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Campbell NRC, McKay DW, Petrella R, Kaczorowski J. The Urgent Need to Re-establish a Health Coalition Focused on Hypertension Prevention and Control in Canada. Can J Cardiol 2024; 40:610-612. [PMID: 38416078 DOI: 10.1016/j.cjca.2023.11.039] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 02/29/2024] Open
Affiliation(s)
- Norm R C Campbell
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Donald W McKay
- Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Robert Petrella
- Department of Family Practice, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia. Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, University of Montréal, Montréal, Québec, Canada
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2
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MacKinnon N, Lane D, Scheuermeyer F, Kaczorowski J, Dong K, Orkin AM, Daoust R, Moe J, Andolfatto G, Klaiman M, Yan J, Koh JJ, Crowder K, Atkinson P, Savage D, Stempien J, Besserer F, Wale J, Kestler A. Factors associated with frequent buprenorphine / naloxone initiation in a national survey of Canadian emergency physicians. PLoS One 2024; 19:e0297084. [PMID: 38315732 PMCID: PMC10843078 DOI: 10.1371/journal.pone.0297084] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/27/2023] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE To identify individual and site-related factors associated with frequent emergency department (ED) buprenorphine/naloxone (BUP) initiation. BUP initiation, an effective opioid use disorder (OUD) intervention, varies widely across Canadian EDs. METHODS We surveyed emergency physicians in 6 Canadian provinces from 2018 to 2019 using bilingual paper and web-based questionnaires. Survey domains included BUP-related practice, demographics, attitudes toward BUP, and site characteristics. We defined frequent BUP initiation (the primary outcome) as at least once per month, high OUD prevalence as at least one OUD patient per shift, and high OUD resources as at least 3 out of the following 5 resources: BUP initiation pathways, BUP in ED, peer navigators, accessible addiction specialists, and accessible follow-up clinics. We excluded responses from sites with <50% participation (to minimize non-responder bias) and those missing the primary outcome. We used univariate analysis to identify associations between frequent BUP initiation and factors of interest, stratifying by OUD prevalence. RESULTS We excluded 3 responses for missing BUP initiation frequency and 9 for low response rate at one ED. Of the remaining 649 respondents from 34 EDs, 374 (58%) practiced in metropolitan areas, 384 (59%) reported high OUD prevalence, 312 (48%) had high OUD resources, and 161 (25%) initiated BUP frequently. Age, gender, board certification and years in practice were not associated with frequent BUP initiation. Site-specific factors were associated with frequent BUP initiation (high OUD resources [OR 6.91], high OUD prevalence [OR 4.45], and metropolitan location [OR 2.39],) as were individual attitudinal factors (willingness, confidence, and responsibility to initiate BUP.) Similar associations persisted in the high OUD prevalence subgroup. CONCLUSIONS Individual attitudinal and site-specific factors were associated with frequent BUP initiation. Training to increase physician confidence and increasing OUD resources could increase BUP initiation and benefit ED patients with OUD.
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Affiliation(s)
- Nathalie MacKinnon
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Daniel Lane
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Frank Scheuermeyer
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | | | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Aaron M. Orkin
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Raoul Daoust
- Université de Montréal, Montreal, Quebec, Canada
- Centre de Recherche de l’Hôpital Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Jessica Moe
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Gary Andolfatto
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Michelle Klaiman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Justin Yan
- Division of Emergency Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Justin J. Koh
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kathryn Crowder
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul Atkinson
- Department of Emergency Medicine, Dalhousie University, St. John, New Brunswick, Canada
| | - David Savage
- Division of Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - James Stempien
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Floyd Besserer
- Department of Emergency Medicine, University of British Columbia, Prince George, British Columbia, Canada
| | - Jason Wale
- Department of Emergency Medicine, University of British Columbia, Victoria, British Columbia, Canada
| | - Andrew Kestler
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
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3
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Layani G, Tremblay A, Lussier MT, Godbout I, Bihan H, Gosselin C, Pierre M, Motulsky A, Brault I, Rodrigues I, Kaczorowski J, Vanier MC, Yapi SM. Cross-Sector Collaboration to Improve Access to Community Services for People Living With Diabetes: Contributions From Actor-Network Theory. Health Serv Insights 2024; 17:11786329231222408. [PMID: 38288094 PMCID: PMC10823851 DOI: 10.1177/11786329231222408] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/07/2023] [Indexed: 01/31/2024] Open
Abstract
Diabetes is a global public health issue. The Public Health Agency of Canada published a Diabetes Framework 2022 which recommends collaborative work across sectors to mitigate the impact of diabetes on health and quality of life. Since 2020, the INMED-COMMUNITY pathway has been implemented in Laval, Québec developing collaboration between healthcare and community sectors through a participatory action research approach. The aim of this article is to gain a better understanding of the INMED-COMMUNITY pathway implementation process, based on the mobilization of network actor theory. Qualitative analysis of semi-structured interviews conducted from January to March 2023 with 12 participants from 3 different sectors (community, health system, research), were carried out using actor-network theory. The results explored the conditions for effective intersectoral collaboration in a participatory action research approach to implement the INMED-COMMUNITY pathway. These were: (1) contextualization of the project, (2) a consultation approach involving various stakeholders, (3) creation of new partnerships, (4) presence of a project coordinator, and (5) mobilization of stakeholders around a common definition of diabetes. Mediation supported by a project coordinator contributed to the implementation of an intersectoral collaborative health intervention, largely due to early identification of controversies.
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Affiliation(s)
- Géraldine Layani
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montreal, Montreal, QC, Canada
- Research Centre of the University of Montreal, Montréal, QC, Canada
- Pôle 1, Centre de recherche des pratiques cliniques et organisationnelles du Centre intégré de santé et de services sociaux de Laval, Laval, QC, Canada
| | | | - Marie-Thérèse Lussier
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montreal, Montreal, QC, Canada
- Research Centre of the University of Montreal, Montréal, QC, Canada
| | | | - Hélène Bihan
- Avicenne hospital, Bobigny, France
- Health Education and Practices Laboratory, Université Paris 13, Paris, France
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | - Claire Gosselin
- Research Centre of the University of Montreal, Montréal, QC, Canada
| | - Mégane Pierre
- Research Centre of the University of Montreal, Montréal, QC, Canada
| | - Aude Motulsky
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Department of Management, School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Isabelle Brault
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Department of Management, School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Isabel Rodrigues
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montreal, Montreal, QC, Canada
- Pôle 1, Centre de recherche des pratiques cliniques et organisationnelles du Centre intégré de santé et de services sociaux de Laval, Laval, QC, Canada
| | - Janusz Kaczorowski
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montreal, Montreal, QC, Canada
- Research Centre of the University of Montreal, Montréal, QC, Canada
| | - Marie-Claude Vanier
- Pôle 1, Centre de recherche des pratiques cliniques et organisationnelles du Centre intégré de santé et de services sociaux de Laval, Laval, QC, Canada
- Health Education and Practices Laboratory, Université Paris 13, Paris, France
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
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4
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Shaver N, Beck A, Bennett A, Wilson BJ, Garritty C, Subnath M, Grad R, Persaud N, Thériault G, Flemming J, Thombs BD, LeBlanc J, Kaczorowski J, Liu P, Clark CE, Traversy G, Graham E, Feber J, Leenen FHH, Premji K, Pap R, Skidmore B, Brouwers M, Moher D, Little J. Screening for hypertension in adults: protocol for evidence reviews to inform a Canadian Task Force on Preventive Health Care guideline update. Syst Rev 2024; 13:17. [PMID: 38183086 PMCID: PMC10768239 DOI: 10.1186/s13643-023-02392-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/16/2023] [Indexed: 01/07/2024] Open
Abstract
PURPOSE To inform updated recommendations by the Canadian Task Force on Preventive Health Care on screening in a primary care setting for hypertension in adults aged 18 years and older. This protocol outlines the scope and methods for a series of systematic reviews and one overview of reviews. METHODS To evaluate the benefits and harms of screening for hypertension, the Task Force will rely on the relevant key questions from the 2021 United States Preventive Services Task Force systematic review. In addition, a series of reviews will be conducted to identify, appraise, and synthesize the evidence on (1) the association of blood pressure measurement methods and future cardiovascular (CVD)-related outcomes, (2) thresholds for discussions of treatment initiation, and (3) patient acceptability of hypertension screening methods. For the review of blood pressure measurement methods and future CVD-related outcomes, we will perform a de novo review and search MEDLINE, Embase, CENTRAL, and APA PsycInfo for randomized controlled trials, prospective or retrospective cohort studies, nested case-control studies, and within-arm analyses of intervention studies. For the thresholds for discussions of treatment initiation review, we will perform an overview of reviews and update results from a relevant 2019 UK NICE review. We will search MEDLINE, Embase, APA PsycInfo, and Epistemonikos for systematic reviews. For the acceptability review, we will perform a de novo systematic review and search MEDLINE, Embase, and APA PsycInfo for randomized controlled trials, controlled clinical trials, and observational studies with comparison groups. Websites of relevant organizations, gray literature sources, and the reference lists of included studies and reviews will be hand-searched. Title and abstract screening will be completed by two independent reviewers. Full-text screening, data extraction, risk-of-bias assessment, and GRADE (Grading of Recommendations Assessment, Development and Evaluation) will be completed independently by two reviewers. Results from included studies will be synthesized narratively and pooled via meta-analysis when appropriate. The GRADE approach will be used to assess the certainty of evidence for outcomes. DISCUSSION The results of the evidence reviews will be used to inform Canadian recommendations on screening for hypertension in adults aged 18 years and older. SYSTEMATIC REVIEW REGISTRATION This protocol is registered on PROSPERO and is available on the Open Science Framework (osf.io/8w4tz).
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Affiliation(s)
- Nicole Shaver
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Andrew Beck
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alexandria Bennett
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Brenda J Wilson
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - Chantelle Garritty
- Global Health and Guidelines Division, Public Health Agency of Canada, Ottawa, Canada
| | - Melissa Subnath
- Global Health and Guidelines Division, Public Health Agency of Canada, Ottawa, Canada
| | - Roland Grad
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Navindra Persaud
- Department of Family and Community Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Guylène Thériault
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Jennifer Flemming
- Department of Medicine, Queen's University, Kingston, ON, Canada
- Kingston Health Sciences Centre, Kingston, Canada
| | - Brett D Thombs
- Lady Davis Institute of the Jewish General Hospital, Montreal, QC, Canada
- Faculty of Medicine, McGill University, Montreal, Canada
| | - John LeBlanc
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, University of Montreal, Montreal, QC, Canada
| | - Peter Liu
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Christopher E Clark
- Primary Care Research Group, University of Exeter Medical School, Exeter, Devon, England
| | - Gregory Traversy
- Global Health and Guidelines Division, Public Health Agency of Canada, Ottawa, Canada
| | - Eva Graham
- Substance-Related Harms Division, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Janusz Feber
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Frans H H Leenen
- Department of Medicine and Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kamila Premji
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Robert Pap
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Melissa Brouwers
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Julian Little
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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5
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Del Grande C, Kaczorowski J. Rating versus ranking in a Delphi survey: a randomized controlled trial. Trials 2023; 24:543. [PMID: 37596699 PMCID: PMC10436639 DOI: 10.1186/s13063-023-07442-6] [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: 12/01/2022] [Accepted: 06/08/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND The Delphi technique has steeply grown in popularity in health research as a structured approach to group communication process. Rating and ranking are two different procedures commonly used to quantify participants' opinions in Delphi surveys. We explored the influence of using a rating or ranking approach on item prioritization (main outcome), questionnaire completion time, and evaluation of task difficulty in a Delphi survey aimed at identifying priorities for the organization of primary cardiovascular care. METHODS A randomized controlled parallel group trial was embedded in a three-round online Delphi survey. After an "open" first round, primary care patients, trained patient partners, and primary care clinicians from seven primary care practices were allocated 1:1 to a rating or ranking assessment group for the remainder of the study by stratified permuted block randomization, with strata based on participants' gender and status. Agreement on item prioritization between the experimental groups was measured by calculating Krippendorff's alpha reliability coefficient on the aggregate rank order of items in each group after the final round. Self-reported ease or difficulty with the assessment task was measured with the Single Ease Question. RESULTS Thirty-six panelists (13 clinic patients, 7 patient partners, 16 clinicians; 60% females) were randomized to the rating (n = 18) or ranking (n = 18) group, with 30 (83%) completing all rounds. Both groups identified the same highest priorities from a set of 41 items, but significant discrepancies were found as early as the seventh top item. There was moderately strong agreement between the priority ordering of top items common to both groups (Krippendorff's alpha = 0.811, 95% CI = 0.669-0.920). A 9-min mean difference to complete the third-round questionnaire in favor of the rating group failed to achieve statistical significance (p = 0.053). Ranking was perceived as more difficult (p < 0.001). CONCLUSIONS A rating or ranking procedure led to modestly similar item prioritization in a Delphi survey, but ranking was more difficult. This study should be replicated with a larger number of participants and with variations in the ranking and rating procedures. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Claudio Del Grande
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Saint-Antoine Tower, 850 Saint-Denis Street, Montreal, QC, H2X 0A9, Canada.
- School of Public Health, Université de Montréal, Montreal, QC, Canada.
| | - Janusz Kaczorowski
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Saint-Antoine Tower, 850 Saint-Denis Street, Montreal, QC, H2X 0A9, Canada
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, QC, Canada
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6
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Galarneau LR, Scheuermeyer FX, Hilburt J, O'Neill ZR, Barbic S, Moe J, Buxton JA, Orkin AM, Kaczorowski J, Dong K, Tobin D, Miles I, Bath M, Grier S, Garrod E, Kestler A. Qualitative Exploration of Emergency Department Care Experiences Among People With Opioid Use Disorder. Ann Emerg Med 2023; 82:1-10. [PMID: 36967276 DOI: 10.1016/j.annemergmed.2023.02.007] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 03/28/2023]
Abstract
STUDY OBJECTIVE We described the experiences and preferences of people with opioid use disorder who access emergency department (ED) services regarding ED care and ED-based interventions. METHODS Between June and September 2020, we conducted phone or in-person semistructured qualitative interviews with patients recently discharged from 2 urban EDs in Vancouver, BC, Canada, to explore experiences and preferences of ED care and ED-based opioid use disorder interventions. We recruited participants from a cohort of adults with opioid use disorder who were participating in an ED-initiated outreach program. We transcribed audio recordings verbatim. We iteratively developed a thematic coding structure, with interim analyses to assess for thematic saturation. Two team members with lived experience of opioid use provided feedback on content, wording, and analysis throughout the study. RESULTS We interviewed 19 participants. Participants felt discriminated against for their drug use, which led to poorer perceived health care and downstream ED avoidance. Participants desired to be treated like ED patients who do not use drugs and to be more involved in their ED care. Participants nevertheless felt comfortable discussing their substance use with ED staff and valued continuous ED operating hours. Regarding opioid use disorder treatment, participants supported ED-based buprenorphine/naloxone programs but also suggested additional options (eg, different initiation regimens and settings and other opioid agonist therapies) to facilitate further treatment uptake. CONCLUSION Based on participant experiences, we recommend addressing potentially stigmatizing practices, increasing patient involvement in their care during ED visits, and increasing access to various opioid use disorder-related treatments and community support.
