Assessing the feasibility of extracting clinical information to create quality indicators from primary healthcare practice EMRs.

In 2011, a panel of primary healthcare (PHC) providers in Nova Scotia rated 19 of 35 selected Canadian Institute for Health Information (2006) clinical quality indicators (QIs) as "acceptable." In this study, the authors explored the feasibility of extracting electronic medical record (EMR) data required to create these PHC QI measures.

Adherence to antihypertensive medications among family practice patients with diabetes mellitus and hypertension.

Objective: To measure adherence and to identify factors associated with adherence to antihypertensive medications in family practice patients with diabetes mellitus (DM) and hypertension.

Design: A cross-sectional study using a mailed patient self-report survey and clinical data.

Setting: Twenty-seven family physician and nurse practitioner clinics from Nova Scotia, New Brunswick, and Prince Edward Island (the Maritime Family Practice Research Network).

Assessing the acceptability of quality indicators and linkages to payment in primary care in nova scotia.

In 2006, the Canadian Institute for Health Information (CIHI) released a comprehensive set of quality indicators (QIs) for primary healthcare (PHC). We explored the acceptability of a subset of these as measures of the technical quality of care and the potential link to payment incentive tools. A modified Delphi approach, based on the RAND consensus panel method, was used with an expert panel composed of PHC providers (family physicians, nurses and nurse practitioners) and decision-makers with no previous experience of "pay for performance.

Self-reported health beliefs, lifestyle and health behaviours in community-based patients with diabetes and hypertension.

Objective: This study describes self-reported health and lifestyle behaviours and health risk beliefs among community patients diagnosed with type 2 diabetes and hypertension.

Methods: Patients with both type 2 diabetes and hypertension were recruited from community family practices across 3 Canadian Maritime provinces. Patients completed a survey targeting health risk beliefs, and health and lifestyle behaviours.

Ethics and privacy issues of a practice-based surveillance system: need for a national-level institutional research ethics board and consent standards.

Objective: To describe the challenges the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) experienced with institutional research ethics boards (IREBs) when seeking approvals across jurisdictions and to provide recommendations for overcoming challenges of ethical review for multisite and multijurisdictional surveillance and research.

Background: The CPCSSN project collects and validates longitudinal primary care health information (relating to hypertension, diabetes, depression, chronic obstructive lung disease, and osteoarthritis) from electronic medical records across Canada. Privacy and data storage security policies and processes have been developed to protect participants' privacy and confidentiality, and IREB approval is obtained in each participating jurisdiction.

Hypertension and type 2 diabetes: what family physicians can do to improve control of blood pressure--an observational study.

Background: The prevalence of type 2 diabetes is rising, and most of these patients also have hypertension, substantially increasing the risk of cardiovascular morbidity and mortality. The majority of these patients do not reach target blood pressure levels for a wide variety of reasons. When a literature review provided no clear focus for action when patients are not at target, we initiated a study to identify characteristics of patients and providers associated with achieving target BP levels in community-based practice.

Trends in risk factors for cardiovascular disease in Canada: temporal, socio-demographic and geographic factors.

Background: Temporal trends in risk factors for cardiovascular disease and the impact of socio-economic status on these risk factors remain unclear.

Methods: Using data from the National Population Health Survey and the Canadian Community Health Survey, we examined national trends in heart disease, hypertension, diabetes mellitus, obesity and smoking prevalence from 1994 to 2005, adjusting for age and sex. We stratified data by income adequacy category, body mass index and region of residence.

Drug management for hypertension in type 2 diabetes in family practice.

Objective: To describe the number and classes of antihypertensive medications prescribed to patients with type 2 diabetes in community family practices, and to estimate the aggressiveness or "dosage intensity" of prescribing for hypertension in these situations.

Design: Practice-based, cross-sectional observational study.

Setting: Seventeen rural and urban family practices in the Maritime Family Practice Research Network in Nova Scotia, New Brunswick, and Prince Edward Island.

Family practice patients' adherence to statin medications.

Objective: To measure family practice patients' adherence to statin medications and to identify factors associated with adherence to these medications.

Design: Cross-sectional study using a mailed self-report survey sent to 400 patients.

Setting: Two academic family practice clinics in Halifax, NS.

Quality indicators for cardiovascular primary care.

