IntroductionPulmonary exercise testing, including six-minute walk tests, exercise oximetry, and independent exercise assessments, are critical tools for managing chronic respiratory and cardiac conditions, evaluating treatment response, and determining long-term oxygen therapy needs. During the COVID-19 pandemic, testing was reduced to limit viral spread. This study aimed to evaluate post-pandemic trends of pulmonary exercise testing utilization in Ontario overall and across demographic groups.MethodsWe conducted a population-based cohort study using Ontario administrative data between April 2015 and December 2023 to evaluate pulmonary exercise testing before, during, and after the COVID-19 pandemic. We used an Auto-Regressive Integrated Moving Average Model (ARIMA) model and incidence rate ratios to evaluate recovery trends. Subgroup analysis examined if trends were similar in different groups.ResultsDuring the study period, 505,902 tests were performed for 362,888 individuals. As of December 2023, testing rates were still 21% below pre-pandemic levels (IRR 0.79, 95%CI 0.70-0.89). Recovery was lower in males (IRR 0.76, 95%CI 0.66-0.86) and individuals living in lower socioeconomic status neighborhoods (IRR 0.71, 95%CI 0.58-0.86). Northern Ontario saw the most pronounced shortfall compared to other regions, with testing rates one-third of pre-pandemic levels (IRR 0.33, 95% CI 0.26-0.43).ConclusionMore than three years after the pandemic began, pulmonary exercise testing rates have yet to return to pre-pandemic levels, with certain groups disproportionately affected. This highlights a significant and ongoing disruption in diagnostic capacity and quality of care for people with respiratory and cardiac diseases.

Background Schizophrenia is associated with substantial physical and psychiatric comorbidities that increase the risk of severe outcomes in COVID-19 infection. However, few studies have examined the differences in care and outcomes among people with schizophrenia throughout the pandemic. We hypothesized that rates of in-hospital mortality, admission to the intensive care unit (ICU), and length of stay differed among people with and without schizophrenia. Study design We conducted a population-based retrospective cohort study using administrative health data from Ontario, Canada, which included individuals hospitalized for COVID-19 between February 2020 and October 2023. We compared mortality, ICU admission, and length of stay using regression models adjusted for age, sex, comorbidities, vaccination status, and sociodemographic characteristics. Study results We evaluated 66 959 hospital admissions, 4.3% (2884) of which involved people with schizophrenia. People with schizophrenia had a significantly decreased rate of ICU admission (adjusted Odds Ratio [OR]: 0.74 [0.67, 0.82]), a longer length of stay (adjusted RR: 1.25 [1.21, 1.30]), but a similar risk of mortality (adjusted OR: 1.09 [0.98, 1.22]) as people without schizophrenia. Age modified the relationship between schizophrenia and ICU admission. People with schizophrenia aged 60-75 were substantially less likely to be admitted to the ICU relative to those without (18.4% vs 26.5%, P < .001). Conclusions Our findings underscore disparities in care among people with and without schizophrenia. These disparities vary by age and suggest that people with schizophrenia may not be receiving the same level of care as people without schizophrenia hospitalized for COVID-19.

BACKGROUND:Pulmonary Function Tests are critical in diagnosing and managing respiratory conditions such as chronic obstructive pulmonary disease and asthma. However, because they generate aerosols, they were restricted in laboratories and offices during the COVID-19 pandemic to prevent virus spread. OBJECTIVE:To determine whether Pulmonary Function Test capacity had returned to pre-pandemic levels overall and across demographic groups in a large North American cohort. METHODS:We conducted a population cohort study in individuals aged 7 and older from 2015 to 2023 in Ontario, Canada, using provincial health administrative data. Incidence rate ratios (IRR) were used to compare observed rates to rates that would have been expected if the pandemic had never occurred and to assess whether test utilization returned to pre-pandemic levels. Subgroup analyses were conducted across various demographic characteristics. MAIN FINDINGS:There were 8,302,872 tests performed on 2,683,844 people during the study period. As of December 2023, testing rates were still 27% lower than they were prior to the pandemic (IRR 0.73, 95% CI 0.63 - 0.87). Recovery was lower in males (IRR 0.72, 95%CI 0.62-0.86), those aged 18-65 (IRR 0.68, 95%CI 0.59-0.82), urban residents (IRR 0.72, 95%CI 0.62-0.86), and individuals of lower socioeconomic status (IRR 0.68, 95%CI 0.59-0.81). CONCLUSION:More than three years after the pandemic onset, pulmonary function test rates in Ontario still have not recovered to pre-pandemic levels, with certain groups more affected than others. These findings suggest persistent reductions in PFT utilization and disparities in care for people with respiratory conditions.

