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Public health physicians (PHPs) are trained in both medicine and public health, yet practice models in each of these fields incompletely describe their work. A model of practice for public health physicians would better enable training and professional development in the specialty. The objective of this study was to develop an empirically grounded method of the practice of public health medicine by public health physicians. This was designed as a constructivist grounded theory (CGT) study. Semistructured interviews with 18 public health physicians in Canada were conducted over the course of 1 year. Transcribed interviews were coded in three stages (line-by-line, focused, and theoretical). Constant comparison, theoretical sampling, reflective and analytic memos, and team discussion on reflexivity were used to ensure rigor and the proper application of CGT methods. The key finding of this study is the population-centered medical method (POP-CMM), an empirically grounded method of PHP practice. In this model, PHPs bring values, knowledge, and stances to their practice of medicine with populations as patients. They work to diagnose and intervene on public health issues, with a focus on prevention and systems. Essential to this work is knowledge sharing and relationship building between physicians and populations. POP-CMM represents a method of practice for PHPs. Further exploration of this method in other countries and systems would bring insight into PHP practice globally. The model has important connections to the practice of medicine and presents the possibility of developing a general model of physician practice for a range of patients, from individuals to populations. [ABSTRACT FROM AUTHOR]

Rationale: The evidentiary standards and epistemic models of clinical care, especially those of evidence‐based medicine, are dissimilar to those used in philosophy and examination of how the two systems intersect may help clinicians make more informed treatment decisions. Aims and Objectives: This paper examines the use of ethical frameworks in routine clinical decision‐making, using the example of acute stroke treatment decisions to demonstrate that ethical evaluation is integral to clinical practice. Method: Utilising acute stroke care as a lens through which to examine the phenomenon of ethical evaluation in medical practice, we offer a philosophical analysis of the presence of ethical evaluation in medicine. Results and Conclusion: We find that the medical establishment should embrace ethical evaluation as intrinsic to medical practice and that medical training and treatment guidelines should reflect this reality. Patients deserve clarity and transparency about how physicians make determinations about their treatment, and physicians should be prepared to offer explanations for those decisions. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic changed the healthcare system, leading to the rapid evolution and implementation of telemedicine (TM). TM has the potential to improve the quality of primary health care and increase accessibility for the population. However, its use may represent challenges for older people, as they may have distinct needs from the general population due to age-related changes in perceptual, motor, and cognitive capacities. We, thus, aimed to identify potential facilitators and barriers to TM use in primary care for older adults and develop recommendations accordingly. Methods: We conducted a qualitative study to explore the challenges associated with TM use among older adults and healthcare professionals (HCPs) in primary care practice. Interviews were conducted with 29 older adults, and three focus groups involving HCPs from four McGill family medicine sites were organized. Employing a hybrid codebook thematic analysis, guided by the Consolidated Framework for Implementation Research (CFIR), we identified facilitators and barriers affecting the optimal use of TM by older adults and HCPs. We synthesized the results from semi-structured interviews and focus groups. These findings were then presented during a deliberative dialogue with eight participants, including family physicians, nurses, a social worker, and a government-level TM expert, to validate our results. The purpose was to gather feedback, identify and refine actionable recommendations. Subsequently, we utilized a thematic analysis using the same codebook to synthesize findings from the deliberative dialogue. Results: Participants agreed that TM contributed to maintaining the continuity of care and was particularly convenient when there was an existing or established patient-physician relationship or for addressing minor health issues. TM was found to be beneficial for people with limited mobility, reducing their exposure to potentially high-risk environments. However, participants expressed concerns about the lack of visual contact, causing essential details to be overlooked. Additionally, issues related to miscommunication due to language or hearing barriers were identified. HCPs perceived that most older adults did not consider phone consultations a medical act. Participants were open to a hybrid approach, combining in-person consultations and TM, based on their specific health conditions. Building upon these results, we formulated seven key recommendations. Conclusions: Both older adults and HCPs consider TM a good alternative for accessing healthcare services. To improve the effective use of TM, it's crucial to advocate for a hybrid approach that integrates both in-person and virtual methods. This approach should actively encourage and support individuals in becoming familiar with technological tools. [ABSTRACT FROM AUTHOR]

The article discusses a 2024 study of the enhanced recovery after surgery (ERAS) approach to improve patients' surgical pathways via multimodal interventions. Topics covered include nurse managers' contribution to ERAS implementation, and results which show the themes of resource, innovation and change management, interprofessional collaboration, developing professional practice, and proximity team management. Also noted are the challenges of unclear roles and practice scope among stakeholders.

Aim: To explore clinician-perceived barriers to and facilitators for the provision of actionable processes of care important for patients with persistent or chronic critical illness. Design: Qualitative descriptive interview study. Methods: Secondary analysis of semi-structured telephone interviews (December 2018 – February 2019) with professionally diverse clinicians working with adults experiencing persistent or chronic critical illness in Canadian intensive care units. We used deductive content analysis informed by the Social-Ecological Model. Results: We recruited 31 participants from intensive care units across nine Canadian provinces. Reported intrapersonal level barriers to the provision of actionable processes of care included lack of training, negative emotions and challenges prioritizing these patients. Facilitators included establishment of positive relations and trust with patients and family. Interpersonal barriers included communication difficulties, limited access to physicians and conflict. Facilitators included communication support, time spent with the patient/family and conflict management. Institutional barriers comprised inappropriate care processes, inadequate resources and disruptive environmental conditions. Facilitators were regular team rounds, appropriate staffing and employment of a primary care (nurse and/or physician) model. Communitylevel barriers included inappropriate care location and insufficient transition support. Facilitators were accessed to alternate care sites/teams and to formalized transition support. Public policy-level barriers included inadequacy of formal education programs for the care of these patients; knowledge implementation for patient management was identified as a facilitator. Conclusion: Our results highlighted multilevel barriers and facilitators to the delivery of actionable processes important for quality care for patient/family experiencing persistent or chronic critical illness. Impact: Using the Social-Ecological Model, the results of this study provide intra and interpersonal, institutional, community and policy-level barriers to address and facilitators to harness to improve the care of patients/family experiencing persistent or chronic critical illness. Reporting Method: Consolidated criteria for reporting qualitative studies. [ABSTRACT FROM AUTHOR]

