Public experiences and perspectives of primary care in Canada: results from a cross-sectional survey.

BACKGROUND: Through medicare, residents in Canada are entitled to medically necessary physician services without paying out of pocket, but still many people struggle to access primary care. We conducted a survey to explore people's experience with and priorities for primary care. METHODS: We conducted an online, bilingual survey of adults in Canada in fall 2022. We distributed an anonymous link through diverse channels and a closed link to 122 053 people via a national public opinion firm. We weighted completed responses to mirror Canada's population and adjusted for sociodemographic characteristics using regression models. RESULTS: We analyzed 9279 completed surveys (5.9% response rate via closed link). More than one-fifth of respondents (21.8%) reported having no primary care clinician, and among those who did, 34.5% reported getting a same or next-day appointment for urgent issues. Of respondents, 89.4% expressed comfort seeing another team member if their doctor recommended it, but only 35.9%, 9.5%, and 12.4% reported that their practice had a nurse, social worker, or pharmacist, respectively. The primary care attribute that mattered most was having a clinician who "knows me as a person and considers all the factors that affect my health." After we adjusted for respondent characteristics, people in Quebec, the Atlantic region, and British Columbia had lower odds of reporting a primary care clinician than people in Ontario (adjusted odds ratio 0.30, 0.33, and 0.39, respectively; p < 0.001). We also observed large provincial variations in timely access, interprofessional care, and walk-in clinic use. INTERPRETATION: More than 1 in 5 respondents did not have access to primary care, with large variation by province. Reforms should strive to expand access to relationship-based, longitudinal care in a team setting.

Factors Associated with the Usefulness of Public Health Communication in the Context of COVID-19: Lessons Learned from the African, Caribbean, and Black Communities in Ottawa, Ontario.

Public health communication is critical for promoting behaviours that can prevent the transmission of COVID-19. However, there are concerns about the effectiveness of public health communication within Canada's African, Caribbean, and Black (ACB) communities. In the community sample of ACB people in Ottawa, Ontario, we asked community members if they perceive public health message related to COVID-19 to be effective. Using this question, the current study aimed to explore factors associated with the perceived usefulness of public health messages related to COVID-19. Results from the multivariate analysis have shown that ACB people with lower levels of risk perception for COVID-19 were less likely to perceive that public health messages were useful (OR = 0.405, p < 0.01). In addition, mistrust in government COVID-19 information was also negatively associated with their perception that health messages are useful (OR = 0.169, p < 0.01). For socioeconomic status, ACB people with no high school diploma (OR = 0.362, p < 0.05) and income dissatisfaction (OR = 0.431, p < 0.05) were less likely to report the perceived usefulness compared to those with a bachelor's degree and income satisfaction. Based on these findings, we discussed implications for policymakers and directions for future research.

Lateral versus medial needle approach for ultrasound-guided supraclavicular block: a randomized controlled trial.

BACKGROUND: When performing a supraclavicular brachial plexus block (SCB) under ultrasound (US) guidance, the needle may approach the nerves in-plane with the US beam from 1 of 2 directions relative to the transducer, lateral-to-medial (lateral) or medial-to-lateral (medial). We aimed to compare the rates of sensory and motor block of the 4 major peripheral nerves of the upper extremity following a lateral or medial needle approach for US-guided SCB. METHODS: Eighty adult patients undergoing US-guided SCB for elective hand, wrist, forearm, or elbow procedures were randomized to either a lateral or medial needle approach. A 30-mL local anesthetic admixture (1:1 lidocaine 2%-bupivacaine 0.5% with 1:200,000 epinephrine) was injected to all patients. Sensory and motor function was assessed by a blinded observer at predetermined intervals. The primary outcome was the rate of sensory block in the distribution of the ulnar nerve measured 20 mins after block performance. RESULTS: Seventy-two patients were included in the final analysis. Patient characteristics were similar between groups. The rate of ulnar nerve sensory block at 20 mins was 63% in the lateral group and 62% in the medial group (P = 0.81). The rate of ulnar nerve sensory block at 30 mins increased to 89% in the lateral and 84% in the medial group (P = 0.96). The rates of both sensory and motor block in the distributions of the median, radial, and musculocutaneous nerves were high and did not differ between groups at any measured time interval. The block performance time and the postoperative pain scores were similar between the 2 groups. Complications were minor and transient and did not differ between groups. CONCLUSIONS: The rates of sensory and motor block of all 4 major peripheral nerves of the upper extremity did not differ at any time following a lateral compared with medial needle approach for US-guided SCB. Regardless of needle approach, the rate of ulnar nerve sensory block was less compared with the other peripheral nerves following US-guided SCB.

