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Introduction
Skills and Expertise
Publications
Publications (168)
Background
Rheumatoid Arthritis (RA) is a chronic inflammatory disease that is primarily diagnosed and managed by rheumatologists; however, it is often primary care providers who first encounter RA-related symptoms. This study developed and validated a case definition for RA using national surveillance data in primary care settings.
Methods
This c...
This presentation introduces Candidacy 2.0, an enhanced framework that better captures the complexity of accessing care for conditions like rheumatoid arthritis.
Background
The Dixon-Woods et al. Candidacy Framework, a valuable tool since its 2006 introduction, has been widely utilized to analyze access to various services in diverse contexts, including healthcare. This social constructionist approach examines micro, meso, and macro influences on access, offering concrete explanations for access challenges...
Objective
The objective was to analyse how the pandemic affected primary care access and comprehensiveness in chronic disease management by comparing primary care patterns before and during the early COVID-19 pandemic.
Design
We conducted a quasi-experimental pre–post design cohort study and reported indicators for the 21 months before and after t...
Background:
Most antibiotics dispensed by community pharmacies in Canada are prescribed by family physicians, but using the prescribing information contained within primary care electronic medical records (EMRs) for secondary purposes can be challenging owing to variable data quality. We used antibiotic medications as an exemplar to validate a mac...
Background:
Since the COVID-19 pandemic began, there have been concerns that interruptions to the health care system may have led to changes in primary care, especially for care of chronic conditions such as diabetes and heart failure. Such changes may have longer term implications for population health.
Objective:
This study aims to describe th...
BACKGROUND
Since the COVID-19 pandemic began, there have been concerns that interruptions to the health care system may have led to changes in primary care, especially for care of chronic conditions such as diabetes and heart failure. Such changes may have longer term implications for population health.
OBJECTIVE
This study aims to describe the im...
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: Physical activity (PA) is an important contributor to the health of Canadians. However, the extent that PA is included in family medicine residents' education is largely unknown. This study surveyed curriculum experts in Canadian family medicine residency programs to understand what residents learn about PA and to what extent this varie...
Objective:
To characterize transitions to acute and residential care and identify variables associated with specific transitions among community-based persons living with dementia (PLWD).
Design:
Retrospective cohort study using primary care electronic medical record data linked with health administrative data.
Setting:
Alberta.
Participants:...
Objective
Documenting cannabis use is important for patient care, but no formal requirements for consistent reporting exist in primary care. The objective of this study was to understand how cannabis use is documented in primary care electronic medical record (EMR) data.
Results
This was a cross-sectional study using de-identified EMR data from ov...
These two draft abstracts will be submitted for consideration by review panel of Family Medicine Forum in Montreal, November 8 – 11, 2023. If accepted, we invite you to join us for one or both interactive presentations
The relationship between individuals living with dementia and their caregivers is important and can impact their dementia journey. However, limited national longitudinal data exists about the caregiver-person living with dementia dyad. Availability of such data would provide important information about joint trajectories and help to better identify...
The International Classification of Diseases, Ninth Revision (ICD-9) was released in the 1970s and adopted in Canada for physician billing claims in 1979 (CIHI n.d.b.; WHO & International Conference for the Ninth Revision of the International Classification of Diseases 1977). ICD-9 is no longer adequate for representing our modern healthcare enviro...
Background
Cardiovascular disease (CVD) is a major cause of morbidity and mortality in Canada. Assessment and management of CVD risk is essential in reducing disease burden. This includes both clinical risk factors and socioeconomic factors, though few studies report on socioeconomic status in relation to CVD risk and treatment. The primary objecti...
The purpose of this study was to examine the content of physical activity inputs in Canadian family physician electronic medical records. Of 1 225 948 patients aged 18–64 years, a sample of 1535 patients’ charts were reviewed. A minority (n = 148; 9.6%) of patients had at least 1 mention of physical activity at any time. Insufficient information ex...
