Jan Klimas

Objectives: Several opioid prescribing initiatives have been recently evaluated including the Portrait letter program in British Columbia (BC). The experiences of primary care providers targeted by these programs have not been fully characterized. This qualitative study sought to examine barriers and facilitators to implementing prescribing Portraits with educational webinars on pain management with opioids in primary care. Methods: This study involved qualitative analysis of focus groups conducted for a mixed-method, randomized trial of an opioid prescribing feedback intervention (REDONNA). Participants were recruited following an educational webinar from primary care settings. As part of REDONNA’s qualitative arm, 19 family physicians, 13 nurse practitioners, and 3 other professionals participated in focus groups. The data were analyzed in the light of the Consolidated Framework for Implementation Research. Results: The Consolidated Framework for Implementation Research highlighted 4 topics represented by 12 subtopics: 4 structural, 3 organizational, 2 individual, and 3 interventional factors. Participants identified that their decision-making for opioid prescribing was influenced not only by the intended educational messages but also by their experiences with people who had opioid use disorders (PWOUD). Spending time with patients, supportive working environments, tailoring Portraits, and accessing expertise facilitated implementation. Suggested improvements included more funding for nonpharmacological alternatives and more in-depth stratified data. Conclusions: Prescribing feedback programs should move beyond opioid-sparing approaches to better address the challenges experienced by marginalized populations. Appropriate understanding of and sensibility toward PWOUD appears to benefit the meaningful implementation of opioid training programs in primary care. Objectifs: Plusieurs initiatives de prescription d’opioïdes ont été récemment évaluées, y compris le programme Portrait Letter en Colombie-Britannique (C.-B.). Les expériences des fournisseurs de soins primaires ciblés par ces programmes n’ont pas été entièrement caractérisées. Cette étude qualitative visait à examiner les obstacles et les facilitateurs à la mise en œuvre de Portraits de prescription avec des webinaires éducatifs sur la gestion de la douleur avec des opioïdes dans les soins primaires. Méthodes: Cette étude a consisté en une analyse qualitative de groupes de discussion organisés dans le cadre d’un essai randomisé à méthode mixte portant sur une intervention de rétroaction en matière de prescription d’opioïdes (REDONNA). Les participants ont été recrutés à la suite d’un webinaire éducatif dans des établissements de soins primaires. Dans le cadre du volet qualitatif de REDONNA, 19 médecins de famille, 13 infirmier(e)s praticien(ne)s et trois autres professionnel(le)s ont participé à des groupes de discussion. Les données ont été analysées à la lumière du cadre du groupe The Consolidated Framework for Implementation Research (CFIR). Résultats: Le CFIR a mis en évidence quatre thèmes principaux représentés par 12 sous-thèmes : quatre facteurs structurels, trois facteurs organisationnels, deux facteurs individuels et trois facteurs interventionnels. Les participants ont indiqué que leur prise de décision concernant la prescription d’opioïdes était influencée non seulement par les messages éducatifs prévus, mais aussi par leurs expériences avec des personnes souffrant de troubles liés à l’utilisation d’opioïdes (PSTUO). Le fait de passer du temps avec les patients, des environnements de travail favorables, l’adaptation des Portraits et l’accès à l’expertise ont facilité la mise en œuvre. Parmi les améliorations suggérées, citons un financement accru des alternatives non pharmacologiques et des données stratifiées plus approfondies. Conclusions: Les programmes de rétroaction en matière de prescription devraient aller au-delà des approches d'économie d’opioïdes afin de mieux répondre aux défis auxquels sont confrontées les populations marginalisées. Une bonne compréhension et une sensibilité à l'égard de la PSTUO semblent favoriser une mise en œuvre significative des programmes de formation sur les opioïdes dans le cadre des soins primaires.

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. Methods: This cross-sectional study used publicly available data from all walk-in clinics and UPCCs in BC. A structured data collection form was used to record access characteristics from clinic websites, including business hours, weekend availability, attachment to a longitudinal family practice, and provision of virtual services. Findings: In total, 268 clinics were included in the analysis (243 walk-in clinics, 25 UPCCs). Of those, 225 walk-in clinics (92.6%) and two UPCCs (8.0%) were attached to a longitudinal family practice. Only 153 (63%) walk-in clinics offered weekend services, compared to 24 (96%) of UPCCs. Walk-in clinics offered the majority (8,968.6/ 78.4%) of their service hours between 08:00 and 17:00, Monday to Friday. UPCCs offered the majority (889.3/ 53.7%) of their service hours after 17:00. Conclusion: Most walk-in clinics were associated with a longitudinal family practice and provided the majority of clinic services during typical business hours. More research that includes patient characteristics and care outcomes, analyzed at the clinic level, may be useful to support the optimization of episodic primary healthcare delivery.

