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Acceptability of reminder letters for Papanicolaou tests: a survey of women from 23 Family Health Networks in Ontario.

https://arctichealth.org/en/permalink/ahliterature160995
Source
J Obstet Gynaecol Can. 2007 Oct;29(10):829-34
Publication Type
Article
Date
Oct-2007
Author
Tina Karwalajtys
Janusz Kaczorowski
Lynne Lohfeld
Stephanie Laryea
Kelly Anderson
Stefanie Roder
Rolf J Sebaldt
Author Affiliation
Department of Family Medicine, McMaster University, Hamilton ON.
Source
J Obstet Gynaecol Can. 2007 Oct;29(10):829-34
Date
Oct-2007
Language
English
Publication Type
Article
Keywords
Adult
Aged
Female
Health Care Surveys
Health Promotion - methods
Humans
Middle Aged
Ontario
Papanicolaou test
Patient compliance
Reminder Systems
Vaginal Smears
Women's health
Abstract
To explore women's perspectives on the acceptability and content of reminder letters from the family physician for Papanicolaou (Pap) test screening and the effect of reminder letters on compliance with screening recommendations.
A population-based survey was conducted in 23 Family Health Networks and Primary Care Networks participating in a demonstration project to increase the delivery of preventive services in Ontario. Questionnaires were mailed to randomly selected women aged 35 to 69 years who had received a reminder letter for a Pap test from their family physician within the previous six months. Two focus groups were conducted with a volunteer sample of respondents.
The usable response rate was 54.3% (406/748). Two-thirds (65.8%, 267/406) of women who completed the survey recalled receiving the reminder letter. Overall, 52.3% (212/405) reported having a Pap test in the past six months. Among women who recalled the reminder letter and scheduled or had a Pap test, 71.4% (125/175) reported that the letter influenced their decision to be screened. The majority of respondents (80.8%, 328/406) wanted to continue to receive reminder letters for Pap tests from their physician, and 34.5% (140/406) wanted to receive additional information about cervical screening. Focus group interviews indicated that women who have had a Pap test may still be unsure about screening recommendations, what the test detects, and the rationale for follow-up procedures.
Reminder letters in family practice were viewed as useful and influenced women's decisions to undergo Pap test screening. Women who have had a Pap test may still need additional information about the test.
PubMed ID
17915066 View in PubMed
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Blood pressure self-monitoring in pharmacies. Building on existing resources.

https://arctichealth.org/en/permalink/ahliterature187650
Source
Can Fam Physician. 2002 Oct;48:1594-5, 1602-4
Publication Type
Article
Date
Oct-2002

Cardiovascular Health Awareness Program (CHAP): a community cluster-randomised trial among elderly Canadians.

https://arctichealth.org/en/permalink/ahliterature158054
Source
Prev Med. 2008 Jun;46(6):537-44
Publication Type
Article
Date
Jun-2008
Author
Janusz Kaczorowski
Larry W Chambers
Tina Karwalajtys
Lisa Dolovich
Barbara Farrell
Beatrice McDonough
Rolf Sebaldt
Cheryl Levitt
William Hogg
Lehana Thabane
Karen Tu
Ron Goeree
J Michael Paterson
Mamdouh Shubair
Tracy Gierman
Shannon Sullivan
Megan Carter
Author Affiliation
Department of Family Practice, University of British Columbia, Canada. janusz.kaczorowski@familymed.ubc.ca
Source
Prev Med. 2008 Jun;46(6):537-44
Date
Jun-2008
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Awareness
Canada
Cardiovascular Diseases - prevention & control
Cardiovascular System
Cluster analysis
Community Medicine
Female
Health Knowledge, Attitudes, Practice
Health promotion
Humans
Hypertension - prevention & control
Male
Program Evaluation
Social Marketing
Abstract
High blood pressure is an important and modifiable cardiovascular disease risk factor that remains under-detected and under-treated. Community-level interventions that address high blood pressure and other modifiable risk factors are a promising strategy to improve cardiovascular health in populations. The present study is a community cluster-randomised trial testing the effectiveness of CHAP (Cardiovascular Health Awareness Program) on the cardiovascular health of older adults.
Thirty-nine mid-sized communities in Ontario, Canada were stratified by geographic location and size of the population aged >or=65 years and randomly allocated to receive CHAP or no intervention. In CHAP communities, residents aged >or=65 years were invited to attend cardiovascular risk assessment sessions held in pharmacies over 10 weeks in Fall, 2006. Sessions included blood pressure measurement and feedback to family physicians. Trained volunteers delivered the program with support from pharmacists, community nurses and local organisations.
The primary outcome measure is the relative change in the mean annual rate of hospital admission for acute myocardial infarction, congestive heart failure and stroke (composite end-point) among residents aged >or=65 years in intervention and control communities, using routinely collected, population-based administrative health data.
This paper highlights considerations in design, implementation and evaluation of a large-scale, community-wide cardiovascular health promotion initiative.
PubMed ID
18372036 View in PubMed
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A community-based program for cardiovascular health awareness.

