Practice-based Research Network Research Articles

Disruptions in Primary Care among People with Schizophrenia in Ontario, Canada, During the COVID-19 Pandemic.

To investigate how primary care access, intensity and quality of care changed among patients living with schizophrenia before and after the onset of the COVID-19 pandemic in Ontario, Canada. This cohort study was performed using primary care electronic medical record data from the University of Toronto Practice-Based Research Network (UTOPIAN), a network of > 500 family physicians in Ontario, Canada. Data were collected during primary care visits from 2643 patients living with schizophrenia. Rates of primary care health service use (in-person and virtual visits with family physicians) and key preventive health indices indicated in antipsychotic monitoring (blood pressure readings, hemoglobin A1c, cholesterol and complete blood cell count [CBC] tests) were measured and compared in the 12 months before and after onset of the COVID-19 pandemic. Access to in-person care dropped with the onset of the COVID-19 pandemic. During the first year of the pandemic only 39.5% of patients with schizophrenia had at least one in-person visit compared to 81.0% the year prior. There was a corresponding increase in virtual visits such that 78.0% of patients had a primary care appointment virtually during the pandemic period. Patients prescribed injectable antipsychotics were more likely to continue having more frequent in-person appointments during the pandemic than patients prescribed only oral or no antipsychotic medications. The proportion of patients who did not have recommended tests increased from 41.0% to 72.4% for blood pressure readings, from 48.9% to 60.2% for hemoglobin A1c, from 57.0% to 67.8% for LDL cholesterol and 45.0% to 56.0% for CBC tests during the pandemic. There were substantial decreases in preventive care after the onset of the pandemic, although primary care access was largely maintained through virtual care. Addressing these deficiencies will be essential to promoting health equity and reducing the risk of poor health outcomes.

Patients Receiving Integrative Medicine Effectiveness Registry (PRIMIER) of the BraveNet practice-based research network: Outcomes of the PRIMIER cohort

ObjectiveTo evaluate the real-world effectiveness of integrative medicine treatment on quality of life using the Patients Receiving Integrative Medicine Effectiveness Registry (PRIMIER). DesignA prospective, longitudinal, observational evaluation of patient reported outcomes for quality of life. SettingParticipants were patients from 17 integrative medicine clinics who received personalized, integrative medicine treatments between August 2013 and October 2017. Main outcome measuresParticipants completed the Patient Reported Outcomes Measurement Information System (PROMIS)− 29, Perceived Stress Scale-4 (PSS-4), and the Patient Activation Measure (PAM) at index (baseline) visit and at 2, 4, 6, and 12 month follow-up assessments. Electronic health record data included diagnostic and billing codes/descriptions. A linear mixed-effects model was used to test whether outcomes changed from index through 12 months ResultsDuring enrollment, 4883 participants began the assessment, 3658 completed the index measures, and 2374 (65 %) completed at least 1 follow-up assessment, had electronic health record data and at least 1 integrative medicine visit. Most participants (mean age=51.4 years) were white (88.4 %), female (79.7 %), and college-educated (78.5 %). Significant improvements (p < 0.001) were observed at 12-months on all PROMIS-29 measures, PSS-4, and PAM. At 12 months, clinically meaningful improvements were found for 38 % and 28 % on PROMIS-29 Mental and Physical Health Summary scores respectively. ConclusionsPRIMIER is the largest study to assess the real-world effectiveness of integrative medicine. Results indicate a statistical and clinical improvement across all measures at 12 months. Future research could explore whether dosing, timing or combinations of integrative medicine interventions have differential impacts on quality of life.

Chatbot-Delivered Cognitive Behavioral Therapy in Adolescents With Depression and Anxiety During the COVID-19 Pandemic: Feasibility and Acceptability Study.

