Wayne Putnam - Academia.edu (original) (raw)
Papers by Wayne Putnam
Canadian family physician Médecin de famille canadien, 2004
To explore obstacles to and opportunities for applying specific lifestyle and pharmacologic recom... more To explore obstacles to and opportunities for applying specific lifestyle and pharmacologic recommendations on chronic ischemic heart disease. Qualitative study. Rural, town, and city settings in Nova Scotia. Fifty family physicians caring for patients with cardiovascular (CV) disease. Nine focus groups were conducted, audiotaped, and transcribed. Seven recommendations had been selected for discussion based on their relevance to primary care, strength, and class of supporting evidence. Analysis was guided by grounded-theory methodology. "Ischemic events" can be powerful motivators for change, whereas the asymptomatic nature of CV risks and distant outcomes can form obstacles. Trust built through previous experiences and the opportunity to repeat important messages can facilitate application of evidence, but patient-physician relationships can also pose obstacles. Physicians can take steps to improve care, but success at reducing CV risks depends upon active involvement of ...
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 11, 2002
Little is known about the impact of evidence-based medicine in primary care. Our objective was to... more Little is known about the impact of evidence-based medicine in primary care. Our objective was to explore the influence of evidence on day-to-day family practice, with specific reference to cardiovascular disease. A total of 9 focus groups were conducted in rural, semi-urban and urban settings in Nova Scotia. The participants were 50 family physicians who had practised in their communities for more than 1 year and who were treating patients with cardiovascular disease. Two major themes emerged: evidence in the clinical encounter and the culture of evidence. The family physicians reported thinking about evidence during the clinical encounter but still situated that evidence within the specific context of their patients and their communities. They appreciated evidence that had been appraised, summarized and published as a guideline by an independent national organization. Evidence remained in the forefront of consciousness for a limited time frame. Local specialists, trusted because o...
Canadian Journal of Diabetes, 2011
This study describes self-reported health and lifestyle behaviours and health risk beliefs among ... more This study describes self-reported health and lifestyle behaviours and health risk beliefs among community patients diagnosed with type 2 diabetes and hypertension.
The Canadian journal of clinical pharmacology = Journal canadien de pharmacologie clinique, 2003
Oral anticoagulants reduce the incidence of stroke by 68%, yet suboptimal use has been documented... more Oral anticoagulants reduce the incidence of stroke by 68%, yet suboptimal use has been documented in surveys of patients with atrial fibrillation. The present study examined current patterns of anticoagulant use for patients hospitalized with atrial fibrillation across an entire health care system. Improving Cardiovascular Outcomes in Nova Scotia (ICONS) is a prospective cohort study involving all patients hospitalized in Nova Scotia with atrial fibrillation, among other conditions. Consecutive inpatients with atrial fibrillation from October 15, 1997 to October 14, 1998 were studied. Detailed demographic and clinical data were collected and the proportion of patients using antithrombotic therapy was tabulated by risk category. Multivariate logistic regression was used to assess the relationship of various demographic and clinical factors with the use of antithrombotic agents. There were 2202 patients hospitalized with atrial fibrillation; 644 admitted specifically for this conditio...
Canadian family physician Médecin de famille canadien, 2004
Atrial fibrillation (AF) substantially increases risk of stroke. Evidence suggests that anticoagu... more Atrial fibrillation (AF) substantially increases risk of stroke. Evidence suggests that anticoagulation to reduce risk is underused (a "care gap"). Our objectives were to clarify measures of this gap in care by including data from family physicians and to determine why eligible patients were not receiving anticoagulation therapy. Telephone survey of family physicians regarding specific patients in their practices. Nova Scotia. Ambulatory AF patients not taking warfarin who had risk factors that made anticoagulation appropriate. Proportion of patients removed from the care gap; reasons given for not giving the remainder anticoagulants. Half the patients thought to be in the care gap had previously unknown contraindications to anticoagulation, lacked a clear indication for anticoagulation, or were taking warfarin. Patients' refusal and anticipated problems with compliance and monitoring were among the reasons for not giving patients anticoagulants. Adding data from prima...
Journal of Health Services Research & Policy, 2006
Public reporting of health data is well established in the United States and in the United Kingdo... more Public reporting of health data is well established in the United States and in the United Kingdom, and is assumed to promote better health care through informed choice by consumers. To be successful, reporting systems must have the support of physicians, but their opinions have been mixed. The purpose of this study was to explore with practising physicians the perceived usefulness of, and barriers to use of, quality indicators in the care of acute myocardial infarction and congestive heart failure, and the contexts in which these issues arise. Six focus groups were conducted in small-, medium- and large-sized communities in two provinces in Canada. Subjects were family physicians, emergency physicians, internists and cardiologists. Data were analysed inductively. Our participants were generally supportive of the quality indicators, with concerns expressed regarding interpretation of data from measures created by "experts" but applied in the context of community hospitals and community-based practice. Content analysis disclosed that a majority of the indicators was acceptable; few were outright unacceptable. Inductive analysis revealed two contextual concerns: issues arising from the structure and organization of the health care system, such as equitable access to health care resources and discontinuity or fragmentation of the system, and patient-related issues, such as compliance with medications post-discharge and costs of medications. There is general support for this set of quality indicators, with the caveat that data should be carefully interpreted in the context of each community in which they are applied.
