Center for Family Medicine Family Health Team

Kitchener, Canada

Center for Family Medicine Family Health Team

Kitchener, Canada
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Lee L.,Center for Family Medicine Family Health Team | Lee L.,McMaster University | Molnar F.,University of Ottawa
Canadian Family Physician | Year: 2017

Objective To provide primary care physicians with an approach to driving safety concerns when older persons present with memory diffculties. Sources of information The approach is based on an accredited memory clinic training program developed by the Centre for Family Medicine Primary Care Collaborative Memory Clinic. Main message One of the most challenging aspects of dementia care is the assessment of driving safety. Drivers with dementia are at higher risk of motor vehicle collisions, yet many drivers with mild dementia might be safely able to continue driving for several years. Because safe driving is dependent on multiple cognitive and functional skills, clinicians should carefully consider many factors when determining if cognitive concerns affect driving safety. Specific findings on corroborated history and offce-based cognitive testing might aid in the physician's decisions to refer for comprehensive on-road driving evaluation and whether to notify transportation authorities in accordance with provincial reporting requirements. Sensitive communication and a person-centred approach are essential. Conclusion Primary care physicians must consider many factors when determining if cognitive concerns might affect driving safety in older drivers.


Lee L.,Center for Family Medicine Family Health Team | Lee L.,McMaster University | Heckman G.,Health Science University | McKelvie R.,McMaster University | And 4 more authors.
Canadian Family Physician | Year: 2015

Objective To explore the barriers to and facilitators of adapting and expanding a primary care memory clinic model to integrate care of additional complex chronic geriatric conditions (heart failure, falls, chronic obstructive pulmonary disease, and frailty) into care processes with the goal of improving outcomes for seniors. Design Mixed-methods study using quantitative (questionnaires) and qualitative (interviews) methods. Setting Ontario. Participants Family physicians currently working in primary care memory clinic teams and supporting geriatric specialists. Methods Family physicians currently working in memory clinic teams (n = 29) and supporting geriatric specialists (n = 9) were recruited as survey participants. Interviews were conducted with memory clinic lead physicians (n = 16). Statistical analysis was done to assess differences between family physician ratings and geriatric specialist ratings related to the capacity for managing complex chronic geriatric conditions, the role of interprofessional collaboration within primary care, and funding and staffing to support geriatric care. Results from both study methods were compared to identify common findings. Main findings Results indicate overall support for expanding the memory clinic model to integrate care for other complex conditions. However, the current primary care structure is challenged to support optimal management of patients with multiple comorbidities, particularly as related to limited funding and staffing resources. Structured training, interprofessional teams, and an active role of geriatric specialists within primary care were identified as important facilitators. Conclusion The memory clinic model, as applied to other complex chronic geriatric conditions, has the potential to build capacity for high-quality primary care, improve health outcomes, promote efficient use of health care resources, and reduce health care costs.


Moore C.,University of Waterloo | Lee J.,Center for Family Medicine Family Health Team | Milligan J.,Center for Family Medicine Family Health Team | Giangregorio L.,University of Waterloo
Applied Physiology, Nutrition and Metabolism | Year: 2015

A Family Health Team (FHT) is a multi-disciplinary primary healthcare model that may be an ideal setting to engage patients in physical activity. An environmental scan was conducted to determine the prevalence and characteristics of physical activity services offered by FHTs in Ontario. Of the 186 FHTs, 102 (55%) completed the survey. Almost 60% of responding FHTs offered a physical activity service; however, the availability, duration, size, and target population of the services varied depending on the individual FHT. ©, 2006 National Research Council of Canada. All rights reserved.


Lee J.,McMaster University | Lee J.,Center for Family Medicine Family Health Team | Alfieri M.,Center for Family Medicine Family Health Team | Alfieri M.,McMaster University | And 4 more authors.
Canadian Family Physician | Year: 2011

Objective: To describe key determinants for residents' selection of a new community-based, interprofessional site for their family medicine training, and to evaluate residents' satisfaction with their programs. Design: Combined qualitative and quantitative methods using in-depth interviews and a survey. Setting: McMaster University, including the new site of the Centre for Family Medicine in Kitchener-Waterloo, Ont, and a long-established site in Hamilton, Ont. Participants: Eleven first-year and second-year family medicine residents from the Kitchener-Waterloo site participated in in-depth interviews. Forty-four first-year and second-year family medicine residents completed the survey, 22 in Kitchener-Waterloo and 22 in Hamilton. Methods: Kitchener-Waterloo residents participated in in-depth interviews during their residency programs in 2008 to 2009 using a semistructured format to explore their choice of site and the effect of an interprofessional environment on their education. Common themes were established using qualitative analysis techniques; based on these themes, a survey was developed and distributed to residents from both sites to further explore factors influencing site selection, satisfaction, and effects of interprofessional education. Main findings: Residents identified several reasons for selecting a new community-based, interprofessional family medicine residency program. Reasons included preference for the location and opportunities to learn in an interprofessional teaching environment. A less hierarchical structure and greater opportunities for one-on-one teaching also influenced their choices. Perception of poor communication from the well established site was identified as a challenge. Residents at both sites indicated similarly high levels of program satisfaction. Conclusion: Residents selected the new community-based family medicine site for reasons of geographic location and the potential for clinical learning experiences and interprofessional education. High program satisfaction was achieved at both the new and well established sites. Family medicine residency programs developing community-based networks might consider and encourage the positive influence of interprofessional care and education. Good communication between distributed sites remains a challenge.


