Centre for Studies in Primary Care ANNUAL · PDF fileCentre for Studies in Primary Care ANNUAL REPORT ... (KtI) sta ﬀ Admin staﬀ 19 ... Monitoring and Evaluation of Neonatal Hepatitis

Centre for Studies in Primary Care

ANNUAL REPORT2015 –2016

Department of Family MedicineQueen’s University

Kingston, Ontario, Canada

1,031Primary Care Physicians

Recruited to CPCssN

48National & International

Conference Presentations

4New seed-Granted

Projects

34Peer-Reviewed

Publications

6Ongoing Research

Portfolios

1,282,791Patients in the CPCssN database

12.5MDollars Raised in matching Funds

for CPCssN

Faculty (KtI)

staff

Admin

staff

19 Research Faculty (Kingston)

10 Research staff

5 CsPC Administration

4 Research Faculty (sites)

O u R I m P A C t : B y t h e N u m B e R s

194Primary Care Research

Day Attendees

CSPC ANNUAL REPORT 2015/2016

t A B l e O F C O N t e N t s

1 Vision, Mission and Overview

2 Message from the Director

3 Message from the Department Head

4 Executive Summary

10 Primary Care Research Day 2016

15 Current Projects

19 Project Portfolios

19 Canadian Primary Care Sentinel Surveillance Network (CPCSSN)

19 National

21 Regional

22 Community and Program Evaluation

24 Education Research

26 Global Health

29 Intellectual and Developmental Disability

31 Quality Improvement

32 Advisory Council 2015-2016

33 Centre Administration

34 Centre Faculty and Staff

38 Publications 2015-2016

40 Conference Presentations 2015-2016

v I s I O N Improve the health and well-being of people in Southeastern Ontario and beyond through research, surveillance and education in primary care.

O v e R v I e w

m I s s I O N The Centre for Studies in Primary Care (CSPC) is dedicated to the conduct of primary careresearch, surveillance and education that extend our understanding of health, healthmaintenance, disease and its treatment, and care delivery, and the assessment anddissemination of evidence.

The CSPC conducts high-quality research that isfocused on the improvement of primary healthcare practice, delivery and education. As part of theDepartment of Family Medicine, the CSPC providesclinical faculty members with research support anddirects the department’s resident researchprogram. Our research activities draw on a widerange of disciplines through collaborativeacademic partnerships, and include involvement ofpractising physicians who participate in ourresearch program through our Practice-BasedResearch Network (PBRN). The centre’s currentresearch activities are in areas relevant to thepractice of primary health care, primary care

chronic disease surveillance, population health,health promotion, family medicine educationresearch, program evaluation and evidenceassessment for clinical practice. Additionally, manyof the centre’s research activities respond tocommunity needs and funding opportunities.

The CSPC’s leadership is supported by an advisorycouncil that oversees the centre’s development andadvises on opportunities that fall within its mission,vision and goal. Chaired by a respected communitymember, the advisory council comprises membersfrom across Queen's University, community-basedprimary care practitioners and residents.


Ou

R v

IsIO

N A

ND

mIs

sIO

N

CSPC ANNUAL REPORT 2015/2016 2

departmental support and leadership. In its report, the senate highlighted the need for ongoingdevelopment and better communication of activities with the rest of the university and beyond. The recommendations are being carefully considered, and plans for developing a new strategic and communications plan are in the works.

I would like to highlight some key research initiatives that are happening through the centre:

B Dr. Lawrence Leung has joined the centre as the Assistant Director, Clinical Research. Dr. Leung’sinterests are in dermatology, chronic pain, complementary and alternative medicine, knowledgesynthesis, First Nations health and efficacy of clinical teaching.

B Dr. Meg Gemmill and Dr. Ian Casson have been leading the development of research in adults withintellectual and developmental disabilities. They have received funding from the SEAMO InnovationFund and CSPC seed-granting competition to carry out this important research.

B Dr. Eva Purkey, who leads the department’s global health initiative, has embarked on work in neonatalimmunization for hepatitis B in Myanmar. She is also part of a group funded through the SEAMOInnovation Fund to study poverty screening in family medicine and pediatrics.

B Dr. Robert Webster, director of the Belleville-Quite site, Dr. Catherine Donnelly, an occupational therapistat the Belleville-Quinte site, and Abby Leavitt, the program manager for the Belleville-Quinte site, aredoing a project to assess the development of core indicators of the care outcomes of primary careteams. This is the second project they have led in this area.

B There is growing research interest and activity from residents at all four sites of the department’sresidency training program. This is reflected by the superb research presentations at the annual PrimaryCare Research Day.

I also acknowledge the tremendous work of CSPC staff members in supporting faculty and residents in thedevelopment of their research proposals, as well as their ongoing engagement in doing the importantwork of data collection, analysis and publication writing of ongoing research projects.

I am confident that 2016 will be another good year.

me

ss

AG

e F

RO

m t

he

DIR

eC

tO

R

m e s s A G e F R O m t h e D I R e C t O R

The CSPC continued to grow and thrive in2015. Faculty members have published 32peer-reviewed papers over the last year

that reflect the breadth of interests and diversitythat is typical of family medicine research. I ampleased to report that the CSPC receivedunanimous Senate approval to operate as aQueen’s centre for another five years. This is verygratifying, as it recognizes the CSPC as a matureand successful research centre with strong

Dr. Richard Birtwhistle, mD, msc, FCFPDirector, Centre for studies in Primary CareQueen’s university


me

ss

AG

e F

RO

m t

he

De

PA

Rt

me

Nt

he

AD

data analysis to gain insight into the management of chronic diseases, and issues important topromoting health equity and progressive health-care policy.

The CSPC benefits from the inspired leadership of Director Dr. Richard Birtwhistle, who has beentireless in pursuit of opportunities for the centre and supporting faculty members in addressingresearch questions. Other key faculty members include Dr. Michael Green, Associate Director ofResearch in the Department of Family Medicine and the new Clinical Teachers’ Association ofQueen’s (CTAQ) Chair in Applied Health Economics/Health Policy as of November 1, 2014. New tothe CSPC team, department faculty member Dr. Lawrence Leung has accepted the position ofAssistant Director, Clinical Research. Dr. Leung brings extensive expertise and enthusiasm in thisarea, and will lead and develop the clinical research portfolio. Acknowledgment also goes to theongoing commitment and vision of the centre’s board of directors in advancing the centre’smandate.

This year, the department was honoured to have the College of Family Physicians of Canada nameDr. Birtwhistle and fellow CSPC member Dr. Walter Rosser as among the Top 20 Pioneers of FamilyMedicine Research in Canada. In recognition of the 20 pioneers, the College published The Top 20Pioneers in Family Medicine Research, which provides biographies of the researchers’ outstandingaccomplishments.

We are fortunate that the CSPC engages with the department in hosting our annual Primary CareResearch Day. This is always a highly successful event and a highlight of the year. It is clear that thequality of the resident research projects continues to improve annually, and that all sites are fullyengaged with and support our residents in this endeavour.

We said goodbye to Jyoti Kotecha this year in her role as the centre’s assistant director, a positionshe held since 2007. Jyoti’s contribution to the centre was significant, and we thank her for hercommitment and wish her well. We also welcomed Colleen Grady to the CSPC as the new researchmanager, and see an exciting new chapter for the centre with Colleen’s management skills.

I would like to offer my congratulations to the board, all faculty members and residents, and allstaff who have contributed to the success of the CSPC over the past year.

m e s s A G e F R O m t h e D e P A R t m e N t h e A D

Dr. Glenn Brown, Bsc, mD, CCFP (em), FCFP, mPhhead, Department of Family medicineQueen’s university

I would like to take this opportunity to express my appreciation to the Centre for Studies in Primary Care (CSPC) for its success in the past year.

The CSPC continues to evolve, with researchimportant to all stakeholders in our health-care system. Beyond educational research

critical to the ongoing development of ourdisciplines, this work includes clinical questions,


ex

eC

ut

Ive

su

mm

AR

y

e x e C u t I v e s u m m A R y

The Centre for Studies in Primary Care(CSPC) acts as the research arm of theDepartment of Family Medicine (DFM) at

Queen’s University. As such, the CSPC providesthe DFM with research development andsupport, directs the resident research-teachingprogram, convenes Primary Care Research Day,and helps to build capacity in primary careresearch by providing an environment thatsupports research training and academicexcellence. The CSPC’s research activities are inareas relevant to the practice of primary healthcare, primary care chronic disease surveillance,health services research, population health,health promotion, use of electronic medicalrecords, family medicine education research,program evaluation and evidence assessment forclinical practice. The primary research portfolios

the CSPC holds include educational research,community and program evaluation, intellectualand developmental disabilities, global health,and the Canadian Primary Care SentinelSurveillance Network (CPCSSN).

