Nadyne Girard

Effect of a community oriented problem based learning curriculum on quality of primary care delivered by graduates: historical cohort comparison study

Abstract Objective To assess whether the transition from a traditional curriculum to a community oriented problem based learning curriculum at Sherbrooke University is associated with the expected improvements in preventive care and continuity of care without a decline in diagnosis and management of disease. Design Historical cohort comparison study. Setting Sherbrooke University and three traditional medical schools in Quebec, Canada. Participants 751 doctors from four graduation cohorts (1988-91); three before the transition to community based problem based learning (n = 600) and one after the transition (n = 151). Outcome measures Annual performance in preventive care (mammography screening rate), continuity of care, diagnosis (difference in prescribing rates for specific diseases and relief of symptoms), and management (prescribing rate for contraindicated drugs) assessed using provincial health databases for the first 4-7 years of practice. Results After transition to a community oriented problem based learning curriculum, graduates of Sherbrooke University showed a statistically significant improvement in mammography screening rates (55 more women screened per 1000, 95% confidence interval 10.6 to 99.3) and continuity of care (3.3% more visits coordinated by the doctor, 0.9% to 5.8%) compared with graduates of a traditional medical curriculum. Indicators of diagnostic and management performance did not show the hypothesised decline. Sherbrooke graduates showed a significant fourfold increase in disease specific prescribing rates compared with prescribing for symptom relief after the transition. Conclusion Transition to a community oriented problem based learning curriculum was associated with significant improvements in preventive care and continuity of care and an improvement in indicators of diagnostic performance.

Influence of Physicians' Management and Communication Ability on Patients' Persistence With Antihypertensive Medication

BACKGROUND Less than 75% of people prescribed antihypertensive medication are still using treatment after 6 months. Physicians determine treatment, educate patients, manage side effects, and influence patient knowledge and motivation. Although physician communication ability likely influences persistence, little is known about the importance of medical management skills, even though these abilities can be enhanced through educational and practice interventions. The purpose of this study was to determine whether a physicians medical management and communication ability influence persistence with antihypertensive treatment. METHODS This was a population-based study of 13,205 hypertensive patients who started antihypertensive medication prescribed by a cohort of 645 physicians entering practice in Quebec, Canada, between 1993 and 2007. Medical Council of Canada licensing examination scores were used to assess medical management and communication ability. Population-based prescription and medical services databases were used to assess starting therapy, treatment changes, comorbidity, and persistence with antihypertensive treatment in the first 6 months. RESULTS Within 6 months after starting treatment, 2926 patients (22.2%) had discontinued all antihypertensive medication. The risk of nonpersistence was reduced for patients who were treated by physicians with better medical management (odds ratio per 2-SD increase in score, 0.74; 95% confidence interval, 0.63-0.87) and communication (0.88; 0.78-1.00) ability and with early therapy changes (odds ratio, 0.45; 95% confidence interval, 0.37-0.54), more follow-up visits, and nondiuretics as the initial choice of therapy. Medical management ability was responsible for preventing 15.8% (95% confidence interval, 7.5%-23.3%) of nonpersistence. CONCLUSION Better clinical decision-making and data collection skills and early modifications in therapy improve persistence with antihypertensive therapy.

Patient and nurse staffing characteristics associated with high sitter use costs

AIM This paper is a report of a study of the relationships between patient health conditions, nurse staffing characteristics and high sitter use costs. BACKGROUND Increasing recourse to patient sitters is a major cost concern to hospitals. To reduce these expenses, we need to understand better the factors associated with high sitter use costs. METHODS From a cohort of 43,212 medical/surgical patients admitted to an academic health centre in Montreal (Canada) in 2007 and 2008, all 1151 patients who received a sitter were selected. We applied multivariate logistic regression, using the Generalized Estimating Equation framework, to estimate the relationships between patient health conditions, nurse staffing characteristics and being in the upper two quintiles of sitter costs, vs. the lower three. RESULTS The median sitter cost per patient, in Canadian dollars, was

Do physician communication skills influence screening mammography utilization

772·35 (IQR =

Health services and policy research in the first decade at the Canadian Institutes of Health Research

1737·84); and

Assumptions made when preparing drug exposure data for analysis have an impact on results: an unreported step in pharmacoepidemiology studies

2397·00 (IQR =

Assessment of potential bias in research grant peer review in Canada

3085·03) among the patients with high sitter use costs. In multivariate analyses, dementia, delirium and other cognitive impairments (OR = 1·49; 95% CI = 1·01-2·22) and schizophrenia and other psychoses (OR = 2·42; 95% CI = 1·08-5·76) increased the likelihood of high sitter use costs. In addition, every additional worked hour per patient per day by Registered Nurses (OR =0·33; 95% CI = 0·27-0·39) and by patient care assistants (OR = 0·11; 95% CI = 0·08-0·15) reduced the likelihood of high sitter use costs. Conclusion.  Circumstances of understaffing and patients having psycho-geriatric conditions are associated with high sitter use costs. Improving staffing and providing additional resources to support the care of psycho-geriatric patients may lower these expenses.

Pharmacosurveillance without borders: electronic health records in different countries can be used to address important methodological issues in estimating the risk of adverse events

BackgroundThe quality of physician communication skills influences health-related decisions, including use of cancer screening tests. We assessed whether patient-physician communication examination scores in a national, standardized clinical skills examination predicted future use of screening mammography (SM).MethodsCohort study of 413 physicians taking the Medical Council of Canada clinical skills examination between 1993 and 1996, with follow up until 2006. Administrative claims for SM performed within 12 months of a comprehensive health maintenance visit for women 50–69 years old were reviewed. Multivariable regression was used to estimate the relationship between physician communication skills exam score and patients’ SM use while controlling for other factors.ResultsOverall, 33.8 % of 96,708 eligible women who visited study physicians between 1993 and 2006 had an SM in the 12 months following an index visit. Patient-related factors associated with increased SM use included higher income, non-urban residence, low Charlson co-morbidity index, prior benign breast biopsy and an interval >12 months since the previous mammogram. Physician-related factors associated with increased use of SM included female sex, surgical specialty, and higher communication skills score. After adjusting for physician and patient-related factors, the odds of SM increased by 24 % for 2SD increase in communication score (OR: 1.24, 95 % CI: 1.11 - 1.38). This impact was even greater in urban areas (OR 1.30, 95 % CI: 1.16, 1.46) and did not vary with practice experience (interaction p-value 0.74).ConclusionPhysicians with better communication skills documented by a standardized licensing examination were more successful at obtaining SM for their patients.

Physician scores on a national clinical skills examination as predictors of complaints to medical regulatory authorities.

BACKGROUND Health services and policy research is the innovation engine of a health care system. In 2000, the Canadian Institutes of Health Research (CIHR) was formed to foster the growth of all sciences that could improve health care. We evaluated trends in health services and policy research funding, in addition to determinants of funding success. METHODS All applications submitted to CIHR strategic and open operating grant competitions between 2001 and 2011 were included in our analysis. Age, sex, size of research team, critical mass, season, year and research discipline were retrieved from application information. A cohort of 4725 applicants successfully funded between 2001 and 2005 were followed for 5 years to evaluate predictors of continuous funding. Multivariate generalized estimating equation logistic regression was used to estimate predictors of funding success and sustained funding. RESULTS Between 2001 and 2011, 80 163 applications were submitted to open and strategic grant competitions. Over time, grant applications increased from 327 to 1137 per year, and annual funding increased from

Association Between Licensure Examination Scores and Practice in Primary Care

12.6 to