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Richard Birtwhistle - One of the best experts on this subject based on the ideXlab platform.
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Surveillance of concussion related injuries using electronic medical records from the canadian primary care Sentinel Surveillance network cpcssn a proof of concept
Canadian Journal of Public Health-revue Canadienne De Sante Publique, 2020Co-Authors: Richard Birtwhistle, John A Queenan, Felix Bang, Behrouz Ehsani, Steven R Mcfaull, Vicky C Chang, Minh T DoAbstract:INTRODUCTION: Previous studies on traumatic brain injury trends in Canada have been restricted to hospitalization and emergency department visit data. However, many concussion patients may present first, or only, to family physicians. Therefore, the true burden of concussion in Canada is likely underestimated. The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) collects information electronically from family physicians across Canada and can potentially be used for concussion Surveillance. The objective of this study is to explore the feasibility of using data collated from CPCSSN for concussion Surveillance purposes and examine trends over time. METHODS: Electronic medical records housed by CPCSSN from 2010 to 2016 were analyzed. Case ascertainment was determined through a combination of International Classification of Diseases, Ninth Revision codes. Binomial regression models were used to calculate the prevalence ratio (PR) of concussion by age, sex, deprivation indices, body mass index, and comorbid conditions. RESULTS: Concussion prevalence rates increased from 2010 to 2016 (p < 0.001). Based on 2016 data, males had a higher prevalence of concussion compared with females (PR = 1.09; 95% CI 1.02, 1.18), and those aged 10-14 (PR = 8.52; 95% confidence interval [CI] 6.34, 11.44) and 15-19 (PR = 7.75; 95% CI 5.84, 10.28) had higher prevalence of concussion compared with those aged 0-4 years. CONCLUSION: This pilot study demonstrates the feasibility of using the CPCSSN system for Surveillance of concussion in the Canadian population. The initial findings on prevalence are in agreement with previous studies that have used hospitalization or emergency department data.
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Surveillance of concussion related injuries using electronic medical records from the canadian primary care Sentinel Surveillance network cpcssn a proof of concept
Canadian Journal of Public Health-revue Canadienne De Sante Publique, 2020Co-Authors: Felix Bang, John A Queenan, Behrouz Ehsani, Steven R Mcfaull, Vicky C Chang, Richard BirtwhistleAbstract:Previous studies on traumatic brain injury trends in Canada have been restricted to hospitalization and emergency department visit data. However, many concussion patients may present first, or only, to family physicians. Therefore, the true burden of concussion in Canada is likely underestimated. The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) collects information electronically from family physicians across Canada and can potentially be used for concussion Surveillance. The objective of this study is to explore the feasibility of using data collated from CPCSSN for concussion Surveillance purposes and examine trends over time. Electronic medical records housed by CPCSSN from 2010 to 2016 were analyzed. Case ascertainment was determined through a combination of International Classification of Diseases, Ninth Revision codes. Binomial regression models were used to calculate the prevalence ratio (PR) of concussion by age, sex, deprivation indices, body mass index, and comorbid conditions. Concussion prevalence rates increased from 2010 to 2016 (p < 0.001). Based on 2016 data, males had a higher prevalence of concussion compared with females (PR = 1.09; 95% CI 1.02, 1.18), and those aged 10–14 (PR = 8.52; 95% confidence interval [CI] 6.34, 11.44) and 15–19 (PR = 7.75; 95% CI 5.84, 10.28) had higher prevalence of concussion compared with those aged 0–4 years. This pilot study demonstrates the feasibility of using the CPCSSN system for Surveillance of concussion in the Canadian population. The initial findings on prevalence are in agreement with previous studies that have used hospitalization or emergency department data.
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representativeness of patients and providers in the canadian primary care Sentinel Surveillance network a cross sectional study
CMAJ Open, 2016Co-Authors: John A Queenan, Tyler Williamson, Shahriar Khan, Rachael Morkem, Neil Drummond, Stephanie Garies, Richard BirtwhistleAbstract:BACKGROUND The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) has established a national repository of primary care patient health data that is used for both Surveillance and research. Our main objective was to determine how representative the data for patients and primary care practitioners in the CPCSSN are when compared with the Canadian population. METHODS In this cross-sectional study, we compared the 2013 CPCSSN patient sample with age and sex information from the 2011 census. The CPCSSN provider sample in 2013 was compared with the 2013 National Physician Survey. Results were stratified by 5 clinically relevant age categories and sex, and male-to-female ratios were calculated. RESULTS Patients who were 65 years of age and older represented 20.4% of the CPCSSN sample but only represented 14.8% of the Canadian population (2011 census). Among young adults (20-39 yr), 39.3% fewer men than women visited their primary care practitioner within 2 years. CPCSSN sample practitioners were more likely to be under 45 years of age, more likely to be female and more likely to be in an academic practice. INTERPRETATION It is important to consider adjusting for age and sex when using CPCSSN data. CPCSSN practitioners are likely not representative of family physicians; therefore, CPCSSN needs to recruit more nonacademic practices, community clinics and practices that have a larger proportion of male providers.
