Factors associated with plans for early retirement among Ontario family physicians during the COVID-19 pandemic: a cross-sectional study.

BACKGROUND: Higher numbers of family physicians (FPs) stopped practicing or retired during the COVID-19 pandemic, worsening the family doctor shortage in Canada. Our study objective was to determine which factors were associated with FPs' plans to retire earlier during the COVID-19 pandemic. METHODS: We administered two cross-sectional online surveys to Ontario FPs asking whether they were "planning to retire earlier" as a result of the pandemic during the first and third COVID-19 pandemic waves (Apr-Jun 2020 and Mar-Jul 2021). We used logistic regression to determine which factors were associated with early retirement planning, adjusting for age. RESULTS: The age-adjusted proportion of FP respondents planning to retire earlier was 8.2% (of 393) in the first-wave and 20.5% (of 454) in the third-wave. Planning for earlier retirement during the third-wave was associated with age over 50 years (50-59 years odds ratio (OR) 5.37 (95% confidence interval (CI):2.33-12.31), 60 years and above OR 4.18 (95% CI: 1.90-10.23)), having difficulty handling increased non-clinical responsibilities (OR 2.95 (95% CI: 1.79-4.94)), feeling unsupported to work virtually (OR 1.96 (95% CI: 1.19-3.23)) or in-person (OR 2.70 (95% CI: 1.67-4.55)), feeling unable to provide good care (OR 1.82 (95% CI: 1.10-3.03)), feeling work was not valued (OR 1.92 (95% CI: 1.15-3.23)), feeling frightened of dealing with COVID-19 (OR 2.01 (95% CI: 1.19-3.38)), caring for an elderly relative (OR 2.36 (95% CI: 1.69-3.97)), having difficulty obtaining personal protective equipment (OR 2.00 (95% CI: 1.16-3.43)) or difficulty implementing infection control practices in clinic (OR 2.10 (95% CI: 1.12-3.89)). CONCLUSIONS: Over 20% of Ontario FP respondents were considering retiring earlier by the third-wave of the COVID-19 pandemic. Supporting FPs in their clinical and non-clinical roles, such that they feel able to provide good care and that their work is valued, reducing non-clinical (e.g., administrative) responsibilities, dealing with pandemic-related fears, and supporting infection control practices and personal protective equipment acquisition in clinic, particularly in those aged 50 years or older may help increase family physician retention during future pandemics.

The prevalence of documented cardiovascular-related pregnancy complications: cross-sectional study in an academic primary care centre.

BACKGROUND: Pregnancy and the postpartum period offer a unique opportunity to identify patients with risk factors leading to premature cardiovascular disease (CVD), which often go unrecognised. AIM: This study investigates self-reported prevalence of CVD-related pregnancy complications and its documentation in electronic medical records (EMRs) in an academic family health team (AFHT). DESIGN & SETTING: A retrospective cross-sectional survey conducted from 2016 to 2017 in an AFHT. METHOD: The survey assessed self-reported pregnancy complications and obstetric histories of adult females. EMRs of responders who provided consent were appraised for documented pregnancy complications, and management of traditional cardiovascular risk factors post-pregnancy. RESULTS: Out of 211 responders, 28% (n = 60) had at least one pregnancy complication reported in the survey and/or in the EMR, of which 67% (n = 40) had the complication documented in their EMR. The most prevalent complications were preterm birth (PTB; 12%, n = 25), hypertensive disorders of pregnancy (HDP; 10%, n = 22), and gestational diabetes mellitus (GDM; 7%, n = 14). Twenty-nine per cent (n = 4) of the patients with GDM had a 75 g oral glucose tolerance test result documented post-pregnancy. Of those with HDP, 36% (n = 8) had body mass index and 50% (n = 11) had a blood pressure measurement recorded after delivery. CONCLUSION: There has been a significant lack of documentation of pregnancy-related cardiovascular risk factors and subsequent management, introducing a missed opportunity for early cardiovascular intervention. Adequate documentation of pregnancy complications in the EMR and better transitions in care between obstetric and primary care teams could potentially enable clinicians to intervene early and better manage females at increased risk of CVD.

Improving the Management of Terminal Delirium at the End of Life.

OBJECTIVE: Terminal delirium is a distressing process that occurs in the dying phase, often misdiagnosed and undertreated. A hospital developed the "comfort measures order set" for dying patients receiving comfort care in the final 72 h of life. A chart review of patients experiencing terminal delirium revealed that the current medication option initially included in the order set was suboptimally effective and patients with terminal delirium were consistently undertreated. The purpose of this pilot study was to highlight an in-service intervention educating nurses on the management of terminal delirium at the end of life and to assess its effect on their knowledge of the management of patients with terminal delirium. METHODS: A before-and-after survey design was used to assess the effect of the in-service training on nurses' knowledge of terminal delirium. RESULTS: We describe the results from a small sample of nurses at a large urban tertiary care center in Canada. Of the twenty nurses who attended the in-services, 60% had cared for a patient with terminal delirium; however, 50% felt that their knowledge of the topic was inadequate. Despite no statistical significance between the pre- and posttest scores for both the oncology and the medicine unit nurses, all participants who completed posttest survey found the in-services useful. CONCLUSIONS: The findings from this study provide initial insights into the importance of in-service trainings to improve the end-of-life care and nursing practice. Future research will include expanding this pilot project with sufficient power to assess the significance of these types of interventions.