Search

BackgroundTobacco use, physical inactivity, and poor diet are associated with morbidity and premature death. Health promotion and primary prevention counseling, advice, and support by a primary care provider lead to behavior change attempts among patients. However, although physicians consider preventative health important, there is often a larger focus on symptom presentation, acute care, and medication review. ObjectiveThis study evaluated the feasibility, adoption, and integration of the tablet-based Risk Factor Identification Tool (RFIT) that uses algorithmic information technology to support obtainment of patient risk factor information in primary care clinics. MethodsThis is a pragmatic developmental evaluation. Each clinic developed a site-specific implementation plan adapted to their workflow. The RFIT was implemented in 2 primary care clinics located in Manitoba. Perceptions of 10 clinic staff and 8 primary care clinicians informed this evaluation. ResultsClinicians reported a smooth and fast transfer of RFIT responses to an electronic medical record encounter note. The RFIT was used by 207 patients, with a completion rate of 86%. Clinic staff reported that approximately 3%-5% of patients declined the use of the RFIT or required assistance to use the tablet. Among the 207 patients that used the RFIT, 22 (12.1%) smoked, 39 (21.2%) felt their diet could be improved, 20 (12.0%) reported high alcohol consumption, 103 (56.9%) reported less than 150 minutes of physical activity a week, and 6 (8.2%) patients lived in poverty. Clinicians suggested that although a wide variety of patients were able to use the tablet-based RFIT, implemented surveys should be tailored to patient subgroups. ConclusionsClinicians and clinic staff positively reviewed the use of information technology in primary care. Algorithmic information technology can collect, organize, and synthesize individual health information to inform and tailor primary care counseling to the patients’ context and readiness to change. The RFIT is a user-friendly tool that provides an effective method for obtaining risk factor information from patients. It is particularly useful for subsets of patients lacking continuity in the care they receive. When implemented within a context that can support practical interventions to address identified risk factors, the RFIT can inform brief interventions within primary care.

BackgroundPhysical activity is a key behavioral component for the primary prevention of noncommunicable disease. The uptake of physical activity is influenced by individual and broader factors including social, economic, and environmental conditions. ObjectiveThe purpose of this paper is to describe a protocol for a scoping review of reviews (SRR) that aims to map a decade of research focused on physical activity interventions within the domain of primary prevention. MethodsThe 5 stages of our SRRs design were adapted from a seminal scoping review methodology. Our search strategy was developed for the following databases: SPORTDiscus, PubMed, Scopus, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Educational Resources Information Centre. Two reviewers (LG and AK) independently screened eligible studies and compared results to determine the final study selection. One reviewer will conduct the data extraction (LG); a second reviewer (AK) will assess the results to ensure comprehensiveness and accuracy of the scoping review synthesis. ResultsThe SRRs will provide a broad overview of the physical activity research literature specific to primary prevention, and will describe key features of physical activity interventions. Potential gaps in the physical activity action areas will be identified, and thus, the results will inform future research directions. ConclusionsThis paper describes an innovative approach for comprehensively mapping an important topic’s research trends in the last decade.

