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Background: Primary care surveys are a key source of evaluative data; understanding how survey respondents compare to the intended population is important to understand results in context. The objective of this study was to examine the physician and patient representativeness of two primary care surveys (TRANSFORMATION and QUALICOPC) that each used different sampling and recruitment techniques., Methods: We linked the physician and patient participants of the two surveys to health administrative databases. Patients were compared to other patients visiting the practice on the same day and other randomly selected dates using sociodemographic data, chronic disease diagnosis, and health system utilization. Physicians were compared to other physicians in the same practice, and other physicians in the intended geographic area using sociodemographic and practice characteristics., Results: Physician respondents of the TRANSFORMATION survey included more males compared to their practice groups, but not to other physicians in the area. TRANSFORMATION physicians cared for a larger roster of patients than other physicians in the area. Patient respondents of the QUALICOPC survey did not have meaningful differences from other patients who visit the practice. Patient respondents of the TRANSFORMATION survey resided in more rural areas, had less chronic disease, and had lower use of health services than other patients visiting the practice., Conclusion: Differences in survey recruitment methods at the physician and patient level may help to explain some of the differences in representativeness. When conducting primary care surveys, investigators should consider diverse methods of ensuring representativeness to limit the potential for nonresponse bias., (© 2023. The Author(s).)

Introduction: The purpose of this study is to assess whether annual refresher session offerings match the needs of physicians by coding and comparing session syllabi to physician questions collected electronically at the point of care., Methods: Thirteen syllabi from annual refresher continuing medical education (CME) events offered to family physicians in Canada were collected and their session titles and descriptions entered into a database. Titles and descriptions were coded using the International Classification for Primary Care version 2 (ICPC-2). Titles and descriptions were further coded depending on whether the sessions involved a drug treatment/medication component. Syllabi content was compared to previously determined questions asked by physicians at the point of care., Results: Of the original 701 session titles, 625 (89.2%) were suitable for analysis. CME sessions focused on musculoskeletal, digestive, skin, urologic, and general categories were underrepresented in comparison to point-of-care questions. The reverse was true for the psychological/mental health category., Discussion: Differences between questions asked by physicians at the point of care and the content of contemporaneous CME refresher courses can be analyzed to identify gaps in CME offerings. This knowledge could be used to develop CME curricula and highlight areas of need for inclusion in refresher courses., (© 2015 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.)

Purpose: In a primary care context favoring group practices, we assessed the validity of 2 new continuity measures (both versions of known provider continuity, KPC) that capture the concentration of care over time from multiple physicians (multiple provider continuity, KPC-MP) or from the physician seen most often (personal provider continuity, KPC-PP)., Methods: Patients with diabetes or cardiovascular disease (N = 765) were approached in the waiting rooms of 28 primary care clinics in 3 regions of the province of Quebec, Canada; answered a survey questionnaire measuring relational continuity, interpersonal communication, coordination within the clinic, coordination with specialists, and overall coordination; and gave permission for their medical records to be reviewed and their medical services utilization data for the previous 2 years to be accessed to measure KPC. Using generalized linear mixed models, we assessed the association between KPC and the patients' responses., Results: Among the 5 different patient-reported measures or their combination, KPC-MP was significantly related with overall coordination of care: for high continuity, the odds ratio (OR) = 2.02 (95% CI, 1.33-3.07), and for moderate continuity, OR = 1.61 (95% CI, 1.06-2.46). KPC-MP was also related with the combined continuity score: for high continuity, OR = 1.52 (95% CI, 1.11-2.09), and for moderate continuity, OR = 1.48 (95% CI, 1.10-2.00). KPC-PP was not significantly associated with any of the survey measures., Conclusions: The KPC-MP measure, based on readily available administrative data, is associated with patient-perceived overall coordination of care among multiple physicians. KPC measures are potentially a valuable and low-cost way to follow the effects of changes favoring group practice on continuity of care for entire populations. They are easy to replicate over time and across jurisdictions., (© 2014 Annals of Family Medicine, Inc.)