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prevalence and management of hypertension in primary care practices with electronic medical records a report from the canadian primary care Sentinel Surveillance network
CMAJ Open, 2015Co-Authors: Marshall Godwin, Tyler Williamson, Shahriar Khan, Rachael Morkem, Janusz Kaczorowski, Shabnam Asghari, Martin Dawes, Richard BirtwhistleAbstract:Background: Most epidemiologic reports on hypertension in Canada are based on data from surveys or on administrative data. We report on the prevalence and management of hypertension based on data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), which consists of validated, national, point-of-care data from primary care practices. Methods: We included CPCSSN data as of Dec. 31, 2012, for patients 18 years and older who had at least 1 clinical encounter during the previous 2 years with one of the 444 family physicians and nurse-practitioners who participate in the CPCSSN. We calculated the prevalence of hypertension, the proportion of patients who achieved blood pressure targets, the number of encounters with primary care providers, comorbidities and pharmacologic management. Results: Of the 250 346 patients who met the eligibility criteria, 57 180 (22.8%) had a diagnosis of hypertension. Of the 44 981 patients for whom blood pressure data were available, 35 094 (78.0%) had achieved both targets for systolic (≤ 140 mm Hg) and diastolic (≤ 90 mm Hg) pressure. Compared with patients who did not have a hypertension diagnosis, those with hypertension were significantly more likely to have a comorbidity and visited their primary care provider more often. Among the patients with hypertension, 12.1% were not taking antihypertensive medications; nearly two-thirds (61.7%) had their condition controlled with 1 or 2 drugs. Interpretation: The prevalence of hypertension based on CPCSSN data was similar to estimates from the Canadian Health Measures Survey. Although achievement of blood pressure targets was high, patients with hypertension had more comorbidities and saw their primary care provider more often than those without hypertension.
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prevalence and management of osteoarthritis in primary care an epidemiologic cohort study from the canadian primary care Sentinel Surveillance network
CMAJ Open, 2015Co-Authors: Richard Birtwhistle, Tyler Williamson, Shahriar Khan, Rachael Morkem, Michael E Green, George Peat, Kelvin P JordanAbstract:Background Osteoarthritis is a common chronic condition that affects many older Canadians and is a considerable cause of disability. Our objective was to describe the epidemiology of osteoarthritis in patients aged 30 years and older using electronic medical records (EMRs) in a Canadian primary care population. Methods In this retrospective cohort study, we analyzed the EMRs of 207 610 patients over 30 years of age (extracted on December 31, 2012) who had at least one clinic visit during the preceding 2 years. We calculated the age-sex standardized prevalence of diagnosed osteoarthritis and its association with comorbidities and covariates available in the Canadian Primary Care Sentinel Surveillance Network database. Results The estimated prevalence of diagnosed osteoarthritis was 14.2% (15.6% among women, 12.4% among men). The diagnosis of osteoarthritis was associated with several comorbidities: hypertension (prevalence ratio [PR] 1.17, 95% confidence interval [CI] 1.15-1.18), depression (PR 1.26, 95% CI 1.22-1.3), chronic obstructive pulmonary disease (COPD) (PR 1.16, 95% CI 1.11-1.21) and epilepsy (PR 1.27, 95% CI 1.13-1.43). In addition, 56.6% of patients had received a prescription for a range of nonsteroidal anti-inflammatory drugs, 45% of which were topical. Opioid medications were prescribed to 33% of patients for pain management. Conclusion Osteoarthritis is a common disease in middle-aged and older Canadians. It is more common in women than in men and is associated with comorbid conditions. Most patients with osteoarthritis received pharmacotherapy for inflammation and pain management. As the Canadian population ages, osteoarthritis will become an increasing burden for individuals and the health care system.
Michelle Greiver - One of the best experts on this subject based on the ideXlab platform.
