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Primary Healthcare Research Unit

Projects

Current Projects

NL Primary Healthcare Research and Integration to Improve Health System Efficiency (PRIIME) Network
Funding Source: CIHR, Janeway Foundation, Newfoundland and Labrador Medical Assocation, Department of Health and Community Services
Amount Awarded: $150,000
Project Years: 2014–2015
Investigators: Kris Aubrey-Bassler, Marshall Godwin, Rob Greenwood, Kevin Chan, Roger Chafe
Abstract: Healthcare spending in Canada has been increasing at an unsustainable pace, and Canadian provinces spent approximately 40% of their budgets on healthcare in 2013. Despite this, the system has struggled at all levels to meet the needs of Canadians, particularly those who have chronic illnesses or other complex health needs. In Newfoundland & Labrador, where the government spends more per person on healthcare than any other province, problems in the system are compounded by an aging population; the challenge of providing care to people in rural and remote communities; and a primary care system that has seen little change in the past twenty years. As part of their Strategy for Patient-Oriented Research, the Canadian Institutes of Health Research have funded Networks in Primary and Integrated Health Care Innovations in each province. In Newfoundland & Labrador, a multidisciplinary team including researchers, clinicians and policymakers has been assembled to conduct primary care research with a clear focus on results that matter to patients. Citizens and patients will play a key role in the Network, sitting on governance committees, contributing to research projects and providing insight from the patient’s perspective. The Network will facilitate research to generate evidence that can be used by policymakers and other key stakeholders to effect change in the system. Our goal is to make the system more integrated, evidence-based, patient-centred, and accessible for patients and their families.

Advancing Primary Healthcare for Persons Living with HIV in Canada
Funding Source: CIHR
Amount Awarded: $2.5 million
Project Years: 2013–2018
Investigators: Clare Liddy, Shabnam Asghari, Marissa Becker, Christopher Kaposy, Sean Rourke, Patricia Caetano, Frank McGee
Abstract: The number of people living with HIV in Canada is increasing as people who receive antiretroviral therapy live longer. As people with HIV develop other conditions associated with aging, such as cardiovascular disease, diabetes, cancer, liver disease and HIV-associated neurocognitive disorders, their health care become increasing complex. It is important that we connect people with care early and help them adhere to treatment for their own well-being and to prevent transmission to others. There are several ways in which people with HIV obtain care from specialists and/or primary care physicians, but we do not yet understand the best way to care for this population in the primary care setting over time. Our research program will address several challenges in the management of HIV in the primary care setting including: the way specialists and primary care doctors communicate; the way we manage chronic conditions and health promotion activities; the way people with HIV access care in rural and remote areas; the engagement of people who are not yet accessing care; and the ethics of interventions in these areas for people with HIV. Our team will bring together collaborators across five provinces (SK, MB, ON, NB, NL) including researchers; front-line providers who work in a variety of primary care, HIV-specific care and medical ethics settings; people with lived experience; and key policy makers and organizations; in order to improve care for this population. Our goal is to develop a tool kit of effective interventions for primary care practitioners, people with HIV and other community-based organizations that serve people with HIV.
Progress: Newfoundland and Labrador cohort data from the provincial HIV clinic are currently being transcribed into electronic form. Once this activity has been completed and the cohort of patients has been identified, linkage to other datasets will commence. 