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Affiliation(s)
- Lexis R Galarneau
- George Spady Society, Edmonton, Alberta; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia.
| | - Frank X Scheuermeyer
- Department of Emergency Medicine, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia; Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia
| | - Jesse Hilburt
- Vancouver Coastal Health, Vancouver, British Columbia
| | - Zoe R O'Neill
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec
| | - Skye Barbic
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia; Providence Health Research, Vancouver, British Columbia
| | - Jessica Moe
- Department of Emergency Medicine, University of British Columbia, and Vancouver General Hospital and British Columbia Children's Hospital, Vancouver, British Columbia; British Columbia Centre for Disease Control, Vancouver, British Columbia
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia; British Columbia Centre for Disease Control, Vancouver, British Columbia
| | - Aaron M Orkin
- Department of Family and Community Medicine, University of Toronto, and Inner City Health Associates, Toronto, Ontario
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, University of Montréal, and Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta
| | - Dianne Tobin
- Vancouver Area Network of Drug Users, Vancouver, British Columbia, Canada
| | - Isabelle Miles
- Department of Emergency Medicine, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia
| | - Misty Bath
- Vancouver Coastal Health, Vancouver, British Columbia
| | - Sherry Grier
- Portland Hotel Society Community Services Society, Vancouver, British Columbia, Canada
| | - Emma Garrod
- Providence Health Care, Vancouver, British Columbia, Canada; British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Andrew Kestler
- Department of Emergency Medicine, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia; Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia; British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
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7
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Adekpedjou R, Léon P, Dewidar O, Al‐Zubaidi A, Jbilou J, Kaczorowski J, Muscedere J, Hirdes J, Heckman G, Girard M, Hébert PC. Effectiveness of interventions to address different types of vulnerabilities in community-dwelling older adults: An umbrella review. Campbell Syst Rev 2023; 19:e1323. [PMID: 37180567 PMCID: PMC10168691 DOI: 10.1002/cl2.1323] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Background Frailty, social isolation, loneliness, and poverty may render older adults vulnerable to social or health stressors. It is imperative to identify effective interventions to address them especially in the context of COVID-19 pandemic. Objective To identify effective community-based interventions to address frailty, social isolation, loneliness, and poverty among community-dwelling older adults. Design Umbrella review. Data Source We systematically searched PubMed, Ovid MEDLINE, Embase, Cochrane CENTRAL, EBM-Reviews, CINAHL via EBSCO, and APA PsycInfo via Ovid from January 2009 to December 2022. Eligibility Criteria We included systematic reviews or quantitative reviews of non-pharmacologic interventions targeting community-dwelling older adults. Data Selection Extraction and Management Two review authors independently screened the titles and abstracts, performed data extraction and appraised the methodological quality of the reviews. We used a narrative synthesis approach to summarize and interpret the findings. We assessed the methodological quality of the studies using AMSTAR 2.0 tool. Results We identified 27 reviews incorporating 372 unique primary studies that met our inclusion criteria. Ten of the reviews included studies conducted in low-middle-income countries. Twelve reviews (46%, 12/26) included interventions that addressed frailty. Seventeen reviews (65%, 17/26) included interventions that addressed either social isolation or loneliness. Eighteen reviews included studies with single component interventions, while 23 reviews included studies with multi-component interventions. Interventions including protein supplementation combined with physical activity may improve outcomes including frailty status, grip strength, and body weight. Physical activity alone or in combination with diet may prevent frailty. Additionally, physical activity may improve social functioning and interventions using digital technologies may decrease social isolation and loneliness. We did not find any review of interventions addressing poverty among older adults. We also noted that few reviews addressed multiple vulnerabilities within the same study, specifically addressed vulnerability among ethnic and sexual minority groups, or examined interventions that engaged communities and adapted programs to local needs. Conclusion Evidence from reviews support diets, physical activity, and digital technologies to improve frailty, social isolation or loneliness. However, interventions examined were primarily conducted under optimal conditions. There is a need for further interventions in community settings and conducted under real world settings in older adults living with multiple vulnerabilities.
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Affiliation(s)
- Rhéda Adekpedjou
- Carrefour de l'innovation et de l'évaluation en santéCentre Hospitalier de l'Université de MontréalMontréalCanada
| | - Pascale Léon
- Carrefour de l'innovation et de l'évaluation en santéCentre Hospitalier de l'Université de MontréalMontréalCanada
| | - Omar Dewidar
- Bruyère Research InstituteUniversity of OttawaOttawaOntarioCanada
| | - Ali Al‐Zubaidi
- Bruyère Research InstituteUniversity of OttawaOttawaOntarioCanada
| | - Jalila Jbilou
- Centre de formation médicale du Nouveau‐Brunswick et École de psychologie, Faculté des sciences de la santé et des services communautairesUniversité de MonctonNouveau‐BrunswickCanada
| | - Janusz Kaczorowski
- Carrefour de l'innovation et de l'évaluation en santéCentre Hospitalier de l'Université de MontréalMontréalCanada
| | - John Muscedere
- Department of Critical Care MedicineQueens University and Canadian Frailty NetworkKingstonOntarioCanada
| | - John Hirdes
- Centre de formation médicale du Nouveau‐Brunswick et École de psychologie, Faculté des sciences de la santé et des services communautairesUniversité de MonctonNouveau‐BrunswickCanada
| | - George Heckman
- School of Public Health and Health SystemsUniversity of WaterlooWaterlooCanada
- Schlegel Research Institute for AgingWaterlooCanada
| | - Magali Girard
- Bureau de Recherche Développement ValorisationUniversité de MontréalMontréalCanada
| | - Paul C. Hébert
- Carrefour de l'innovation et de l'évaluation en santéCentre Hospitalier de l'Université de MontréalMontréalCanada
- Bruyère Research InstituteUniversity of OttawaOttawaOntarioCanada
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8
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Yapi SM, Poitras ME, Donnelly C, Ashcroft R, Greiver M, Couturier Y, Nikiema JN, Breton M, Layani G, Kaczorowski J, Bergman H, Lussier MT, Aggarwal M, Fernainy P, McGraw M, Milius D, Mehta K, Samson K, Sourial N. Identify and classify interprofessional primary care performance indicators: a scoping review protocol. BMJ Open 2023; 13:e072186. [PMID: 37253498 DOI: 10.1136/bmjopen-2023-072186] [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: 06/01/2023] Open
Abstract
INTRODUCTION Measuring the performance of interprofessional primary care is needed to examine whether this model of care is achieving its desired outcomes on patient care and health system effectiveness as well as to guide quality improvement initiatives. The aim of this scoping review is to map the literature on primary care performance measurement indicators to determine the extent to which current indicators capture or could be adapted to capture processes, outputs and outcomes that reflect interprofessional primary care. METHODS AND ANALYSIS The review will be guided by the six-stage framework by Arksey and O'Malley (2005). MEDLINE, Embase, CINAHL, grey literature and the reference list of key studies will be searched to identify any study, published in English or French between 2000 and 2022, related to the concepts of performance indicators, frameworks, interprofessional teams and primary care. Two reviewers will independently screen all abstracts and full-text studies for inclusion. Eligible indicators will be classified according to process, output and outcome domains proposed by two validated frameworks. This study started in November 2022 and is expected to be completed by July 2023. ETHICS AND DISSEMINATION This review does not require ethical approval. The results will be disseminated through a peer-reviewed publication, conference presentations and presentations to stakeholders.
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Affiliation(s)
- Sopie Marielle Yapi
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
| | - Marie-Eve Poitras
- Département des sciences de la santé, Université du Québec à Chicoutimi, Chicoutimi, Québec, Canada
| | - Catherine Donnelly
- Health Services and Policy Research Institute, Queen's University Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Rachelle Ashcroft
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Greiver
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yves Couturier
- School of Social Work, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Jean Noël Nikiema
- Department of Health Management, Evaluation & Policy, University of Montreal, Montreal, Québec, Canada
| | - Mylaine Breton
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Quebec, Canada
| | - Géraldine Layani
- Department of Family and Emergency Medicine, University of Montreal, Montreal, Québec, Canada
| | - Janusz Kaczorowski
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
- Department of Family and Emergency Medicine, University of Montreal, Montreal, Québec, Canada
| | - Howard Bergman
- Department of Family Medicine, McGill University, Montreal, Québec, Canada
| | | | - Monica Aggarwal
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Pamela Fernainy
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
- Department of Health Management, Evaluation & Policy, University of Montreal, Montreal, Québec, Canada
| | - Monica McGraw
- Département des sciences de la santé, Université du Québec à Chicoutimi, Chicoutimi, Québec, Canada
| | - Djims Milius
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
| | - Kavita Mehta
- Association of Family Health Teams of Ontario, Toronto, Ontario, Canada
| | - Kevin Samson
- Association of Family Health Teams of Ontario, Toronto, Ontario, Canada
| | - Nadia Sourial
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
- Department of Health Management, Evaluation & Policy, University of Montreal, Montreal, Québec, Canada
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9
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Breton M, Gaboury I, Martin E, Green ME, Kiran T, Laberge M, Kaczorowski J, Ivers N, Deville-Stoetzel N, Bordeleau F, Beaulieu C, Descoteaux S. Impact of externally facilitated continuous quality improvement cohorts on Advanced Access to support primary healthcare teams: protocol for a quasi-randomized cluster trial. BMC Prim Care 2023; 24:97. [PMID: 37038126 PMCID: PMC10088119 DOI: 10.1186/s12875-023-02048-y] [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] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/29/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Improving access to primary health care is among top priorities for many countries. Advanced Access (AA) is one of the most recommended models to improve timely access to care. Over the past 15 years, the AA model has been implemented in Canada, but the implementation of AA varies substantially among providers and clinics. Continuous quality improvement (CQI) approaches can be used to promote organizational change like AA implementation. While CQI fosters the adoption of evidence-based practices, knowledge gaps remain, about the mechanisms by which QI happens and the sustainability of the results. The general aim of the study is to analyse the implementation and effects of CQI cohorts on AA for primary care clinics. Specific objectives are: 1) Analyse the process of implementing CQI cohorts to support PHC clinics in their improvement of AA. 2) Document and compare structural organisational changes and processes of care with respect to AA within study groups (intervention and control). 3) Assess the effectiveness of CQI cohorts on AA outcomes. 4) Appreciate the sustainability of the intervention for AA processes, organisational changes and outcomes. METHODS Cluster-controlled trial allowing for a comprehensive and rigorous evaluation of the proposed intervention 48 multidisciplinary primary care clinics will be recruited to participate. 24 Clinics from the intervention regions will receive the CQI intervention for 18 months including three activities carried out iteratively until the clinic's improvement objectives are achieved: 1) reflective sessions and problem priorisation; 2) plan-do-study-act cycles; and 3) group mentoring. Clinics located in the control regions will receive an audit-feedback report on access. Complementary qualitative and quantitative data reflecting the quintuple aim will be collected over a period of 36 months. RESULTS This research will contribute to filling the gap in the generalizability of CQI interventions and accelerate the spread of effective AA improvement strategies while strengthening local QI culture within clinics. This research will have a direct impact on patients' experiences of care. CONCLUSION This mixed-method approach offers a unique opportunity to contribute to the scientific literature on large-scale CQI cohorts to improve AA in primary care teams and to better understand the processes of CQI. TRIAL REGISTRATION Clinical Trials: NCT05715151.
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Affiliation(s)
- Mylaine Breton
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada.
| | - Isabelle Gaboury
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
| | - Elisabeth Martin
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
| | | | - Tara Kiran
- University of Toronto, Toronto, ON, Canada
| | | | | | - Noah Ivers
- University of Toronto, Toronto, ON, Canada
| | - Nadia Deville-Stoetzel
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
| | - Francois Bordeleau
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
| | - Christine Beaulieu
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
| | - Sarah Descoteaux
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
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10
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Renner RM, Ennis M, Maazi M, Dunn S, Norman WV, Kaczorowski J, Guilbert E. Development and pilot testing of the 2019 Canadian Abortion Provider Survey. Pilot Feasibility Stud 2023; 9:49. [PMID: 36959670 PMCID: PMC10034882 DOI: 10.1186/s40814-023-01279-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/10/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Substantial changes in abortion care regulations, available medications and national clinical practice guidelines have occurred since a 2012 national Canadian Abortion Provider Survey (CAPS). We developed and piloted the CAPS 2019 survey instrument to explore changes of the abortion provider workforce, their clinical care as well as experiences with stigma and harassment. METHODS We undertook development and piloting in three phases: (1) development of the preliminary survey sections and questions based on the 2012 survey instrument, (2) content validation and feasibility of including certain content aspects via a modified Delphi Method with panels of clinical and research experts, and (3) pilot testing of the draft survey for face validity and clarity of language; assessing usability of the web-based Research Electronic Data Capture platform including the feasibility of complex skip pattern functionality. We performed content analysis of phase 2 results and used a general inductive approach to identify necessary survey modifications. RESULTS In phase 1, we generated a survey draft that reflected the changes in Canadian abortion care regulations and guidelines and included questions for clinicians and administrators providing first and second trimester surgical and medical abortion. In phase 2, we held 6 expert panel meetings of 5-8 participants each representing clinicians, administrators and researchers to provide feedback on the initial survey draft. Due to the complexity of certain identified aspects, such as interdisciplinary collaboration and interprovincial care delivery differences, we revised the survey sections through an iterative process of meetings and revisions until we reached consensus on constructs and questions to include versus exclude for not being feasible. In phase 3, we made minor revisions based on pilot testing of the bilingual, web-based survey among additional experts chosen to be widely representative of the study population. Demonstrating its feasibility, we included complex branching and skip pattern logic so each respondent only viewed applicable questions based on their prior responses. CONCLUSIONS We developed and piloted the CAPS 2019 survey instrument suitable to explore characteristics of a complex multidisciplinary workforce, their care and experience with stigma on a national level, and that can be adapted to other countries.
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Affiliation(s)
- Regina M Renner
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC Canada, V6Z 2K8, Canada.
- Contraception and Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, 4500 Oak Street, Vancouver, BC Canada, V6H 3N1, Canada.
| | - Madeleine Ennis
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC Canada, V6Z 2K8, Canada
- Contraception and Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, 4500 Oak Street, Vancouver, BC Canada, V6H 3N1, Canada
| | - Mahan Maazi
- Contraception and Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, 4500 Oak Street, Vancouver, BC Canada, V6H 3N1, Canada
| | - Sheila Dunn
- Contraception and Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, 4500 Oak Street, Vancouver, BC Canada, V6H 3N1, Canada
- Department of Family and Community Medicine, University of Toronto, 27 King's College Cir, Toronto, ON Canada, M5S 1A1, Canada
| | - Wendy V Norman
- Contraception and Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, 4500 Oak Street, Vancouver, BC Canada, V6H 3N1, Canada
- Department of Family Practice, University of British Columbia, 3Rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, BC Canada, V6T 1Z3, Canada
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Janusz Kaczorowski
- Contraception and Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, 4500 Oak Street, Vancouver, BC Canada, V6H 3N1, Canada
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, Pavillon Roger-Gaudry, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
| | - Edith Guilbert
- Contraception and Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, 4500 Oak Street, Vancouver, BC Canada, V6H 3N1, Canada
- Department of Obstetrics, Gynecology and Reproduction, Laval University, 2325 Rue de L'Université, Québec City, QC Canada, G1V 0A6, Canada
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11
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Layani G, Vachon B, Duhoux A, Lussier MT, Gil J, Brault I, Vanier MC, Rodrigues I, Motulsky A, Kaczorowski J, David PM, Battaglini A. Structuring and organizing interprofessional healthcare in partnership with patients with diabetes: the INterprofessional Management and Education in Diabetes care (INMED) pathway. J Interprof Care 2023; 37:329-332. [PMID: 35403546 DOI: 10.1080/13561820.2022.2051452] [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: 02/06/2023]
Abstract
Type 2 diabetes is a complex chronic disease that requires ongoing monitoring by an interprofessional team to prevent complications. The INMED (INterprofessional Management and Education in Diabetes) care pathway was developed by our team to optimize primary care services for these patients and their families. The objective of this study is to describe the preliminary results of its adoption and implementation. The INMED care pathway is organized into four axes: (a) continuing professional education, (b) self-management support, (c) case management, and (d) ongoing evaluation of the quality of diabetes care and services. A multiple-case study is underway to document its effects on practice change using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Preliminary results on the adoption and implementation revealed some strengths: (a) regular patient follow-up by the case manager, (b) scheduling of physician appointments when required, and (c) regular screening for risk factors. Barriers were also identified: (a) lack of clear understanding of the case manager role, (b) lack of referrals to team members, and (c) lack of use of the motivational interview approach. The INMED care pathway is being adopted by primary care teams but challenges need to be overcome to improve its reach and effectiveness.
