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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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Bjerre LM, Parlow S, de Launay D, Hogel M, Black CD, Mattison DR, Grimshaw JM, Watson MC. Comparative, cross-sectional study of the format, content and timing of medication safety letters issued in Canada, the USA and the UK. BMJ Open 2018; 8:e020150. [PMID: 30297342 PMCID: PMC6194396 DOI: 10.1136/bmjopen-2017-020150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 06/19/2018] [Accepted: 08/22/2018] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To assess consistency in the format and content, and overlap of subject and timing, of medication safety letters issued by regulatory health authorities to healthcare providers in Canada, the USA and the UK. DESIGN A cross-sectional study comparing medication safety letters issued for the purpose of alerting healthcare providers to newly identified medication problems associated with medications already on the market. SETTING Online databases operated by Health Canada, the US Food and Drug Administration and the UK Medicines and Healthcare products Regulatory Agency were searched to select medication safety letters issued between 1 January 2010 and 31 December 2014. Format, content and timing of each medication safety letter were assessed using an abstraction tool comprising 21 characteristics deemed relevant by consensus of the research team. MAIN OUTCOME MEASURES Main outcome measures included, first, characteristics (format and content) of medication safety letters and second, overlap of subject and release date across countries. RESULTS Of 330 medication safety letters identified, 227 dealt with unique issues relating to medications available in all three countries. Of these 227 letters, 21 (9%) medication problems were the subject of letters released in all three countries; 40 (18%) in two countries and 166 (73%) in only one country. Only 13 (62%) of the 21 letters issued in all three countries were released within 6 months of each other. CONCLUSIONS Significant discrepancies in both the subject and timing of medication safety letters issued by health authorities in three countries (Canada, the USA and the UK) where medical practice is otherwise comparable, raising questions about why, how and when medication problems are identified and communicated to healthcare providers by the authorities. More rapid communication of medication problems and better alignment between authorities could enhance patient safety.
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Affiliation(s)
- Lise M Bjerre
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- CT Lamont Primary Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Simon Parlow
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David de Launay
- CT Lamont Primary Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Matthew Hogel
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- CT Lamont Primary Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Cody D Black
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- CT Lamont Primary Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Donald R Mattison
- Risk Sciences International, (RSI), Ottawa, Ontario, Canada
- McLaughlin Center for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeremy M Grimshaw
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Margaret C Watson
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
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Bjerre LM, Farrell B, Hogel M, Graham L, Lemay G, McCarthy L, Raman-Wilms L, Rojas-Fernandez C, Sinha S, Thompson W, Welch V, Wiens A. Deprescribing antipsychotics for behavioural and psychological symptoms of dementia and insomnia: Evidence-based clinical practice guideline. Can Fam Physician 2018; 64:17-27. [PMID: 29358245 PMCID: PMC5962971] [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 develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper and stop antipsychotics; to focus on the highest level of evidence available and seek input from primary care professionals in the guideline development, review, and endorsement processes. METHODS The overall team comprised 9 clinicians (1 family physician, 1 family physician specializing in long-term care, 1 geriatric psychiatrist, 2 geriatricians, 4 pharmacists) and a methodologist; members disclosed conflicts of interest. For guideline development, a systematic process was used, including the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Evidence was generated from a Cochrane systematic review of antipsychotic deprescribing trials for the behavioural and psychological symptoms of dementia, and a systematic review was conducted to assess the evidence behind the benefits of using antipsychotics for insomnia. A review of reviews of the harms of continued antipsychotic use was performed, as well as narrative syntheses of patient preferences and resource implications. This evidence and GRADE quality-of-evidence ratings were used to generate recommendations. The team refined guideline content and recommendation wording through consensus and synthesized clinical considerations to address common front-line clinician questions. The draft guideline was distributed to clinicians and stakeholders for review and revisions were made at each stage. RECOMMENDATIONS We recommend deprescribing antipsychotics for adults with behavioural and psychological symptoms of dementia treated for at least 3 months (symptoms stabilized or no response to an adequate trial) and for adults with primary insomnia treated for any duration or secondary insomnia in which underlying comorbidities are managed. A decision-support algorithm was developed to accompany the guideline. CONCLUSION Antipsychotics are associated with harms and can be safely tapered. Patients and caregivers might be more amenable to deprescribing if they understand the rationale (potential for harm), are involved in developing the tapering plan, and are offered behavioural advice or management. This guideline provides recommendations for making decisions about when and how to reduce the dose of or stop antipsychotics. Recommendations are meant to assist with, not dictate, decision making in conjunction with patients and families.
