Conference Program

Wednesday, June 5, 2019 Delta Toronto

Presented by INSPIRE-PHC in partnership with:

Conference Floorplan Convention Level 1 (Second Floor)

Room Listing

Kensington Ballroom Welcome, Distinguished Lecture & Panel Discussion, Poster Presentations Martin Bass Lecture, Evaluation

Kensington Ballroom Pre-Function Area

Lunch (Buffet), Nutrition Break, Poster Presentations

Beaches, Cabbagetown, Distillery, Rosedale

Concurrent Oral Presentation Sessions 1&2, Workshops 1&2

I

Welcome

On behalf of our organizing and planning committees, I would like to extend a sincere welcome to all attendees of this years’ conference. Students and emerging researchers, please take the opportunity to network and engage with our stakeholder groups as well as the many experienced researchers in primary health care in attendance. You will find we have focused our energies on providing research engagement and networking opportunities within this years’ conference. Thank you to the Ontario SPOR Support Unit and the Ontario Departments of Family Medicine for making this event possible.

Dr. Michael Green Lead, INSPIRE-PHC

Learning Objectives

To provide a forum for presentation of innovative activities or original research in primary care, either in progress or completed.

To bring together a variety of health care providers, including academic and practicing clinicians, residents, graduate students, researchers, patient/community members and administrators working in primary health care.

To provide an opportunity for the enhancement of research skills through workshops, oral and poster presentations and through the informal exchange of information among peers.

Accreditation Trillium Primary Health Care Research Day 2019 is fully accredited with the College of Family Physicians of Canada. Participants who attend this conference are eligible to receive up to 6 Mainpro+ credits. Please see PAGE 11 for more information.

Program Disclosure

Disclosure of Commercial Support This program has received financial report from LIST SPONSORS in the form of educational grants This program has not received in-kind support from any organizations

How This Program Mitigates Potential Bias All programs begin with a needs assessment Planning Committee is made up of members of the health care community No industry personnel are on the Planning Committee Presenters are required to disclose any/all relationships with industry We ask for your feedback; please tell us if you feel biased information is being presented, or better yet, join a

planning committee

II

Acknowledgements

Trillium Primary Health Care Research Day 2019 is facilitated by the INSPIRE-PHC research partnership, supported by a grant from the Ontario Ministry of Health and Long-Term Care’s Health System Research Fund.

About INSPIRE-PHC INSPIRE-PHC is an overarching program focused on primary health care including a research component, a support component, and a network component to serve the primary health care research community. The INSPIRE-PHC research/policy partnership aims to address major health system challenges of equitable access to high quality primary health care (PHC) and better co-ordination and integration of PHC with other parts of the health and social care system (community care, public health and specialty care).

New studies will provide better quality information on patient needs and PHC capacity to deliver care in defined geographic areas, and will provide early feedback on the successes and challenges in introducing PHC reforms. This research will help improve access to care, the care experience for patients, and better health outcomes for all Ontarians.

For more information, please visit: https://inspire-phc.org/

Program Sponsors

Organizers of Trillium Primary Health Care Research Day 2019 would like to acknowledge generous support from the following sponsors:

III

Contents

Welcome ............................................................................................................................................................................................................. i

Learning Objectives ...................................................................................................................................................................................... i

Accreditation .................................................................................................................................................................................................. i

Program Disclosure ....................................................................................................................................................................................... i

Disclosure of Commercial Support ........................................................................................................................................................ i

How This Program Mitigates Potential Bias ........................................................................................................................................ i

Acknowledgements ........................................................................................................................................................................................... ii

About INSPIRE-PHC ...................................................................................................................................................................................... ii

Program Sponsors ........................................................................................................................................................................................ ii

Program Agenda .............................................................................................................................................................................................. 1

Distinguished Lecture: CIHR Investments to Date – What we know, what we have learned ............................................................. 2

Panel Discussion ............................................................................................................................................................................................ 2

Poster Presentations ......................................................................................................................................................................................... 4

Concurrent Oral Presentations: Session 1 .................................................................................................................................................... 6

Martin Bass Lecture: Indigenous Data and Research ................................................................................................................................. 7

Concurrent Oral Presentations: Session 2 .................................................................................................................................................... 8

Concurrent Workshops ..................................................................................................................................................................................... 9

Pragmatic Trials ............................................................................................................................................................................................ 9

Sex and Gender Analysis ....................................................................................................................................................................... 10

Evaluation ........................................................................................................................................................................................................ 11

Mainpro+ credits ...................................................................................................................................................................................... 11

Abstracts: Oral Presentations ...................................................................................................................................................................... 12

Abstracts: Poster Presentations ................................................................................................................................................................... 24

1

Program Agenda

8:00 AM

Registration and Breakfast Kensington Ballroom Pre-Function Area

9:00 AM

Opening Remarks Land Acknowledgement Kensington Ballroom Dr. Michael Green Dr. Jennifer Walker Chair, Conference Planning Committee

9:10 AM

Distinguished Lecture Kensington Ballroom Featuring Dr. Rick Glazier CIHR Investments to Date: What we know, what we have learned In his new role as Scientific Director of the CIHR Institute of Health Services and Policy Research, Rick will be setting the stage for where the Institute is coming from, where they are going. He will be looking for input on where they should be directing energies and resources going forward. To assist, 3 panelists will respond to his talk, and address the question; How does CIHR/IHSPR best support primary care? Investments /tactics/ strategies. The session will conclude with a lengthy audience participation session engaging all in how to best move forward.

10:00 AM

Panel Discussion Kensington Ballroom

10:35 AM

Poster Presentations and Nutrition Break Kensington Pre-Function Area & Ballroom

11:40 AM

Concurrent Oral Presentations Beaches, Cabbagetown, Distillery, Rosedale

12:25 PM

Lunch Kensington Ballroom Pre-Function Area

12:50 PM

Martin Bass Lecture Kensington Ballroom Featuring Dr. Jennifer Walker Indigenous Data and Research Jennifer holds a Canada Research Chair in Indigenous Health at Laurentian University and is a Core Scientist and Indigenous Lead at ICES. She is a health services research and a member of the Six Nations of the Grand River. She holds appointments at the Maamwizing Indigenous Research Institute, the Centre for Rural and Northern Health Research, and the Dalla Lana School of Public Health. Her talk will focus on the use of Indigenous health and health services data.

2:00 PM

Concurrent Oral Presentations Beaches, Cabbagetown, Distillery, Rosedale

2:45 PM Choose which workshop you would like to attend

Workshop 1: Pragmatic Trials Distillery Lead: Dr. Merrick Zwarenstein Merrick is a Professor at Western University and the Director of the Centre for Studies in Family Medicine at the Department of Family Medicine. He is a health services researcher who works on development and mixed methods evaluation of complex health care and knowledge translation interventions in real world health care settings in Canada and internationally. He is interested in use of mixed methods evaluation approaches including pragmatic randomized trials, and their integration into policy and program decision-making. Workshop 2: Sex and Gender Analysis Cabbagetown Lead: Dr. Susan Phillips Susan Phillips is a Professor in Family Medicine and Public Health Sciences, and a senior researcher with internationally recognized expertise in gender as a social determinant of health. Dr. Phillips has been an advisor on gender to the EU, Gendered Innovations, the French and Swedish Research Councils, the WHO, the World Bank, and the gender equity consultant for a multi-year Canadian government funded development project in Bosnia and Serbia.

4:10 PM

Adjournment and Evaluation Kensington Ballroom

2

Distinguished Lecture

CIHR Investments to Date: What we know, what we have learned

Dr. Rick Glazier is a family physician and senior scientist and program lead of Primary Care and Population Health at ICES. He is a staff physician at St. Michael’s Hospital and a scientist in its Centre for Urban Health Solutions. At the University of Toronto, Dr. Glazier is a professor in the Department of Family and Community Medicine, and cross-appointed at the Institute of Health Policy, Management and Evaluation and at the Dalla Lana School of Public Health. His research interests include evaluating health system transformation, primary care health services delivery models, health of disadvantaged populations, management of chronic conditions, and population-based and geographic methods for improving equity in health.

In his new role as Scientific Director of the Canadian Institutes of Health Research – Institute of Health Services and Policy Research (CIHR-IHSPR), Rick will be setting the stage for where the Institute is coming from, where they are going. He will be looking for input on where they should be directing energies and resources going forward.

Learning Objectives

1. Participants will gain a better understanding of the role the Canadian Institutes of Health Research (CIHR) plays in health policy development and funding of research in primary care.

2. Participants will gain a better understanding of the connection between their area of primary care research and/or clinical practice and CIHR involvement and funding initiatives

Panel Discussion Selected panelists will respond to Dr. Glazier’s talk, aiming to address the question:

How does CIHR-IHSPR best support primary care?

3

Moderator

Dr. Michael Green is the Brian Hennen Chair and Head of the Department of Family Medicine, Faculty of Health Sciences at Queen's University. He is also the Director of the Queen’s Health Services and Policy Research Institute, an Associate Professor in the Department of Public Health Sciences, and a Senior Adjunct Scientist at ICES. He has worked as a consultant for both the Ontario Ministry of Health and Long-Term Care and Health Canada and has served on many professional and government expert committees including the Ontario Expert Panel on Wait Times in Primary Care, the Advisory Committee on Ontario’s Immunization System Review, the College of Family Physicians of Canada Aboriginal Health Working Group and Patient’s Medical Home Steering Committee, and Health Quality Ontario’s Primary Care Advisory Committee. He regularly serves on grant review panels, including CIHR’s Aboriginal Health Committee and new Foundation Scheme. He reviews for a wide range of journals and is on the editorial board of the Canadian Journal of Rural Medicine.

Panelists

Dr. Onil Bhattacharyya is a family physician and the Frigon-Blau Chair in Family Medicine Research at Women’s College Hospital. He is also the Harkness Fellow in Health Care Policy and Practice, Commonwealth Fund, and an associate professor in the Department of Family and Community Medicine and an assistant professor at the Institute of Health Policy, Management and Evaluation, University of Toronto. Dr. Bhattacharyya studies innovative health service delivery models in both high and low income settings. He is committed to using health services research to make a more effective, responsive, and integrated health care system.

Anne Hayes currently serves as Director of the Research, Analysis and Evaluation Branch, Strategic Policy and Planning Division, Ministry of Health and Long-Term Care. Since joining the Division, Anne has taken on key leadership roles on significant collaborative projects including: the Value Demonstrating Initiative on COPD – a unique collaboration with the pharmaceutical industry and Ontario Lung Association; the Low-Income Health Benefit initiative – a complex, multifaceted project to design a new health benefits program.

Alies Maybee has been a patient advisor in various areas of healthcare since 2011, notably in health research. She leads the Patients Canada SPOR Demonstration project examining the experience of patient/caregiver as partners in research and is a Patient and Community Engagement Research program graduate. Alies has been trained by CIHR to deliver patient oriented research training. She also conducts workshops for partnering with citizens in research. Apart from research, she is a Patient and Family Advisor and co-chair of the Community Engagement Council at St. Joseph's Health Centre; a member of the Toronto Central LHIN Council and participates on several working groups at Health Quality Ontario, notably on patient experience measurement.

Dr. Moira Stewart is a Distinguished University Professor Emeritus at the Centre for Studies in Family Medicine at Western University and formerly the Dr. Brian W. Gilbert Canada Research Chair in Primary Health Care Research. She has published widely on the topic of Patient-Centered Care and has edited, with colleagues, an international series of books applying the patient-centered clinical method. She is a National leader in capacity building for research as the Principal Investigator on a CIHR Strategic Training Grant on interdisciplinary primary health care research called TUTOR-PHC.

The Session will conclude with a lengthy audience participation session, engaging all in how best to move forward.

4

Poster Presentations A listing of posters is provided below; abstracts are included beginning on PAGE 24

Poster Presentations Kensington Ballroom / Pre-Function Area

Poster 1 Poster 2 Impact Of The Diabetes Canada Guideline Dissemination Strategy on Dispensed Vascular Protective Medications for 

Older PatientsiIn Ontario, Canada: A Linked EMR  and Administrative Study  

Alanna Rigobon 

Deprescribing Proton Pump Inhibitors at Women’s College Hospital Family Practice Health Centre: A Quality  

Improvement Project Taylor Raiche

Poster 3 Poster 4 Chest Pain Symptoms for Males and Females: A Longitudinal 

Study Using Electronic Medical Records in The Delphi Database Heather Maddocks

Sleep Disturbance in Family Practice: A Study Using Electronic Medical Records (EMRs) in The Delphi Database 

Thomas Freeman Poster 5 Poster 6

SPIDER, A QI‐PBRN Collaboration Facilitating Medication Appropriateness in Primary Care for Complex Older Patients – 

Preliminary Findings of the Feasibility Study Susy Lam & Michelle Greiver

Building Partnerships Between Community Health Centres and Community Partners for the Treatment of Mental Health and 

Addictions Dariya Gusovsky

Poster 7 Poster 8 Artificial Intelligence and Primary Care: What Research Has 

Been Done and How Do We Move Forward Jaky Kueper

Patient‐Centered Consultations: An Analysis of E‐Consults in Primary Care Mary Martin

Poster 9 Poster 10

The Impact of a Single‐Entry Intake SystemoOn Access to Outpatient Specialist Visits: A Systematic Review  

Ann Marie Corrado

The Patient Engagement Resource Centre: A Strategy forSupporting Patient Engagement in Primary Healthcare 

Research Divya Bhati

Poster 11 Poster 12 The Adoption of a Population Health Approach to Sexual Health 

Programs In Public Health in Ontario: A Multi‐Phase Mixed Methods Study 

Linda Brousseau

The Relationship Between Primary Care Practice Organizational Characteristics and Chronic Disease Prevention and 

Management Christy Costanian

Poster 13 Poster 14 Technology‐Enabled Collaborative Care for Youth: 

A Feasibility Study  Iqra Ashfaq & Danielle Dawson

The Recognition and Utilization of Team Members' Scope of Practice in Family Health Teams    

Carol Mulder Poster 15 Poster 16

Impact of an EMR Dashboard On EMR Data Quality and Practice Patterns    

Carol Mulder

Identifying Help‐Seeking Patterns in Primary Care by Young People with First‐Episode Psychosis 

Nicole Schoer Poster 17 Poster 18

A Mixed Methods Evaluation of the Implementation of aChronic Obstructive Pulmonary Disease Management Program 

Stefan Paciocco

A Cross Case Analysis of the Implementations of Interprofessional Care for COPD 

Stefan Paciocco Poster 19 Poster 20

Continuting Collaboration: Planning, Implementing, and Evaluating a Deliberative Dialogue with Public Health, Primary 

Care, and Community Residents of Social Housing Rebecca Ganann & Tiffany Scurr

Describing Quality Improvement Initiatives in Ontario: Results From a Cross Sectional Study on Primary Healthcare Practices 

Simone Dahrouge

5

Poster Presentations Kensington Ballroom / Pre-Function Area

Poster 21 Poster 22 The Partners in Research Course: Impacting Patient‐Oriented 

Research Through an Educational Intervention Lorraine Bayliss & Melissa Courvoisier

Impact of Primary Care Based Patient’s Medical Home (PMH) Models of Care on Cost Related Outcomes:  A Rapid Review 

Joan Tranmer Poster 23 Poster 24

Validating The All Aspects Of Health Literacy Scale in Syrian Refugees Raafia Siddiqui

Management of Physical Health for People with Psychotic Disorders in Primary Care: A Systematic Review 

Joshua Wiener Poster 25 Poster 26

Cardiovascular Risk Factors in Social Housing Residents: AMulti‐Site Descriptive Survey in Older Adults in Ontario, Canada

Leila Harrison & Drashti Pete

Fall Risk in Older Adults Residing in Social Housing in Ontario Manika Bhandari & Drashti Pete

Poster 27 Poster 28 Evaluating a Primary Care Group‐Based Mindfulness Program: Is a Pragmatic, Accessible, Mental Wellness Program Effective? 

