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Objective: To determine the organizational predictors of higher scores on team climate measures as an indicator of the functioning of a family health team (FHT)., Design: Cross-sectional study using a mailed survey., Setting: Family health teams in Ontario., Participants: Twenty-one of 144 consecutively approached FHTs; 628 team members were surveyed., Main Outcome Measures: Scores on the team climate inventory, which assessed organizational culture type (group, developmental, rational, or hierarchical); leadership perceptions; and organizational factors, such as use of electronic medical records (EMRs), team composition, governance of the FHT, location, meetings, and time since FHT initiation. All analyses were adjusted for clustering of respondents within the FHT using a mixed random-intercepts model., Results: The response rate was 65.8% (413 of 628); 2 were excluded from analysis, for a total of 411 participants. At the time of survey completion, there was a median of 4 physicians, 11 other health professionals, and 4 management and clerical staff per FHT. The average team climate score was 3.8 out of a possible 5. In multivariable regression analysis, leadership score, group and developmental culture types, and use of more EMR capabilities were associated with higher team climate scores. Other organizational factors, such as number of sites and size of group, were not associated with the team climate score., Conclusion: Culture, leadership, and EMR functionality, rather than organizational composition of the teams (eg, number of professionals on staff, practice size), were the most important factors in predicting climate in primary care teams.

The purpose of this study was to explore nurses' perceptions of and level of satisfaction with the medication administration system in long-term care (LTC). The cross-sectional survey design included both quantitative and open-ended questions. Data were collected from licensed registered nurses (RNs) and registered practical nurses (RPNs) at 9 LTC residences in southwestern Ontario, Canada. Using independent sample t tests, the researchers found that RNs were significantly less satisfied than RPNs with their medication administration system, particularly with respect to safety issues. RNs identified a number of related barriers, including time constraints, poor packaging, insufficient drug information, prescription changes, lack of staff competency, and unwieldy medication carts. Implications for practice and policy are discussed, including recommendations for improving medication administration practices and for addressing the workload demands of LTC nurses.

Objective: To determine the feasibility and usefulness of collecting 9 previously described quality indicators of cardiovascular disease (CVD) prevention in primary care., Design: Retrospective chart audit., Setting: Family health team in Hamilton, Ont, comprising approximately 30 000 patients and 25 physicians over 2 sites., Participants: A random sample of community-dwelling men who were 40 to 80 years of age and women who were 50 to 80 years of age on January 1, 2003, and who had complete physical examinations in 2003., Main Outcome Measures: The frequency with which quality indicators were collected during the complete physical examination, whether the collection of these indicators predicted subsequent collection of the same indicators, and physician or patient behavioural changes to reduce the risk of CVD., Results: Of the 237 patient charts reviewed, 142 were of men and 95 were of women. Collection of most of the quality indicators was high (> 50%). Results were adjusted for age, sex, and family health team site. Measurements to check for obesity were collected more frequently in women, while blood pressure measurements and follow-up when required were completed more frequently in men. The relationship between the collection of an indicator and the subsequent times the same indicator was collected was not significant for any of the variables except excess alcohol consumption, in that collection of the excess alcohol consumption indicator led to a significant increase in subsequent collection of that same indicator (P = .0091). Age significantly predicted the number of times cholesterol and blood pressure were repeatedly checked (P = .0074 and P = .0077, respectively). The collection of these indicators was significantly associated with behavioural changes related to CVD prevention on the part of the patient or physician, with collection of the alcohol consumption indicator being the most likely to encourage subsequent behavioural changes. The only indicator to not reach statistical significance for subsequent changes was the cholesterol indicator (P = .08)., Conclusion: The collection of previously described quality indicators for the primary prevention of CVD in Canada is feasible. Collection of the indicators does not generally predict short-term outcomes; however, collection of most indicators increased the odds of patient or physician behavioural changes for the primary prevention of CVD.