Background Differential access to healthcare has contributed to a higher burden of illness and mortality among First Nations compared to other people in Canada. Throughout the Coronavirus Disease 2019 (COVID-19) pandemic, First Nations organizations in Manitoba partnered with public health and Manitoba government officials to ensure First Nations had early, equitable and culturally safe access to COVID-19 diagnostic testing and vaccination. In this study, we examined whether prioritizing First Nations for vaccination was associated with faster uptake of COVID-19 vaccines among First Nations versus All Other Manitobans (AOM). Methods and findings In this retrospective cohort study, we used linked, whole-population administrative data from the Manitoba healthcare system (February 2020 to December 2021) to determine rates of COVID-19 diagnostic testing, infection, and vaccination, and used adjusted restricted mean survival time (RMST) models to test whether First Nations received their first and second vaccine doses more quickly than other Manitobans. The cohort comprised 114,816 First Nations (50.6% female) and 1,262,760 AOM (50.1% female). First Nations were younger (72.3% were age 0 to 39 years) compared to AOM (51% were age 0 to 39 years) and were overrepresented in the lowest 2 income quintiles (81.6% versus 35.6% for AOM). The 2 groups had a similar burden of comorbidities (65.8% of First Nations had none and 6.3% had 3 or more; 65.9% of AOM had none and 6.0% had 3 or more) and existing mental disorders (36.9% of First Nations were diagnosed with a mood/anxiety disorder, psychosis, personality disorder, or substance use disorder versus 35.2% of AOM). First Nations had crude infection rates of up to 17.20 (95% CI 17.15 to 17.24) COVID-19 infections/1,000 person-months compared with up to 6.24 (95% CI 6.16 to 6.32) infections/1,000 person-months among AOM. First Nations had crude diagnostic testing rates of up to 103.19 (95% CI 103.06 to 103.32) diagnostic COVID-19 tests/1,000 person-months compared with up to 61.52 (95% CI 61.47 to 61.57) tests/1,000 person-months among AOM. Prioritizing First Nations to receive vaccines was associated with faster vaccine uptake among First Nations versus other Manitobans. After adjusting for age, sex, income, region of residence, mental health conditions, and comorbidities, we found that First Nations residents received their first vaccine dose an average of 15.5 (95% CI 14.9 to 16.0) days sooner and their second dose 13.9 (95% CI 13.3 to 14.5) days sooner than other Manitobans in the same age group. The study was limited by the discontinuation of population-based COVID-19 testing and data collection in December 2021. As well, it would have been valuable to have contextual data on potential barriers to COVID-19 testing or vaccination, including, for example, information on social and structural barriers faced by Indigenous and other racialized people, or the distrust Indigenous people may have in governments due to historical harms. Conclusion In this study, we observed that the partnered COVID-19 response between First Nations and the Manitoba government, which oversaw creation and enactment of policies prioritizing First Nations for vaccines, was associated with vaccine acceptance and quick uptake among First Nations. This approach may serve as a useful framework for future public health efforts in Manitoba and other jurisdictions across Canada., Author(s): Nathan C. Nickel 1,*, Wanda Phillips-Beck 2,*, Jennifer E. Enns 1, Okechukwu Ekuma 1, Carole Taylor 1, Sarah Fileatreault 1, Nkiru Eze 1, Leona Star 2, Josée Lavoie 3, [...]

We describe changes in the comprehensiveness of services delivered by family physicians in 4 Canadian provinces (British Columbia, Manitoba, Ontario, Nova Scotia) during the periods 1999-2000 and 2017-2018 and explore if changes differ by years in practice. We measured comprehensiveness using province-wide billing data across 7 settings (home, long-term care, emergency department, hospital, obstetrics, surgical assistance, anesthesiology) and 7 service areas (pre/postnatal care, Papanicolaou [Pap] testing, mental health, substance use, cancer care, minor surgery, palliative home visits). Comprehensiveness declined in all provinces, with greater changes in number of service settings than service areas. Decreases were no greater among new-to-practice physicians. Key words: comprehensive health care; scope of practice; primary care; family medicine; cohort effect; Canada https://doi.org/10.1370/afm.2945, INTRODUCTION Declining comprehensiveness of family physician practice has been documented across multiple jurisdictions, (1-8) with accompanying speculation that this is driven by lack of interest or inadequate training among more [...]

Background Posttraumatic stress disorder (PTSD) has significant morbidity and economic costs. This study describes the prevalence and characteristics of patients with PTSD using primary care electronic medical record (EMR) data. Methods This retrospective cross-sectional study used EMR data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). This study included 1,574 primary care providers located in 7 Canadian provinces. There were 689,301 patients that visited a CPCSSN provider between 1 January 2017 and 31 December 2019. We describe associations between PTSD and patient characteristics using descriptive statistics, chi-square, and multiple logistic regression models. Results Among the 689,301 patients included, 8,817 (1.3%, 95% CI 1.2–1.3) had a diagnosis of PTSD. On multiple logistic regression analysis, patients with depression (OR 4.4, 95% CI 4.2–4.7, P < 0.001), alcohol abuse/dependence (OR 1.7, 95% CI 1.6–1.9, P < 0.001), and/or drug abuse/dependence (OR 2.6, 95% CI 2.5–2.8, P < 0.001) had significantly higher odds of PTSD compared with patients without those conditions. Patients residing in community areas considered the most material deprived (OR 2.1, 95% CI 1.5–2.1, P < 0.001) or the most socially deprived (OR 2.8, 95% CI 2.7–5.3, P < 0.001) had higher odds of being diagnosed with PTSD compared with patients in the least deprived areas. Conclusions The prevalence of PTSD in Canadian primary care is 1.3% (95% CI 1.25–1.31). Using EMR records we confirmed the co-occurrence of PTSD with other mental health conditions within primary care settings suggesting benefit for improved screening and evidence-based resources to manage PTSD. [ABSTRACT FROM AUTHOR]

