To present the results of a pilot study of an innovative methodology for translating best evidence about spinal cord injury (SCI) for family practice.
Review of Canadian and international peer-reviewed literature to develop SCI Actionable Nuggets, and a mixed qualitative-quantitative evaluation to determine Nuggets' effect on physician knowledge of and attitudes toward patients with SCI, as well as practice accessibility.
Ontario, Newfoundland, and Australia.
Forty-nine primary care physicians.
Twenty Actionable Nuggets (pertaining to key health issues associated with long-term SCI) were developed. Nugget postcards were mailed weekly for 20 weeks to participating physicians. Prior knowledge of SCI was self-rated by participants; they also completed an online posttest to assess the information they gained from the Nugget postcards. Participants' opinions about practice accessibility and accommodations for patients with SCI, as well as the acceptability and usefulness of Nuggets, were assessed in interviews.
With Actionable Nuggets, participants' knowledge of the health needs of patients with SCI improved, as knowledge increased from a self-rating of fair (58%) to very good (75%) based on posttest quiz results. The mean overall score for accessibility and accommodations in physicians' practices was 72%. Participants' awareness of the need for screening and disease prevention among this population also increased. The usefulness and acceptability of SCI Nugget postcards were rated as excellent.
Actionable Nuggets are a knowledge translation tool designed to provide family physicians with concise, practical information about the most prevalent and pressing primary care needs of patients with SCI. This evidence-based resource has been shown to be an excellent fit with information consumption processes in primary care. They were updated and adapted for distribution by the Canadian Medical Association to approximately 50,000 primary care physicians in Canada, in both English and French.
The paper summarizes the results of a scoping review that focused on the occurrence of adverse events experienced by homecare patients.
The literature search covered published and grey literature between 1998 and 2007. Databases searched included: MEDLINE, EMBASE, CINAHL and EBM REVIEWS including the Cochrane Library, AGELINE, the National Patient Safety Foundation Bibliography, Agency for Healthcare Research and Quality and the Patient Safety Net bibliography.
Papers included research studies, review articles, policy papers, opinion articles and legal briefs. Inclusion criteria were: (i) homecare directed services provided in the home by healthcare professionals or caregivers; (ii) addressed a characteristic relevant to patient experienced adverse events (e.g. occurrences, rates, definitions, prevention or outcomes); and (iii) were in English. Data extraction A pool of 1007 articles was reduced to 168 after analysis. Data were charted according to six categories: definitions, rates, causes, consequences, interventions and policy.
Eight categories emerged: adverse drug events, line-related, technology-related, infections and urinary catheters, wounds, falls, studies reporting multiple rates and other. Reported overall rates of adverse events ranged from 3.5 to 15.1% with higher rates for specific types. Few intervention studies were found. Adverse events were commonly associated with communication problems. Policy suggestions included the need to improve assessments, monitoring, education, coordination and communication.
A standardized definition of adverse events in the homecare setting is needed. Prospective cohort studies are needed to improve estimates and intervention studies should be undertaken to reduce the risk that homecare patients will experience adverse events.
Comment In: Int J Qual Health Care. 2010 Apr;22(2):75-720144941
Little is known about the extent to which adverse events compromise the quality of community care. This article describes the results of a consensus workshop in which 31 healthcare professionals were asked to identify and rank common adverse events and important research questions relating to community care. Workshop participants were decision-makers and healthcare providers with areas of expertise that included community and home care; acute and primary care; patient safety; medical errors; and health services policy, administration and research. Results include prioritized lists of adverse events, research questions and contributing factors associated with adverse events. Further study should be aimed at defining and implementing research priorities and developing standardized definitions of common adverse events associated with community care.
The news media has become a major source of health information for the public, and hence vital in the individuals' opinions and decisions about health topics. The first decrease in the usage of antidepressants in Denmark in over a decade happened alongside an intensive period of media coverage about antidepressants.
The aim of this study was to examine the Danish media's coverage of antidepressants during 2010-2011 in order to explore what influence it could have had on the change in the use of antidepressants.