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Affiliation(s)
- Géraldine Layani
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montreal, C.P. 6128, Succ. Centre-ville, Montreal, QC, Canada.,Centre de recherche des pratiques cliniques et organisationnelles du Centre intégré de santé et des services sociaux de Laval, Laval, Qc, Canada
| | - Brigitte Vachon
- Centre de recherche des pratiques cliniques et organisationnelles du Centre intégré de santé et des services sociaux de Laval, Laval, Qc, Canada.,School of rehabilitation, Faculty of Medicine, Université de Montréal, CP 6128 Succursale Centre-Ville, Montreal, QC, Canada
| | - Arnaud Duhoux
- Centre de recherche des pratiques cliniques et organisationnelles du Centre intégré de santé et des services sociaux de Laval, Laval, Qc, Canada.,Faculty of Nursing, Université de Montréal, CP 6128 Succursale Centre-Ville, Montreal, QC, Canada
| | - Marie-Thérèse Lussier
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montreal, C.P. 6128, Succ. Centre-ville, Montreal, QC, Canada.,Centre de recherche des pratiques cliniques et organisationnelles du Centre intégré de santé et des services sociaux de Laval, Laval, Qc, Canada
| | - Julian Gil
- Centre de recherche des pratiques cliniques et organisationnelles du Centre intégré de santé et des services sociaux de Laval, Laval, Qc, Canada
| | - Isabelle Brault
- Faculty of Nursing, Université de Montréal, CP 6128 Succursale Centre-Ville, Montreal, QC, Canada
| | - Marie-Claude Vanier
- Centre de recherche des pratiques cliniques et organisationnelles du Centre intégré de santé et des services sociaux de Laval, Laval, Qc, Canada.,Faculty of Pharmacy, Université de Montréal, CP 6128 Succursale Centre-Ville, Montreal, QC, Canada
| | - Isabel Rodrigues
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montreal, C.P. 6128, Succ. Centre-ville, Montreal, QC, Canada.,Centre de recherche des pratiques cliniques et organisationnelles du Centre intégré de santé et des services sociaux de Laval, Laval, Qc, Canada
| | - Aude Motulsky
- Department of Management, School of Public Health, Université de Montréal, Cp 6128 Succursale Centre-Ville, Montreal, QC, Canada
| | - Janusz Kaczorowski
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montreal, C.P. 6128, Succ. Centre-ville, Montreal, QC, Canada
| | - Pierre-Marie David
- Centre de recherche des pratiques cliniques et organisationnelles du Centre intégré de santé et des services sociaux de Laval, Laval, Qc, Canada.,Faculty of Pharmacy, Université de Montréal, CP 6128 Succursale Centre-Ville, Montreal, QC, Canada
| | - Alex Battaglini
- Centre de recherche des pratiques cliniques et organisationnelles du Centre intégré de santé et des services sociaux de Laval, Laval, Qc, Canada
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12
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Del Grande C, Kaczorowski J, Pomey MP. What are the top priorities of patients and clinicians for the organization of primary cardiovascular care in Quebec? A modified e-Delphi study. PLoS One 2023; 18:e0280051. [PMID: 36598919 DOI: 10.1371/journal.pone.0280051] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Cardiovascular diseases are the leading cause of death and disability worldwide. Little is known about the organizational priorities of patients and clinicians involved in primary cardiovascular care. This study aimed to identify their shared top priorities and explore on which aspects their perspectives differed. METHODS A three-round modified online Delphi study was carried out with patients and clinicians in seven academic primary care settings from metropolitan, suburban and small-town areas in Quebec, Canada. Patient partners experienced in the mobilization of their experiential knowledge also participated in the study. Following an "open" round, the items elicited were assessed by a combined rating and ranking approach. Items achieving an initial consensus level ≥70% were reassessed and then rank-ordered based on their final scores. Levels of consensus achieved among patients and clinicians were compared using Fisher's Exact tests. RESULTS Thirty panelists completed the study (9 clinic patients, 7 patient partners and 14 clinicians). Out of 41 organizational aspects generated, six top priorities were shared by patients and clinicians. These related to listening and tailoring care to each patient, provision of personalized information, rapid response in the event of a problem, keeping professional training up-to-date, and relational and informational continuity of care. Statistically significant differences were found between patients' and clinicians' perspectives regarding the importance of offering healthy lifestyle and prevention activities at the clinic (lower for patients), timely access to the treating physician (higher for patients), and effective collaboration with specialist physicians (higher for patients). CONCLUSION Although their views differ on some organizational aspects, patients and clinicians share a small set of top priorities for primary cardiovascular care that may be transferable to other chronic diseases. These top priorities should remain a central focus of clinical settings, alongside other primary care reform goals.
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Affiliation(s)
- Claudio Del Grande
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- School of Public Health, Université de Montréal, Montreal, Quebec, Canada
| | - Janusz Kaczorowski
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Pascale Pomey
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- School of Public Health, Université de Montréal, Montreal, Quebec, Canada
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13
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Sourial N, Kaczorowski J, Quesnel-Vallee A, Lussier MT, Khanassov V, Develay E, Layani G, Godard-Sebillotte C, Adams A, Authier M, Beauchet O, Motulsky A, Archambault P. Evaluation of a Virtual Pre-Consultation Tool for Older Adults in Primary Care: Results from a Randomized Trial. Clinical trial 2023. [PMID: 37023251 DOI: 10.1370/afm.21.s1.3887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Context: Virtual pre-consultation screening of patient needs may offer opportunities to improve the care and health outcomes of older patients in primary care, especially those with multiple care needs. Objective: We sought to implement and evaluate the effectiveness of a multidimensional virtual pre-consultation tool in the primary care setting to support rapid and standardized needs assessment for older persons. Study Design and Analysis: Pragmatic, multi-center, 1:1 individually randomized trial design. Implementation was conducted using a participatory approach over a 3-month period. Baseline and 3-month follow-up data were collected through phone-based questionnaires. An intention-to-treat analysis was carried out. Setting: Four university-affiliated interprofessional primary care clinics, two clinics in one urban region (Montreal) and two in one rural region (Abitibi) in Quebec, Canada. Population Studied: Patients 65 years and older with a consultation with a primary care provider (physician, nurse, social worker, other) during the implementation period in one of the participating clinics. Intervention: A virtual pre-consultation tool, ESOGER, was administered as a phone-based questionnaire by a member of the clinic staff to eligible patients prior to their consultation with the primary care provider. The ESOGER tool provides a general assessment of the physical, social, mental and cognitive health needs of older adults and produces a summary report available to clinicians at the time of consultation. Outcome Measures: The primary endpoint consisted of the EQ-5D quality of life score at 3-month follow-up. Secondary endpoints were unplanned primary care visits, visits to the ED and hospital admissions in last 3 months. Results: Of the 659 eligible patients contacted to date, 345 (52.3%) agreed to participate and have been randomized. Follow-up assessments are ongoing with a loss to follow-up of 22.8% and will be completed by August 2022. Final results of the intention-to-treat analysis will be presented overall and stratified by urban and rural sites. Conclusions: Intended consequences of this intervention include an increased responsiveness of consultations for providers resulting in improved care of older patients. Overall, we hope results will support the implementation of evidence-based, multidimensional and virtual pre-consultation tools for older persons in the primary care setting.
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14
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Norman WV, Darling E, Kaczorowski J, Dunn S, Schummers L, Law M, McGrail K. P031Mifepristone as a normal prescription rapidly increased rural and urban providers. Contraception 2022. [DOI: 10.1016/j.contraception.2022.09.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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15
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Peiris RG, Ross H, Chan CT, Poon S, Auguste BL, Rac VE, Farkouh M, McDonald M, Kaczorowski J, Code J, Duero Posada J, Ong S, Kobulnik J, Tomlinson G, Huszti E, Arcand J, Thomas SG, Akbari A, Maunder R, Grover S, Seto E, Simard A, Pope B, Bains M, McIntyre C, Torbay C, Syed F, Nolan RP. Automated digital counselling with social network support as a novel intervention for patients with heart failure: protocol for randomised controlled trial. BMJ Open 2022; 12:e059635. [PMID: 36691152 PMCID: PMC9445232 DOI: 10.1136/bmjopen-2021-059635] [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] [Received: 04/19/2022] [Accepted: 07/25/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Heart failure (HF) symptoms improve through self-care, for which adherence remains low among patients despite the provision of education for these behaviours by clinical teams. Open Access Digital Community Promoting Self-Care, Peer Support and Health Literacy (ODYSSEE-vCHAT) combines automated digital counselling with social network support to improve mortality and morbidity, engagement with self-care materials, and health-related quality of life. METHODS AND ANALYSIS Use of ODYSSEE-vCHAT via Internet-connected personal computer by 162 HF patients will be compared with a control condition over 22 months. The primary outcome is a composite index score of all-cause mortality, all-cause emergency department visits, and HF-related hospitalisation at trial completion. Secondary outcomes include individual components of the composite index, engagement with self-care materials, and patient-reported measures of physical and psychosocial well-being, disease management, health literacy, and substance use. Patients are recruited from tertiary care hospitals in Toronto, Canada and randomised on a 1:1 ratio to both arms of the trial. Online assessments occur at baseline (t=0), months 4, 8 and 12, and trial completion. Ordinal logistic regression analyses and generalised linear models will evaluate primary and secondary outcomes. ETHICS AND DISSEMINATION The trial has been approved by the research ethics boards at the University Health Network (20-5960), Sunnybrook Hospital (5117), and Mount Sinai Hospital (21-022-E). Informed consent of eligible patients occurs in person or online. Findings will be shared with key stakeholders and the public. Results will allow for the preparation of a Canada-wide phase III trial to evaluate the efficacy of ODYSSEE-vCHAT in improving clinical outcomes and raising the standard of outpatient care. TRIAL REGISTRATION NUMBER NCT04966104.
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Affiliation(s)
- Rachel Grace Peiris
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Heather Ross
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
- Division of Cardiology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Christopher T Chan
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
- Division of Nephrology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Stephanie Poon
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
- Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Bourne Lewis Auguste
- Division of Nephrology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Valeria E Rac
- Institute of Health Policy, Management, and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | - Michael Farkouh
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
- Peter Munk Centre of Excellence in Multinational Clinical Trials, University Health Network, Toronto, Ontario, Canada
| | - Michael McDonald
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, University of Montreal Faculty of Medicine, Montreal, Quebec, Canada
| | - Jillianne Code
- Department of Curriculum and Pedagogy, University of British Columbia, Vancouver, British Columbia, Canada
- HeartLife Foundation, Vancouver, British Columbia, Canada
| | - Juan Duero Posada
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
| | - Stephanie Ong
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Jeremy Kobulnik
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
- Division of Cardiology, Sinai Health System, Toronto, Ontario, Canada
| | - George Tomlinson
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
- Division of Biostatistics, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Ella Huszti
- Institute of Health Policy, Management, and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - JoAnne Arcand
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Scott G Thomas
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Ayub Akbari
- Division of Nephrology, Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robert Maunder
- Department of Psychiatry, Sinai Health System, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Steven Grover
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Emily Seto
- Institute of Health Policy, Management, and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada
| | - Anne Simard
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | - Brad Pope
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Marc Bains
- HeartLife Foundation, Vancouver, British Columbia, Canada
| | - Carmen McIntyre
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Chris Torbay
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Fatima Syed
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Robert P Nolan
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Campbell NRC, Padwal R, Tsuyuki RT, Leung AA, Bell A, Kaczorowski J, Tobe SW. Ups and downs of hypertension control in Canada: critical factors and lessons learned. Rev Panam Salud Publica 2022; 46:e141. [PMID: 36071924 PMCID: PMC9440728 DOI: 10.26633/rpsp.2022.141] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022] Open
Abstract
As the leading risk for death, population control of increased blood pressure represents a major challenge for all countries of the Americas. In the early 1990’s, Canada had a hypertension control rate of 13%. The control rate increased to 68% in 2010, accompanied by a sharp decline in cardiovascular disease. The unprecedented improvement in hypertension control started around the year 2000 when a comprehensive program to implement annually updated hypertension treatment recommendations started. The program included a comprehensive monitoring system for hypertension control. After 2011, there was a marked decrease in emphasis on implementation and evaluation and the hypertension control rate declined, driven by a reduction in control in women from 69% to 49%. A coalition of health and scientific organizations formed in 2011 with a priority to develop advocacy positions for dietary policies to prevent and control hypertension. By 2015, the positions were adopted by most federal political parties, but implementation has been slow. This manuscript reviews key success factors and learnings. Some key success factors included having broad representation on the program steering committee, multidisciplinary engagement with substantive primary care involvement, unbiased up to date credible recommendations, development and active adaptation of education resources based on field experience, extensive implementation of primary care resources, annual review of the program and hypertension indicators and developing and emphasizing the few interventions important for hypertension control. Learnings included the need for having strong national and provincial government engagement and support, and retaining primary care organizations and clinicians in the implementation and evaluation.
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Affiliation(s)
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ross T. Tsuyuki
- Faculty of Pharmacology, University of Alberta, Edmonton, Canada
| | | | - Alan Bell
- Department of Family Medicine, University of Toronto, Toronto, Canada
| | - Janusz Kaczorowski
- Department of Family Medicine, University of Montreal and CRCHUM, Montreal, Canada
| | - Sheldon W Tobe
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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Renner RM, Ennis M, Contandriopoulos D, Guilbert E, Dunn S, Kaczorowski J, Darling EK, Albert A, Styffe C, Norman WV. Abortion services and providers in Canada in 2019: results of a national survey. CMAJ Open 2022; 10:E856-E864. [PMID: 36167421 PMCID: PMC9578753 DOI: 10.9778/cmajo.20210232] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Since 2016, abortion care has undergone several important changes, particularly related to the provision of medical abortion using mifepristone. We aimed to document characteristics of the abortion care workforce in Canada after the update of clinical practice guidelines of mifepristone use for medical abortion. METHODS We conducted a national, web-based, anonymized, bilingual (English/French) survey. We collected demographics and clinical care characteristics of physicians and nurse practitioners who provided abortion care in 2019. Between July and December 2020, we distributed the survey through professional organizations, including The College of Family Physicians of Canada and The Society of Obstetricians and Gynaecologists of Canada. We present descriptive statistics. RESULTS Overall, 465 respondents representing all 10 provinces and 3 territories in Canada completed the survey. Of these, 388 (83.4%), including 30 nurse practitioners, provided first-trimester medical abortion, of which 350 (99.4%) used mifepristone. Two hundred and nineteen (47.1%) respondents provided first-trimester surgical abortion, 109 (23.4%) provided second-trimester surgical abortion and 115 (24.7%) provided second- or third-trimester medical abortion. Half of respondents reported fewer than 5 years of experience with any abortion care. Respondents reported providing a total of 48 509 abortions in 2019, including 32 345 (66.7%) first-trimester surgical abortions and 13 429 (27.7%) first-trimester medical abortions. In Quebec, only 1918 (12.5%) of reported abortions were first-trimester medical abortions. Primary care providers provided 34 540 (71.2%) of the total abortions. First-trimester medical abortions represented 44.4% (n = 2334) of all abortions in rural areas, as opposed to 25.6% (n = 11 067) in urban areas. INTERPRETATION The increased availability of medical abortion facilitates abortion access, especially in primary care and rural settings, and where surgical abortion is not available. Rejuvenation of the workforce is a critical contributor to equitable access to abortion services.