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Affiliation(s)
- Lise M Bjerre
- Assistant Professor in the Department of Family Medicine and in the School of Epidemiology and Public Health at the University of Ottawa in Ontario, Scientist in the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute, and Adjunct Scientist at the Institute for Clinical Evaluative Sciences (ICES).
| | - Barbara Farrell
- Assistant Professor in the Department of Family Medicine at the University of Ottawa, Adjunct Assistant Professor in the School of Pharmacy at the University of Waterloo in Ontario, and Scientist at the Bruyère Research Institute at the University of Ottawa
| | - Matthew Hogel
- Research Associate at the Bruyère Research Institute at the time of guideline development
| | - Lyla Graham
- Medical Director of St Patrick's Home of Ottawa and Assistant Professor in the Department of Family Medicine at the University of Ottawa
| | - Geneviève Lemay
- Assistant Professor of Medicine at the University of Ottawa, Chief of Geriatric Services at Hôpital Montfort, and a staff geriatrician with the Ottawa Hospital Division of Geriatrics
| | - Lisa McCarthy
- Scientist at the Women's College Research Institute of Women's College Hospital in Toronto, Ont, and Assistant Professor with the Leslie Dan Faculty of Pharmacy and the Department of Family and Community Medicine at the University of Toronto
| | - Lalitha Raman-Wilms
- Associate Professor and Associate Dean of Professional Programs in the Leslie Dan Faculty of Pharmacy at the University of Toronto at the time of guideline development
| | - Carlos Rojas-Fernandez
- Schlegel Research Chair in Geriatric Pharmacotherapy at the Schlegel-UW Research Institute on Ageing and the School of Pharmacy at the University of Waterloo at the time of guideline development
| | - Samir Sinha
- Director of Geriatrics at Mount Sinai Hospital and the University Health Network hospitals in Toronto, Assistant Professor in the Department of Medicine, the Department of Family and Community Medicine, and the Institute for Health Policy, Management and Evaluation at the University of Toronto, and Assistant Professor in the Division of Geriatric Medicine and Gerontology at the Johns Hopkins University School of Medicine in Baltimore, MD
| | - Wade Thompson
- Master's student in the School of Epidemiology and Public Health at the University of Ottawa at the time of guideline development
| | - Vivian Welch
- Director of the Methods Centre at the Bruyère Research Institute and Assistant Professor in the School of Epidemiology and Public Health at the University of Ottawa at the time of guideline development
| | - Andrew Wiens
- Associate Professor and Head of the Division of Geriatric Psychiatry in the Department of Psychiatry at the University of Ottawa
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Bjerre LM, Farrell B, Hogel M, Graham L, Lemay G, McCarthy L, Raman-Wilms L, Rojas-Fernandez C, Sinha S, Thompson W, Welch V, Wiens A. Déprescription des antipsychotiques pour les symptômes comportementaux et psychologiques de la démence et l’insomnie. Can Fam Physician 2018; 64:e1-e12. [PMID: 29358261 PMCID: PMC5962991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objectif Élaborer un guide de pratique clinique fondé sur des données probantes pour aider les cliniciens à prendre des décisions quant au moment et à la façon de réduire et de cesser les antipsychotiques en toute sécurité; insister sur les données les plus probantes et solliciter les contributions des professionnels des soins primaires pour l’élaboration, la révision et l’approbation des lignes directrices. Méthodologie L’équipe comptait 9 cliniciens (1 médecin de famille, 1 médecin de famille spécialisée en soins de longue durée, 1 psychiatre gériatrique, 2 gériatres, 4 pharmaciens) et une spécialiste en méthodologie; les membres ont divulgué leurs conflits d’intérêts. Un processus systématique a été utilisé pour l’élaboration du guide de pratique, y compris le protocole GRADE (Grading of Recommendations Assessment, Development and Evaluation). Les données probantes ont été tirées d’une revue systématique de Cochrane portant sur des études sur la déprescription des antipsychotiques pour les symptômes comportementaux et psychologiques de la démence. Nous avons effectué une revue systématique pour évaluer les données probantes étayant les bienfaits de l’utilisation