Seymour N.,University of Waterloo | Patel T.,University of Waterloo | Patel T.,Center for Family Medicine Family Health Team | Dixon H.,Center for Family Medicine Family Health Team
Journal of Pharmacy Technology | Year: 2013

Objective: To report a case of worsening myasthenia gravis after the initiation of gabapentin for treatment of essential tremor. Case Summary: A 69-year-old man experienced minor ptosis of the left eyelid, slight neck weakness, and transient difficulties in chewing food on day 6 of a slow gabapentin dosage titration. As the titration continued, the myasthenia symptoms progressed to bilateral ptosis, and there was dramatic worsening of weakness by day 23. He was taking gabapentin 1500 mg daily at the time; the drug was then tapered to discontinuation. All myasthenia gravis symptoms were reported as resolved 3 days after discontinuation of gabapentin. The initiation and discontinuation of gabapentin also coincided with improvement, then worsening of the patient's tremor. Discussion: Three published case reports describe worsening of myasthenia gravis during use of gabapentin for the treatment of various neuropathies. To the best of our knowledge, this is the first case report of a patient experiencing worsening of myasthenia gravis upon initiation of gabapentin for essential tremor. The Naranjo probability scale suggests a probable association between gabapentin and worsening of myasthenia gravis symptoms in our patient. Several myasthenia-like symptoms are listed in the gabapentin mongraph as low-frequency adverse events, increasing the possibility that gabapentin may have been unmasking or worsening myasthenia gravis in clinical trials. However, myasthenia gravis is not identified as a contraindication or caution for gabapentin use. Conclusions: Gabapentin should be used with caution in patients with myasthenia gravis, and clinicians must be aware of the potential risks of this therapy. © 1985-2013 Harvey Whitney Books Co. All rights reserved.


McMillan C.,Center for Family Medicine Family Health Team | McMillan C.,University of Waterloo | Lee J.,Center for Family Medicine Family Health Team | Lee J.,McMaster University | And 6 more authors.
Health and Social Care in the Community | Year: 2016

Despite the high health risks associated with severe mobility impairments, individuals with physical disabilities are less likely to receive the same level of primary care as able-bodied persons. This study explores family physicians’ perspectives on primary care for individuals with mobility impairments to identify and better understand the challenges that prevent equitable service delivery to this group of patients. Semi-structured interviews were conducted in the autumn of 2012 with a purposeful sample of 20 family physicians practising in Southwestern Ontario to gather their perspectives of the personal and professional barriers to healthcare delivery for individuals with mobility impairments, including perceptions of challenges, contributing reasons and possible improvements. A thematic analysis was conducted on the transcripts generated from the interviews to identify perceptions of existing barriers and gaps in care, needs and existing opportunities for improving primary care for this patient population. Eight themes emerged from the interviews that contributed to understanding the perceived challenges of providing care to patients with mobility impairments: transportation barriers, knowledge gaps and practice constraints resulting in episodic care rather than preventive care, incongruence between perceived and actual accessibility to care, emergency departments used as centres for primary care, inattention to mobility issues among specialist and community services, lack of easily accessible practice tools, low patient volumes impact decision-making regarding building decreased motivation to expand clinical capacity due to low patient volume, and lastly, remuneration issues. Despite this patient population presenting with high healthcare needs and significant barriers and care gaps in primary care, low prevalence rates negatively impact the acquisition of necessary equipment and knowledge required to optimally care for these patients in typical primary care settings. Novel approaches to address inequitable healthcare practices for this vulnerable group are needed. © 2015 John Wiley & Sons Ltd


Lofters A.,Li Ka Shing Knowledge Institute | Guilcher S.,University of Toronto | Maulkhan N.,Center for Family Medicine Family Health Team | Milligan J.,Center for Family Medicine Family Health Team | Lee J.,Center for Family Medicine Family Health Team
Canadian Family Physician | Year: 2016

Objective To compare the potential risk factors for lower-quality primary care, the potential markers of unmet needs in primary care, and the willingness to participate in future research among primary care patients with versus without physical disabilities. Design A waiting room survey using a convenience sample. Setting A family health team (FHT) in Kitchener-Waterloo, Ont, with a designated Mobility Clinic. Participants A total of 40 patients seen at the FHT Mobility Clinic and 80 patients from the general patient population of the same FHT. Main outcome measures Socioeconomic status and social capital, number of self-reported emergency department visits and hospitalizations in the preceding year, and willingness of the patients in the 2 groups to participate in future research studies. Results Patients from the Mobility Clinic were more than twice as likely to be receiving benefts or social assistance (75.0% vs 32.1%, P<.001), were twice as likely to report an annual household income of less than $40 000 (58.6% vs 29.2%, P=.006), and were more likely to report their health status to be fair or poor (42.5% vs 16.2%, P =.002). Half of Mobility Clinic patients had visited the emergency department at least once in the preceding year, compared with 29.7% in the general patient population (P=.027). When asked if they would be willing to provide their health card number in the future so that it could be linked to health care data for research, 82.5% of Mobility Clinic patients agreed versus 55.0% of those in the general patient population (P=.004). Conclusion In this study, patients with disabilities were at a social disadvantage compared with their peers without disabilities and were more likely to use the emergency department, suggesting that they had unmet health needs. Future research should continue to explore this patient population and to investigate if an interprofessional primary health care team approach focused on patients with disabilities can help to increase quality of care.


