PRISM :: Browsing by Author "McBrien, Kerry"

Browsing by Author "McBrien, Kerry"

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Open Access
A data quality assessment to inform hypertension surveillance using primary care electronic medical record data from Alberta, Canada
(2021-02-02) Garies, Stephanie; McBrien, Kerry; Quan, Hude; Manca, Donna; Drummond, Neil; Williamson, Tyler
Abstract Background Hypertension is a common chronic condition affecting nearly a quarter of Canadians. Hypertension surveillance in Canada typically relies on administrative data and/or national surveys. Routinely-captured data from primary care electronic medical records (EMRs) are a complementary source for chronic disease surveillance, with longitudinal patient-level details such as sociodemographics, blood pressure, weight, prescribed medications, and behavioural risk factors. As EMR data are generated from patient care and administrative tasks, assessing data quality is essential before using for secondary purposes. This study evaluated the quality of primary care EMR data from one province in Canada within the context of hypertension surveillance. Methods We conducted a cross-sectional, descriptive study using primary care EMR data collected by two practice-based research networks in Alberta, Canada. There were 48,377 adults identified with hypertension from 53 clinics as of June 2018. Summary statistics were used to examine the quality of data elements considered relevant for hypertension surveillance. Results Patient year of birth and sex were complete, but other sociodemographic information (ethnicity, occupation, education) was largely incomplete and highly variable. Height, weight, body mass index and blood pressure were complete for most patients (over 90%), but a small proportion of outlying values indicate data inaccuracies were present. Most patients had a relevant laboratory test present (e.g. blood glucose/glycated hemoglobin, lipid profile), though a very small proportion of values were outside a biologically plausible range. Details of prescribed antihypertensive medication, such as start date, strength, dose, frequency, were mostly complete. Nearly 80% of patients had a smoking status recorded, though only 66% had useful information (i.e. categorized as current, past, or never), and less than half had their alcohol use described; information related to amount, frequency or duration was not available. Conclusions Blood pressure and prescribed medications in primary care EMR data demonstrated good completeness and plausibility, and contribute valuable information for hypertension epidemiology and surveillance. The use of other clinical, laboratory, and sociodemographic variables should be used carefully due to variable completeness and suspected data errors. Additional strategies to improve these data at the point of entry and after data extraction (e.g. statistical methods) are required.
Embargo
An Examination of Patients’ Experiences with Navigation Services in Alberta’s Healthcare System
(2024-06-20) Rabi, Sarah; Tang, Karen; Santana, Maria; McBrien, Kerry; Dimitropoulos, Gina
Background: The concept of patient navigation (PN) was first envisioned to assist marginalized cancer patients access appropriate and timely healthcare resources. While this understanding of PN may still hold for a subgroup of programs today, the expansion of PN over the past 30 years has resulted in a diverse set of interventions with distinct care settings, patient eligibility criteria, navigator training, and program objectives. Noting this, our study sought to better understand how PN has evolved by gathering information on patients’ perspectives and interactions with PN programs across Alberta. Our objectives were to (i) explore patients’ current experiences with PN programs, and (ii) identify the features of PN felt to be of particular value to patients. Methods: To address these objectives, we conducted an interpretive descriptive study to collate the experiences of adult patients with longitudinal exposure to Albertan PN programs (involvement for greater than or equal to one month). Participant recruitment occurred via key informant sampling with navigators across Alberta. One-on-one semi-structured interviews were conducted to explore patient experiences with PN and their understanding of it as a broader concept. Inductive thematic analysis and interpretive exercises were subsequently performed to construct a coherent message from the data. Continued collaboration with two patient partners was maintained throughout the study to ensure responsiveness to patient priorities. Results: This study involved 23 participants with experience using nurse navigators, transition navigators, and lay community health navigators. Irrespective of navigation type, the participants’ stories were tethered by their navigators’ promotion of seamless and personalized care, as well as their ability to seemingly humanize the healthcare system. This was accomplished through a set of participant-identified navigator characteristics, including approachability, accessibility, and comprehensive systems knowledge. While the identified functions and characteristics of navigators were consistent across participants, how these components were operationalized varied based on the program’s setting and the particular needs of each patient. Conclusion: As a patient-centred intervention, understanding patients’ experiences and valuations of PN is critical to distilling the essence of the intervention. This research directly addresses ongoing knowledge gaps surrounding contemporary understandings of PN, particularly from patients’ perspectives.
