IMPORTANCE Although patients with chronic kidney disease (CKD) are routinely managed in primary care settings, no nationally representative study has assessed the quality of care received by these patients in Canada.

Introduction: Surveillance systems enable optimal care delivery and appropriate resource allocation, yet Canada lacks a dedicated surveillance system for chronic kidney disease (CKD). Using data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), a national chronic disease surveillance system, this study describes the geographic, sociodemographic, and clinical variations in CKD prevalence in the Canadian primary care context. Methods: This cross-sectional study included 559,745 adults in primary care in 5 provinces across Canada from 2010 through 2015. Data were analyzed by geographic (urban or rural residence), sociodemographic (age, sex, deprivation index), and clinical (medications prescribed, comorbid conditions) factors, using data from CPCSSN and the Canadian Deprivation Index. CKD stage 3 or higher was defined as 2 estimated glomerular filtration rate (eGFR) values of <60 ml/min per 1.73 m 2 more than 90 days apart as of January 1, 2015. Results: Prevalence of CKD was 71.9 per 1000 individuals and varied by geography, with the highest prevalence in rural settings compared with urban settings (86.2 vs. 68.4 per 1000). CKD was highly prevalent among individuals with 3 or more other chronic diseases (281.7 per 1000). Period prevalence of CKD indicated a slight decline over the study duration, from 53.4 per 1000 in 2010 to 46.5 per 1000 in 2014. Conclusion: This is the first study to estimate the prevalence of CKD in primary care in Canada at a national level. Results may facilitate further research, prioritization of care, and quality improvement activities to identify gaps and improvement in CKD care.

ObjectiveExercise is an effective modality for the prevention and treatment of chronic conditions and family physicians are the healthcare providers tasked to manage patients’ chronic disease status. However, little is known about the exercise documentation in family-physician records. Therefore, a scoping review was conducted to describe family-physician-recorded exercise-related advice to patients in electronic medical records.DesignScoping review.SettingPrimary care clinics.Search strategyPubMed, Medline, SPORTDiscus, Google, Dissertations & Theses Global, OCLC PapersFirst (via First Search) and included references were searched between 1 January 1990 and 10 June 2018. Extracted information included year, geographic origin, data input structure, input frequency and content of exercise inputs in family physicians’ electronic medical records. The primary outcomes are the structure, purpose and frequency of inputs.ResultsOf a possible 1758 documents, 83 remained after a title and abstract scan and 22 after a full-text review. These documents included 32 findings of physical activity/exercise medical record documentation: counselling/advising patients (50.0%), status (12.5%), embedded questionnaires (12.5%), status as a risk factor (12.5%), health promotion documentation (6.3%), inactivity status (3.1%) and grading (3.1%). The frequency of exercise inputs in primary care records vary from as low as 0.4% of patients with documentation of physical activity health promotion inputs to as high as 87.8% of patients with exercise or physical activity status recorded. The majority of included documents (63.6%) were focused on patients with identified chronic conditions.ConclusionThe findings suggest that the structure and purpose of exercise documentation is often unclear or unspecified. Studies that present exercise information from family-physician medical records tend to focus on patients with specific chronic conditions and present little detail about the field from which information was extracted. The review found that the proportion of patients with physical activity or exercise information is often less than half.

Background The dementias are long-term, chronic conditions caused by progressive neurological degeneration. Current literature suggests that cardiovascular disease risk factors may contribute to the onset of dementia; however, evidence of these associations is inconsistent. Objectives This study aimed to examine the impact of risk factors on dementia onset in older adults diagnosed and managed in Canadian primary care settings. Methods A retrospective cohort study was employed utilizing electronic medical records data in the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Patients aged 65+ years with no dementia diagnosis at baseline who were followed from 2009 to 2017 with a run-in year to exclude existing undiagnosed dementia cases. Multivariate Cox proportional hazard models were used to estimate risk. Results Age was associated with an increased incidence risk of dementia in both examined age groups: 65–79 years (13%) and 80+ years (5%). History of depression increased dementia risk by 38% and 34% in the age groups. There were significant associations with lower social deprivation area quintile, smoking history, osteoarthritis, and diabetes mellitus in patients aged 65–79 years but not in those aged 80+ years. Sex, hypertension, obesity, dyslipidemia, and the use of antihypertensive medications and statins were not associated with risk of incident dementia diagnosis. Conclusions The association between chronic health conditions and dementia onset is complicated. Primary care electronic medical record data might be useful for research in this topic, though follow-up time is still relatively short to observe a clear causal relationship. Future studies with more complete data may provide evidence for dementia preventive strategies within primary care practice.

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