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prevalence and epidemiology of diabetes in canadian primary care practices a report from the canadian primary care Sentinel Surveillance network
Canadian Journal of Diabetes, 2014Co-Authors: Michelle Greiver, Tyler Williamson, David Barber, Richard Birtwhistle, Babak Aliarzadeh, Shahriar Khan, Rachael Morkem, Gayle HalasAbstract:Objective: The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) is a large, validated national primary care Electronic Medical Records (EMR)-based database. Our objective was to describe the epidemiology of diabetes in this Canadian sample. Methods: We analyzed the records of 272469patients10years ofageand older,withat least 1 primarycare clinical encounter between January 1, 2011, and December 31, 2012. We calculated the age-gender standardized prevalence of diabetes. We compared health care utilization and comorbidities for 7 selected chronic conditions inpatients with and without diabetes. We also examined patterns of medication usage. Results: The estimated population prevalence of diabetes was 7.6%. Specifically, we studied 25 425 people with diabetes who had at least 1 primary care encounter in 2 years. On average, patients with diabetes had 1.42 times as many practice encounters as patients without diabetes (95% CI 1.42 to 1.43, p<0.0001). Patients with diabetes had 1.29 times as many other comorbid conditions as those without diabetes (95% CI 1.27 to 1.31, p<0.0001). We found that 85.2% of patients taking hypoglycemic medications were taking metformin, and 51.8% were taking 2 or more classes of medications. Conclusions: This study is the first national Canadian report describing the epidemiology of diabetes using primary care EMR-based data. We found significantly higher rates of primary care use, and greater numbers of comorbidities in patients with diabetes. Most patients were on first-line hypoglycemic medications. Data routinely recorded in EMRs can be used for Surveillance of chronic diseases such as diabetes in Canada. These results can enable comparisons with other national EMR-based datasets. 2014 Canadian Diabetes Association resume
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building a pan canadian primary care Sentinel Surveillance network initial development and moving forward
Journal of the American Board of Family Medicine, 2009Co-Authors: Richard Birtwhistle, Michelle Greiver, Karim Keshavjee, Anita Lambertlanning, Marshall Godwin, Donna Manca, Claudia LagaceAbstract:The development of a pan-Canadian network of primary care research networks for studying issues in primary care has been the vision of Canadian primary care researchers for many years. With the opportunity for funding from the Public Health Agency of Canada and the support of the College of Family Physicians of Canada, we have planned and developed a project to assess the feasibility of a network of networks of family medicine practices that exclusively use electronic medical records. The Canadian Primary Care Sentinel Surveillance Network will collect longitudinal data from practices across Canada to assess the primary care epidemiology and management of 5 chronic diseases: hypertension, diabetes, depression, chronic obstructive lung disease, and osteoarthritis. This article reports on the 7-month first phase of the feasibility project of 7 regional networks in Canada to develop a business plan, including governance, mission, and vision; develop memorandum of agreements with the regional networks and their respective universities; develop and obtain approval of research ethics board applications; develop methods for data extraction, a Canadian Primary Care Sentinel Surveillance Network database, and initial assessment of the types of data that can be extracted; and recruitment of 10 practices at each network that use electronic medical records. The project will continue in phase 2 of the feasibility testing until April 2010.
Shahriar Khan - One of the best experts on this subject based on the ideXlab platform.
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representativeness of patients and providers in the canadian primary care Sentinel Surveillance network a cross sectional study
CMAJ Open, 2016Co-Authors: John A Queenan, Tyler Williamson, Shahriar Khan, Rachael Morkem, Neil Drummond, Stephanie Garies, Richard BirtwhistleAbstract:BACKGROUND The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) has established a national repository of primary care patient health data that is used for both Surveillance and research. Our main objective was to determine how representative the data for patients and primary care practitioners in the CPCSSN are when compared with the Canadian population. METHODS In this cross-sectional study, we compared the 2013 CPCSSN patient sample with age and sex information from the 2011 census. The CPCSSN provider sample in 2013 was compared with the 2013 National Physician Survey. Results were stratified by 5 clinically relevant age categories and sex, and male-to-female ratios were calculated. RESULTS Patients who were 65 years of age and older represented 20.4% of the CPCSSN sample but only represented 14.8% of the Canadian population (2011 census). Among young adults (20-39 yr), 39.3% fewer men than women visited their primary care practitioner within 2 years. CPCSSN sample practitioners were more likely to be under 45 years of age, more likely to be female and more likely to be in an academic practice. INTERPRETATION It is important to consider adjusting for age and sex when using CPCSSN data. CPCSSN practitioners are likely not representative of family physicians; therefore, CPCSSN needs to recruit more nonacademic practices, community clinics and practices that have a larger proportion of male providers.
