Canadian Adaptive Platform Trial of Treatments for COVID in Community Settings (CanTreatCOVID): protocol for a randomised controlled adaptive platform trial of treatments for acute SARS-CoV-2 infection in community settings.

Introduction: SARS-CoV-2 is now endemic and expected to remain a health threat, with new variants continuing to emerge and the potential for vaccines to become less effective. While effective vaccines and natural immunity have significantly reduced hospitalisations and the need for critical care, outpatient treatment options remain limited, and real-world evidence on their clinical and cost-effectiveness is lacking. In this paper, we present the design of the Canadian Adaptive Platform Trial of Treatments for COVID in Community Settings (CanTreatCOVID).

Interventions to Address Potentially Inappropriate Prescribing for Older Primary Care Patients: A Systematic Review and Meta-Analysis.

Importance: Prescriptions for potentially inappropriate medications are common and, by definition, may carry risks that outweigh benefits.

Objective: To determine whether interventions to address potentially inappropriate prescribing for older primary care patients are associated with changes in the number of medications prescribed, drug-related harms, hospitalizations, and mortality.

Data Sources: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to September 6, 2024.

Primary care physician characteristics associated with becoming opioid agonist treatment prescribers in British Columbia: a retrospective case-control study.

Background: Opioid agonist treatment (OAT) is the gold standard of care for patients living with opioid use disorder. Since 2016, efforts to expand OAT access have focused on primary care physicians. This study aimed to understand how OAT-prescribing-naïve primary care physicians who began prescribing OAT differed from their peers who did not.

Informing family physician payment reform in Canada: protocol for a cross-provincial, multimethod study.

Background: Amid growing concerns about primary care accessibility and the need to support longitudinal, community-based models of care, Canadian provinces have implemented major reforms to how family physicians are paid. These models share objectives of making longitudinal, community-based family practice more attractive and, to some degree, addressing long-standing disparities in pay between family medicine and other specialties. These new remuneration models require robust evaluation to guide improvements, future investments and planning.

Designed for simplicity, used for complexity: The systemic pressures shaping walk-in clinic practices and outcomes.

Walk-in clinics (WICs), appreciated for their accessibility and convenience, have become an increasingly popular healthcare option in Ontario for patients with and without primary care enrolment. Despite their utility, WICs face criticism for delivering lower-quality care compared to comprehensive, enrolment-based primary care models. Critics argue that WICs contribute to system inefficiencies and encourage practice patterns misaligned with population health goals.

The effects of a provincial opioid prescribing standard on prescribing for pain in adults: an interrupted time-series analysis.

Background: In 2016, the College of Physicians and Surgeons of British Columbia released a legally enforceable opioid prescribing practice standard for the treatment of chronic noncancer pain (CNCP); it was revised in 2018 in response to concerns that it was misinterpreted. We aimed to test the effects of the practice standard on access to opioids for people treated for CNCP, living with cancer, or receiving palliative care.

Methods: We used comprehensive administrative health data from Oct.

Changing primary care capacity in Canada: protocol for a cross-provincial mixed methods study.

Introduction: Despite having more family physicians (FPs) and nurse practitioners (NPs) per capita than ever before in Canada, there is a clear gap between population primary care needs and system capacity. Primary care needs may be shaped by population ageing, increasing clinical and social complexity and growing service intensity. System capacity may be shaped by falling practice volumes, increasing administrative workload, changing clinician demographics and new health system roles (eg, hospitalist and focused practices).

The impact of eliminating out-of-pocket payments for medicines on low-income households: a controlled interrupted time series analysis using linked administrative data from British Columbia.

Background: There is interest in reducing out-of-pocket payments for prescription medicines, but the effects of such interventions remain unclear.

Objective: To study the impact of changes to the public prescription drug insurance program in British Columbia (BC), Canada that eliminated copayments for low-income households.

Methods: We used administrative data from 2017 to 2021 from Population Data BC and a controlled interrupted time-series design to examine a 2019 policy that eliminated copayments for households with incomes below $13,750.

Health Care Utilization After a Visit to a Within-Group Family Physician vs a Walk-In Clinic Physician.

Purpose: Primary care access is a key health system metric, but little research has compared models to provide primary care access when one's regular physician is not available. We compared health system use after a visit with a patient's own family physician group (ie, within-group physician who was not the patient's primary physician) vs a visit with a walk-in clinic physician who was not part of the patient's family physician group.

Methods: We conducted a population-based, retrospective cohort study using administrative data from Ontario, Canada, including all individuals formally enrolled with a family physician, from April 1, 2019 to March 31, 2020.

Chronic pain management in primary care: Using population-based data to examine family physician practice patterns.

Objective: To examine trends in chronic pain (CP) practice patterns among community-based family physicians (FPs).

