Describing primary care patterns before and during the COVID-19 pandemic across Canada: a quasi-experimental pre-post design cohort study using national practice-based research network data.

OBJECTIVE: The objective was to analyse how the pandemic affected primary care access and comprehensiveness in chronic disease management by comparing primary care patterns before and during the early COVID-19 pandemic. DESIGN: We conducted a quasi-experimental pre-post design cohort study and reported indicators for the 21 months before and after the onset of the COVID-19 pandemic. SETTING: We used electronic medical record data from primary care clinics enrolled in the Canadian Primary Care Sentinel Surveillance Network from 1 January 2018 to 31 December 2021. POPULATION: The study population included patients (n=919 928) aged 18 years or older with at least one primary care contact from 12 March 2018 to 12 March 2020, in Canada. OUTCOME MEASURES: The study indicators included three indicators measuring access to primary care (encounters, blood pressure measurements and lab tests) and three for comprehensiveness (diagnoses, non-COVID-19 vaccines administered and referrals). RESULTS: 67.3% of the cohort was aged ≥40 years, 56.4% were female and 53.5% were from Ontario, Canada. Fewer patients received an encounter during the pandemic (91.5% to 81.5%), while the median (IQR) number of encounters remained the same (5 (2-1)) for those with access. Fewer patients received a blood pressure measurement (47.9% to 31.8%), and patients received fewer measurements during the pandemic (2 (1-4) to 1 (0-2)). CONCLUSIONS: Encounters with primary care remained consistent during the pandemic, but in-person care, such as lab tests and blood pressure measurements, decreased. In-person care indicators followed temporally to national COVID-19 case counts during the pandemic.

Prevalence of multimorbidity and polypharmacy among adults and older adults: a systematic review.

Multimorbidity (multiple conditions) and polypharmacy (multiple medications) are increasingly common, yet there is a need to better understand the prevalence of co-occurrence. In this systematic review, we examined the prevalence of multimorbidity and polypharmacy among adults (≥18 years) and older adults (≥65 years) in clinical and community settings. Six electronic databases were searched, and 87 studies were retained after two levels of screening. Most studies focused on adults 65 years and older and were done in population-based community settings. Although the operational definitions of multimorbidity and polypharmacy varied across studies, consistent cut-points (two or more conditions and five or more medications) were used across most studies. In older adult samples, the prevalence of multimorbidity ranged from 4·8% to 93·1%, while the prevalence of polypharmacy ranged from 2·6% to 86·6%. High heterogeneity between studies indicates the need for more consistent reporting of specific lists of conditions and medications used in operational definitions.

Drug and Natural Health Product Data Collection and Curation in the Canadian Longitudinal Study on Aging.

This study aimed to develop an efficient data collection and curation process for all drugs and natural health products (NHPs) used by participants to the Canadian Longitudinal Study on Aging (CLSA). The three-step sequential process consisted of (a) mapping drug inputs collected through the CLSA to the Health Canada Drug Product Database (DPD), (b) algorithm recoding of unmapped drug and NHP inputs, and (c) manual recoding of unmapped drug and NHP inputs. Among the 30,097 CLSA comprehensive cohort participants, 26,000 (86.4%) were using a drug or an NHP with a mean of 5.3 (SD 3.8) inputs per participant user for a total of 137,366 inputs. Of those inputs, 70,177 (51.1%) were mapped to the Health Canada DPD, 20,729 (15.1%) were recoded by algorithms, and 44,108 (32.1%) were manually recoded. The Direct algorithm correctly classified 99.4 per cent of drug inputs and 99.5 per cent of NHP inputs. We developed an efficient three-step process for drug and NHP data collection and curation for use in a longitudinal cohort.

Relationship between multimorbidity, functional limitation, and quality of life among middle-aged and older adults: findings from the longitudinal analysis of the 2013-2020 Survey of Health, Ageing, and Retirement in Europe (SHARE).

