Rachael Morkem

Prevalence and Epidemiology of Diabetes in Canadian Primary Care Practices: A Report from the Canadian Primary Care Sentinel Surveillance Network

OBJECTIVE The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) is a large, validated national primary care Electronic Medical Records (EMR)-based database. Our objective was to describe the epidemiology of diabetes in this Canadian sample. METHODS We analyzed the records of 272 469 patients10 years of age and older, with at least 1 primary care clinical encounter between January 1, 2011, and December 31, 2012. We calculated the age-gender standardized prevalence of diabetes. We compared health care utilization and comorbidities for 7 selected chronic conditions in patients with and without diabetes. We also examined patterns of medication usage. RESULTS The estimated population prevalence of diabetes was 7.6%. Specifically, we studied 25 425 people with diabetes who had at least 1 primary care encounter in 2 years. On average, patients with diabetes had 1.42 times as many practice encounters as patients without diabetes (95% CI 1.42 to 1.43, p<0.0001). Patients with diabetes had 1.29 times as many other comorbid conditions as those without diabetes (95% CI 1.27 to 1.31, p<0.0001). We found that 85.2% of patients taking hypoglycemic medications were taking metformin, and 51.8% were taking 2 or more classes of medications. CONCLUSIONS This study is the first national Canadian report describing the epidemiology of diabetes using primary care EMR-based data. We found significantly higher rates of primary care use, and greater numbers of comorbidities in patients with diabetes. Most patients were on first-line hypoglycemic medications. Data routinely recorded in EMRs can be used for surveillance of chronic diseases such as diabetes in Canada. These results can enable comparisons with other national EMR-based datasets.

Representativeness of patients and providers in the Canadian Primary Care Sentinel Surveillance Network: a cross-sectional study

BACKGROUND The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) has established a national repository of primary care patient health data that is used for both surveillance and research. Our main objective was to determine how representative the data for patients and primary care practitioners in the CPCSSN are when compared with the Canadian population. METHODS In this cross-sectional study, we compared the 2013 CPCSSN patient sample with age and sex information from the 2011 census. The CPCSSN provider sample in 2013 was compared with the 2013 National Physician Survey. Results were stratified by 5 clinically relevant age categories and sex, and male-to-female ratios were calculated. RESULTS Patients who were 65 years of age and older represented 20.4% of the CPCSSN sample but only represented 14.8% of the Canadian population (2011 census). Among young adults (20-39 yr), 39.3% fewer men than women visited their primary care practitioner within 2 years. CPCSSN sample practitioners were more likely to be under 45 years of age, more likely to be female and more likely to be in an academic practice. INTERPRETATION It is important to consider adjusting for age and sex when using CPCSSN data. CPCSSN practitioners are likely not representative of family physicians; therefore, CPCSSN needs to recruit more nonacademic practices, community clinics and practices that have a larger proportion of male providers.

The diagnosis of depression and its treatment in Canadian primary care practices: an epidemiological study

BACKGROUND A diagnosis of depression is common in primary care practices, but data are lacking on the prevalence in Canadian practices. We describe the prevalence of the diagnosis among men and women, patient characteristics and drug treatment in patients diagnosed with depression in the primary care setting in Canada. METHODS Using electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network, we examined whether the prevalence of a depression diagnosis varied by patient characteristics, the number of chronic conditions and the presence of the following chronic conditions: hypertension, diabetes, chronic obstructive pulmonary disease, osteoarthritis, dementia, epilepsy and parkinsonism. We used regression models to examine whether patient characteristics and type of comorbidity were associated with a depression diagnosis. RESULTS Of the 304 412 patients who had at least 1 encounter with their primary care provider between Jan. 1, 2011, and Dec. 31, 2012, 14% had a diagnosis of depression. Current or past smokers and women with a high body mass index had higher rates of depression. One in 4 patients with a diagnosis of depression also had another chronic condition; those with depression had 1.5 times more primary care visits. About 85% of patients with depression were prescribed medication, most frequently selective serotonin reuptake inhibitors, followed by atypical antipsychotics. INTERPRETATION Our data provide information on the prevalence of a depression diagnosis in primary care and associations with being female, having a chronic condition, smoking history and obesity in women. Our findings may inform research and assist primary care providers with early detection and interventions in at-risk patient populations.

A Canadian Primary Care Sentinel Surveillance Network Study Evaluating Antidepressant Prescribing in Canada From 2006 to 2012

Objective: To evaluate the prescribing patterns of antidepressants (ADs) by primary care providers to youth, adults, and seniors, from 2006 to 2012, using data from electronic medical records (EMRs). Method: This was a retrospective cross-sectional database study that used primary care data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Data on more than 600 000 Canadian primary care patients were used to determine the prevalence and incidence of AD prescribing to patients 15 years and older who had an encounter in the years of study (from 2006 to 2012). Each study year was evaluated independently. Results: The study population consisted of 86 927 patients in 2006 (mean age 48.1 years [SD 18.7], 38% male) and grew to 273 529 (mean age 49.6 years [SD 19.3], 40% male) in 2012. The prevalence of AD prescribing increased from 9.20% in 2006 to 12.80% in 2012 (P < 0.001). While the incidence rate of AD prescribing dropped from 3.54% in 2006 to 2.72% in 2008 (P < 0.001) the rate started to significantly rise again, reaching an incidence of 3.07% by 2012 (P < 0.001). Conclusions: The prevalence of AD prescribing by primary care providers in Canada continued to rise from 2006 to 2012. Conversely, incidence has remained stable or declined during the 6-year study period. While many complex factors likely contribute to the observed prevalence and incidence rates, our findings suggest that the guidelines indicating the efficacy of long-term AD therapy for patients with highly recurrent or severe depression are being followed.

