Characteristics of primary care practices by proportion of patients unvaccinated against SARS-CoV-2: a cross-sectional cohort study

BACKGROUND

Variations in primary care practices may explain some differences in health outcomes during the COVID-19 pandemic. We sought to evaluate the characteristics of primary care practices by the proportion of patients unvaccinated against SARS-CoV-2.

METHODS

We conducted a population-based, cross-sectional cohort study using linked administrative data sets in Ontario, Canada. We calculated the percentage of patients unvaccinated against SARS-CoV-2 enrolled with each comprehensive-care family physician, ranked physicians according to the proportion of patients unvaccinated, and identified physicians in the top 10% (v. the other 90%). We compared characteristics of family physicians and their patients in these 2 groups using standardized differences.

RESULTS

We analyzed 9060 family physicians with 10 837 909 enrolled patients. Family physicians with the largest proportion (top 10%) of unvaccinated patients (n = 906) were more likely to be male, to have trained outside of Canada, to be older, and to work in an enhanced fee-for-service model than those in the remaining 90%. Vaccine coverage (≥ 2 doses of SARS-CoV-2 vaccine) was 74% among patients of physicians with the largest proportion of unvaccinated patients, compared with 87% in the remaining patient population. Patients in the top 10% group tended to be younger and live in areas with higher levels of ethnic diversity and immigration and lower incomes.

INTERPRETATION

Primary care practices with the largest proportion of patients unvaccinated against SARS-CoV-2 served marginalized communities and were less likely to use team-based care models. These findings can guide resource planning and help tailor interventions to integrate public health priorities within primary care practices.

Practice Facilitation to Support Family Physicians in Encouraging COVID-19 Vaccine Uptake: A Multimethod Process Evaluation

PURPOSE

We offered a practice facilitation intervention to family physicians in Ontario, Canada, known to have large numbers of patients not yet vaccinated against coronavirus disease 2019 (COVID-19).

METHODS

We conducted a multimethod process evaluation embedded within a randomized controlled trial (clinical trial #NCT05099497). We collected descriptive statistics regarding engagement and qualitative interview data from family physicians and practice facilitators, as well as data from facilitator field notes. We analyzed and triangulated the data using thematic analysis and mapped barriers to and enablers for implementation to structural, organizational, physician, and patient factors.

RESULTS

Of the 300 approached, 90 family physicians (30%) accepted facilitation. Of these, 57% received technical support to identify unvaccinated patients, 29% used trained medical student volunteers to contact patients on their behalf, and 30% used automated calling to reach patients. Key factors affecting engagement with the intervention were staff shortages owing to COVID-19 (structural), clinic characteristics such as technical issues and gatekeeping by staff, which prevented facilitators from talking with physicians (organizational), burnout (physician), and specialized populations that required targeted resources (patient). The facilitator's ability to address technical issues and connect family physicians with medical students helped with engagement.

CONCLUSIONS

Strategies to help underresourced family physicians serving high-needs populations for issues of public health importance, such as vaccine promotion, must acknowledge the scarcity of physicians' time and provide new resources. To successfully engage family physicians, practice facilitators should seek to build trust and relationships over time, including with front-office staff.

#FAIL: Defining, Understanding and Owning Our Failures

Despite our best efforts to reform the healthcare system, significant challenges remain. To some extent, our progress is being hampered because of our hesitation to learn from past mistakes. In his article "Systematically Identified Failure Is the Route to a Successful Health System", Zwarenstein (2015) argues that we must right this wrong and begin to systematically identify, acknowledge and learn from failure if we want to make true progress. This commentary outlines some key steps that must be taken to help us move past failure and apply lessons to future healthcare reforms. To achieve this end state we propose adopting a disciplined approach that includes clearly defining policy goals, stratifying failures into categories to help facilitate learning and encouraging leaders to acknowledge and learn from failure.

U5 monoclonal antibody identifies a novel lymphocyte surface antigen preferentially expressed in human circulating natural killer cells with high cytotoxic activity

U5 monoclonal antibody (mAb), developed against Japanese monkey lymphocytes, identified a glycoprotein of 32 000 MW that is expressed in a subset of human circulating natural killer (NK) cells. The distribution of U5 molecules was restricted among CD16+ cells, and U5 antigen was preferentially expressed in the CD38+ subset. U5+ CD16+ CD56+ cells were highly active on NK assay against K562 target cells. Variations in cytolytic activities and mRNA expression of perforin, granzyme B and Fas ligand (FasL) were observed in U5- CD16+ CD56+ cells depending on the donor. We found that in some donors, a phenotypically mature (CD16+ CD56+) but functionally immature subset was present in the peripheral circulation. The U5- CD16+ CD56+ cells of some donors exhibited negligible cytolytic activity with no detectable expression of the above mRNAs, whereas those of the other donors had a significant but lower cytolytic activity with a reduced expression of granzyme B mRNA as compared with those of U5+ CD16+ CD56+ cells. Concanavalin A (Con A) stimulation induced an expression of U5 antigen in U5- CD16+ CD56+ cells accompanied by an up-regulation of granzyme B mRNA expression. These findings suggest that U5 antigen may be a novel molecule involved in the maturation or differentiation of human circulating NK cells.

Immunological studies on Crohn's disease. VIII. Diminished phagocytic activity in peripheral blood monocytes

We have been examining superoxide production activity in patients with Crohn's disease and we noted an increase in this activity in peripheral whole blood and monocytes, determined by a luminol-dependent chemiluminescence. However, superoxide production and phagocytosis are different phenomena. To search for the "real" phagocytic capacity, we examined the phagocytic activity of peripheral blood monocytes and neutrophils in 20 Japanese patients with Crohn's disease, using automated laser flow cytometry. In contrast to the results obtained with the chemiluminescence assay, we found a decrease in the "real" phagocytic function in monocytes, yet there was no difference in the phagocytic ability in neutrophils. The phagocytic activity in patients with an active form of the disease was lower than that in patients with inactive form of the disease. These results provide pertinent information on the role of monocytes in Crohn's disease. The depressed phagocytic activity in monocytes from these patients may play some role in the pathogenesis of this disease.