Yaswanta Gummadi

Primary Stroke Prevention: Comparison of Information Sharing Preferences of Patients with Family Physicians’ Practices 

Tazeen Quereshi Poster 29 Poster 30

Collaborative Knowledge Sharing: Developing and Disseminating a Visual Representation of Standards of Care for 

Pregnant and Parenting Adolescents in the GTA Barbara Chyzzy

Implementation & Uptake of an Online Patient‐Oriented Primary Health Care Research Training Program: PORTL‐PHC 

Lorraine Bayliss & Amanda Terry

Poster 31 Poster 32

Community Development in Action: An Evaluation of a Program to Enhance Seniors Health in Sarnia‐Lambton 

Amanda Terry

Exploring the Use of Electronic Medical Record‐Integrated Machine Learning Predictive Analytics in Primary Care:  

A Study Protocol Tara Upshaw

Poster 33 Poster 34 Developing a Survey to Describe Physiotherapy Practice in 

Primary Health Care in Ontario Kyle Vader

Home‐Based Primary Care in a Rural Academic Family Medicine Clinic: A Program Evaluation 

Sarah Davies & Joy Sun Poster 35 Poster 36

Diabetes Risk in Older Adults Living in Social Housing: A Cross‐Sectional Study 

Manika Bhandari & Ying Zhu

Patient and Physician Factors Associated with First Diagnosis of Psychotic Disorder in Primary Care 

Rebecca Rodrigues Poster 37 Poster 38

Understanding the Role of the Family Physician in Early Psychosis Intervention: A Mixed Methods Protocol 

Rebecca Rodrigues

Family Physician Access Among Young People with First‐Episode Psychosis 

Rebecca Rodrigues Poster 39 Poster 40

Patterns of Physician Services Among Children and Youth Seen in Community Mental Health Agencies within Ontario 

Graham Reid

Prioritizing Coordination of Primary Healthcare: A Case Report 

Kimia Sedig & Vaidehi Misra

6

Concurrent Oral Presentations Session 1 A listing of oral presentations is provided below; abstracts are included beginning on PAGE 12

Theme # Presentation Title Presenter Affiliation/ Institution

Mental Health & Multimorbidity

Moderator: Amanda Mofina Evaluator: Jordan Miller

Room: Beaches

1 1-A-1 The Forgotten Pap?: Examining Comprehensiveness of Care in the Setting of Depression Through Associations with Primary Care Utilization and Cervical Cancer Screening

Maggie Siu Queen's University

2 1-A-2 Feasibility and Implementation of a Healthy Lifestyles Program

Elizabeth Alvarez McMaster University

3 1-A-3 Examining Multimorbidity and Polypharmacy in Primary Health Care Patients in Canada Using a National Electronic Medical Record Database

Kathryn Nicholson Western University

Collaborative Approaches in Primary Care

Moderator: Catherine Donnelly

Evaluator: Jennifer Rayner Room: Rosedale

4 1-B-1 Primary Care, Public Health and Resident Collaborations to Foster a Safe, Healthy, Socially-Connected Social Housing Environment

Rebecca Ganann & Tiffany Scurr

McMaster University

5 1-B-2 Meaningful Engagement with Family Physicians in the Primary Health Care System: Challenges And Strategies

Cathy Thorpe Western University

6 1-B-3 “It Takes A Special Lens”: Interprofessoinal Primary Health Care for Adults with Intellectual & Developmental Disabilities in Ontario

Nicole Bobbette Queen's University

E-Visits, E-Referral & Virtual Care

Moderator: Kyle Vader

Evaluator: Nancy Murray Room: Cabbagetown

7 1-C-1 E-Visits Adoption Among Ontario Based Primary Care Providers

Payal Agarwal Women's College Hospital

8 1-C-2 Virtual Primary Care in Ontario: Asynchronous Messaging Dominating as Communication Modality

Vess Stamenova Women’s College Hospital

9 1-C-3 Electronic Referral Systems Worldwide: Informing Provincial Plain for E-Referral in Ontario

Stephanie Karch University of Waterloo

Interprofessional Teams (A)

Moderator: Christy Costanian Evaluator: Joan Tranmer

Room: Distillery

10 1-D-1 It Starts with a Strong Foundation: Constructing Interdisciplinary Teams in Primary Care

Judith Brown Western University

11 1-D-2 The Formal and Informal Team Building Activities in Family Health Teams

Rebecca Clark Western University

12 1-D-3 How Leaders in Family Health Teams Contribute to Team Functioning

Laura Belsito Western University

7

Martin Bass Lecture Dr. Martin J. Bass was Chair of the Graduate Studies Program in the Department of Family Medicine at Western University from 1977 to 1980, and the first Director of the Centre for Studies in Family Medicine from 1986 to 1996. His career as a family physician researcher had a major impact on the development of family practice research around the world. This lecture honours Dr. Bass and his strong commitment to family medicine research.

Indigenous Data and Research

Dr. Jennifer Walker holds a Canada Research Chair in Indigenous Health at Laurentian University and is a Core Scientist and Indigenous Lead at ICES. She is a health services researcher, epidemiologist, and a member of the Six Nations of the Grand River. She holds appointments at the Maamwizing Indigenous Research Institute, the Centre for Rural and Northern Health Research, and the Dalla Lana School of Public Health. Dr. Walker’s research programs aim to work with First Nations and Metis populations so that they are able to take ownership and control of their health data, thereby leveraging it to the benefit and wellbeing of their people and communities. She also responds to requests from communities seeking assistance with the use of this data. It is hoped that this data can be used as “medicine to heal” communities which will in turn help inform decision-making surrounding health issues.

Learning Objectives

1. Participants will have the ability to describe various ways of respectfully acquiring information about First Nations, Inuit, and Métis populations which involves communities as partners.

2. Participants will have the ability to describe appropriate strategies to work with First Nations, Inuit, and Métis populations to identify health issues and needs.

First Nations Data Métis Data Inuit Data

Image source: https://www.ices.on.ca/About-ICES/Collaborations-and-Partnerships/Indigenous-Portfolio

8

Concurrent Oral Presentations Session 2: 2:00 – 2:45 PM A listing of oral presentations is provided below; abstracts are included beginning on PAGE 12.

Theme # Presentation Title Presenter Affiliation/ Institution

Medications and Screening in Primary Care

Moderator: JP Singh

Evaluator: Merrick Zwarenstein Room: Beaches

13 2-A-1 Feasibility of Rapid Hepatitis C Point-Of-Care RNA Testing and Treatment at a Primary Care Integrated Supervised Consumption Site in Toronto, Canada

Bernadette Lettner Toronto Community Hep C Program

14 2-A-2 High Levels of Inadequately Justified TSH Testing in Canadian Primary Care

Noah Cramptom University of Toronto

15 2-A-3 Searching for the Roots of the Opioid Crisis: Pharmaceutical Industry Influence in Clinical Practice Guidelines

Sheryl Spithoff Women's College Hospital

The Family Physician in Primary Care

Moderator: Imaan Bayoumi

Evaluator: Dr. Michael Green Room: Rosedale

16 2-B-1 A Four-Step Process for Engaging Family Physicians in the Primary Health Care System

Judith Brown Western University

17 2-B-2 Pursuing Enhanced Skills PGY3 Training in Family Medicine

Melad Marbeen Western University

18 2-B-3 The Strategic Plan of the College of Family Physicians of Canada’s Section of Researchers - Blueprint 2 (2018-2023)

Michelle Greiver University of Toronto

Patients in Primary Care

Moderator: Divya Bhati Evaluator: Simone Dahrouge

Room: Cabbagetown

19 2-C-1 Screening for Poverty and Related Social Determinants and Intervening to Improve Knowledge of and Links to Resources (SPARK) Study

Marjeiry Robinson & Anne Ruccetto

Li Ka Shing Knowledge Institute, St. Michael’s Hospital

20 2-C-2 User-Centred Design to Refine a Postpartum Mental Health Primary Care Tool

Natasha Kithulegoda

Women’s College Hospital Institute for Health Systems Solutions & Virtual Care

21 2-C-3 Patient Perspectives From a Virtual Primary Care Pilot Project

Michelle Phung Women’s College Hospital Institute for Health System Solutions & Virtual Care

Interprofessional Teams (B)

Moderator: Nicole Bobbette Evaluator: Rachelle Ashcroft

Room: Distillery

22 2-D-1 Advancing Access to Team-Based Care Rayner, Jennifer Alliance for Healthier Communities

23 2-D-2 The Influence of Clinic Funding on the Integration of Family Practice Nurses: A Qualitative Study from Newfoundland and Labrador

Mathews, Maria Western University

24 2-D-3 The Impact Of Interprofessional Primary Care Providers On Health Utilization In Individuals With Diabetes

Donnelly, Catherine

Queen's University

9

Concurrent Workshops Conference participants will have the option of attending one of the following workshops:

Pragmatic Trials Lead: Dr. Merrick Zwarenstein

Dr. Merrick Zwarenstein is a Professor at Western University and the former Director of the Centre for Studies in Family Medicine at the Department of Family Medicine. He is a health services researcher who works on development and mixed methods evaluation of complex health care and knowledge translation interventions in real world health care settings in Canada and internationally. He is interested in use of mixed methods evaluation approaches including pragmatic randomized trials, and their integration into policy and program decision-making.

Part 1: Discussion on Pragmatic and Explanatory randomized trials

In 1967 Daniel Schwartz and Jacob Lellouch published a revolutionary conceptual paper which for the first time, clearly distinguished two types of randomized trials, differing in purpose and design. The first kind they described as Pragmatic trials, and suggested that the intention behind such trials is to help readers decide which of two or more intervention options was most effective, i.e. to assist in making a choice. The second kind of randomized trials as described as explanatory, like a laboratory experiment, and intended to confirm or reject a hypothesis regarding a mechanism of action for an intervention, by comparing its effect with an otherwise identical group of participants who did not receive that intervention.

We will review this concept and the design consequences of each of the attitudes, pragmatic and explanatory.

Part 2: Exercise

We will then work in small groups to review a single randomized trial to assess whether the design and intentions of the authors are more explanatory or more pragmatic, and in what ways. We will share in plenary these small group conclusions and consider the implications for readers like ourselves of the authors' design choices and what their likely intention was in doing the trial. The question we will address with this appraisal is: Is this trial relevant to my primary care situation, setting and patients? The trial we will appraise is a well-known and well conducted recent primary care trial.

Learning Objectives

1. Participants will acquire the knowledge needed to design and conduct pragmatic trials.

2. Participants attending the workshops will practice designing pragmatic trials.

3. Participants will recognize different design options for pragmatic relative effectiveness (RE) trials that aim to better meet HTA needs.

4. Participants will have the ability to identify operational challenges in setting-up and conducting pragmatic RE trials.

5. Participants will have the ability to assess the impact of these design options & their operational challenges on study validity, precision and generalizability and to identify areas of further research needs.

10

Sex and Gender Analysis Lead: Dr. Susan Phillips

Dr. Susan Phillips is a Professor in Family Medicine and Public Health Sciences at Queen’s University, and a senior researcher with internationally recognized expertise in gender as a social determinant of health. She has been an advisor on gender to the European Union, Gendered Innovations, the French and Swedish Research Councils, the World Health Organization, the World Bank, and the gender equity consultant for a multi-year Canadian government funded development project in Bosnia and Serbia.

We all have a gender, a race, a social context, and these shape health as much as do genes and biology. There is a gender paradox, however. Greater wealth brings greater health. Women have lower socioeconomic status than do men throughout the world. Never the less, universally, they outlive men and are less vulnerable to the health effects of lower income.

We will explore examples of sex/gender and health and specific measures of, for example, socioeconomic status and whether they have different meanings for women and men. We will also examine how we can move beyond the two categories of men and women to recognize heterogeneity, that is, within group differences, and reflect on how to avoid embedding gender bias in research.

Learning Objectives

1. Build awareness and capacity in understanding the role and use of sex-disaggregated statistics.

2. Participants will learn when it is appropriate to highlight sex/gender differences in their analyses

11

Evaluation Please be sure to complete the evaluation form included in your registration package. This will help conference organizers to ensure the program enhanced your knowledge of the material presented, and that stated learning objectives were met.

Mainpro+ credits

Mainpro+® (Maintenance of Proficiency) is the CFPC’s program designed to support and promote family physicians’ continuing professional development.

Trillium Primary Health Care Research Day 2019 is fully accredited with the College of Family Physicians of Canada. Participants who attend this conference are eligible to receive up to 6 Mainpro+ credits.

Following the conference, you will be sent a certificate indicating the number of credits you received. If you have any questions, please do not hesitate to contact conference organizers: trillium@inspire-phc.org

12

Abstracts: Oral Presentations

THE FORGOTTEN PAP?: EXAMINING COMPREHENSIVENESS OF CARE IN THE SETTING OF DEPRESSION THROUGH ASSOCIATIONS WITH PRIMARY CARE UTILIZATION AND CERVICAL CANCER SCREENING Maggie Siu MD, Rachael Morkem MSc, David Barber MD, John Queenan PhD, and Michelle Greiver MD MSc Objective: Mental illness is increasingly being managed in primary care. It can be associated with adverse health outcomes, some of which could be mitigated through screening and prevention. We aimed to explore comprehensiveness of care in patients with mental illness in the primary care setting, by examining associations between a diagnosis of depression, frequency of primary care visits and cervical cancer screening rates. Methods: This was a cross-sectional retrospective study using Ontario primary care electronic medical record data obtained from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). The population consisted of women aged 21-69, eligible for cervical cancer screening in 2015. We measured associations between two predictors (depression and primary care visits), and the main outcome, Pap test completion. Results: 125,258 women were included. 20.5% had a Pap test in 2015, and 16.4% had a diagnosis of depression. Having depression was associated with a lower likelihood of Pap test completion (AOR=0.92, 95%CI [0.88 to 0.95]). A greater number of primary care visits was associated with a higher likelihood of Pap test completion; this association was greater in women with a diagnosis of depression (OR=4.9 (95%CI [4.2, 5.7])), than those without (OR=3.4 (95%CI [3.3, 3.6])). Conclusion: While depression was overall associated with fewer Pap tests, depressed women who saw their primary care provider more often were more likely to be screened for cervical cancer. Despite the complexities of managing mental illness, more primary care visits may improve provision of routine preventative services.

FEASIBILITY AND IMPLEMENTATION OF A HEALTHY LIFESTYLES PROGRAM Elizabeth Alvarez, Majdi Qutob, Japteg Singh, Arielle Sutton, Lawrence Mbuagbaw, Bria Barton, Sarah Smith Background and purpose: Rates of chronic conditions, such as diabetes, obesity and depression, are increasing throughout Canada, impacting quality and quantity of people’s lives. General mental health is rarely addressed in the context of chronic disease management due to time limitations, payment schemes, and lack of training. Behaviour change is difficult yet underlies patient self-management. Innovative methods are needed to achieve patient-centered care and sustainable improvements in health. A new healthy lifestyles program was developed. Objectives: 1) To evaluate the feasibility and implementation of a year-long healthy lifestyles program, 2) To measure patient- and clinically-relevant outcomes Methodology: A pragmatic mixed methods pilot study (N=30), including a randomized controlled trial and qualitative components, was used. Participants were randomized to a more intensive program (MIP) (intervention) or a less intensive program (LIP) (control). LIP participants meet every three months with a research assistant to develop health goals and create action plans. The MIP includes weekly group sessions and monthly individualized visits to address the “how to” gap to lifestyle changes, including mental health approaches. Preliminary results: 9/15 participants remain in the intervention arm and 7/15 participants remain in the control arm at 9 months. Statistically significant decrease in depression and insomnia from baseline to 3 months, sustained at 9 months, and in perceived stress from baseline to 9 months in the intervention arm. Conclusion: Rates of chronic conditions are increasing throughout Canada. This study is evaluating the feasibility and implementation of a person-centred healthy lifestyles program to address gaps in current care.

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EXAMINING MULTIMORBIDITY AND POLYPHARMACY IN PRIMARY HEALTH CARE PATIENTS IN CANADA USING A NATIONAL ELECTRONIC MEDICAL RECORD DATABASE Martin Fortin MD MSc CMFC (F), Lauren Griffith PhD, Amanda Terry PhD, Tyler Williamson PhD, Saverio Stranges MD PhD FAHA, Dee Mangin MBChB DPH FRNZCGP Statement of Purpose: The accumulation of multiple chronic diseases (multimorbidity) and multiple prescribed medications (polypharmacy) is a burden for patients and primary health care (PHC) providers alike. This research aims to describe the prevalence, patterns and progression of multimorbidity and polypharmacy over time among adult and older adult PHC patients in Canada. Methods: Data are derived from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) electronic medical record (EMR) database that holds ≥ 1 million longitudinal, de-identified records. Multimorbidity will be identified with 20 categories, cut-off points of ≥2 and ≥3 chronic conditions and the International Classification of Disease (ICD) classification system. Polypharmacy will be identified using the cut-off points of ≥5 and ≥10 medication classes and the Anatomical Therapeutic Chemical (ATC) classification system. Analyses will be conducted using Java and Stata 14.2 software. Results: The prevalence of chronic diseases and prescribed medications will be presented, as well as the patterns that are observed among adults and older adults in Canada. The most frequent patterns (combinations and permutations) of multimorbidity and polypharmacy will be presented, stratified by sex and age category. As well, the challenges to identifying the presence and sequence of multimorbidity and polypharmacy in national, longitudinal data will be discussed. Conclusions: These findings can be used strategically to inform health care delivery and to build a more nuanced understanding of multimorbidity and polypharmacy in the international literature. In fact, reducing the burden of prescribed medications and the harms of polypharmacy are key tasks within the context of multimorbidity.