Background: Social determinants of health (SDOH) are the non-medical factors that impact health. Although geographical measures of deprivation are used, individual measures of social risk could identify those most at risk and generate more personalised care and targeted referrals to community resources. We know SDOH are important to health care, but it is not yet known whether their collection via the electronic health record (EHR) is acceptable and useful from the patient perspective. Aim: To synthesise relevant literature to explore patient perspectives on integrating information about SDOH into primary care EHRs, and the opportunities and challenges of its implementation in a general practice setting. Design & setting: Systematic review of primary care-based qualitative and mixed-method studies using thematic framework analysis. Method: Key databases were searched for articles reporting patient perspectives of SDOH collection within the primary care EHR. Qualitative and mixed-methods studies written in English were included. A framework analysis was conducted to identify themes. Results: From 14 included studies, the following five main themes were identified: rationale for SDOH screening and the anticipated outcomes; impact of the provider-patient relationship on patient perceptions; data, which included privacy concerns; screening process and referral; and recommendations for future research. Conclusion: Integration of information on SDOH into the EHR appears acceptable to patients. This review has added to the discussion of whether and how to implement SDOH screening and referral programmes into UK primary care systems. [ABSTRACT FROM AUTHOR]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction/Objective Advance Care Planning (ACP) discussions are infrequently conducted with physicians, even fewer among minorities. We explored physicians' experiences in engaging Chinese (CH) and South Asian (SA) patients in ACP conversations to understand initiation and participation patterns, topics covered, and barriers and facilitating factors. Method Twenty-two physicians with 15%+ SA patients aged 55+ and 19 with 15%+ CH patients aged 55+ were interviewed. Results SA- and CH-serving physicians described similar initiation patterns, cultural context, and need for standardized ACP routines. However, the SA-serving physicians described greater involvement of family members, while CH-serving physicians described more communication barriers and family members' desire to hide the diagnosis from patients. Conclusion Cultural taboos surrounding discussion around death and dying appear to influence CH older adults and families strongly. Lack of familiarity with ACP amongst the SA population accounts more for their limited engagement in ACP discussions. [ABSTRACT FROM AUTHOR]

Background: A growing body of literature points to the potential of mindfulness to support therapeutic relationships, and the importance of the therapeutic relationship when working with children and youth, yet little attention has been paid to this topic in occupational therapy. Aims/Objectives: The aim of this study was to inquire into occupational therapists' experiences of mindfulness in the therapeutic relationship with children and youth. Materials and Methods: Hermeneutic phenomenology was the methodological approach, with Heidegger's concepts of being-with and care as theoretical underpinnings of the study. Eight North American occupational therapists participated in semi-structured interviews that elicited first-hand accounts of mindfulness in the therapeutic relationship with children and youth. Interviews were transcribed verbatim and analysed using a phenomenological approach. Results: Four key themes were identified: fostering a safe space, enhancing presence, being authentic, and cultivating acceptance. Conclusions and Significance: The findings offer insights regarding the potential affordances of mindfulness to support clinicians in the development of therapeutic relationships with children and youth. Further, this study highlights research priorities for future inquiry. [ABSTRACT FROM AUTHOR]

The military lifestyle can be defined by a triad of unique stressors: frequent relocation, parental absence, and risk of injury, illness and/or death of a serving member. Research has suggested that this unique triad of stressors can impact the mental health of children and youth living in military families. However, research focusing on the mental health of children and youth living in military families overwhelmingly focuses on the American context. Due to key contextual differences, it is unclear to what extent the American findings are representative of military-connected children and youth living in other geographical contexts, such as Canada. A large qualitative study was conducted to explore the mental health of military-connected children in Canada from three perspectives: child, parent, and service provider. This paper reports on the service provider findings. Using individual semi-structured interviews, data were collected from 11 service providers. Data analysis was guided by qualitative content analysis. Two main themes emerged: (1) the mental health of children living in military families may be impacted by the military lifestyle stressors, and (2) the mental health of children living in military families can be impacted by the accessibility and availability of mental health services. While this qualitative study builds upon recent Canadian work that has considered the service provider perspective, additional research is needed to better understand the experiences of service providers who support military-connected children and youth. Highlights: American research shows that the military lifestyle factors can impact the mental health of military-connected children. The mental health of military-connected children has yet to be extensively explored in Canada. The mental health of children living in Canadian military families may be impacted by the military lifestyle stressors. The mental health of Canadian military-connected children can be impacted by the accessibility and availability of mental health services. Our findings can help build capacity and knowledge for service providers who support Canadian military-connected children. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, family physicians faced challenges including travel restrictions for patients, lockdowns, diagnostic testing delays, and changing public health guidelines. Given that 95% of Canadian physicians are members of the Canadian Medical Protective Association (CMPA), the CMPA's telephone helpline — which offers peer-to-peer support — provides valuable insights into family physicians' experiences during the pandemic. Methods: We used a content analysis approach to identify and understand family physicians' questions and concerns related to the COVID-19 pandemic expressed during calls to the Canadian Medical Protective Association (CMPA) telephone helpline. Calls were classified with preliminary codes and subsequently organized into themes. We collected aggregated data on calls, including province, call date, and whether the physician self-identified having hospital-based activities as part of their practice. Findings from the analysis were explored alongside family physician calls per month (call volume). Results: Between 01 and 2020 and 31 December 2021, 2,272 family physician calls related to the pandemic were included for content analysis. We identified six major themes across these calls: challenging patient interactions; COVID-related care; the impact of the pandemic on the healthcare system; virtual care; physician obligations and rights; and public health matters. COVID-related call volumes were highest early in the pandemic especially among physicians without major hospital affiliation when family physicians practiced with little guidance on how to balance patient care and scarce resources in the face of a novel pandemic. Conclusions: This research provides unique insight on the effects the COVID-19 pandemic had on family medicine in Canada. These results provide insights on the needs and information gaps of family physicians in a public health crisis and can inform preparedness efforts by public health agencies, professional organizations, educators, and practitioners. [ABSTRACT FROM AUTHOR]

Objective: Understanding how medical cannabis (MC) use is integrated into medical practice for rheumatic disease management is essential. We characterized rationale for MC use, patient–physician interactions around MC, and MC use patterns among people with rheumatic conditions in the US and Canada. Methods: We surveyed 3406 participants with rheumatic conditions in the US and Canada, with 1727 completing the survey (50.7% response rate). We assessed disclosure of MC use to health care providers, MC authorization by health care providers, and MC use patterns and investigated factors associated with MC disclosure to health care providers in the US versus Canada. Results: Overall, 54.9% of US respondents and 78.0% of Canadians reported past or current MC use, typically because of inadequate symptom relief from other medications. Compared to those in Canada, fewer US participants obtained MC licenses, disclosed MC use to their health care providers, or asked advice on how to use MC (all P values <0.001). Overall, 47.4% of Canadian versus 28.2% of US participants rated their medical professionals as their most trusted information source. MC legality in state of residence was associated with 2.49 greater odds of disclosing MC use to health care providers (95% confidence interval: 1.49‐4.16, P < 0.001) in the US, whereas there were no factors associated with MC disclosure in Canada. Our study is limited by our convenience sampling strategy and cross‐sectional design. Conclusion: Despite widespread availability, MC is poorly integrated into rheumatic disease care, with most patients self‐directing use with minimal or no clinical oversight. Concerted efforts to integrate MC into education and clinical policy is critical. [ABSTRACT FROM AUTHOR]

