6th Annual McGill Family Medicine Research Symposium | May 13-14, 2021
Family Medicine Graduate Student Society (FMGSS)
Published online: 13 May 2021Describing Trends in the Quality of Health Care and Services for Men and Women Living with Dementia
Tammy Bui MSc1, Genevieve Arsenault-Lapierre PhD2, Claire Godard-Sebillotte3, Nadia Sourial PhD4, Louis Rochette MSc3,4, Victoria Massamba MSc3,4, Isabelle Vedel MD PhD2,31Epidemiology, Biostatistics and Occupational Health Department Montreal, Canada.
2Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.
3McGill University Department of Family Medicine, Montreal, Canada.
4Département de Médecine de Famille et de Médecine d'Urgence, Faculté de médecine, Université de Montréal, Montreal, Canada.
5Institut national de santé publique du Québec Quebec, Canada.
Corresponding author: Tammy Bui, email: tammy.bui@mail.mcgill.ca
Abstract
Background: As the Canadian population ages, challenges emerge with the healthcare utilization of services for persons living with dementia (PWD). There is evidence that points to how sex/gender differences influence the healthcare utilization where older adult women may differ compared to older men when seeking and receiving treatment. The aim of this study is to describe the sex-based inequities on the healthcare utilization among PWD.
Methods: We used a repeated annual cross-sectional cohort design from 2000-2001 to 2016-2017. Data was obtained from linked population-based administrative databases from the Institut national de santé publique du Québec. Community-dwelling older adults age 65+ with incident cases of dementia occurring between April 1st and March 31st for each year between were included. Healthcare utilization indicators were measured as age-standardized rates. To ascertain the differences between males and females, indicators were stratified by sex over 17 cohort-years and graphed. A visual and graphical analysis allowed for clinically meaningful interpretation.
Results: A total of 237,259 persons with dementia was included in our study (62.7% women). Men had higher rate and number emergency department visits, rate of hospitalizations, rate of admission to long term care, rate of mortality. While women had higher prescription of cholinesterase inhibitors, benzodiazepines, and antidepressants compared to men. There was no meaningful difference for antipsychotic prescriptions and ambulatory visits to cognition specialists.
Conclusions: These results are consistent with an Ontario study conducted by Sourial et. al. (2020). Addressing the sex-based inequities in healthcare utilization in PWD will inform decision-makers for the implementation of adequate policies to promote equity in dementia care.
Combining conceptual frameworks on maternal health in indigenous communities - Fuzzy cognitive mapping using participant- and operator-independent weighting
Iván Sarmiento1,2, Anne Cockcroft1, Anna Dion1, Sergio Paredes-Solís3, Abraham De Jesús-García3, David Melendez4, Anne Marie Chomat1, Germán Zuluaga2, Alba Meneses-Rentería3, Neil Andersson1,31CIET-PRAM, Faculty of Medicine, Department of Family Medicine, McGill University.
2Grupo de Estudios en Sistemas Tradicionales de Salud. Universidad del Rosario.
3Centro de Investigación de Enfermedades Tropicales. Universidad Autónoma de Guerrero.
4Comité Promotor por una Maternidad Segura en México. Carretera a Chamula No.108, la
Corresponding Author: Iván Sarmiento, email: ivan.sarmiento@mail.mcgill.ca
Abstract
Background: A recurring issue in intercultural research is whose knowledge should inform project conceptualisation and design. Fuzzy cognitive mapping can combine different stakeholder perspectives to generate composite theories that inform further research. These maps present causal understanding as relationship weights, but participant weighting is not always straightforward.
Objectives: Develop and a procedure to combine and to condense maps and an alternative operator-independent weighting procedure adapted from Harris’ discourse analysis.