https://arctichealth.org/en/permalink/ahliterature169670
Source
Can J Public Health. 2005 Jul-Aug;96(4):294-8
Publication Type
Article
Author
Larry W Chambers
Janusz Kaczorowski
Lisa Dolovich
Tina Karwalajtys
Heather L Hall
Beatrice McDonough
William Hogg
Barbara Farrell
Alexandra Hendriks
Cheryl Levitt
Author Affiliation
Elisabeth Bruyère Research Institute, Ottawa, ON. lchamber@scohs.on.ca
Source
Can J Public Health. 2005 Jul-Aug;96(4):294-8
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Attitude to Health
Cardiovascular Diseases - prevention & control
Community Health Planning - organization & administration
Family Practice - organization & administration
Health Education - organization & administration
Health Knowledge, Attitudes, Practice
Health Promotion - organization & administration
Humans
Ontario
Patient Acceptance of Health Care
Pharmacies - organization & administration
Process Assessment (Health Care)
Abstract
The objective of the Cardiovascular Health Awareness Program (CHAP) is to improve the processes of care related to the cardiovascular health of older adults.
Two Ontario communities including family physicians (FP), pharmacists, public health units and nurses, volunteer peer health educators, older adult patients and community organizations.
Community pharmacies and family physician offices.
CHAP is designed to close a process of care loop around cardiovascular health awareness that originates from, and returns to, the FP. Older patients are invited by their FP to attend pharmacy CHAP sessions. At these sessions, trained volunteer peer health educators (PHEs) assist patients both in recording their blood pressure using a calibrated automated device and in completing a cardiovascular risk profile. This information is relayed to their respective FP via an automated computerized database. Pharmacists and patients receive copies of the results. Based on these cumulative risk profiles, patients are advised to follow-up with their FP.
Of the FPs and pharmacists asked, 47% and 79%, respectively, agreed to participate in the project. 39% of older adult patients invited by their FPs attended the CHAP community pharmacy sessions. Of these, 100% agreed to having their risk profile, including their blood pressure readings, forwarded to their FP. Positive feedback about CHAP was expressed by the volunteer PHEs, the FPs and the pharmacists.
The community-based pharmacy CHAP sessions are a feasible way of improving patient, physician, and pharmacist access to reliable blood pressure measurements and to cardiovascular health information. A randomized trial is in progress that will assess the impact of CHAP on monitoring of blood pressure.
PubMed ID
16625801 View in PubMed
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Community mobilization, participation, and blood pressure status in a Cardiovascular Health Awareness Program in Ontario.