Lee J.,Center for Family Medicine Family Health Team | Lee J.,McMaster University | Walus A.,Center for Family Medicine Family Health Team | Billing R.,Hennepin Regions Psychiatry Residency Program | And 3 more authors.
Postgraduate Medical Journal | Year: 2016

Background Distributed medical education (DME) programmes, in which training occurs in underserviced areas, have been established as a strategy to increase recruitment and retention of new physicians following graduation to these areas. Little is known about what makes physicians remain in the area in which they train. Objectives To explore the factors that contributed to family physician's decisions to practice in an underserviced area following graduation from a DME programme. Methods Semistructured inperson interviews were conducted with 19 family physicians who graduated from a DME residency training programme. Programme records were reviewed to identify practice location of DME programme graduates. Results Of the 32 graduates to date from this DME programme, 66% (N=21) and all of the interview participants established their practices in this region after completing their residency training. Five key themes were identified from the interview analysis as impacting physicians' decisions to establish their practice in an underserviced area following graduation: familial ties to the region, practice opportunities, positive clerkship and residency experiences, established relationships with specialists and services in the area and lifestyle opportunities afforded by the location. Conclusions This study suggests that DME programmes can be an effective strategy for equalising the distribution of family physicians and highlights the ways in which these programmes can facilitate recruitment and retention in underserviced areas, including being responsive to residents' personal preferences and objectives for learning and shaping their residency experiences to meet to these objectives. © 2016 The Fellowship of Postgraduate Medicine.


PubMed | McMaster University, Center for Family Medicine Family Health Team, Hennepin Regions Psychiatry Residency Program and Lawson Health Research Institute
Type: Journal Article | Journal: Postgraduate medical journal | Year: 2016

Distributed medical education (DME) programmes, in which training occurs in underserviced areas, have been established as a strategy to increase recruitment and retention of new physicians following graduation to these areas. Little is known about what makes physicians remain in the area in which they train.To explore the factors that contributed to family physicians decisions to practice in an underserviced area following graduation from a DME programme.Semistructured inperson interviews were conducted with 19 family physicians who graduated from a DME residency training programme. Programme records were reviewed to identify practice location of DME programme graduates.Of the 32 graduates to date from this DME programme, 66% (N=21) and all of the interview participants established their practices in this region after completing their residency training. Five key themes were identified from the interview analysis as impacting physicians decisions to establish their practice in an underserviced area following graduation: familial ties to the region, practice opportunities, positive clerkship and residency experiences, established relationships with specialists and services in the area and lifestyle opportunities afforded by the location.This study suggests that DME programmes can be an effective strategy for equalising the distribution of family physicians and highlights the ways in which these programmes can facilitate recruitment and retention in underserviced areas, including being responsive to residents personal preferences and objectives for learning and shaping their residency experiences to meet to these objectives.


PubMed | Center for Family Medicine Family Health Team and St. Joseph's Health Care London
Type: Journal Article | Journal: Health & social care in the community | Year: 2016

Despite the high health risks associated with severe mobility impairments, individuals with physical disabilities are less likely to receive the same level of primary care as able-bodied persons. This study explores family physicians perspectives on primary care for individuals with mobility impairments to identify and better understand the challenges that prevent equitable service delivery to this group of patients. Semi-structured interviews were conducted in the autumn of 2012 with a purposeful sample of 20 family physicians practising in Southwestern Ontario to gather their perspectives of the personal and professional barriers to healthcare delivery for individuals with mobility impairments, including perceptions of challenges, contributing reasons and possible improvements. A thematic analysis was conducted on the transcripts generated from the interviews to identify perceptions of existing barriers and gaps in care, needs and existing opportunities for improving primary care for this patient population. Eight themes emerged from the interviews that contributed to understanding the perceived challenges of providing care to patients with mobility impairments: transportation barriers, knowledge gaps and practice constraints resulting in episodic care rather than preventive care, incongruence between perceived and actual accessibility to care, emergency departments used as centres for primary care, inattention to mobility issues among specialist and community services, lack of easily accessible practice tools, low patient volumes impact decision-making regarding building decreased motivation to expand clinical capacity due to low patient volume, and lastly, remuneration issues. Despite this patient population presenting with high healthcare needs and significant barriers and care gaps in primary care, low prevalence rates negatively impact the acquisition of necessary equipment and knowledge required to optimally care for these patients in typical primary care settings. Novel approaches to address inequitable healthcare practices for this vulnerable group are needed.

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