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Grant A, Kontak J, Jeffers E, Lawson B, MacKenzie A, Burge F, Boulos L, Lackie K, Marshall EG, Mireault A, Philpott S, Sampalli T, Sheppard-LeMoine D, Martin-Misener R. Barriers and enablers to implementing interprofessional primary care teams: a narrative review of the literature using the consolidated framework for implementation research. BMC Prim Care 2024; 25:25. [PMID: 38216867 PMCID: PMC10785376 DOI: 10.1186/s12875-023-02240-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 12/11/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Interprofessional primary care teams have been introduced across Canada to improve access (e.g., a regular primary care provider, timely access to care when needed) to and quality of primary care. However, the quality and speed of team implementation has not kept pace with increasing access issues. The aim of this research was to use an implementation framework to categorize and describe barriers and enablers to team implementation in primary care. METHODS A narrative review that prioritized systematic reviews and evidence syntheses was conducted. A search using pre-defined terms was conducted using Ovid MEDLINE, and potentially relevant grey literature was identified through ad hoc Google searches and hand searching of health organization websites. The Consolidated Framework for Implementation Research (CFIR) was used to categorize barriers and enablers into five domains: (1) Features of Team Implementation; (2) Government, Health Authorities and Health Organizations; (3) Characteristics of the Team; (4) Characteristics of Team Members; and (5) Process of Implementation. RESULTS Data were extracted from 19 of 435 articles that met inclusion/exclusion criteria. Most barriers and enablers were categorized into two domains of the CFIR: Characteristics of the Team and Government, Health Authorities, and Health Organizations. Key themes identified within the Characteristics of the Team domain were team-leadership, including designating a manager responsible for day-to-day activities and facilitating collaboration; clear governance structures, and technology supports and tools that facilitate information sharing and communication. Key themes within the Government, Health Authorities, and Health Organizations domain were professional remuneration plans, regulatory policy, and interprofessional education. Other key themes identified in the Features of Team Implementation included the importance of good data and research on the status of teams, as well as sufficient and stable funding models. Positive perspectives, flexibility, and feeling supported were identified in the Characteristics of Team Members domain. Within the Process of Implementation domain, shared leadership and human resources planning were discussed. CONCLUSIONS Barriers and enablers to implementing interprofessional primary care teams using the CFIR were identified, which enables stakeholders and teams to tailor implementation of teams at the local level to impact the accessibility and quality of primary care.
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Affiliation(s)
- Amy Grant
- Maritime SPOR Support Unit, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Julia Kontak
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Elizabeth Jeffers
- Maritime SPOR Support Unit, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Beverley Lawson
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Building Research for Integrated Primary Care, Halifax, Nova Scotia, Canada
| | - Adrian MacKenzie
- Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Building Research for Integrated Primary Care, Halifax, Nova Scotia, Canada
| | - Leah Boulos
- Maritime SPOR Support Unit, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Kelly Lackie
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Emily Gard Marshall
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Building Research for Integrated Primary Care, Halifax, Nova Scotia, Canada
| | - Amy Mireault
- Maritime SPOR Support Unit, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Susan Philpott
- Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | | | | | - Ruth Martin-Misener
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada.
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Delahunty-Pike A, Lambert M, Schwarz C, Howse D, Bisson M, Aubrey-Bassler K, Burge F, Chouinard MC, Doucet S, Luke A, Macdonald M, Zed J, Taylor J, Hudon C. Stakeholders' perceptions of a nurse-led telehealth case management intervention in primary care for patients with complex care needs: a qualitative descriptive study. BMJ Open 2023; 13:e073679. [PMID: 37844984 PMCID: PMC10582901 DOI: 10.1136/bmjopen-2023-073679] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE With the onset of the COVID-19 pandemic, telehealth case management (TCM) was introduced in primary care for patients requiring care by distance. While not all healthcare needs can be addressed via telehealth, the use of information and communication technology to support healthcare delivery has the potential to contribute to the management of patients with chronic conditions and associated complex care needs. However, few qualitative studies have documented stakeholders' perceptions of TCM. This study aimed to describe patients', primary care providers' and clinic managers' perceptions of the use of a nurse-led TCM intervention for primary care patients with complex care needs. DESIGN Qualitative descriptive study. SETTING Three primary care clinics in three Canadian provinces. PARTICIPANTS Patients with complex care needs (n=30), primary care providers (n=11) and clinic managers (n=2) participated in qualitative individual interviews and focus groups. INTERVENTION TCM intervention was delivered by nurse case managers over a 6-month period. RESULTS Participants' perceptions of the TCM intervention were summarised in three themes: (1) improved patient access, comfort and sense of reassurance; (2) trusting relationships and skilled nurse case managers; (3) activities more suitable for TCM. TCM was a generally accepted mode of primary care delivery, had many benefits for patients and providers and worked well for most activities that do not require physical assessment or treatment. Participants found TCM to be useful and a viable alternative to in-person care. CONCLUSIONS TCM improves access to care and is successful when a relationship of trust between the nurse case manager and patient can develop over time. Healthcare policymakers and primary care providers should consider the benefits of TCM and promote this mode of delivery as a complement to in-person care for patients with complex care needs.
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Affiliation(s)
- Alannah Delahunty-Pike
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mireille Lambert
- Département de Médecine de Famille et de Médecine d'Urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Charlotte Schwarz
- Department of Nursing and Health Sciences, University of New Brunswick, Saint. John, New Brunswick, Canada
| | - Dana Howse
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Mathieu Bisson
- Département de Médecine de Famille et de Médecine d'Urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Fred Burge
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Saint. John, New Brunswick, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, Saint. John, New Brunswick, Canada
| | - Marilyn Macdonald
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joanna Zed
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Catherine Hudon
- Département de Médecine de Famille et de Médecine d'Urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Lavergne MR, Rudoler D, Peterson S, Stock D, Taylor C, Wilton AS, Wong ST, Scott I, McGrail KM, McCracken RK, Marshall EG, MacKenzie A, Katz A, Jamieson M, Hedden L, Grudniewicz A, Goldsmith LJ, Glazier RH, Burge F, Blackie D. Changes in comprehensiveness of services delivered by Canadian family physicians: Analysis of population-based linked data in 4 provinces. Can Fam Physician 2023; 69:550-556. [PMID: 37582603 PMCID: PMC10426375 DOI: 10.46747/cfp.6908550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
OBJECTIVE To describe changes in the comprehensiveness of services delivered by family physicians across service settings and service areas in 4 Canadian provinces, to identify which settings and areas have changed the most, and to compare the magnitude of changes by physician characteristics. DESIGN Descriptive analysis of province-wide, population-based billing data linked to population and physician registries. SETTING British Columbia, Manitoba, Ontario, and Nova Scotia. PARTICIPANTS Family physicians registered to practise in the 1999-2000 and 2017-2018 fiscal years. MAIN OUTCOME MEASURES Comprehensiveness was measured across 7 service settings (home care, long-term care, emergency departments, hospitals, obstetric care, surgical assistance, anesthesiology) and in 7 service areas consistent with office-based practice (prenatal and postnatal care, Papanicolaou testing, mental health, substance use, cancer care, minor surgery, palliative home visits). The proportion of physicians with activity in each setting and area are reported and the average number of service settings and areas by physician characteristics is described (years in practice, sex, urban or rural practice setting, and location of medical degree training). RESULTS Declines in comprehensiveness were observed across all provinces studied. Declines were greater for comprehensiveness of settings than for areas consistent with office-based practice. Changes were observed across all physician characteristics. On average across provinces, declines in the number of service settings and service areas were highest among physicians in practice 20 years or longer, male physicians, and physicians practising in urban areas. CONCLUSION Declining comprehensiveness was observed across all physician characteristics, pointing to changes in the practice and policy contexts in which all family physicians work.
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Affiliation(s)
- M Ruth Lavergne
- Associate Professor in the Department of Family Medicine at Dalhousie University in Halifax, NS, and holds a Tier II Canada Research Chair in Primary Care.
| | - David Rudoler
- Assistant Professor in the Faculty of Health Sciences at Ontario Tech University in Oshawa and Research Chair at the Ontario Shores Centre for Mental Health Sciences in Whitby
| | - Sandra Peterson
- Research analyst in the Centre for Health Services and Policy Research at the University of British Columbia in Vancouver
| | - David Stock
- Senior health services researcher in the Department of Family Medicine at Dalhousie University
| | - Carole Taylor
- Data analyst in the Manitoba Centre for Health Policy at the University of Manitoba in Winnipeg
| | | | - Sabrina T Wong
- Senior investigator with the Division of Intramural Research of the National Institute of Nursing Research
| | - Ian Scott
- Associate Professor in the Department of Family Practice and Director of the Centre for Health Education Scholarship at the University of British Columbia
| | - Kimberlyn M McGrail
- Professor in the Centre for Health Services and Policy Research at the University of British Columbia
| | - Rita K McCracken
- Assistant Professor in the Department of Family Practice at the University of British Columbia
| | - Emily Gard Marshall
- Professor in the Department of Family Medicine and the Primary Care Research Unit at Dalhousie University and with the Nova Scotia Health Authority
| | - Adrian MacKenzie
- Project executive for Health Workforce Planning with the Nova Scotia Department of Health and Wellness, co-Investigator with the WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Adjunct Faculty in the Department of Community Health and Epidemiology at Dalhousie University, and an affiliate scientist with Nova Scotia Health
| | - Alan Katz
- Professor in the Department of Family Medicine and the Department of Community Health Sciences at the University of Manitoba
| | - Margaret Jamieson
- Doctoral candidate in the Institute of Health Policy Management and Evaluation at the University of Toronto
| | - Lindsay Hedden
- Assistant Professor in the Faculty of Health Sciences at Simon Fraser University in Burnaby, BC
| | - Agnes Grudniewicz
- Associate Professor in the Telfer School of Management at the University of Ottawa
| | - Laurie J Goldsmith
- Adjunct Professor in the Faculty of Health Sciences at Simon Fraser and the founder and Principal of GoldQual Consulting
| | - Richard H Glazier
- Senior core scientist with ICES, a Professor of Family and Community Medicine at the University of Toronto, and a family physician and scientist at St Michael's Hospital
| | - Fred Burge
- Professor and a faculty researcher in the Department of Family Medicine at Dalhousie University
| | - Doug Blackie
- Associate Faculty member at the School of Leadership Studies, Royal Roads University, Victoria, BC and a certified health care consultant
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Hudon C, Bisson M, Chouinard MC, Delahunty-Pike A, Lambert M, Howse D, Schwarz C, Dumont-Samson O, Aubrey-Bassler K, Burge F, Doucet S, Ramsden VR, Luke A, Macdonald M, Gaudreau A, Porter J, Rubenstein D, Scott C, Warren M, Wilhelm L. Implementation analysis of a case management intervention for people with complex care needs in primary care: a multiple case study across Canada. BMC Health Serv Res 2023; 23:377. [PMID: 37076851 PMCID: PMC10116737 DOI: 10.1186/s12913-023-09379-7] [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: 06/27/2022] [Accepted: 04/08/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Case management is one of the most frequently performed interventions to mitigate the negative effects of high healthcare use on patients, primary care providers and the healthcare system. Reviews have addressed factors influencing case management interventions (CMI) implementation and reported common themes related to the case manager role and activities, collaboration with other primary care providers, CMI training and relationships with the patients. However, the heterogeneity of the settings in which CMI have been implemented may impair the transferability of the findings. Moreover, the underlying factors influencing the first steps of CMI implementation need to be further assessed. This study aimed to evaluate facilitators and barriers of the first implementation steps of a CMI by primary care nurses for people with complex care needs who frequently use healthcare services. METHODS A qualitative multiple case study was conducted including six primary care clinics across four provinces in Canada. In-depth interviews and focus groups with nurse case managers, health services managers, and other primary care providers were conducted. Field notes also formed part of the data. A mixed thematic analysis, deductive and inductive, was carried out. RESULTS Leadership of the primary care providers and managers facilitated the first steps of the of CMI implementation, as did the experience and skills of the nurse case managers and capacity development within the teams. The time required to establish CMI was a barrier at the beginning of the CMI implementation. Most nurse case managers expressed apprehension about developing an "individualized services plan" with multiple health professionals and the patient. Clinic team meetings and a nurse case managers community of practice created opportunities to address primary care providers' concerns. Participants generally perceived the CMI as a comprehensive, adaptable, and organized approach to care, providing more resources and support for patients and better coordination in primary care. CONCLUSION Results of this study will be useful for decision makers, care providers, patients and researchers who are considering the implementation of CMI in primary care. Providing knowledge about first steps of CMI implementation will also help inform policies and best practices.
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Affiliation(s)
- Catherine Hudon
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Pavillon Z7-Room 3007, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada.
- Centre Hospitalier Universitaire de Sherbrooke Research Centre, Sherbrooke, QC, Canada.
| | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Pavillon Z7-Room 3007, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | | | | | - Mireille Lambert
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Pavillon Z7-Room 3007, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Dana Howse
- Primary Healthcare Research Unit, Memorial University, St-John's, NL, Canada
| | - Charlotte Schwarz
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, NB, Canada
| | - Olivier Dumont-Samson
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Pavillon Z7-Room 3007, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University, St-John's, NL, Canada
| | - Fred Burge
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, NB, Canada
| | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, NB, Canada
| | - Marilyn Macdonald
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | | | - Judy Porter
- Nova Scotia Health Authority, Halifax, NS, Canada
| | | | - Cathy Scott
- Canadian Cancer Society, Toronto, ON, Canada
| | - Mike Warren
- Patient Advisory Council, Newfoundland and Labrador SPOR SUPPORT Unit, St. John's, NL, Canada
| | - Linda Wilhelm
- Canadian Arthritis Patient Alliance, Ottawa, ON, Canada
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Embrett M, Packer TL, Fitzgerald E, Jaswal SK, Lehman MJ, Brown M, Burge F, Christian E, Isenor JE, Marshall EG, Martin-Misener R, Sampalli T, Zed J, Leigh JP. The impact of the COVID-19 pandemic on primary care physicians and nurses in Nova Scotia: a qualitative exploratory study. CMAJ Open 2023; 11:E274-E281. [PMID: 36944428 PMCID: PMC10035666 DOI: 10.9778/cmajo.20210315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has brought immense disruption worldwide, dramatically altering the ways we live, work and learn on a day-to-day basis; however, few studies have investigated this from the perspective of primary care providers. In this study, we sought to explore the experiences of primary care providers in the province of Nova Scotia, with the intention of understanding the impact of the COVID-19 pandemic on primary care providers' ability to provide care, their information pathways, and the personal and professional impact of the pandemic. METHODS We conducted an exploratory qualitative research study involving semistructured interviews conducted via Zoom videoconferencing or telephone with primary care providers (physicians, nurse practitioners and family practice nurses) who self-identified as working in primary health care in Nova Scotia from June 2020 to April 2021. We performed a thematic analysis involving coding and classifying data according to themes. Emergent themes were then interpreted by seeking commonalties, divergence, relationships and overarching patterns in the data. RESULTS Twenty-four primary care providers were interviewed. Subsequent analysis identified 4 interrelated themes within the data: disruption to work-life balance, disruptions to "non-COVID-19" patient care, impact of provincial and centralized policies, and filtering and processing an influx of information. INTERPRETATION Our findings showed that managing a crisis of this magnitude requires coordination and new ways of working, balancing professional and personal life, and adapting to already implemented changes (i.e., virtual care). A specific primary care pandemic response plan is essential to mitigate the impact of future health care crises.
