Assessing the Validity of Electronic Medical Records for Identifying High Antibiotic Prescribers in Primary Care.

Objectives: Electronic medical record (EMR) prescription data may identify high antibiotic prescribers in primary care. However, practitioners doubt that population differences between providers and delayed antibiotic prescriptions are adequately accounted for in EMR-derived prescription rates. This study assessed the validity of using EMR prescription data to produce antibiotic prescription rates, accounting for these factors.

Development and evaluation of a primary care antimicrobial stewardship program (PC-ASP) in Toronto, Ontario, Canada.

Background: Effective community-based antimicrobial stewardship programs (ASPs) are needed because 90% of antimicrobials are prescribed in the community. A primary care ASP (PC-ASP) was evaluated for its effectiveness in lowering antibiotic prescriptions for six common infections.

Methods: A multi-faceted educational program was assessed using a before-and-after design in four primary care clinics from 2015 through 2017.

Turning challenges into design principles: Telemonitoring systems for patients with multiple chronic conditions.

People with multiple chronic conditions often struggle with managing their health. The purpose of this research was to identify specific challenges of patients with multiple chronic conditions and to use the findings to form design principles for a telemonitoring system tailored for these patients. Semi-structured interviews with 15 patients with multiple chronic conditions and 10 clinicians were conducted to gain an understanding of their needs and preferences for a smartphone-based telemonitoring system.

External validation study of a clinical decision aid to reduce unnecessary antibiotic prescriptions in women with acute cystitis.

Background: Empirical prescribing of antibiotics to women with symptoms of acute cystitis prior to culture results is common, but subsequent culture results are often negative. A clinical decision aid for prescribing decisions in acute cystitis was previously developed that could reduce these unnecessary antibiotic prescriptions but has not been validated. This study sought to validate this decision aid for empirical antibiotic prescribing decisions in a new cohort of women with suspected acute cystitis.

The Effect of Changes in Cervical Cancer Screening Guidelines on Chlamydia Testing.

Purpose: Many chlamydia infections are identified through screening, which is frequently offered to females concomitantly with cervical cancer screening. Recent cervical cancer screening guidelines recommend screening less frequently and starting later. We sought to evaluate the impact of the May 2012 Ontario, Canada, cervical cancer screening guideline change on Papanicolaou (Pap) and chlamydia trachomatis (chlamydia) testing and incidence.

Antibiotic-resistant Escherichia coli in women with acute cystitis in Canada.

Background: Trimethoprim-sulfamethoxazole (TMP-SMX) has been a traditional first-line antibiotic treatment for acute cystitis; however, guidelines do not recommend TMP-SMX in regions where Escherichia coli resistance exceeds 20%. While resistance is increasing, there are no recent Canadian estimates from a primary care setting to guide prescribing decisions.

Methods: A total of 330 family physicians assessed 752 women with suspected acute cystitis between 2009 and 2011.

Effect of home blood pressure telemonitoring with self-care support on uncontrolled systolic hypertension in diabetics.

Lowering blood pressure reduces cardiovascular risk, yet hypertension is poorly controlled in diabetic patients. In a pilot study we demonstrated that a home blood pressure telemonitoring system, which provided self-care messages on the smartphone of hypertensive diabetic patients immediately after each reading, improved blood pressure control. Messages were based on care paths defined by running averages of transmitted readings.

Who’s in the driver's seat? The influence of patient and physician enthusiasm on regional variation in degenerative lumbar spinal surgery: a population-based study.

Study Design: Cross-sectional population-based study using administrative databases, census data, and surveys of orthopedic/neurosurgeons, family physicians (FPs) and patients in Ontario, Canada.

Objective: To determine the influence of the enthusiasm of patients, FPs, and surgeons for surgery on the regional variation in surgical rates for degenerative diseases of the lumbar spine (DDLS), such as spinal stenosis and degenerative spondylolisthesis.

Summary Of Background Data: Rates of surgery and healthcare costs for treating DDLS have been increasing.

Overestimation error and unnecessary antibiotic prescriptions for acute cystitis in adult women.

Background: Empiric antibiotic prescribing for suspected acute cystitis may lead to unnecessary prescriptions when urine cultures are negative. This study assessed whether physician overestimation of the likelihood of bacterial infection contributed to unnecessary antibiotic prescriptions.

Methods: This was a cross-sectional study in Toronto, Canada, from 1998 to 2000 of 231 women 16 years and older who underwent standardized clinical assessments and urine culture testing.

Referral practices for spinal surgery are poorly predicted by clinical guidelines and opinions of primary care physicians.

Background: Degenerative disease of the lumbar spine is common. Although surgery can benefit selected patients, variation in surgical referrals reduces overall access to care.

Objectives: To compare the actual referral practices for patients with degenerative disease of the lumbar spine with recommendations for surgical referral based on clinical practice guidelines (CPGs) and family physician (FP) opinions.

In the eye of the beholder: preferences of patients, family physicians, and surgeons for lumbar spinal surgery.

Study Design: Survey to all orthopedic and neurosurgeons, a random sample of family physicians (FPs) and patients in Ontario, Canada.

Objective: To identify the dominant clinical factors influencing patient and physician preferences for lumbar spinal surgery.

Summary Of Background Data: Surgery on the degenerative lumbar spine offers significant benefit for patients with moderate-severe symptoms failing nonoperative treatment.

