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Book ; Online ; E-Book: Patient-centered medicine

Stewart, Moira / Brown, Judith Belle / Weston, W. Wayne / Freeman, Thomas / Ryan, Bridget L. / McWilliam, Carol L. / McWhinney, Ian R.

transforming the clinical method

2024

Abstract: Fully revised by its highly experienced author team, this new edition will be welcomed by a wide international audience comprising all health professionals from medicine, nursing, social work, occupational therapy, physical therapy, pharmacy, veterinary ... ...

Author's details	Moira Stewart, Judith Belle Brown, W Wayne Weston, Thomas R Freeman, Bridget L Ryan, Carol L McWilliam, and Ian R McWhinney
Abstract	Fully revised by its highly experienced author team, this new edition will be welcomed by a wide international audience comprising all health professionals from medicine, nursing, social work, occupational therapy, physical therapy, pharmacy, veterinary medicine, and other fields.
Keywords	Medical personnel and patient ; Medicine-Philosophy ; Patient-centered health care ; Physician and patient
Subject code	610 ; 610.696
Language	English
Size	1 Online-Ressource (xx, 342 Seiten)
Edition	Fourth edition
Publisher	CRC Press
Publishing place	Boca Raton, FL
Publishing country	United States
Document type	Book ; Online ; E-Book
Remark	Zugriff für angemeldete ZB MED-Nutzerinnen und -Nutzer
HBZ-ID	HT030707277
ISBN	978-1-00-384728-1 ; 978-1-003-39467-9 ; 9781032480596 ; 9781032496238 ; 1-00-384728-5 ; 1-003-39467-1 ; 1032480599 ; 1032496231
Database	ZB MED Catalogue: Medicine, Health, Nutrition, Environment, Agriculture

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Article ; Online: Understanding intersectional inequality in access to primary care providers using multilevel analysis of individual heterogeneity and discriminatory accuracy.

He, Jennifer W / Terry, Amanda L / Lizotte, Dan / Bauer, Greta / Ryan, Bridget L

PloS one

2024 Volume 19, Issue 1, Page(s) e0296657

Abstract: Background: Despite the Canadian healthcare system's commitment to equity, evidence for disparate access to primary care (PC) providers exists across individual social identities/positions. Intersectionality allows us to reflect the realities of how ... ...

Abstract	Background: Despite the Canadian healthcare system's commitment to equity, evidence for disparate access to primary care (PC) providers exists across individual social identities/positions. Intersectionality allows us to reflect the realities of how social power shapes healthcare experiences at an individual's interdependent and intersecting social identities/positions. The objectives of this study were to determine: (1) the extent to which intersections can be used classify those who had/did not have a PC provider; (2) the degree to which each social identity/position contributes to the ability to classify individuals as having a PC provider; and (3) predicted probabilities of having a PC provider for each intersection. Methods and findings: Using national cross-sectional data from 241,445 individuals in Canada aged ≥18, we constructed 320 intersections along the dimensions of gender, age, immigration status, race, and income to examine the outcome of whether one had a PC provider. Multilevel analysis of individual heterogeneity and discriminatory accuracy, a multi-level model using individual-level data, was employed to address intersectional objectives. An intra-class correlation coefficient (ICC) of 23% (95%CI: 21-26%) suggests that these intersections could, to a very good extent, explain individual variation in the outcome, with age playing the largest role. Not all between-intersection variance in this outcome could be explained by additive effects of dimensions (remaining ICC: 6%; 95%CI: 2-16%). The highest intersectional predicted probability existed for established immigrant, older South Asian women with high income. The lowest intersectional predicted probability existed for recently immigrated, young, Black men with low income. Conclusions: Despite a "universal" healthcare system, our analysis demonstrated a substantial amount of inequity in primary care across intersections of gender, age, immigration status, race, and income.
MeSH term(s)	Male ; Humans ; Female ; Cross-Sectional Studies ; Multilevel Analysis ; Access to Primary Care ; Intersectional Framework ; Health Status Disparities ; Canada
Language	English
Publishing date	2024-01-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0296657
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Article ; Online: Utilization of healthcare by immigrants in Canada: a cross-sectional analysis of the Canadian Community Health Survey.

Ravichandiran, Nisanthini / Mathews, Maria / Ryan, Bridget L

BMC primary care

2022 Volume 23, Issue 1, Page(s) 69

Abstract: Background: Immigrants to Canada face unique barriers to health care, which leads to inequities in health care utilization. Lower utilization of health care by immigrants to Canada is associated with the deteriorating health of individual immigrants as ... ...

