Beatrice (Bea) Ann McDonough:
We are saddened by the loss of our colleague and friend Beatrice (Bea) McDonough who passed away on February 21, 2015. Bea was a public health clinician with a research background in health promotion, population health, implementation research, knowledge translation and community development. She was an integral part of our research team in the Department of Family Medicine working mainly on the Cardiovascular Health Awareness Program (CHAP) and the Truckers Research for Innovative Health Promotion Programs (TRIHPP). Bea had an innate ability to mentor others, continually provided support and encouragement to her colleagues and trainees, and brought a positive energy to every project. She was a tireless advocate for the needs of marginalized and vulnerable populations and brought these issues to the forefront of her research. Bea was an accomplished researcher and teacher. She completed a Masters in Nursing Science and a Masters in Science and was working towards completing her PhD in health policy and organizational networks at the University of Toronto. She held cross appointments as an adjunct associate professor in the Department of Family Medicine at McMaster University and as a clinical faculty member in the Faculty of Nursing at McMaster University. Bea tutored and supervised undergraduate and graduate students in Nursing and the Masters of Health Promotion programs. Bea was a co-investigator with the CHAP for 13 years. In that time, she provided the health promotion context and chronic disease prevention risk mitigation perspective. She was also responsible for recruiting many of CHAP’s community partners and developing part of the training for the peer volunteer aspect of the program. Bea’s most recent contribution was as a co-lead for the Community Health Assessment Program through Emergency Medical Services (CHAP-EMS); a community based initiative focused on the promotion and prevention of chronic conditions in older adults living in subsidized housing. Bea also co-led the Diffusion of Health Innovation area of work within the Hamilton area Hypertension Collaborative that focused on how the organization of community-based networks foster screening, prevention and management of blood pressure through knowledge transfer and integration of research into practice. Bea was also involved in workplace health and wellness research with vulnerable populations in health promotion focusing on nontraditional occupations, specifically the transportation industry. She was the co-lead of the Canadian Health Institutes of Research (CIHR) funded project Primary Health Care and Truck Drivers, and a CIHR funded dissemination grant that hosted knowledge transfer workshops with stakeholders in the trucking industry. This workplace initiative is the first in Canada to examine male lone workers in the transport sector, both from an individual health risk perspective and an organizational workplace capacity perspective. Bea’s research contributions reflected her focus on population health and primary health issues and the integration of community-based and primary health care approaches to chronic disease prevention and management. Bea breadth of knowledge, depth of commitment and positive energy made her a joy to work with as a research leader within the Department of Family Medicine. Bea will be greatly missed by her colleagues.
The top 10 most noteworthy family medicine research studies are presented in this article and illustrate the unique contribution that Canadian family medicine research brings to health care in Canada. They have helped advance the quality of health care and improve care delivery, beneficially influencing health care practices, health care policy, and patient experiences. These Canadian studies in family medicine have contributed to improving the delivery of family medicine in Canada and throughout the world.
- A primary care pragmatic cluster randomized trial of the use of home blood pressure monitoring on blood pressure levels in hypertensive patients with above target blood pressure. In this award-winning paper by Dr Marshall Godwin and colleagues, it was demonstrated that home blood pressure (BP) monitoring did not improve BP compared with usual care at 12 months’ follow-up, but that it might improve BP monitoring in men. Further studies are needed.
- Does episiotomy prevent perineal trauma and pelvic floor relaxation? First North American trial of episiotomy.Dr Michael Klein questioned the use of episiotomy in childbirth, which was being widely used, because he suspected that it caused many of the problems it was supposed to prevent. He and his colleagues carried out the first North American trial of episiotomy in childbirth. The work of Dr Klein and colleagues is often credited for the dramatic reduction in the use of episiotomy.
- The impact of patient-centred care on outcomes. Published in 2000 by a team of family medicine researchers at Western University, this study was one of the first to demonstrate that the patient-centred clinical method improved health outcomes. Since the publication of this study, patient-centredness has become a foundation of the practice of family medicine.