Three media theoretical concepts, agenda-setting, priming and framing, were used to explain the media influence with regard to which subject the public should think about, which criteria the public should judge the subject by, and how the public should think about the subject. All articles about antidepressants in the main Danish Internet newspapers from 2010-2011 were analyzed via quantitative and qualitative content analyses. The quantitative analysis was used to determine agenda-setting (number of articles) and, by coding articles, how priming was used in the descriptions of antidepressants. In the qualitative analysis, all articles were analyzed and condensed to determine which frames were used.
Quantitative results: 271 articles were included. Agenda-setting was shown by a marked increase in the number of articles about antidepressants. Eight main codes were identified, with the negatively-associated side effects being the major one, thereby priming the public to use side effects as a criterion when judging antidepressants. Qualitative results: Two main frames were identified: 1) economic profits vs. medicine safety, and 2) the necessity of antidepressants. Both frames presented a critical view on antidepressants.
It is believed that the media's agenda-setting, priming and framing of antidepressants led the public to have a more skeptical view on antidepressants, which may have probably contributed to a decrease in the usage of antidepressants.
To compare patterns of practice between graduates of core 2-year family medicine (FM) training programs and those completing an additional postgraduate year (PGY3) of training.
Retrospective cohort study using administrative data from the Ontario Health Insurance Plan.
Graduates of Ontario FM residency programs from 1996 to 2002 who provided insured services in Ontario for 1 or more fiscal years between 1996 and 2004.
Proportion of physician years of service in which a minimum number of services were provided in each of the following categories: anesthesia, emergency medicine (EM), home visits, hospital visits, nursing home visits, intrapartum obstetrics, palliative care, office-only practice, and rural locations, as well as deciles for proportion of billings for emergency department work and "quasi-specialty" designations based on billing patterns. Results are stratified by type of training and years in practice.
Graduates of PGY3 programs are significantly more likely to practise in a range of nonoffice settings than their counterparts who completed core 2-year FM training programs. Differences were the most marked in areas in which additional training had been undertaken, but also extended to other categories. There was no effect on the proportion practising in rural locations, unless the training was undertaken in a rural setting or in anesthesia. Physicians including EM in their practices were more likely to practise mostly or almost all EM if they had undertaken either EM programs or self-directed programs at non-northern training sites. Very few graduates of any type were classified as belonging to a quasi-specialty group, other than those who completed care of the elderly or palliative care (hospitalist) and anesthesia programs.
Completion of a PGY3 program is strongly associated with increased participation in practice outside the office, particularly in the area of the training provided.
Cites: CMAJ. 2002 Feb 19;166(4):429-3411876170
Cites: Can Fam Physician. 2009 Sep;55(9):904-5.e1-819752262
To determine the views of family medicine (FM) program directors, third-year program coordinators, and residents on the factors affecting demand and allocation of postgraduate year 3 (PGY3) positions and the effects of these programs on the professional activities of program graduates.
Cross-sectional surveys and key informant interviews.
Ontario (FM residents) and across Canada (program directors) in 2006.
All FM residents in Ontario and all core program directors and PGY3 program coordinators nationally were eligible to participate in the surveys. Eighteen key informant interviews were conducted, all in Ontario. Interviewees included all FM program directors, selected PGY3 program coordinators, residents, and other community stakeholders.
Resident surveys were Web-based; invitations to participate were delivered by FM programs via e-mail lists. The program director and coordinator surveys were postal surveys. Interviews were audiotaped and transcribed, and the authors coded the interviews for themes.
Response rates for the surveys were 34% to 39% for residents and 78% for program directors and coordinators. Respondents agreed that programs should include flexible training options of varied duration. Demand for training is determined more by resident need than community or health system factors, and is either increasing or stable. Overall, respondents believed that approximately one-third of core program graduates should have the opportunity for PGY3 training. They thought re-entry from practice should be permitted, but mandatory return-of-service agreements were not desired. Program allocation and resident selection is a complex process with resident merit playing an important role. Respondents expected PGY3 graduates to practise differently than PGY2 graduates and to provide improved quality of care in their fields. They also thought that PGY3 graduates might play larger roles in leadership and teaching than core program graduates.