Over the last two years, the CSPC has focused onbuilding research capacity within the DFM. Thecentre oversees a peer-reviewed seed-grantingcompetition and provides research support forDFM faculty members. Through this year’scompetition, the CSPC funded four new projects.Project investigators are from across the regionalteaching sites and include allied healthprofessionals within the department. Details ofthese projects are highlighted in the followingtable.


ex

eC

ut

Ive

su

mm

AR

y

PRINCIPAl INvestIGAtOR CO-INvestIGAtORs PROJeCt tItle FuNDING AmOuNt

Dr. Eva Purkey Dr. Susan Bartels,Dr. Colleen Davison,Dr. Hugh Guan,Dr. Shruti Sebastian

Monitoring and Evaluation of Neonatal Hepatitis B Immunization Project in Karenni State, Myanmar

$16,900

Dr. Meg Gemmill Dr. Ian Casson,Dr. Liz Grier

Implementation and Evaluation of Health Links’ Coordinated Care PlansTailored for Adults with Intellectual and Developmental Disabilities

$19,278

Dr. Jane Griffiths Nancy Dalgarno,Catherine Donnelly

Competency-based medical education implementation: How are we shifting assessment culture? Part 2

$13,103

Dr. Robert Webster Catherine Donnelly,Abby Leavitt,Cindy Adams,Nicole Bobbette,Stephanie Lynch,Andrea DiGiovanni,Dr. Yan Cao,Ashleigh Wolfe,Judith Proulx

Multidimensional Outcomes in Primary Care: Part 2 $12,588


ex

eC

ut

Ive

su

mm

AR

yC

AR

e R

es

eA

RC

h D

Ay

20

15

(left to right) CsPC faculty and staff members mary martin, Ken martin, Dr. Nancy Dalgarno, Rachael morkem, Dr. walter Rosser, Dr. David Barber, marissa Beckles, lorne Kinsella, emily Pollock, Dr. Richard Birtwhistle, Dr. hanhan, Dr. John Queenan and Dr. Colleen Grady; missing Dr. michael Green, Dr. lawrence leung and Fred Zeltser

In 2015, the CSPC had its third five-year review. The Senate Advisory Research Committeeunanimously recommended that the senateapprove the centre’s renewal for a further five-year period. In its recommendation, thecommittee highlighted the centre’s evolution overthe past 15 years, during which it has enhanced itsimpact, funding and presence in primary careresearch. The committee congratulated CSPCDirector Dr. Richard Birtwhistle for his outstandingleadership and long list of achievements thatreflect well on the centre. Effective changemanagement was also highlighted, as CPCSSNwill transfer assets and continued leadership toQueen’s University from the College of FamilyPhysicians of Canada (CFPC). Finally, as the CSPChas helped the DFM in meeting SEAMO-relatedresearch deliverables, the committee underscoredthe centre’s valuable role within the DFM and theQueen's Faculty of Health Sciences.


ex

eC

ut

Ive

su

mm

AR

y

h O u O u R s A N D A w A R D s

Dr. Richard Birtwhistle (left) and Dr. walter Rosser

In honour of the 20th anniversary of the CFPC’s Section of Researchers, theCollege has named Dr. Richard Birtwhistle and Dr. Walter Rosser as two of theTop 20 Pioneers of Family Medicine Research in Canada for their contributionsto advancing health care in Canada and globally. Dr. Birtwhistle was honouredfor his accomplishments in advancing technology through the development of CPCSSN. Dr. Rosser was recognized for his research with Practice-BasedResearch Networks, teaching evidence-based medicine and building capacityin family medicine. The CFPC also gave Dr. Birtwhistle a lifetime achievementaward this year for his contribution to family medicine research.

Dr. Ruth wilsonThe CSPC is particularly proud of Dr. RuthWilson, who was named as a Member of theOrder of Canada by His Excellency the RightHonourable David Johnston, GovernorGeneral of Canada. Dr. Wilson was honouredfor her contributions to improving theprimary care system in Ontario and for herleadership in family medicine.

Dr. michael GreenDr. Michael Green won an IMPACT Award toassess diabetes among Ontario’s First Nationspeoples and to help develop new programsand policies. This project has been funded forthree years through the Ontario SPORSUPPORT Unit (OSSU), and is a partnershipwith the Chiefs of Ontario, the NorthernOntario School of Medicine, NipissingUniversity and the Institute for ClinicalEvaluative Studies. The project aims to producea comprehensive assessment of diabetes, itscomplications and related health services forFirst Nations peoples across Ontario.


ex

eC

ut

Ive

su

mm

AR

y

Dr. Katrin Dolganova

The Ontario College of Family Physicians named Dr.Katrin Dolganova winner of the Resident ResearchCompetition at the Family Medicine Forum. Dr.Dolganova was nominated for her postgraduateyear-two resident research project, “Interpretationof Urine Drug Screens in Patients on Opioids forChronic Non-Malignant Pain: Practical Tools,” forwhich she also won best academic project atPrimary Care Research Day in 2015.


ex

eC

ut

Ive

su

mm

AR

y (left to right) Dr. lawrence leung, Dr. Colleen Grady, Dr. Nancy Dalgarno

The CSPC is thrilled to announce the addition of three new faces. Department of Family Medicinefaculty member Dr. Lawrence Leung has joined the centre as the assistant director of clinical research. In this new position, Dr. Leung will facilitate the resident research training program and help buildcapacity for research among community preceptors at the DFM’s three distributed training sites:Oshawa, Peterborough and Belleville. Specifically, Dr. Leung plans to support learners and colleaguesfrom the stage of initial research idea to proposal development and grant application completion,where applicable. Additionally, he will facilitate the process of applying for conference presentationsand preparation of manuscripts for publication. Dr. Leung has a broad scope of personal researchinterests including dermatology, chronic pain, First Nations health and efficacy of clinical teaching.

Dr. Colleen Grady has joined the CSPC as the new research manager. She comes to Queen’s from theLoyalist Family Health Team in Amherstview, where she was executive director. With a doctorate inbusiness administration, Dr. Grady brings with her significant leadership and management experience.

Dr. Nancy Dalgarno joins the CSPC as a part-time education researcher and consultant. With a PhD in education, she brings with her significant experience in program evaluation, curriculumdevelopment and research. Dr. Dalgarno splits her time between the CSPC and Queen’s Office of Health Sciences Education.

New Additions

To learn more about the CSPC’s research activitiesand project highlights, consult the CSPC’s websiteat www.queensu.ca/cspc/ and follow along on

Twitter @CsPC_Queensu.

CSPC ANNUAL REPORT 2015/2016 1 0

PR

ImA

Ry

CA

Re

Re

se

AR

Ch

DA

y 2

01

6Primary Care Research Day is an annualevent that brings together faculty, staffand residents from all four sites of the

Queen’s Department of Family Medicine. Theday’s objectives are to learn from and discusscurrent research and scholarly projectsconducted by family medicine residents, and toenhance understanding of topics relevant tofamily medicine practice through two keynoteaddresses from distinguished academics in thefield of primary care research.

P R I m A R y C A R e R e s e A R C h D A y 2 0 1 6

Dr. Richard Birtwhistle, CsPC Director, provided the morning greetings.


PR

ImA

Ry

CA

Re

Re

se

AR

Ch

DA

y 2

01

6

Dr. Richard Reznick, Dean of health sciences at Queen’s university, provided the opening remarks.

A total 194 guests attended Primary Care Research Day, held at Kingston’s Four Points by Sheraton.Guests included Queen’s Department of Family Medicine and Department of Public Health andPreventive Medicine faculty and residents, Queen’s Family Health Team staff, faculty from acrossQueen’s University, community health-care providers, and family physicians from across the South EastLocal Health Integration Network.

Researchers Dr. Fred Burge and Dr. IanJanssen presented the keynoteaddresses. Dr. Burge is a Professor ofFamily Medicine and CommunityHealth and Epidemiology at DalhousieUniversity in Halifax. His researchinterests lie in health services researchin primary health care. He recently leda large provincial morality follow-backstudy to examine unmet health-careneeds among the dying. Dr. Janssen isan Associate Professor in theDepartment of Community Health &Epidemiology at Queen’s University,with a joint appointment in the Schoolof Kinesiology & Health Studies. He isthe Canada Research Chair in PhysicalActivity and Obesity. His researchprogram focuses on the surveillance,causes and health consequences ofphysical inactivity and obesity.


PR

ImA

Ry

CA

Re

Re

se

AR

Ch

DA

y 2

01

6

Dr. Fred Burge, “One of the biggest challenges: the end. A population-based lenson caring for the dying”

Dr. Ian Janssen, “the importance of active play for health in children”

PR

ImA

Ry

CA

Re

Re

se

AR

Ch

DA

y 2

01

6


Dr. marie-Pier marleau presenting her poster to Dr. Geoff hodgetts on “Opinions ofthe prenatal population on childhood immunization education”

Dr. heidi wells demonstrating her Rourke Baby Record mobile application.

Postgraduate year-two family medicine residents presented their researchas either a poster or oral presentation. This year, 21 oral presentations werecompleted concurrently and 42 posters were displayed.

1 4

PR

ImA

Ry

CA

Re

Re

se

AR

Ch

DA

y 2

01

6


Dr. Johnny Nguyen presenting his research project “Anti-virals and macrolides in thetreatment of Pityriasis Rosae”

(left to right) Dr. Iris Chin, Dr. theresa Robertson, Dr. Jaclyn Oldham. missing: Dr. Johnny Nguyen.

Each resident project was evaluated by two judges. Projects were assessedbased on topic relevance, quality of presentation, and integration of newknowledge. The four “Best Academic Research Projects” were awarded to:

Dr. Iris Chin (Kingston): “Evidence for Probiotics in Constipation”

Dr. Johnny Nguyen (Oshawa-Bowmanville-lakeridge): “Anti-Virals andMacrolides in the Treatment of Pityriasis Rosea”

Dr. Jaclyn Oldham (Kingston): “Mom Guilt: Ensuring a Nourished Body andMind during Pregnancy”

Dr. theresa Robertson (Peterborough-Kawartha): “An Exploration ofPhysician and Resident Attitudes toward Performing Pap Tests in the Emer-gency Department on High Risk Women Undergoing Pelvic Examinations”

Thank you to all speakers, judges, moderators and participants for makingthe day such a success. Our next Primary Care Research Day is tentativelyscheduled for Thursday, February 23, 2017. We hope you can join us!