Methods: Eight experienced intercultural researchers each produced a map of factors contributing to maternal health in indigenous communities, showing causal relationships as arrows weighted to indicate their perceived strength. Inductive thematic analysis grouped factors to create category maps. We used fuzzy transitive closure to calculate the cumulative net influence between categories. As an alternative to participant weighting, we determined weights of relationships based on their frequency in the original maps. We compared maps with participant weights and frequency-based weights in terms of the strength of each factor’s outgoing edges and cumulative net influence of categories.
Results: In both weighting procedures cultural continuity and access to culturally safe Western health care had the strongest positive influences on maternal health, while culturally unsafe environment had the strongest negative influence. Cultural continuity included access to traditional midwifery and other care practices. For Western health care, respectful services and antenatal care showed strong influence, reinforced by collaboration with traditional midwives and reduced delays in women deciding to access care. The nine most influential factors were the same though in a different order in the two weighting procedures. Category-level maps had an almost identical structure using participant and frequency weights.
Conclusion: The maps succinctly described the perspectives of the researchers about contributors of good maternal health. Participant and frequency weighting procedures produced almost identical results at the category level, suggesting applicability of Harris’ discourse analysis in exploratory inquiries into structural issues when participant weighting is not feasible.
An acceptability and needs assessment for the implementation of a patient portal in HIV clinical care (Opal)
Dominic Chu1,2, Tibor Schuster1, David Lessard2,3,4, Kedar Mate2,3, Kim Engler2,3,4, Yuanchao Ma2,3,4, Ayoub Abulkhir1,2, Anish Arora1,2, Stephanie Long1,2, Alexandra de Pokomandy1,3,4, Karine Lacombe3,4, Hayette Rougier5,6, Joseph Cox2,3,4, Nadine Kronfli1,3,4, Tarek Hijal7, John Kildea8, Jean-Pierre Routy4, Jamil Asselah7, Bertrand Lebouché1,2,3,41Department of Family Medicine, McGill University, Montreal, Canada
2Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, Canada
3Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
4Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, Canada
5AP-HP, Hôpital Saint-Antoine, Service des Maladies Infectieuses et Tropicales, Paris, France
6IMEA, Institut de Médecine et d’Epidémiologie Appliquée, Paris, F75018, France
7Department of Radiation Oncology, Cedars Cancer Centre, McGill University Health Centre, Montreal, Canada
8Medical Physics Unit, Gerald Bronfman Department of Oncology, McGill University, Montreal, Canada
Corresponding author: Bertrand Lebouché phone: +1 514-843-2090, email: bertrand.lebouche@mcgill.ca
Abstract
Background: Opal (opalmedapps.com) is a patient portal currently used in oncology at the McGill University Health Centre (MUHC). Opal allows patients to access their medical records, patient-reported outcome measures (PROMs), and other services. Opal achieved high satisfaction rates in oncology, garnering interest for its use in other chronic conditions, including HIV. However, to implement it in HIV healthcare, Opal must be configured for people living with HIV (PLWH) and their healthcare providers (HCPs).
Objectives: To evaluate the acceptability of Opal for HIV healthcare and its compatibility with PLWH’s and HCPs’ needs, concerns, and recommendations.
Methods: This study follows a convergent parallel mixed-methods design. A quantitative cross-sectional survey and qualitative semi-structured focus group discussions (FGDs) were performed with PLWH and HCPs from the Chronic Viral Illness Service, the Centre Hospitalier de l’Université de Montréal, Clinique Médicale du Quartier Latin, Clinique Médicale l’Actuel, and Hôpital Saint-Antoine (Paris, France) from August 2019 to February 2020.
Results: 114 PLWH and 31 HCPs were recruited for the survey. The mean age was 47.8 years (SD = 12.4) for PLWH and 46.5 years (SD = 11.4) for HCPs. Most PLWH (96.5%) and all HCPs owned at least one type of smart-device (smartphone, tablet). Most participants were willing to use Opal (74% of PLWH, 68% of HCPs), although 64% of PLWH noted privacy concerns. Most Opal functions and Opal administered PROMs demonstrated high acceptability, including functions such as an appointment calendar (93.8% PLWH, 96.7% HCPs), appointment reminders (92.1% PLWH, 86.1% HCPs) and PROMs capturing quality of life (89% PLWH, 77% HCPs) and HIV self-management (92% PLWH, 97% HCPs).