A Cross-Sectional and Case-Control Analysis of Healthy Versus Unhealthy Aging in a Cohort of Old Elderly: Part One of the Life After 80 Study
Funding Source: CIHR/RDC
Amount Awarded: $179,306
Project Years: 2013–2015
Investigators: Marshall Godwin (PI), Shabnam Asghari, Karen Parsons, Kris Aubrey, Wanda Parsons, Andrea Pike, Farah McCrate, Sharon Buehler, Veeresh Gadag
Abstract: The old elderly, those people aged 80 and over, are the fastest growing subset of the population. Despite stereotypes that depict the old elderly as a generally frail group, the physical health, cognitive skills, living situations, and activity levels of this group are quite varied. Some do indeed reach the age of 80 having accumulated many medical problems. However, at the other end of the spectrum, many of those aged 80 and over are healthy, active, and alert with very few chronic medical problems, few or no ongoing medications, and living independently without assistance. They are experiencing “healthy aging.”What is different between these two groups that may have lead to the differences in their current daily living? What was different about their life’s circumstances and experiences that might have contributed to their current situation? What is likely to happen to them in the coming years? These are questions we hope to answer with the current study—a comparison of old elderly individuals who are experiencing “healthy aging” and those who are not. We plan to recruit 200 study participants from these two groups through family physician offices, personal care homes, and nursing homes with 100 in each group (healthy aging versus unhealthy aging). After each person is recruited we will begin collecting information about him or her. This information will include basic demographics (age, sex, education level, marital status, etc.), as well as assessments of activities of daily living, lifestyle, current medical conditions and medications, self assessed health status, depression, general happiness, and life expectancy (both in terms of number of years and quality of life). This study will improve our understanding of the health outcomes and needs of the aged.
Progress: Enrolment began in November 2013 and there are currently over 60 participants in the study. Recruitment is ongoing.

The Atlantic Renal Colic Study: Predicting the Need for Computed Tomography Diagnosis
Funding Source: Health Care Foundation of Eastern Health
Amount Awarded: $10,000
Project Years: 2013–2015
Investigators: Kris Aubrey-Bassler, Richard Barter, Richard Cullen
Abstract: Nephrolithiasis and renal colic are common problems encountered in the emergency room resulting in a high rate of CT scan usage for confirmatory diagnosis. The sensitivity of CT scans for the diagnosis of renal colic approaches 100% and it can also help with finding alternative explanations for a patient’s symptoms. However, a CT scan is a costly test and results in a relatively high exposure to ionizing radiation which has been linked to the subsequent development of cancer. Because most kidney stones will pass uneventfully without procedural intervention and without long term sequelae, we believe that many CT scans performed for suspected renal colic are unnecessary. We are requesting funding to hire a part-time research assistant to coordinate data collection activities and follow-up with patients presenting to the Health Sciences Centre and St. Clare’s Hospital Emergency Rooms with a provisional diagnosis of renal colic. Using the prospective data gained from this study, we will test the results of our previous retrospective chart review study, in which we identified a subset of patients that could have been managed without a CT scan. Our long term goal is a “Renal CT decision rule” that would accurately predict a subset of patients with renal colic for whom an immediate renal CT is unnecessary or could be delayed.
Progress: Data collection for this study began in early 2012 and is continuing at the two adult emergency rooms in St. John’s.

Quality and Costs of Primary Care (QualiCoPC)
Funding Source: CIHI, RDC
Amount Awarded: $22,500
Project Years: 2013-2014
Investigators: Kris Aubrey-Bassler, Marshall Godwin, Richard Cullen, Julia Kawamoto
Abstract: Given the current trend of population aging, healthcare expenditures are expected to increase substantially over the next two decades. Strong systems of Primary Healthcare are associated with reduced costs and improved outcomes, but it is unclear which characteristics of PHC are most strongly associated with these desirable features. Family physicians and their patients will be asked to complete detailed surveys about their practice and experiences. This project and anticipated future projects using the data collected here will be able to dramatically improve the evidence base on the relative importance of different aspects of primary healthcare. Cost effective analyses of these data will provide information on health system reforms that could result in decreased costs and improved outcomes. The QualiCo PC study originated in Europe and is truly an international research collaboration of 35 countries which provides much greater learning opportunities than studies of a smaller scale. Similar studies can then be conducted on an ongoing basis to demonstrate changes over time.
Progress: Data has been collected from 41 primary care practices in the province. Data from all other Canadian provinces has also been obtained. A report of descriptive results has been published by the Canadian Foundation for Healthcare Improvement. Inferential data analyses and manuscript preparations are in progress. 