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Affiliation(s)
- Mark Embrett
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Tanya L Packer
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Emily Fitzgerald
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Sabrena K Jaswal
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Michelle J Lehman
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Marion Brown
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Fred Burge
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Erin Christian
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Jennifer E Isenor
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Emily Gard Marshall
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Ruth Martin-Misener
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Tara Sampalli
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Joanna Zed
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Jeanna Parsons Leigh
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
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Lavergne MR, Rudoler D, Peterson S, Stock D, Taylor C, Wilton AS, Wong ST, Scott I, McGrail KM, McCracken R, Marshall EG, MacKenzie A, Katz A, Jamieson M, Hedden L, Grudniewicz A, Goldsmith LJ, Glazier RH, Burge F, Blackie D. Declining Comprehensiveness of Services Delivered by Canadian Family Physicians Is Not Driven by Early-Career Physicians. Ann Fam Med 2023; 21:151-156. [PMID: 36973051 PMCID: PMC10042570 DOI: 10.1370/afm.2945] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 03/29/2023] Open
Abstract
We describe changes in the comprehensiveness of services delivered by family physicians in 4 Canadian provinces (British Columbia, Manitoba, Ontario, Nova Scotia) during the periods 1999-2000 and 2017-2018 and explore if changes differ by years in practice. We measured comprehensiveness using province-wide billing data across 7 settings (home, long-term care, emergency department, hospital, obstetrics, surgical assistance, anesthesiology) and 7 service areas (pre/postnatal care, Papanicolaou [Pap] testing, mental health, substance use, cancer care, minor surgery, palliative home visits). Comprehensiveness declined in all provinces, with greater changes in number of service settings than service areas. Decreases were no greater among new-to-practice physicians.
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Affiliation(s)
- M. Ruth Lavergne
- Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (M. R. L., F. B.)
- Canada Research Chairs Program, Tier II Primary Care, Ottawa, Ontario, Canada (M. R. L.)
- CORRESPONDING AUTHOR: M. Ruth Lavergne Department of Family Medicine, Dalhousie University 402-1465 Brenton St Halifax, NS, B3J 3T4
| | - David Rudoler
- Ontario Tech University, Faculty of Health Sciences, Oshawa, Ontario, Canada (D. R.)
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada (D. R.)
| | - Sandra Peterson
- The University of British Columbia, Centre for Health Services and Policy Research, Vancouver, British Columbia, Canada (S. P., S. T. W., K. M. M.)
| | - David Stock
- Dalhousie University, Department of Community Health and Epidemiology, Halifax, Nova Scotia, Canada (D. S., A. M.)
| | - Carole Taylor
- University of Manitoba, Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada (C. T.)
| | - Andrew S. Wilton
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (A. S. W., R. H. G.)
| | - Sabrina T. Wong
- The University of British Columbia, Centre for Health Services and Policy Research, Vancouver, British Columbia, Canada (S. P., S. T. W., K. M. M.)
- National Institute of Nursing Research, Division of Intramural Research (this work was completed while at the University of British Columbia, School of Nursing, Vancouver, British Columbia, Canada) (S. T. W.)
| | - Ian Scott
- The University of British Columbia, Department of Family Practice, Vancouver, British Columbia, Canada (I. S., R. M.)
- The University of British Columbia, Centre for Health Education Scholarship, Vancouver, British Columbia, Canada (I. S.)
| | - Kimberlyn M. McGrail
- The University of British Columbia, Centre for Health Services and Policy Research, Vancouver, British Columbia, Canada (S. P., S. T. W., K. M. M.)
| | - Rita McCracken
- The University of British Columbia, Department of Family Practice, Vancouver, British Columbia, Canada (I. S., R. M.)
| | - Emily G. Marshall
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada (E. G. M., A. M.)
- Dalhousie University, Primary Care Research Unit, Department of Family Medicine, Halifax, Nova Scotia, Canada (E. G. M.)
| | - Adrian MacKenzie
- Dalhousie University, Department of Community Health and Epidemiology, Halifax, Nova Scotia, Canada (D. S., A. M.)
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada (E. G. M., A. M.)
| | - Alan Katz
- University of Manitoba, Department of Family Medicine, Winnipeg, Manitoba, Canada (A.K.)
- University of Manitoba, Department of Community Health Sciences, Winnipeg, Manitoba, Canada (A. K.)
| | - Margaret Jamieson
- University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada (M. J., R. H. G.)
| | - Lindsay Hedden
- Simon Fraser University, Faculty of Health Sciences, Burnaby, British Columbia, Canada (L. H., L. J. G.)
| | - Agnes Grudniewicz
- University of Ottawa, Telfer School of Management, Ottawa, Ontario, Canada (A. G.)
| | - Laurie J. Goldsmith
- Simon Fraser University, Faculty of Health Sciences, Burnaby, British Columbia, Canada (L. H., L. J. G.)
- GoldQual Consulting, Ontario, Canada (L. J. G.)
| | - Richard H. Glazier
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (A. S. W., R. H. G.)
- University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada (M. J., R. H. G.)
- St Michael’s Hospital, Toronto, Ontario, Canada (R. H. G.)
- University of Toronto, Department of Family and Community Medicine, Toronto, Ontario, Canada (R. H. G.)
| | - Fred Burge
- Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (M. R. L., F. B.)
| | - Doug Blackie
- Royal Roads University, School of Leadership Studies, Victoria, British Columbia, Canada (D. B.)
- Doug Blackie Consulting, Inc, Edmonton, Alberta, Canada (D. B.)
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Rudoler D, Peterson S, Stock D, Taylor C, Wilton D, Blackie D, Burge F, Glazier RH, Goldsmith L, Grudniewicz A, Hedden L, Jamieson M, Katz A, MacKenzie A, Marshall E, McCracken R, McGrail K, Scott I, Wong ST, Lavergne MR. Changes over time in patient visits and continuity of care among graduating cohorts of family physicians in 4 Canadian provinces. CMAJ 2022; 194:E1639-E1646. [PMID: 36511867 PMCID: PMC9828986 DOI: 10.1503/cmaj.220439] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Lack of patient access to family physicians in Canada is a concern. The role of recent physician graduates in this problem of supply of primary care services has not been established. We sought to establish whether career stage or graduation cohort were related to family physician practice volume and continuity of care over time. METHODS We conducted a retrospective cohort study of family physician practice from 1997/98 to 2017/18. We collected administrative health and physician claims data in British Columbia, Manitoba, Ontario and Nova Scotia. We included all physicians who registered with their respective provincial regulatory colleges as having a medical specialty of family practice or who had billed the provincial health insurance system for patient care as family physicians, or both. We used regression models to isolate the effects of 3-year categories of years in practice (at all career stages), time period and cohort on patient contacts and physician-level continuity of care. RESULTS Between 1997/98 and 2017/18, the median number of patient contacts per provider per year fell by between 515 and 1736 contacts in the 4 provinces examined. Median contacts peaked at 27-29 years in practice in all provinces, and median physician-level continuity of care increased until 30 or more years in practice. We found no association between graduation cohort and patient contacts or physician-level continuity of care. INTERPRETATION Recent cohorts of family physicians practise similarly to their predecessors in terms of practice volumes and continuity of care. Because family physicians of all career stages showed declining patient contacts, we suggest that system-wide solutions to recent challenges in the accessibility of primary care in Canada are needed.
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Affiliation(s)
- David Rudoler
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Sandra Peterson
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - David Stock
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont.
| | - Carole Taylor
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Drew Wilton
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Doug Blackie
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Fred Burge
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Richard H Glazier
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Laurie Goldsmith
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Agnes Grudniewicz
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Lindsay Hedden
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Margaret Jamieson
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Alan Katz
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Adrian MacKenzie
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Emily Marshall
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Rita McCracken
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Kim McGrail
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Ian Scott
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Sabrina T Wong
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - M Ruth Lavergne
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
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8
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Seow H, Bainbridge D, Stajduhar K, Marshall D, Howard M, Brouwers M, Barwich D, Burge F, Kelley ML. Building Palliative Care Capacity for Generalist Providers in the Community: Results From the Capaciti Pilot Education Program. Am J Hosp Palliat Care 2022:10499091221134709. [PMID: 36269212 DOI: 10.1177/10499091221134709] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: Primary care providers play an important role in providing early palliative care, however they often lack practical supports to operationalize this approach in practice. CAPACITI is a virtual training program aimed at providing practical tips, strategies, and action plans to help primary care providers offer an early palliative approach to care. The CAPACITI pilot program consisted of 10 facilitated, monthly training sessions, covering identification and assessment, communication, and engaging caregivers and specialists. We present the findings of an evaluation of the pilot program. Method: We conducted a single cohort study of primary care providers who participated in CAPACITI. Study outcomes were the change in the percentage of caseload reported as requiring palliative care and improved confidence in competencies measured on a 20-item, study-created survey. Pre and post survey data were analyzed using paired t-tests. Results: Twenty-two teams representing 127 care providers (including 36 physicians and 28 Nurse Practitioners) completed CAPACITI. Paired comparisons showed a moderate improvement in confidence across the competencies covered (.6 to 1.3 mean improvement across items using seven-point scales, all P < .05). Pre-CAPACITI, clinician prescribers (N = 32) identified a mean of 1.2% of their caseload requiring a palliative approach to care, which increased to 1.6% post-program (P = .02). Said differently, the total group of paired clinician prescribers identified 338 patients as requiring palliative care in their caseloads at baseline vs 482 patients following the intervention, for an overall increase of 144 patients in their collective caseloads. Conclusion: CAPACITI improved self-assessed palliative care identification and provider confidence in core competencies. The program demonstrated potential for building palliative care capacity in primary care teams.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, 3710McMaster University, Hamilton, ON, Canada
| | - Daryl Bainbridge
- Department of Oncology, 3710McMaster University, Hamilton, ON, Canada
| | - Kelli Stajduhar
- Department of School of Nursing and Institute on Aging and Lifelong Health, 8205University of Victoria, Victoria, BC, Canada
| | - Denise Marshall
- Department of Health Sciences, 62703McMaster University, Hamilton, ON, Canada
| | - Michelle Howard
- Department of Family Medicine, 152996McMaster University, Hamilton, ON, Canada
| | - Melissa Brouwers
- School of Epidemiology and Public Health, 177403University of Ottawa, Ottawa, ON, Canada
| | - Doris Barwich
- 12358The University of British Columbia, Vancouver, BC, Canada
| | - Fred Burge
- Department of Family Medicine, 152980Dalhousie University, Halifax, NS, Canada
| | - Mary Lou Kelley
- School of Social Work, 157782Lakehead University, Thunder Bay, ON, Canada
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9
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Moody E, Martin-Misener R, Baxter L, Boulos L, Burge F, Christian E, Condran B, MacKenzie A, Michael E, Packer T, Peacock K, Sampalli T, Warner G. Patient perspectives on primary care for multimorbidity: An integrative review. Health Expect 2022; 25:2614-2627. [PMID: 36073315 DOI: 10.1111/hex.13568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Improving healthcare for people with multiple chronic or ongoing conditions is receiving increased attention, particularly due to the growing number of people experiencing multimorbidity (MM) and concerns about the sustainability of the healthcare system. Primary care has been promoted as an important resource for supporting people with MM to live well with their conditions and to prevent unnecessary use of health care services. However, traditional primary care has been criticized for not centring the needs and preferences of people with MM themselves. Our aim was to conduct a review that centred on the perspective of people with MM in multiple ways, including having patient partners co-lead the design, conduct and reporting of findings, and focusing on literature that reported the perspective of people with MM, irrespective of it being experimental or nonexperimental. METHODS We searched for published literature in CINAHL with Full Text (EBSCOhost) and MEDLINE All (Ovid). Findings from experimental and nonexperimental studies were integrated into collaboration with patient partners. RESULTS Twenty-nine articles were included in the review. Findings are described in five categories: (1) Care that is tailored to my unique situation; (2) meaningful inclusion in the team; (3) a healthcare team that is ready and able to address my complex needs; (4) supportive relationships and (5) access when and where I need it. CONCLUSION This review supports a reorientation of primary care systems to better reflect the experiences and perspectives of people with MM. This can be accomplished by involving patient partners in the design and evaluation of primary care services and incentivizing collaboration among health and social supports and services for people with MM. PATIENT OR PUBLIC CONTRIBUTION Patient partners were involved in the design and conduct of this review, and in the preparation of the manuscript. Their involvement is further elucidated in the manuscript text.
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Affiliation(s)
- Elaine Moody
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Larry Baxter
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Leah Boulos
- Maritime SPOR SUPPORT Unit, Halifax, Nova Scotia, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Brian Condran
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada.,Canadian Center for Vaccinology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | | | - Tanya Packer
- School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada.,School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kylie Peacock
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada.,Canadian Center for Vaccinology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada
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10
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Terry AL, Stewart M, Ashcroft R, Brown JB, Burge F, Haggerty J, McWilliam C, Meredith L, Reid GJ, Thomas R, Wong ST. Complex skills are required for new primary health care researchers: a training program responds. BMC Med Educ 2022; 22:565. [PMID: 35869518 PMCID: PMC9306239 DOI: 10.1186/s12909-022-03620-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Current dimensions of the primary health care research (PHC) context, including the need for contextualized research methods to address complex questions, and the co-creation of knowledge through partnerships with stakeholders - require PHC researchers to have a comprehensive set of skills for engaging effectively in high impact research. MAIN BODY In 2002 we developed a unique program to respond to these needs - Transdisciplinary Understanding and Training on Research - Primary Health Care (TUTOR-PHC). The program's goals are to train a cadre of PHC researchers, clinicians, and decision makers in interdisciplinary research to aid them in tackling current and future challenges in PHC and in leading collaborative interdisciplinary research teams. Seven essential educational approaches employed by TUTOR-PHC are described, as well as the principles underlying the curriculum. This program is unique because of its pan-Canadian nature, longevity, and the multiplicity of disciplines represented. Program evaluation results indicate: 1) overall program experiences are very positive; 2) TUTOR-PHC increases trainee interdisciplinary research understanding and activity; and 3) this training assists in developing their interdisciplinary research careers. Taken together, the structure of the program, its content, educational approaches, and principles, represent a complex whole. This complexity parallels that of the PHC research context - a context that requires researchers who are able to respond to multiple challenges. CONCLUSION We present this description of ways to teach and learn the advanced complex skills necessary for successful PHC researchers with a view to supporting the potential uptake of program components in other settings.