BACKGROUND:Inhalers are essential for respiratory disease management, but commonly used metered-dose inhalers (MDIs) can often be replaced, when clinically appropriate, with lower-emission alternatives such as dry powder inhalers (DPIs) or soft mist inhalers (SMIs). The COVID-19 pandemic may have influenced prescribing patterns. We aim to describe changes in inhaler prescription trends and determine whether MDI use decreased during the pandemic. METHODS AND FINDINGS:Retrospective cohort study using Ontario's health administrative data. Individuals aged 65 and older with new inhaler prescription instances from April 1, 2017, to March 31, 2023, were included. Monthly prescription event rates by inhaler type and socioeconomic factors were modeled for pre-pandemic (April 2017-March 2020) and pandemic (April 2020-March 2023) periods using interrupted time series and Generalized Additive Models to account for autocorrelation and seasonality. 750,517 new inhaler prescriptions were made during the study period. A significant drop was observed at the pandemic's onset. MDIs were the predominant type of inhaler initially prescribed for both pre-pandemic ~77% and pandemic ~70% periods. The proportion of DPI initial prescriptions modestly increased from ~17% to ~23% and SMI initial prescriptions remained similar. Inhaler prescription rates did not significantly differ across sex, income quintiles, or rurality. CONCLUSIONS:The COVID-19 pandemic disrupted inhaler prescribing patterns in Ontario, leading to a temporary decline in new prescriptions. Despite environmental and guideline recommendations, MDIs continued to dominate prescribing practices. These findings underscore the need for targeted interventions to align clinical practices with current guidelines and environmental sustainability goals.

There is a growing need to document sociodemographic factors in electronic medical records to produce representative cohorts for medical research and to perform focused research for potentially vulnerable populations. The objective of this work was to assess the content of family physicians’ electronic medical records and characterize the quality of the documentation of sociodemographic characteristics. Descriptive statistics were reported for each sociodemographic characteristic. The association between the completeness rates of the sociodemographic data and the various clinics, electronic medical record vendors, and physician characteristics was analyzed. Supervised machine learning models were used to determine the absence or presence of each characteristic for all adult patients over the age of 18 in the database. Documentation of marital status (51.0%) and occupation (47.2%) were significantly higher compared to the rest of the variables. Race (1.4%), sexual orientation (2.5%), and gender identity (0.8%) had the lowest documentation rates with a 97.5% missingness rate or higher. The correlation analysis for vendor type demonstrated that there was significant variation in the availability of marital and occupation information between vendors (χ2 > 6.0, P < 0.05). Variability in documentation between clinics indicated that the majority of characteristics exhibited high variation in completeness rates with the highest variation for occupation (median: 47.2, interquartile range: 60.6%) and marital status (median: 45.6, interquartile: 59.7%). Finally, physician sex, years since a physician graduated, and whether a physician was a foreign vs a Canadian medical graduate were significantly associated with documentation rates of place of birth, citizenship status, occupation, and education in the electronic medical records. Our findings suggest a crucial need to implement better documentation strategies for sociodemographic information in the healthcare setting. To improve completeness rates, healthcare systems should monitor, encourage, enforce, or incentivize sociodemographic data collection standards.

Individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) experienced worsening symptoms during the COVID-19 pandemic resulting in increased demand for healthcare services. However, it is unclear how those with and without ADHD utilized these services during the COVID-19 pandemic. This study examined healthcare utilization among individuals with and without ADHD and as a secondary objective, investigated these trends among female and male subgroups, from April 1, 2014-March 31, 2023. We conducted a population-based longitudinal retrospective cohort study among ADHD cases identified using a validated algorithm, and controls from Ontario, Canada over the same study period. We matched ADHD cases 1:1 to controls by sex, birth year, and geographical area. Outcomes were number of outpatient visits per person per fiscal year to family physicians, for mental health and to emergency departments, stratified by sex and age group over the follow-up period. Crude visit rate differences between sex-specific cases and controls were calculated with 95% confidence intervals (CI). We matched 427 716 ADHD cases to 427 716 controls. ADHD cases were 163 528 ≤ 17 years (32% female), and 264 188 adults (52% female). From 2013-2024, where March 17, 2020 marked the onset of the COVID-19 pandemic, females aged 1-17 years with ADHD appeared to have higher visit rate differences to family physicians, emergency departments, and increased mental health services, relative to their controls, particularly in 2020 [2.66 (95% CI: 2.65-2.68)]. In the same year, males with ADHD still had a higher mental health visit rate difference, [2.02 (95% CI: 2.01-2.02)] in 2020, but lower than that observed in females. Adult females with ADHD had the highest mental health visit rate difference in 2020 [5.09 (95% CI: 5.07-5.11)] and males with ADHD had 4.41 (95% CI: 4.40-4.43). These higher service utilization differences likely reflected greater health needs among females with ADHD while males underutilized these services.

BACKGROUND:Limited research exists on key issues that healthcare professionals perceive as important for optimizing Attention-Deficit/Hyperactivity Disorder (ADHD) care. This study identified the top ten priorities that healthcare professionals consider vital to support ADHD care in Canada. METHODS:A three-round online Delphi study was conducted using electronic surveys from 2022-2024 across Canada. In Round 1, healthcare professionals were asked to rate 21 predetermined items using a 5-point Likert scale and re-evaluated those rankings in Round 2. In Round 2, a new set of 34 items identified from Round 1 were rated and the rankings re-evaluated in Round 3. Consensus was determined by percentage agreement ≥ 90% with a Likert score ≥ 4. For each priority item, the mean Likert score, standard deviation, 95% confidence interval (CI), and the minimum and maximum Likert scores were calculated. RESULTS:96 Canadian healthcare professionals completed Round 1. 82 (85% response rate) completed Round 2 and 73 (89% response rate) completed Round 3. The two highest ranked priorities that achieved 100% consensus agreement were: providing access to well-trained healthcare providers in ADHD (mean score 4.74, 95% CI 4.65-4.84) and access to ADHD-related services (mean score 4.50, 95% CI 4.39-4.61). Among the top ten consensus-derived items, the highest frequency pertained to providing access to healthcare experts in ADHD and related-services (50%) followed by research into ADHD on socio-emotional functioning, co-existing conditions and in diagnosing ADHD in females (30%). Increasing knowledge and educating healthcare professionals and school systems on ADHD was also identified among the top ten priorities (20%). CONCLUSIONS:Healthcare professionals identified ten top priorities by consensus where most focused on providing access to trained healthcare providers and services to support ADHD care in Canada. Implementing strategies to improve access on a national level will improve the quality of life for individuals living with ADHD.

The COVID-19 pandemic required a rapid transition to virtual care as a key strategy to maintain healthcare access while minimizing virus transmission risks. However, the impact of this shift on hospitalizations and emergency department (ED) visits for ambulatory care-sensitive conditions (ACSCs) remains unclear. This study aims to assess the relationship between the modality of outpatient care for ACSCs and their outcomes in Ontario, Canada. In this population-based retrospective cohort study, we analyzed hospitalization and ED visit data for ACSCs, including diabetes, epilepsy, congestive heart failure, hypertension, and angina, during the pandemic (April 2020 to April 2023) and post-pandemic (May 2023 to August 2023) periods. Monthly trends in hospitalizations and ED visits were evaluated using Generalized Additive Models and Generalized Additive Mixed Models, accounting for the effects of virtual and in-person care within 30 days and 60 days preceding each event. Despite a notable decrease in virtual visits and a corresponding rise in in-person visits, overall hospitalizations and ED visits for ACSCs remained relatively stable. Our analysis found no significant association between care modality and changes in hospitalizations and ED visits, suggesting that virtual care, particularly during the early pandemic, effectively supported chronic disease management and contributed to the stability of acute care needs. In conclusion, virtual care proved to be a sustainable component of ACSC management during and after the COVID-19 pandemic, complementing in-person care.

