Leanne Kosowan

• Master of Science
• University of Manitoba

Background Data on the social determinants of health could be used to improve care, support quality improvement initiatives, and track progress toward health equity. However, this data collection is not widespread. Artificial intelligence (AI), specifically natural language processing and machine learning, could be used to derive social determinant...

Objectives We assessed trends in primary care paediatric blood pressure (BP) screening, follow-up, and treatment before and during the coronavirus disease 2019 (COVID-19) pandemic. Methods Retrospective cohort study using electronic medical records from the Canadian Primary Care Sentinel Surveillance Network to capture paediatric visits (aged 3 to...

This study examined the effects of medical fitness facility (MFF) attendance, a proxy for exercise, on the incidence of mental disorders. This retrospective cohort study linked members at two MFFs in Winnipeg, Canada, to health administrative databases held at the Manitoba Centre for Health Policy population research data repository. Adults aged ≥...

Background Physical inactivity is common among older adults and is associated with poor health outcomes. Medical fitness facilities provide a medically focused approach to physical fitness and can improve physical activity in their communities. This study aimed to assess the relationship between membership in the medical fitness model and all-cause...

Objectives Case ascertainment algorithms were developed and validated to identify people living with cirrhosis in administrative health data in Manitoba, Canada using primary care electronic medical records (EMR) to define the reference standards. Methods We linked provincial administrative health data to primary care EMR data. The validation coho...

Importance In 2016 and 2017, respectively, new Canadian and US guidelines for diagnosis and management of pediatric hypertension (HTN) were published. Six years after their publication, it is unknown whether the recommendations have led to changes in primary care practice patterns. Objectives To determine whether HTN guidelines are associated with...

Objective This study aims to characterise respondents who have COVID-19 and long COVID syndrome (LCS), and describe their symptoms and healthcare utilisation. Design Observational cross-sectional survey. Setting The one-time online survey was available from June 2022 to November 2022 to capture the experience of residents in Manitoba, Canada. Pa...

Background Healthcare organizations are increasingly exploring ways to address the social determinants of health. Accurate data on social determinants is essential to identify opportunities for action to improve health outcomes, to identify patterns of inequity, and to help evaluate the impact of interventions. The objective of this study was to re...

Aims To develop and validate case definitions to identify patients with cirrhosis and alcohol-related cirrhosis using primary care electronic medical records (EMRs) and to estimate cirrhosis prevalence and incidence in pan-Canadian primary care database, between 2011 and 2019. Methods A total of 689,301 adult patients were included with ≥1 visit t...

BACKGROUND Data on the social determinants of health could be used to improve care, support quality improvement initiatives, and track progress toward health equity. However, this data collection is not widespread. Artificial intelligence (AI), specifically natural language processing and machine learning, could be used to derive social determinant...

Background To validate case definitions for eczema using primary care Electronic Medical Record (EMR) data from the Canadian Primary Care Sentential Surveillance Network (CPCSSN). Methods This study used EMR data from 1,574 primary care providers in seven Canadian provinces, representing 689,301 patients. Using a subset of patient records seven me...

A proper understanding of the relationship between people living with dementia (PLWD) and their care partners across the dementia trajectory provides an opportunity to better meet their healthcare needs. However, few studies in Canada have explored the nature of this relationship, considering the well-being of both parties simultaneously. There is...

Background: Cardiovascular disease (CVD) is a leading cause of death globally. This study validates a primary care-based electronic medical record case definition for CVD. Methods: This retrospective, cross-sectional study explores electronic medical record data from 1574 primary care providers participating in the Canadian Primary Care Sentinel...

Objective Research directly examining brain tissue has played an important role in understanding the pathology and pathogenesis of multiple sclerosis (MS) and other diseases of the central nervous system. Such research relies heavily on donations of post-mortem brain tissue yet little is known about the attitudes of people with multiple sclerosis (...

Withdrawal statement “The authors have withdrawn this manuscript owing to one of the authors, Lynn Thompson, no longer standing by her participation in this work. Therefore, the authors do not wish this work to be cited as reference for the project. The remaining authors have since published the work in BMC Primary Care: Adekoya, I., Delahunty-Pike...

Background Understanding which children are at highest risk for high blood pressure (HBP) can inform surveillance and treatment. This study evaluated sex differences in childhood HBP and its associations with socioeconomic status.Methods This retrospective cross-sectional study assessed 74,233 children with data from a national primary care electro...

Background In March 2020, Canada implemented restrictions to curb viral transmission of COVID-19, which resulted in abrupt disruptions to conventional (in-person) clinical care. To retain continuity of care the delivery of primary care services shifted to virtual care. This study examined the nature of virtual visits, characterizing the use and use...