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Affiliation(s)
- Amanda L. Terry
- Centre for Studies in Family Medicine, Department of Family Medicine, Department of Epidemiology & Biostatistics, Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, The University of Western Ontario, Western Centre for Public Health and Family Medicine, 1151 Richmond Street, London, Ontario N6A 3K7 Canada
| | - Moira Stewart
- Centre for Studies in Family Medicine, Department of Family Medicine; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario Canada
| | - Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario Canada
| | - Judith Belle Brown
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia Canada
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montréal, Québec Canada
| | - Carol McWilliam
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, The University of Western Ontario, London, Ontario Canada
| | - Leslie Meredith
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario Canada
| | - Graham J. Reid
- Centre for Studies in Family Medicine, Department of Family Medicine, Department of Psychology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario Canada
| | - Roanne Thomas
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Sabrina T. Wong
- School of Nursing, Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia Canada
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11
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Béland S, Lambert M, Delahunty-Pike A, Howse D, Schwarz C, Chouinard MC, Aubrey-Bassler K, Burge F, Doucet S, Danish A, Dumont-Samson O, Bisson M, Luke A, Macdonald M, Gaudreau A, Porter J, Rubenstein D, Sabourin V, Scott C, Warren M, Wilhelm L, Hudon C. Patient and researcher experiences of patient engagement in primary care health care research: a participatory qualitative study. Health Expect 2022; 25:2365-2376. [PMID: 35593113 PMCID: PMC9615076 DOI: 10.1111/hex.13542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/11/2022] [Accepted: 05/18/2022] [Indexed: 11/28/2022] Open
Abstract
Background Studies have highlighted common challenges and barriers to patient engagement in research, but most were based on patient partners' or academic researchers' experiences. A better understanding of how both groups differentially experience their partnership could help identify strategies to improve collaboration in patient engagement research. Aim This study aimed to describe and compare patient partners' and academic researchers' experiences in patient engagement research. Methods Based on a participatory approach, a descriptive qualitative study was conducted with patient partners and academic researchers who are involved in the PriCARE research programme in primary health care to examine their experience of patient engagement. Individual semi‐structured interviews with patient partners (n = 7) and academic researchers (n = 15) were conducted. Academic researchers' interview verbatims, deidentified patient partners' summaries of their interviews and summaries of meetings with patient partners were analysed using inductive thematic analysis in collaboration with patient partners. Results Patient partners and academic researchers' experiences with patient engagement are captured within four themes: (1) evolving relationships; (2) creating an environment that fosters patient engagement; (3) striking a balance; and (4) impact and value of patient engagement. Evolving relationships refers to how partnerships grew and improved over time with an acceptance of tensions and willingness to move beyond them, two‐way communication and leadership of key team members. Creating an environment that fosters patient engagement requires appropriate structural support, such as clear descriptions of patient partner roles; adequate training for all team members; institutional guidance on patient engagement; regular and appropriate translation services; and financial assistance. For patient partners and academic researchers, striking a balance referred to the challenge of reconciling patient partners' interests and established research practices. Finally, both groups recognized the value and positive impact of patient engagement in the programme in terms of improving the relevance of research and the applicability of results. While patient partners and academic researchers identified similar challenges and strategies, their experiences of patient engagement differed according to their own backgrounds, motives and expectations. Conclusion Both patient partners and academic researchers highlighted the importance of finding a balance between providing structure or guidelines for patient engagement, while allowing for flexibility along the way. Patient or Public Contribution Patient partners from the PriCARE research programme were involved in the following aspects of the current study: (1) development of the research objectives; (2) planning of the research design; (3) development and validation of data collection tools (i.e., interview guides); (4) production of data (i.e., acted as interviewees); (5) validation of data analysis tools (code book); (6) analysis of qualitative data; and (7) drafting of the manuscript and contributing to other knowledge translation activities, such as conference presentations and the creation of a short animated video.
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Affiliation(s)
- Sophie Béland
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Canada
| | - Mireille Lambert
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Canada
| | | | - Dana Howse
- Primary Healthcare Research Unit, Memorial University, St-John's, Canada
| | - Charlotte Schwarz
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada
| | | | | | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Canada
| | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada
| | - Alya Danish
- Institut national d'excellence en santé et en services sociaux, Montréal, Canada
| | - Olivier Dumont-Samson
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Canada
| | - Mathieu Bisson
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada
| | | | | | | | | | | | | | | | | | - Catherine Hudon
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Canada.,Centre de recherche du centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada
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12
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Bisson M, Hudon C, Burge F, Lambert M, Doucet S, Howse D, Dumont-Samson O, Aubrey-Bassier FK, Chouinard MC, Porter J, Ramsden V, Gaudreau A, Schwarz C, Rubenstein D, Scott C, Wilhelm L, Macdonald M, Delanunty-Pike A. Planning, operationalizing, and evaluating patient partners' engagement in primary care research: a logic model. Ann Fam Med 2022; 20:2798. [PMID: 38270680 PMCID: PMC10549048 DOI: 10.1370/afm.20.s1.2798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Context. There is growing evidence supporting patients' engagement (PE) in primary care research to improve the quality, relevance, and uptake of research. However, guidance is still needed to plan and operationalize this engagement during the research process. Objective. To develop a logic model illustrating empirically the causal links between context, resources, activities, and expected outcomes of PE in an implementation research program in primary care. Study design. Instrumental case study. Setting. A research program (PriCARE) aiming to implement and evaluate a case management intervention (CMI) in primary care clinics across five provinces in Canada. Population studied. Research team members. Methods. Data collection. Participant observation and in-depth interviews (n=22) conducted by two independent research assistants with research team members: principal investigators (n=5); co-investigators (n=2); research coordinators and assistants (n=8); and patient partners (n=7). Analysis. Deductive thematic analysis using components of the logic model as coding categories. All data were coded using NVivo 12 software. Data were reduced and organized in a first logic model version. Team meetings helped to refine the logic model. The final version was validated by all research team members. Results. The logic model provides an empirical illustration of the relationship between context, resources, activities, and expected outcomes for PE. Mobilized resources (human, financial, organizational, and communicational) allow research team members to be involved in many activities related to PE: recruitment, training, and support of patient partners; development of a governance structure; participation in research activities; agreement on decision-making processes; training and support of clinicians; development of tools for patients' involvement in the CMI. These activities lead to the following benefits for health research: improved communication amongst all team members, results and knowledge translation; development of a PE culture; capacity building; democratization of health research; and for healthcare: improved implementation of the intervention; improved patient engagement in their care; better health outcomes and resource utilization; support of decision-makers and clinicians; and better practices. Conclusions. The logic model may be useful for the planning, operationalization and evaluation of PPE in primary care research programs.
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Howse D, Delahunty-Pike A, Dumont-Samson O, Bisson M, Lambert M, Doucet S, Chouinard MC, Hudon C, Scott C, Burge F, Wilhelm L, Warren M, Porter J, Schwarz C, Rubenstein D, Gaudreau A. Patient engagement works: Patient and researcher experiences of patient partnership in primary healthcare research. Ann Fam Med 2022; 20:2908. [PMID: 38270736 PMCID: PMC10548982 DOI: 10.1370/afm.20.s1.2908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Context: Health researchers are increasingly engaging patients and their families as partners in the research process, from inception to knowledge translation. The trend toward 'patient-oriented' research is encouraged by a growing view that studies which integrate the patient perspective will make better use of resources to produce more relevant evidence that can be more easily translated to clinical settings. While there is an emerging literature on best practices, challenges, and learnings related to patient engagement (PE), few studies consider the experiences of patient partners (PP) and researchers in the same project. This presentation will present PP and researcher experiences of PE, highlighting important similarities and differences and proposing recommendations. Objectives: To characterize PE experience from the perspective of researchers and PP working together on the same research program, PriCARE; to identify successes and challenges; to ascertain contributions of PE in health research. Study Design: Qualitative. Setting or Dataset: This study was conducted within the larger 5-province PriCARE study examining a nurse-led case management intervention for primary care patients with complex needs. Population studied: 22 members of the study team (7 PP, 8 coordinators, 2 co-investigators, 5 principal investigators). Methods: Data collection: In-depth interviews using guides co-created by researchers and PP covering topics such as PE-related training and knowledge, and reflections on PE processes and impact. Research assistants external to the PriCARE study conducted interviews, transcribed researcher interviews, and generated a summary of PP interviews. Analysis: Data were analyzed thematically using a coding framework that was co-developed with PP. Outcome Measures: Researcher and patient experiences of PE, PP contributions to health research. Results: All team members need PE training at the beginning of and throughout the research process. Evolving trust and flexibility helped team members to navigate different experiences and priorities. PP make integral contributions to study and instrument design, data analysis, and knowledge translation. Clear expectations about the degree and nature of PE and team members' roles are critical. Conclusions: Meaningful PE requires patient-researcher partnership and clear expectation setting at the outset and throughout the research process, and ongoing flexibility to adapt.
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Seow H, Barbera LC, McGrail K, Burge F, Guthrie DM, Lawson B, Chan KKW, Peacock SJ, Sutradhar R. Effect of Early Palliative Care on End-of-Life Health Care Costs: A Population-Based, Propensity Score-Matched Cohort Study. JCO Oncol Pract 2022; 18:e183-e192. [PMID: 34388021 PMCID: PMC8758090 DOI: 10.1200/op.21.00299] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE This study aimed to investigate the impact of early versus not-early palliative care among cancer decedents on end-of-life health care costs. METHODS Using linked administrative databases, we created a retrospective cohort of cancer decedents between 2004 and 2014 in Ontario, Canada. We identified those who received early palliative care (palliative care service used in the hospital or community 12 to 6 months before death [exposure]). We used propensity score matching to identify a control group of not-early palliative care, hard matched on age, sex, cancer type, and stage at diagnosis. We examined differences in average health system costs (including hospital, emergency department, physician, and home care costs) between groups in the last month of life. RESULTS We identified 144,306 cancer decedents, of which 37% received early palliative care. After matching, we created 36,238 pairs of decedents who received early and not-early (control) palliative care; there were balanced distributions of age, sex, cancer type (24% lung cancer), and stage (25% stage III and IV). Overall, 56.3% of early group versus 66.7% of control group used inpatient care in the last month (P < .001). Considering inpatient hospital costs in the last month of life, the early group used an average (±standard deviation) of $7,105 (±$10,710) versus the control group of $9,370 (±$13,685; P < .001). Overall average costs (±standard deviation) in the last month of life for patients in the early versus control group was $12,753 (±$10,868) versus $14,147 (±$14,288; P < .001). CONCLUSION Receiving early palliative care reduced average health system costs in the last month of life, especially via avoided hospitalizations.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, McMaster University, Hamilton, ON, Canada,Hsien Seow, PhD, Department of Oncology, McMaster University, 699 Concession St, 4th Fl, Rm 4-229, Hamilton, ON L8V 5C2, Canada; e-mail:
| | - Lisa C. Barbera
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Kimberlyn McGrail
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Fred Burge
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Dawn M. Guthrie
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Beverley Lawson
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | | | | | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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Wong ST, Johnston S, Burge F, Ammi M, Campbell JL, Katz A, Martin-Misener R, Peterson S, Thandi M, Haggerty J, Hogg W. Comparing the Attainment of the Patient's Medical Home Model across Regions in Three Canadian Provinces: A Cross-Sectional Study. Healthc Policy 2021; 17:19-37. [PMID: 34895408 PMCID: PMC8665731 DOI: 10.12927/hcpol.2021.26659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: The aim of this work was to show the feasibility of providing a comprehensive portrait of regional primary care performance. Methods: The TRANSFORMATION study used a mixed-methods concurrent study design where we analyzed survey data and case studies. Data were collected in British Columbia, Ontario and Nova Scotia. Patient's Medical Home (PMH) pillar scores were created by calculating mean clinic-level scores across regions. Scores and qualitative themes were compared. Results: Participation included 86 practices (n = 1,929 patients; n = 117 clinicians). Regions had differential attainment towards PMH orientation with respect to infrastructure; community adaptiveness and accountability; and patient and family partnered care. The lowest PMH attainment for all regions were observed in connected care; accessible care; measurement, continuous quality improvement and research; and training, education and continuing professional development. Conclusions: Comprehensive performance reporting that draws on multiple data sources in primary care is possible. Regional portraits highlighting many of the key pillars of a PMH approach to primary care show that despite differences in policy contexts, achieving a PMH remains elusive.
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Affiliation(s)
- Sabrina T Wong
- Professor, Centre for Health Services and Health Research, University of British Columbia, School of Nursing, University of British Columbia, Vancouver, BC
| | - Sharon Johnston
- Associate Professor, Department of Family Medicine, University of Ottawa, Ottawa, ON
| | - Fred Burge
- Professor, Department of Family Medicine, Dalhousie University, Halifax, NS
| | - Mehdi Ammi
- Associate Professor, School of Public Policy and Administration, Carleton University, Ottawa, ON
| | - John L Campbell
- Professor, Primary Care Research Group, University of Exeter College of Medicine and Health, Exeter, England
| | - Alan Katz
- Professor, Departments of Community Health Sciences and Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
| | | | - Sandra Peterson
- Research Analyst, Centre for Health Services and Health Research, University of British Columbia Vancouver, BC
| | - Manpreet Thandi
- Doctoral Student, Centre for Health Services and Health Research, School of Nursing, University of British Columbia, Vancouver, BC
| | - Jeannie Haggerty
- Professor, Department of Family Medicine, McGill University, Montreal, QC
| | - William Hogg
- Co-Investigator, TRANSFORMATION Study, Professor, Department of Family Medicine, University of Ottawa; Vice-président associé recherche et Directeur scientifique, Institut du Savoir Montfort, Ottawa, ON
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Khan A, Seow H, Sutradhar R, Peacock S, Chan K, Burge F, McGrail K, Lawson B, Raymakers A, Barbera L. 42: Understanding End-of-Life Cancer Care in Canada: an Updated 12-Year Retrospective Analysis of Three Provinces’ Administrative Health Care Data. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08920-9] [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: 10/19/2022]
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Seow H, Sutradhar R, Barbera LC, Guthrie D, McGrail K, Burge F, Peacock S, Chan KK. Does early palliative care reduce end-of-life hospital costs? A propensity-score matched, population-based, cohort study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.12006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12006 Background: Few studies describe how early versus late palliative care affects end-of-life health services costs. The aim of this study was to investigate the impact of early vs not-early palliative care among cancer decedents on the combined costs of receiving aggressive care (ED/hospitalization) and supportive care (home care/physician home visit). Methods: Using linked administrative databases, we created a retrospective cohort of cancer decedents between 2004 -2014 in Ontario, Canada. We identified those who received “early” palliative care (palliative care service used in the hospital or community 12 to 6 months before death [exposure]). We used propensity score matching to identify a control group of “not-early” palliative care, hard matched on age, sex, cancer type and stage. The propensity score included region, year, treatment, etc. We examined differences in median costs (including hospital, ED, physician, and home care costs) between pairs in the last month of life. Results: We identified 144,306 cancer decedents, of which 37% received early palliative care in the exposure period. After propensity score matching, we created 36,238 pairs of decedents who received early and not-early palliative care. After matching the early and not-early groups had equal distributions of age, sex, cancer type (24% lung cancer) and stage (25% stage 3 or 4). Among those who received early palliative care, 56.3% used hospital in-patient care in the last month, whereas 66.7% of the control group (not-early palliative care) used in-patient care; considering only inpatient hospital costs, those receiving early palliative care used a median of $2,894 in the last month of life compared to the control group of $5,311 (p < 0.001). Overall median costs in the last month of life for patients in the early palliative care vs the control group was $11,129 vs. $10,598 (p < 0.001). Conclusions: In our population-based, propensity-score matched, cohort study of cancer decedents, receiving early palliative care reduced the median overall health system costs, especially via avoiding hospitalizations in the last month of life.
