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Objectives: Electronic medical record (EMR) prescription data may identify high antibiotic prescribers in primary care. However, practitioners doubt that population differences between providers and delayed antibiotic prescriptions are adequately accounted for in EMR-derived prescription rates. This study assessed the validity of using EMR prescription data to produce antibiotic prescription rates, accounting for these factors. Methods: The study was a secondary analysis of antimicrobial prescriptions collected from 4 primary care clinics from 2015 to 2017. For adults with selected respiratory and urinary infections, EMR diagnostic codes, prescription data, clinical diagnoses and demographics were abstracted. Overall and delayed prescription rates were produced for EMR diagnostic codes, clinical diagnoses, by clinic, and types of infection. Direct standardization was used to adjust for case mix differences by clinic. High antibiotic prescribers, above the 75th percentile for prescriptions, were compared with low antibiotic prescribers. Results: Of 3108 EMR visits, there were 2577 (85.4%) eligible visits with a clinical diagnosis and prescription information. Overall antibiotic prescription rates were similar utilizing EMR records (31.6%) or clinical diagnoses (32.6%, P =.40). When delayed prescriptions were removed, prescribing rates were lower (22.4%, P <.01). EMR data overestimated prescribing rates for conditions where antibiotics are usually not indicated (17.7% EMR vs 7.6% clinical diagnoses, P <.001). High antibiotic prescribers saw more cases where antibiotics are usually indicated (23.4%) compared to low prescribers (16.8%; P =.001). Conclusions: Electronic medical record prescribing rates are similar to those using clinical diagnoses overall, but overestimate prescribing by clinicians for conditions usually not needing antibiotics. EMR prescription rates do not account for delayed antibiotic prescriptions or differences in infection case-mix. [ABSTRACT FROM AUTHOR]

Evidence-based guidelines recommend physical activity during pregnancy, however, most pregnant individuals fail to achieve the minimum recommended amount of physical activity. Uncertainty about the safety of physical activity is a common reason why pregnant individuals do not participate in regular physical activity. The purpose of this study was to develop an evidence-based educational video and evaluate its effectiveness at improving pregnant individuals' attitudes regarding the safety of physical activity during pregnancy. Pregnant individuals attending their first prenatal appointment from an urban academic interprofessional teaching unit in Toronto, Canada were invited to participate. Participants (n=37) completed a survey during their first trimester (x²= 12.4 weeks gestation) before watching an evidence-based physical activity safety video. The cohort was then asked to complete surveys two months later in their second trimester (x²= 22.6 weeks gestation) after watching the video. While all participants felt confident engaging in physical activity pre-intervention (100%), most participants expressed benefit from further education (80.8%). After watching the video, there was a significant difference in participants' beliefs regarding high impact activities (p=0.03) and knowledge about physical activity amount as recommended by current guidelines (p<0.01). Overall, participants felt the video improved their knowledge about the safety of physical activity during pregnancy (90.9%) and they would recommend the video to other pregnant individuals (95.5%). The evidence-based video provided to patients early in pregnancy appears effective in reinforcing positive attitudes towards the safety of prenatal physical activity. Future studies exploring more diverse populations are needed to confirm the results of this pilot study. [ABSTRACT FROM AUTHOR]

Objective: To determine patient knowledge and preferences about primary human papillomavirus (HPV) testing., Design: Cross-sectional survey., Setting: Two family practice clinics (urban and suburban) and the social media platforms of 2 hospitals in the greater Toronto area between January and February 2023., Participants: A total of 413 Ontario residents aged 25 to 69 years, with a cervix, who qualified for Papanicolaou (Pap) screening and could communicate in English., Methods: Electronic survey containing questions about knowledge of, and preferences for, cervical cancer screening, including types of screening and screening intervals, and about education related to HPV and screening intervals., Main Findings: Of 441 potential participants, 426 were eligible and consented to participate in the study; ultimately 413 provided completed or partially completed surveys (96.9% response rate). Of those who completed a recent Pap test, 57.8% (208 of 360) knew of HPV testing. Initially, 27.8% thought HPV testing was better than Pap testing for cervical cancer screening. After learning HPV tests exist and have self-sampling options, most participants preferred HPV testing (self-sampling 46.3%, provider sampling 34.1%). Annual cervical cancer screening was preferred by 50.1% of participants despite knowing that, for most people, Pap tests should be conducted every 3 years (74.8%). After learning about HPV testing, participants were more likely to prefer 5-year screening intervals (43.8%); however, those in the family practice group were still more likely to prefer 3-year intervals compared with those in the social media group ( P <.01)., Conclusion: Participants in this study identified a preference for HPV testing and self-sampling options. Concerns were raised about extended screening intervals and the safety of self-collected samples that need to be addressed in public health education initiatives during rollout of new screening programs., (Copyright © 2024 the College of Family Physicians of Canada.)

Background: Effective community-based antimicrobial stewardship programs (ASPs) are needed because 90% of antimicrobials are prescribed in the community. A primary care ASP (PC-ASP) was evaluated for its effectiveness in lowering antibiotic prescriptions for six common infections., Methods: A multi-faceted educational program was assessed using a before-and-after design in four primary care clinics from 2015 through 2017. The primary outcome was the difference between control and intervention clinics in total antibiotic prescriptions for six common infections before and after the intervention. Secondary outcomes included changes in condition-specific antibiotic use, delayed antibiotic prescriptions, prescriptions exceeding 7 days duration, use of recommended antibiotics, and emergency department visits or hospitalizations within 30 days. Multi-method models adjusting for demographics, case mix, and clustering by physician were used to estimate treatment effects., Results: Total antibiotic prescriptions in control and intervention clinics did not differ (difference in differences = 1.7%; 95% CI -12.5% to 15.9%), nor did use of delayed prescriptions (-5.2%; 95% CI -24.2% to 13.8%). Prescriptions for longer than 7 days were significantly reduced (-21.3%; 95% CI -42.5% to -0.1%). However, only 781 of 1,777 encounters (44.0%) involved providers who completed the ASP education. Where providers completed the education, delayed prescriptions increased 17.7% ( p = 0.06), and prescriptions exceeding 7 days duration declined (-27%; 95% CI -48.3% to -5.6%). Subsequent emergency department visits and hospitalizations did not increase., Conclusions: PC-ASP effectiveness on antibiotic use was variable. Shorter prescription durations and increased use of delayed prescriptions were adopted by engaged primary care providers., Competing Interests: Linda Dresser reports grants from Merck, Avir, and Sunovion outside of the submitted work., (Copyright © 2021, Association of Medical Microbiology and Infectious Disease Canada (AMMI Canada).)