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Biomedical subjects

William Hogg

Publications and source records attributed to William Hogg.

14 recordsLinked to original sources
PubMed2006

Physical activity counseling in primary care: who has and who should be counseling?

OBJECTIVE: To examine the physical activity (PA) counseling literature in primary care in order to identify which intervention provider has been used to date and their relative effectiveness for increasing PA. METHOD: MEDLINE and PsycINFO databases were searched for PA intervention studies in primary care settings. RESULTS: Of the 19 studies, 37% were conducted solely by physicians, 37% by allied health professionals, while 26% were combined-provider interventions. There was a decline in the number of physician-only interventions and a shift towards interventions offered by allied health professionals as adjuncts or alone. Interventions across all provider categories generated some improvements in physical activity behavior, however, it appears that allied health professionals as adjuncts or alone produced the best results in the long-term (>6 months). There was substantial variation in the location and counseling approach employed by allied health professionals. CONCLUSION: We argue for an interdisciplinary model in which physicians recommend PA and provide referrals to allied health professionals such as physical activity counselors. PRACTICE IMPLICATIONS: With physical activity counselors' specialized training and greater time available to the patient, they may provide more intensive and effective counseling required for behavior change and maintenance.

Allied Health Personnel↗
PubMed2006

Remunerating primary care physicians: emerging directions and policy options for Canada.

How primary care physicians are remunerated is an important component of healthcare reform debates in Canada. This paper contributes to the policy debate by drawing together the theoretical insights gained from existing economic theory and evidence on how payment schemes affect physicians' behaviour. Several policy implications for the efficient and effective remuneration of physicians emerge from the analysis, as do directions for future research.

Canada↗
PubMed2006

Why do family physicians fail to detect renal impairment?

OBJECTIVE: To investigate why many patients with renal impairment (30.7%) were not recognized by their family physicians despite an earlier educational intervention on detecting renal impairment; and to determine whether certain factors related to physicians, patients, or the intervention itself were associated with whether renal impairment was detected. DESIGN: Qualitative approach using grounded theory. SETTING: A Health Service Organization in Ottawa, Ont. PARTICIPANTS: A purposeful sample of six family physicians. METHODS: In semistructured interviews, participants were asked to describe the workup ordered and their decision-making processes for patients in whom they had recently detected renal impairment. They were also asked to evaluate the six components of an educational intervention designed to help them to detect renal impairment. Finally, one patient's chart was reviewed (a chart containing a laboratory report noting an abnormal result for kidney function and having no indication that renal impairment had been recognized) to identify reasons for lack of detection. RESULTS: Most physicians did not investigate every patient with renal impairment (glomerular filtration rate of < 78 mL/min) in the same way because they took individual patient factors into consideration. Reasons for not detecting renal impairment were "managed differently" or "missed," with the former being the most common. The educational intervention physicians remembered most often was chart rounds, and these were viewed as helpful. "Missed" cases were more often deliberately managed differently than unintentionally not detected. CONCLUSION: Physicians used various approaches to detect and manage renal impairment despite interventions that recommended a consistent procedure.

Adult↗
PubMed2005

Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis.

BACKGROUND: Outreach facilitation has been proven successful in improving the adoption of clinical preventive care guidelines in primary care practice. The net costs and savings of delivering such an intensive intervention need to be understood. We wanted to estimate the proportion of a facilitation intervention cost that is offset and the potential for savings by reducing inappropriate screening tests and increasing appropriate screening tests in 22 intervention primary care practices affecting a population of 90,283 patients. METHODS: A cost-consequences analysis of one successful outreach facilitation intervention was done, taking into account the estimated cost savings to the health system of reducing five inappropriate tests and increasing seven appropriate tests. Multiple data sources were used to calculate costs and cost savings to the government. The cost of the intervention and costs of performing appropriate testing were calculated. Costs averted were calculated by multiplying the number of tests not performed as a result of the intervention. Further downstream cost savings were determined by calculating the direct costs associated with the number of false positive test follow-ups avoided. Treatment costs averted as a result of increasing appropriate testing were similarly calculated. RESULTS: The total cost of the intervention over 12 months was $238,388 and the cost of increasing the delivery of appropriate care was $192,912 for a total cost of $431,300. The savings from reduction in inappropriate testing were $148,568 and from avoiding treatment costs as a result of appropriate testing were $455,464 for a total savings of $604,032. On a yearly basis the net cost saving to the government is $191,733 per year (2003 Can dollars) equating to $3,687 per physician or $63,911 per facilitator, an estimated return on intervention investment and delivery of appropriate preventive care of 40%. CONCLUSION: Outreach facilitation is more expensive but more effective than other attempts to modify primary care practice and all of its costs can be offset through the reduction of inappropriate testing and increasing appropriate testing. Our calculations are based on conservative assumptions. The potential for savings is likely considerably higher.