Background: Despite the apparent benefits to teaching, many faculty members are reluctant to participate in medical education research (MER) for a variety of reasons. In addition to the further demand on their time, physicians often lack the confidence to initiate MER projects and require more support in the form of funding, structure and guidance. These obstacles have contributed to a decline in physician participation in MER as well as to a perceived decay in its quality. As a countermeasure to encourage physicians to undertake research, the Department of Family Medicine at the University of Ottawa implemented a programme in which physicians receive the funding, coaching and support staff necessary to complete a 2-year research project. The programme is intended primarily for first-time researchers and is meant to serve as a gateway to a research career funded by external grants. Since its inception in 2010, the Program for Innovation in Medical Education (PIME) has supported 16 new clinician investigators across 14 projects.Methods: We performed a programme evaluation 3 years after the programme launched to assess its utility to participants. This evaluation employed semi-structured interviews with physicians who performed a research project within the programme.Results: Programme participants stated that their confidence in conducting research had improved and that they felt well supported throughout their project. They appreciated the collaborative nature of the programme and remarked that it had improved their willingness to solicit the expertise of others. Finally, the programme allowed participants to develop in the scholarly role expected by family physicians in Canada.Conclusion: The PIME may serve as a helpful model for institutions seeking to engage faculty physicians in Medical Education Research and to thereby enhance the teaching received by their medical learners. [ABSTRACT FROM AUTHOR]

Background: Canadians' health care-seeking behaviour for physical and mental health issues was examined using the international Quality and Cost of Primary Care (QUALICOPC) survey that was conducted in 2013 in Canada. Method: This study used the cross-sectional Patient Experiences Survey collected from 7260 patients in 759 practices across 10 Canadian provinces as part of the QUALICOPC study. A Responsive Care Scale (RCS) was constructed to reflect the degree of health care-seeking behaviour across 11 health conditions. Using several patient characteristics as independent variables, four multiple regression analyses were conducted. Results: Patients' self-reports indicated that there were gender differences in health care-seeking behaviour, with women reporting they visited their primary care provider to a greater extent than did men for both physical and mental health concerns. Overall, patients were less likely to seek care for mental health concerns in comparison to physical health concerns. For both women and men, the results of the regressions indicated that age, illness prevention, trust in physicians and chronic conditions were important factors when explaining health care-seeking behaviours for mental health concerns. Conclusion: This study confirms the gender differences in health care-seeking behaviour advances previous research by exploring in detail the variables predicting differences in health care-seeking behaviour for men and women. The variables were better predictors of health care-seeking behaviour in response to mental health concerns than physical health concerns, likely reflecting greater variation among those seeking mental health care. This study has implications for those working to improve barriers to health care access by identifying those more likely to engage in health care-seeking behaviours and the variables predicting health care-seeking. Consequently, those who are not accessing primary care can be targeted and policies can be developed and put in place to promote their health care-seeking behavior. [ABSTRACT FROM AUTHOR]

Background: Practice facilitation is an effective way to help physicians implement change in their clinics, but little is known about physicians' perspectives on this service.Objectives: To examine physicians' responses to a practice facilitation program, focussing on their overall satisfaction, perceived most significant clinical changes, and interactions with the facilitator.Methods: The Improved Delivery of Cardiovascular Care program investigated the impact of practice facilitation on improving the quality of cardiovascular primary care in Eastern Ontario, Canada, from 2007 to 2011. We conducted a qualitative content analysis of post-intervention surveys completed by participating physicians, using a constant comparison approach framed around the Chronic Care Model.Results: Ninety-five physicians completed the survey. Physicians overwhelmingly viewed the program positively, though descriptions of its benefits and impact varied widely. Facilitators filled three key roles for physicians, acting as a resource centre, motivator and outside perspective. Physicians adopted a number of changes in their practices. These changes include adoption of clinical information systems (diabetes registries), decision support tools (chart audits, guideline documents, flow sheets) and delivery system design (community resources).Conclusions: Most physicians appreciated having access to a practice facilitator and viewed the intervention positively. Insight into physicians' perspectives on practice facilitation provides a valuable counterpoint to outcomes-based evaluations of such services. Further research should investigate potential obstacles in the group of physicians who make fewer practice changes, as well as the sustainability of this type of facilitation intervention. [ABSTRACT FROM AUTHOR]

Background: People with HIV are living longer and their care has shifted towards the prevention and management of comorbidities. However, little is known about who is providing their care. Our objective was to characterize the provision of HIV care in Ontario by physician specialty. Methods: We conducted a retrospective population-based observational study using linked administrative databases in Ontario, Canada, a single payer health care system. All Ontarians with HIV were identified using a validated case ascertainment algorithm. We examined office-based health care visits for this cohort between April 1, 2009 and March 31, 2012. Physician characteristics were compared between specialty groups. We stratified the frequency and distribution of physician care into three categories: (a) care by physician specialty (family physicians, internal medicine specialists, infectious disease specialists, and other specialists), (b) care based on physician caseload (low, medium or high categorized as =5, 6-49 or =50 HIV patients per physician), and (c) care that is related to HIV versus unrelated to HIV. Results: Family physicians were older, graduated earlier, were more often female, and were the only group practicing in rural settings. Unlike other specialists, most family physicians (76.8%) had low-volume caseloads. There were 406,411 outpatient visits made by individuals with HIV; one-third were for HIV care. Family physicians provided the majority of care (53.6% of all visits and 53.9% of HIV visits). Internal medicine specialists provided 4.9% of all visits and 9.6% of HIV visits. Infectious disease specialists provided 12.5% of all visits and 32.7% of HIV visits. Other specialties provided 29.0% of visits; most of these (33.0%) were to psychiatrists. Conclusions: The distribution of visits to physicians caring for HIV patients reveals different patterns of health care delivery by specialty and HIV caseload. Further research should delineate how specialties share care for this population and how different patterns relate to quality of care. [ABSTRACT FROM AUTHOR]