Open Access
Assessing Changes in Relational Continuity of Care Among Adults with Vulnerable Housing in a Transitional Case Management Program
(2022-06-17) Chiew, Alexandra; McBrien, Kerry; Fabreau, Gabriel; Ronksley, Paul
Background: Individuals with vulnerable housing commonly experience barriers to health and social care. Connect 2 Care (C2C) is a case management intervention that connects people with vulnerable housing and high acute care use to community-based care. Relational continuity of care, a proxy for stable patient-provider relationships, is associated with improved patient outcomes in the general population. We assessed whether adults with vulnerable housing experience improved primary care use and relational continuity following C2C engagement, and evaluated predictors of improved continuity. Methods: We used practitioner claims data to conduct a pre-post cohort study with 390 adults engaged with C2C. Participants must have been homeless or vulnerably housed, had ≥3 emergency department presentations or ≥2 hospitalizations within the past year, and ≥3 primary care visits pre- and post-C2C for continuity analyses. We examined changes in the proportion of low primary care users (<3 visits/year) using McNemar’s test. Relational continuity was measured at the provider and site level using the Usual Provider of Care (UPC) and Continuity of Care (COCI) indices. We performed paired t-tests to compare continuity within the year pre- and post-C2C and multivariable logistic regression to identify characteristics associated with improved continuity. Results: Of 390 participants, 220 had ≥3 primary care visits pre- and post-C2C and 116 were low primary care users. Following C2C engagement, the proportion of low primary care users significantly decreased by 15% in absolute terms and continuity of care significantly increased. Pre- to post-C2C, there was a mean increase of 0.04 in provider- and site-UPC. Similar increases were observed for the COCI, though only the increase in site-COCI was significant. Stratified analyses demonstrated no differences in effect on care continuity in subgroups across 11 patient characteristics and we did not identify characteristics associated with increased continuity following C2C engagement. Significance: Our results suggest that Connect 2 Care was associated with improved primary care use and relational continuity of care among individuals with vulnerable housing. These findings add to our understanding of how primary care access may be improved using case management interventions in this population.
Open Access
Cost-effectiveness of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors: An Economic Evaluation
(2017) Zhang, Ziyu; Clement, Fiona; McBrien, Kerry; Spackman, Eldon
Familial hypercholesterolemia is an autosomal inherited genetic disorder characterized by high levels of low-density lipoprotein cholesterol circulating in the bloodstream. If left untreated, this condition can substantially increase cardiovascular risk, lead to the rapid development of premature coronary artery disease, or cause sudden cardiac death. Despite the high risks associated with familial hypercholesterolemia, a considerable number of these individuals are unable to achieve adequate reductions in low-density lipoprotein cholesterol levels with conventional lipid lowering therapy. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are emerging pharmacological treatments for managing patients with these conditions. Therefore, the goal of this thesis is to assess the cost-effectiveness of PCSK9 inhibitors for the treatment of elevated low-density lipoprotein cholesterol in individuals with familial hypercholesterolemia.
Open Access
Costs of the Acute Respiratory Distress Syndrome
(2023-11-29) Boucher, Paul; Clement, Fiona; Noseworthy, Tom; McBrien, Kerry
The acute respiratory distress syndrome (ARDS) is an inflammatory condition of the lungs and is a common condition in adult intensive care units (ICU). The resources required and costs of care for patients with ARDS are substantial due to the severity of illness, resource intensity and extended lengths of stay. There are two parts to this thesis: to systematically review the costing literature in ARDS and to perform a costing study of a cohort of patients with ARDS. The systematic review searched the literature through to April 29, 2021 for articles relevant to ARDS and costs. 4633 publications were found of which 110 were included for full-text review. A total of 22 publications met inclusion criteria and were kept for the final analysis. The assessment was done independently by two reviewers and the systematic review followed PRISMA guidelines. Quality assessment was done using a modified version of the Quality of Health Economic Studies Instrument. This review helped contextualize the results of the costing study. The aim of the costing study was to calculate both hospital inpatient costs and post discharge costs for the three years that followed for patients with ARDS. Clinical factors associated with costs during both the time periods were examined. The costing study was done on a cohort of 585 patients with ARDS who were prospectively identified using a standardized screening protocol in the 4 adults ICUs in Calgary, Alberta, Canada. The post discharge costs were calculated on 364 patients who survived their initial hospital stay and had a traceable, valid Alberta postal codes at the end of the three year follow-up period.
