ABSTRACT: This article describes and evaluates a unique site-visit process for community-based teaching sites. A continuous quality-improvement program was developed by the undergraduate program in the Department of Family and Community Medicine at the University of Toronto Faculty of Medicine to facilitate and document both self- and peer-assessment. A pilot program was launched in 2000, and, after some adjustments based on initial feedback, the program in its current form was implemented in 2002. This program provides individualized support mechanisms to address the faculty development needs and infrastructure requirements of community-based, mostly volunteer, teachers. It also trains participating reviewers to provide individualized faculty development at the point of teaching. During their training, reviewers receive a toolkit consisting of suggestions for initial contact with teachers, guidelines for peer assessments, previously completed previsit teacher surveys, reviewer checklists, postvisit feedback forms, sample thank-you letters, and a faculty development reference resource list. A two-year evaluation of the program demonstrated that faculty and reviewer participants perceived it to be comprehensive, consistent, informative, and an acceptable method of reviewing existing and prospective community-based teaching sites. This program should be transferable to other institutions that engage in community-based teaching.
Academic Medicine 06/2007; 82(5):465-8. · 3.52 Impact Factor
Canadian family physician Medecin de famille canadien 04/2007; 53(3):424-5. · 1.19 Impact Factor
Canadian family physician Medecin de famille canadien 04/2007; 53(3):485-7. · 1.19 Impact Factor
ABSTRACT: To develop a typology of after-hours care (AHC) instructions and to examine physician and practice characteristics associated with each type of instruction.
Cross-sectional telephone survey. Physicians' offices were called during evenings and weekends to listen to their messages regarding AHC. All messages were categorized. Thematic analysis of a subset of messages was conducted to develop a typology of AHC instructions. Logistic regression analysis was used to identify associations between physician and practice characteristics and the instructions left for patients.
Family practices in the greater Toronto area.
Stratified random sample of family physicians providing office-based primary care.
Form of response (eg, answering machine), content of message, and physician and practice characteristics.
Of 514 after-hours messages from family physicians' offices, 421 were obtained from answering machines, 58 were obtained from answering services, 23 had no answer, 2 gave pager numbers, and 10 had other responses. Message content ranged from no AHC instructions to detailed advice; 54% of messages provided a single instruction, and the rest provided a combination of instructions. Content analysis identified 815 discrete instructions or types of response that were classified into 7 categories: 302 instructed patients to go to an emergency department; 122 provided direct contact with a physician; 115 told patients to go to a clinic; 94 left no directions; 76 suggested calling a housecall service; 45 suggested calling Telehealth; and 61 suggested other things. About 22% of messages only advised attending an emergency department, and 18% gave no advice at all. Physicians who were female, had Canadian certification in family medicine, held hospital privileges, or had attended a Canadian medical school were more likely to be directly available to their patients.
Important issues identified included the recommendation to use an emergency department as the sole source of AHC, practices providing no specific AHC instructions to their patients, and physicians' lack of acceptance of Telehealth. To improve AHC, new initiatives should build upon the existing system, changes should be integrated, and there should be a range of AHC options for patients and physicians.
Canadian family physician Medecin de famille canadien 04/2007; 53(3):451-6, 450. · 1.19 Impact Factor
ABSTRACT: To present a practical approach to the symptom complex called chronic pelvic pain (CPP). Chronic pelvic pain is defined as nonmenstrual pain lasting 6 months or more that is severe enough to cause functional disability or require medical or surgical treatment.
MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched from January 1996 to December 2004.
While the source of pain in CPP can be gynecologic, urologic, gastrointestinal, musculoskeletal, or psychoneurologic, 4 conditions account for most CPP: endometriosis, adhesions, interstitial cystitis, and irritable bowel syndrome. More than one source of pain can be found in the same patient. Management involves treating the underlying condition, the pain itself, or both. Nonnarcotic analgesics are first-line therapy for pain relief; hormonal therapies are beneficial if the pain has a cyclical component. A multidisciplinary approach addressing environmental factors and incorporating medical management with physiotherapy, psychotherapy, and dietary modifications works best.
Although caring for patients with CPP can be challenging and frustrating, family physicians are in an ideal position to manage and coordinate their care.
Canadian family physician Medecin de famille canadien 01/2007; 52(12):1556-62. · 1.19 Impact Factor
ABSTRACT: To determine family physicians' availability to their general practice patients after hours and to explore the characteristics and determinants of after-hours services.
