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PURPOSE We offered a practice facilitation intervention to family physicians in Ontario, Canada, known to have large numbers of patients not yet vaccinated against coronavirus disease 2019 (COVID-19). METHODS We conducted a multimethod process evaluation embedded within a randomized controlled trial (clinical trial #NCT05099497). We collected descriptive statistics regarding engagement and qualitative interview data from family physicians and practice facilitators, as well as data from facilitator field notes. We analyzed and triangulated the data using thematic analysis and mapped barriers to and enablers for implementation to structural, organizational, physician, and patient factors. RESULTS Of the 300 approached, 90 family physicians (30%) accepted facilitation. Of these, 57% received technical support to identify unvaccinated patients, 29% used trained medical student volunteers to contact patients on their behalf, and 30% used automated calling to reach patients. Key factors affecting engagement with the intervention were staff shortages owing to COVID-19 (structural), clinic characteristics such as technical issues and gatekeeping by staff, which prevented facilitators from talking with physicians (organizational), burnout (physician), and specialized populations that required targeted resources (patient). The facilitator's ability to address technical issues and connect family physicians with medical students helped with engagement. CONCLUSIONS Strategies to help underresourced family physicians serving high- needs populations for issues of public health importance, such as vaccine promotion, must acknowledge the scarcity of physicians' time and provide new resources. To successfully engage family physicians, practice facilitators should seek to build trust and relationships over time, including with front-office staff. Key words: practice facilitation; vaccines; COVID-19; process evaluation, INTRODUCTION Many Canadians consider family physicians to be their most trusted source of vaccine information, (1,2) underscoring the important role family doctors play in encouraging vaccine uptake, addressing hesitancies, and [...]

PURPOSE: Primary care access is a key health system metric, but little research has compared models to provide primary care access when one's regular physician is not available. We compared health system use after a visit with a patient's own family physician group (ie, within-group physician who was not the patient's primary physician) vs a visit with a walk-in clinic physician who was not part of the patient's family physician group. METHODS: We conducted a population-based, retrospective cohort study using administrative data from Ontario, Canada, including all individuals formally enrolled with a family physician, from April 1, 2019 to March 31, 2020. We compared those visiting within-group physicians to those visiting walk-in clinic physicians using propensity score matching to account for differences in patient characteristics. The primary outcome was any emergency department visit within 7 days of the initial visit. RESULTS: Matched patients who visited a within-group physician (N = 506,033) were 10% less likely to visit an emergency department in the 7 days after the initial visit compared to patients who saw a walk-in clinic physician (N = 506,033; 20,117 [4.0%] vs 22,320 [4.4%]; risk difference [RD] 0.4%; 95% CI 0.4-0.5; relative risk [RR] 0.90; 95% CI, 0.89-0.92). Restricting to visits occurring on weekends, the observed association was stronger (7,964 [3.7%] vs 10,055 [4.7%]; RD 1.0%; 95% CI 0.9-1.1; RR 0.79; 95% CI, 0.77-0.82). Those accessing after-hours within-group physician visits were more likely to have =1 additional virtual or in-person withingroup physician visit within 7 days (virtual RR 1.86, in-person RR 1.87). CONCLUSIONS: Compared to visiting a walk-in clinic physician, seeing a within-group physician after hours might decrease downstream emergency department visits. This finding could be explained by better continuity of care and can inform primary care service models and the policies that support them. [ABSTRACT FROM AUTHOR]

Context: One way to build vaccine confidence is through advice from a trusted health professional, like a family physician. We implemented and evaluated a practice facilitation intervention in partnership with Ontario Health, a provincial government agency, to support the family physicians in Ontario known to have the largest number of unvaccinated patients. Objective: To understand how and why this intervention offered to family physicians most in need was used and to identify opportunities to adapt this targeted approach for other aspects of primary care. Study Design and Analysis: This was a qualitative process evaluation embedded within a randomized trial. Data were analyzed using inductive and deductive techniques informed by the Theoretical Domains Framework. Setting or Dataset: Data was collected through interviews with participating and non-participating family physicians, as well as from practice facilitator field notes. Population Studied: Family physicians with the largest number of unvaccinated patients in the province. Intervention/Instrument: Practice facilitators offered physicians support to identify, reach out, and counsel their unvaccinated patients. Outcome Measures: N/A Results: Of the 300 physicians randomized to the intervention, 29% accepted support. Among those who received facilitation, 58% used technical support to identify unvaccinated patients, 29% were linked with medical student volunteers to contact patients on their behalf, and 31% used automated calling to reach patients. The main barriers encountered were: a) gatekeeping from the front-office staff, which prevented the practice facilitator from contacting the physician, b) inability to dedicate extra time, c) technical issues with identifying patients requiring vaccines, and d) belief that outreach to patients would not result in more vaccinations. Facilitators were: a) clinics that had support staff, especially a tech-savvy workforce, b) physician, or the team passionate about COVID-19 vaccine uptake, and therefore willing to prioritize time or resources to outreach, and c) the belief that COVID-19 vaccine uptake was part of their role as a family physician. Conclusion: Strategies to help family physicians regarding vaccine rollout or other primary care areas of public health import must acknowledge the scarcity of time and resources of these physicians, and seek to build trust and relationships over time, including the front-office staff., Presenters Jennifer Shuldiner, PhD, Dominik Nowak, Noah Ivers, MD, PhD, CCFP, Aisha Lofters, MD, Tara Kiran, MD, MSc, CCFP, FCFP, David Kaplan, MD, CCFP, FCFP, MSc, Monica Taljaard, PhD, Michael [...]