We conducted three FGDs with 22 PLWH and five FGDs with 24 HCPs, and identified four key needs: 1) simple patient-oriented information, including education material and treatment plans; 2) adaptable and user-friendly tools for promotion of self-management, including medication reminders and appointment scheduling; 3) communication tools identifying PLWH barriers-to-care through PROMs administration; and 4) security and confidentiality to maintain PLWH’s privacy.
Conclusions: Opal, its functions, and PROMs administration are highly acceptable to stakeholders. During its implementation, efforts must be made to reassure stakeholders’ security and privacy concerns.
Visualising the effectiveness of interventions to reduce emergency department transfers from long-term care settings using harvest and other plot methods
Deniz Cetin-Sahin1,2, Ovidiu Lungu3,4, Matteo Peretti3,4, Philippe Voyer6, Brian Gore2, Genevieve Gore7, Isabelle Vedel1,9, Greta G. Cummings8, Mark Karanofsky1, Tibor Schuster1, and Machelle Wilchesky1,2,91Department of Family Medicine, McGill University, Montreal, QC, Canada
2Donald Berman Maimonides Geriatric Centre, Montreal, QC, Canada
3Department of Psychiatry, Université de Montréal, Montreal, QC, Canada
4Montreal Neurological Institute, McGill University, Montreal, QC, Canada
5The Fenway Institute, Fenway Health, Boston, MA, United States
6Faculté des Sciences Infirmières, Université Laval, Quebec City, QC, Canada
7Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, QC, Canada
8Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
9Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
Corresponding author: Machelle Wilchesky, email: machelle.wilchesky@mcgill.ca
Abstract
Objectives: To synthesize the knowledge about the effectiveness/efficacy of interventions to reduce ED transfers from LTC using harvest, bubble, and scatter plot methods of data representation.
Methods: A systematic review of quantitative and mixed primary studies was conducted in Embase, MEDLINE, CINAHL, Social Work Abstracts, PsycINFO, The Cochrane Library, AMED, Global Health, Health and Psychosocial Instruments, Joanna Briggs Institute EBP Database, Ovid Healthstar, and Web of Science from inception until April 2020. Forward and backward citation tracking and grey literature review was performed. A narrative synthesis was conducted using the ‘Synthesis Without Meta-analysis’ in systematic reviews reporting guideline. PICO elements of interventions were categorized, i.e., Population (eligibility criteria), Intervention components (thematic analysis), Comparators (usual care), and Outcome measures (overall and/or potentially avoidable ED transfers). Plots were produced indicating the direction of intervention effects for the set of included studies.
Results: From 20,218 records identified from our larger review (that included hospitalizations), 47 studies were included for synthesis. Population categories included LTC resident age category, having dementia and/or chronic disease, end-of-life status, admitted to hospital, emergency calls made, and having healthcare policy/specific insurance. Four intervention components (training, human resources, technology, and tools) emerged within two dimensions (delivery of care and communication). Outcome measures included number/mean/rate of transfers, number or time to return transfers, number of emergency calls, and ED use cost. In total, 21 studies reported some degree of significant reduction. Three studies specifically measured avoidable transfers, all showing significant reduction.
Conclusions: PICO inconsistencies suggest that better targeted interventions are needed specifically to reduce avoidable ED transfers. The use of harvest plots and other visualization methods are informative in identifying useful components from among complex interventions for person-centered care.
