The Long-Term Effects of a Housing First Intervention on Primary Care and Non-Primary Care Physician Visits Among Homeless Adults with Mental Illness: A 7-Year RCT Follow-Up

Background: Housing First (HF)-based interventions have been implemented in North America and beyond to help people exit homelessness. The effect of these interventions on access to primary and specialist care services is not well-defined. This study assesses the long-term effects of an HF intervention for homeless adults with mental illness on primary care physician (PCP) and non-primary care physician (non-PCP) visits. Methods: This is a secondary analysis of the At Home/Chez Soi study, a randomized trial of HF for homeless adults with mental illness in Toronto, Canada. High-need (HN) participants were randomized to HF with assertive community treatment (HF-ACT) or treatment as usual (TAU). Moderate needs (MN) participants were randomized to HF with intensive case management (HF-ICM) or TAU. The primary outcomes were the incidence and the number of visits to a PCP and non-PCP over 7-years post-randomization, compared to the 1-year pre-randomization. Results: Of 575 enrolled participants, 527 (80 HN and 347 MN) participants were included in the analyses. HN participants who received HF-ACT had a significant reduction in the number of visits to a PCP compared to TAU participants (ratio of rate ratios (RRR): 0.66, 95% CI: 0.48-0.93) and a significant reduction in the number of non-PCP visits compared with TAU participants (RRR: 0.64, 95% CI: 0.42-0.97) in the 7-years post-randomization compared to the 1-year pre-randomization. MN participants who received HF-ICM had a significant increase in incident visits to a PCP compared to TAU participants (RRR: 1.66, 95% CI: 1.10-2.50). No effect of HF-ICM was observed on the incidence or number of non-PCP visits. Conclusion: HF has differing effects on visits to PCPs and non-PCPs among homeless people with high and moderate needs for mental health supports. HF does not result in a consistent increase in PCP and non-PCP visits over a 7-year follow-up period. The At Home/Chez Soi study is registered with ISRCTN (ISRCTN, ISRCTN42520374).

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Otologic Photography: Indications and Technique

Otolaryngology ◽

10.1016/s0194-5998(05)80343-2 ◽

1995 ◽

Vol 112 (5) ◽

pp. P133-P133

Author(s):

C. Bruce MacDonald

Keyword(s):

Primary Care ◽

Informed Consent ◽

Primary Care Physician ◽

Resident Education ◽

Care Physician ◽

Patient Counseling ◽

Educational Objectives

Educational objectives: To understand the benefits of photodocumentation of otologic disease with respect to patient counseling, informed consent, billing, long-term patient follow-up, and primary care physician and resident education.

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Long-term urological follow-up of multicystic dysplastic kidneys: Is it still indicated in 2007?

Canadian Urological Association Journal ◽

10.5489/cuaj.53 ◽

2012 ◽

Vol 1 (2) ◽

Author(s):

Karen Psooy

Keyword(s):

Primary Care ◽

Primary Care Physician ◽

Literature Search ◽

Care Physician ◽

Renal Ultrasound ◽

Contralateral Kidney ◽

Increased Risk ◽

Dysplastic Kidneys

Objective: To determine whether the current indications for the long-term urologicalfollow-up of children with multicystic dysplastic kidneys (MCDKs) are supported by the literature.Methods: The membership of the Pediatric Urologists of Canada was surveyedto determine if long-term urological follow-up was being performed, and if so, for what indications. A literature search using PubMed, EMBASE and aConference Papers Index was performed to determine whether the indicationslisted were supported by the literature.Results: A response rate of 72% was achieved for the survey, with most respondentsfollowing children with MCDK long-term. The main indications for long term follow-up were the increased risk of Wilms’ tumour (54%) and hypertension(32%), observation of the contralateral kidney (43%) and involutionof the MCDK (36%). The literature search did not support long-term urological follow-up for any of these indications, provided unilateral MCDK was anisolated genitourinary abnormality. Although it is rare, a primary care physician could monitor for hypertension.Conclusion: Long-term urological follow-up of children with “simple MCDK”is not supported by the literature, provided the diagnosis has been confirmedwith a follow-up renal ultrasound at 12–24 months. Blood pressure monitoringby a primary care physician is recommended.

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