PRIMARY CARE, PUBLIC HEALTH AND RESIDENT COLLABORATIONS TO FOSTER A SAFE, HEALTHY, SOCIALLY-CONNECTED SOCIAL HOUSING ENVIRONMENT Rebecca Ganann, RN, PhD, Ruta Valaitis, RN, PhD; Anita Kothari, PhD; Nancy Murray, RN, PhD; Amanda Terry, PhD; Gina Agarwal, MD, PhD; Ivo Vassilev, PhD; Anne Rogers, PhD Primary health care (PHC) and public health (PH) collaboration can strengthen the primary health care system. Public engagement in developing and testing community interventions is critical to address health inequities. This study replicates a Dutch step-wise approach to improve neighbourhood health involving: Phase 1 Creation of a community health profile by an inclusive Working Group (WG) (residents; PH, PHC and social service providers); Phase 2 A deliberative dialogue to develop an integrated community plan. Phase 1 results will be reported. Purpose: To test the feasibility of implementing this approach in social housing in Ontario. Methodology: Prospective case study to explore residents’ and providers’ views on collaborative profile development and its impact on partnership relationships, collaboration and action planning. Results: Collaboration was enhanced by leadership support, human resource investments and rotating resident/provider WG co-chairs. Engaging residents was critically important yet had challenges. Building on existing housing and city leadership committees helped the WG gain credibility; aligning with local committees enabled building on previously identified priorities for the housing complex. Trust was essential for sharing population data and past evaluations. Data on residents’ health, social networks and interests in community services were collected via an app. The community health profile validated WG lived experiences and was a powerful tool to foster collective action. Conclusions: Trust and communication between residents and PHC, PH, and social service providers were key drivers of success. Results inform strategies to support spread of the intervention to other social housing communities aiming to improve resident health and safety.

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MEANINGFUL ENGAGEMENT WITH FAMILY PHYSICIANS IN THE PRIMARY HEALTH CARE SYSTEM: CHALLENGES AND STRATEGIES Cathy Thorpe, MA; Saadia Hameed, MBBS MCISc(FM); Rebecca E. Clark, MSc; Yashoda Valliere, BSc; Judith B. Brown, PhD Purpose: To identify existing challenges and strategies to meaningfully engage family physicians in the primary health care system, and explore the impact of these factors on building sustainable relationships with family physicians. Methods: Descriptive qualitative study. Purposive sample was used to recruit participants for individual interviews. An iterative and interpretive process was conducted with both individual and team analysis to identify overarching themes. Forty-five health care policy leaders, family physician leaders, and home care leaders from across five regions of Ontario (North, South, East, West, Central) were interviewed. Results: Three overarching themes emerged from the analysis. First, there are numerous challenges to engage family physicians in the primary health care system. The main factors identified include time, money and physicians feeling overwhelmed with information. Second, participants use a variety of strategies to mitigate some of the challenges. One prominent strategy involves using family physicians leaders as champions of change and their position of influence to engage other physicians. Lastly, by learning and understanding existing challenges to engaging family physicians, and employing the appropriate strategies to overcome challenges, decision makers and healthcare professionals are better equipped to develop and foster relationships with family physicians. Participants identified strong relationships as the foundation of continuous meaningful engagement. Conclusion: The study findings reveal the concrete strategies decision makers and health care professionals have explored and adopted to facilitate relationship building with family physicians. These strategies are important for professionals to utilize, as relationships are pivotal to the engagement process.

“IT TAKES A SPECIAL LENS”: INTERPROFESSOINAL PRIMARY HEALTH CARE FOR ADULTS WITH INTELLECTUAL & DEVELOPMENTAL DISABILITIES IN ONTARIO N. Bobbette, MSc.OT, PhD (Cand.), C. Donnelly, PhD, J. Tranmer, RN, PhD., H. Ouellette-Kuntz, PhD, R. Lysaght, PhD Statement of Purpose: To explore how interprofessional care is currently provided for adults with intellectual and developmental disabilities (I/DD) in team-based primary health care. Methodology: Multiple case study. Primary health care teams were purposefully recruited to ensure variation in practice models and geography within one region in Ontario. Data collection included: document review, practice report, organizational survey, interviews with patients, caregivers, health and social service professionals. Pattern matching within and across cases was the overall analytic approach. Results: All teams were providing care to this population. Although special considerations were identified, there were no standardized processes or approaches to interprofessional primary health care delivery within or across practice models. Two teams had formal programs of care including: periodic health exams and ongoing care coordination respectively. Practice champions were a key driver for the development of programs and practice processes, advocacy was a critical role and experience with the population an asset. A number of strategies identified could be used to improve interprofessional care provision. Organizational processes are needed to capture the impact of an interprofessional approach and ensure these patients equitable access to a range of services and programs. Conclusions: This study highlights special considerations for interprofessional primary health care and reflects perspectives of multiple stakeholder groups. Interprofessional team-based primary health care may be an ideal approach to support adults with I/DD along the lifespan. However, further work is needed to identify patient priorities for care and develop processes to ensure access to comprehensive, collaborative and coordinated primary health care.

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E-VISITS ADOPTION AMONG ONTARIO BASED PRIMARY CARE PROVIDERS Payal Agarwal, MD., Jamie Fujioka, MPH., Leah Kelley, BSc., Vess Stamenova, PhD., Michelle Phung, MSc., Payam Pakravan, MA., Megan Nguyen, MN., RN., Ivy Wong, MPA., Nike Onabajo, MSc., Lency Abraham, MHSc., Onil Bhattacharyya MD, PhD. Context: eVisits are gaining recognition as an alternative to traditional in-clinic visits to improve access and decrease health system costs. However, physician adoption remains low. In response, the Enhanced Access to Primary Care (EAPC) initiative was launched in September 2017 and represents the largest implementation of eVisits in primary care within Canada. Purpose: To explore primary care providers’ (PCPs) experience integrating eVisits into their practice. Methodology: The EAPC initiative was implemented in five Ontario regions. All participants were provided a technology platform that enables asynchronous messaging or an audio/video visit and billing codes to support services provided. Vendor data captured technology utilization for all PCPs enrolled in the pilot. Interviews were conducted with 27 PCPs involved in the pilot and 5 PCPs who adopted virtual care independent of the initiative. Results: Between September 2017 and February 2019, 194 providers completed at least one eVisit. Uptake by providers was variable and impacted by personal characteristics (e.g., perceptions and comfort with virtual care), organizational factors (e.g., leadership and available administrative support) and health-systems factors (e.g., remuneration). PCPs discussed the substantive administrative burden and upfront effort required to incorporate eVisits into clinical workflows. PCPs perceived minimal inappropriate use by patients and 81% of visits required no additional follow-up. Conclusions: PCPs viewed eVisits as a viable alternative for in-clinic visits and non-reimbursed phone or email based care. However, clinical champions and implementation support are necessary to drive uptake.

ELECTRONIC REFERRAL SYSTEMS WORLDWIDE: INFORMING PROVINCIAL PLAIN FOR EREFERRAL IN ONTARIO Clare Liddy, MD, MSc, CCFP, FCFP with Stephanie Karch, BSc Candidate and Isabella Moroz, PhD, on behalf of the Champlain BASETM eConsult Team Purpose: The Ministry of Health and Long Term Care (MOHLTC) are developing a provincial strategic plan for eReferral and posed the following applied health research question to inform it: Are there existing frameworks for prioritizing clinical pathways to implement eReferral to better support both patients and providers across Ontario? Methodology: We performed a rapid scoping review, supplemented by a direct outreach to Canadian and US stakeholders with implementation experience in eReferral. We also identified and characterized the existing eReferral systems worldwide in countries/regions with access issues and publicly funded healthcare systems. The current state of wait times and eReferrals was also reviewed. Results: We examined eReferral development and implementation in 11 countries. In most cases, the services were multispecialty. Although no specific frameworks for prioritization of clinical pathways in eReferral were identified, different countries were very deliberate in choosing to address a specific priority via eReferral. These priorities include addressing excessive wait times, patient safety focus, clinical pathway initiated due to leadership by a specialist champion, to policy and strategic priority. Conclusions: To ensure success of eReferral on a provincial scale, based on our analysis we recommend an approach which deliberately applies the Institute of Medicine’s (IOM) 6 quality domains of Safety, Timeliness, Patient-centeredness, Effectiveness, Efficiency, and Equity to prioritize clinical pathways in eReferral. Fully engaging patient/public stakeholders in the implementation process and incentivizing or mandating the use of eReferrals is proving to be effective in other countries.

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IT STARTS WITH A STRONG FOUNDATION: CONSTRUCTING INTERDISCIPLINARY TEAMS IN PRIMARY CARE Judith B. Brown, PhD; Rebecca Clark, MSc; Laura Belsito, RD MAN; Carol Mulder, PhD; Cathy Thorpe, MA. Purpose: The purpose of this study was to explore how team members experience and enact the specific dimensions of teamwork in primary health care settings. Methods: This was a descriptive qualitative study using in-depth individual interviews, which were audiotaped and transcribed verbatim. Individual and team analysis was conducted. Participants were recruited from Family Health Teams (FHTs) affiliated with the Association of Family Health Teams of Ontario. Fifty-three participants including executive directors, family physicians, nurses, and interdisciplinary professionals from eight FHTs were interviewed. Results: Participants described a shared philosophy as the foundation of interdisciplinary teamwork including a set of shared values. Collaboration and communication are key to enacting a shared philosophy including trust and respect. Finally, a shared philosophy is supported by bringing together personalities that ‘fit together’. Built on this foundation are the pillars of leadership, teambuilding and scope of practice. In the leadership pillar, specific attributes were highlighted such as listening, and having an open door policy. Leaders are also considered resources in conflict resolution and change management. In the team building pillar, participants highlighted both formal (regular team meetings) and informal (potlucks) activities. The third pillar is optimizing scope of practice through recognition and utilization of each members’ scope of practice. Once the foundation is built and the pillars are firmly in place, teams can achieve interdisciplinary collaborative teamwork. Conclusion: Interdisciplinary teams are often the expected form of primary health care delivery. Therefore, these findings provide a framework for enhancing interdisciplinary collaborative team work in primary health care.

THE FORMAL AND INFORMAL TEAM BUILDING ACTIVITIES IN FAMILY HEALTH TEAMS Rebecca Clark, MSc; Laura Belsito, RD MAN; Carol Mulder, PhD; Cathy Thorpe, MA; Judith Belle Brown, PhD Purpose: The purpose of the study was to explore formal and informal team building activities in Family Health Teams (FHTs). Methods: This was a descriptive qualitative study using in-depth individual interviews, which were audiotaped and transcribed verbatim. Individual and team analysis was conducted. Participants were recruited from FHTs affiliated with the Association of Family Health Teams of Ontario. There were 53 participants including executive directors, family physicians, nurses, interdisciplinary professionals, and others from eight FHTs. Results: The analysis revealed a wide variety of formal and informal team building activities. Formal activities include yearly retreats, clinical rounds and team meetings involving the entire team, or smaller discipline specific groups. Informal team building consists of celebrations for birthdays, holiday parties, barbeques and other interpersonal interactions. All of these activities can be highly organized or occur on an ad hoc basis. Collectively these team building activities can promote team members feeling appreciated and valued. These activities allow team members to learn more about each other’s scope of practice as well as getting to know them as a person, beyond their professional role. Working together as a whole team was viewed as greater than the sum of its parts and contributes to enhanced patient care. Conclusion: These findings elaborate on formal and informal team building activities FHTs are currently using to promote interdisciplinary team work. Team building activities offer benefits, not only to the team, but also to the patients they serve.

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HOW LEADERS IN FAMILY HEALTH TEAMS CONTRIBUTE TO TEAM FUNCTIONING Laura Belsito, RD, MAN; Rebecca Clark, MSc; Carol Mulder, PhD; Cathy Thorpe, MA; Judith Belle Brown, PhD Purpose: The purpose of the study was to explore attributes of family health team (FHT) leaders and their contributions to team functioning. Methods: This was a descriptive qualitative study using in-depth individual interviews, which were audiotaped and transcribed verbatim. Individual and team analysis was conducted. Participants were recruited from FHTs affiliated with the Association of Family Health Teams of Ontario. There were 53 participants including executive directors, family physicians, nurses, interdisciplinary professionals, and others from eight FHTs. Results: Findings reveal how leadership in FHTs is viewed positively. Attributes assigned to leaders included being supportive, a good listener, and approachable. Leaders are pivotal in encouraging team members to feel valued and engaged. This occurred through clear communication and intentional actions to demonstrate appreciation for team members’ contributions. Leaders also assumed the responsibility for hiring suitable members to join the team. Being supportive, and listening to the needs of team members can guide leaders in promoting change management within the FHT. Participants noted that leaders who did not micromanage created a trusting environment allowing team members to provide optimal patient care. By establishing a conflict resolution policy, leaders can mitigate conflict. Leaders’ attributes such as being approachable and respectful as well as having an open door policy also contribute to conflict resolution. Conclusion: Findings suggest that being a strong and effective leader may not require attending formal leadership training. Instead, exhibiting specific leadership attributes can lead to a strong cohesive team that engages in successful change management and resolves conflict.

FEASIBILITY OF RAPID HEPATITIS C POINT-OF-CARE RNA TESTING AND TREATMENT AT A PRIMARY CARE INTEGRATED SUPERVISED CONSUMPTION SITE IN TORONTO, CANADA  Bernadette Lettner, RN; Kate Mason, MSc; Erin Mandel, HBS; Sushi Rosborough, Harm Reduction Worker; Frank Crichlow, Harm Reduction Worker3; Jason Altenberg, MSW; Jordan Feld, MD, MPH, Jeff Powis, MD, MS Purpose: Recent expansion of supervised injection/consumption services (SCS) in Canada offers a unique opportunity to engage people who inject drugs in health care. The purpose of this study was to evaluate the feasibility of offering rapid, point-of-care Hepatitis C (HCV) RNA testing and treatment among service users of a small-scale SCS. Methodology: The SCS is integrated within a community health centre and is staffed by nurses, health promoters, harm reduction workers, with an average of 30 visits per day and 5-10 new service users per month. HCV RNA testing was conducted by the Health Centre’s HCV Nurse 2.5 days/week using capillary blood samples with results available within 1 hour. Baseline questionnaires captured socio-demographics and history of HCV care. Results: Of 102 participants tested over 6 months, 69% were male with an average age of 41 years. 72% had unstable/no housing and 70% reported daily injection drug use. 33% reported no previous history of HCV testing. Of those with a history of HCV testing, only 34% had received RNA testing. 14 test results were invalid with 5 participants who agreed to repeat testing. Of 90 valid tests, 39% were positive. Of these 35 individuals, 15 have started further HCV assessments including three who have initiated treatment. Conclusion: Interest in point-of-care testing was high, and among those found to be HCV RNA positive there was substantial engagement in hepatitis C care. Ongoing access to the HCV nurse within the SCS and staff with lived experience of HCV facilitated linkage to care.

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HIGH LEVELS OF INADEQUATELY JUSTIFIED TSH TESTING IN CANADIAN PRIMARY CARE Noah Crampton MD CCFP, Lisa Del Giudice MD MSc CCFP, Kimberly Wintemute MD CCFP FCFP, Frank Sullivan FRSE, FRCP, FRCGP, MCFP, Babak Aliarzadeh, Sumeet Kalia, Chris Meaney, Rahim Moineddin PhD, Alex Singer MDB BAO BCh. CCFP , Michelle Greiver MD MSc CCFP FCFP Statement of Purpose: Population-based Thyroid Stimulating Hormone assay (TSH) screening of asymptomatic adults for thyroid disorders is not recommended. TSH testing is the second most costly laboratory test in Ontario, Canada. As there are no pan-Canadian studies on TSH ordering in primary care, our objective was to describe ordering patterns during a two-year period for adult patients without a clear indication for testing in the EMR data. Methodology: We used EMR data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). A cross-sectional cohort was generated for adult patients, age 18+, with at least one TSH test ordered and no clear indications for testing. Known indications were obtained from such patient-linked CPCSSN data as medical history, medications and billing codes. Multilevel logistic regression modelling was used to estimate associations between TSH ordering and patient and provider characteristics. Results: Thirty seven percent of patients had at least one TSH test done in a two-year period. There was high variability in TSH ordering as the proportion of patients tested ranged from 0.2% to 81.6% among 806 family physicians. Patients were more likely to be tested if they were older, female, depressed, had dementia or rheumatoid arthritis; had more clinical encounters; or had multiple co-morbidities. Over half of TSH tests were bundled with a HbA1c or a lipid profile. Conclusions: There was a high rate of TSH testing with no clear indication recorded in EMR, high physician variability and high levels of bunding with other screening blood tests. Our results point to opportunities to reduce unnecessary TSH ordering in primary care.

