Best practice: quality assessment outcomes of the Practice Enhancement Program among family physicians in Saskatchewan, Canada.

Increased family physician workloads have strained primary care. The objective of this study was to describe the frequency and types of quality concerns identified among Saskatchewan's family physicians, changes in these concerns over time, associated physician characteristics, and recommendations made for improvement. In this repeated cross-sectional study (1997-2020), we examined family physician assessment reports from the Saskatchewan Practice Enhancement Program, a mandatory practice review strategy, for quality concerns on three outcomes: care, medical record, and facility. We recorded demographic and practice characteristics, the presence or absence of quality concerns, and the type of recommendations made. Concern incidence was calculated both overall and across subperiods, and three outcome-specific multiple logistic regression models were developed. Recommendations made were quantified, and their nature was evaluated using thematic analysis. Among 824 assessments, 20.8% identified concerns, with a statistically significant increase in 2015-20 over earlier years (14.2% versus 43.4%, P < .001). Corresponding proportions also significantly increased within each quality outcome (6.0%-37.1%, P < .001 for care concerns; 12.7%-19.6%, P = .03 for medical record concerns; 3.9%-21.0%, P < .001 for facility concerns). We found statistically significant adjusted associations between care concerns and both urban location [odds ratio (OR): 2.2; 95% confidence interval (CI): 1.30, 3.8] and international medical training (OR: 2.4; 95% CI: 1.34, 4.2); facility concerns and solo practice (OR: 2.5 95% CI: 1.10, 5.7); and medical record concerns and male gender (OR: 1.88; 95% CI: 1.09, 3.3), solo practice (OR: 1.67; 95% CI: 1.01, 2.7), and increased age. Reflecting a statistically significant interaction found between age as a continuous covariate and time period, older physicians were more likely to have a medical record concern in later years (OR: 1.072; 95% CI: 1.026, 1.120) compared to earlier ones (OR: 1.021; 95% CI: 1.001, 1.043). Among physicians where a concern was identified, recommendations most frequently pertained to documentation (91.2%), chronic disease management (78.2%), cumulative patient profiles (62.9%), laboratory investigations (53.5%), medications (51.8%), and emergency preparedness (51.2%). A concerning and increasing proportion of family physicians have quality gaps, with identifiable factors and recurring recommendations. These findings provide direction for strategic support development.

Review of cancer control policy in Nigeria and comparison with selected African countries: implications for future policy making

Context: The public health importance of cancers in Nigeria is emerging. Robust cancer control policies are needed at all levels of government, especially the state. Objective: To review cancer control policies in Nigeria, especially regarding breast and cervical cancers, with emphasis on policy development process, scope and policy implementation. Also to compare Nigerian cancer control policy with selected African countries and suggest ways through which Nigerian states, such as Abia, can develop evidence-informed, patient-centered cancer control policy. Methods: A structured literature search was done using relevant subject headings and keywords. Boolean operators 'and'/'or' were used to refine the search. Databases searched were Pubmed/Medline, Embase, PsychInfo, Cinahl, Global Health and ERIC. The search included articles published between 2008 and 2018. Data was also collected from the International Cancer Control Plan portal as well as focused Google search. Results: Of the 194 abstracts retrieved, only 29 were included in this review. The 2018 Nigerian National Cancer Control plan (NCCP) showed significant improvement over the 2008 version, in terms of scope and policy development process. Literature search did not reveal any state-level comprehensive cancer control policy. The Nigerian policy lacked specific guidelines for breast cancer compared with the Ghanaian policy. Ghana allocated 12% of total budget to cancer research compared to 0.4% in Nigeria. The South African Breast Cancer policy was developed using more findings from local research and had the most encompassing, multiple perspectives approach. Conclusion: Review shows the content, process, pearls and pitfalls of cancer control policy from Nigeria and five other African countries. Findings will inform the strategy for developing cancer control framework states in Nigeria and other countries. As more Nigerian states work towards developing state cancer control plans, it is important to address the shortfalls identified in the current NCCP, especially regarding the use of multiple perspectives analysis

Parents' rationale for male circumcision.

