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Context: The COVID-19 pandemic has led to increased stress and anxiety as well as maladaptive coping strategies including substance use. Objective: This study aims to assess the impact of the COVID-19 pandemic on the frequency of primary care visits for substance use including tobacco, alcohol, and other drug use among primary care patients in Ontario, Canada. Study Design and Analysis: We conducted a longitudinal cohort study of family medicine patients from March 14, 2019, to March 13, 2021. We used generalized linear models to compare the frequency of substance-use related fee and diagnostic codes pre-pandemic and during the pandemic. Logistic regression was used to model the binary outcome of whether a substance-use related visit took place in either period. Setting or Dataset: Patient data was obtained from the University of Toronto Practice-Based Research Network (UTOPIAN) database with over four hundred contributing family physicians. Population Studied: The study population included 234,730 and 240,044 adult family medicine outpatients in the pre-pandemic and pandemic periods, respectively. Intervention/Instrument: The study looked at the impact of the COVID-19 pandemic on the frequency of visits for substance use; March 14-2019-March 13, 2020 was defined as the pre-pandemic period while March 14, 2020-March 13, 2021 was defined as the pandemic period. Outcome Measures: We used two types of measures to identify patients presenting to family physicians with a substance use-related issue: (1) Ontario Health Insurance Plan (OHIP) service fee codes for primary care visits related to substance use and (2) OHIP diagnostic codes for primary care visits related to substance use. Results: Relative to the pre-pandemic period, there were decreases during the pandemic in the proportion of patients who had a primary care visit for tobacco-use related reasons from 1411 to 419 per 100,000 patients, and alcohol-use related reasons from 314 to 274 per 100,000 patients. However, the proportion of patients having a primary care visit for other drug-use related reasons increased from 618 to 717 per 100,000 patients. Conclusions: Substance-use related primary care visits were found to have decreased in the first year of the COVID-19 pandemic relative to the year before. Our results, interpreted in a context of increased substance use prevalence during the COVID-19 pandemic, likely represent an unmet need for patients with substance use disorders during the pandemic., Presenters Colin Siu, MD, Ellen Stephenson, PhD, Chelsea Christie, Karen Tu, MD, MSc, CCFP, [...]

Context The stresses of the pandemic have been felt by most. Working in family medicine we have noticed an increase in patient inquiries into Attention Deficit/Hyperactivity Disorder (ADHD). Objective We set out to examine if the trends in the patients presenting to family medicine for ADHD have changed during the pandemic. Study Design We did a retrospective cohort study examining rates of patients presenting to the family physician office with a visit with the most responsible reason for visit as ADHD or a prescription for an ADHD medication. Setting We used the UTOPIAN primary care EMR database in Ontario, Canada containing patients in the Greater Toronto Area and beyond. Population Studied Over 200,000 patients annually age 5-55 years presenting to a UTOPIAN physician in 2017-2021. Outcome Measures Proportion of patients each year with a visit to a family physician where the most responsible reason for visit was documented as ADHD. Proportion of patients each year receiving a prescription for an ADHD medication. Patients visiting family physicians for ADHD were examined by age, sex, income quintile and urban vs rural residence. Results The proportion of patients with an ADHD visit in 2017-2019 ranged from 2.4 to 3.5/1000 in 2017-2019 and rose to 5.5/1000 by the end of 2021. The proportion of patients visiting for ADHD was relatively stable in 2017-2019 for all age groups but was higher than pre-pandemic for the 20-24 year olds and the 25-34 year olds by 2021. The proportion of patients with an ADHD medication prescription in 2017-2019 ranged from 12.9 to 16.5/1000 and rose to 21.9/1000 by the end of 2021. Prior to the pandemic ADHD visits were higher in rural patients compared to patients residing in urban areas (2.8 rural and 2.4/1000 urban in 2017) but the reverse occurred with the pandemic onset (3.9 rural and 5.7/1000 urban in 2021). ADHD visits and medications were higher both before and after the pandemic for males compared to females. This persistent pattern was also seen with income quintiles both before and during the pandemic with the patients in highest income quintile consistently having more ADHD visits and prescriptions compared to the lowest income quintile. Conclusions There has been an increasing proportion of patients seeing family physicians for ADHD and receiving prescriptions for ADHD medications over the past 5 years with amplification of these increases in some patient populations particularly in 2021., Presenters Karen Tu, MD, MSc, CCFP, FCFP, Debra Butt, MD, MSc, Sumeet Kalia, MSc, Rahim Moineddin, PhD, Ellen Stephenson, [...]