Adult obesity prevalence in primary care users: An exploration using Canadian Primary Care Sentinel Surveillance Network (CPCSSN) data.

ObjectivesThis research examines the feasibility of using electronic medical records within the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) for obesity surveillance in Canada by assessing obesity trends over time and comparing BMI distribution estimates from CPCSSN to those obtained from nationally representative surveys.MethodsData from 2003–2012 on patients 18 years and older (n = 216,075) were extracted from the CPCSSN database. Patient information included demographics (age and sex) and anthropometric measures (height, weight, body mass index (BMI), waist circumference, and waist-to-hip ratio). Standard descriptive statistics were used to characterize the sample, including, as appropriate, means, proportions and medians. The BMI distribution of the CPCSSN population was compared to estimates from the Canadian Community Health Survey (CCHS) and the Canadian Health Measures Survey (CHMS) for the years: 2004, 2007–2009 and 2009–2011.ResultsThe estimated prevalence of obesity increased from 17.9% in 2003 to 30.8% in 2012. Obesity class I, II and III prevalence estimates from CPCSSN in 2009–2011 (18.0%, 95% CI: 17.8–18; 7.4%, 95% CI: 7.3–7.6; 4.2%, 95% CI: 4.1–4.3 respectively) were greater than those from the most recent (2009–2011) cycle of the CHMS (16.2%, 95% CI: 14–18.7; 6.3%, 95% CI: 4.6–8.5; 3.7%, 95% CI: 2.8–4.8 respectively), however these differences were not statistically significant.ConclusionThe data from CPCSSN present a unique opportunity for longitudinal obesity surveillance among primary care users in Canada, and offer prevalence estimates similar to those obtained from nationally representative survey data.RésuméObjectifsNous avons examiné la faisabilité d’utiliser les dossiers médicaux électroniques au sein du Réseau canadien de surveillance sentinelle en soins primaires (RCSSSP) pour la surveillance de l’obésité au Canada en évaluant la progression de l’obésité au fil du temps et en comparant les estimations de répartition de l’IMC du RCSSSP à celles obtenues dans des enquêtes nationales représentatives.MéthodeNous avons extrait de la base de données du RCSSSP les données de 2003–2012 sur les patients de 18 ans et plus (n = 216 075). Les renseignements sur les patients étaient leur profil démographique (âge et sexe) et leurs mesures anthropométriques (taille, poids, indice de masse corporelle [IMC], périmètre ombilical et rapport taille-hanches). Des statistiques descriptives types ont servi à caractériser l’échantillon, notamment, le cas échéant, les moyennes, les proportions et les médianes. La répartition de l’IMC dans la population du RCSSSP a été comparée aux estimations de l’Enquête sur la santé dans les collectivités canadiennes (ESCC) et de l’Enquête canadienne sur les mesures de la santé (ECMS) pour les années 2004, 2007–2009 et 2009–2011.RésultatsLa prévalence estimative de l’obésité est passée de 17,9 % en 2003 à 30,8 % en 2012. Les estimations de la prévalence de l’obésité de classe I, II et III dans la population du RCSSSP en 2009–2011 (18 %, IC de 95 %: 17,8–18; 7,4 %, IC de 95 %: 7,3–7,6; 4,2 %, IC de 95 %: 4,1–4,3, respectivement) étaient supérieures à celles du cycle le plus récent (2009–2011) de l’ECMS (16,2 %, IC de 95 %: 14–18,7; 6,3 %, IC de 95 %: 4,6–8,5; 3,7 %, IC de 95 %: 2,8–4,8, respectivement), mais ces différences n’étaient pas significatives.ConclusionLes données du RCSSSP offrent une occasion unique de faire une surveillance longitudinale de l’obésité chez les utilisateurs de soins primaires au Canada, et elles donnent des estimations de prévalence semblables à celles obtenues par les données d’enquêtes nationales représentatives.

Recent Trends in the Prescribing of ADHD Medications in Canadian Primary Care

Objective: The aim of this study was to describe the prevalence and incidence of ADHD medication prescribing, by age and gender, from 2005 to 2015 in Canadian primary care. Method: A population-based retrospective cohort study was conducted to evaluate the prescribing of ADHD medications between 2005 and 2015 using electronic medical record data. Yearly prevalence and incidence of ADHD medication prescribing were calculated for preschoolers (up to 5 years old), school-aged children (6-17 years old), and adults (18-65 years old) along with a description of the types of ADHD medications prescribed between 2005 and 2015. Results: Between 2005 and 2015, there was a 2.6-fold increase in the prevalence of ADHD medication prescribing to preschoolers, a 2.5-fold increase in school-aged children, and a fourfold increase in adults. There was a corresponding rise in incidence of prescribing although this rise was moderate and estimates were much lower compared with prevalence. The most commonly prescribed medication was Methylphenidate (65.0% of all ADHD medications prescribed). Conclusion: Although the prevalence of ADHD has remained stable over time, this study found an increase in the prescribing of ADHD medications in all age groups between 2005 and 2015. Incidence of new prescriptions was small relative to prevalence, suggesting that longer term treatments are being adopted.

Trends in antidepressant prescribing to children and adolescents in Canadian primary care: A time‐series analysis

The purpose of this study was to describe the trends and patterns of antidepressant (AD) prescribing to children and adolescents in Canadian primary care before and after the black‐box warning in 2004.