Context: There are significant concerns about vaccine hesitancy and the equitable distribution of the COVID-19 vaccines. The inclusion of first-contact primary care providers in the vaccine distribution is one approach that can increase vaccine confidence and adoption. Objective: The aim of this study was to examine the experience of nine global jurisdictions that engaged primary care providers to administer COVID-19 vaccines during the pandemic. Study Design and Analysis: A rapid review methodology was adopted. Searches and analyses took place from May 2021 to July 2021. Inclusion criteria were: previously identified jurisdictions focused on COVID-19, referred to the role of primary care, published from January 2020 to July 2021 and in English. Data were extracted based upon study characteristics (e.g., study design) and research questions (e.g., role of primary care, vaccine strategy change over time). Dataset: MEDLINE, CINAHL, the Cochrane Library, SCOPUS and PsychINFO, Google, and the websites of national health departments. Population Studied: Australia, Hong Kong, Germany, France, Israel, Singapore, Spain, United States, and the United Kingdom. Intervention/Instrument: COVID-19 vaccine distribution strategy. Outcome Measures: Primary care involvement. Results: Sixty-two documents met the inclusion criteria. This review found that the vaccine distribution approach started at hospitals in almost all jurisdictions. In some jurisdictions, primary care providers were engaged at the beginning, and the majority included primary care providers over time. Vaccine hesitancy was not explicitly considered in the selection of vaccine distribution approaches. Support to primary care providers was provided through education and training, financial incentives, and organizational support. The barriers to the rollout of the vaccines included individual, organizational and system-level factors. Empirical evidence is lacking on the impact of a primary care-led vaccine distribution approach on vaccine hesitancy, adoption, and equity. Conclusions: Globally, the primary care workforce had an essential role in administering vaccines during the COVID-19 pandemic. Future vaccine distribution approaches need to be informed by evaluating vaccine distribution approaches and their impact on patient and population outcomes., Presenters Monica Aggarwal, PhD, Kristina Kokorelias, Richard Glazier, MD, MPH, Jessica Shiers, BSc, MLIS, Alan Katz, CCFP, MBChB, MSc, [...]

PURPOSE To measure the effectiveness of a 4-month interdisciplinary multifaceted intervention based on a change in care delivery for patients with multimorbidity in primary care practices. METHODS A pragmatic randomized controlled trial with a mixed-methods design in patients aged 18 to 80 years with 3 or more chronic conditions from 7 family medicine groups (FMGs) in Quebec, Canada. Health care professionals (nurses, nutritionists, kinesiologists) from the FMGs were trained to deliver the patient-centered intervention based on a motivational approach and self-management support. Primary outcomes: self-management (Health Education Impact Questionnaire); and self-efficacy. Secondary outcomes: health status, quality of life, and health behaviors. Quantitative analyses used multi-level mixed effects and generalized linear mixed models controlling for clustering within FMGs. We also conducted in-depth interviews with patients, family members, and health care professionals. RESULTS The trial randomized 284 patients (144 in intervention group, 140 in control group). The groups were comparable. After 4 months, the intervention showed a neutral effect for the primary outcomes. There was significant improvement in 2 health behaviors (healthy eating with odds ratios [OR] 4.36; P = .006, and physical activity with OR 3.43; P = .023). The descriptive qualitative evaluation revealed that the patients reinforced their self-efficacy and improved their self-management which was divergent from the quantitative results. CONCLUSIONS Quantitatively, this intervention showed a neutral effect on the primary outcomes and substantial improvement in 2 health behaviors as secondary outcomes. Qualitatively, the intervention was evaluated as positive. The combination of qualitative and quantitative designs proved to be a good design for evaluating this complex intervention. Key words: interdisciplinary research; multimorbidity; patient care team; pragmatic clinical trial, INTRODUCTION Much effort has been deployed internationally to improve care and outcomes for persons with multimorbidity in primary care. The Patient-Centered Innovations for Persons with Multimorbidity research program, funded by [...]