SEARCHING FOR THE ROOTS OF THE OPIOID CRISIS: PHARMACEUTICAL INDUSTRY INFLUENCE IN CLINICAL PRACTICE GUIDELINES Sheryl Spithoff MD CCFP MSc, Pamela Leece MD MSc, Frank Sullivan FRCGP FRSE, Nav Persaud MD MSc, Peter Belesiotis, Liane Steiner Purpose: Our goal was to determine if the guidelines for opioid prescribing for chronic non-cancer pain (CNCP) published between July 2007 and July 2013-- the peak of opioid prescribing—were at risk of bias because of pharmaceutical industry influence. Methodology: We used the Guideline Panel Review (GPR) to analyze the opioid prescribing guidelines for CNCP. The GPR assigns red flags to items known to permit bias from financial conflicts of interest. Two reviewers independently evaluated and scored each guideline. Difference were resolved with discussion. We compared our findings to findings from a 2014 critical appraisal of the same guidelines conducted by another study group, Nuckols and colleagues. Results: The number of red flags per guideline ranged from one to six (on a scale of zero to seven). On average guidelines had 3.3 red flags. Four guidelines were missing information so red flags may be higher than reported. The guidelines with the highest and second highest ratings for quality in the 2014 critical appraisal by Nuckols and colleagues had five and three red flags, respectively. Conclusions: Our findings reveal that the guidelines for opioid prescribing for CNCP from 2007 to 2013 were at risk of bias because of the pervasive influence of the pharmaceutical industry and a paucity of mechanisms to address bias. Even highly rated guidelines in a 2014 critical appraisal had many red flags.

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A FOUR-STEP PROCESS FOR ENGAGING FAMILY PHYSICIANS IN THE PRIMARY HEALTH CARE SYSTEM Judith B. Brown, PhD; Cathy Thorpe, MA; Saadia Hameed, MBBS MCISc(FM); Rebecca E. Clark, MSc; Yashoda Valliere, BSc. Purpose: To identify the process used to meaningfully engage family physicians in the primary care system. Methods: Descriptive qualitative study. Purposive sample used to recruit participants for individual interviews. An iterative and interpretive process was conducted with both individual and team analysis to identify overarching themes. Forty-five health care policy leaders, family physician leaders, and home care leaders from regions across Ontario (North, South, East, West, Central) were interviewed. Results: The process of meaningful engagement involves four key steps. The first step is making contact with physicians. This ranges from going door-to-door to professional development events. Making direct contact is an intentional strategy not left to chance. Step two is attentively listening and learning to appreciate and respond to family physicians’ experiences and expectations. This step includes building relationships and trust. Step three involves actively responding with flexibility, creativity, and consistently ensuring added value for the family physicians and the patients they serve. This includes timely access to resources, and seamless system navigation. Step four is the culmination of the previous three steps and focuses on maintaining and sustaining meaningful engagement. This requires returning to the previous steps through constant contact, actively dialoging, and continually adding value as the physicians’ and their patients’ needs evolve. Conclusion: The study findings reveal a set of meaningful engagement strategies that are enacted through an iterative process. These findings are pertinent and applicable to family physician leaders, health care policy and decision makers as well as family physicians traversing the primary health care system.

PURSUING ENHANCED SKILLS PGY3 TRAINING IN FAMILY MEDICINE Melad Marbeen, MBChB; CCFP, Tom Freeman, MD, MClinSci, CCFP; Amanda Terry, PhD Statement of purpose: The 2012 National Physician Survey revealed that (27.9%) of family medicine residents were planning to undertake a third year postgraduate (PGY3) training. The study aims were: 1) to explore the perspectives of PGY3 residents regarding their decision to pursue extended training, and 2) understand the career intentions of PGY3 residents, particularly as they relate to the type of practice they envision themselves working within. Methodology: Descriptive qualitative study consisting of ten semi-structured interviews with residents accepted in the Enhanced Skills (PGY3) programs in 2018 at Western University. Data analysis was both iterative and interpretative. Results: Participants considered pursuing PGY3 training to meet a need for care in specialized settings, to mitigate the perceived complexity of family medicine, and to develop their professional identity while recognizing the evolving nature of family medicine. Although acquiring enhanced skills through extended training was consistent with perceived community needs, the decision to undertake a PGY3 had to be compatible with resident’s professional aspirations and life outside medicine. Participants’ career intentions were variable depending on the area of enhanced training and was influenced by health system issues and personal factors. Some participants envisioned themselves having a focused practice, while others were planning to work in specialized clinics in addition to a family practice. Conclusion: The study shows that PGY3 residents’ interest in enhanced training and career decision making are shaped by their experiences within the family medicine discipline and training contexts, and conditioned by individual resident’s personal and professional aspirations.

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THE STRATEGIC PLAN OF THE COLLEGE OF FAMILY PHYSICIANS OF CANADA’S SECTION OF RESEARCHERS - BLUEPRINT 2 (2018-2023) Fortin M, MD, MSc, CCFP, FCFP, Greiver M, MD, MSc, CCFP, FCFP, Pereira J, MBChB, CCFP, MSc, FCFP, Ramsden V, RN, MS, PhD, MCFP (Hon.), Hutchison B, MD, MSc, CCFP, FCFP, Menear M, MSc, PhD on behalf of the Section of Researchers Council Statement of Purpose: The College of Family Physicians of Canada (CFPC)’s Section of Researchers (SOR) Blueprint 2 (2018–2023) builds on the successes of the first Blueprint (2012–2017) to advance family medicine and primary care research across Canada. Method: Participatory processes, evaluation, and transformative action research. Results: The Blueprint 2, “Improving lives through research and quality improvement” encompasses four strategic priorities: Membership, Capacity Building, Advocacy, and Partnerships. Barbara Starfield’s work has shown that health systems oriented towards primary care perform better; the Advocacy priority area reiterates the importance of commensurate financial support for research infrastructure and projects in family medicine and primary health care. Patient- and community-oriented approaches are at the core, as is the Quadruple Aim: better care, better patient experience of care, more cost-efficient care, and better work experience for health care providers. CFPC’s Blueprint 2 emphasizes research and quality improvement (QI) work that emanates from the realities of everyday practice and is deeply rooted in the daily work of family physicians and other primary health care providers. Conclusion: The recommendations of Blueprint 2 will guide the development of the SOR’s Action Plan. The implementation of the Objectives will promote research and QI and nurture a culture of curiosity in family medicine and primary health care. Metrics are being developed alongside the implementation of Blueprint 2 to track its outputs and outcomes as well as to ensure alignment with current and future opportunities.

SCREENING FOR POVERTY AND RELATED SOCIAL DETERMINANTS AND INTERVENING TO IMPROVE KNOWLEDGE OF AND LINKS TO RESOURCES (SPARK) STUDY Anne Rucchetto MPH, Marjeiry Robinson, Kris Aubrey-Bassler MD CCFP(EM), Frederick Burge MD, FCFP, MSc, Lois Jackson PhD, Nazeem Muhajarine BA, MSc, PhD, Cory Neudorf BSc, MD, MHSc, FRCPC, Alan Katz MBChB, MSc, Andrew D. Pinto MD CCFP FRCPC MSc Purpose: Numerous studies confirm the role of the social determinants across health inequities. We lack evidence to address social determinants in healthcare, and lack individual-level data to target interventions. Our research program builds on previous work in Canada and the United States. Our objectives include: 1) Conducting a definitive implementation study of routine sociodemographic data collection across diverse primary care settings in multiple provinces and 2) Conduct a cluster RCT to examine intervening with one key domain: poverty. This RCT will compare a "modest" vs. "intensive" intervention approach. Methods: The study design includes: 1) a systematic review to identify existing tools to collect data on sociodemographics and social needs; 2) a modified Delphi process to achieve consensus on a Canadian tool for primary care; 3) Evaluating the acceptability and feasibility of collecting sociodemographic data; 3) conducting a cluster RCT, after a pilot study, comparing a “modest” to an “intensive” intervention to address poverty. The SPARK Study involves patients, primary care and public health professionals, academics, community organizations and charities, and will engage clinics in Saskatchewan, Manitoba, Ontario, Nova Scotia, and Newfoundland. Results: Study outcomes will include providers’ perspectives on addressing social needs in primary care; impact of assistance with social needs for patients; and staff and leadership responses to routinely addressing social needs in primary care for the duration of the study. Conclusions: This program of research will have national and international impact, ultimately advancing the ability of health providers, organizations and systems to “go upstream” and address social determinants.

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USER-CENTRED DESIGN TO REFINE A POSTPARTUM MENTAL HEALTH PRIMARY CARE TOOL Kithulegoda, N. MPH, Agarwal, P. MD, Ivers, N. MD, PhD Statement of Purpose: While postpartum depression and anxiety are common, most parents do not seek treatment and few primary care providers (PCPs) proactively assess the mental health of new parents. We aimed to create a digital health tool that supports proactive screening and tailored treatment of postpartum mental health, using a user-centered design (UCD) approach. There is increasing evidence that using this iterative framework grounded in the needs of the end-user can increase uptake and scale of new interventions. Methods: To understand the needs of end-users and refine the design of an eHealth tool to support postpartum mental health, a UCD process was carried out consisting of three phases: (1) low-fidelity prototype development by a team of PCPs, psychiatrists and researchers; (2) prototype testing through focus groups and semi-structured interviews with target end-users to understand needs, values and engagement; and (3) incorporating feedback to create a final prototype. Results: 2 PCP focus groups and 11 parent interviews were conducted. PCPs provided feedback on alignment with care pathways, and language for the electronic medical record. Insights from parents included layout for ease of use, lay language and consideration of unique challenges such as relationships, financial stress, and the stigma associated with mental health, especially among fathers. The final prototype included an e-survey and algorithm that produced tailored e-toolkits for both the patient and PCP, based on survey responses. Conclusions: UCD in intervention development enabled researchers to elicit early feedback from end-users, minimizing the overuse of resources during the design phase, and maximizing the consideration of end-user needs.

PATIENT PERSPECTIVES FROM A VIRTUAL PRIMARY CARE PILOT PROJECT Michelle Phung, MSc., Leah Kelley, BSc., Vess Stamenova, PhD., Payal Agarwal, MD., Payam Pakravan, MA., Jamie Fujioka, MPH., Megan Nguyen, MN, RN., Ivy Wong, MPA., Nike Onabajo, MSc., Lency Abraham, MHSc., Onil Bhattacharyya MD, PhD Statement of purpose: The Enhanced Access to Primary Care (EAPC) initiative in Ontario is the largest implementation of virtual primary care visits in Canada. The virtual visit platform enables primary care providers (PCPs) to respond to their patients’ clinical requests using asynchronous messaging or audio/video within 48 hours. The purpose of this study was to understand the patient experience of virtual visits provided through the EAPC initiative. Methodology: A mixed-methods approach, including 17 patient interviews, a survey of patients who experienced at least one virtual visit, and utilization data directly from the technology platforms. Results: 6,354 patients completed at least one virtual visit on the platform between September 2017 and February 2019. Over 90% of the visits were conducted via asynchronous messaging. Results from the 1742 survey respondents indicated that patients perceive the quality of virtual visits to be on par or better than in-person visits. Almost all patients would use it again (99.9%) and 90% were satisfied with the care they received. The main value propositions reported by patients in interviews were convenience and improved access to their PCP, especially when using asynchronous messaging. Related benefits included time savings, elimination of transportation difficulties, and not needing to arrange for childcare. Conclusions: Patients were very satisfied with their virtual visits through the EAPC project and agree that the quality of care is at least on par with in-person visits. They prefer using asynchronous messaging due to its convenience and ability to gain more timely access to their PCPs.

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ADVANCING ACCESS TO TEAM-BASED CARE Jennifer Rayner, PhD; Walter Wodchis, PhD; Elana Commisso, MA Purpose: The Advancing Access to Team-based Care (AA-TBC) project is an integrated, collaboration model that facilitates equitable access to interprofessional teams for physicians who currently do not have access to team based care for their patients. Examples of available services include counselling, chronic disease education, foot care, physiotherapy, addiction services, settlement services and employment services. Methodology: Team-based practices identify and recruit primary care providers/physicians who are not part of an interprofessional team team (PCPs) using facilitated outreach. PCPs are engaged in the design of referral and communication processes to best suit their practice needs. Interprofessional teams use continual quality improvement to expand their service capacity to accommodate increasing numbers of patients. Physicians remain the primary care provider and patients have access to the full range services and programs offered at the team-based practice setting. This is not a referral or consultation model but represents authentic interprofessional shared care and integration of care. An implementation evaluation is being conducted that includes 4 components: 1) qualitative implementation evaluation; 2) rapid cycle feedback of patient experience; 3) developmental evaluation using operational metrics; and 4) summative evaluation. Results: To-date over 36 primary care organizations have expanded access to TBC to over 1500 PCPs. Early evidence suggests that providers and patients are satisfied with the increased availability of services. Conclusions: Enabled by extensive and collaborative facilitated outreach with solo physicians, this program will improve PCPs engagement and satisfaction with the health system. Improved access to team-based care services will improve patient experience and health outcomes.

THE INFLUENCE OF CLINIC FUNDING ON THE INTEGRATION OF FAMILY PRACTICE NURSES: A QUALITATIVE STUDY FROM NEWFOUNDLAND AND LABRADOR Maria Mathews, PhD; Julia Lukewich, PhD, RN; Dana Ryan, MA; Richard Buote, MSc; Sandra Parsons, MPSc, MER Purpose: The integration of family practice nurses (FPN) into primary healthcare settings may offer vital solutions towards addressing health system challenges in Newfoundland and Labrador (NL). This study explores the roles of FPN in primary care settings funded by fee-for-service (FFS) and alternate payment plans (APP) in an attempt to understand the influence of funding arrangements on FPN roles and activities. Methodology: Study invitations were sent to primary care physicians or registered nurses working in FFS or APP primary care settings in NL. During semi-structured telephone interviews, participants were asked about their experiences, current roles and activities, and barriers/facilitators to maximizing their scope of practice within primary care. Interviews were transcribed verbatim and a content analysis approach was used to identify recurring themes. Results: Clinic funding was instrumental in the integration of FPN into primary care settings in NL, and FPN roles differed between FFS and APP practices. In FFS practices, FPN work in tandem with physicians and focus on one-on-one patient care in primarily office-based settings, whereas FPN in APP practices work more independently, in a wider range of settings, and with a more balanced emphasis on both individual and group-based encounters. Compared to APP practices, FPN roles in FFS practices are more restricted due to physician billing requirements. Conclusions: These findings highlight how funding arrangements can be used to optimize FPN roles. Understanding the relationship between funding and how FPN function within a team will inform future integration and optimization of FPN within primary care models across Canada.

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THE IMPACT OF INTERPROFESSIONAL PRIMARY CARE PROVIDERS ON HEALTH UTILIZATION IN INDIVIDUALS WITH DIABETES

Catherine Donnelly PhD OT, Michael Green MD, Nyguen, P., PhD, Richard Birtwhistle MD, Rachael Morkem MSc, Joan Tranmer PhD, Simon French Phd, Patrick Esperanzate

MD, Abby Leavitt BA Stephanie Lynch DPharm Purpose: Diabetes impacts an estimated 3.3 million Canadians and the prevalence has increased by 70% in the past decade. Emerging evidence suggests that individuals with chronic conditions who receive care from an interprofessional primary care (IPC) team have improved outcomes. However, there is a lack of research on how team-based care affects outcomes related to diabetes and specifically if access to IPC health providers results in improved outcomes and reduced healthcare utilization compared to physician only care. Objective: Determine the impact of IPC health providers on health outcomes and health utilization for individuals with diabetes. Methodology: A descriptive, cross sectional data linkage study of interprofessional primary care practice. The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) provided patient level data obtained through the electronic medical record (EMR). CPCSSN data was linked with health utilization outcomes obtained through selected databases housed within the Institute for Clinical Evaluative Sciences. CPCSSN data was used to identify a practice cohort of Ontario residents receiving care at IPC practices who have had at least one visit to an IPC provide.. An IPC visit was denoted by a visit to any health professional(s) other than physicians and nurse practitioners (e.g. pharmacist, social worker, occupational therapist). Results: The proportion of emergency department visits and hospitalizations was lower for individuals with diabetes who see a physician and an IHP provider compared to those who see a physician only. Conclusions: IPC health providers provide additional supports to individuals with chronic conditions and have the potential to impact health utilization.

