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Article ; Online: Patient perspectives on tablet-based technology to collect risk factor information in primary care

Leanne Kosowan / Alan Katz / Gayle Halas / Alexander Singer

BMC Family Practice, Vol 22, Iss 1, Pp 1-

2021 Volume 8

Abstract: Abstract Background Primary care provides an opportunity to introduce prevention strategies and identify risk behaviours. Algorithmic information technology such as the Risk Factor Identification Tool (RFIT) can support primary care counseling. This ... ...

Abstract	Abstract Background Primary care provides an opportunity to introduce prevention strategies and identify risk behaviours. Algorithmic information technology such as the Risk Factor Identification Tool (RFIT) can support primary care counseling. This study explores the integration of the tablet-based RFIT in primary care clinics to support exploration of patient risk factor information. Methods Qualitative study to explore patients’ perspectives of RFIT. RFIT was implemented in two primary care clinics in Manitoba, Canada. There were 207 patients who completed RFIT, offered to them by eight family physicians. We conducted one-on-one patient interviews with 86 patients to capture the patient’s perspective. Responses were coded and categorized into five common themes. Results RFIT had a completion rate of 86%. Clinic staff reported that very few patients declined the use of RFIT or required assistance to use the tablet. Patients reported that the tablet-based RFIT provided a user-friendly interface that enabled self-reflection while in the waiting room. Patients discussed the impact of RFIT on the patient-provider interaction, utility for the clinician, their concerns and suggested improvements for RFIT. Among the patients who used RFIT 12.1% smoked, 21.2% felt their diet could be improved, 9.3% reported high alcohol consumption, 56.4% reported less than 150 min of PA a week, and 8.2% lived in poverty. Conclusion RFIT is a user-friendly tool for the collection of patient risk behaviour information. RFIT is particularly useful for patients lacking continuity in the care they receive. Information technology can promote self-reflection while providing useful information to the primary care clinician. When combined with practical tools and resources RFIT can assist in the reduction of risk behaviours.
Keywords	Risk Factors ; Information technology ; Primary health care ; Primary prevention ; Medicine (General) ; R5-920
Language	English
Publishing date	2021-05-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Evaluation of administrative case definitions for hypertension in Canadian children

Allison Dart / Alexander Singer / Rahul Chanchlani / Thomas Ferguson / Navdeep Tangri / Michael Zappitelli

Scientific Reports, Vol 13, Iss 1, Pp 1-

2023 Volume 8

Abstract: Abstract Hypertension is increasing in children and warrants disease surveillance. We therefore sought to evaluate the validity of case definitions to identify pediatric hypertension in administrative healthcare data. Cases of hypertension in children 3– ... ...

Abstract	Abstract Hypertension is increasing in children and warrants disease surveillance. We therefore sought to evaluate the validity of case definitions to identify pediatric hypertension in administrative healthcare data. Cases of hypertension in children 3–18 years of age were identified utilizing blood pressures recorded in the Manitoba Primary Care Research Network (MaPCReN) electronic medical record from 2014 to 2016. Prevalence of hypertension and associated clinical characteristics were determined. We then evaluated the validity of 18 case definitions combining outpatient physician visits (ICD9CM codes), hospital claims (ICD9CM/ICD10 codes) and antihypertensive use within 1–3 years of data housed at the Manitoba Centre for Health Policy. The MaPCReN database identified 241 children with hypertension and 4090 without (prevalence = 5.6%). The sensitivity of algorithms ranged between 0.18 and 0.51 and the specificity between 0.98 and 1.00. Pharmaceutical use increased the sensitivity of algorithms significantly. The algorithms with the highest sensitivity and area under the ROC curve were 1 or more hospitalization OR 1 or more physician claim OR 1 or more pharmaceutical record. Evaluating 2 years of data is recommended. Administrative data alone reflects diagnosis of hypertension with high specificity, but underestimate the true prevalence of this disease. Alternative data sources are therefore required for disease surveillance.
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2023-05-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Seven tips for clinical supervision in the time of COVID 19

Karen Schultz / Alexander Singer / Ivy Oadansan

Canadian Medical Education Journal, Vol 12, Iss

2020 Volume 1

Abstract: Virtual care (VC) rapidly has become the preferred care model in family medicine settings during the COVID-19 pandemic. Both residents and preceptors must rapidly adapt and develop new skills to provide and supervise virtual care. The College of Family ... ...