Symptoms of depression and anxiety, suicidal ideation, and self-harm have escalated among adolescents to crisis levels during the COVID-19 pandemic. As a result, primary care providers (PCPs) are often called on to provide first-line care for these youth. Digital health interventions can extend mental health specialty care, but few are evidence based. We evaluated the feasibility of delivering an evidence-based mobile health (mHealth) app with an embedded conversational agent to deliver cognitive behavioral therapy (CBT) to symptomatic adolescents presenting in primary care settings during the pandemic. In this 12-week pilot study, we evaluated the feasibility of delivering the app-based intervention to adolescents aged 13 to 17 years with moderate depressive symptoms who were treated in a practice-based research network (PBRN) of academically affiliated primary care clinics. We also obtained preliminary estimates of app acceptability, effectiveness, and usability. This small, pilot randomized controlled trial (RCT) evaluated depressive symptom severity in adolescents randomized to the app or to a wait list control condition. The primary end point was depression severity at 4-weeks, measured by the 9-item Patient Health Questionnaire (PHQ-9). Data on acceptability, feasibility, and usability were collected from adolescents and their parent or legal guardian. Qualitative interviews were conducted with 13 PCPs from 11 PBRN clinics to identify facilitators and barriers to incorporating mental health apps in treatment planning for adolescents with depression and anxiety. The pilot randomized 18 participants to the app (n=10, 56%) or to a wait list control condition (n=8, 44%); 17 participants were included in the analysis, and 1 became ineligible upon chart review due to lack of eligibility based on documented diagnosis. The overall sample was predominantly female (15/17, 88%), White (15/17, 88%), and privately insured (15/17, 88%). Mean PHQ-9 scores at 4 weeks decreased by 3.3 points in the active treatment group (representing a shift in mean depression score from moderate to mild symptom severity categories) and 2 points in the wait list control group (no shift in symptom severity category). Teen- and parent-reported usability, feasibility, and acceptability of the app was high. PCPs reported preference for introducing mHealth interventions like the one in this study early in the course of care for individuals presenting with mild or moderate symptoms. In this small study, we demonstrated the feasibility, acceptability, usability, and safety of using a CBT-based chatbot for adolescents presenting with moderate depressive symptoms in a network of PBRN-based primary care clinics. This pilot study could not establish effectiveness, but our results suggest that further study in a larger pediatric population is warranted. Future study inclusive of rural, socioeconomically disadvantaged, and underrepresented communities is needed to establish generalizability of effectiveness and identify implementation-related adaptations needed to promote broader uptake in pediatric primary care. ClinicalTrials.gov NCT04603053; https://clinicaltrials.gov/ct2/show/NCT04603053.

General practitioners' views and experiences of communicating with older people about cancer screening: a qualitative study.

Older adults should be supported to make informed decisions about cancer screening. However, it is unknown how general practitioners (GPs) in Australia communicate about cancer screening with older people. To investigate GPs' views and experiences of communicating about cancer screening (breast, cervical, prostate, and bowel) with older people (≥70 years). Qualitative, semi-structured interviews, Australia. Interviews were conducted with GPs practising in Australia (n = 28), recruited through practice-based research networks, primary health networks, social media, and email invitation. Interviews were audio-recorded and analysed thematically using Framework Analysis. Findings across GPs were organized into 3 themes: (i) varied motivation to initiate cancer screening discussions; some GPs reported that they only initiated screening within recommended ages (<75 years), others described initiating discussions beyond recommended ages, and some experienced older patient-initiated discussions; (ii) GPs described the role they played in providing screening information, whereby detailed discussions about the benefits/risks of prostate screening were more likely than other nationally funded screening types (breast, cervical, and bowel); however, some GPs had limited knowledge of recommendations and found it challenging to explain why screening recommendations have upper ages; (iii) GPs reported providing tailored advice and discussion based on personal patient preferences, overall health/function, risk of cancer, and previous screening. Strategies to support conversations between GPs and older people about the potential benefits and harms of screening in older age and rationale for upper age limits to screening programmes may be helpful. Further research in this area is needed.

