ImportancePeople with opioid use disorder are less likely than others to have a primary care physician.ObjectiveTo determine if family physicians are less likely to accept people with opioid use disorder as new patients than people with diabetes.Design, Setting, and ParticipantsThis randomized clinical trial used an audit design to survey new patient intake at randomly selected family physicians in Ontario, Canada. Eligible physicians were independent practitioners allowed to prescribe opioids who were located in an office within 50 km of a population center greater than 20 000 people. A patient actor made unannounced telephone calls to family physicians asking for a new patient appointment. The data were analyzed in September 2021.InterventionIn the first randomly assigned scenario, the patient actor played a role of patient with diabetes in treatment with an endocrinologist. In the second scenario, the patient actor played a role of a patient with opioid use disorder undergoing methadone treatment with an addiction physician.Main Outcomes and MeasuresTotal offers of a new patient appointment; a secondary analysis compared the proportions of patients offered an appointment stratified by gender, population, model of care, and years in practice.ResultsOf a total 383 family physicians included in analysis, a greater proportion offered a new patient appointment to a patient with diabetes (21 of 185 physicians [11.4%]) than with opioid use disorder (8 of 198 physicians [4.0%]) (absolute difference, 7.4%; 95% CI, 2.0 to 12.6; P = .007). Physicians with more than 20 years in practice were almost 13 times less likely to offer an appointment to a patient with opioid use disorder compared with diabetes (1 of 108 physicians [0.9%] vs 10 of 84 physicians [11.9%]; absolute difference, 11.0; 95% CI, 3.8 to 18.1; P = .001). Women were almost 5 times less likely (3 of 111 physicians [2.7%] vs 14 of 114 physicians [12.3%]; absolute difference, 9.6%; 95% CI, 2.4 to 16.3; P = .007) to offer an appointment to a patient with opioid use disorder than with diabetes.Conclusions and RelevanceIn this randomized clinical trial, family physicians were less likely to offer a new patient appointment to a patient with opioid use disorder compared with a patient with diabetes. Potential health system solutions to this disparity include strengthening policies for accepting new patients, improved compensation, and clinician anti-oppression training.Trial RegistrationClinicalTrials.gov Identifier: NCT05484609

BackgroundEmployers in Canada are increasingly offering physician services to their employees, often through enterprise virtual care platforms. To date however, little work has been done to understand this method of organizing and delivering care.ObjectiveTo understand the nature, extent and implications of enterprise virtual care in Canada.MethodsWe conducted structured internet and database searches to identify enterprise virtual care platforms and their public websites. To answer our research question, we extracted data from their websites, and linked company documents, including investor reports, and information from Mergent Intellect, a web-based application with business data on Canadian companies.FindingsWe identified nine companies offering enterprise virtual care physician services to employees in Canada on behalf of their employers. According to enterprise virtual care company claims, over four million Canadian employees and their family members have access to enterprise virtual care services. All platforms offer virtual physician services to employees and four also offer in person visits arranged through their platforms. Eight of the platforms provide primary care services and one offers only addiction medicine services. Four of the platforms offer to communicate and share information with an employee’s regular primary care provider. Four state they share aggregate or de-identified health data with employers.ImplicationsEnterprise virtual care companies provide millions of Canadian employees and their families with access to physician services. These services appear to disrupt continuity of care (care by the same provider over time) and pose risks to privacy. As other Canadians do not have access to these services, enterprise virtual care is also introducing two-tiered health care broadly across Canada.

Background Intact cognitive function is crucial for healthy aging. Functional social support is thought to protect against cognitive decline. We conducted a systematic review to investigate the association between functional social support and cognitive function in middle- and older-aged adults. Methods Articles were obtained from PubMed, PsycINFO, Sociological Abstracts, CINAHL and Scopus. Eligible articles considered any form of functional social support and cognitive outcome. We narratively synthesized extracted data by following the Synthesis Without Meta-Analysis (SWiM) guidelines and assessed risk of bias using the Newcastle-Ottawa Scale (NOS). Results Eighty-five articles with mostly low risk-of-bias were included in the review. In general, functional social support—particularly overall and emotional support—was positively associated with cognitive function in middle- and older-aged adults. However, these associations were not all statistically significant. Substantial heterogeneity existed in the types of exposures and outcomes evaluated in the articles, as well as in the specific tools used to measure exposures and outcomes. Conclusions Our review highlights the role of functional social support in the preservation of healthy cognition in aging populations. This finding underscores the importance of maintaining substantive social connections in middle and later life. Systematic review registration Rutter EC, Tyas SL, Maxwell CJ, Law J, O'Connell ME, Konnert CA, Oremus M. Association between functional social support and cognitive function in middle-aged and older adults: a protocol for a systematic review. BMJ Open;10(4):e037301. doi: 10.1136/bmjopen-2020-037301

Background Intact cognitive function is crucial for healthy aging. Functional social support is thought to protect against cognitive decline. We conducted a systematic review to investigate the association between functional social support and cognitive function in middle- and older-aged adults. Methods Articles were obtained from PubMed, PsycINFO, Sociological Abstracts, CINAHL, and Scopus. Eligible articles considered any form of functional social support and cognitive outcome. We narratively synthesized extracted data by following the Synthesis Without Meta-Analysis (SWiM) guidelines and assessed risk of bias using the Newcastle–Ottawa Scale (NOS). Results Eighty-five articles with mostly low risk-of-bias were included in the review. In general, functional social support—particularly overall and emotional support—was associated with higher cognitive function in middle- and older-aged adults. However, these associations were not all statistically significant. Substantial heterogeneity existed in the types of exposures and outcomes evaluated in the articles, as well as in the specific tools used to measure exposures and outcomes. Conclusions Our review highlights the role of functional social support in the preservation of healthy cognition in aging populations. This finding underscores the importance of maintaining substantive social connections in middle and later life. Systematic review registration Rutter EC, Tyas SL, Maxwell CJ, Law J, O'Connell ME, Konnert CA, Oremus M. Association between functional social support and cognitive function in middle-aged and older adults: a protocol for a systematic review. BMJ Open;10(4):e037301. https://doi.org/10.1136/bmjopen-2020-037301