Cu

RR

eN

t P

RO

Je

Ct

s

C u R R e N t P R O J e C t s

ORGANIZAtION FuNDING CsPC ReseARCh leAD PROJeCt

Canadian Institute of Health Research $80,213 Dr. Michael Green Educating for Equity

Canadian Institute of Health Research $49,993 Dr. Richard Birtwhistle, Jyoti Kotecha,John Queenan

CIHR SPOR Network in Chronic DiseaseApplication: ePRISM (electronicPatient-centred Research andInnovations in MultimorbidityNetwork)

Canadian Institute of Health Research $3,750 Dr. Richard Birtwhistle Program for the Identification ofActionable Atrial Fibrillation in theFamily Practice setting (PIAAF-FP)

Public Health Agency of Canada $646,241 Dr. Richard Birtwhistle, Dr. DavidBarber, Dr. Walter Rosser

Canadian Primary Care SentinelSurveillance Network (CPCSSN)

Public Health Agency of Canada $1,077,163 Dr. Richard Birtwhistle, Dr. DavidBarber, John Queenan

Enhanced Surveillance for ChronicDisease Program (PHAC-DPT)

Ministry of Health and Long Term Care $36,132 Dr. Richard Birtwhistle, Dr. MichaelGreen

Linking Canadian Primary Care SentinelSurveillance System (CPCSSN) Datawith Administrative Data from ICES forComplex Patients to Better UnderstandUtilization Patterns and CareRequirements

Ministry of Health and Long Term Care $40,075 Jyoti Kotecha, Dr. Susan Phillips A Review of Home Services Offered bySeniors Associations Across Ontario toSupport Healthy Aging in the Homeand How These Services Can BeLeveraged by Primary Care


Cu

RR

eN

t P

RO

Je

Ct

s



Frontenac Paramedic Services $81,055 Jyoti Kotecha, Dr. Richard Birtwhistle Environmental Scan and a NeedsAssessment to Support theDevelopment of a Paramedic WellnessProgram for Frail Older Adults

TVN Impact Grant $85,120 Jyoti Kotecha, Dr. Richard Birtwhistle Enhancing the Primary HealthcareSystem’s Ability to Identify and Planwith Seriously Ill Frail Elderly

Health Canada $69,000 Dr. Richard Birtwhistle, Dr. TylerWilliamson, Dr. Linda Levesque

Health Canada AR Surveillance usingCPCSSN data-Phase I

Health Canada $49,856 Dr. Richard Birtwhistle, Dr. LindaLevesque

Evaluation of Depersonalized AdverseReaction Data Collected in National,Primary Care Electronic MedicalRecords for its use inPharmacovigilance Activities-Phase II.

Queen’s University Endowed Chair $53,000 (Interest only part year) Dr. Michael Green Clinical Teachers’ Association ofQueen’s Chair in Applied HealthEconomics/Health Policy

Queen’s University Undergraduate Medical Education

$10,000 Dr. Lawrence Leung UGME Diversity Panel Project Grant

Bruyère Research Institute $50,000 Dr. David Barber, Dr. RichardBirtwhistle, Jyoti Kotecha

Testing CPCSSN’s Ability to Supportthe Development of Data ReportsDesigned to Test the Impact of theCardiovascular Health AwarenessProgram Health PromotionIntervention Across ParticipatingCommunity Health Centres in Ottawa


Cu

RR

eN

t P

RO

Je

Ct

s


SEAMO Education $13,000 Dr. Geoffrey Hodgetts, Dr. JaneGriffiths, Dr. Elaine Van Melle, Dr. Karen Schultz

Preparedness for Practice as a CriticalTransition in Residency Education

SEAMO Education $14,945 Dr. Shayna Watson Mapping Reflective Practice - ThematicAnalysis of Family Medicine ClerkshipCase Reflections

Merck $123,500 Dr. Richard Birtwhistle, John Queenan Exploring the Prevalence of ZosterAmongst Patients with Diabetes in aCanadian Primary Care Dataset inComparisons to Other High-risk andLow-risk Patients

Phoenix Project (AMS) $11,817 Dr. Elaine Van Melle, Dr. Karen Schultz,Dr. Jane Griffiths

Developing a Call to Care:Understanding How Family MedicineResidents’ Values Shape Their Practiceof Patient-Centred Care

CSPC Research Initiation Grant $20,000 Dr. Brent Wolfrom, Dr. Eric Sauerbrei,Dr. David MacPherson, Jyoti Kotecha

Diagnostic Ultrasound in FamilyMedicine (Pilot Project)

CSPC Research Initiation Grant $17,812 Dr. Meg Gemmill, Dr. Liz Grier, Dr. IanCasson, Nicole Bobbette

Primary Care Physician and AlliedHealth Care Provider Attitudes andPerceptions of the Identification ofAdults with Suspected MildIntellectual Disability

CSPC Research Initiation Grant $16,999 Dr. Eva Purkey, Dr. Rupa Patel, TraceyBeckett, Francoise Mathieu

Women's Experience of Trauma-informed Care in the Context ofChronic Disease Management inFamily Medicine



Cu

RR

eN

t P

RO

Je

Ct

s



CSPC Research Initiation Grant $16,000 Dr. Michael Green, Colleen Savage, Dr. Richard Birtwhistle, Heather Stuart,Evelyn Bowring, Dr. David Barber

Validity of CPCSSN DepressionDiagnostic Algorithm IncorporatingPatient Reports

CSPC Research Initiation Grant $8,200 Dr. Susan Phillips, Diane Batchelor Assessing resilience among childrenand youth in primary care

CSPC Research Initiation Grant $4,600 Dr. Robert Webster, CatherineDonnelly, Abby Leavitt, Cindy Adams,Nicole Bobbette, Stephanie Lyn, Dr. Yan Cao, Judith Proulx, KatrinaLevasseur, Andrea DiGiovanni

Multidimensional Outcomes in Primary Care

CSPC Research Initiation Grant $12,588 Dr. Robert Webster, CatherineDonnelly, Abby Leavitt, Cindy Adams,Nicole Bobbette, Stephanie Lyn, Dr. Yan Cao, Judith Proulx, KatrinaLevasseur, Andrea DiGiovanni

Multidimensional Outcomes inPrimary care: Part 2

CSPC Research Initiation Grant $13,103 Dr. Jane Griffiths, Nancy Dalgarno,Catherine Donnelly

Competency-based Medical EducationImplementation: How are We ShiftingAssessment Culture? Part 2

CSPC Research Initiation Grant $19,278 Dr. Meg Gemmill, Dr. Ian Casson, Dr. Liz Grier

Implementation and Evaluation ofHealth Links’ Coordinated Care PlansTailored for Adults with Intellectualand Developmental Disabilities

CSPC Research Initiation Grant $16,900 Dr. Eva Purkey, Dr. Susan Bartels, Dr.Colleen Davison, Dr. T. Hugh Guan,Shruti Sebastian

Monitoring and Evaluation of NeonatalHepatitis B Immunization Project inKarenni State, Myanmar

CSPC ANNUAL REPORT 2015/2016 CSPC ANNUAL REPORT 2015/2016

The CSPC continues to be home to thecentral office of the Canadian PrimaryCare Sentinel Surveillance Network

(CPCSSN). The network extracts patient healthdata from the electronic medical records (EMRs)of participating physicians (sentinels) acrossCanada. This anonymized data is used toconduct public-health surveillance and researchfocused on (but not limited to) eight key chronicconditions: diabetes, high blood pressure,depression, arthritis, COPD, dementia, epilepsyand Parkinson’s disease.

C A N A D I A N P R I m A R y C A R e s e N t I N e l s u R v e I l l A N C e N e t w O R K ( C P C s s N )

CPCssN NationalSince its inception in 2008, the network hasrecruited 1,031 primary care physicians and isextracting and processing EMR data at 182practice sites that span seven provinces and oneterritory. As of January 1, 2016, CPCSSN containedthe detailed health information of 1,282,791patients.

The last year has seen the publication of 15papers, 23 presentations and 14 posters.Highlighting this output, in CMAJ Open, weretwo publications: “Prevalence and Managementof Osteoarthritis in Primary Care: AnEpidemiologic Cohort Study from the CanadianPrimary Care Sentinel Surveillance Network” and“Representativeness of Patients and Providers inthe Canadian Primary Care Sentinel SurveillanceNetwork: A Cross-Sectional Study.” Publication ofthese two papers, along with four previouspapers on the primary care prevalence of chronicdisease, was the culmination of CPCSSN’s originalfive-year mandate. Funded by the Public HealthAgency of Canada (PHAC), CPCCN’s mandate wasto create a synoptic national database ofelectronic medical records, create validated casedefinitions of five chronic diseases and describetheir epidemiology, and report their prevalencein Canadian primary care.

Over the last six years, CPCSSN has become anaward-winning leader in the extraction and useof EMR data in Canada. The network continues toprovide all participating physicians withfeedback reports, comparing information abouttheir patient population and key healthindicators with their colleagues at the site and atregional, provincial and national levels. CPCSSNalso demonstrated the feasibility of integratingmultiple EMRs and a predictive analytics toolwith its own data processing, for the potentialbenefit of clinicians and patients. CPCSSN willcontinue to improve the quality of primary caredata, expand its overall data holdings anddevelop new tools. Canada Health Infoway hasrecognized the network as a leader in innovationrelated to the re-use of primary care data inCanada.

After the main funding for CPCSSN’s original five-year mission came to an end, the PHAC fundedthe network for another two years (2015-2017) tofurther develop, implement and evaluate theCPCSSN Data Presentation Tool (CPCSSN DPT)across Canada. The CPCSSN DPT provides userswith ready access to their data (for querying andreporting) after it has undergone processing andcleaning. The DPT has already proved useful to

Dr. Richard Birtwhistle

PR

OJ

eC

t P

OR

tF

Ol

IOs

1 9


practices for quality improvement andpopulation-health management. The currentiteration of the CPCSSN DPT is web-based andoffers useful new additions such as GIS mappingcapability. This funding will be partially used toperform a major upgrade to CPCSSN’sinformation technology infrastructure.

