Inspring Health Advocay Among Residents: Multiple Perspectives
~ Lisa Mu
It is widely understood that the main determinants of health are social ones, and that poverty and inequitable distributions of resources underlie much of the worlds' burden of disease. Physicians are increasingly called upon to address these underlying determinants of health. In turn, academic medical institutions have an obligation to train physicians who will be attuned to and responsive to the needs of disadvantaged populations. The Royal College of Physicians and Surgeons has adopted 'Health Advocate' as one of the seven core competencies which physician trainees in Canada will be expected to possess upon graduation from residency. However, there is no clear guideline for how this competency should be taught or evaluated in residency. The goal of this project is to develop a better understanding of how family physicians can be inspired during their residency training to engage in health advocacy. We will seek health advocate learners', educators' and physicians' perspectives on the interaction between residency training and health advocacy, and explore their views on how health advocacy can be most effectively taught in residency.
Addressing Poverty in Family Practice: Benefits, Harms and Interventions
~ Vanessa Brcic
A large body of evidence indicates that poverty is associated with poor health outcomes and a higher incidence and prevalence of acute and chronic illnesses when compared to more affluent populations. A case-finding tool has been validated to help physicians identify patients affected by poverty in a clinical setting so that they may provide appropriate patient-centered care for this population in need. Within the context of a physician's role as health advocate, this study will explore the effectiveness of this tool; potential barriers, harms and benefits of identifying poverty in family practice; as well as possible interventions for patients who "have difficulty making ends meet." The study will facilitate a dialogue between patients and physicians about concrete ways of addressing an important determinant of health and reducing health inequities in family practice.
Are Refugees Accessing Family Doctors in BC? - Three Years After Their Arrival How Is Their Health, Resiliency and Use of the Health System?
~ Maureen Mayhew
Canada accepts 21,859 new refugees each year who settle in urban areas. (CIC 2008) Since 2002, when the Immigrant and Refugee Protection Act was revised, refugees with significant barriers to healthcare have come to Canada. (CIC 2004, Simich 2007, Hyman 2004, Wu 2005, Caulford 2006) In Vancouver and elsewhere in Canada, specialized refugee clinics have limited capacities. As a result, refugees are encouraged to secure family doctors in their communities 12 months after arrival. No follow up of these refugees has occurred. Part A of this study aims to develop and validate the tools necessary to conduct research on this group of refugees, namely a telephone survey questionnaire that will shed light on how refugees accessed mainstream primary health care 2-3 years after they initially registered at Bridge Clinic and a topic guide to be used in focus group discussions that will further explore challenges faced by refugees while accessing care as well as describing their resiliency when faced with challenges. Questions on access to care, health status and determinants of access to care will be adapted from the Canadian Community Health Survey and a variety of international survey question sources. Proportions of refugees having a family doctor and those with particular health characteristics will be compared to the general Lower Mainland population. This study aims to influence refugee health planning policies in BC by integrating the perspective of refugees regarding their health status, access to care and resiliency.
Preventing Repeat Abortions: Is the Immediate Insertion of Intrauterine Devices Post Abortion a Cost Effective Option Associated with Fewer Repeat Abortions?
~ Christina Ames
It has been shown that the immediate insertion of intrauterine devices (IUDs) post-abortion prevents repeat abortions. However, the initial high cost of IUDs serves as a barrier for many women. We hypothesize that providing free IUDs post-abortion will be associated with a lower rate of repeat abortion in a Canadian population. Further, we hypothesize that providing free IUDs post-abortion will be associated with decreased costs for the health care system. We will conduct an analysis to determine if the provision of free IUDs post-abortion is cost-effective. A demonstrated cost reduction may influence health care policy decisions, and thereby encourage health care decision makers to preserve and implement free IUD programs. As family doctors, it is our responsibility to advocate for public policy that promotes patient well-being. By conducting this research, we may effect a health system change supporting women and their families to avoid unintended pregnancies and thus reduce the rate of abortion in Canada.