Investigating Celiac Disease in Newfoundland and Labrador
Funding Source: Faculty of Medicine – Medical Research Foundation Award
Amount Awarded: $10,000
Project Years: 2012–2015
Investigators: Pauline Duke, Marshall Godwin, Jeff Critch, Sudesh Vasdev, Shabnam Asghari, John Fardy, Andrea Pike
Abstract: Very little is known about Celiac Disease (CD) in Newfoundland & Labrador (NL); to the best of our knowledge there is no published data regarding CD in this province. This study represents the first step in a research program aimed at better identifying, treating and supporting patients with CD. This initial study will investigate the number of patients with CD and factors related to this illness in our province. We will use this information to provide us with a better picture of what CD “looks like” in NL. As rates of CD are high in Europe, and Newfoundlanders are primarily from European ancestry, it makes sense to predict that Newfoundlanders will have a high rate of CD. If left untreated there are many complications associated with CD. Therefore, it would be beneficial to determine the rates of CD testing and associated diseases and number of deaths. This information will prove useful for increasing general awareness of CD and perhaps generating education materials about the disease for both patients and physicians. Doctors may have a better understanding of associated risks for their patients and thus improved delivery of healthcare services and use of screening practices. This can, in turn, lead to better patient outcomes. From here, we will design community and population based studies to assess disease prevalence, treatment guidelines and current screening practices as well as studies to evaluate access to and cost of gluten free foods and related services in rural areas of the country.
Progress: This project is just beginning. We are in the process of obtaining access to the data necessary to begin our analysis.

Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Family Practice: The BETTER 2 Project
Funding Source: Canadian Partnership Against Cancer
Amount Awarded: $1.5 million
Project Years: 2012–2014
Investigators: Donna Manca, Eva Grunfeld, Kris Aubrey-Bassler
Abstract: The BETTER Project is aimed at improving chronic disease prevention and screening (CDPS) for cardiovascular disease, diabetes and cancer in family practice settings. The BETTER Project aims to improve CDPS by: 1) Reviewing and identifying existing evidence-based tools for CDPS; and 2) Developing and evaluating a multi-faceted intervention which adapts these strategies to the family practice setting. Interventions involve guidelines and tools for best practice, trained prevention practitioners, Electronic Medical Record (EMR) optimization, and tailored patient “Prevention Prescriptions.” BETTER 2 is the second phase of this project and is aimed at implementing the BETTER approach in multiple jurisdictions and evaluating the sustainability of the approach for family practice.
Progress: Data collection is complete in the province but continues in the Northwest Territories. Data analyses and preparation of a final report and academic

Evaluation of the Project for Enhanced Rural and Remote Training
Funding Source: Health Canada
Amount Awarded: $9.4 million (NunaFam: $4.9 million; NLFAM: $4.5 million)
Project Years: 2011–2016
Investigators: Nicole Porter, Reanne Kinsella, Marshall Godwin, Sara O'Reilly, Shannon Aylward, Andrea Pike
Abstract: Rural and remote areas of Canada continue to struggle with shortages of family physicians. Memorial University’s Discipline of Family Medicine initiated the Project for Enhanced Rural and Remote Training (PERRT) to provide an enhanced model of family medicine residency training in three rural or remote sites with the goal of increasing the number of appropriately trained, long term family physicians working in rural and remote areas. PERRT encompasses two projects: 1) a partnership between Memorial University and the Government of Newfoundland and Labrador (NLFAM); 2) a partnership between Memorial University and the Government of Nunavut (NunaFam). As a part of this study, two evaluators were hired to evaluate the PERRT over a 5-year period, so as to provide key stakeholders with useful information to facilitate decision-making. The evaluation of PERRT will consist of a process evaluation (to assess the ongoing implementation of the program and identify areas requiring improvement), as well as an outcome evaluation to investigate the overall effects of the program in relation to its intended outcomes. Preceptors, residents, administrative staff and members of the PERRT Advisory Committee will be interviewed every year to capture their perspectives on how the PERRT project is operating; what barriers exist to the recruitment and retention of family physicians in rural and remote parts of Canada, and what can be done to improve rural training. Memorial University Family Medicine residents and graduates were surveyed in order to establish a baseline of intentions and decisions to practice rurally/remotely; comfort levels in responding to healthcare needs of rural and remote populations, and potential strategies to improve physician recruitment and retention in rural and remote locations.
Progress: Completed.