PURPOSE: The increased burden of multimorbidity is restricting individuals' ability to live autonomously, leading to a poorer quality of life. This study estimated trajectories of functional limitation and quality of life among middle-aged (ages 50 to 64 years) and older (aged 65 years and older) individuals with and without multimorbidity. We also assessed differences in the relationship between these two trajectories by multimorbidity status and separately for each age cohort. METHODS: Data originated from the Survey of Health, Ageing, and Retirement in Europe (SHARE). In Luxembourg, data were obtained between 2013 and 2020, involving 1,585 respondents ≥ 50 years of age. Multimorbidity was defined as a self-reported diagnosis of two or more out of 16 chronic conditions; functional limitation was assessed by a combined (Instrumental) Activities of Daily Living (ADL/IADLI) scale; and to measure quality of life, we used the Control, Autonomy, Self-Realization, and Pleasure (CASP-12) scale. Latent growth curve modelling techniques were used to conduct the analysis where repeated measures of quality of life and functional limitation were treated as continuous and zero-inflated count variables, respectively. The model was assessed separately in each age cohort, controlling for the baseline covariates, and the estimates from the two cohorts were presented as components of a synthetic cohort covering the life course from the age of 50. RESULTS: Middle-aged and older adults living with multimorbidity experienced poorer quality of life throughout the life course and were at a higher risk of functional limitation than those without multimorbidity. At baseline, functional limitation had a negative impact on quality of life. Furthermore, among middle-aged adults without multimorbidity and older adults with multimorbidity, an increase in the number of functional limitations led to a decline in quality of life. These results imply that the impact of multimorbidity on functional limitation and quality of life may vary across the life course. CONCLUSION: Using novel methodological techniques, this study contributes to a better understanding of the longitudinal relationship between functional limitation and quality of life among individuals with and without multimorbidity and how this relationship changes across the life course. Our findings suggest that lowering the risk of having multimorbidity can decrease functional limitation and increase quality of life.

Who sleeps well in Canada? The social determinants of sleep health among middle-aged and older adults in the Canadian Longitudinal Study on Aging.

OBJECTIVES: Sleep health inequities likely contribute to disparities in health outcomes. Our objective was to identify social determinants of sleep health among middle-aged/older adults in Canada, where prior evidence is limited. METHODS: We analyzed cross-sectional data from the Canadian Longitudinal Study on Aging, a survey of over 30,000 community-dwelling adults aged 45-85years. Self-reported measures included sleep duration, sleep satisfaction, and sleep efficiency. We explored associations between sleep measures and social determinants of health. We used modified Poisson regression to estimate prevalence ratios for sleep satisfaction and sleep efficiency, and linear regression for sleep duration. Estimates were adjusted for all social, lifestyle, and clinical covariates. We explored effect modification by sex. RESULTS: Of the 11 social determinants explored, all were significantly associated with at least one domain of sleep health. These associations were reduced to 9 variables with adjustment for all social variables, and 7 with further adjustment for lifestyle and clinical covariates, including differences by sex, age, education, marital status, employment, race/ethnicity, and sexual orientation. Better sleep health in >1 domain was observed among males, older age groups (65 and older), higher income groups, the retired group, and homeowners with adjustment for social variables, and only in males and older age groups with additional adjustment for lifestyle and clinical variables. Only sleep duration associations were modified by sex. CONCLUSIONS: Sleep health disparities among Canadian adults exist across socioeconomic gradients and racial/ethnic minority groups. Poor sleep health among disadvantaged groups warrants increased attention as a public health problem in Canada.

The relationship between sleep health and multimorbidity in community dwelling populations: Systematic review and global perspectives.

Previous research has identified a relationship between sleep problems and multimorbidity, defined as the co-occurrence of two or more chronic health conditions in the same individual. This systematic review sought to summarize the literature on the association between sleep duration and quality and multimorbidity in adult community-dwelling populations. A comprehensive search of the PubMed, Embase and CINAHL databases identified studies published between January 1990 and January 2023. Studies were included if they focused on community-dwelling populations, used an observational design, measured sleep quality or duration, used multimorbidity as the main study outcome, and explored the relationship between sleep and multimorbidity. Two reviewers independently conducted study screening, data extraction, and bias assessments. Twenty-four cross-sectional and five prospective cohort studies met the inclusion criteria, with studies from 16 countries and two with cross-country comparisons, and a total participant number of 481,862. Overall, poorer sleep quality and sleep duration outside current recommendations were consistently associated with multimorbidity, though with varying strength. This association was present regardless of specific multimorbidity definitions from different studies. Definitions of sleep duration and quality were inconsistent across studies, possibly contributing to mixed evidence on the observed association. Most studies were cross-sectional, limiting the assessment of the temporal direction of association. Our results corroborate relationships between poor sleep and risk of multimorbidity in adult community-dwelling populations around the world. Examining this relationship may help increase public health awareness of sleep as a modifiable risk factor for the prevention of chronic disease and healthy aging.