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Affiliation(s)
- Hsien Seow
- McMaster University, Hamilton, ON, Canada
| | | | | | - Dawn Guthrie
- Wilfrid Laurier University, Waterloo, ON, Canada
| | - Kim McGrail
- University of British Columbia, Vancouver, BC, Canada
| | - Fred Burge
- Dalhousie University, Halifax, NS, Canada
| | | | - Kelvin K. Chan
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
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Seow H, Guthrie DM, Stevens T, Barbera LC, Burge F, McGrail K, Chan KKW, Peacock SJ, Sutradhar R. Trajectory of End-of-Life Pain and Other Physical Symptoms among Cancer Patients Receiving Home Care. ACTA ACUST UNITED AC 2021; 28:1641-1651. [PMID: 33924801 PMCID: PMC8161760 DOI: 10.3390/curroncol28030153] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/15/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe the trajectory of physical symptoms among cancer decedents who were receiving home care in the six months before death. PATIENTS AND METHODS An observational cohort study of cancer decedents in Ontario, Canada, who received home care services between 2007 and 2014. To be included, decedents had to use at least one home care service in the last six months of life. Outcomes were the presence of pain and several other physical symptoms at each week before death. RESULTS Our cohort included 27,295 cancer decedents (30,368 assessments). Forty-seven percent were female and 56% were age 75 years or older. The prevalence of all physical symptoms increased as one approached death, particularly in the last month of life. In the last weeks of life, 69% of patients reported having moderate-severe pain; however, only 20% reported that the pain was not controlled. Loss of appetite (63%), shortness of breath (59%), high health instability (50%), and self-reported poor health (44%) were also highly prevalent in the last week of life. Multivariate regression showed that caregiver distress, high health instability, social decline, uncontrolled pain, and signs of depression all worsened the odds of having a physical symptom in the last 3 months of life. CONCLUSION In this large home care cancer cohort, trajectories of physical symptoms worsened close to death. While presence of moderate-severe pain was common, it was also reported as mostly controlled. Covariates, such as caregiver distress and social decline, were associated with having more physical symptoms at end of life.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada;
- Correspondence: ; Tel.: +1-905-387-9711 (ext. 67175); Fax: +1-905-575-6308
| | - Dawn M. Guthrie
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada; (D.M.G.); (T.S.)
| | - Tara Stevens
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada; (D.M.G.); (T.S.)
| | - Lisa C. Barbera
- Department of Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Kimberlyn McGrail
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Kelvin K. W. Chan
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada;
- Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC V5Z 1L3, Canada;
| | - Stuart J. Peacock
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC V5Z 1L3, Canada;
- British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada;
- Division of Biostatistics, University of Toronto, Toronto, ON M5S 1A1, Canada
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Seow H, Sutradhar R, Burge F, McGrail K, Guthrie DM, Lawson B, Oz UE, Chan K, Peacock S, Barbera L. End-of-life outcomes with or without early palliative care: a propensity score matched, population-based cancer cohort study. BMJ Open 2021; 11:e041432. [PMID: 33579764 PMCID: PMC7883853 DOI: 10.1136/bmjopen-2020-041432] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To investigate whether cancer decedents who received palliative care early (ie, >6 months before death) and not-early had different risk of using hospital care and supportive home care in the last month of life. DESIGN/SETTING We identified a population-based cohort of cancer decedents between 2004 and 2014 in Ontario, Canada using linked administrative data. Analysis occurred between August 2017 to March 2019. PARTICIPANTS We propensity-score matched decedents on receiving early or not-early palliative care using billing claims. We created two groups of matched pairs: one that had Resident Assessment Instrument (RAI) home care assessments in the exposure period (Yes-RAI group) and one that did not (No-RAI group) to control for confounders uniquely available in the assessment, such as health instability and pain. The outcomes were the absolute risk difference between matched pairs in receiving hospital care, supportive home care or hospital death. RESULTS In the No-RAI group, we identified 36 238 pairs who received early and not-early palliative care. Those in the early palliative care group versus not-early group had a lower absolute risk difference of dying in hospital (-10.0%) and receiving hospital care (-10.4%) and a higher absolute risk difference of receiving supportive home care (23.3%). In the Yes-RAI group, we identified 3586 pairs, where results were similar in magnitude and direction. CONCLUSIONS Cancer decedents who received palliative care earlier than 6 months before death compared with those who did not had a lower absolute risk difference of receiving hospital care and dying in hospital, and an increased absolute risk difference of receiving supportive home care in the last month of life.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kimberlyn McGrail
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dawn M Guthrie
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Beverley Lawson
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Urun Erbas Oz
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Kelvin Chan
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Stuart Peacock
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Lisa Barbera
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
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Johnston S, Hogg W, Wong ST, Burge F, Peterson S. Differences in Mode Preferences, Response Rates, and Mode Effect Between Automated Email and Phone Survey Systems for Patients of Primary Care Practices: Cross-Sectional Study. J Med Internet Res 2021; 23:e21240. [PMID: 33427675 PMCID: PMC7834947 DOI: 10.2196/21240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/23/2020] [Accepted: 10/28/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A growing number of health care practices are adopting software systems that link with their existing electronic medical records to generate outgoing phone calls, emails, or text notifications to patients for appointment reminders or practice updates. While practices are adopting this software technology for service notifications to patients, its use for collection of patient-reported measures is still nascent. OBJECTIVE This study assessed the mode preferences, response rates, and mode effect for a practice-based automated patient survey using phone and email modalities to patients of primary care practices. METHODS This cross-sectional study analyzed responses and respondent demographics for a short, fully automated, telephone or email patient survey sent to individuals within 72 hours of a visit to their regular primary care practice. Each survey consisted of 5 questions drawn from a larger study's patient survey that all respondents completed in the waiting room at the time of their visit. Automated patient survey responses were linked to self-reported sociodemographic information provided on the waiting room survey including age, sex, reported income, and health status. RESULTS A total of 871 patients from 87 primary care practices in British Columbia, Ontario, and Nova Scotia, Canada, agreed to the automated patient survey and 470 patients (45.2%) completed all 5 questions on the automated survey. Email administration of the follow-up survey was preferred over phone-based administration, except among patients aged 75 years and older (P<.001). Overall, response rates for those who selected an emailed survey (369/606, 60.9%) were higher (P<.001) than those who selected the phone survey (101/265, 38.1%). This held true irrespective of age, sex, or chronic disease status of individuals. Response rates were also higher for email (range 57.4% [58/101] to 66.3% [108/163]) compared with phone surveys (range 36% [23/64] to 43% [10/23]) for all income groups except the lowest income quintile, which had similar response rates (email: 29/63, 46%; phone: 23/50, 46%) for phone and email modes. We observed moderate (range 64.6% [62/96] to 78.8% [282/358]) agreement between waiting room survey responses and those obtained in the follow-up automated survey. However, overall agreement in responses was poor (range 45.3% [43/95] to 46.2% [43/93]) for 2 questions relating to care coordination. CONCLUSIONS An automated practice-based patient experience survey achieved significantly different response rates between phone and email and increased response rates for email as income group rose. Potential mode effects for the different survey modalities may limit multimodal survey approaches. An automated minimal burden patient survey could facilitate the integration of patient-reported outcomes into care planning and service organization, supporting the move of our primary care practices toward a more responsive, patient-centered, continual learning system. However, practices must be attentive to furthering inequities in health care by underrepresenting the experience of certain groups in decision making based on the reach of different survey modes.
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Affiliation(s)
- Sharon Johnston
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Family Medicine, Institu du Savoir, Hôpital Montfort, University of Ottawa, Ottawa, ON, Canada
| | - William Hogg
- Department of Family Medicine, Institu du Savoir, Hôpital Montfort, University of Ottawa, Ottawa, ON, Canada
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Sandra Peterson
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
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21
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Seow H, Stevens T, Barbera LC, Burge F, McGrail K, Chan KKW, Peacock SJ, Sutradhar R, Guthrie DM. Trajectory of psychosocial symptoms among home care patients with cancer at end-of-life. Psychooncology 2020; 30:103-110. [PMID: 33007119 DOI: 10.1002/pon.5559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/11/2020] [Accepted: 09/21/2020] [Indexed: 11/06/2022]
Abstract
PURPOSE Understanding the end-of-life psychosocial needs of cancer patients at home is a knowledge gap. This study describes the trajectory of psychosocial symptoms in the last 6 months of life among cancer decedents who were receiving home care. METHODS Observational population-based cohort study of cancer decedents who were receiving home care services between 2007 and 2014. Decedents had to have at least one home care assessment in the last 6 months of life for inclusion. Outcomes were the presence of psychosocial symptoms (i.e., anxiety, loneliness, depression, social decline, caregiver distress, and cognitive decline) at each week before death. RESULTS Our cohort included 27,295 unique cancer decedents (30,368 assessments), of which 58% died in hospital. Fifty-six percent were older than 74, and 47% were female. The prevalence of all symptoms increased approaching death, except loneliness. Social decline (48%-78%) was the most prevalent psychosocial symptom, though loneliness was reported in less than 10% of the cohort. Caregiver distress rose over time from 15%-27%. A third of the cohort reported issues with cognitive impairment. Multivariate regression showed that physical symptoms such as uncontrolled pain, impairment in independent activities of daily living, and a high level of health instability all significantly worsened the odds of having a psychosocial symptom in the last 3 months of life. CONCLUSION In this large home care cancer cohort, trajectories of psychosocial symptoms worsened close to death. Physical symptoms, such as uncontrolled pain, were associated with having worse psychosocial symptoms at end of life.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Tara Stevens
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Lisa C Barbera
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kimberlyn McGrail
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelvin K W Chan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada.,Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada
| | - Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada.,British Columbia Cancer Agency, Vancouver, British Columbia, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Division of Biostatistics, University of Toronto, Toronto, Ontario, Canada
| | - Dawn M Guthrie
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada.,Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
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Abstract
High-performing and equitable healthcare systems are influenced by the strength of primary healthcare (PHC), which means that there should be special attention on this sector because we are changing how we monitor and improve overall care. Comprehensive data are the foundation for actionable information and are urgently needed in PHC because of the heterogeneity in both the demographics and the healthcare needs of the populations served. An ideal information system would combine multiple data sources such as electronic medical records (EMRs), administrative data and patient-reported information, drawing on the strengths of each to develop a comprehensive view of PHC. The purpose of this commentary is to draw attention to data gaps and offer suggestions about where and how this information could be obtained. Linked patient experience, EMRs and administrative data could be used in a learning health system to support decisions at the practice level and the jurisdictional level, where resources (financial and human) can be deployed to improve the quality of care, particularly when care is needed across sectors. The information gained from the analysis of these data are of high value for clinician/practice quality improvement efforts and for regional and jurisdictional health system planning and resource allocation.
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Affiliation(s)
- Sabrina T Wong
- Professor, Centre for Health Services Research, University of British Columbia, Vancouver, BC, School of Nursing, University of British Columbia, Vancouver, BC
| | - Sharon Johnston
- Associate Professor, Department of Family Medicine, University of Ottawa, Bruyère Research Institute and Institut du Savoir Montfort, Ottawa, ON
| | - Fred Burge
- Professor, Faculty of Medicine, Dalhousie University, Halifax, NS
| | - Kim McGrail
- Professor, Centre for Health Services Research and School of Population and Public Health, University of British Columbia, Vancouver, BC
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Alsabbagh MW, Kueper JK, Wong ST, Burge F, Johnston S, Peterson S, Lawson B, Chung H, Bennett M, Blackman S, McGrail K, Campbell J, Hogg W, Glazier R. Development of comparable algorithms to measure primary care indicators using administrative health data across three Canadian provinces. Int J Popul Data Sci 2020; 5:1340. [PMID: 33644408 PMCID: PMC7893851 DOI: 10.23889/ijpds.v5i1.1340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Performance measurement has been recognized as key to transforming primary care (PC). Yet, performance reporting in PC lags behind even though high-performing PC is foundational to an effective and efficient health care system. OBJECTIVES We used administrative data from three Canadian provinces, British Columbia, Ontario and Nova Scotia, to: 1) identify and develop a core set of PC performance indicators using administrative data and 2) examine their ability to capture PC performance. METHODS Administrative data used included Physician Billings, Discharge Abstract Database, the National Ambulatory Care and Reporting System database, Census and Vital Statistics. Indicators were compiled based on a literature review of PC indicators previously developed with administrative data available in Canada (n=158). We engaged in iterative discussions to assess data conformity, completeness, and plausibility of results in all jurisdictions. Challenges to creating comparable algorithms were examined through content analysis and research team discussions, which included clinicians, analysts, and health services researchers familiar with PC. RESULTS Our final list included 21 PC performance indicators pertaining to 1) technical care (n=4), 2) continuity of care (n=6), and 3) health services utilization (n=11). Establishing comparable algorithms across provinces was possible though time intensive. A major challenge was inconsistent data elements. Ease of data access, and a deep understanding of the data and practice context, was essential for selecting the most appropriate data elements. CONCLUSIONS This project is unique in creating algorithms to measure PC performance across provinces. It was essential to balance internal validity of the indicators within a province and external validity across provinces. The intuitive desire of having the exact same coding across provinces was infeasible due to lack of standardized PC data. Rather, a context-tailored definition was developed for each jurisdiction. This work serves as an example for developing comparable PC performance indicators across different provincial/territorial jurisdictions.
