Moira Stewart's research while affiliated with The University of Western Ontario and other places

Publications (179)

Article
Background: Patients with multimorbidity require coordinated and patient-centred care. Telemedicine IMPACT Plus provides such care for complex patients in Toronto, Ontario. We conducted a randomized controlled trial (RCT) comparing health care utilization and costs at 1-year postintervention for an intervention group and 2 control groups (RCT and...
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Background The onset of the COVID-19 pandemic necessitated a rapid shift in primary health care from predominantly in-person to high volumes of virtual care. The pandemic afforded the opportunity to conduct a deep regional examination of virtual care by family physicians in London and Middlesex County, Ontario, Canada that would inform the foundati...
Chapter
This chapter will help the reader apply the patient-centred clinical method to the virtual care environment. It will also challenge the reader to critically reflect on their assumptions and implicit biases and understand their potential impact on patient care, with a particular focus on the virtual care environment. Throughout the chapter, suggeste...
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Background Effective deployment of AI tools in primary health care requires the engagement of practitioners in the development and testing of these tools, and a match between the resulting AI tools and clinical/system needs in primary health care. To set the stage for these developments, we must gain a more in-depth understanding of the views of pr...
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Background Current dimensions of the primary health care research (PHC) context, including the need for contextualized research methods to address complex questions, and the co-creation of knowledge through partnerships with stakeholders – require PHC researchers to have a comprehensive set of skills for engaging effectively in high impact research...
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Objectives We aimed to identify the core elements of centredness in healthcare literature. Our overall research question is: How has centredness been represented within the health literature published between 1990 and 2019? Methods A scoping review across five databases (Medline (Ovid), PsycINFO, CINAHL, Embase (Ovid) and Scopus; August 2019) to i...
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Background People with multimorbidity, who may be more vulnerable to certain social determinants of health, often require care by an interprofessional primary healthcare (PHC) team that can tailor their approach to address the multiple and complex needs of this population. This paper describes how the needs of vulnerable patients experiencing multi...
Conference Paper
Context: On March 14, 2020, the Ontario, Canada health insurance plan approved COVID-19 physician virtual billing codes; family physicians (FPs) rapidly adopted a new model of care. Virtual care may remain post-pandemic; however, its future should be informed by evidence that considers access and continuity. Objective: 1) to determine FP virtual vi...
Article
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Multimorbidity has received much attention and there is a growing number of original studies. However, randomized controlled trials (RCTs) have failed to demonstrate effectiveness of interventions aimed at improving outcomes for patient with multimorbidity in primary care. The purpose of this article is to synthesize and analyze the most recent RCT...
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Objectives Pregnant women prioritize the health of their pregnancy, and weight gain contributes to the pregnancy’s health. Women encounter different messages about gestational weight gain from various sources that can be confusing. This study aimed to increase our understanding of the processes influencing how women experience the gestational weigh...
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Objective A patient-centred care interdisciplinary pragmatic intervention to support self-management for patients with multimorbidity was implemented in one region of Quebec, Canada. This embedded study aimed to evaluate the process of implementation. Design A descriptive qualitative study was conducted in 2016–2017 using semistructured individual...
Preprint
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Background People with multimorbidity, who may be more vulnerable, often require care by an interprofessional primary healthcare (PHC) team that can tailor their approach to address the multiple and complex needs of this population. This study explored how the needs of vulnerable patients experiencing multimorbidity receive care by innovative inter...
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Context Interventions for people with multimorbidity have obtained mixed results. We aimed to document the long-term effect of an intervention for people with multimorbidity. Methods 284 patients (18–80 years) presenting three or more chronic conditions were recruited from seven family medicine groups in the Saguenay-Lac St-Jean region, Quebec, Ca...
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Background The prevalence of multimorbidity varies widely due to the lack of consensus in defining multimorbidity. This study aimed to measure the prevalence of multimorbidity in a primary care setting using two definitions of multimorbidity with two different lists of chronic conditions. Methods We conducted a cross-sectional study of 787,446 pat...
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Multimorbidity, the presence of 1+ chronic condition in an individual, remains one of the greatest challenges to health on a global scale. Although the prevalence of multimorbidity has been well-established, its incidence is not fully understood. This systematic review determined the incidence of multimorbidity across the lifespan; the order in whi...
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Objectives: There are multiple instruments for measuring multimorbidity. The main objective of this systematic review was to provide a list of instruments that are suitable for use in studies aiming to measure the association of a specific outcome with different levels of multimorbidity as the main independent variable in community-dwelling indivi...
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PURPOSE To measure the effectiveness of a 4-month interdisciplinary multifaceted intervention based on a change in care delivery for patients with multimorbidity in primary care practices. METHODS A pragmatic randomized controlled trial with a mixed-methods design in patients aged 18 to 80 years with 3 or more chronic conditions from 7 family medic...