The CPCSSN project has placed priority infinding sustainable long-term funding. Asubstantial amount of effort was placed inapplying for a Canadian Institutes of HealthResearch SPOR Networks in Chronic Diseasegrant with a proposal centred on research on

multimorbidity and eHealthsolutions to improving care.Although the proposal wasnot funded, we weresuccessful in raising the$12.5 million in matchingfunds and some of thisfunding will be used tomaintain and extendCPCSSN research.

Research

CMAJ OPEN

E28 CMAJ OPEN, 4(1) ©2016 8872147 Canada Inc. or its licensors

The clinical data contained within electronic medical records (EMRs) are a valuable source of information for surveillance, research and practice quality improve-

ment.1,2 Issues of generalizability are a primary concern for observational studies that rely on data obtained from databases containing population-based patient health information.3 A recent systematic review of the literature published from data held by the General Practice Research Database in the United Kingdom underscored the importance of generalizability and its subsequent impact on the validity of reported results.4 The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) is a network of 11 practice-based primary care research networks in British Columbia, Alberta, Manitoba, Ontario, Quebec, Nova Scotia, Newfoundland and Labrador, and the Northwest Territories. The CPCSSN established a process to extract, clean and merge EMR data from 12 differ-ent EMR databases into a single structured database of use-able, quality primary care data.5 Family physicians and nurse practitioners who contribute de-identified patient data to CPCSSN participate on a voluntary basis.

The scope of the data collected is comprehensive and robust, and has the potential to become a large, useable data source for Canadian health research, similar to well-established general practice databases in other countries.6 For research and surveillance findings to be generalizable in a provincial or national context, it is important to consider how representative the data are to the Canadian base populations of primary care patients and practitioners.

The main objective of this study was to determine how representative the data of the patients and primary care practi-tioners in the CPCSSN are when compared with the Canadian population.

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

John A. Queenan PhD, Tyler Williamson PhD, Shahriar Khan MSc, Neil Drummond PhD, Stephanie Garies MPH, Rachael Morkem MSc, Richard Birtwhistle MD

Competing interests: None declared.

This article has been peer reviewed.

Correspondence to: Richard Birtwhistle, [email protected]

CMAJ Open 2016. DOI:10.9778/cmajo.20140128

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.

Abstract

PR

OJ

eC

t P

OR

tF

Ol

IOs

182 practice sites across Canada



PR

OJ

eC

t P

OR

tF

Ol

IOs

It’s been a busy year for the Eastern Ontario Network (EON), the Department of Family Medicine’sPractice Based Research Network (PBRN). The EON spent a good portion of 2015 writing grants andpapers to support its research initiatives. While originally founded as one of 11 networks acrossCanada that comprise the CPCSSN project, the EON has since developed into an independent PBRNwith a goal to leverage electronic medical record data to transform primary care through cutting-


CPCssN Regionaledge research that impacts patient care andmanagement. We submitted our first large grantapplication last spring, and althoughunsuccessful, it received very positive reviewsand we hope to continue this momentum intofuture applications.

Alongside several grant applications, the EONpublished a local research project on datadiscipline in the December 2015 issue of theCanadian Family Physician as well as research onantidepressant prescribing in the December 2015issue of the Canadian Journal of Psychiatry. Thenetwork also presented several projects at the2015 North American Primary Care Groupconference in Cancun, Mexico, includingresearch on trending HbA1c to predict diabetesand antidepressant prescribing to children inprimary care.

The EON collects data on almost 200,000patients in the Eastern Ontario region, and usingthis data for research and quality improvement isintegral to improving the efficiency of Ontario’shealth-care system and increasing the quality ofcare to its residents.

Principal Investigator: Dr. David Barber, mD, CCFP

2 1

CSPC ANNUAL REPORT 2015/2016CSPC ANNUAL REPORT 2015/2016

primary care and seniors’ association servicesacross the region. Next, it was recommended thatthe existing wellness clinics be expanded toadditional locations in order to provide monitoringand prevention of chronic conditions in isolatedcommunities. Home visits to high users ofemergency services were also recommended,followed by a possible introduction of electronicpatient monitoring for the most high-riskpopulations. The final report CSPC prepared,including a logic model and detailed referralpathways, will support the Frontenac ParamedicServices in obtaining funding to implement CPprograms in our region.

In response to health-care reform and increasing pressure on the health-care system, the CSPC has developed a research armdedicated to improving the health and wellness of communities across the South East LHIN. Through collaboration with variouscommunity stakeholders, research initiatives target vulnerable populations such as frail seniors, palliative care patients and those with

multiple and complex conditions. Our Community Projects research arm aims to bridge knowledge gaps; inform provincial and nationalpolicy development; and design, implement and evaluate innovative health-care programs that deliver patient-centred, high-quality careto vulnerable populations.

Connecting seniors and the frail elderly inFrontenac County and the city of Kingstonwith primary care: An environmental scan tosupport the development of the paramedicreferral and wellness program

Community Paramedicine (CP) programs expandon the traditional emergency response role ofparamedics, focusing instead on the organizationand delivery of preventative health and socialservices in the community and in the patient’s ownhome. Often making use of existing services in aregion, CP can maximize efficiency of resourceswhile providing vital connections between seniors,community care, primary care and hospitals. Thisyear, the CSPC completed an environmental scanto support the development of a potential CPprogram in the County of Frontenac and the City ofKingston. Through a review of relevant literature,

C O m m u N I t y A N D P R O G R A m e v A l u A t I O N

conversations with representatives fromestablished CP programs across Ontario and inputfrom community, social and health-carestakeholders in the Kingston region, a frameworkwas developed and presented to FrontenacParamedic Services.

The overall goal of the proposed program was toimprove delivery and co-ordination of services andto promote healthy aging in the home for seniorsand other patients in the community with unmetneeds. Target populations were identified as heavyusers of 911 and emergency services, frail elderlyand palliative care patients, individuals withcomplex health conditions and geographicallyisolated adults. In the first phase, the frameworkfocuses on developing strong referral pathways toensure front-line paramedics are able to quicklyconnect patients to CCAC, mental health services,

Principal Investigator: Jyoti Kotecha, mPA, mRsC, CChemCo-Investigators: Dr. Richard Birtwhistle, mD, msc, FCFP

PR

OJ

eC

t P

OR

tF

Ol

IOs

2 2


C O m m u N I t y A N D P R O G R A m e v A l u A t I O N

Principal Investigator: Jyoti Kotecha, mPA, mRsC, CChemCo-investigator: Richard Birtwhistle, mD, msc, FCFP

enhancing the primary healthcare system’sability to identify and plan with seriously illfrail elderly

Advanced Care Planning (ACP) is the process bywhich a patient, in consultation with health-careproviders and family members, considers theiroptions regarding future health-care decisions. Ingeneral, ACP is associated with facilitating lessaggressive or intrusive care for patients nearing theend-of-life (EOL). This process includes clarifyingillness trajectory and treatment options, exploringpatient values, and helping them to identify andplan their wishes based on their goals for futurecare. Though evidence shows that ACP is vital toproviding high-quality care for those with life-limiting illness, those who would benefit from ACPare often identified too late for proactive needsidentification and desired care plans to befacilitated. The aim of this study is to increase thecapacity to support primary health-care providersand systems in early identification of elderlypatients who are frail and/or living with advancedlife-limiting chronic illness and inform best practicesfor the ACP process.

Funded by the Canadian Frailty Network (Formerlythe Technology Evaluation in the Elderly Network,TVN) Strategic Impact Program, this study is beingconducted in partnership with researchers atDalhousie Department of Family Medicine an theNova Scotia Health Authority. Using healthinformation contained in electronic medicalrecords, CSPC researchers will assist in developingand validating an algorithm to identify senior adultsat most risk of declining health and dying.Additionally, we will conduct in-depth interviewswith patients and caregivers to explore their viewsand perceptions about the use of electronic medicalrecords for early identification; their opinions onand need for ACP; and whom they feel shouldinitiate ACP discussions, where they should occurand at what time in the illness they should takeplace. We will also hold a focus group to explore theviews and perceptions of family physiciansregarding their role in ACP as well as organizational,clinical and social implications of primary carepractice-level identification strategies for providers,patients and their families.

PR

OJ

eC

t P

OR

tF

Ol

IOs

2 3


An important activity for the CSPC is to support educational research. The centre supportsevaluation and research that leads to improvements in the quality of family medicine residenttraining and education curriculum. We currently have a number of projects, including an

evaluation of the Triple C Curriculum within the postgraduate distributed medical education programat Queen’s University and an evaluation of competency-based medical education assessment culture.

e D u C A t I O N R e s e A R C h

Principal Investigator: Dr. Jane Griffiths, mD, CCFP, FCFPCo-Investigators: Dr. Nancy Dalgarno, PhD; Dr. Catherine Donnelly, B.sc. (Ot), msc, PhD

Competency-Based medical educationImplementation: how are we shiftingAssessment Culture? Part 2

The Department of Family Medicine (DFM) is anearly adopter of competency-based medicaleducation (CBME). It is an approach thatrepresents a paradigm shift from traditionaltraining to one that is fundamentally oriented tooutcomes and grounded by relevantcompetencies. CBME required us to think aboutassessment in both holistic and longitudinalways. Given this, the DFM began to implementthe Portfolio Assessment and Support System in2011 and a preliminary study was conducted todetermine if there was an initial change in theway we assessed our residents. Now that theportfolio system has been fully embedded intothe DFM for the past five years, it is important todetermine if and how there has been a change inour assessment culture—one that supports theCBME curriculum.

This phenomenological study involves aqualitative design. Semi-structured interviewswith nine academic advisors and two focusgroups with residents (n = 10) will be conductedto gather evidence documenting perspectivesof, and approaches to, the competency-basedportfolio system. An inductive, emergent designwill be used to analyze the data. Locally, findingsfrom this study will allow us to examine theextent to which our approach represents acultural shift in how assessment is viewed andimplemented. The findings will also inform andshape ongoing improvements to the portfoliosystem, and act as a guide for facultydevelopment at all DFM distributed sites.Globally, our findings may assist other programswith the development and implementation ofcompetency-based assessment tools in theirresidency training programs.

