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The antibiotic management of gonorrhoea in Ontario, Canada following multiple changes in guidelines: an interrupted time-series analysis.

https://arctichealth.org/en/permalink/ahliterature290374
Source
Sex Transm Infect. 2017 12; 93(8):561-565
Publication Type
Journal Article
Date
12-2017
Author
Catherine Dickson
Monica Taljaard
Dara Spatz Friedman
Gila Metz
Tom Wong
Jeremy M Grimshaw
Author Affiliation
Medical Resident,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Alta Vista Campus Room, Ottawa, Canada.
Source
Sex Transm Infect. 2017 12; 93(8):561-565
Date
12-2017
Language
English
Publication Type
Journal Article
Keywords
Female
Gonorrhea - drug therapy - epidemiology
Guideline Adherence
Humans
Interrupted Time Series Analysis
Male
Microbial Sensitivity Tests
Neisseria gonorrhoeae - drug effects
Ontario - epidemiology
Practice Guidelines as Topic
Public Health
Abstract
This study assessed adherence with first-line gonorrhoea treatment recommendations in Ontario, Canada, following recent guideline changes due to antibiotic resistance.
We used interrupted times-series analyses to analyse treatment data for cases of uncomplicated gonorrhoea reported in Ontario, Canada, between January 2006 and May 2014. We assessed adherence with first-line treatment according to the guidelines in place at the time and the use of specific antibiotics over time. We used the introduction of new recommendations in the Canadian Guidelines for Sexually Transmitted Infections in 2008 and 2011 and the release of the province of Ontario's Guidelines for the Treatment and Management of Gonococcal Infections in Ontario in 2013 as interruptions in the time-series analysis.
Overall, 34?287 gonorrhoea cases were reported between 1 January 2006 and 31 May 2014. Treatment data were available for 32?312 (94.2%). Our analysis included 32?272 (94.1%) cases without either a conjunctival or disseminated infection. Following the release of the 2011 recommendations, adherence with first-line recommendations immediately decreased to below 30%. Adherence slowly increased but did not reach baseline levels before the 2013 guidelines were released. Following release of the 2013 guidelines, adherence again decreased; adherence is slowly recovering but by May 2014, was only approximately 60%.
Due to concerns about antibiotic resistance, gonorrhoea treatment guidelines need to be updated regularly and rapidly adopted in practice. Our study showed poor adherence following dissemination of updated guidelines. Over a year after the latest Ontario guidelines were released, 40% of patients did not receive first-line treatment, putting them at risk of treatment failure and potentially promoting further drug resistance. Greater attention should be devoted to dissemination and implementation of new guidelines.
PubMed ID
28844044 View in PubMed
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Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study.