Open Access
Creating a Frailty Case Definition for Primary Care EMR Using Machine Learning
(2021-05-04) Aponte-Hao, Zhi Yun (Sylvia); Williamson, Tyler; Lee, Joon; McBrien, Kerry; Ronksley, Paul
Background: Frailty is a geriatric syndrome characterized by increased vulnerability and increased risk of adverse events. The Clinical Frailty Scale (CFS) is a judgement-based scale used to identify frailty in senior populations (over the age of 65). Primary care electronic medical records (EMRs) contain routinely collected medical data and can be used for frailty screening. There is currently no method to detect frailty automatically using primary care electronic medical records that aligns with the CFS definition. Purpose: To create a machine learning based algorithm for the identification of frailty in routinely collected primary care electronic medical records. Methods: Primary care physicians within the Canadian Primary Care Sentinel Surveillance Network retrospectively identified frailty in 5466 senior patients from their own practice using the CFS, and the corresponding patient EMR data were extracted and processed as features. The patient data were split 30-70, with 30% being the hold-out set used for final testing and 70% for the training set. A collection of machine learning algorithms was created using the training dataset, including regularized logistic regression models, support vector machines, random forests, k-nearest neighbours, classification and regression trees, feedforward neural networks, Naïve Bayes, and XGBoost. A balanced training dataset was also created by oversampling. Sensitivity analyses were also performed using two alternative dichotomization cut-offs of frailty. Final model performance was assessed using the hold-out dataset, and reported using ROC, accuracy, F1-score, sensitivity, specificity, positive and negative predictive values. Results: 18.4% of patients were classified as frail based on a CFS score of 5 and above. Of the 8 models developed, an XGBoost model had the best classification performance, with sensitivity of 78.14% and specificity of 74.41%. Neither the balanced training dataset, nor the sensitivity analyses using two alternative cut-offs resulted in improved performance. Conclusion: Supervised machine learning was able to distinguish between frail and non-frail patients with good performance. Future work may wish to develop a protocol for standardized assignment of the CFS, use all available unstructured and structured data, and supplement with additional geriatric-specific data.
Open Access
Decade of Turmoil: A Characterization of a Specialized Refugee Health Clinic 2011-2020
(2023-05-03) Norrie, Eric Culham; Fabreau, Gabriel; McBrien, Kerry; Ronksley, Paul; Montesanti, Stephanie
Background: Canadian refugee healthcare has been impacted by periodic upheavals including federal funding cuts, Syrian and Yazidi resettlement programs, and COVID-19. These upheavals may have led to changes in clinic use, demographics, clinic policy, or may impact provider wellness. Refugees are a vulnerable population with specific biopsychosocial health needs. One model of care that can address these needs is a specialized refugee health clinic. Understanding the impacts of recent upheavals on a specialized refugee health clinic’s utilization, its staff and clinicians is critical. Methods: We used a mixed methods sequential explanatory case study design to investigate changes (including patient demographic characteristics, clinic utilization, and care adaptations), at a specialized refugee health clinic in Calgary from 2011 to 2020, across five time periods: Pre-Interim Federal Health Program (IFHP) Cuts, IFHP Cuts, Syrian Surge, Yazidi Period, and COVID-19. We used segmented linear regression (SLR), Kruskal-Wallis, and chi-square analyses to assess quantitative changes to utilization and demographics across these time periods. Then we conducted semi-structured interviews with clinic leadership which we analyzed thematically. Finally, we merged our quantitative and qualitative findings, by assessing which of our qualitative themes converged with our quantitative findings during each time period. Results: We included 10,661 patients in our quantitative analysis; 48.2% were female and the mean age was 24.4 years (SD: 17.0). The most common region of origin was first East Africa, and then West Asia after the Syrian period. Total monthly appointments increased 576% from 478/month to 2752/month over 10 years. The mean appointments/month increased significantly (p<0.05) during each time period, but the rate of increase varied. Our qualitative and merged results converged with and expanded upon these quantitative results, especially by emphasizing the impact of health system upheavals on provider wellness. Conclusion: Utilization increased greatly over different policy changes and a pandemic, at a specialized refugee clinic over ten years. These upheavals challenged clinic leadership and providers to adapt. Qualitative participants consistently indicated that the stress of these upheavals negatively impacted staff wellness and patient care. Canada and other countries of resettlement should consider how health policies and other upheavals may have downstream consequences.
Open Access
The Economic Impact of Dietary Sodium Reduction in Canada
(2017-12-21) Qureshi, Hena; McBrien, Kerry; Campbell, Norman; Clement, Fiona
OBJECTIVES: To determine the cost-utility of dietary sodium reduction in the Canadian population, given on the anticipated effect on incident cardiovascular disease (CVD). METHODS: The Canadian Cardiovascular Disease Policy Model is a state transition model, which simulates CVD events, healthcare costs and consequences from the perspective of a publically funded healthcare system for the Canadian population. We evaluated the economic impact of reducing the dietary sodium intake of Canadian adults. RESULTS: Over a 50-year time horizon, reducing dietary sodium by 1800 mg/day is projected to reduce the cumulative incidence of coronary heart disease and stroke by 2.66% and 4.45% respectively, while decreasing the total number of myocardial infarctions and strokes by 2.23% and 4.45% respectively. The model predicted a decrease in overall mortality of 0.47%, a gain of 1.22 million QALYs, and a savings of $20.7 billion in healthcare costs. CONCLUSION: Reducing dietary sodium intake at the population level has the potenital to substantially decrease healthcare costs and improve health outcomes.
