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Phillips, W. R; Herbert, C. P. PubDate: 2022-11-14T07:35:31-08:00 DOI: 10.46747/cfp.6811e298 Issue No:Vol. 68, No. 11 (2022)
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Dickinson, J. A; Theriault, G, Grad, R, Bell, N. R, Szafran, O. PubDate: 2022-11-14T07:35:31-08:00 DOI: 10.46747/cfp.6811e310 Issue No:Vol. 68, No. 11 (2022)
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Sawchuk, P; Condon, A, Stewart, T. PubDate: 2022-11-14T07:35:31-08:00 DOI: 10.46747/cfp.6811e318 Issue No:Vol. 68, No. 11 (2022)
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Varner, C. E; Lee, S, McLeod, S, Bearss, E, Singwi, A, Hu, S, Nahiddi, N, Borgundvaag, B. Abstract: ObjectiveTo evaluate the use of point-of-care ultrasound (POCUS) for the assessment of patients experiencing first-trimester bleeding or abdominal pain by family physicians working in family medicine clinics following first-trimester POCUS training and certification.DesignMultisite, retrospective chart review.SettingTwo hospital-affiliated academic family medicine clinics in Toronto, Ont.ParticipantsTwelve family physicians who completed a first-trimester POCUS training and certification course.Main outcome measuresThe primary outcome was the proportion of family physicians using POCUS during their evaluations of patients in the first trimester of pregnancy in the 6 months following the FPs’ successful completion of the Family Medicine Obstetrical Ultrasound (FaMOUS) course. Secondary outcomes included indications for POCUS use, diagnostic accuracy of POCUS compared with radiologist-interpreted ultrasound, pregnancy outcomes, and emergency department visits within 10 days of the index family medicine clinic visit.ResultsOf the 12 certified family physicians, 7 (58.3%) used POCUS during their assessments of first-trimester patients during the study period. The FPs used POCUS with 56 patients for the following indications: 11 (19.6%) had only vaginal bleeding, 5 (8.9%) had only abdominal pain, and 8 (14.3%) had both vaginal bleeding and abdominal pain; the indication for 32 patients (57.1%) was unclear. Forty-six patients (82.1%) underwent a subsequent radiologist-interpreted ultrasound within 10 days of the index POCUS test. Compared with radiologist-interpreted ultrasound, POCUS had a sensitivity of 91.3% (95% CI 79.2% to 97.6%) for documenting intrauterine pregnancy and a sensitivity of 81.4% (95% CI 66.6% to 91.6%) for documenting the presence of fetal cardiac activity.ConclusionFollowing a first-trimester POCUS certification course, family physicians used POCUS for the assessment of first-trimester patients with varying frequency and for indications other than vaginal bleeding or abdominal pain. Further study is needed to assess the clinical impact of office-based POCUS, unforeseen barriers and facilitators to its use, and patient and provider preferences. PubDate: 2022-11-14T07:35:31-08:00 DOI: 10.46747/cfp.6811e326 Issue No:Vol. 68, No. 11 (2022)
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Neufeld, A; Au nom du Groupe de travail sur les relations avec les residents de la Section des residents PubDate: 2022-11-14T07:35:31-08:00 DOI: 10.46747/cfp.6811e333 Issue No:Vol. 68, No. 11 (2022)
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Please help us test our new pre-print finding feature by giving the pre-print link a rating. A 5 star rating indicates the linked pre-print has the exact same content as the published article.
Please help us test our new pre-print finding feature by giving the pre-print link a rating. A 5 star rating indicates the linked pre-print has the exact same content as the published article.
Please help us test our new pre-print finding feature by giving the pre-print link a rating. A 5 star rating indicates the linked pre-print has the exact same content as the published article.
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Authors:
Asrar, F. M; Saint-Jacques, D, Williams, D. Pages: 797 - 798, 800 PubDate: 2022-11-14T07:35:31-08:00 DOI: 10.46747/cfp.6811797 Issue No:Vol. 68, No. 11 (2022)
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Phillips, W. R; Herbert, C. P. Pages: 801 - 802 PubDate: 2022-11-14T07:35:31-08:00 DOI: 10.46747/cfp.6811801 Issue No:Vol. 68, No. 11 (2022)
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Asrar, F. M; Saint-Jacques, D, Williams, D. Pages: 803 - 804, 806 PubDate: 2022-11-14T07:35:31-08:00 DOI: 10.46747/cfp.6811803 Issue No:Vol. 68, No. 11 (2022)
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Chin, T; Huyghebaert, T, Svrcek, C, Oluboka, O. Pages: 807 - 814 Abstract: ObjectiveTo introduce a visual clinical decision support tool to assist with individualizing first-line antidepressant pharmacotherapy for adults with major depressive disorder (MDD) in a Canadian context.Sources of informationA literature review was conducted with Google Scholar, PubMed, the Cochrane Database of Systematic Reviews, and Trip Pro using the MeSH headings depression, antidepressive agents, primary care, practice patterns, medication adherence, and decision making, shared.Main messageMajor depressive disorder affects about 4.7% of Canadians annually and is a prevalent condition encountered and diagnosed in primary care. Untreated depression is associated with decreased quality of life, increased risk of suicide, and worsening physical health outcomes when depression co-occurs with other chronic medical conditions. In a network meta-analysis, antidepressant medications (such as selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, bupropion, and vortioxetine) reduced depressive symptoms by 50% or more when compared with placebo in acute treatment of adults with moderate to severe MDD. Poor treatment adherence and high discontinuation rates limit MDD treatment success. Factors such as strong therapeutic alliances between patients and prescribers, collaborative care, patient education, and supportive self-management have been shown to enhance treatment adherence. The most recent Canadian Network for Mood and Anxiety Treatments depression treatment guidelines (published in 2016) suggest 15 different first-line antidepressant medication options for the treatment of MDD. There is a need for evidence-informed decision support aids to individualize antidepressant therapy to treat patients diagnosed with MDD.ConclusionRecent studies on antidepressants have indicated no single antidepressant is superior to others in treating patients with MDD. This suggests there may be opportunities to enhance treatment adherence and success by tailoring antidepressant therapy to align with each patient’s preferences. The Antidepressant Decision Support Tool was developed to help prescribers and adult patients engage in shared decision making to select an individualized and optimal first-line antidepressant for the treatment of acute MDD. PubDate: 2022-11-14T07:35:31-08:00 DOI: 10.46747/cfp.6811807 Issue No:Vol. 68, No. 11 (2022)
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Dickinson, J. A; Theriault, G, Grad, R, Bell, N. R, Szafran, O. Pages: 815 - 822 PubDate: 2022-11-14T07:35:31-08:00 DOI: 10.46747/cfp.6811815 Issue No:Vol. 68, No. 11 (2022)
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Please help us test our new pre-print finding feature by giving the pre-print link a rating. A 5 star rating indicates the linked pre-print has the exact same content as the published article.
