Our Projects

Maritime Research Network for Family Practice (MaRNet FP)

The Maritime Family Practice Regional Network’s largest activity is as a node for CPCSSN, the Canadian Primary Care Sentinel Surveillance Network. It continues to thrive with now over >100,000 Nova Scotia primary care patients included. Each year the network grows, both in terms of the number who have ‘plugged in’ to the network and the quality of the data being collected. 

In Nova Scotia, we have recruited 55 sentinel physicians and nurse practitioners from 20 sites, both urban and rural environments, and are poised to expand further over the next several months. The sites incorporate the Nightingale electronic medical record (EMR) system. In addition to general health information, data are being collected on eight chronic diseases: hypertension, diabetes, osteoarthritis, COPD, depression, epilepsy, Parkinson’s disease, and dementia.  The data are robust and the algorithms used by CPCSSN to identify cases of diabetes, hypertension, etc. have a sensitivity and specificity of 90 per cent and higher, in most cases. Researchers are already beginning to use the collected data for research projects and it is expected that the data resulting from CPCSSN efforts will become a key information source for national chronic disease management.

Read more about the Canadian Primary Care SEntinel Surveillance Network.

Read more about Hypertension in patients with Type 2 Diabetes. 

Screening for Poverty And Related social determinants and intervening to improve Knowledge of and links to resources (SPARK) is a multi-provincial study aiming to address poverty and social needs through sociodemographic data collection and screening for benefits and community resources.

This study will take place in primary health care clinics with a designated Patient Navigator offering assistance and follow-up to patients. 

The relationship between timing of screening for gestational diabetes mellitus and maternal and fetal outcomes: a retrospective cohort study linking primary care electronic and hospital administrative data

Building on previous work that pioneered the first step in establishing a platform for the systematic extraction of prenatal and postpartum data at the primary care level, the objective of this retrospective cohort study was to link primary care prenatal and laboratory data to intrapartum data contained in a provincial hospital administrative database (Nova Scotia Atlee Perinatal Database) to explore the association between the timing of gestational diabetes (GDM) screening and outcomes including shoulder dystocia, c-section, large-for-gestational age (LGA) and macrosomia. Deterministic linkage between the two databases was undertaken using a unique identifier. The main independent variable was the “timing of screening for GDM” (appropriate or not appropriate). Women with singleton pregnancies who received prenatal care from 12 family physician MaRNet sentinels between July 1, 2019 and December 31, 2022 and delivered at the IWK Health Centre during that time period were included in the study. A pre-pregnancy diagnosis of type 1 or type 2 diabetes constituted exclusion criteria. The study enrolled 198 participants, of which 69.4% had initial screening for GDM undertaken at an appropriate time during pregnancy based on their risk for GDM. Appropriate timing of GDM screening was associated with lower rates of LGA (p = .016).  However, when controlling for gestational weight gain concordance with guidelines, this relationship remained significant only for participants who had experienced excess gestational weight gain (p = .004).

References

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PUPPY Study – Problems Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year: A Longitudinal Mixed Methods Study with Rapid Reporting and Planning for the Road Ahead.  The PUPPY-study leverages current research with an experienced team to address clinical management and health system interventions in primary care (PC). Most healthcare visits in Canada are to family physicians and nurse practitioners. Our study also examines growing pharmacist PC services. If PC access and care is done well, it decreases the number of both COVID and non-COVID patients requiring acute care and directly facilitates capacity across our healthcare system as the anticipated waves of COVID fallout emerge. As the locus of most healthcare interactions, including those to detect, triage, and treat COVID, exploration of rapid policy change in PC and its impacts on patient access and outcomes is critically relevant to clinical management and health system interventions. Our cross-jurisdictional study will analyze the impact of COVID-related transformation on multiple key elements of PC.  Through our established network, we will rapidly identify and share best practices and strategies for managing patients and provider wellbeing throughout the pandemic trajectory.

“The CUP Study: Comparative Analysis of Centralized Waitlist Effectiveness, Policies, and Innovations for Connecting Unattached Patients to Primary Care Providers”.  This study will compare centralized wait lists in Nova Scotia, Quebec, and Ontario to see how effective they are at connecting unattached patients to primary care providers. The findings from this study will be shared with stakeholders from all three provinces.

Family doctors and other primary care providers offer access to care and coordinate services that patients need throughout the system. There are more family doctors per person than ever before in Nova Scotia (and the rest of Canada), but more people than ever struggle to access the care they need, and primary care providers report stress and unmanageable workloads. While multiple factors contribute to these problems, increasing administrative workload related to providing care and operating clinics may play a substantial role.The Research Nova Scotia funded A thousand papercuts: Understanding and addressing changing administrative workload in primary care study addresses the overarching goal of reducing administrative workload while ensuring efficient coordination of care in Nova Scotia.

The overarching goal of the Structured Process Informed by Data, Evidence and Research (SPIDER) project is to establish and evaluate a model to help primary care practices optimize care for patients with persisting complex care needs and who take multiple medications. SPIDER will attempt to reduce the risk of harm related by targeting attention to potentially inappropriate prescriptions (PIPs) in adults aged 65 years of age and older. SPIDER, a uniquely positioned pragmatic cluster randomized trial, will be rolled out in the seven regions that have Practice Based Research Networks (PBRNs) across the country. Locally, it is one of the Building Research for Integrated Primary Healthcare in Nova Scotia multi-year CIHR funded projects. See https://bricns.com/

The Models of Access and Practices in Nova Scotia study aims to build a descriptive atlas of how all primary practices in Nova Scotia are organized and specifically what access is like from the patient’s perspective.  Preliminary findings are already being presented and are of interest to our local decision-makers and providers.

Care-By-Design (CBD), a new model of primary medical care in Long Term Care in the Capital District Health Authority, aims to provide comprehensive, skilled, timely resident-centered care making appropriate use of specialized health care resources in serving residents.  The coordinated nature of the CBD model has created relationships, lines of communication and structures for sharing ongoing concerns and collaborations for finding solutions.  Preliminary are demonstrating the effectiveness of this approach to care.

Case management in primary care for frequent users of healthcare services with chronic diseases and complex care needs: implementation and realist evaluations is a multi-provincial study aiming to provide case management for those living with one or multiple chronic diseases who frequently use the health system.

Case management is led a by a family practice nurse or social worker in a primary care setting, with collaboration from other providers and community resources.

Sixty Nova Scotia practices participated in this study of the “Quality and Costs of Primary Care”.  Key questions were to determine how primary care is organized in Canada and how patient experience compares province-to-province and to other countries.  Results will be forthcoming.

The TRANSFORMATION Study is a multi-provincial research project aiming to improve both the science of performance measurement and the ways those results are reported to practitioners, decision makers, and the public to encourage improvement within the health care system. To view information on our four linked studies, please visit www.transformationphc.ca or contact our Project Manager, Stephanie Blackman, at transform@dal.ca and follow us on Twitter. (@transformphc).