Annals of family medicine
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Annals of family medicine · Apr 2022
Randomized Controlled TrialRandomized controlled trial of an audit and feedback cycle to improve adherence to Choosing Wisely Canada recommendations.
Context: Choosing Wisely Canada (CWC) aims to engage healthcare providers to reduce unnecessary care. Reducing overuse of antimicrobials and antipsychotics in patients with dementia in primary care settings remains an ongoing challenge. Audit and Feedback (A&F) interventions can facilitate practice change but can be improved by understanding factors affecting the likelihood of uptake of the feedback. ⋯ There were no statistically significant provider characteristics when considering all providers with improved prescribing, but male, rural and fee for service providers were more likely to decrease prescribing greater than the mean. Conclusion: Both practice specific and generic A&F information sent directly to primary care providers by a trusted source reduced potentially unnecessary prescriptions. This supports ongoing engagement with primary care providers in practice-based research networks to improve care and promote sustained practice changes.
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Annals of family medicine · Apr 2022
Characterizing posttraumatic stress disorder in primary care using electronic medical records: a retrospective cohort study.
Posttraumatic stress disorder (PTSD) is a chronic mental health disorder associated with significant morbidity and economic cost. Primary care providers are frequently involved in the ongoing management of patients experiencing PTSD, as well as related comorbid conditions. Despite recognized need to enhance PTSD management in primary care settings, knowledge regarding its prevalence in these settings is limited. ⋯ This is the first study to describe PTSD prevalence in a large Canadian sample of primary care patients using an EMR-based case definition. Characterizing patients with PTSD in primary care may improve disease surveillance and inform the interdisciplinary care required to manage PTSD symptoms.
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Annals of family medicine · Apr 2022
Assessment and management of allergy history with a novel mRNA vaccine.
Tertiary care hospital provided onsite COVID-19 vaccine roll out as a work benefit for all care team members with medically supervised waiting period at the time of the distribution of the first round of the novel mRNA COVID-19 vaccines. Little was known about the immediate hypersensivity reactions or what might predispose to cross reactivity. ⋯ We used this data to inform our employee health vaccination campaign and to inform the health system as strategies and safety protocols for vaccination of the population were developed.
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Annals of family medicine · Apr 2022
Using chart reviews to evaluate a continuing medical education (CME) program.
Context Moore's Expanded Outcomes Framework is a 7 level framework commonly used to assess the outcomes of continuing medical education (CME) programs. Levels 1 to 5 are provider-level outcomes (participation, satisfaction, knowledge, competence, and performance) while levels 6 and 7 are patient- and community-level outcomes. Chart reviews are one method to assess level 5 (performance). ⋯ Trends in results showed marginal, but non-significant, improvements in PCP performance after ECHO as indicated by increased use of pain and opioid management strategies. Conclusions Conducting chart reviews was a challenging method to assess provider performance. Future work to assess provider performance should include a qualitative component (in-depth interviews or focus groups) in order to complement the quantitative data and provide context for care and management decisions.
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Annals of family medicine · Apr 2022
Impacts of the COVID-19 pandemic on gamblers in Canada: qualitative analysis of responses to an open-ended question.
draw up a portrait of the experience of gamblers regarding the impacts of the COVID-19 pandemic on their gambling practices. STUDY DESIGN: Qualitative analysis. SETTING: Content analysis of responses to a single open-ended question placed at the end of a cross-sectional survey which was online from February 16 to March 15 2021 in Quebec (Canada). Participants were recruited by a non-randomised online sampling. POPULATION STUDIED: 1529 individuals participated in the study, of whom 724 answered the open-ended question. Inclusion criteria were: (1) 18 years and older (2) living in the province of Quebec, Canada (3) has gambled at least once in the past year. ⋯ The pandemic has created space to fill into many individuals' lives as usual leisure activities, hobbies and spending habits became out of reach. It led to increased gambling for many participants. While many did not report deleterious effects of this increase, others expressed being at great risk and therefore need primary care professionals to be equipped to support them.