Secondary analysis of the 2001 National Family Physician Workforce Survey.
Canadian family physicians and general practitioners currently in practice (n = 10,553).
Provision of after-hours care, defined as providing care to all practice patients outside of normal office hours.
Sixty-two percent of Canadian family physicians reported providing after-hours service. The lowest rates were found in Quebec (34%) and the highest in Alberta and Saskatchewan (88%). Respondents practising in academic and community clinics, offering selective medical services (emergency care, palliative care, housecalls, after-hours care), or living outside of Ontario or Quebec were more likely to provide after-hours care. Women physicians, those practising in walk-in clinics, or physicians primarily paid by fee-for-service were less likely to do so. Urban versus rural location, organization of practice (solo or group), age of physician, country of graduation, and physician satisfaction were not found to significantly affect the likelihood of providing after-hours services.
Knowledge of these factors can be used to inform policy development for after-hours service arrangements, which is particularly relevant today, given provincial governments' interests in exploring alternative payment plans and primary care reform options.
Canadian family physician Médecin de famille canadien 12/2005; 51:1504-5. · 1.41 Impact Factor
ABSTRACT: To determine the prevalence and content of existing or developing policies and guidelines of medical associations and colleges regarding after-hours care by family physicians and general practitioners, especially legal requirements.
Telephone survey in fall 2002, updated in fall 2004.
All national and provincial medical associations, Colleges of Family Physicians, Colleges of Physicians and Surgeons, local government offices for the north, and the Canadian Medical Protective Association (CMPA).
RESPONSE TO THE QUESTION: "Does your agency have a policy in place regarding after-hours health care coverage by FPs/GPs, or are there active discussions regarding such a policy?"
The College of Physicians and Surgeons of British Columbia was the first to institute a policy, in 1995, requiring physicians to make "specific arrangements" for after-hours care of their patients. The College of Physicians and Surgeons of Alberta adopted a similar policy in 1996 along with a guideline to aid implementation. In 2002, the College of Physicians and Surgeons of Nova Scotia approved a guideline on the Availability of Physicians After Hours. The Saskatchewan Medical Association and the College of Physicians and Surgeons of Saskatchewan formulated a joint policy on medical practice coverage that was released in 2003. Many agencies actively discussed the topic. Provincial and national Colleges of Family Physicians did not have any policies in place. The CMPA does not generate guidelines but released in an information letter in May 2000 a section entitled "Reducing your risk when you're not available."
There is increasing interest Canada-wide in setting policy for after-hours care. While provincial Colleges of Physicians and Surgeons have traditionally led the way, a trend toward more collaboration between associations was identified. The effect of policy implementation on physicians' coverage of patients is unclear.
Canadian family physician Médecin de famille canadien 05/2005; 51:536-7. · 1.41 Impact Factor
ABSTRACT: To describe errors Canadian family physicians found in their practices and reported to study investigators. To compare errors reported by Canadian family physicians with those reported by physicians in five other countries.
Analytical study of reports of errors. The Linnaeus Collaboration was formed to study medical errors in primary care. General practitioners in six countries, including a new Canadian family practice research network (Nortren), anonymously reported errors in their practices between June and December 2001. An evolving taxonomy was used to describe the types of errors reported.
Practices in Canada, Australia, England, the Netherlands, New Zealand, and the United States.
Family physicians in the six countries.
Types of errors reported. Differences in errors reported in different countries.
In Canada, 15 family doctors reported 95 errors. In the other five countries, 64 doctors reported 413 errors. Although the absence of a denominator made it impossible to calculate rates of errors, Canadian doctors and doctors from the other countries reported similar proportions of errors arising from health system dysfunction and gaps in knowledge or skills. All countries reported similar proportions of laboratory and prescribing errors. Canadian doctors reported harm to patients from 39.3% of errors; other countries reported harm from 29.3% of errors. Canadian physicians considered errors "very serious" in 5.8% of instances; other countries thought them very serious in 7.1% of instances. Hospital admissions and death were among the consequences of errors reported in other countries, but these consequences were not reported in Canada.
Serious errors occur in family practice and affect patients in similar ways in Canada and other countries. Validated studies that analyze errors and record error rates are needed to better understand ways of improving patient safety in family practice.
Canadian family physician Médecin de famille canadien 04/2005; 51:386-7. · 1.41 Impact Factor