Background: No primary practice care model has been shown to be superior in achieving high-quality primary care. We aimed to identify the organizational characteristics of primary care practices that provide high-quality primary care. Methods: We performed a cross-sectional observational study involving a stratified random sample of 37 primary care practices from 3 regions of Quebec. We recruited 1457 patients who had 1 of 2 chronic care conditions or 1 of 6 episodic care conditions. The main outcome was the overall technical quality score. We measured organizational characteristics by use of a validated questionnaire and the Team Climate Inventory. Statistical analyses were based on multilevel regression modelling. Results: The following characteristics were strongly associated with overall technical quality of care score: physician remuneration method (27.0; 95% confidence interval [CI] 19.0-35.0), extent of sharing of administrative resources (7.6; 95% CI 0.8-14.4), presence of allied health professionals (15.3; 95% CI 5.4-25.2) and/or specialist physicians (19.6; 95% CI 8.3-30.9), the presence of mechanisms for maintaining or evaluating competence (7.7; 95% CI 3.0-12.4) and average organizational access to the practice (4.9; 95% CI 2.6-7.2). The number of physicians (1.2; 95% CI 0.6-1.8) and the average Team Climate Inventory score (1.3; 95% CI 0.1-2.5) were modestly associated with high-quality care. Interpretation: We identified a common set of organizational characteristics associated with high-quality primary care. Many of these characteristics are amenable to change through practice-level organizational changes. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the appropriateness of potential data sources for the population of performance indicators for primary care (PC) practices. Methods: This project was a cross sectional study of 7 multidisciplinary primary care teams in Ontario, Canada. Practices were recruited and 5-7 physicians per practice agreed to participate in the study. Patients of participating physicians (20-30) were recruited sequentially as they presented to attend a visit. Data collection included patient, provider and practice surveys, chart abstraction and linkage to administrative data sets. Matched pairs analysis was used to examine the differences in the observed results for each indicator obtained using multiple data sources. Results: Seven teams, 41 physicians, 94 associated staff and 998 patients were recruited. The survey response rate was 81% for patients, 93% for physicians and 83% for associated staff. Chart audits were successfully completed on all but 1 patient and linkage to administrative data was successful for all subjects. There were significant differences noted between the data collection methods for many measures. No single method of data collection was best for all outcomes. For most measures of technical quality of care chart audit was the most accurate method of data collection. Patient surveys were more accurate for immunizations, chronic disease advice/information dispensed, some general health promotion items and possibly for medication use. Administrative data appears useful for indicators including chronic disease diagnosis and osteoporosis/ breast screening. Conclusions: Multiple data collection methods are required for a comprehensive assessment of performance in primary care practices. The choice of which methods are best for any one particular study or quality improvement initiative requires careful consideration of the biases that each method might introduce into the results. In this study, both patients and providers were willing to participate in and consent to, the collection and linkage of information from multiple sources that would be required for such assessments. [ABSTRACT FROM AUTHOR]

Strategies to improve primary care in the Canadian Primary Care Reform include integrating different professionals to the medical team. This demonstration project explores the perceived impact on doctors and patients, of having family doctors and psychologists work together. Two family practices of Eastern Ontario, Canada Two board certified psychologists (one per practice) were integrated in the practices for 12 months. Psychologists conducted assessments, consultations and short-term treatments, as well as knowledge-transfer sessions for doctors. Outcome measures included referral patterns, patient outcomes, patient and provider satisfaction as well as doctors' billing. Three hundred and seventy-six participants received psychological care; most were women (68%) and between the ages of 25-64 (67%). Anxiety and depression were the most prevalent diagnoses. Reasons for referral included: psychological treatment (70%); emotional support and counselling (35%); clarification of diagnosis and case conceptualization (25%). Referrals could be for more than one reason. After intervention, 60% of patients had improvement on the outcome questionnaire-45 (OQ-45). Quality of life as measured by the EuroQol-5D also improved ( P < 0.001). Over 77% of patients reported increased confidence in handling their problems after treatment. Compared with their family doctor, patients felt the psychologist had more time and was better trained (75%) Doctors felt mental health problems were diagnosed more rapidly, patient care improved as well as their own knowledge of psychological management and treatment. Doctors felt it freed up their time and improved working conditions. Audit of the doctors' billing showed reduction in doctors' mental health billing. Having an on-site psychologist was highly satisfactory for patients and providers, resulting in improved patient care and outcomes. [ABSTRACT FROM AUTHOR]

