Canadian Medical Association Journal

Family doctors call for guaranteed access to EMR data for research and quality improvement

To support quality improvement and research, family physicians and medical research networks need guaranteed, safe and affordable access to the data in electronic medical records (EMR) from the companies that provide the software, according to the College of Family Physicians of Canada.

The college, along with the Canadian Primary Care Sentinel Surveillance Network and the University of Toronto Practice-Based Research Network, recently issued a position statement decrying demands imposed by EMR vendors, such as prohibitive fees, restrictions on third-party extraction and analyses, and limitations on the type and frequency of data extractions. Read more in CMAJ.

Study by proponent of neck vein-widening therapy for MS finds treatment ineffective

The controversial “liberation therapy,” which aims to treat Multiple Sclerosis (MS) by widening narrowed veins in the neck and chest, has been dealt a blow by its main backer.

large-scale randomized clinical trial of venous percutaneous transluminal angioplasty (PTA) found that it is ineffective in treating the neurological condition. The study, published in JAMA Neurology, was led by Dr. Paolo Zamboni — the Italian vascular surgeon who first suggested, in 2009, that narrowed veins in the head and neck, a condition he dubbed chronic cerebrospinal venous insufficiency (CCSVI), could be a cause of MS and that widening them could treat the diseaseRead more in CMAJ.

CMA adopts patient focus

The Canadian Medical Association’s new three-year strategy, CMA 2020, aims to make the organization more outward-facing and patient-focused.

The changes came after a period of soul-searching on what the purpose of the CMA was, and how it could best serve its members and the public, said Dr. Brian Brodie, chairman of the board of directors. “We recognize that there are a lot of associations doctors belong to, and why would they pay to belong to different ones that do the same thing?” he said. “So it was important to look for opportunities for us to do something different.” Read more in CMAJ.

Drugs are going missing, but why?

Dr. Jacalyn Duffin, a hematologist and medical historian at Queen’s University in Kingston, first became aware that certain drugs were sometimes getting hard to find in 2010, when her patient at a cancer clinic wanted to stop chemotherapy because she couldn’t get prochlorperazine, a common anti-nausea drug.

Duffin was shocked. “I just couldn’t believe that it was gone. It is a very old, reliable drug that has been around for a long time and it was the only one that worked for her.”

Duffin started investigating and quickly discovered the problem went far beyond an old anti-nausea drug. Read more in CMAJ.

Evolution in models of primary care

British Columbia has jettisoned its ambitious 2013 election promise to match everyone in the province with a family doctor. It’s yet another sign that governments are beginning to recognise an evolution in the provision of primary medical care — an evolution that’s supported by the College of Family Physicians of Canada.

The GP for Me program had aimed to match every BC resident with a family physician (FP) by the end of 2015. That didn’t happen, despite the fact that BC has 125 FPs per 100 000 population — higher than the national average of 114. Instead of individual FPs, BC will match people with a primary care team that includes doctors as well as nurse practitioners, mental health counsellors, physiotherapists and others. Read more in CMAJ.

CMAJ gets interim editor amid governance shake-up

Dr. Diane Kelsall, a long-time CMAJ deputy editor and editor of CMAJ Open, has been appointed interim editor of the CMAJ as part of the journal owner’s restructuring and modernization plan.

On Feb. 29, the Canadian Medical Association (CMA) board of directors dismissed the journal’s editor-in-chief, Dr. John Fletcher, who had held the post for four years, and disbanded the Journal Oversight Committee, which was tasked with mediating between the journal and CMA on matters of editorial independence. Read more in CMAJ.

Online tools improve mental health in primary care

Mental health issues make up a big part of the workload for primary care physicians. In Ontario, about 20% of patient visits to primary care practitioners are related to mental health, and in many more visits, mental health issues underlie physical symptoms.

But most frontline health care workers often don’t get much training in mental health, says Dr. Peter Selby, director of medical education at the Centre for Addiction and Mental Health (CAMH) in Toronto. “We know that most people with mental health problems are seen in primary care. How do we make sure that doctors have access to this information that may have been missed during med school?” Read more in CMAJ.

Calls for more independence for government medical officers

Physicians are calling for Canada’s chief medical officers of health to be given greater independence from provincial governments following the recent firing of New Brunswick’s medical officer, Dr. Eilish Cleary, for reasons that remain unknown.

“The position is too important to allow people to be arbitrarily dismissed,” says Dr. James Talbot, the former chief medical officer of health for Alberta. “We need to be sure they can speak out.” Read more in CMAJ.

Survey aims to capture patient experience

Patients who have spent time in hospital in Canada will soon be asked to rate their experience as part of an effort by the Canadian Institute of Health Information (CIHI) to document and improve patient care across Canada.

“CIHI has been really focused on health system performance reporting, and the kinds of things you need to measure in order to understand [it],” says Kira Leeb, CIHI’s director of health system performance. “Part of that is understanding the patient experience.” Read more in CMAJ.


Ebola needed better coordinated Canadian response

IMG_7104Canada needs to step up its game when responding to international disease outbreaks, says New Brunswick’s Chief Medical Officer of Health, who spent more than six months in Africa with the World Health Organization during the Ebola outbreak. Dr. Eilish Cleary was disappointed that the Public Health Agency of Canada was not able to deploy teams of public health experts to help with the response.

“When I was there, especially in the beginning, there were a lot of people from other countries — Americans, a lot of Euro­peans particularly, but there were not that many Canadians. Some Canadian doctors had gone independently, but there was no organized group,” she says. “I think the value for money is better if you send teams.” Read more in CMAJ.