Distress experienced by lung cancer patients and their family caregivers in the first year of their cancer journey.

Objectives: Diagnosis of cancer is emotionally threatening not only for patients but also for their family caregivers (FC) who witness and share much of the illness experience. This study compares distress experienced by lung cancer patients and their FC during the year following the diagnosis.

Methods: A prospective cohort study of 206 patients recently diagnosed with inoperable lung cancer (participation rate 79.

Continuity of Cancer Care and Collaboration Between Family Physicians and Oncologists: Results of a Randomized Clinical Trial.

Purpose: Collaboration between family physicians (FPs) and oncologists can be challenging. We present the results of a randomized clinical trial of an intervention designed to improve continuity of care and interprofessional collaboration, as perceived by patients with lung cancer and their FPs.

Methods: The intervention included (1) supplying FPs with standardized summaries related to each patient, (2) recommending that patients see their FP after receiving the cancer diagnosis, (3) supplying the oncology team with patient information resulting from FP visits, and (4) providing patients with priority access to FPs as needed.

Quebec College of Family Physicians' new formal mentorship program.

Problem Addressed: The stresses that arise during the first years of practice can discourage future physicians from choosing family medicine. Quebec is experiencing challenges in recruiting clinical family physicians to replace those nearing retirement. Mentorship is a promising approach that supports future family physicians.

Psychometric analysis of the TRANSIT quality indicators for cardiovascular disease prevention in primary care.

Objective: To assess a selection of psychometric properties of the TRANSIT indicators.

Design: Using medical records, indicators were documented retrospectively during the 14 months preceding the end of the TRANSIT study.

Setting: Primary care in Quebec, Canada.

External facilitators and interprofessional facilitation teams: a qualitative study of their roles in supporting practice change.

Background: Facilitation is a powerful approach to support practice change. The purpose of this study is to better understand the facilitation roles exercised by both external facilitators and interprofessional facilitation teams to foster the implementation of change. Building on Dogherty et al.

Facilitating Implementation of Interprofessional Collaborative Practices Into Primary Care: A Trilogy of Driving Forces.

Implementing interprofessional collaborative practices in primary care is challenging, and research about its facilitating factors remains scarce. The goal of this participatory action research study was to better understand the driving forces during the early stage of the implementation process of a community-driven and patient-focused program in primary care titled "TRANSforming InTerprofessional cardiovascular disease prevention in primary care" (TRANSIT). Eight primary care clinics in Quebec, Canada, agreed to participate by creating and implementing an interprofessional facilitation team (IFT).

Priority interventions to improve the management of chronic non-cancer pain in primary care: a participatory research of the ACCORD program.

Purpose: There is evidence that the management of chronic non-cancer pain (CNCP) in primary care is far from being optimal. A 1-day workshop was held to explore the perceptions of key actors regarding the challenges and priority interventions to improve CNCP management in primary care.

Methods: Using the Chronic Care Model as a conceptual framework, physicians (n=6), pharmacists (n=6), nurses (n=6), physiotherapists (n=6), psychologists (n=6), pain specialists (n=6), patients (n=3), family members (n=3), decision makers and managers (n=4), and pain researchers (n=7) took part in seven focus groups and five nominal groups.

Providing high-quality care in primary care settings: how to make trade-offs.

Objective: To gain a deeper understanding of how primary care (PC) practices belonging to different models manage resources to provide high-quality care.

Design: Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices.

Setting: Three regions of Quebec.

Pharmacotherapeutic management of chronic noncancer pain in primary care: lessons for pharmacists.

Purpose: Describe the pharmacotherapeutic management of primary-care patients with chronic noncancer pain, assess their satisfaction with pain treatment, and identify the determinants of their satisfaction.

Methods: A cohort study was conducted in Quebec (Canada). Patients reporting chronic noncancer pain with an average pain intensity of at least 4 on a 0-10 scale (10= worst possible pain) and having an active analgesic prescription from a primary-care physician were recruited.

Development of an interprofessional program for cardiovascular prevention in primary care: A participatory research approach.

Background: The chronic care model provides a framework for improving the management of chronic diseases. Participatory research could be useful in developing a chronic care model-based program of interventions, but no one has as yet offered a description of precisely how to apply the approach.

Objectives: An innovative, structured, multi-step participatory process was applied to select and develop (1) chronic care model-based interventions program to improve cardiovascular disease prevention that can be adapted to a particular regional context and (2) a set of indicators to monitor its implementation.

Characteristics of primary care practices associated with high quality of care.

Background: No primary practice care model has been shown to be superior in achieving high-quality primary care. We aimed to identify the organizational characteristics of primary care practices that provide high-quality primary care.

Methods: We performed a cross-sectional observational study involving a stratified random sample of 37 primary care practices from 3 regions of Quebec.

Effects of continuing professional development on clinical performance: results of a study involving family practitioners in Quebec.

Objective: To evaluate the link between the quantity and quality of continuing professional development (CPD) activities completed by family physicians in Quebec and the quality of their practice.

Design: Retrospective analysis of data collected during professional inspection visits (PIVs).

Setting: Quebec.

Priorities for action to improve cardiovascular preventive care of patients with multimorbid conditions in primary care--a participatory action research project.

Background: Cardiovascular disease (CVD) prevention in patients with multimorbid conditions is not always optimal in primary care (PC). Interactive collaborative processes involving PC community are recommended to develop new models of care and to successfully reshape clinical practices.