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Background Patient-centred interventions to help patients with multimorbidity have had mixed results. Aim To assess the effectiveness of a provider-created, patient-centred, multi-provider case conference with follow-up, and understand under what circumstances it worked, and did not work. Design and setting Mixed-methods design with a pragmatic r...
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The International Multimorbidity Symposium was held in November 2019 at Western University to achieve three main objectives: to discuss progress and findings from various jurisdictions; to facilitate collaboration through group discussion to identify strategies to move multimorbidity research forward; and to create concrete plans to ensure advances...
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Background The Patient Perception of Patient‐Centeredness (PPPC) questionnaire was revised, and there is a need for the questionnaire to be tested in diverse primary care populations. Objectives This study aimed to examine the factor structure of the Revised PPPC questionnaire (PPPC‐R) in French‐speaking patients with multimorbidity. Design Secon...
Article
Background: Patients with multimorbidity often require services across different health care settings, yet team processes among settings are rarely implemented. We explored perceptions of specialists and family physicians collaborating in a telemedicine interprofessional consultation for patients with multimorbidity to better understand the value...
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Aim To describe activities and outcomes of a cross-team capacity building strategy that took place over a five-year funding period within the broader context of 12 community-based primary health care (CBPHC) teams. Background In 2013, the Canadian Institutes of Health Research funded 12 CBPHC Teams (12-Teams) to conduct innovative cross-jurisdicti...
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Background: Multimorbidity challenges the health-care system and requires innovative approaches. In 2015, a 4-month patient-centred interdisciplinary pragmatic intervention was implemented in primary care with the aim of supporting self-management for patients with multimorbidity. Objective: To explore the perceptions and experiences of health-c...
Article
Purpose: Most models for managing chronic disease focus on single diseases. Managing patients with multimorbidity is an increasing challenge in family medicine. We evaluated the feasibility of a novel approach to caring for patients with multimorbidity, performing a case study of TIP-Telemedicine IMPACT (Interprofessional Model of Practice for Agi...
Article
Purpose: Given the ongoing desire to make health care more patient-centered and growing evidence supporting the provision of patient-centered care, it is important to have valid tools for measuring patient-centered care. The patient-centered clinical method (PCCM) is a conceptual framework for providing patient-centered care. A revision to the PCC...
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Background Musculoskeletal (MSK) conditions are a common presentation in primary care. This study sought to determine the prevalence of MSK conditions in primary care in Ontario and to validate the extent to which health administrative date billing codes accurately represent MSK diagnoses. Methods De-identified electronic medical records (EMR) fro...
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Background: Social aspects play an important role in individual health and should be taken into consideration in the long-term care for people with multimorbidity. Purposes: To describe social vulnerability, to examine its correlation with the number of chronic conditions, and to investigate which chronic conditions were significantly associated...
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Background The increased use of electronic medical records (EMRs) in Canadian primary health care practice has resulted in an expansion of the availability of EMR data. Potential users of these data need to understand their quality in relation to the uses to which they are applied. Herein, we propose a basic model for assessing primary health care...
Article
Increasing prevalence of chronic conditions and multimorbidity challenges health care systems and calls for patient-centered coordination of care. Implementation and evaluation of health policies focusing on the development of patient-centered coordination of care needs valid instruments measuring this dimension of care. The aim of this validation...
Article
Objectives: To determine volumes and rates of multimorbidity in Ontario by age group, sex, material deprivation, and geography. Methods: A cross-sectional population-based study was completed using linked provincial health administrative databases. Ontario residents were classified as having multimorbidity (3+ chronic conditions) or not, based o...
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Background: Interventions to improve patient-centered care for persons with multimorbidity are in constant growth. To date, the emphasis has been on two separate kinds of interventions, those based on a patient-centered care approach with persons with chronic disease and the other ones created specifically for persons with multimorbidity. Their ef...
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Background: A referral from a family physician (FP) to a specialist is an inflection point in the patient journey, with potential implications for clinical outcomes and health policy. Primary care electronic medical record (EMR) databases offer opportunities to examine referral patterns. Until recently, software techniques were not available to mo...
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Objective Primary healthcare (PHC) quality improvement (QI) initiatives are designed to improve patient care and health outcomes. We evaluated the Quality Improvement and Innovation Partnership (QIIP), an Ontario-wide PHC QI program on access to care, diabetes management and colorectal cancer screening. This manuscript highlights the impact of QIIP...
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Background: The high prevalence of multimorbidity necessitates rethinking of the health care system. The overarching goal of the Patient-Centred Innovations for Persons with Multimorbidity program is to build on existing structures and find and evaluate patient-centred innovations relevant to multimorbidity. Methods: We describe the protocol for a...
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Building on a previous study, which identified gaps in primary healthcare electronic medical record (EMR) research and knowledge, a one-day conference was held to facilitate a strategic discussion of these issues. This paper offers a multi-faceted research agenda and suggestions for policy actions as a way forward in bridging the gaps. One facet fo...