Objective: To estimate prevalence and incidence rates over time in children and youth with attention deficit/hyperactivity disorder from the validation of population-based administrative data algorithms using family physicians' electronic medical records as a reference standard. Methods: A retrospective cohort study was conducted in Ontario, Canada to identify attention deficit/hyperactivity disorder among children and youth aged 1-24 years in health administrative data derived from case-finding algorithms using family physicians' electronic medical records. Multiple administrative data algorithms identifying attention deficit/hyperactivity disorder cases were developed and tested from physician-diagnosis of attention deficit/hyperactivity disorder in the electronic medical record to determine their diagnostic accuracy. We calculated algorithm performance using sensitivity, specificity, and predictive values. The most optimal algorithm was used to estimate prevalence and incidence rates of attention deficit/hyperactivity disorder from 2014 to 2021 in Ontario. Results: The optimal performing algorithm was "2 physician visits for attention deficit/hyperactivity disorder in 1 year or 1 attention deficit/hyperactivity disorder-specific prescription" with sensitivity: 83.2% (95% confidence interval [CI], 81.8% to 84.5%), specificity: 98.6% (95% CI, 98.5% to 98.7%), positive predictive value: 78.6% (95% CI, 77.1% to 80.0%) and negative predictive value: 98.9% (95% CI, 98.8% to 99.0%). From 2014, prevalence rates for attention deficit/hyperactivity disorder increased from 5.29 to 7.48 per 100 population in 2021 (N = 281,785). Males had higher prevalence rates (7.49 to 9.59 per 100 population, 1.3-fold increase) than females (2.96-5.26 per 100 population, 1.8-fold increase) from 2014 to 2021. Incidence rates increased from 2014 (0.53 per 100 population) until 2018, decreased in 2020 then rose steeply in 2021 (0.89 per 100 population, N = 34,013). Males also had higher incidence rates than females from 2014 to 2020 with females surpassing males in 2021 (0.70-0.81 per 100 male population,1.2-fold increase versus 0.36-0.97 per 100 female population, 2.7-fold increase). Conclusions: Attention deficit/hyperactivity disorder is increasing in prevalence. We developed an administrative data algorithm that can reliably identify children and youth with attention deficit/hyperactivity disorder with good diagnostic accuracy.

BACKGROUND:Higher numbers of family physicians (FPs) stopped practicing or retired during the COVID-19 pandemic, worsening the family doctor shortage in Canada. Our study objective was to determine which factors were associated with FPs' plans to retire earlier during the COVID-19 pandemic. METHODS:We administered two cross-sectional online surveys to Ontario FPs asking whether they were "planning to retire earlier" as a result of the pandemic during the first and third COVID-19 pandemic waves (Apr-Jun 2020 and Mar-Jul 2021). We used logistic regression to determine which factors were associated with early retirement planning, adjusting for age. RESULTS:The age-adjusted proportion of FP respondents planning to retire earlier was 8.2% (of 393) in the first-wave and 20.5% (of 454) in the third-wave. Planning for earlier retirement during the third-wave was associated with age over 50 years (50-59 years odds ratio (OR) 5.37 (95% confidence interval (CI):2.33-12.31), 60 years and above OR 4.18 (95% CI: 1.90-10.23)), having difficulty handling increased non-clinical responsibilities (OR 2.95 (95% CI: 1.79-4.94)), feeling unsupported to work virtually (OR 1.96 (95% CI: 1.19-3.23)) or in-person (OR 2.70 (95% CI: 1.67-4.55)), feeling unable to provide good care (OR 1.82 (95% CI: 1.10-3.03)), feeling work was not valued (OR 1.92 (95% CI: 1.15-3.23)), feeling frightened of dealing with COVID-19 (OR 2.01 (95% CI: 1.19-3.38)), caring for an elderly relative (OR 2.36 (95% CI: 1.69-3.97)), having difficulty obtaining personal protective equipment (OR 2.00 (95% CI: 1.16-3.43)) or difficulty implementing infection control practices in clinic (OR 2.10 (95% CI: 1.12-3.89)). CONCLUSIONS:Over 20% of Ontario FP respondents were considering retiring earlier by the third-wave of the COVID-19 pandemic. Supporting FPs in their clinical and non-clinical roles, such that they feel able to provide good care and that their work is valued, reducing non-clinical (e.g., administrative) responsibilities, dealing with pandemic-related fears, and supporting infection control practices and personal protective equipment acquisition in clinic, particularly in those aged 50 years or older may help increase family physician retention during future pandemics.

