Recent trends in adult body mass index and prevalence of excess weight: Data from the Canadian Primary Care Sentinel Surveillance Network.

OBJECTIVE: To explore recent body mass index (BMI) trends over time among Canadian adults seen in primary care to identify the best target groups for preventive interventions. DESIGN: Retrospective descriptive cohort design. SETTING: Data for this study were derived from the Canadian Primary Care Sentinel Surveillance Network database. PARTICIPANTS: All patients aged 18 years and older who had BMI measurements available between 2011 and 2016 were identified. A closed cohort (N = 243 078 unique patients) with a start date of January 1, 2011, was defined. Patients were excluded if key variables were missing or if BMI measurements were 15 kg/m2 or less or 50 kg/m2 or greater. MAIN OUTCOME MEASURES: The dependent variable for this study was BMI (kg/m2). Measured BMI values recorded in electronic medical records were used. A linear mixed-effect estimate was fit to model changes in BMI over time with control of baseline age and sex. RESULTS: Patients in the Canadian Primary Care Sentinel Surveillance Network database experienced a modest increase in mean (95% CI) BMI by 2.1% from 28.5 (28.4 to 28.6) kg/m2 in 2011 to 29.1 (28.9 to 29.2) kg/m2 in 2016 (P < .0001). This increase is not a measured difference in BMI in the same individual but reflects the difference in the average BMI of the population in 2011 versus 2016. Male patients had BMI values that were on average 1.02 kg/m2 higher than those of female patients (P < .0001). Mean BMI values increased most rapidly in young adults (18 to 34 years) compared with older adults. CONCLUSION: The findings indicate that current obesity management in primary care is failing to moderate weight trajectories in different groups by age and sex. The results also suggest that younger age groups, in whom accelerated weight gain occurred, should be the target of prevention initiatives.

Shifting traditional healthcare paradoxes-The case for true system transformation.

Although national spending on healthcare has progressed on an upward trend over several decades, issues regarding performance remain. Challenges such as access to specialist care and maternal and infant mortality rates contributed to Canada's recent ranking of ninth among 11 Organisation for Economic Co-operation and Development countries for overall health system performance. Although disruptive transformation is required to resolve our chronic performance issues, effective change cannot be realized without addressing the foundational elements of patient-centred care, interprofessional care, and system integration. Inspired by examples of innovative disruption in other jurisdictions and industries, these three concepts are outlined as the core ingredients for healthcare transformation and describe how they currently function in a paradoxical manner-as self-contradictory statements which in reality are not executed to their true meaning. This article illustrates how improvements in health system performance are hinged to the need to rectify and fuse these three mutually inclusive and inseparable concepts.

Patient Education Tools: Using Pets to Empower Patients' Self-care-A Pilot Study.

Six patient education tools were designed to guide patients' self-care by activating pets to positively impact social determinants of health. Distributed to both pet owners and primary health-care providers, each tool addressed a specific area of health and outlined a pet-related activity. Surveys questioned how participants used the tools and their impact on health and health care. Pet owners shared the tools with family and friends. Primary health-care providers used the tools to target specific health concerns. Primary health-care providers reported that working with the tools improved rapport with their patients.

Asking About Pets Enhances Patient Communication and Care: A Pilot Study.

This research explored whether asking patients about their pets would enable better environmental/social history taking, and improve patient communication/care. Primary health care providers (PHPs) were surveyed about prevalence of patients living with pets, the health impact of pets, and influences on patient communication. Following an educational intervention, they committed to asking patients about their pets. A follow-up survey was conducted electronically. PHPs were recruited at a continuing medical education (CME) conference and at CME workshops. All 225 participants were PHPs. At the conference, participants were educated one-on-one about the clinical relevance of pets in the family. CME sessions were large or small group teaching. Baseline and final surveys measured awareness of pets in patients' families, assessment of determinants of health, impact on rapport with patients, and patient care. A sign test assessed difference in scores using repeated-measures analysis. Binomial outcomes were assessed using Fisher's exact test. Comments were themed. Ninety-four PHPs (42%) completed the study. Pet-related discussions opened communication with patients. Two-thirds of participants identified positive effects on practice and on relationships with patients. PHPs were able to leverage the health benefits of pets (zooeyia) and mitigate zoonotic risk. Asking patients about pets in the family reveals clinically relevant information, improves communication, and strengthens the therapeutic alliance.

Pets' Impact on Your Patients' Health: Leveraging Benefits and Mitigating Risk.

Over two thirds of Americans live with pets and consider them important members of the family. Pets benefit human health (zooeyia) in 4 ways: as builders of social capital, as agents of harm reduction, as motivators for healthy behavior change, and as potential participants in treatment plans. Conversely, pets can present risks to their owners. They are potential sources of zoonotic disease and injury. Pets can also challenge a family's prioritization of financial and social resources. To activate the benefits of zooeyia and appropriately calibrate and mitigate zoonotic risk, physicians first need to know about the pets in their patients' families. Asking about pets is a simple and feasible approach to assess patients' environmental history and social capital. Asking about pets is a nonthreatening way to build rapport and demonstrates an interest in the whole family, which can improve the physician-patient therapeutic alliance. Physicians can use an interprofessional, collaborative approach with veterinarians to address zoonotic health risks and leverage zooeyia.

Time to treat: a system redesign focusing on decreasing the time from suspicion of lung cancer to diagnosis.

INTRODUCTION: Multiple investigations often result in a lengthy process from the onset of lung cancer-related symptoms until diagnosis. An unpublished chart audit indicated suboptimal delays in patients' courses from onset of symptoms until diagnosis of cancer. METHODS: The Time to Treat Program was designed for patients with clinical or radiographic suspicion of lung cancer. Pre- and postimplementation data on median wait times were compared. RESULTS: From April 2005 to January 2007, 430 patients were referred. After Time to Treat Program implementation, the median time from suspicion of lung cancer to referral for specialist consultation decreased from 20 days to 6 days, and the median time from such referral to the actual consultation date decreased from 17 days to 4 days. The median time from specialist consultation to computed tomography scan decreased from 52 days to 3 days, and the median time from computed tomography scan to diagnosis decreased from 39 days to 6 days. Overall, the median time from suspicion of lung cancer to diagnosis decreased from 128 days to 20 days. Of all patients in the Time to Treat Program, 33% were eventually diagnosed with lung cancer. CONCLUSIONS: Time to Treat Program was effective in shortening the time from suspicion of lung cancer to diagnosis and reduced time intervals at each step in the process. Earlier diagnosis of lung cancer may allow increased treatment options for patients and may improve outcomes.