- The Kahnawake Schools Diabetes Prevention Project: intervention, evaluation, and baseline results of a diabetes primary prevention program with a Native community in Canada. Published in 1997 by Dr Ann Macaulay and colleagues, this study demonstrated the feasibility of implementing a community-based diabetes prevention program in an aboriginal community through the use of participatory research.
- Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP). This very large, well designed study, which involved 39 communities in 2 Canadian provinces, demonstrated how, at the community level with the support of family doctors, a simple BP test in older adults could be taken in a setting like a pharmacy by trained volunteers and could decrease death and hospitalization from heart disease.
- The impact of not having a primary care physician among people with chronic conditions. Carried out by researchers at the Institute for Clinical Evaluative Sciences, this 2008 study shows how important having a family doctor can be in avoiding emergency department visits, reducing health care costs, and reducing demands on the health care system.
- Building a pan-Canadian primary care sentinel surveillance network: initial development and moving forward.This study demonstrated the feasibility of the development of a pan-Canadian primary care research network that would help researchers collect longitudinal data from practices across Canada to assess the primary care epidemiology and management of 5 chronic diseases: hypertension, diabetes, depression, chronic obstructive pulmonary disease, and osteoarthritis.
- Principles for the justification of public health intervention.This study by Dr Ross Upshur focuses on the intersection of primary care and public health, particularly with respect to the interrelationship between ethics and evidence. These principles are colloquially and widely referred to as the Upshur principles.
- Evidence to action: a tailored multifaceted approach to changing family physician practice patterns and improving preventive care. Ontario has been on the leading edge of primary care reform with its family health teams, aiming to demonstrate how teams of caregivers can improve performance and health outcomes in primary care. This rigorously designed study demonstrated the effectiveness of an intervention delivered by nurse facilitators in improving preventive care procedures in primary care settings.
- Prevalence of multimorbidity among adults seen in family practice. This study was the first in Canada to examine multimorbidity in the adult population receiving primary care from family physicians. It demonstrates the complexity of problems common in the Canadian population that confront family physicians daily.
For more information visit: http://www.cfp.ca/content/61/6/523.full
To mark the 20th anniversary of The BMJ’s website, the journal asked 20 UK and international readers, authors, friends, and former colleagues to name an outstanding article published since the mid-1990s. The result is an extraordinary mix of editorials, research papers, analysis, and comment, including an investigation, on topics as wide ranging as the MMR vaccine scare, death, evidence based medicine, and the use of stirrups for pelvic examinations. Some represent seminal moments in recent medical history, others are pieces of research that, for their sheer simplicity and focus on patient experience, have inspired our readers to think and work differently.
So here is The BMJ’s top 20 and why, according to our 20 chosen readers, they are the best.
Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP), Januz Kaczorowski, Larry W Chambers, Lisa Dolovich, et al (Research, BMJ 2011;342:d442, doi:10.1136/bmj.d442)
“This article will have enormous influence over the coming years because it tests, with positive, patient important results, an intervention aimed at harnessing ‘volunteer power’ in the community.” Brian Haynes, professor of clinical epidemiology and medicine, McMaster University Faculty of Health Sciences, Canada.
For more information visit: http://www.bmj.com/content/351/bmj.h3660
The Canadian Institutes of Health Research (CIHR) and the Canadian Medical Association Journal (CMAJ) have honoured five outstanding Canadian individuals and teams as part of the latest CIHR-CMAJ Top Canadian Achievements in Health Research Awards, which celebrate Canadian health research excellence.