Article
Objective: To examine family physicians' practices in and opinions on asking patients about their religious and spiritual beliefs, as well as physicians' comfort levels in asking. Design: Cross-sectional study using self-administered questionnaires. Setting: Kitchener-Waterloo, Ont. Participants: A total of 155 family physicians with office...
Article
Objective: To discover the frequency of psychosocial and other diagnoses occurring at the end of a visit when patients present to their FPs with concerns about fatigue. Design: Cross-sectional study of patient-FP encounters for fatigue. Setting: Ten FP practices in southwestern Ontario. Participants: A total of 259 encounters involving 167 p...
Article
An integrated knowledge translation strategy is a key factor in fostering the implementation of practice changes. Building on a 15-year history of projects that include close collaboration between researchers and decision-makers in the Saguenay region of Quebec (Canada), the authors identify several key elements that resulted in practice changes in...
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Background The use of portals might be expected to rise; however, adoption has been slow. Development of portals has occurred with limited patient involvement. This paper fills a need for literature concerning perspectives regarding the value of portals, how best to organize and provide portals, and critically how to seek patient involvement in imp...
Article
Objective: To identify gestational weight gain trajectories, stratified by prepregnancy body mass index (BMI), of women with singleton pregnancies who received prenatal care in a primary care setting, and to compare these trajectories with the 2009 Institute of Medicine gestational weight gain recommendations. Design: Retrospective cohort study. Se...
Article
To provide a population-based, Canada-wide picture of health care needs and health care use, and present it in a highly accessible manner, allowing provincial comparisons and comparisons with other international jurisdictions. A comparison of the rates of health care use among jurisdictions, using Canadian-population survey data and health administ...
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Background: The symptom of fatigue is one of the top five most frequently presented health complaints in primary care, yet it remains underexplored in the Canadian primary care context. Objective: The objective of this study was to examine the prevalence and impact of patients presenting with fatigue in primary care, using the only known electro...
Article
While the barriers to electronic medical record (EMR) adoption by physicians are well-known, we have much less knowledge about the broader challenges regarding EMR use faced by primary healthcare (PHC) EMR stakeholders in Canada. Therefore, we conducted interviews (from June 2009 to September 2010) and consultation sessions (in October and November...
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Rigorous comprehensive evaluations of primary healthcare (PHC) quality improvement (QI) initiatives are lacking. This article describes the evaluation of the Quality Improvement & Innovation Partnership Learning Collaborative (QIIP-LC), an Ontario-wide PHC QI program targeting type 2 diabetes management, colorectal cancer (CRC) screening, access to...
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Purpose: Quality improvement (QI) initiatives have been implemented to facilitate transition to a chronic disease management approach in primary health care. However, the effect of QI initiatives on diabetes clinical processes and outcomes remains unclear. This article reports the effect of Partnerships for Health, a QI program implemented in South...
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Background: As the population ages, practice and policy need to be guided by accurate estimates of chronic disease burden in primary care. Objective: To produce a preliminary set of methodological considerations for cross-sectional and retrospective cohort studies of multi-morbidity in primary care using three studies as examples. Prevalence rat...
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To examine the health care-related experiences of individuals who have lost their FPs. A qualitative design using phenomenology. Southwestern Ontario. Eighteen participants (9 women and 9 men, with a mean age of 48.9 years) from urban or rural areas who had lost their FPs. Semistructured interviews were conducted, which were audiotaped and transcri...
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To assess the psychometric properties of dyadic measures for shared decision making (SDM) research. We conducted an observational cross-sectional study in 17 primary care clinics with physician-patient dyads. We used seven subscales to measure six elements of SDM: (1) defining the problem, presenting options, and discussing pros and cons; (2) clari...
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Objective: Many parents of preschool-age children have concerns about how to discipline their child but few receive help. We examined the effects of a brief treatment along with usual care, compared with receiving usual care alone. Patients. Parents (N = 178) with concerns about their 2- to 5-year olds' discipline were recruited when they visited...
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Background: Reducing wait times is a key goal of Canadian health planners and policy makers. Using data from the EMRs of 23 family physicians across southwestern Ontario, we present data on wait times to see a specialist, and evaluate these data for equity. Methods: Cross-sectional analysis of EMR database of 29,303 patients and 544,398 encounte...
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Major initiatives are underway in Canada which are designed to increase electronic medical record (EMR) implementation and maximise its use in primary health care. These developments need to be supported by sufficient evidence from the literature, particularly relevant research conducted in the Canadian context. This study sought to quantify this l...
Article
This qualitative study explored the experiences of primary health care providers and staff who had moved beyond the stage of implementing electronic medical records (EMRs) in their practices to using this technology on an on-going basis. A descriptive qualitative approach was used. Semistructured interviews were conducted with 19 participants. Data...