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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17. Feig DS, Berger H, Donovan L, Godbout A, Kader T, Keely E, et al. Erratum to “Diabetes and Pregnancy”: Canadian Journal of Diabetes 2018;42(S1):S255-S282. Can J Diabetes. 2018 Jun;42(3):337.
18. Berger H, Gagnon R, Sermer M. Guideline No. 393-Diabetes in Pregnancy. Journal of obstetrics and gynaecology Canada : JOGC = Journal d’obstetrique et gynecologie du Canada : JOGC. 2019 Dec;41(12):1814-1825 e1.
19. Sacks DA, Feig DS. Caring for pregnant women whose diabetes antedates pregnancy: is there room for improvement? Diabetologia. 2018 May;61(5):1022–6.
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27. ​Jenny Yang. Proportion of primary care physicians who use electronic medical records in their practice in Canada in 2019, by jurisdiction [Internet]. 2023 Nov [cited 2024 Mar 25]. Available from: https://www.statista.com/statistics/1097585/proportion-of-primary-physicians-using-emr-by-jurisdiction-canada/
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“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.

Problems Coordinating and Accessing Primary Care for Attached and Unattached Patients in a Pandemic Year (PUPPY). A Longitudinal Mixed Methods Study with Rapid Reporting and Planning for the Road Ahead.

COVID-19 has caused significant changes in primary care. In Canada, many walk-in clinics and family practices closed. Pharmacies remained open but had restrictions on patient interactions. Other major changes in care (e.g., virtual care, reduced referrals) have been made to respect public health and emergency orders.

During these times with significant restrictions, patients can be unclear or unaware of how to get the right care, at the right time, from the right provider. Patients also fear getting COVID-19 and avoid care settings. Some will also avoid seeking care for COVID-like symptoms due to fear and a lack of access to a primary care provider.

For more information please visit: PUPPY Study

Principal Investigator: Dr Ruth Lavergne

There are more primary care providers per person than ever before in Canada. At the same time, Canadians struggle to access needed care and primary care providers report record levels of stress and overwork. There is an urgent need to understand factors contributing to the gap between growing per-capita supply of primary care providers and declining patient primary care visits. Administrative activities, including work related to caring for individual patients and clinic administration, may play a substantial role in understanding changing primary care workload, however this has not been carefully studied.

For more information please visit:  Papercuts | Health Systems Research In Canada

There are more family doctors and nurse practitioners per person than ever before in Canada, but primary care access is falling, inequities are widening, and clinicians report stress and overwork. Several factors may explain the gap between primary care need and system capacity. Population aging, increasing clinical complexity, and increasing service intensity may shape primary care needs. Falling practice volumes, increasing administrative workload, changing clinician demographics, and new health system roles (e.g. hospitalist and focused practices) may shape system capacity. Existing workforce planning tools consider population demographics, but not these other potentially important factors.

This CIHR funded mixed-method, multi-province (British Columbia, Manitoba, New Brunswick, and Nova Scotia) project explores how primary care workload, factors shaping population service use, and factors shaping system capacity are changing over time, and use this information to develop planning tools to estimate future need and capacity.

For more information please visit:  4C | My Site

Principal Investigator: Dr Ruth Lavergne 

People with serious mental illness (SMI) have poor health outcomes, in part because of inequitable access to quality health services. As a consequence, they have more preventable hospitalizations and higher mortality rates. 

Primary care is well suited to coordinate and manage care for this population; however, providers may feel ill-equipped to do so and patients may not have the support and resources required to coordinate their care. We lack a strong understanding of prevention and management of chronic disease in primary care among people with SMI as well as the context-specific barriers that exist at the patient, provider, and system levels.

This CIHR funded concurrent mixed methods study is being conducted in British Columbia and Ontario, and involves quantitative analyses of linked administrative data and in-depth qualitative interviews with people living with SMI and primary care providers. 

For more information please visit: PriSMI | Health Systems Research in Canada

Nominated Principal Investigator: Ruth Lavergne

Health systems are under pressure as one in five Canadians has no regular place for primary care and people face substantial travel time and delays accessing care. Virtual platforms have responded to urgent needs offering virtual services that mirror “walk-in” style clinics, in that they offer immediate access, but more limited longitudinal continuity or coordination. We refer to these services as episodic virtual care (EVC), to distinguish them from virtual services offered in longitudinal primary care. Nova Scotia (NS) and New Brunswick (NB) offer a unique opportunity to study the deployment of publicly-funded EVC. In NS, patients on the Need a Family Practice Registry can access care via Virtual Care Nova Scotia (VCNS). In NB, all residents eligible for provincial health insurance can access eVisitNB, including people who have a regular place of care. Differences in how these services have been deployed, staffed (nurse practitioners and family physicians), and connected to other parts of the health system make these highly informative policy examples.

The overarching goal of this work is to learn from the implementation of EVC in Nova Scotia and New Brunswick and understand experiences and system impacts, including:

1. What are patient perceptions and experiences of EVC and how do these differ by patient characteristics?
2. What are the characteristics of patients who use EVC?
3. What are the system impacts of EVC?

For more information please visit: EVC

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).