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Introduction: Care by Design™ (CBD) (Canada), a model of coordinated team-based primary care, was implemented in long-term care facilities (LTCFs) in Halifax, Nova Scotia, Canada, to improve access to and continuity of primary care and to reduce high rates of transfers to emergency departments (EDs)., Methods: This was an observational time series before and after the implementation of CBD (Canada). Participants are LTCF residents with 911 Emergency Health Services calls from 10 LTCFs, representing 1424 beds. Data were abstracted from LTCF charts and Emergency Health Services databases. The primary outcome was ambulance transports from LTCFs to EDs. Secondary outcomes included access (primary care physician notes in charts) and continuity (physician numbers and contacts)., Results: After implementation of CBD (Canada), transports from LTCFs to EDs were reduced by 36%, from 68 to 44 per month (P = .01). Relational and informational continuity of care improved with resident charts with ≥10 physician notes, increasing 38% before CBD to 55% after CBD (P = .003), and the median number of chart notes increased from 7 to 10 (P = .0026). Physicians contacted before 911 calls and onsite assessment increased from 38% to 54% (P = .01) and 3.7% to 9.2% (P = .03), respectively, before CBD to after CBD., Conclusion: A 34% reduction in overall transports from LTCFs to EDs is likely attributable to improved onsite primary care, with consistent physician and team engagement and improvements in continuity of care., (© Copyright 2016 by the American Board of Family Medicine.)

Objective: To document the potential for drug interactions in seniors with osteoarthritis and to consider the usefulness of computerized support for detecting clinically important interactions., Design: Self-administered mailed survey. One question requested a list of all medications (prescribed drugs and self-care products, including herbal and "natural" health products) taken in the last 7 days. Interactions among all medications were assessed using an on-line software package., Setting: Three urban primary care practices in Nova Scotia., Participants: Questionnaires were sent to 244 patients aged 65 years and older with physician-confirmed osteoarthritis., Main Outcome Measures: Number of potential interactions and level of clinical significance associated with each., Results: Response rate was 78% (n = 191); 174 respondents (92%) supplied information on medications. Respondents took an average of 4.7 products of which 2.8 were prescription medications and 1.9 were self-care products. A total of 214 potential interactions were identified; 30 (14%) of these were clinically significant. Most interactions involved nonprescription products, most frequently acetylsalicylic acid. Recommendations in 29 of these 30 clinically significant interactions were cautionary, advising such measures as closer monitoring of blood tests, observation for toxic effects, or making patients aware of side effects. Only 1 interaction prompted a recommendation for avoidance. Respondents reported use of 7 different herbal and natural health products; these products were associated with 5 clinically insignificant interactions., Conclusion: Risk of drug interactions in seniors might be high, but few interactions are clinically significant. Only 1 found in our study carried a recommendation for avoidance. The on-line program reported all significant interactions, but the high proportion of insignificant interactions (6 : 1) also reported could lead physicians to override computer-generated alerts.