Effects of the COVID-19 Pandemic on Primary Health Care for Chronic Conditions in Canada: Protocol for a Retrospective Pre-Post Study Using National Practice-Based Research Network Data.

BACKGROUND: Since the COVID-19 pandemic began, there have been concerns that interruptions to the health care system may have led to changes in primary care, especially for care of chronic conditions such as diabetes and heart failure. Such changes may have longer term implications for population health. OBJECTIVE: This study aims to describe the impacts of the COVID-19 pandemic on indicators of primary care access, comprehensiveness, and appropriateness among adult patients, as well as on specific indictors of chronic conditions. Additionally, this study aims to determine whether any identified changes were associated with patient sociodemographic characteristics and multimorbidity. METHODS: This is a retrospective, single-arm, pre-post study using Canadian Primary Care Sentinel Surveillance Network (CPCSSN) data. CPCSSN is a research network supported by a primary care electronic medical record database, comprising over 1500 physicians and nearly 2 million patients. We are examining changes in care (eg, frequency of contacts, laboratory tests and investigations, referrals, medications prescribed, etc) among adults. We will also examine indicators specific to evidence-based recommendations for care in patients with diabetes and those with heart failure. We will compare rates of outcomes during key periods of the pandemic between March 13, 2020, and December 31, 2022, with equal time periods before the pandemic. Differences will be examined among specific subgroups of adults, including by decade of age, number of comorbidities, and socioeconomic status. Regression models appropriate to outcome distributions will be used to estimate changes, adjusting for potential confounders. This analysis is part of a mixed-methods study with a qualitative component investigating how patients with diabetes with or without concurrent heart failure perceived the impact of the pandemic on access to primary care and health care-related decisions. This study was approved by the Hamilton Integrated Research Ethics Board (14782-C). RESULTS: The start date of this study was October 5, 2022, and the prospective end date is January 31, 2024. As of May 2023, the study cohort (n=875,934) is defined, data cleaning is complete, and exploratory analyses have begun. Extended analyses using 2022 data are planned once the new data becomes available. We will disseminate results through peer-reviewed publications and academic conference, as well as creating evidence briefs, infographics, and a video for policy maker and patient audiences. CONCLUSIONS: This study will investigate whether the COVID-19 pandemic has resulted in changes in the provision of primary care in Canada and whether these potential changes have led to gaps in care. This study will also identify patient-level characteristics associated with changes in care patterns across the COVID-19 pandemic. Indicators specific to chronic conditions, namely diabetes and heart failure, will also be explored to determine whether there were changes in care of these conditions. TRIAL REGISTRATION: ClinicalTrials.gov NCT05813652; https://clinicaltrials.gov/ct2/show/NCT05813652. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/49131.

Strategies to improve health status among adults with multimorbidity: A scoping review.

Although public health and medical care advancements have enabled an increased lifespan among many populations around the world, there is an ongoing need to enhance the health span of adults and older adults. Due to the increasingly substantial prevalence of multiple chronic conditions, also known as multimorbidity, this scoping review aims to identify and describe the current literature on programs or interventions to improve the health status of and to prevent further chronic conditions among adults and older adults who are already living with multimorbidity. Of the 2898 articles identified from a search of PubMed and Embase, 72 underwent full-text screening and 14 were included in the review. A total of 8 articles included both adult and older adult participants, while 6 articles involved only participants who were older adults. The articles reported a variety of settings, components and key outcomes, and reported varying degrees of success in improving the health status of the participants. Some of the interventions were tailored to a specific population such as individuals receiving home care services, nursing home residents or individuals who were living with obesity along with multiple co-occurring conditions. While many interventions involved dimensions of physical activity and healthy eating to improve health status, many interventions also utilized a combination of components to enhance the impact of the initiative. Overall, this scoping review highlights the literature and the continued need for multifaceted research that can help inform future programs and policies to support individuals living with multimorbidity.