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Abstracts: Poster Presentations

IMPACT OF THE DIABETES CANADA GUIDELINE DISSEMINATION STRATEGY ON DISPENSED VASCULAR PROTECTIVE MEDICATIONS FOR OLDER PATIENTS IN ONTARIO, CANADA: A LINKED EMR AND ADMINISTRATIVE STUDY Alanna Rigobon, MSc, Sumeet Kalia, MSc, Rahim Moineddin, PhD, Simon Chen, MPH, Raquel Duchen, RD, MPH, Michelle Greiver, MSc, MD Purpose: The 2013 Diabetes Canada guidelines recommended routinely using vascular protective medications for most patients with diabetes. Using both EMR and administrative health data, we examined whether guideline dissemination impacted the dispensing of these medications. Methodology: The study population included patients with diabetes (≥66y) in Ontario, Canada. We created two cohorts using two different approaches: an Electronic Medical Record (EMR) algorithm for diabetes using linked CPCSSN EMR-ICES administrative data and an administrative algorithm using population level ICES data. Medication data came from the Ontario Drug Benefit Database. We examined data from January 2010 to December 2016. Patients were deemed to be likely taking a medication (or covered) during a quarter if the daily amount for a dispensed medication lasted at least 75% of days in any given quarter. Interrupted time series analysis was used to assess trends in the proportion of patients covered by each medication. Proton pump inhibitors (PPIs) were the reference control. Results: There was no increase in the rate of change for medication coverage following guideline release in EMR or administrative diabetes cohorts. For statins, the change in trend was -0.03, p=0.7 (EMR) and -0.12, p=0.04 (administrative). For ACEI/ARBs, this was 0.03, p=0.6 (EMR) and 0, p=1 (administrative). For antiplatelets, this was 0.001, p=0.97 (EMR) and -0.03, p=0.03 (administrative). The comparator PPI was -0.07, p=0.4 (EMR) and -0.11, p=0.002 (administrative). Conclusions: The 2013 Diabetes Canada guideline dissemination strategy did not increase the rate of vascular protective medication coverage. Alternative strategies are needed to effect change in practice.

DEPRESCRIBING PROTON PUMP INHIBITORS AT WOMEN’S COLLEGE HOSPITAL FAMILY PRACTICE HEALTH CENTRE: A QUALITY IMPROVEMENT PROJECT Taylor Raiche BSP, Lisa Fernandes BScPhm PharmD, Jessica Visentin PharmD, Danielle Martin MD CCFP FCFP MPP, Brad Lichtblau MD CCFP, Carol Kitai MD CCFP FCFP, Natalie Crown BSc(Pharm) PharmD, Lisa McCarthy

BScPhm PharmD MSc Purpose: To develop a pharmacy team-led intervention that could reduce suboptimal proton pump inhibitor (PPI) use (defined as ≥ 50% reduction in dose or frequency [including complete discontinuation]) in ≥ 20% of patients who meet eligibility criteria and engage in a discussion about deprescribing with a healthcare professional. Methodology: Quality improvement project using the IHI Model for Improvement. Pharmacy team members generated reports from the electronic medical record of patients prescribed PPI therapy longer than 8 weeks with an upcoming appointment. The pharmacy team member met with the patient at that appointment to discuss deprescribing or prompted the physician to assess PPI use. Follow-up was provided at 4, 8, and 12 weeks for those who agreed to trial deprescribing. Results: Between October and December 2018, 67% (48/72) of eligible patients were assessed in clinic, of which 40% (19/48) agreed to trial deprescribing. After 12 weeks of follow-up, 23% (11/48) of patients reduced their PPI use by ≥ 50%. Four patients discontinued their PPI. Between January and March 2019, only 29% (15/52) of eligible patients were assessed and 6% (3/52) agreed to deprescribing. The causes for discordance in success achieved between these two periods were analyzed, and revealed administrative and capacity-related barriers to efficicent identification of patients. Conclusions: Population-based PPI deprescribing is successful when a primary care pharmacy practitioner has the capacity to engage patients in shared-decision making. Identification of barriers that impede the ability to engage both patients and prescribers in deprescribing will be explored further.

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CHEST PAIN SYMPTOMS FOR MALES AND FEMALES: A LONGITUDINAL STUDY USING ELECTRONIC MEDICAL RECORDS IN THE DELPHI DATABASE Maddocks HL, Stewart M, Freeman T, Leger D, Jordan J, Hons I, Copeland J, Ryan BL Statement of Purpose: Chest pain is a common symptom in family practice and may present differently for males and females. Objective: Describe differences in the prevalence, patient characteristics and outcomes of patients with chest pain by sex. Methodology: Electronic medical records from the DELPHI database; n=1790 patients, 18+years, 23 physicians, 10 practices in southwestern Ontario (October 2005-June 2010). Outcomes: 1) symptom trajectories; 2) diagnoses; and 3) length of episode. Results: 111 patients with chest pain, (prevalence 6.7%, 5.8% of males and females, respectively; mean age 63.9, 62.9yrs). ANOVA and chi-square comparison revealed no significant differences by sex for: age, %rural, additional symptoms, chronic conditions, musculoskeletal conditions, social/relationship problems, investigations, and referrals. However, a higher proportion of females (32% vs 10% males) had prior psychological conditions (p=.005). Outcomes: 1) Symptom trajectories: majority of females (68% vs 43% males) chest pain remain undiagnosed; 6.7% females and 15.7% males had a diagnosis made yet symptom continued, and 25% of females, compared to 42% of males had a diagnosis made and no further symptoms (p=.025). 2) a higher proportion of males (28% vs. 12% females) were diagnosed with ischaemic heart disease with angina (p=.034). 3) Among those with 2+visits, females visited for chest pain over 3.2 months, compared to 1.1 months for males (ns p=.085). Conclusions: Females with chest pain were more likely to have prior psychological conditions including anxiety and depression, and more likely to remain undiagnosed. Males were more likely to have a diagnosis of ischaemic heart disease, and no further visits.

SLEEP DISTURBANCE IN FAMILY PRACTICE: A STUDY USING ELECTRONIC MEDICAL RECORDS (EMRS) IN THE DELPHI DATABASE Freeman T, Stewart M, Maddocks HL, Leger D, Jordan J, Hons I, Copeland J, Ryan BL Methodology: Cross-sectional and longitudinal analysis of EMRs from the Deliver Primary Healthcare Information (DELPHI) database. N=1790 patients, 18+years from 23 physicians in 10 practices in Southwestern Ontario, coded with International Classification of Primary Care for 4 years. Outcomes from our cross-sectional study include: no diagnosis, new diagnosis, pre-existing diagnosis. Longitudinal study: symptom remained; diagnosis made but symptom continues; diagnosis made and symptom no longer RFE; episode length; total visits. Results: Cross sectional: 218 visits (1.4% of total), 65.6% first visits; 63.8% women; age 57.2 years; 66.5% no diagnosis; 17.9% pre-existing diagnosis; 8.7% new diagnosis with depressive disorder, anxiety disorder most common. Most (74.8%) had prior chronic conditions including MSK (56.0%), and 38.9% prior psychological conditions. 46.8% additional symptoms. Longitudinal: 140 patients, 59.3% women; age 59.3; prior psychological conditions 32.9%; 48.6% no diagnosis, with 86.8% one visit; 40% diagnosed and 94.6% single visit; diagnoses included depressive disorder, anxiety and back syndrome; 11.4% diagnosis made, yet symptom continues, youngest (average age 46.2) and least likely to have prior chronic conditions; most common diagnoses -depressive disorder, anxiety, back symptoms; 36.7% had a prior MSK condition; average episode 13.7 months, mean 3.06 visits. Conclusions: Sleep disturbance is common, usually 1-2visits, however a minority of younger patients (11.4%) are diagnosed, yet continue to have the symptom for >1year. Musculoskeletal symptoms commonly accompany sleep disturbance regardless of outcome group.

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SPIDER, A QI-PBRN COLLABORATION FACILITATING MEDICATION APPROPRIATENESS IN PRIMARY CARE FOR COMPLEX OLDER PATIENTS - PRELIMINARY FINDINGS OF THE FEASIBILITY STUDY J. Wang, MBBS, BHS, S. Lam, MD, MSc, P. O’Brien RN, MScCH, C. Southey, MSc, M. Greiver, MD, MSc, CCFP, FCFP Statement of Purpose: To evaluate the impact of a Structured Process Informed by Data, Evidence and Research (SPIDER) on improving medication appropriateness for complex older patients in primary care. Methods: Single-arm mixed methods feasibility study in three Practice-Based Research Networks (PBRNs) including Toronto, followed by a 2-arm (Intervention vs. Usual Care) pragmatic cluster randomized controlled trial in 5 PBRNs. Participants include family physician led multidisciplinary practice teams and active patients 65+ years taking 10+ different medications identified by participating physicians’ EMR. The main outcome is the reduction of potentially inappropriate prescriptions for patients 65+ years prescribed 10+ different medications in the past 12 months measured using EMR data. Results: Thirty-three physicians from ten family health teams/practices and one nurse practitioner and three family physicians from a community health centre in Toronto were recruited. All teams have accessed coaching support, reflecting high engagement. Teams were given flexibility in developing deprescription strategies and action plans that fit for the local context. Review and validation of patient cohort identified by the EMR were time-consuming for some, depending on the size of the cohort and data entry patterns for each practice. Engaging pharmacists in the medication review and deprescription process allowed for the sharing of their specific expertise thereby alleviating workload for physicians. Conclusions: SPIDER appears to be feasible and has the potential to enhance safer prescribing for complex older patients. Having access to embedded QI and data support and the availability of a pharmacist may enhance the sustainability of the approach.

BUILDING PARTNERSHIPS BETWEEN COMMUNITY HEALTH CENTRES AND COMMUNITY PARTNERS FOR THE TREATMENT OF MENTAL HEALTH AND ADDICTIONS Dariya Gusovsky, MSc; Jennifer Rayner, PhD Statement of Purpose: Community Health Centres provide primary health care in an inter-professional environment, often focusing on populations facing barriers to care. They also focus on the social determinants of health. Recent data from ICES has shown that mental health clients of community health centres have high rates of concurrent disorders, as well as other co-existing medical and social issues. This work highlights how community health centres build partnerships with community agencies to meet client needs, while identifying existing barriers and gaps. Research has demonstrated that mental disorders are frequently encountered in the primary care setting, and that management can be effective there. CHCs often engage in partnerships with local mental health and addictions agencies to coordinate care. Methods: After a literature review on collaboration in primary care for mental health & addictions services, a survey was sent out to 74 CHCs asking questions about which agencies they partner with, how effective the partnerships are, and what gaps still exist in securing effective partnerships. This poster will present basic quantitative analysis of the data, as well as themes identified through coding of written answers. Results: CHCs considered their partnerships to be mostly effective, and identified communication about client treatment, relationship building, and formal documentation as key facilitators. Identified barriers included lack of resources, lack of role clarity and the need for designated staff time. Conclusions: Ontario's CHCs see a population with complex needs that are best met through collaboration and partnerships. It is important to understand how to undertake them effectively.

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ARTIFICIAL INTELLIGENCE AND PRIMARY CARE: WHAT RESEARCH HAS BEEN DONE AND HOW DO WE MOVE FORWARD Jacqueline K. Kueper, Amanda L. Terry, Merrick Zwarenstein, Daniel J. Lizotte

Statement of purpose: Our research summarizes the nature and extent of the body of research on artificial intelligence for primary care purposes in order to provide a foundation for future research in this field. Methodology: A scoping review was performed to capture empirical research on artificial intelligence and primary care. Eleven published and grey literature databases were searched for English-language documents in April 2018 using keywords and subject headings pertaining to 1) artificial intelligence and 2) primary care. Screening was performed in a two-step process. Data extracted from eligible documents included author appointments, overall study purpose, type of artificial intelligence, location of data source, primary care function addressed, target health condition(s), and author reported end-user(s). Results: After removing duplicates and screening 405 eligible studies were included. Predominantly the body of research was a focused on developing new or modifying existing artificial intelligence methods for supporting physicians with diagnostic or treatment decisions for chronic physical conditions. Notable gaps included evaluation studies, nurses as reported end users, and authors with a family medicine appointment. Additional trends and gaps will be presented. Conclusions: The body of research on artificial intelligence and primary care is in an early stage of maturity—primary care researchers and end users can increase involvement and drive the field forward. Our poster will provide an opportunity to understand the current state of research on artificial intelligence for primary care and to brainstorm future directions to meet current primary care needs.

PATIENT-CENTERED CONSULTATIONS: AN ANALYSIS OF ECONSULTS IN PRIMARY CARE Mary Martin MSc, Susan Phillips MD, CCFP Background: While the many benefits of eConsults are documented in the literature, it is unknown whether the lack of in-person consultation reduces the patient-centeredness of the healthcare experience. Purpose: In this project, we explore what happens to ‘the person’ in the process of consulting a specialist through an e-consult to examine the differences in patient-centeredness compared to traditional face-to-face consultations. Methodology: The EMR of one large, teaching practice was searched to identify 100 eConsults and 50 referral letters, which were analyzed on a scale developed by researchers according to 5 domains: demographic information; description of patient personality or adjective use; living environment and social history; individual preferences or wishes (FIFE); person-centered language. Descriptive and inferential statistics completed with SPSS. Results: eConsults had an average of 3.18 instances of patient-centeredness per document; referral letters had 2.56 (>0.05). This is concerning as eConsults did not differ meaningfully in terms of their ability to convey the person compared to referral letters, which are followed up with a face-to-face consultation, while eConsult are not and should provide the entire clinical picture. Additionally, a tiny minority of eConsults scored high (14-16), suggesting that is possible to provide a detailed patient history, but this is not common practice. Conclusion: Through improving the level of patient centeredness in all medical interactions, including eConsults, we can better insure that the patient is receiving the best possible care. To more optimally use eConsults, we recommend that physicians be more mindful of the patient story and circumstances when creating them.

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THE IMPACT OF A SINGLE-ENTRY INTAKE SYSTEM ON ACCESS TO OUTPATIENT SPECIALIST VISITS: A SYSTEMATIC REVIEW Ann Marie Corrado, MSc, Milica Milakovic, MSc, Mary Elizabeth Nguyen, Noah Ivers, MD, PhD, CCFP Introduction: Canada lags behind other health systems in regard to wait times for specialist visits. Single-entry models (SEM), which combine patients in a shared queue to see the first available specialist, represent a promising strategy to reduce wait times. The effects of SEM, and the factors associated with successful implementation are unknown. Objectives: To assess the impact of a SEM on waiting time, referral volume and patient/provider satisfaction. Methods: A systematic review was conducted using MEDLINE, EMBASE, Cochrane, and CINAHL. Original studies from the inception of each database to July 1st, 2018 were included if they were conducted in high-income countries and reported on the effects of SEM on wait time one (WT1), which is the period of time between a referral from a family doctor to the first assessment by a specialist. Due to substantial heterogeneity, a narrative synthesis was conducted. Results: Of the 4540 studies identified, 10 studies met the inclusion criteria. The range of improvement in WT1 across the 10 studies was 5 days–9 months. Three interventions required mandatory implementation of the SEM and the range of improvement in WT1 was 5 days–47 days. The other seven interventions allowed for optional involvement and the range of improvement in WT1 was 6 days-9 months. Patient and provider satisfaction was reported in only two and three studies, respectively. Conclusion: SEM appears a promising option to improve access to health services and decrease wait times, but there is a need for prospective, rigorous evaluation to inform policy.

THE PATIENT ENGAGEMENT RESOURCE CENTRE: A STRATEGY FOR SUPPORTING PATIENT ENGAGEMENT IN PRIMARY HEALTHCARE RESEARCH D. Bhati, L. Bayliss, J. Boyle, J. Barker, A. Maybee, R. Beleno, C. Leid, M. Huang, ID. Graham, VR Ramsden, S. Dahrouge Statement of purpose: Meaningful patient engagement (PE) in research is a key priority for patients and research funders but is challenging to implement because of the lack of coordinated efforts to support research teams. A virtual Patient Engagement Resource Centre (PERC) was established to foster meaningful PE in primary healthcare research (https://www.patientengagement-phcresearch.com/) and promote inclusiveness, support, mutual respect, and co-creation. Methodology: PERC activities are guided by a Patient Advisory Board (PAB) that believes in ‘I know, I share, I guide’. PAB is composed of seven patients/caregivers with lived experience and who had previously worked in partnerships with policy makers, health planners, and/or researchers, and three researchers with expertise in collaborative patient partnerships. PERC’s main outcome is to effectively supporting PE in research. Results: PERC produced four types of outputs: 1) Clearing House: an online resource for existing PE related materials. 2) Guides/tools development: i. A Guide for Research Teams for Building PE in Research. ii. A toolkit for patients that offers: a research lexicon; description of each research team member’s roles; and, strategies for optimizing abilities to contribute. 3) Indirect support: At the request of funding and research organizations, PERC delivered webinars/presentations to support researchers incorporating patient partnerships into their research plan. 4) Direct support: PERC was invited by research teams to facilitate and evaluate the integration of patient partners with teams and assess the quality of the partnership. Conclusions: PERC will describe its key activities and products that support the growing imperative to integrate PE into primary healthcare research.