It is likely that PGY3 programs will continue to grow and form an increasingly important part of the FM training system in Canada. Flexible programs that can adapt to changing educational, health system, and community needs are essential. Training programs and national and provincial colleges of FM will also need to ensure that these physicians are provided with opportunities to maintain their links with the rest of the FM community.
Cites: Can Fam Physician. 2004 May;50:687-9, 693-515171666
Cites: Can Fam Physician. 2004 Sep;50:120915508362
Cites: Can Fam Physician. 2004 Sep;50:1209-1015508363
Cites: Can Fam Physician. 2004 Sep;50:1210-115508365
Cites: Can Fam Physician. 1994 Feb;40:273-88080510
Cites: CMAJ. 1995 Nov 15;153(10):1447-527585371
Cites: CMAJ. 2003 Jun 10;168(12):1548-912796334
Cites: Can J Rural Med. 2005 Fall;10(4):26816356390
Cites: Can Fam Physician. 2005 Apr;51:538-916926929
Cites: Can Fam Physician. 1999 Oct;45:2416-22, 2426-3210540701
Cites: Can Fam Physician. 1999 Nov;45:2698-700, 2703-4, 2717-2110587779
Cites: Can Fam Physician. 1999 Jan;45:88-9110889861
Cites: CMAJ. 2002 Oct 15;167(8):869-7012406944
Cites: Can Fam Physician. 2004 Oct;50:135515526867
Underutilized and undertheorized: the use of hospitalization for ambulatory care sensitive conditions for assessing the extent to which primary healthcare services are meeting needs in British Columbia First Nation communities.
Since the 1960s, the federal government has been providing or funding a selection of community-based primary healthcare (PHC) programs on First Nations reserves. A key question is whether local access to PHC can help address health inequities in First Nations on-reserve communities in British Columbia (BC).
This paper examines whether hospitalization for Ambulatory Care Sensitive Conditions (1) can be used as a proxy measure for the organization of PHC in First Nations reserve areas; and (2) is associated with premature mortality rates.
In this descriptive correlational study, we used administrative data available through Population Data BC, including demographic and ecological information (i.e. geo-codes indicating location of residence). We used two different measures of hospitalization: rates of episodic hospital care and rates of length of stay. We correlated hospitalization rates with premature mortality rates and the level of care available in First Nations communities, which depends on a federal funding formula based upon community size and, more specifically, the level of isolation from a provincial point of care.
First Nations communities in BC that have local 24/7 access to PHC services have similar rates of hospitalization for ACSC to those living in urban centres. This is demonstrated by the similarities in the strengths of the correlation between premature mortality rates and rates of avoidable hospitalization for conditions treatable in a PHC setting. This is not the case for communities served by a Health Centre (weaker correlation) and for communities serviced by a Health Station or with no on-reserve point of care (no correlation).
Improving access to PHC services in First Nations communities can be associated with a significant reduction in avoidable hospitalization and premature mortality rates. The method we tested is an important tool that could serve health care planning decisions in small communities.
The objective of this study was to assess the validity of electronic medical records-based diagnostic algorithms for 5 chronic conditions.
A retrospective validation study using primary chart abstraction. A standardized abstraction form was developed to ascertain diagnoses of diabetes, hypertension, osteoarthritis, chronic obstructive pulmonary disease, and depression. Information about billing, laboratory tests, notes, specialist and hospital reports, and physiologic data was collected. An age-stratified random sample of 350 patient charts was selected from Kingston, Ontario, Canada. Approximately 90% of those charts were allocated to people aged =60 years.
Three hundred thirteen patient records were included in the study. Patients' mean age was 68 years and 52% were women. High interrater reliability was indicated by 92% complete agreement and a ? statistic of 89.3%. The sensitivities of algorithms were 100% (diabetes), 83% (hypertension), 45% (osteoarthritis), 41% (chronic obstructive pulmonary disease), and 39% (depression). The lowest specificity was 97%, for depression. The positive predictive value ranged from 79% (depression) to 100%, and the negative predictive value ranged from 68% (osteoarthritis) to 100%.
The diagnostic algorithms for diabetes and hypertension demonstrate adequate accuracy, thus allowing their use for research and policy-making purposes. The algorithms for the other 3 conditions require further refinement to attain better sensitivities.