11 Clinician Management of Childhood Dyslipidemia in the Community Setting

Abstract Background Childhood dyslipidemia is a known risk factor for the development of cardiovascular disease (CVD) in adulthood. Although adverse health outcomes of dyslipidemias are rare in childhood, the atherosclerotic process begins in early life. An overlooked lifelong progression of disease may result in myocardial infarction and stroke in later life. There are currently no Canadian paediatric guidelines for lipid screening. Despite dyslipidemia identification, early treatment or management may not be initiated. Primary care providers (PCP) are well positioned to advise and reinforce cardiovascular health behaviours to minimize the risk of CVD and promote lifelong cardiovascular health. Objectives To describe clinician practice patterns associated with childhood dyslipidemia management in the community setting. Design/Methods A retrospective chart review was conducted for children 2 to 10 years of age with abnormal lipid profiles. Participants were recruited from a practice-based research network. Non-fasting blood samples were obtained. The primary study outcome was the proportion of physicians engaging in each step of management practice. R version 3.6.2 (R Foundation for Statistical Computing, Vienna, Austria) was used for statistical analysis. Results Among 462 children identified with dyslipidemia, all were seen by PCP at their next follow-up visit. PCP rarely informed families about abnormal lipid profiles. PCP frequently counselled on diet and eating habits (n=424, 95.1%), but less often on physical activity (n=154, 34.5%), screen time (n=24, 5.4%), and sleep (n=1, 0.2%). Family history of CVD, diabetes, high cholesterol, or hypertension was infrequently discussed (n=5, 1.1%). PCP repeated fasting lipid profiles uncommonly (n=20, 4.5%). Management plans for abnormal lipid profiles were not documented. Only one participant had a follow-up visit (n=1, 0.2%). Referrals were rarely made to dieticians (n=2, 0.4%) and were not in response to abnormal lipid levels. Conclusion Dyslipidemia in childhood is a risk factor for the development of adult cardiovascular disease. Among children with abnormal lipid profiles, our study showed PCP rarely identified and initiated early management for abnormal lipid levels. Our results may inform the need for paediatric lipid screening and management guidelines to develop best clinical practice.

52 Underweight in the first 2 years of life and growth in later childhood

Abstract Background Underweight occurs when caloric intake is insufficient to maintain growth. While it has long been assumed that underweight in the first 2 years of life is associated with lower growth potential in later childhood, longer term growth outcomes in high income countries are unclear. Objectives The primary objective was to evaluate the relationship between underweight in the first 2 years of life and body mass index z-score (zBMI) in later childhood. Secondly, we examined the relationship between underweight in the first 2 years of life and weight-for-age z-score (WAZ) and height-for-age z-score (HAZ) in later childhood, and how sex and the zBMI growth trajectory in the first 2 years of life modify these associations. Design/Methods This was a prospective cohort study conducted through The Applied Research Group for Kids (TARGetKids!) practice-based research network. Healthy children 0-10 years of age were included. The primary exposure was underweight in the first 2 years of life using zBMI &amp;lt;-2 as per the World Health Organization (WHO). The primary outcome was zBMI, and secondary outcomes were WAZ and HAZ between 2 and 10 years of age. Linear mixed effects models were used for the primary and secondary analysis to take into account multiple growth measures over time. Interaction terms for sex, and the zBMI growth trajectory in the first 2 years of life were used to explore effect modification. Results Among the 5,803 children included in the primary analysis, the mean age was 4.07 months, and 52.2% were male at baseline. In adjusted models, underweight in the first 2 years of life was associated with lower zBMI, lower WAZ, and higher odds of underweight at 2, 5, and 10 years of age (p &amp;lt;0.0001). Underweight in the first 2 years was associated with a lower HAZ at 2 years of age (p&amp;lt;0.0001), but not 5 (p=0.08), or 10 years of age (p=0.8). Females with underweight had lower zBMI and WAZ at 5 and 10 years of age, and lower HAZ at 10 years of age compared to males with underweight (p&amp;lt;0.05). Children with underweight and lower growth trajectory in the first 2 years had lower zBMI, WAZ, HAZ, and higher odds of underweight at 2, 5, and 10 years of age compared to children who did not have underweight (p&amp;lt;0.05). Children with underweight and high growth trajectory in the first 2 years had similar zBMI, WAZ, higher HAZ and lower odds of overweight at 10 years of age (p&amp;lt;0.05), compared to children who did not have underweight. Conclusion Underweight in the first 2 years of life was associated with lower growth in later childhood. These relationships were amplified for females and children with underweight who had low growth trajectory in the first 2 years of life and were attenuated among children with underweight who had high growth trajectory in the first 2 years of life.