Background: Posttraumatic stress disorder (PTSD) has significant morbidity and economic costs. This study describes the prevalence and characteristics of patients with PTSD using primary care electronic medical record (EMR) data. Methods: This retrospective cross-sectional study used EMR data from the Canadian Primary Care Sentinel Surveillance...

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....

Background The availability of electronic medical record (EMR) free-text data for research varies. However, access to short diagnostic text fields is more widely available. Objective This study assesses agreement between free-text and short diagnostic text data from primary care EMR for identification of posttraumatic stress disorder (PTSD). Meth...

Background Despite the known safety risks of long-term use of sedative-hypnotic/anxiolytic medications, there has been limited guidance for the safe and effective use of their chronic use in a primary care clinic setting. Understanding the characteristics of patients who receive sedative-hypnotic/anxiolytic medication and the clinical documentation...

Importance: Cough is a common symptom in idiopathic interstitial lung diseases (ILDs), there is little information of its management in primary care. The objective of this study was to explore the frequency of cough-related consultations and the medications prescribed to patients with ILDs in primary care. Methods: This retrospective cohort stud...

Background and Objectives The COVID-19 pandemic has dramatically increased telehealth use. We assessed access to and use of telehealth care including videoconferencing, and usability of videoconferencing among persons with multiple sclerosis (MS). Methods In Fall 2020, we surveyed participants in the North American Research Committee on Multiple S...

Context: Choosing Wisely Canada (CWC) aims to engage healthcare providers to reduce unnecessary care. Reducing overuse of antimicrobials and antipsychotics in patients with dementia in primary care settings remains an ongoing challenge. Audit and Feedback (A&F) interventions can facilitate practice change but can be improved by understanding factor...

Context: Posttraumatic stress disorder (PTSD) is a chronic mental health disorder associated with significant morbidity and economic cost. Primary care providers are frequently involved in the ongoing management of patients experiencing PTSD, as well as related comorbid conditions. Despite recognized need to enhance PTSD management in primary care...

Context: Most epidemiological research on eczema has largely relied on patient survey data. With the increasing use of electronic medical records (EMR) in primary care, there has been a shift in epidemiological research towards the use of validated case definitions to study disease. Objective: Apply a validated case definition for eczema to EMR...

Objective Robust program evaluations can identify effective promotion strategies. This scoping review aimed to analyze review articles (including systematic reviews, meta-analysis, meta-synthesis, scoping review, narrative review, rapid review, critical review, and integrative reviews) to systematically map and describe physical activity program ev...

Objective To explore whether participation in a series of cardiology continuing medical education (CME) activities affects primary care providers’ (PCPs’) lipid management for their patients. Design This retrospective cohort study used a database of participation in cardiology CME activities (2011 to 2017) linked to electronic medical records. Stat...

Background Leveraging the data management resources of the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) is a viable approach for describing the prevalence of allergic disease documented in primary care settings. Methods The dataset used for this study was inclusive of data from EMR initiation up to Dec 31st 2018. The sample include...

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease that produces non-reversible airflow limitations. Approximately 10% of Canadians aged 35 years or older are living with COPD. Primary care is often the first contact an individual will have with the healthcare system providing acute care, chronic disease management, and serv...

This study proposes a predictive model that uses structured data and unstructured narrative notes from Electronic Medical Records to accurately identify patients diagnosed with Post-Traumatic Stress Disorder (PTSD). We utilize data from primary care clinicians participating in the Manitoba Primary Care Research Network (MaPCReN) representing 154,11...

Introduction Interventions that increase physical activity behavior can reduce morbidity and prolong life, but long-term effects in large populations are unproven. This study investigates the association of medical fitness facility membership and frequency of attendance with all-cause mortality and rate of hospitalization. Methods A propensity wei...

Objectives Screening for hypertension in children is recommended by pediatric consensus guidelines. However, current practice is unknown. We evaluated rates of blood pressure assessment and hypertension recognition in primary care. Methods This retrospective cohort study evaluated electronic medical record data from the Canadian Primary Care Senti...

Background Understanding how patient values and preferences towards polypharmacy and deprescribing have been studied is important to gain insight on current knowledge in this area and to identify knowledge gaps. Aim To describe methods and outcomes for studying patient values and preferences towards polypharmacy and deprescribing, and to identify g...

Objective By surveying a multiple sclerosis (MS) population, we tested the hypothesis that influenza vaccine uptake would not meet public health targets and that vaccine misconceptions would contribute to lower than desired uptake. Methods In spring 2020, we surveyed participants in the North American Research Committee on Multiple Sclerosis Regis...

The majority of Canadian primary care systems record patient data in the form of Electronic Medical Records (EMR). EMRs hold structured, semi-structured and unstructured demographic and health care data about patients. The value of EMR data for research, health surveillance and quality improvement continues to be explored. Data analytics such as Ma...

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 pat...

