Canadian family physician knowledge and attitudes toward laboratory utilization management.

OBJECTIVES: Mitigation of unnecessary and redundant laboratory testing is an important quality assurance priority for laboratories and represents an opportunity for cost savings in the health care system. Family physicians represent the largest utilizers of laboratory testing by a large margin. Engagement of family physicians is therefore key to any laboratory utilization management initiatives. Despite this, family physicians have been largely excluded from the planning and implementation of such initiatives. Our purposes were to (1) assess the importance of lab management issues to family physicians, and (2) attempt to define the types of initiatives most acceptable to family physicians. DESIGN AND METHODS: We invited all Alberta family practice residents and practicing physicians to participate in a self-administered online electronic survey. Survey questions addressed the perceived importance of lab misutilization, prevalence of various types of misutilization, acceptability of specific approaches to quality control, and responsibility of various parties to address this issue. RESULTS: Of 162 respondents, 95% considered lab misutilization to be either important or very important. Many physicians placed the responsibility for addressing lab misutilization issues on multiple parties, including patients, but most commonly the ordering physician (97%). Acceptability for common strategies for quality improvement in lab misutilization showed a wide range (35%-98%). CONCLUSIONS: These responses could serve as a framework for laboratories to begin discussions on this important topic with primary care groups.

The occasional removal of an ingrowing toenail.

The ingrowing toenail is a painful foot condition that can be treated by most rural physicians. If it is not too severe, conservative management can be initiated first. If the situation is not improving or is worsening, removal of the nail plate with destruction of the nail matrix, by either surgical or chemical matricectomy, is indicated. Neither matricectomy technique is particularly complicated. Quick healing, minimal postoperative morbidity, high success rates and cosmetically acceptable results are the rule. Risks associated with the procedure include infection, chronic ulcer formation, pain, prolonged healing, irregular nail regrowth and recurrence. Patients should be aware of these risks before the matricectomy is performed.

Understanding relationships between diabetes mellitus and health-related quality of life in a rural community.

INTRODUCTION: There is a lack of information on health-related quality of life (HRQOL) for Aboriginal diabetic people. OBJECTIVE: To investigate HRQOL among aboriginal diabetics living in an isolated, rural Canadian community. DESIGN: Mixed methods: (1) A mailed health-related survey; and (2) a population based retrospective chart review. STUDY POPULATION: People aged 17 years and older living in the Bella Coola Valley, British Columbia, Canada, and having a chart at the Bella Coola Medical Clinic as of September 2001 were asked to complete a detailed HRQOL survey during the period August to December 2001. MAIN OUTCOME MEASURES: Demographics (age, sex, ethnicity). Health-related quality of life was measured using the MOS 36-item Short Form Health Survey (SF-36), and the US Centers for Disease Control healthy day's items. RESULTS: Relatively greater percentages of diabetic people (n = 72 [57%]) completed the survey than did non-diabetics (n = 675 [37%]). Mean scores for Aboriginal people were lower/poorer than mean scores for non-Aboriginal people in all the quality of life questions. Mean scores for diabetic people were lower than mean scores for non-diabetics in all the quality of life questions. Aboriginal diabetics reported the worst scores on almost all of our quality of life questions. CONCLUSION: Rural diabetics experience significant impairment in their health-related quality of life. Among rural diabetics, Aboriginals report the worst HRQOL scores. Compared with other people, Aboriginals fare worse in HRQOL, which may explain the difference.