Background In March 2020, Canada implemented restrictions to curb viral transmission of COVID-19,... more Background In March 2020, Canada implemented restrictions to curb viral transmission of COVID-19, which resulted in abrupt disruptions to conventional (in-person) clinical care. To retain continuity of care the delivery of primary care services shifted to virtual care. This study examined the nature of virtual visits, characterizing the use and users of virtual care in primary care settings from March 14/20 to June 30/20 of the COVID-19 pandemic. Methods Retrospective cohort study of primary care providers in Manitoba, Canada that participate in the Manitoba Primary Care Research Network (MaPCReN) and offered ≥ 1 virtual care visit between 03/14/20 and 06/30/20 representing 142,616 patients. Tariff codes from billing records determined the visit type (clinic visit, virtual care). Between 03/14/20, and 06/30/20, we assessed each visit for a follow-up visit between the same patient and provider for the same diagnosis code. Patient (sex, age, comorbidities, visit frequency, prescripti...
To cite: Halas G, Singer A, Katz A, et al. Examining virtual visit use during a pandemic and pers... more To cite: Halas G, Singer A, Katz A, et al. Examining virtual visit use during a pandemic and perspectives of primary care providers, patients and caregivers: a mixed-methods research protocol. BMJ Open 2022;12:e062807.
ObjectivesTo identify, critically appraise and summarise evidence on the impact of employing prim... more ObjectivesTo identify, critically appraise and summarise evidence on the impact of employing primary healthcare professionals (PHCPs: family physicians/general practitioners (GPs), nurse practitioners (NP) and nurses with increased authority) in the emergency department (ED) triage, on patient flow outcomes.MethodsWe searched Medline (Ovid), EMBASE (Ovid), Cochrane Library (Wiley) and CINAHL (EBSCO) (inception to January 2020). Our primary outcome was the time to provider initial assessment (PIA). Secondary outcomes included time to triage, proportion of patients leaving without being seen (LWBS), length of stay (ED LOS), proportion of patients leaving against medical advice (LAMA), number of repeat ED visits and patient satisfaction. Two independent reviewers selected studies, extracted data and assessed study quality using the National Institute for Health and Care Excellence quality assessment tool.ResultsFrom 23 973 records, 40 comparative studies including 10 randomised control...
Context: Prior to the COVID-19 pandemic, there was limited integration of virtual care (VC) in pr... more Context: Prior to the COVID-19 pandemic, there was limited integration of virtual care (VC) in primary care clinical practice. However, the pandemic precipitated a shift with primary care providers utilizing VC to facilitate safe access to primary health services. Objective: To describe and characterize VC visits by primary care providers to patients following the introduction of the VC tariff code in Manitoba, Canada. Design: Retrospective cohort study. Setting: Primary care clinics that offered at least one VC visit and participate in the Manitoba Primary Care Research Network (MaPCReN), a practice-based network that contains de-identified EMR data from 265 primary care clinicians in Manitoba. Population: All encounters with a primary care provider participating in MaPCReN between 01/01/18 and 06/30/20. Outcome Measures: Tariff codes from billing records between 03/14/20 and 06/30/20 determine the visit type (clinic visit, virtual visit). Patient (sex, age, comorbidities, visit frequency, medication rates) and provider (sex, age, clinic location, provider type, remuneration model, country of graduation, return visit rate) characteristics describe the study population based on visit type. Generalized estimate equation models describe factors associated with VC. Results: There were 154 primary care providers that provided on average, VC for 47.6% of their patient visits. Among the 142,616 patients, 19.4% had at least one virtual care appointment, 29.4% had only a clinic visit, and 51.2% did not attend a visit with their primary care provider. Female patients (OR 1.16, CI 1.09-1.22) with ≥3 comorbidities (OR1.71, CI 1.44-2.02), ≥10 medications (OR 2.71, CI 2.2-1.53) have significantly higher odds of VC than male patients, with no comorbidities and no prescriptions. Follow-up visits were required for 21.2% of VC encounters; the majority (55.9%) had the same visit type. For follow-up encounters where the visit type changed, 42.2% of clinic visits were followed by VC, whereas 26.9% of VC was followed by a clinic visit. Conclusion: During the first 3 months of pandemic restrictions, there was an increase in the use of VC in Manitoba's primary care settings. VC was utilized more commonly by patients with the most comorbidities and prescriptions, suggesting that those who require ongoing attention from primary care made use of VC services.