Sleep Problems and Psychological Well-Being: Baseline Findings from the Canadian Longitudinal Study on Aging.

International studies have demonstrated associations between sleep problems and poor psychological well-being; however, Canadian data are limited. This study investigated this association using cross-sectional baseline data from the Canadian Longitudinal Study on Aging, a national survey of 30,097 community-dwelling adults, 45-85 years of age. Short sleep duration, sleep dissatisfaction, insomnia symptoms, and daytime impairment were consistently associated with a higher prevalence of dissatisfaction with life, psychological distress, and poor self-reported mental health. Long sleep duration was associated with a higher prevalence of psychological distress and poor self-reported mental health, but not with dissatisfaction with life. Associations between sleep problems and psychological distress were 11-18 per cent stronger in males. With each 10-year increase in age, the association between daytime impairment and life dissatisfaction increased by 11 per cent, and insomnia symptoms and poor mental health decreased by 11 per cent. Sleep problems in middle-aged and older adults warrant increased attention as a public health problem in Canada.

Examining the prevalence and correlates of multimorbidity among community-dwelling older adults: cross-sectional evidence from the Canadian Longitudinal Study on Aging (CLSA) first-follow-up data.

INTRODUCTION: multimorbidity has become an increasingly important issue for many populations around the world, including Canada. The objectives of this study were to estimate the prevalence of multimorbidity at first follow-up and to identify factors associated with multimorbidity using data from the Canadian Longitudinal Study on Aging (CLSA). METHODS: this study included 27,701 community-dwelling participants in the first follow-up of the CLSA. Multimorbidity was operationalised using two definitions (Public Health and Primary Care), as well as the cut-points of two or more chronic conditions (MM2+) and three or more chronic conditions (MM3+). The prevalence of multimorbidity was calculated at first follow-up and multivariable regression models were used to identify correlates of multimorbidity occurrence. RESULTS: the prevalence of multimorbidity at first follow-up was 32.3% among males and 39.3% among females when using the MM2+ Public Health definition, whereas the prevalence was 67.2% among males and 75.8% among females when using the MM2+ Primary Care definition. Older age, lower alcohol consumption, lower physical activity levels, dissatisfaction with sleep quality, dissatisfaction with life and experiencing social limitations due to health conditions were significantly associated with increased odds of multimorbidity for both males and females, regardless of the definition of multimorbidity used. CONCLUSION: various sociodemographic, behavioural and psychosocial factors are associated with multimorbidity. Future research should continue to examine how the prevalence of multimorbidity changes with time and how these changes may be related to specific risk factors. This future research should be supplemented with studies examining the longitudinal impacts of multimorbidity over time.

Associations between sleep patterns, smoking, and alcohol use among older adults in Canada: Insights from the Canadian Longitudinal Study on Aging (CLSA).

Poor sleep is associated with chronic health conditions among older adults. As substance use rates increase in this population, age-related physiological and cognitive declines may exacerbate its detrimental consequences, including sleep problems. We analyzed cross-sectional associations between sleep patterns, smoking, and alcohol use using baseline data from 30,097 community-dwelling Canadian adults aged 45-85 years from the Canadian Longitudinal Study on Aging. Insomnia symptoms (difficulties falling/staying asleep), sleep duration (short:<6h; long:>8h), and sleep satisfaction(dissatisfied/neutral/satisfied) were measured. Smoking and alcohol-use frequency (past 12 months), average daily amount (past 30 days), and binge drinking (past 12 months) were self-reported, and associations were examined using modified Poisson regression. Approximately 23% of participants had insomnia symptoms, and 26% reported sleep dissatisfaction. 91% of participants were current non-smokers, whereas 7% reported smoking daily. Over 50% drank ≤ 2 drinks daily, and 3% reported binge drinking. There was a higher adjusted prevalence of insomnia among daily smokers (PR = 1.10, 95% CI = 1.00-1.21) and binge drinkers (PR = 1.21, 95% CI = 1.02-1.43). Odds of short sleep duration were lower among regular drinkers (COR = 0.71, 95% CI = 0.56-0.90) and higher among daily smokers (COR = 1.19, 95% CI = 1.01-1.40). Heavy and frequent smoking and alcohol use are associated with both insomnia symptoms and sleep dissatisfaction, but not consistently with sleep duration. Further longitudinal investigation of this relationship in aging populations is needed in clinical and public health settings to infer the extent of causality and design effective public health interventions in this vulnerable population.