Background: The Canadian Cardiovascular Outcomes Research Team was established in 2001 to improve the quality of cardiovascular care for Canadians. Initially, quality indicators (QIs) for hospital-based care for those with acute myocardial infarctions and congestive heart failure were developed and measured. Qualitative research on the acceptability of those indicators concluded that indicators were needed for ambulatory primary care practice, where the bulk of cardiovascular disease care occurs.

Potential for drug interactions in seniors with osteoarthritis.

Objective: To document the potential for drug interactions in seniors with osteoarthritis and to consider the usefulness of computerized support for detecting clinically important interactions.

Design: Self-administered mailed survey. One question requested a list of all medications (prescribed drugs and self-care products, including herbal and "natural" health products) taken in the last 7 days.

What influences seniors' choice of medications for osteoarthritis? Qualitative inquiry.

Objective: To explore with seniors what influences their choice of medication for osteoarthritis.

Design: Qualitative study using semistructured in-depth interviews.

Setting: Interviews were conducted in patients' homes in two cities in Nova Scotia.

Quality indicators for cardiac care: national standards in a community context.

Objective: Public reporting of health data is well established in the United States and in the United Kingdom, and is assumed to promote better health care through informed choice by consumers. To be successful, reporting systems must have the support of physicians, but their opinions have been mixed. The purpose of this study was to explore with practising physicians the perceived usefulness of, and barriers to use of, quality indicators in the care of acute myocardial infarction and congestive heart failure, and the contexts in which these issues arise.

Population-based evaluation of the management of antithrombotic therapy for atrial fibrillation.

Background: Oral anticoagulation is an effective therapy for the prevention of cardioembolic complications in patients with atrial fibrillation. However, previous practice reviews have indicated that oral anticoagulants are often underused in this setting. Most of those reports have focused on reviews of hospitalized and institutionalized patients, or small geographical areas.

Managing osteoarthritis. Medication use among seniors in the community.

Objective: To determine what types of medication seniors in the community were using to manage osteoarthritis (OA).

Design: Mailed self-administered survey.

Setting: Three family medicine community practice sites in cities in Nova Scotia.

Evidence-based cardiovascular care. Family physicians' views of obstacles and opportunities.

Objective: To explore obstacles to and opportunities for applying specific lifestyle and pharmacologic recommendations on chronic ischemic heart disease.

Design: Qualitative study.

Setting: Rural, town, and city settings in Nova Scotia.

Anticoagulation in atrial fibrillation. Is there a gap in care for ambulatory patients?

Objective: Atrial fibrillation (AF) substantially increases risk of stroke. Evidence suggests that anticoagulation to reduce risk is underused (a "care gap"). Our objectives were to clarify measures of this gap in care by including data from family physicians and to determine why eligible patients were not receiving anticoagulation therapy.

Evidence-based cardiovascular care in the community: a population-based cross-sectional study.

Background: Ischaemic heart disease and congestive heart failure are common and important conditions in family practice. Effective treatments may be underutilized, particularly in women and the elderly. The objective of the study was to determine the rate of prescribing of evidence-based cardiovascular medications and determine if these differed by patient age or sex.

Stroke prevention in hospitalized patients with atrial fibrillation: a population-based study.

Background: Oral anticoagulants reduce the incidence of stroke by 68%, yet suboptimal use has been documented in surveys of patients with atrial fibrillation. The present study examined current patterns of anticoagulant use for patients hospitalized with atrial fibrillation across an entire health care system.

Methods: Improving Cardiovascular Outcomes in Nova Scotia (ICONS) is a prospective cohort study involving all patients hospitalized in Nova Scotia with atrial fibrillation, among other conditions.

A qualitative study of evidence in primary care: what the practitioners are saying.

Background: Little is known about the impact of evidence-based medicine in primary care. Our objective was to explore the influence of evidence on day-to-day family practice, with specific reference to cardiovascular disease.

Methods: A total of 9 focus groups were conducted in rural, semi-urban and urban settings in Nova Scotia.

Group interviews in primary care research: advancing the state of the art or ritualized research?

Background: Focus groups have become an important data gathering technique in primary care research.

Objectives: This study provides an integrated review of recent articles that used focus groups as a data collection method to gather information from family physicians.

Methods: Medline was searched for articles that used focus groups with family physicians in a North American setting during the 1990s.