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THE ADOPTION OF A POPULATION HEALTH APPROACH TO SEXUAL HEALTH PROGRAMS IN PUBLIC HEALTH IN ONTARIO: A MULTI-PHASE MIXED METHODS STUDY Linda Brousseau Purpose: Transformation is happening within the public health sector, including the role it has in the broader health system. To support this transformation the standards that guide the programs and services provided through public health units underwent modernization. The emphasis is about expanding the scope of public health, by supporting the role of population health in the development and delivery of programs and services. Methods: A sequential multi-phase mixed methods design will be used for this study. In the first qualitative phase, items for the survey will be generated from literature and focus groups with experts. The second qualitative phase will involve testing the instrument for validity. In the third quantitative phase a cross-sectional on-line survey, based on the eight key elements of a population health approach (Health Canada, 2001) will be sent to sexual health managers from each of the 36 health units, to measure the extent to which these elements are incorporated in public health units in Ontario. The fourth qualitative phase will be an explanatory case study that will involve the selection of two health units. The focus of this phase will be a follow-up with senior management and front-line staff, to explain their understanding of the factors (i.e. barriers and facilitators) that influenced implementing a population health approach in their sexual health programs. Expected Findings: Expect that there will be factors that are internal and external to the sexual health program that influence implementation. Conclusions: Findings will highlight that certain key elements of a population health approach are more actionable than others in the area of sexual health and will identify barriers and facilitators to conducting sexual health activities.

THE RELATIONSHIP BETWEEN PRIMARY CARE PRACTICE ORGANIZATIONAL CHARACTERISTICS AND CHRONIC DISEASE PREVENTION AND MANAGEMENT Christy Costanian, PhD; Simone Dahrouge, PhD; Michelle Howard, PhD; Sharon Johnston, MD, LLM; Joan Tranmer, PhD; Roberta Heale, DNP, PhD; Gina Agarwal, MBBS, PhD; Judith Brown, PhD; Richard Glazier, MD, MPH; Michael Green, MD, MPH; Laura Muldoon, MD; Jennifer Rayner, PhD; Carol Mulder, PhD; Laura Belstio, MAN. Statement of Purpose: This study aims to examine the association between inter-professional primary care practices’ organizational attributes and measures of quality of primary care. Methodology: An online population-based survey of primary care practices ((Community Health Centres (n=59) and Family Health Teams (n=66)) in Ontario was conducted in 2016 to capture organizational characteristics such as, model type, team composition, organizational vision, resources, context, structures, and practice service provision. Data from this cross sectional survey are being linked to health administrative data located at ICES. An ICES based overall chronic disease prevention and management (CDPM) composite score encompassing breast, cervical and colorectal cancer screening, diabetes/lipids screening, and diabetes management indicators has been previously developed using the Organization for Economic Cooperation and Development (OECD) approach. This approach involved: 1. Identification of potential indicators to include, 2. Principal Component Analyses to limit indicators to related measures, 3. Aggregation of measures into a single score, and 4. Score validation with hospitalization. The association between organizational attributes and the CDPM score will be examined using hierarchical linear modelling. The CDPM measured at the patient level will be the dependent variable, and the organizational attributes will be the exposure variables. Anticipated Results: Preliminary analyses show high variability in the organizational attributes across practices and a mean CDPM score of 65% (SD=0.42). Conclusions: Results from this study will highlight factors that are likely to drive quality in primary care practices, and can be used to inform practices and policy makers on future investments to strengthen primary care delivery.

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TECHNOLOGY-ENABLED COLLABORATIVE CARE FOR YOUTH: A FEASIBILITY STUDY Dr. Peter Selby, Dr. Osnat Melamed, Dr. Laura Lachance, Dr. Rebecca Carriere, Rosa Dragonetti, Gaya.Amirthavasar, Dr. Elizabeth Dettmer, Dr. George Foussias, Dr. Seena Grewal, Dr. Margaret Hahn, Dr. John Haltigan, Dr. Sean Kidd, Dr. Sara Ahola Kohut, Dr. Daphne Korczak, Dr. Benoit Mulsant, Athina Perivolaris, Dr. Trisha Tulloch, Dr. Aristotle Voineskos, Dr. Ian Zenlea Purpose: People with complex mental illness experience a 15-20 year shorter life expectancy due to premature cardiovascular disease. This presents a complex health issue that requires specialist attention to both mental and physical care. However, the healthcare system in Ontario currently lacks consistent collaboration between physical and mental health care, resulting in gaps in treatment and poor health outcomes. Methods: This mixed methods feasibility study engages youth with early episode psychosis. Participants are randomized into a high or low-intensity intervention for 12-weeks. Low-intensity participants get an account on an e-platform where they can access psychoeducational resources and attend live virtual webinars on modifiable health behaviours like diet, physical activity, and smoking, selected for their connection to cardiovascular risk factors. The platform also has a discussion board, goal setting tool, and programmable calendar. The high-intensity participants receive the low-intensity intervention with the additional support of weekly video calling with a Care Coordinator, supported by a Virtual Care Team consisting of psychiatrists, an addictions specialist, dietitian, occupational therapist, and peer mentor who provide case consultations weekly. Results: Preliminary results and a patient road-map from this ongoing feasibility study will be presented to outline progress of the study to date. Conclusions/Implications: This study seeks to assess engagement within this special population and improve satisfaction in provision of care. It presents an innovative way of bridging the gap in services between mental and physical care models through the use of technology, with important implications for extending the use of collaborative approaches to care.

THE RECOGNITION AND UTILIZATION OF TEAM MEMBERS’ SCOPE OF PRACTICE IN FAMILY HEALTH TEAMS Carol Mulder, PhD; Rebecca Clark, MSc; Laura Belsito, RD MAN; Cathy Thorpe, MA; Judith Belle Brown, PhD Purpose: The purpose of the study was to explore how Family Health Teams (FHTs) experience and respond to other team members’ scope of practice. Methods: This was a descriptive qualitative study using in-depth interviews, which were audiotaped and transcribed verbatim. Individual and team analysis was conducted. Participants were recruited from FHTs affiliated with the Association of Family Health Teams of Ontario. There were 53 participants including executive directors, family physicians, nurses, and interdisciplinary professionals from eight FHTs. Results: Findings illuminated several aspects to participants’ experiences of scope of practice. First is recognizing and respecting each team members’ scope of practice including both their professionalism and expertise. This involves creating opportunities to learn about each others’ scope of practice and subsequently helps build trust. Second is utilizing each team members’ scope of practice to optimize their collective skillsets in delivery of patient care. This includes dialoging around cases and dedicating time during team meetings to learn about new resources and programs. Third is acknowledging the limits of one’s own scope of practice and feeling comfortable in articulating these limits. Noteworthy were occasions for individuals to build their scope of practice via medical directives and engaging in new opportunities within the practice. This was intentional in some teams and could increase team members’ sense of being valued and appreciated. Conclusion: FHTs are intentionally trying to optimize team members’ scope by recognizing, utilizing and building on each individual team members’ scope of practice.

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IMPACT OF AN EMR DASHBOARD ON EMR DATA QUALITY AND PRACTICE PATTERNS Carol Mulder, Darren Larsen, Simon Ling, Jack Cooper Purpose: Determine how access to an EMR dashboard affects EMR data quality and prevention activities in primary care Methods: This was an observational cross-sectional study in Ontario primary care (various models of practice). The sample was 216 family physicians enrolled in the OntarioMD EMR Quality Dashboard Proof-of-Concept. The Dashboard summarizes physician’s own data on 30 performance indicators, with “drill-down” functionality to facilitate immediate action with relevant patients. The study examined changes in EMR data quality (eg completeness, consistency) and preventive activities (eg blood pressure & cancer screening) Results: Performance of each physician at 90 days post-enrolment showed the following changes from baseline (significant at p<0.01): standard diagnostic code assigned for 2.8% and 4.3

% more hypertensive and diabetic patients (respectively)

BMI and smoking status recorded 2.8% and 3.2% more patients, respectively

breast and colorectal cancer screening up-to-date for 2.3% and 2.9% more of eligible patients respectively

Physicians in Family Health Teams had higher baseline performance than physicians in other practice models. They also had less improvement post-enrolment (p<0.01). Physicians receiving “practice enhancement” coaching improved more than those who were not coached (p<0.01). Conclusions: Physicians who were given near-real-time private access to data summarizing their own performance on their own patients put better data in their EMRs (more complete and consistent data) and used that data to change their practices for the better (more screening). With the expansion of the dashboard project, more information may be available regarding changes in patient outcomes.

IDENTIFYING HELP-SEEKING PATTERNS IN PRIMARY CARE BY YOUNG PEOPLE WITH FIRST-EPISODE PSYCHOSIS Nicole Schoer, MSc Candidate, Rebecca Rodrigues, MSc, Jennifer Reid, MSc, Bridget L. Ryan, PhD, Daniel J. Lizotte, PhD, Richard Booth, PhD, Arlene G. MacDougall, PhD, & Kelly K. Anderson, PhD Introduction: Minimizing duration of untreated psychosis within the first few years after onset of psychosis are essential for improving prognosis. Leading up to the onset of psychosis, people often experience negative symptoms, cognitive disturbances, or psychotic-like experiences, suggesting that there may be help-seeking in primary care prior to first diagnosis. Methodology: Health administrative data from Ontario was used to construct a population-based retrospective cohort. These data were used to explore whether people with psychotic disorders had distinctive patterns of help-seeking from primary care in the six years preceding the first diagnosis of psychosis, relative to the general population. We compared the number of contacts with primary care, the timing of primary care visits, and the reason for the primary care visit. Results: People with psychosis visit primary care over twice as frequently during the 6 years leading up to first diagnosis, relative to the population comparison group matched on age, sex, and postal code. They have higher visit frequency across nearly all conditions, including mental health, physical conditions, and preventative health related reasons. The median number of primary care visits per year begins to increase approximately two years before diagnosis for people with psychosis, with no change for the comparison group over the six-year observation period. Latent Class Growth Modelling was used to identify distinct help-seeking profiles. Discussion: Findings from this study will help improve early detection and treatment of early psychosis in primary care, which has implications for improved social, educational, and professional development in young people with first-episode psychosis.

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A MIXED METHODS EVALUATION OF THE IMPLEMENTATION OF A CHRONIC OBSTRUCTIVE PULMONARY DISEASE MANAGEMENT PROGRAM Stefan Paciocco, MSc Candidate, Shannon Sibbald, PhD Purpose: Chronic obstructive pulmonary disease (COPD) is a prevalent chronic disease that requires comprehensive approaches to manage. Interprofessional teams are effective in providing care that meets the needs of patients. A COPD management model of care was implemented in an interprofessional primary healthcare team. Due to the model’s success (improved patient outcomes, decreased admissions, and decreased emergency department visits), it is now being spread to other primary care clinics across the province. The program began serving 12 family health teams (FHTs; a model of primary care delivery in the province of Ontario) in one geographic region and is now being spread to other FHTs in a different region using a peer-to-peer implementation approach. The purpose of this study is to observe the use of the peer-to-peer implementation approach and explore factors that support or hinder implementation. Methodology: A mixed methods constructivist case study methodology will be used, including focus groups, surveys, observation, document analysis, and interviews. Findings: This study is currently ongoing. Preliminary results indicate the importance of context, leadership, team cohesion and structural support will be essential facilitators to implementation. Conclusion: This study has significant implication for informing the spread and implementation of other similar models of interprofessional healthcare as well as understanding how interprofessional teams such as the one studied adapt and implement a COPD management model of care. It may provide a clearer and deeper understanding of the various mediating factors related to implementation as well as a better understanding of the function of peer-to-peer implementation.

A CROSS-CASE ANALYSIS OF THE IMPLEMENTATION OF INTERPROFESSIONAL CARE FOR COPD Shannon L. Sibbald, PhD; Bianca Ziegler, MSc(c); Rachelle Maskell, MSc; Karen Schouten, MSc Purpose: Successful chronic disease management requires interprofessional and team-based approaches, yet a lack of purposeful cultivation of teams has led to systematic inefficiencies in the delivery of care. We evaluated two teams implementing chronic disease management programs focused on chronic obstructive pulmonary disease (COPD). We aimed to understand the key facilitators and barriers to implementing integrated team-based care. Methodology: Mixed-methods data was collected on two Family Health Teams (FHTs) in Ontario, Canada through interviews, focus groups, observations, and document analysis. Kompier’s five-step framework was used to assess the factors that affected the implementation process and to understand interactions between providers, patients, and organizations. Results: Despite both teams’ high performance according to the framework, their independent implementation outcomes were very different. One team more successfully facilitated the sustainability and spread of their chronic disease management program by executing a flexible implementation, mitigating risks, implementing theory, fostering a supportive team culture, and securing buy-in from senior leadership. The other team pursued stringent and aggressive implementation, could not mitigate risk, struggled to integrate theory in implementation, and was unable to engage senior leadership. Conclusion: The evaluation results identified that evidence-based planning and evidence-based implementation are essential to facilitate sustainability. With regards to planning, there is a need to plan for sustainability from the outset to promote implementation success. By better understanding key facilitators and barriers to implementation, we can support the development and sustainability of high-performing, interprofessional health teams.

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CONTINUTING COLLABORATION: PLANNING, IMPLEMENTING, AND EVALUATING A DELIBERATIVE DIALOGUE WITH PUBLIC HEALTH, PRIMARY CARE, AND COMMUNITY RESIDENTS OF SOCIAL HOUSING Anita Kothari, PhD, Rebecca Ganann, RN, PhD, Tiffany Scurr, BAS, Nancy Murray, RN, PhD, Amanda Terry, PhD, Ivo Vasilev, PhD, Anne Rogers, PhD, Gina Agarwal, MD, PhD, Ruta Valaitis, RN, PhD Deliberative dialogues are a collaborative tool used in policy making to enhance knowledge exchange with input from various stakeholders and research evidence. A two-phase study replicates a Dutch step-wise approach to improve neighbourhood health through collaboration between residents of a social housing complex in Ontario, public health (PH), primary care (PC) and service providers. Phase 2 of this study develops a deliberative dialogue that aims to facilitate discussion and determine feasible next steps based on the community health profile developed in Phase 1. Preliminary results from Phase 2 are reported. Purpose: To determine whether a deliberative dialogue involving PH, PC, and community residents is an appropriate and feasible approach that leads to community and stakeholder collaboration. Additionally, to assess the impact of involving community residents in the planning and execution of a deliberative dialogue. Methodology: Collaboration on the development of and involvement in a deliberative dialogue is assessed using participant observation and key participant survey and interview responses. Thirty-five people have been invited to participate in the dialogue including PH, PC, researchers, service providers, and residents. Anticipated Results: We expect that the deliberative dialogue will strengthen collaboration between community stakeholders which may lead to actionable plans and increased understanding of community needs. Challenges, key features, and participant perceptions of the process will be reported. Conclusions: The findings of this study will demonstrate the viability of using a deliberative dialogue as the policy dialogue in this Dutch step-wise approach and provide recommendations for creating community-led deliberative dialogues involving PH and PC.

DESCRIBING QUALITY IMPROVEMENT INITIATIVES IN ONTARIO: RESULTS FROM A CROSS SECTIONAL STUDY ON PRIMARY HEALTHCARE PRACTICES Simone Dahrouge, PhD; Christy Costanian, PhD; Stefan Maksimovic, MSc; Jennifer Rayner, PhD; Carol Mulder, PhD; Laura Belstio, MAN; Gina Agarwal, MBBS, PhD; Richard Glazier, MD, MPH; Michael Green, MD, MPH. Statement of Purpose: To describe quality improvement (QI) activities performed by Community Health Centres (CHCs) (n=59) and Family Health Teams (FHTs) (n=66). Methodology: This was a cross-sectional study of primary care practices in Ontario. In summer 2016, all FHTs and CHCs were encouraged to complete an online survey by their respective organizations (AOHC and AFHTO) that captured practice structures across a number of domains, including QI activities. Three sub-domains of QI activities were captured: i) Internal Quality Improvement Processes (Processes, 8-questions), ii) Clinical Quality Improvement Initiatives (Initiatives, 4-questions), and iii) Audit and Patient Feedback (Feedback, 3-questions). Results: Overall scores were as follows: Processes: 75% (84%/68% for CHCs/FHTs), Initiatives 81%: (92%/72%, CHCs/FHTs), Feedback: 81% for (74%/85%, CHCs/FHTs). Mid-sized practices (# primary care providers) reported more QI activities across all domains (Overall: <6: 76%, 6-10: 84%, >10: 75%). There was a small gradient in QI across Rurality Index of Ontario groups (Overall: <10: 82%, 10-45: 78%, >45: 73%). In a multivariable regression, CHC model (9.5%, 95% CI: 2.9%, 16%) and mid-sized (9.9%, 95% CI: 3.0%, 17%) as compared to small-size, practices were independently associated with higher overall QI score. Conclusions: Results demonstrating the variability observed in terms of QI activities performed between practice types were presented to AOHC and AFHTO members, who provided insight into how their organizations’ policies for QI activities and other factors can explain the observed results. We will present details of our findings with a hypothesized explanation for variability across other contexts.