Abstract	Background: Immigrants to Canada face unique barriers to health care, which leads to inequities in health care utilization. Lower utilization of health care by immigrants to Canada is associated with the deteriorating health of individual immigrants as well as increased costs to the health care system. The existing literature suggests that time since immigration is an important predictor for utilization of health care for Canadian immigrants; however, few studies have included this variable in their analysis. This study aims to examine the relationships between having a regular health care provider and time since immigration, and number of medical consultations in the past year and time since immigration. Methods: A secondary cross-sectional data analysis using Andersen and Newman's Framework of Health Service Utilization and data from the 2015-2016 Canadian Community Health Survey (CCHS) was conducted to examine health care utilization among immigrants in Canada. We used multiple logistic regression to examine the relationship between time since immigration and having a regular physician and negative binomial regression to compare the number of consultations of recent (less than 10 years since immigration) and established (10 or more years since immigration) immigrants. Results: Eighty four percent of immigrant respondents to CCHS 2015-2016 had a regular health care provider. After controlling for other independent variables, established immigrants were 1.75 (95% confidence interval: 1.45-2.10) times more likely to have a regular health care provider compared to recent immigrants. Immigrants had a mean of 3.37 (standard deviation 4.53) medical consultations in the preceding year. There was no difference in the mean number of medical consultations by recent and established immigrants. Conclusions: After controlling for other independent variables, this study found that time since immigration had a significant effect on having a regular provider but not on number of consultations. Differences in health care utilization for recent and for established immigrants observed in this study may be partially explained by Canada's evolving immigration policy and the economic and social integration of immigrants over time.
MeSH term(s)	Canada/epidemiology ; Cross-Sectional Studies ; Emigrants and Immigrants ; Health Services Accessibility ; Humans ; Public Health ; Surveys and Questionnaires
Language	English
Publishing date	2022-04-06
Publishing country	England
Document type	Journal Article
ISSN	2731-4553
ISSN (online)	2731-4553
DOI	10.1186/s12875-022-01682-2
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Article: Real-World Effects of Second-Generation Versus Earlier Intermediate/Basal Insulin Analogues on Rates of Hypoglycemia in Adults with Type 1 and 2 Diabetes (iNPHORM, US).

Black, Jason E / Harris, Stewart B / Ryan, Bridget L / Zou, Guangyong / Ratzki-Leewing, Alexandria

Diabetes therapy : research, treatment and education of diabetes and related disorders

2023 Volume 14, Issue 8, Page(s) 1299–1317

Abstract: Introduction: Second-generation basal insulin analogues have been shown to reduce hypoglycemia in several trials and observational studies of select populations; however, it remains unclear whether these results persist in real-world settings. Using ... ...

Abstract	Introduction: Second-generation basal insulin analogues have been shown to reduce hypoglycemia in several trials and observational studies of select populations; however, it remains unclear whether these results persist in real-world settings. Using self-reported hypoglycemia events, we assessed whether second-generation basal insulin analogues reduce rates of hypoglycemia events (non-severe/severe; overall/daytime/nocturnal) compared to earlier intermediate/basal insulin analogues among people with insulin-treated type 1 or 2 diabetes. Methods: We used prospectively collected data from the Investigating Novel Predictions of Hypoglycemia Occurrence Using Real-World Models (iNPHORM) panel survey. This US-wide, 1-year internet-based survey assessed hypoglycemia experiences and related sociodemographic and clinical characteristics of people with diabetes (February 2020-March 2021). We estimated population-average rate ratios for hypoglycemia comparing second-generation to earlier intermediate/basal insulin analogues using negative binomial regression, adjusting for confounders. Within-person variability of repeated observations was addressed with generalized estimating equations. Results: Among iNPHORM participants with complete data, N = 413 used an intermediate/basal insulin analogue for ≥ 1 month during follow-up. After adjusting for baseline and time-updated confounders, average second-generation basal insulin analogue users experienced a 19% (95% CI 3-32%, p = 0.02) lower rate of overall non-severe hypoglycemia and 43% (95% CI 26-56%, p < 0.001) a lower rate of nocturnal non-severe hypoglycemia compared to earlier intermediate/basal insulin users. Overall severe hypoglycemia rates were similar among second-generation and earlier intermediate/basal insulin users (p = 0.35); however, the rate of severe nocturnal hypoglycemia was reduced by 44% (95% CI 10-65%, p = 0.02) among second-generation insulin users compared to earlier intermediate/basal insulin users. Conclusion: Our real-world results suggest second-generation basal insulin analogues reduce rates of hypoglycemia, especially nocturnal non-severe and severe events. Whenever possible and feasible, clinicians should prioritize prescribing these agents over first-generation basal or intermediate insulin in people with type 1 and 2 diabetes.
Language	English
Publishing date	2023-06-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2566702-6
ISSN	1869-6961 ; 1869-6953
ISSN (online)	1869-6961
ISSN	1869-6953
DOI	10.1007/s13300-023-01423-3
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Article ; Online: Virtual care during COVID-19: The perspectives of older adults and their healthcare providers in a cardiac rehabilitation setting.

