40 research outputs found
Primary health care services for patients with chronic disease in Newfoundland and Labrador: a descriptive analysis
Background: Newfoundland and Labrador has a rapidly aging population, much of which is rural, with poor health behaviours and high rates of chronic disease. These factors contribute to a unique challenge in health care delivery. Our aim was to describe the availability of publicly funded primary health care programs and services delivered by regional health authorities across the province.
Methods: We performed a descriptive analysis using data from a cross-sectional provincial primary health care survey deployed across Newfoundland and Labrador. Survey data included location, disease-specific chronic disease prevention programming, types of routine primary care, allied health prevention and promotion, chronic disease prevention and management services, and team-based care. The mode of service delivery was identified for most programs and services.
Results: Surveys were returned by 153 sites (99.4% response rate). Family physician services were available at 66% of sites (95/145) and nurse practitioner services were available at 51% (74/144) of sites. Many sites offered screening for cervical (60%, 86/144), colon (42%, 59/142) and prostate cancers (43%, 60/141), in addition to various self-management and education services. Allied health services, such as clinical nutrition counselling (47%, 68/46) and occupational therapy (46%, 68/147), were available at many sites. Available health care services were most often offered by on-site staff, and few sites provided primary health care services through telehealth. Overall, rural sites offered a greater variety of services than urban sites.
Interpretation: Considerable variability exists in the range of primary health care services available across Newfoundland and Labrador, with limited delivery of some programs and services. Future research should examine how availability of programs and services affects health outcomes and costs
Patient education materials for non-specific low back pain and sciatica: a protocol for a systematic review and meta-analysis
Introduction Low back pain accounts for more disability than any other musculoskeletal condition and is associated with severe economic burden. Patients commonly present with negative beliefs about low back pain and this can have detrimental effects on their health outcomes. Providing evidence-based, patient-centred education that meets patient needs could help address these negative beliefs and alleviate the substantial low back pain burden. The primary aim of this review is to investigate the effectiveness of patient education materials on immediate process, clinical and health system outcomes.
Methods and analysis The search strategy was developed in collaboration with a librarian and systematic searches will be performed in MEDLINE, EMBASE, CINAHL, PsycINFO and SPORTDiscus. We will also search trial registries and grey literature through the OpenGrey database. Study selection will include a title and abstract scan and full-text review by two authors. Only randomised controlled trials will be included in this review. Trials must include patients with low back pain or sciatica and investigate educational interventions with at least one of the following contrasts: (1) education alone versus no intervention; (2) education alone versus another intervention; (3) education in addition to another intervention versus the same intervention with no education. Data extraction, risk of bias and grading of the quality of evidence will be performed independently by two reviewers. Risk of bias will be assessed using the PEDro scale, and the quality of evidence will be assessed with the Grades of Recommendation, Assessment, Development and Evaluation approach. A random-effects model will be used for each contrast, and results will be pooled if the participants, interventions, and outcomes are homogeneous. If heterogeneity is high (I2 >75%), we will evaluate the magnitude and direction of the differences in effect sizes across studies to determine if it remains reasonable to pool the results. Analyses of acute and subacute low back pain (less than 12 weeks duration) will be performed separately from chronic low back pain (12 weeks or greater duration). Likewise, analyses of short-term (less than 6 months) and long-term (6 months or greater) follow-up will be performed separately. Subgroup analyses will be performed on non-specific low back pain, sciatica and mixed populations
Developing clinical decision tools to implement chronic disease prevention and screening in primary care: the BETTER 2 program (building on existing tools to improve chronic disease prevention and screening in primary care).
BackgroundThe Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Family Practice (BETTER) trial demonstrated the effectiveness of an approach to chronic disease prevention and screening (CDPS) through a new skilled role of a 'prevention practitioner'(PP). The PP has appointments with patients 40-65 years of age that focus on primary prevention activities and screening of cancer (breast, colorectal, cervical), diabetes and cardiovascular disease and associated lifestyle factors. There are numerous and occasionally conflicting evidence-based guidelines for CDPS, and the majority of these guidelines are focused on specific diseases or conditions; however, primary care providers often attend to patients with multiple conditions. To ensure that high-level evidence guidelines were used, existing clinical practice guidelines and tools were reviewed and integrated into blended BETTER tool kits. Building on the results of the BETTER trial, the BETTER tools were updated for implementation of the BETTER 2 program into participating urban, rural and remote communities across Canada.MethodsA clinical working group consisting of PPs, clinicians and researchers with support from the Centre for Effective Practice reviewed the literature to update, revise and adapt the integrated evidence algorithms and tool kits used in the BETTER trial. These resources are nuanced, based on individual patient risk, values and preferences and are designed to facilitate decision-making between providers across the target diseases and lifestyle factors included in the BETTER 2 program. Using the updated BETTER 2 toolkit, clinicians 1) determine which CDPS actions patients are eligible to receive and 2) develop individualized 'prevention prescriptions' with patients through shared decision-making and motivational interviewing.ResultsThe tools identify the patients' risks and eligible primary CDPS activities: the patient survey captures the patient's health history; the prevention visit form and integrated CDPS care map identify eligible CDPS activities and facilitate decisions when certain conditions are met; and the 'bubble diagram' and 'prevention prescription' promote shared decision-making.ConclusionThe integrated clinical decision-making tools of BETTER 2 provide resources for clinicians and policymakers that address patients' complex care needs beyond single disease approaches and can be adapted to facilitate CDPS in the urban, rural and remote clinical setting.Trial registrationThe registration number of the original RCT BETTER trial was ISRCTN07170460