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chronic obstructive pulmonary disease in primary care an epidemiologic cohort study from the canadian primary care Sentinel Surveillance network
CMAJ Open, 2015Co-Authors: Michael E Green, Tyler Williamson, Shahriar Khan, Nandini Natajaran, Denis E Odonnell, Jyoti Kotecha, Andrew CaveAbstract:Methods: The Canadian Primary Care Sentinel Surveillance Network is a national “network of networks” whose member practices use electronic medical records (EMRs). At the time of the study, it included data from 444 physicians from 10 networks in 8 provinces. We conducted an epidemiologic cohort study of all patients who had EMR data collected by the network at the end of 2012. Validated case-finding algorithms were used to identify cases of COPD. We used descriptive statistics and multivariate modelling analyses to calculate the prevalence of COPD, its association with key demographic factors and comorbidities, and patterns of medication prescribing. Results: The observed prevalence of COPD was 4.0% (10 043/250 346), which represents a population prevalence of 3.4% using age-sex standardization. Comorbidity was common, with prevalence ratios ranging from 1.1 for the presence of a single comorbid condition to 1.9 for 4 or more comorbid conditions. Anticholinergic agents (63%), short- (48%) and long-acting (38%) β-agonists and inhaled corticosteroids (41%) were the most commonly used medications. Interpretation: The prevalence of physician-diagnosed COPD in Canadian primary care practices was similar to that reported in other practice-based studies at about 3%–4%. Most patients had comorbid conditions and were taking multiple medications. EMR data may be useful to assess both the epidemiology and management of COPD in primary care practices.
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prevalence and management of hypertension in primary care practices with electronic medical records a report from the canadian primary care Sentinel Surveillance network
CMAJ Open, 2015Co-Authors: Marshall Godwin, Tyler Williamson, Shahriar Khan, Rachael Morkem, Janusz Kaczorowski, Shabnam Asghari, Martin Dawes, Richard BirtwhistleAbstract:Background: Most epidemiologic reports on hypertension in Canada are based on data from surveys or on administrative data. We report on the prevalence and management of hypertension based on data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), which consists of validated, national, point-of-care data from primary care practices. Methods: We included CPCSSN data as of Dec. 31, 2012, for patients 18 years and older who had at least 1 clinical encounter during the previous 2 years with one of the 444 family physicians and nurse-practitioners who participate in the CPCSSN. We calculated the prevalence of hypertension, the proportion of patients who achieved blood pressure targets, the number of encounters with primary care providers, comorbidities and pharmacologic management. Results: Of the 250 346 patients who met the eligibility criteria, 57 180 (22.8%) had a diagnosis of hypertension. Of the 44 981 patients for whom blood pressure data were available, 35 094 (78.0%) had achieved both targets for systolic (≤ 140 mm Hg) and diastolic (≤ 90 mm Hg) pressure. Compared with patients who did not have a hypertension diagnosis, those with hypertension were significantly more likely to have a comorbidity and visited their primary care provider more often. Among the patients with hypertension, 12.1% were not taking antihypertensive medications; nearly two-thirds (61.7%) had their condition controlled with 1 or 2 drugs. Interpretation: The prevalence of hypertension based on CPCSSN data was similar to estimates from the Canadian Health Measures Survey. Although achievement of blood pressure targets was high, patients with hypertension had more comorbidities and saw their primary care provider more often than those without hypertension.