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Affiliation(s)
| | | | - ST Wong
- University of British Columbia
| | | | - S Johnston
- Bruyère Research Institute, University of Ottawa
| | | | | | | | | | | | | | | | - W Hogg
- University of Ottawa, Montfort Hospital Research Institute
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Slater M, Abelson J, Wong ST, Langton JM, Burge F, Hogg W, Hogel M, Martin-Misener R, Johnston S. Priority measures for publicly reporting primary care performance: Results of public engagement through deliberative dialogues in 3 Canadian provinces. Health Expect 2020; 23:1213-1223. [PMID: 32744413 PMCID: PMC7696126 DOI: 10.1111/hex.13100] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/09/2020] [Accepted: 06/19/2020] [Indexed: 11/30/2022] Open
Abstract
Objective While public reporting of hospital‐based performance measurement is commonplace, it has lagged in the primary care sector, especially in Canada. Despite the increasing recognition of patients as active partners in the health‐care system, little is known about what information about primary care performance is relevant to the Canadian public. We explored patient perspectives and priorities for the public reporting of primary care performance measures. Methods We conducted six deliberative dialogue sessions across three Canadian provinces (British Columbia, Ontario, Nova Scotia). Participants were asked to rank and discuss the importance of collecting and reporting on specific dimensions and indicators of primary care performance. We conducted a thematic analysis of the data. Results Fifty‐six patients participated in the dialogue sessions. Measures of access to primary care providers, communication with providers and continuity of information across all providers involved in a patient's care were identified as the highest priority indicators of primary care performance from a patient perspective. Several common measures of quality of care, such as rates of cancer screening, were viewed as too patient dependent to be used to evaluate the health system or primary care provider's performance. Conclusions Our findings suggest that public reporting aimed at patient audiences should focus on a nuanced measure of access, incorporation of context reported alongside measurement that is for public audiences, clear reporting on provider communication and a measure of information continuity. Participants highlighted the importance the public places on their providers staying up to date with advances in care.
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Affiliation(s)
- Morgan Slater
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Julia Abelson
- Department of Clinical Epidemiology & Biostatistics, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada.,School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Julia M Langton
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - William Hogg
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.,CT Lamont Primary Health Care Research Centre, ÉlisabethBruyère Research Institute, Ottawa, ON, Canada
| | - Matthew Hogel
- CT Lamont Primary Health Care Research Centre, ÉlisabethBruyère Research Institute, Ottawa, ON, Canada
| | | | - Sharon Johnston
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.,CT Lamont Primary Health Care Research Centre, ÉlisabethBruyère Research Institute, Ottawa, ON, Canada
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Kennie-Kaulbach N, Cormier R, Kits O, Reeve E, Whelan AM, Martin-Misener R, Burge F, Burgess S, Isenor JE. Influencers on deprescribing practice of primary healthcare providers in Nova Scotia: An examination using behavior change frameworks. Medicine Access @ Point of Care 2020; 4:2399202620922507. [PMID: 36204093 PMCID: PMC9413600 DOI: 10.1177/2399202620922507] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 02/04/2020] [Accepted: 04/08/2020] [Indexed: 01/24/2023] Open
Abstract
Background: Deprescribing is a complex process requiring consideration of behavior change theory to improve implementation and uptake. Aim: The aim of this study was to describe the knowledge, attitudes, beliefs, and behaviors that influence deprescribing for primary healthcare providers (family physicians, nurse practitioners (NPs), and pharmacists) within Nova Scotia using the Theoretical Domains Framework version 2 (TDF(v2)) and the Behavior Change Wheel. Methods: Interviews and focus groups were completed with primary care providers (physicians, NPs, and pharmacists) in Nova Scotia, Canada. Coding was completed using the TDF(v2) to identify the key influencers. Subdomain themes were also identified for the main TDF(v2) domains and results were then linked to the Behavior Change Wheel—Capability, Opportunity, and Motivation components. Results: Participants identified key influencers for deprescribing including areas related to Opportunity, within TDF(v2) domain Social Influences, such as patients and other healthcare providers, as well as Physical barriers (TDF(v2) domain Environmental Context and Resources), such as lack of time and reimbursement. Conclusion: Our results suggest that a systematic approach to deprescribing in primary care should be supported by opportunities for patient and healthcare provider collaborations, as well as practice and system level enhancements to support sustainability of deprescribing practices.
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Affiliation(s)
- Natalie Kennie-Kaulbach
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada
| | | | - Olga Kits
- Research Methods Unit, Research & Innovation, Nova Scotia Health Authority, Halifax, NS, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Emily Reeve
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
- Geriatric Medicine Research, Faculty of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, NS, Canada
| | | | | | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Sarah Burgess
- Pharmacy Department, Nova Scotia Health Authority, Halifax, NS, Canada
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Danish A, Chouinard MC, Aubrey-Bassler K, Burge F, Doucet S, Ramsden VR, Bisson M, Cassidy M, Condran B, Lambert M, Penney C, Sabourin V, Warren M, Hudon C. Protocol for a mixed-method analysis of implementation of case management in primary care for frequent users of healthcare services with chronic diseases and complex care needs. BMJ Open 2020; 10:e038241. [PMID: 32487584 PMCID: PMC7265033 DOI: 10.1136/bmjopen-2020-038241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Case management (CM) in a primary care setting is a promising approach to integrating and improving healthcare services and outcomes for patients with chronic conditions and complex care needs who frequently use healthcare services. Despite evidence supporting CM and interest in implementing it in Canada, little is known about how to do this. This research aims to identify the barriers and facilitators to the implementation of a CM intervention in different primary care contexts (objective 1) and to explain the influence of the clinical context on the degree of implementation (objective 2) and on the outcomes of the intervention (objective 3). METHODS AND ANALYSIS A multiple-case embedded mixed-methods study will be conducted on CM implemented in ten primary care clinics across five Canadian provinces. Each clinic will represent a subunit of analysis, detailed through a case history. Cases will be compared and contrasted using multiple analytical approaches. Qualitative data (objectives 1 and 2) from individual semistructured interviews (n=130), focus group discussions (n=20) and participant observation of each clinic (36 hours) will be compared and integrated with quantitative (objective 3) clinical data on services use (n=300) and patient questionnaires (n=300). An evaluation of intervention fidelity will be integrated into the data analysis. ETHICS AND DISSEMINATION This project received approval from the CIUSSS de l'Estrie - CHUS Research Ethic Board (project number MP-31-2019-2830). Results will provide the opportunity to refine the CM intervention and to facilitate effective evaluation, replication and scale-up. This research provides knowledge on how to resp ond to the needs of individuals with chronic conditions and complex care needs in a cost-effective way that improves patient-reported outcomes and healthcare use, while ensuring care team well-being. Dissemination of results is planned and executed based on the needs of various stakeholders involved in the research.
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Affiliation(s)
- Alya Danish
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | | | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University, St-John's, Newfoundland and Labrador, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Monique Cassidy
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Brian Condran
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mireille Lambert
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Quebec, Canada
| | - Carla Penney
- Primary Healthcare Research Unit, Memorial University, St-John's, Newfoundland and Labrador, Canada
| | | | - Mike Warren
- NL-SPOR Suppport Unit, St-John's, Newfoundland and Labrador, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre hospitalier universitaire de Sherbrooke Research Centre, Sherbrooke, Québec, Canada
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Langton JM, Wong ST, Burge F, Choi A, Ghaseminejad-Tafreshi N, Johnston S, Katz A, Lavergne R, Mooney D, Peterson S, McGrail K. Population segments as a tool for health care performance reporting: an exploratory study in the Canadian province of British Columbia. BMC Fam Pract 2020; 21:98. [PMID: 32475339 PMCID: PMC7262753 DOI: 10.1186/s12875-020-01141-w] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 04/14/2020] [Indexed: 11/26/2022]
Abstract
Background Primary care serves all age groups and individuals with health states ranging from those with no chronic conditions to those who are medically complex, or frail and approaching the end of life. For information to be actionable and guide planning, there must be some population disaggregation based on differences in expected needs for care. Promising approaches to segmentation in primary care reflect both the breadth and severity of health states, the types and amounts of health care utilization that are expected, and the roles of the primary care provider. The purpose of this study was to assess population segmentation as a tool to create distinct patient groups for use in primary care performance reporting. Methods This cross-sectional study used administrative data (patient characteristics, physician and hospital billings, prescription medicines data, emergency department visits) to classify the population of British Columbia (BC), Canada into one of four population segments: low need, multiple morbidities, medically complex, and frail. Each segment was further classified using socioeconomic status (SES) as a proxy for patient vulnerability. Regression analyses were used to examine predictors of health care use, costs and selected measures of primary care attributes (access, continuity, coordination) by segment. Results Average annual health care costs increased from the low need ($ 1460) to frail segment ($10,798). Differences in primary care cost by segment only emerged when attributes of primary care were included in regression models: accessing primary care outside business hours and discontinuous primary care (≥5 different GP’s in a given year) were associated with higher health care costs across all segments and higher continuity of care was associated with lower costs in the frail segment (cost ratio = 0.61). Additionally, low SES was associated with higher costs across all segments, but the difference was largest in the medically complex group (cost ratio = 1.11). Conclusions Population segments based on expected need for care can support primary care measurement and reporting by identifying nuances which may be lost when all patients are grouped together. Our findings demonstrate that variables such as SES and use of regression analyses can further enhance the usefulness of segments for performance measurement and reporting.
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Affiliation(s)
- Julia M Langton
- Centre for Health Services and Policy Research, The University of British Columbia (UBC), 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, The University of British Columbia (UBC), 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.,School of Nursing, UBC, Vancouver, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Alexandra Choi
- Centre for Health Services and Policy Research, The University of British Columbia (UBC), 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Niloufar Ghaseminejad-Tafreshi
- Centre for Health Services and Policy Research, The University of British Columbia (UBC), 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Sharon Johnston
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alan Katz
- Department of Family Medicine and Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ruth Lavergne
- Faculty of Health Science, Simon Fraser University, Burnaby, BC, Canada
| | - Dawn Mooney
- Centre for Health Services and Policy Research, The University of British Columbia (UBC), 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Sandra Peterson
- Centre for Health Services and Policy Research, The University of British Columbia (UBC), 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, The University of British Columbia (UBC), 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada. .,School of Population and Public Health, UBC, Vancouver, BC, Canada.
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Hudon C, Chouinard MC, Aubrey-Bassler K, Muhajarine N, Burge F, Bush PL, Danish A, Ramsden VR, Légaré F, Guénette L, Morin P, Lambert M, Fick F, Cleary O, Sabourin V, Warren M, Pluye P. Case Management in Primary Care for Frequent Users of Health Care Services: A Realist Synthesis. Ann Fam Med 2020; 18:218-226. [PMID: 32393557 PMCID: PMC7213991 DOI: 10.1370/afm.2499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/29/2019] [Accepted: 09/06/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Case management (CM) is a promising intervention for frequent users of health care services. Our research question was how and under what circumstances does CM in primary care work to improve outcomes among frequent users with chronic conditions? METHODS We conducted a realist synthesis, searching MEDLINE, CINAHL, Embase, and PsycINFO (1996 to September 2017) for articles meeting the following criteria: (1) population: adult frequent users with chronic disease, (2) intervention: CM in a primary care setting with a postintervention evaluation, and (3) primary outcomes: integration of services, health care system use, cost, and patient outcome measures. Academic and gray literature were evaluated for relevance and robustness. Independent reviewers extracted data to identify context, mechanism, and outcome (CMO) configurations. Analysis of CMO configurations allowed for the modification of an initial program theory toward a refined program theory. RESULTS Of the 9,295 records retrieved, 21 peer-reviewed articles and an additional 89 documents were retained. We evaluated 19 CM interventions and identified 11 CMO configurations. The development of a trusting relationship fostering patient and clinician engagement in the CM intervention was recurrent in many CMO configurations. CONCLUSION Our refined program theory proposes that in the context of easy access to an experienced and trusted case manager who provides comprehensive care while maintaining positive interactions with patients, the development of this relationship fosters the engagement of both individuals and yields positive outcomes when the following mechanisms are triggered: patients and clinicians feel supported, respected, accepted, engaged, and committed; and patients feel less anxious, more secure, and empowered to self-manage.
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Affiliation(s)
- Catherine Hudon
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Maud-Christine Chouinard
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Kris Aubrey-Bassler
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Nazeem Muhajarine
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Fred Burge
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Paula Louise Bush
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Alya Danish
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Vivian R Ramsden
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - France Légaré
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Line Guénette
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Paul Morin
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Mireille Lambert
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Fiona Fick
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Olivia Cleary
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Véronique Sabourin
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Mike Warren
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Pierre Pluye
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
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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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Guthrie DM, Harman LE, Barbera L, Burge F, Lawson B, McGrail K, Sutradhar R, Seow H. Quality Indicator Rates for Seriously Ill Home Care Clients: Analysis of Resident Assessment Instrument for Home Care Data in Six Canadian Provinces. J Palliat Med 2019; 22:1346-1356. [DOI: 10.1089/jpm.2019.0022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dawn M. Guthrie
- Department of Kinesiology and Physical Education and Wilfrid Laurier University, Waterloo, Ontario, Canada
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Lisa E. Harman
- Department of Kinesiology and Physical Education and Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Lisa Barbera
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Beverley Lawson
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kimberlyn McGrail
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
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Martin-Misener R, Wong ST, Johnston S, Blackman S, Scott C, Hogg W, Burge F, Grool AM, Campbell JL, Wuite S. Regional variation in primary care improvement strategies and policy: case studies that consider qualitative contextual data for performance measurement in three Canadian provinces. BMJ Open 2019; 9:e029622. [PMID: 31628125 PMCID: PMC6803109 DOI: 10.1136/bmjopen-2019-029622] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 08/26/2019] [Accepted: 09/13/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore regional primary care improvement strategies that are potentially determinants of primary care performance. DESIGN Multiple comparative embedded case study. SETTING Three regions in Canada: Fraser East, British Columbia; Eastern Ontario Health Unit, Ontario; Central Zone, Nova Scotia. DATA SOURCES (1) In-depth interviews with purposively selected key informants (eg, primary care decision-makers, physician leads, regulatory agencies) and focus groups with patients and clinicians (n=68 participants) and (2) published and grey literature (n=205 documents). OUTCOME MEASURES Variations in spread and uptake of primary care improvement strategies across the three study regions. NVivo (V.11) was used to manage data and perform content analysis to identify categories within and across cases. The coding structure was developed by researchers through iterative collaboration, using inductive and deductive processes. RESULTS Six overarching primary care improvement strategies, differing in focus and spread, were implemented across the three study regions: interprofessional team-based approaches, provider skill mix expansion, physician groups and networks, information systems, remuneration and performance measurement and reporting infrastructure. CONCLUSION The addition of information on regional improvement strategies to primary care performance reports could add important contextual insights into primary care performance results. This could help identify possible drivers of reported performance outcomes and levers for change in practice, regional and system-level settings.