Community pharmacist-provided opioid intervention frequencies and barriers

BackgroundCommunity pharmacists are well-positioned to engage in opioid-related harm reduction activities (i.e., opioid interventions). However, several barriers to providing these interventions have been identified. Comparing the frequencies of opioid interventions and identifying which barriers are perceived to have the highest impact in providing interventions will yield valuable information for increasing opioid use disorder (OUD) care access within pharmacies. ObjectivesTo (1) characterize the frequency of 9 opioid interventions in community practice settings and (2) assess community pharmacists’ perceptions of what impact 15 key barriers have on providing opioid interventions. MethodsThis was a multi-state, cross-sectional, and descriptive survey study. Opioid interventions evaluated included prevention (e.g., OUD screening) and treatment (e.g., OUD resource referral); barriers encompassed confidence and knowledge, work environment, provider interactions, and patient interactions. Respondents were recruited from 3 community pharmacy practice-based research networks in the Midwest and South regions of the US. Recruitment and telephone survey administration occurred between December 2021 and March 2022. Descriptive statistics were computed and open-ended items were reviewed to identify common themes. ResultsSixty-nine of 559 pharmacists contacted (12.3%) completed the survey. All opioid interventions were reported to be provided less frequently than indicated in practice. Screening and referral interventions were provided least frequently, at 1.2 and 1.6 times on average, respectively, to the last 10 patients for which respondents felt each intervention was needed. Patient refusal, minimal or no reimbursement, inadequate staffing and time, and negative patient reactions were identified as the highest-impact barriers to providing opioid interventions. Approximately 26% of respondents agreed or strongly agreed that pharmacy school adequately prepared them to provide opioid interventions in practice. ConclusionPrioritizing the resolution of pharmacy work environment barriers will support pharmacists in routinely providing opioid interventions. Changes in Doctor of Pharmacy curricula and continuing education are also indicated to further prepare pharmacists to engage in opioid-related harm reduction.

Dental Sleep Medicine among dental practitioners: Preliminary findings from the National Dental Practice-Based Research Network.

Dental sleep medicine (DSM) focuses on oral appliance therapy (OAT) to manage sleep-disordered breathing (SDB), including obstructive sleep apnea (OSA). This brief poll aimed to assess the interest and practices of dental practitioners in DSM. To this day lack of data exists regarding how DSM practices function in the clinical setting. Therefore, identifying knowledge gaps in DSM among dental practitioners may improve patient outcomes. A preliminary brief questionnaire ("Quick Poll") on DSM was conducted through the National Dental Practice-Based Research Network (Network) members (n=311). The poll contained five questions about DSM. Results showed that 66% of practitioners have involvement in DSM patient care. A total of 44% of practitioners who answered the Quick Poll do not screen for snoring or SDBs. About 40% of respondents are either interested in continuing education courses on the topic or had already taken multiple courses on DSM. The top three topics of DSM research of interest to practitioners were various DSM practice models, response to OAT, and compliance with OAT. Network dental practitioner respondents face challenges regarding the treatment of SDBs. Despite these challenges, most practitioners are interested in engaging in DSM. Based on these preliminary findings, there are informational needs regarding the current state of clinical care, side effects of OAT, choice of OAT, titration protocols, and patient outcomes.

Deep caries removal strategies: Findings from The National Dental Practice-Based Research Network

BackgroundThe International Caries Consensus Collaboration (ICCC) has published recommendations on carious tissue removal to treat cavitated carious lesions in a manner that preserves hard tissue and retains teeth long term. This study quantifies The National Dental Practice-Based Research Network dentists’ use of selective caries removal. MethodsThis cross-sectional questionnaire study assessed reported use of selective caries removal when treating deep caries in asymptomatic and symptomatic teeth in response to clinical case scenarios. Statistical methods included the proportion of respondents concordant with ICCC guidelines at various thresholds and logistic regression to model factors associated with concordance. ResultsA total of 500 dentists responded. The study sample was 57% male, mean (SD) age was 50.9 (12.6) years, and 60% worked in private practice settings. Higher levels of concordance for choosing selective caries removal 50% or greater of the time were found for asymptomatic (62.4%; 95% CI, 57.6 to 67.2) than for symptomatic caries (49.3%; 95% CI, 44.4 to 54.2). These differences were significantly associated with type of practice setting. ConclusionsThe National Dental Practice-Based Research Network dentists reported using selective caries removal strategies when managing deep carious lesions more often than in previous US and Japanese practice-based research network studies and from results of a systematic review and meta-analysis. Nonetheless, substantive discordance with the ICCC guidelines was seen by the authors of this study. Practical ImplicationsMore dissemination and continuing education activities, as well as implementation studies, may further encourage use of selective caries removal to soft or firm dentin when indicated.