des antipsychotiques pour traiter l’insomnie. Nous avons examiné les revues portant sur les torts associés à l’utilisation des antipsychotiques sur une base continue, et nous avons fait une synthèse narrative des préférences des patients et des répercussions sur le plan des ressources. Ces données probantes, de même que l’évaluation de la qualité des données selon GRADE, ont été utilisées pour produire les recommandations. L’équipe a peaufiné le contenu du guide de pratique et le libellé des recommandations, et elle a résumé les considérations d’ordre clinique pour répondre aux questions courantes des cliniciens de première ligne. Une ébauche du guide de pratique a été distribuée à des cliniciens et à des intervenants aux fins d’examen. Des révisions ont été apportées au texte à chaque étape. Recommandations Nous recommandons la déprescription des antipsychotiques chez les adultes ayant des symptômes comportementaux et psychologiques de démence traités depuis au moins 3 mois (symptômes stabilisés ou sans réponse après un essai adéquat) et chez les adultes souffrant d’insomnie primaire, quelle que soit la durée du traitement, ou d’une insomnie secondaire lorsque les comorbidités sous-jacentes sont prises en charge. Un algorithme décisionnel accompagne le guide de pratique clinique. Conclusion Les antipsychotiques sont associés à des préjudices et il est possible de procéder à un sevrage en toute sécurité. Les patients et leurs aidants peuvent être plus réceptifs à la déprescription s’ils comprennent ce qui la justifie (potentiel de préjudices), s’ils participent à l’élaboration du plan de sevrage et si on leur offre des conseils ou une prise en charge quant aux comportements. Le présent guide de pratique clinique offre des recommandations pour décider du moment et de la façon de réduire la dose d’antipsychotiques ou de les cesser complètement. Les recommandations servent à aider à prendre les décisions conjointement avec les patients et leur famille plutôt qu’à les dicter.
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Affiliation(s)
- Lise M Bjerre
- Professeure adjointe au Département de médecine familiale et à l'École d'épidémiologie et de santé publique de l'Université d'Ottawa, en Ontario, scientifique au Centre de recherche C.T. Lamont en soins de santé primaires de l'Institut de recherche Bruyère et scientifique auxiliaire à l'Institut de recherche en services de santé (IRSS).
| | - Barbara Farrell
- Professeure adjointe au Département de médecine familiale à l'Université d'Ottawa, professeure adjointe à la Faculté de pharmacie de l'Université de Waterloo, en Ontario, et scientifique à l'Institut de recherche Bruyère de l'Université d'Ottawa
| | - Matthew Hogel
- Associé de recherche à l'Institut de recherche Bruyère au moment de l'élaboration du guide de pratique
| | - Lyla Graham
- Directrice médicale du St Patrick's Home of Ottawa et professeure adjointe au Département de médecine familiale de l'Université d'Ottawa
| | - Geneviève Lemay
- Professeure adjointe de médecine à l'Université d'Ottawa, directrice des Services de gériatrie à l'Hôpital Montfort, et gériatre membre du personnel de la Division de gériatrie de L'Hôpital d'Ottawa
| | - Lisa McCarthy
- Scientifique à l'Institut de recherche du Women's College Hospital à Toronto, en Ontario, et professeure adjointe à la Faculté de pharmacie Leslie Dan et au Département de médecine familiale et communautaire de l'Université de Toronto
| | - Lalitha Raman-Wilms
- Professeure agrégée et vice-doyenne des Programmes professionnels à la Faculté de pharmacie Leslie Dan de l'Université de Toronto au moment de l'élaboration du guide de pratique
| | - Carlos Rojas-Fernandez
- Titulaire de la Chaire de recherche Schlegel en pharmacothérapie gériatrique à l'Institut de recherche Schlegel-UW sur le vieillissement et à la Faculté de pharmacie de l'Université de Waterloo au moment de l'élaboration du guide de pratique
| | - Samir Sinha
- Directeur de la Gériatrie à l'Hôpital Mount Sinai et des hôpitaux universitaires du réseau de la santé à Toronto, professeur adjoint au Département de médecine, au Département de médecine familiale et communautaire, et à l'Institute for Health Policy, Management and Evaluation de l'Université de Toronto, et professeur adjoint à la Division de médecine gériatrique et de gérontologie de la Faculté de médecine de l'Université Johns Hopkins à Baltimore, MD (É.-U.)