Purpose To assess the effects of group therapy focused on the experience of living with prostate cancer (PC) on depression and mental well-being among men with the disease and to explore participant experiences of a guided opportunity to ‘speak the unspeakable’ as it pertains to living with PC. Methods We used a mixed-method convergent design. Participants completed four validated self-report questionnaires at baseline, immediately after the final session, and at three, six, and 12 months follow-up. A repeated measures mixed-effect model examined the effects of the program on depression, mental well-being, and masculinity. Seven focus groups (n = 37) and 39 semi-structured individual interviews explored participant reactions at follow-up. Results Thirty-nine (93%) participants completed the questionnaires at all follow-ups. Responses indicated improved mental well-being up to three months (p < 0.01) and a decrease in depressive symptoms to 12 months (p < 0.05). Qualitative analysis revealed how the cohesive group environment alleviated psychological stress, enabled participants to identify significant issues and concerns in their lives, and improved communication and relationship skills that were of value in the group as well as with family and friends. The facilitation was essential to guiding participants to ‘speak the unspeakable.’ Conclusion Men with PC who speak of their experience in a group setting with a guided process incorporating features of a life review appear to gain insight into the impact of PC in their lives, experience diminished features of depression and isolation, and enhance their communication skills within the groups as well as with family members and friends.

As deaths from the illicit drug poisoning crisis continue to rise in Canada, increasing the number of healthcare professionals qualified to effectively prescribe opioids could be beneficial. The wi...

Background: There has been a notable deficiency in the implementation of addiction science in clinical practice and many healthcare providers feel unprepared to treat patients with substance use disorders (SUD) following training. However, the perceptions of addiction medicine training by learners in health professions have not been fully investigated. This qualitative study explored perceptions of prior training in SUD care among early-career trainees enrolled in Addiction Medicine fellowships and electives in Vancouver, Canada. Methods: From April 2015 – August 2018, we interviewed 45 early-career physicians, social workers, nurses, and 17 medical students participating in training in addiction medicine. We coded transcripts inductively using qualitative data analysis software (NVivo 11.4.3). Results: Findings revealed six key themes related to early-career training in addiction medicine: (1) Insufficient time spent on addiction education, (2) A need for more structured addictions training, (3) Insufficient hands-on clinical training and skill development, (4) Lack of patient-centeredness and empathy in the training environment, (5) Insufficient implementation of evidence-based medicine, and (6) Prevailing stigmas toward addiction medicine. Conclusion: Early clinical training in addiction medicine appears insufficient and largely focused on symptoms, rather than etiology or evidence. Early career learners in health professions perceived benefit to expanding access to quality education and reported positive learning outcomes after completing structured training programs.

Introduction The emergence of COVID-19 introduced a dual public health emergency in British Columbia, which was already in the fourth year of its opioid-related overdose crisis. The public health response to COVID-19 must explicitly consider the unique needs of, and impacts on, communities experiencing marginalisation including people with opioid use disorder (PWOUD). The broad move to virtual forms of primary care, for example, may result in changes to healthcare access, delivery of opioid agonist therapies or fluctuations in co-occurring health problems that are prevalent in this population. The goal of this mixed-methods study is to characterise changes to primary care access and patient outcomes following the rapid introduction of virtual care for PWOUD. Methods and analysis We will use a fully integrated mixed-methods design comprised of three components: (a) qualitative interviews with family physicians and PWOUD to document experiences with delivering and accessing virtual visits, respectively; (b) quantitative analysis of linked, population-based administrative data to describe the uptake of virtual care, its impact on access to services and downstream outcomes for PWOUD; and (c) facilitated deliberative dialogues to co-create educational resources for family physicians, PWOUD and policymakers that promote equitable access to high-quality virtual primary care for this population. Ethics and dissemination Approval for this study has been granted by Research Ethics British Columbia. We will convene PWOUD and family physicians for deliberative dialogues to co-create educational materials and policy recommendations based on our findings. We will also disseminate findings via traditional academic outputs such as conferences and peer-reviewed publications.