Flores-Sandoval, Cecilia / Sibbald, Shannon L / Ryan, Bridget L / Adams, Tracey L / Suskin, Neville / McKelvie, Robert / Elliott, Jacobi / Orange, Joseph B

Canadian journal on aging = La revue canadienne du vieillissement

2024 , Page(s) 1–8

Abstract: The present study aimed to explore the perspectives of older adults and health providers on cardiac rehabilitation care provided virtually during COVID-19. A qualitative exploratory methodology was used. Semi-structured interviews were conducted with 15 ... ...

Abstract	The present study aimed to explore the perspectives of older adults and health providers on cardiac rehabilitation care provided virtually during COVID-19. A qualitative exploratory methodology was used. Semi-structured interviews were conducted with 15 older adults and 6 healthcare providers. Five themes emerged from the data: (1) Lack of emotional intimacy when receiving virtual care, (2) Inadequacy of virtual platforms, (3) Saving time with virtual care, (4) Virtual care facilitated accessibility, and (5) Loss of connections with patients and colleagues. Given that virtual care continues to be implemented, and in some instances touted as an optimal option for the delivery of cardiac rehabilitation, it is critical to address the needs of older adults living with cardiovascular disease and their healthcare providers. This is particularly crucial related to issues accessing and using technology, as well as older adults' need to build trust and emotional connection with their providers.
Language	English
Publishing date	2024-02-23
Publishing country	Canada
Document type	Journal Article
ZDB-ID	632851-9
ISSN	1710-1107 ; 0714-9808
ISSN (online)	1710-1107
ISSN	0714-9808
DOI	10.1017/S0714980824000102
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Article ; Online: Early Psychosis Intervention and Primary Care: A Mixed Methods Study of Family Physician Knowledge, Attitudes, Preferences, and Needs.

Carter, Brooke / Rodrigues, Rebecca / Edwards, Jordan / Jan, Saadia Hameed / Ryan, Bridget L / Booth, Richard G / Archie, Suzanne / Anderson, Kelly K

Community mental health journal

2024

Abstract: Family physicians (FPs) play an important but underappreciated role in the pathways to care for people with early psychosis. We conducted a mixed-methods study to describe the knowledge, attitudes, preferences, and needs of FPs towards the recognition ... ...

Abstract	Family physicians (FPs) play an important but underappreciated role in the pathways to care for people with early psychosis. We conducted a mixed-methods study to describe the knowledge, attitudes, preferences, and needs of FPs towards the recognition and management of early psychosis. We sent a cross-sectional postal survey to a random sample of FPs in Ontario, Canada, and conducted in-depth qualitative interviews with twenty. FPs were generally aware of important early psychosis symptoms, however, there were some knowledge gaps. Among surveyed FPs, 25% were unsure of the availability of early psychosis intervention services in their region, and most (80%) would prefer to co-manage with specialists. In the qualitative interviews, FPs expressed varied comfort levels in recognizing psychosis, and that timely access to psychiatry was a main concern. Our findings suggest that FPs require better support in recognizing and managing early psychosis and facilitating connections with specialized care.
Language	English
Publishing date	2024-03-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	215855-3
ISSN	1573-2789 ; 0010-3853
ISSN (online)	1573-2789
ISSN	0010-3853
DOI	10.1007/s10597-024-01242-1
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Article ; Online: Processes that influence the evolution of family health teams.

Brown, Judith Belle / Ryan, Bridget L

Canadian family physician Medecin de famille canadien

2018 Volume 64, Issue 6, Page(s) e283–e289

Abstract: Objective: To identify the processes that influence the evolution of family health teams (FHTs).: Design: Qualitative study using grounded theory methodology.: Setting: Family health teams in Ontario.: Participants: A total of 110 team members ... ...