To support primary care physicians (PCPs) and their patients with knee osteoarthritis (OA), we created a series of evidence-based whiteboard educational videos for patients with knee OA. In a previous study we piloted these videos with patients to understand their acceptability and impact. The purpose of this study was to explore PCPs' perspectives to understand the utility of novel patient education videos to support management. We conducted a qualitative descriptive study using semi-structured interviews of newly practicing and resident PCPs after watching a series of patient education videos. A thematic analysis approach was used combining both inductive and research question driven coding, category formation, and theme identification. Ten participants were included. Barriers to optimal management were identified including the challenge of patient adherence and access to non-operative treatments. PCPs indicated that the videos would support their management of patients with knee OA by (1) supporting credibility and building trust with their patient, (2) reinforcing patient understanding, and (3) enhancing their own management of patients. Future implementation of these resources with attention to barriers that may limit uptake is necessary and may optimize management of knee OA in primary care. The provision of patient educational materials may support patient buy-in regarding appropriate management, enhance patient understanding, and improve physicians' future practice. Viewing these videos could potentially improve physicians' future resource use, recommendation of non-operative treatments, and the quality of their total knee replacement referrals, which has benefits to both the patient and the healthcare system. Perceived barriers to implementing evidence-based recommendations may pose a challenge for patients and clinicians and should be considered to help facilitate the uptake of educational interventions. [ABSTRACT FROM AUTHOR]

The authors comment on the article "Slowing the Slide Down th Slippery Slope of Medical Assistance in Dying: Mutual Learnings for Canada and the US" by Daryl Pullman which uses a rhetorical device to immediately bias readers toward perceiving the increasing sanctioning of medical assistance in dying (MAiD) in Canada as descent into immoral nether regions. Topics include the MAiD legislation in the U.S. and their agreement with Pullman that decisions concerning MAiD are complicated.

The author comments on Daryl Pullman's article in the issue which compares influencing factors in the uptake of assisted suicide and euthanasia practices in Canada and California. Topics include differences that account for greater medical assistance in dying (MAiD) access rates in Canada, implications of the structure of conscientious objection in the Canadian and Californian laws, and significance of the doctor-patient relationship to MAiD.

Objective: This study was undertaken to assess the effects of a web‐based program, MyLupusGuide, developed to facilitate self‐management in systemic lupus erythematosus (SLE). Methods: In this randomized controlled online study, participants received either immediate access to the MyLupusGuide site or delayed access starting on month 3. The primary outcome was the patient activation measure (PAM) score. Secondary outcomes included measurements of health status, self‐efficacy, coping, perceived patient–physician relationship, and medication adherence. Outcomes were measured at the baseline visit and at the 3‐month and 6‐month follow‐up visits. We used linear mixed modeling to compare PAM scores between the 2 groups at months 3 and 6. Results: There were 541 participants included in this study. The mean ± SE age was 50 ± 14 years; 93% were female and 74% were White. The mean ± SE disease duration was 17 ± 12 years, and 56% visited MyLupusGuide at least once. The baseline mean ± SE PAM score was 61.2 ± 13, with 36% scoring low for perceived self‐management skills. After 3 months of exposure to MyLupusGuide, there were no differences in terms of PAM scores between groups. In exploratory analyses, we found significant improvement in PAM scores in those who had low PAM scores at baseline and in male individuals. We observed significant improvements in self‐efficacy before and after access to MyLupusGuide and delayed improvements at month 6 compared to month 3 in terms of mental health and emotional coping. Conclusion: MyLupusGuide increases self‐efficacy but not patient activation. A total of 56% of participants visited the MyLupusGuide site during the study period. Individuals with lupus need support to become activated toward self‐management behaviors. [ABSTRACT FROM AUTHOR]

Adequate health literacy is essential to navigate the healthcare system and has a major role in peri-operative care and outcomes. Minimal information exists regarding surgeons' understanding of health literacy, clinical implications, and awareness of universal measures of support. This study assessed Canadian surgeons' perceptions of patients' health literacy and their knowledge of available supportive resources. We conducted a cross-sectional study using an electronic survey distributed to surgeons at academic institutions. Data collected included sociodemographics, health literacy knowledge, and practice surrounding the use of supportive measures. Across four Canadian academic institutions (University of Toronto, McMaster University, University of Alberta, and University of Calgary), 35 surgeons from various surgical specialties, including general, plastic, and orthopedic surgery, completed the survey. Approximately 74% of surgeons reported familiarity with the concept "health literacy", but they used general impressions to estimate their patients' health literacy levels. Surgeons' perceptions were that patients who had proficient health literacy represented 50% or less of their practice. However, knowledge of supportive tools for measuring patient health literacy was variable. Surgeons familiar with health literacy spent significantly more time (>15 minutes) counselling patients (38%, p=0.02) and used language at a 10th grade level or less (92%, p=0.04). Common supportive measures included using simple, non-medical terms (97%, n=34), repetition (83%, n=29), and drawing pictures/diagrams (83%, n=29). This study highlights the importance of surgeon awareness of health literacy and how improved awareness may guide patient-surgeon interactions and improve the quality of care. [ABSTRACT FROM AUTHOR]

The aim of this study is to explore how the perceptions of patients and physicians align throughout the medical care process of IBD, as proposed by a previous study. Various aspects of the experience of patients and physicians with the medical care process of IBD at different points in time were explored through a web-based survey administered to 210 IBD patients (members of Crohn's and Colitis Canada (CCC)), and 6 focus groups held with 28 physicians across Canada. Statistical tests (Paired Wilcoxon-Pratt test; logistic regressions) and inter-coder deductive thematic analyses were performed respective to each data collection methods. The results revealed that: 1) reassured patients were more satisfied with the care they received and physicians tried to fulfill their patients' emotional and cognitive needs; 2) the patients' stress level decreased and satisfaction increased as the medical process progressed, and physicians acknowledged that stress may have led patients to be more compliant with their recommendations; and 3) patient confidence is associated with greater involvement in care and an increase in satisfaction with the improvement of their condition, a component also recognized by physicians as fundamental to IBD management and monitoring. Overall, this study highlights an interconnection between the diverse experiences of patients and physicians in the medical care process, which led to the development of a trusting relationship between patients and physicians. [ABSTRACT FROM AUTHOR]

The experiences of African, Caribbean and Black (ACB) Canadians are seldom explored in the Canadian context. Family physicians act as a gateway to the rest of the healthcare system and are necessary to provide proper patient care. However, Canada's history with colonialism may impact the socio-cultural context in which patients receive care. 41 participants from Waterloo Region, Ontario, were engaged in eight focus groups to discuss their experiences in the healthcare system. Data were analysed following thematic analysis. Style of care, racism and discrimination and a lack of cultural competence hindered access. oor Inadequate cultural competence was attributed to western and biomedical approaches, poor understanding of patients' context, physicians failing to address specific health concerns, and racism and discrimination. Participants highlighted that the two facilitators to care were having an ACB family physician and fostering positive relationships with physicians. Participants predominantly expressed dissatisfaction in physicians' approaches to care, which were compounded by experiences of racism and discrimination. Findings demonstrate how ACB patients are marginalized and excluded from the healthcare syste Iimplications for better access to care included utilizing community healthcare centres, increasing physicians' capacity around culturally inclusive care, and increasing access to ACB physicians. [ABSTRACT FROM AUTHOR]

