Kalpana Nair

Patients' consent preferences regarding the use of their health information for research purposes: a qualitative study:

Objective: To explore the consent preferences of patients whose health data are currently being used for research purposes. Methods: Semi-structured interviews were conducted with 17 patients whose primary physicians were taking part in a study that utilized de-identified individual-level health information from their electronic medical record. All physicians practised in southwestern Ontario. All interviews were taped, transcribed verbatim and analysed using a constant comparative method. All transcripts and debriefing notes were read and reread to elicit general themes. Results: Three main themes emerged from the data: patients recognized the need to balance their consent preferences with time pressures in the clinical encounter when deciding the nature of consent for a study; patients generally regarded the seeking of consent as being an issue of respect for them as individuals; and patients were also weighing their perceived benefits and concerns related to the research. For these patients, seeking their consent was an important step in research participation. For some patients, the sponsor and the research topic were factors that would influence their decision to provide consent. Conclusion: Patients want their consent to be sought when their data are used for research purposes. This will involve explicitly informing patients that a study is taking place, providing written consent and offering regular updates about the study.

Providing evidence-based information to patients in general practice and pharmacies: what is the acceptability, usefulness and impact on drug use?

Background  A common and often integral method of delivering patient information is the use of patient guides. However, the acceptability, utility and impact of evidence‐based therapeutic guides on physicians, pharmacists and patients have not been well evaluated.

Minding the gap: Prioritization of care issues among nurse practitioners, family physicians and geriatricians when caring for the elderly

Abstract Accumulating health problems of the elderly requires recognition of geriatric syndromes, while shifting away from a conventional disease-specific approach. We surveyed 179 practitioners representing Family Physicians (FPs), Nurse Practitioners (NPs) and geriatricians in Ontario, in order to quantify how they prioritize syndromes, diseases and conditions in the elderly. Identifying differences may inform opportunities for interprofessional sharing of expertise among professionals pursuing a common goal, which is expected to improve interprofessional collaboration. Our survey (response rate 36%) identifies that NP, FP and geriatrician respondents all recognize co-occurrence of “multiple morbidities” as one of the most frequently encountered issues when serving the elderly, however FPs and NPs place higher priority on managing individual chronic diseases than explicitly prioritizing geriatric syndromes. Our findings identify a need for a more clearly defined role for the geriatrician as syndrome-educator and implies further need for collaborative approaches to caring for seniors that values different professional’s expertise.

Parental Concerns, Developmental Temperature Taking, and the Necessary Conditions for Developmental Surveillance and Screening

The early years are a critical period that can impact development across the life course in both negative and positive ways. Identification of children who have or may be at risk for delay is an area fraught with challenges related to how and when to do surveillance and screening, what tools to use, as well as the necessary conditions for assessments. We propose that efforts to identify children with developmental problems use a system of developmental surveillance that focuses on measuring parental concerns as developmental temperature taking along with contextual risk factors. Furthermore, we propose to move to a process of developmental surveillance that incorporates the 4M’s: many eyes, many times, many measures, and many situations, concepts that address the inherent limitations of traditional screening.

Impact of clinician judgement on formulary committees' recommendations in Canada

Objectives In formulary committee deliberations, evidence for the efficacy of medications is often based on changes in the scale scores of patient-reported outcome measures. Our aim was to examine whether clinician judgement about the efficacy of medications for Alzheimers disease, when added to scale score evidence, affects formulary committee members’ recommendations about providing these medications under public insurance. Methods The study was conducted using mixed methods. In a survey of formulary committee members in Canada, 32 participants were presented with scenarios that outlined different levels of efficacy for a medication. For each scenario, participants were asked to specify their likelihood of recommending that the medication be provided under public insurance. Of the 32 participants, 23 agreed to take part in an interview to explain the survey results. Content analysis was used to elicit recurrent themes across the interviews. Results When a medication was disease modifying, use of clinician judgement increased the mean likelihood of recommending that the medication be provided under public insurance. Despite this, some participants felt formulary committees should not use clinician judgement because of risks of subjectivity and bias. However, other participants believed the addition of clinician judgement would enhance the clinical relevance of evidence that might otherwise be based entirely on changes in scale score. Conclusions Clinician judgement about the efficacy of medications can influence formulary committee recommendations. This suggests the need for a new approach to govern the consideration of expert evidence during formulary committee deliberations.

P3-438: The role of clinician judgment in Canadian formulary committee members' recommendations to insure an Alzheimer's disease medication: Results of a pilot qualitative study

Background: An online survey, sent to members of government drug formulary committees in Canada, was conducted to assess whether clinician judgment would influence committee members’ recommendations for insuring an Alzheimer’s disease medication. Results showed that clinician judgment failed to have an impact as a main effect, but the addition of clinician judgment to evidence presented as changes in scale score improved the likelihood of recommending that a medication be insured by the government. A qualitative study was designed to explain the results of the online survey. This report contains the pilot results of the qualitative study. Methods: Formulary members who completed the original online survey were contacted within twelve months of completion to participate in a one-on-one, semi-structured, telephone interview. A cognitive interviewing approach was used whereby respondents were given the same questions from the original survey and asked to explain their answers. For the pilot study, thematic coding was independently done by two researchers using the results of four interviews. The independent codes were merged via researcher consensus into a codebook that will be used to analyze the remaining transcripts. Results: Based on the pilot results, formulary members felt clinician judgment helped to affirm their recommendation decisions, which were based primarily on other forms of evidence (i.e., changes in scale score, cost-effectiveness, safety, and quality of evidence). Members described cost-effectiveness as a particularly important variable because of the relatively high cost of Alzheimer’s disease medications and the modest efficacy of these drugs. Conclusions: Clinician judgment might help raise formulary committee members’ level of confidence that other types of evidence (changes in scale score, cost-effectiveness, safety, and overall quality of evidence) present valid information about Alzheimer’s disease medications.