Open Access
Health care stakeholder perspectives regarding the role of a patient navigator during transition to adult care
(2019-06-17) Dimitropoulos, Gina; Morgan-Maver, Elizabeth; Allemang, Brooke; Schraeder, Kyleigh; Scott, Shannon D; Pinzon, Jorge; Andrew, Gail; Guilcher, Gregory; Hamiwka, Lorraine; Lang, Eddy; McBrien, Kerry; Nettel-Aguirre, Alberto; Pacaud, Daniele; Zwaigenbaum, Lonnie; Mackie, Andrew; Samuel, Susan
Abstract Background Transition to adult care represents a vulnerable period for young people with special health care needs as they navigate multiple life transitions and developmental issues. Patient navigators are a promising intervention designed to facilitate the transfer from pediatric to adult care. However, consistent definitions, key tasks, roles and responsibilities are lacking in guiding the scope of practice and the implementation of patient navigators. Methods Fundamental qualitative description was utilized in this study to identify perceptions from health care providers about implementing a patient navigator service for young people with special health care needs in transition to adult care. A purposive sample of health care providers with a variety of backgrounds within pediatric and adult systems in Alberta, Canada were recruited. Semi-structured interviews with participants were analyzed using thematic analysis to inductively identify perceptions regarding the role of patient navigators. Results A total of 43 health care providers highlighted the need for a patient navigator service to encompass 4 key stages for young people with special health care needs transitioning from pediatric to adult services: (1) identification of young people with special health care needs and families requiring support, (2) preparation for transfer, (3) health system navigation and, (4) post-transfer support. Conclusions The results of this qualitative study provide guidance for the development of patient navigator interventions for young people with special health care needs, as well as provide support for current transition services offered across Canada.
Open Access
Mapping variation in intervention design: a systematic review to develop a program theory for patient navigator programs
(2019-01-08) Desveaux, Laura; McBrien, Kerry; Barnieh, Lianne; Ivers, Noah M
Abstract Background There is a great deal of variation in the design and delivery of patient navigator (PN) programs, making it difficult to design or adopt these interventions in new contexts. We (1) systematically reviewed the literature to generate a preliminary program theory to describe how patient navigator interventions are designed and delivered; and (2) describe how the resulting program theory was applied in context to inform a prototype for a patient navigator program. Methods The current study includes a secondary review of a larger systematic review. We reviewed studies included in the primary review to identify those that designed and evaluated programs to assist patients in accessing and/or adhering to care. We conducted a content analysis of included publications to describe the barriers targeted by PN interventions and the navigator activities addressing those barriers. A program theory was constructed by mapping patient navigator activities to corresponding constructs within the capability-opportunity-motivation model of behavior change (COM-B) model of behavior change. The program theory was then presented to individuals with chronic disease, healthcare providers, and system stakeholders, and refined iteratively based on feedback. Results Twenty one publications describing 19 patient navigator interventions were included. A total of 17 unique patient navigator activities were reported. The most common included providing education, facilitating referrals, providing social and emotional support, and supporting self-management. The majority of navigator activities targeted barriers to physical opportunity, including facilitating insurance claims, assistance with scheduling, and providing transportation. Across all interventions, navigator activities were designed to target a total of 20 patient barriers. Among interventions reporting positive effects, over two thirds targeted knowledge barriers, problems with scheduling, proactive re-scheduling following a missed appointment, and insurance. The final program design included a total of 13 navigator activities—10 informed by the original program theory and 3 unique activities informed by stakeholders. Conclusions There is considerable heterogeneity in intervention content across patient navigator interventions. Our results provide a schema from which to develop PN interventions and illustrate how an evidence-based model was used to develop a real-world PN intervention. Our findings also highlight a critical need to improve the reporting of intervention components to facilitate translation. Systematic review registration PROSPERO CRD42013005857
Open Access
Methods to improve the quality of smoking records in a primary care EMR database: exploring multiple imputation and pattern-matching algorithms
(2020-03-14) Garies, Stephanie; Cummings, Michael; Quan, Hude; McBrien, Kerry; Drummond, Neil; Manca, Donna; Williamson, Tyler
