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Objective To introduce the new Team-based care Evaluation and Adoption Model (TEAM) Framework. Quality of evidenceThe initial TEAM Framework was derived from a series of reviews and consultations with academic and clinical experts. In a parallel process, team-based primary and community care evaluation in Canada was assessed through a structured review of academic literature, followed by a review of policy literature of existing primary care evaluation frameworks. Main messageThe review of academic articles alongside an analysis of policy documents and existing evaluation frameworks in primary care resulted in the development of the 10-dimension TEAM Framework. ConclusionPrimary care transformation requires evaluation over time. The TEAM Framework provides a comprehensive framework for assessing evidence needed to support short-and long-term actionable improvements for teambased primary and community care in Canada. This framework will inform the development of an evaluation tool kit for primary care teams. Editor's key points Primary care transformation in Canada has been positioned as the way to address increasing costs, improve access to primary care providers, and address changing population needs. However, primary care transformation requires evaluation, both formative and summative, over time. To date, there has been little focus on comprehensive evaluation of transformation efforts in the context of team-based primary and community care. The new Team-based care Evaluation and Adoption Model Framework described in this article provides a comprehensive framework for assessing evidence needed to support short-and longterm actionable improvements for team-based primary and community care in Canada. Révision cliniqueThis article has been peer reviewed. Cet article a fait l'objet d'une révision par des pairs.

Objective:To examine characteristics and incidence of opioid analgesic initiations to opioid naïve patients in a Canadian primary care setting.Methods:This is a population-based cross-sectional study, outlining an analysis of health administrative data recorded in a centralized medication monitoring database (PharmaNet) covering 96% of population in British Columbia, Canada. From the PharmaNet database, 5657 doctors (87% of all practicing family physicians) were selected on the bases of (1) having been currently treating patients (defined as having written at least 25 prescriptions, for any drug, in preceding 12 months); and (2) having prescribed at least 1 opioid during study period. The primary outcome measure is incidence of new starts for opioid analgesics in opioid naïve people, stratified by several important prescriber and regional characteristics (eg, graduation year, geographical location).Results:Between December 1, 2018 and November 30, 2019, there were 139,145 opioid initiations to opioid naïve patients. The mean monthly initiation rate was 2.05 prescriptions per physician. Most initiations were in Lower Mainland regions of British Columbia, also where the population is most concentrated (46,456, 33% in the Fraser region), by prescribers who graduated between 1986 and 1995 (39,601, 28%), and had less than 10 patient visits per day (72,506, 52%).Conclusions:From data presented in this study, it appears that the rate of opioid analgesic initiations in primary care remains unchanged. Individualized prescribing interventions targeted at physicians are urgently needed considering the current opioid epidemic and known links with opioid analgesics that raise concerns about the potential to cause harm.

Background Some Canadians have limited access to longitudinal primary care, despite its known advantages for population health. Current initiatives to transform primary care aim to increase access to team-based primary care clinics. However, many regions lack a reliable method to enumerate clinics, limiting estimates of clinical capacity and ongoing access gaps. A region-based complete clinic list is needed to effectively describe clinic characteristics and to compare primary care outcomes at the clinic level. Objective The objective of this study is to show how publicly available data sources, including the provincial physician license registry, can be used to generate a verifiable, region-wide list of primary care clinics in British Columbia, Canada, using a process named the Clinic List Algorithm (CLA). Methods The CLA has 10 steps: (1) collect data sets, (2) develop clinic inclusion and exclusion criteria, (3) process data sets, (4) consolidate data sets, (5) transform from list of physicians to initial list of clinics, (6) add additional metadata, (7) create working lists, (8) verify working lists, (9) consolidate working lists, and (10) adjust processing steps based on learnings. Results The College of Physicians and Surgeons of British Columbia Registry contained 13,726 physicians, at 2915 unique addresses, 6942 (50.58%) of whom were family physicians (FPs) licensed to practice in British Columbia. The CLA identified 1239 addresses where primary care was delivered by 4262 (61.39%) FPs. Of the included addresses, 84.50% (n=1047) were in urban locations, and there was a median of 2 (IQR 2-4, range 1-23) FPs at each unique address. Conclusions The CLA provides a region-wide description of primary care clinics that improves on simple counts of primary care providers or self-report lists. It identifies the number and location of primary care clinics and excludes primary care providers who are likely not providing community-based primary care. Such information may be useful for estimates of capacity of primary care, as well as for policy planning and research in regions engaged in primary care evaluation or transformation.

Background Prescribing rates of some analgesics decreased during the public health crisis. Yet, up to a quarter of opioid-naïve persons prescribed opioids for noncancer pain develop prescription opioid use disorder. We, therefore, sought to evaluate a pilot educational session to support primary care-based sparing of opioid analgesics for noncancer pain among opioid-naïve patients in British Columbia (BC). Methods Therapeutics Initiative in BC has launched an audit and feedback intervention. Individual prescribing portraits were mailed to opioid prescribers, followed by academic detailing webinars. The webinars’ learning outcomes included defining the terms opioid naïve and opioid sparing, and educating attendees on the (lack of) evidence for opioid analgesics to treat noncancer pain. The primary outcome was change in knowledge measured by four multiple-choice questions at the outset and conclusion of the webinar. Results Two hundred participants attended four webinars; 124 (62%) responded to the knowledge questions. Community-based primary care professionals (80/65%) from mostly urban settings (77/62%) self-identified as family physicians (46/37%), residents (22/18%), nurse practitioners (24/19%), and others (32/26%). Twelve participants (10%) recalled receiving the individualized portraits. While the correct identification of opioid naïve definitions increased by 23%, the correct identification of opioid sparing declined by 7%. Knowledge of the gaps in high-quality evidence supporting opioid analgesics and risk tools increased by 26% and 35%, respectively. Conclusion The educational session outlined in this pilot yielded mixed results but appeared acceptable to learners and may need further refinement to become a feasible way to train professionals to help tackle the current toxic drugs crisis.