PR

OJ

eC

t P

OR

tF

Ol

IOs

2 4

PR

OJ

eC

t P

OR

tF

Ol

IOs


Principal Investigator: Dr. Kelly howse, mD, CCFP

medical student Career Advising: NationalRecommendations

Career planning, specialty decision-making andpreparation for residency matching aresignificant sources of stress for medical students.The Future of Medical Education in CanadaPostgraduate (FMEC PG) Implementation Project,funded by Health Canada and a consortiumpartnership of the Association of Faculties ofMedicine of Canada, Collège des Médecins duQuébec, College of Family Physicians of Canada,and Royal College of Physicians and Surgeons ofCanada, included a specific recommendation to“ensure effective integration and transitionsalong the educational continuum,” and furthernoted that this “requires development throughthe increase of responsibility across the medicaleducation continuum and effective transitionsfrom UGME into PGME.” Under the “integrationand transitions” umbrella, the Career Planningand Residency Matching Process Working Groupidentified a clear need for a sub-working groupto examine career advising processes acrossCanada and the development of guidelines andrecommendations that could be published andshared. The sub-working group has been led byDr. Kelly Howse (Queen’s), with collaborationfrom colleagues across the country.

The final document, completed in November2015, provides an overview of the resultingrecommendations regarding the guidingprinciples and essential elements of medicalstudent career advising. The goal is toencourage standardization of career advisingcontent across all Canadian medical schools inorder to better assist medical students in makinginformed career decisions. It is the sub-workinggroup’s hope that this will help guide theexploration and sharing of relevant resources,and promote discussion regarding therequirements and processes for implementingthe recommendations nationally. Projectevaluation will include determining if theserecommendations help the offices of studentaffairs and career advisors better assist medicalstudents in their career decision-making.

The document is posted on various national andprovincial websites and can be accessed at:http://cou.on.ca/papers/the-future-of-medical-education-in-canada-postgraduate-project/. Itwill be presented at CCME 2016 and submittedfor publication later this year.

e D u C A t I O N R e s e A R C h

PR

OJ

eC

t P

OR

tF

Ol

IOs


monitoring and evaluation of neonatalhepatitis B immunization project in Karennistate, myanmar

A team of researchers from the Faculty of HealthSciences is looking at the impact and quality ofan intervention to decrease vertical transmissionof hepatitis B in a rural area of Karenni State,Myanmar. Hepatitis B is endemic in Myanmar,and mother to child is a common mode oftransmission. In partnership with a local Karennihealth agency and an international non-governmental organization (NGO) that is seekingto implement neonatal immunization withhepatitis B vaccine to prevent mother-to-childtransmission of the virus, Queen’s researcherstravelled to Myanmar in January 2015 to run atraining session in monitoring and evaluation.Researchers will follow the project over the next18 months to assess implementation of theintervention, as well as impact on mother-to-child transmission of the hepatitis B virus. If this

Principal Investigator: Dr. eva Purkey, mD, CCFP

G l O B A l h e A l t h

The Global Health research portfolio examines issues related to the health care and well-being of vulnerable populations or persons struggling with health inequities such as those linked topoverty, migration status or aboriginal status. Included in this portfolio is research that focuses

on preventive medicine and screening. The following are new projects being undertaken.

project is successful, the goal is to roll outimplementation throughout Karenni State. The Centre for Studies in Primary Care fundedthis project.

Implementation evaluation of a povertyscreening tool

This project is aligned with various provincialinitiatives looking at the implementation andimpact of screening patients for poverty, andinterventions aimed at reducing the effects ofpoverty, in primary-care settings in Ontario. In partnership with colleagues from theDepartment of Pediatrics and KingstonCommunity Health Centres, researchers will trainKingston physicians from a variety of settings inthe use of the poverty screening tools promotedby the Ontario College of Family Physicians.These physicians will then be followed over threemonths to assess the implementation of povertyscreening in their various practice settings. Usingphysician questionnaires, patient questionnairesand focus groups, barriers to implementation –as well as characteristics that improveimplementation – will be assessed. Followingthis study, the next logical step would be to lookat the impact of screening for poverty in terms ofaccess to services and overall health outcomes.

PR

OJ

eC

t P

OR

tF

Ol

IOs


the influence of social determinants of healthon research

The majority of randomized controlled trials(RCTs) cannot be reproduced, and when theiroriginal data are reanalyzed, one-third of thefindings change. My research on socialdeterminants of health – whether gender,adversity in childhood, or individual strengthsand assets – suggests that considering humanparticipants to be interchangeable subjectsdevoid of social traits explains some of theseerrors in RCT results. Clinical trials assume allsubjects with a specific diagnosis are like lab ratsand that their individual and socialcharacteristics can be removed from study byrandomization. The reality is that thosecharacteristics are strong determinants of healthand interact with, for example, the treatmentbeing studied, even if they are ignored. Here area few examples of the research I do that speaksto this.

In a review of 500 recent RCTs (co-author:Katarina Hamberg), we uncovered significantbiases in recruitment, retention and analyses offindings, particularly with respect to gender. Aseparate systematic review demonstrated that

men’s greater susceptibility to health harm frommaterial deprivation may be an artifact ofgender-bias in research methods. Analysis ofdata from an ongoing prospective cohort studyon which I am the principal investigator hasrevealed that life experiences and realities haveunexpected and long-lasting effects on health.Across four study countries, early parental losshad a lifelong impact on self-rated health,particularly among men. This is novel researchon what turns out to be a major adversity inchildhood not previously examined. Otheranalyses using this same International Mobilityin Aging (IMIAS) data show the correlates ofelder abuse, the importance of social support,and the nature and benefits of resilience amongthe elderly. And because resilience is known topredict health, I am also completing severalstudies of how doctors can assess this strengthamong young people.

There’s more to tell – about examining successfulaging, empathy and professionalism amongmedical trainees, sexual harassment of medicalstudents, and teaching about reproductivechoice. If you are curious, please ask [email protected]

Principal Investigator: Dr. susan Phillips, mD, msc(epid), CCFP, mD(hC)


PR

OJ

eC

t P

OR

tF

Ol

IOs


Principal Investigator: Dr. michael Green, mD, mPh,CCFP, FRCP


educating for equity (e4e): exploring howhealth Professional education Can ReduceDisparities in Chronic Disease Care and ImproveOutcomes for Aboriginal Populations

Educating for Equity (E4E) is an internationalcollaborative research project aimed at developingIndigenous health professional education capacityas a vehicle for improving care and healthoutcomes. The Canadian Team, composed ofresearchers from Queen’s University, the Universityof Calgary, North Ontario School of Medicine, andthe University of British Columbia, is focused onimproving diabetes care in Aboriginal populationsthrough a research and evidence informedAboriginal health continuing medical education(CME) intervention. In Phase 1, focus groups andinterviews were conducted with Aboriginal patientsand healthcare providers to understand needs andgaps in health services. This knowledge was used togenerate a care framework which was translatedinto an E4E CME workshop. In Phase 2, a one-dayCME workshop, with a pre-workshop needsassessment and post workshop reflection, wasdeveloped and delivered to northern healthcareproviders. To date, five workshops have been

delivered in three communities in Northern Ontarioto a total of 32 healthcare providers. The workshopfocused on (a) key social factors that affectAboriginal diabetes outcomes, (b) culturally attunedapproaches to building therapeutic relationshipswith Aboriginal diabetic patients, (c) methods toaddress discord in the doctor-patient relationship,and (d) culturally informed ways to supportAboriginal people in health care and society.

A mixed-method, multi-measure, controlled designwas used to evaluate the E4E CME intervention.Data collection included physician practice chartaudits and patient experience survey 3-month postand 12 month post workshop, respectively. Co-primary outcomes include HbAIC and a summarypatient experience score. Chart audits prior to andpost intervention indicate impact of physicians’participation on clinical outcomes. Patient surveysreflect any changes perceived by patients inphysician care delivery.

Data collection is nearly complete and analysis isongoing. This project is expected to close in Marchof 2017.


I N t e l l e C t u A l A N D D e v e l O P m e N t A l D I s A B I l I t I e s

The Queen's University Intellectual and De-velopmental Disabilities (QUIDD) Collabo-rative is an initiative of Queen's

Department of Family Medicine and the Centrefor Studies in Primary Care. The collaborative iscomposed of physicians, health-care providers,researchers and stakeholders who are commit-ted to advancing research and education in intel-lectual and developmental disabilities (IDD) andto delivering quality health care to IDD patientsand their families.This year, data collection was completed for ourstudy exploring the experiences of physicians, al-lied health and social service agency workers insupporting adults with an undiagnosed but sus-

pected mild IDD, including an exploration oftheir experience obtaining formal diagnoses forthis population. Additionally, the DFM continuesto work toward implementing the Primary CareGuidelines to ensure faculty and residents worktogether to provide annual health checks to eachof their IDD patients. Most recently, QUIDD cele-brated a major achievement after being awardeda 2015/2016 SEAMO Innovation Fund grant toconduct a pilot study that will evaluate the im-plementation of HealthLinks Coordinated CarePlans for adults with IDD and complex needs inthe Kingston region.