Background With the onset of the COVID-19 pandemic and the large uptake in virtual care in primary care in Canada, the care of patients with type 2 diabetes has been greatly affected. This includes decreased in-person visits, laboratory testing and in-person assessments such as blood pressure (BP). No studies have investigated if these changes persisted with pandemic progression, and it is unclear if shifts impacted patient groups uniformly. The purpose of this paper was to examine changes in diabetes care pre, early, and later pandemic across different patient groups. Methods A repeated cross-sectional design with an open cohort was used to investigate diabetes care in adults with type 2 diabetes for a 6-month interval from March 14 to September 13 over three consecutive years: 2019 (pre-pandemic period), 2020 (early pandemic period), and 2021 (later pandemic period). Data for this study were abstracted from the University of Toronto Practice-Based Research Network (UTOPIAN) Data Safe Haven, a primary care electronic medical records database in Ontario, Canada. Changes in diabetes care, which included primary care total visits, in-person visits, hemoglobin A1c (HbA1c) testing, and BP measurements were evaluated across the phases of the pandemic. Difference in diabetes care across patient groups, including age, sex, income quintile, prior HbA1c levels, and prior BP levels, were assessed. Results A total of 39,401 adults with type 2 diabetes were included in the study. Compared to the 6-month pre-pandemic period, having any in-person visits decreased significantly early pandemic (OR = 0.079 (0.076–0.082)), with a partial recovery later pandemic (OR = 0.162 (95% CI: 0.157–0.169). Compared to the pre-pandemic period, there was a significant decrease early pandemic for total visits (OR = 0.486 (95% CI: 0.470–0.503)), HbA1c testing (OR = 0.401 (95% CI: 0.389–0.413)), and BP measurement (OR = 0.121 (95% CI: 0.116–0.125)), with partial recovery later pandemic. Conclusions All measures of diabetes care were substantially decreased early pandemic, with a partial recovery later pandemic across all patient groups. With the increase in virtual care due to the COVID-19 pandemic, diabetes care has been negatively impacted over 1-year after pandemic onset.

BackgroundThe global burden of Parkinson's disease (PD) has more than doubled over the past three decades, and this trend is expected to continue. Despite generally poorer access to health care services in rural areas, little previous work has examined health system use in persons with PD by rurality. We examined trends in the prevalence of PD and health service use among persons with PD by rurality in Ontario, Canada.MethodsWe conducted a repeated, cross-sectional analysis of persons with prevalent PD aged 40+ years on April 1st of each year from 2000 to 2018 using health administrative databases and calculated the age-sex standardized prevalence of PD. Prevalence of PD was also stratified by rurality and sex. Negative binomial models were used to calculate rate ratios with 95% confidence intervals comparing rates of health service use in rural compared to urban residents in 2018.ResultsThe age-sex standardized prevalence of PD in Ontario increased by 0.34% per year (p<0.0001) and was 459 per 100,000 in 2018 (n = 33,479), with a lower prevalence in rural compared to urban residents (401 vs. 467 per 100,000). Rates of hospitalizations and family physician visits declined over time in both men and women with PD in rural and urban areas, while rates of emergency department, neurologist, and other specialist visits increased. Adjusted rates of hospitalizations were similar between rural and urban residents (RR = 1.04, 95% CI [0.96, 1.12]), while rates of emergency department visits were higher among rural residents (RR = 1.35, 95% CI [1.27, 1.42]). Rural residents had lower rates of family physician (adjusted RR = 0.82, (95% CI [0.79, 0.84]) and neurologist visits (RR = 0.74, 95% CI [0.72, 0.77]).InterpretationLower rates of outpatient health service use among persons residing in rural regions, contrasting with higher rates of emergency department visits suggest inequities in access. Efforts to improve access to primary and specialist care for persons with PD in rural regions are needed.