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Affiliation(s)
| | - Sabrina T Wong
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sharon Johnston
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Catherine Scott
- PolicyWise for Children & Families, Calgary, Alberta, Canada
| | - William Hogg
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Montfort Hospital Research Institute, Ottawa, Ontario, Canada
| | - Fred Burge
- Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anne M Grool
- Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - John L Campbell
- Peninsula Medical School, University of Exeter, Exeter, United Kingdom
| | - Sara Wuite
- Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Lavergne MR, Goldsmith LJ, Grudniewicz A, Rudoler D, Marshall EG, Ahuja M, Blackie D, Burge F, Gibson RJ, Glazier RH, Hawrylyshyn S, Hedden L, Hernandez-Lee J, Horrey K, Joyce M, Kiran T, MacKenzie A, Mathews M, McCracken R, McGrail K, McKay M, McPherson C, Mitra G, Sampalli T, Scott I, Snadden D, Murphy GT, Wong ST. Practice patterns among early-career primary care (ECPC) physicians and workforce planning implications: protocol for a mixed methods study. BMJ Open 2019; 9:e030477. [PMID: 31551384 PMCID: PMC6773300 DOI: 10.1136/bmjopen-2019-030477] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Canadians report persistent problems accessing primary care despite an increasing per-capita supply of primary care physicians (PCPs). There is speculation that PCPs, especially those early in their careers, may now be working less and/or choosing to practice in focused clinical areas rather than comprehensive family medicine, but little evidence to support or refute this. The goal of this study is to inform primary care planning by: (1) identifying values and preferences shaping the practice intentions and choices of family medicine residents and early career PCPs, (2) comparing practice patterns of early-career and established PCPs to determine if changes over time reflect cohort effects (attributes unique to the most recent cohort of PCPs) or period effects (changes over time across all PCPs) and (3) integrating findings to understand the dynamics among practice intentions, practice choices and practice patterns and to identify policy implications. METHODS AND ANALYSIS We plan a mixed-methods study in the Canadian provinces of British Columbia, Ontario and Nova Scotia. We will conduct semi-structured in-depth interviews with family medicine residents and early-career PCPs and analyse survey data collected by the College of Family Physicians of Canada. We will also analyse linked administrative health data within each province. Mixed methods integration both within the study and as an end-of-study step will inform how practice intentions, choices and patterns are interrelated and inform policy recommendations. ETHICS AND DISSEMINATION This study was approved by the Simon Fraser University Research Ethics Board with harmonised approval from partner institutions. This study will produce a framework to understand practice choices, new measures for comparing practice patterns across jurisdictions and information necessary for planners to ensure adequate provider supply and patient access to primary care.
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Affiliation(s)
- M Ruth Lavergne
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Laurie J Goldsmith
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Agnes Grudniewicz
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - David Rudoler
- University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Emily Gard Marshall
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Megan Ahuja
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Doug Blackie
- School of Leadership Studies, Royal Roads University, Victoria, British Columbia, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Richard H Glazier
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Steve Hawrylyshyn
- First Five Years group, College of Family Physicians of Canada, Toronto, Ontario, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Kathleen Horrey
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mike Joyce
- Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | - Tara Kiran
- Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Adrian MacKenzie
- Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology and WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Maria Mathews
- Department of Family Medicine, University of Western Ontario, London, Ontario, Canada
| | - Rita McCracken
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Madeleine McKay
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Goldis Mitra
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tara Sampalli
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Ian Scott
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Snadden
- Department of Family Practice, Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, British Columbia, Canada
| | - Gail Tomblin Murphy
- Department of Community Health and Epidemiology and WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
INTRODUCTION Primary health care (PHC) is the foundation of healthcare systems around the world, recognized for its ability to deliver cost-effective, equitable, and high-quality care. Measuring and reporting on PHC performance allows decision-makers to ensure accountability and quality improvement. Rural areas, where residents are few and widely dispersed across vast areas, present special challenges for PHC delivery, and performance measurement systems need to acknowledge the ways rural PHC is unique. The objective of this scoping review is to establish the features of PHC that should be measured and reported in a rural versus a non-rural context. METHODS The electronic databases PubMed, Scopus, and CINAHL, as well as grey literature in the form of government reports and research institute publications, were searched for relevant studies. Identified articles were eligible for inclusion if they reported or described (1) rural primary health care; (2) healthcare practice characteristics or structures, provider scope of practice, provider practice patterns, or patient patterns of health care use; and (3) one of four 'pillars' of quality PHC outlined in the College of Family Physicians of Canada's 'Patient's Medical Home' model: accessibility, continuity, comprehensiveness, or electronic health records. Articles were excluded if they reported or described (1) specific patient populations, health concerns, or health outcomes; or (2) patient preferences or experiences with PHC. Data were extracted and analyzed to determine unique aspects of rural PHC. Twenty-six articles met inclusion criteria. RESULTS Results suggest important differences in aspects of rural PHC, particularly in how rural patients access such care and the types of services they receive from providers compared to non-rural patients. CONCLUSION These differences between rural and non-rural PHC will need to be considered in the design of performance measurement systems. Key words: Canada, health reporting, performance measurement, primary health care.
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Affiliation(s)
- Patrick Murphy
- Department of Family Medicine, Dalhousie University, 5909 Veterans' Memorial Lane, Abbie J. Lane Building, Halifax, NS, B3H 2E2, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, 5909 Veterans' Memorial Lane, Abbie J. Lane Building, Halifax, NS, B3H 2E2, Canada
| | - Sabrina T Wong
- School of Nursing, University of British Columbia, T201 2211 Westbrook Mall, Vancouver, BC, V6T 2B5, Canada; and Centre for Health Services and Policy Research, University of British Columbia, 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
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Greiver M, Dahrouge S, O'Brien P, Manca D, Lussier MT, Wang J, Burge F, Grandy M, Singer A, Twohig M, Moineddin R, Kalia S, Aliarzadeh B, Ivers N, Garies S, Turner JP, Farrell B. Improving care for elderly patients living with polypharmacy: protocol for a pragmatic cluster randomized trial in community-based primary care practices in Canada. Implement Sci 2019; 14:55. [PMID: 31171011 PMCID: PMC6551894 DOI: 10.1186/s13012-019-0904-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 04/26/2019] [Accepted: 05/13/2019] [Indexed: 01/17/2023] Open
Abstract
Background Elders living with polypharmacy may be taking medications that do not benefit them. Polypharmacy can be associated with elevated risks of poor health, reduced quality of life, high care costs, and persistently complex care needs. While many medications could be problematic, this project targets medications that should be deprescribed for most elders and for which guidelines and evidence-based deprescribing tools are available. These are termed potentially inappropriate prescriptions (PIPs) and are as follows: proton pump inhibitors, benzodiazepines, antipsychotics, and sulfonylureas. Implementation strategies for deprescribing PIPs in complex older patient populations are needed. Methods This will be a pragmatic cluster randomized controlled trial in community-based primary care practices across Canada. Eligible practices provide comprehensive primary care and have at least one physician that consents to participate. Community-dwelling patients aged 65 years and older with ten or more unique medication prescriptions in the past year will be included. The objective is to assess whether the intervention reduces targeted PIPs for these patients compared with usual care. The intervention, Structured Process Informed by Data, Evidence and Research (SPIDER), is a collaboration between quality improvement (QI) and research programs. Primary care teams will form interprofessional Learning Collaboratives and work with QI coaches to review electronic medical record data provided by their regional Practice Based Research Networks (PBRNs), identify areas of improvement, and develop and implement changes. The study will be tested for feasibility in three PBRNs (Toronto, Montreal, and Edmonton) using prospective single-arm mixed methods. Findings will then guide a pragmatic cluster randomized controlled trial in five PBRNs (Calgary, Winnipeg, Ottawa, Montreal, and Halifax). Seven practices per PBRN will be recruited for each arm. The analysis will be by intention to treat. Ten percent of patients who have at least one PIP at baseline will be randomly selected to participate in the assessment of patient experience and self-reported outcomes. Qualitative methods will be used to explore patient and physician experience and evaluate SPIDER’s processes. Conclusion We are testing SPIDER in a primary care population with complex care needs. This could provide a widely applicable model for care improvement. Trial registration Clinicaltrials.gov NCT03689049; registered September 28, 2018 Electronic supplementary material The online version of this article (10.1186/s13012-019-0904-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Greiver
- North York General Hospital, 4001 Leslie Street, LE-140, Toronto, Ontario, M2K 1E1, Canada. .,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 4001 Leslie Street, LE-140, Toronto, Ontario, M2K 1E1, Canada.
| | - S Dahrouge
- Department of Family Medicine, University of Ottawa, 85 Primrose Avenue, Ottawa, Ontario, K1R 6M1, Canada.,Bruyère Research Institute, 43 Bruyère Street, Ottawa, Ontario, K1N 5C8, Canada
| | - P O'Brien
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 4001 Leslie Street, LE-140, Toronto, Ontario, M2K 1E1, Canada
| | - D Manca
- Department of Family Medicine, University of Alberta, 8303 - 112 Street NW, 610 University Terrace, Edmonton, Alberta, T6G 2T4, Canada
| | - M T Lussier
- Department of Family Medicine and Emergency Medicine, University of Montreal, 1755 René Laennec, Bureau DS-079, Laval, Québec, H7M3L9, Canada
| | - J Wang
- North York General Hospital, 4001 Leslie Street, LE-140, Toronto, Ontario, M2K 1E1, Canada
| | - F Burge
- Department of Family Medicine, Dalhousie University, 8F, 8525 Abbie J Lane Building, 5909 Veterans' Memorial Lane, Halifax, Nova Scotia, B3H 2E2, Canada
| | - M Grandy
- Department of Family Medicine, Dalhousie University, 8F, 8525 Abbie J Lane Building, 5909 Veterans' Memorial Lane, Halifax, Nova Scotia, B3H 2E2, Canada
| | - A Singer
- Department of Family Medicine, University of Manitoba, D009 - 780 Bannatyne Ave, Winnipeg, Manitoba, R3T 2N2, Canada
| | - M Twohig
- North York General Hospital, 4001 Leslie Street, LE-140, Toronto, Ontario, M2K 1E1, Canada
| | - R Moineddin
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 4001 Leslie Street, LE-140, Toronto, Ontario, M2K 1E1, Canada.,ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1V7, Canada
| | - S Kalia
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 4001 Leslie Street, LE-140, Toronto, Ontario, M2K 1E1, Canada
| | - B Aliarzadeh
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 4001 Leslie Street, LE-140, Toronto, Ontario, M2K 1E1, Canada
| | - N Ivers
- Family Practice Health Centre and Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, M5S 1B2, Canada
| | - S Garies
- Department of family Medicine, Cumming School of Medicine, University of Calgary, G012 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada
| | - J P Turner
- Faculty of Pharmacy, University of Montreal, 2900 Edouard Montpetit Boulevard, Montreal, Quebec, H3T 1J4, Canada.,Centre de Recherche, Institut Universitaire de Geriatrie de Montreal, Montreal, Canada
| | - B Farrell
- Department of Family Medicine, University of Ottawa, 85 Primrose Avenue, Ottawa, Ontario, K1R 6M1, Canada.,Bruyère Research Institute, 43 Bruyère Street, Ottawa, Ontario, K1N 5C8, Canada.,School of Pharmacy, University of Waterloo, Waterloo, Canada
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Johnston S, Abelson J, Wong ST, Langton J, Hogel M, Burge F, Hogg W. Citizen perspectives on the use of publicly reported primary care performance information: Results from citizen-patient dialogues in three Canadian provinces. Health Expect 2019; 22:974-982. [PMID: 31074573 PMCID: PMC6803417 DOI: 10.1111/hex.12902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 04/05/2019] [Accepted: 04/06/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Performance measurement and reporting is proliferating in all sectors of the healthcare system, including primary care, despite a dearth of evidence on how the public uses reports on primary care performance. We explored how the public might use this information, to guide the development of effective reporting systems for primary care. METHODS We conducted six full-day deliberative dialogue sessions with a purposive sample of 56 citizen-patients across three Canadian provinces (British Columbia, Ontario and Nova Scotia). Participants identified how they would use publicly reported performance data. We conducted a thematic analysis of the data by region. RESULTS Common uses for primary care performance information emerged across all sessions. Participants most often discussed the utility of this information for community advocacy and participation in health system decision making. Similar barriers for using performance information to choose a primary care provider were identified in each region including the perceived lack of choice of providers and the high value placed on relationships with current providers. Finally, the value of public performance reporting in enhancing trust that people would receive good care was also a common theme. CONCLUSIONS Citizen-patient perspectives highlight that public reporting on primary care performance could promote the health system's responsiveness by enabling public engagement in decision making at the community level. The role of public reporting in promoting trust rather than empowering patient choice may reflect unique elements of the Canadian health system's context.