Health Coaching to Effect Lifestyle Behaviour Change: A Clinical Trial of Individuals with Pre-disease
Funding Source: CIHR
Amount Awarded: $400,939
Project Years: 2011–2015
Investigators: Marshall Godwin (PI), Kris Aubrey, Shirley Solberg, Andrea Pike, Farah McCrate, Alice Gaudine, Veeresh Gadag, Heather Pitcher, Sandra LeFort. Holly Etchegary, Shabnam Asghari
Abstract: Cardiovascular disease related to lifestyle (in particular, a person's diet, exercise habits, smoking status, stress levels, and alcohol consumption) is on the rise in Canada, especially in Newfoundland. Interventions aimed at promoting lifestyle change without addressing an overall change in how people think are less likely to be successful in the long run. Using a health coaching strategy we have developed an intervention for people with pre-diabetes and pre-hypertension. The intervention will include both group and individual sessions with a health coach. We hope to determine whether people with pre-diabetes and pre-hypertension will change the way they think about their health and change their unhealthy lifestyle behaviours. The primary outcomes of the study are change in thinking and change in lifestyle. The intervention will last for 6 months and the outcomes will be measured at the end of the intervention and again at 12 months. We hope to prove that the intervention will be effective at changing lifestyle at 6 months and that those people who also changed their thinking will continue to have improved lifestyle at 12 months.
Progress: Enrolment has begun and there are currently over 65 participants enrolled in the study. Two rounds of intervention (involving approximately 12 participants per group) have been completed and a third has begun. We are in the process of completing six-month follow-up visits and compiling preliminary data. Recruitment is ongoing.

Exploring the Feasibility and Process of Establishing an Online Spatio-Temporal Information System for Chronic Disease in Newfoundland
Funding Source: Newfoundland and Labrador Centre for Applied Health Research (NLCAHR)
Amount Awarded: $40,000
Project Years: 2011–2013
Investigators: Shabnam Asghari (PI), Marshall Godwin, Alvin Simms, Kayla Collins, Kris Aubrey, Robert Reid
Abstract: In order to properly plan, manage, and monitor any health program, it is vital that current and relevant information is available to decision-makers and participants at all levels of the health system. Such information is vital in understanding and improving the population health of our province. To do this, we must have at our disposal the best available data taking into consideration epidemiology, demographics, existing health and social services, as well as other geographic and environmental information. Spatio-temporal systems (STIS) provide the ability to store, analyze, and represent the dynamic properties of the environment, that is, geographic information in space and time. Several researchers have proposed using STIS to create an online spatio-temporal information system for chronic diseases (OSTIS). No such system exists in Newfoundland. The ultimate goal of the study is to establish an ongoing and online spatio-temporal information system for chronic disease in this province. This project is a feasibility study meant to develop and provide a general overview of the basic principles, as well as the fundamental steps and issues involved in developing this sort of system. Given that this is a feasibility study, the focus will be on one chronic disease: diabetes. The primary purpose of the study is to consider all factors associated with the project and determine if the investment of time and other resources will allow us to establish an ongoing and online spatio-temporal information system in Newfoundland.
Progress: This study is in its initial stages. Ethical approval has been granted.

