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Problem Being Addressed: Research is not perceived as an integral part of family practice by most family physicians working in community practices. OBJECTIVE OF THE PROGRAM To assist community-based practitioners in answering research questions that emerge from their practices in order for them to gain a better understanding of research and its value., Program Description: The Ontario College of Family Physicians developed a program consisting of 5 sets of weekend workshops, each 2 months apart. Two pilots of the 5-weekend program occurred between 2000 and 2003. After the pilots, thirteen 5-weekend programs were held in 2 waves by 20 facilitators, who were trained in one of two 1-day seminars., Conclusion: This 5-weekend program, developed and tested in Ontario, stimulates community practitioners to learn how to answer research questions emerging from their practices. A 1-day seminar is adequate to train facilitators to successfully run these programs. Evaluations by both facilitators and program participants were very positive, with many participants stating that their clinical practices were improved as a result of the program. The program has been adapted for residency training, and it has already been used internationally.

Background: There continues be a problem with the proportion of treated hypertension patients who are actually at recommended blood pressure targets., Objective: Is an intensive protocol-based strategy for achieving blood pressure control effective in family practice and will family physicians and their hypertensive patients adhere to such a protocol., Methods: Design of the study is a cluster randomized controlled trial at the Centre for Studies in Primary Care, Queen's University, Kingston, Ontario. Participants were 19 family physicians and 156 (98 intervention group and 58 control group) of their patients in and around the Kingston area. Patients were eligible if they had a diagnosis of hypertension and had not yet achieved their target blood pressure. Patients in the intervention group were managed according to a protocol that involved seeing their family doctor every 2 weeks over a 16-week period and having their antihypertensive medication regimen adjusted at each visit if target was not achieved. This was compared to usual care. Main outcomes were primary effectiveness outcome measured at 12 months was the differences in blood pressure between baseline and 12 months in the two groups. Secondary effectiveness outcomes included rates of achieving BP target and compliance with protocol by physicians and patients. Adherence outcomes were assessed by determining the number of visits made during the 16-week intervention period and the increase in the number of drugs being used., Results: Of the patients enrolled, 72 (74%) from the intervention group and 41 (71%) in the control group were available for analysis. Improvement between baseline and 12-month follow-up was significantly better for the intervention group than the control for diastolic mean daytime BP on 24 hours ambulatory blood pressure monitoring (4.5 mmHg reduction versus 0.5 mmHg reduction) and for both systolic (14.7 mmHg reduction versus 2.7 mmHg reduction) and diastolic (7.4 mmHg reduction versus 0.6 mmHg increase) blood pressure on BpTRU. Of the 98 patients in the intervention, 80% attended four or more of the eight visits and 25% attended all eight visits; physicians increased the number or dosage of drugs the patient was taking in 52% of the visits. Conclusions. An intensive, protocol-based, management approach to achieving blood pressure control in hypertensive patients in family practice is effective and works even when there is flexibility built into the algorithm to allow family physicians to use their judgement in individual patients.

Objective: To examine the practice patterns and clinical and academic roles of family physicians who have care of the elderly training., Design: Cross-sectional survey., Setting: Family medicine practices or specialized geriatric services programs., Participants: Fifty-two family physicians, surveyed in 2005 and 2006, identified as having 6 or 12 months' care of the elderly training., Main Outcome Measures: Self-reported practice type and description of clinical and academic roles., Results: Surveys were sent to 103 physicians; the response rate was 50.5% (N = 52). Respondents were relatively young, with a mean age of 42 years. Slightly more respondents had completed 6 months of training than had completed a full year of training (54.9% vs 45.1%). More than half (55.8%) described their medical practice areas as "general family medicine." The remainder worked in "restricted practices" (25.0%) or provided "specialist care" (17.3%); 1 physician was no longer practising medicine. Many provided some care within specialized geriatric service areas, most commonly in-hospital consultation and rehabilitation. More than half (51.9%) provided active hospital care, and a substantial number worked in long-term care facilities as physicians or medical directors. More than 20% provided newborn care, although only a small percentage (7.7%) performed obstetric services. Respondents were actively involved in teaching and other academic activities, including resident supervision., Conclusion: Care of the elderly physicians provide comprehensive family medicine services, but also often provide care in other areas currently facing physician shortages. Care of the elderly physicians play relevant clinical and academic roles in both family medicine training and specialized geriatric services.