| | - Wade Thompson
- Étudiant à la maîtrise à l'École d'épidémiologie et de santé publique de l'Université d'Ottawa au moment de l'élaboration du guide de pratique
| | - Vivian Welch
- Directrice du Centre de méthodologie de l'Institut de recherche Bruyère et professeure adjointe à l'École d'épidémiologie et de santé publique de l'Université d'Ottawa au moment de l'élaboration du guide de pratique
| | - Andrew Wiens
- Professeur agrégé et directeur de la Division de psychiatrie gériatrique du Département de psychiatrie de l'Université d'Ottawa
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Asghari S, Maybank A, Hurley O, Modir H, Farrell A, Marshall Z, Kendall C, Johnston S, Hogel M, Rourke SB, Liddy C. Perspectives of People Living with HIV on Access to Health Care: Protocol for a Scoping Review. JMIR Res Protoc 2016; 5:e71. [PMID: 27193076 PMCID: PMC4889870 DOI: 10.2196/resprot.5263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/13/2016] [Accepted: 01/17/2016] [Indexed: 11/13/2022] Open
Abstract
Background Strategies to improve access to health care for people living with human immunodeficiency virus (PLHIV) have demonstrated limited success. Whereas previous approaches have been informed by the views of health providers and decision-makers, it is believed that incorporating patient perspectives into the design and evaluations of health care programs will lead to improved access to health care services. Objective We aim to map the literature on the perspectives of PLHIV concerning access to health care services, to identify gaps in evidence, and to produce an evidence-informed research action plan to guide the Living with HIV program of research. Methods This scoping review includes peer-reviewed and grey literature from 1946 to May 2014 using double data extraction. Variations of the search terms “HIV”, “patient satisfaction”, and “health services accessibility” are used to identify relevant literature. The search strategy is being developed in consultation with content experts, review methodologists, and a librarian, and validated using gold standard studies identified by those stakeholders. The inclusion criteria are (1) the study includes the perspectives of PLHIV, (2) study design includes qualitative, quantitative, or mixed methods, and (3) outcome measures are limited to patient satisfaction, their implied needs, beliefs, and desires in relation to access to health care. The papers are extracted by two independent reviewers, including quality assessment. Data is then collated, summarized, and thematically analyzed. Results A total of 12,857 references were retrieved, of which 326 documents were identified as eligible in pre-screening, and 64 articles met the inclusion criteria (56% qualitative studies, 38% quantitative studies and 6% mixed-method studies). Only four studies were conducted in Canada. Data synthesis is in progress and full results are expected in June, 2016. Conclusions This scoping review will record and characterize the extensive body of literature on perspectives of PLHIV regarding access to health care. A literature repository will be developed to assist stakeholders, decision-makers, and PLHIV in developing and implementing patient-oriented health care programs.
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Affiliation(s)
- Shabnam Asghari
- Primary Healthcare Research Unit, Department of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.
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Johnston S, Hogel M. A Decade Lost: Primary Healthcare Performance Reporting across Canada under the Action Plan for Health System Renewal. Healthc Policy 2016. [DOI: 10.12927/hcpol.2016.24593] [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: 10/21/2022] Open
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Johnston S, Hogel M. A Decade Lost: Primary Healthcare Performance Reporting across Canada under the Action Plan for Health System Renewal. Healthc Policy 2016; 11:95-110. [PMID: 27232240 PMCID: PMC4872556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
In 2004, Canada's First Ministers committed to reforms that would shape the future of the Canadian healthcare landscape. These agreements included commitments to improved performance reporting within the primary healthcare system. The aim of this paper was to review the state of primary healthcare performance reporting after the public reporting mandate agreed to a decade ago in the Action Plan for Health System Renewal of 2003 expired. A grey literature search was performed to identify reports released by the governmental and independent reporting bodies across Canada. No province, or the federal government, met their performance reporting obligations from the 2004 accords. Although the indicators required to report on in the 2004 Accord no longer reflect the priorities of patients, policy makers and physicians, provinces are also failing to report on these priorities. Canada needs better primary healthcare performance reporting to enable accountability and improvement within and across provinces. Despite the national mandate to improve public health system reporting, an opportunity to learn from the diverse primary healthcare reforms, underway across Canada for the past decade, has already been lost.