Abstract	Virtual care (VC) rapidly has become the preferred care model in family medicine settings during the COVID-19 pandemic. Both residents and preceptors must rapidly adapt and develop new skills to provide and supervise virtual care. The College of Family Physicians of Canada (CFPC) created a VC supervision guide for family medicine residents and preceptors by quickly mobilizing a consensus driven approach leveraging existing CFPC educational committees, representing a broad range of teachers and residents in the country. The guide can be adapted to other settings and is provided in the hopes of being helpful to all preceptors providing VC and (virtual) supervision during the pandemic.
Keywords	Education (General) ; L7-991 ; Medicine (General) ; R5-920
Language	English
Publishing date	2020-12-01T00:00:00Z
Publisher	Canadian Medical Education Journal
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Evaluation of BASE eConsult Manitoba

Alexander Singer / Laurie Ireland / Zahra Sepehri / Kelly Brown / Kevin Turner / Clare Liddy / Erin Keely / Luis Oppenheimer

BMC Health Services Research, Vol 23, Iss 1, Pp 1-

patient perspectives on the use of electronic consultation to improve access to specialty advice in Manitoba

2023 Volume 8

Abstract: Abstract Background The burden of waiting to access specialist expertise may contribute to poorer health outcomes and causes distress for patients and providers. One solution to improve access to specialist care is to use innovative tools such as remote ... ...

Abstract	Abstract Background The burden of waiting to access specialist expertise may contribute to poorer health outcomes and causes distress for patients and providers. One solution to improve access to specialist care is to use innovative tools such as remote asynchronous electronic consultation (eConsult). Modeled after the Champlain BASE™ (Building Access to Specialist Advice) eConsult service, BASE™ eConsult Manitoba was launched in 2017 to help address long waits for patients to access specialist advice. Objective We aimed to evaluate patients’ experiences after obtaining a BASE™ eConsult Manitoba service in their primary care setting. Methods Patients whose Primary Care Providers (PCPs) used BASE™ eConsult as part of their care were asked to participate and complete a telephone-based or online 29-question survey between January 2021 and October 2021. The survey questions were created in consultation with patient partners and based on questions asked in studies done in other jurisdictions. Results Of the 36 patients who chose to participate, 29 completed the entire survey (80%). Two-thirds (n = 22) agreed that eConsult has been helpful in their situation, and over 80% (n = 24) of participants agreed that eConsult was an acceptable way to access specialist care. During the visit when their PCP sent the eConsult, 7 patients were expecting to be referred to a specialist for a face-to-face consultation. Over half of all respondents (n = 15) reported that before the eConsult occurred, their PCP asked them what questions they wanted to be answered by the specialist. Almost all of these respondents’ questions were fully answered by the eConsult. All of the respondents were satisfied with the experience of receiving an eConsult. Conclusion Using eConsult is an acceptable way to improve access to specialist advice from patients’ perspectives. Consideration should be given to expanding the use of eConsult services to improve access to specialist expertise for PCPs and their patients.
Keywords	Access to care ; Primary care ; Qualitative research ; Quality of care ; eConsult ; Public aspects of medicine ; RA1-1270
Subject code	050
Language	English
Publishing date	2023-02-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Who is asked about alcohol consumption? A retrospective cohort study using a national repository of Electronic Medical Records

Alexander Singer / Leanne Kosowan / Shilpa Loewen / Sheryl Spithoff / Michelle Greiver / Joanna Lynch

Preventive Medicine Reports, Vol 22, Iss , Pp 101346- (2021)

2021

Abstract: Documentation of alcohol use in electronic medical record (EMR) informs interventions to reduce alcohol-related morbidity and mortality. This retrospective cohort study explored EMR data from 960 primary care providers participating in the Canadian ... ...