How Does the Entourage Use Online Parenting Information to Support Others in their Social Circle? Preliminary Results from a Mixed Methods Research Study
Reem El Sherif1, Pierre Pluye1, Fidelia Ibekwe2, Tibor Schuster1, Roland Grad11Department of Family Medicine, McGill University, Montreal, Canada
2School of Journalism & Communication, Aix-Marseille University, France
Corresponding author: Reem El Sherif email: reem.elsherif@mail.mcgill.ca
Abstract
Background: High quality online consumer health information (OCHI) can reduce unnecessary visits to health professionals and improve health. One of the ways people use OCHI is to support others with health conditions. Members of an individual’s entourage may help them overcome information-seeking barriers and illness challenges. However, little is known on how people use OCHI with others, and the outcomes of said use.
Objective: To explore the OCHI outcomes for members of the entourage who consult an online parenting information website.
Methods: A convergent mixed methods study in the context of an ongoing partnership between Naître et Grandir (N&G - an online parenting resource) and our team at McGill (developers of the Information Assessment Method -IAM- questionnaire).
Quantitative component: I will analyze responses by all Canadian N&G readers who had completed at least one IAM questionnaire between January 8th, 2019 and January 7th, 2021. Participants will be divided into two groups: parents of 0-8-year-old children (n=21107) or entourage members: grandparents, family members, friends, or neighbours (n=7015). Descriptive statistics and Pearson’s chi-test will be used to determine whether the difference in responses between two groups is statistically significant.
Qualitative component: I will interview N&G entourage members who agreed to be contacted for an interview when completing the IAM. I will start with 20 semi-structured phone interviews and increase the sample until saturation. A hybrid deductive-inductive thematic analysis will be conducted in NVivo.
Integration: The two components will be conducted and analysed separately. Integration will occur as comparison post-intersection where the results of each component will be compared using a joint display to provide a complete picture of the phenomenon being described.
Anticipated results: Two main anticipated results: a better understanding of OCHI outcomes reported by the N&G entourage, and contextual factors of OCHI social support by the entourage.
Conclusion: This is an important topic for researchers, primary health care practitioners, and patients. By better understanding how people use information together, information providers can adapt information to meet both individual and group needs. Health care practitioners can target patients’ entourage with information for dissemination and use.
Wearable sensor technology for assessment and monitoring of neuropsychiatric symptoms of dementia-systematic review – Are we there yet?
Elena Guseva1, Andrea Iaboni2, Nathan Hermann3, Krista Lanctot3, Dallas Seitz4, Amer M. Burhan3,4, Sanjeev Kumar6, Marie-Andrée Bruneau7, Andrew Lim3, Machelle Wilchesky1,81Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Rd, Montreal, Quebec H3S 1Z1
2Toronto Rehab, UHN, 550 University Ave, Toronto, ON M5G 2A2
3Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON M4N 3M5
4Faculty of Health Science, Queens University,18 Barrie Street, Kingston, On, K7L 3N6, Canada
5Ontario Shores Centre for Mental Health Sciences, University of Toronto, 700 Gordon Street, Whitby, ON, L1N 5S9
6Centre for Addiction & Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4
7Centre de Recherche de l’IUGM (CRIUGM), Université de Montréal, 4545 Queen Mary Rd, Montreal, Quebec H3W 1W6
8Lady Davis Institute for Medical Research - Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1E2
Corresponding author: Elena Guseva, email elena.guseva@mail.mcgill.ca
Abstract
Background: There is a tremendous potential to improve identification and monitoring of neuropsychiatric symptoms (NPS) in persons with dementia (PwD) using objective physiological signals from wearable sensor technology (WST). These technologies can potentially generate continuous data that identifies behavior patterns, which in turn could lead to earlier NPS detection and guide more precise management strategies. In addition, WST could improve monitoring treatment responses across dementia care settings. A wide array of new technologies may provide solutions, especially those explicitly designed to support people with dementia and their formal and informal caregivers. A small but rapidly growing body of evidence investigating sensors in dementia care is paving the way for the field, bringing into focus both the potential and pitfalls of this approach.