Context: Audit and Feedback (A&F), the summary and provision of clinical performance, is a popular quality improvement strategy. We are developing a web-based dashboard that uses data from the electronic medical record to help physicians identify gaps in care and act. However, A&F tools can only be effective if the targeted health professionals actively review their data and take action. In order to maximise the impact of A&F, the design should consider the needs and goals of clinicians. Objective: To describe the development of a user-centered design process to optimize the effect of an A&F dashboard for family physicians. Study Design and Analysis: Our design process includes (1) Prototype development based on A&F theory and input from clinical improvement leaders; (2) a co-creation workshop with family physician quality improvement leaders to develop personas (i.e., fictional characters that represent an archetype character); (3) user-centered interviews with family physicians to learn about the physician's who will be using the dashboard and their context, and their reactions to the dashboard. Setting or Dataset: A workshop for the creation of personas and user- centered qualitative interviews with family physicians. Population Studied: Family physicians who contribute data to the University of Toronto Practice-Based Research Network Intervention/Instrument: Audit and Feedback dashboard Outcome Measures: N/A Results: Our persona workshop produced four personas that enabled the team to identify physician's needs and wishes and facilitated empathy during the design process: Dr. Skeptic, Frazzled Physician, The Eager Implementer, and Sidney Big Wig. Our interviews found that: (1) physicians are interested in how they compare with their peers; however, if their performance was above average, they were not motivated to improve even if gaps in care remained; (2) Burnout levels are high, physicians are trying to catch up on missed care during the pandemic, and were not highly motivated to act on the dashboard data; (3) Features that were important to physicians were integration within the EMR, and up-to-date and accurate data. Conclusions: A successful design of an A&F performance dashboard should consider the serious lack of time and capacity among family physicians to engage in quality improvement work. If designed properly, the QI dashboard can be a great assistance in helping family physicians provide more proactive and targeted care., Presenters Jennifer Shuldiner, PhD, Susie Kim, MD, CCFP, Noah Ivers, MD, PhD, CCFP, Michelle Greiver, MD, MSc, CCFP, Tara Kiran, MD, MSc, CCFP, FCFP, Kelly Thai, Adam Cadotte, [...]

Background: Menthol in cigarettes has been shown to increase regular cigarette smoking and nicotine dependence, and decrease success in smoking cessation. Owing to these reasons, in May 2015, the province of Ontario introduced a menthol ban on tobacco products that came into effect in January 2017 prior to a Federal Canadian Ban in October 2017. The objective of this article was to assess the effect of a provincial menthol ban on cigarette wholesale sales in Ontario.Methods: Wholesale data submitted by tobacco manufacturers to Health Canada pursuant to the federal Tobacco Reporting Regulations from October 2012 to September 2017 were analyzed using interrupted time-series analysis. Changes in sales of cigarettes with and without menthol were estimated, using the province of British Columbia as a comparison. Analyses were seasonally adjusted.Results: Sales of menthol and nonmenthol cigarettes increased from 2013 until the implementation of the 2017 provincial ban. Subsequently, a sharp decline of 55 million menthol cigarettes and 128 million total cigarettes was observed in Ontario. As a comparison, no significant changes were observed in British Columbia.Conclusion: This study supports the conclusion that implementation of a menthol ban in Ontario was associated with significant reduction of menthol cigarette sales and total cigarettes sales, compared to British Columbia where there was no provincial menthol ban. This suggests that menthol regulations in jurisdictions with a larger percentage of menthol smokers are likely to be highly effective.Implications: The 2017 menthol ban was associated with significant reduction of menthol cigarette sales and total cigarette sales suggesting that menthol regulations will have important effects on cigarette consumption. [ABSTRACT FROM AUTHOR]

Context: Audit and Feedback (A&F), the summary and provision of clinical performance, is a popular quality improvement strategy. We are developing a web-based dashboard that uses data from the electronic medical record to help physicians identify gaps in care and act. However, A&F tools can only be effective if the targeted health professionals actively review their data and take action. In order to maximise the impact of A&F, the design should consider the needs and goals of clinicians. Objective: To describe the development of a user-centered design process to optimize the effect of an A&F dashboard for family physicians. Study Design and Analysis: Our design process includes (1) Prototype development based on A&F theory and input from clinical improvement leaders; (2) a co-creation workshop with family physician quality improvement leaders to develop personas (i.e., fictional characters that represent an archetype character); (3) user-centered interviews with family physicians to learn about the physician's who will be using the dashboard and their context, and their reactions to the dashboard. Setting or Dataset: A workshop for the creation of personas and user-centered qualitative interviews with family physicians. Population Studied: Family physicians who contribute data to the University of Toronto Practice-Based Research Network Intervention/Instrument: Audit and Feedback dashboard Outcome Measures: N/A Results: Our persona workshop produced four personas that enabled the team to identify physician's needs and wishes and facilitated empathy during the design process: Dr. Skeptic, Frazzled Physician, The Eager Implementer, and Sidney Big Wig. Our interviews found that: (1) physicians are interested in how they compare with their peers; however, if their performance was above average, they were not motivated to improve even if gaps in care remained; (2) Burnout levels are high, physicians are trying to catch up on missed care during the pandemic, and were not highly motivated to act on the dashboard data; (3) Features that were important to physicians were integration within the EMR, and up-to-date and accurate data. Conclusions: A successful design of an A&F performance dashboard should consider the serious lack of time and capacity among family physicians to engage in quality improvement work. If designed properly, the QI dashboard can be a great assistance in helping family physicians provide more proactive and targeted care. [ABSTRACT FROM AUTHOR]