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Affiliation(s)
- Sharon Johnston
- Associate Professor, University of Ottawa, Department of Family Medicine, C.T. Lamont Primary Health Care Research Centre, Ottawa, ON
| | - Matthew Hogel
- Research Associate, C.T. Lamont Primary Health Care Research Centre, Ottawa, ON
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Bjerre LM, Halil R, Catley C, Farrell B, Hogel M, Black CD, Williams M, Ryan C, Manuel DG. Potentially inappropriate prescribing (PIP) in long-term care (LTC) patients: validation of the 2014 STOPP-START and 2012 Beers criteria in a LTC population--a protocol for a cross-sectional comparison of clinical and health administrative data. BMJ Open 2015; 5:e009715. [PMID: 26453592 PMCID: PMC4606433 DOI: 10.1136/bmjopen-2015-009715] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Potentially inappropriate prescribing (PIP) is frequent and problematic in older patients. Identifying PIP is necessary to improve prescribing quality; ideally, this should be performed at the population level. Screening Tool of Older Persons' potentially inappropriate Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) and Beers criteria were developed to identify PIP in clinical settings and are useful at the individual patient level; however, they are time-consuming and costly to apply. Only a subset of these criteria is applicable to routinely collected population-level health administrative data (HAD) because the clinical information necessary to implement these tools is often missing from databases. The performance of subsets of STOPP/START and Beers criteria in HAD compared with clinical data from the same patients is unknown; furthermore, the performance of the updated 2014 STOPP-START and 2012 Beers criteria compared with one another is also unknown. METHODS AND ANALYSIS A cross-sectional study of linked HAD and clinical data will be conducted to validate the subsets of STOPP/START and Beers criteria applicable to HAD by comparing their performance when applied to clinical and HAD for the same patients. Eligible patients will be 66 years and over and recently admitted to 1 of 6 long-term care facilities in Ottawa, Ontario. The target sample size is 275, but may be less if statistical significance can be achieved sooner. Medication, diagnostic and clinical data will be collected by a consultant pharmacist. The main outcome measure is the proportion of PIP missed by the subset of STOPP/START and Beers criteria applied to HAD when compared with clinical data. ETHICS AND DISSEMINATION The study was approved by the Ottawa Health Services Network Research Ethics Board, the Bruyère Continuing Care Research Ethics Board and the ethics board of the City of Ottawa Long Term Care Homes. Dissemination will occur via publication, national and international conference presentations, and exchanges with regional, provincial and national stakeholders. TRIAL REGISTRATION NUMBER NCT02523482.
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Affiliation(s)
- Lise M Bjerre
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES@ uOttawa, Ottawa, Ontario, Canada
| | - Roland Halil
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Academic Family Health Team, Ottawa, Ontario, Canada
| | | | - Barbara Farrell
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Matthew Hogel
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Cody D Black
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Margo Williams
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Cristín Ryan
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Douglas G Manuel
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES@ uOttawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Johnston S, Kendall C, Hogel M, McLaren M, Liddy C. Measures of Quality of Care for People with HIV: A Scoping Review of Performance Indicators for Primary Care. PLoS One 2015; 10:e0136757. [PMID: 26414994 PMCID: PMC4586139 DOI: 10.1371/journal.pone.0136757] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/07/2015] [Indexed: 01/17/2023] Open
Abstract
The healthcare of people with HIV is transitioning from specialty care to the primary healthcare (PHC) system. However, many of the performance indicators used to measure the quality of HIV care pre-date this transition. The goal of this work was to examine how existing HIV care performance indicators measure the comprehensive and longitudinal care offered in a PHC setting. A scoping review consisting of peer-reviewed and grey literature searches was performed. Two reviewers evaluated study eligibility and indicators in documents meeting inclusion criteria were extracted into a database. Indicators were matched to a PHC performance measurement framework to determine their applicability for evaluating quality of care in the PHC setting. The literature search identified 221 publications, of which 47 met inclusion criteria. 1184 indicators were extracted and removal of duplicates left 558 unique indicators. A majority of the 558 indicators fell under the 'secondary prevention' (12%) and 'care of chronic conditions' (33%) domains when indicators were matched to the PHC performance framework. Despite the imbalance, nearly all performance domains in the PHC framework were populated by at least one indicator with significant concentrations in domains such as patient-provider relationship, patient satisfaction, population and community characteristics, and access to care. Existing performance frameworks for the care of people with HIV provide a comprehensive set of indicators that align well with a PHC performance framework. Nonetheless, some important elements of care, such as patient-reported outcomes, are poorly covered by existing indicators. Advancing our understanding of how the experience of care for people with HIV is impacted by changes in health services delivery, specifically more care within the PHC system, will require performance indicators to capture this aspect of HIV care.
