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PURPOSE Most models for managing chronic disease focus on single diseases. Managing patients with multimorbidity is an increasing challenge in family medicine. We evaluated the feasibility of a novel approach to caring for patients with multimorbidity, performing a case study of TIP--Telemedicine IMPACT (Interprofessional Model of Practice for Aging and Complex Treatments) Plus--a 1-time interprofessional consultation with primary care physicians (PCPs) and their patients in Toronto, Canada. METHODS We assessed feasibility of the TIP model from the number of referrals from PCPs and emergency departments in Toronto, Canada; the intervention cost; and the satisfaction of patients, PCPs, and team members with the new model. One patient and PCP story highlights the model's impact. We also performed thematic analysis of written feedback. RESULTS A total of 76 patients were referred from 53 PCPs and 4 emergency departments, and 65 PCPs participated in TIP. All 74 patient survey respondents indicated TIP improved their access to interdisciplinary resources, and 97% reported feeling hopeful their conditions would improve as a result. Of 21 PCP survey respondents, 100% reported they would use TIP again, and 90% reported improved confidence in managing their patient's care. Of 87 team member survey respondents, 97% rated TIP as effective. Qualitative findings indicated benefits to both patients and health professionals. The cost was about 22% less than that of a 1-day hospital admission through the emergency department (C$854 vs C$1,088). CONCLUSIONS TIP is a feasible intervention in multiple primary care settings that gives patients an active role in their health management, supported by their team. The model effectively addresses the needs of the most complex patients and their PCPs. Key words: multimorbidity; chronic disease; primary care; care coordination; integrated care; interprofessional relations; health care use; health information technology; health care team; practice-based research; telemedicine; primary care; patient-centered care; interdisciplinary health team, INTRODUCTION Canada, like other developed countries, is facing challenges in providing cost-effective, quality care to the 5% of patients with high needs, a group that consumes the majority of health [...]

Background: As the first point of contact in health care, primary care providers play an integral role in pandemic response. Despite this, primary care has been overlooked in previous pandemic plans, with a lack of emphasis on ways in which the unique characteristics of family practice could be leveraged to create a more effective response. Aim: To explore family physicians' perceptions of the integration of primary care in the COVID-19 pandemic response. Design and setting: Descriptive qualitative approach examining family physician roles during the COVID-19 pandemic across four regions in Canada. Method: Semi-structured qualitative interviews were conducted with family physicians and participants were asked about their roles during each pandemic stage, as well as facilitators and barriers they experienced in performing these roles. Interviews were transcribed and a thematic analysis approach was employed to develop a unified coding template across the four regions and identify recurring themes. Results: In total, 68 family physicians completed interviews. Four priorities for integrating primary care in future pandemic planning were identified: 1) improve communication with family physicians; 2) prioritise community-based primary care; 3) leverage the longitudinal relationship between patients and family physicians; and 4) preserve primary care workforce capacity. Across all regions, family physicians felt that primary care was not well incorporated into the COVID-19 pandemic response. Conclusion: Future pandemic plans require greater integration of primary care to ensure the delivery of an effective and coordinated pandemic response. Strengthening pandemic preparedness requires a broader reconsideration and better understanding of the central role of primary care in health system functioning. [ABSTRACT FROM AUTHOR]

