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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 [...]

Context: Many older adults take multiple medications prescribed by a variety of providers, which leads to concerns about medication management, appropriateness, and adverse drug events. Interdisciplinary, team-based primary care models can improve coordination of health care services, which could translate to improved medication management and related outcomes. Objective: Evaluate the impact of interdisciplinary team-based primary care models implemented in two Canadian provinces--Ontario and Quebec--on outcomes related to medication use. Study Design and Analysis: Retrospective cohort analysis of population- level administrative health data. We used difference-in-differences analysis to compare older adults rostered to team-based primary care models, to older adults not rostered to team-based models. Dataset: Data housed at ICES in Ontario and the Institut national d'excellence en sante et services sociaux (INESSS) in Quebec. We focused on fiscal years 1999/00 to 2017/18. Population Studied: Eligible patients were between 66 and 104 years of age. We matched (1-to-1 propensity score matching without replacement) an exposure group of older adults who were rostered to a physician affiliated with a team-based primary care model to a comparison group of older adults rostered to non-team family physicians. Intervention: Quebec's Family Medicine Groups (implemented in 2002) and Ontario's Family Health Teams (implemented in 2005). Outcome Measures: Any adverse drug event resulting in hospitalization, polypharmacy (5+ medication classes), and any potentially inappropriate prescription (adapted from Beer's and STOPP/START criteria). Results: Matched cohorts included 429,104 older adults in Ontario and 310,198 in Quebec. In the year before they rostered, 53% and 40% of older adults had a potentially inappropriate prescription in Ontario and Quebec, respectively. In both provinces, 1% had an adverse drug event. Quebec's Family Medicine Groups were more likely to experience an adverse drug event (RR = 1.14; 95% CI: 1.10-1.17). We found no other differences between the exposure and comparison groups. Conclusions: The implementation of team-based primary care models in Ontario and Quebec was not associated with a variety of outcomes related to medication management. These results point to a need for further investigation of the composition and functioning of primary care teams to determine how they can support older adults with complex health needs, Presenters David Rudoler, PhD, Agnes Grudniewicz, PhD, Nichole Austin, PhD, Sara Allin, PhD, Richard Glazier, MD, MPH, Elisabeth Martin, PhD, Caroline Sirois, PhD, Erin [...]

Context: Polypharmacy and inappropriate medications can lead to adverse drug events and avoidable health systems costs. Family physicians may find it challenging to manage multiple medications for seniors, especially in fragmented systems with multiple prescribers. Interprofessional primary care teams have capacity for improved medication management. However, we know little about how these teams work together to manage medications. Objective: To describe and understand how family physicians and interdisciplinary health providers (IHPs) work together when managing medications for seniors. Study Design and Analysis: Qualitative semi-structured interviews and thematic analysis. Setting: Interprofessional primary care Family Health Teams (FHTs) in Ontario. Population Studied: Administrators, family physicians, and IHPs (nurses, pharmacists, etc.). Results: Interviews (n=38) were conducted across six FHTs in Ontario. The way physicians and IHPs worked together to manage medications for seniors varied in and across FHTs. We identified three themes in the data related to approach to medication management: 1) no engagement with IHPs (i.e., physicians did not refer their patients to the team's IHPs), 2) some engagement (i.e., physicians referred patients to IHPs and IHP-led programs for medication management but rarely engaged in ongoing communication), and 3) shared care (i.e., physicians shared decision-making about care with IHPs, there was ongoing communication between physicians and IHPs). Some IHPs were frustrated with tailoring their approach to care and communication based on the preferences of each physician. These differences were perceived to be a result of hierarchy, work style and use of the electronic medical record, and physician expectations. Trust also appeared to be a factor in that the more physicians interacted with IHPs, the more comfortable and trusting they were giving them an active role in patient care. Regardless of the approach to medication management, participants agreed that physicians had the final say in patient care. Conclusions: Despite the FHT model's emphasis on teamwork, participants did not report a lot of shared care in medication management. While in many cases there was a lack of ongoing communication between IHPs and family physicians, there are opportunities to improve teamwork and strengthen collaboration., Presenters Agnes Grudniewicz, PhD, Monika Roerig, BSc, MA, Julie Vizza, BSc, MHS, Elisabeth Martin, PhD, Sara Allin, PhD, Erin Strumpf, David Rudoler, [...]

