Marianne Xhignesse

Enhancing prevention in primary care: are interventions targeted towards consumers’ and providers’ perceived needs?

To explore perceived barriers to the implementation of prevention guidelines, with a particular interest to perceived information needs from the point of view of health professionals and consumers.

Evaluation of Clinical Innovation: A Gray Zone in the Ethics of Modern Clinical Practice?

BACKGROUNDVarious stakeholders can have differing opinions regarding ethical review when introducing new procedures with patients.OBJECTIVEThis pilot study examines the way in which Research Ethics Boards (REBs; Institutional Review Boards) and clinical biochemists (CBs; laboratory medicine specialists) differ in their interpretation of what is research and what should be considered common practice versus innovation versus experimentation when introducing new procedures with patients. It also explores whether these groups agree on who is responsible for the ethical review of new procedures.METHODSA validated case scenario for the introduction of a new diagnostic test into clinical practice was sent to CBs and REBs across Canada. Participants were asked to determine whether the scenario constituted research; whether the test procedure should be considered as experimental, innovative, or commonly accepted care; and whether the project required approval by a REB and, if not, who should be responsible for ethical review.RESULTSResults showed 81% of 37 CBs and 52% of 27 REBs identified the scenario as research. Responsibility for ethical review was assigned to REBs by 44% of REBs and 54% of CBs. Of all participants, 53% classified the test procedure as ‘innovative’, 8% as ‘experimental’, whereas 17% classified it as ‘commonly accepted’.CONCLUSIONSThis pilot study indicates a substantial variation in the ethical assessment of innovation in clinical care. This suggests the need to further elaborate on the types of innovation in health care and categorize the nature of the risks associated with each.

Obesity Preceptorship and Virtual Community Result in Changes of Primary Care Practice

Obesity Preceptorship and Virtual Community Result in Changes of Primary Care Practice JEAN-PATRICE BAILLARGEON*, MARIANNE XHIGNESSE, ANDRE CARPENTIER, DENISE DONOVAN, ANDREW GRANT, MARTIN FORTIN, DENISE ST-CYR-TRIBBLE, JUDITH SIMONEAU-ROY, CHRISTINE BROWN, ANICK CHAMPOUX, MARIE-FRANCE LANGLOIS. Dept. of Medicine, Universite de Sherbrooke, Sherbrooke, QC Considering the growing prevalence of obesity, the majority of patients should be managed by primary care providers. Our objectives were to implement and evaluate a clinical preceptorship on obesity associated with an interdisciplinary obesity care network for primary care providers. Primary care providers practicing in Family Medicine Groups (FMGs) were offered a 2-day clinical preceptorship in conjunction with web-based documentation, teaching materials, monthly virtual meetings and forums. Current practice and management of obesity was assessed at baseline, 3 months and 1 year using questionnaires referring to 2 situations: an obese patient consulting for another problem (A) and an obese patient consulting for obesity (B). Only significant results (P<0.05) are reported. Thirty-eight participants (13 nurses and 25 physicians) from 8 FMGs were enrolled. Actual practice for management of obesity was improved: both vignettes were more likely to elicit an offer of follow up regarding weight management; and the vignette of a patient consulting for obesity was more likely to further elicit use of the Prochaska model, food diaries and pedometers. Qualitative assessment also showed many changes in the management of obese patients in FMGs. Participants reported to find the preceptorships really useful and that time was the major barrier to participate in the virtual community. Obesity preceptorships and associated interdisciplinary obesity care network changed reported management of obesity as well as reported practices in FMG’s primary care providers after one year. The next step would be to assess the impact of our intervention on obesity management directly among patients followed by FMG’s. This work was supported by Canadian Institutes for Health Research Operating Grant PHE78707 and Fonds de la Recherche en Sante du Quebec grant #5635. ABSTRACT #20

Association between physical activity motives and type of physical activity in children

Objectives: Motives for participating in a specific type of physical activity (PA) may differ across PA type in youth. We studied the relationship between PA motives and type of PA engaged in by youth. Design: Cross-sectional analysis using data from the Monitoring Activities of Teenagers to Comprehend their Habits (MATCH) study. Method: Eight hundred and two students age 10–11 years from 17 primary schools in New Brunswick, Canada completed a questionnaire that collected data on type of PA participated in (individual, group-based, organised and non-organised), PA motives (enjoyment, social affiliation, competence, fitness/health, and appearance) and attainment of PA guidelines (60 minutes of moderate-to-vigorous PA (MVPA) per day). The associations between PA motives and PA type and between PA motives and attainment of PA recommendations were assessed in multi-level logistic regression models. Results: Endorsing enjoyment motives was associated with participation in organised PA (odds ratio, 95% confidence interval (CI): 1.54, 1.24–1.91). Competence motives were associated with participation in group-based PA (1.27, 1.11–1.46) and achievement of PA recommendations (1.95, 1.37–2.78). Conclusion: Targeting enjoyment and competence motives may be associated with increased participation in organised and group-based PA as well as with an increased likelihood of meeting PA guidelines in youth.

Episódios de cuidados: um conceito em saúde pública

This paper presents a revision of the literature on the definition of episodes of care, which emerged as a concept in health services research during the 1960s. Episodes of care have been described from three different perspectives: that of the patient (episode of indisposition); the care provider (episode of illness); and the financial sponsor (episode of care). The main scope of this study is to present a review of the literature on the operational definition of episode of care. A computerized bibliographical review was conducted for the period between 1950 and 2007 in the MEDLINE database and 54 articles met the criteria for evaluation. The definition of episode of care differs widely in the literature. The operational definition of the episode of care to be applied should be determined by the overall goals of the study, as well as the relative advantages and limitations of the methodology used.