Background: A discordance exists between the proportion of Canadian family physicians that we expect should be able to perform minor office procedures and the actual provision of care. This pattern has not been extensively studied. The objective of this study was to determine the current patterns and obstacles relating to the provision of four minor office procedures by GP/FPs in a small city in Ontario, Canada. An additional goal was to determine the impact of the remuneration method on the provision of such services., Methods: A survey was mailed to all GP/FPs practising in Kingston, Ontario. The main outcomes measured in the study were work setting and remuneration method, current procedural practices with respect to four procedures, reasons for not performing procedures, current skill levels, and desire to upgrade., Results: Surveys were mailed to all 108 GP/FPs in the City of Kingston. Completed surveys were collected for 82 percent (89/108) and 10 were excluded leaving 79 eligible participants. The percentages of GP/FPs who reported performing the procedure were as follows: dermatological excision (63.3%), endometrial biopsy (35.4%), shoulder injection (31.6%), and knee injection (43.0%). The majority of GP/FPs who would not do the procedure themselves would refer to a specialist colleague rather than to another GP/FP. The top reason cited for not performing a specific procedure was "lack of up to date skills" followed by "lack of time". The latter was the only statistically significant difference reported between GP/FPs working in Family Health Networks and GP/FPs working in fee for service settings (26.7% vs 47.0%, chi2 = 4.191 p = 0.041)., Conclusion: A large number of Kingston, Ontario GP/FPs refer patients who require one of four minor office-based procedures for specialist consultation. Referral to other GP/FP colleagues appears underutilized. A perceived lack of up to date skills and a lack of time appear to be concerns. GP/FPs working in Family Health Networks were more likely to perform these procedures themselves. Further studies would clarify the role of changes in medical education, the role of continuing education, and the impact of different remuneration models.

Objective: To elicit the opinions of family physician anesthetists (FPAs) and hospital Chief Executive Officers (CEOs) regarding the structure of their organizations and the importance of family medicine anesthesia., Design: Mailed survey., Setting: Ontario hospitals., Participants: The CEOs of Ontario hospitals and family physicians who provide anesthetic services in Ontario hospitals., Main Outcome Measures: Demographics, practices, and opinions of FPAs and CEOs regarding family medicine anesthesia., Results: Responses were received from 159 of 195 practising FPAs (82%). Of the 128 hospitals in Ontario that offered anesthesia services, 59% used at least one FPA; in 39% of these hospitals, all services were provided by FPAs. Both FPAs and CEOs thought that FPAs were competent to meet the anesthesia needs of small community hospitals. Most FPAs and CEOs supported certification and maintenance of competence programs coordinated by a national body, such as the College of Family Physicians of Canada. Both FPAs and CEOs thought there should be support for additional training programs in family medicine anesthesia., Conclusion: Small community hospitals rely completely on FPAs to provide essential anesthesia services. Additional training programs and a national structure to coordinate certification and maintenance of competence programs are important to maintain and enhance this essential service.