Background: While some research has been conducted examining recruitment methods to engage physicians and practices in primary care research, further research is needed on recruitment methodology as it remains a recurrent challenge and plays a crucial role in primary care research. This paper reviews recruitment strategies, common challenges, and innovative practices from five recent primary care health services research studies in Ontario, Canada. Methods: We used mixed qualitative and quantitative methods to gather data from investigators and/or project staff from five research teams. Team members were interviewed and asked to fill out a brief survey on recruitment methods, results, and challenges encountered during a recent or ongoing project involving primary care practices or physicians. Data analysis included qualitative analysis of interview notes and descriptive statistics generated for each study. Results: Recruitment rates varied markedly across the projects despite similar initial strategies. Common challenges and creative solutions were reported by many of the research teams, including building a sampling frame, developing front-office rapport, adapting recruitment strategies, promoting buy-in and interest in the research question, and training a staff recruiter. Conclusions: Investigators must continue to find effective ways of reaching and involving diverse and representative samples of primary care providers and practices by building personal connections with, and buy-in from, potential participants. Flexible recruitment strategies and an understanding of the needs and interests of potential participants may also facilitate recruitment. [ABSTRACT FROM AUTHOR]

The article presents a study which underscores the chronic illness care plans in Ontario, Canada. This study examined the experience of family physicians and patients with chronic illness management initiative that necessitated the joint formulation of comprehensive individual patient care plans. It was established that there are individual level-barriers to chronic illness management in primary care in this location.

Primary care is a promising venue to build patient motivation and confidence to increase physical activity (PA). Physician PA counselling has demonstrated some success; however, maintenance of behaviour change appears to require more intensive interventions. In reality, most physicians do not have the necessary training nor the time for this type of counselling. The purpose of this paper is to outline the rationale, methods, and interventions for the ongoing physical activity counselling (PAC) randomized controlled trial (RCT), which aims to assess the impact of integrating a PA counsellor into a primary care practice. This RCT has 2 arms: (i) brief PA counselling (2–4 min) from a health care provider and (ii) brief PA counselling + intensive PA counselling from a PA counsellor (3 months). The impact of this intervention is being evaluated using the comprehensive RE-AIM framework. One hundred twenty insufficiently active adult patients, aged 18 to 69 y and recruited during regular primary care visits have been randomized. Dependent measures include psychological mediators, PA participation, quality of life, and physical and metabolic outcomes. The PAC project represents an innovative, theoretically-based approach to promoting PA in primary care, focusing on psychological mediators of change. We anticipate that key lessons from this study will be useful for shaping future public health interventions, theories, and research. [ABSTRACT FROM AUTHOR]

Objective This study aimed to discover what the family doctors who attended an annual refresher course wished to obtain from participating in the event and what their response was to evidence that doctor behaviour is not changed by such programmes. Design The study used the qualitative method of in-depth interviews. Setting Ottawa, Ontario, Canada and the surrounding area. Participants The informants for the study were a sample of 6 family doctors who attended the 50th Annual Refresher Course for Family Physicians, held in April 2001 in Ottawa, Ontario, Canada. Method In-depth interviews with the participants were conducted before and after they attended the annual refresher course. The doctors had pre-registered for the 3-day course. They were purposely selected to obtain diversity of gender, year of graduation from medical school and practice location. Results The doctors interviewed had 3 main reasons for attending the refresher course: to obtain information or to be updated; to be reassured that their practice behaviour was within accepted guidelines, and to hear from and interact with the specialists who gave presentations. All the participants in the study were able to name changes they had made as the result of attending a similar type of programme in the past and were sceptical of findings that practice behaviour did not change as a result of traditional continuing medical education (CME). Conclusions Despite current support for interactive and practice-linked educational activities, the doctors in this study valued the input of the experts who lectured at the course. These doctors were not prepared to accept the currently held precept that their behaviour did not change as a result of attendance at traditional CME programmes. [ABSTRACT FROM AUTHOR]