Background: Some Canadians have limited access to longitudinal primary care, despite its known advantages for population health. Current initiatives to transform primary care aim to increase access to team-based primary care clinics. However, many regions lack a reliable method to enumerate clinics, limiting estimates of clinical capacity and ongoing access gaps. A region-based complete clinic list is needed to effectively describe clinic characteristics and to compare primary care outcomes at the clinic level. Objective: The objective of this study is to show how publicly available data sources, including the provincial physician license registry, can be used to generate a verifiable, region-wide list of primary care clinics in British Columbia, Canada, using a process named the Clinic List Algorithm (CLA). Methods: The CLA has 10 steps: (1) collect data sets, (2) develop clinic inclusion and exclusion criteria, (3) process data sets, (4) consolidate data sets, (5) transform from list of physicians to initial list of clinics, (6) add additional metadata, (7) create working lists, (8) verify working lists, (9) consolidate working lists, and (10) adjust processing steps based on learnings. Results: The College of Physicians and Surgeons of British Columbia Registry contained 13,726 physicians, at 2915 unique addresses, 6942 (50.58%) of whom were family physicians (FPs) licensed to practice in British Columbia. The CLA identified 1239 addresses where primary care was delivered by 4262 (61.39%) FPs. Of the included addresses, 84.50% (n=1047) were in urban locations, and there was a median of 2 (IQR 2-4, range 1-23) FPs at each unique address. Conclusions: The CLA provides a region-wide description of primary care clinics that improves on simple counts of primary care providers or self-report lists. It identifies the number and location of primary care clinics and excludes primary care providers who are likely not providing community-based primary care. Such information may be useful for estimates of capacity of primary care, as well as for policy planning and research in regions engaged in primary care evaluation or transformation.

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 Primary Care Centres (UPCCs) were introduced to British Columbia (BC) in 2018 as an additional primary care resource that provides urgent, but not emergent care during extended hours. This study identifies publicly-reported access characteristics for episodic primary care in BC, and provides a clinic-level comparison between walk-in clinics and UPCCs. Methodology: This cross-sectional study used publicly available data from all walk-in clinics and UPCCs in BC. A structured data collection form was used to record access characteristics from clinic websites, including business hours, weekend availability, attachment to a longitudinal family practice, and provision of virtual services. Results: In total, 268 clinics were included in the analysis (243 walk-in clinics, 25 UPCCs). Of those, 225 walk-in clinics (92.6%) and two UPCCs (8.0%) were attached to a longitudinal family practice. Only 153 (63%) walk-in clinics offered weekend services, compared to 24 (96%) of UPCCs. Walk-in clinics offer the majority (8,968.6/ 78.4%) of their service hours between 08:00 and 17:00, Monday to Friday. UPCCs offer the majority (889.3/ 53.7%) of their service hours after 17:00. Conclusion: Most walk-in clinics are associated with a longitudinal family practice and provide the majority of clinic services during typical business hours. More research that includes patient characteristics and care outcomes, analyzed at the clinic level, may be useful to support the optimization of episodic primary health care delivery.

Background: Prescribing rates of some analgesics decreased during the public health crisis. Yet, up to a quarter of opioid-naïve persons prescribed opioids for noncancer pain develop prescription opioid use disorder. We, therefore, sought to evaluate a pilot educational session to support primary care-based sparing of opioid analgesics for noncancer pain among opioid-naïve patients in British Columbia (BC).Methods: Therapeutics Initiative in BC has launched an audit and feedback intervention. Individual prescribing portraits were mailed to opioid prescribers, followed by academic detailing webinars. The webinars’ learning outcomes included defining the terms opioid naïve and opioid sparing, and educating attendees on the (lack of) evidence for opioid analgesics to treat noncancer pain. The primary outcome was change in knowledge measured by four multiple-choice questions at the outset and conclusion of the webinar.Results: Two hundred participants attended four webinars; 124 (62%) responded to the knowledge questions. Community-based primary care professionals (80/65%) from mostly urban settings (77/62%) self-identified as family physicians (46/37%), residents (22/18%), nurse practitioners (24/19%), and others (32/26%). Twelve participants (10%) recalled receiving the individualized portraits. While the correct identification of opioid naïve definitions increased by 23%, the correct identification of opioid sparing declined by 7%. Knowledge of the gaps in high-quality evidence supporting opioid analgesics and risk tools increased by 26% and 35%, respectively.Conclusion: The educational session outlined in this pilot yielded mixed results but appeared acceptable to learners and may need further refinement to become a feasible way to train professionals to help tackle the current toxic drugs crisis.