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prevalence and management of osteoarthritis in primary care an epidemiologic cohort study from the canadian primary care Sentinel Surveillance network
CMAJ Open, 2015Co-Authors: Richard Birtwhistle, Tyler Williamson, Shahriar Khan, Rachael Morkem, Michael E Green, George Peat, Kelvin P JordanAbstract:Background Osteoarthritis is a common chronic condition that affects many older Canadians and is a considerable cause of disability. Our objective was to describe the epidemiology of osteoarthritis in patients aged 30 years and older using electronic medical records (EMRs) in a Canadian primary care population. Methods In this retrospective cohort study, we analyzed the EMRs of 207 610 patients over 30 years of age (extracted on December 31, 2012) who had at least one clinic visit during the preceding 2 years. We calculated the age-sex standardized prevalence of diagnosed osteoarthritis and its association with comorbidities and covariates available in the Canadian Primary Care Sentinel Surveillance Network database. Results The estimated prevalence of diagnosed osteoarthritis was 14.2% (15.6% among women, 12.4% among men). The diagnosis of osteoarthritis was associated with several comorbidities: hypertension (prevalence ratio [PR] 1.17, 95% confidence interval [CI] 1.15-1.18), depression (PR 1.26, 95% CI 1.22-1.3), chronic obstructive pulmonary disease (COPD) (PR 1.16, 95% CI 1.11-1.21) and epilepsy (PR 1.27, 95% CI 1.13-1.43). In addition, 56.6% of patients had received a prescription for a range of nonsteroidal anti-inflammatory drugs, 45% of which were topical. Opioid medications were prescribed to 33% of patients for pain management. Conclusion Osteoarthritis is a common disease in middle-aged and older Canadians. It is more common in women than in men and is associated with comorbid conditions. Most patients with osteoarthritis received pharmacotherapy for inflammation and pain management. As the Canadian population ages, osteoarthritis will become an increasing burden for individuals and the health care system.
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prevalence and epidemiology of diabetes in canadian primary care practices a report from the canadian primary care Sentinel Surveillance network
Canadian Journal of Diabetes, 2014Co-Authors: Michelle Greiver, Tyler Williamson, David Barber, Richard Birtwhistle, Babak Aliarzadeh, Shahriar Khan, Rachael Morkem, Gayle HalasAbstract:Objective: The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) is a large, validated national primary care Electronic Medical Records (EMR)-based database. Our objective was to describe the epidemiology of diabetes in this Canadian sample. Methods: We analyzed the records of 272469patients10years ofageand older,withat least 1 primarycare clinical encounter between January 1, 2011, and December 31, 2012. We calculated the age-gender standardized prevalence of diabetes. We compared health care utilization and comorbidities for 7 selected chronic conditions inpatients with and without diabetes. We also examined patterns of medication usage. Results: The estimated population prevalence of diabetes was 7.6%. Specifically, we studied 25 425 people with diabetes who had at least 1 primary care encounter in 2 years. On average, patients with diabetes had 1.42 times as many practice encounters as patients without diabetes (95% CI 1.42 to 1.43, p<0.0001). Patients with diabetes had 1.29 times as many other comorbid conditions as those without diabetes (95% CI 1.27 to 1.31, p<0.0001). We found that 85.2% of patients taking hypoglycemic medications were taking metformin, and 51.8% were taking 2 or more classes of medications. Conclusions: This study is the first national Canadian report describing the epidemiology of diabetes using primary care EMR-based data. We found significantly higher rates of primary care use, and greater numbers of comorbidities in patients with diabetes. Most patients were on first-line hypoglycemic medications. Data routinely recorded in EMRs can be used for Surveillance of chronic diseases such as diabetes in Canada. These results can enable comparisons with other national EMR-based datasets. 2014 Canadian Diabetes Association resume
Tyler Williamson - One of the best experts on this subject based on the ideXlab platform.
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representativeness of patients and providers in the canadian primary care Sentinel Surveillance network a cross sectional study
CMAJ Open, 2016Co-Authors: John A Queenan, Tyler Williamson, Shahriar Khan, Rachael Morkem, Neil Drummond, Stephanie Garies, Richard BirtwhistleAbstract:BACKGROUND The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) has established a national repository of primary care patient health data that is used for both Surveillance and research. Our main objective was to determine how representative the data for patients and primary care practitioners in the CPCSSN are when compared with the Canadian population. METHODS In this cross-sectional study, we compared the 2013 CPCSSN patient sample with age and sex information from the 2011 census. The CPCSSN provider sample in 2013 was compared with the 2013 National Physician Survey. Results were stratified by 5 clinically relevant age categories and sex, and male-to-female ratios were calculated. RESULTS Patients who were 65 years of age and older represented 20.4% of the CPCSSN sample but only represented 14.8% of the Canadian population (2011 census). Among young adults (20-39 yr), 39.3% fewer men than women visited their primary care practitioner within 2 years. CPCSSN sample practitioners were more likely to be under 45 years of age, more likely to be female and more likely to be in an academic practice. INTERPRETATION It is important to consider adjusting for age and sex when using CPCSSN data. CPCSSN practitioners are likely not representative of family physicians; therefore, CPCSSN needs to recruit more nonacademic practices, community clinics and practices that have a larger proportion of male providers.