Adult↗
PubMed2004

Detection of chronic kidney disease with laboratory reporting of estimated glomerular filtration rate and an educational program.

BACKGROUND: Serum creatinine concentration is an inadequate screening test for chronic kidney disease, especially in elderly patients. We hypothesized that laboratory reporting of estimated glomerular filtration rate (GFR) accompanied with an educational intervention would improve recognition of chronic kidney disease (CKD). METHODS: We conducted a before-and-after study at an outpatient family medicine practice. Patients 65 years or older for whom a Cockcroft-Gault GFR could be calculated from their medical record were included. The intervention consisted of automatic reporting of estimated GFR by the hospital laboratory along with an educational intervention directed toward the primary care physicians. The primary outcome was the recognition of CKD (defined as a Cockroft-Gault GFR <60 mL/min [<1.0 mL/s]) by the primary care physician. Factors associated with the recognition of CKD were also determined. RESULTS: The study population comprised 324 patients. Prior to the study intervention, 22.4% of patients with CKD were recognized, which increased to 85.1% after the intervention. Before the intervention, recognition was more likely in male subjects (odds ratio, 4.3; 95% confidence interval, 1.9-9.8) and patients with diabetes (odds ratio, 3.4; 95% confidence interval, 1.6-7.6). These associations were no longer statistically significant after the intervention. CONCLUSION: Laboratory reporting of estimated GFR coupled with an educational program markedly improves the recognition of CKD in the primary care setting.

Aged↗
PubMed2004

Health sciences research and Aboriginal communities: pathway or pitfall?

OBJECTIVE: To provide health researchers and clinicians with background information and examples regarding Aboriginal health research challenges, in an effort to promote effective collaborative research with Aboriginal communities. METHODS: An interdisciplinary team of experienced Aboriginal-health researchers conducted a thematic analysis of their planning meetings regarding a community-based Aboriginal health research training project and of the text generated by the meetings and supplemented the analysis with a literature review. RESULTS: Four research challenges are identified and addressed: (1) contrasting frameworks of Western science and indigenous knowledge systems; (2) the impact of historic colonialist processes upon the interface between health science research and Aboriginal communities; (3) culturally relevant frameworks and processes for knowledge generation and knowledge transfer; and (4) Aboriginal leadership, governance, and participation. CONCLUSION: Culturally appropriate and community-controlled collaborative research can result in improved health outcomes in Aboriginal communities and contribute new insights and perspectives to the fields of public health and medicine in general.

Attitude to Health↗
PubMed2004

Knowledge translation and indigenous knowledge.

OBJECTIVE: We wanted to evaluate the interface between knowledge translation theory and Indigenous knowledge. DESIGN: Literature review supplemented by expert opinion was carried out. METHOD: Thematic analysis to identify gaps and convergences between the two domains was done. RESULTS: The theoretical and epistemological frameworks underlying Western scientific and Indigenous knowledge systems were shown to have fundamental differences. CONCLUSION: Knowledge translation methods for health sciences research need to be specifically developed and evaluated within the context of Aboriginal communities.

Canada↗
PubMed2003

Why do doctors attend traditional CME events if they don't change what they do in their surgeries? Evaluation of doctors' reasons for attending a traditional CME programme.

