care (PC). Yet, performance reporting in PC lags behind even though high-performing PC is foundational to an effective and efficient health care system. OBJECTIVES We used administrative data from three Canadian provinces, British Columbia, Ontario and Nova Scotia, to: 1) identify and develop a core set of PC performance indicators using administrative data and 2) examine their ability to capture PC performance. METHODS Administrative data used included Physician Billings, Discharge Abstract Database, the National Ambulatory Care and Reporting System database, Census and Vital Statistics. Indicators were compiled based on a literature review of PC indicators previously developed with administrative data available in Canada (n=158). We engaged in iterative discussions to assess data conformity, completeness, and plausibility of results in all jurisdictions. Challenges to creating comparable algorithms were examined through content analysis and research team discussions, which included clinicians, analysts, and health services researchers familiar with PC. RESULTS Our final list included 21 PC performance indicators pertaining to 1) technical care (n=4), 2) continuity of care (n=6), and 3) health services utilization (n=11). Establishing comparable algorithms across provinces was possible though time intensive. A major challenge was inconsistent data elements. Ease of data access, and a deep understanding of the data and practice context, was essential for selecting the most appropriate data elements. CONCLUSIONS This project is unique in creating algorithms to measure PC performance across provinces. It was essential to balance internal validity of the indicators within a province and external validity across provinces. The intuitive desire of having the exact same coding across provinces was infeasible due to lack of standardized PC data. Rather, a context-tailored definition was developed for each jurisdiction. This work serves as an example for developing comparable PC performance indicators across different provincial/territorial jurisdictions.
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Affiliation(s)
| | | | - ST Wong
- University of British Columbia
| | | | - S Johnston
- Bruyère Research Institute, University of Ottawa
| | | | | | | | | | | | | | | | - W Hogg
- University of Ottawa, Montfort Hospital Research Institute
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