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chronic obstructive pulmonary disease in primary care an epidemiologic cohort study from the canadian primary care Sentinel Surveillance network
CMAJ Open, 2015Co-Authors: Michael E Green, Tyler Williamson, Shahriar Khan, Nandini Natajaran, Denis E Odonnell, Jyoti Kotecha, Andrew CaveAbstract:Methods: The Canadian Primary Care Sentinel Surveillance Network is a national “network of networks” whose member practices use electronic medical records (EMRs). At the time of the study, it included data from 444 physicians from 10 networks in 8 provinces. We conducted an epidemiologic cohort study of all patients who had EMR data collected by the network at the end of 2012. Validated case-finding algorithms were used to identify cases of COPD. We used descriptive statistics and multivariate modelling analyses to calculate the prevalence of COPD, its association with key demographic factors and comorbidities, and patterns of medication prescribing. Results: The observed prevalence of COPD was 4.0% (10 043/250 346), which represents a population prevalence of 3.4% using age-sex standardization. Comorbidity was common, with prevalence ratios ranging from 1.1 for the presence of a single comorbid condition to 1.9 for 4 or more comorbid conditions. Anticholinergic agents (63%), short- (48%) and long-acting (38%) β-agonists and inhaled corticosteroids (41%) were the most commonly used medications. Interpretation: The prevalence of physician-diagnosed COPD in Canadian primary care practices was similar to that reported in other practice-based studies at about 3%–4%. Most patients had comorbid conditions and were taking multiple medications. EMR data may be useful to assess both the epidemiology and management of COPD in primary care practices.
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prevalence and management of hypertension in primary care practices with electronic medical records a report from the canadian primary care Sentinel Surveillance network
CMAJ Open, 2015Co-Authors: Marshall Godwin, Tyler Williamson, Shahriar Khan, Rachael Morkem, Janusz Kaczorowski, Shabnam Asghari, Martin Dawes, Richard BirtwhistleAbstract:Background: Most epidemiologic reports on hypertension in Canada are based on data from surveys or on administrative data. We report on the prevalence and management of hypertension based on data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), which consists of validated, national, point-of-care data from primary care practices. Methods: We included CPCSSN data as of Dec. 31, 2012, for patients 18 years and older who had at least 1 clinical encounter during the previous 2 years with one of the 444 family physicians and nurse-practitioners who participate in the CPCSSN. We calculated the prevalence of hypertension, the proportion of patients who achieved blood pressure targets, the number of encounters with primary care providers, comorbidities and pharmacologic management. Results: Of the 250 346 patients who met the eligibility criteria, 57 180 (22.8%) had a diagnosis of hypertension. Of the 44 981 patients for whom blood pressure data were available, 35 094 (78.0%) had achieved both targets for systolic (≤ 140 mm Hg) and diastolic (≤ 90 mm Hg) pressure. Compared with patients who did not have a hypertension diagnosis, those with hypertension were significantly more likely to have a comorbidity and visited their primary care provider more often. Among the patients with hypertension, 12.1% were not taking antihypertensive medications; nearly two-thirds (61.7%) had their condition controlled with 1 or 2 drugs. Interpretation: The prevalence of hypertension based on CPCSSN data was similar to estimates from the Canadian Health Measures Survey. Although achievement of blood pressure targets was high, patients with hypertension had more comorbidities and saw their primary care provider more often than those without hypertension.
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prevalence and management of osteoarthritis in primary care an epidemiologic cohort study from the canadian primary care Sentinel Surveillance network
CMAJ Open, 2015Co-Authors: Richard Birtwhistle, Tyler Williamson, Shahriar Khan, Rachael Morkem, Michael E Green, George Peat, Kelvin P JordanAbstract:Background Osteoarthritis is a common chronic condition that affects many older Canadians and is a considerable cause of disability. Our objective was to describe the epidemiology of osteoarthritis in patients aged 30 years and older using electronic medical records (EMRs) in a Canadian primary care population. Methods In this retrospective cohort study, we analyzed the EMRs of 207 610 patients over 30 years of age (extracted on December 31, 2012) who had at least one clinic visit during the preceding 2 years. We calculated the age-sex standardized prevalence of diagnosed osteoarthritis and its association with comorbidities and covariates available in the Canadian Primary Care Sentinel Surveillance Network database. Results The estimated prevalence of diagnosed osteoarthritis was 14.2% (15.6% among women, 12.4% among men). The diagnosis of osteoarthritis was associated with several comorbidities: hypertension (prevalence ratio [PR] 1.17, 95% confidence interval [CI] 1.15-1.18), depression (PR 1.26, 95% CI 1.22-1.3), chronic obstructive pulmonary disease (COPD) (PR 1.16, 95% CI 1.11-1.21) and epilepsy (PR 1.27, 95% CI 1.13-1.43). In addition, 56.6% of patients had received a prescription for a range of nonsteroidal anti-inflammatory drugs, 45% of which were topical. Opioid medications were prescribed to 33% of patients for pain management. Conclusion Osteoarthritis is a common disease in middle-aged and older Canadians. It is more common in women than in men and is associated with comorbid conditions. Most patients with osteoarthritis received pharmacotherapy for inflammation and pain management. As the Canadian population ages, osteoarthritis will become an increasing burden for individuals and the health care system.