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Affiliation(s)
- Sharon Johnston
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
- * E-mail:
| | - Claire Kendall
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
| | - Matthew Hogel
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
| | - Meaghan McLaren
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
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Bammeke F, Liddy C, Hogel M, Archibald D, Chaar Z, MacLaren R. Family medicine residents’ barriers to conducting scholarly work. Can Fam Physician 2015; 61:780-787. [PMID: 26623463 PMCID: PMC4569112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To identify family medicine residents’ barriers to conducting high-quality research for the mandatory family medicine resident scholarly project, as well as to determine possible strategies to encourage research activity among family medicine residents. DESIGN Descriptive study using an online survey. SETTING Department of Family Medicine at the University of Ottawa in Ontario. PARTICIPANTS A total of 54 first- and second-year residents. MAIN OUTCOME MEASURES Family medicine residents’ involvement in research activities, perceived quality of their mandatory scholarly project, intentions for publication and presentation, and attitudes toward potential barriers to and facilitators of conducting high-quality research. RESULTS Of the 54 residents, 20 (37%) reported that their project was of high quality, 6 (11%) intended to publish their findings, and 2 (4%) intended to present their findings. Respondents indicated that the main barriers to conducting high-quality research were lack of time, interest, and scholarly skills. The proposed solutions to increase participation in scholarly work were to allow full research days to be used in half-day increments and to offer a journal club where residents could learn scholarly activities. CONCLUSION Family medicine residents found several factors to be considerable barriers to completing the required family medicine resident scholarly project. This indicates that there is a need to change the current approach to developing scholarly skills in family medicine. Greater allotment of and flexibility in protected research time and more sessions focused on developing scholarly skills might facilitate scholarly activity among family medicine residents.
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Liddy C, Johnston S, Guilcher S, Irving H, Hogel M, Jaglal S. Impact of a chronic disease self-management program on healthcare utilization in eastern Ontario, Canada. Prev Med Rep 2015; 2:586-90. [PMID: 26844122 PMCID: PMC4721386 DOI: 10.1016/j.pmedr.2015.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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] [Indexed: 11/05/2022] Open
Abstract
This study aims to examine patients' patterns of health care utilization before and after participation in a Chronic Disease Self-Management Program (CDSMP). We conducted a pre-post study using health care administrative data from 186 individuals in the Ottawa region who participated in our CDSMP between September 2009 and January 2011. We collected the number of general practitioner/specialist visits, planned/unplanned emergency department visits, and hospitalizations, measured 6 months and 1 year before and after participation in the CDSMP. Multivariate analysis was performed to identify associations between patient characteristics and pre-post CDSMP health care utilization. CDSMP participation showed no effect on number of physician visits, hospitalizations, or emergency department visits. Individuals with > 5 chronic conditions were more likely to visit a physician and the emergency department following the CDSMP than those with 1 chronic condition. Among individuals > 61 years of age, those with the marital status widowed were more likely to visit their physician and the emergency department following the CDSMP than married individuals. To conclude, the CDSMP appeared not to decrease health care utilization. Low baseline utilization rates, short-term follow-ups, and a relatively healthy patient population may have contributed to the program's low impact. We examine patients' health care use before and after a self-management program. Patients complete six workshops teaching chronic disease self-management skills. The program does not appear to decrease health care utilization. Several factors (e.g. low baseline usage, high patient health) may reduce impact.
