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Background: High-quality ambulatory care can reduce cardiovascular disease risk, but important gaps exist in the provision of cardiovascular preventive care. We sought to develop a set of key performance indicators that can be used to measure and improve cardiovascular care in the primary care setting. Methods: As part of the Cardiovascular Health in Ambulatory Care Research Team initiative, we established a 14-member multidisciplinary expert panel to develop a set of indicators for measuring primary prevention performance in ambulatory cardiovascular care. We used a 2-stage modified Delphi panel process to rate potential indicators, which were identified from the literature and national cardiovascular organizations. The top-rated indicators were pilot tested to determine their measurement feasibility with the use of data routinely collected in the Canadian health care system. Results: A set of 28 indicators of primary prevention performance were identified, which were grouped into 5 domains: risk factor prevalence, screening, management, intermediate outcomes and long-term outcomes. The indicators reflect the major cardiovascular risk factors including smoking, obesity, hypertension, diabetes, dyslipidemia and atrial fibrillation. All indicators were determined to be amenable to measurement with the use of population-based administrative (physician claims, hospital admission, laboratory, medication), survey or electronic medical record databases. Interpretation: The Cardiovascular Health in Ambulatory Care Research Team indicators of primary prevention performance provide a framework for the measurement of cardiovascular primary prevention efforts in Canada. The indicators may be used by clinicians, researchers and policy-makers interested in measuring and improving the prevention of cardiovascular disease in ambulatory care settings. [ABSTRACT FROM AUTHOR]

Background: Patients with cardiovascular-related chronic diseases may face financial barriers to accessing health care, even in Canada, where universal health care insurance is in place. No current theory or framework is adequate for understanding the impact of financial barriers to care on these patients or how they experience financial barriers. The overall objective of this study is to develop a framework for understanding the role of financial barriers to care in the lives of patients with cardiovascular-related chronic diseases and the impact of such barriers on their health. Methods: We will perform an inductive qualitative grounded theory study to develop a framework to understand the effect of financial barriers to care on patients with cardiovascular-related chronic diseases. We will use semistructured interviews (face-to-face and telephone) with a purposive sample of adult patients from Alberta with at least 1 of hypertension, diabetes, heart disease or stroke. We will analyze interview transcripts in triplicate using grounded theory coding techniques, including open, focused and axial coding, following the principle of constant comparison. Interviews and analysis will be done iteratively to theoretical saturation. Member checking will be used to enhance rigour. Interpretation: A comprehensive framework for understanding financial barriers to accessing health care is instrumental for both researchers and clinicians who care for patients with chronic diseases. Such a framework would enable a better understanding of patient behaviour and nonadherence to recommended medical therapies and lifestyle modifications. [ABSTRACT FROM AUTHOR]

Background: The recent increase in the incidence of primary liver cancer in Canada has been attributed to a higher proportion of immigrants from countries endemic for hepatitis B virus (HBV) and hepatitis C virus (HCV). We examined hospital discharges for liver disease in Canada, focusing on those for all liver-related diseases, HBV infection, HCV infection and primary liver cancer, by 3 immigration- related variables: immigration status, duration of residence in Canada and risk level of the source country. Methods: We calculated annualized crude and age-standardized rates of a hospital stay in Canada for HBV infection, HCV infection, primary liver cancer and all liver-related diseases using data from the 2006 Canadian census (long form) linked to the Canadian Institute for Health Information Discharge Abstract Database for fiscal years 2006/07 to 2008/09. We estimated the odds of a hospital stay using logistic regression for the 3 immigration-related variables, adjusting for sociodemographic indicators. Results: Immigrants were less likely than Canadian-born residents to be discharged with a diagnosis of any liver-related condition (odds ratio [OR] 0.83, 95% confidence interval [CI] 0.78-0.89); however, they were more likely to be discharged with a diagnosis of HBV infection (OR 2.02, 95% CI 1.57-2.60) and primary liver cancer (OR 1.43, 95% CI 1.22-1.68). There was a clear association between a hospital stay for HBV infection and immigration from HBV-endemic countries (OR 5.15, 95% CI 3.87-6.84) and between a stay for HCV infection and immigration from HCV-endemic countries (OR 2.98, 95% CI 1.74-5.11). Adjustment for low income status and urban residence did not change the results. Interpretation: Although the odds of a liver-related hospital stay were lower among immigrants than among those born in Canada, immigrants from countries at high risk for HBV infection, HCV infection and primary liver cancer were more likely than Canadian-born residents to have a corresponding liver-related hospital stay. These findings emphasize the importance of identifying immigrants with hepatitis and engaging them in care to prevent complications. [ABSTRACT FROM AUTHOR]