Principal Investigator: Dr. meg Gemmill, mD, CCFPCo-Investigators: Dr. Ian Casson, mD, CCFP(em), FCFP;Dr. liz Grier, mD, CCFP

PR

OJ

eC

t P

OR

tF

Ol

IOs

2 9

PR

OJ

eC

t P

OR

tF

Ol

IOs


Implementation and evaluation of healthlinks’ Coordinated Care Plans tailored foradults with intellectual and developmentaldisabilities

Adults with intellectual and developmentaldisabilities (IDD) have poorer health status andexperience more barriers to accessing healthcare compared to the general population.Multiple factors contribute to this, includingcommunication difficulties, health literacy,difficulty navigating the system and lack ofcoordination among health care providers aswell as across social and health services.Recently, the Ontario Ministry of Health andLong-Term Care (MOHLTC) introduced The HealthLinks Complex Patient Coordinated CarePlanning (CCP) program to help alleviate suchbarriers for complex patients. The processinvolves the completion of a CCP by aHealthLinks nurse in order to aid the patient’sfamily doctor in connecting with specialists andother health/social care providers. The goal ofthe program is to provide coordinated careacross health and social care systems, leading toimproved quality and continuity of care, as wellas reduced burden on healthcare resources.Though IDD is recognized as a risk factor by theCommunity Health Links in the South-East Local

Health Integration Network (SELHIN), CCPs havenot yet been completed for adults with IDD inthis region.

This pilot study, which was awarded a 2015-2016SEAMO Innovation Fund grant, is a collaborativeeffort joining the SELHIN HealthLinks CCPprocess with the Ministry of Community andSocial Services (MCSS) and researchers at QFHTand the CSPC. MCSS will aid in the identificationof patient participants who have IDD andcomplex needs, who will in turn meet with aHealthLinks nurse to identify goals, documenthealth information and develop a CCP tailored tofit their unique need for health and socialsupport. Using a mixed method approachcombining participant surveys, interviews andchart reviews, researchers will evaluate theimplementation of this pilot project. They willexplore whether bringing together these cross-sector programs to develop CCPs for adults withIDD and complex needs will increase thecapacity of patients, families, social servicesworkers and the health care providers to provideand coordinate health care, as well as comparehealth and health/social service usage outcomesbefore and after the intervention. It is their hopethat this pilot project can be used as a frameworkfor expansion across Ontario’s LHINs.

I N t e l l e C t u A l A N D D e v e l O P m e N t A l D I s A B I l I t I e s

PR

OJ

eC

t P

OR

tF

Ol

IOs


Principal Investigator: Dr. Robert webster, mD, CCFP,FRCPCo-investigators: Dr. Catherine Donnelly, Bsc(Ot),msc, PhD; Abby leavitt, BBA

multidimensional Outcomes in Primary Care

Responding to demographic changes, advances inhealth care, disease-management strategies, andmounting evidence that strong primary care systemsare associated with better and more equitable healthoutcomes, interprofessional primary care teams acrossCanada have undergone major reforms in the pastdecade. Performance measurement and feedback inprimary care seeks to provide a summary of the clinicalperformance of health care provider(s) over a specifiedperiod of time. Both public and private performancereporting at the practice level have been shown to drivepractice improvement in primary care. Nonetheless, veryfew studies have explored the effect of performancemeasurement and feedback on interprofessional teams,despite their growing role in providing primary care andthe growing international focus on performancemeasurement in primary care. This leavesinterprofessional primary care teams at a greatdisadvantage in trying to improve the care they deliver,even though performance data sources from electronicmedical records (EMRs) to provincial screening registriesare proliferating. In parallel with the need to identifyoutcomes and indicators reflective of theinterprofessional team is the importance of leveragingthe EMR to systematically capture this data in order to a)extract data for continuous quality improvement (CQI)and b) support research on team-based primary care.

Phase 1 of the project focused on the development of afamily health team (FHT) program logic model with thegoal of identifying specific program outcomes andperformance indicators. This was done in collaborationwith allied health professionals and the physician lead inBelleville. This collaborative process had multiplebenefits. First, developing a common vision among theteam members supported a commitment to building aculture of quality from which to move forward. Second,the process allowed the team to develop outputs, whichcould then be used to track and gather information thatwill inform results-based programming and qualityimprovement.

Phase 2 of the project involved the creation of EMRmeasurement strategies to efficiently capture theoutcomes and indicators identified in Phase 1. The teamidentified the World Health Organization Quality of Life(WHOQOL) assessment as the global outcome measurefor the FHT. Currently, all patients the FHT see completethe WHOQOL assessment, which will provide a profile ofpatients receiving services from the interprofessionalteam.

The project has highlighted the importance ofidentifying non-physician outcomes and indicators. It isthe FHT’s first step in creating meaningful non-medicalindictors for quality improvement, and the only knownexample within the province.

Q u A l I t y I m P R O v e m e N t


The CSPC has an advisory council that meets regularly to advise and steer the centre’s research activities.The board members currently include:

Margaret Alden Chair, CSPC Advisory Council

Dr. Richard Birtwhistle Director, CSPC

Dr. Michael Green AssociateDirector, CSPC

Dr. Lawrence Leung Assistant Director, CSPC

Dr. Colleen Grady Research Manager, CSPC

Dr. Glenn Brown Head, Department of Family Medicine

Dr. Karen Schultz Postgraduate Education Program Director, Department of Family Medicine

Dr. Walter Rosser Department of Family Medicine Representative

Dr. Susan Phillips Department of Family Medicine Representative

Dr. Joan Tranmer Queen’s Faculty Member, School of Nursing

Dr. Dana S. Edge Queen’s Faculty Member, School of Nursing

Dr. Pattie Groome Queen’s Faculty Member, Community & Epidemiology

Dr. Catherine Donnelly Queen’s Faculty Member, School of Rehabilitation Therapy

Dr. Jeffrey Sloan Community Physician

Carolyn Hamilton Kuby Community Representative

Judith Mackenzie Community Representative

Dr. Vikram Gill Family Medicine Resident

Marissa Beckles Administrative Assistant, CSPC

A D v I s O R y C O u N C I l 2 0 1 5 – 2 0 1 6

margaret Alden, Chair

AD

vIs

OR

y C

Ou

NC

Il 2

01

5 –

20

16

3 2


C e N t R e A D m I N I s t R A t I O N

Dr. Richard Birtwhistle, mD, msc,FCFPDirector, Centre for studies in Primary CareProfessorDepartment of Family medicine,Department of Community health and epidemiology [email protected]

Dr. michael Green, mD, mPh,CCFP, FCFPAssociate Director, Centre forstudies in Primary CareAssociate ProfessorDepartment of Family medicine,Department of Communityhealth and [email protected]

laurence leungAssistant Director, Centre forstudies in Primary CareAssociate [email protected]

Colleen Grady, mBA, DBAResearch manager, Centre forstudies in Primary CareDepartment of Family [email protected]

marissa BecklesAdministrative Assistant, Centrefor studies in Primary [email protected]

Ce

Nt

Re

AD

mIN

Ist

RA

tIO

N

3 3


C e N t R e F A C u l t y A N D s t A F F

Jane Griffiths, Assistant [email protected]

Glenn Brown, head, Department ofFamily medicine , Associate [email protected]

David Barber, CPCssN RegionalNetwork Director, Assistant [email protected]

Ian Casson, Associate [email protected]

Patrick esperanzate, Assistant [email protected]

meg Gemmill, Assistant [email protected]

liz Grier, Assistant [email protected]

Nancy Dalgarno, education Researcherand [email protected]

Ce

Nt

Re

AD

mIN

Ist

RA

tIO

N

3 4


susan macDonald, Associate [email protected]

Geoff hodgetts, [email protected]

shahriar Khan, senior Data [email protected]

lorne Kinsella, local Data [email protected]

Kelly howse, Assistant [email protected]


Karen hall Barber, Associate [email protected]

han han, Research [email protected]

Ce

Nt

Re

AD

mIN

Ist

RA

tIO

N

3 5

Jyoti Kotecha, Adjunct [email protected]


mary martin, Research [email protected]

Rachael morkem, Research [email protected]

susan Phillips, [email protected]

emily Pollock, Research [email protected]

eva Purkey, Assistant [email protected]

John Queenan, [email protected]


Ken martin, Information technologyand Data [email protected]

David macPherson, Assistant [email protected]

Ce

Nt

Re

AD

mIN

Ist

RA

tIO

N

3 6


Fred Zeltser, Research [email protected]

michael ward, Assistant [email protected]

Robert webster, Assistant [email protected]

Ruth wilson, [email protected]

Brent wolfrom, Assistant [email protected]

C e N t R e F A C u l t y A N D s t A F F missing: Benedict Chan, Assistant [email protected]

shayna watsonAssistant [email protected]

Karen schultz, Associate [email protected]

Cathy vakil, Assistant [email protected]

Ce

Nt

Re

AD

mIN

Ist

RA

tIO

N

3 7

walter Rosser, Professor [email protected]


This has been a busy year for publications and conferencepresentations. Thirty-four peer-reviewed articles were publishedthrough the work of the CSPC, including three resident

publications. Forty-eight oral or poster presentations were presented at national and international research conferences. Details of thesepublications and presentation can be found below.

Publications:

Adibi F, Leung L. The obvious versus not so obvious. J Fam Med 2015;12(5):1038

Barber D, Williamson T, Biro S, Hall Barber K, Martin D, Kinsella L,2Morkem R. Data Discipline in electronic medical records: Improvingsmoking status documentation with a standardized intake tool andprocess. Canadian Family Physician. 2015 December; 61:e570-e575

Birtwhistle R, Barber D, Drummond N, Godwin M, Greiver M, Singer3A, Lussier MT, Manca D, Natarajan N, Terry A, Wong S, Martin RE,Mangin D. Horses and buggies have some advantages over cars, butno one is turning back. Can Fam Physician 2015;61(5):416-9. Birtwhistle R, Godwin M, Leggett JA, Martin K. Linking health4databases for research. Can Fam Physician 2015; 61(4):382.

