Background
While quitting smoking dramatically decreases overall mortality, general practitioners (GPs) are less likely to prescribe medications for smoking cessation than other cardiovascular risk factors. Guidelines recommend providers first assess patients’ “readiness” to quit, an “opt-in” strategy, but only a minority of tobacco users are ready to quit on a given day. An “opt-out” strategy offering treatment as the default choice increased quit attempts in hospital and with pregnant women, but has not been tested in primary care. We will assess the efficacy of training GPs to offer treatment as the default choice using an encounter decision aid with current smokers seen in primary care.

Methods
This is a pragmatic cluster-randomized controlled superiority trial with block randomization at the GP level in private practice in French-speaking Switzerland. GPs will be blinded to the arm allocation. The intervention is a half-day training course teaching an ‘opt-out’ approach to smoking cessation using an encounter decision aid (paper or electronic). GPs in the enhanced usual care group receives a brief refresher training about smoking cessation without changing their behaviour. GPs in both arms will recruit 23 patients each prior to routine primary care visits. The primary outcome is the effect of consulting a GP who received the intervention on the 7-day, point prevalence, smoking abstinence 6 months after the baseline appointment. Secondary outcomes include continuous abstinence; number of quit attempts; use of smoking cessation aids; patient-perceived involvement in discussions; and changes in GP behaviour. Patient outcomes will be collected using paper and telephone questionnaires. Assuming 15% drop-out, recruiting 46 GPs with 23 patients each will give us 80% power to detect an increase in smoking cessation from 4% (control) to 10.5% (intervention), with an alpha < 0.05.

Discussion
GP visits are an opportunity to administer proven smoking cessation treatments. We hypothesize GPs offering smoking cessation treatment as the default choice using an encounter decision aid will increase the number of patients who quit. This study could significantly change our approach to smoking cessation in primary care. Default choices and the electronic decision aid are low-cost, easily diffusible interventions.

Trial registration
ClinicalTrials.gov Identifier: NCT04868474, First Posted May 3, 2021, Last Update Posted October 6, 2021.

Objective To develop a framework of population-based primary care quality indicators adapted to patients with dementia and to identify a subset of stakeholder-driven priority indicators.

Design Framework development was carried out through the selection of an initial framework based on a rapid review and identification of relevant indicators and enrichment based on existing dementia indicators and guidelines. Prioritization of indicators was carried out through a stakeholder survey.

Setting Ontario, Quebec, New Brunswick, and Saskatchewan.

Participants Stakeholders in community dementia care (N=109) including clinicians, patients, caregivers, decision makers, and managers.

Main outcome measures Primary care quality indicators.

Results The framework comprised 34 indicators across 8 domains of quality (access, integration, effective care, efficient care, equity, safety, population health, and patient-centred care). Access to a regular primary care provider, continuity of care, early-stage diagnosis, and access to home care were consistently rated as priorities. Equitable care was a specific priority among patients and caregivers; clinicians reported avoidable hospitalizations as among their priorities.

Conclusion A framework of indicators was established for persons with dementia that adds an important dimension to existing primary care and dementia quality indicators by providing primary care and population-based perspectives. This framework could set a foundation for the ongoing monitoring of primary care practices and policies for persons with dementia at a population level.

Dementia, including Alzheimer disease, has been recognized by the World Health Organization as a global public health crisis.1,2 Half a million Canadians live with dementia, a number expected to double over the next generation.3 Moreover, more than 60% of persons with dementia live at home and are cared for in the community.4 There is growing consensus in Canada and elsewhere that family physicians, with the support of other health care professionals, are ideally positioned to provide a person-centred approach with respect to the prevention of dementia and to the diagnosis, treatment, and follow-up of most persons with dementia.5-9 Given the growing role of primary care in the care of the population with dementia, it is essential to monitor and evaluate ongoing quality initiatives or policy interventions aimed at improving the quality of care of persons with dementia in primary care. Quality indicators that align with stakeholders’ needs and can be measured routinely using readily available sources are necessary to ensure feedback and improvement are continuous and decision making is efficient and timely.10,11

Within the primary care literature, several general frameworks have been proposed to measure the quality of primary care.12-14 However, it is unclear whether these frameworks are applicable or appropriate for persons with dementia; incorporate indicators relevant to dementia and of importance to stakeholders; and have indicators that can be measured using routinely collected data such as health administrative data. In addition, within the dementia literature, work on indicators has focused on clinical processes of care assessed primarily through chart review.15-19 While these indicators provide an essential component of the evaluation of the quality of care provided to patients with dementia, they cannot easily be measured routinely.

This study aimed to develop a framework of primary care quality indicators for persons with dementia based on health administrative data and to identify stakeholder-relevant priority indicators for ongoing quality monitoring in this population.

Background and Objectives: The use of telehealth has risen dramatically due to the Covid-19 pandemic and is expected to be a regular part of patient care moving forward. We know little currently about how satisfied physicians are with this type of patient care. The present systematic review examines physician satisfaction with telehealth, as physician acceptance remains vital to telehealth gaining wider and more permanent adoption.

Methods: A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-guided systematic review of empirical articles published between 2010 and 2020 that contain a finding examining physician satisfaction with using telehealth, using 4 article databases (PubMed, Web of Science, COCHRANE, and CINAHL), to identify relevant studies. A standardized data abstraction Excel sheet was used to extract relevant information from each of the included studies. Relevant study findings related to physician satisfaction with telehealth were reviewed for each of the 37 studies by the coauthors.