Objectives: (1) to present the evidence for the use of WST in detecting and/or monitoring each of the NPS domain in PWD; (2) to present the evidence for the feasibility and acceptability of WST use in this population.
Methods: A systematic literature search was carried out from inception until December 2020 was conducted using Ovid MEDLINE, EMBASE, PsycINFO, EBSCOhost CINAHL, Scopus, Compendex, INSPEC, GEOBASE, IEEE Xplore library databases. To warrant inclusion, studies were required to use WST as a diagnostic tool for NPS detection or use WST for NPS monitoring. Our protocol was registered https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=219917
Results: A systematic literature search produced 6112 articles. Informed by the PRISMA guidelines, screening produced a final corpus of 103 titles. Dementia types under study included Alzheimer’s disease 41(39.8%), frontotemporal 6(5%), and Lewy body dementia 6(5%). The majority of studies investigated sleep disturbances 43(41.75%), agitation 30(29.12%), wandering/pacing 19(18.44%), and apathy 17(16.5%). Technology used included accelerometry 45(43.69%), actigraphy 37(35.92%), and electrodermal activity 5(4.85%). In total, 24(23.3%) studies investigated the acceptability and feasibility of these devices for PwD.
Conclusion/implications: This will be the first comprehensive systematic review to investigate the validity of WST for the detection and monitoring for each NPS domain. If valid, feasible and acceptable, these technologies are poised to revolutionize dementia person-centered care.
Focusing on the big picture: developing a clinical tool that optimizes shared decision-making to optimally promote physical activity in primary care settings
Abbesha Nadarajah1, Tracie Barnett1,2, Constantine Filip1,3,4, Peter Nugus1,51Department of Family Medicine, McGill University, Montréal, Canada
2Research Center, Sainte-Justine University Hospital Research Center, Montréal, Québec, Canada
3GMF-U Jardins-Roussillon, CISSS de la Montérégie Ouest, Canada.
4GMF En Route Square-Victoria, Montréal, Canada.
5Institute of Health Sciences Education and Department of Family Medicine, McGill University, Montréal, Canada.
Corresponding author: Abbesha Nadarajah email: abbesha.nadarajah@umontreal.ca
Abstract
Background: Given the well-known health benefits of physical activity, primary care clinicians frequently recommend their patients to adopt a physically active lifestyle both in the context of primary prevention and chronic disease management. However, rarely are aspects of the patient’s lived experiences such as the built and social environments integrated into this continual dialogue. Despite the existence of some clinical tools, such as the 5As of motivational interviewing, barriers such as a lack of standardized practice, time constraints, and perhaps limited transferability impede the application of such tools uniformly in clinical practice.
Objectives: Our main objective is to develop or refine a clinical tool that will allow primary care clinicians to effectively incorporate elements of their patients’ built and social environment into a patient-centered care plan thereby allowing them to promote physical activity appropriately and feasibly.
Methods: We propose a 3-phase study. Phase one is centered on knowledge acquisition, primarily to understand current perspectives and practices concerning built and social environments. In phase two, knowledge gained in the previous step with the added input of stakeholders will allow us to co-develop and/or refine the tool. In phase three, we will implement and validate the tool in several clinical settings. The first phase has ultimately been completed at the moment. To consider diverse perspectives and proceed to the next phase, we have received support from the Centre of Excellence on Partnership with Patients and the Public (CEPPP) to include patient partners in our team, and have established a partnership with GMF-U Jardins Roussillon to potentially include the views of clinicians and members from management.
Anticipated Results: Widespread transferability of the tool will be sought. Furthermore, its lessons will model optimal practice-based research that includes patient perspectives.
Implications: The tool will contribute to guiding more efficient and effective patient-centered care by enabling a systematic account to be taken of broader contextual factors suspected to impact patient health and assist clinicians to incorporate these influences when relevant, in the context of promoting physical activity. While our focus is on physical activity, the process may eventually be extended to other behavior changes.