Engagement of BC Primary Care Physicians in Online-Based CME (Webinar) on Recommended Cancer Screening Practices
~ Robert Bluman
Results from the 2009 BC Cancer Screening Needs Assessment developed and administered by the UBC Division of Continuing Professional Development will be used to engage primary care physicians in BC in an online-based CME opportunity on recommended cancer screening practices. This online CME webinar event will be an accredited, interactive, free and timely learning platform on the evidence and recommendations for strategies aimed at supporting primary care physicians in BC in providing recommended cancer screening practices and utilizing available community resources for the BC population. Studies have shown there are several key benefits to patient populations engaged in cancer screening and that primary care physicians have the greatest degree of influence in patient screening practices. It is important to ensure that primary care physicians in BC are well equipped to not only understand the benefits, limitations and evidence surrounding cancer screening, but to also ensure they have the resources available to make appropriate cancer screening recommendations for their diverse patient populations. The scope of the webinar will be tailored according to the findings from the 2009 Cancer Screening Needs Assessment. In this way, this webinar event will benefit primary care physicians in BC by addressing the following educational messages: (i) increasing awareness and knowledge base of established cancer screening programs in BC; (ii) improving knowledge base in performing screening procedures; (iii) enhancing ability in nterpreting the results from screening procedures; as well as (iv) clarifying the processes for patient following-up following screening procedures.
Genders Dysphoria and Pervasive Developmental Disorders in Youth
~ Trevor Corneil
The prevalence of Asperger Syndrome is known to be higher in youth with a trans versus cis gender identity. With the increase in young adults presenting with Gender Dysphoria, an understanding of how symptoms normally associated with Asperger Syndrome affect a clinician's ability to identify and diagnose Gender Identity Disorder is essential. In this case series, we used both DSM4TR criteria, and psychometric scales to describe youth and identify those with tendencies towards both diagnoses. Trends revealed will be useful in supporting both the primary care provider and gender specialist in their initial assessment as they work together in determinining a definitive diagnosis, appropriate therapy and an approach to psychosocial support over the course of parital or full transition.
Self-Efficacy and Treatment Literacy Survey in HIV (SETLS-HIV): A Sub-Study of the Complete HIV Care for Native Urban People (CHCNUP) Study
~ Paul Gross
This study is a randomized controlled trial that will employ a novel community-bsed, 10-week, HIV patient self-management support (PSMS) module to assess changes in qualitative indicators of self-efficacy and treatment literacy (SETLS-HIV); two inportant variables in HIV outcomes. This is a sub-study of CHCNUP which, over one year, will randomize 196 patients to undergo the PSMS module with a community-based peer coach, a nurse/doctor, or to undergo standard care without the SMS module. CHCNUP will focus on the clinical indicators of HIV outcome, especially adherence. Therefore, interesting comparisons will be possible between the findings of SETLS-HIV and CHCNUP.
A Retrospective Longitudinal Cohort Study Comparing Health Services Utilization and Health Outcomes Between Patients Admitted to an Urban Tertiary Care Centre's Family Practice Inpatient Ward, Either Under Their Own Family Doctor or a Previously Unknown Family Doctor
~ Chuck Wen
In many urban hospitals more and more family physicians are choosing not to be responsible for the in-hospital care of their patients for various reasons. In this project we propose to compare health service utilization and health outcomes of patiens admitted to an urban tertiary care centre, either under their own family physician, or under a previously unknown family physician such as a hospitalist. Our results will allow the family practice and funding bodies to better understand the sequelae of this steady exodus of commuity family physicians from urban hospital setting over the recent years, as well as the resulting increase in hospitalist care.
Back to Basics: Boric Acid, Alternate Solution for Intravaginal Colonization Comparing Intraveaginal Metronidazole to Boric Acid in Women Symtomatic Bacterial Vaginosis
~ Konia Trouton
Bacteria vaginosis (BV) is the world's most common vaginal infection. BV has been asssociated with increased transmission of sexually transmitted infections, pre-term labour, post-surgical infections and endometritis. Current evidence-based treatment for symptomatic BV includes both oral and intravaginal antibiotics, like metronidazole, which have treatment rates of 70 to 80 percent at 1 month after treatment. These treatments also have a high recurrence rate and side effects including secondary candida infections. Intravaginal boric acid (BA) has been used for more than 100 years to treat vaginal infections and is commonly prescribed today for BV treatment. BA is cheap, accessible and shown to be an effective treatment of vaginal candidiasis. There is no clinical trial to date that studies BA's effectiveness in treating BV.
Doing Time: A Time for Incarcerated Women to Develop an Action Health Strategy
~ Ruth Elwood Martin
At present the recidivism rate among the 7000 admissions to female correctional centres in Canada is 40% within one year. Few researchers have conceptualized imprisonment as an outcome of a disordered health and social environment. The overwhelming majority of women in prison have been subjected to poverty, child abuse, and role modeling of criminal behaviour by parents and, as adults, domestic violence. The overall goal is to work with incarcerated women to improve our understanding of factors that contribute to their physical, spiritual, emotional and psychological health in order to develop a community-based action health strategy that will support their reintegration into society.