https://arctichealth.org/en/permalink/ahliterature115965
Source
Am J Health Promot. 2013 Mar-Apr;27(4):252-61
Publication Type
Article
Author
Tina Karwalajtys
Janusz Kaczorowski
Larry W Chambers
Heather Hall
Beatrice McDonough
Lisa Dolovich
Rolf Sebaldt
Lynne Lohfeld
Brian Hutchison
Author Affiliation
Department of Family Medicine, Faculty of Health Sciences, McMaster University, Grimsby, Ontario, Canada.
Source
Am J Health Promot. 2013 Mar-Apr;27(4):252-61
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Blood Pressure Determination
Cardiovascular Diseases - prevention & control
Community Networks
Feasibility Studies
Female
Health Knowledge, Attitudes, Practice
Health promotion
Humans
Hypertension - diagnosis - drug therapy
Male
Ontario
Pilot Projects
Risk factors
Abstract
To determine the feasibility of a community-wide approach integrated with primary care (Cardiovascular Health Awareness Program [CHAP]) to promote monitoring of blood pressure (BP) and awareness of cardiovascular disease risk.
Demonstration project.
Two midsized Ontario communities.
Community-dwelling seniors.
CHAP sessions were offered in pharmacies and promoted to seniors using advertising and personalized letters from physicians. Trained volunteers measured BP, completed risk profiles, and provided risk-specific education materials.
We examined the distribution of risk factors among participants and predictors of multiple visits and elevated BP.
Opinion leaders aided recruitment of family physicians (n ?=? 56/63) and pharmacists (n ?=? 18/19). Over 90 volunteers were recruited. Invitations were mailed to 4394 seniors. Over 10 weeks, there were 4165 assessments of 2350 unique participants (approximately 30% of senior residents). 37.5% of attendees had untreated (16%; 360/2247) or uncontrolled (21.5%; 482/2247) high BP. Participants who received a letter (odds ratio [OR] 2.5, 95% confidence interval [CI] 2.1-3.0), had an initial elevated BP (OR 1.2, 95% CI 1.0-1.5), or reported current antihypertensive medication (OR 1.4, 95% CI 1.1-1.6) were more likely to attend multiple sessions (p = .05 for all). Older age (= 70 years; OR 1.5, 95% CI 1.3-1.8), BMI = 30 (OR 1.7, 95% CI 1.4-2.2), current antihypertensive medication (OR 1.6, 95% CI 1.3-1.9), and diabetes (OR 2.4, 95% CI 1.9-3.2) predicted elevated BP (p
PubMed ID
23448415 View in PubMed
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Development of the volunteer peer educator role in a community Cardiovascular Health Awareness Program (CHAP): a process evaluation in two communities.

https://arctichealth.org/en/permalink/ahliterature151650
Source
J Community Health. 2009 Aug;34(4):336-45
Publication Type
Article
Date
Aug-2009
Author
Tina Karwalajtys
Beatrice McDonough
Heather Hall
Manal Guirguis-Younger
Larry W Chambers
Janusz Kaczorowski
Lynne Lohfeld
Brian Hutchison
Author Affiliation
Department of Family Medicine, McMaster University, ON, Canada. karwalt@mcmaster.ca
Source
J Community Health. 2009 Aug;34(4):336-45
Date
Aug-2009
Language
English
Publication Type
Article
Keywords
Aged
Cardiovascular Diseases - prevention & control
Female
Health education
Health Knowledge, Attitudes, Practice
Health promotion
Human Experimentation
Humans
Male
Middle Aged
Ontario
Peer Group
Questionnaires
Teaching - manpower
Abstract
Volunteers can support the delivery and sustainability of programs promoting chronic disease awareness to improve health at the community level. This paper describes the development of the peer education component of the Cardiovascular Health Awareness Program (CHAP) and assessment of the volunteer peer educator role in a community-wide demonstration project in two mid-sized Ontario communities. A case study approach was used incorporating process learning, a volunteer survey and debriefing discussions with volunteers. A post-program questionnaire was administered to 48 volunteers. Five debriefing discussions were conducted with 27 volunteers using a semi-structured interview guide. Discussions were audio-recorded and transcribed. Analysis used an editing approach to identify themes, taking into account the community-specific context. Volunteers reported an overall positive experience and identified rewarding aspects of their involvement. They felt well prepared but appreciated ongoing training and support and requested more refresher training. Understanding of program objectives increased volunteer satisfaction. Volunteers continued to develop their role during the program; however, organizational and logistical factors sometimes limited skill acquisition and contributions. The prospect of greater involvement in providing tailored health education resources addressing modifiable risk factors was acceptable to most volunteers. Continued refinement of strategies to recruit, train, retain and support volunteers strengthened the peer education component of CHAP. The experience and contributions of volunteers were influenced by the wider context of program delivery. Process evaluation allowed program planners to anticipate challenges, strengthen support for volunteer activities, and expand the peer educator role. This learning can inform similar peer-led health promotion initiatives.
PubMed ID
19350374 View in PubMed
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Implementing a standardized community-based cardiovascular risk assessment program in 20 Ontario communities.