OBJECTIVE:To estimate prevalence and incidence rates over time in children and youth with attention deficit/hyperactivity disorder from the validation of population-based administrative data algorithms using family physicians' electronic medical records as a reference standard.METHODS:A retrospective cohort study was conducted in Ontario, Canada to identify attention deficit/hyperactivity disorder among children and youth aged 1-24 years in health administrative data derived from case-finding algorithms using family physicians' electronic medical records. Multiple administrative data algorithms identifying attention deficit/hyperactivity disorder cases were developed and tested from physician-diagnosis of attention deficit/hyperactivity disorder in the electronic medical record to determine their diagnostic accuracy. We calculated algorithm performance using sensitivity, specificity, and predictive values. The most optimal algorithm was used to estimate prevalence and incidence rates of attention deficit/hyperactivity disorder from 2014 to 2021 in Ontario.RESULTS:The optimal performing algorithm was "2 physician visits for attention deficit/hyperactivity disorder in 1 year or 1 attention deficit/hyperactivity disorder-specific prescription" with sensitivity: 83.2% (95% confidence interval [CI], 81.8% to 84.5%), specificity: 98.6% (95% CI, 98.5% to 98.7%), positive predictive value: 78.6% (95% CI, 77.1% to 80.0%) and negative predictive value: 98.9% (95% CI, 98.8% to 99.0%). From 2014, prevalence rates for attention deficit/hyperactivity disorder increased from 5.29 to 7.48 per 100 population in 2021 (N = 281,785). Males had higher prevalence rates (7.49 to 9.59 per 100 population, 1.3-fold increase) than females (2.96-5.26 per 100 population, 1.8-fold increase) from 2014 to 2021. Incidence rates increased from 2014 (0.53 per 100 population) until 2018, decreased in 2020 then rose steeply in 2021 (0.89 per 100 population, N = 34,013). Males also had higher incidence rates than females from 2014 to 2020 with females surpassing males in 2021 (0.70-0.81 per 100 male population,1.2-fold increase versus 0.36-0.97 per 100 female population, 2.7-fold increase).CONCLUSIONS:Attention deficit/hyperactivity disorder is increasing in prevalence. We developed an administrative data algorithm that can reliably identify children and youth with attention deficit/hyperactivity disorder with good diagnostic accuracy.

Background:Primary care electronic medical record (EMR) data can be used to identify, manage, and screen hypertension cases. However, this approach relies on completeness and accessibility of documented blood pressure (BP) values. With the large switch to virtual care due to the COVID-19 pandemic, we assessed BP documentation in primary care EMRs during the pandemic, across patient and physician groups. Methods:Hypertension-related visits were identified during the pre-pandemic (January 2017 to February 2020) and pandemic (March 2020 to December 2021) periods from a primary care EMR database in Ontario, Canada. Clustered logistic regression models were used to analyze the relationship of physician and patient characteristics with an outcome variable of documented BP. A chart review of 3200 hypertension visits without a BP recorded in structured data fields was conducted to determine if BP was recorded in progress notes. Results:Pre-pandemic, 75.7% of hypertension-related visits (113,966 of 150,511) had a BP recorded in structured documentation, but this significantly decreased to 36.4% (26,660 of 73,239) during the pandemic (odds ratio [OR] = 0.18, 95% confidence interval [CI]: 0.18-0.19). For virtual visits, 14.3% (6357 of 44,572) had a documented BP, vs 74.0% (20,056 of 27,089) for in-person visits. Chart review found that 55.9% of hypertension visits had no associated BP in structured documentation, but did have a BP recorded in the progress note. Male providers, compared to female providers, were less likely to record BPs pre-pandemic (OR = 0.45, 95% CI: 0.32-0.63) and during the pandemic, for both virtual visits (OR = 0.48, 95% CI: 0.32-0.71) and in-person visits (OR = 0.46, 95% CI: 0.33-0.64). Conclusions:BP documented in primary care EMRs declined during the pandemic, most likely due to high rates of virtual visits impacting hypertension detection and management.