Design: Population-based descriptive study using health administrative data.

Setting: British Columbia from fiscal years 2008-2009 to 2017-2018.

"Family doctors are also people": a qualitative analysis of how family physicians managed competing personal and professional responsibilities during the COVID-19 pandemic.

Background: Family physicians (FPs) fill an essential role in public health emergencies yet have frequently been neglected in pandemic response plans. This exclusion harms FPs in their clinical roles and has unintended consequences in the management of concurrent personal responsibilities, many of which were amplified by the pandemic. The objective of our study was to explore the experiences of FPs during the first year of the COVID-19 pandemic to better understand how they managed their competing professional and personal priorities.

"Technology has allowed us to do a lot more but it's not necessarily the panacea for everybody": Family physician perspectives on virtual care during the COVID-19 pandemic and beyond.

Introduction: Early in the COVID-19 pandemic, Canadian primary care practices rapidly adapted to provide care virtually. Most family physicians lacked prior training or expertise with virtual care. In the absence of formal guidance, they made individual decisions about in-person versus remote care based on clinical judgement, their longitudinal relationships with patients, and personal risk assessments.

Evaluating the cost of NP-led vs. GP-led primary care in British Columbia.

In 2020, British Columbia (BC) opened four pilot Nurse Practitioner Primary Care Clinics (NP-PCCs) to improve primary care access. The aim of this economic evaluation is to compare the average cost of care provided by Nurse Practitioners (NPs) working in BC's NP-PCCs to what it would have cost the government to have physicians provide equivalent care. Comparisons were made to both the Fee-For-Service (FFS) model and BC's new Longitudinal Family Physician (LFP) model.

Access to episodic primary care: a cross-sectional comparison of walk-in clinics and urgent primary care centers in British Columbia.

Aim: This study aimed to identify publicly reported access characteristics for episodic primary care in BC and provided a clinic-level comparison between walk-in clinics and UPCCs.

Background: Walk-in clinics are non-hospital-based primary care facilities that are designed to operate without appointments and provide increased healthcare access with extended hours. Urgent and Primary Care Centres (UPCCs) were introduced to British Columbia (BC) in 2018 as an additional primary care resource that provided urgent, but not emergent care during extended hours.

Evaluation of audit and feedback to family physicians on prescribing of opioid analgesics to opioid-naïve patients: A pragmatic randomized delay trial.

Background: Exposure to opioid analgesics have historically raised concern for a risk of developing opioid use disorder. Prescriber audit-and-feedback interventions may reduce opioid prescribing, but some studies have shown detrimental effects for current users. We examined the effectiveness of an audit and feedback intervention, named Portrait, to reduce initiation of opioid analgesics among opioid-naïve patients experiencing pain.

Productivity Decline or Administrative Avalanche? Examining Factors That Shape Changing Workloads in Primary Care.

Background: In Canada, family physicians (FPs) per capita have increased but so have access challenges. We explored changes in population characteristics, service delivery and FP practice that may help understand these trends.

Methods: We used linked administrative data in British Columbia to describe changes in patient ages and comorbidities, hospitalizations and receipt of services that may require FP coordination, review and/or follow-up: prescriptions dispensed, laboratory tests, diagnostic imaging (radiology and ultrasound), specialist visits and emergency department visits.

For health or for profit? Understanding how private financing and for-profit delivery operate within Canadian healthcare (4H|4P): protocol for a multimethod knowledge mobilisation research project.

Introduction: Privatisation through the expansion of private payment and investor-owned corporate healthcare delivery in Canada raises potential conflicts with equity principles on which Medicare (Canadian public health insurance) is founded. Some cases of privatisation are widely recognised, while others are evolving and more hidden, and their extent differs across provinces and territories likely due in part to variability in policies governing private payment (out-of-pocket payments and private insurance) and delivery.

Methods And Analysis: This pan-Canadian knowledge mobilisation project will collect, classify, analyse and interpret data about investor-owned privatisation of healthcare financing and delivery systems in Canada.

What can publicly funded schools teach us about how to fix the family doctor shortage?

Recent estimates suggest that up to 22% of Canadians over 18 do not have regular access to a family doctor or nurse practitioner. This lack of access is often characterized as a "family doctor shortage" and has been making headlines for decades. However, we have more family doctors than ever before, and in fact, the lack of primary care access is less about a shortage of physicians and more a need to develop a modern infrastructure and new way of funding and organizing care.

Walk-in clinic patient characteristics and utilization patterns in Ontario, Canada: a cross-sectional study.

Background: Walk-in clinics are common in North America and are designed to provide acute episodic care without an appointment. We sought to describe a sample of walk-in clinic patients in Ontario, Canada, which is a setting with high levels of primary care attachment.

Methods: We performed a cross-sectional study using health administrative data from 2019.