The prospect of shared learning through telemedicine: Inter-professional perspectives on primary care during the Covid-19 pandemic
Cynthia Vincent1, Nadjib Mokraoui2, Jeannie Haggerty3, and Peter Nugus31Department of Education, University of Quebec in Montreal, Montreal, QC, Canada
2Practice Based Research Network, McGill University, Montreal, QC, Canada
3Department of Family Medicine, McGill University, Montreal, QC, Canada
Corresponding Author: Cynthia Vincent, vincent.cynthia.2@courrier.uqam.ca
Abstract
Background: To enable patients’ access to health care during the Covid-19 pandemic, Quebec have revised regulations to allow health care clinics to adopt or expand their application of telemedicine. Telemedicine, which we call here teleconsultations, are real-time, technology-enabled professional-patient consultations. In this context, teleconsultations are being deployed rapidly, and healthcare professionals have had minimal training and guidance on how to undertake teleconsultations safely. To derive lessons for long-term adoption and implementation, it is important to identify how health care professionals have been engaging with teleconsultations under the current circumstances.
Objectives: Identify what new aspect(s) on clinical work can emerge from inter-professional perspectives on teleconsultations in primary care during the Covid-19 pandemic.
Methods: The study engages eight focus groups – four of physicians, and four of nurses and allied health care professionals. The focus groups represent all four of Quebec’s Practice-based Research Networks (PBRNs) affiliated with Departments of Family Medicine. The verbatim of the focus groups were analyzed by thematic analysis, comparing and contrasting particular data excerpts, from codes initially organized into NVivo 12 software.
Results/Anticipated results: Overall, participants reported positive experiences and smooth adjustment for themselves and their patients. Some reported benefits reflected previous research: protecting high-risk groups from Covid-19 virus; providing safe and convenient access to routine treatment without the need to visit the clinic; and overcome travel restrictions; among others. In new ways, teleconsultations were reported to help health care professionals facilitate multi-disciplinarity appointments; develop new assessment skills such as better listening, foster creativity in educating patients; enjoy more autonomy as a professional (for nurses); deliver efficient and quality care thus create a feeling of increased helpfulness; produce fewer consultation “no-shows”; and find a better use of time to experience a better work-life balance. Participants believe that teleconsultations’ use for routine treatments and follow-ups should be made permanent.
Conclusion/Implications: Focusing on the generally positive views on telemedicine provided insight into the shared learning that telemedicine is enabling. Participants also conveyed concerns about the use of telemedicine, which will be presented elsewhere. Moving forward, telemedicine should be seen as a safe, effective, efficient and sustainable mode of healthcare delivery, if used appropriately and for appropriate cases.
Access to Healthcare by Socially Vulnerable Persons during the COVID-19 Pandemic: A protocol for an explorative study on the impacts of race
Khandideh Williams1,2, Jeannie Haggerty1,2, Alayne Adams11Department of Family Medicine, McGill University, Montreal, QC, Canada
2St. Mary’s Research Centre, Montreal, QC, Canada
Corresponding author: Khandideh Williams email: Khandideh.williams@mail.mcgill.ca
Abstract
Background: Although the Canadian universal healthcare system was created to increase access to healthcare services and to exemplify the values of equity and social justice, healthcare disparities still exist. The Covid-19 pandemic has exposed and exacerbated these disparities and has drawn attention to their social determinants. For example, in Montreal, Quebec, the largest number of Covid-19 cases are reported in neighborhoods with high rates of poverty and the most racial diversity. Although over 22% of the Canadian population identify as a non-white visible minority, racial differences are rarely considered in the Canadian healthcare literature, nor is race-based data routinely collected.
Objectives: Using a qualitative exploratory design, this study will elicit the experiences of racialized minorities in accessing primary healthcare services during the Covid-19 pandemic to determine potential barriers and facilitators that influence access.