https://arctichealth.org/en/permalink/ahliterature148045
Source
Health Promot Int. 2009 Dec;24(4):325-33
Publication Type
Article
Date
Dec-2009
Author
Megan Carter
Tina Karwalajtys
Larry Chambers
Janusz Kaczorowski
Lisa Dolovich
Tracy Gierman
Dana Cross
Stephanie Laryea
Author Affiliation
Elisabeth Bruyère Research Institute, Ottawa, Ontario, Canada. mcart037@uottawa.ca
Source
Health Promot Int. 2009 Dec;24(4):325-33
Date
Dec-2009
Language
English
Publication Type
Article
Keywords
Cardiovascular Diseases - epidemiology
Community Pharmacy Services - organization & administration
Consumer Participation - methods
Data Collection - methods
Health Promotion - organization & administration
Humans
Hypertension - diagnosis
Information Storage and Retrieval
Ontario
Physicians, Family
Risk assessment
Volunteers - organization & administration
Abstract
The aim of the study is to describe the implementation of the Cardiovascular Health Awareness Program (CHAP) in 20 mid-sized communities across Ontario, Canada, and identify key factors in the successful multi-site delivery of a collaborative cardiovascular risk assessment and management program. Lead organizations were identified and contracted following a request for proposals. An Implementation Guide detailed steps in community mobilization and delivery of volunteer-led pharmacy-based cardiovascular risk assessment sessions. Process data were collected through final reports; a debriefing meeting; and interviews with program staff. All 20 communities successfully implemented CHAP. Overall, 99% (338/341) of family physicians agreed to receive assessment results and 89% (129/145) of pharmacies held sessions. Five hundred and seventy-seven volunteers conducted 27,358 risk assessments for 15,889 unique participants. Essential program components were consistently included, however, variations in materials, processes and support occurred. Factors in program success included: local expertise, centralized support, identification and engagement of local physician and pharmacist opinion leaders and a balance of standardization and flexibility. Monitoring delivery of a multi-community cardiovascular risk assessment program yielded key factors in program success to inform development of a sustainable and transferable model.
PubMed ID
19819896 View in PubMed
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Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP).

https://arctichealth.org/en/permalink/ahliterature137272
Source
BMJ. 2011;342:d442
Publication Type
Article
Date
2011
Author
Janusz Kaczorowski
Larry W Chambers
Lisa Dolovich
J Michael Paterson
Tina Karwalajtys
Tracy Gierman
Barbara Farrell
Beatrice McDonough
Lehana Thabane
Karen Tu
Brandon Zagorski
Ron Goeree
Cheryl A Levitt
William Hogg
Stephanie Laryea
Megan Ann Carter
Dana Cross
Rolf J Sabaldt
Author Affiliation
Department of Family Practice, University of British Columbia, 320-5950 University Boulevard, Vancouver, BC, Canada V6T 1Z3. Janusz.kaczorowski@familymed.ubc.ca
Source
BMJ. 2011;342:d442
Date
2011
Language
English
Publication Type
Article
Keywords
Aged
Cardiovascular Diseases - mortality - prevention & control
Cluster analysis
Community Health Services - statistics & numerical data
Continuity of Patient Care
Female
Health Promotion - methods
Hospitalization - statistics & numerical data
Humans
Male
Ontario - epidemiology
Program Evaluation
Referral and Consultation
Abstract
To evaluate the effectiveness of the community based Cardiovascular Health Awareness Program (CHAP) on morbidity from cardiovascular disease.
Community cluster randomised trial.
39 mid-sized communities in Ontario, Canada, stratified by location and population size.
Community dwelling residents aged 65 years or over, family physicians, pharmacists, volunteers, community nurses, and local lead organisations.
Communities were randomised to receive CHAP (n = 20) or no intervention (n = 19). In CHAP communities, residents aged 65 or over were invited to attend volunteer run cardiovascular risk assessment and education sessions held in community based pharmacies over a 10 week period; automated blood pressure readings and self reported risk factor data were collected and shared with participants and their family physicians and pharmacists.
Composite of hospital admissions for acute myocardial infarction, stroke, and congestive heart failure among all community residents aged 65 and over in the year before compared with the year after implementation of CHAP.
All 20 intervention communities successfully implemented CHAP. A total of 1265 three hour long sessions were held in 129/145 (89%) pharmacies during the 10 week programme. 15,889 unique participants had a total of 27,358 cardiovascular assessments with the assistance of 577 peer volunteers. After adjustment for hospital admission rates in the year before the intervention, CHAP was associated with a 9% relative reduction in the composite end point (rate ratio 0.91, 95% confidence interval 0.86 to 0.97; P = 0.002) or 3.02 fewer annual hospital admissions for cardiovascular disease per 1000 people aged 65 and over. Statistically significant reductions favouring the intervention communities were seen in hospital admissions for acute myocardial infarction (rate ratio 0.87, 0.79 to 0.97; P = 0.008) and congestive heart failure (0.90, 0.81 to 0.99; P = 0.029) but not for stroke (0.99, 0.88 to 1.12; P = 0.89).
A collaborative, multi-pronged, community based health promotion and prevention programme targeted at older adults can reduce cardiovascular morbidity at the population level. Trial registration Current controlled trials ISRCTN50550004.
Notes
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PubMed ID
21300712 View in PubMed
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Medical records 1954 to 1974. Navigation of a "new" discipline.