Trivial trauma and delayed rupture of a normal spleen: a case report
Although a majority of splenic ruptures present acutely with a known mechanism of injury, a
minority of patients present days to weeks following trauma with a delayed rupture. Also uncommon is the
atraumatic rupture, the vast majority of which occur in patients with underlying splenic pathology. A handful of
cases of apparently spontaneous rupture of a normal spleen are reported; however, there is debate about whether
these actually represent delayed ruptures following a history of trauma that is not elicited. Although a few cases of
delayed rupture of the spleen following trivial trauma have been reported, the majority of these present evidence
of an underlying disease process. We found only two such cases that documented a normal spleen and three
cases where underlying splenic pathology was not reported. We review the literature and discuss the
phenomenon of delayed rupture of the normal spleen following trivial trauma
A systematic review of reviews: Recruitment and retention of rural family physicians
The recruitment and retention of family physicians in rural and remote communities has been the topic of many reviews; however, a lack of consensus among them with regard to which factors are most influential makes it difficult for setting priorities. We performed a systematic review of reviews which helped to establish an overall conclusion and provided a set of fundamental influential factors, regardless of the consistency or generalisability of the findings across reviews. This review also identified the knowledge gaps and areas of priority for future research. Methods: A literature search was conducted to find the review articles discussing the factors of recruitment or retention of rural family physicians. Results were screened by two independent reviewers. The number of times that each factor was mentioned in the literature was counted and ordered in terms of frequency. Results: The literature search identified 84 systematic reviews. Fourteen met the inclusion criteria, from which 158 specific factors were identified and summarised into 11 categories: personal, health, family, training, practice, work, professional, pay, community, regional and system/legislation. The three categories referenced most often were training, personal and practice. The specific individual factors mentioned most often in the literature were 'medical school characteristics', 'longitudinal rural training' and 'raised in a small town'. Conclusion: The three most often cited categories resemble three distinct phases of a family physician's life: pre-medical school, medical school and post-medical school. To increase the number of physicians who choose to work in rural practice, strategies must encompass and promote continuity across all three of these phases. The results of this systematic review will allow for the identification of areas of priority that require further attention to develop appropriate strategies to improve the number of family physicians working in rural and remote locations
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
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
Human hippocampal theta power indicates movement onset and distance travelled
Rodent hippocampal theta-band oscillations are observed throughout translational movement, implicating theta in the encoding of self-motion. Interestingly, increases in theta power are particularly prominent around movement onset. Here, we use intracranial recordings from epilepsy patients navigating in a desktop virtual reality environment to demonstrate that theta power is also increased in the human hippocampus around movement onset and throughout the remainder of movement. Importantly, these increases in theta power are greater both before and during longer paths, directly implicating human hippocampal theta in the encoding of translational movement. These findings help to reconcile previous studies of rodent and human hippocampal theta oscillations and provide additional insight into the mechanisms of spatial navigation in the human brain
Developing clinical decision tools to implement chronic disease prevention and screening in primary care: the BETTER 2 program (building on existing tools to improve chronic disease prevention and screening in primary care)
The influence of gender and other patient characteristics on health care-seeking behaviour: a QUALICOPC study
Abstract
Background
Canadians’ health care-seeking behaviour for physical and mental health issues was examined using the international Quality and Cost of Primary Care (QUALICOPC) survey that was conducted in 2013 in Canada.
Method
This study used the cross-sectional Patient Experiences Survey collected from 7260 patients in 759 practices across 10 Canadian provinces as part of the QUALICOPC study. A Responsive Care Scale (RCS) was constructed to reflect the degree of health care-seeking behaviour across 11 health conditions. Using several patient characteristics as independent variables, four multiple regression analyses were conducted.
Results
Patients’ self-reports indicated that there were gender differences in health care-seeking behaviour, with women reporting they visited their primary care provider to a greater extent than did men for both physical and mental health concerns. Overall, patients were less likely to seek care for mental health concerns in comparison to physical health concerns. For both women and men, the results of the regressions indicated that age, illness prevention, trust in physicians and chronic conditions were important factors when explaining health care-seeking behaviours for mental health concerns.
Conclusion
This study confirms the gender differences in health care-seeking behaviour advances previous research by exploring in detail the variables predicting differences in health care-seeking behaviour for men and women. The variables were better predictors of health care-seeking behaviour in response to mental health concerns than physical health concerns, likely reflecting greater variation among those seeking mental health care. This study has implications for those working to improve barriers to health care access by identifying those more likely to engage in health care-seeking behaviours and the variables predicting health care-seeking. Consequently, those who are not accessing primary care can be targeted and policies can be developed and put in place to promote their health care-seeking behavior