Implementing virtual primary care: experiences, perspectives and identification of improvement opportunities in an academic primary care setting.

Background: One of the biggest changes to primary care triggered by the COVID-19 pandemic was the rapid integration of virtual care (VC). VC offers benefits to patients and providers but implementation presents challenges.

Methods: This study is a secondary analysis of a 2021 quality improvement (QI) driven environmental scan comprising a survey and 1:1 interviews, at the Department of Family and Community Medicine at the University of Toronto.

Factors influencing family physician engagement in practice-based quality improvement: Qualitative study.

Objective: To explore the experiences of family physicians leading quality improvement (QI) efforts and to better understand facilitators and barriers related to advancing QI in family practice.

Design: Qualitative descriptive study.

Setting: The Department of Family and Community Medicine at the University of Toronto in Ontario.

Implementing social interventions in primary care in Canada: A qualitative exploration of lessons learned from leaders in the field.

Purpose: Primary health care providers and practices are increasingly instituting direct interventions into social determinants of health and health inequities, but experiences of the leaders in these initiatives remain largely unexamined.

Methods: Sixteen semi-structured interviews with Canadian primary care leaders in developing and implementing social interventions were conducted to assess barriers, keys to success, and lessons learned from their work.

Results: Participants focused on practical approaches to establishing and maintaining social intervention programs and our analysis pointed to six major themes.

Dread and solace: Talking about perinatal mental health.

Perinatal mental health issues are a global public health challenge. Worldwide, it is estimated that 10% of pregnant women, and 13% of women who have just given birth, experience a mental disorder. Yet, for many reasons - including stigma, limited access to services, patients' lack of awareness about symptoms, and inadequate professional intervention - actual rates of clinical and subclinical perinatal mental health issues are likely higher.

Exploring the potential for introducing home monitoring of blood pressure during pregnancy into maternity care: current views and experiences of staff-a qualitative study.

Objective: One in 20 women are affected by pre-eclampsia, a major cause of maternal and perinatal morbidity, death and premature birth worldwide. Diagnosis is made from monitoring blood pressure (BP) and urine and symptoms at antenatal visits after 20 weeks of pregnancy. There are no randomised data from contemporary trials to guide the efficacy of self-monitoring of BP (SMBP) in pregnancy.

If You Build It They Will Come…and Stay: A Community-Based Family Medicine Program.

Introduction: In response to a government request to address physician shortages in underserved communities, the University of Toronto (U of T) established the Family Medicine Residency Program (FMRP) at the Royal Victoria Regional Health Centre (RVH) in Barrie, Ontario, Canada. Prior to establishing the FMRP, approximately 21% of Barrie residents did not have a family physician. This study investigated residents' training experiences, strengths and opportunities for improvement of a community FMRP, reasons why graduates choose to work in Barrie after graduation, and graduates' practice setting and location.

Family Medicine Journal Club: To Tweet or Not to Tweet?

Background And Objectives: Online journal clubs have recently become popular, but their effectiveness in promoting meaningful discussion of the evidence is unknown. We aimed to understand the learner experience of a hybrid online-traditional family medicine journal club.

Methods: We used a qualitative descriptive study to understand the experience of medical students and residents at the University of Toronto with the hybrid online-traditional family medicine journal club, including perceived useful and challenging aspects related to participant engagement and fostering discussion.

A virtual second opinion: Acceptability of a computer-based decision tool to assess older drivers with dementia.

Clinicians face challenges in deciding which older patients with dementia to report to transportation administrators. This study used a qualitative thematic analysis to understand the utility and limitations of implementing a computer-based Driving in Dementia Decision Tool in clinical practice. Thirteen physicians and eight nurse practitioners participated in an interview to discuss their experience using the tool.

What does meaningful look like? A qualitative study of patient engagement at the Pan-Canadian Oncology Drug Review: perspectives of reviewers and payers.

Objectives While there is wide support for patient engagement in health technology assessment, determining what constitutes meaningful (as opposed to tokenistic) engagement is complex. This paper explores reviewer and payer perceptions of what constitutes meaningful patient engagement in the Pan-Canadian Oncology Drug Review process. Methods Qualitative interview study comprising 24 semi-structured telephone interviews.

Development of a decision-making tool for reporting drivers with mild dementia and mild cognitive impairment to transportation administrators.

Background: Driving in persons with dementia poses risks that must be counterbalanced with the importance of the care for autonomy and mobility. Physicians often find substantial challenges in the assessment and reporting of driving safety for persons with dementia. This paper describes a driving in dementia decision tool (DD-DT) developed to aid physicians in deciding when to report older drivers with either mild dementia or mild cognitive impairment to local transportation administrators.

Universal tumor screening for Lynch syndrome: health-care providers' perspectives.

Purpose: Population-based reflex testing of colorectal tumors can identify individuals with Lynch syndrome (LS), but there is debate regarding the type of patient discretion such a program warrants. We examined health-care providers' views and experiences to inform the design of a reflex-testing program and their perspectives regarding an opt-out option.

Methods: We interviewed providers managing LS or colorectal cancer patients, including surgeons, genetic counselors, oncologists, primary-care physicians, and gastroenterologists.

Equity and practice issues in colorectal cancer screening: Mixed-methods study.