Bosma R, Mojarad E, Leung L, Pukall C, Staud R, Stroman P. Neural5correlates of temporal summation of second pain in the humanbrainstem and spinal cord. Hum Brain Mapp 2015 Dec; 36(12):5038-50. doi: 10.1002/hbm.22993 Brown G, Park K, Bicknell RT. Management of occupational shoulder6

injuries in primary care. J Musculoskelet Disord Treat 2015 Sept 25;1:1.

Davidson C, Pulver A, Parpia A, Purkey E, Pickett W. Nonmedical use7of prescription opiods and injury risk among youth. Journal of Childand Adolescent Substance Abuse. [In press] Frank C, Wilson CR. Models of primary care for frail patients. Can Fam8Physician 2015; 61(7): 601-6. Griffiths J, Luhanga U, McEwen L A, Schultz K, and Dalgarno N.9(Accepted). Promoting quality feedback: A tool for reviewingfeedback given to learners by teachers. Can FamPhysician. Guedes DT, Alvarado BE, Phillips SP, Curcio CL, Zunzunegui MV,10Guerra RO. Socioeconomic status, social relations and domesticviolence against elderly people in Canada, Albania, Colombia andBrazil. Arch of Gerontol Geriatr 2015; 60(3):492-500. doi:10.1016/j.archger.2015.01.010

Hall Barber K, Schultz K, Scott A, Pollock E, Kotecha J, Martin D.11Teaching quality improvement in graduate medical education: anexperiential and team-based approach to the acquisition of qualityimprovement competencies. Acad Med 2015; 90(10): 1363-7. Jain S, Ward MA. HDL and its role in cardiovascular disease: a primary12care perspective. J Fam Med Community Health 2015 June;2(3):1037. Keshavjee K, Williamson T, Martin K, Truant R, Aliarzadeh B, Ghany A,13Greiver M. Getting to usable EMR data. Can Fam Physician 2014Apr;60(4): 392.

P u B l I C A t I O N s A N D P R e s e N t A t I O N s

Pu

Bl

ICA

tIO

Ns

AN

D P

Re

se

Nt

At

ION

s

3 8


Kotecha J, Han H, Green M, Russell G, Martin MI, Birtwhistle R. The14role of the practice facilitators in Ontario primary healthcarequality improvement. BMC Fam Pract 2015 July;16:93. doi:10.1186/s12875-015-0298-6Leung L, Han H, Martin M, Kotecha J. Mindfulness-based stress15reduction (MBSR) as sole intervention for non-somatisation chronicnon-cancer pain (CNCP): protocol for a systematic review andmeta-analysis of randomized controlled trials. MBJ Open2015;5:e007650. DOI: 10.1136/bmjopen-2015-007650.Leung LK, Harding J. A chemical mixer with dark-green nails. BMJ16Case Rep 2015 June; 2015. doi:10.1136/bcr-2014-209203.McColl MA, Aiken A, Smith K, McColl A, Green M, Godwin M,17Birtwhistle R, Norman K, Brankston G, Schaub M. ActionableNuggests: Knowledge translation tool for the needs of patientswith spinal cord injury. Can Fam Physician 2015;61:e240-e248.McEwen LA, Griffiths J, Schultz K. Developing and successfully18implementing a competency-based portfolio assessment system ina postgraduate family medicine residency program. Acad Med2015;90(11):1515-26.Miszkurka M, Steensma C, Phillips SP. Correlates of partner and19family violence among older Canadians: a lifecourse approach.Health Promotion and Chronic Disease Prevention in Canada 2015;(in press)Morkem R, Barber D, Williamson T, Patten S. A Canadian Primary20Care Sentinel Serveillance Network Study Evaluating

Antidepressant Prescribing in Canada from 2006 to 2012. CanadianJournal of Psychiatry. 2015 December; 60(12):564-570Patricio AC, Zunzunegui MV, Li A, Phillips SP, Guralnik J, Guerra R.21Association between C-reactive protein and physical performancein older populations: Results from the International Mobility inAging Study (IMIAS). Age Ageing 2016; 45(2):274-80. doi:10.1093/ageing/afv202.Phillips SP, Carver L. Early parental Loss and self-rated health of22older women and men: a population-based, multi-country study.PLoS ONE 2015; 10(4): e0120762.doi:10.1371/journal.pone.0120762.Phillips SP, Hamberg K. Women’s relative immunity to the socio-23economic health gradient: artifact or real? Glob Health Action 2015May;8:27259.Phillips SP, Hamberg K. Doubly blind: a systematic review of gender24in randomized controlled trials. Glob Health Action 2015 May;8:27259. doi: 10.3402/gha.v8.27259. Phillips SP, Swift SA. Therapeutic abortion counseling and25provision: are Canadian educational institutions opting out? CanFam Physician 2016; epub ahead of print.Queenan JA, Williamson T, Khan S, Drummond N, Garies S, Morkem26R, Birtwhistle. Representativeness of patients and providers in theCanadian Primary Care Sentinel Surveillance Network: a corss-sectional study. CMAJ Open 2016 Jan;4(1):E28-E32Ranger NS, Ward MA. A Comparison of the direct oral27


Pu

Bl

ICA

tIO

Ns

AN

D P

Re

se

Nt

At

ION

s

3 9



anticoagulants in treatment of acute deep vein thrombosis forprimary care physicians. J Family Med Community Health2015;2(2):1032.Sacks J, Valin S, Casson RI, Wilson CR. Are 2 heads better than 1?28Perspectives on job sharing in academic family medicine. Can FamPhysician 2015;61(1):11-13.Schultz K, Griffiths J. Implementing competency-based medical29education in a postgraduate family medicine residency trainingprogram: a stepwise approach, facilitating factors and processes orsteps that would have been helpful. Acad Med 2015. Epub ahead ofprint.Schultz K, Griffiths J, Lacasse M. A practical application of30entrustable professional activities to inform competency decisionsin a family medicine training program. Acad Med 2015; 90(7):888-97.Schultz K, Griffiths J, McEwen L. Applying Kolb’s Learning Cycle to31competency-based residency education. Acad Med 2016; 91(2):284.Sethi A, Hughes P. Celiac disease and attention deficit hyperactivity32disorder: a systematic review of the literature. J Fam MedCommunity Health 2015;2(8): 1069.Squissato V, Brown G, Baxter S. Get out of scrape! An approach to33corneal foreign bodies and abrasions for the primary care

physician. Occup Med Health Aff 2015;3:3.Wolfrom B, Hodgetts G, Kotecha J, Pollock E, Han H, Martin M,34Morrisette P. (Accepted). Satisfaction with civilian family medicineresidency training: Perspectives from serving General Duty MedicalOfficers in the Canadian Armed Forces. Can Fam Physician.

Presentations:

Barber D, Morkem R, Queenan J, Zeltser F. Using trends in HbA1c1test results to predict diabetes onset. Poster session presented at:NAPCRG Annual Meeting; 2015 Oct 24-28; Cancun, Mexico. Barber D, Morkem R, Queenan J, Janssen I, Kotecha J, Zeltser F. The2Role of antibiotic administration on childhood weight. Paperpresented at: NAPCRG Annual Meeting; 2015 Oct 24-28; Cancun,Mexico. Birtwhistle R, Glazier R, Green M, Dahrouge S, Martin K, Barber D,3Terry A, Greiver M, Frymire E. Lessons learned in linking an EMRwith health administration data: The case of ICES and CPCSSN.Poster session presented at: NAPCRG Annual Meeting; 2015 Oct 24-28; Cancun, Mexico. Birtwhistle R, Green M, Dahrouge S, Frymire E, Terry A, Barber D,4Greiver M, Glazier R. Linking electronic medical records withadministrative data: Diabetic control and hospital and emergency

Pu

Bl

ICA

tIO

Ns

AN

D P

Re

se

Nt

At

ION

s

4 0



room utilization. Poster session presented at: NAPCRG AnnualMeeting; 2015 Oct 24-28; Cancun, Mexico. Birtwhistle R, Green ME, Glazier RH, Dahrouge S, Greiver M, Barber5D, Martin K, Terry A, Chiarella L, Frymire E. Lessons learned inlinking an EMR with health administration data: the case of ICESand CPCSSN. Poster session presented at: NAPCRG Annualmeeting; 2015 Oct 24-28; Cancun, Mexico. Birtwhistle R, Green ME, Glazier RH, Dahrouge S, Greiver M, Barber6D, Martin K, Terry A, Frymire E. Linking Electronic Medical recordswith administrative data: diabetic control and hospital andemergency room utilization. Poster session presented at: NAPCRGAnnual meeting; 2015 Oct 24-28; Cancun, Mexico Birtwhistle R, Green ME, Glazier RH, Dahrouge S, Greiver M, Barber7D, Martin K, Terry A, Frymire E. Linking electronic medical recordswith administrative data: diabetic control and hospital andemergency room utilization. Poster session presented at: TrilliumAnnual Conference; 2015 Jun 20; Toronto, Ontario. Brown G, Laughlin B, Blaney B, Smythe J, Zeltser F. Assessing the8impact of incorporating self-compassion training into cognitive-behavioral therapy groups for adolescents with anxiety disorders.Poster session presented at: NAPCRG Annual Meeting; 2015 Oct 24-28; Cancun, Mexico.