Examining early and late onset of multimorbidity in the Canadian Longitudinal Study on Aging.

BACKGROUND/OBJECTIVES: The study objective was to understand characteristics and health outcomes of multimorbidity, distinguishing between multimorbidity onset in earlier and later phases of life among community-dwelling older adults in Canada. DESIGN: A cross-sectional analysis was conducted using baseline data from the Canadian Longitudinal Study on Aging (CLSA). SETTING AND PARTICIPANTS: This analysis included 11,161 older adults who were between the ages of 65 and 85 years at baseline and who were living in community-based settings. MEASUREMENTS: Multimorbidity was defined using two cutpoints: two or more chronic conditions (MM2+) and three or more chronic conditions (MM3+). After calculating the age of diagnosis for eligible participants, "early multimorbidity" was defined as multiple chronic conditions diagnosed before 45 years of age, while "late multimorbidity" was defined as multiple chronic conditions diagnosed at or after 45 years of age. The five health outcomes explored were physical disability, social limitation, frailty level, perceived general health status, and perceived mental health status. RESULTS: Overall, the prevalence of MM2+ was 75.3% (95% CI: 74.3, 76.1) and the prevalence of MM3+ was 47.0% (95% CI: 46.0, 48.0). The majority of participants (both females and males) living with multimorbidity were categorized with late multimorbidity. Participants with early multimorbidity or both early and late multimorbidity had increased odds of physical disability, social limitation, increased frailty level, and negative perceived general and mental health. These patterns were detected for both MM2+ and MM3+. CONCLUSION: This study examined the impact of the timing of multimorbidity onset on five health outcomes. Our findings highlight the importance of clinical and public health interventions to prevent and manage the causes and consequences of multimorbidity, with particular focus on age of onset. Future longitudinal research should be done to further articulate the relationships between multimorbidity and these health outcomes over time.

Multimorbidity in large Canadian urban centres: A multilevel analysis of pooled 2015-2018 cross-sectional cycles of the Canadian Community Health Survey.

BACKGROUND: There is limited knowledge on how the prevalence of multimorbidity varies within and across major Canadian urban centres. The objective of this study was to investigate the between-neighbourhood variation in the prevalence of multimorbidity in Canada's large urban centres, controlling for compositional effects associated with individual-level demographic and socioeconomic factors. METHODS: Cross-sectional data from the 2015-2018 cycles of the Canadian Community Health Survey (CCHS) were pooled at the microdata level. Respondents (20 years and older) residing in one of the 35 census metropolitan areas (CMAs) were included (N = 100,803). Census tracts (CTs) were used as a measure of neighbourhood. To assess the between-neighbourhood differences in multimorbidity prevalence, we fitted three sequential random intercept logistic regression models. RESULTS: During the 2015-2018 period, 8.1% of residents of large urban centres had multimorbidity. The results from the unadjusted model indicate that 13.4% of the total individual variance in multimorbidity could be attributed to the between-neighbourhood differences. After adjustment for overall characteristics of the CMAs in which these neighbourhoods are located, as well as for individual-level demographic and socioeconomic factors related to compositional effects, 11.0% of the individual variance in multimorbidity could still be attributed to the between-neighbourhood differences. CONCLUSION: There is significant and substantial geographic variation in multimorbidity prevalence across neighbourhoods in Canada's large urban centres. Residing in some neighbourhoods could be associated with increased odds of having multimorbidity, even after accounting for overall characteristics of the CMAs in which these neighbourhoods are located, as well as individual-level factors.