Health, Risk & Society, 2004
The management of patients through the use of evidence-based medicine has become the &amp... more The management of patients through the use of evidence-based medicine has become the 'mantra' of medicine within many Western countries. Evidence-based medicine is aimed at providing the best objective, scientific care to all patients, and reducing as far as possible patients' risks of disease and complications from disease. Based on family physicians' discussions of the use of evidence-based recommendations for
Journal of Continuing Education in the Health Professions, 1998
Canadian family physician Médecin de famille canadien, 2004
To explore obstacles to and opportunities for applying specific lifestyle and pharmacologic recom... more To explore obstacles to and opportunities for applying specific lifestyle and pharmacologic recommendations on chronic ischemic heart disease. Qualitative study. Rural, town, and city settings in Nova Scotia. Fifty family physicians caring for patients with cardiovascular (CV) disease. Nine focus groups were conducted, audiotaped, and transcribed. Seven recommendations had been selected for discussion based on their relevance to primary care, strength, and class of supporting evidence. Analysis was guided by grounded-theory methodology. "Ischemic events" can be powerful motivators for change, whereas the asymptomatic nature of CV risks and distant outcomes can form obstacles. Trust built through previous experiences and the opportunity to repeat important messages can facilitate application of evidence, but patient-physician relationships can also pose obstacles. Physicians can take steps to improve care, but success at reducing CV risks depends upon active involvement of ...
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 11, 2002
Little is known about the impact of evidence-based medicine in primary care. Our objective was to... more Little is known about the impact of evidence-based medicine in primary care. Our objective was to explore the influence of evidence on day-to-day family practice, with specific reference to cardiovascular disease. A total of 9 focus groups were conducted in rural, semi-urban and urban settings in Nova Scotia. The participants were 50 family physicians who had practised in their communities for more than 1 year and who were treating patients with cardiovascular disease. Two major themes emerged: evidence in the clinical encounter and the culture of evidence. The family physicians reported thinking about evidence during the clinical encounter but still situated that evidence within the specific context of their patients and their communities. They appreciated evidence that had been appraised, summarized and published as a guideline by an independent national organization. Evidence remained in the forefront of consciousness for a limited time frame. Local specialists, trusted because o...
Canadian Journal of Diabetes, 2011
This study describes self-reported health and lifestyle behaviours and health risk beliefs among ... more This study describes self-reported health and lifestyle behaviours and health risk beliefs among community patients diagnosed with type 2 diabetes and hypertension.
The Canadian journal of clinical pharmacology = Journal canadien de pharmacologie clinique, 2003
Oral anticoagulants reduce the incidence of stroke by 68%, yet suboptimal use has been documented... more Oral anticoagulants reduce the incidence of stroke by 68%, yet suboptimal use has been documented in surveys of patients with atrial fibrillation. The present study examined current patterns of anticoagulant use for patients hospitalized with atrial fibrillation across an entire health care system. Improving Cardiovascular Outcomes in Nova Scotia (ICONS) is a prospective cohort study involving all patients hospitalized in Nova Scotia with atrial fibrillation, among other conditions. Consecutive inpatients with atrial fibrillation from October 15, 1997 to October 14, 1998 were studied. Detailed demographic and clinical data were collected and the proportion of patients using antithrombotic therapy was tabulated by risk category. Multivariate logistic regression was used to assess the relationship of various demographic and clinical factors with the use of antithrombotic agents. There were 2202 patients hospitalized with atrial fibrillation; 644 admitted specifically for this conditio...
Canadian family physician Médecin de famille canadien, 2004
Atrial fibrillation (AF) substantially increases risk of stroke. Evidence suggests that anticoagu... more Atrial fibrillation (AF) substantially increases risk of stroke. Evidence suggests that anticoagulation to reduce risk is underused (a "care gap"). Our objectives were to clarify measures of this gap in care by including data from family physicians and to determine why eligible patients were not receiving anticoagulation therapy. Telephone survey of family physicians regarding specific patients in their practices. Nova Scotia. Ambulatory AF patients not taking warfarin who had risk factors that made anticoagulation appropriate. Proportion of patients removed from the care gap; reasons given for not giving the remainder anticoagulants. Half the patients thought to be in the care gap had previously unknown contraindications to anticoagulation, lacked a clear indication for anticoagulation, or were taking warfarin. Patients' refusal and anticipated problems with compliance and monitoring were among the reasons for not giving patients anticoagulants. Adding data from prima...
Journal of Health Services Research & Policy, 2006
Public reporting of health data is well established in the United States and in the United Kingdo... more Public reporting of health data is well established in the United States and in the United Kingdom, and is assumed to promote better health care through informed choice by consumers. To be successful, reporting systems must have the support of physicians, but their opinions have been mixed. The purpose of this study was to explore with practising physicians the perceived usefulness of, and barriers to use of, quality indicators in the care of acute myocardial infarction and congestive heart failure, and the contexts in which these issues arise. Six focus groups were conducted in small-, medium- and large-sized communities in two provinces in Canada. Subjects were family physicians, emergency physicians, internists and cardiologists. Data were analysed inductively. Our participants were generally supportive of the quality indicators, with concerns expressed regarding interpretation of data from measures created by "experts" but applied in the context of community hospitals and community-based practice. Content analysis disclosed that a majority of the indicators was acceptable; few were outright unacceptable. Inductive analysis revealed two contextual concerns: issues arising from the structure and organization of the health care system, such as equitable access to health care resources and discontinuity or fragmentation of the system, and patient-related issues, such as compliance with medications post-discharge and costs of medications. There is general support for this set of quality indicators, with the caveat that data should be carefully interpreted in the context of each community in which they are applied.
Health, Risk & Society, 2004
The management of patients through the use of evidence-based medicine has become the &amp... more The management of patients through the use of evidence-based medicine has become the 'mantra' of medicine within many Western countries. Evidence-based medicine is aimed at providing the best objective, scientific care to all patients, and reducing as far as possible patients' risks of disease and complications from disease. Based on family physicians' discussions of the use of evidence-based recommendations for
Journal of Continuing Education in the Health Professions, 1998