A Multilevel Model of the Effects of Primary Care Reform on Ambulatory Care Sensitive Hospital Outcomes
Funding Source: CIHR/RDC Regional Partnership Program
Amount Awarded: $120,000
Project Years: 2011–2013
Investigators: Kris Aubrey-Bassler, Kayla Collins, John Knight, Richard Cullen, Rahim Moineddin, Alvin Simms, Peter Wang, Yanqing Yi
Abstract: Primary care reform is proceeding in Canada under the assumption that improvements to primary care delivery models will have an overall positive effect on patient outcomes and population health. Where the presumed effects on patient outcomes have been specified, they have not been measured or estimated by quantitative means. Enough data exist at present to begin to evaluate these effects. Our objective is to quantify the effects of implemented primary care reforms on patient outcomes in Newfoundland and Labrador and simultaneously examine the feasibility of using this method to conduct a similar pan-Canadian study of primary care reform. We will link and analyse administrative data including the provincial health registry, physician claims, hospital abstracts, mortality records, data on physician and practice characteristics and neighborhood-level socio-demographic characteristics from the Census. Data from pre-reform (2001–2003), reform (2004–2006), and post-reform (2007–2009) periods will be used to develop multilevel regression models to investigate the extent to which primary care reforms are associated with improvements in ambulatory care sensitive hospital outcomes. We expect that reforms will be associated with reduced hospitalizations but are unlikely to result in a significant change to mortality at this early phase after implementation.
Progress: Data extraction from the Newfoundland and Labrador Centre for Health Information is completed. Data analysis will proceed in 2015.

An Investigation of Cancer Rates in the Placentia Region, Newfoundland
Funding Source: N/A
Amount Awarded: N/A
Project Years: 2011–2013
Investigators: Pauline Duke, Marshall Godwin, Farah McCrate, Peter Wang, Stephen Bornstein, Andrea Pike
Abstract: The Argentia region of NL, Canada housed an American Naval Base from the 1940s–1990s. Activities at this Base left behind an array of toxic and hazardous toxins, many of which are known cancer causing agents. The base was the lifeblood of the community from the '40 to the '60s; many residents of the region worked at the base and/or lived nearby. Cancer rates for the Argentia region have often been thought to be high compared to the rest of the province; however, there has been no systematic study to determine if this is the case. Our objective is to determine if the odds of cancer diagnosis and cancer incidence rates are greater for those living in the Argentia Region of NL, Canada (compared to other regions of the province, and to the province as a whole). Cancer diagnosis information from the NL Cancer Registry and population counts from the Canadian census will be used to evaluate the rates of cancer diagnosis in the Argentia Region versus both other regions of the province and the province as a whole.
Progress: Complete.

Canadian Primary Care Sentinel Surveillance Network (CPCSSN) – Phase III
Funding Source: Public Health Agency of Canada
Amount Awarded: $11 million ($600,000 for NL network)
Project Years: 2010–2015
Investigators: Richard Birtwhistle, Walter Rosser (PIs), Marshall Godwin, Neil Drummond, Alan Katz, Wayne Putnam, Donna Manca, Marie-Thérèse Lussier, Moira Stewart, Michelle Greiver, Anita Lambert-Lanning
Abstract: This project is an assessment of the feasibility of developing a pan-Canadian network of primary care research networks for the purposes of studying chronic disease. In essence, the study is meant to determine a) whether a meta-network of this variety is plausible; and b) whether, once established, such a network can effectively develop a researchable database using electronic medical record (EMR) data collected from sentinel physician practices. The CPCSSN is tasked with the collection of information about patients with any one of eight chronic diseases: hypertension, diabetes, osteroarthritis, COPD, depression, epilepsy, Parkinson’s Disease, and dementia. This data will be collected from primary care practices (that are using electronic medical records) across the country. The CPCSSN is further tasked to then amalgamate this data from the different types of EMRs into a single, researchable database.
Progress: To date, primary care research networks representing nine of Canada’s provinces have been recruited to the CPCSSN initiative. All networks have received appropriate ethics and institutional approvals and have begun the process of recruiting sentinel physicians. Data collection at each of the sites is ongoing. In the NL region (represented by the Atlantic Practice Based Research Network or APBRN), we have recruited sentinel physicians from four sites in St. John’s and one site each in Grand Falls-Windsor, Corner Brook, and Channel-Port aux Basques. These sites represent two EMR systems—Wolf and Nightingale. Data extraction from these sites is ongoing and progressing smoothly. We are currently in the process of validating existing CPCSSN case definitions. Physician recruitment is also ongoing.