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Affiliation(s)
- Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyere St, Annex E, Ottawa, Ontario K1N 5C8, Canada; Department of Family Medicine, University of Ottawa, 43 Bruyere Street (Floor 3JB), Ottawa, Ontario K1N 5C8, Canada
| | - Sharon Johnston
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyere St, Annex E, Ottawa, Ontario K1N 5C8, Canada; Department of Family Medicine, University of Ottawa, 43 Bruyere Street (Floor 3JB), Ottawa, Ontario K1N 5C8, Canada
| | - Sara Guilcher
- Canadian Population Health Initiative, Canadian Institute for Health Information, 4110 Yonge Street, Suite 300, Toronto, Ontario M2P 2B7, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - Hannah Irving
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyere St, Annex E, Ottawa, Ontario K1N 5C8, Canada
| | - Matthew Hogel
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyere St, Annex E, Ottawa, Ontario K1N 5C8, Canada
| | - Susan Jaglal
- Toronto Rehabilitation Institute-University Health Network, 7-504, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada; Institute for Clinical Evaluative Sciences, University of Toronto, 155 College Street, Suite 424, Toronto, Ontario M5T 3M6, Canada
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Liddy C, Hogel M, Blazkho V, Keely E. The current state of electronic consultation and electronic referral systems in Canada: an environmental scan. Stud Health Technol Inform 2015; 209:75-83. [PMID: 25980708] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Access to specialist care is a point of concern for patients, primary care providers, and specialists in Canada. Innovative e-health platforms such as electronic consultation (eConsultation) and referral (eReferral) can improve access to specialist care. These systems allow physicians to communicate asynchronously and could reduce the number of unnecessary referrals that clog wait lists, provide a record of the patient's journey through the referral system, and lead to more efficient visits. Little is known about the current state of eConsultation and eReferral in Canada. The purpose of this work was to identify current systems and gain insight into the design and implementation process of existing systems. An environmental scan approach was used, consisting of a systematic and grey literature review, and targeted semi-structured key informant interviews. Only three eConsultation/eReferral systems are currently in operation in Canada. Four themes emerged from the interviews: eReferral is an end goal for those provinces without an active eReferral system, re-organization of the referral process is a necessity prior to automation, engaging the end-user is essential, and technological incompatibilities are major impediments to progress. Despite the acknowledged need to improve the referral system and increase government spending on health information technology, eConsultation and eReferral systems remain scarce as Canada lags behind the rest of the developed world.
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Affiliation(s)
- Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
| | - Matthew Hogel
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
| | - Valerie Blazkho
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Ottawa, Canada
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Hogel M, Laprairie RB, Denovan-Wright EM. Promoters are differentially sensitive to N-terminal mutant huntingtin-mediated transcriptional repression. PLoS One 2012; 7:e41152. [PMID: 22815947 PMCID: PMC3399790 DOI: 10.1371/journal.pone.0041152] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 06/18/2012] [Indexed: 11/18/2022] Open
Abstract
Huntington’s disease (HD) is a neurodegenerative disorder caused by the inheritance of one mutant copy of the huntingtin gene. Mutant huntingtin protein (mHtt) contains an expanded polyglutamine repeat region near the N-terminus. Cleavage of mHtt releases an N-terminal fragment (N-mHtt) which accumulates in the nucleus. Nuclear accumulation of N-mHtt has been directly associated with cellular toxicity. Decreased transcription is among the earliest detected changes that occur in the brains of HD patients, animal and cellular models of HD. Transcriptional dysregulation may trigger many of the perturbations that occur later in disease progression. An understanding of the effects of mHtt may lead to strategies to slow the progression of HD. Current models of N-mHtt-mediated transcriptional dysregulation suggest that abnormal interactions between N-mHtt and transcription factors impair the ability of these transcription factors to associate at N-mHtt-affected promoters and properly regulate gene expression. We tested various aspects of the current models using two N-mHtt-affected promoters in two cell models of HD using overexpression of known N-mHtt-interacting transcription factors, promoter deletion and mutation analyses and in vitro promoter binding assays. Consequently, we proposed a new model of N-mHtt-mediated transcriptional dysregulation centered on the presence of N-mHtt at promoters. In this model, N-mHtt interacts with multiple partners whose presence and affinity for N-mHtt influence the severity of gene dysregulation. We concluded that simultaneous interaction of N-mHtt with multiple binding partners within the transcriptional machinery would explain the gene-specificity of N-mHtt-mediated transcriptional dysregulation, as well as why some genes are affected early in disease progression while others are affected later. Our model explains why alleviating N-mHtt-mediated transcriptional dysregulation through overexpression of N-mHtt-interacting proteins has proven to be difficult and suggests that the most realistic strategy for restoring gene expression across the spectrum of N-mHtt affected genes is by reducing the amount of soluble nuclear N-mHtt.
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Affiliation(s)
- Matthew Hogel
- Laboratory of Molecular Neurobiology, Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert B. Laprairie
- Laboratory of Molecular Neurobiology, Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Eileen M. Denovan-Wright
- Laboratory of Molecular Neurobiology, Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
- * E-mail:
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