Advancing cross-national planning and partnership: Proceedings from the International Multimorbidity Symposium 2019.

The International Multimorbidity Symposium was held in November 2019 at Western University to achieve three main objectives: to discuss progress and findings from various jurisdictions; to facilitate collaboration through group discussion to identify strategies to move multimorbidity research forward; and to create concrete plans to ensure advances in multimorbidity research and knowledge can be achieved through cross-national partnership. This event included keynote presentations, elevator pitch presentations and breakout sessions and there was a total of 35 attendees from eight countries, representing diverse disciplines and training levels. The overall themes arising from the event were: the importance of integrating the study and management of multimorbidity from both the primary care and public health perspectives; meaningful engagement and collaboration with patients and caregivers to understand key dimensions of multimorbidity; the considerable benefit of collaborative international partnerships; and the need to spread and scale innovations for health care systems that can better respond to the complex needs of patients and caregivers who are living with multimorbidity. Finally, it was well-acknowledged among the attendees that expanding the collaboration and discussion among international colleagues via in-person and virtual events will be important to move multimorbidity research forward.

Sleep behaviours and multimorbidity occurrence in middle-aged and older adults: findings from the Canadian Longitudinal Study on Aging (CLSA).

OBJECTIVE: Poor sleep quality and reduced sleep duration impact over half of older adults and are associated with adverse health outcomes, such as multiple chronic conditions (multimorbidity) and reduced longevity. Our objective was to examine the relationship between sleep behaviours and multimorbidity in Canada. METHODS: We analysed data from the Canadian Longitudinal Study on Aging (CLSA), a cross-sectional national health survey of community-dwelling adults over the age of 45 years. A total of 30,011 participants had physiological and psychosocial data collected at baseline. Sleep measures included self-reported sleep duration (short: <6 h; normal: 6-8 h; long: >8 h) and sleep quality (dissatisfied/very dissatisfied; neutral; satisfied/very satisfied). Multimorbidity was defined using two definitions (public health and primary care) and two cut-points (2 or more and 3 or more chronic conditions). RESULTS: Approximately 70% were living with multimorbidity using the primary care definition (females: 67.9%; males 57.9%), whereas approximately 30% were living with multimorbidity using the public health definition (females: 30.9%; males: 24.0%). Adjusted analyses indicated that the odds of multimorbidity were higher for participants who selfreported either short or long sleep duration, as well as dissatisfaction with sleep quality. Associations were stronger among younger age groups (45-54 years and 55-64 years). CONCLUSIONS: Disrupted sleep may be a risk factor for multimorbidity across sexes and age groups. It is necessary to understand the potential impact of sleep on the risk of multimorbidity to inform both clinical and public health guidelines for the prevention and management of this major health issue.

Electronic Data Capture Versus Conventional Data Collection Methods in Clinical Pain Studies: Systematic Review and Meta-Analysis.

BACKGROUND: The most commonly used means to assess pain is by patient self-reported questionnaires. These questionnaires have traditionally been completed using paper-and-pencil, telephone, or in-person methods, which may limit the validity of the collected data. Electronic data capture methods represent a potential way to validly, reliably, and feasibly collect pain-related data from patients in both clinical and research settings. OBJECTIVE: The aim of this study was to conduct a systematic review and meta-analysis to compare electronic and conventional pain-related data collection methods with respect to pain score equivalence, data completeness, ease of use, efficiency, and acceptability between methods. METHODS: We searched the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), and Cochrane Central Register of Controlled Trials (CENTRAL) from database inception until November 2019. We included all peer-reviewed studies that compared electronic (any modality) and conventional (paper-, telephone-, or in-person-based) data capture methods for patient-reported pain data on one of the following outcomes: pain score equivalence, data completeness, ease of use, efficiency, and acceptability. We used random effects models to combine score equivalence data across studies that reported correlations or measures of agreement between electronic and conventional pain assessment methods. RESULTS: A total of 53 unique studies were included in this systematic review, of which 21 were included in the meta-analysis. Overall, the pain scores reported electronically were congruent with those reported using conventional modalities, with the majority of studies (36/44, 82%) that reported on pain scores demonstrating this relationship. The weighted summary correlation coefficient of pain score equivalence from our meta-analysis was 0.92 (95% CI 0.88-0.95). Studies on data completeness, patient- or provider-reported ease of use, and efficiency generally indicated that electronic data capture methods were equivalent or superior to conventional methods. Most (19/23, 83%) studies that directly surveyed patients reported that the electronic format was the preferred data collection method. CONCLUSIONS: Electronic pain-related data capture methods are comparable with conventional methods in terms of score equivalence, data completeness, ease, efficiency, and acceptability and, if the appropriate psychometric evaluations are in place, are a feasible means to collect pain data in clinical and research settings.