Background: Satisfaction with access to primary care is one component of overall patient satisfaction. The objectives of this paper were to describe patient satisfaction with access in interprofessional family practices and to examine predictors of being less than satisfied with access., Methods: A survey was mailed to 770 randomly selected patients in two academic interprofessional family practices in Hamilton, Canada. Most items were positively worded statements on a five-point scale from strongly agree to strongly disagree. Outcomes were the proportion of respondents agreeing with statements regarding access. For items where > or =25% of respondents did not agree, we examined socio-demographic predictors of disagreement using multiple variable logistic regression., Results: The response rate was 49.9% (384/770). One-quarter or more of respondents did not agree that they received an explanation if the appointment was delayed at the office, obtain urgent appointments, obtain prescription refills without a visit or that wait times at the office were reasonable. Predictors of not agreeing included younger age, being married or single, more educated, employed and of non-white ethnicity. Less than 10 minutes was the most satisfactory wait time for the appointment to begin; however, the most common wait time reported was 11-20 minutes. One-quarter of respondents had visited the weekend/holiday clinic in the past 12 months; however, use was not associated with perceived ability to obtain an appointment in 1-2 days., Conclusions: While satisfaction was generally high, some aspects of access could be improved by changes in practice organization or patient education regarding expectations.

Background: Stigma refers to a distinguishing personal trait that is perceived as or actually is physically, socially, or psychologically disadvantageous. Little is known about the opinion of those who have more or less stigmatizing health conditions regarding the need for consent for use of their personal information for health research., Methods: We surveyed the opinions of people 18 years and older with seven health conditions. Participants were drawn from: physicians' offices and clinics in southern Ontario; and from a cross-Canada marketing panel of individuals with the target health conditions. For each of five research scenarios presented, respondents chose one of five consent choices: (1) no need for me to know; (2) notice with opt-out; (3) broad opt-in; (4) project-specific permission; and (5) this information should not be used. Consent choices were regressed onto: demographics; health condition; and attitude measures of privacy, disclosure concern, and the benefits of health research. We conducted focus groups to discuss possible reasons for observed consent choices., Results: We observed substantial variation in the control that people wish to have over use of their personal information for research. However, consent choice profiles were similar across health conditions, possibly due to sampling bias. Research involving profit or requiring linkage of health information with income, education, or occupation were associated with more restrictive consent choices. People were more willing to link their health information with biological samples than with information about their income, occupation, or education., Conclusions: The heterogeneity in consent choices suggests individuals should be offered some choice in use of their information for different types of health research, even if limited to selectively opting-out. Some of the implementation challenges could be designed into the interoperable electronic health record. However, many questions remain, including how best to capture the opinions of those who are more privacy sensitive.

Objectives: To conduct a systematic review and meta-analysis of the accuracy of self-reported Pap smear and mammography screening compared to medical record., Methods: About 37 articles were reviewed and accuracy indices of self-report were calculated. Meta-analysis with random effects was used. Study heterogeneity was investigated and meta-regressions were done including in the models those factors that were hypothesized, a priori, to potentially explain heterogeneity., Results: Pooled sensitivity and specificity for Pap recall were 94.7% (95% confidence interval [CI]; 93.0%-96.4%) and 47.4% (95% CI; 39.0%-55.7%), and for mammography were 94.9% (95% CI; 93.4%-96.4%) and 61.8% (95% CI; 54.1%-69.5%), respectively. There was significant heterogeneity for all indices. Stratifying by the study population source (population versus clinic-based), population characteristics (minority or low socio-economic status versus not), length of recall (within past 12 months versus longer), and expected completeness of the medical record (authors searched radiology or pathology reports of all likely facilities women may have attended, versus studies that did not) did not eliminate heterogeneity., Conclusions: Women tend to over-report their participation in Pap and mammography screening in a given timeframe. The pooled estimates should be interpreted with caution due to unexplained heterogeneity.