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Affiliation(s)
- Regina M Renner
- Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Québec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
| | - Madeleine Ennis
- Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Québec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
| | - Damien Contandriopoulos
- Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Québec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
| | - Edith Guilbert
- Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Québec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
| | - Sheila Dunn
- Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Québec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
| | - Janusz Kaczorowski
- Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Québec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth K Darling
- Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Québec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
| | - Arianne Albert
- Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Québec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
| | - Claire Styffe
- Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Québec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
| | - Wendy V Norman
- Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Québec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
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Norman W, Darling E, Dunn S, Law M, Kaczorowski J, Schummers L, McGrail K. Mifepristone’s Effect on the Abortion Workforce and Rural Services in Ontario. Journal of Obstetrics and Gynaecology Canada 2022. [DOI: 10.1016/j.jogc.2022.02.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schummers L, McGrail K, Darling EK, Dunn S, Gayowsky A, Kaczorowski J, Norman WV. A more accurate approach to define abortion cohorts using linked administrative data: an application to Ontario, Canada. Int J Popul Data Sci 2022; 7:1700. [PMID: 37650033 PMCID: PMC10464872 DOI: 10.23889/ijpds.v7i1.1700] [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] [Indexed: 10/18/2022] Open
Abstract
Background The shifting landscape of abortion care from a hospital-only to a distributed service including primary care has implications for how to identify abortion cohorts for research and surveillance. The objectives of this study were to 1) create an improved approach to define abortion cohorts using linked administrative data sets and 2) evaluate the performance of this approach for abortion surveillance compared with standard approaches. Methods We applied four principles to identify induced abortion cohorts when some services are delivered beyond hospital settings; 1) exclude early pregnancy losses and postpartum procedures; 2) use multiple data sources; 3) define episodes of care; 4) apply a hierarchical algorithm to determine abortion date to a population-based cohort of all abortion events in Ontario (Canada) from January 1, 2018-March 15, 2020. We calculated risk differences (RD, with 95% confidence intervals) comparing the proportion of medication vs. surgical, first vs. second trimester, and complication incidence applying these principles vs. standard approaches. Results Hospital-only data (versus multiple data sources) underestimated the frequency of medication abortion (16.1% vs. 31.4%; RD -15.3% [-14.3, -16.3]) and first-trimester abortion (82.1% vs. 94.5%; RD -12.8 [-11.4, 13.4]) and overestimated incidence of abortion complication (2.9% vs. 0.69%; RD 2.2% [1.8, 2.7]). An unlinked (versus linked) approach underestimated the frequency of abortion complications (0.19% vs 0.69%, -RD 0.50% [-0.44--0.56]). Including (versus excluding) abortions following early pregnancy loss or delivery events increased the estimated incidence of abortion complications (1.29% vs. 0.69%, RD 0.60% [0.51-0.69]. Conclusion New methods are required to accurately identify abortion cohorts for surveillance or research. When legal or regulatory approaches to medication abortion evolve to enable abortion in primary care or office-based settings, hospital-based surveillance systems will become incomplete and biased; to continue valid and complete abortion surveillance, methods must be adjusted to ensure complete capture of procedures across all settings.
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Affiliation(s)
- Laura Schummers
- Department of Family Practice, University of British Columbia
- Institute for Clinical Evaluative Sciences (ICES) McMaster
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia
| | - Elizabeth K Darling
- Institute for Clinical Evaluative Sciences (ICES) McMaster
- Department of Obstetrics & Gynecology, McMaster University
| | - Sheila Dunn
- Department of Family & Community Medicine, University of Toronto
- Women’s College Research Institute, Women’s College Hospital, Toronto
| | | | | | - Wendy V. Norman
- Department of Family Practice, University of British Columbia
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine
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20
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Schummers L, Darling EK, Dunn S, McGrail K, Gayowsky A, Law MR, Laba TL, Kaczorowski J, Norman WV. Abortion Safety and Use with Normally Prescribed Mifepristone in Canada. N Engl J Med 2022; 386:57-67. [PMID: 34879191 DOI: 10.1056/nejmsa2109779] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In the United States, mifepristone is available for medical abortion (for use with misoprostol) only with Risk Evaluation and Mitigation Strategy (REMS) restrictions, despite an absence of evidence to support such restrictions. Mifepristone has been available in Canada with a normal prescription since November 2017. METHODS Using population-based administrative data from Ontario, Canada, we examined abortion use, safety, and effectiveness using an interrupted time-series analysis comparing trends in incidence before mifepristone was available (January 2012 through December 2016) with trends after its availability without restrictions (November 7, 2017, through March 15, 2020). RESULTS A total of 195,183 abortions were performed before mifepristone was available and 84,032 after its availability without restrictions. After the availability of mifepristone with a normal prescription, the abortion rate continued to decline, although more slowly than was expected on the basis of trends before mifepristone had been available (adjusted risk difference in time-series analysis, 1.2 per 1000 female residents between 15 and 49 years of age; 95% confidence interval [CI], 1.1 to 1.4), whereas the percentage of abortions provided as medical procedures increased from 2.2% to 31.4% (adjusted risk difference, 28.8 percentage points; 95% CI, 28.0 to 29.7). There were no material changes between the period before mifepristone was available and the nonrestricted period in the incidence of severe adverse events (0.03% vs. 0.04%; adjusted risk difference, 0.01 percentage points; 95% CI, -0.06 to 0.03), complications (0.74% vs. 0.69%; adjusted risk difference, 0.06 percentage points; 95% CI, -0.07 to 0.18), or ectopic pregnancy detected after abortion (0.15% vs. 0.22%; adjusted risk difference, -0.03 percentage points; 95% CI, -0.19 to 0.09). There was a small increase in ongoing intrauterine pregnancy continuing to delivery (adjusted risk difference, 0.08 percentage points; 95% CI, 0.04 to 0.10). CONCLUSIONS After mifepristone became available as a normal prescription, the abortion rate remained relatively stable, the proportion of abortions provided by medication increased rapidly, and adverse events and complications remained stable, as compared with the period when mifepristone was unavailable. (Funded by the Canadian Institutes of Health Research and the Women's Health Research Institute.).
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Affiliation(s)
- Laura Schummers
- From the Department of Family Practice (L.S., W.V.N.) and the Centre for Health Services and Policy Research, School of Population and Public Health (K.M., M.R.L.), University of British Columbia, Vancouver, ICES (L.S., E.K.D., A.G.) and the Department of Obstetrics and Gynecology (E.K.D.), McMaster University, Hamilton, ON, the Department of Family and Community Medicine, University of Toronto, and the Women's College Research Institute, Women's College Hospital, Toronto (S.D.), and the Department of Family and Emergency Medicine, University of Montreal, Montreal (J.K.) - all in Canada; the Centre for Health Economics Research and Evaluation, University of Technology, Sydney (T.-L.L.); and the Department of Public Health, Environments, and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London (W.V.N.)
| | - Elizabeth K Darling
- From the Department of Family Practice (L.S., W.V.N.) and the Centre for Health Services and Policy Research, School of Population and Public Health (K.M., M.R.L.), University of British Columbia, Vancouver, ICES (L.S., E.K.D., A.G.) and the Department of Obstetrics and Gynecology (E.K.D.), McMaster University, Hamilton, ON, the Department of Family and Community Medicine, University of Toronto, and the Women's College Research Institute, Women's College Hospital, Toronto (S.D.), and the Department of Family and Emergency Medicine, University of Montreal, Montreal (J.K.) - all in Canada; the Centre for Health Economics Research and Evaluation, University of Technology, Sydney (T.-L.L.); and the Department of Public Health, Environments, and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London (W.V.N.)
| | - Sheila Dunn
- From the Department of Family Practice (L.S., W.V.N.) and the Centre for Health Services and Policy Research, School of Population and Public Health (K.M., M.R.L.), University of British Columbia, Vancouver, ICES (L.S., E.K.D., A.G.) and the Department of Obstetrics and Gynecology (E.K.D.), McMaster University, Hamilton, ON, the Department of Family and Community Medicine, University of Toronto, and the Women's College Research Institute, Women's College Hospital, Toronto (S.D.), and the Department of Family and Emergency Medicine, University of Montreal, Montreal (J.K.) - all in Canada; the Centre for Health Economics Research and Evaluation, University of Technology, Sydney (T.-L.L.); and the Department of Public Health, Environments, and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London (W.V.N.)
| | - Kimberlyn McGrail
- From the Department of Family Practice (L.S., W.V.N.) and the Centre for Health Services and Policy Research, School of Population and Public Health (K.M., M.R.L.), University of British Columbia, Vancouver, ICES (L.S., E.K.D., A.G.) and the Department of Obstetrics and Gynecology (E.K.D.), McMaster University, Hamilton, ON, the Department of Family and Community Medicine, University of Toronto, and the Women's College Research Institute, Women's College Hospital, Toronto (S.D.), and the Department of Family and Emergency Medicine, University of Montreal, Montreal (J.K.) - all in Canada; the Centre for Health Economics Research and Evaluation, University of Technology, Sydney (T.-L.L.); and the Department of Public Health, Environments, and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London (W.V.N.)
| | - Anastasia Gayowsky
- From the Department of Family Practice (L.S., W.V.N.) and the Centre for Health Services and Policy Research, School of Population and Public Health (K.M., M.R.L.), University of British Columbia, Vancouver, ICES (L.S., E.K.D., A.G.) and the Department of Obstetrics and Gynecology (E.K.D.), McMaster University, Hamilton, ON, the Department of Family and Community Medicine, University of Toronto, and the Women's College Research Institute, Women's College Hospital, Toronto (S.D.), and the Department of Family and Emergency Medicine, University of Montreal, Montreal (J.K.) - all in Canada; the Centre for Health Economics Research and Evaluation, University of Technology, Sydney (T.-L.L.); and the Department of Public Health, Environments, and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London (W.V.N.)
| | - Michael R Law
- From the Department of Family Practice (L.S., W.V.N.) and the Centre for Health Services and Policy Research, School of Population and Public Health (K.M., M.R.L.), University of British Columbia, Vancouver, ICES (L.S., E.K.D., A.G.) and the Department of Obstetrics and Gynecology (E.K.D.), McMaster University, Hamilton, ON, the Department of Family and Community Medicine, University of Toronto, and the Women's College Research Institute, Women's College Hospital, Toronto (S.D.), and the Department of Family and Emergency Medicine, University of Montreal, Montreal (J.K.) - all in Canada; the Centre for Health Economics Research and Evaluation, University of Technology, Sydney (T.-L.L.); and the Department of Public Health, Environments, and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London (W.V.N.)
| | - Tracey-Lea Laba
- From the Department of Family Practice (L.S., W.V.N.) and the Centre for Health Services and Policy Research, School of Population and Public Health (K.M., M.R.L.), University of British Columbia, Vancouver, ICES (L.S., E.K.D., A.G.) and the Department of Obstetrics and Gynecology (E.K.D.), McMaster University, Hamilton, ON, the Department of Family and Community Medicine, University of Toronto, and the Women's College Research Institute, Women's College Hospital, Toronto (S.D.), and the Department of Family and Emergency Medicine, University of Montreal, Montreal (J.K.) - all in Canada; the Centre for Health Economics Research and Evaluation, University of Technology, Sydney (T.-L.L.); and the Department of Public Health, Environments, and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London (W.V.N.)
| | - Janusz Kaczorowski
- From the Department of Family Practice (L.S., W.V.N.) and the Centre for Health Services and Policy Research, School of Population and Public Health (K.M., M.R.L.), University of British Columbia, Vancouver, ICES (L.S., E.K.D., A.G.) and the Department of Obstetrics and Gynecology (E.K.D.), McMaster University, Hamilton, ON, the Department of Family and Community Medicine, University of Toronto, and the Women's College Research Institute, Women's College Hospital, Toronto (S.D.), and the Department of Family and Emergency Medicine, University of Montreal, Montreal (J.K.) - all in Canada; the Centre for Health Economics Research and Evaluation, University of Technology, Sydney (T.-L.L.); and the Department of Public Health, Environments, and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London (W.V.N.)
| | - Wendy V Norman
- From the Department of Family Practice (L.S., W.V.N.) and the Centre for Health Services and Policy Research, School of Population and Public Health (K.M., M.R.L.), University of British Columbia, Vancouver, ICES (L.S., E.K.D., A.G.) and the Department of Obstetrics and Gynecology (E.K.D.), McMaster University, Hamilton, ON, the Department of Family and Community Medicine, University of Toronto, and the Women's College Research Institute, Women's College Hospital, Toronto (S.D.), and the Department of Family and Emergency Medicine, University of Montreal, Montreal (J.K.) - all in Canada; the Centre for Health Economics Research and Evaluation, University of Technology, Sydney (T.-L.L.); and the Department of Public Health, Environments, and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London (W.V.N.)
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Breton M, Deville-Stoetzel N, Gaboury I, Smithman MA, Kaczorowski J, Lussier MT, Haggerty J, Motulsky A, Nugus P, Layani G, Paré G, Evoy G, Arsenault M, Paquette JS, Quinty J, Authier M, Mokraoui N, Luc M, Lavoie ME. Telehealth in Primary Healthcare: A Portrait of its Rapid Implementation during the COVID-19 Pandemic. Healthc Policy 2021; 17:73-90. [PMID: 34543178 PMCID: PMC8437249 DOI: 10.12927/hcpol.2021.26576] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This study documents the adoption of telehealth by various types of primary healthcare (PHC) providers working in teaching PHC clinics in Quebec during the COVID-19 pandemic. It also identifies the perceived advantages and disadvantages of telehealth. METHOD A cross-sectional study was conducted between May and August 2020. The e-survey was completed by 48/50 teaching primary care clinics representing 603/1,357 (44%) PHC providers. RESULTS Telephone use increased the most, becoming the principal virtual modality of consultation, during the pandemic. Video consultations increased, with variations by type of PHC provider: between 2% and 16% reported using it "sometimes." The main perceived advantages of telehealth were minimizing the patient's need to travel, improved efficiency and reduction in infection transmission risk. The main disadvantages were the lack of physical exam and difficulties connecting with some patients. CONCLUSION The variation in telehealth adoption by type of PHC provider may inform strategies to maximize the potential of telehealth and help create guidelines for its use in more normal times.
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Affiliation(s)
- Mylaine Breton
- Associate Professor, Department of Community Health Sciences, Université de Sherbrooke Longueuil, QC
| | - Nadia Deville-Stoetzel
- Research Professional, Université de Sherbrooke, Longueuil, QC; Doctoral Student, Department of Sociology, Université du Québec à Montréal, Montréal, QC
| | - Isabelle Gaboury
- Professor, Department of Family and Emergency Medicine, Université de Sherbrooke, Longueuil, QC
| | - Mélanie Ann Smithman
- Doctoral Student, Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, QC
| | - Janusz Kaczorowski
- Professor, Department of Family and Emergency Medicine, Université de Montréal, Montréal, QC
| | - Marie-Thérèse Lussier
- Director, Réseau de recherche en soins primaires de l'Université de Montréal (RRSPUM); Professor, Department of Family and Emergency Medicine, Université de Montréal, Montréal, QC
| | - Jeannie Haggerty
- Professor, Department of Family Medicine, McGill University, Montreal, QC
| | - Aude Motulsky
- Adjunct Professor, Department of Management Evaluation and Health Policy, School of Public Health of the Université de Montréal, Montréal, QC
| | - Peter Nugus
- Associate Professor, Department of Family Medicine, McGill University, Montreal, QC
| | - Géraldine Layani
- Clinical Adjunct Professor, Department of Family and Emergency Medicine, Université de Montréal, Montréal, QC
| | - Guy Paré
- Professor, Department of Information Technologies, HEC Montréal, Montréal, QC
| | - Gabrielle Evoy
- Student of Medicine, Université de Sherbrooke, Sherbrooke, QC
| | - Mylène Arsenault
- Family Physician, UFM-G Herzl Family Practice Centre; Assistant Professor, Department of Family Medicine, McGill University, Montreal, QC
| | - Jean-Sébastien Paquette
- Co-Director, Réseau de recherche axé sur les pratiques de première ligne de l'Université Laval; Associate Clinical Professor, Département médecine familiale et de médecine d'urgence (DMFMU), Université Laval, Québec City, QC
| | - Julien Quinty
- Adjunct Professor, Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, QC
| | - Marie Authier
- Research Facilitator, Réseau de recherche en soins primaires de l'Université de Montréal (RRSPUM), Montreal, QC
| | - Nadjib Mokraoui
- Research Facilitator and Coordinator, McGill Practice-Based Research Network (PBRN), Montreal, QC
| | - Mireille Luc
- Deputy Director, Department of Family and Emergency Medicine, Practice-Based Research Network, Université de Sherbrooke, Sherbrooke, QC
| | - Marie-Eve Lavoie
- Scientific Coordinator and Research Facilitator, Réseau de recherche en soins primaires de l'Université de Montréal (RRSPUM), Montreal, QC
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22
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Grad R, Leger D, Kaczorowski J, Schuster T, Adler S, Aman M, Archibald D, Beaulieu MC, Chmelicek J, Cornelissen E, Delleman B, Hadj-Mimoune S, Horvey S, Macaluso S, Mintsioulis S, Murdoch S, Ng B, Papineau A, Rangwala S, Rousseau M, Rudkin T, Schabort I, Schultz K, Snow P, Wong E, Wu P, Brailovsky C. Does spaced education improve clinical knowledge among Family Medicine residents? A cluster randomized controlled trial. Adv Health Sci Educ Theory Pract 2021; 26:771-783. [PMID: 33389233 PMCID: PMC8338813 DOI: 10.1007/s10459-020-10020-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] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 12/14/2020] [Indexed: 06/12/2023]
Abstract
UNLABELLED Spaced education is a learning strategy to improve knowledge acquisition and retention. To date, no robust evidence exists to support the utility of spaced education in the Family Medicine residency. We aimed to test whether alerts to encourage spaced education can improve clinical knowledge as measured by scores on the Canadian Family Medicine certification examination. METHOD We conducted a cluster randomized controlled trial to empirically and pragmatically test spaced education using two versions of the Family Medicine Study Guide mobile app. 12 residency training programs in Canada agreed to participate. At six intervention sites, we consented 335 of the 654 (51%) eligible residents. Residents in the intervention group were sent alerts through the app to encourage the answering of questions linked to clinical cases. At six control sites, 299 of 586 (51%) residents consented. Residents in the control group received the same app but with no alerts. Incidence rates of case completion between trial arms were compared using repeated measures analysis. We linked residents in both trial arms to their knowledge scores on the certification examination of the College of Family Physicians of Canada. RESULTS Over 67 weeks, there was no statistically significant difference in the completion of clinical cases by participants. The difference in mean exam scores and the associated confidence interval did not exceed the pre-defined limit of 4 percentage points. CONCLUSION Further research is recommended before deploying spaced educational interventions in the Family Medicine residency to improve knowledge.