OBJECTIVE: To determine which factors parents consider to be most important when pursuing elective circumcision procedures in newborn male children. DESIGN: Prospective survey. SETTING: Saskatoon, Sask. PARTICIPANTS: A total of 230 participants attending prenatal classes in the Saskatoon Health Region over a 3-month period. MAIN OUTCOME MEASURES: Parents' plans to pursue circumcision, personal and family circumcision status, and factors influencing parents' decision making on the subject of elective circumcision. RESULTS: The reasons that parents most often gave for supporting male circumcision were hygiene (61.9%), prevention of infection or cancer (44.8%), and the father being circumcised (40.9%). The reasons most commonly reported by parents for not supporting circumcision were it not being medically necessary (32.0%), the father being uncircumcised (18.8%), and concerns about bleeding or infection (15.5%). Of all parents responding who were expecting children, 56.4% indicated they would consider pursuing elective circumcision if they had a son; 24.3% said they would not. In instances in which the father of the expected baby was circumcised, 81.9% of respondents were in favour of pursuing elective circumcision. When the father of the expected child was not circumcised, 14.9% were in favour of pursuing elective circumcision. Regression analysis showed that the relationship between the circumcision status of the father and support of elective circumcision was statistically significant (P < .001). Among couples in which the father was circumcised, 82.2% stated that circumcision by an experienced medical practitioner was a safe procedure for all boys, in contrast to 64.1% of couples in which the father of the expected child was not circumcised. When the expecting father was circumcised, no one responded that circumcision was an unsafe procedure, compared with 7.8% when the expecting father was not circumcised (P = .003). CONCLUSION: Despite new medical information and updated stances from various medical associations, newborn male circumcision rates continue to be heavily influenced by the circumcision status of the child's father.

Is There a Need for Men's Health Training for Family Physicians in Canada?

Objective. The goal of this study was to explore which topics were rendered important to incorporate into a men's health curriculum for family medicine resident training. Design. A mixed-methodology was used. A case study method with a sequential transformative strategy was utilized. A quantitative survey was sent to the 17 program directors of Canadian family medicine training programs. This was followed by a qualitative phase with interviews of selected program directors and two focus groups with practicing family physicians from a rural and an urban clinic. Main Findings. Certain issues were identified for incorporation into a men's health curriculum for family medicine resident training. These issues were grouped in three groups: male sexual and reproductive health, general topics, and procedures specific to men's health. Conclusion. It appears that there is no formal curriculum to address any of these issues in any of the current family medicine training programs in Canada. Based on the information gathered from participants in this study, there is a great need for such a curriculum to exist.

Pharmacist educators in family medicine residency programs: a qualitative analysis.

BACKGROUND: 25-29% of North American family medicine residency programs utilize a pharmacist to teach residents. Little is known about the impact that these pharmacist educators have on residency training. The purpose of this study was to examine the experiences of residents, residency directors and pharmacists within Canadian family medicine residency programs that employ a pharmacist educator to better understand the impact of the role. METHODS: Recruitment from three cohorts (residents, residency directors, pharmacists) within family medicine residency programs across Canada for one-on-one semi-structured interviews followed by thematic analysis of anonymized transcript data. RESULTS: 11 residents, 6 residency directors and 17 pharmacist educators participated in interviews. Data themes were: (1) strong value of the teaching with respect to improved resident knowledge, confidence and patient care delivery; (2) lack of a formal pharmacotherapy curriculum; (3) desire for expansion of pharmacist teaching; (4) impact of teaching on collaboration; (5) impact of teaching on residency program faculty; and (6) lack of criticism of the role. CONCLUSIONS: The pharmacist educator role is valued within residency programs across Canada and the role has a positive impact on several important aspects of family medicine resident training. Suggestions for improvement focused on expanding the teaching role and on implementing a formal curriculum for pharmacist educators to follow.

Pharmacists teaching in family medicine residency programs: National survey.

OBJECTIVE: To determine the percentage of family medicine residency programs that have pharmacists directly involved in teaching residents, the types and extent of teaching provided by pharmacists in family medicine residency programs, and the primary source of funding for the pharmacists. DESIGN: Web-based survey. SETTING: One hundred fifty-eight resident training sites within the 17 family medicine residency programs in Canada. PARTICIPANTS: One hundred residency program directors who were responsible for overseeing the training sites within the residency programs were contacted to determine the percentage of training sites in which pharmacists were directly involved in teaching. Pharmacists who were identified by the residency directors were invited to participate in the Web-based survey. MAIN OUTCOME MEASURES: The percentage of training sites for family medicine residency that have pharmacists directly involved in teaching residents. The types and the extent of teaching performed by the pharmacists who teach in the residency programs. The primary source of funding that supports the pharmacists' salaries. RESULTS: More than a quarter (25.3%) of family medicine residency training sites include direct involvement of pharmacist teachers. Pharmacist teachers reported that they spend a substantial amount of their time teaching residents using a range of teaching modalities and topics, but have no formal pharmacotherapy curriculums. Nearly a quarter (22.6%) of the pharmacists reported that their salaries were primarily funded by the residency programs. CONCLUSION: Pharmacists have a role in training family medicine residents. This is a good opportunity for family medicine residents to learn about issues related to pharmacotherapy; however, the role of pharmacists as educators might be optimized if standardized teaching methods, curriculums, and evaluation plans were in place.