Lay Summary
Primary care providers can deliver tailored advice and support to patients who are overweight or have obesity. The 2020 Canadian Adult Obesity Practice Guideline for primary care providers recommended that patients’ waist circumference (WC) be measured if their height and weight place them in the overweight or Class I obesity category....
Background
GLP-1 RA and SGLT2i have shown cardiorenal benefits independent of their glucose-lowering effects among persons living with T2DM. This study aimed to describe the proportion of persons with T2DM eligible to receive and currently receiving these agents based on their risk criteria for cardiorenal events.
Methods
This study was a cross-se...
Background:
The dementias are long-term, chronic conditions caused by progressive neurological degeneration. Current literature suggests that cardiovascular disease risk factors may contribute to the onset of dementia; however, evidence of these associations is inconsistent.
Objectives:
This study aimed to examine the impact of risk factors on d...
Background
Polypharmacy, often defined as the concomitant use of ≥ 5 medications, has been identified as a significant global public health threat. Aging and multimorbidity are key drivers of polypharmacy and have been linked to a broad range of adverse health outcomes and mortality. Patients with chronic kidney disease (CKD) are particularly at hi...
Background:
Research based in primary care suggests that hearing loss may be underreported as well as inconsistently recorded in patient histories. In this study, we aimed to develop and validate a case definition for hearing loss among older adults in primary care, using electronic medical records.
Methods:
We used data from adult patients aged...
Background
Dementia is an increasing concern in many countries, especially in those experiencing rapid growth in the proportion of older adults in their population.
Objective
This study aims to describe trends and demographic characteristics of incident dementia cases in community-dwelling older adults managed by primary care physicians.
Methods...
Chronic obstructive pulmonary disease (COPD) is a complex disease that is predicted to be the third most common cause of death by 2030. In Canada, the care and management of chronic conditions is largely provided by primary care providers. Although there is emerging research and initiatives that describe the prevalence of COPD in Canadian primary c...
Background
Hypertension is a common chronic condition affecting nearly a quarter of Canadians. Hypertension surveillance in Canada typically relies on administrative data and/or national surveys. Routinely-captured data from primary care electronic medical records (EMRs) are a complementary source for chronic disease surveillance, with longitudinal...
Although asthma is one of the most common chronic conditions affecting Canadians, its epidemiologic characteristics and burden in primary care contexts are poorly understood. The aim of this study was to develop and validate a case definition to identify adults with asthma who consult family physicians and to estimate the prevalence of asthma in th...
Objective
To describe the process for linking electronic medical record (EMR) and administrative data in Alberta and examine the advantages and limitations of utilising linked data for hypertension surveillance.
Methods
De-identified EMR data from 323 primary care providers contributing to the Canadian Primary Care Sentinel Surveillance Network (C...
Background:
To date, there has been no validated method to identify cases of pelvic floor disorders in primary care electronic medical record (EMR) data. We aimed to develop and validate symptom-based case definitions for urinary incontinence, fecal incontinence and pelvic organ prolapse in women, for use in primary care epidemiologic or clinical...
Background:
Primary care electronic medical record (EMR) data are emerging as a useful source for secondary uses, such as disease surveillance, health outcomes research, and practice improvement. These data capture clinical details about patients' health status, as well as behavioural risk factors, such as smoking. While the importance of document...
Objective:
To validate a case definition for speech and language disorders in community-dwelling older adults and to determine the prevalence of speech and language disorders in a primary care population.
Design:
This is a combined case definition validation and cross-sectional prevalence study. Chart review was considered the reference standard...
Evidence-Informed Approaches for Managing Dementia Transitions provides evidence-informed approaches and future directions for supporting a higher quality of life for people living with dementia. Through a person-centered lens, this book equips care providers to better help people living with dementia align their expectations and hopes with the tra...