Ayurveda-Practice-Based Research Network (A-PBRN): Lesson Learned and Way Forward in the UK

We have recently undertaken a corporate strategy evaluation for a more accurate appraisal of the Ayurveda Practice Based Research Network&amp;#39;s two-year outcomes. While many of our views and experiences may not be original to PBRN networks, we feel that for Integrative Ayurveda, our insights will be valuable to others who are constructing or reshaping Ayurveda practice in a shifting health care context.&#x0D; &#x0D; Research that is contemporary, applicable, and amenable to integration into practice must be prioritized. Clinicians, academics, information technologists, and various scientists, as well as strategy implementation professionals, combining to establish a creative Hub, is a viable approach for reaching this objective in comparison to the original PBRN models. The creative Hub could assist academics in identifying significant research topics and meeting &amp;quot;critical&amp;quot; standards. Bridging the ends between practitioners, researchers, and clinicians may require novel partnerships and non-traditional funding sources in the future.

Naturopathic knowledge and approaches to managing endometriosis: a cross-sectional survey of naturopaths with experience in endometriosis care.

Endometriosis is a chronic gynaecological disease with varying symptomatology and negative health outcomes. To ensure the best care for women with endometriosis, women require a multidisciplinary team approach. While some women consult with naturopaths for endometriosis, there has been little research on naturopathic knowledge and the naturopathic approach to endometriosis care. This cross-sectional survey recruited naturopaths with experience in menstrual disorders from the Practitioner Research and Collaboration Initiative (PRACI) a Practice-Based Research Network (PBRN). Data collection was conducted viaan online self-administrated 62-item questionnaire. Invitations were sent to 109 naturopaths who self-reported having experience in menstrual disorders, of whom 29 completed the survey (26.6% response rate). Naturopaths perceived endometriosis to be caused by inflammation (n=28, 96.5%) and risk factors associated with familial history (n=26, 89.6%). Many naturopaths aimed at reducing inflammation (n=27, 93.1%) and supporting gastrointestinal function (n=25, 86.2%) in their prescriptions. Naturopaths reported using various healthcare referrals to support women with endometriosis, primarily general practitioners (n=12, 41.3%), acupuncturists/Traditional Chinese Medicine practitioners (n=11, 37.9%), and gynaecologists (n=9, 31%). Naturopaths reported receiving referrals from general practitioners (n=8, 27.5%) and psychologists (n=6, 20.6%). Naturopathic knowledge and management of endometriosis targets known problematic areas of endometriosis that can have debilitating effects on women's quality of life. Naturopathic care has the potential to align with important health outcomes for women with endometriosis however, further attention is needed to assess the effectiveness and continue to establish a multidisciplinary approach involving naturopathic care.

Priorities for improvement across cancer and non-cancer related preventive services among rural and non-rural clinicians

IntroductionIt is not realistic for most clinicians to perform the multitude of recommended preventive primary care services. This is especially true in low resource and rural settings, creating challenges to delivering high-quality care. This study collected stakeholder input from clinicians on which services they most need to improve.MethodsThe authors conducted a survey of primary care physicians 9–12/2021, with an emphasis on rural practices, to assess areas in which clinicians felt the greatest needs for improvement. The survey focused on primary prevention (behavior change counseling) and cancer screening, and contrasted needs for improvement for these services vs. other types of screening, and between clinicians in rural vs. non-rural practices.ResultsThere were 326 respondents from 4 different practice-based research networks, a wide range of practice types, 49 states and included 177 clinicians in rural settings. Respondents rated the need to improve delivery of primary prevention counseling services highest, with needs for nutrition and dietary assessment and counseling rated highest followed by physical activity and with almost no differences between rural and nonrural. Needs for improvement in cancer screenings were rated higher than non-cancer screenings, except for blood pressure screening.ConclusionsBoth rural and nonrural primary care clinicians feel a need for improvement, especially with primary prevention activities. Although future research is needed to replicate these findings with different populations and other types of preventive service activities, greater priority should be given to development of practical, stakeholder informed assistance and resources for primary care to conduct primary prevention.