Background: The human papillomavirus (HPV) vaccine was recently approved for men. To effectively tailor HPV education efforts toward men, it is important to understand what men know about HPV and how this knowledge relates to their decision to receive the vaccine. This study examines how objective HPV knowledge, objective HPV vaccine knowledge, and perceived knowledge (level of confidence in one's HPV knowledge) relate to males' HPV vaccination intentions. Methods: One hundred and twenty-eight college men completed a questionnaire survey assessing their demographics, sexual health, and objective and perceived knowledge of HPV and the HPV vaccine. Results: Logistic regression analyses revealed that perceived knowledge and objective HPV vaccine knowledge were associated with vaccination intentions. Perceived knowledge was significantly associated with vaccination intentions even when accounting for objective HPV and HPV vaccine knowledge. Discussion and Translation to Health Education Practice: Perceived knowledge may play an especially important role in motivating men to receive the HPV vaccine. Educational programs that aim to increase HPV vaccine acceptability should foster individual's confidence in their HPV knowledge, beyond providing factual HPV-related information. (Contains 1 table.)

Objective: To investigate how primary care access, intensity and quality of care changed among patients living with schizophrenia before and after the onset of the COVID-19 pandemic in Ontario, Canada. Methods: This cohort study was performed using primary care electronic medical record data from the University of Toronto Practice-Based Research Network (UTOPIAN), a network of > 500 family physicians in Ontario, Canada. Data were collected during primary care visits from 2643 patients living with schizophrenia. Rates of primary care health service use (in-person and virtual visits with family physicians) and key preventive health indices indicated in antipsychotic monitoring (blood pressure readings, hemoglobin A1c, cholesterol and complete blood cell count [CBC] tests) were measured and compared in the 12 months before and after onset of the COVID-19 pandemic. Results: Access to in-person care dropped with the onset of the COVID-19 pandemic. During the first year of the pandemic only 39.5% of patients with schizophrenia had at least one in-person visit compared to 81.0% the year prior. There was a corresponding increase in virtual visits such that 78.0% of patients had a primary care appointment virtually during the pandemic period. Patients prescribed injectable antipsychotics were more likely to continue having more frequent in-person appointments during the pandemic than patients prescribed only oral or no antipsychotic medications. The proportion of patients who did not have recommended tests increased from 41.0% to 72.4% for blood pressure readings, from 48.9% to 60.2% for hemoglobin A1c, from 57.0% to 67.8% for LDL cholesterol and 45.0% to 56.0% for CBC tests during the pandemic. Conclusions: There were substantial decreases in preventive care after the onset of the pandemic, although primary care access was largely maintained through virtual care. Addressing these deficiencies will be essential to promoting health equity and reducing the risk of poor health outcomes. [ABSTRACT FROM AUTHOR]

Objective: Accurate and rapid phenotyping is a prerequisite to leveraging electronic health records for biomedical research. While early phenotyping relied on rule-based algorithms curated by experts, machine learning (ML) approaches have emerged as an alternative to improve scalability across phenotypes and healthcare settings. This study evaluates ML-based phenotyping with respect to (1) the data sources used, (2) the phenotypes considered, (3) the methods applied, and (4) the reporting and evaluation methods used.Materials and Methods: We searched PubMed and Web of Science for articles published between 2018 and 2022. After screening 850 articles, we recorded 37 variables on 100 studies.Results: Most studies utilized data from a single institution and included information in clinical notes. Although chronic conditions were most commonly considered, ML also enabled the characterization of nuanced phenotypes such as social determinants of health. Supervised deep learning was the most popular ML paradigm, while semi-supervised and weakly supervised learning were applied to expedite algorithm development and unsupervised learning to facilitate phenotype discovery. ML approaches did not uniformly outperform rule-based algorithms, but deep learning offered a marginal improvement over traditional ML for many conditions.Discussion: Despite the progress in ML-based phenotyping, most articles focused on binary phenotypes and few articles evaluated external validity or used multi-institution data. Study settings were infrequently reported and analytic code was rarely released.Conclusion: Continued research in ML-based phenotyping is warranted, with emphasis on characterizing nuanced phenotypes, establishing reporting and evaluation standards, and developing methods to accommodate misclassified phenotypes due to algorithm errors in downstream applications. [ABSTRACT FROM AUTHOR]

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The current study aimed to test competing hypotheses about the role of appraisals of family stressor severity in long-term relationship outcomes. Traditional cognitive models of stress predict that those who appraise stress as most serious are at greatest risk of poor outcomes. However, social contextual and dyadic models of stress and coping argue that a belief that one's spouse shares in this appraisal might play a protective role in marital outcomes. We examined the associations between appraisals of family stressor severity and subsequent marital dissolution in a sample of 170 couples in stepfamilies. Stepfamilies are an at-risk group, given they have been found to experience a greater number and variety of stressors as compared to traditional families, and have an increased risk of marital instability. As predicted by traditional cognitive models of stress, participants who reported family problems that they appraised as more serious were found to be at greater risk of marital dissolution over time. However, the risk of separation or divorce was lower when participants reported that their spouse also considered the problem as serious. In addition, comparing data from both spouses indicated that when both reported the same problem as their most serious, the risk of marital dissolution was also decreased. Our findings support social contextual and dyadic coping models in which shared appraisals of stress, and even the perception of such, can serve a protective function. Understanding how couples appraise the stressors they encounter may help identify useful targets for preventive marital interventions. [ABSTRACT FROM AUTHOR]