Documenting cannabis use in primary care: a descriptive cross-sectional study using electronic medical record data in Alberta, Canada.

OBJECTIVE: Documenting cannabis use is important for patient care, but no formal requirements for consistent reporting exist in primary care. The objective of this study was to understand how cannabis use is documented in primary care electronic medical record (EMR) data. RESULTS: This was a cross-sectional study using de-identified EMR data from over 398,000 patients and 333 primary care providers in Alberta, Canada. An automated pattern-matching algorithm was developed to identify text and ICD-9 diagnostic codes indicating cannabis use in the EMR. There was a total of 11,724 records indicating cannabis use from 4652 patients, representing approximately 1.2% of the patient sample. Commonly used terms and ICD-9 codes included cannabis, marijuana/marihuana, THC, 304.3 and 305.2. Nabilone was the most frequently prescribed cannabinoid medication. Slightly more males and those with a chronic condition had cannabis use recorded more often. Overall, very few patients have cannabis use recorded in primary care EMR data and this is not captured in a systematic way. We propose several strategies to improve the documentation of cannabis use to facilitate more effective clinical care, research, and surveillance.

Older persons living with dementia and their use of acute care services over 2 years in Alberta.

OBJECTIVE: To characterize transitions to acute and residential care and identify variables associated with specific transitions among community-based persons living with dementia (PLWD). DESIGN: Retrospective cohort study using primary care electronic medical record data linked with health administrative data. SETTING: Alberta. PARTICIPANTS: Adults aged 65 years or older living in the community who had been diagnosed with dementia and who saw a Canadian Primary Care Sentinel Surveillance Network contributor between January 1, 2013, and February 28, 2015. MAIN OUTCOME MEASURES: All emergency department visits, hospitalizations, residential care (supportive living and long-term care) admissions, and deaths within a 2-year follow-up period. RESULTS: In total, 576 PLWD were identified who had a mean (SD) age of 80.4 (7.7) years; 55% were female. In 2 years, 423 (73.4%) had at least 1 transition and, of these, 111 (26.2%) had 6 or more. Emergency department visits, including multiple visits, were common (71.4% had ≥1, 12.1% had ≥4). Of those hospitalized (43.8%), nearly all were admitted from the emergency department; the average (SD) length of stay was 23.6 (35.8) days, and 32.9% had at least 1 alternate level of care day. In total, 19.3% entered residential care, most admitted from hospital. Those admitted to hospital and those admitted to residential care were older and had greater historical health system use, including home care. One-quarter of the sample did not have any transitions (or die) during follow-up; they were typically younger and had limited historical health system use. CONCLUSION: Older PLWD experienced frequent, and frequently compound, transitions that have implications for them, their family members, and the health system. There was also a large proportion without transitions suggesting that appropriate supports enable PLWD to do well in their own communities. The identification of PLWD who are at risk of or who make frequent transitions may allow for more proactive implementation of community-based supports and smoother transitions to residential care.

Primary care EMR and administrative data linkage in Alberta, Canada: describing the suitability for hypertension surveillance.

OBJECTIVE: To describe the process for linking electronic medical record (EMR) and administrative data in Alberta and examine the advantages and limitations of utilising linked data for hypertension surveillance. METHODS: De-identified EMR data from 323 primary care providers contributing to the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) in Alberta were used. Mapping files from each contributing provider were generated from their EMR to facilitate linkage to administrative data within the provincial health data warehouse. Deterministic linkage was conducted using valid personal healthcare number (PHN) with age and/or sex. Characteristics of patients and providers in the linked cohort were compared with population-level sources. Criteria used to define hypertension in both sources were examined. RESULTS: Data were successfully linked for 6307 hypertensive patients (96.2% of eligible patients) from 49 contributing providers. Non-linkages from invalid PHN (n=246) occurred more for deceased patients and those with fewer primary care encounters, with differences due to type of EMR and patient EMR status. The linked cohort had more patients who were female, >60 years and residing in rural areas compared to the provincial healthcare registry. Family physicians were more often female and medically trained in Canada compared to all physicians in Alberta. Most patients (>97%) had ≥1 record in the registry, pharmacy, emergency/ambulatory care and claims databases; 44.3% had ≥1 record in the hospital discharge database. CONCLUSION: EMR-administrative data linkage has the potential to enhance hypertension surveillance. The current linkage process in Alberta is limited and subject to selection bias. Processes to address these deficiencies are under way.