Practice Facilitation to Support Family Physicians in Encouraging COVID-19 Vaccine Uptake: A Multimethod Process Evaluation.

PURPOSE: We offered a practice facilitation intervention to family physicians in Ontario, Canada, known to have large numbers of patients not yet vaccinated against coronavirus disease 2019 (COVID-19). METHODS: We conducted a multimethod process evaluation embedded within a randomized controlled trial (clinical trial #NCT05099497). We collected descriptive statistics regarding engagement and qualitative interview data from family physicians and practice facilitators, as well as data from facilitator field notes. We analyzed and triangulated the data using thematic analysis and mapped barriers to and enablers for implementation to structural, organizational, physician, and patient factors. RESULTS: Of the 300 approached, 90 family physicians (30%) accepted facilitation. Of these, 57% received technical support to identify unvaccinated patients, 29% used trained medical student volunteers to contact patients on their behalf, and 30% used automated calling to reach patients. Key factors affecting engagement with the intervention were staff shortages owing to COVID-19 (structural), clinic characteristics such as technical issues and gatekeeping by staff, which prevented facilitators from talking with physicians (organizational), burnout (physician), and specialized populations that required targeted resources (patient). The facilitator's ability to address technical issues and connect family physicians with medical students helped with engagement. CONCLUSIONS: Strategies to help underresourced family physicians serving high-needs populations for issues of public health importance, such as vaccine promotion, must acknowledge the scarcity of physicians' time and provide new resources. To successfully engage family physicians, practice facilitators should seek to build trust and relationships over time, including with front-office staff.

Anorectal symptom management in pregnancy: development of a severity scale.

BACKGROUND: Anorectal conditions are very common and under-diagnosed in pregnancy, with severe implications on quality of life. Presently no validated scale is available to quantify the severity of symptoms and their response to therapy. The objective of this study was to create and validate a scale for symptoms associated with anal/rectal conditions. METHODS: Patients attending a colorectal clinic were assessed twice, for severity of anorectal symptoms; once by the new questionnaire-ColoRectal Evaluation of Clinical Therapeutics Scale (CORECTS)--followed by a direct examination by a proctologist. Linear regression analysis was performed to correlate the clinician's and CORECTS scores. In parallel, 209 pregnant women with hemorrhoids were assessed using CORECTS before and after treatment with Proctofoam-HC®. We evaluated whether scores' improvement corresponded to changes in quality of life. RESULTS: There was a significant concordance between each component of the CORECTS scale as well as impact on quality of life, with direct clinical examination of a proctologist. Significant reduction in symptoms, as measured by the scale following use of Proctofoam-HC® highly correlated with changes in quality of life before and after treatment. CONCLUSION: CORECTS is a reliable tool in capturing the severity of symptoms associated with colorectal symptoms in pregnancy and is highly sensitive in detecting changes in symptom severity following treatment.