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Affiliation(s)
- Sharon Johnston
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.,CT Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Julia Abelson
- Department of Clinical Epidemiology & Biostatistics, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada.,School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julia Langton
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mathew Hogel
- CT Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - William Hogg
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.,CT Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, Ottawa, Ontario, Canada
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36
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Affiliation(s)
- Fred Burge
- Department of Family Medicine, Dalhousie University and Palliative Care Service, Camp Hill Medical Centre, Halifax, Nova Scotia, Canada
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37
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Affiliation(s)
- Scott A. Murray
- Primary Palliative Care Research Group, Division of Community Health Sciences: General Practice, University of Edinburgh, Edinburgh, Scotland, UK
| | | | - Fred Burge
- Department of Family Practice, Dalhousie University, Halifax, Canada
| | - Alan Barnard
- Division of Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - David Nowels
- Department of Family Medicine, University of Colorado at Denver and Health Sciences Center, Aurora, Colorado, USA
| | - Rodger Charlton
- Institute of Clinical Education, the Medical School, University of Warwick, England, UK
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Digout C, Lawson B, MacKenzie A, Burge F. Prevalence of Having Advance Directives and a Signed Power of Attorney in Nova Scotia. J Palliat Care 2019; 34:189-196. [DOI: 10.1177/0825859719831312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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)
- Christian Digout
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Beverley Lawson
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Adrian MacKenzie
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Terry AL, Stewart M, Cejic S, Marshall JN, de Lusignan S, Chesworth BM, Chevendra V, Maddocks H, Shadd J, Burge F, Thind A. A basic model for assessing primary health care electronic medical record data quality. BMC Med Inform Decis Mak 2019; 19:30. [PMID: 30755205 PMCID: PMC6373085 DOI: 10.1186/s12911-019-0740-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 01/02/2019] [Indexed: 11/29/2022] Open
Abstract
Background The increased use of electronic medical records (EMRs) in Canadian primary health care practice has resulted in an expansion of the availability of EMR data. Potential users of these data need to understand their quality in relation to the uses to which they are applied. Herein, we propose a basic model for assessing primary health care EMR data quality, comprising a set of data quality measures within four domains. We describe the process of developing and testing this set of measures, share the results of applying these measures in three EMR-derived datasets, and discuss what this reveals about the measures and EMR data quality. The model is offered as a starting point from which data users can refine their own approach, based on their own needs. Methods Using an iterative process, measures of EMR data quality were created within four domains: comparability; completeness; correctness; and currency. We used a series of process steps to develop the measures. The measures were then operationalized, and tested within three datasets created from different EMR software products. Results A set of eleven final measures were created. We were not able to calculate results for several measures in one dataset because of the way the data were collected in that specific EMR. Overall, we found variability in the results of testing the measures (e.g. sensitivity values were highest for diabetes, and lowest for obesity), among datasets (e.g. recording of height), and by patient age and sex (e.g. recording of blood pressure, height and weight). Conclusions This paper proposes a basic model for assessing primary health care EMR data quality. We developed and tested multiple measures of data quality, within four domains, in three different EMR-derived primary health care datasets. The results of testing these measures indicated that not all measures could be utilized in all datasets, and illustrated variability in data quality. This is one step forward in creating a standard set of measures of data quality. Nonetheless, each project has unique challenges, and therefore requires its own data quality assessment before proceeding. Electronic supplementary material The online version of this article (10.1186/s12911-019-0740-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amanda L Terry
- Department of Family Medicine, Department of Epidemiology & Biostatistics, Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, The University of Western Ontario, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada.
| | - Moira Stewart
- Department of Family Medicine, Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
| | - Sonny Cejic
- Department of Family Medicine, Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
| | - J Neil Marshall
- Department of Family Medicine, Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Bert M Chesworth
- School of Physical Therapy, Faculty of Health Sciences, Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
| | - Vijaya Chevendra
- Science and Software Educator and Consultant, 58 Moraine Walk, London, Ontario, N6G 4Y8, Canada
| | - Heather Maddocks
- Department of Family Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
| | - Joshua Shadd
- Department of Family Medicine, McMaster University, 100 Main Street West, 6th Floor, Hamilton, Ontario, L8P 1H6, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, 5909 Veterans Memorial Lane, Abbie J Lane Building, Room 8101B, Halifax, Nova Scotia, B3H 2E2, Canada
| | - Amardeep Thind
- Department of Family Medicine, Department of Epidemiology & Biostatistics, Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, The University of Western Ontario, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
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40
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Lawson B, Sampalli T, Warner G, Burge F, Moorhouse P, Gibson R, Wood S, Harnish A, Bedford LG, Edwards L, Ryan-Carson S. Improving Care for the Frail in Nova Scotia: An Implementation Evaluation of a Frailty Portal in Primary Care Practice. Int J Health Policy Manag 2019; 8:112-123. [PMID: 30980624 PMCID: PMC6462204 DOI: 10.15171/ijhpm.2018.102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 10/09/2018] [Indexed: 12/15/2022] Open
Abstract
Background: Understanding and addressing the needs of frail patients has been identified as an important strategy by the Nova Scotia Health Authority (NSHA). Primary care (PC) providers are in a key position to aid in the identification of, and response to frailty as part of routine care. Unlike singular chronic conditions such as diabetes and hypertension which garner a disease-based approach and identification as part of standard practice, frailty is only just emerging as a concept for PC. The web-based Frailty Portal was developed to aid in the identification of, assessment and care planning for frail patients in PC practice. In this study we assess the implementation feasibility and impact of the Frailty Portal by: (1) identifying factors influencing the Frailty Portal’s use in community PC practice, and (2) examination of the immediate impact of the ‘Frailty Portal’ on frail patients, their caregivers and PC providers.
Methods: A convergent mixed method approach was implemented among PC providers in community-based practice in the NSHA, Central Zone. Quantitative and qualitative data were collected concurrently over a 9-month period. A sample of patients who underwent assessment and/or their caregiver were approached for survey participation.
Results: Fourteen community PC providers (10 family physicians, 4 nurse practitioners) completed 48 patient assessments and completed or begun 41 care plans; semi-structured interviews were conducted among 9 providers. Nine patients and 5 caregivers participated in the survey. PC providers viewed frailty as an important concept but implementation challenges were met, primarily with respect to the time required for use and lack of fit with traditional practice routines. Additional barriers included tool usability and accessibility, training and care planning steps, and privacy. Impacts of the tools use with respect to confidence and knowledge showed early promise.
Conclusion: This feasibility study highlights the need for added health system supports, resources and financial incentives for successful implementation of the Frailty Portal in community PC practice. We suggest future implementation integrate the Frailty Portal to practice electronic medical records (EMRs) and target providers with largely geriatric practice populations and those practicing within interdisciplinary, collaborative primary healthcare (PHC) teams.
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Affiliation(s)
- Beverley Lawson
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Tara Sampalli
- Research and Innovation, Nova Scotia Health Authority, Primary Health Care & Chronic Disease Management, Halifax, NS, Canada.,Dalhousie University, Halifax, NS, Canada
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada.,Health Populations Institute, Dalhousie University, Halifax, NS, Canada.,Continuing Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
| | - Paige Moorhouse
- Division of Geriatric Medicine, Nova Scotia Health Authority, Halifax, NS, Canada.,Dalhousie University, Halifax, NS, Canada.,Palliative and Therapeutic Harmonization (PATH) Program, Halifax, NS, Canada
| | - Rick Gibson
- Department of Family Practice, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Stephanie Wood
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Ashley Harnish
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Lisa G Bedford
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Lynn Edwards
- Primary Heath Care, Family Practice and Chronic Disease and Wellness, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Shannon Ryan-Carson
- Chronic Disease and Wellness, Nova Scotia Health Authority, Halifax, NS, Canada
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Abstract
Access to high-quality end-of-life (EOL) care is critical for all those with incurable cancer. The objective of this study was to examine inequalities in access to, and quality of, EOL care by assessing registration in a palliative care program, emergency room visits in the last 30 days of life, and location of death among individuals who died of colorectal cancer in Nova Scotia, Canada, between 2001 and 2008. We used population-based linked administrative data and performed multivariate logistic regression models to assess the association between socio-economic, geographic, and demographic factors and outcomes related to access to, and quality of, EOL care (n=1,201). This study demonstrates that although access to, and quality of, EOL care appears to have improved, there remain significant inequalities throughout the population. Of primary concern is the variation in access to, and quality of, EOL care based on geographic location of residence and patient age.
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Affiliation(s)
- André R. Maddison
- AR Maddison (corresponding author): Faculty of Medicine, Dalhousie University, 5849 University Avenue, Mailbox No. 257, Halifax, Nova Scotia, Canada B3H 4R2
| | - Yukiko Asada
- Y Asada: Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Fred Burge
- F Burge: Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Grace W. Johnston
- GW Johnston: School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robin Urquhart
- R Urquhart: Cancer Outcomes Research Program, Cancer Care Nova Scotia, Halifax, Nova Scotia, Canada
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Abstract
Performance measurement must be meaningful to those being asked to contribute data and to the clinicians who are collecting the information. It must be actionable if performance measurement and reporting is to influence health system transformation. To date, measuring patient experiences in all parts of the healthcare system in Canada lags behind other countries. More attention needs to be paid to capturing patients with complex intersecting health and social problems that result from inequitable distribution of wealth and/or underlying structural inequities related to systemic issues such as racism and discrimination, colonialism and patriarchy. Efforts to better capture the experiences of patients who do not regularly access care and who speak English or French as a second language are also needed. Before investing heavily into collecting patient experience data as part of a performance measurement system the following ought to be considered: (1) ensuring value for and buy-in from clinicians who are being asked to collect the data and/or act on the results; (2) investment in the infrastructure to administer iterative, cost-effective patient/family experience data collection, analysis and reporting (e.g., automated software tools) and (3) incorporating practice support (e.g., facilitation) and health system opportunities to integrate the findings from patient experience surveys into policy and practice. Investment into the infrastructure of measuring, reporting and engaging clinicians in improving practice is needed for patient/caregiver experiences to be acted upon.
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Affiliation(s)
- Sabrina T Wong
- Centre for Health Services Research and School of Nursing, University of British Columbia, Vancouver, BC
| | - Sharon Johnston
- CT Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, Department of Family Medicine, University of Ottawa, Ottawa, ON
| | - Fred Burge
- Faculty of Medicine, Dalhousie University, Halifax, NS
| | - Kim McGrail
- Centre for Health Services Research, University of British Columbia, Vancouver, BC
| | - William Hogg
- CT Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, Department of Family Medicine, University of Ottawa, Montfort Hospital Research Institute, Ottawa, ON
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Wong ST, Hogg W, Burge F, Johnston S, French I, Blackman S. Using the CollaboraKTion framework to report on primary care practice recruitment and data collection: costs and successes in a cross-sectional practice-based survey in British Columbia, Ontario, and Nova Scotia, Canada. BMC Fam Pract 2018; 19:87. [PMID: 29898667 PMCID: PMC6001004 DOI: 10.1186/s12875-018-0782-x] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 05/25/2018] [Indexed: 12/16/2022]
Abstract
Background Across Canada and internationally we have poor infrastructure to regularly collect survey data from primary care practices to supplement data from chart audits and physician billings. The purpose of this work is to: 1) examine the variable costs for carrying out primary care practice-based surveys and 2) share lessons learned about the level of engagement required for recruitment of practices in primary care. Methods This work was part of a larger study, TRANSFORMATION that collected data from three provincial study sites in Canada. We report here on practice-based engagement. Surveys were administered to providers, organizational practice leads, and up to 20 patients from each participating provider. We used the CollaboraKTion framework to report on our recruitment and engagement strategies for the survey work. Data were derived from qualitative sources, including study team meeting minutes, memos/notes from survey administrators regarding their interactions with practice staff, and patients and stakeholder meeting minutes. Quantitative data were derived from spreadsheets tracking numbers for participant eligibility, responses, and completions and from time and cost tracking for patient survey administration. Results A total of 87 practices participated in the study (n = 22 in BC; n = 26 in ON; n = 39 in NS). The first three of five CollaboraKTion activities, Contacting and Connecting, Deepening Understandings, and Adapting and Applying the Knowledge Base, and their associated processes were most pertinent to our recruitment and data collection. Practice participation rates were low but similar, averaging 36% across study sites, and completion rates were high (99%). Patient completion rates were similarly high (99%), though participation rates in BC were substantially lower than the other sites. Recruitment and data collection costs varied with the cost per practice ranging from $1503 to $1792. Conclusions A comprehensive data collection system in primary care is possible to achieve with partnerships that balance researcher, clinical, and policy maker contexts. Engaging practices as valued community members and independent business owners requires significant time, and financial and human resources. An integrated knowledge translation and exchange approach provides a foundation for continued dialogue, exchange of ideas, use of the information produced, and recognises recruitment as part of an ongoing cycle.
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Affiliation(s)
- Sabrina T Wong
- School of Nursing, University of British Columbia, T201 2211 Westbrook Mall, Vancouver, BC, V6T 2B5, Canada. .,Centre for Health Services and Policy Research, University of British Columbia, 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - William Hogg
- Department of Family Medicine, University of Ottawa, 201-600 Peter Morand Cresc, Ottawa, ON, K1G 5Z3, Canada.,Montfort Hospital Research Institute, 713 Montreal Rd, Ottawa, ON, K1K 0T2, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, 5909 Veterans' Memorial Lane, Abbie J. Lane Building, Halifax, NS, B3H 2E2, Canada
| | - Sharon Johnston
- Department of Family Medicine, University of Ottawa, 201-600 Peter Morand Cresc, Ottawa, ON, K1G 5Z3, Canada.,Montfort Hospital Research Institute, 713 Montreal Rd, Ottawa, ON, K1K 0T2, Canada
| | - Ilisha French
- Montfort Hospital Research Institute, 713 Montreal Rd, Ottawa, ON, K1K 0T2, Canada
| | - Stephanie Blackman
- Department of Family Medicine, Dalhousie University, 5909 Veterans' Memorial Lane, Abbie J. Lane Building, Halifax, NS, B3H 2E2, Canada
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Warner G, Lawson B, Sampalli T, Burge F, Gibson R, Wood S. Applying the consolidated framework for implementation research to identify barriers affecting implementation of an online frailty tool into primary health care: a qualitative study. BMC Health Serv Res 2018; 18:395. [PMID: 29855306 PMCID: PMC5984376 DOI: 10.1186/s12913-018-3163-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/30/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Frailty is associated with multi-system deterioration, and typically increases susceptibility to adverse events such as falls. Frailty can be better managed with early screening and intervention, ideally conducted in primary health care (PHC) settings. This study used the Consolidated Framework for Implementation Research (CFIR) as an evaluation framework during the second stage piloting of a novel web-based tool called the Frailty Portal, developed to aid in the screening, identification, and care planning of frail patients in community PHC. METHODS This qualitative study conducted semi-structured key informant interviews with a purposive sample of PHC providers (family physicians, nurse practitioners) and key PHC stakeholders who were administrators, decision makers and staff. The CFIR was used to guide data collection and analysis. Framework Analysis was used to determine the relevance of the CFIR constructs to implementing the Frailty Portal. RESULTS A total of 17 interviews were conducted. The CFIR-inspired interview questions helped clarify critical aspects of implementation that need to be addressed at multiple levels if the Frailty Portal is to be successfully implemented in PHC. Finding were organized into three themes 1) PHC Practice Context, 2) Intervention attributes affecting implementation, and 3) Targeting providers with frail patients. At the intervention level the Frailty Portal was viewed positively, despite the multi-level challenges to implementing it in PHC practice settings. Provider participants perceived high opportunity costs to using the Frailty Portal due to changes they needed to make to their practice routines. However, those who had older patients, took the time to learn how to use the Frailty Portal, and created processes for sharing tasks with other PHC personnel become proficient at using the Frailty Portal. CONCLUSIONS Structuring our evaluation around the CFIR was instrumental in identifying multi-level factors that will affect large-scale adoption of the Frailty Portal in PHC practices. Incorporating CFIR constructs into evaluation instruments can flag factors likely to impede future implementation and impact the effectiveness of innovative practices. Future research is encouraged to identify how best to facilitate changes in PHC practices to address frailty and to use implementation frameworks that honor the complexity of implementing innovations in PHC.