Abstract Background Primary care electronic medical record (EMR) data are emerging as a useful source for secondary uses, such as disease surveillance, health outcomes research, and practice improvement. These data capture clinical details about patients’ health status, as well as behavioural risk factors, such as smoking. While the importance of documenting smoking status in a healthcare setting is recognized, the quality of smoking data captured in EMRs is variable. This study was designed to test methods aimed at improving the quality of patient smoking information in a primary care EMR database. Methods EMR data from community primary care settings extracted by two regional practice-based research networks in Alberta, Canada were used. Patients with at least one encounter in the previous 2 years (2016–2018) and having hypertension according to a validated definition were included (n = 48,377). Multiple imputation was tested under two different assumptions for missing data (smoking status is missing at random and missing not-at-random). A third method tested a novel pattern matching algorithm developed to augment smoking information in the primary care EMR database. External validity was examined by comparing the proportions of smoking categories generated in each method with a general population survey. Results Among those with hypertension, 40.8% (n = 19,743) had either no smoking information recorded or it was not interpretable and considered missing. Those with missing smoking data differed statistically by demographics, clinical features, and type of EMR system used in the clinic. Both multiple imputation methods produced fully complete smoking status information, with the proportion of current smokers estimated at 25.3% (data missing at random) and 12.5% (data missing not-at-random). The pattern-matching algorithm classified 18.2% of patients as current smokers, similar to the population-based survey (18.9%), but still resulted in missing smoking information for 23.6% of patients. The algorithm was estimated to be 93.8% accurate overall, but varied by smoking status category. Conclusion Multiple imputation and algorithmic pattern-matching can be used to improve EMR data post-extraction but the recommended method depends on the purpose of secondary use (e.g. practice improvement or epidemiological analyses).
Open Access
Online clinical pathway for chronic kidney disease management in primary care: a retrospective cohort study
(2021-10-06) Donald, Maoliosa; Smekal, Michelle D.; Elliott, Meghan J.; McBrien, Kerry; Weaver, Robert G.; Manns, Braden J.; Tonelli, Marcello; Bello, Aminu; Straus, Sharon E.; Scott-Douglas, Nairne; Jindal, Kailash; Hemmelgarn, Brenda R.
Abstract Background Clinical pathways aim to improve patient care. We sought to determine whether an online chronic kidney disease (CKD) clinical pathway was associated with improvements in CKD management. Methods We conducted a retrospective pre/post population-based cohort study using linked health data from Alberta, Canada. We included adults 18 years or older with mean estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2. The primary outcome was measurement of an outpatient urine albumin creatinine ratio (ACR) in a 28-day period, among people without a test in the prior year. Secondary outcomes included use of guideline-recommended drug therapies (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and statins). Results The study period spanned October 2010 to March 2017. There were 84 independent 28-day periods (53 pre, 31 post pathway implementation) including 345,058 adults. The population was predominantly female (56%) with median age 77 years; most had category 3A CKD (67%) and hypertension (82%). In adjusted segmented regression models, the increase in the rate of change of ACR testing was greatest in Calgary zone (adjusted OR 1.19 per year, 95% CI 1.16–1.21), where dissemination of the pathway was strongest; this increase was more pronounced in those without diabetes (adjusted OR 1.25 per year, 95% CI 1.21–1.29). Small improvements in guideline-concordant medication use were also observed. Conclusions Following implementation of an online CKD clinical pathway, improvements in ACR testing were evident in regions where the pathway was most actively used, particularly among individuals without diabetes.
Open Access
Perspectives from primary health care providers on their roles for supporting adolescents and young adults transitioning from pediatric services
(2020-07-13) Schraeder, Kyleigh; Dimitropoulos, Gina; McBrien, Kerry; Li, Jessica Yijia; Samuel, Susan
Abstract Background Transitioning from pediatric care to adult-oriented care at age 18 (the age of transfer in most countries and jurisdictions) is a complex process for adolescents and young adults affected by chronic physical health and/or mental health conditions. The role of primary health care (PHC) providers for this population is poorly understood. Perspectives from these providers, such as family physicians and other members of the primary care team, have not been explored in depth. Methods A total of 18 participants (e.g., family physicians, social workers, nurses) were recruited from 6 Primary Care Networks in Calgary, Alberta, Canada. Semi-structured individual interviews were conducted, and transcribed verbatim. A qualitative description approach was used to analyze the data, and included thematic analysis. Results Five distinct, yet overlapping, roles of primary health care providers for adolescents and young adults transitioning to adult care resulted from our analysis: (1) being the “common thread” (continuous accessible care); (2) caring for the “whole patient” (comprehensive care); (3) “knowing families” (family-partnered care); (4) “empowering” adolescents and young adults to develop “personal responsibility” (developmentally-appropriate care); and (5) “quarterbacking” care (coordination of specialist and/or community-based care). Participants identified potential benefits of these roles for adolescents and young adults transitioning to adult care, and barriers in practice (e.g., lack of time, having minimal involvement in pediatric care). Conclusions Input from family physicians, who follow their patients across the lifespan and provide the majority of primary care in Canada, are critical for informing and refining recommended transition practices. Our findings provide insights, from PHC providers themselves, to bolster the rationale for primary care involvement during transitions from pediatric specialty and community-based care for AYAs. Solutions to overcome barriers for integrating primary care and specialty care for adolescents and young adults need to be identified, and tested, with input from key stakeholders.