The management of acute uncomplicated cystitis in adult women by family physicians in Canada.

Introduction: There are few Canadian studies that have assessed prescribing patterns and antibiotic preferences of physicians for acute uncomplicated cystitis. A cross-Canada study of adult women with symptoms of acute cystitis seen by primary care physicians was conducted to determine current management practices and first-line antibiotic choices.

Methods: A random sample of 2000 members of The College of Family Physicians of Canada were contacted in April 2002, and were asked to assess two women presenting with new urinary tract symptoms.

Community-acquired antibiotic resistance in urinary isolates from adult women in Canada.

Background: There are currently limited data regarding the prevalence of antimicrobial-resistant organisms causing community-acquired urinary tract infections among adult women in Canada. Trimethoprim-sulfamethoxazole (TMP-SMX) is the recommended first-line empirical antibiotic treatment, unless resistance of Escherichia coli to TMP-SMX exceeds 20%.

Objective: To assess current levels of TMP-SMX-resistant E coli in community-acquired cases of urinary tract infection in adult women.

Attitudes of primary care physicians and their patients about home blood pressure monitoring in Ontario.

Objective: Guidelines recommend home blood pressure monitoring (HBPM) to improve blood pressure control, but the attitudes of primary care physicians and their hypertensive patients towards its use are not known.

Methods: A 28-item self-administered survey about home blood pressure monitoring was mailed to a random sample of 1418 primary care physicians in Ontario and 765 (55%) were returned. Of the 478 physicians treating hypertension, 299 agreed to give surveys to their hypertensive patients.

Uropathogen antibiotic resistance in adult women presenting to family physicians with acute uncomplicated cystitis.

Background: Increasing rates of trimethoprim-sulfamethoxazole (TMP-SMX) resistance among uropathogens have raised concerns about its continued role in empirical treatment of acute uncomplicated cystitis in adult women.

Objective: To determine current rates of antibiotic resistance among uropathogens in the community.

Methods: Urine culture reports from adult women with symptoms of cystitis attending the offices of family physicians from across Canada were examined.

Validation of a decision aid to assist physicians in reducing unnecessary antibiotic drug use for acute cystitis.

Background: In a previous study, use of a decision aid based on 4 clinical items would have reduced unnecessary antibiotic prescriptions for acute cystitis by 30% compared with usual physician care.

Methods: We assessed the decision aid in a different population of females seen in community-based practice. Between April 7, 2002, and March 20, 2003, 225 Canadian family physicians recorded clinical findings, urine dip test results, and treatment decisions for 331 females with suspected cystitis.

Mobile phone-based remote patient monitoring system for management of hypertension in diabetic patients.

Background: Rising concern over the poor level of blood-pressure (BP) control among hypertensive patients has prompted searches for novel ways of managing hypertension. The objectives of this study were to develop and pilot-test a home BP tele-management system that actively engages patients in the process of care.

Methods: Phase 1 involved a series of focus-group meetings with patients and primary care providers to guide the system's development.

Antibiotic prescribing for upper respiratory tract infection: the importance of diagnostic uncertainty.

Objectives: Antibiotic misuse for viral upper respiratory tract infections (URI) in children is a significant problem. We determined the influence on antibiotic prescribing of clinical features that may increase concern about possible bacterial infection (age, appearance, fever) in children with URI.

Study Design: We created 16 scenarios of children with URI and distributed them by mail survey to 540 pediatricians and family practitioners in Ontario, Canada.

Antibiotics for lower respiratory tract infections. Still too frequently prescribed?

Objective: To examine how Canadian family physicians currently prescribe for lower respiratory tract infections (LRTIs).

Design: Prospective assessment of adults with symptoms of LRTIs.

Setting: Offices of 120 community-based members of the College of Family Physicians of Canada.

Empirical validation of guidelines for the management of pharyngitis in children and adults.

Context: Recent guidelines for management of pharyngitis vary in their recommendations concerning empirical antibiotic treatment and the need for laboratory confirmation of group A streptococcus (GAS).

Objective: To assess the impact of guideline recommendations and alternative approaches on identification and treatment of GAS pharyngitis in children and adults.

Design, Setting, And Participants: Throat cultures and rapid antigen tests were performed on 787 children and adults aged 3 to 69 years with acute sore throat attending a family medicine clinic in Calgary, Alberta, from September 1999 to August 2002.

The validity of decision rules for selecting women with primary osteoporosis for bone mineral density testing.

The purpose of this study was to determine the validity of the Osteoporosis Risk Assessment Instrument (ORAI), Osteoporosis Self-Assessment Tool (OST) chart and equation, and a criterion based on body weight for identifying women with asymptomatic primary osteoporosis. Prospective recruitment and chart abstractions from family practices of three University affiliated hospitals were completed for women aged 45 years or more with baseline bone mineral density (BMD) testing results by dual energy X-ray absorptiometry. Those taking bone active medication other than hormone therapy, with prior fragility fracture or with risk factors for secondary osteoporosis were excluded.

Information needs in the management of osteoporosis in family practice: an illustration of the failure of the current guideline implementation process.

The objectives of this study were to determine information needs of family physicians around issues in the management of osteoporosis and preferences for dissemination of this information. A mailed survey was sent to a stratified random sample of 1000 family physicians in Ontario in May 2001. Female physicians and those practicing in rural communities were over-sampled from the College of Family Physicians' database.