OBJECTIVE: This study aimed to discover what the family doctors who attended an annual refresher course wished to obtain from participating in the event and what their response was to evidence that doctor behaviour is not changed by such programmes. DESIGN: The study used the qualitative method of in-depth interviews. SETTING: Ottawa, Ontario, Canada and the surrounding area. PARTICIPANTS: The informants for the study were a sample of 6 family doctors who attended the 50th Annual Refresher Course for Family Physicians, held in April 2001 in Ottawa, Ontario, Canada. METHOD: In-depth interviews with the participants were conducted before and after they attended the annual refresher course. The doctors had pre-registered for the 3-day course. They were purposely selected to obtain diversity of gender, year of graduation from medical school and practice location. RESULTS: The doctors interviewed had 3 main reasons for attending the refresher course: to obtain information or to be updated; to be reassured that their practice behaviour was within accepted guidelines, and to hear from and interact with the specialists who gave presentations. All the participants in the study were able to name changes they had made as the result of attending a similar type of programme in the past and were sceptical of findings that practice behaviour did not change as a result of traditional continuing medical education (CME). CONCLUSIONS: Despite current support for interactive and practice-linked educational activities, the doctors in this study valued the input of the experts who lectured at the course. These doctors were not prepared to accept the currently held precept that their behaviour did not change as a result of attendance at traditional CME programmes.

Canada↗
PubMed2002

Improved preventive care in family practices with outreach facilitation: understanding success and failure.

OBJECTIVES: To understand why some family practices with a facilitator improved preventive performance more than others. Sustainability of practice improvements one year after the intervention was also explored. METHODS: Interviews with physicians and nurses from seven practices and data gathered during the intervention were used to form case studies of three high performing and four low performing family practices. Case studies were developed using cross-case analysis with a combination of the constant-comparative method and memoing-diagramming. Two researchers independently conducted in-depth coding of transcripts and documents, individual case construction for each study site, and then cross-case analysis of the identified themes between study sites. RESULTS: Staff involvement and a positive attitude toward implementation of changes were central to high improvement in performance. A lack of computers, low staff involvement or high staff turnover were associated with low improvement in performance. Personal characteristics of the facilitator are important. Six of the seven practices still had the prevention tools in place one year after the intervention and all noted that participation had improved their understanding of preventive medicine. CONCLUSIONS: When using facilitators, one should avoid practices in turmoil, strive for continuity over time, and recognise the importance of the relationship between the facilitator and the practice.

Attitude of Health Personnel↗
PubMedDate not supplied

A community-based program for cardiovascular health awareness.

OBJECTIVE: The objective of the Cardiovascular Health Awareness Program (CHAP) is to improve the processes of care related to the cardiovascular health of older adults. PARTICIPANTS: Two Ontario communities including family physicians (FP), pharmacists, public health units and nurses, volunteer peer health educators, older adult patients and community organizations. SETTING: Community pharmacies and family physician offices. INTERVENTION: CHAP is designed to close a process of care loop around cardiovascular health awareness that originates from, and returns to, the FP. Older patients are invited by their FP to attend pharmacy CHAP sessions. At these sessions, trained volunteer peer health educators (PHEs) assist patients both in recording their blood pressure using a calibrated automated device and in completing a cardiovascular risk profile. This information is relayed to their respective FP via an automated computerized database. Pharmacists and patients receive copies of the results. Based on these cumulative risk profiles, patients are advised to follow-up with their FP. OUTCOMES: Of the FPs and pharmacists asked, 47% and 79%, respectively, agreed to participate in the project. 39% of older adult patients invited by their FPs attended the CHAP community pharmacy sessions. Of these, 100% agreed to having their risk profile, including their blood pressure readings, forwarded to their FP. Positive feedback about CHAP was expressed by the volunteer PHEs, the FPs and the pharmacists. CONCLUSION: The community-based pharmacy CHAP sessions are a feasible way of improving patient, physician, and pharmacist access to reliable blood pressure measurements and to cardiovascular health information. A randomized trial is in progress that will assess the impact of CHAP on monitoring of blood pressure.

Attitude of Health Personnel↗