Casson I, Gemmill M, Grier E, Green L. Using EMR tools to improve9the primary care of adults with developmental disabilities. Paperpresented at: Family Medicine Forum; 2015 Nov 11-14; Toronto,Ontario. Craig, W., Cummings, J., & Dalgarno, N. Scaffolding, social10architecture, and classroom management to address bullying andvictimization. Full day workshop presented at: PromotingRelationships and Eliminating Violence (PrevNET); 2015 Nov;Toronto, Ontario, CA.Dahrouge S, Rolfe D, Muldoon L, Kotecha J, Birtwhistle R, Barber D,11Dolovich L, Liddy C, Kaczorowski J. Using automated, regularlyextracted electronic medical record (EMR) data for interventionresearch. Presented at: Family Medicine Forum; 2015 Nov 11-14;Toronto, Ontario. Dahrouge S, Muldoon L, Heale R, Green M, Tranmer J, Howard M,12Mark A, Taljaard M, Brown J, Johnston S, Agarwal G. Creatingmeaningful composite scores for primary care. Poster sessionpresented at: NAPCRG Annual Meeting; 2015 Oct 24-28; Cancun,Mexico. Dahrouge S, Rolfe D, Muldoon L, Kaczorowski J, Dolovich L, Liddy C,13Kotecha J, Barber D. Optimizing the reach of population-basedcardiovascular awareness interventions. Poster session presented

Pu

Bl

ICA

tIO

Ns

AN

D P

Re

se

Nt

At

ION

s

4 1



at: NAPCRG Annual Meeting; 2015 Oct 24-28; Cancun, Mexico. Donnelly C, Boudreau ML, Garand I, Mitchell B, Letts L. Falls14screening in primary care: The missing link. Poster sessionpresented at: NAPCRG Annual Meeting; 2015 Oct 24-28; Cancun,Mexico. Donnelly C, Watson S, Brander R, O’Riordan A, Murphy S, Chapman15C. Compassionate collaborative primary care. Poster sessionpresented at: NAPCRG Annual Meeting; 2015 Oct 24-28; Cancun,Mexico. Gemmill M, Grier E, Bobbette N, Martin M, Casson I. Family16physician and allied health provider attitudes and perceptions ofthe identification of adults with suspected mild intellectualdisability. Poster session presented at: NAPCRG Annual Meeting;2015 Oct 24-28;Cancun, Mexico. Gozdyra P, Glazier R, Dahrouge S, Green M, Frymire E, Muldoon L,17Tranmer J. Geographic availability, proximity and accessibility toprimary care (PC) doctors - review and application of methods.Workshop at: NAPCRG Annual Meeting; 2015 Oct 24-58; Cancun,Mexico. Guedes D, Alvarado B, Phillips SP, CL Curcio, Zunzunegui MV,18Guerra RO. Socioeconomic status, social support and domesticviolence against elderly people in Canada, Albania, Colombia and

Brazil. Workshop at: American Gerontological Society AnnualConference; 2015 Nov 18-22; Orlando, FL. Han H, Martin M, Van-Melle E, Schultz K, Griffiths J, Hodgetts G.19From family medicine residency to independent practice: How aretransitions experienced? Poster session presented at: NAPCRGAnnual Meeting; 2015 Oct 24-28; Cancun, Mexico. Kotecha J, Lévesque L, Martin M, Viaznikova T. Patient perspectives20of the importance of physical activity counselling in primary caresettings. Poster session presented at: NAPCRG Annual Meeting;2015 Oct 24-28; Cancun, Mexico.Kotecha J, Martin M, Han H, MacLaren S, Christie E, Green M,21Birtwhistle R. Cost to provide allied healthcare to patients in a ruralHospital-at-Home demonstration program in Prince EdwardCounty, Ontario, Canada. Poster session presented at: NAPCRGAnnual Meeting; 2015 October 24-28; Cancun, Mexico.Kotecha J, Phillips S, Kukkar R, Martin M, Han H, Pollock E.22Connecting seniors to care: Strengthening links through primarycare. A scoping review. Poster session presented at: TrilliumPrimary Health Care Research Day; 2015 June 4; Toronto, Ontario.Leung L. Red and Itchy: How to approach and manage common23skin conditions and avoid pitfalls. Presentation at: Family MedicineForum; 2015 Nov 11-14; Toronto, Ontario.

Pu

Bl

ICA

tIO

Ns

AN

D P

Re

se

Nt

At

ION

s

4 2


Leung L. Fire over ice: In the face of recalcitrant non-genital warts.24Presentation at: Family Medicine Forum; 2015 Nov 11-14; Toronto,Ontario. Leung L. Odd and scary: How to approach and manage unusual25skin conditions and avoid pitfalls. Presentation at: Family MedicineForum; 2015 Nov 11-14; Toronto, Ontario. Martin M, Kotecha J, Han H, MacLaren S, Christie E, Green M,26Birtwhistle R. Cost to provide allied healthcare to patients in a ruralHospital-at-Home demonstration program in Prince EdwardCounty, Ontario, Canada. Poster session presented at: NAPCRGAnnual Meeting; 2015 Oct 24-28; Cancun, Mexico. Morkem R, Barber D, Williamson T, Patten S. Antidepressant27prescribing to children and adolescence in Canadian primary care.Paper presented at: NAPCRG Annual Meeting; 2015 Oct 24-28;Cancun, Mexico. Morkem R, Barber D, Queenan J, Janssen I, Kotecha J, Zeltser F. The28role of antibiotic administration on childhood weight. Paperpresented at: NAPCRG Annual Meeting; 2015 Oct 24-28; Cancun,Mexico. Morkem R, Barber D, Queenan J, Zeltser F. Using Trends in HbA1c29Test Results to Predict Diabetes Onset. Poster session presented at:NAPCRG Annual Meeting; 2015 Oct 24-28; Cancun, Mexico.

Phillips S. Can we correct inequalities via medical practice?30Workshop at: Family Medicine Forum; 2015 Nov 11-14; Toronto,Ontario. . Phillips S, Byrnes M. Continuity of care and hospital utilization – a31new report from CIHI. Paper presented at: Trillium Primary HealthCare Research Day; 2015 June 4; Toronto, Ontario. Phillips S. Death of a parent in childhood and health in old age.32Presented at: Association for Medical Education in Europe; 2015Sept 5-9; Glasgow, UK. Phillips S. Workshop for teachers of IMGs. Workshop at: Family33Medicine Forum; 2015 Nov 11-14; Toronto, Ontario. Phillips S. Psychometric properties and confirmatory analysis of34BEM sex role inventory in an international sample of older adults.Poster session presented at: American Gerontological SocietyAnnual Conference; 2015 Nov 18-22; Orlando, FL. Perez Zepeda MU, Zunzunegui MV, Phillips SP, Ylli A, Guralnik J. Self-35rated health maintains a consistent relationship with physicalperformance across countries. Workshop at: AmericanGerontological Society Annual Conference; 2015 Nov 18-22;Orlando, FL. Purkey E, Patel R, Beckett T, Mathieu F. Trauma-informed care: why36it matters for you and your patients. Paper presented at: Family

Pu

Bl

ICA

tIO

Ns

AN

D P

Re

se

Nt

At

ION

s

4 3


Medicine Forum; 2015 Nov 11-14; Toronto, Ontario. Schultz K, Griffiths J. Implementing competency based medical37education. Workshop at: Association for Medical Education inEurope; 2015 Sept 5-9; Glasgow, UK. Schultz K., Griffiths J. Transforming your program to be38competency-based: An interactive workshop to explore strategiesand solutions. Workshop at: Association for Medical Education inEurope; 2015 Sept 5-9; Glasgow, UK. Schultz K., Griffiths J. Transforming your program to be39competency-based: An interactive workshop to explore strategiesand solutions. Workshop at: International Conference on ResidencyEducation. 2015 Oct 22-24; Vancouver, British Columbia. Sousa ACP, Guerra RO, Tu MT, Phillips SP, Guralnik J, Zunzunegui40MV. Lifecourse adversity and physical performance across countriesamong men and women aged 65-74. Workshop at: AmericanGerontological Society Annual Conference; 2015 Nov 18-22;Orlando, FL. Sousa ACP, Zunzunegui MV, Li A, Phillips SP, Gomez JF, Guralnik J,41Guerra RO. C reactive protein and physical performance in elderlypopulations: Results from the IMIAS Study. Workshop at: AmericanGerontological Society Annual Conference; 2015 Nov 18-22;Orlando, FL. Vakil C. Radiation and health. Paper presented at: World Uranium42Symposium; 2015 Apr 14-16; Quebec City, Quebec.

Vance L, Howse K. Personal healthcare practices in residency: A43cross-sectional survey. Poster session presented at: FamilyMedicine Forum; 2015 Nov 11-14; Toronto, Ontario. Van Melle, E., & Dalgarno, N. Family medicine residents’ perceptions44of patient-centred care: Is it time to make the implicit explicit?Workshop presented at: Family Medicine Forum; 2015 Nov 11-14;Toronto, Ontario, CA. Webster R, Chapman C. The implementation and impact of Health45Links. Paper presented at: Health Quality Transformation; 2015 Oct14; Toronto, Ontario. Webster R, Chapman C, Page-Brown J. The Collective46implementation an impact of Health Links: A formative evaluationof the South East Local Health Integration Network Health Links.Poster session presented at: South East LHIN Primary Health CareForum; 2015 Sept 22; Kingston, Ontario. Wolfrom B, Hodgetts G, Pollock E, Martin M, Han H, Kotecha J.47Satisfaction of military family medicine practitioners with familymedicine residency training. Poster session presented at: NAPCRGAnnual Meeting; 2015 Oct 24-28; Cancun, Mexico. Wolfrom B, Pollock E, MacPherson D, Sauerbrei E, Kotecha J.48Introducing diagnostic ultrasound in an academic family healthteam. Poster session presented at: NAPCRG Annual Meeting; 2015Oct 24-28; Cancun, Mexico.

Pu

Bl

ICA

tIO

Ns

AN

D P

Re

se

Nt

At

ION

s

4 4

Department of Family Medicine Queen’s University 220 Bagot Street Kingston, Ontario k7l 5e9 613.533.6000 x 73934

16-011

8 Queen’sUniversity

Marke

ting

queensu.ca/cspc

Documents

Centre for Studies in Primary Care ANNUAL · PDF fileCentre for Studies in Primary Care ANNUAL REPORT ... (KtI) sta ﬀ Admin staﬀ 19 ... Monitoring and Evaluation of Neonatal Hepatitis