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Affiliation(s)
- Roland Grad
- Herzl Family Practice Centre, McGill University, 3755 Cote Ste Catherine Road, Montreal, H3T 1E2, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Brian Ng
- University of British Columbia, Vancouver, Canada
| | | | | | | | - Teresa Rudkin
- Family Medicine, McGill University, Montreal, Canada
| | | | | | - Pamela Snow
- Memorial University of Newfoundland, St. John's, Canada
| | | | - Pearson Wu
- Herzl Family Practice Centre, McGill University, 3755 Cote Ste Catherine Road, Montreal, H3T 1E2, Canada
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23
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Galarneau LR, Hilburt J, O’Neill ZR, Buxton JA, Scheuermeyer FX, Dong K, Kaczorowski J, Orkin AM, Barbic SP, Bath M, Moe J, Miles I, Tobin D, Grier S, Garrod E, Kestler A. Experiences of people with opioid use disorder during the COVID-19 pandemic: A qualitative study. PLoS One 2021; 16:e0255396. [PMID: 34324589 PMCID: PMC8320992 DOI: 10.1371/journal.pone.0255396] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/15/2021] [Indexed: 12/24/2022] Open
Abstract
AIM To capture pandemic experiences of people with opioid use disorder (OUD) to better inform the programs that serve them. DESIGN We designed, conducted, and analyzed semi-structured qualitative interviews using grounded theory. We conducted interviews until theme saturation was reached and we iteratively developed a codebook of emerging themes. Individuals with lived experience of substance use provided feedback at all steps of the study. SETTING We conducted phone or in-person interviews in compliance with physical distancing and public health regulations in outdoor Vancouver parks or well-ventilated indoor spaces between June to September 2020. PARTICIPANTS Using purposive sampling, we recruited participants (n = 19) who were individuals with OUD enrolled in an intensive community outreach program, had visited one of two emergency departments, were over 18, lived within catchment, and were not already receiving opioid agonist therapy. MEASUREMENTS We audio-recorded interviews, which were later transcribed verbatim and checked for accuracy while removing all identifiers. Interviews explored participants' knowledge of COVID-19 and related safety measures, changes to drug use and healthcare services, and community impacts of COVID-19. RESULTS One third of participants were women, approximately two thirds had stable housing, and ages ranged between 23 and 59 years old. Participants were knowledgeable on COVID-19 public health measures. Some participants noted that fear decreased social connection and reluctance to help reverse overdoses; others expressed pride in community cohesion during crisis. Several participants mentioned decreased access to housing, harm reduction, and medical care services. Several participants reported using drugs alone more frequently, consuming different or fewer drugs because of supply shortages, or using more drugs to replace lost activities. CONCLUSION COVID-19 had profound effects on the social lives, access to services, and risk-taking behaviour of people with opioid use disorder. Pandemic public health measures must include risk mitigation strategies to maintain access to critical opioid-related services.
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Affiliation(s)
- Lexis R. Galarneau
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- * E-mail: (LG); (AK)
| | - Jesse Hilburt
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Zoe R. O’Neill
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Jane A. Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Frank X. Scheuermeyer
- Department of Emergency Medicine, St Paul’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, University of Montréal, and Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
| | - Aaron M. Orkin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Inner City Health Associates, Toronto, Ontario, Canada
| | - Skye Pamela Barbic
- Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Misty Bath
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Jessica Moe
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columba, Canada
| | - Isabelle Miles
- Department of Emergency Medicine, St Paul’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Dianne Tobin
- Vancouver Area Network of Drug Users, Vancouver, British Columbia, Canada
| | - Sherry Grier
- Portland Hotel Society Community Services Society, Vancouver, British Columbia, Canada
| | - Emma Garrod
- Providence Health Care, Vancouver, British Columbia, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Andrew Kestler
- Department of Emergency Medicine, St Paul’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- * E-mail: (LG); (AK)
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24
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Lussier MT, Kaczorowski J, Girard M, Arpin E. Volunteer engagement to inform research on cardiovascular health awareness, Canada. Health Promot Int 2021; 35:1570-1576. [PMID: 32191301 DOI: 10.1093/heapro/daaa015] [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] [Indexed: 11/12/2022] Open
Abstract
Volunteers have been extensively used in health promotion programmes. However, they have been less frequently involved in the research process. In its most recent iterations, the Cardiovascular Health Awareness Program (CHAP) integrated volunteers (i) to facilitate CHAP sessions with participating patients for data collection and (ii) to evaluate the intervention. Drawing on the patient and public involvement literature, our research team included volunteers in the data collection and evaluation of CHAP sessions as part of the programme's implementation in the province of Quebec (Canada). We sought volunteers' formal feedback through individual online and phone interviews and through focus groups for each of the four projects conducted in Quebec. We found that volunteers provide valuable insight on the research protocol as well as patient needs. Their feedback led to several modifications to the research protocol and procedures of subsequent CHAP sessions. Changes included involving volunteers at earlier stages of the research process, adding more learning modules and practice sessions during the volunteer training and defining research priorities according to patient needs. Our methodology of engaging volunteers in the research process was useful to gain important and unique insight on patient needs and for future programme planning to modify the research process.
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Affiliation(s)
- Marie-Thérèse Lussier
- Équipe de recherche en soins de première ligne, Centre intégré de santé et de services sociaux de Laval, Laval, Canada.,Département de Médecine de Famille et de Médecine d'Urgence, Faculté de médecine, Université de Montréal, Montréal, Canada
| | - Janusz Kaczorowski
- Département de Médecine de Famille et de Médecine d'Urgence, Faculté de médecine, Université de Montréal, Montréal, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Magali Girard
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Emmanuelle Arpin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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25
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Kestler A, Kaczorowski J, Dong K, Orkin AM, Daoust R, Moe J, Van Pelt K, Andolfatto G, Klaiman M, Yan J, Koh JJ, Crowder K, Webster D, Atkinson P, Savage D, Stempien J, Besserer F, Wale J, Lam A, Scheueremeyer F. A cross-sectional survey on buprenorphine-naloxone practice and attitudes in 22 Canadian emergency physician groups: a cross-sectional survey. CMAJ Open 2021; 9:E864-E873. [PMID: 34548331 PMCID: PMC8476213 DOI: 10.9778/cmajo.20200190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Buprenorphine-naloxone (BUP) initiation in emergency departments improves follow-up and survival among patients with opioid use disorder. We aimed to assess self-reported BUP-related practices and attitudes among emergency physicians. METHODS We designed a cross-sectional physician survey by adapting a validated questionnaire on opioid harm reduction practices, attitudes and barriers. We recruited physician leads from 6 Canadian provinces to administer surveys to the staff physicians in their emergency department groups between December 2018 and November 2019. We included academic and community non-locum emergency department staff physicians. We excluded responses from emergency department groups with response rates less than 50% to minimize nonresponse bias. Primary (BUP prescribing practices) and secondary (willingness and attitudes) outcomes were analyzed using descriptive statistics. RESULTS After excluding 1 group for low response (9/26 physicians), 652 of 798 (81.7%) physicians responded from 22 groups serving 34 emergency departments. Among respondents, 64.1% (95% confidence interval [CI] 60.4%-67.8%, emergency department group range 7.1%-100.0%) had prescribed BUP at least once in their career, 38.4% had prescribed it for home initiation and 24.8% prescribed it at least once a month. Overall, 68.9% (95% CI 65.3%-72.4%, emergency department group range 24.1%-97.6%) were willing to administer BUP, 64.2% felt it was a major responsibility and 37.1% felt they understood people who use drugs. Respondents most frequently rated lack of adequate training (58.2%) and lack of time (55.2%) as very important barriers to BUP initiation. INTERPRETATION Two-thirds of the emergency physicians surveyed prescribed BUP, although only one-quarter did so regularly and one-third prescribed it for home initiation; wide variation between emergency department groups existed. Strategies to increase BUP initiation must address physicians' lack of time and training for BUP initiation and improve their understanding of people who use drugs.
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Affiliation(s)
- Andrew Kestler
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que.
| | - Janusz Kaczorowski
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Kathryn Dong
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Aaron M Orkin
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Raoul Daoust
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Jessica Moe
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Kelsey Van Pelt
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Gary Andolfatto
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Michelle Klaiman
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Justin Yan
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Justin J Koh
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Kathryn Crowder
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Devon Webster
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Paul Atkinson
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - David Savage
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - James Stempien
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Floyd Besserer
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Jason Wale
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Alice Lam
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
| | - Frank Scheueremeyer
- Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que
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Kaczorowski J, Lussier MT, Girard M, Beaulieu-Carbonneau A. Implementation of Modified Cardiovascular Health Awareness Program for Canadian Adults on a Waiting List for a Family Physician. J Prim Care Community Health 2021; 11:2150132720976484. [PMID: 33243046 PMCID: PMC7708698 DOI: 10.1177/2150132720976484] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION The Cardiovascular Health Awareness Program (CHAP) was originally developed and evaluated as a community-based cardiovascular diseases (CVD) prevention program in communities where access to family physicians was not a significant issue. Many Canadians now face sub-optimal access to a regular source of primary care. Centralized waiting lists and prioritization based on urgency of medical need were created to address this problem. We aimed to assess the acceptability, CVD risk profile, and potential benefits of offering a modified version of CHAP to adults on the waiting list. METHODS The implementation was conducted in Laval (Canada) between March and June 2016, targeting individuals 40 years of age or older who were registered on the waiting list (GACO) and had a priority code of 3. Participants were invited through a personalized letter to attend sessions in community health centers. During the sessions, participants completed CVD risk profiles, risk of type 2 diabetes questionnaire (CANRISK); had their blood pressure, height and weight as well as waist circumference measured. They also received targeted healthy lifestyle and patient education materials and were referred to local programs including a medical follow-up, when required. RESULTS A total of 1976 invitation letters were sent resulting in 281 (14.2%) participants. The average age of attendees was 58.1 (SD = 8.2) and a majority were female (58%, n = 163). A third of participants (34.2%, n = 96) had BP ≥140/90 and 11.4% (n = 32) were classified as having a very high risk for developing diabetes. Almost half (41.6%, n = 117) of participants were referred either to health promotion programs offered by local health authorities, to family physicians (4.6%, n = 13) or emergency departments (1.8%, n = 5) for short-term medical assistance. CONCLUSION Despite low participation rate, many adults on a waiting list had elevated risk for CVD and would greatly benefit from having a regular source of primary care.
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Affiliation(s)
- Janusz Kaczorowski
- University of Montreal, Montreal, QC, Canada.,CRCHUM, Montreal, QC, Canada
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Dong KA, Lavergne KJ, Salvalaggio G, Weber SM, Xue CJ, Kestler A, Kaczorowski J, Orkin AM, Pugh A, Hyshka E. Emergency physician perspectives on initiating buprenorphine/naloxone in the emergency department: A qualitative study. J Am Coll Emerg Physicians Open 2021; 2:e12409. [PMID: 33969340 PMCID: PMC8082712 DOI: 10.1002/emp2.12409] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Received: 11/26/2020] [Revised: 02/05/2021] [Accepted: 02/25/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The objective of this study was to examine the perspectives of Canadian emergency physicians on the care of patients with opioid use disorders in the emergency department (ED), in particular the real-world facilitators to prescribing buprenorphine/naloxone (BUP) in the ED. METHODS We conducted semistructured qualitative interviews using a multi-site-focused ethnographic design. Purposive sampling via an existing national research network was used to recruit ED physicians. Interviews were conducted by phone using an interview guide and continued until theoretical data saturation was reached. Interviews were transcribed and analyzed using latent content analysis. Interviews took place between June 21, 2019, and February 11, 2020. RESULTS A total of 32 physicians were included in the analysis. Participants had a median of 10 years of experience, and most (29/32) worked in urban settings. Clinical care of patients with opioid use disorder was found to be variable and physician dependent. Although some physicians reported routinely prescribing BUP, others felt that this was outside the clinical scope of emergency medicine. Access to clinical pathways, incentivized training, dedicated human resources, and follow-up care were identified as critical facilitators for supporting BUP prescribing. Participants also identified a shared responsibility between patients and the ED, including the importance of a patient-centered approach that enhanced patient autonomy. ED BUP prescribing became self-reinforcing over time. CONCLUSIONS Although there remains practice variability among Canadian emergency physicians, successful implementation of ED BUP prescribing has occurred in some locations. Jurisdictions wanting to facilitate BUP uptake should consider providing incentivized training, treatment protocols, dedicated human resources, and streamlined access to follow-up care.
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Affiliation(s)
- Kathryn A. Dong
- Department of Emergency MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Karine J. Lavergne
- School of Public HealthUniversity of AlbertaEdmontonAlbertaCanada
- Employment and Social Development CanadaGatineauQuébecCanada
| | | | | | - Cindy Jiaxin Xue
- Faculty of Medicine and DentistryUniversity of AlbertaEdmontonAlbertaCanada
| | - Andrew Kestler
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Janusz Kaczorowski
- Department of Family and Emergency MedicineUniversity of Montreal and University of Montreal Hospital Research CentreMontrealQuebecCanada
| | - Aaron M. Orkin
- Department of Family and Community MedicineUniversity of TorontoTorontoOntarioCanada
| | - Arlanna Pugh
- School of Public HealthUniversity of AlbertaEdmontonAlbertaCanada
- CASA Child, Adolescent and Family Mental HealthEdmontonAlbertaCanada
| | - Elaine Hyshka
- School of Public HealthUniversity of AlbertaEdmontonAlbertaCanada
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Affiliation(s)
- Janusz Kaczorowski
- Department of Family and Emergency Medicine, University of Montreal, Montreal, Canada; Centre de recherche, Centre hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada.
| | - Claudio Del Grande
- School of Public Health, University of Montreal, Montreal, Canada; Centre de recherche, Centre hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
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Girard M, Kaczorowski J, Lussier MT, Martin V. Attendance, activation and health profiles of participants, a prospective study on a regional cardiometabolic disease self-management program in Laval, Canada. BMC Public Health 2021; 21:497. [PMID: 33711973 PMCID: PMC7953555 DOI: 10.1186/s12889-021-10558-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 03/04/2021] [Indexed: 11/15/2022] Open
Abstract
Background Chronic diseases are responsible for over 70% of all deaths globally. While some self-management programs have been shown to be efficacious in preventing or altering trajectories for some chronic conditions, scaling-up and sustaining such programs beyond tightly-controlled study conditions remain a major challenge. CISSS-Laval partnered with the Cardiovascular Health Awareness Program team to co-develop Cible-santé/prévention and evaluate the first cohort of participants enrolled in the program, in order to better understand the program’s implementation and scope. The objective of the current study was to describe the profile of attendees and the level of engagement of participants in a new, region-wide cardiometabolic disease self-management program offered in Laval, Canada. Methods This was a prospective study with no comparison group. Potential participants were identified and referred to the program from April to December 2015 by their primary care health professional practicing in one of the city’s interdisciplinary primary care clinics. They had their blood pressure, waist circumference and body mass index measured by trained volunteers, and completed a questionnaire on health habits, level of activation and the risk of developing prediabetes and type 2 diabetes over the next 10 years. Results A descriptive analysis of the first cohort of 141 Cible-Santé/prévention participants showed very low attendance. Furthermore, only 1 in 10 of enrolled participants completed the full program. The program typically attracted adults with some risk factors associated with their conditions (high waist circumference, obesity), but with an already high level of knowledge, skills and confidence to participate in self-management activities. Conclusion This study provides a portrait of new participants to a self-management cardiometabolic disease program, which highlights the potential of supporting patients ready to make changes but also exposes the difficulty of attracting a larger number and diversity of participants and in encouraging completion of the program. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10558-6.
