Search

Abstract Background 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. Methods 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. Results 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 Conclusions There remain significant opportunities for primary care providers to engage high risk patients in prevention activities such as weight management and smoking cessation. Despite high adherence rates for hypertension, dyslipidemia, and coronary artery disease, a significant proportion of patients failed to meet treatment targets, highlighting the complexity of caring for people with multiple chronic conditions. Trial Registration NCT00574808

There has been growing concern as to the mental health status of persons with learning disabilities (PWLD). This study examined rates of mental health problems among PWLD aged 15 to 44 years using a large, nationally representative data set. PWLD were more than twice as likely to report high levels of distress, depression, anxiety disorders, suicidal thoughts, visits to mental health professionals, and poorer overall mental health than were persons without disabilities (PWOD). Multivariate regression analyses determined that these significantly higher rates of mental health problems remained for all six measures after controlling for confounding factors including income, education, social support, and physical health. Differences found in the older adult sample (ages 30-44) were even larger than in the adolescent sample (ages 15-21) for suicidal thoughts, depression, and distress. Males with learning disabilities were more likely to report depressive episodes, anxiety disorders, and consultations with health professionals, whereas females with learning disabilities were more likely to report high distress, suicidal thoughts, and poor general mental health relative to PWOD. On balance, learning disabilities were not found to be more detrimental to mental health for one gender or the other. (Contains 8 tables and 1 note.)

Volunteers are reputedly healthier and happier than their non-volunteering counterparts. But is this a causal link or are healthier, happy individuals simply more likely to volunteer? Some papers have attempted to identify the causal relationship using an instrumental variable methodology, mostly relying on measures of religiosity as instruments for volunteering – however, religiosity may also affect health thus calling into question the validity of this approach. We rely on a novel instrument, a measure physical proximity to volunteer opportunities, to help identify the causal link from volunteering to health and happiness using econometric regression techniques. We find that volunteering is a robustly significant predictor of health, and positively affects life satisfaction for all but those aged under 35. [ABSTRACT FROM AUTHOR]

Background: Practice facilitation (PF), a multifaceted approach in which facilitators (external health care professionals) help family physicians to improve their adoption of best practices, has been highly successful. Improved Delivery of Cardiovascular Care (IDOCC) was an innovative PF trial designed to improve evidence-based care for people who have, or are at risk of, cardiovascular disease (CVD). The intervention was found to be ineffective as assessed by a patient-level composite score based on chart reviews from a subsample of patients (N = 5292). Here, we used population-based administrative data to examine IDOCC's effect on CVD-related hospitalizations.Methods: IDOCC used a pragmatic, stepped wedge cluster randomized controlled design involving primary care providers recruited across Eastern Ontario, Canada. IDOCC's effect on CVD-related hospitalizations was assessed in the 2 years of active intervention and post-intervention years. Marginal and mixed-effects regression analyses were used to account for the study design and to control for patient, physician, and practice characteristics. Secondary and subgroup analyses investigated robustness.Results: Our sample included 262,996 patient/year observations representing 54,085 unique patients who had, or were at risk of, CVD, from 70 practices. There was a strong decreasing secular trend in CVD-related hospitalizations but no statistically significant effect of IDOCC. Relative to patients in the control condition, patients in the intervention condition were estimated to have 4 % lower odds of CVD-related hospitalizations (adjOR = 0.96, 99 % CI 0.83 to 1.11). The nonsignificant result persisted across robustness analyses.Conclusions: Clinical outcomes from administrative databases were examined to form a more complete picture of the (in)effectiveness of a large-scale quality improvement intervention. IDOCC did not have a significant effect on CVD hospitalizations, suggesting that the results from the primary composite adherence score analysis were neither due to choice of outcome nor relatively short follow-up period.Trial Registration: ClinicalTrials.gov NCT00574808 , registered on 14 December 2007. [ABSTRACT FROM AUTHOR]

Excessive wait times and poor access to care are among the most significant problems facing health care service delivery in Canada and beyond. We implemented the Champlain BASE eConsult service in the region of Ottawa, Canada to increase access to specialist care. We have collected ongoing utilization data and provider surveys over a three year period, providing a unique opportunity to explore the economic aspects of this multispecialty eConsult service. This is an economic evaluation from the perspective of the payer: the Ministry of Health and Long-Term Care of Ontario. All eConsults submitted during April 1, 2011 to March 31, 2014 were included. We attributed cost savings only to those cases where an eConsult led to the avoidance of a face-to-face specialist visit. A total of 2606 eConsults directed to 27 different speciality groups were included. In 40.3% (n=1051) of cases processed, a face-to-face specialist visit was originally planned but avoided as a result of eConsult, while 29% led to a referral. The estimated cost per eConsult for Years 1, 2, and 3 were $131.05, $10.34, and $6.45 respectively. Results from a sensitivity analysis project that the eConsult service will break even once we reach 7818 eConsults. This is one of the first studies to examine costs across a multispecialty eConsult service. We saw a marked decrease in the cost per eConsult over each annual period. Future research is needed to identify and examine similar outcomes that may lead to cost savings. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Family Physician / Médecin de Famille Canadien is the property of College of Family Physicians of Canada and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The Champlain BASE™ eConsult Service was developed in a Local Health Integration Network (LHIN) in Ontario, Canada in 2010 to reduce wait times and improve access to specialist care. The service allows primary care providers to receive advice from specialists via a secure electronic platform without necessarily requiring a face-to-face consultation., Introduction: As of 2015, over half of the LHIN's family physicians were registered and trained to use the service. However, 24% of registrants never went on to submit a case. The purpose of this study is to examine the demographic characteristics associated with usage., Materials and Methods: Usage data for the pool of physicians registered between January 1, 2011 and September 30, 2015 were linked to physician characteristics retrieved from the College of Physicians and Surgeons of Ontario database. Probit regressions were estimated to determine characteristics associated with usage., Results: Neither sex, being an international medical school graduate-documented predictors of electronic medical records adoption-nor proximity to specialists were found to explain usage. Only length of time in practice was found to be predictive. Being out of medical school an additional 10 years was estimated to decrease the probability of ever using eConsult by five percentage points (p < 0.01)., Conclusion: Lower use by veteran physicians may reflect their lower need for services like eConsult given their well-established specialist networks, or their greater confidence in practicing medicine. Future work should explore the reasons and barriers for not registering, or not using eConsult, with an aim toward increasing the appropriate use of this cost-effective and innovative service.