Among those honoured were Drs. Larry W. Chambers (Bruyère Research Institute in Ottawa); Lisa Dolovich and Lehana Thebane (McMaster University); Janusz Kaczorowski (University of Montreal); and Michael Paterson and Karen Tu (Institute for Clinical Evaluative Sciences) for their work in developing the Cardiovascular Health Awareness Program (CHAP). Designed to increase cardiovascular risk awareness at the community level, CHAP has demonstrated that primary prevention integrated with family physicians, community pharmacists, and community partners and volunteers can significantly reduce the burden of cardiovascular morbidity.
The winners were selected by a peer-review panel of Canadian and international experts, who looked for the discoveries and innovations that had the biggest impact on the health of people in this country and around the world.
A community-based health promotion program delivered by over 500 peer volunteers significantly reduces heart disease and stroke in seniors, Canadian Stroke Network researcher Dr. Janusz Kaczorowski told the Canadian Stroke Congress today.
As part of the Cardiovascular Health Awareness Program (CHAP), family physicians in 20 mid-sized Ontario communities invited patients aged 65 and over to attend risk assessment sessions held at local pharmacies over a 10 week period.
Over 15,000 residents took part in the program.
“Volunteer-led risk assessments combined with health information and linkages to primary care providers and community resources led to an impressive nine percent reduction in their rates of hospitalization for stroke, heart attack, and congestive heart failure,” says Dr. Kaczorowski, from the University of British Columbia and the Child and Family Research Institute.
The Program, co-developed by Drs Kaczorowski, Lisa Dolovich and Larry Chambers from McMaster University and the Elisabeth Bruyere Research Institute, received the Canadian Stroke Congress Chair’s Award for Impact, awarded to the research study presented at Congress which was judged to have the most impact on preventing or treating stroke.
The CHAP team randomly selected 39 communities and stratified them by location and population size. Twenty communities received CHAP. Nineteen communities served as controls and did not receive the program.
In the CHAP communities, over 500 trained peer volunteers met with the residents to check blood pressure, review the warning signs of stroke and heart attack, look at risk factors, and promote blood pressure control and healthy living.
“CHAP is a unique, low cost way to activate community organizations, volunteers, health care providers, and the participants themselves,” says Dr. Kaczorowski.
Pharmacists were onsite as part of the primary care team to discuss concerns about blood pressure medications and recommendations on how to maximize the benefits of blood pressure lowering medications.
The program focused primarily on blood pressure reduction. “Controlling blood pressure is key to lowering rates of stroke and heart disease,” says Dr. Kaczorowski. “We found that even small reductions can have a dramatic impact on the health of older adults.” According to the Heart and Stroke Foundation, one in five Canadian adults has high blood pressure.
With the largest cohort of baby boomers in Canada’s history entering their at-risk years, Dr. Kaczorowski says that the next steps will be to roll out the program across Canada.
“It’s never too late to reduce your risk of stroke, and this project is showing us how quickly the benefits of blood pressure management can accrue” says Canadian Stroke Network spokesperson Dr. Antoine Hakim. “Good health isn’t just for the young; it’s a life-long pursuit.”
He notes that simple solutions can lead to big results: “Here is a prevention strategy that doesn’t require large health expenditures but has significant impact on health outcomes. It’s worth pursuing this peer model with other at-risk populations such as youth and the Aboriginal population.”
The 2010 Heart and Stroke Foundation report card recently warned that a ‘perfect storm’ of risk factors and demographic changes are creating an unprecedented burden on Canada’s fragmented cardiovascular care system.
“We currently have a patchwork quilt of prevention and treatment initiatives,” says Heart and Stroke Foundation spokesperson Dr. Michael Hill. “Community programs like CHAP are integral to helping individuals within at-risk populations understand and manage their health risks.”
Canadians can assess and manage their blood pressure risk with the My Heart&Stroke Blood Pressure Action Plan™ at heartandstroke.ca/bp. The Canadian Stroke Congress is a joint initiative of the Heart and Stroke Foundation of Canada, the Canadian Stroke Network, and the Canadian Stroke Consortium.
For more information about CHAP, visit www.chapprogram.ca.a.openmind-gear.net .