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Background: Robust and integrated primary care and home care are core components of effective chronic disease management in the community. We described the primary care and other health system use by a cohort of home care patients. Methods: We conducted a population-based retrospective cohort study of patients who received publicly funded home care in Ontario, Canada, from October 2014 to September 2016. Primary outcomes were primary care physician visits including coordination with home care, home visits and visits after hours or on weekends or holidays within 6 months of a home care assessment. Secondary outcomes included specialist physician visits, emergency department use, home care visits and placement in a long-term care home. Multivariable models examined associations between patient characteristics and subsequent primary care use. Results: There were 226 054 home care patients in our cohort, with a median age of 81 years. Following assessment, home care patients visited primary care physicians at a rate of 0.78 visits per month. Physician-based home care coordination codes were billed for 3.9% of patients. Primary care home visits were received by 13.1% of patients, and 15.1% of patients used primary care after hours or on weekends or holidays. Interpretation: Patients receiving publicly funded home care frequently visited a primary care physician. Physician billings for coordination between primary care and home care were infrequent but were more common in interprofessional primary care practices. Physician home visits were more likely to be received by the oldest and most functionally impaired patients, suggesting that home visits are responsive to the needs of home care patients. [ABSTRACT FROM AUTHOR]

Background: Low-income older adults who live in subsidized housing have higher mortality and morbidity. We aimed to determine if a community paramedicine program - in which paramedics provide health care services outside of the traditional emergency response - reduced the number of ambulance calls to subsidized housing for older adults.Methods: We conducted an open-label pragmatic cluster-randomized controlled trial (RCT) with parallel intervention and control groups in subsidized apartment buildings for older adults. We selected 6 buildings using predefined criteria, which we then randomly assigned to intervention (Community Paramedicine at Clinic [CP@clinic] for 1 yr) or control (usual health care) using computer-generated paired randomization. CP@clinic is a paramedic-led, community-based health promotion program to prevent diabetes, cardiovascular disease and falls for residents 55 years of age and older. The primary outcome was building-level mean monthly ambulance calls. Secondary outcomes were individual-level changes in blood pressure, health behaviours and risk of diabetes assessed using the Canadian Diabetes Risk Questionnaire. We analyzed the data using generalized estimating equations and hierarchical linear modelling.Results: The 3 intervention and 3 control buildings had 455 and 637 residents, respectively. Mean monthly ambulance calls in the intervention buildings (3.11 [standard deviation (SD) 1.30] calls per 100 units/mo) was significantly lower (-0.88, 95% confidence interval [CI] -0.45 to -1.30) than in control buildings (3.99 [SD 1.17] calls per 100 units/mo), when adjusted for baseline calls and building pairs. Survey participation was 28.4% (n = 129) and 20.3% (n = 129) in the intervention and control buildings, respectively. Residents living in the intervention buildings showed significant improvement compared with those living in control buildings in quality-adjusted life years (QALYs) (mean difference 0.09, 95% CI 0.01 to 0.17) and ability to perform usual activities (odds ratio 2.6, 95% CI 1.2 to 5.8). Those who received the intervention had a significant decrease in systolic (mean change 5.0, 95% CI 1.0 to 9.0) and diastolic (mean change 4.8, 95% CI 1.9 to 7.6) blood pressure.Interpretation: A paramedic-led, community-based health promotion program (CP@clinic) significantly lowered the number of ambulance calls, improved QALYs and ability to perform usual activities, and lowered systolic blood pressure among older adults living in subsidized housing. Trial registration: Clinicaltrials.gov, no. NCT02152891. [ABSTRACT FROM AUTHOR]

Thank you to Dr. Minhas for raising the important topic of "self-whitening", whereby racialized individuals seek to remove evidence of nonwhite attributes, activities or connections in an effort to become more acceptable to employers or colleagues.[1] He suggests that his actions were due to his own internalized racism. It has also involved removing traces of South Asian heritage from my curriculum vitae (CV), known as "resumé-whitening" or "white-washing a CV."[2] I have been advised to remove my ability to speak a South Asian language, extracurricular talents in South Asian music and academic credits gained in religious studies that were non-Eurocentric to render myself more attractive to the academic medical job market. 2020;192:E1169-70. 2 Brait E. "Resume whitening" doubles callbacks for minority job candidates, study finds. [Extracted from the article]

Presents a letter to the editor in response to the article "The Impact of New Guidelines for Glucose Tolerance Testing on Clinical Practice and Laboratory Services," by Andrew W. Lyon et al., which appeared in a 2004 issue of the "Canadian Medical Association Journal."

Presents a humorous month-by-month guide that explains what supervising staff need to know about the first year with new medical residents. Problems and issues outlined for the preceptor in the month-by-month guide including cocky residents, depression, separation anxiety, sleep deprivation.

A letter to the editor is presented about the need for obesity register in Canada.