Background: Central to establishing continuity of care is the development of a relationship between doctor and patient/caregiver. Transfer of information between these parties facilitates the development of continuity in general; and specifically informational continuity of care. We conducted a systematic review of published literature to gain a better understanding of the roles that different parties - specifically doctors, patients, family caregivers, and technology - play in establishing and maintaining informational continuity of care within family practice., Methods: Relevant published articles were sought from five databases. Accepted articles were reviewed and appraised in a consistent way. Fifty-six articles were retained following title and abstract reviews. Of these, 28 were accepted for this review., Results: No articles focused explicitly on the roles involved in establishing or maintaining informational continuity of care within family practice. Most informational continuity of care literature focused on the transfer of information between settings and not at the first point of contact. Numerous roles were, however, were interpreted using the data extracted from reviewed articles. Doctors are responsible for record keeping, knowing patients' histories, recalling accumulated knowledge, and maintaining confidentiality. Patients are responsible for disclosing personal and health details, transferring information to other practitioners (including new family doctors), and establishing trust. Both are responsible for developing a relationship of trust. Technology is an important tool of informational continuity of care through holding important information, providing search functions, and providing a space for recorded information. There is a significant gap in our knowledge about the roles that family caregivers play., Conclusion: The number of roles identified and the interrelationships between them indicates that establishing and maintaining informational continuity of care within family practice is a complex and multifaceted process. This synthesis of roles provided serves as an important resource for continuity of care researchers in general, for the development of continuity of care quality indicators, and for the practice of family medicine.

Background: The availability of patient information to practitioners forms the basis of informational continuity of care. Changes in family practice that now encourage multiphysician clinics have meant that informational continuity of care has become crucial because it is likely that a patient will not continuously see the same doctor. Therefore a review of the nature of informational continuity is useful., Aim: To answer the question 'How is informational continuity developed in general practice?'., Design of Study: A rigorous systematic review of relevant electronic databases., Method: Databases were searched for articles answering the research question. Articles focused on family medicine and informational continuity of care were included. Data from reviewed articles were independently extracted and reviewed by two researchers. Conceptual and evidence-based articles were included., Results: Initially, 193 articles were obtained from all five bibliographic databases; 57 were retained following title and abstract review. Of these, 34 articles were included in the final systematic review. Results show that informational continuity of care is developed using paper/electronic records and remembered information collectively, through a series of doctor-patient consultations over time. Obstacles to its development are practitioners not recording patient information and patients not disclosing important details., Conclusion: These findings have implications for newer styles of primary care that may have a negative impact in the successful management of chronic illnesses in particular.

Background: Evidence suggests that insulin is under-prescribed in older people. Some reasons for this include physician's concerns about potential side-effects or patients' resistance to insulin. In general, however, little is known about how GPs make decisions related to insulin prescribing in older people., Aim: To explore the process and rationale for prescribing decisions of GPs when treating older patients with type 2 diabetes., Design of Study: Qualitative individual interviews using a grounded theory approach., Setting: Primary care., Method: A thematic analysis was conducted to identify themes that reflected factors that influence the prescribing of insulin., Results: Twenty-one GPs in active practice in Ontario completed interviews. Seven factors influencing the prescribing of insulin for older patients were identified: GPs' beliefs about older people; GPs' beliefs about diabetes and its management; gauging the intensity of therapy required; need for preparation for insulin therapy; presence of support from informal or formal healthcare provider; frustration with management complexity; and GPs' experience with insulin administration. Although GPs indicated that they would prescribe insulin allowing for the above factors, there was a mismatch in intended approach to prescribing and self-reported prescribing., Conclusion: GPs' rationale for prescribing (or not prescribing) insulin is mediated by both practitioner-related and patient-related factors. GPs intended and actual prescribing varied depending on their assessment of each patient's situation. In order to improve prescribing for increasing numbers of older people with type 2 diabetes, more education for GPs, specialist support, and use of allied health professionals is needed.