Objective: To investigate overall colorectal cancer (CRC) screening rates, patterns in the use of types of CRC screening, and sociodemographic characteristics associated with CRC screening; and to gain insight into physicians' perceptions about and use of fecal occult blood testing [FOBT] and colonoscopy for patients at average risk of CRC.

Design: Mixed-methods study using cross-sectional administrative data on patient sociodemographic characteristics and semistructured telephone interviews with physicians.

Setting: Toronto, Ont.

Exploring approaches to patient safety: the case of spinal manipulation therapy.

Background: The purpose of this study was to gain insight into the current safety culture around the use of spinal manipulation therapy (SMT) by regulated health professionals in Canada and to explore perceptions of readiness for implementing formal mechanisms for tracking associated adverse events.

Methods: Fifty-six semi-structured telephone interviews were conducted with professional leaders and frontline practitioners in chiropractic, physiotherapy, naturopathy and medicine, all professions regulated to perform SMT in the provinces of Alberta and Ontario Canada. Interviews were digitally audio-recorded for verbatim transcription.

A qualitative study of the variable effects of audit and feedback in the ICU.

Background: Audit and feedback is integral to performance improvement and behaviour change in the intensive care unit (ICU). However, there remain large gaps in our understanding of the social experience of audit and feedback and the mechanisms whereby it can be optimised as a quality improvement strategy in the ICU setting.

Methods: We conducted a modified grounded theory qualitative study.

The value of personalizing medicine: medical oncologists' views on gene expression profiling in breast cancer treatment.

Objectives: Guidelines recommend gene-expression profiling (GEP) tests to identify early-stage breast cancer patients who may benefit from chemotherapy. However, variation exists in oncologists' use of GEP. We explored medical oncologists' views of GEP tests and factors impacting its use in clinical practice.

Exploring the value of technology to stimulate interprofessional discussion and education: a needs assessment of emergency medicine professionals.

Background: The emergency department (ED) is an environment fraught with increasing patient volumes, competing priorities, fluctuating information, and ad hoc interprofessional clinical teams. Limited time is available to reflect on and discuss clinical experiences, policies, or research with others on the involved team. Online resources, such as webcasts and blogs, offer an accessible platform for emergency shift workers to engage in interprofessional discussion and education.

Evaluation of perceived collaborative behaviour amongst stakeholders and clinicians of a continuing education programme in arthritis care.

Successful implementation of new extended practice roles which transcend conventional boundaries of practice entails strong collaboration with other healthcare providers. This study describes interprofessional collaborative behaviour perceived by advanced clinician practitioner in arthritis care (ACPAC) graduates at 1 year beyond training, and relevant stakeholders, across urban, community and remote clinical settings in Canada. A mixed-method approach involved a quantitative (survey) and qualitative (focus group/interview) evaluation issued across a 4-month period.

Scarcity: the context of rationing in an Ontario ICU.

Objectives: Clinicians' perceptions of scarcity influence rationing of critical care resources, which may lead to serious adverse outcomes for patients who are denied access. We sought to better understand the phenomenon of scarcity in the critical care setting.

Design: Qualitative research methods.

Aligning community engagement with traditional authority structures in global health research: a case study from northern Ghana.

Despite the recognition of its importance, guidance on community engagement practices for researchers remains underdeveloped, and there is little empirical evidence of what makes community engagement effective in biomedical research. We chose to study the Navrongo Health Research Centre in northern Ghana because of its well-established community engagement practices and because of the opportunity it afforded to examine community engagement in a traditional African setting. Our findings suggest that specific preexisting features of the community have greatly facilitated community engagement and that using traditional community engagement mechanisms limits the social disruption associated with research conducted by outsiders.

Barriers to primary care responsiveness to poverty as a risk factor for health.

Background: Poverty is widely recognized as a major determinant of poor health, and this link has been extensively studied and verified. Despite the strong evidentiary link, little work has been done to determine what primary care health providers can do to address their patients' income as a risk to their health. This qualitative study explores the barriers to primary care responsiveness to poverty as a health issue in a well-resourced jurisdiction with near-universal health care insurance coverage.

Information gaps for patients requiring craniotomy for benign brain lesion: a qualitative study.

Doctor-patient communication in the setting of a life-threatening illness poses considerable challenges. This study aimed to determine the information needs of a subset of neurosurgical patients. Qualitative case study methodology was used.

'Getting through' not 'going under': a qualitative study of gender and spousal support after diagnosis with colorectal cancer.

Many studies have found that people with cancer value family support. Feminist work suggests that women carry most responsibility for practical and emotional support in families, but few qualitative cancer studies explicitly incorporate a gender perspective. We undertook secondary analysis of in-depth interviews with 33 married or cohabiting respondents with colorectal cancer in the UK to compare men and women's accounts of 'spousal' support.

Transforming the experience of cancer care: a qualitative study of a hospital-based volunteer psychosocial support service.

Purpose: As volunteer support services for cancer patients evolve and seek to gain credibility and acceptance, it is important that these services be carefully evaluated. This paper describes findings from a research study conducted by the Healing Beyond the Body (HBB) program, a hospital-based volunteer psychosocial support service in a comprehensive cancer center in Toronto, Canada. The goal of this study was to gain insight into the experience of patients who have interacted with HBB volunteers and to evaluate the benefits and risks of this program for these patients.