Perceived effectiveness and use of naturopathic treatments for endometriosis: A cross-sectional survey of Australian naturopaths experienced in endometriosis management

Women with endometriosis are commonly dissatisfied with the standard treatments available and, as such, novel treatment options for endometriosis care needs to be explored. Women with endometriosis are known to seek care from naturopaths to assist in disease management. However, there is limited evidence on the types of treatments naturopaths employ when providing care to women with endometriosis. This cross-sectional survey describes the naturopathic treatments utilised to manage endometriosis and the perceived effectiveness of those treatments. Naturopaths who self-identified as having experience in women's reproductive diseases were invited to participate in the survey ( n = 109). Participants were recruited from the Practitioner Research and Collaboration Initiative (PRACI), a Practice-Based Research Network (PBRN). Data was collected via an online 62-item survey. A total of 29 Australian naturopaths completed the survey (response rate = 26.6%). Participants reported frequently utilising lifestyle recommendations (75.8%), herbal medicines (72.4%), clinical nutritional medicines (72.4%), and dietary recommendations (68.9%). The most frequently prescribed treatments included essential fatty acids (65.5%), exercise (62%), magnesium (55.1%), and Curcuma longa (Turmeric) (48.2%). Respondents who reported prescribing these treatments frequently perceived them to be effective, with the highest level of perceived effectiveness reported for Curcuma longa (Turmeric) (48.2%) and magnesium (44.8%). Naturopaths appear to employ various treatments and report varied perceived effectiveness of those treatments in the management of endometriosis. Clinical research is needed to evaluate the clinician experience and verify the potential value of naturopathic treatments in improving the symptoms and quality of life of women with endometriosis.

The Pragmatic Return to Effective Dental Infection Control Through Triage and Testing (PREDICT) Study: Protocol for a Prospective Clinical Study in the National Dental Practice-Based Research Network.

BackgroundDental practice has been greatly affected by the COVID-19 pandemic. As SARS-CoV-2 infection is transmitted by respiratory fluids, dental practice techniques, which include aerosol-generating procedures, can increase the risk of transmission causing heightened safety concerns for both dental health care workers (DHCWs) and patients. These concerns have resulted in the reduction in patient volume and the available workforce within dental practices across the United States. Standardized methods for COVID-19 triage and testing may lead to increased safety and perceptions of safety for DHCWs and their patients and promote willingness to provide and access oral health care services.ObjectiveThis study is designed to develop procedures that test the feasibility of enhanced COVID-19 triage and testing in dental offices. It will provide preliminary data to support a larger network-wide study grant application aimed at developing protocols to address safety concerns of patients and DHCWs in a peri–COVID-19 pandemic era.MethodsThe feasibility study is being conducted in 4 private dental practices, each of which has a dentist member of the National Dental Practice–Based Research Network. Participants include the DHCWs and patients of the dental practice. Study procedures include completion of COVID-19 triage, completion of COVID-19 testing (point-of-care [POC] or laboratory-based [LAB] SARS-CoV-2 viral, antigen, and antibody tests based on office designation), and administration of perception and attitude surveys for participating DCHWs and patients of the dental practice over a defined study period. The office designation and the participant’s role in the practice determines which testing protocol is executed within the office. There are 4 study groups following 4 distinct protocols: (1) POC DHCWs, (2) POC patients, (3) LAB DHCWs, and (4) LAB patients.ResultsData collection began in December of 2021 and concluded in March 2022. Study results are expected to be published in fall 2022.ConclusionsThe results of this feasibility study will help identify the viability and functionality of COVID-19 triage and testing in dental practices and inform a larger network-wide study grant application that develops protocols that address safety concerns of patients and DHCWs in a COVID-19 environment.Trial RegistrationClinicalTrials.gov NTC05123742; https://clinicaltrials.gov/ct2/show/NCT05123742?term=NCT05123742International Registered Report Identifier (IRRID)DERR1-10.2196/38386

Characterizing athletic healthcare: A perspective on methodological challenges, lessons learned, and paths forward.

Recently, there has been an emphasis on collecting large datasets in the field of sports medicine. While there have been great advances in areas of sport performance and sport epidemiology, there have been fewer efforts dedicated to understanding the effectiveness and impact of athletic healthcare, including injury prevention programs and rehabilitation interventions provided at the point-of-care. In 2009, the Athletic Training Practice-Based Research Network (AT-PBRN) was launched to address this need, with the mission of improving the quality of care provided by athletic trainers. Unlike other research efforts in sports and medicine, such as sport epidemiology, there are fewer methodological best practices specifically related to clinical data in athletic healthcare. As a result, the AT-PBRN has encountered several methodological challenges during its tenure and has established guidelines based on various sources within the fields of sports and medicine to address these challenges. Therefore, the purpose of this perspective is to identify the challenges and describe strategies to address these challenges related to characterizing athletic healthcare using a large database. Specifically, challenges related to data entry (data quality and reliability) and data extraction and processing (data variability and missing data) will be discussed. Sharing challenges and perspectives on solutions for collecting and reporting on athletic healthcare data may facilitate a greater consistency in the approach used to collect, analyze, and report on clinical data in athletic healthcare, with the goal of improving patient outcomes and the quality of care provided by athletic trainers.