Purpose: Strong leadership in primary care is necessary to coordinate an effective pandemic response; however, descriptions of leadership roles for family physicians are absent from previous pandemic plans. This study aims to describe the leadership roles and functions family physicians played during the COVID-19 pandemic in Canada and identify supports and barriers to formalizing these roles in future pandemic plans. Design/methodology/approach: This study conducted semi-structured qualitative interviews with family physicians across four regions in Canada as part of a multiple case study. During the interviews, participants were asked about their roles during each pandemic stage and the facilitators and barriers they experienced. Interviews were transcribed and a thematic analysis approach was used to identify recurring themes. Findings: Sixty-eight family physicians completed interviews. Three key functions of family physician leadership during the pandemic were identified: conveying knowledge, developing and adapting protocols for primary care practices and advocacy. Each function involved curating and synthesizing information, tailoring communications based on individual needs and building upon established relationships. Practical implications: Findings demonstrate the need for future pandemic plans to incorporate formal family physician leadership appointments, as well as supports such as training, communication aides and compensation to allow family physicians to enact these key roles. Originality/value: The COVID-19 pandemic presents a unique opportunity to examine the leadership roles of family physicians, which have been largely overlooked in past pandemic plans. This study's findings highlight the importance of these roles toward delivering an effective and coordinated pandemic response with uninterrupted and safe access to primary care. [ABSTRACT FROM AUTHOR]

Objective To explore how young adults with chronic pain define a successful transition from pediatric to adult chronic pain care and how they would like to be empowered to achieve a successful transition. Design A descriptive qualitative design. Setting Participants were recruited from a hospital-based chronic pain clinic in Toronto, Canada, and through social media. Subjects Young adults (18–25 years of age, inclusive) who received chronic pain care in a pediatric setting and continued to self-identify as having a need for chronic pain care in an adult chronic pain care setting. Methods Semistructured interviews were used to understand the perspectives of young adults with chronic pain. Interviews were audio-recorded, transcribed verbatim, and checked for accuracy. Qualitative inductive content analysis was used to analyze the interview data. Results Eight young adults with chronic pain were interviewed (all women; median age=19 years). Five themes that addressed the study objectives are described: 1) Young adults value skill-building and knowledge about the transition, 2) establishment of a strong therapeutic alliance with health care providers, 3) coordinated and planned transition, 4) social and environmental support, and 5) respect for young adults' independence and autonomy. Conclusion Findings suggest the need for a collaborative and individualized approach to the successful transition of young adults across the continuum of chronic pain care that addresses their unique needs. To promote successful transition, clinicians should build relationships with young adults that facilitate choice and autonomy while enhancing skill-building and education on available resources. [ABSTRACT FROM AUTHOR]

The subjective experience of ageism among older men has received little research attention. This study examines older Canadian men's experiences with and perceptions of ageism during interactions with physicians. In-depth, face-to-face interviews were conducted with 21 men aged 55 years and over. The findings indicate a seeming lack of awareness of ageism among many, and many did not believe ageism was likely to occur during patient–physician interaction. Negative stereotyping of older patients was common. A large majority of the participants reported that they had not personally experienced ageism during a medical encounter, nor were they concerned about it. Numerous rationales were proffered as explanations of why a particular participant had not experienced ageism and who was more likely to be a target. [ABSTRACT FROM AUTHOR]

Relationships, built on trust, knowledge, regard, and loyalty, have been demonstrated to be fundamental to health care delivery. Strong relationships between patients and providers have been linked to more compassionate care delivery, and better patient experience and outcomes, and may be particularly important in primary care. The rapid adoption of digital technologies since the onset of COVID-19 has led health care systems to seriously consider a "digital-first" primary care delivery model. Questions remain regarding what impact this transformation will have on the therapeutic relationship. Using a rapid ethnographic approach this study explores how patient and provider understandings of therapeutic relationships and digital health technologies may influence relationship-building or maintenance between patients with complex care needs and their care providers. Three team-based primary care sites in Toronto, Ontario, Canada were included in the study. Across the three sites 9 patients with chronic health conditions, 1 caregiver, and 10 healthcare providers (including family physicians, family medicine residents, social workers, and nurse practitioners) participated. Interviews were conducted with all participants and 8 observations of virtual clinical encounters (phone and video visits) were conducted. Using social representation theory as a lens, analysis revealed that participants' constructions of therapeutic relationships and digital technologies were informed by their identities, experiences, and expectations. For participants to see technologies as enabling to the therapeutic relationship, there needed to be alignment between how participants viewed the role of technology in care and in their lives, and how they recognized (or constructed) a good therapeutic relationship. This exploratory work suggests the need to think about how both patients' and providers' views of technology may determine whether digital technologies can be leveraged to meet patient needs while maintaining, or building, strong therapeutic relationships. • Digital health tools can both support and disrupt therapeutic relationships. • The meaning of digital tools for patients and providers plays an important role. • The Theory of Social Representation helps to understand construction of meaning. • Constructed meanings of technology and therapeutic relationships needs to align. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Midwifery Research & Practice is the property of Canadian Association of Midwives and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Current clinical note-taking approaches cannot capture the entirety of information available from patient encounters and detract from patient-clinician interactions. By surveying healthcare providers' current note-taking practices and attitudes toward new clinical technologies, we developed a patient-centered paradigm for clinical note-taking that makes use of hybrid tablet/keyboard devices and artificial intelligence (AI) technologies. PhenoPad is an intelligent clinical note-taking interface that captures free-form notes and standard phenotypic information via a variety of modalities, including speech and natural language processing techniques, handwriting recognition, and more. The output is unobtrusively presented on mobile devices to clinicians for real-time validation and can be automatically transformed into digital formats that would be compatible with integration into electronic health record systems. Semi-structured interviews and trials in clinical settings rendered positive feedback from both clinicians and patients, demonstrating that AI-enabled clinical note-taking under our design improves ease and breadth of information captured during clinical visits without compromising patient-clinician interactions. We open source a proof-of-concept implementation that can lay the foundation for broader clinical use cases. [ABSTRACT FROM AUTHOR]