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Affiliation(s)
- Magali Girard
- University of Montreal Hospital Research Centre (CRCHUM), 850, rue St-Denis, Montreal, Canada.
| | - Janusz Kaczorowski
- University of Montreal Hospital Research Centre (CRCHUM), 850, rue St-Denis, Montreal, Canada.,Department of Family and Emergency Medicine, University of Montreal, Montreal, Canada
| | - Marie-Thérèse Lussier
- Department of Family and Emergency Medicine, University of Montreal, Montreal, Canada
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Dawes M, Beerman S, Gelfer M, Hobson B, Khan N, Kuyper L, Mangat B, Tran K, Wilson MG, Kaczorowski J. The challenges of measuring blood pressure during COVID-19: How to integrate and support home blood pressure measurements. Can Fam Physician 2021; 67:112-113. [PMID: 33608363 DOI: 10.46747/cfp.6702112] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Martin Dawes
- Martin Dawes, MD FRCGP, Professor of Family Medicine at the University of British Columbia in Vancouver and Chair of the British Columbia Guidelines and Protocols Advisory Committee (GPAC) hypertension guideline committee
| | - Stephen Beerman
- Stephen Beerman, MD FCFP, Member of the British Columbia GPAC hypertension guideline committee
| | - Mark Gelfer
- Mark Gelfer, MD FCFP, Member of the British Columbia GPAC hypertension guideline committee
| | - Bruce Hobson
- Bruce Hobson, MD, Member of the British Columbia GPAC hypertension guideline committee
| | - Nadia Khan
- Nadia Khan, MD FRCPC MSc, Professor of Medicine at the University of British Columbia and a member of the British Columbia GPAC hypertension guideline committee
| | - Laura Kuyper
- Laura Kuyper, MD, Clinical Assistant Professor and a member of the British Columbia GPAC hypertension guideline committee
| | - Birinder Mangat
- Birinder Mangat, MD MPH FRCPC, Clinical Assistant Professor at the University of British Columbia and a member of the British Columbia GPAC hypertension guideline committee
| | - Karen Tran
- Karen Tran, MD FRCPC, General internist in the Division of General Internal Medicine at the University of British Columbia and a member of the British Columbia GPAC hypertension guideline committee
| | - Marnie G Wilson
- Marnie G. Wilson, MD MSc FRCPC, General internist in the Division of Internal Medicine at the University of British Columbia and a member of the British Columbia GPAC hypertension guideline committee
| | - Janusz Kaczorowski
- Janusz Kaczorowski, PhD, Professor and Research Director in the Department of Family and Emergency Medicine at the University of Montreal and the Centre de recherche du CHUM in Montreal, Que
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Gelfer M, Bell A, Petrella R, Campbell NRC, Cloutier L, Lindsay P, Leung AA, Morris D, McLean D, Tsuyuki RT, Dattani S, Kaczorowski J. Response. Can Fam Physician 2021; 67:157. [PMID: 33727371 PMCID: PMC7963024 DOI: 10.46747/cfp.6703157] [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: 06/12/2023]
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Deville-Stoetzel N, Kaczorowski J, Agarwal G, Lussier MT, Girard M. Participation in the Cardiovascular Health Awareness Program (CHAP) by older adults residing in social housing in Quebec: Social network analysis. BMC Health Serv Res 2021; 21:37. [PMID: 33413324 PMCID: PMC7791708 DOI: 10.1186/s12913-020-06019-2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Cardiovascular Health Awareness Program (CHAP) is as a community-based cardiovascular disease prevention program recently adapted to target older adults living in 14 social housing buildings in Ontario (7) and Quebec (7). Social network analysis (SNA) has been used successfully to assess and strengthen participation in health promotion programs. We applied SNA methods to investigate whether interpersonal relationships among residents within buildings influenced their participation in CHAP. METHODS Our aim was to examine relational dynamics in two social housing buildings in Quebec with low and high CHAP attendance rates, respectively. We used sociometric questionnaires and network analysis for the quantitative phase of the study, supplemented by a phase of qualitative interviews. All residents of both buildings were eligible for the sociometric questionnaire. Respondents for the qualitative interviews were purposively selected to represent the different attendance situations following the principle of content saturation. RESULTS In total, 69 residents participated in the study, 37 through sociometric questionnaires and 32 in qualitative interviews. Of the latter, 10 attended almost all CHAP sessions, 10 attended once, and 12 attended none. Results of the quantitative analysis phase identified well-known and appreciated local leaders. In Building 1, which had a high attendance rate (34.3%), there was a main leader (in-degree or 'named by others' frequency 23.2%) who had attended all CHAP sessions. In Building 2, which had a low attendance rate (23.9%), none of the leaders had attended CHAP sessions. Results of the qualitative analysis phase showed that residents who did not attend CHAP sessions (or other activities in the building) generally preferred to avoid conflicts, vindictiveness, and gossip and did not want to get involved in clans and politics within their building. CONCLUSION We identified four potential strategies to increase attendance at CHAP sessions by residents of subsidized housing for older adults: strengthen confidentiality for those attending the sessions; use community peer networks to enhance recruitment; pair attendees to increase the likelihood of participation; and intervene through opinion leaders or bridging individuals.
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Affiliation(s)
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, University of Montreal, and University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, Canada.,Department of Health, Aging and Society, McMaster University, Hamilton, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
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Kaczorowski J, Bilodeau J, Orkin A, Dong K, Daoust R, Kestler A. Emergency Department-initiated Interventions for Patients With Opioid Use Disorder: A Systematic Review. Acad Emerg Med 2020; 27:1173-1182. [PMID: 32557932 DOI: 10.1111/acem.14054] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The opioid crisis has risen dramatically in North America in the new millennium, due to both illegal and prescription opioid use. While emergency departments (EDs) represent a potentially strategic setting for interventions to reduce harm from opioid use disorder (OUD), the absence of a recent synthesis of literature limits implementation and scalability. To fill this gap, we conducted a systematic review of the literature on interventions targeting OUDs initiated in EDs. METHODS Using an explicit search strategy (PROSPERO), the MEDLINE, CINAHL Complete, EMBASE, and EBM reviews databases were searched from 1980 to October 4, 2019. The gray literature was explored using Google Scholar. Study characteristics were abstracted independently. The methodologic quality and risk of bias were assessed. RESULTS Twelve of 2,270 studies met the inclusion criteria (two of high quality). In addition to the heterogeneity of the outcome measures used (retention in treatment, opioid consumption, and overdose), brief intervention and buprenorphine initiation (six of 12 studies) were the most documented with mixed effects for the former and positive short-term and confined to single ED sites effects for the latter. CONCLUSION Emergency departments can be an appropriate setting for initiating opioid agonist treatment, but to be sustained, it likely needs to be coupled with community-based follow-up and support to ensure longer-term retention. The scarcity of high-quality evidence on OUD interventions initiated in emergency settings highlights the need for future research.
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Affiliation(s)
- Janusz Kaczorowski
- From the Département de Médecine de Famille et Médecine d'Urgence Université de Montréal Montréal Québec Canada
- the Centre de recherche du centre hospitalier de l'Université de Montréal (CRCHUM) Université de Montréal Montréal Québec Canada
| | - Jaunathan Bilodeau
- the Centre de recherche du centre hospitalier de l'Université de Montréal (CRCHUM) Université de Montréal Montréal Québec Canada
| | - Aaron Orkin
- the Department of Family & Community Medicine University of Toronto Toronto Ontario Canada
| | - Kathryn Dong
- the Department of Emergency Medicine University of Alberta Edmonton Alberta Canada
| | - Raoul Daoust
- From the Département de Médecine de Famille et Médecine d'Urgence Université de Montréal Montréal Québec Canada
- the Centre de recherche de l’Hôpital Sacré‐Coeur de Montréal Montréal Québec Canada
| | - Andrew Kestler
- and the Department of Emergency Medicine University of British Columbia Vancouver British Columbia Canada
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Gelfer M, Bell A, Petrella R, Campbell NRC, Cloutier L, Lindsay P, Leung AA, Morris D, McLean D, Tsuyuki RT, Dattani S, Kaczorowski J. Take urgent action diagnosing, treating, and controlling hypertension in older women. Can Fam Physician 2020; 66:726-731. [PMID: 33077448 PMCID: PMC7571660] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Mark Gelfer
- Clinical Assistant Professor in the Department of Family Practice at the University of British Columbia and the Copeman Healthcare Centre in Vancouver
| | - Alan Bell
- Assistant Professor in the Department of Family and Community Medicine at the University of Toronto in Ontario
| | - Robert Petrella
- Professor in and Head of the Department of Family Practice at the University of British Columbia
| | - Norm R C Campbell
- Emeritus Professor in the Department of Medicine, the Department of Physiology and Pharmacology, and the Department of Community Health Sciences in the O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta at the University of Calgary.
| | - Lyne Cloutier
- Professor in the Department of Nursing at the Université du Québec à Trois-Rivières
| | - Patrice Lindsay
- Director of Systems Change and the Stroke Program for the Heart & Stroke Foundation of Canada in Ottawa, Ont
| | - Alexander A Leung
- Assistant Professor in the Department of Medicine and the Department of Community Health Sciences in the Cumming School of Medicine at the University of Calgary
| | - Dorothy Morris
- Clinical Nurse Educator for the Coronary Care Unit and the Cardiovascular Unit at the Royal Jubilee Hospital in Victoria, BC
| | - Donna McLean
- Member of faculty in the Faculty of Nursing at MacEwan University and a nurse practitioner in internal and emergency medicine for Covenant Health-Misericordia Hospital in Edmonton, Alta
| | - Ross T Tsuyuki
- Professor in and Chair of the Department of Pharmacology, Professor in the Department of Medicine and the Division of Cardiology, and Director of the EPICORE Centre in the Faculty of Medicine and Dentistry at the University of Alberta in Edmonton
| | - Shelita Dattani
- Director of Practice Development and Knowledge Translation for the Canadian Pharmacists Association in Toronto
| | - Janusz Kaczorowski
- Professor and Research Director in the Department of Family and Emergency Medicine at the University of Montreal and the Centre de recherche du CHUM in Quebec
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35
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Campbell NRC, Dattani S, Bell A, Gelfer M, Cloutier L, Petrella R, Lindsay P, Leung AA, McLean D, Kaczorowski J, Tsuyuki RT. Urgent need to increase the rates of diagnosing, treating and controlling hypertension in older women: A call for action. Can Pharm J (Ott) 2020; 153:264-269. [PMID: 33110465 DOI: 10.1177/1715163520947006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Norm R C Campbell
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Shelita Dattani
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Alan Bell
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Mark Gelfer
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Lyne Cloutier
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Robert Petrella
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Patrice Lindsay
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Alexander A Leung
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Donna McLean
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Janusz Kaczorowski
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Ross T Tsuyuki
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
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Abstract
A recent report from the American Heart Association stated that automated office blood pressure (AOBP) is preferred for evaluating office blood pressure (BP) because it is more accurate and devoid of white coat effect, which is mostly caused by higher systolic BP readings. However, AOBP has been criticized for being too variable to be used for identifying patients with possible hypertension. We, therefore, compared AOBP with home BP monitoring (HBPM) with respect to variability as determined by their relationship with the gold standard for determining BP status, awake ambulatory BP (ABP). The main focus was on systolic BP. Data on AOBP, HBPM, and awake ABP were collected on 300 patients referred from the community for 24-hour ambulatory BP monitoring. The SD of the difference between mean systolic awake ABP (136.4±11.5) and AOBP (131.2±15.7) was 13.6 mm Hg compared with 13.1 for the SD of the difference (
P
=0.52) between the systolic awake ABP and the HBPM (136.7±16.1). Coefficients of correlation were slightly lower for systolic awake ABP versus AOBP (
r
=0.54) compared with HBPM (
r
=0.60). Coefficients of variation for AOBP (12.0%) and HBPM (11.8%) and variances between AOBP and HBPM were similar. Of the 139 patients with hypertension as defined by a manual office systolic BP ≥140 mm Hg, variability in BP readings as determined by the SDs of the mean difference versus awake ABP were similar (
P
=0.56) for AOBP (14.6) and HBPM (13.9). Overall, both systolic AOBP and HBPM exhibited a similar degree of variability as assessed by the various methods.
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Affiliation(s)
- Martin G. Myers
- From the Schulich Heart Program, Sunnybrook Health Sciences Centre, and the Department of Medicine, University of Toronto (M.G.M.)
| | - Janusz Kaczorowski
- the Department of Family and Emergency Medicine, Université de Montréal, and Canadian Institutes of Health Research-Institute of Circulatory and Respiratory Health, Montreal, Canada (J.K.)
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37
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Valaitis RK, Wong ST, MacDonald M, Martin-Misener R, O’Mara L, Meagher-Stewart D, Isaacs S, Murray N, Baumann A, Burge F, Green M, Kaczorowski J, Savage R. Addressing quadruple aims through primary care and public health collaboration: ten Canadian case studies. BMC Public Health 2020; 20:507. [PMID: 32299399 PMCID: PMC7164182 DOI: 10.1186/s12889-020-08610-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 03/29/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Health systems in Canada and elsewhere are at a crossroads of reform in response to rising economic and societal pressures. The Quadruple Aim advocates for: improving patient experience, reducing cost, advancing population health and improving the provider experience. It is at the forefront of Canadian reform debates aimed to improve a complex and often-fragmented health care system. Concurrently, collaboration between primary care and public health has been the focus of current research, looking for integrated community-based primary health care models that best suit the health needs of communities and address health equity. This study aimed to explore the nature of Canadian primary care - public health collaborations, their aims, motivations, activities, collaboration barriers and enablers, and perceived outcomes. METHODS Ten case studies were conducted in three provinces (Nova Scotia, Ontario, and British Columbia) to elucidate experiences of primary care and public health collaboration in different settings, contexts, populations and forms. Data sources included a survey using the Partnership Self-Assessment Tool, focus groups, and document analysis. This provided an opportunity to explore how primary care and public health collaboration could serve in transforming community-based primary health care with the potential to address the Quadruple Aims. RESULTS Aims of collaborations included: provider capacity building, regional vaccine/immunization management, community-based health promotion programming, and, outreach to increase access to care. Common precipitators were having a shared vision and/or community concern. Barriers and enablers differed among cases. Perceived barriers included ineffective communication processes, inadequate time for collaboration, geographic challenges, lack of resources, and varying organizational goals and mandates. Enablers included clear goals, trusting and inclusive relationships, role clarity, strong leadership, strong coordination and communication, and optimal use of resources. Cases achieved outcomes addressing the Q-Aims such as improving access to services, addressing population health through outreach to at-risk populations, reducing costs through efficiencies, and improving provider experience through capacity building. CONCLUSIONS Primary care and public health collaborations can strengthen community-based primary health care while addressing the Quadruple Aims with an emphasis on reducing health inequities but requires attention to collaboration barriers and enablers.