Introduction: Acute care hospitals often inadequately prepare older adults to transition back to ... more Introduction: Acute care hospitals often inadequately prepare older adults to transition back to the community. Interventions that seek to improve this transition process are usually evaluated using healthcare use outcomes (e.g., hospital re-visit rates) only, and do not gather provider and patient perspectives about strategies to better integrate care. This protocol describes how we will use complementary research approaches to evaluate an in-hospital sub-acute care (SAC) intervention, designed to better prepare and transition older adults home. Methods: In three sequential research phases, we will assess (1) SAC transition pathways and effectiveness using administrative data, (2) provider fidelity to SAC core practices using chart audits, and (3) SAC implementation outcomes (e.g., facilitators and barriers to success, strategies to better integrate care) using provider and patient interviews. Results: Findings from each phase will be combined to determine SAC effectiveness and efficiency; to assess intervention components and implementation processes that ‘work’ or require modification; and to identify provider and patient suggestions for improving care integration, both while patients are hospitalized and to some extent after they transition back home. Discussion: This protocol helps to establish a blueprint for comprehensively evaluating interventions conducted in complex care settings using complementary research approaches and data sources.
OBJECTIVE Robust program evaluations can identify effective promotion strategies. This scoping re... more OBJECTIVE Robust program evaluations can identify effective promotion strategies. This scoping review aimed to analyze review articles (including systematic reviews, meta-analysis, meta-synthesis, scoping review, narrative review, rapid review, critical review, and integrative reviews) to systematically map and describe physical activity program evaluations published between January 2014 and July 2020 to summarize key characteristics of the published literature and suggest opportunities to strengthen current evaluations. DATA SOURCE We conducted a systematic search of the following databases: Medline, Scopus, Sportdiscus, Eric, PsycInfo, and CINAHL. INCLUSION/EXCLUSION CRITERIA Abstracts were screened for inclusion based on the following criteria: review article, English language, human subjects, primary prevention focus, physical activity evaluation, and evaluations conducted in North America. EXTRACTION Our initial search yielded 3193 articles; 211 review articles met the inclusio...
Background In March 2020, Canada implemented restrictions to curb viral transmission of COVID-19,... more Background In March 2020, Canada implemented restrictions to curb viral transmission of COVID-19, which resulted in abrupt disruptions to conventional (in-person) clinical care. To retain continuity of care the delivery of primary care services shifted to virtual care. This study examined the nature of virtual visits, characterizing the use and users of virtual care in primary care settings from March 14/20 to June 30/20 of the COVID-19 pandemic. Methods Retrospective cohort study of primary care providers in Manitoba, Canada that participate in the Manitoba Primary Care Research Network (MaPCReN) and offered ≥ 1 virtual care visit between 03/14/20 and 06/30/20 representing 142,616 patients. Tariff codes from billing records determined the visit type (clinic visit, virtual care). Between 03/14/20, and 06/30/20, we assessed each visit for a follow-up visit between the same patient and provider for the same diagnosis code. Patient (sex, age, comorbidities, visit frequency, prescripti...
To cite: Halas G, Singer A, Katz A, et al. Examining virtual visit use during a pandemic and pers... more To cite: Halas G, Singer A, Katz A, et al. Examining virtual visit use during a pandemic and perspectives of primary care providers, patients and caregivers: a mixed-methods research protocol. BMJ Open 2022;12:e062807.
ObjectivesTo identify, critically appraise and summarise evidence on the impact of employing prim... more ObjectivesTo identify, critically appraise and summarise evidence on the impact of employing primary healthcare professionals (PHCPs: family physicians/general practitioners (GPs), nurse practitioners (NP) and nurses with increased authority) in the emergency department (ED) triage, on patient flow outcomes.MethodsWe searched Medline (Ovid), EMBASE (Ovid), Cochrane Library (Wiley) and CINAHL (EBSCO) (inception to January 2020). Our primary outcome was the time to provider initial assessment (PIA). Secondary outcomes included time to triage, proportion of patients leaving without being seen (LWBS), length of stay (ED LOS), proportion of patients leaving against medical advice (LAMA), number of repeat ED visits and patient satisfaction. Two independent reviewers selected studies, extracted data and assessed study quality using the National Institute for Health and Care Excellence quality assessment tool.ResultsFrom 23 973 records, 40 comparative studies including 10 randomised control...