https://arctichealth.org/en/permalink/ahliterature130373
Source
BMC Fam Pract. 2011;12:114
Publication Type
Article
Date
2011
Author
Clare Liddy
Jatinderpreet Singh
William Hogg
Simone Dahrouge
Monica Taljaard
Author Affiliation
CT Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, Ottawa, Ontario, K1N 5C8, Canada. cliddy@bruyere.org
Source
BMC Fam Pract. 2011;12:114
Date
2011
Language
English
Publication Type
Article
Keywords
Capitation Fee
Cardiovascular Diseases - economics - epidemiology - prevention & control
Community Health Centers - economics - organization & administration - standards
Comorbidity
Cross-Sectional Studies
Evidence-Based Practice - economics - statistics & numerical data
Fee-for-Service Plans
Guideline Adherence - economics - statistics & numerical data
Humans
Medical Audit
Models, Economic
Models, organizational
Ontario - epidemiology
Primary Health Care - classification - economics - standards
Reimbursement Mechanisms - classification - economics - statistics & numerical data
Abstract
Primary care providers play an important role in preventing and managing cardiovascular disease. This study compared the quality of preventive cardiovascular care delivery amongst different primary care models.
This is a secondary analysis of a larger randomized control trial, known as the Improved Delivery of Cardiovascular Care (IDOCC) through Outreach Facilitation. Using baseline data collected through IDOCC, we conducted a cross-sectional study of 82 primary care practices from three delivery models in Eastern Ontario, Canada: 43 fee-for-service, 27 blended-capitation and 12 community health centres with salary-based physicians. Medical chart audits from 4,808 patients with or at high risk of developing cardiovascular disease were used to examine each practice's adherence to ten evidence-based processes of care for diabetes, chronic kidney disease, dyslipidemia, hypertension, weight management, and smoking cessation care. Generalized estimating equation models adjusting for age, sex, rurality, number of cardiovascular-related comorbidities, and year of data collection were used to compare guideline adherence amongst the three models.
The percentage of patients with diabetes that received two hemoglobin A1c tests during the study year was significantly higher in community health centres (69%) than in fee-for-service (45%) practices (Adjusted Odds Ratio (AOR) = 2.4 [95% CI 1.4-4.2], p = 0.001). Blended capitation practices had a significantly higher percentage of patients who had their waistlines monitored than in fee-for-service practices (19% vs. 5%, AOR = 3.7 [1.8-7.8], p = 0.0006), and who were recommended a smoking cessation drug when compared to community health centres (33% vs. 16%, AOR = 2.4 [1.3-4.6], p = 0.007). Overall, quality of diabetes care was higher in community health centres, while smoking cessation care and weight management was higher in the blended-capitation models. Fee-for-service practices had the greatest gaps in care, most noticeably in diabetes care and weight management.
This study adds to the evidence suggesting that primary care delivery model impacts quality of care. These findings support current Ontario reforms to move away from the traditional fee-for-service practice.
ClinicalTrials.gov: NCT00574808.
Notes
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PubMed ID
22008366 View in PubMed
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International survey of emergency physicians' awareness and use of the Canadian Cervical-Spine Rule and the Canadian Computed Tomography Head Rule.

https://arctichealth.org/en/permalink/ahliterature154594
Source
Acad Emerg Med. 2008 Dec;15(12):1256-61
Publication Type
Article
Date
Dec-2008
Author
Debra Eagles
Ian G Stiell
Catherine M Clement
Jamie Brehaut
Monica Taljaard
Anne-Maree Kelly
Suzanne Mason
Arthur Kellermann
Jeffrey J Perry
Author Affiliation
Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Source
Acad Emerg Med. 2008 Dec;15(12):1256-61
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Adult
Australasia
Canada
Cervical Vertebrae - injuries
Craniocerebral Trauma - radiography
Decision Support Techniques
Emergency Medicine - statistics & numerical data
Female
Great Britain
Guideline Adherence - statistics & numerical data
Health Care Surveys
Health Knowledge, Attitudes, Practice
Humans
Internationality
Male
Middle Aged
Physician's Practice Patterns - statistics & numerical data
Population Surveillance
Spinal Injuries - radiography
Tomography, X-Ray Computed - standards - utilization
United States
Abstract
The derivation and validation studies for the Canadian Cervical-Spine (C-Spine) Rule (CCR) and the Canadian Computed Tomography (CT) Head Rule (CCHR) have been published in major medical journals. The objectives were to determine: 1) physician awareness and use of these rules in Australasia, Canada, the United Kingdom, and the United States and 2) physician characteristics associated with awareness and use.
A self-administered e-mail and postal survey was sent to members of four national emergency physician (EP) associations using a modified Dillman technique. Results were analyzed using repeated-measures logistic regression models.
The response rate was 54.8% (1,150/2,100). Reported awareness of the CCR ranged from 97% (Canada) to 65% (United States); for the CCHR it ranged from 86% (Canada) to 31% (United States). Reported use of the CCR ranged from 73% (Canada) to 30% (United States); for the CCHR, it was 57% (Canada) to 12% (United States). Predictors of awareness were country, type of rule, full-time employment, younger age, and teaching hospital (p
PubMed ID
18945241 View in PubMed
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Quality of cardiovascular disease care in Ontario, Canada: missed opportunities for prevention - a cross sectional study.