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Affiliation(s)
- Ruta K. Valaitis
- School of Nursing, McMaster University, 1280 Main Street W., HSC 3N25E, Hamilton, ON L8S4K1 Canada
| | - Sabrina T. Wong
- School of Nursing and Centre for Health Services and Policy Research, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5 Canada
| | - Marjorie MacDonald
- School of Nursing, University of Victoria, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Ruth Martin-Misener
- Dalhousie University, School of Nursing, Room G26, Forrest Bldg, 5869 University Avenue, PO Box 15000, Halifax, NS B3H 4R2 Canada
| | - Linda O’Mara
- McMaster University, School of Nursing, 1280 Main Street W, Hamilton, ON L8S4K1 Canada
| | - Donna Meagher-Stewart
- Dalhousie University, School of Nursing, Room G26, Forrest Bldg, 5869 University Avenue, PO Box 15000, Halifax, NS B3H 4R2 Canada
| | - Sandy Isaacs
- McMaster University, School of Nursing, 1280 Main Street W, Hamilton, ON L8S4K1 Canada
| | - Nancy Murray
- McMaster University, School of Nursing, 1280 Main Street W, Hamilton, ON L8S4K1 Canada
| | - Andrea Baumann
- McMaster University, School of Nursing, 1280 Main Street W, Hamilton, ON L8S4K1 Canada
| | - Fred Burge
- Dalhousie University Department of Family Medicine, 8th floor, 8525 Abbie J Lane Building, 5909 Veterans’ Memorial Lane, Halifax, NS B3H 2E2 Canada
| | - Michael Green
- Queen’s University Centre for Studies in Primary Care, 220 Bagot Street, P.O. Bag 8888, Kingston, ON K7L 5E9 Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, University of Montreal, Tour Saint-Antoine, 850, rue St-Denis Montreal, Quebec, H2X 0A9 Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Tour Saint-Antoine, 850, rue St-Denis Montreal, Quebec, H2X 0A9 Canada
| | - Rachel Savage
- Dalla Lana School of Public Health, University of Toronto, 155 College St, 6th Floor, Toronto, ON M5T 3M7 Canada
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Klein MC, Kaczorowski J. Routine use of episiotomy with forceps should not be encouraged. CMAJ 2020; 192:E190. [PMID: 32094270 DOI: 10.1503/cmaj.74132] [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] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Michael C Klein
- Emeritus professor of family practice, University of British Columbia, Vancouver, BC
| | - Janusz Kaczorowski
- Professor of family and emergency medicine, Université de Montréal and Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Que
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Isenor JE, Kervin MS, Halperin DM, Langley J, Bettinger JA, Top KA, Lalji F, Slayter K, Kaczorowski J, Bowles SK, Waite NM, Halperin SA. Pharmacists as immunizers to Improve coverage and provider/recipient satisfaction: A prospective, Controlled Community Embedded Study with vaccineS with low coverage rates (the Improve ACCESS Study): Study summary and anticipated significance. Can Pharm J (Ott) 2020; 153:88-94. [PMID: 32206153 DOI: 10.1177/1715163519900221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jennifer E Isenor
- Canadian Center for Vaccinology (Isenor, Kervin, D. Halperin, Langley, Top, Slayter, Bowles, S. Halperin), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax.,College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Department of Pediatrics (Langley, Top, S. Halperin), Dalhousie University, Halifax.,Department of Community Health and Epidemiology (Langley, Top), Dalhousie University, Halifax.,Department of Medicine (Slayter, Bowles), Dalhousie University, Halifax.,Department of Microbiology and Immunology (S. Halperin), Dalhousie University, Halifax.,Rankin School of Nursing (D. Halperin), St. Francis Xavier University, Antigonish, Nova Scotia.,Vaccine Evaluation Center (Bettinger), British Columbia Children's Hospital and University of British Columbia, Vancouver.,Faculty of Pharmaceutical Sciences (Lalji), University of British Columbia, Vancouver, British Columbia.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal, Montreal, Quebec.,School of Pharmacy (Waite), University of Waterloo, Kitchener, Ontario
| | - Melissa S Kervin
- Canadian Center for Vaccinology (Isenor, Kervin, D. Halperin, Langley, Top, Slayter, Bowles, S. Halperin), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax.,College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Department of Pediatrics (Langley, Top, S. Halperin), Dalhousie University, Halifax.,Department of Community Health and Epidemiology (Langley, Top), Dalhousie University, Halifax.,Department of Medicine (Slayter, Bowles), Dalhousie University, Halifax.,Department of Microbiology and Immunology (S. Halperin), Dalhousie University, Halifax.,Rankin School of Nursing (D. Halperin), St. Francis Xavier University, Antigonish, Nova Scotia.,Vaccine Evaluation Center (Bettinger), British Columbia Children's Hospital and University of British Columbia, Vancouver.,Faculty of Pharmaceutical Sciences (Lalji), University of British Columbia, Vancouver, British Columbia.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal, Montreal, Quebec.,School of Pharmacy (Waite), University of Waterloo, Kitchener, Ontario
| | - Donna M Halperin
- Canadian Center for Vaccinology (Isenor, Kervin, D. Halperin, Langley, Top, Slayter, Bowles, S. Halperin), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax.,College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Department of Pediatrics (Langley, Top, S. Halperin), Dalhousie University, Halifax.,Department of Community Health and Epidemiology (Langley, Top), Dalhousie University, Halifax.,Department of Medicine (Slayter, Bowles), Dalhousie University, Halifax.,Department of Microbiology and Immunology (S. Halperin), Dalhousie University, Halifax.,Rankin School of Nursing (D. Halperin), St. Francis Xavier University, Antigonish, Nova Scotia.,Vaccine Evaluation Center (Bettinger), British Columbia Children's Hospital and University of British Columbia, Vancouver.,Faculty of Pharmaceutical Sciences (Lalji), University of British Columbia, Vancouver, British Columbia.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal, Montreal, Quebec.,School of Pharmacy (Waite), University of Waterloo, Kitchener, Ontario
| | - Joanne Langley
- Canadian Center for Vaccinology (Isenor, Kervin, D. Halperin, Langley, Top, Slayter, Bowles, S. Halperin), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax.,College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Department of Pediatrics (Langley, Top, S. Halperin), Dalhousie University, Halifax.,Department of Community Health and Epidemiology (Langley, Top), Dalhousie University, Halifax.,Department of Medicine (Slayter, Bowles), Dalhousie University, Halifax.,Department of Microbiology and Immunology (S. Halperin), Dalhousie University, Halifax.,Rankin School of Nursing (D. Halperin), St. Francis Xavier University, Antigonish, Nova Scotia.,Vaccine Evaluation Center (Bettinger), British Columbia Children's Hospital and University of British Columbia, Vancouver.,Faculty of Pharmaceutical Sciences (Lalji), University of British Columbia, Vancouver, British Columbia.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal, Montreal, Quebec.,School of Pharmacy (Waite), University of Waterloo, Kitchener, Ontario
| | - Julie A Bettinger
- Canadian Center for Vaccinology (Isenor, Kervin, D. Halperin, Langley, Top, Slayter, Bowles, S. Halperin), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax.,College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Department of Pediatrics (Langley, Top, S. Halperin), Dalhousie University, Halifax.,Department of Community Health and Epidemiology (Langley, Top), Dalhousie University, Halifax.,Department of Medicine (Slayter, Bowles), Dalhousie University, Halifax.,Department of Microbiology and Immunology (S. Halperin), Dalhousie University, Halifax.,Rankin School of Nursing (D. Halperin), St. Francis Xavier University, Antigonish, Nova Scotia.,Vaccine Evaluation Center (Bettinger), British Columbia Children's Hospital and University of British Columbia, Vancouver.,Faculty of Pharmaceutical Sciences (Lalji), University of British Columbia, Vancouver, British Columbia.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal, Montreal, Quebec.,School of Pharmacy (Waite), University of Waterloo, Kitchener, Ontario
| | - Karina A Top
- Canadian Center for Vaccinology (Isenor, Kervin, D. Halperin, Langley, Top, Slayter, Bowles, S. Halperin), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax.,College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Department of Pediatrics (Langley, Top, S. Halperin), Dalhousie University, Halifax.,Department of Community Health and Epidemiology (Langley, Top), Dalhousie University, Halifax.,Department of Medicine (Slayter, Bowles), Dalhousie University, Halifax.,Department of Microbiology and Immunology (S. Halperin), Dalhousie University, Halifax.,Rankin School of Nursing (D. Halperin), St. Francis Xavier University, Antigonish, Nova Scotia.,Vaccine Evaluation Center (Bettinger), British Columbia Children's Hospital and University of British Columbia, Vancouver.,Faculty of Pharmaceutical Sciences (Lalji), University of British Columbia, Vancouver, British Columbia.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal, Montreal, Quebec.,School of Pharmacy (Waite), University of Waterloo, Kitchener, Ontario
| | - Fawziah Lalji
- Canadian Center for Vaccinology (Isenor, Kervin, D. Halperin, Langley, Top, Slayter, Bowles, S. Halperin), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax.,College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Department of Pediatrics (Langley, Top, S. Halperin), Dalhousie University, Halifax.,Department of Community Health and Epidemiology (Langley, Top), Dalhousie University, Halifax.,Department of Medicine (Slayter, Bowles), Dalhousie University, Halifax.,Department of Microbiology and Immunology (S. Halperin), Dalhousie University, Halifax.,Rankin School of Nursing (D. Halperin), St. Francis Xavier University, Antigonish, Nova Scotia.,Vaccine Evaluation Center (Bettinger), British Columbia Children's Hospital and University of British Columbia, Vancouver.,Faculty of Pharmaceutical Sciences (Lalji), University of British Columbia, Vancouver, British Columbia.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal, Montreal, Quebec.,School of Pharmacy (Waite), University of Waterloo, Kitchener, Ontario
| | - Kathryn Slayter
- Canadian Center for Vaccinology (Isenor, Kervin, D. Halperin, Langley, Top, Slayter, Bowles, S. Halperin), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax.,College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Department of Pediatrics (Langley, Top, S. Halperin), Dalhousie University, Halifax.,Department of Community Health and Epidemiology (Langley, Top), Dalhousie University, Halifax.,Department of Medicine (Slayter, Bowles), Dalhousie University, Halifax.,Department of Microbiology and Immunology (S. Halperin), Dalhousie University, Halifax.,Rankin School of Nursing (D. Halperin), St. Francis Xavier University, Antigonish, Nova Scotia.,Vaccine Evaluation Center (Bettinger), British Columbia Children's Hospital and University of British Columbia, Vancouver.,Faculty of Pharmaceutical Sciences (Lalji), University of British Columbia, Vancouver, British Columbia.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal, Montreal, Quebec.,School of Pharmacy (Waite), University of Waterloo, Kitchener, Ontario
| | - Janusz Kaczorowski
- Canadian Center for Vaccinology (Isenor, Kervin, D. Halperin, Langley, Top, Slayter, Bowles, S. Halperin), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax.,College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Department of Pediatrics (Langley, Top, S. Halperin), Dalhousie University, Halifax.,Department of Community Health and Epidemiology (Langley, Top), Dalhousie University, Halifax.,Department of Medicine (Slayter, Bowles), Dalhousie University, Halifax.,Department of Microbiology and Immunology (S. Halperin), Dalhousie University, Halifax.,Rankin School of Nursing (D. Halperin), St. Francis Xavier University, Antigonish, Nova Scotia.,Vaccine Evaluation Center (Bettinger), British Columbia Children's Hospital and University of British Columbia, Vancouver.,Faculty of Pharmaceutical Sciences (Lalji), University of British Columbia, Vancouver, British Columbia.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal, Montreal, Quebec.,School of Pharmacy (Waite), University of Waterloo, Kitchener, Ontario
| | - Susan K Bowles
- Canadian Center for Vaccinology (Isenor, Kervin, D. Halperin, Langley, Top, Slayter, Bowles, S. Halperin), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax.,College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Department of Pediatrics (Langley, Top, S. Halperin), Dalhousie University, Halifax.,Department of Community Health and Epidemiology (Langley, Top), Dalhousie University, Halifax.,Department of Medicine (Slayter, Bowles), Dalhousie University, Halifax.,Department of Microbiology and Immunology (S. Halperin), Dalhousie University, Halifax.,Rankin School of Nursing (D. Halperin), St. Francis Xavier University, Antigonish, Nova Scotia.,Vaccine Evaluation Center (Bettinger), British Columbia Children's Hospital and University of British Columbia, Vancouver.,Faculty of Pharmaceutical Sciences (Lalji), University of British Columbia, Vancouver, British Columbia.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal, Montreal, Quebec.,School of Pharmacy (Waite), University of Waterloo, Kitchener, Ontario
| | - Nancy M Waite
- Canadian Center for Vaccinology (Isenor, Kervin, D. Halperin, Langley, Top, Slayter, Bowles, S. Halperin), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax.,College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Department of Pediatrics (Langley, Top, S. Halperin), Dalhousie University, Halifax.,Department of Community Health and Epidemiology (Langley, Top), Dalhousie University, Halifax.,Department of Medicine (Slayter, Bowles), Dalhousie University, Halifax.,Department of Microbiology and Immunology (S. Halperin), Dalhousie University, Halifax.,Rankin School of Nursing (D. Halperin), St. Francis Xavier University, Antigonish, Nova Scotia.,Vaccine Evaluation Center (Bettinger), British Columbia Children's Hospital and University of British Columbia, Vancouver.,Faculty of Pharmaceutical Sciences (Lalji), University of British Columbia, Vancouver, British Columbia.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal, Montreal, Quebec.,School of Pharmacy (Waite), University of Waterloo, Kitchener, Ontario
| | - Scott A Halperin
- Canadian Center for Vaccinology (Isenor, Kervin, D. Halperin, Langley, Top, Slayter, Bowles, S. Halperin), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority, Halifax.,College of Pharmacy (Isenor, Bowles), Dalhousie University, Halifax.,Department of Pediatrics (Langley, Top, S. Halperin), Dalhousie University, Halifax.,Department of Community Health and Epidemiology (Langley, Top), Dalhousie University, Halifax.,Department of Medicine (Slayter, Bowles), Dalhousie University, Halifax.,Department of Microbiology and Immunology (S. Halperin), Dalhousie University, Halifax.,Rankin School of Nursing (D. Halperin), St. Francis Xavier University, Antigonish, Nova Scotia.,Vaccine Evaluation Center (Bettinger), British Columbia Children's Hospital and University of British Columbia, Vancouver.,Faculty of Pharmaceutical Sciences (Lalji), University of British Columbia, Vancouver, British Columbia.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal, Montreal, Quebec.,School of Pharmacy (Waite), University of Waterloo, Kitchener, Ontario
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40
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Vachon B, Gaboury I, Menear M, Pomey MP, Roy D, Houle L, Breton M, Duhoux A, Émond V, Giasson G, Kaczorowski J, Légaré F, Lussier MT, Pluye P, Vanasse A. Evaluating implementation and impact of a provincial quality improvement collaborative for the management of chronic diseases in primary care: the COMPAS+ study protocol. BMC Fam Pract 2020; 21:3. [PMID: 31910814 PMCID: PMC6947939 DOI: 10.1186/s12875-019-1072-y] [Citation(s) in RCA: 2] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/18/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chronic conditions such as diabetes and chronic obstructive pulmonary disease (COPD) are common and burdensome diseases primarily managed in primary care. Yet, evidence points to suboptimal quality of care for these conditions in primary care settings. Quality improvement collaboratives (QICs) are organized, multifaceted interventions that can be effective in improving chronic disease care processes and outcomes. In Quebec, Canada, the Institut national d'excellence en santé et en services sociaux (INESSS) has developed a large-scale QIC province-wide program called COMPAS+ that aims to improve the prevention and management of chronic diseases in primary care. This paper describes the protocol for our study, which aims to evaluate implementation and impact of COMPAS+ QICs on the prevention and management of targeted chronic diseases like diabetes and COPD. METHODS This is a mixed-methods, integrated knowledge translation study. The quantitative component involves a controlled interrupted time series involving nine large integrated health centres in the province. Study sites will receive one of two interventions: the multifaceted COMPAS+ intervention (experimental condition) or a feedback only intervention (control condition). For the qualitative component, a multiple case study approach will be used to achieve an in-depth understanding of individual, team, organizational and contextual factors influencing implementation and effectiveness of the COMPAS+ QICs. DISCUSSION COMPAS+ is a QI program that is unique in Canada due to its integration within the governance of the Quebec healthcare system and its capacity to reach many primary care providers and people living with chronic diseases across the province. We anticipate that this study will address several important gaps in knowledge related to large-scale QIC projects and generate strong and useful evidence (e.g., on leadership, organizational capacity, patient involvement, and implementation) having the potential to influence the design and optimisation of future QICs in Canada and internationally.