Objective: To identify challenges and priorities for action in PC to improve CVD prevention among patients with multimorbid conditions.

Patient, primary care physician and specialist expectations of primary care physician involvement in cancer care.

Background: In Canada, many health authorities recommend that primary care physicians (PCP) stay involved throughout their patients' cancer journey to increase continuity of care. Few studies have focused on patient and physician expectations regarding PCP involvement in cancer care.

Objective: To compare lung cancer patient, PCP and specialist expectations regarding PCP involvement in coordination of care, emotional support, information transmission and symptom relief at the different phases of cancer.

Physician-pharmacist collaborative care in dyslipidemia management: the perception of clinicians and patients.

Background: Collaborative practices allow physicians and pharmacists to comanage pharmacotherapy to maximize the benefits of medication regimens. The Trial to Evaluate an Ambulatory primary care Management program for patients with dyslipidemia (TEAM) study compared the efficacy of a physician-pharmacist collaborative primary care (PPCC) intervention, where pharmacists requested laboratory tests and adjusted medication dosage, to the usual care (UC) for patients under treatment with lipid-lowering medication.

Objective: In a qualitative study nested within the TEAM study, the perceptions of physicians, pharmacists, and patients regarding the PPCC model, interprofessional collaboration, and the clinicians' willingness to implement the model in their practice were explored.

Family physician involvement in cancer care follow-up: the experience of a cohort of patients with lung cancer.

Purpose: There has been little research describing the involvement of family physicians in the follow-up of patients with cancer, especially during the primary treatment phase. We undertook a prospective longitudinal study of patients with lung cancer to assess their family physician's involvement in their follow-up at the different phases of cancer.

Methods: In 5 hospitals in the province of Quebec, Canada, patients with a recent diagnosis of lung cancer were surveyed every 3 to 6 months, whether they had metastasis or not, for a maximum of 18 months, to assess aspects of their family physician's involvement in cancer care.

Family physician involvement in cancer care and lung cancer patient emotional distress and quality of life.

Purpose: This study aims to describe emotional distress and quality of life (QoL) of patients at different phases of their lung cancer and the association with their family physician (FP) involvement.

Methods: A prospective study on patients with lung cancer was conducted in three regions of Quebec, Canada. Patients completed, at baseline, several validated questionnaires regarding their psychosocial characteristics and their perceived level of FP involvement.

A cluster randomized controlled Trial to Evaluate an Ambulatory primary care Management program for patients with dyslipidemia: the TEAM study.

Background: Few studies have reported the efficacy of collaborative care involving family physicians and community pharmacists for patients with dyslipidemia.

Methods: We randomly assigned clusters consisting of at least two physicians and at least four pharmacists to provide collaborative care or usual care. Under the collaborative care model, pharmacists counselled patients about their medications, requested laboratory tests, monitored the effectiveness and safety of medications and patients' adherence to therapy, and adjusted medication dosages.

Physician-pharmacist collaborative care for dyslipidemia patients: knowledge and skills of community pharmacists.

Introduction: In a physician-pharmacist collaborative-care (PPCC) intervention, community pharmacists were responsible for initiating lipid-lowering pharmacotherapy and adjusting the medication dosage. They attended a 1-day interactive workshop supported by a treatment protocol and clinical and communication tools. Afterwards, changes in pharmacists' knowledge, their skills, and their satisfaction with the workshop were evaluated.

[Development of nursing pratice in family medecine groups].

The purpose of the study was to analyze the development of nursing practice in family medicine groups (FMGs). The two-year case study consisted of 73 semi-directed interviews ofnurses, physicians and managers in five FMGs. The findings led to three main observations: nursing practice varies considerably from one FMG to another, the development of nurses' practice seems to be associated with the development of a collaborative relationship, and the satisfaction of the professionals in the FMG, nurses in particular, depends on the type of practice.

Primum non nocere: could the health care system contribute to suffering? In-depth study from the perspective of terminally ill cancer patients.

Objective: To explore terminally ill patients' perceptions of their own suffering in order to describe, from these patients' perspective, some elements of health care providers' response to suffering.

Design: Qualitative study using content analysis methods suited to a grounded theory approach.

Setting: Teaching and nonteaching hospital oncology clinics, palliative care services (both ambulatory and in-unit), and family practices.

The nature of suffering and its relief in the terminally ill: a qualitative study.

The essential mandate of medicine is the relief of suffering. However, the quest for an integrated model towards a conceptualization of suffering is still ongoing and empirical studies are few. Qualitative inquiry using 31 in-depth interviews and content analysis was carried out between 1999 and 2001 in 26 patients diagnosed with terminal cancer.

Integration of the recommendations of the Canadian Task Force on Preventive Health Care: obstacles perceived by a group of family physicians.

Background: Surveys conducted in North America and in several European countries show that the preventive activities recommended by some groups of experts are difficult to integrate into medical practice. Interventions to correct this problem have produced mitigated results.

Objectives: Our aim was to gain a better understanding of the obstacles perceived by a group of family physicians concerning the integration of prevention into their routine practices.

Using standardized patients to measure professional performance of physicians.

Objective: To determine the nature of inaccuracies likely to occur when standardized patients (SPs) are used to measure physician behaviour and to evaluate the potential impact of these inaccuracies on estimates of physician performance.

Design: Secondary analysis from a randomized controlled trial.

Setting: Family physicians' offices.