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Team-based care is recognized as a foundational building block of high-performing primary care. The purpose of this study was to identify primary care practice characteristics associated with team functioning and examine whether there is relationship between team composition or size and team functioning. We sought to answer the following research questions: (1) are primary care practice characteristics associated with team functioning; and (2) does team composition or size influence team functioning. This cross-sectional correlational study was conducted in Fraser East, British Columbia, Eastern Ontario Health Unit, Ontario and Central Zone, Nova Scotia in Canada. Data were collected from primary care practices using an organization survey and the Team Climate Inventory (TCI) as a measure team functioning. The independent variables of interest were: physicians' payment model, internal clinic meetings to discuss clinical issues, care coordination through informal and ad hoc exchange, care coordination through electronic medical records and sharing clinic mission, values and objectives among health professionals. Potentially confounding variables were as follows: team size, composition, and practice panel size. A total of 63 practices were included in these analyses. The overall mean score of team climate was 73 (SD: 10.75) out of 100. Regression analyses showed that care coordination through human interaction and sharing the practice's mission, values, and objectives among health professionals were positively associated with higher functioning teams. Care coordination through electronic medical records and larger team size were negatively associated with team climate. This study provides baseline data on what practice characteristics are associated with highly functioning teams in Canada. [ABSTRACT FROM AUTHOR]

Background: Perturbation-based balance training (PBT) is a relatively new type of balance training that aims to improve control of reactions to a loss of balance. This study aimed to determine the prevalence of use of PBT in clinical practice, and the most significant barriers and facilitators to implementing PBT in practice. Methods: Health-care professionals across Canada (primarily physiotherapists and kinesiologists) who provide balance training to individuals with balance impairments and/or increased fall risk completed a questionnaire that asked about knowledge and use of PBT in practice. Results: Overall, 76.3% of participants (299/392) reported that they had used PBT in their practices, with 22.4% (88/392) reporting regular PBT use. Lack of knowledge of PBT appeared to be the most significant barrier for those not currently using PBT in their practices, whereas individuals who were familiar with PBT and open to using it in practice experienced barriers related to training, knowledge, human resources, client characteristics, and the practice setting. More than 90% of respondents were interested in learning more about almost all aspects of PBT. Conclusions: These findings could be used to inform development of future educational strategies to increase uptake of PBT in rehabilitation practice. [ABSTRACT FROM AUTHOR]

Objective: Gait dysfunction is common following acquired brain injury (ABI). Clinical practice guidelines can improve patient outcomes; however, information regarding ABI-specific management of gait dysfunction is limited. This study aimed to describe practice patterns of Canadian physiotherapists regarding gait rehabilitation in adults post-ABI. Methods: An electronic questionnaire was developed and distributed across Canada to describe physiotherapy assessment methods, outcome measures, and treatment interventions used to manage gait dysfunction in adults with mild-moderate and severe ABI. Results: Of 103 respondents who accessed the questionnaire, 59 met inclusion criteria and participated in the study. Methods most frequently used "often or very often" at initial and discharge assessments included visual observation (≥88.2% for adults with mild-moderate and severe ABI) and the Berg Balance Scale (≥76.3% for adults with mild-moderate ABI). Higher level gait training exercises were used more often for adults with mild-moderate than severe ABI. Physiotherapists commonly reported further research was required to develop and validate gait-specific outcome measures (42.4%) and treatment techniques (76.3%). Conclusions: Physiotherapists' use of gait-specific treatment interventions, but not assessment methods, differs depending on ABI severity. Future work should investigate factors influencing these practice patterns. In addition, clinician-identified research priorities include ABI gait-specific outcome measures and technology-based interventions. [ABSTRACT FROM AUTHOR]

Background: Methadone maintenance treatment is an effective way to reduce harms associated with opioid use disorder and, in several countries, is delivered in community-based primary care settings. Expanding methadone into primary care depends, in part, on physicians' willingness and readiness to integrate it into their practices. Objectives: This qualitative study explores factors that primary care physicians consider important when contemplating prescribing methadone to treat opioid use disorder. Methods: In-depth interviews were conducted during 2015 with 20 primary care physicians in various sized communities throughout Nova Scotia, Canada. Participants shared their views and experiences related to prescribing methadone to treat opioid use disorder. Data were analyzed inductively using thematic analysis to identify predominant themes. Results: Participants discussed an interplay of factors as they contemplated prescribing methadone to treat opioid use disorder in primary care. Physician-related factors included access to methadone expertise, support from allied professionals, suitability of skills, and personal experiences. Patient-related factors involved perceptions about methadone users as a difficult patient group with highly complex needs. Practice-related factors encompassed concerns about threats to physicians' careers, surveillance duties, unfair remuneration, safety risks, and practice disruptions. Contextual factors included knowledge deficits about substance use disorders, the generalist nature of primary care, methadone's socio-political context, and opioid prescribing patterns in primary care. Conclusions: Understanding the perspectives of physicians is vital to expanding methadone into primary care. This study identifies factors that should be addressed to attract, support, and retain primary care physicians in prescribing methadone to treat opioid use disorder. [ABSTRACT FROM AUTHOR]

