The objective of this study was to investigate the relationship between continuity of family physician (FP) care and inpatient hospitalizations in elderly people with diabetes who have universally-insured health care. We constructed a population-based retrospective cohort study using a sample of 1143 people aged 65 years or older with newly diagnosed diabetes who were selected from a longitudinal surveillance database in the province of Newfoundland and Labrador (NL), Canada. Continuity of FP care was estimated by 3 chronological indices (Continuity of Care [COC], Usual Provider Continuity [UPC], and Sequential Continuity [SECON]) using administrative physician claims data. Age, sex, number of chronic conditions, and income were used as control variables. People with high continuity had lower crude rates of hospitalization than those with lower continuity. Log-linear regression analysis showed that higher continuity was associated with decreased rates of hospitalization in an unadjusted model [rate ratio (95% confidence interval)]; COC: 0.73 (0.61-0.86); UPC: 0.71 (0.59-0.86); SECON: 0.64 (0.52-0.78), and after adjusting for control variables; COC: 0.82 (0.69-0.97); UPC: 0.82 (0.68-0.98); SECON: 0.75 (0.61-0.91). Other significant predictors of reduced hospitalizations were female sex, fewer chronic conditions, and higher income. The findings suggest that high levels of continuity of FP care are associated with reduced hospitalizations in elderly people with diabetes within a universally-insured health care system.

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Incarcerated young offenders show elevated rates of psychological problems that require treatment. Rural and urban differences in the rates of these problems may reflect differences in community service availability in these areas or in environmental influences on the development of child behavioural problems.

Objectives:Are people 75 or over enabled to stay at home longer through annual assessments and referrals to health/social services than through assessments only or without assessments?Design:randomized controlled trialParticipants:520 people 75 or over living in their own homesIntervention:Four annual RAI-HC computerized functional assessments. Intervention group 1: elders and primary caregivers received the results and were invited to take appropriate actions. Intervention group 2: elders and primary caregivers were offered referrals to health/social services.Measurements/Outcomes:death, institutionalization, home care services, RAI-HC scores, self-rated health, perceived self-efficacy, caregiver burdenResults:By the end of the study, annual functional assessment and offers of referrals to health/social services led to a greater use of home care (6.3%) than did assessment alone (1.8%), but there were no significant differences in death rates, institutionalization, perceived self-efficacy, self-rated health status, or caregiver burden scores between groups.Conclusion:We discovered that this was a group of healthy seniors. Multi-dimensional functional assessment is time- and labour-intensive and should be targeted at the minority of least self-reliant seniors.

We developed a point-of-care tool indicating risk categories for colorectal cancer (CRC) based on family history (FH) and management recommendations tailored to risk. The study objective was to determine if this CRC Risk Triage/ Management Too would enable family physicians (FPs) to appropriately triage and make screening and genetics referral recommendations for patients with CRC FH. Baseline questionnaires were mailed to a random sample of FPs in Ontario and Newfoundland, Canada. Participants were asked to use the tool for 3 months and then complete a follow-up questionnaire. The primary outcomes were correct responses to questions regarding CRC risk category, screening method, starting age, frequency, and decision to refer to genetics, for eight clinical vignettes. The study was completed by 75/121 (62 %) participating FPs. Most (77 %) agreed they routinely recommended fecal occult blood testing for average risk patients age ≥50. This did not change significantly following the intervention. There was a significant increase in confidence in CRC risk assessment (52 % pre; 88 % post; p<0.001), correct management recommendations for patients with CRC FH (51 % pre; 84 % post; p<0.001), and improvement in total mean scores on outcome measures for all vignettes. Most demonstrates the value of point-of-care tools and illustrates a process for development, evaluation, and dissemination of tools needed by FPs if potential impacts of genomic advances are to be achieved.