Impaired awareness of hypoglycemia (IAH) has been linked to an increased rate of severe hypoglycemia (SH) in T1DM. Yet, few investigations have focused on quantifying this relationship in the context of T2DM, particularly from a pragmatic epidemiological lens. This study leverages the value of self-reported SH data to explore the real-world, population-based effect of IAH severity on SH rates in T2DM. A validated questionnaire (InHypo-DMPQ) was administered online to a nationally representative panel comprising Canadians (≥18 years) with T2DM using insulin and/or secretagogues. Data were collected on respondents' socio-demographic/clinical traits; self-reported incidence of SH (in the past year); and IAH severity, trisected by no, moderate, and severe impairment. Multivariable negative binomial regression (NBR) analysis was used to isolate the effect of IAH on SH. A directed acyclic graph was devised to identify the minimally sufficient adjustment set. Of the 452 complete respondents (mean age: 53.2 (SD: 14.7) years; male: 56%), 6% were classified with severe IAH, 67% with moderate IAH, and 27% with no IAH. Those with severe IAH had the highest crude annual SH rate (5.89 events/person-year, 95% CI: 5.01-6.88), which over doubled and tripled the SH rate in people with moderate IAH (p<0.001) and no IAH (p<0.001), respectively. The adjusted NBR analysis revealed a statistically significant association between IAH and SH (p=0.039). Individuals with severe IAH reported an adjusted annual SH rate that was 3.23 (95% CI: 1.13-9.27, p=0.029) times greater than those with no IAH. A similar trend was observed for moderate IAH versus no IAH (p=0.038). This real-world, population-based study provides timely insight into the high prevalence of moderate and severe IAH in people with T2DM using insulin and/or secretagogues. The marked impact of IAH on increased SH rates underscores a pressing need for the clinical prioritization of IAH assessment and management in T2DM. Disclosure: A. Ratzki-Leewing: None. S.B. Harris: Advisory Panel; Self; AstraZeneca, Janssen Pharmaceuticals, Inc., Lilly/Boehringer Ingelheim, Merck & Co., Inc., Novo Nordisk A/S, Sanofi. Consultant; Self; AstraZeneca, Janssen Pharmaceuticals, Inc., Lilly/Boehringer Ingelheim, Merck & Co., Inc., Novo Nordisk Inc., Sanofi. Research Support; Self; Abbott, AstraZeneca, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk A/S, Sanofi. Other Relationship; Self; Canadian Diabetes Association, Canadian Institutes of Health Research, The Lawson Foundation. N.H. Au: None. S. Webster-Bogaert: None. J.B. Brown: None. S.M. Reichert: Advisory Panel; Self; Abbott, AstraZeneca, Novo Nordisk Inc., Sanofi, Servier. Research Support; Self; Canadian Institutes of Health Research. Speaker's Bureau; Self; Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Inc., Sanofi. B.L. Ryan: None. Funding: Sanofi Canada [ABSTRACT FROM AUTHOR]

Using qualitative interviews with 68 family physicians (FPs) in Canada, we describe practice- and system-based approaches that were used to mitigate COVID-19 exposure in primary care settings across Canada to ensure the continuation of primary care delivery. Participants described how they applied infection prevention and control procedures (risk assessment, hand hygiene, control of environment, administrative control, personal protective equipment) and relied on centralized services that directed patients with COVID-19 to settings outside of primary care, such as testing centres. The multi-layered approach mitigated the risk of COVID-19 exposure while also conserving resources, preserving capacity and supporting supply chains., (Copyright © 2023 Longwoods Publishing.)

Objective: To explore the experiences and recommendations for recruitment of family physicians who practise and teach primary care obstetrics., Design: Qualitative study using in-depth interviews., Setting: Six primary care obstetrics groups in Edmonton, Alta, that were involved in teaching family medicine residents in the Department of Family Medicine at the University of Alberta., Participants: Twelve family physicians who practised obstetrics in groups. All participants were women, which was reasonably representative of primary care obstetrics providers in Edmonton., Methods: Each participant underwent an in-depth interview. The interviews were audiotaped and transcribed verbatim. The investigators independently reviewed the transcripts and then analyzed the transcripts together in an iterative and interpretive manner., Main Findings: Themes identified in this study include lack of confidence in teaching, challenges of having learners, benefits of having learners, and recommendations for recruiting learners to primary care obstetrics. While participants described insecurity and challenges related to teaching, they also identified positive aspects, and offered suggestions for recruiting learners to primary care obstetrics., Conclusion: Despite describing poor confidence as teachers and having challenges with learners, the participants identified positive experiences that sustained their interest in teaching. Supporting these teachers and recruiting more such role models is important to encourage family medicine learners to enter careers such as primary care obstetrics.