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THE PARTNERS IN RESEARCH COURSE: IMPACTING PATIENT-ORIENTED RESEARCH THROUGH AN EDUCATIONAL INTERVENTION Melissa Courvoisier, MEd; Lorraine Bayliss, MEd; Richelle Baddeliyanage, BSc; Shusmita Rashid, MPH; and Sharon E. Straus, MD, FRCPC, MSc, HBSc Statement of Purpose: Patient-oriented research (POR) makes research more relevant to targeted populations, yet limited training exists on how to conduct POR. Furthermore, there is a lack of evidence about effective capacity building for providing patients and researchers with the skills needed to collaborate on research. We describe course development and evaluation results of the Partners in Research (PiR) course, an online course bringing patients and researchers together to learn how to do POR. Methodology: PiR was delivered to 4 cohorts between 2017-2018, including 72 patients and 79 researchers. For each cohort, we evaluated the outcomes of the PiR course on participants’ knowledge, self-efficacy, intentions, and use of POR using surveys at 3 timepoints: pre-course, immediately post-course, and 6-months post-course. Utilizing the post-course survey which evaluated course satisfaction as well as through informal participant feedback, we also monitored the process of course design and delivery to improve each iteration. Results: Preliminary analysis indicates that participants’ knowledge, self-efficacy, intentions and use of POR increased after taking the course. Final results would be reported at the conference. The average course satisfaction score out of a 7-point Likert scale was 6.29 for cohort 1, 6.43 for cohort 2, 6.46 for cohort 3 and 6.45 for cohort 4. Using participant feedback, we continuously revised the course to make it more relevant and engaging. Conclusions: PiR aimed to build POR capacities among patients and researchers. Participation in the course increased participants’ knowledge, self-efficacy and intention to use POR compared to baseline.

IMPACT OF PRIMARY CARE BASED PATIENT’S MEDICAL HOME (PMH) MODELS OF CARE ON COST RELATED OUTCOMES: A RAPID REVIEW Tranmer, JE; Rotter, T; Safarov, A; Grewal, DJ; Keen, A; Alsius, A; Ritonja, J; Paré, G Statement of purpose: The Patient’s Medical Home (PMH) is a vision for family practice guided by a set of principles designed to strengthen primary care, enhance access and patient experience The main goal of this rapid review was to evaluate the financial impact of implementation of the PMH model of care. Methodology: Rapid narrative review. 1518 studies were retrieved from Ovid Medline, Ovid Embase, EconLit and the NHSEED databases. Following abstract and full text review, by 2 independent reviewers, we synthesized the data from 45 peer-reviewed studies. All studies evaluated PMH interventions that included 1) system level, primary care team-based, patient centered interventions led by family and 2) quantified cost or health care utilization (HCU) measures. Results: Overall, the PMH model was associated with improved HCU outcomes: 68% reported better HCU patterns, 20% reported mixed findings, 9% reported no changes, and only 4% reported poorer patterns. In terms of cost, 48.8% reported no change in cost, 22% reported lower cost, 12% reported mixed findings and 7% reported that increased cost. Combining the healthcare utilization and cost outcomes together, 48% of the studies show positive impact (i.e., better patterns of HCU combined with either lower or no change in cost). Conclusions: PMH interventions generally lead to better patient outcomes in terms of healthcare utilization with minimal or no impact on total care spending. PMH may be better value for health care investment.

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VALIDATING THE ALL ASPECTS OF HEALTH LITERACY SCALE IN SYRIAN REFUGEES Raafia Siddiqui, MSc; Bruce Newbold, PhD Objectives: The purpose of this study was to quantify current health literacy levels amongst a segment of the Syrian refugee population in Canada by translating and validating an existing comprehensive health literacy assessment tool, the All Aspects of Health Literacy Scale (AAHLS) into Arabic. This study determined functional, communicative and critical health literacy levels amongst Syrian refugees. Methods: The All Aspects of Health Literacy Scale (AAHLS) was translated to Arabic. Following back-translation, verification and piloting of the resulting tool, it was applied among a sub-sample of Syrian refugees residing in Toronto. The translated version was tested for internal consistency, content validity, and construct validity. Results: The overall scale had high content validity. Functional and critical health literacy was comparatively low but respondents seemed able to effectively communicate with their providers and access supports to read and fill in health documents. Significant correlates of low health literacy were presence of long-term health conditions and place of origin (country versus refugee camp). This study also validated the AAHLS in Arabic-speaking Syrian refugees, with a Cronbach’s alpha of 0.67 for the overall scale and 0.63 for health literacy items. Conclusion: The feasibility of this instrument as a self-administered screening tool in clinical or community settings was demonstrated with a high response rate of 0.86.

MANAGEMENT OF PHYSICAL HEALTH FOR PEOPLE WITH PSYCHOTIC DISORDERS IN PRIMARY CARE: A SYSTEMATIC REVIEW Joshua C Wiener, BHSc; Myanca D Rodrigues, BSc; Kelly K Anderson, PhD Objective: To determine how the physical health of people with psychotic disorders is managed by family physicians in primary care relative to people without psychotic disorders. Methodology: A comprehensive literature search was conducted in three electronic databases for articles published in English up to January 2019. Studies were included if: (1) the study design was observational; (2) the population was patients receiving primary care from family physicians; (3) the exposure was a psychotic disorder; (4) the comparison group was composed of persons without psychotic disorders; and (5) the outcome was management of a physical health condition. Data will be collected into established extraction tables, including study characteristics, subject characteristics, and study findings. Risk of bias will be assessed using the McMaster CLARITY tool. Study findings will be summarized descriptively. Preliminary Results: A total of 16 articles that met inclusion criteria have been identified. These articles describe retrospective cohort studies comparing patients with psychotic disorders to those without psychotic disorders. The types of physical health management evaluated were screening (10 articles) and monitoring (6 articles). The physical health conditions studied were diabetes (6 articles), cardiovascular disease (6 articles), and cancer (4 articles). Overall, the rate of monitoring and screening for physical health conditions appears to be lower among people with psychotic disorders relative to those without them.

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CARDIOVASCULAR RISK FACTORS IN SOCIAL HOUSING RESIDENTS: A MULTI-SITE DESCRIPTIVE SURVEY IN OLDER ADULTS IN ONTARIO, CANADA Gina Agarwal, PhD, Melissa Pirrie, MA, Janice Lee, BSc, Ricardo Angeles, PhD, Francine Marzanek, BSc, Manika Bhandari, BSc, Leila Harrison, BSc, Drashti Pete, BSc Purpose: To determine the prevalence of cardiovascular disease risk factors in older adults residing in social housing. Methodology: A cross-sectional study with interviewer-administered questionnaire and objective blood pressure measurement. Participants were residents aged 55 years and older in 25 subsidized social housing buildings in five Ontario regions. Outcome measures were prevalence of cardiovascular risk factors and association of these risk factors with measured high BP, controlled hypertension, and undiagnosed hypertension. Results: In 1101 residents, mean age was 72.4 years, 78% were female, 87% white, and 69% high school education or less. Self-reported risk factors included diabetes (29%), hypertension (59%), high cholesterol (44%), overweight (30%) or obese (39%), current smoker (29%), no daily fruit/vegetables (61%), and low physical activity (50%). Conditions that could indirectly impact cardiovascular health were limited mobility (58%), difficulty performing usual activities (41%), and pain/discomfort (70%). In a subset of 595 residents with BP measured, 304 (51%) had high BP. Less than post-secondary education, white ethnicity, older age (75+), and taking 1-4 medications were significantly associated with high BP (p<0.05). White ethnicity was significantly associated with increased odds of uncontrolled hypertension (p<0.05). Low physical activity and older age (75+) were associated with having increased odds of undiagnosed hypertension (p<0.05). Conclusion: There is a high prevalence of modifiable cardiovascular risk factors in this vulnerable population and the majority had either undiagnosed or unmanaged high BP. Although dietary risk factors were prevalent, they were not significantly associated with high BP, suggesting that other low-income factors may have a greater influence.

FALL RISK IN OLDER ADULTS RESIDING IN SOCIAL HOUSING IN ONTARIO Melissa Pirrie, MA, Guneet Saini, MPH, Ricardo Angeles, PhD, Francine Marzanek, BSc, Jenna Parascandalo, MPH, Manika Bhandari, BSc, Leila Harrison, BSc, Drashti Pete, BSc, Gina Agarwal, PhD Purpose: Older adults in social housing are a vulnerable population that may have unique risk factors for falls. This study aimed to describe the risk factors for falls, fear of falling, and seeking medical attention for falls in this population. Methodology: Data was collected through a community-based health assessment program. Using three pre-screening questions, individuals who screened positive for potential fall risk performed the Timed Up and Go (TUG) test. Logistic regression was used to analyse risk factors associated with falls in the past year, seeking medical attention for falls, fear of falling, and fall risk. Results: In 557 participants evaluated, 81.3% were female, 86.7% white, 50.0% did not complete high school, 56.2% had mobility issues, 34.5% had fallen in the past year, 34.5% sought medical attention for a fall, and 38.8% had a fear of falling. The TUG test was completed by 231 participants. Males had significantly reduced odds of seeking medical attention (OR=0.50, 95%CI 0.25-0.98) and having a fear of falling (OR=0.42, 95%CI 0.24-0.76); daily fruit/vegetable consumption was associated with decreased odds of falling (OR=0.55, 95%CI 0.37-0.83), and alcohol consumption was associated with increased fear of falling (OR=1.72, 95%CI 1.03-2.88). Conclusion: Older adults in social housing have unique risk factors for falls, such as low fruit and vegetable consumption. These findings can inform tailored fall prevention interventions for this population.

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EVALUATING A PRIMARY CARE GROUP-BASED MINDFULNESS PROGRAM: IS A PRAGMATIC, ACCESSIBLE, MENTAL WELLNESS PROGRAM EFFECTIVE? Yaswanta Gummadi, BHSc, Lawrence Mbuagbaw MD,PhD, Carlos Yu, MD, Anita Iacono, BSc, Sarah Macdonald, MPH, Elizabeth Alvarez, MD,PhD Purpose: Mood and anxiety disorders are among several chronic conditions rising in Ontario, Canada, as well as around the world. An emerging method for the long-term management and treatment of mental health conditions is mindfulness. Integrating mindfulness programs into primary care may provide benefits through reducing healthcare utilization for chronic diseases and comorbid mental health conditions. The study aims to evaluate the effectiveness of a pragmatic mindfulness-based stress reduction program in improving anxiety and depression in a generalizable comorbid population of primary care patients. Methodology: A retrospective chart review was conducted on past program participants. Using a generalized estimating equation (GEE) approach, regression models were built to assess the association between program attendance and GAD-7/PHQ-9 scores separately. Models included covariates of gender, age, marital status and employment status and time-confounding adjustments. Results: Program attendance (sessions) was negatively associated with both GAD-7 (β = -0.33) and PHQ-9 scores (β = -0.26), reflecting clinically significant reduction after 4-6 sessions (3-4 points). Age was also negatively associated with both anxiety and depression (β = -0.48, β = -0.49, respectively). Women reported significantly higher depression scores than men (β = 0.16) though anxiety was not associated with gender. Conclusions: This study demonstrates that group-based mindfulness programs can be effectively conducted in a primary care setting, to improve symptoms of both anxiety and depression. This study will inform the development of a prospective before-after study program, which may mitigate effects of time-confounding and reduce survivorship bias providing more substantive evidence of the program’s effectiveness.

PRIMARY STROKE PREVENTION: COMPARISON OF INFORMATION SHARING PREFERENCES OF PATIENTS WITH FAMILY PHYSICIANS’ PRACTICES Tazeen Qureshi, MBBS, MHSc (c); Gurpreet Jaswal, MD, FRCPC, MHSc (c); Saddaf Syed, BSc. (hon), OCT, PGCE, MHSc (c); Alejandro Fernandez, MD, MHSc (c); Richard Foty, PhD Statement of purpose: Stroke is the second leading cause of death and third leading cause of disability worldwide (1). The Canadian Stroke Best Practice Recommendations suggest a coordinated approach to public awareness and education of stroke and its risk factors because national and international trials indicate that knowledge about stroke and its risk management is poor amongst the public (2,3). Primary care physicians are appropriately situated to assess stroke risk of patients prior to the first stroke and initiate preventive strategies for them (4). However, there is sparse literature on the quality of communication between family physicians and patients regarding stroke risk based on patients’ risk factors. Our research will address this gap in the literature. Methodology: We are using the translational thinking framework TM which has two phases: 1) problem exploration phase 2) the translation and solution co-creation phase. This project will use mixed methods including demographic survey, stroke knowledge and communication questionnaire, and focus groups to explore the problem space with three stakeholder groups including at-risk patients, stroke survivors and family physicians. Results: Preliminary interviews conducted by our team found that at-risk patients in the community, have an inadequate understanding of the association of vascular disease risk factors with stroke indicating lower stroke literacy. Our results showed, that patients are not always informed about the connection between their risk factors and stroke by their family physicians. Conclusion: The results will provide an understanding of perceived barriers in discussion for promoting primary prevention of stroke.

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COLLABORATIVE KNOWLEDGE SHARING: DEVELOPING AND DISSEMINATING A VISUAL REPRESENTATION OF STANDARDS OF CARE FOR PREGNANT AND PARENTING ADOLESCENTS IN THE GREATER TORONTO AREA Barbara Chyzzy, RN, PhD; Simone Lebeuf MD, FRCPC; Gillian Thompson MN, NP-Paediatrics, Ashley Vandermorris MD, FRCPC; Sierra Henry, BA

Purpose: There are over 3000 children born to adolescent mothers in Ontario every year. Adolescent-led families have unique strengths and needs that must be effectively addressed by healthcare providers to promote optimal health and developmental outcomes. Methodology: This project has three phases. The objective of phase one examines stakeholder involved in health care for pregnant and parenting adolescents in the human-centered design of an infographic which meaningfully integrates evidence-based guidelines and lived-experiences. The second phase of the project seeks to examine whether a collaboratively developed infographic can improve healthcare provider awareness of best practices for the care of pregnant and parenting adolescents. The final phase of the project endeavors to engage youth ambassadors in a process of knowledge translation through dissemination of the infographic in various forums. Results: A design team consisting of community and academic healthcare providers, and adolescent mothers collaboratively developed an infographic depicting evidence-based best practices and local resources for adolescent parents. The infographic will be refined based on feedback from two advisory panels representing stakeholder groups. The infographic will then be piloted among a sample of end-users: family physicians, pediatricians, nurse-practitioners, midwives and obstetricians in neighbourhoods with high numbers of adolescent-led families. End-users will complete a survey probing change in awareness based on the infographic. Survey results will be compiled and descriptive statistics calculated. The final infographic will be launched during conferences and community education events. It will be made available online and promoted through social media. Youth ambassadors will be trained to disseminate the infographic as an advocacy tool. Conclusion: Knowledge translation activities will follow and will be an ongoing effort with community stakeholders and will continue into 2020.

IMPLEMENTATION & UPTAKE OF AN ONLINE PATIENT-ORIENTED PRIMARY HEALTH CARE RESEARCH TRAINING PROGRAM: PORTL-PHC A.L. Terry PhD, L. Bayliss MEd, L. Meredith MEd, S. Regan RN PhD, R. Van Hoorn MA Statement of Purpose: People seeking to conduct and use patient-oriented research (POR) in primary health care (PHC) want to learn how to best approach this work. To address this goal, we developed the Patient-Oriented Research Training and Learning – Primary Health Care (PORTL) on-line program. Methodology: An iterative process was used to develop, test, and implement PORTL-PHC. First, we conducted a comprehensive needs assessment to identify the knowledge needs of our potential users (all stakeholder groups). Next, we designed a series of modules using tested pedagogical and andragogic approaches for the content and program delivery. Finally, we conducted user tests of the content and the program interface. Initial steps to evaluate PORTL-PHC have been completed. Interim measures include number of users, program spread, and impact on users’ levels of POR knowledge and skills. Results: PORTL-PHC has four self-directed modules: patient priorities and engagement in PHC research; methods and examples of POR; skills development in POR; and, applying POR in the learner’s own context. To date, we have 100 program users; 50% are new to POR. The users represent every province in Canada. Users report that the program has enhanced their understanding of POR and their ability to use POR in their own context. Conclusions: PORTL-PHC successfully launched in January 2019. We anticipate further uptake and use as the program spreads. This will facilitate the training of a cadre of stakeholders who are prepared to conduct and use POR to improve PHC.healthy lifestyles program to address gaps in current care.