Data on Patient Record Trajectory for Linkage (DataPRinT Linkage).

The linkage of Electronic Medical Records, Administrative and other data sources is highly valuable for research and health system monitoring. Once linked, combined resources can be analyzed to provide the answers to a variety of health questions that otherwise could not be answered. However, legislative and administrative barriers, including lengthy processes for data sharing agreements, may preclude timely linkage which is a key requirement during pandemics.&#x0D; ObjectiveTo develop a method using a patient’s health trajectory to probabilistically link primary care Electronic Medical Record (EMR) data with administrative and other data, without the need to transfer large datasets or identifiable information. To determine the legislative feasibility, accuracy and validity of this linkage process.&#x0D; Study DesignIdentify data strings that do not directly identify patients and could be used as unique linkage variables. The data strings, which we are calling dataprints, are sufficiently similar over time in different databases. One example in Ontario, Canada, is the pattern of submitted health claims. For every patient seen by a family physician, there exists a unique pattern of dates/billing codes/diagnoses over time. These unique patterns are reasonably similar in EMR and administrative datasets. We will apply an algorithm which turns the string in the selected dataprints to an irreversibly hashed code for each person. The hashed code and no additional information will be provided by both data controllers to a trusted-third party who will determine which records match and send a mapping table to both. This enables analyses to be run in parallel, without divulging any direct person identifiers.&#x0D; DatasetIndividuals contained in the University of Toronto Practice Based Research Network (UTOPIAN).&#x0D; Outcome MeasuresLinkage quality will be assessed by the number of true matches and represented by sensitivity, specificity and positive and negative predictive values.&#x0D; ResultsThe method will be evaluated against a validated, deterministically linked reference standard at North York General Hospital using de-identified EMR and hospital data. Results will inform processes to enable analyses across datasets while adhering to privacy legislation.

Text Message Reminders for the Second Dose of Influenza Vaccine for Children: An RCT.

Among children requiring 2 influenza doses in a given season, second dose receipt nearly halves the odds of influenza. Nationally, many children do not receive both needed doses. This study sought to compare the effectiveness of text message reminders with embedded interactive educational information versus usual care on receipt and timeliness of the second dose of influenza vaccine. This trial took place over the 2017 to 2018 and 2018 to 2019 influenza seasons among 50 pediatric primary care offices across 24 states primarily from the American Academy of Pediatrics' Pediatric Research in Office Settings practice-based research network. Caregiver-child dyads of children 6 months to 8 years in need of a second influenza vaccination that season were individually randomized 1:1 into intervention versus usual care, stratified by age and language within each practice. Intervention caregivers received automated, personalized text messages, including educational information. Second dose receipt by April 30 (season end) and by day 42 (2 weeks after second dose due date) were assessed using Mantel Haenszel methods by practice and language. Analyses were intention to treat. Among 2086 dyads enrolled, most children were 6 to 23 months and half publicly insured. Intervention children were more likely to receive a second dose by season end (83.8% versus 80.9%; adjusted risk difference (ARD) 3.8%; 95% confidence interval [0.1 to 7.5]) and day 42 (62.4% versus 55.7%; ARD 8.3% [3.6 to 13.0]). In this large-scale trial of primary care pediatric practices across the United States, text message reminders were effective in promoting increased and timelier second dose influenza vaccine receipt.