Au Canada, plus de 2 millions de personnes vivent avec l’ostéoporose, une maladie qui accroît le risque de fracture, ce qui fait augmenter la morbidité et la mortalité, et entraîne une perte de qualité de vie et d’autonomie. La présente actualisation des lignes directrices vise à accompagner les professionnelles et professionnels de la santé au Canada dans la prestation de soins visant à optimiser la santé osseuse et à prévenir les fractures chez les femmes ménopausées et les hommes de 50 ans et plus. MÉTHODES: Le présent document fournit une actualisation des lignes directrices de pratique clinique de 2010 d’Ostéoporose Canada sur le diagnostic et la prise en charge de l’ostéoporose au pays. Nous avons utilisé l’approche GRADE (Grading of Recommendations Assessment, Development and Evaluation) et effectué l’assurance de la qualité conformément aux normes de qualité et de présentation des rapports de la grille AGREE II (Appraisal of Guidelines for Research & Evaluation). Les médecins de premier recours et les patientes et patients partenaires ont été représentés à tous les niveaux des comités et des groupes ayant participé à l’élaboration des lignes directrices, et ont participé à toutes les étapes du processus pour garantir la pertinence des informations pour les futurs utilisateurs et utilisatrices. Le processus de gestion des intérêts concurrents a été entamé avant l’élaboration des lignes directrices et s’est poursuivi sur toute sa durée, selon les principes du Réseau international en matière de lignes directrices. Dans la formulation des recommandations, nous avons tenu compte des avantages et des risques, des valeurs et préférences de la patientèle, des ressources, de l’équité, de l’acceptabilité et de la faisabilité; la force de chacune des recommandations a été déterminée en fonction du cadre GRADE.Les 25 recommandations et les 10 énoncés de bonne pratique sont répartis en sections : activité physique, alimentation, évaluation du risque de fracture, instauration du traitement, interventions pharmacologiques, durée et séquence du traitement, et monitorage. La prise en charge de l’ostéoporose devrait se fonder sur le risque de fracture, établi au moyen d’une évaluation clinique réalisée avec un outil d’évaluation du risque de fracture validé. L’activité physique, l’alimentation et la pharmacothérapie sont des éléments essentiels à la stratégie de prévention des fractures, qui devraient être personnalisés. INTERPRÉTATION: Les présentes lignes directrices ont pour but d’outiller les professionnelles et professionnels de la santé et la patientèle afin qu’ensemble ils puissent parler de l’importance de la santé osseuse et du risque de fracture tout au long de la vie adulte avancée. La détection et la prise en charge efficace de la fragilité osseuse peuvent contribuer à réduire les fractures et à préserver la mobilité, l’autonomie et la qualité de vie.

Objective To determine whether more patients presented with Attention-deficit/hyperactivity disorder (ADHD)-related visits and/or sought care from family physicians more frequently during the COVID-19 pandemic. Methods Electronic medical records from the University of Toronto Practice-Based Research Network were used to characterize changes in family physician visits and prescriptions for ADHD medications. Annual patient prevalence and visit rates pre-pandemic (2017–2019) were used to calculate the expected rates in 2020 and 2021. The expected and observed rates were compared to identify any pandemic-related changes. Results The number of patients presenting for ADHD-related visits during the pandemic was consistent with pre-pandemic trends. However, observed ADHD-related visits in 2021 were 1.32 times higher than expected (95% CI: 1.05–1.75), suggesting that patients visited family physicians more frequently than before the pandemic. Conclusion Demand for primary care services related to ADHD has continued to increase during the pandemic, with increased health service use among those accessing care.