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prevalence and epidemiology of diabetes in canadian primary care practices a report from the canadian primary care Sentinel Surveillance network
Canadian Journal of Diabetes, 2014Co-Authors: Michelle Greiver, Tyler Williamson, David Barber, Richard Birtwhistle, Babak Aliarzadeh, Shahriar Khan, Rachael Morkem, Gayle HalasAbstract:Objective: The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) is a large, validated national primary care Electronic Medical Records (EMR)-based database. Our objective was to describe the epidemiology of diabetes in this Canadian sample. Methods: We analyzed the records of 272469patients10years ofageand older,withat least 1 primarycare clinical encounter between January 1, 2011, and December 31, 2012. We calculated the age-gender standardized prevalence of diabetes. We compared health care utilization and comorbidities for 7 selected chronic conditions inpatients with and without diabetes. We also examined patterns of medication usage. Results: The estimated population prevalence of diabetes was 7.6%. Specifically, we studied 25 425 people with diabetes who had at least 1 primary care encounter in 2 years. On average, patients with diabetes had 1.42 times as many practice encounters as patients without diabetes (95% CI 1.42 to 1.43, p<0.0001). Patients with diabetes had 1.29 times as many other comorbid conditions as those without diabetes (95% CI 1.27 to 1.31, p<0.0001). We found that 85.2% of patients taking hypoglycemic medications were taking metformin, and 51.8% were taking 2 or more classes of medications. Conclusions: This study is the first national Canadian report describing the epidemiology of diabetes using primary care EMR-based data. We found significantly higher rates of primary care use, and greater numbers of comorbidities in patients with diabetes. Most patients were on first-line hypoglycemic medications. Data routinely recorded in EMRs can be used for Surveillance of chronic diseases such as diabetes in Canada. These results can enable comparisons with other national EMR-based datasets. 2014 Canadian Diabetes Association resume
G De Serres - One of the best experts on this subject based on the ideXlab platform.
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interim estimates of 2013 14 vaccine effectiveness against influenza a h1n1 pdm09 from canada s Sentinel Surveillance network january 2014
Eurosurveillance, 2014Co-Authors: Danuta M Skowronski, G De Serres, James A Dickinson, S Sabaiduc, Jonathan B Gubbay, C Chambers, Anneluise Winter, Kevin Fonseca, Hugues CharestAbstract:The 2013/14 influenza season to date in Canada has been characterised by predominant (90%) A(H1N1)pdm09 activity. Vaccine effectiveness (VE) was assessed in January 2014 by Canada's Sentinel Surveillance network using a test-negative case-control design. Interim adjusted-VE against medically-attended laboratory-confirmed influenza A(H1N1)pdm09 infection was 74% (95% CI: 58-83). Relative to vaccine, A(H1N1)pdm09 viruses were antigenically similar and genetically well conserved, with most showing just three mutations across the 50 amino acids comprising antigenic sites of the haemagglutinin protein. .
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interim estimates of influenza vaccine effectiveness in 2012 13 from canada s Sentinel Surveillance network january 2013
Eurosurveillance, 2013Co-Authors: Danuta M Skowronski, Naveed Z Janjua, G De Serres, James A Dickinson, Al Winter, Salaheddin M Mahmud, S Sabaiduc, Jonathan B GubbayAbstract:The 2012/13 influenza season in Canada has been characterised to date by early and moderately severe activity, dominated (90%) by the A(H3N2) subtype. Vaccine effectiveness (VE) was assessed in January 2013 by Canada's Sentinel Surveillance network using a test-negative case-control design. Interim adjusted-VE against medically attended laboratory-confirmed influenza A(H3N2) infection was 45% (95% CI: 13-66). Influenza A(H3N2) viruses in Canada are similar to the vaccine, based on haemagglutination inhibition; however, antigenic site mutations are described in the haemagglutinin gene. .