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COMMUNITY DEVELOPMENT IN ACTION: AN EVALUATION OF A PROGRAM TO ENHANCE SENIORS HEALTH IN SARNIA-LAMBTON Amanda L. Terry PhD, Leslie Meredith MEd, Amardeep Thind MD PhD, Shannon Sibbald PhD, Rebecca Clark MSc , Jennifer Graham MPH, Anita Trusler MPH Purpose: The 2-year program “Building an Integrated Community Care Model for Sarnia-Lambton” aims to support seniors receiving home and community care in Lambton County. The objectives are to 1) improve linkages between local health and social sectors with an online networking management system; 2) Improve information access for older adults, their families and caregivers; and, 3) Increase capacity for community outreach services that address the needs of priority clients in the community. Design: A goal-based evaluation design was used to assess the implementation and impact of the program with a logic model describing the anticipated inputs, activities, outputs and outcomes of the program to guide the overall evaluation. Interviews, focus groups, observations, reflective discussions and surveys were utilized for the evaluation. This poster focusses on the interviews/focus group conducted with the three organizations implementing the program to fulfill the third objective. Results: Themes were identified relating to challenges, facilitators and benefits project implementation. Themes identified as challenges were 1) Uncertainty and 2) Capacity. The projects were able to overcome these challenges, and with the identified facilitators of 1) Existing Services, 2) Adaptability and 3) Community Connectedness, successfully implement the projects. At this stage of implementation, the projects are already seeing benefits represented by the following themes 1) Prevention, 2) Education, 3) System Navigation, 4) Decrease in Social Isolation and 5) Maximizing Capacity and Access. Conclusions: The evaluation team was able to conduct a comprehensive assessment of the implementation of the program after 1 year. The identification of themes based on input from community projects will contribute to the understanding of successful implementation for future projects.

EXPLORING THE USE OF ELECTRONIC MEDICAL RECORD-INTEGRATED MACHINE LEARNING PREDICTIVE ANALYTICS IN PRIMARY CARE: A STUDY PROTOCOL TL Upshaw MHSc (Cand)., NH Crampton MD MSc (Cand), P Agarwal MD MSc (Cand), M Griever MD MSc, JA Shaw PT PhD, C Steele-Gray PhD, J Gibson PhD, R Upshur MA MD MSc, AD Pinto MD MSc Statement of purpose: Advances in artificial intelligence, particularly natural language processing and machine learning, offer an opportunity to utilize primary care electronic medical record (EMR) data for real-time prediction of patient outcomes that are otherwise difficult to anticipate. These include non-elective hospital admissions, avoidable emergency department (ED) visits and even premature mortality. Such predictive tools could be used by primary care providers (PCPs) to target and personalize interventions to high-risk patients, enhancing both population-based and patient-centred primary care. However, it is unclear how these novel tools will impact clinic workflows and change the experience of care for patients and providers. This qualitative study aims to clarify this ambiguity by engaging primary care providers (PCPs) and patients in the design and implementation of a machine-learning predictive analytic model for reducing unplanned hospital admissions. Methods: We will (1) conduct field observations of post-hospital discharge visits in three primary care practices; (2) conduct focus groups with PCPs and interviews with high-hospitalization risk patients to explore the potential impact of novel predictive tools on non-elective hospitalizations and ED visits, as well as the experience of providing and receiving care; and (3) use service design methods to integrate participants’ views into the design and implementation of a predictive tool. Results: We will describe current practices of primary care providers and patients in managing unplanned hospitalization risk, as well as their views on how EMR-integrated machine learning predictive analytics will impact these practices. Conclusions: This research will provide a formative example of setting-specific and user-centred development of an EMR-integrated machine learning predictive analytics tool.

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DEVELOPING A SURVEY TO DESCRIBE PHYSIOTHERAPY PRACTICE IN PRIMARY HEALTH CARE IN ONTARIO Kyle Vader PT MScPT, Rachelle Ashcroft MSW PhD, Brenna Bath PT PhD, Simon Decary PT PhD, Simon Deslauriers PT PhD Candidate, Francois Desmeules PT PhD, Catherine Donnelly OT Reg. (Ont.) PhD, Kadija Perrault PT PhD, Julie Richardson PT PhD, Sarah Wojkowski PT PhD, Jordan Miller PT PhD Statement of purpose: There has been substantial growth in the number of physiotherapists integrated within publicly funded primary health care organizations in Ontario since 2013. While there has been work done by the Ontario Physiotherapy Association and their advisory group to track physiotherapists working in these settings, there is no published environmental scan of physiotherapy practice among primary care in Ontario. The purpose of this survey is to: (1) describe physiotherapy practice among primary health care organizations in Ontario and (2) explore barriers and facilitators of integrating physiotherapy among primary health care organizations in Ontario. Methodology: The survey was designed based on two surveys: Dieticians of Canada and a survey exploring social worker roles in Ontario family health teams. Cognitive interviewing will be conducted with relevant stakeholders prior to administration. Physiotherapists practicing in publicly funded primary health care organizations in Ontario, including Family Health Teams, Community Health Centres, Aboriginal Health Centres, and Nurse Practitioner Led Clinics, will be surveyed. All physiotherapists practicing in publicly funded primary health care organizations in Ontario will be invited to participate via relevant email listservs. Results: An online survey was developed including 29 questions. Domains of the survey include: demographics, physiotherapy service delivery formats, physiotherapy practice areas, access to physiotherapy care, collaboration, and barriers and facilitators to integrating physiotherapy in primary health care organizations. Conclusions: An improved understanding of the physiotherapist role in primary health care organizations will help to appreciate current challenges and opportunities to improve physiotherapy service delivery in Ontario.

HOME-BASED PRIMARY CARE IN A RURAL ACADEMIC FAMILY MEDICINE CLINIC: A PROGRAM EVALUATION Sarah Davies BHSc, Joy Sun BSc, Paula Day RN, Jessica Howard MD, CCFP Dip P Derm Statement of purpose: To evaluate a newly developed, multidisciplinary, home-based primary care program and its impacts on patient care and resident learning. Methodology: Standardized interviews were conducted via telephone with patients and family members of patients who have participated in the home-based primary care program. Five neutral questions with standardized follow-up prompts were used, and responses were documented verbatim. Residents were surveyed on their experiences via electronic surveys which included a variety of closed and open-ended question formats. Results: Both patients and Family Medicine residents responded favourably to the home-based primary care program. Patients found the opportunity to be evaluated in their home environment beneficial in terms of both rapport-building and accuracy in assessment of functional status. Patients with reduced mobility benefitted especially from home visits, and the reduction in caregiver burden was a significant theme in interviews with both patients and families. Residents in the program reported positive learning experiences, recognition of the value of a practice which incorporates home visits, and an increasing level of comfort with providing home-based primary care. Finally, a skilled nurse coordinator was noted to be crucial to the success of the program. Conclusions: Home-based, multidisciplinary primary care is, in select patient populations, is a useful tool which can allow for reliable assessment of patient status, improved rapport, and caregiver burden reduction. Clinical education experiences are positive, patient-centred, and holistic for residents who are exposed to quality home-based care strategies.

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DIABETES RISK IN OLDER ADULTS LIVING IN SOCIAL HOUSING: A CROSS-SECTIONAL STUDY Gina Agarwal, PhD, Ying Zhu, MPH, Melissa Pirrie, MA, Ricardo Angeles, PhD, Manika Bhandari, BSc, Leila Harrison, BSc, Drashti Pete, BSc Purpose: This study aimed to describe the risk of developing prediabetes and diabetes based on the CANRISK and probable dysglycemia status measured by fasting capillary blood glucose (CBG) levels among residents aged 55 years and older of subsidized social housing. Methodology: This was a cross-sectional study and data collected from an ongoing community health program in social housing; the CP@clinic program. Community paramedics staffing the CP@clinic program conducted life-style related modifiable risk factor assessments among participating social housing residents who were 55 years or older. The CANRISK was administered to all participants and those identified as having a high risk for developing diabetes had a fasting CBG measurement. Results: There were 728 participants; the majority were women (80.5%), aged 65-84 (68.1%), white (85.4%), and had high school education or less (69.2%). Of the non-diabetic CP@clinic participants, 1.1% were found to have a low risk of developing diabetes, 30.1% moderate risk, and 66.6% high risk. Participants with high CANRISK category are more likely to be obese (53.7%), stressed (55.2%), physical inactive (50%), consume less fruits and vegetables (57.4%) compared with the moderate group (14.2%, 54.2%, 38.7%, and 61.3%, respectively). Conclusions: This study provides data regarding the diabetes risk in older adults living in social housing for future developments of effective strategies in the control of diabetic for this population.

PATIENT AND PHYSICIAN FACTORS ASSOCIATED WITH FIRST DIAGNOSIS OF PSYCHOTIC DISORDER IN PRIMARY CARE Kelly K. Anderson, PhD, Suzanne Archie, MD, Richard G. Booth, PhD, Chiachen Cheng, MD, Saadia Hameed, MD, Arlene G. MacDougall, MD, Lena Palaniyappan, MD, PhD, Bridget Ryan, PhD, Aristotle Voineskos, MD, & Rebecca Rodrigues, MSc Purpose: Increasing family physician involvement in psychosis identification may improve service-related outcomes. We sought to estimate the proportion of youth with early psychosis diagnosed in primary care, and to identify associated patient- and physician-level factors. Methodology: Using health administrative data, we constructed a retrospective cohort of people (14-35 years) with a first diagnosis of psychotic disorder in Ontario between 2005 and 2015. We identified mental health help-seeking attempts in primary care in the six-month period preceding the first diagnosis. Restricting the sample to people with primary care help-seeking, we used modified Poisson regression to model patient and physician characteristics associated with diagnosis in primary care. Results: Within the cohort (N=39,449), 59% had primary care help-seeking contacts. Of those, 59% received a first diagnosis in primary care (35% of total cohort), versus 41% in secondary/tertiary care (24% of total cohort). People who were older at psychosis onset were more likely to receive their first diagnosis in primary care, whereas males, immigrants, and people with a history of psychosocial comorbidities were less likely. Characteristics of physicians less likely to diagnose psychosis included females, urban practice, longer time since graduation, international medical school graduate, and non-mental health focused practice. Conclusions: Over half of people with early psychosis are seeking help in primary care, and one third receive a first diagnosis of psychosis in primary care. Physician subgroups less likely to diagnose psychosis could be targeted with continuing medical education to support family physicians in their role in pathways to care for early psychosis.

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UNDERSTANDING THE ROLE OF THE FAMILY PHYSICIAN IN EARLY PSYCHOSIS INTERVENTION: A MIXED METHODS PROTOCOL Kelly K. Anderson, PhD, Suzanne Archie, MD, Richard G. Booth, PhD, Chiachen Cheng, MD, Daniel Lizotte, PhD, Arlene G. MacDougall, MD , Ross Norman, PhD, Bridget L. Ryan, PhD, Amanda L. Terry, PhD, & Rebecca Rodrigues, MSc Purpose: Youth with first-episode psychosis who seek help from family physicians (FP) tend to have less aversive pathways to care, longer intervals to psychiatric care, and some receive ongoing psychiatric treatment. Our objective is to understand the role of the FP in help-seeking, recognition, and ongoing management of first-episode psychosis. Methodology: This mixed methods study incorporates health administrative data, electronic medical records (EMRs), and qualitative methodologies to study the role of the FP at three points on the pathway to care: (1) Help-Seeking: We will use health administrative data to examine FP access and patterns of primary care use preceding the first diagnosis of psychosis; (2) Recognition: We will identify first-onset cases of psychosis in health administrative data, and look back in linked primary care EMRs to define a “risk profile” for undetected cases; and (3) Management: We will examine service provision to identified cases using EMR data. We will conduct qualitative interviews and focus groups with key stakeholders to better understand the trends we are observing in the quantitative data. Results: Results from health administrative data indicate that 71% of people with first-episode psychosis have FP access. Furthermore, FPs are involved in help-seeking and/or diagnosis for two-thirds of people with first-episode psychosis. Results from EMRs and qualitative interviews are in progress. Conclusions: Our findings will provide an in-depth description of first-episode psychosis in primary care. This will inform strategies to build linkages between FPs and psychiatric services to improve transitions of care during the crucial early stages of psychosis.

FAMILY PHYSICIAN ACCESS AMONG YOUNG PEOPLE WITH FIRST-EPISODE PSYCHOSIS Kelly K. Anderson, PhD, Suzanne Archie, MD, Richard G. Booth, PhD, Chiachen Cheng, MD, Arlene G. MacDougall, MD, Lena Palaniyappan, MD, PhD, Bridget Ryan, PhD, Aristotle Voineskos, MD, & Rebecca Rodrigues, MSc Purpose: Family physicians (FP) are key players in facilitating access to psychiatric treatment for people with first-episode psychosis, however, approximately a third of people do not seek help for mental health reasons from primary care prior to the first diagnosis. Our objective was to estimate the proportion of people with first-episode psychosis who have access to a regular FP, and to examine factors associated with access. Methodology: Using health administrative data, we constructed a retrospective cohort of people aged 14 to 35 with a first diagnosis of psychosis in Ontario between 2005 and 2015. We randomly sampled four age- and sex-matched controls to compare FP access between people with first-episode psychosis and the general population. Among youth with first-episode psychosis, we examined factors associated with FP access using modified Poisson regression. Results: Among young people with first-episode psychosis (n=39,449), 28% did not have access to a FP at illness onset. People with psychotic disorders were more likely to have a regular FP relative to controls (PR=1.28; 95%CI=1.27, 1.29), however, adjustment for physical and psychosocial comorbidities attenuated this difference (PR=0.96; 95%CI=0.96, 0.97). Factors associated with a lower likelihood of FP access included younger age, male gender, low neighbourhood-level income quintile, residential instability, and migrant status. Conclusions: Approximately one in four people with first-episode psychosis lack regular FP access at psychosis onset, suggesting this may be a help-seeking barrier in primary care. Interventions aimed at improving access to FPs among vulnerable groups may improve pathways to care for youth with first-episode psychosis.

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PATTERNS OF PHYSICIAN SERVICES AMONG CHILDREN AND YOUTH SEEN IN COMMUNITY MENTAL HEALTH AGENCIES WITHIN ONTARIO Reid, G. J., Barwick, M., Cairney, J., Carter, J. R., Lau, C., Kurdyak, P., Mowat, S., Neufeld, R. W. J., Schraeder, K. E., St. Pierre, J., Stewart, S. L., Tobon, J. I., Vingilis, E.R., Yang, X.Q., & Zaric, G. S. Purpose: Many youth with mental health (MH) problems are involved with multiple providers and agencies. They may be cared for by physicians and at community child and youth mental health (CYMH) agencies. We examined utilization of outpatient MH care provided by physicians (family physicians, pediatricians, psychiatrists) among children and youth who received care in community CYMH agencies. Methodology: The design was a longitudinal, prospective, case-control study using administrative data. CYMH youth were 5-13 years old at their first CYMH visit between 2004-2006 (N=4,302). Office-based MH care by physicians (Ontario Health Insurance Plan data) were obtained for one year before, during (up to 4 years), and one year after CYMH services. Outpatient MH visit with physicians were compared with those of population-based age-, sex-, region-matched (N=12,906) controls. Results: Overall, more CYMH youth (69%) had at least one outpatient-MH visit than controls (19%). Of CYMH youth who had an outpatient-MH visit, the proportion of cases who saw a family physician was lower in the year after their CYMH involvement (50%), compared to before (59%) or during (58%). Cases were much more likely (p < .0001) than controls to have seen two or all three (39%) types of physicians, compared to controls (5%). Conclusion: The majority of youth receiving CYMH services are receiving MH care from family physicians at the same time. Many youth are receiving care from both CYMH agencies and multiple types of physicians. Family physicians likely have an important role to play in coordinating the care of these youth.

PRIORITIZING COORDINATION OF PRIMARY HEALTHCARE: A CASE REPORT Kimia Sedig, BHSc; Shannon L. Sbbald, PhD; Vaidehi Misra, BHSc Purpose: Primary care has acted as a foundation for multiple avenues of health system improvement, but support has been lacking in the coordination of care between primary and other healthcare sectors. The impact of weak care coordination on patients’ quality of care, access to care, and, ultimately, quality of life, cannot be ignored. This case report explores the implementation of an innovative coordination improvement model called the Primary Care Connections (PCC) in a clinic under a Family Health Team. Methodology: Members of the clinic who implemented the PCC model participated in semi-structured interviews and provided insights into the implementation process. Findings: The case report identifies three successes and three challenges associated with implementation of the PCC model. Successes associated with implementation of the PCC model relate to the relationship between healthcare providers and patients, communication, and the standard of care. Challenges associated with implementation of the PCC model relate to relationship dynamics within the clinic, sustainability, and evaluation metrics. Additionally, the case identifies three essential elements for the application of the PCC by other clinics. These elements encompass time-management and communication, bridging silos, and navigational skills. Conclusion: This case is a concrete example of a care coordination strategy in action. The PCC demonstrates that the experience of care coordination can be improved by facilitating communication within and across sectors, leveraging existing resources, and streamlining existing organizational structures. This case can act as a resource for other clinics and health organizations pursuing similar improvement in care coordination.