Objective: To compare e-mail with regular mail for conducting surveys of physicians., Design: Randomized controlled trial., Setting: Ontario, Canada., Participants: A random sample of physicians listed in the College of Family Physicians of Canada's membership database., Interventions: Survey delivered by e-mail and by post., Main Outcome Measures: Response rates and times, and completeness and characteristics of responses to the survey., Results: Overall response rate was 44.7% (33.6% of e-mail recipients, 52.7% of post recipients who have e-mail, and 47.8% of post recipients without e-mail). While the e-mail rate was significantly lower than for both post groups, e-mail responses were received much faster. There was no significant difference among groups as to completeness of responses, but e-mail responses had more frequent and longer comments., Conclusion: E-mail provides faster but fewer responses to surveys. Content of structured-response questions was similar in all groups, but e-mail provided more and longer responses to open-ended questions. Where a quick response to a survey is required, e-mail is superior.

Background: The number of family physicians practising obstetrics in Canada is declining. On the assumption that factors related to the obstetrics training of family medicine residents may be influencing this trend, we conducted a cohort study of residents' stated intentions with regard to practising obstetrics, their educational experiences and their subsequent obstetric practice., Methods: We followed a cohort consisting of all residents who enrolled in family medicine residency programs in Ontario in 1994 and 1995. The data, collected by mail-in survey at entry to, during and 2 years after completion of the 2-year training programs, consisted of residents' characteristics, stated plans during residency to practise obstetrics, obstetric experiences during training, attitudes and opinions related to obstetrics, and actual practice 2 years after completion of residency. We used logistic regression to determine the factors influencing whether a family physician practises obstetrics after graduation., Results: Of the 498 residents who started programs in 1994 and 1995, 480 were eligible for inclusion, although not all of those eligible responded to the various surveys. At entry into the residency programs, 216 (52%; 95% confidence interval [CI] 47-57%) of the 411 respondents expressed an intention to practise obstetrics. By the end of residency, the proportion intending to practise obstetrics had fallen to 17% (95% CI 13-22%; 46 of 274 respondents), and only 16% (95% CI 12% to 20%) were actually practising intrapartum obstetrics (i.e., delivering babies) 2 years later. The proportions of residents in the 7 Ontario family medicine programs who were actually practising obstetrics 2 years later ranged from 2% of those from the University of Western Ontario to 38% of those from Thunder Bay. Three factors were independently associated with practising intrapartum obstetrics 2 years after completing residency: intention at the end of residency to practise intrapartum obstetrics (odds ratio [OR] 11.7, 95% CI 3.1-44.7, p = 0.001), not having the opinion that intrapartum care is too disruptive of personal life (OR 9.1, 95% CI 1.5-55.5, p = 0.02) and practising in a community of 15 000 or fewer people (OR 6.0, 95% CI 1.8-19.4, p = 0.003)., Interpretation: Residents who have positive attitudes toward obstetrics at the end of their training and who intend at that time to perform deliveries are more likely to be doing so 2 years later, especially if they practise in communities of 15,000 or fewer people.

Objective: To determine the effect of the Queen's University alternative funding plan (AFP) on the Department of Family Medicine in terms of patient, staff, and faculty satisfaction; patient encounter logistics; clinical volume; and academic activity., Design: Before-after study., Setting: Department of Family Medicine at Queen's University of Kingston, Ont., Participants: Patients, faculty, and staff of the Department of Family Medicine's Family Medicine Centre., Interventions: The AFP of Queen's University., Main Outcome Measures: Patient satisfaction, staff and faculty job satisfaction, patient waiting time, time spent with patients, patient volume, number of publications, and amount of research funding obtained by faculty members. These outcomes were measured before the AFP began (time 0), 1 year post-AFP (time 1), and 2.5 years post-AFP (time 2)., Results: In some categories patients' satisfaction decreased at time 1, but in all cases it was either unchanged or improved at time 2. Staff and faculty job satisfaction did not change over time. Patients spent less time in the waiting room at time 2 than at time 0. Patient volume dropped about 10% between time 0 and time 2. Publication rate did not change, but external research funding increased significantly during the study period., Conclusion: The AFP has improved academic productivity, decreased patient volume by 10%, and improved patient flow during clinics. No negative effects on patient satisfaction or on job satisfaction of staff or faculty are apparent.