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In memoriam for 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.

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CHAP has been selected as one of the Ten most notable family medicine research studies in Canada by CFPC/SOR

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

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C-CHAP was selected by BMJ as one of the Twenty top papers to mark: The BMJ’s two digital decades

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

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(Français) Un projet médical qui cumule les honneurs s’implante à Laval

Caroline Lévesque/Publié le 19 novembre 2014

Programme de sensibilisation à la santé cardiovasculaire

MÉDECINE FAMILIALE. Laval est la seule ville au Québec où l’on implantera, dès janvier, un projet-pilote qui rafle les honneurs ailleurs au Canada en plus d’avoir eu une mention dans le prestigieux British Medical Journal. Le Programme de sensibilisation à la santé cardiovasculaire (PSSC) a été lancé en 2000 par des chercheurs canadiens et mis sur pied dans plusieurs petites communautés à travers le pays. Il vise la prévention des hospitalisations pour des maladies importantes comme des infarctus, des AVC et de l’insuffisance cardiaque. Il est basé sur le travail de bénévoles de la communauté et est supervisé par des professionnels de la santé. À Laval, ce programme s’adressera aux personnes de 50 ans et plus. Il sera mis en place dans deux groupes de médecine de famille (GMF), soit ceux du Médi-Centre Chomedey et de l’Hôpital de la Cité-de-la-Santé. Mais pourquoi privilégier la région lavalloise plutôt que Montréal ou même la capitale nationale? «Initialement, on l’avait dans des villes de 20 000 à 60 000 habitants et on trouvait qu’une ville de taille intermédiaire, mais plus urbaine, était une bonne chose, explique Dr Marie-Thérèse Lussier, cochercheuse pour le PSSC et médecin à l’UMF de la Cité-de-la-Santé de Laval. L’équivalent en Ontario, où le projet se fait en même temps, c’est la région de York, qui est à peu près de 400 000 habitants.» Le patient recevra donc une lettre de son médecin de famille l’invitant à participer à une session animée par des bénévoles, généralement de la même tranche d’âge que lui, et formés dans le GMF selon un protocole rigoureux. Le programme se base sur le partage d’information sur la prévention des maladies cardiométaboliques. Maladies chroniques Les maladies cardiométaboliques sont des sous-ensembles des maladies chroniques, tout comme l’hypertension, le diabète, le cholestérol élevé et l’angine. Le Centre de santé et de services sociaux (CSSS) de Laval travaille depuis deux ans dans le développement d’un programme clinique de prévention et promotion de la santé pour prévenir les maladies chroniques, nommé Cible santé. «Nous, les membres de l’équipe de recherche, on s’est intégrés à ce programme depuis le début, indique Dr Lussier. En ce sens, le nôtre sur la sensibilisation des maladies cardiovasculaires en fait partie.» Après analyse des résultats, il sera déployé pour l’ensemble du Québec. «Ça dépend des organismes subventionnaires», précise la médecin qui travaille à l’implantation du projet depuis trois ans. Les «Olympiques de la recherche» Le groupe de chercheurs fait partie d’une poignée de personnes ayant reçu une subvention des Instituts de recherche en santé du Canada (IRSC), principal organisme fédéral responsable du financement de la recherche en santé au pays. Un montant de 2,5 M$ sera divisé entre Laval et la région de York. «Avoir eu ces sommes-là dans les concours hautement compétitifs, c’est un grand honneur, se réjouit Marie-Thérèse Lussier. Comme chercheur de Laval, c’est comme si c’était les Olympiques de la recherche de gagner aux IRSC. On a à peu près 1 chance sur 10 de l’avoir quand on soumet une demande.» Elle mentionne que ce projet médical a fait ses preuves. «On arrive avec un programme solide scientifiquement et on a hâte de l’appliquer au Québec.» L’équipe du PSSC est actuellement à la recherche de bénévoles. Informations: 450 681-6164, poste 329.

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Paramedics’ weekly drop-in sessions at seniors complex result in fewer EMS calls and saves on costly emergency room visits

Paramedics’ weekly drop-in sessions at seniors complex result in fewer EMS calls and saves on costly emergency room visits

Hamilton, October 2013 – Emergency medical service (EMS) staff may be effective in preventing, as well as responding to, emergencies.

A pilot project found weekly visits by two paramedics to a seniors’ home cut EMS calls by up to a third.

The study was presented at the Canadian Cardiovascular Congress by Dr. Gina Agarwal, associate professor in the Department of Family Medicine of the Michael G. DeGroote School of Medicine at McMaster.

She led the Cardiovascular Health Awareness Program (CHAP) EMS pilot project at a subsidized housing complex with about 280 residents, predominantly low income seniors. It’s a group at increased risk of cardiovascular disease, diabetes and falls. The local EMS receives frequent calls from the building.

As a pilot, two paramedics provided weekly drop-in sessions to review healthy lifestyles, measure blood pressure, assess diabetes risk and risk of falls.

Preliminary data shows a trend of up to 32 per cent reduction in EMS calls from the single building in which the program was offered since the sessions began. 

“As members of the health team on the front line, paramedics can play a valuable role in reducing the risk and improving the health of seniors,” said Agarwal.

Over eight months, 56 residents – 25 per cent of residents over age 65 – had made over 580 visits to the EMS session. More than 60 per cent of the residents who attended the sessions had an elevated body mass index, 40 per cent reported a low level of physical activity, one-third smoked, one-third had a high salt intake, one-third had a high fat intake, and 50 per cent had high blood pressure.

Of the residents with high blood pressure, 80 per cent were already on medication for it. With their permission, the readings taken at the sessions were conveyed to their family doctor, who could then take action like adjusting medication.

“At each visit the paramedics discussed one or two risk factors, such as smoking, lack of exercise or diet; tried to link residents to community resources and give advice, and then followed up to see how residents were managing,” said Agarwal.

Paramedics made many referrals to the in-house wellness exercise program; a diabetes foot care and education program; family doctors and made linkages with community food advisors and the quit smoking line.

 “With their regular presence thanks to the weekly schedule, the paramedics seem approachable,” said Agarwal. “The number of new attendees keeps rising, with word of mouth. The high number of multiple visits also indicates a hunger for this type of health information when it’s so readily available.”

 “The residents’ value the time that they spend at the clinic, and build a trusting relationship because they know that the paramedics are highly trained professionals who are knowledgeable and compassionate,” said Brent McLeod, superintendent of education for the Hamilton Paramedic Service.  “It is also an opportunity for paramedics to keep in contact with patients.”

 “This project truly is a preventative model which is in line with the goals of the Local Health Integration Network.” 

“Communication is the key here. Discussing preventive behaviours and making the advice accessible is important for people all age groups and backgrounds,” says Heart and Stroke Foundation spokesperson Dr. Beth Abramson.

“Community-based health programs like this can be a very effective way to promote good health and prevent chronic conditions. We can all learn from this experience.”

Agarwal says the study will follow up to assess whether the risk profile of the session attendees has evolved.

The study was carried out by the Department of Family Medicine in collaboration with Hamilton Paramedics Service, Public Health Services for the City of Hamilton, CityHousing Hamilton, and the Hamilton Community Care Access Centre.

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CHAP team among leading Canadian health researchers honoured

CHAP team among leading Canadian health researchers honoured

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.

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A good CHAP reduces rates of heart disease and stroke in communities Blood pressure reduction the key to improved outcomes

A good CHAP reduces rates of heart disease and stroke in communities Blood pressure reduction the key to improved outcomes

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 .

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