Objective:There has been much attention on appropriate prescribing in older adults in recent years. Recent guidelines favor the use of newer antidepressants over older agents based on their safety profile in this population. This study aimed to examine whether there has been a decline in older antidepressants and an increase in newer antidepressants used by older adults. Method:A retrospective cross-sectional study using administrative databases examined the annual incidence of antidepressant use (per 1000) of community-dwelling adults ≥60 years old between 1997/1998 and 2012/2013 in Manitoba, Canada. Results:The population of Manitoba ≥60 years increased by 25.6% from 188,296 to 236,569 from 1997/1998 to 2012/2013. New antidepressant use peaked to 45.9 per 1000 in 1999/2000, and then decreased steadily to 30.5 per 1000 in 2012/2013 (p< 0.0001). Incident amitriptyline use was high but declined from 15.5 to 7.4 per 1000 (p< 0.001). An increase in incident trazodone, mirtazapine, and venlafaxine use was observed (p< 0.001). Conclusions:There has been an overall decrease in the annual incidence of antidepressant users in older adults over the last 16 years, with a marked decline in new amitriptyline use and an increase in the incidence of newer agents. [ABSTRACT FROM AUTHOR]

Purpose: To describe current practices for manual wheelchair (MWC) skills training in Canadian rehabilitation centers. Methods: An online survey was sent to practice leaders in occupational (OT) and physical therapy (PT) at 87 Canadian rehabilitation centers. Responses were solicited from individuals who could report about wheelchair skills training at facilities with at least 10 beds designated for rehabilitation. Thirty-four questions asked about: (1) demographics, (2) components of MWC training, (3) amount of MWC skills training, (4) use of validated programs and (5) perceived barriers to using validated programs. Data were analyzed using summary statistics. Results: About 68/87 responses were received primarily from OTs (42/68). Basic MWC skills training (e.g. wheel-locks) was consistently part of clinical practice (45/68), while advanced skills training (e.g. curb-cuts) was rare (8/68). On an average, 1-4 h of training was done (29/68). Validated training programs were used by 16/68, most of whom used them ' rarely' (7/16). Common barriers to using validated programs were lack of time (43/68) and resources (39/68). Conclusions: Learning to use a wheelchair is important for those with ambulation impairments because the wheelchair enables mobility and social participation. Providing opportunities for advanced wheelchair skills training may enhance mobility and social participation in a safe manner. [ABSTRACT FROM AUTHOR]

Background: While client-centred practice has received wide support, it remains difficult to apply in many practice settings. Identified barriers include constraints on time, resources, and services imposed by healthcare policies. Healthcare professionals' prioritizing of client safety over (other) interests that clients may name may further restrict the application of client-centred practice. Discharge planning is one area where such considerations can conflict. Aim: This paper presents a secondary analysis of data examining the process of discharge in one Canadian rehabilitation setting. It examines how discourses of client-centred practice and of prioritizing safety were reflected in discharge planning with older adults and considers the implications of potential conflicts between these discourses. Method: Taking a critical bioethics perspective informed by relational autonomy theory, microethnographic case studies were used to examine discharge planning from the perspectives of older adult clients and healthcare professionals. Results: Healthcare professionals interpreted client-centred practice to require abiding by client wishes, as long as this was safe; furthermore prioritizing safety took precedence over other considerations in discharge planning. Conclusion and significance: Client-centred practice was not promoted in discharge planning processes in the research setting. Applying a relational autonomy lens to practice could promote approaches that better facilitate client-centred practice. [ABSTRACT FROM AUTHOR]

Objective: To assess the use of concussion/mild traumatic brain injury (mTBI) guidelines, criteria used in the initiation of return-to-play (RTP) and management of RTP for brain injured children and youth by Canadian paediatricians. Methods: A cross-sectional survey was mailed through the Canadian Paediatric Surveillance Program to ∼2600 paediatric specialists and sub-specialists. Results: Of 809 respondents (31%), 503 encountered newly diagnosed paediatric concussion/mTBI within the past 12 months, reporting ∼6900 cases. Of the respondents, 96.7% (95% CI = 94.7-98.6%) reported using one or more of the presented concussion/mTBI guidelines in the management of their patients. The most frequently reported criteria (>50%) used to determine asymptomatic status were: free from all concussion symptoms, by patient report (92%), by proxy report (76%), normal physical examination (65%), in school full-time, with usual school performance (53%). Most respondents (84.9%) did not initiate RTP immediately after their patients became asymptomatic. The median time waiting before initiating RTP was 7 days. The median duration of the RTP sequence was 7 days, with considerable variation reported. Conclusions: Canadian paediatricians frequently encounter patients with concussion/mTBI. Their concussion/mTBI care appears to be consistent with current guidelines, but also shows practice variation, particularly when current guidelines become less proscriptive. [ABSTRACT FROM AUTHOR]

This article examines treatment recommendations in orthopedic surgery consultations and shows how surgery is treated as “omni-relevant” within this activity, providing a context within which the broad range of treatment recommendations proposed by surgeons is offered. Using conversation analysis to analyse audiotaped encounters between orthopedic surgeons and patients, we highlight how surgeons treat surgery as having a special, privileged status relative to other treatment options by (1) invoking surgery (whether or not it is actually being recommended) and (2) presenting surgery as the “last best resort” (in relation to which other treatment options are calibrated, described and considered). This privileged status surfaces in the design and delivery of recommendations as a clear asymmetry: Recommendationsforsurgery are proposed early, in relatively simple and unmitigated form. In contrast, recommendationsnot forsurgery tend to be delayed and involve significantly more interactional work in their delivery. Possible implications of these findings, including how surgeons' structuring of recommendations may shape patient expectations (whether for surgery or some alternative), and potentially influence the distribution of orthopedic surgery procedures arising from these consultations, are considered. [ABSTRACT FROM PUBLISHER]