Ultrasound imaging facilitates spinal anesthesia in adults with difficult surface anatomic landmarks.

BACKGROUND: Poor surface anatomic landmarks are highly predictive of technical difficulty in neuraxial blockade. The authors examined the use of ultrasound imaging to reduce this difficulty. METHODS: The authors recruited 120 orthopedic patients with one of the following: body mass index more than 35 kg/m² and poorly palpable spinous processes; moderate to severe lumbar scoliosis; or previous lumbar spine surgery. Patients were randomized to receive spinal anesthetic by the conventional surface landmark-guided technique (group LM) or by an ultrasound-guided technique (group US). Patients in group US had a preprocedural ultrasound scan to locate and mark a suitable needle insertion point. The primary outcome was the rate of successful dural puncture on the first needle insertion attempt. Normally distributed data were summarized as mean ± SD and nonnormally distributed data were summarized as median [interquartile range]. RESULTS: The first-attempt success rate was twice as high in group US than in group LM (65% vs. 32%; P < 0.001). There was a twofold difference between groups in the number of needle insertion attempts (group US, 1 [1-2] vs. group LM, 2 [1-4]; P < 0.001) and number of needle passes (group US, 6 [1-10] vs. group LM, 13 [5-21]; P = 0.003). More time was required to establish landmarks in group US (6.7 ± 3.1; group LM, 0.6 ± 0.5 min; P < 0.001), but this was partially offset by a shorter spinal anesthesia performance time (group US, 5.0 ± 4.9 vs. group LM, 7.3 ± 7.6 min; P = 0.038). Similar results were seen in subgroup analyses of patients with body mass index more than 35 kg/m and patients with poorly palpable landmarks. CONCLUSION: Preprocedural ultrasound imaging facilitates the performance of spinal anesthesia in the nonobstetric patient population with difficult anatomic landmarks.

Dexamethasone added to mepivacaine prolongs the duration of analgesia after supraclavicular brachial plexus blockade.

BACKGROUND AND OBJECTIVES: Corticosteroids have been used successfully to prolong the duration of local anesthetic action after peripheral nerve and epidural blockade. We hypothesized that the addition of dexamethasone to mepivacaine would prolong the duration of analgesia after ultrasound-guided supraclavicular brachial plexus block for patients undergoing upper-limb surgery. METHODS: After Federal Health Department and institutional review board approval, 45 adult patients undergoing elective hand or forearm surgery under supraclavicular brachial plexus blockade were randomized to receive either 30 mL mepivacaine 1.5% plus dexamethasone 8 mg (4 mg/mL), or 30 mL mepivacaine 1.5% plus 2 mL normal saline. The primary outcome measure was duration of analgesia. Secondary outcomes included onset times of sensory and motor blockade, pain and satisfaction scores, analgesic consumption, and block-related complications. RESULTS: Patient characteristics were similar between groups. The median duration of analgesia was significantly prolonged in the Dexamethasone group (332 mins; interquartile range, 225-448 mins) compared with the Normal Saline group (228 mins; interquartile range, 207-263 mins; P = 0.008). The onset times of sensory and motor block were similar between the groups. Complications were minor and transient and did not differ between groups at 2 weeks postoperatively. CONCLUSIONS: The addition of dexamethasone to mepivacaine prolongs the duration of analgesia but does not reduce the onset of sensory and motor blockade after ultrasound-guided supraclavicular block compared with mepivacaine alone.