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estimates of influenza vaccine effectiveness for 2007 2008 from canada s Sentinel Surveillance system cross protection against major and minor variants
The Journal of Infectious Diseases, 2012Co-Authors: Naveed Z Janjua, Danuta M Skowronski, G De Serres, James A Dickinson, Kevin Fonseca, Natasha S Crowcroft, Marsha Taylor, Anne Winter, Travis S Hottes, Hugues CharestAbstract:Objectives. To estimate influenza vaccine effectiveness (VE) for the 2007–2008 season and assess the Sentinel Surveillance system in Canada for monitoring virus evolution and impact on VE. Methods. Nasal/nasopharyngeal swabs and epidemiologic details were collected from patients presenting to a Sentinel physician within 7 days of influenza-like illness onset. Cases tested positive for influenza A/B virus by real-time polymerase chain reaction; controls tested negative. Hemagglutination inhibition (HI) and gene sequencing explored virus relatedness to vaccine. VE was calculated as 1 minus the odds ratio for influenza in vaccinated versus nonvaccinated participants, with adjustment for confounders. Results. Of 1425 participants, 21% were vaccinated. Influenza virus was detected in 689 (48%), of which isolates from 663 were typed/subtyped: 189 (29%) were A/H1, 210 (32%) were A/H3, and 264 (40%) were B. Of A/H1N1 isolates, 6% showed minor HI antigenic mismatch to vaccine, with greater variation based on genetic identity. All A/H3N2 isolates showed moderate antigenic mismatch, and 98% of influenza B virus isolates showed major lineage-level mismatch to vaccine. Adjusted VE for A/H1N1, A/H3N2, and B components was 69% (95% confidence interval [CI], 44%–83%), 57% (95% CI, 32%–73%), and 55% (95% CI, 32%–70%), respectively, with an overall VE of 60% (95% CI, 45%–71%). Conclusions. Detailed antigenic and genotypic analysis of influenza viruses was consistent with epidemiologic estimates of VE showing cross-protection. A routine Sentinel Surveillance system that combines detailed virus and VE monitoring annually, as modeled in Canada, may guide improved vaccine selection and protection.
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component specific effectiveness of trivalent influenza vaccine as monitored through a Sentinel Surveillance network in canada 2006 2007
The Journal of Infectious Diseases, 2009Co-Authors: Danuta M Skowronski, G De Serres, James A Dickinson, Kevin Fonseca, Martin Petric, Annie Mak, Trijntje L Kwindt, Tracy Chan, Nathalie Bastien, Hugues CharestAbstract:Background Trivalent inactivated influenza vaccine (TIV) is reformulated annually to contain representative strains of 2 influenza A subtypes (H1N1 and H3N2) and 1 B lineage (Yamagata or Victoria). We describe a Sentinel Surveillance approach to link influenza variant detection with component-specific vaccine effectiveness (VE) estimation. Methods The 2006-2007 TIV included A/NewCaledonia/20/1999(H1N1)-like, A/Wisconsin/67/2005(H3N2)-like, and B/Malaysia/2506/2004(Victoria)-like components. Included participants were individuals >or=9 years of age who presented within 1 week after influenza like illness onset to a Sentinel physician between November 2006 and April 2007. Influenza was identified by real-time reverse-transcriptase polymerase chain reaction and/or culture. Isolates were characterized by hemagglutination inhibition assay (HI) and HA1 gene sequence. VE was estimated as 1-[odds ratio for influenza in vaccinated versus nonvaccinated persons]. Results A total of 841 participants contributed: 69 (8%) were >or=65 years of age; 166 (20%) received the 2006-2007 TIV. Influenza was detected in 337 subjects (40%), distributed as follows: A/H3N2, 242 (72%); A/H1N1, 55 (16%); and B, 36 (11%). All but 1 of the A/H1N1 isolates were well matched, half of A/H3N2 isolates were strain mismatched, and all B isolates were lineage-level mismatched to vaccine. Age-adjusted estimated VE for A/H1N1, A/H3N2, and B components was 92% (95% CI, 40%-91%), 41% (95% CI, 6%-63%), and 19% (95% CI, -112% to 69%), respectively, with an overall VE estimate of 47% (95% CI, 18%-65%). Restriction of the analysis to include only working-age adults resulted in lower VE estimates with wide confidence intervals but similar component-specific trends. Conclusions Sentinel Surveillance provides a broad platform to link new variant detection and the composite of circulating viruses to annual monitoring of component-specific VE.