Background The COVID-19 pandemic has highlighted the importance of accurate capture of vaccine, and vaccine component, allergy. There remains a gap in the prevalence literature from the perspective of direct primary care provider (PCP) reporting at a population level. Objective To determine the prevalence of PCP-documented vaccine and polyethylene...

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, curre...

BACKGROUND Tobacco use, physical inactivity and poor diet are associated with morbidity and premature death. Health promotion and primary prevention counseling, advice and support by a primary care provider leads to behaviour change attempts among patients. However, although physicians consider preventative health important the focus on symptoms pr...

Background Tobacco use, physical inactivity, and poor diet are associated with morbidity and premature death. Health promotion and primary prevention counseling, advice, and support by a primary care provider lead to behavior change attempts among patients. However, although physicians consider preventative health important, there is often a larger...

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 me...

Background Food allergy prevalence data has largely been derived from self-report, and estimates vary. Objective Determine the prevalence of physician-reported food allergy in children using Electronic Medical Record (EMR) data from the Canadian Primary Care Sentinel Surveillance Network (CPSSN). Methods Retrospective cohort study using the CPCSS...

BACKGROUND Tobacco use, physical inactivity and poor diet are associated with morbidity and premature death. Health promotion and primary prevention counseling, advice and support by a primary care provider leads to behaviour change attempts among patients. However, although physicians consider preventative health important the focus on presentatio...

Introduction: The burden of disease associated with tobacco use has prompted a substantial increase in tobacco-related research, but the breadth of this literature has not been comprehensively examined. This review examines the nature of the research addressing the action areas in World Health Organization's Framework Convention on Tobacco Control...

Objectives: To utilize complementary data from primary care and administrative health and social services to describe the clinical, social and demographic characteristics of high users of health care services. Methods: We conducted a retrospective cohort study using data from the Manitoba Primary Care Research Network (MaPCReN) and the Manitoba...

Objective: We aimed to determine the adequacy of disease control and intensity of treatment for diabetes and hypertension in individuals with multiple sclerosis (MS) as compared to individuals without MS using the Canadian Primary Care Sentinel Surveillance System (CPCSSN). Methods: We identified individuals aged ≥18 years, with ≥1 record in the...

Post-traumatic stress disorder (PTSD) can be a debilitating condition and early intervention can be instrumental in preventing patients' suffering. Identifying patients at risk for PTSD is challenging because of the limitations of the available data set, variations in the symptoms of PTSD for different patients, and misdiagnosis due to symptoms bei...

Background: We validated a case definition for multiple sclerosis using a clinical cohort linked with the Manitoba Primary Care Research Network of the Canadian Primary Care Sentinel Surveillance Network, and applied this definition to describe multiple sclerosis epidemiology using the Canadian Primary Care Sentinel Surveillance Network repository...

Background: The care of patients with diabetes Mellitus (DM), compiled in the Canadian Diabetes Association clinical practice guidelines and in recommendations from the Choosing Wisely (CW) Canada program, is informed by a large body of evidence. This study sought to assess to what extent primary care providers (PCPs) incorporate recommended statin...

Objectives: To compose and validate an electronic medical records-based case definition for pediatric diabetes in primary care. Methods: Data from the electronic medical records of 221 primary care providers participating in the Manitoba Primary Care Research Network were extracted from April 1, 1998, to March 31, 2015. We assessed agreement amo...

Objectives To present findings of a workshop with physical activity professionals in Manitoba, Canada, to facilitate the enhancement of physical activity promotion efforts by exploring (1) effective physical activity strategies, (2) methods to strengthen physical activity strategies, (3) challenges in implementing physical activity strategies in Ma...

Experiences during infancy create durable and heritable patterns of social deprivation and illness producing health disparities. This retrospective cohort study of 71 836 infants from Winnipeg, Manitoba, assessed associations between maternal social and economic factors and infant mortality, morbidity, and congenital anomaly. This study found that...

BACKGROUND The prevalence of paediatric diabetes is increasing. Identifying and describing populations with paediatric diabetes using Primary Care Electronic Medication Records (EMR) can improve surveillance and management. OBJECTIVES To describe the population of children diagnosed with paediatric diabetes in Manitoba using Electronic Medical Rec...

Background: As questions have been raised about the appropriateness of direct oral anticoagulant (DOAC) dosing among outpatients with atrial fibrillation, we examined this issue in patients being managed by primary care providers. Methods and results: This was a retrospective cohort new-user study using electronic medical records from 744 Canadi...

Background: Antimicrobial stewardship (AS) programs promote the optimal use of antimicrobials and safe patient care. With most antimicrobials prescribed in the ambulatory setting, establishing benchmark data is imperative to gauge the impact of future AS initiatives. Objectives: To determine the frequency of potentially inappropriate antimicrobi...