Abstract	Documentation of alcohol use in electronic medical record (EMR) informs interventions to reduce alcohol-related morbidity and mortality. This retrospective cohort study explored EMR data from 960 primary care providers participating in the Canadian Primary Care Sentinel Surveillance Network to describe documentation of alcohol use (e.g. none, current or past use) in the EMR. Included providers represented 700,620 adult patients from across Canada with an encounter between 2015 and 2018. Bivariate comparisons characterized the patients with, and without, documentation of alcohol use. Multivariate generalized estimating equation models with logit function assessed patient and provider characteristics associated with (1) documentation of alcohol and (2) patients with heightened risk for alcohol-related problems. Forty percent of patients had alcohol use documentation in the EMR. Light alcohol consumption was recorded for 43.6% of these patients. Male patients (OR1.09, CI 1.07–1.12), who were older (OR1.26, CI 1.23–1.30), had more frequent visits to their provider (OR1.11, CI 1.09–1.13) and had hypertension (OR1.07, CI 1.06–1.09) or depression (OR1.07, CI 1.09–1.14) had higher odds of alcohol documentation. There were 4.7% of patients with a record indicating heightened risk for alcohol-related problems. Male patients (OR3.27 CI 3.14–3.4), patients with depression (OR2.01 CI1.93–2.1) and rural residency (OR1.35 CI1.29–1.42) was associated with risk for alcohol-related problems. Heavy alcohol consumption is associated with an increased risk of negative health outcomes, particularly for patients with certain chronic conditions. However, these patients do not have alcohol use consistently documented in the EMR. Strategies should be designed and implemented to support more consistent alcohol-screening among high-risk patients.
Keywords	Electronic health records ; Alcohol drinking ; Primary health care ; Supervised machine learning ; Medicine ; R
Subject code	616
Language	English
Publishing date	2021-06-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Implementing an audit and feedback cycle to improve adherence to the Choosing Wisely Canada recommendations

Alexander Singer / Leanne Kosowan / Elissa M. Abrams / Alan Katz / Lisa Lix / Katrina Leong / Allison Paige

BMC Primary Care, Vol 23, Iss 1, Pp 1-

clustered randomized trail

2022 Volume 8

Abstract: Abstract Background Audit and Feedback (A&F), a strategy aimed at promoting modified practice through performance feedback, is a method to change provider behaviour and reduce unnecessary medical services. This study aims to assess the use of A&F to ... ...

Abstract	Abstract Background Audit and Feedback (A&F), a strategy aimed at promoting modified practice through performance feedback, is a method to change provider behaviour and reduce unnecessary medical services. This study aims to assess the use of A&F to reduce antibiotic prescribing for viral infections and antipsychotic prescribing to patients with dementia. Methods Clustered randomized trial of 239 primary care providers in Manitoba, Canada, participating in the Manitoba Primary Care Research Network. Forty-six practices were randomly assigned to one of three groups: control group, intervention 1 (recommendations summary), intervention 2 (recommendations summary and personalized feedback). We assessed prescribing rates prior to the intervention (2014/15), during and immediately after the intervention (2016/17) and following the intervention (2018/19). Physician characteristics were assessed. Results Between 2014/15–2016/17, 91.6% of providers in intervention group 1 and 95.9% of providers in intervention group 2 reduced their antibiotic and antipsychotic prescribing rate by ≥ 1 compared to the control group (77.6%) (p-value 0.0073). This reduction was maintained into 2018/19 at 91.4%. On multivariate regression alternatively funded providers had 2.4 × higher odds of reducing their antibiotic prescribing rate compared to fee-for-service providers. In quantile regression of providers with a reduction in antibiotic prescribing, alternatively funded (e.g. salaried or locum) providers compared to fee-for-service providers were significant at the 80th quantile. Conclusions Both A&F and recommendation summaries sent to providers by a trusted source reduced unnecessary prescriptions. Our findings support further scale up of efforts to engage with primary care practices to improve care with A&F. Trial registration ClinicalTrials.gov NCT05385445, retrospectively registered, 23/05/2022.
Keywords	Primary health care ; Health care quality ; Access and evaluation ; Health services research ; Choosing wisely ; Randomized controlled trial ; Medicine (General) ; R5-920
Subject code	360
Language	English
Publishing date	2022-11-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Combining population-based administrative health records and electronic medical records for disease surveillance