Open Access
Primary care during the transition to adult care for adolescents involved with pediatric specialty services: a scoping review protocol
(2021-02-02) Schraeder, Kyleigh; Allemang, Brooke; Scott, Cathie; McBrien, Kerry; Dimitropoulos, Gina; Felske, Ashley; Samuel, Susan
Abstract Background Of the 15–20% of youth in North America affected by a chronic health condition (e.g., type 1 diabetes, cystic fibrosis) and/or mental health or neurodevelopmental disorder (e.g., depression, eating disorder, Attention Deficit-Hyperactivity Disorder), many often require lifelong specialist healthcare services. Ongoing primary care during childhood and into young adulthood is recommended by best practice guidelines. To date, it is largely unknown if, how, and when primary care physicians (PCPs; such as family physicians) collaborate with specialists as AYAs leave pediatric-oriented services. The proposed scoping review will synthesize the available literature on the roles of PCPs for AYAs with chronic conditions leaving pediatric specialty care and identify potential benefits and challenges of maintaining PCP involvement during transition. Methods Arksey and O’Malley’s original scoping review framework will be utilized with guidance from Levac and colleagues and the Joanna Briggs Institute. A search of databases including MEDLINE (OVID), EMBASE, PsycINFO, and CINAHL will be conducted following the development of a strategic search strategy. Eligible studies will (i) be published in English from January 2004 onwards, (ii) focus on AYAs (ages 12–25) with a chronic condition(s) who have received specialist services during childhood, and (iii) include relevant findings about the roles of PCPs during transition to adult services. A data extraction tool will be developed and piloted on a subset of studies. Both quantitative and qualitative data will be synthesized. Discussion Key themes about the roles of PCPs for AYAs involved with specialist services will be identified through this review. Findings will inform the development and evaluation of a primary-care based intervention to improve transition care for AYAs with chronic conditions.
Open Access
Results from the BETTER WISE trial: a pragmatic cluster two arm parallel randomized controlled trial for primary prevention and screening in primary care during the COVID-19 pandemic
(2023-09-28) Manca, Donna P.; Fernandes, Carolina; Lofters, Aisha; Aubrey-Bassler, Kris; Shea-Budgell, Melissa; Campbell-Scherer, Denise; Sopcak, Nicolette; Meaney, Christopher; Moineddin, Rahim; McBrien, Kerry; Krueger, Paul; Wong, Tracy; Grunfeld, Eva
Abstract Background Cancer and chronic diseases are a major cost to the healthcare system and multidisciplinary models with access to prevention and screening resources have demonstrated improvements in chronic disease management and prevention. Research demonstrated that a trained Prevention Practitioner (PP) in multidisciplinary team settings can improve achievement of patient level prevention and screening actions seven months after the intervention. Methods We tested the effectiveness of the PP intervention in a pragmatic two-arm cluster randomized controlled trial. Patients aged 40–65 were randomized at the physician level to an intervention group or to a wait-list control group. The intervention consisted of a patient visit with a PP. The PP received training in prevention and screening and use of the BETTER WISE tool kit. The effectiveness of the intervention was assessed using a composite outcome of the proportion of the eligible prevention and screening actions achieved between intervention and control groups at 12-months. Results Fifty-nine physicians were recruited in Alberta, Ontario, and Newfoundland and Labrador. Of the 1,005 patients enrolled, 733 (72.9%) completed the 12-month analysis. The COVID-19 pandemic occurred during the study time frame at which time nonessential prevention and screening services were not available and in-person visits with the PP were not allowed. Many patients and sites did not receive the intervention as planned. The mean composite score was not significantly higher in patients receiving the PP intervention as compared to the control group. To understand the impact of COVID on the project, we also considered a subset of patients who had received the intervention and who attended the 12-month follow-up visit before COVID-19. This assessment demonstrated the effectiveness of the BETTER visits, similar to the findings in previous BETTER studies. Conclusions We did not observe an improvement in cancer and chronic disease prevention and screening (CCDPS) outcomes at 12 months after a BETTER WISE prevention visit: due to the COVID-19 pandemic, the study was not implemented as planned. Though benefits were described in those who received the intervention before COVID-19, the sample size was too small to make conclusions. This study may be a harbinger of a substantial decrease and delay in CCDPS activities under COVID restrictions. Trial registration ISRCTN21333761. Registered on 19/12/2016. http://www.isrctn.com/ISRCTN21333761 .