Background: Health care providers have shown considerable interest in using information technologies such as email, text messages and video conferencing to facilitate the management of chronic noncommunicable diseases such as hypertension, diabetes mellitus and vascular disease. We sought to determine whether these technologies are available and appealing to the target population. Methods: We analyzed cross-sectional data from a computer-assisted telephone survey, conducted by Statistics Canada in February and March 2012, of western Canadian adults with at least 1 chronic condition. Survey respondents were asked about their capacity (e.g., "Do you own a mobile phone?") and willingness to use each of 3 information technologies (email, text messages and video conferencing) to interact with health care providers. For all analyses, Statistics Canada's calibrated design weights and bootstrap weights were used to obtain population-level point estimates for proportions and odds ratios. Results: In total, 1849 (79.8%) of 2316 eligible people participated. Of the 1849 participants, 81.9% had hypertension, 26.2% had diabetes, 21.4% had heart disease, and 7.9% had stroke; 32.2% had more than 1 of the 4 chronic conditions of interest. High proportions of respondents owned a computer with Internet access (76.4%, 95% confidence interval [CI] 73.3%-79.3%) or a mobile phone (73.9%, 95% CI 70.7%-76.8%). About two-thirds of respondents were interested in using email to interact with a specialist (66.3%, 95% CI 63.0%-69.5%); respondents were less enthusiastic about using text messages (44.9%, 95% CI 41.2%-48.7%). Enthusiasm for video conferencing was more pronounced among those residing further from medical specialists than among those living closer. Among respondents who were potentially interested in video conferencing, almost 50% of remote dwellers would use this technology if it saved more than 60 minutes of travel time. Interpretation: Many people were interested in using electronic technologies, especially video conferencing and email-based methods, to help manage their chronic condition. The effectiveness and cost implications of using email and video conferencing in the management of chronic disease deserve further consideration. [ABSTRACT FROM AUTHOR]

Background: For adults with chronic conditions, access to primary care, including multidisciplinary care, is associated with better outcomes. Few studies have assessed barriers to such care. We sought to describe barriers to primary care, including care from allied health professionals, for adults with chronic conditions., Methods: We surveyed western Canadians aged 40 years or older who had hypertension, diabetes, heart disease or stroke about access to primary care and other use of health care. Using log binomial regression, we determined the association between sociodemographic variables and several indicators of access to primary care and care from allied health professionals., Results: Of the 2316 people who were approached, 1849 (79.8%) completed the survey. Most of the respondents (95.1%) had a regular medical doctor, but two-thirds (68.1%) did not have after-hours access. Only 6.1% indicated that allied health professionals were involved in their care, although most respondents (87.3%) indicated they would be willing to see a nurse practitioner if their primary care physician was not available. Respondents who were obese or less than 65 years of age were less likely to have a regular medical doctor. Individuals who had diabetes, lived in a rural area, were residents of Alberta or had poorer health were more likely to have allied health professionals involved in their care., Interpretation: The survey results identified barriers to accessing primary care for people with chronic conditions. Opportunities for improving access to primary care may include greater involvement by allied health professionals, such as nurse practitioners.