Patient satisfaction is important to patient outcomes. Previous attempts to conceptualize satisfaction have often taken an atheoretical approach and focused on doctors' communication skills. Patients are becoming more active health consumers involved in their health care and current definitions of patient satisfaction may not accurately reflect patient expectations about their health consultations. Earlier research found that meeting patients' emotional needs - through empathy and patient-centered communication - is important to patient satisfaction. New research is needed to explore how those needs can be met given the changing trend in patient behaviors and the focus on patient-centredness. This study employed two communication theories - the Willingness to Communicate Model and Communication Accommodation Theory - to consider both patients' communicative decisions, and the intergroup features of the health context that can influence communicative behaviors. Two hundred and fiftythree patients from health clinics in Canada and Australia described what satisfaction meant to them, and identified what aspects of their health consultation were satisfying (or not), and we investigated their perceptions of doctor's emotional expression. Results suggest that patient perceptions of their participation in the consultation predicts their perceptions of doctor emotional expression, and their satisfaction with the consultation. Patients want both emotional and medical needs met in an environment that balances interpersonal and intergroup communication. Our findings suggest the need to expand current definitions of patient satisfaction, patient-centredness and emotional expression. We discuss the implications of these findings for health practitioners and consider future research that addresses the need for more individualized health care. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic significantly changed the lives of a majority of the world's population. People have been encouraged to implement social distancing behaviors enforced by governments, and have experienced loss of employment or changes to their usual working environment. In the mental health sector, psychologists and psychiatrists have been forced to alter the standard care of patients without compromising safety. This article documents the experiences of the authors – mental health professionals in four countries, Canada, Russia, Australia and Japan – at the time of the COVID-19 pandemic, and offers recommendations on how clinical, training, and research practices may need to be adjusted to deal with lockdown situations. Clinicians adapted their usual best practices by learning new skills and updating their knowledge base. Mental health clinicians noticed that the pandemic led to symptomatic changes in some of their patients. Most clinicians moved towards providing telemental health services, such as conducting assessments and treatments remotely. Those who continued seeing patients in person employed personal protective equipment with various impacts on the clinician–patient relationship. The dilemmas of mass quarantines need to be carefully examined, as their effects on numerous health and psychosocial variables appear to be far-reaching. [ABSTRACT FROM AUTHOR]

The Child-Hospital Consumer Assessment of Healthcare Providers and Systems (Child-HCAHPS) survey is a validated measure of paediatric inpatient experience. The study objective was to determine which survey questions were most correlated with respondents' overall rating of care. Knowing which questions are most important may provide valuable insights for developing targeted quality improvement initiatives. Methods: Within 6 weeks of discharge, 3,389 telephone surveys were completed by parents/guardians of children who were hospitalized for at least 24 hours. The survey was comprised of 66 questions, with responses based on Likert-scales. One survey question asked respondents to rate the overall care that their child received on a scale from 0 (worst care) to 10 (best care). The correlation between the overall rating of care and each survey measure and question was then examined using Spearman correlation coefficients. All survey questions were normalized to a 100-point score (0=worst, 100=best). Results: Questions on provider coordination and nursing care were most correlated with overall experience. Quietness of hospital room (r=0.19, P<0.001), and keeping families informed in the emergency room (r=0.12, P<0.001) showed poor correlation. Correlation with overall experience was strongest for the 'communication with nurses' domain (r=0.46, P<0.001). Conclusions: To our knowledge, this is the first study which examines the correlation of individual questions of the Child-HCAHPS to overall rating of care within a Canadian context. Our results suggest that our large health care organization may attain initial inpatient experience improvements by focusing upon personnel-based initiatives, rather than physical attributes of our hospitals. [ABSTRACT FROM AUTHOR]

Given barriers of patient-centred care (PCC) among physicians and trainees, this study assessed how medical schools addressed PCC in curriculum. The authors used content analysis to describe PCC in publicly-available curriculum documents of Canadian medical schools guided by McCormack's PCC Framework, and reported results using summary statistics and text examples. The authors retrieved 1459 documents from 16 medical schools (median 49.5, range 16–301). Few mentioned PCC (301, 21.2%), and even fewer thoroughly or accurately described PCC. Significantly more clerkship versus pre-clerkship (24.0% vs 12.6%, p < 0.00001), and elective compared with core course descriptions (24.7% vs 14.9%, p < 0.00001) mentioned PCC. The domain of foster a healing relationship was common (79.0%) compared with other domains: address concerns (16.5%), exchange information (14.9%), enable self-care (10.4%), share decisions (4.5%), and manage uncertainty (1.3%). Overall, few documents mentioned or described PCC or related concepts. This varied by school, and was more frequent in clerkship and elective courses, suggesting that student exposure may be brief and variable. Thus, it remains unclear if medical students are fully exposed to what PCC means and how to implement it. Future research is needed to confirm if PCC content in medical curriculum is lacking. [ABSTRACT FROM AUTHOR]

Background: Since 2002, paramedics have been working in primary care within the United Kingdom (UK), a transition also mirrored within Australia, Canada and the USA. Recent recommendations to improve UK NHS workforce capacities have led to a major push to increase the numbers of paramedics recruited into primary care. However, gaps exist in the evidence base regarding how and why these changes would work, for whom, in what context and to what extent. To understand the ways in which paramedics impact (or not) the primary care workforce, we conducted a realist review.Methods: A realist approach aims to provide causal explanations through the generation and articulation of contexts, mechanisms and outcomes. Our search of electronic databases was supplemented with Google and citation checking to locate grey literature including news items and workforce reports. Included documents were from the UK, Australia, Canada and the Americas-countries within which the paramedic role within primary care is well established.Results: Our searches resulted in 205 included documents, from which data were extracted to produce context-mechanism-outcome configurations (CMOCs) within a final programme theory. Our results outline that paramedics are more likely to be effective in contributing to primary care workforces when they are supported to expand their existing role through formal education and clinical supervision. We also found that unless paramedics were fully integrated into primary care services, they did not experience the socialisation needed to build trusting relationships with patients or physicians. Indeed, for patients to accept paramedics in primary care, their role and its implications for their care should be outlined by a trusted source.Conclusions: Our realist review highlights the complexity surrounding the introduction of paramedics into primary care roles. As well as offering an insight into understanding the paramedic professional identity, we also discuss the range of expectations this professional group will face in the transition to primary care. These expectations come from patients, general practitioners (family physicians) and paramedics themselves. This review is the first to offer insight into understanding the impact paramedics may have on the international primary care workforce and shaping how they might be optimally deployed. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to analyze guidance about medical decision making contained in ethics codes. The primary question we address is which of the main decision-making models - informed decision making (IDM), shared decision making (SDM), or paternalism - is promoted by these codes.Methods: We manually searched codes of medical ethics for guidance on medical decision making. Our analysis focused on the major international code, the World Medical Association International Code of Medical Ethics (ICME), and national codes of the US, Canada, Australia, New Zealand, the UK, Ireland, Germany, France and Norway.Results: The ICME does not promote any specific model of medical decision making. 10 of the 11 analyzed national codes contain guidance about IDM, while only four refer to SDM. Some codes contain articles which are imprecise with regard to the question of medical decision making.Conclusions: All of the analyzed national codes should be updated or amended. In particular, given the great importance of SDM in medicine, codes which do not contain relevant guidance should be updated.Practice Implications: Relevant amendments introduced to ethics codes could contribute to promoting of adequate standards of medical decision making (especially those regarding SDM) among doctors. [ABSTRACT FROM AUTHOR]