Context The stresses of the pandemic have been felt by most. Working in family medicine we have noticed an increase in patient inquiries into Attention Deficit/Hyperactivity Disorder (ADHD). Objective We set out to examine if the trends in the patients presenting to family medicine for ADHD have changed during the pandemic. Study Design We did a retrospective cohort study examining rates of patients presenting to the family physician office with a visit with the most responsible reason for visit as ADHD or a prescription for an ADHD medication. Setting We used the UTOPIAN primary care EMR database in Ontario, Canada containing patients in the Greater Toronto Area and beyond. Population Studied Over 200,000 patients annually age 5-55 years presenting to a UTOPIAN physician in 2017-2021. Outcome Measures Proportion of patients each year with a visit to a family physician where the most responsible reason for visit was documented as ADHD. Proportion of patients each year receiving a prescription for an ADHD medication. Patients visiting family physicians for ADHD were examined by age, sex, income quintile and urban vs rural residence. Results The proportion of patients with an ADHD visit in 2017-2019 ranged from 2.4 to 3.5/1000 in 2017-2019 and rose to 5.5/1000 by the end of 2021. The proportion of patients visiting for ADHD was relatively stable in 2017-2019 for all age groups but was higher than pre-pandemic for the 20-24 year olds and the 25-34 year olds by 2021. The proportion of patients with an ADHD medication prescription in 2017-2019 ranged from 12.9 to 16.5/1000 and rose to 21.9/1000 by the end of 2021. Prior to the pandemic ADHD visits were higher in rural patients compared to patients residing in urban areas (2.8 rural and 2.4/1000 urban in 2017) but the reverse occurred with the pandemic onset (3.9 rural and 5.7/1000 urban in 2021). ADHD visits and medications were higher both before and after the pandemic for males compared to females. This persistent pattern was also seen with income quintiles both before and during the pandemic with the patients in highest income quintile consistently having more ADHD visits and prescriptions compared to the lowest income quintile. Conclusions There has been an increasing proportion of patients seeing family physicians for ADHD and receiving prescriptions for ADHD medications over the past 5 years with amplification of these increases in some patient populations particularly in 2021.

Background: Early onset dementia (EOD) occurs when symptoms of dementia begin between 45 to 64 years of age. Objective: We developed and validated health administrative data algorithms for EOD and compared demographic characteristics and presence of comorbid conditions amongst adults with EOD, late onset dementia (LOD) and adults with no dementia in Ontario, Canada. Methods: Patients aged 45 to 64 years identified as having EOD in their primary care electronic medical records had their records linked to provincial health administrative data. We compared several combinations of physician’s claims, hospitalizations, emergency department visits and prescriptions. Age-standardized incidence and prevalence rates of EOD were estimated from 1996 to 2016. Results: The prevalence of EOD for adults aged 45 to 64 years in our primary care reference cohort was 0.12%. An algorithm of ≥1 hospitalization or ≥3 physician claims at least 30 days apart in a two-year period or ≥1 dementia medication had a sensitivity of 72.9% (64.5–81.3), specificity of 99.7% (99.7–99.8), positive predictive value (PPV) of 23.7% (19.1–28.3), and negative predictive value of 100.0%. Multivariate logistic regression found adults with EOD had increased odds ratios for several health conditions compared to LOD and no dementia populations. From 1996 to 2016, the age-adjusted incidence rate increased slightly (0.055 to 0.061 per 100 population) and the age-adjusted prevalence rate increased three-fold (0.11 to 0.32 per 100 population). Conclusion: While we developed a health administrative data algorithm for EOD with a reasonable sensitivity, its low PPV limits its ability to be used for population surveillance.