Utilisation of Family Physicians in the H1N1 Vaccination Programs of Canadian Provinces and Territories during the Fall 2009 Pandemic
Funding Source: CIHR
Amount Awarded: $99,981
Project Years: 2010–2011
Investigators: Marshall Godwin (PI), Pauline Duke (co-PI), Andrea Pike, David Allison, Inese Grava-Gubins, Kris Aubrey, Peter Wang, Shabnam Asghari
Abstract: The roll out of the H1N1 vaccination program across the country was fraught with various issues related to long line-ups, followed by supply issues, and then subsequent issues around lack of interest in getting the vaccine after the initial rush. The primary care system (mainly family physicians) was, in large part, excluded from the distribution of the vaccine in many areas of the country. The purpose of this study was to survey both family physicians and medical officers of health across Canada who experienced the pandemic. Family physicians were surveyed to determine their opinions on how the H1N1 vaccination program rolled out in their region; to assess their perspectives/knowledge of their opportunity to volunteer or apply for permission to administer the vaccine; to determine whether, if given the opportunity, they would have administered the vaccine in their clinics, and to determine what they believe are the pros and cons of involving family physicians in vaccination programs in the context of a pandemic. Medical officers of health in healthcare regions across the country were surveyed in order to document exactly what the policy was regarding family physicians involvement in the H1N1 vaccination programs in their regions, the reasoning behind the decisions to institute those policies, and to determine their opinions of the utilization of family physicians in future pandemics based on their experience with the 2009 H1N1 pandemic.
Progress: Complete.

Residential Proximity and Hospital Level of Service: A Geospatial Epidemiological Study of Obstetrical Outcomes
Funding Source: Memorial University, Dr. A. R. Cox Research Grant Competition
Amount Awarded: $30,000
Project Years: 2009–2013
Investigators: Kris Aubrey-Bassler, Alvin Simms, Peter Wang, Marshall Godwin, Joan Crane, Richard Cullen
Abstract: Previous research suggests that neonatal mortality, the risk of an abnormal neonate, and hospital charges are all greater for women with poor access to obstetrical care at their home hospital, even though these women are usually travelling to deliver at high volume, specialized centres. Thus, in determining the obstetrical outcomes for rural women, it appears as though proximity to care is more important than the level of service actually provided. Despite this, obstetrical programs in small rural hospitals are closing. In this study, we will examine obstetrical outcome data from across the country in order to determine the factors contributing to obstetrical outcomes in Canadian communities, ranging from those with no services to those with the most highly specialized hospitals.
Progress: A manuscript comparing adverse outcomes of deliveries by family physicians and obstetricians has been drafted and is currently under review for publication. Additional analyses are proceeding. 