Objectives: The COVID-19 pandemic has led to death and hardship around the world, and increased popular discourse about end-of-life circumstances and conditions. The extent to which this discourse and related pandemic experiences have precipitated advance care planning (ACP) activities was the focus of this study with a particular emphasis on sexual orientation. Methods: A large, national online survey was conducted between 10 August and 10 October 2020 in Canada. The final sample of 3923 persons aged 55 and older was recruited using social media, direct email, and Facebook advertising and in conjunction with community groups. Women comprised almost 78% of the sample; just more than 7% of the sample identified as lesbian, gay, and bisexual (LGB). Measures included demographic variables and a series of questions on ACP, including documents and discussions undertaken prior to the pandemic and since its onset. Results: Descriptive analyses revealed few gender or sexual orientation differences on documents and discussions prior to the pandemic; since its onset, LGB persons have completed or initiated wills, powers of attorney, advance directives, representation agreements, and have engaged in ACP discussions in greater proportion than heterosexuals. Logistic regressions reveal the increased likelihood of pre-pandemic ACP engagement by age, gender (women), and education; since the pandemic onset, gender, education, and sexual orientation were predictive of greater ACP engagement. Care discussions were more likely undertaken by women and LGB persons since the pandemic most often with spouses, family, and friends, especially among LGB persons. Discussion: Gender roles and previous pandemic experiences (HIV/AIDS, in particular) are implicated in this pattern of results; opportunities for educational interventions are considered. [ABSTRACT FROM AUTHOR]

Introduction: Harms caused by prescription opioid analgesics (POAs) have been identified as a major international public health concern. Recent statistics show rising numbers of opioid-related deaths across Canada. However, Canadian family physicians appear to have inadequate resources to safely and effectively prescribe opioid analgesics to treat chronic non-cancer pain (CNCP). Methods: We completed a qualitative study of the barriers and facilitators to safe and effective prescribing of opioid analgesics for CNCP through semi-structured interviews with eight family physicians in Nova Scotia. Thematic analysis was used to identify the barriers and facilitators. Results: Family physicians identified challenges in prescribing opioid analgesics for CNCP: the complexity of CNCP management, addictions risks and prescribing tools, physician training, the physician-patient relationship, prescription monitoring and control, and systemic factors. Conclusion: Family physicians described themselves as inadequately supported in their prescribing of opioid analgesics for CNCP and could benefit from an integrated and coordinated approach to prescriber support. [ABSTRACT FROM AUTHOR]

Background: Some jurisdictions restrict primary care physicians' daily patient volume to safeguard quality of care for complex patients. Our objective was to determine whether people with dementia receive lower-quality care if their primary care physician sees many patients daily. Methods: Population-based retrospective cohort study using health administrative data from 100,256 community-living adults with dementia aged 66 years or older, and the 8,368 primary care physicians who cared for them in Ontario, Canada. Multivariable Poisson GEE regression models tested whether physicians' daily patient volume was associated with the adjusted likelihood of people with dementia receiving vaccinations, prescriptions for cholinesterase inhibitors, benzodiazepines, and antipsychotics from their primary care physician. Results: People with dementia whose primary care physicians saw ≥ 30 patients daily were 32% (95% CI: 23% to 41%, p < 0.0001) and 25% (95% CI: 17% to 33%, p < 0.0001) more likely to be prescribed benzodiazepines and antipsychotic medications, respectively, than patients of primary care physicians who saw < 20 patients daily. Patients were 3% (95% CI: 0.4% to 6%, p = 0.02) less likely to receive influenza vaccination and 8% (95% CI: 4% to 13%, p = 0.0001) more likely to be prescribed cholinesterase inhibitors if their primary care physician saw ≥ 30 versus < 20 patients daily. Conclusions: People with dementia were more likely to receive both potentially harmful and potentially beneficial medications, and slightly less likely to be vaccinated by high-volume primary care physicians. [ABSTRACT FROM AUTHOR]

Background: Many individuals with intellectual disabilities and their caregivers struggle to provide accurate and complete information to healthcare providers. Method: The present authors provided personal medical information cards (PMICs) containing contact and medical information to 52 Canadian adults with 22q11.2 deletion syndrome, a genetic condition associated with intellectual disability. The authors invited them and/or their caregivers to complete a user satisfaction survey concerning usage of the card. Results: Forty‐eight (92%) patients or their caregivers completed the survey. Twenty‐two (46%) respondents used the PMIC over a median of 8 months during encounters with doctors and other professionals, and a majority of these used it more than once. Users reported finding the PMIC "very helpful" (86%) or "helpful" (14%), providing necessary information, speeding up interactions with professionals and helping avoid repeat storytelling. Conclusion: Providing a PMIC to individuals with intellectual disabilities and their caregivers could help improve patient safety and assist in advocacy. [ABSTRACT FROM AUTHOR]

Objectives: Patients adapt to cancer through self‐management, which requires collaboration between patients and their healthcare providers. We aimed to describe patterns of patient–provider collaboration during radiotherapy and examine associations among patient–provider collaboration, self‐management and well‐being. Methods: An observational, cross‐sectional study was conducted at a cancer centre in the province of Ontario, Canada. Cancer patients (N = 130) completed a one‐time questionnaire during their radiotherapy. The questionnaire assessed three variables: collaboration with healthcare providers, self‐management and well‐being. Patterns of collaboration were analysed using descriptive statistics. Associations among study variables were assessed through structural equation modelling (SEM). Separate models were tested for patient–nurse and patient–oncologist collaboration. Results: Participants reported greater collaboration with oncologists than with nurses or radiation therapists. Most participants reported no collaboration with other providers within healthcare teams (e.g. social workers, dietitians). SEM revealed different patterns for the patient–nurse and patient–oncologist collaboration models, where collaboration predicted one self‐management aspect, and both physical and mental well‐being. Conclusion: During radiotherapy, patients collaborated mainly with doctors, nurses and radiation therapists. Collaborative relationships between patients and providers may enhance patient outcomes by fostering their self‐management skills. Initiatives to strengthen patient–provider relationships and support self‐management should be developed and applied to interprofessional‐cancer‐care teams. Impact: This is the first known study to empirically support the links among patient–provider collaboration, self‐management and patient outcomes. The study results can enhance practice, research and education. [ABSTRACT FROM AUTHOR]

Given his history of polio, and with no other causes identified, a physiatrist diagnosed postpolio syndrome.[1] Because of ongoing symptoms, Barry applied for long-term disability in 1996. Patient's perspective There are about 31 000 aging polio survivors in Canada, and fewer than half have symptoms of postpolio syndrome. Barry McMahon, a 72-year-old retired film and video producer, received a diagnosis of acute paralytic polio in 1951 when he was 3 years old. Several factors make Barry's postpolio syndrome-related symptoms difficult to manage. [Extracted from the article]