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Affiliation(s)
- Brigitte Vachon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal and Centre de recherche du CIUSSS de l’Est-de-l’Île-de-Montréal, Montreal, Quebec, Canada
| | - Isabelle Gaboury
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Matthew Menear
- Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | | | - Denis Roy
- Institut national d’excellence en santé et en services sociaux, Montreal, Canada
| | - Lise Houle
- Institut national d’excellence en santé et en services sociaux, Montreal, Canada
| | - Mylaine Breton
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montreal, Canada
| | - Valérie Émond
- Institut national de santé publique du Québec, Quebec, Canada
| | - Guylaine Giasson
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | | | - France Légaré
- Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | | | - Pierre Pluye
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Alain Vanasse
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
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41
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Agarwal G, Girard M, Angeles R, Pirrie M, Lussier MT, Marzanek F, Dolovich L, Paterson JM, Thabane L, Kaczorowski J. Design and rationale for a pragmatic cluster randomized trial of the Cardiovascular Health Awareness Program (CHAP) for social housing residents in Ontario and Quebec, Canada. Trials 2019; 20:760. [PMID: 31870415 PMCID: PMC6929306 DOI: 10.1186/s13063-019-3806-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/17/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Cardiovascular Health Awareness Program (CHAP) uses volunteers to provide cardiovascular disease (CVD) and diabetes screening in a community setting, referrals to primary care providers, and locally available programs targeting lifestyle modification. CHAP has been adapted to target older adults residing in social housing, a vulnerable segment of the population. Older adults living in social housing report poorer health status and have a higher burden of a multitude of chronic illnesses, such as CVD and diabetes. The study objective is to evaluate whether there is a reduction in unplanned CVD-related Emergency Department (ED) visits and hospital admissions among residents of social seniors' housing buildings receiving the CHAP program for 1 year compared to residents in matched buildings not receiving the program. METHODS/DESIGN This is a pragmatic, cluster randomized controlled trial in community-based social (subsidized) housing buildings in Ontario and Quebec. All residents of 14 matched pairs (intervention/control) of apartment buildings will be included. Buildings with 50-200 apartment units with the majority of residents aged 55+ and a unique postal code are included. All individuals residing within the buildings at the start of the intervention period are included (intention to treat, open cohort). The intervention instrument consists of CHAP screens for high blood pressure using automated blood pressure monitors and for diabetes using the Canadian Diabetes Risk (CANRISK) assessment tool. Monthly drop-in sessions for screening/monitoring are held within a common area of the building. Group health education sessions are also held monthly. Reports are sent to family doctors, and attendees are encouraged to visit their family doctor. The primary outcome measure is monthly CVD-related ED visits and hospitalizations over a 1-year period post randomization. Secondary outcomes are all ED visits, hospitalizations, quality of life, cost-effectiveness, and participant experience. DISCUSSION It is anticipated that CVD-related ED visits and hospitalizations will decrease in the intervention buildings. Using the volunteer-led CHAP program, there is significant opportunity to improve the health of older adults in social housing. TRIAL REGISTRATION ClinicalTrials.gov,NCT03549845. Registered on 15 May 2018. Updated on 21 May 2019.
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Affiliation(s)
- Gina Agarwal
- Department of Family Medicine, McMaster University, 100 Main Street West, DBHSC, 5th Floor, Hamilton, ON, L8P 1H6, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
| | - Magali Girard
- Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | - Ricardo Angeles
- Department of Family Medicine, McMaster University, 100 Main Street West, DBHSC, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Melissa Pirrie
- Department of Family Medicine, McMaster University, 100 Main Street West, DBHSC, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Marie-Thérèse Lussier
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, Canada
- Primary Care Research Team, Centre intégré de santé et des services sociaux de Laval, Laval, QC, Canada
| | - Francine Marzanek
- Department of Family Medicine, McMaster University, 100 Main Street West, DBHSC, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Lisa Dolovich
- Department of Family Medicine, McMaster University, 100 Main Street West, DBHSC, 5th Floor, Hamilton, ON, L8P 1H6, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - J Michael Paterson
- Department of Family Medicine, McMaster University, 100 Main Street West, DBHSC, 5th Floor, Hamilton, ON, L8P 1H6, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Biostatistics Unit, St Joseph's Healthcare Research Institute, Hamilton, Canada
| | - Janusz Kaczorowski
- Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, Canada
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42
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Khan N, Bell A, Berg A, Campbell N, Kaczorowski J, Rabi D, Schiffrin EL, Tsuyuki RT. A call to action to implement prescribing authority to pharmacists for hypertension management. Can Pharm J (Ott) 2019; 152:285-287. [PMID: 31534583 DOI: 10.1177/1715163519866144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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43
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Agarwal G, Angeles RN, Dolovich L, Kaczorowski J, Gaber J, Guenter D, Arnuco FD, Lam HY, Thabane L, O'Reilly D, Agbulos RM, Arciaga RS, Barrera J, Gregorio E, Halili S, Jalani N, Cristobal F. The Community Health Assessment Program in the Philippines (CHAP-P) diabetes health promotion program for low- to middle-income countries: study protocol for a cluster randomized controlled trial. BMC Public Health 2019; 19:682. [PMID: 31159778 PMCID: PMC6547510 DOI: 10.1186/s12889-019-6974-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Received: 02/27/2019] [Accepted: 05/14/2019] [Indexed: 11/17/2022] Open
Abstract
Background Type 2 diabetes is increasing globally, with the highest burden in low- to middle-income countries (LMICs) such as the Philippines. Developing effective interventions could improve detection, prevention, and treatment of diabetes. The Cardiovascular Health Awareness Program (CHAP), an evidence-based Canadian intervention, may be an appropriate model for LMICs due to its low cost, ease of implementation, and focus on health promotion and disease prevention. The primary aim of this study is to adapt the CHAP model to a Philippine context as the Community Health Assessment Program in the Philippines (CHAP-P) and evaluate the effect of CHAP-P on glycated hemoglobin (HbA1c) compared to a random sample of community residents in control communities. Methods Six-month, 26-community (13 intervention, 13 control) parallel cluster randomized controlled trial in Zamboanga Peninsula, an Administrative Region in the southern Philippines. Criteria for community selection include: adequate political stability, connection with local champions, travel feasibility, and refrigerated space for materials. The community-based intervention, CHAP-P sessions, are volunteer-led group sessions with chronic condition assessment, blood pressure monitoring, and health education. Three participant groups will be involved: 1) Random sample of community participants aged 40 or older, 100 per community (1300 control, 1300 intervention participants total); 2) Community members aged 40 years or older who attended at least one CHAP-P session; 3) Community health workers and staff facilitating sessions. Primary outcome: mean difference in HbA1c at 6 months in intervention group individuals compared to control. Secondary outcomes: modifiable risk factors, health utilization and access (individual); diabetes detection and management (cluster). Evaluation also includes community process evaluation and cost-effectiveness analysis. Discussion CHAP has been shown to be effective in a Canadian setting. Individual components of CHAP-P have been piloted locally and shown to be acceptable and feasible. This study will improve understanding of how best to adapt this model to an LMIC setting, in order to maximize prevention, detection, and management of diabetes. Results may inform policy and practice in the Philippines and have the potential to be applied to other LMICs. Trial registration ClinicalTrials.gov (NCT03481335), registered March 29, 2018. Electronic supplementary material The online version of this article (10.1186/s12889-019-6974-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gina Agarwal
- Department of Family Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada.
| | - Ricardo N Angeles
- Department of Family Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada.,School of Medicine, Ateneo de Zamboanga University, La Purisima St, 7000, Zamboanga City, Philippines
| | - Lisa Dolovich
- Department of Family Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario, M5S 3M2, Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, University of Montreal and CRCHUM, 850 Saint-Denis St, Montreal, Quebec, H2X 0A9, Canada
| | - Jessica Gaber
- Department of Family Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada
| | - Dale Guenter
- Department of Family Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada
| | - Floro Dave Arnuco
- School of Medicine, Ateneo de Zamboanga University, La Purisima St, 7000, Zamboanga City, Philippines
| | - Hilton Y Lam
- Institute of Health Policy and Development Studies, University of the Philippines Manila, One Adriatico Place Tower One, Adriatico Street Corner Pedro Gill Street, 1000, Manila, Philippines
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada
| | - Daria O'Reilly
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada
| | - Rodelin M Agbulos
- Zamboanga City Health Office, Pettit Barracks, 7000, Zamboanga City, Philippines
| | - Rosemarie S Arciaga
- School of Medicine, Ateneo de Zamboanga University, La Purisima St, 7000, Zamboanga City, Philippines.,Zamboanga Medical Research Foundation, Zamboanga City, Philippines
| | - Jerome Barrera
- School of Medicine, Ateneo de Zamboanga University, La Purisima St, 7000, Zamboanga City, Philippines
| | - Elgie Gregorio
- School of Medicine, Ateneo de Zamboanga University, La Purisima St, 7000, Zamboanga City, Philippines
| | - Servando Halili
- Graduate School, Ateneo de Zamboanga University, La Purisima St, 7000, Zamboanga City, Philippines
| | - Norvie Jalani
- Department of Health, Zamboanga Peninsula, 7000, Zamboanga City, Philippines
| | - Fortunato Cristobal
- School of Medicine, Ateneo de Zamboanga University, La Purisima St, 7000, Zamboanga City, Philippines
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Roerecke M, Kaczorowski J, Myers MG. Methodological Issues in Determining the Accuracy of Automated Office Blood Pressure Readings for Diagnosing Hypertension-Reply. JAMA Intern Med 2019; 179:850-851. [PMID: 31157852 DOI: 10.1001/jamainternmed.2019.1221] [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: 11/14/2022]
Affiliation(s)
- Michael Roerecke
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, Quebec, Canada.,University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Martin G Myers
- Division of Cardiology, Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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45
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Bacon SL, Campbell NRC, Raine KD, Tsuyuki RT, Khan NA, Arango M, Kaczorowski J. Canada's new Healthy Eating Strategy: Implications for health care professionals and a call to action. Can Fam Physician 2019; 65:393-398. [PMID: 31189626 PMCID: PMC6738387] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Simon L Bacon
- Co-Director of the Montreal Behavioural Medicine Centre in Quebec, a researcher at the CIUSSS-NIM and Hôpital du Sacré-Coeur de Montréal, and Professor in the Department of Health, Kinesiology and Applied Physiology at Concordia University in Montreal.
| | - Norm R C Campbell
- Professor of Medicine, Physiology and Pharmacology, and Community Health Sciences at the University of Calgary in Alberta and a member of the O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta
| | - Kim D Raine
- Professor and Associate Dean (Research) in the School of Public Health at the University of Alberta in Edmonton
| | - Ross T Tsuyuki
- Professor in the Department of Medicine and the Division of Cardiology at the University of Alberta
| | - Nadia A Khan
- Associate Professor in the Department of Medicine and Division of General Internal Medicine at the University of British Columbia in Vancouver
| | - Manuel Arango
- Director, Health Policy & Advocacy for the Heart and Stroke Foundation of Canada in Ottawa, Ont
| | - Janusz Kaczorowski
- Professor and Research Director in the Department of Family and Emergency Medicine at the University of Montreal and the Centre de Recherche CHUM in Montreal
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46
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Bacon SL, Campbell NRC, Raine KD, Tsuyuki RT, Khan NA, Arango M, Kaczorowski J. [Not Available]. Can Fam Physician 2019; 65:e244-e250. [PMID: 31189637 PMCID: PMC6738384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Simon L Bacon
- Codirecteur du Centre de médecine comportementale de Montréal (Québec), chercheur au CIUSSS-NIM et à l'Hôpital du Sacré-Cœur de Montréal, et professeur au Département de santé, kinésiologie et physiologie appliquée de l'Université Concordia à Montréal.
| | - Norm R C Campbell
- Professeur de médecine, physiologie et pharmacologie, et de sciences de la santé communautaire à l'Université de Calgary (Alberta), et membre de l'O'Brien Institute for Public Health et du Libin Cardiovascular Institute of Alberta
| | - Kim D Raine
- Professeure et vice-doyenne (Recherche) à l'École de santé publique de l'Université de l'Alberta à Edmonton
| | - Ross T Tsuyuki
- Professeur au Département de médecine et à la Division de cardiologie à l'Université de l'Alberta
| | - Nadia A Khan
- Professeure agrégée au Département de médecine et à la Division de médecine interne générale de l'Université de la Colombie-Britannique à Vancouver
| | - Manuel Arango
- Directeur, Politiques de la santé et Mobilisation à la Fondation des maladies du cœur et de l'AVC du Canada à Ottawa (Ontario)
| | - Janusz Kaczorowski
- Professeur et directeur de la recherche au Département de médecine de famille et de médecine d'urgence de l'Université de Montréal et au Centre de Recherche CHUM à Montréal
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Campbell NR, Bacon S, Pipe A, Grace SL, Arango M, Raine K, Kaczorowski J. Dietary Sodium and the Health of Canadians. Can J Cardiol 2019; 35:671.e1. [DOI: 10.1016/j.cjca.2019.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 11/29/2022] Open
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Parkash R, Magee K, McMullen M, Clory M, D’Astous M, Robichaud M, Andolfatto G, Read B, Wang J, Thabane L, Atzema C, Dorian P, Kaczorowski J, Banner D, Nieuwlaat R, Ivers N, Huynh T, Curran J, Graham I, Connolly S, Healey J. The Canadian Community Utilization of Stroke Prevention Study in Atrial Fibrillation in the Emergency Department (C-CUSP ED). Ann Emerg Med 2019; 73:382-392. [DOI: 10.1016/j.annemergmed.2018.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/13/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
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Bacon SL, Campbell NR, Raine KD, Tsuyuki R, Khan NA, Arango M, Kaczorowski J. Canada's New Healthy Eating Strategy: Implications for Healthcare Professionals and a Call to Action. Can J Diabetes 2019; 43:155-160. [DOI: 10.1016/j.jcjd.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Masucci L, Schreiber RA, Kaczorowski J, Collet JP, Bryan S. Universal screening of newborns for biliary atresia: Cost-effectiveness of alternative strategies. J Med Screen 2019; 26:113-119. [DOI: 10.1177/0969141319832039] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objective Biliary atresia, a rare newborn liver disease, is the most common cause of liver-related death in children and the main indication for paediatric liver transplantation. Early detection and surgical intervention with a Kasai portoenterostomy offers the best chance for long-term patient survival. We conducted a cost-effectiveness analysis to compare no universal screening with screening using either a home-based infant stool colour card with passive card distribution strategy, or conjugated bilirubin testing. Methods A Markov model was developed, with structure, costs, and probabilities informed by the literature and clinical expert opinion, to simulate a newborn cohort over a 10-year time horizon. Health benefits were expressed as life-years gained. This analysis was conducted from the perspective of the Canadian publicly funded health care system (all costs in Canadian dollars). Both deterministic and probabilistic analyses were conducted. Results Screening using a home-based colour card with passive card distribution was a cost-effective option. For a population of 392,902 annual births in Canada, this strategy cost approximately $192,000 more than no universal screening but led to eight life-years gained (incremental cost-effectiveness ratio (ICER) = $24,065 per life-year gained). Screening using conjugated bilirubin testing versus the colour card cost $2,369,199 more and led to five more life-years gained (ICER= $473,840 per life year gained), and so was not cost-effective. Conclusions A home-based screening program using infant stool colour cards with a passive distribution strategy could be highly cost-effective when administered at a low unit cost and with a reasonable screening performance.
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Affiliation(s)
- Lisa Masucci
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Richard A Schreiber
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of British Columbia, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, British Columbia, Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, Université de Montréal and CRCHUM, Montréal, Canada
| | - JP Collet
- Department of Pediatrics, University of British Columbia, British Columbia, Canada
- Child and Family Research Institute, Vancouver, Canada
| | - Stirling Bryan
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
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