Capacity building and mentorship among pan-Canadian early career researchers in community-based primary health care.

AIM: To describe activities and outcomes of a cross-team capacity building strategy that took place over a five-year funding period within the broader context of 12 community-based primary health care (CBPHC) teams. BACKGROUND: In 2013, the Canadian Institutes of Health Research funded 12 CBPHC Teams (12-Teams) to conduct innovative cross-jurisdictional research to improve the delivery of high-quality CBPHC to Canadians. This signature initiative also aimed to enhance CBPHC research capacity among an interdisciplinary group of trainees, facilitated by a collaboration between a capacity building committee led by senior researchers and a trainee-led working group. METHODS: After the committee and working group were established, capacity building activities were organized based on needs and interests identified by trainees of the CBPHC Teams. This paper presents a summary of the activities accomplished, as well as the outcomes reported through an online semistructured survey completed by the trainees toward the end of the five-year funding period. This survey was designed to capture the capacity building and mentorship activities that trainees either had experienced or would like to experience in the future. Descriptive and thematic analyses were conducted based on survey responses, and these findings were compared with the existing core competencies in the literature. FINDINGS: Since 2013, nine webinars and three online workshops were hosted by trainees and senior researchers, respectively. Many of the CBPHC Teams provided exposure for trainees to innovative methods, CBPHC content, and showcased trainee research. A total of 27 trainees from 10 of the 12-Teams responded to the survey (41.5%). Trainees identified key areas of benefit from their involvement in this initiative: skills training, networking opportunities, and academic productivity. Trainees identified gaps in research and professional skill development, indicating areas for further improvement in capacity building programs, particularly for trainees to play a more active role in their education and preparation.

Prevalence, characteristics, and patterns of patients with multimorbidity in primary care: a retrospective cohort analysis in Canada.

BACKGROUND: Multimorbidity is a complex issue in modern medicine and a more nuanced understanding of how this phenomenon occurs over time is needed. AIM: To determine the prevalence, characteristics, and patterns of patients living with multimorbidity, specifically the unique combinations (unordered patterns) and unique permutations (ordered patterns) of multimorbidity in primary care. DESIGN AND SETTING: A retrospective cohort analysis of the prospectively collected data from 1990 to 2013 from the Canadian Primary Care Sentinel Surveillance Network electronic medical record database. METHOD: Adult primary care patients who were aged ≥18 years at their first recorded encounter were followed over time. A list of 20 chronic condition categories was used to detect multimorbidity. Computational analyses were conducted using the Multimorbidity Cluster Analysis Tool to identify all combinations and permutations. RESULTS: Multimorbidity, defined as two or more and three or more chronic conditions, was prevalent among adult primary care patients and most of these patients were aged <65 years. Among female patients with two or more chronic conditions, 6075 combinations and 14 891 permutations were detected. Among male patients with three or more chronic conditions, 4296 combinations and 9716 permutations were detected. While specific patterns were identified, combinations and permutations became increasingly rare as the total number of chronic conditions and patient age increased. CONCLUSION: This research confirms that multimorbidity is common in primary care and provides empirical evidence that clinical management requires a tailored, patient-centred approach. While the prevalence of multimorbidity was found to increase with increasing patient age, the largest proportion of patients with multimorbidity in this study were aged <65 years.