Context: It is becoming more difficult to find a family physician in Canada. This has led to speculation that new family physicians may be to blame because they are more likely to provide lower service volume and less likely to provide longitudinal primary care. Objective: To investigate the impact of graduation cohort on family physician practice volume and continuity of care over two decades. Study Design and Analysis: Retrospective-cohort of family physicians from 1997/98 to 2017/18. Median polish analysis of patient contacts and physician-level continuity was completed to isolate years in practice, period, and cohort effects. Dataset: Administrative health and physician claims data were collected in British Columbia, Manitoba, Ontario, and Nova Scotia, Canada. Databases included registry files from provincial regulatory colleges, physician billing information, and patient registration files for provincial insurers. Population Studied: All physicians registered with their respective provincial regulatory colleges with a medical specialty of family practice and/or billed the provincial health insurance system for patient care as FPs. Outcome Measures: Patient contacts (count of unique patient-physician day combinations) and physician-level continuity (proportion of total annual contacts--excluding ED visits--that all patients seen by an FP had with that FP). Results: Median patient contacts per provider fell over time in the four provinces examined. In all provinces, median contacts increased with years in practice until mid-to- late-career and declined into end-of-career. We found no relationship between graduation cohort and practice volume or FP-level continuity. Conclusions: Declines in service volume were observed in all provinces, with expected trajectories of service volume and continuity over a FP's career. We found no generational differences in FP practice. These findings are important for health workforce planning in primary care sectors across the country, and for the general discourse concerning the behaviours and preferences of recent medical graduates. Our findings highlight that intergenerational tension and blame is unfounded and only distracts from important issues in workforce planning in primary care sectors., Presenters David Rudoler, PhD, Agnes Grudniewicz, PhD, Ruth Lavergne, PhD, Emily Gard Marshall, PhD, MSc, Laurie Goldsmith, [...]

Background. Improving the recruitment and retention of healthcare workers in the continuing care sector is critical to ensuring adequate care for older adults, which was highlighted following the COVID-19 pandemic. Purpose. The purpose of this study was to understand the perceptions of prospective registered nurses about working in the continuing care sector and identify workplace attributes that attract prospective nurses to the sector. Methods. A sequential mixed methods study was conducted with nursing students at Ontario Tech University. Focus groups (n = 14) asked students to comment on views about working in the continuing care sector, and job attributes that may attract them to the sector. Focus group data were analyzed using thematic analysis. Subsequently, a cross-sectional survey asked students to respond to elicited choice job scenarios that varied job attributes. The job attributes were shaped by the focus group interview data. To assess respondent's preferences, the survey data (n = 139) were analyzed to generate willingness-to-pay (WTP) values for each job attribute. Results. Focus group interviews suggested that fair compensation, optimal client-to-staff ratios, unionized work environments, comprehensive benefits packages, and flexible work arrangements were important job attributes. In survey results, 18.0% expressed interest in working in the continuing care sector compared to 75.5% in acute care. Regression analysis suggested that higher amounts of paid vacation (WTP: −5.983; 95% CI: −13.749 and −0.037) and higher risk of injury (WTP: 0.684; 95% CI: 0.124 and 1.208) were associated with work in the continuing care sector. Impact. Continuing care workplaces can attract nurses by offering flexible options such as part-time positions and paid vacation and by taking actions that can mitigate the risk of workplace injury, violence, and abuse. Nursing students should be shown the positive aspects of working with older adults and dispel negative perceptions about the continuing care sector. Further research is needed to understand the preferences for work and risk perceptions among currently employed nursing staff. [ABSTRACT FROM AUTHOR]

This article reports on an evaluation the effectiveness of e-mailed grade "nudges" on students' performance and engagement in an introductory statistics course for undergraduate health science students. In 2020-2021, 358 students were randomized to an e-mail (n = 178) or no e-mail (n = 180) group. The intervention e-mail contained information on each student's predicted final grade (grade nudge). Using two-sample t-tests, the statistical analysis of final grades in the course showed a higher compatibility with a model of no mean difference for students in the e-mail (73.5%) vs. no e-mail (72.1%) group. Comparison of the distributions of final grades between the two groups, however, suggested the e-mailed nudges may be related to slight improvements in final grades. Specifically, the median final grade was higher in the e-mail group (74.6 vs. 72.4); the Q1 value in the e-mail group was also higher, and the interquartile range was similar: no e-mail group (15.8) vs. e-mail group (14.2). Students also completed the Scale of Student Engagement in Statistics (SSES). Total engagement, affective and cognitive subscale scores of the SSE-S were higher in the email group, resulting in low compatibility with a model of no difference in engagement scores. Overall, the results showed there is potential for our midterm warning system to be used to improve outcomes, particularly given that it is simple to implement, cost-effective, and easily scalable. [ABSTRACT FROM AUTHOR]

Aim The purpose of this analysis was to report the prevalence of falls and falls-related injuries among those reporting different volumes of weekly sedentary time, and to understand the association of sedentary time and falls, accounting for functional fitness. Methods Baseline and first follow-up data from the Canadian Longitudinal Study on Aging (CSLA) were analyzed (n=22,942). Participants self-reported whether they had a fall in the past 12 months (at baseline) and whether they had an injury that was a result of a fall (follow-up). In-home interviews collected self-reported leisure sedentary time using the Physical Activity Scale for Elderly. Functional fitness was assessed using grip strength, timed-up-and-go, and chair rise tests during clinic visits. Results The prevalence of falls was higher among those who reported higher sedentary time. For example, among males aged 65 and older who reported lower sedentary time (<1,080 min/week), the prevalence of falls in the past 12 months (at baseline) was 7.8% compared to 9.8% in those reporting higher sedentary time. The odds of reporting a fall (at baseline) was 21% higher in those who reported higher sedentary time (OR: 1.21; 95%CI: 1.11-1.33) in adjusted models. No associations were found between sedentary time and injuries due to a fall. Conclusions Reporting high volumes of sedentary time may increase the risk of falls. Future research using device-based estimates of total sedentary time and breaks in sedentary time is needed to further elucidate this association. [ABSTRACT FROM AUTHOR]