Effect of continuity of care on emergency department and hospital visits for obesity-associated chronic conditions: A federated cohort meta-analysis

BackgroundObesity-associated chronic conditions (OCC) are prevalent in medically underserved areas of the Southern US. Continuity of care with a primary care provider is associated with reduced preventable healthcare utilization, yet little is known regarding the impact of continuity of care among populations with OCC. This study aimed to examine whether continuity of care protects patients living with OCC and the subgroup with type 2 diabetes (OCC+T2D) from emergency department (ED) and hospitalizations, and whether these effects are modified by race and patient residence in health professional shortage areas (HPSA) MethodsWe conducted a retrospective federated cohort meta-analysis of 2015–2018 data from four large practice-based research networks in the Southern U.S. among adult patients with obesity and one more more additional diagnosed OCC. The outcomes included overall and preventable ED visits and hospitalizations. Continuity of care was assessed at the clinic-level using the Bice-Boxerman Continuity of Care Index ResultsA total of 111,437 patients with OCC and 47,071 patients with OCC+T2D from the four large practice-based research networks in the South were included in the meta-analysis. Continuity of Care index varied among sites from a mean (SD) of 0.6 (0.4) to 0.9 (0.2). Meta-analysis demonstrated that, regardless of race or residence in HPSA, continuity of care significantly protected OCC patients from preventable ED visits (IRR:0.95; CI:0.92–0.98) and protected OCC+T2D patients from overall ED visits (IRR:0.92; CI:0.85–0.99), preventable ED visits (IRR:0.95; CI:0.91–0.99), and overall hospitalizations (IRR:0.96; CI:0.93–0.98) ConclusionImproving continuity of care may reduce ED and hospital use for patients with OCC and particularly those with OCC+T2D.

Statin Prescription Patterns and Associations with Subclinical Inflammation.

Background and Objectives: Statins have been extensively utilised in atherosclerotic cardiovascular disease (ASCVD) prevention and can inhibit inflammation. However, the association between statin therapy, subclinical inflammation and associated health outcomes is poorly understood in the primary care setting. Materials and Methods: Primary care electronic health record (EHR) data from the electronic Practice-Based Research Network (ePBRN) from 2012–2019 was used to assess statin usage and adherence in South-Western Sydney (SWS), Australia. Independent determinants of elevated C-reactive protein (CRP) were determined. The relationship between baseline CRP levels and hospitalisation rates at 12 months was investigated. Results: The prevalence of lipid-lowering medications was 14.0% in all adults and 44.6% in the elderly (≥65 years). The prevalence increased from 2012 to 2019 despite a drop in statin use between 2013–2015. A total of 55% of individuals had good adherence (>80%). Hydrophilic statin use and higher intensity statin therapy were associated with elevated CRP levels. However, elevated CRP levels were not associated with all-cause or ASCVD hospitalisations after adjusting for confounders. Conclusions: The prevalence and adherence patterns associated with lipid-lowering medications highlighted the elevated ASCVD-related burden in the SWS population, especially when compared with the Australian general population. Patients in SWS may benefit from enhanced screening protocols, targeted health literacy and promotion campaigns, and timely incorporation of evidence into ASCVD clinical guidelines. This study, which used EHR data, did not support the use of CRP as an independent marker of future short-term hospitalisations.

The National Home-Based Primary Care Learning Network: A Practice-Based Quality Improvement and Research Network.

Home-based primary care (HBPC) provides interdisciplinary, comprehensive care at home for homebound older adults and has been largely excluded from the national conversation on care quality and quality improvement. In this Pragmatic Innovations article, we describe the work of the National HBPC Learning Network (LN), which focuses on fostering a continuous learning culture among HBPC practices to improve practice quality, elevate the field of HBPC, and create a community of continuous growth and quality of care accountability. The LN recruits HBPC practices in waves of 9 to 10 practices. It currently comprises 38 HBPC practices that care for 58,000 patients across 25 states (approximately 26% of all patients receiving HBPC in the United States). In a Kickoff meeting, the HBPC practices in each wave are instructed in the basics of quality improvement, develop project aim statements and their first plan-do-study-act cycle, receive an introduction to the LN quality improvement software platform, and review plans for LN engagement. Each month, practices submit updates and receive real-time feedback on their quality improvement work. Monthly virtual workshops are held with all practices that include sharing results of a "1-minute survey" (a monthly 1-to 3-question survey sent to all LN participants on a topic relevant to HBPC practices), a didactic and discussion related to the 1-minute survey topic, and interactive progress updates from LN participants regarding their quality improvement work. Each wave ends with "Moving-up Day," where practices report on their overall project and reflect on how their practice has changed as a result of the LN. LN practices have addressed and improved performance in multiple HBPC-related quality areas including assessment of functional status and cognitive impairment, falls prevention, advanced care planning, COVID-19 vaccination, and others. We present case studies of 3 LN practices and how LN participation strengthened their practices.