https://arctichealth.org/en/permalink/ahliterature120776
Source
BMC Cardiovasc Disord. 2012;12:74
Publication Type
Article
Date
2012
Author
Clare Liddy
Jatinderpreet Singh
William Hogg
Simone Dahrouge
Catherine Deri-Armstrong
Grant Russell
Monica Taljaard
Ayub Akbari
George Wells
Author Affiliation
C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada. cliddy@bruyere.org
Source
BMC Cardiovasc Disord. 2012;12:74
Date
2012
Language
English
Publication Type
Article
Keywords
Aged
Cardiovascular Diseases - diagnosis - epidemiology - prevention & control - therapy
Cluster analysis
Comorbidity
Cross-Sectional Studies
Female
Guideline Adherence - statistics & numerical data
Health Care Surveys
Humans
Male
Middle Aged
Ontario - epidemiology
Physician's Practice Patterns - statistics & numerical data
Practice Guidelines as Topic
Preventive Health Services - statistics & numerical data
Primary Health Care - statistics & numerical data
Quality of Health Care - statistics & numerical data
Risk assessment
Risk factors
Risk Reduction Behavior
Abstract
Primary care plays a key role in the prevention and management of cardiovascular disease (CVD). We examined primary care practice adherence to recommended care guidelines associated with the prevention and management of CVD for high risk patients.
We conducted a secondary analysis of cross-sectional baseline data collected from 84 primary care practices participating in a large quality improvement initiative in Eastern Ontario from 2008 to 2010. We collected medical chart data from 4,931 patients who either had, or were at high risk of developing CVD to study adherence rates to recommended guidelines for CVD care and to examine the proportion of patients at target for clinical markers such as blood pressure, lipid levels and hemoglobin A1c.
Adherence to preventive care recommendations was poor. Less than 10% of high risk patients received a waistline measurement, half of the smokers received cessation advice, and 7.7% were referred to a smoking cessation program. Gaps in care exist for diabetes and kidney disease as 54.9% of patients with diabetes received recommended hemoglobin-A1c screenings, and only 55.8% received an albumin excretion test. Adherence rates to recommended guidelines for coronary artery disease, hypertension, and dyslipidemia were high (>75%); however
Notes
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PubMed ID
22970753 View in PubMed
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Quality of diabetes care in the Canadian forces.

https://arctichealth.org/en/permalink/ahliterature105107
Source
Can J Diabetes. 2014 Feb;38(1):11-6
Publication Type
Article
Date
Feb-2014
Author
Amole Khadilkar
Jeff Whitehead
Monica Taljaard
Doug Manuel
Author Affiliation
Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: amolek@rogers.com.
Source
Can J Diabetes. 2014 Feb;38(1):11-6
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Adult
Canada
Diabetes Mellitus - therapy
Female
Guideline Adherence - statistics & numerical data
Humans
Male
Middle Aged
Military Personnel
Practice Guidelines as Topic
Quality of Health Care
Retrospective Studies
Abstract
Published data on quality of care indicators from various countries indicate the challenges of providing high-quality diabetes care. The objective of this study was to evaluate the quality of care provided to members of the Canadian Forces (CF) who have diabetes, by determining the extent to which healthcare providers adhere to recommendations outlined in the 2008 Canadian Diabetes Association (CDA) clinical practice guidelines.
All 14 CF bases meeting eligibility criteria were included in the evaluation. Cases of diabetes were ascertained based on laboratory criteria. Adherence to 21 CDA guideline recommendations was evaluated following a review of patient medical records.
The CF demonstrated high adherence (>75%) with 9 recommendations, moderate adherence (50% to 75%) with 7 recommendations and low adherence (
PubMed ID
24485207 View in PubMed
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