Abstract	Objective: To identify the processes that influence the evolution of family health teams (FHTs). Design: Qualitative study using grounded theory methodology. Setting: Family health teams in Ontario. Participants: A total of 110 team members from 20 FHT sites in Ontario. Methods: Individual semistructured interviews were conducted and data were analyzed using initial coding, focused coding, and a constant comparison analysis. Main findings: The analysis illuminated the complex and diverse nature of the FHTs' evolutionary trajectories, which were influenced by 7 discrete but interrelated processes: sharing a common philosophy about teamwork; having effective leadership; respecting each other's scopes of practice; sharing the physical environment; including team activities; supporting conflict resolution; and managing change. The status of each site's evolution was categorized as evolving, progressing, or stalled. Conclusion: The concept of evolution by its very definition does not imply stasis, and as the data revealed, change is always on the horizon. This study revealed 7 processes that influenced team evolution, and these processes were observed to be either optimally applied or noticeably limited in their execution, irrespective of team composition or configuration. These processes can be extrapolated to other primary health care teams to facilitate team evolution.
MeSH term(s)	Delivery of Health Care/methods ; Family Health ; Grounded Theory ; Humans ; Interprofessional Relations ; Ontario ; Patient Care Team/organization & administration ; Primary Health Care/methods ; Process Assessment (Health Care) ; Qualitative Research
Language	English
Publishing date	2018-06-19
Publishing country	Canada
Document type	Evaluation Studies ; Journal Article
ZDB-ID	2146676-2
ISSN	1715-5258 ; 0008-350X
ISSN (online)	1715-5258
ISSN	0008-350X
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Article ; Online: The prevalence of physical multimorbidity among people with non-affective psychotic disorders 10 years after first diagnosis: a matched retrospective cohort study.

Rodrigues, Myanca / Stranges, Saverio / Ryan, Bridget L / Anderson, Kelly K

Social psychiatry and psychiatric epidemiology

2021 Volume 57, Issue 3, Page(s) 495–503

Abstract: Aims: The higher prevalence of chronic physical health conditions among people with psychotic disorders may result in a reduced life expectancy as compared to the general population. More research is needed on the risk of multiple co-occurring chronic ... ...

Abstract	Aims: The higher prevalence of chronic physical health conditions among people with psychotic disorders may result in a reduced life expectancy as compared to the general population. More research is needed on the risk of multiple co-occurring chronic health conditions, known as multimorbidity, for people with psychotic disorders. Methods: We conducted a matched retrospective cohort study to quantify the prevalence of multimorbidity and associated factors among people with psychotic disorders over the 10-year period following first diagnosis, relative to those without psychosis. Data from an early psychosis intervention program in London, Canada were linked to population-based health administrative data to identify patients with first-episode psychosis (n = 439), and a comparison group from the general population (n = 1759) matched on age, sex, and postal code. We followed the cohort for 10 years to ascertain the prevalence of multimorbidity. We compared people with and without psychosis using modified Poisson regression models, and explored risk factors for multimorbidity among those with psychotic disorders. Results: People with psychotic disorders may have a 26% higher prevalence of multimorbidity 10 years following first diagnosis, although our findings include the possibility of a null effect (PR = 1.26, 95% CI 0.96-1.66). People with psychosis living in areas with the highest levels of material deprivation had a threefold higher prevalence of multimorbidity as compared to those in the lowest areas of material deprivation (PR = 3.09, 95% CI 1.21-7.90). Conclusion: Multimorbidity is prevalent among those with psychosis, and assessment for chronic health conditions should be integrated into clinical care for younger populations with psychotic illness.
MeSH term(s)	Cohort Studies ; Humans ; Multimorbidity ; Prevalence ; Psychotic Disorders/diagnosis ; Psychotic Disorders/epidemiology ; Retrospective Studies
Language	English
Publishing date	2021-08-06
Publishing country	Germany
Document type	Journal Article
ZDB-ID	623071-4
ISSN	1433-9285 ; 0037-7813 ; 0933-7954
ISSN (online)	1433-9285
ISSN	0037-7813 ; 0933-7954
DOI	10.1007/s00127-021-02157-y
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Article ; Online: Real-world risk factors of confirmed or probable COVID-19 in Americans with diabetes: A prospective, community-based study (iNPHORM).