Open Access
The role of Community Health Navigators in the creation of plans to support patients with chronic conditions: A sub study of the ENCOMPASS trial
(2022-07-05) Leong, Michelle; McBrien, Kerry; Campbell, David; Ronksley, Paul
Background: Patients with chronic conditions implement care plans in the community but barriers to care, such as financial constraints, may hinder their abilities to do so. Support from patient navigators has been shown to improve health disparities associated with socioeconomic barriers and increase patient adherence with care plans. However, the role of patient navigators in providing individualized support to address unique patient needs is not well defined in the literature. The ENhancing COMmunity health through Patient navigation, Advocacy and Social Support (ENCOMPASS) research program in Calgary is testing a patient navigation program to address patient barriers and build self-efficacy. Non-clinically trained Community Health Navigators (CHNs) are paired with patients diagnosed with two or more (of a set of six) common chronic conditions and provide support by helping patients set and meet priorities. Purpose: To explore if and how CHNs tailor their plans of support to address patient social and/or health-related needs in the ENCOMPASS program of research. Methods: A multimethod qualitative description approach was used. Case notes completed by CHNs documenting information on patient barriers, priorities, and the CHN’s support plan for each patient priority were analyzed. Two reviewers subjectively assessed Priority-CHN plans to determine the appropriateness of the plan. Patient priorities and CHN plans of support were coded separately using thematic codebook analysis, with codes being subsequently linked and quantitized to show percent correlation. Descriptive statistics was used to summarize findings. Results: 86 patients were included in the analysis. A total of 179 patient priorities were evaluated and 157 priorities (88%) were assessed as having CHN support plans that had a reasonable link to addressing the priority. The strongest correlations between a priority and support plan were found for: medication adherence and CHN verifying adherence to care plan (100%); transportation and CHN facilitating transportation (90%); increasing knowledge about medical information and CHN gathering and sharing information (60%). Conclusion: CHNs planned diverse and appropriate supports to help address patient priorities. Future work should consider linking the supports provided by CHNs during the intervention to patient priorities and barriers to further understand how CHNs provide tailored support.
Open Access
Spread of Makoyoh’sokoi (Wolf Trail): a community led, physical activity-based, holistic wellness program for Indigenous women in Canada
(2023-08-12) Frehlich, Levi; Amson, Ashley; Doyle-Baker, Patricia; Black, Tia; Boustead, Dawn; Cameron, Erin; Crowshoe, Lynden (Lindsay); McBrien, Kerry; Ji, Yunqi (Jacob); McGuire, Ashlee; Oliver, Alicia; Tuttauk, Loretta; Zhang, Jessica; Checholik, Carly; Wicklum, Sonja
Abstract Globally, Indigenous populations have been impacted by colonization. Populations who have endured colonization are at higher risk of developing chronic diseases. Canada’s Truth and Reconciliation Commission emphasizes reducing barriers to participation in physical activity and recommends the creation of culturally relevant and supportive policies and programing. Physical activity is a cornerstone in health promotion and public health to combat chronic diseases; however, in Canada, Indigenous developed physical activity programing is sparse, and those targeting women are non-existent in some regions. Makoyoh'sokoi (The Wolf Trail Program) is an 18-week long, holistic wellness program that was created by and for Indigenous women. Makoyoh'sokoi was developed by communities following extensive consultation and cultural oversight. Makoyoh'sokoi’s core program consists of 12 weeks of weekly physical activity programing and health education, followed by another 6 weeks of weekly health education. Notably, communities have control over the program to modify based on individual needs and challenges. Programs commence and conclude with a ceremony with Elders giving a blessing and opening each other to connection. The goals of Makoyoh'sokoi are to empower women, improve health outcomes, and to implement a sustainable program by training a network of community members in their respective communities to facilitate delivery.
Open Access
The Association Between Income and Patient-Reported Diabetes Care: Results of a Cross-Sectional Survey
(2016) Saad, Nathalie; Hemmelgarn, Brenda; McBrien, Kerry; Edwards, Alun; Zhang, Jianguo
The main objective of this study was to evaluate the association between income and indicators of access to care as well as indicators of guideline-concordant recommended care in patients with diabetes and poor glycemic control. We used data from a cross-sectional telephone survey of outpatients with diabetes and linked this data with administrative and laboratory data. The study population included adult outpatients living in Calgary, Alberta with diabetes. The exposure was the total household income in the prior 12 months, as reported by survey respondents. We conducted a poisson regression analysis to determine the association between income and each of the outcome variables. We found that participants with an annual household income of < $20,000 were less likely to report taking recommended aspirin as well as statin therapy compared to those with an annual household income > $50,000. Further research is required to delineate the underlying reasons for these results.