Saeed Al-Azazi / Alexander Singer / Rasheda Rabbani / Lisa M. Lix

BMC Medical Informatics and Decision Making, Vol 19, Iss 1, Pp 1-

2019 Volume 12

Abstract: Abstract Background Administrative health records (AHRs) and electronic medical records (EMRs) are two key sources of population-based data for disease surveillance, but misclassification errors in the data can bias disease estimates. Methods that ... ...

Abstract	Abstract Background Administrative health records (AHRs) and electronic medical records (EMRs) are two key sources of population-based data for disease surveillance, but misclassification errors in the data can bias disease estimates. Methods that combine information from error-prone data sources can build on the strengths of AHRs and EMRs. We compared bias and error for four data-combining methods and applied them to estimate hypertension prevalence. Methods Our study included rule-based OR and AND methods that identify disease cases from either or both data sources, respectively, rule-based sensitivity-specificity adjusted (RSSA) method that corrects for inaccuracies using a deterministic rule, and probabilistic-based sensitivity-specificity adjusted (PSSA) method that corrects for error using a statistical model. Computer simulation was used to estimate relative bias (RB) and mean square error (MSE) under varying conditions of population disease prevalence, correlation amongst data sources, and amount of misclassification error. AHRs and EMRs for Manitoba, Canada were used to estimate hypertension prevalence using validated case definitions and multiple disease markers. Results The OR method had the lowest RB and MSE when population disease prevalence was 10%, and the RSSA method had the lowest RB and MSE when population prevalence increased to 20%. As the correlation between data sources increased, the OR method resulted in the lowest RB and MSE. Estimates of hypertension prevalence for AHRs and EMRs alone were 30.9% (95% CI: 30.6–31.2) and 24.9% (95% CI: 24.6–25.2), respectively. The estimates were 21.4% (95% CI: 21.1–21.7), for the AND method, 34.4% (95% CI: 34.1–34.8) for the OR method, 32.2% (95% CI: 31.8–32.6) for the RSSA method, and ranged from 34.3% (95% CI: 34.1–34.5) to 35.9% (95% CI, 35.7–36.1) for the PSSA method, depending on the statistical model. Conclusions The OR and AND methods are influenced by correlation amongst the data sources, while the RSSA method is dependent on the accuracy of ...
Keywords	Administrative data ; Electronic medical records ; Misclassification bias ; Prevalence ; Statistical model ; Computer applications to medicine. Medical informatics ; R858-859.7
Subject code	310
Language	English
Publishing date	2019-07-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Characteristics associated with pediatric growth measurement collection in electronic medical records

Leanne Kosowan / John Page / Jennifer Protudjer / Tyler Williamson / John Queenan / Alexander Singer

BMC Family Practice, Vol 21, Iss 1, Pp 1-

a retrospective observational study

2020 Volume 7

Abstract: Abstract Background Complete growth measurements are an essential part of pediatric care providing a proxy for a child’s overall health. This study describes the frequency of well-child visits, documented growth measurements, and clinic and provider ... ...

