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Background: Performance reporting in primary health care in Canada is challenging because of the dearth of concise and synthesized information. The paucity of information occurs, in part, because the majority of primary health care in Canada is delivered through a multitude of privately owned small businesses with no mechanism or incentives to provide information about their performance. The purpose of this paper is to report the methods used to recruit family physicians and their patients across 10 provinces to provide self-reported information about primary care and how this information could be used in recruitment and data collection for future large scale pan-Canadian and other cross-country studies. Methods: Canada participated in an international large scale study-the QUALICO-PC (Quality and Costs of Primary Care) study. A set of four surveys, designed to collect in-depth information regarding primary care activities was collected from: practices, providers, and patients (experiences and values). Invitations (telephone, electronic or mailed) were sent to family physicians. Eligible participants were sent a package of surveys. Provincial teams kept records on the number of: invitation emails/letters sent, physicians who registered, practices that were sent surveys, and practices returning completed surveys. Response and cooperation rates were calculated. Results: Invitations to participate were sent to approximately 23,000 family physicians across Canada. A total of 792 physicians and 8,332 patients from 772 primary care practices completed the surveys, including 1,160 participants completing a Patient Values survey and 7,172 participants completing a Patient Experience survey. Overall, the response rate was very low ranging from 2% (British Columbia) to 21% (Nova Scotia). However, the participation rate was high, ranging from 72% (Ontario) to 100% (New Brunswick/Prince Edward Island and Newfoundland & Labrador). Conclusions: The difficulties obtaining acceptable response rates by family physicians for survey participation is a universal challenge. This response rate for the QUALICO-PC arm in Canada was similar to rates found in other countries such as Australia and New Zealand. Even though most family physicians operate as self-employed small businesses, they could be supported to routinely submit data through a collective effort and provincial mandate. The groundwork in setting up pan-Canadian collaboration in primary care has been established through this study. [ABSTRACT FROM AUTHOR]

Background: Healthy body weight (HBW) determination affects multiple aspects of eating disorder (ED) treatment. For example, it can inform patients and providers as to when return of menses (ROM), an objective determinant of health, can occur. Growth curves (GCs) are sensitive indicators of health in youth and when up to date provide critical information regarding normal and expected trajectories of growth. Although not widely recommended as a first line tool for HBW calculation, a GC guides providers selecting a HBW that is individualized to each patient. The primary aim of this paper was to assess availability and feasibility of utilizing GC data for HBW prediction in adolescents referred for an ED assessment. We also sought to determine how this calculation compared to the standardized HBW calculation that uses mean body mass index (BMI) for age and how each of these numbers compared to the actual weight at ROM. Methods: A retrospective chart review was completed on outpatients assessed for EDs between January 2004 and December 2006. A total of 102 patients met inclusion criteria. Demographic information, GC data, HBW predictions, and menstrual history were analyzed. A comparison of predicted HBWs using the aforementioned calculations and weight at ROM was performed using t-test analyses. Results: Eighty-one patients (79.4%) had GC data available at assessment although HBW prediction was possible in only 24 patients (23.8%) due to poor GC completion. Of those 24 patients, 9 had ROM data available; no significant difference between our predicted HBW and the weight at ROM was found in these patients. In cases where HBW predictions could be compared using GC data and the BMI method, we found the GC calculation to be overall superior. Conclusions: We found overall rates of GC completion to be very low in our patients, which in turn limited the feasibility of relying on a GC for HBW calculation in ED patients. When complete, GCs provide accurate HBWs for most patients with EDs although it is clear that secondary methods of calculation are required given the gaps in data observed using this cohort. [ABSTRACT FROM AUTHOR]

Background: Goal setting is a recommended approach in clinical care that can help individuals with multi-morbidities and their caregivers manage chronic conditions. In this paper, the types of goals that were important for older persons with multi-morbidities were explored from the perspectives of patients, their caregivers and physicians. Comparisons of goals were made across each patient, caregiver and physician triad to determine alignment. Methods: The study was a qualitative descriptive study facilitated through semi-structured one-on-one interviews. The study took place between May and October 2012 at a Family Health Team located in Ontario, Canada. The sample included 28 family medicine patients, their informal caregivers and family physicians. Socio-demographic data were analyzed via descriptive statistics in SPSS Version 17. Open ended questions pertaining to patient goals of care were analyzed thematically using NVivo9. Themes were derived on patient care goals for each of the participant groups (patients, caregivers and family physicians). Following this, alignment of goals across each of the triads was examined. Goal alignment was defined as concurrence on at least one goal by all three parties in a particular triad (i.e., patient, caregiver and family physician). Results: Just over half of the patients were male (56%); they had an average age of 82.3 years and 4.61 health conditions. Most of the caregivers were female (82%); and 61% were a spouse of the care recipient. At the aggregate level, common goals expressed among patients, caregivers and family physicians were the maintenance of functional independence of patients and the management of their symptoms or functional challenges. Despite these common goals at the aggregate level, little alignment of goals was found when looking across patient-caregiver and physician triads. Lack of alignment tended to occur when patients had unstable or declining functional or cognitive health; when safety threats were noted; and when enhanced care services were required. Conclusions: The data suggest that goal divergence tends to occur when patients are less medically stable. While goal divergence may be expected due to the different roles and responsibilities of each of the players involved, these perspectives should be illuminated when building care plans. Further research is required to observe the extent to which goal setting occurs in family practice as well as how it can be embedded as a standard of practice. [ABSTRACT FROM AUTHOR]