Ratzki-Leewing, Alexandria / Black, Jason E / Ryan, Bridget L / Harris, Stewart B

Endocrinology, diabetes & metabolism

2022 Volume 5, Issue 4, Page(s) e342

Abstract: Introduction: Americans with diabetes are clinically vulnerable to worse COVID-19 outcomes; thus, insight into how to prevent infection is imperative. Using longitudinal, prospective data from the real-world iNPHORM study, we identify the intrinsic and ... ...

Abstract	Introduction: Americans with diabetes are clinically vulnerable to worse COVID-19 outcomes; thus, insight into how to prevent infection is imperative. Using longitudinal, prospective data from the real-world iNPHORM study, we identify the intrinsic and extrinsic risk factors of confirmed or probable COVID-19 in people with type 1 or 2 diabetes. Methods: The iNPHORM study recruited 1206 Americans (18-90 years) with insulin- and/or secretagogue-treated type 1 or 2 diabetes from a probability-based internet panel. Online questionnaires (screener, baseline and 12 monthly follow-ups) assessed COVID-19 incidence and various plausible intrinsic and extrinsic factors. Multivariable Cox regression was used to model the rate of COVID-19 (confirmed or probable). Risk factors were selected using a repeated backwards-selection 'voting' procedure. Results: A sub-sample of 817 iNPHORM participants (type 1 diabetes: 16.9%; age: 52.1 [SD: 14.2] years; female: 50.2%) was analysed between May 2020 and March 2021. During this period, 13.7% reported confirmed or probable COVID-19. Age, body mass index, number of chronic comorbidities, most recent A1C, past severe hypoglycaemia, and employment status were selected in our final model. Body mass index ≥30 kg/m Conclusions: This is the first US-based epidemiologic investigation to characterize community-based COVID-19 susceptibility in diabetes. Our results reveal specific and promising avenues to prevent COVID-19 in this at-risk population. Clinicaltrials: gov Identifier: NCT04219514.
MeSH term(s)	COVID-19/epidemiology ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/epidemiology ; Female ; Glycated Hemoglobin A ; Humans ; Middle Aged ; Prospective Studies ; Risk Factors
Chemical Substances	Glycated Hemoglobin A
Language	English
Publishing date	2022-05-29
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2398-9238
ISSN (online)	2398-9238
DOI	10.1002/edm2.342
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Article ; Online: Family Physician Clinical Inertia in Managing Hypoglycemia.

Rebicki, Caroline V M / Ryan, Bridget L / Ratzki-Leewing, Alexandria / Tremblay, Paul F / Harris, Stewart B

Primary care diabetes

2022 Volume 16, Issue 3, Page(s) 417–421

Abstract: Aims: Clinical inertia behaviour affects family physicians managing chronic disease such as diabetes. Literature addressing clinical inertia in the management of hypoglycemia is scarce. The objectives of this study were to create a measurement for ... ...

Abstract	Aims: Clinical inertia behaviour affects family physicians managing chronic disease such as diabetes. Literature addressing clinical inertia in the management of hypoglycemia is scarce. The objectives of this study were to create a measurement for physician clinical inertia in managing hypoglycemia (ClinInert_InHypoDM), and to determine physicians' characteristics associated with clinical inertia. Methods: The study was a secondary analysis of data provided by family physicians from the InHypo-DM Study, applying exploratory factor analysis. Principal axis factoring with an Oblimin rotation was employed to detect underlying factors associated with physician behaviors. Multiple linear regression was used to determine association between the ClinInert_InHypoDM scores and physician characteristics. Results: Factor analysis identified a statistically sound 12-item one-factor scale for clinical inertia behavior. No statistically significant differences in clinical inertia score for the studied independent variables were found. Conclusions: This study provides a scale for assessing clinical inertia in the management of hypoglycemia. Further testing this scale in other family physician populations will provide deeper understanding about the characteristics and factors that influence clinical inertia. The knowledge derived from better understanding clinical inertia in primary care has potential to improve outcomes for patients with diabetes.
MeSH term(s)	Chronic Disease ; Humans ; Hypoglycemia/chemically induced ; Hypoglycemia/diagnosis ; Hypoglycemia/therapy ; Physicians, Family ; Practice Patterns, Physicians'
Language	English
Publishing date	2022-02-24
Publishing country	England
Document type	Journal Article
ZDB-ID	2273997-X
ISSN	1878-0210 ; 1751-9918
ISSN (online)	1878-0210
ISSN	1751-9918
DOI	10.1016/j.pcd.2022.02.005
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