Background: No prior research studied how to implement patient‐centred care (PCC) for migrant women, who face inequities in health‐care quality. This study explored migrant women's views about what constitutes PCC and how to achieve it. Design: We conducted a qualitative study involving three focus groups with migrant women living in Toronto, Canada, recruited from English language classes at a community settlement agency, used constant comparative technique to inductively analyse transcripts and interpreted themes against a published PCC framework. Participants: Twenty‐three migrant women aged 25‐78 from 10 countries participated. Results: Women articulated 28 physician behaviours important to them across six PCC domains: foster a healing relationship, exchange information, address concerns, manage uncertainty, share decisions and enable self‐care. They emphasized the PCC domain of exchanging information, which included 13 (46.4%) of 28 behaviours: listen to reason for visit, ask questions, provided detailed explanations, communicate clearly, ensure privacy and provide additional information. Women said that instead of practising these behaviours, physicians rushed through discussions, and ignored or dismissed their concerns and questions. As a result, women said that physicians may not fully understand their problem, and they may refrain from stating important details or avoid seeking care. Conclusions: This research characterized the lack of PCC experienced by migrant women and revealed specific physician behaviours to optimize PCC for migrant women. Research is needed to develop and evaluate the impact of strategies targeted at migrant women, physicians and health‐care systems to support PCC for migrant women. [ABSTRACT FROM AUTHOR]

Background: Although antibiotics have little or no benefit for most upper respiratory tract infections (URTIs), they continue to be prescribed frequently in primary care. Physicians perceive that patients' expectations influence their antibiotic prescribing practice; however, not all patients seek antibiotic treatment despite having similar symptoms. In this study, we explored patients' views about URTIs, and the ways patients manage them (including attendance in primary care and taking antibiotics). Methods: Using a qualitative descriptive design, adult English-speaking individuals at a Canadian health center were recruited through convenient sampling. The participants were interviewed using semi-structured interview guide based on the Common Sense-Self-Regulation Model (CS-SRM). The interviews were transcribed verbatim and coded according to CS-SRM dimensions (illness representations, coping strategies). Sampling continued until thematic saturation was achieved. Thematic analysis related to the dimensions of CS-SRM was applied. Results: Generally, participants had accurate perception about the symptoms of URTIs, as well as how to prevent and manage them. However, some participants revealed misconceptions about the causes of URTIs. Almost all participants mentioned that they only visited their doctor if their symptoms got progressively worse and they could no longer self-manage the symptoms. When visiting a doctor, most participants reported that they did not seek antibiotics. They expected to receive an examination and an explanation for their symptoms. Conclusion: Our participants reported good understanding regarding the likely lack of benefit from antibiotics for URTIs. Developing interventions that specifically help patients discuss their concerns with their physicians, instead of providing more education to public may help in reducing the use of unnecessary antibiotics. [ABSTRACT FROM AUTHOR]

Many doctors work or train in foreign countries and speak with a foreign accent. People sometimes assume that a person who speaks with a foreign accent possesses negative traits and personality characteristics. The purpose of this study is to test if doctors who speak with a foreign accent are perceived as less competent than doctors who speak with a standard accent. Both Caucasian Canadian and Chinese Canadian undergraduates rated the competence of a doctor speaking English with either a standard Canadian accent or a Chinese accent. The doctor was delivering either good or bad news about the patient's cholesterol levels or cancer. Previous research has shown that when reminded of death, participants favor in-group members. We found that the Chinese-accented doctor's competence was judged more negatively than the standard Canadian accented doctor by all participants. Both doctors were deemed less competent when delivering bad news than good news. These results suggest that foreign-accented doctors face biases about their competence from their patients. [ABSTRACT FROM AUTHOR]

Background: Although patient-centred care has become increasingly important across all medical specialties, when it comes to end of life care, research has shown that treatments ordered are not often concordant with people's expressed preferences. Patient and family engagement in Advance Care Planning (ACP) in the primary care setting could improve the concordance between patients' wishes and the healthcare received when patients cannot speak for themselves. The aim of this study was to better understand the barriers faced by older patients regarding talking to their family members and family physicians about ACP. Methods: In this multi-site cross-sectional study, three free text questions regarding reasons patients found it difficult to discuss ACP with their families or their family physicians were part of a self-administered questionnaire about patients' knowledge of and engagement in ACP. The questionnaire, which included closed ended questions followed by three probing open ended questions, was distributed in 20 family practices across 3 provinces in Canada. The free text responses were analyzed using thematic analysis and form the basis of this paper. Results: One hundred two participants provided an analyzable response to the survey when asked why they haven't talked to someone about ACP. Two hundred fifty-four answered the question about talking to their physician and 340 answered the question about talking to family members. Eight distinct themes emerged from the free text response analysis: 1. They were too young for ACP; 2. The topic is too emotional; 3. The Medical Doctor (MD) should be responsible for bringing up ACP 4. A fear of negatively impacting the patient-physician relationship; 5. Not enough time in appointments; 6. Concern about family dynamics; 7. It's not a priority; and 8. A lack of knowledge about ACP. Conclusions: Patients in our sample described many barriers to ACP discussions, including concerns about the effect these discussions may have on relationships with both family members and family physicians, and issues relating to patients' knowledge and interpretation of the importance, responsibility for, or relevance of ACP itself. Family physicians may be uniquely placed to leverage the longitudinal, person- centred relationship they have with patients to mitigate some of these barriers. [ABSTRACT FROM AUTHOR]

Background: Specialist LINK is a real-time, non-urgent telephone collaboration line designed to link family doctors and specialists. The purpose was to reduce wait times, improve efficiency and enhance the coordination of patient care through enhanced communication between primary and specialty care. The aim of this study was to determine the awareness and utilization of Specialist LINK and Primary Care Network (PCN) Clinical Pathways among family physicians. Methods: A family physician experience cross-sectional survey was conducted from March to May 2018 in Calgary and Area. The survey was designed to assess family physicians' awareness and utilization of Specialist LINK and PCN Clinical Pathways. We also used a 1–10 scale for respondents to rate the utility of Specialist LINK (1 was least useful and 10 represented highly useful). To obtain a true representative sample, family physicians were selected through a random sampling method. We applied multiple approaches to ensure a high response rate: paper survey, telephone reminders, and an on-site survey for non-responders. Results: A total of 251 participants completed the survey of the 650 randomly selected family physicians (Response rate≈39%). Eighty-nine percent of the family physicians were aware of Specialist LINK [95% Confidence Interval (84–92%)]. The average rating was 8.1 (on a scale of 1–10) for the usefulness of Specialist LINK. We found that the odds of being aware of Specialist LINK were two times higher in female family physicians compared to male physicians. Also, those with less than 5 years of experience, the odds of being aware of Specialist LINK were around five times higher compared to those with 5 or more years of experience. Fifty-five percent of family physicians were aware of PCN Clinical Pathways (95% CI = 48–60%); of those, 82% were accessing and following PCN Clinical Pathways in their clinical practice. The average rating was 7.9 (on a scale of 1–10) for the usefulness of PCN Clinical Pathways. Conclusion: Most of the respondents in Calgary and area were aware of Specialist LINK and a large proportion of them were using it to access advice for their patients. [ABSTRACT FROM AUTHOR]