IntroductionElectronic medical record (EMR) databases have become increasingly popular for secondary purposes, such as health research. The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) is the first and only pan-Canadian primary care EMR data repository, with de-identified health information for almost two million Canadians. Comprehe...
Dementia is a long-term, chronic condition caused by a progressing physical damage in the brain. Evidence suggests that cardiovascular disease risk factors may contribute to the onset of dementia; however, the current literature on this association is inconsistent. To our knowledge, no study that has explored the occurrence of cardiovascular risk f...
Importance
Although patients with chronic kidney disease (CKD) are routinely managed in primary care settings, no nationally representative study has assessed the quality of care received by these patients in Canada.
Objective
To evaluate the current state of CKD management in Canadian primary care practices to identify care gaps to guide developm...
**Up to 50 e-prints of this article are available from https://www.tandfonline.com/eprint/6VN8VISWHEZCIZXKQ9GY/full?target=10.1080/13557858.2019.1655529**
Objectives: This paper explores the role of immigrant-serving agencies in facilitating access to dementia services and supports provided by dementia service agencies (particularly the health auth...
Objective:
To determine the stability of warfarin anticoagulation using a nationally representative sample of Canadian primary care patients and providers.
Design:
Prospective cohort study.
Setting:
Primary care practices associated with the Canadian Primary Care Sentinel Surveillance Network.
Participants:
Adult warfarin users with 7 or mor...
Background:
A risk-based model of care for managing patients with chronic kidney disease (CKD) using the Kidney Failure Risk Equation (KFRE) has been successfully integrated into nephrology care pathways in several jurisdictions. However, as most patients with CKD can be managed in primary care, the next pertinent steps would be to integrate the K...
Introduction
Surveillance systems enable optimal care delivery and appropriate resource allocation, yet Canada lacks a dedicated surveillance system for chronic kidney disease (CKD). Using data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), a national chronic disease surveillance system, this study describes the geographic,...
Background:
Identifying cases of disease in primary care electronic medical records (EMRs) is important for surveillance, research, quality improvement and clinical care. We aimed to develop and validate a case definition for type 1 diabetes mellitus using EMRs.
Methods:
For this exploratory study, we used EMR data from the Southern Alberta Prim...
Background
The trajectory of dementia through time is characterized by common transitions which are difficult for persons with dementia (PWDs) and their families and friends. Our study sought to identify determinants for the quality of transition outcomes.MethodA 24-month, prospective, longitudinal design identified specific transitions as they occ...
Objective:
To use data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) to evaluate the prevalence of antidepressant and antipsychotic prescriptions among patients with no previous depression or psychosis diagnoses, and to identify the factors associated with the use of these drugs in this population.
Design:
Retrospective c...
Introduction
Administrative data are commonly used for a variety of secondary purposes. Although they lack clinical detail and risk factor information, linkage to primary care electronic medical records (EMR) could fill this gap. Primary care EMRs are a relatively new data source available in Alberta and thus, EMR-administrative linkages are novel....
Introduction
Use of administrative health data and primary care electronic medical record data are both ubiquitous in Alberta, but linkage between them at patient level and implementation of the linked data into primary care practice are rare. This demonstration project sought to achieve this for a sample of patients with diabetes.
Objectives and...
Objective:
To explore clinical indicators among patients with diabetes in southern Alberta and assess changes over time, and to compare patients with diabetes attending a reference clinic (RC), which had adapted its service model to address the specific needs of the patient population, with patients with diabetes attending comparison clinics (CCs)...
Objective: The Building Trust project aimed to understand the process of gaining access to dementia-related information, diagnosis, care and psychosocial supports by Punjabi- and Korean-speaking older adults with Alzheimer’s Disease and related dementias and their informal caregivers living in the Fraser Health region of British Columbia, Canada.
M...
Background:
The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) previously carried out a validation study of case definitions for 8 chronic diseases (diabetes mellitus, hypertension, osteoarthritis, depression, dementia, chronic obstructive pulmonary disease, parkinsonism and epilepsy) using direct review of "raw" electronic medical r...