Results: A total of 37 published studies were included in the review. Thirty-three of the 37 (89%) studies reviewed were classified as having findings showing moderate to high levels of physician satisfaction with telehealth. Just under 60% of the studies focused on physician satisfaction with providing telemedicine to patients (21/37). Twelve other studies focused on physician satisfaction with teleconsultations with other providers. Four studies examined physician satisfaction with both. The type of patient telemedicine or provider teleconsultation performed varied greatly across the 37 studies, with several different diagnoses or care situations included. Research designs used in the studies were less robust, with all studies using primary data for assessing physician satisfaction but only one study providing any type of multivariate analysis of physician satisfaction with telehealth.

Conclusion: The results of this review support the observation that physicians across different specialties, geographic locations, practice locations, and care situations appear satisfied with engaging in telehealth for both patient care and consultations with other physicians. The research on telehealth should be enhanced, given how ubiquitous telehealth has become due to the Covid-19 pandemic. This enhancement should include larger physician sample sizes in studies of telehealth satisfaction; more research focused on telehealth in the primary care setting; and the types of virtual modalities that have become more commonplace for physicians to use due to the Covid-19 pandemic.

guidelines and recommendations for the most common outpatient conditions - from sources you can trust!

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Presque tous les cas de cancer du col (CC) sont causés par une infection persistante au virus du papillome humain (VPH). Le cancer du col est le deuxième carcinome en importance chez les femmes; malgré tout, les taux de dépistage pour le Canada en 2017 ont raté l’objectif par 19 %. On a, par exemple, observé des taux aussi bas que 57,6 % dans les quartiers défavorisés de l’Ontario, comparativement à 70 % dans les quartiers aisés. Des obstacles complexes et multifactoriels nuisent à la participation des femmes au dépistage du cancer du col (DCC). Les écueils les plus courants sont directement liés aux disparités dans les déterminants de santé, notamment l’appartenance à une minorité ethnique, le faible statut socio-économique, une moins grande éducation, et la difficulté d’accès aux soins de santé. Les infirmières praticiennes (IP) peuvent aplanir ces obstacles en prodiguant des soins d’avant-garde, fondés sur la recherche, respectueux de la culture et attentifs aux besoins des femmes tout en établissant des liens de confiance avec les patientes, jouant ainsi un rôle plus vaste dans la prévention de la maladie. L’objectif de la présente revue de littérature est de résumer les contraintes au DCC et le rôle que peuvent jouer les IP canadiennes pour les alléger.

Introduction : La rétention des professionnels de la santé (PS) dans le réseau de la santé durant une pandémie telle que celle de la COVID-19 est un enjeu crucial. Mieux comprendre les facteurs pouvant motiver ou dissuader les PS de fournir des soins aux personnes atteintes de la COVID-19 permettrait la mise en place de mesures favorisant le maintien et la qualité des soins.
Objectif : Cette étude vise à identifier les facteurs modulant l’intention des PS à éviter de prendre soin de personnes atteintes de la COVID-19.
Méthode : Les PS du Québec (Canada) ont été invités à répondre à un questionnaire en ligne, entre les mois d’avril et août 2020, durant la première vague de la pandémie de la COVID-19 dans ce pays. Ce questionnaire portait sur leur intention de prendre soin des personnes atteintes de la COVID-19, leur expérience dans la prise en charge de tels patients et leur niveau d’anxiété par rapport à la pandémie. Des analyses statistiques descriptives et des régressions multiples ont été réalisées afin de déterminer si certains PS présentaient un profil différent en regard de l’intention d’éviter de prendre soin d’une personne atteinte de la COVID-19.
Résultats : Un total de 430 PS ont répondu au questionnaire. Les PS étaient en majorité des femmes (87 %) et des infirmières (50 %). De ce nombre, certains ont dit avoir pensé (12 %) ou avoir pris des mesures (5 %) pour se soustraire à l’administration de soins aux personnes atteintes de la COVID-19. Dix-huit pour cent ont dit être prêts à saisir une occasion qui leur permettrait de ne pas prendre soin de tels patients. Être médecin (RC : 0,47 IC 0,23-0,94) et avoir antérieurement prodigué des soins à des personnes atteintes de la COVID-19 (RC : 0,56 IC 0,36-0,86) étaient significativement associés à une intention moindre d’éviter de prendre soin de personnes atteintes de la COVID-19. Une plus grande intention d’éviter de travailler avec de tels patients a été associée positivement avec l’augmentation du score d’anxiété des PS (RC : 1,06 IC 1,04-1,08).
Conclusion : Avoir antérieurement prodigué des soins à une personne atteinte de la COVID-19 et le fait d’être médecin étaient associés à une intention d’évitement moindre à soigner des patients infectés par la COVID-19. L’anxiété représenterait un facteur prédictif de la volonté des PS de se retirer de la prise en charge de personnes atteintes de la COVID-19. L’identification des déterminants de l’anxiété chez les PS et des facteurs pouvant les motiver à fournir des soins aux personnes atteintes de la COVID-19 pourrait permettre l’élaboration de stratégies adaptées visant le bien-être global et la rétention du personnel de santé en temps de pandémie.

Essential Med Notes is a clinical complement and resource for medical trainees. This 37th edition features substantial content revisions to the main text, figures, graphics, and evidence-based medicine boxes of all 31 chapters across the 3 volumes - Primary, Medicine, and Surgery.

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