Context: Prior to the COVID-19 pandemic, there was limited integration of virtual care (VC) in pr... more Context: Prior to the COVID-19 pandemic, there was limited integration of virtual care (VC) in primary care clinical practice. However, the pandemic precipitated a shift with primary care providers utilizing VC to facilitate safe access to primary health services. Objective: To describe and characterize VC visits by primary care providers to patients following the introduction of the VC tariff code in Manitoba, Canada. Design: Retrospective cohort study. Setting: Primary care clinics that offered at least one VC visit and participate in the Manitoba Primary Care Research Network (MaPCReN), a practice-based network that contains de-identified EMR data from 265 primary care clinicians in Manitoba. Population: All encounters with a primary care provider participating in MaPCReN between 01/01/18 and 06/30/20. Outcome Measures: Tariff codes from billing records between 03/14/20 and 06/30/20 determine the visit type (clinic visit, virtual visit). Patient (sex, age, comorbidities, visit frequency, medication rates) and provider (sex, age, clinic location, provider type, remuneration model, country of graduation, return visit rate) characteristics describe the study population based on visit type. Generalized estimate equation models describe factors associated with VC. Results: There were 154 primary care providers that provided on average, VC for 47.6% of their patient visits. Among the 142,616 patients, 19.4% had at least one virtual care appointment, 29.4% had only a clinic visit, and 51.2% did not attend a visit with their primary care provider. Female patients (OR 1.16, CI 1.09-1.22) with ≥3 comorbidities (OR1.71, CI 1.44-2.02), ≥10 medications (OR 2.71, CI 2.2-1.53) have significantly higher odds of VC than male patients, with no comorbidities and no prescriptions. Follow-up visits were required for 21.2% of VC encounters; the majority (55.9%) had the same visit type. For follow-up encounters where the visit type changed, 42.2% of clinic visits were followed by VC, whereas 26.9% of VC was followed by a clinic visit. Conclusion: During the first 3 months of pandemic restrictions, there was an increase in the use of VC in Manitoba's primary care settings. VC was utilized more commonly by patients with the most comorbidities and prescriptions, suggesting that those who require ongoing attention from primary care made use of VC services.
Introduction: Acute care hospitals often inadequately prepare older adults to transition back to ... more Introduction: Acute care hospitals often inadequately prepare older adults to transition back to the community. Interventions that seek to improve this transition process are usually evaluated using healthcare use outcomes (e.g., hospital re-visit rates) only, and do not gather provider and patient perspectives about strategies to better integrate care. This protocol describes how we will use complementary research approaches to evaluate an in-hospital sub-acute care (SAC) intervention, designed to better prepare and transition older adults home. Methods: In three sequential research phases, we will assess (1) SAC transition pathways and effectiveness using administrative data, (2) provider fidelity to SAC core practices using chart audits, and (3) SAC implementation outcomes (e.g., facilitators and barriers to success, strategies to better integrate care) using provider and patient interviews. Results: Findings from each phase will be combined to determine SAC effectiveness and efficiency; to assess intervention components and implementation processes that ‘work’ or require modification; and to identify provider and patient suggestions for improving care integration, both while patients are hospitalized and to some extent after they transition back home. Discussion: This protocol helps to establish a blueprint for comprehensively evaluating interventions conducted in complex care settings using complementary research approaches and data sources.
OBJECTIVE Robust program evaluations can identify effective promotion strategies. This scoping re... more OBJECTIVE Robust program evaluations can identify effective promotion strategies. This scoping review aimed to analyze review articles (including systematic reviews, meta-analysis, meta-synthesis, scoping review, narrative review, rapid review, critical review, and integrative reviews) to systematically map and describe physical activity program evaluations published between January 2014 and July 2020 to summarize key characteristics of the published literature and suggest opportunities to strengthen current evaluations. DATA SOURCE We conducted a systematic search of the following databases: Medline, Scopus, Sportdiscus, Eric, PsycInfo, and CINAHL. INCLUSION/EXCLUSION CRITERIA Abstracts were screened for inclusion based on the following criteria: review article, English language, human subjects, primary prevention focus, physical activity evaluation, and evaluations conducted in North America. EXTRACTION Our initial search yielded 3193 articles; 211 review articles met the inclusio...
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Papers by Gayle Halas