Objective: The objective of this study was to assess the validity of electronic medical records-based diagnostic algorithms for 5 chronic conditions.Methods: A retrospective validation study using primary chart abstraction. A standardized abstraction form was developed to ascertain diagnoses of diabetes, hypertension, osteoarthritis, chronic obstructive pulmonary disease, and depression. Information about billing, laboratory tests, notes, specialist and hospital reports, and physiologic data was collected. An age-stratified random sample of 350 patient charts was selected from Kingston, Ontario, Canada. Approximately 90% of those charts were allocated to people aged >60 years.Results: Three hundred thirteen patient records were included in the study. Patients' mean age was 68 years and 52% were women. High interrater reliability was indicated by 92% complete agreement and a statistic of 89.3%. The sensitivities of algorithms were 100% (diabetes), 83% (hypertension), 45% (osteoarthritis), 41% (chronic obstructive pulmonary disease), and 39% (depression). The lowest specificity was 97%, for depression. The positive predictive value ranged from 79% (depression) to 100%, and the negative predictive value ranged from 68% (osteoarthritis) to 100%. Chronic diseases constitute a major burden of illness in Canada and around the world. Recent estimates suggest that 46% of adult Canadians suffer from one or more of 7 common chronic diseases. 1Of these conditions, 6 million Canadians are affected with hypertension, 2 2 million with diabetes, 3 1.2 million with major depression, 4 Ͼ750,000adults with chronic obstructive pulmonary disease (COPD), 5 and 3 million with osteoarthritis. 6Currently available information on chronic diseases at the national level is derived from databases such as hospital discharge summaries, disease-specific registries, and population health surveys. These sources have significant limitations, such as the inability to capture data on conditions that do not lead to hospitalizations and the unreliability of self-reported surveys.7 A large validation study of the Discharge At the Canadian provincial level, billing for physician services may provide a source of data, but it is limited in the depth of information because administrative data are created for financial management rather than research purposes.10 When compared against a clinical research database, administrative data had only 20% agreement. 11Primary care databases constitute another source of data on chronic conditions. For instance, people with one or more chronic conditions accounted for 51% of family physician encounters, 12 suggesting that comprehensive clinical records collected by primary care physicians could be a rich resource for researchers and policymakers. The benefit of using primary care databases is that they provide prospective and systematic collection of clinically verified data that can be comprehensive for studying a variety of important outcomes. 13The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) is one...

Background: In Canada, primary care practitioners provide the majority of care for elderly patients. Increasing volume and complexity of care compounded by a shortage of specialized geriatric services has lead to problems of fragmented, inefficient, and often ineffective service for this population. Integrated models that bridge primary and secondary care have emerged as a major theme in health reform to address such challenges for care of the elderly. Although primary care practitioners are important stakeholders necessary for successful uptake and sustainability of such integrated models, this perspective has been largely unexplored.

The aim of this study is to determine the efficacy of low-level laser therapy (LLLT) in reducing acute and chronic neck pain as measured by the visual analog scale (VAS). A systematic search of nine electronic databases was conducted to identify original articles. For study selection, two reviewers independently assessed titles, abstracts, and full text for eligibility. Methodological quality was assessed using the Detsky scale. Data were analyzed using random-effects model in the presence of heterogeneity and fixed-effect model in its absence. Heterogeneity was assessed using Cochran's Q statistic and quantifying I (2). Risk ratios (RR) with 95 % confidence intervals (CI) were reported. Eight randomized controlled trials involving 443 patients met the strict inclusion criteria. Inter-rater reliability for study selection was 92.8 % (95 % CIs 80.9-100 %) and for methodological quality assessment was 83.9 % (95 % CIs 19.4-96.8 %). Five trials included patients with cervical myofascial pain syndrome (CMPS), and three trials included different patient populations. A meta-analysis of five CMPS trials revealed a mean improvement of VAS score of 10.54 with LLLT (95 % CI 0.37-20.71; Heterogeneity I (2 )= 65 %, P = 0.02). This systematic review provides inconclusive evidence because of significant between-study heterogeneity and potential risk of bias. The benefit seen in the use of LLLT, although statistically significant, does not constitute the threshold of minimally important clinical difference.

There is large variation in CT ordering among EPs. Physicians' self-reported ordering rate correlates poorly with actual ordering. High CT orderers were rarely aware that they ordered more than their colleagues. Higher rates of ordering were observed among physicians who reported increased concern with 1) risk of missing a diagnosis, 2) medico-legal risk, 3) risk of contrast, 4) patient wishes, and 5) what colleagues would do.