Open Access
The BETTER WISE protocol: building on existing tools to improve cancer and chronic disease prevention and screening in primary care for wellness of cancer survivors and patients – a cluster randomized controlled trial embedded in a mixed methods design
(2018-09-26) Manca, Donna P; Fernandes, Carolina; Grunfeld, Eva; Aubrey-Bassler, Kris; Shea-Budgell, Melissa; Lofters, Aisha; Campbell-Scherer, Denise; Sopcak, Nicolette; O’Brien, Mary A; Meaney, Christopher; Moineddin, Rahim; McBrien, Kerry; Salvalaggio, Ginetta; Krueger, Paul
Abstract Background There is a pressing need to reduce the burden of chronic disease and improve healthcare system sustainability through improved cancer and chronic disease prevention and screening (CCDPS) in primary care. We aim to create an integrated approach that addresses the needs of the general population and the special concerns of cancer survivors. Building on previous research, we will develop, implement, and test the effectiveness of an approach that proactively targets patients to attend an individualized CCDPS intervention delivered by a Prevention Practitioner (PP). The objective is to determine if patients randomized to receive an individualized PP visit (vs standard care) have improved cancer surveillance and CCDPS outcomes. Implementation frameworks will help identify and address facilitators and barriers to the approach and inform future dissemination and uptake. Methods/design The BETTER WISE project is a pragmatic two-arm cluster randomized controlled trial embedded in a mixed methods design, including a qualitative evaluation and an economic assessment. The intervention, informed by the expanded chronic care model and previous research, will be refined by engaging researchers, practitioners, policy makers, and patients. The BETTER WISE tool kit includes blended care pathways for cancer survivors (breast, colorectal, prostate) and CCDPS including lifestyle risk factors and screening for poverty. Patients aged 40–65, including both cancer survivors and general population patients, will be randomized at the physician level to an intervention group or to a wait-list control group. Once the intervention is completed, patients randomized to wait-list control will be invited to receive a prevention visit. The main outcome, calculated at 12-months follow-up, will be an individual patient-level summary composite index, defined as the proportion of CCDPS actions achieved relative to those for which the patient was eligible at baseline. A qualitative evaluation will capture information related to program outcome, implementation (facilitators and barriers), and sustainability. An economic assessment will examine the projected cost-benefit impact of investing in the BETTER WISE approach. Discussion This project builds on existing work and engages end users throughout the process to develop, implement, and determine the effectiveness of a multi-faceted intervention that addresses CCDPS and cancer survivorship in primary care settings. Trial registration ISRCTN21333761 . Registered on December 19, 2016
Open Access
The primary care COVID-19 integrated pathway: a rapid response to health and social impacts of COVID-19
(2022-12-20) Aghajafari, Fariba; Hansen, Brian; McBrien, Kerry; Leslie, Myles; Chiew, Alexandra; Ward, Rick; Li, Bing; Hu, Jia
Abstract Background The first wave of COVID-19 in Calgary, Alberta accelerated the integration of primary care with the province’s centrally managed health system. This integration aimed to deliver wraparound in-community patient care through two interventions that combined to create the COVID-19 Integrated Pathway (CIP). The CIP’s interventions were: 1) a data sharing platform that ensured COVID-19 test results were directly available to family physicians (FPs), and 2) a clinical algorithm that supported FPs in delivering in-community follow up to improve patient outcomes. We describe the CIP function and its capacity to facilitate FP follow-up with COVID-19 patients and evaluate its impact on Emergency Department (ED) visits and hospitalization. Method We generated descriptive statistics by analyzing data from a Calgary Zone hub clinic called the Calgary COVID-19 Care Clinic (C4), provincially maintained records of hospitalization, ED visits, and physician claims. Results Between Apr. 16 and Sep. 27, 2020, 7289 patients were referred by the Calgary Public Health team to the C4 clinic. Of those, 48.6% were female, the median age was 37.4 y. 97% of patients had at least one visit with a healthcare professional, where follow-up was conducted using the CIP’s algorithm. 5.1% of patients visited an ED and 1.9% were hospitalized within 30 days of diagnosis. 75% of patients had a median of 4 visits with their FP. Discussion Our data suggest that information exchange between Primary Care (PC) and central systems facilitates primary care-based management of patients with COVID-19 in the community and has potential to reduce acute care visits.