Opioid use disorder patients' perceptions of healthcare delivery platforms.

OBJECTIVES: To assess the acceptability and quality of web-based videoconferencing telemedicine consultation platform in the treatment of opioid use disorder at TrueNorth Medical Centre. METHODS: We conducted an interview based quality improvement initiative using an investigator-designed questionnaire. The questionnaire consisted of 17 Agree/Disagree questions, measured on a 7-point Likert scale and 2 questions where patients had the ability to elaborate qualitatively on their perceptions and experiences with their telemedicine service. Content-style analysis was performed on qualitative responses. RESULTS: The majority of patients (n=14; 47%) preferred face-to-face over telemedicine consultations. The number of patients that preferred telemedicine consultations over face-to-face consultations was lower (n=6; 20%). A notable number of patients (n=10; 33%) indicated no specific preference for either telemedicine or face-to-face consultations. Patients preferring face-to-face consultations rated their clinical outcome and patient-physician relationship following telemedicine consultations similarly as those who preferred telemedicine consultations. Patients preferring telemedicine rated their experience and overall perceptions of the service significantly higher than those preferring face-to-face consultations. Patients who preferred telemedicine consultations identified the efficient and timesaving nature of telemedicine consultations as primary advantages whereas those preferring face-to-face consultations reported lower levels of empathy from their physician during telemedicine consultations as a major disadvantage. CONCLUSIONS: The majority of patients at TrueNorth Medical Centre viewed telemedicine consultations as an acceptable treatment modality. Patients preferring telemedicine consultations and those preferring face-to-face consultations evaluated the majority of the measured indices of care in a similar fashion.

Family physician satisfaction with two different academic compensation schemes.

BACKGROUND AND OBJECTIVES: A growing body of evidence suggests that comprehensive relative-value-based incentive plans (CRVPs) are more effective at tracking and improving academic productivity than other types of academic compensation schemes (ACSs). However, there is little literature to date exploring physician satisfaction with CRVPs. METHODS: Physicians in two academic family medicine departments in Toronto, Ontario, completed an anonymous satisfaction survey. One of these departments used a CRVP to compensate for non-clinical activities; the control group used a monthly stipend based on full-time equivalents (FTEs). RESULTS: When compared with controls, physicians compensated by a CRVP were more likely to increase their involvement in non-clinical activities, to report being "very satisfied" with their ACS, to feel that their ACS made them "more likely" to continue working in their department, and to feel that their ACS was "fair." CONCLUSIONS: Physicians in a family medicine department that used a CRVP felt a greater sense of sense of satisfaction and fairness in terms of their compensation for non-clinical activities. CRVP physicians also perceived an increased involvement in academic activities, were more likely to continue to work in their current department, and to feel that the compensation for non-clinical activities was adequate.

The use of electronic medical records for homeless outreach.

OBJECTIVES: To assess the features of Electronic Medical Records (EMRs) used by North American homeless outreach organizations. METHODS: Twenty-eight homeless outreach agencies throughout North America were contacted. Nine used EMRs for homeless outreach. Service providers from these nine agencies were interviewed to learn more about their EMRs. RESULTS: While all of the agencies we interviewed were using different EMR systems, the important features of these EMRs were quite similar. Two of the most frequently cited essential features were: 1) the ability of different sites and providers to access medical information; and 2) the capacity to collect aggregated client data (such as numbers of clients served, services provided, and outcomes) for planning, evaluation, and advocacy purposes. CONCLUSION: An electronic medical record (EMR) available at multiple locations to multiple providers is a powerful tool with the potential to improve the coordination, safety, efficiency, and quality of care to people who are homeless.

Gay Abuse Screening Protocol (GASP): screening for abuse in gay male relationships.

Thirty-two male patients in gay relationships and eight family physicians were recruited from a family practice in order to determine comfort with an eight-question Gay Abuse Screening Protocol (GASP). The GASP was administered during a typical clinical encounter. After the encounter, physicians and patients each completed a 5-point Likert Scale questionnaire to assess their comfort levels with each of the 8 GASP questions (Likert Scale: 1 = not at all comfortable to 5 = very comfortable). The mean comfort score was high (Likert >4) for both patients (4.16 +/- 0.18) and physicians (4.71 +/- 0.18). However, mean comfort scores were significantly lower for abused patients (3.26 +/- 0.75) than nonabused patients (4.57 +/- 0.26). Patients were comfortable (Likert >3) with 76.2% of GASP items while physicians were comfortable with all GASP items.

You, me...and drugs--a love triangle: important considerations when both members of a couple are abusing substances.

Concordant couples can be defined as couples in which both partners have issues with "substance abuse." Studies demonstrate that couples display similar patterns of "substance abuse" that cannot be explained by sociodemographic factors alone. Unfortunately, few studies have focused on the unique relationship dynamics and needs of concordant couples. "Substance abuse" by a client's partner can profoundly affect their recovery and treatment. It is therefore important to understand how clients are influenced by their partners' use. This article attempts to define the needs and issues of concordant couples within a broader psychosocial context. In addition, an overview on the concordant couple literature is provided, along with a discussion of effective treatment and potential barriers to treatment.