Please help us test our new pre-print finding feature by giving the pre-print link a rating. A 5 star rating indicates the linked pre-print has the exact same content as the published article.
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Sawchuk, P; Condon, A, Stewart, T. Pages: 829 - 835 Abstract: Problem addressedWhile the home-based primary care model offers potential patient and system-level benefits, implementation of interprofessional home-based primary care teams has not been widespread. When caring for homebound patients, family physicians are often not included as regular contributors or participants in the team that coordinates and plans much of the care for these patients.Objective of programTo describe a selection of home-based primary care practices and to identify barriers to and facilitators of the creation and sustainability of these models within the publicly funded health care system.Program descriptionFive existing home-based primary care practices were examined: 1 each in Victoria and Vancouver in BC; 1 in Winnipeg, Man; and 2 in Toronto, Ont. The research team conducted semistructured team interviews, interviews with the physician leads, and informal observation of elements of team-based care planning at these 5 sites. From these sources, descriptions of each practice were developed in terms of practice history, context, and initiating factors; practice goals and performance management; and practice design elements, including target population, referral sources, and team composition. A qualitative thematic content analysis was used to extract and distil implementation barriers and facilitators across the 5 practices. Members of each practice team validated the interpretation of thematic information. Substantial heterogeneity was found in the composition of the interprofessional teams. The overarching initiating factor for the home-based component of all practices could be described as identifying and addressing unmet community need. Physician leadership, creative funding models, team camaraderie, and community partnerships were the main facilitators. Limited health system support, geography, and lack of existing models of care were the main barriers.ConclusionSubstantial barriers to wider implementation of home-based primary care practices persist. Examination of existing practices identifies the importance of physician leadership and commitment to meeting community need. PubDate: 2022-11-14T07:35:31-08:00 DOI: 10.46747/cfp.6811829 Issue No:Vol. 68, No. 11 (2022)
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Kiran, T; Wang, R, Handford, C, Laraya, N, Eissa, A, Pariser, P, Brown, R, Pedersen, C. Pages: 836 - 846 Abstract: ObjectiveTo determine the extent to which family physicians closed their doors altogether or for in-person visits during the pandemic, their future practice intentions, and related factors.DesignCross-sectional survey.SettingSix geographic areas in Toronto, Ont, aligned with Ontario Health Team regions.ParticipantsFamily doctors practising office-based, comprehensive family medicine.Main outcome measuresPractice operations in January 2021, use of virtual care, and future plans.ResultsOf the 1016 (85.7%) individuals who responded to the survey, 99.7% (1001 of 1004) indicated their practices were open in January 2021, with 94.8% (928 of 979) seeing patients in person and 30.8% (264 of 856) providing in-person care to patients reporting COVID-19 symptoms. Respondents estimated spending 58.2% of clinical care time on telephone visits, 5.8% on video appointments, and 7.5% on e-mail or secure messaging. Among respondents, 17.5% (77 of 439) were planning to close their existing practices in the next 5 years. There were higher proportions of physicians who worked alone in clinics among those who did not see patients in person (27.6% no vs 12.4% yes, P PubDate: 2022-11-14T07:35:31-08:00 DOI: 10.46747/cfp.6811836 Issue No:Vol. 68, No. 11 (2022)
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Neufeld, A; On behalf of the Section of Residents Resident Relations Working Group Pages: 862 - 862 PubDate: 2022-11-14T07:35:31-08:00 DOI: 10.46747/cfp.6811862 Issue No:Vol. 68, No. 11 (2022)
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Authors:Loh L. C. Pages: 865 - 865 PubDate: 2022-11-14T07:35:31-08:00 DOI: 10.46747/cfp.6811865 Issue No:Vol. 68, No. 11 (2022)
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Authors:Loh L. C. Pages: 866 - 866 PubDate: 2022-11-14T07:35:31-08:00 DOI: 10.46747/cfp.6811866 Issue No:Vol. 68, No. 11 (2022)
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