Effect of Vaginal Self-sampling on Cervical Cancer Screening Rates: A Community Based Study
Funding Source: CIHR-RPP, IRIF
Amount Awarded: $344,568
Project Years: 2009–2010
Investigators: Pauline Duke (PI), Marshall Godwin (Co-PI), Adrian Lear, Andrea Pike, Daniel Fontaine, Gerry Mugford, Martha Traverso-Yepez, Mohamed Ravalia, Peter Wang, Sam Ratnam, Wendy Graham, Lesa Dawson
Abstract: Cervical cancer is the second most common cancer in women globally. However, it is a preventable and treatable cancer if detected early. Widespread Pap smear based cervical screening programs are the primary reason for substantial reductions in cervical cancer morbidity and mortality. Despite intense patient education programs however, many women do not attend for regular Pap screening even when it is readily available. This may be due to the inconvenience of a clinic visit, discomfort, embarrassment, or fear surrounding the pelvic exam. There is growing interest in the use of HPV testing as a screening tool for cervical cancer. HPV testing allows for the possibility of self-collection of samples. Self-collection (which of course does not require a pelvic exam by a doctor) has been found to be both effective and acceptable to patients. This study will determine if the introduction of a self-collection strategy for HPV screening in women aged 30-69 results in increased cervical cancer screening in a community based setting. Three communities with similar demographics and existing screening rates will be studied. One community will receive an educational and promotional program regarding the prevalence and preventability of cervical cancer and the availability of a research project to test for HPV through self-collection. A second community will receive a similar campaign but the focus will be on the importance of clinician-collected Pap smears. The third community will receive no intervention. The screening rates of each community will be compared to each other and to the rates of screening in their communities during the previous year.
Progress: Data collection complete; currently working on final data analysis and project write-up.

Assessing Criterion Validity and Developing Population Norms for the Simple Lifestyle Indicator Questionnaire (SLIQ) in the Elderly
Funding Source: Newfoundland and Labrador Healthy Aging Research Program
Amount Awarded: $40,000
Project Years: 2009–2010
Investigators: Marshall Godwin (PI), Allison Kirby, Cheri Bethune
Abstract: Cardiovascular disease is the leading cause of death in Canada. A major risk factor for cardiovascular disease is lifestyle (smoking status, diet, exercise, alcohol use, stress). Currently, however, an instrument to measure cardiovascular lifestyle as a single construct does not exist. The SLIQ was developed to address the need for such an instrument. However, the SLIQ has not been sufficiently tested, nor have population norms been determined. As such, it is not possible to use the instrument as an outcome or exposure measure in large grant applications. In this study, we hope to measure criterion validity of the SLIQ and to collect normative data in the elderly. To assess criterion validity we will compare scores on the SLIQ with scores on other validated measures of diet, stress, alcohol consumption and exercise. We will recruit people in three age categories: 50-64 years, 65-79 years, and 80+ years, from family physician practices. To assess the population norms we will recruit people from various venues: shopping malls, gyms, and the people recruited from family doctors offices. Once we have more clearly delineated these psychometrics (validity and population norms) we will be in a much better position when applying to CIHR and other granting agencies. As well, research and clinical communities will have a validated instrument for measuring lifestyle and changes in lifestyle behaviour.
Progress: This project has been submitted for publication.

The ElderCare Project: Primary Health Care for Community Living Old Elderly
Funding Source: CIHR
Amount Awarded: $371,932
Project Years: 2006–2010
Investigators: Marshall Godwin, Farah McCrate, Robert Miller, Wanda Parsons, Anne Sclater, Sharon Buehler, Veeresh Gadag, Karen Parsons
Abstract: The Old Elderly, those aged 80 and older, are the fastest growing age subset of the population. They are more likely to have chronic illness, more likely to be using multiple medications and are more likely to visit their physician. However, a physician is not always necessary to address the many concerns of the elderly; other venues of care may be more cost and time effective. This study will implement and evaluate a nurse-based program of home-delivered care, linked directly with the family physician or primary care team. The main objectives are to improve QoL for the old elderly and lessen the burden on the primary health care system. These improvements will be made through an intervention called the ElderCare Program. An ElderCare Plan will be developed for each patient using Goal Attainment Scaling methodology and will provide education and information about chronic disease self-management, available community resources, ADL help and any other needs the patient may have. Goals and other needs will be determined based on patient, family member (where applicable), and physician input, and on information from a variety of assessments carried out at baseline. Assessments at 6 months and 12 months will test the outcomes of the program.
Progress: Data collection complete; currently working on data analysis and write-up.
 
 
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