https://arctichealth.org/en/permalink/ahliterature174443
Source
Can Fam Physician. 2005 May;51:706-7
Publication Type
Article
Date
May-2005
Author
Tina Karwalajtys
Author Affiliation
Department of Family Medicine, McMaster University, Hamilton, Ont.
Source
Can Fam Physician. 2005 May;51:706-7
Date
May-2005
Language
English
Publication Type
Article
Keywords
Canada
Family Practice - trends
Forms and Records Control - trends
Humans
Medical Records
Research - trends
Social Responsibility
PubMed ID
15934275 View in PubMed
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Patient views on reminder letters for influenza vaccinations in an older primary care patient population: a mixed methods study.

https://arctichealth.org/en/permalink/ahliterature157380
Source
Can J Public Health. 2008 Mar-Apr;99(2):133-6
Publication Type
Article
Author
Kelly K Anderson
Rolf J Sebaldt
Lynne Lohfeld
Tina Karwalajtys
Afisi S Ismaila
Ron Goeree
Faith C Donald
Ken Burgess
Janusz Kaczorowski
Author Affiliation
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON.
Source
Can J Public Health. 2008 Mar-Apr;99(2):133-6
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Attitude to Health
Female
Health Care Surveys
Humans
Influenza Vaccines
Influenza, Human - prevention & control
Male
Ontario
Patient Acceptance of Health Care
Patient satisfaction
Physicians, Family
Preventive Health Services
Primary Health Care - methods
Qualitative Research
Questionnaires
Reminder Systems
Abstract
To explore the perspectives of older adults on the acceptability of reminder letters for influenza vaccinations.
We randomly selected 23 family physicians from each Family Health and Primary Care network participating in a demonstration project designed to increase the delivery of preventive services in Ontario. From the roster of each physician, we surveyed 35 randomly selected patients over 65 years of age who recently received a reminder letter regarding influenza vaccinations from their physician. The questionnaires sought patient perspectives on the acceptability and usefulness of the letter. We also conducted follow-up telephone interviews with a subgroup of respondents to explore some of the survey findings in greater depth.
85.3% (663/767) of patients completed the questionnaire. Sixty-five percent of respondents recalled receiving the reminder (n=431), and of those, 77.3% found it helpful. Of the respondents who recalled the letter and received a flu shot (n=348), 11.2% indicated they might not have done so without the letter. The majority of respondents reported that they would like to continue receiving reminder letters for influenza vaccinations (63.0%) and other preventive services (77.1%) from their family physician. The interview participants endorsed the use of reminder letters for improving vaccination coverage in older adults, but did not feel that the strategy was required for them personally.
The general attitude of older adults towards reminder letters was favourable, and the reminders appear to have contributed to a modest increase in influenza vaccination rates.
PubMed ID
18457289 View in PubMed
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13 records – page 1 of 2.