Background: Through medicare, residents in Canada are entitled to medically necessary physician services without paying out of pocket, but still many people struggle to access primary care. We conducted a survey to explore people's experience with and priorities for primary care. Methods: We conducted an online, bilingual survey of adults in Canada in fall 2022. We distributed an anonymous link through diverse channels and a closed link to 122 053 people via a national public opinion firm. We weighted completed responses to mirror Canada's population and adjusted for sociodemographic characteristics using regression models. Results: We analyzed 9279 completed surveys (5.9% response rate via closed link). More than one-fifth of respondents (21.8%) reported having no primary care clinician, and among those who did, 34.5% reported getting a same or next-day appointment for urgent issues. Of respondents, 89.4% expressed comfort seeing another team member if their doctor recommended it, but only 35.9%, 9.5%, and 12.4% reported that their practice had a nurse, social worker, or pharmacist, respectively. The primary care attribute that mattered most was having a clinician who "knows me as a person and considers all the factors that affect my health." After we adjusted for respondent characteristics, people in Quebec, the Atlantic region, and British Columbia had lower odds of reporting a primary care clinician than people in Ontario (adjusted odds ratio 0.30, 0.33, and 0.39, respectively; p < 0.001). We also observed large provincial variations in timely access, interprofessional care, and walk-in clinic use. Interpretation: More than 1 in 5 respondents did not have access to primary care, with large variation by province. Reforms should strive to expand access to relationship-based, longitudinal care in a team setting. [ABSTRACT FROM AUTHOR]

The rapid deployment of virtual primary care visits served as a first-line response to COVID-19 and can now be examined for insights, particularly as virtual care is playing an ongoing role in patient care and consultations. Input from primary care providers directly responsible for virtual care delivery is needed to inform policies and strategies for quality care and interactions. The overarching goal of this research study was to examine the use of virtual care as a mechanism for primary healthcare delivery. A phenomenological approach investigated the shift in primary care service delivery as experienced by primary care providers and initiated during the COVID-19 pandemic. Focus groups were conducted with primary care providers (n = 21) recruited through email, advertisements, and professional organizations, exploring how virtual care was delivered, the benefits and challenges, workflow considerations, and recommendations for future use. Integrating virtual care was performed with a great deal of autonomy as well as responsibility, and overwhelmingly depended on the telephone. Technology, communication, and workflow flexibility are three key operational aspects of virtual care and its delivery. Providers highlighted cross-cutting themes related to the dynamics of virtual care including balancing risk for quality care, physician work/life balance, efficiency, and patient benefits. Primary care providers felt that virtual care options allowed increased flexibility to attend to the needs of patients and manage their practice workload, and a few scenarios were shared for when virtual care might be best suited. However, they also recognized the need to balance in-person and virtual visits, which may require guidelines that support navigating various levels of care. Overall, virtual care was considered a good addition to the whole 'care package' but continued development and refinement is an expectation for optimizing and sustaining future use. [ABSTRACT FROM AUTHOR]

Knowledge translation is a central focus of the health research community, which includes strategies to synthesize published research to support uptake within health care practice and policy arenas. Within the literature concerning review methodologies, a new discussion has emerged concerning methods that review and synthesize published review articles. In this paper, our multidisciplinary team from family medicine, nursing, dental hygiene, kinesiology, occupational therapy, physiology, population health, clinical psychology, and library sciences contributes to this discussion by sharing our experiences in conducting 3 scoping reviews of published review studies. A brief discussion of Cochrane Collaboration overview reviews and Joanna Briggs Institute umbrella reviews foreshadows a discussion of insights from our experiences of conducting the 3 scoping reviews of published reviews. We address 6 adaptations along with our recommendations for each, which may guide other researchers with designing scoping review approaches to synthesize published reviews. The ability of researchers to publish research findings is growing, and our ability to effectively transfer findings into useful evidence for health care practice and policy is imperative to our work.