We sought to understand the impact of primary care conversations about obesity on people's everyday life health experience and practices. Using a dialogic narrative perspective, we examined key moments in three very different clinical encounters, the patients' journals, and follow-up interviews over several weeks. We trace how people living with obesity negotiate narrative alternatives that are offered during clinical dialogue to transform their own narrative and experience of obesity and self. Findings provide pragmatic insights into how providers can play a significant role in shifting narratives about obesity and self and how such co-constructed narratives translate into change and tangible health outcomes in people's lives. [ABSTRACT FROM AUTHOR]

As three University of Toronto medical students, we had the privilege of assisting with a study at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC), in Kuala Lumpur, Malaysia, through the CREMS International Health Summer Research program. During the seven-week program, we studied the prevalence and predictors of mental health comorbidities of diabetes, as well as the biopsychosocial factors associated with poor glycemic control among Malaysian patients. Here, we outline four lessons learned while working abroad: 1) working with diverse patient populations provides an opportunity to challenge implicit biases and develop cultural competency; 2) collaborating with team members from diverse backgrounds poses unique challenges and embracing these differences results in a stronger team; 3) establishing trust is crucial when building relationships with patients; and 4) implementing a patient-centred approach is essential because each patient is the expert of their own story. For each lesson, we share relevant personal experiences from our time in Malaysia and describe how the learning opportunity has impacted us as future clinicians. Finally, we illustrate how global health initiatives provide students with an opportunity to gain valuable insight into another way of life. [ABSTRACT FROM AUTHOR]

Background: In order to combat rising rates of antimicrobial resistant infections, it is vital that antimicrobial stewardship become embedded in primary health care (PHC). Despite the high use of antimicrobials in PHC settings, there is a lack of data regarding the integration of antimicrobial stewardship programs (ASP) in non-hospital settings. Our research aimed to determine which antimicrobial stewardship interventions are optimal to introduce into PHC clinics beginning to engage with an ASP, as well as how to optimize those interventions. This work became focused specifically around management of viral upper respiratory tract infections (URTIs), as these infections are one of the main sources of inappropriate antibiotic use. Methods: This mixed methods study of sequential explanatory design was developed through three research projects over 3 years in Regina, Saskatchewan, Canada. First, a survey of PHC providers was performed to determine their perceived needs from a PHC-based ASP. From this work, a "viral prescription pad" was developed to provide a tool to help PHC providers engage in patient education regarding appropriate antimicrobial use, specifically for URTIs. Next, interviews were performed with family physicians to discuss their perceived utility of this tool. Finally, we performed a public survey to determine preferences for the medium by which information is received regarding symptom management for viral URTIs. Results: The majority of PHC providers responding to the initial survey indicated they were improperly equipped with tools to aid in promoting conversations with patients and providing education about the appropriate use of antimicrobials. Following dissemination of the viral prescription pad and semi-structured interviews with family physicians, the viral prescription pad was deemed to be a useful educational tool. However, about half of the physicians interviewed indicated they did not actually provide a viral prescription to patients when providing advice on symptom management for viral URTIs. When asked about their preferences, 76% of respondents to the public survey indicated they would prefer to receive written or a combination of verbal and written information in this circumstance. Conclusions: PHC providers indicated a need for educational tools to promote conversations with patients and provide education about the appropriate use of antimicrobials. Viral prescription pads were regarded by family physicians and patients as useful tools in facilitating discussion on the appropriate use of antimicrobials. PHC providers should exercise caution in opting out of providing written forms of information, as many respondents to the general public survey indicated their preference in receiving both verbal and written information. [ABSTRACT FROM AUTHOR]

Drawing on 5090 English reviews of 486 psychiatrists working in Canada posted on ratemds.com, this study empirically analyses how Canadian mental health service users critique or appraise their doctors. I explore how the online realm serves as a conduit for resistance and discourses about mental health that otherwise become suppressed by psychiatric power in clinical settings. I found that when doctors did not listen to their patients, make careful attempts to learn about their lives and problems beyond their clinical symptoms, and give them a sense of autonomy, service users felt like an inconvenience. Psychiatrists, on the other hand, who were constructed as kind, compassionate, non-judgemental listeners tended to receive praise from service users. Service users who had this kind of positive experience were more likely to align themselves with the forces of psychiatric power, meaning they believed in their doctor's power to make decisions about their health. [ABSTRACT FROM AUTHOR]

Within Canada, the homeless have four times the cancer rates of the general population, lower rates of screening, later stage diagnosis, and poorer outcomes. In the United States, disparities in cancer burden also exist between the homeless and the housed. For example, lung cancer deaths occur at double the rate for the homeless compared with the housed. Cancer care is complex and requires many high-order health literacy skills to obtain and understand the information needed to make informed decisions about cancer care. A scoping review was conducted to summarize what is known about, the homeless, cancer and health literacy. The literature search yielded 1,124 articles. Of these, 33 articles met eligibility criteria. Results suggest that low health literacy may have a significant effect on access to cancer screening and care among the homeless population. [ABSTRACT FROM AUTHOR]

Introduction: To improve reproductive, maternal, and child health, preconception health (PCH) care that is innovative and generationally relevant is essential. In response, Wellington-Dufferin-Guelph Public Health (WDGPH) developed and tested an evidence-based PCH electronic intervention delivered in a primary care setting. The purpose of this study was to: (1) identify the prevalence of PCH risks among women of reproductive age, (2) determine the impact of the PCH intervention on knowledge and behaviour, and (3) assess the implementation of the intervention. Methods: The PCH intervention was designed as a cohort study using a mixed method approach. 300 women aged 15–49 years participated across seven primary care sites. The intervention was implemented using a three-part model. Participants: (1) completed a Risk Assessment (RA) on tablet with results sent to their electronic medical record, (2) discussed results with primary care providers (PCPs), (3) received handout with results and key messages. Data were collected from participants (RA and two surveys), and PCPs (interviews). Results: The RA screened for 34 PCH risk factors. The number of risks identified per participant ranged from 4 to 24, averaging 15. The majority reported a positive experience using the RA and would recommend the intervention. PCPs reported many practice benefits. The study highlights the positive influence that PCPs have around PCH. Discussion: The PCH intervention is the first of its kind in Canada. The intervention is an evidence-based population health approach that may help to improve reproductive, maternal and child health. Further research, evaluation and promotion is needed. [ABSTRACT FROM AUTHOR]