IUD Insertions by Primary Care Providers at a Canadian Urban Centre
~ Konia Trouton and Windy Brown
Despite the fact that the IUD is the cheapest, most effective method of contraception available, it is used by less than 1% of North American women. Several factors may underlie this discrepancy, including widespread primary care provider notions that IUD's are only appropriate for a subgroup of women as well as limitations in knowledge of the procedure and possible complications. We seek to evaluate the prevalence of the GP attitude that only parous women are considered appropriate for IUD insertion, as well as analyze the insertion procedure and rate of complications in relation to variables such as parity, STI status and prior medical history. By means of a retrospective chart review, data will be collected from two primary care centers, which provide the majority of IUD insertions in the greater Victoria region. A standardized form will be used to collect data.
Navigation for Mental Health and Addictions Services: Connecting With Primary Care
~ Ellen Anderson
The Sooke Navigator Project, in partnership with a Community-based steering committee, the Vancouver Island Health Authority, the Center for Applied Research in Mental Health and Addictions at SFU, and UVic, has completed a collection of 21 months of community level data on regional (East Sooke to Port Renfrew) mental health and addictions service need. The project will analyze the efficacy of a navigator model to enhance service access, optimize resource utilization and to knit primary care, community based organizations and the MHAS system into an effectively functioning network of care.
Transgender Health: An Exploratory Study
~Todd Sakakibara, Laurie Ireland and Marria Townsend
This project involves a focus group discussion on transgender health with the following objectives: (1) Identify health issues of importance to the transgender community, (2) Improve the health of transgender individuals and the transgender community as a whole by addressing important health issues, (3) Elicit ideas from transgender participants on themes for further research and ideas on how a community-based research team could be formed to conduct research around these themes, (4) Empower the transgender community by involving the community as an equal partner in the research process and (5) Form the framework for the Vancouver Transgender Community to conduct further community-based participatory action research either, as part of, or following this research study.
Does a Resident's Participation in a Procedural Skills Workshop Correlate with Utilization of Skills in Future Independent Practice?
~ Mark Mackenzie
Since June 2001, the teaching faculty of the UBC Family Medicine Program in Chilliwack, BC has facilitated a series of procedural skills workshops for residents. What has been unclear is whether or not this workshop approach makes a real difference in procedural skills used by residency program graduates. This survey will see if there is a difference in skill sets between residents that received this workshop and residents that didn't.
Finding Lasting Options for Women (FLOW): A Trial Comparing Tampons to a Menstrual Cup
~ Konia Trouton, Renee Fernandes, Courtenay Howard, Sanja Karalic, Nicole Kirkpatrick, Danielle Marentette, Julie Paget and Caren Rose
The primary goal of this project is to determine overall satisfaction with a menstrual cup compared to tampons, as a menstrual flow management strategy. Tampons are costly for women and generate a great deal of waste in Canada every year. An equally safe, effective, cheaper and reusable alternative would provide women with a valuable tool and increased choice in the management of their menstrual flow. This study will provide evidence for family physicians to use as they help women make informed decisions regarding menstrual management. Read the Victoria Times Colonist article on this project.
Family Physicians and Their Experiences of Medical Error
~ Lisa Heidt, Colleen Kirkham and Hilary Pearson
There has been a recent dramatic increase in the medical literature on medical error, much of it directed toward error prevention and detection; however, little discussion to date has addressed the impact of medical error on the physician. As well, even less is known about the situation in primary care where the majority of patient contacts with health care providers occur. The purpose of this study is to gain a better understanding of family physicians? experiences with medical error, which include (1) increasing understanding of the emotional impact of medical error on the family physician, (2) identifying effective error response strategies to reduce emotional harm for both physician and patient, and (3) identifying potential barriers to healing.
Nutrition in Medicine
~ Kristen Taunton, Jacquie Trudeau and Kathryn Wynn
Despite a perceived need for nutrition counselling in the family practice setting, family physicians and residents do not feel comfortable counselling patients about nutrition. This lack of comfort results from inadequate training in nutrition as it relates to family medicine. This study sets out to determine whether family practitioners and medical trainees perceive their nutrition training to be adequate, and furthermore, to identify how physicians have acquired their current level of knowledge of nutrition topics. Do family physicians feel that nutrition counselling would benefit their patients? More specifically, do they feel that this is one of their responsibilities as primary care practitioners?
