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Objectives (a) To ®nd out how much patient information material on display in family physicians' oces refers to management choices, and hence may be useful to support informed and shared decision-making (ISDM) by patients and (b) to evaluate the quality of print information materials exchanged during the consultation, i.e. brought in by patients or given out by family physicians.Design All print information available for patients and exchanged between physicians and patients was collected in a single complete day of the oce practices of 21 family physicians. A published and validated instrument (DISCERN) was used to assess quality.Setting and participants Community oce practices in the greater Vancouver area, British Columbia, Canada. The physicians were purposefully recruited by their association with the medical school Department of Family Practice, their interest in providing patients with print information and their representation of a range of practice types and location.Main variables studied The source of the pamphlets and these categories: available in the physicians' oces; exchanged between physician and patient; and produced with the explicit or apparent intent to support evidence-based patient choice. Main outcome measuresThe quality of the print information to support ISDM, as measured by DISCERN and the ease of use and reliability of the DISCERN tool.Results and conclusions Fewer than 50% of pamphlets available in these oces ful®lled our minimum criteria for ISDM (mentioned more than one management option). Oces varied widely in the proportion of pamphlets on display that supported ISDM and how particular the physician was in selecting materials. The DISCERN tool is quick, valid and reliable for the evaluation of patient information. The quality of patient information materials used in the consultation and available in these oces was below midpoint on the DISCERN score. Major de®ciencies were with respect to the mention of choices, risks, eect of no treatment or uncertainty and reliability (source, evidence-base). Good quality information can be produced; some is available locally.

Background: British Columbia' s primary care reform (initiated in 2002) aims to promote "full-service family practice" through incentive payments and other practice support programs. Despite attention to policy, no longitudinal analysis has been conducted of the activities of BC primary care physicians. Methods: This study employed linked administrative health data from 1991/92 through 2009/10 to describe dimensions of care from the definition of "full-service family practice" used in BC reform, grouped into four categories: access, continuity, coordination and comprehensiveness. Results: Access, continuity and coordination of care fell over the study period (p<0.001). Some dimensions reflecting comprehensiveness of care declined (obstetrics and geriatric care), though the remainder did not change significantly. Overall declining trends were consistent across physician characteristics and remained significant when accounting for shifts to nonfee-for-service payment. Conclusion: Findings suggest efforts are not achieving their intended aims. Rigorous evaluation of individual components of reform is needed. Résumé Contexte : La réforme des soins de santé primaires en Colombie-Britannique (amorcée en 2002) vise la promotion de « cliniques familiales offrant des services intégraux » par le biais de primes d'incitation et autres programmes de soutien aux cliniques. Malgré l' attention portée à la politique, il n'y a eu aucune analyse longitudinale sur les activités des médecins de première ligne en Colombie-Britannique. Méthodes : Cette étude fait appel à des données administratives sur la santé de 1991/1992 à 2009/2010 afin de décrire les aspects des soins au regard de la définition des « cliniques familiales offrant des services intégraux » utilisée dans le cadre de la réforme en Colombie-Britannique, et ce, en fonction de quatre catégories : accès, continuité, coordination et intégralité. Résultats : L' accès, la continuité et la coordination des soins ont diminué au cours de la période étudiée (p<0,001). Certains aspects liés à l'intégralité des soins ont décliné (soins obstétriques et gériatriques), bien que les autres n' aient pas connu de changements significatifs. Les tendances générales du déclin sont cohérentes par rapport aux caractéristiques des médecins et demeurent significatives si on tient compte des déplacements vers des méthodes de paiement qui ne fonctionnent pas à l' acte. Conclusion : Les résultats laissent croire que les efforts ne permettent pas d' atteindre les objectifs visés. Il y a grand besoin d'une évaluation rigoureuse des diverses composantes de la réforme.

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This article describes British Columbia's regulatory model for assisted living and used time series analysis to examine individuals' use of health care services before and after moving to assisted living. The 4,219 assisted living residents studied were older and predominantly female, with 73 per cent having one or more major chronic conditions. Use of health care services tended to increase before the move to assisted living, drop at the time of the move (most notably for general practitioners, medical specialists, and acute care), and remain low for the 12-month follow-up period. These apparent positive effects are not trivial; the cohort of 1,894 assisted living residents used 18,000 fewer acute care days in the year after, compared to the year before, their move. Future research should address whether and how assisted living affects longer-term pathways of care for older adults and ultimately their function and quality of life.