Methods: We will conduct in-depth interviews with different racialized groups in multicultural neighbourhoods in Montreal, to understand their healthcare needs and challenges in accessing care. Deliberative dialogues with family physicians serving these neighborhoods will solicit feedback about possible solutions.
Anticipated results: Given evidence of stark racial inequities in primary healthcare access in the United States, we anticipate that racialized groups may be experiencing additional barriers to accessing primary healthcare services during the Covid-19 pandemic. This research will contribute rich descriptions of these experiences and their perceived determinants and impacts.
Implications: Race-based analysis and the critical discourse it provokes are needed to avert disparities in morbidity and mortality that have already been observed within these populations and which are being amplified by the pandemic. Insights emerging from analysis will inform the development of strategies to enhance healthcare accessibility among racialized populations during the COVID-19 pandemic and beyond.
Providing patient-centred gender-affirming medicine: A mixed-methods evaluation of a digital continuing professional development resource
Gabriel Enxuga1,2, David Rojas Gualdron3,4,5, Stella L. Ng6, James Owen7,8, Yonah Krakowsky9, Kinnon Ross MacKinnon101Master of Social Work Student - School of Social Work, McGill University, Montreal, QC, Canada,
2Research Assistant - Centre for Ambulatory Care Education (CACE), Women’s College Hospital, Toronto, ON, Canada
3Assistant Professor - Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada, David.
4Evaluation Scientist - Centre for Ambulatory Care Education (CACE), Women’s College Hospital, Toronto, ON, Canada
5Evaluation Scientist - Office of Assessment and Evaluation, MD Program, University of Toronto, Toronto, ON, Canada
6Director of Research - Centre for Faculty Development, St. Michael’s Hospital, Toronto, ON, Canada,
7Family Physician - St Michael’s Hospital, Toronto, ON, Canada
8Assistant Professor - Department of Family and Community Medicine, University of Toronto’s Faculty of Medicine, Toronto, ON, Canada
9Urologist and Medical Director - Transition-Related Surgery Clinic, Women’s College Hospital, Toronto, ON, Canada
10Assistant Professor - Faculty of Social Work, York University, Toronto, ON, Canada
Corresponding author: Gabriel Enxuga email: Gabriel.Enxuga@mail.mcgill.ca
Abstract
Introduction: Current approaches to gender-affirming medicine in primary practice focus on ‘one-size-fits-all' eligibility assessments required for trans and nonbinary (trans) patients to access hormones and surgeries. These prevailing practices limit patient-centered care with trans patients. The Path to Patient-Centred Care (PPCC), a digital continuing professional development tool, teaches clinicians an alternative model of gender-affirming medicine: the informed consent model. To improve the PPCC resource for future use, we analyzed the self-reported educational impact of the PPCC with diverse post-graduate medical learners.
Methods: We conducted a mixed-methods education evaluation study. Between July and October 2020, we invited physician participants (total n=29) to test the PPCC tool and collected feedback through an online survey (n=29) and semi-structured interviews (n=13). While participants represented a diverse range of clinical specialties, a majority were family physicians (n=14).
Results: Interviews with family physicians indicated the PPCC tool increased awareness about limitations of the ‘one-size-fits-all’ traditional standards of care, as well as how to tailor care for the purpose of addressing trans patients’ treatment access inequities. A major strength identified by participants was that the PPCC tool provided concrete, actionable steps on how to implement patient-centered care in practice via the informed consent model. Although the data showed that participants’ self-perceived level of knowledge increased after using the tool, survey data also showed that participants self-perceived capacity to deliver gender-affirming medicine did not increase after using the tool.
Discussion: The results of this project suggest that the PPCC tool is an effective resource to provide information about the informed consent model. However, the low self-perceived capacity to implement gender-affirming medicine highlights the need for continuing professional development opportunities. Alternative models of gender-affirming medicine, if employed by family physicians could improve access to hormones and surgeries for trans people and result in better patient care. Therefore, additional gender-affirming medicine resources and teaching approaches are warranted.
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