Context: Dementia is a long-term mental illness often resulting in loss of memory, reasoning ability, and changes in personality. Progressive dementias are especially concerning as they have no effective treatment and prevention. Research has found that cardiovascular disease (CVD) risk factors increase the risk of developing dementia. In Canada, t...
Objectives: A regional health authority and Alzheimer Society chapter in British Columbia have valuable resources on dementia and other health and social supports, but they do not know how to adapt their policy and practice tools to address the complex problems of access for immigrant older adults and their families. Staff in immigrant-serving [IS]...
Introduction
Effective chronic disease care is dependent on well-organised quality improvement (QI) strategies that monitor processes of care and outcomes for optimal care delivery. Although healthcare is provincially/territorially structured in Canada, there are national networks such as the Canadian Primary Care Sentinel Surveillance Network (CPC...
Objectives
Electronic medical records (EMR) can be a cost-effective source for hypertension surveillance. However, diagnosis of hypertension in EMR is commonly under-coded and warrants the needs to review blood pressure and antihypertensive drugs for hypertension case identification. To advocate for the use of EMR data for research, we developed me...
An accurate estimation of the prevalence of paediatric asthma in Alberta and elsewhere is hampered by uncertainty regarding disease definition and diagnosis. Electronic medical records (EMRs) provide a rich source of clinical data from primary-care practices that can be used in better understanding the occurrence of the disease. The Canadian Primar...
The 'Pathways to Diagnosis' study captured the experience of the prediagnosis period of Alzheimer's disease and related dementias through indepth interviews with 29 persons with dementia and 34 of their family caregivers across four sites: anglophones in Calgary, francophones in Ottawa, Chinese-Canadians in Greater Vancouver and Indo-Canadians in T...
Background:
Warfarin is an anticoagulant prescribed to 12% of long-term care residents to reduce the risk of thrombo-embolism. This study used indicators to compare warfarin management by pharmacists to usual care.
Methods:
This was a retrospective cohort study comparing a pharmacist-managed warfarin protocol with usual care of qualified warfari...
Aim: The management of childhood asthma is hindered by difficulties in diagnosis. To perform research involving patients with asthma, as well as to perform clinical audits, it is essential to identify the true asthmatics in the practice. We aim to develop and validate an algorithm for detecting asthmatic children in family physicians' electronic me...
Background
Dementia is common, particularly among older adults, and is one of the major causes of dependency later in life. We sought to provide an overview and comparison of key services related to dementia care as the disease progresses in three large Canadian healthcare centres. Methods
We identified family physicians, geriatric specialists, and...
Background:
The proportion of Canadians living with Alzheimer disease and related dementias is projected to rise, with an increased burden on the primary health care system in particular. Our objective was to describe the prevalence and management of dementia in a community-dwelling sample using electronic medical record (EMR) data from the Canadi...
Background:
Asthma is the most common chronic condition in children. For many, the disease is inadequately controlled, which can burden the lives of children and their families as well as the health care system. Improved use of the best available scientific evidence by primary care practitioners could reduce the need for hospital care and improve...
Background:
The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) has established a national repository of primary care patient health data that is used for both surveillance and research. Our main objective was to determine how representative the data for patients and primary care practitioners in the CPCSSN are when compared with the...
Background:
Electronic medical records (EMR) can be a cost-effective source for hypertension surveillance. However, diagnosis of hypertension in EMR is commonly under-coded and warrants the needs to review blood pressure and antihypertensive drugs for hypertension case identification.
Methods:
We included all the patients actively registered in...
Background:
The impact of telephone consultations between pain specialists and primary care physicians regarding the care of patients with chronic pain is unknown.
Objectives:
To evaluate the impact of telephone consultations between pain specialists and primary care physicians regarding the care of patients with chronic pain. MEETHODS:<⁄span> P...