Abstract	Abstract Background Complete growth measurements are an essential part of pediatric care providing a proxy for a child’s overall health. This study describes the frequency of well-child visits, documented growth measurements, and clinic and provider factors associated with measurement. Methods Retrospective cross-sectional study utilizing electronic medical records (EMRs) from primary care clinics between 2015 and 2017 in Manitoba, Canada. This study assessed the presence of recorded height, weight and head circumference among children (0–24 months) who visited one of 212 providers participating in the Manitoba Primary Care Research Network. Descriptive and multivariable logistic regression analyses assessed clinic, provider, and patient factors associated with children having complete growth measurements. Results Our sample included 4369 children. The most frequent growth measure recorded was weight (79.2% n = 3460) followed by height (70.8% n = 3093) and head circumference (51.4% n = 2246). 67.5% of children (n = 2947) had at least one complete growth measurement recorded (i.e. weight, height and head circumference) and 13.7% (n = 599) had complete growth measurements at all well-child intervals attended. Pediatricians had 2.7 higher odds of documenting complete growth measures within well-child intervals compared to family physicians (95% CI 1.8–3.8). Additionally, urban located clinics (OR 1.7, 95% CI 1.2–2.5), Canadian trained providers (OR 2.3, 95% CI 1.4–3.7), small practice size (OR 1.6, 95% CI 1.2–2.2) and salaried providers (OR 3.4, 95% CI 2.2–5.2) had higher odds of documented growth measures. Conclusions Growth measurements are recorded in EMRs but documentation is variable based on clinic and provider factors. Pediatric growth measures at primary care appointments can improve primary prevention and surveillance of child health outcomes.
Keywords	Primary health care ; Electronic health records ; Growth and development ; Child development ; Medicine (General) ; R5-920
Subject code	360
Language	English
Publishing date	2020-09-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Risk of long-term benzodiazepine and Z-drug use following the first prescription among community-dwelling adults with anxiety/mood and sleep disorders

Dan Chateau / Alexander Singer / Silvia Alessi-Severini / Jaden Brandt / Donica Janzen / Murray Enns / Christine Leong

BMJ Open, Vol 11, Iss

a retrospective cohort study

2021 Volume 11

Keywords	Medicine ; R
Language	English
Publishing date	2021-11-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Strategies for working across Canadian practice-based research and learning networks (PBRLNs) in primary care

Manpreet Thandi / Sabrina T. Wong / Sylvia Aponte-Hao / Mathew Grandy / Dee Mangin / Alexander Singer / Tyler Williamson

BMC Family Practice, Vol 22, Iss 1, Pp 1-

focus on frailty

2021 Volume 15

Abstract: Abstract Background Practice based research and learning networks (PBRLNs) are groups of learning communities that focus on improving delivery and quality of care. Accurate data from primary care electronic medical records (EMRs) is crucial in forming ... ...

Abstract	Abstract Background Practice based research and learning networks (PBRLNs) are groups of learning communities that focus on improving delivery and quality of care. Accurate data from primary care electronic medical records (EMRs) is crucial in forming the backbone for PBRLNs. The purpose of this work is to: (1) report on descriptive findings from recent frailty work, (2) describe strategies for working across PBRLNs in primary care, and (3) provide lessons learned for engaging PBRLNs. Methods We carried out a participatory based descriptive study that engaged five different PBRLNs. We collected Clinical Frailty Scale scores from a sample of participating physicians within each PBRLN. Descriptive statistics were used to analyze frailty scores and patients’ associated risk factors and demographics. We used the Consolidated Framework for Implementation Research to inform thematic analysis of qualitative data (meeting minutes, notes, and conversations with co-investigators of each network) in recognizing challenges of working across networks. Results One hundred nine physicians participated in collecting CFS scores across the five provinces (n = 5466). Percentages of frail (11-17%) and not frail (82-91%) patients were similar in all networks, except Ontario who had a higher percentage of frail patients (25%). The majority of frail patients were female (65%) and had a significantly higher prevalence of hypertension, dementia, and depression. Frail patients had more prescribed medications and numbers of healthcare encounters. There were several noteworthy challenges experienced throughout the research process related to differences across provinces in the areas of: numbers of stakeholders/staff involved and thus levels of burden, recruitment strategies, data collection strategies, enhancing engagement, and timelines. Discussion Lessons learned throughout this multi-jurisdictional work included: the need for continuity in ethics, regular team meetings, enhancing levels of engagement with stakeholders, the need for ...
Keywords	Practice-based research and learning networks ; Learning health systems ; Primary care ; Frailty ; Multi-jurisdictional collaboration ; Medicine (General) ; R5-920
Subject code	360
Language	English
Publishing date	2021-11-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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