Background: Participants in voluntary research present a different demographic profile than those who choose not to participate, affecting the generalizability of many studies. Efforts to evaluate these differences have faced challenges, as little information is available from non-participants. Leveraging data from a recent randomized controlled trial that used health administrative databases in a jurisdiction with universal medical coverage, we sought to compare the quality of care provided by participating and non-participating physicians prior to the program's implementation in order to assess whether participating physicians provided a higher baseline quality of care.Methods: We conducted clustered regression analyses of baseline data from provincial health administrative databases. Participants included all family physicians who were eligible to participate in the Improved Delivery of Cardiovascular Care (IDOCC) project, a quality improvement project rolled out in a geographically defined region in Ontario (Canada) between 2008 and 2011. We assessed 14 performance indicators representing measures of access, continuity, and recommended care for cancer screening and chronic disease management.Results: In unadjusted and patient-adjusted models, patients of IDOCC-participating physicians had higher continuity scores at the provider (Odds Ratio (OR) [95% confidence interval]: 1.06 [1.03-1.09]) and practice (1.06 [1.04-1.08]) level, lower risk of emergency room visits (Rate Ratio (RR): 0.93 [0.88-0.97]) and hospitalizations (RR:0.87 [0.77-0.99]), and were more likely to have received recommended diabetes tests (OR: 1.25 [1.06-1.49]) and cancer screening for cervical cancer (OR: 1.32 [1.08-1.61] and breast cancer (OR: 1.32 [1.19-1.46]) than patients of non-participating physicians. Some indicators remained statistically significant in the model after adjusting for provider factors.Conclusions: Our study demonstrated a participation bias for several quality indicators. Physician characteristics can explain some of these differences. Other underlying physician or practice attributes also influence interest in participating in quality improvement initiatives and existing quality levels. The standard for addressing participation bias by controlling for basic physician and practice level variables is inadequate for ensuring that results are generalizable to primary care providers and practices. [ABSTRACT FROM AUTHOR]

BACKGROUND: We conducted a process evaluation of a multifaceted outreach facilitation intervention to document the extent to which the intervention was implemented with fidelity and to gain insight into how facilitation worked to improve preventive performance. METHODS: We used 5 data collection tools to evaluate the implementation of the intervention, and a combination of descriptive, quantitative, and qualitative analyses. Triangulation was used to attain a complete understanding of the quality of implementation. Twenty-two intervention practices with a total of 54 physicians participated in a randomized controlled trial that took place in Southwestern Ontario, Canada. The key measures of process were the frequency and time involved to deliver intervention components, the scope of the delivery and the utility of the components, and physician satisfaction with the intervention. RESULTS: Of the 7 components in the intervention model, prevention facilitators (PFs) visited the practices most often to deliver the audit and feedback, consensus building, and reminder system components. All of the study practices received preventive performance audit and feedback, achieved consensus on a plan for improvement, and implemented a reminder system. Ninety percent of the practices implemented a customized flow sheet, and 10% used a computerized reminder system. Ninety-five percent of the intervention practices wanted critically appraised evidence for prevention, 82% participated in a workshop, and 100% received patient education materials in a binder. Content analysis of the physician interviews and bivariate analysis of physician self-reported changes between intervention and control group physicians revealed that the audit and feedback, consensus building, and development of reminder systems were the key intervention components. Ninety-five percent of the physicians were either satisfied or very satisfied with the intervention, and 90% would have been willing to have the PF continue working with their practice. CONCLUSIONS: Primary care practices in Ontario can implement significant changes in their practice environments that will improve preventive care activity with the assistance of a facilitator. The main components for creating change are audit and feedback of preventive performance, achieving consensus on a plan for improvement, and implementing a reminder system. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To examine the physical activity (PA) counseling literature in primary care in order to identify which intervention provider has been used to date and their relative effectiveness for increasing PA. Method: MEDLINE and PsycINFO databases were searched for PA intervention studies in primary care settings. Results: Of the 19 studies, 37% were conducted solely by physicians, 37% by allied health professionals, while 26% were combined-provider interventions. There was a decline in the number of physician-only interventions and a shift towards interventions offered by allied health professionals as adjuncts or alone. Interventions across all provider categories generated some improvements in physical activity behavior, however, it appears that allied health professionals as adjuncts or alone produced the best results in the long-term (>6 months). There was substantial variation in the location and counseling approach employed by allied health professionals. Conclusion: We argue for an interdisciplinary model in which physicians recommend PA and provide referrals to allied health professionals such as physical activity counselors. Practice implications: With physical activity counselors’ specialized training and greater time available to the patient, they may provide more intensive and effective counseling required for behavior change and maintenance. [Copyright &y& Elsevier]