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Affiliation(s)
- Grace Warner
- Dalhousie University, Halifax, NS Canada
- Healthy Populations Institute, Halifax, NS Canada
- Primary Care Research Group, Dalhousie Family Medicine, Halifax, NS Canada
| | - Beverley Lawson
- Dalhousie University, Halifax, NS Canada
- Building Research for Integrated Primary Healthcare (BRIC NS), Nova Scotia Primary & Integrated Health Care Innovations Network, Halifax, NS Canada
- Primary Care Research Group, Dalhousie Family Medicine, Halifax, NS Canada
| | - Tara Sampalli
- Dalhousie University, Halifax, NS Canada
- Department of Family Practice, Nova Scotia Health Authority, Halifax, NS Canada
| | - Fred Burge
- Dalhousie University, Halifax, NS Canada
- Building Research for Integrated Primary Healthcare (BRIC NS), Nova Scotia Primary & Integrated Health Care Innovations Network, Halifax, NS Canada
- Primary Care Research Group, Dalhousie Family Medicine, Halifax, NS Canada
| | - Rick Gibson
- Department of Family Practice, Nova Scotia Health Authority, Halifax, NS Canada
| | - Stephanie Wood
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS Canada
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Seow H, Qureshi D, Barbera L, McGrail K, Lawson B, Burge F, Sutradhar R. Benchmarking time to initiation of end-of-life homecare nursing: a population-based cancer cohort study in regions across Canada. BMC Palliat Care 2018; 17:70. [PMID: 29728091 PMCID: PMC5936018 DOI: 10.1186/s12904-018-0321-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 04/18/2018] [Indexed: 01/05/2023] Open
Abstract
Background Several studies have demonstrated the benefits of early initiation of end-of-life care, particularly homecare nursing services. However, there is little research on variations in the timing of when end-of-life homecare nursing is initiated and no established benchmarks. Methods This is a retrospective cohort study of patients with a cancer-confirmed cause of death between 2004 and 2009, from three Canadian provinces (British Columbia, Nova Scotia, and Ontario). We linked multiple administrative health databases within each province to examine homecare use in the last 6 months of life. Our primary outcome was mean time (in days) to first end-of-life homecare nursing visit, starting from 6 months before death, by region. We developed an empiric benchmark for this outcome using a funnel plot, controlling for region size. Results Of the 28 regions, large variations in the outcome were observed, with the longest mean time (97 days) being two-fold longer than the shortest (55 days). On average, British Columbia and Nova Scotia had the first and second shortest mean times, respectively. The province of Ontario consistently had longer mean times. The empiric benchmark mean based on best-performing regions was 57 mean days. Conclusions Significant variation exists for the time to initiation of end-of-life homecare nursing across regions. Understanding regional variation and developing an empiric benchmark for homecare nursing can support health system planners to set achievable targets for earlier initiation of end-of-life care.
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Affiliation(s)
- Hsien Seow
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Danial Qureshi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Lisa Barbera
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Kim McGrail
- University of British Columbia, Vancouver, BC, Canada
| | - Beverley Lawson
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
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Seow H, Arora A, Barbera L, McGrail K, Lawson B, Burge F, Sutradhar R. Does access to end-of-life homecare nursing differ by province and community size?: A population-based cohort study of cancer decedents across Canada. Health Policy 2017; 122:134-139. [PMID: 29254648 DOI: 10.1016/j.healthpol.2017.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 11/27/2017] [Accepted: 11/30/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Studies have demonstrated the strong association between increased end-of-life homecare nursing use and reduced acute care utilization. However, little research has described the utilization patterns of end-of-life homecare nursing and how this differs by region and community size. METHODS A retrospective population-based cohort study of cancer decedents from Ontario, British Columbia, and Nova Scotia was conducted between 2004 and 2009. Provinces linked administrative databases which provide data about homecare nursing use for the last 6 months of life for each cancer decedent. Among weekly users of homecare nursing in their last six months of life, we describe the proportion of patients receiving end-of-life homecare nursing by province and community size. RESULTS Our cohort included 83,746 cancer decedents across 3 provinces. Patients receiving end-of-life nursing among homecare nursing users increased from weeks -26 to -1 before death by: 78% to 93% in British Columbia, 40% to 81% in Ontario, and 52% to 91% in Nova Scotia. In all 3 provinces, the smallest community size had the lowest proportion of patients using end-of-life nursing compared to the second largest community size, which had the highest proportion. CONCLUSIONS Differences in end-of-life homecare nursing use are much larger between provinces than between community sizes.
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Affiliation(s)
- Hsien Seow
- McMaster University, Hamilton, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
| | | | - Lisa Barbera
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Kim McGrail
- University of British Columbia, Vancouver, BC, Canada
| | | | - Fred Burge
- Dalhousie University, Halifax, NS, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
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Gill N, Sabri S, Arsenault D, Burge F, Clarke B, Fleming M, Grandy M, Harrigan K, MacDonald L, Nichols N. DEVELOPING A CASE DEFINITION FOR CONGESTIVE HEART FAILURE USING PRIMARY CARE EMR DATA. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.163] [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: 10/18/2022] Open
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Hudon C, Chouinard MC, Aubrey-Bassler K, Muhajarine N, Burge F, Pluye P, Bush PL, Ramsden VR, Legare F, Guenette L, Morin P, Lambert M, Groulx A, Couture M, Campbell C, Baker M, Edwards L, Sabourin V, Spence C, Gauthier G, Warren M, Godbout J, Davis B, Rabbitskin N. Case management in primary care among frequent users of healthcare services with chronic conditions: protocol of a realist synthesis. BMJ Open 2017; 7:e017701. [PMID: 28871027 PMCID: PMC5589014 DOI: 10.1136/bmjopen-2017-017701] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION A common reason for frequent use of healthcare services is the complex healthcare needs of individuals suffering from multiple chronic conditions, especially in combination with mental health comorbidities and/or social vulnerability. Frequent users (FUs) of healthcare services are more at risk for disability, loss of quality of life and mortality. Case management (CM) is a promising intervention to improve care integration for FU and to reduce healthcare costs. This review aims to develop a middle-range theory explaining how CM in primary care improves outcomes among FU with chronic conditions, for what types of FU and in what circumstances. METHODS AND ANALYSIS A realist synthesis (RS) will be conducted between March 2017 and March 2018 to explore the causal mechanisms that underlie CM and how contextual factors influence the link between these causal mechanisms and outcomes. According to RS methodology, five steps will be followed: (1) focusing the scope of the RS; (2) searching for the evidence; (3) appraising the quality of evidence; (4) extracting the data; and (5) synthesising the evidence. Patterns in context-mechanism-outcomes (CMOs) configurations will be identified, within and across identified studies. Analysis of CMO configurations will help confirm, refute, modify or add to the components of our initial rough theory and ultimately produce a refined theory explaining how and why CM interventions in primary care works, in which contexts and for which FU with chronic conditions. ETHICS AND DISSEMINATION Research ethics is not required for this review, but publication guidelines on RS will be followed. Based on the review findings, we will develop and disseminate messages tailored to various relevant stakeholder groups. These messages will allow the development of material that provides guidance on the design and the implementation of CM in health organisations. TRIAL REGISTRATION NUMBER Prospero CRD42017057753.
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Affiliation(s)
- Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University, St-John's, Newfoundland and Labrador, Canada
| | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Pierre Pluye
- Department of Family Medicine, Université McGill, Montréal, Quebec, Canada
| | - Paula L Bush
- Department of Family Medicine, Université McGill, Montréal, Quebec, Canada
| | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - France Legare
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | - Line Guenette
- Faculty of Pharmacy and CHU de Québec Research Center, Université Laval, Quebec, Canada
| | - Paul Morin
- School of Social Work, University de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mireille Lambert
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Quebec, Canada
| | - Antoine Groulx
- Ministère de la Santé et des Services Sociaux, Quebec, Canada
| | - Martine Couture
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Quebec, Canada
| | - Cameron Campbell
- Department of Health and Community Services, St. John's, Newfoundland, Canada
| | - Margaret Baker
- Saskatchewan Government – Ministry of Health, Regina, Saskatchewan, Canada
| | - Lynn Edwards
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | | | | | | | - Mike Warren
- St. John’s, Newfoundland and Labrador, Canada
| | | | - Breanna Davis
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Norma Rabbitskin
- Sturgeon Lake Health Centre, Prince Albert, Saskatchewan, Canada
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Lawson B, Sampalli T, Wood S, Warner G, Moorhouse P, Gibson R, Mallery L, Burge F, Bedford LG. Evaluating the Implementation and Feasibility of a Web-Based Tool to Support Timely Identification and Care for the Frail Population in Primary Healthcare Settings. Int J Health Policy Manag 2017; 6:377-382. [PMID: 28812833 PMCID: PMC5505107 DOI: 10.15171/ijhpm.2017.32] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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] [Received: 09/19/2016] [Accepted: 02/21/2017] [Indexed: 11/09/2022] Open
Abstract
Background: Understanding and addressing the needs of frail persons is an emerging health priority for Nova Scotia and internationally. Primary healthcare (PHC) providers regularly encounter frail persons in their daily clinical work. However, routine identification and measurement of frailty is not standard practice and, in general, there is a lack of awareness about how to identify and respond to frailty. A web-based tool called the Frailty Portal was developed to aid in identifying, screening, and providing care for frail patients in PHC settings. In this study, we will assess the implementation feasibility and impact of the Frailty Portal to: (1) support increased awareness of frailty among providers and patients, (2) identify the degree of frailty within individual patients, and (3) develop and deliver actions to respond to frailtyl in community PHC practice.
Methods: This study will be approached using a convergent mixed method design where quantitative and qualitative data are collected concurrently, in this case, over a 9-month period, analyzed separately, and then merged to summarize, interpret and produce a more comprehensive understanding of the initiative’s feasibility and scalability. Methods will be informed by the ‘Implementing the Frailty Portal in Community Primary Care Practice’ logic model and questions will be guided by domains and constructs from an implementation science framework, the Consolidated Framework for Implementation Research (CFIR).
Discussion: The ‘Frailty Portal’ aims to improve access to, and coordination of, primary care services for persons experiencing frailty. It also aims to increase primary care providers’ ability to care for patients in the context of their frailty. Our goal is to help optimize care in the community by helping community providers gain the knowledge they may lack about frailty both in general and in their practice, support improved identification of frailty with the use of screening tools, offer evidence based severity-specific care goals and connect providers with local available community supports.
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Affiliation(s)
- Beverley Lawson
- Building Research for Integrated Primary Healthcare (BRIC NS), Nova Scotia Primary & Integrated Health Care Innovations Network, Halifax, NS, Canada.,Primary Care Research Group, Dalhousie Family Medicine, Halifax, NS, Canada.,Dalhousie University, Halifax, NS, Canada
| | - Tara Sampalli
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada.,Dalhousie University, Halifax, NS, Canada
| | - Stephanie Wood
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada.,Continuing Care, Nova Scotia Health Authority, Halifax, NS, Canada.,Healthy Populations Institute, Halifax, NS, Canada
| | - Paige Moorhouse
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada.,Dalhousie University, Halifax, NS, Canada.,Palliative and Therapeutic Harmonization (PATH) Program, Halifax, NS, Canada
| | - Rick Gibson
- Department of Family Practice, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Laurie Mallery
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada.,Dalhousie University, Halifax, NS, Canada.,Palliative and Therapeutic Harmonization (PATH) Program, Halifax, NS, Canada
| | - Fred Burge
- Building Research for Integrated Primary Healthcare (BRIC NS), Nova Scotia Primary & Integrated Health Care Innovations Network, Halifax, NS, Canada.,Primary Care Research Group, Dalhousie Family Medicine, Halifax, NS, Canada.,Dalhousie University, Halifax, NS, Canada
| | - Lisa G Bedford
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
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Anisimowicz Y, Bowes AE, Thompson AE, Miedema B, Hogg WE, Wong ST, Katz A, Burge F, Aubrey-Bassler K, Yelland GS, Wodchis WP. Computer use in primary care practices in Canada. Can Fam Physician 2017; 63:e284-e290. [PMID: 28500211 PMCID: PMC5429070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To examine the use of computers in primary care practices. DESIGN The international Quality and Cost of Primary Care study was conducted in Canada in 2013 and 2014 using a descriptive cross-sectional survey method to collect data from practices across Canada. Participating practices filled out several surveys, one of them being the Family Physician Survey, from which this study collected its data. SETTING All 10 Canadian provinces. PARTICIPANTS A total of 788 family physicians. MAIN OUTCOME MEASURES A computer use scale measured the extent to which family physicians integrated computers into their practices, with higher scores indicating a greater integration of computer use in practice. Analyses included t tests and 2 tests comparing new and traditional models of primary care on measures of computer use and electronic health record (EHR) use, as well as descriptive statistics. RESULTS Nearly all (97.5%) physicians reported using a computer in their practices, with moderately high computer use scale scores (mean [SD] score of 5.97 [2.96] out of 9), and many (65.7%) reported using EHRs. Physicians with practices operating under new models of primary care reported incorporating computers into their practices to a greater extent (mean [SD] score of 6.55 [2.64]) than physicians operating under traditional models did (mean [SD] score of 5.33 [3.15]; t726.60 = 5.84; P < .001; Cohen d = 0.42, 95% CI 0.808 to 1.627) and were more likely to report using EHRs (73.8% vs 56.7%; [Formula: see text]; P < .001; odds ratio = 2.15). Overall, there was a statistically significant variability in computer use across provinces. CONCLUSION Most family physicians in Canada have incorporated computers into their practices for administrative and scholarly activities; however, EHRs have not been adopted consistently across the country. Physicians with practices operating under the new, more collaborative models of primary care use computers more comprehensively and are more likely to use EHRs than those in practices operating under traditional models of primary care.
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Affiliation(s)
- Yvonne Anisimowicz
- Research assistant at the Dalhousie Family Medicine Teaching Unit in Fredericton, NB
| | - Andrea E Bowes
- New Brunswick SPOR (Strategy for Patient-Oriented Research Network) coordinator in Fredericton
| | - Ashley E Thompson
- Assistant Professor in the Department of Psychology at University of Wisconsin-Oshkosh
| | - Baukje Miedema
- Professor and Director of Research at the Dalhousie Family Medicine Teaching Unit in Fredericton.
| | - William E Hogg
- Scientist at the Élisabeth Bruyère Research Institute in Ottawa, Ont, and Professor and Senior Research Advisor in the Department of Family Medicine at the University of Ottawa and the C.T. Lamont Primary Health Care Research Centre
| | - Sabrina T Wong
- Director of the Centre for Health Services and Policy Research at the University of British Columbia in Vancouver
| | - Alan Katz
- Professor in the Department of Family Medicine and the Department of Community Health Sciences and Director of Research at the University of Manitoba in Winnipeg, and Director of the Manitoba Centre for Health Policy
| | - Fred Burge
- Professor and Research Director of the Primary Care Research Unit in the Department of Family Medicine at Dalhousie University in Halifax, NS, and the science lead for Building Research for Integrated Primary Healthcare
| | - Kris Aubrey-Bassler
- Director of the Centre for Rural Health Studies at Memorial University of Newfoundland in St John's
| | - Gregory S Yelland
- Program evaluation consultant for the Quality Health Council of Alberta in Edmonton
| | - Walter P Wodchis
- Associate Professor in the Institute of Health Policy, Management and Evaluation at the University of Toronto in Ontario
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