Public record of meeting, 24 June, 2013

MINUTES

1. Welcome and Meeting Document Review

Marcello Tonelli welcomed the CTFPHC members and other participants and thanked them for attending the meeting. A round table of introductions was held.

1.1 Approval of October 2012 Meeting Minutes

CTFPHC members reviewed the minutes from the February 2013 meeting. No errors or omissions were noted. Gabriela Lewin moved to accept the minutes of the February 2013 meeting and Dr. Paula Brauer seconded the motion. Approved

1.2 Review of Actions from February 2013 Meeting

CTFPHC members reviewed the list of actions stemming from their previous meeting.

1.3 Review of the Meeting Agenda

CTFPHC members reviewed the meeting agenda. There were no revisions noted.

2. Task Force Office Update

Karen Grimsrud provided a brief update regarding the work of the OCTFPHC. She reported that Kim Elmsley has been appointed as Acting Assistant Deputy Minister of Health. Her position at PHAC has been filled by Rodney Ghali. Karen also reported that approval has been provided to develop a business plan for a Task Force on Public Health Guidelines. Sarah Connor Gorber was recognized for recently winning a federal government People Management Award for her exceptional skills as a manager.

3. Developmental Delay Working Group Update

The Developmental Delay Working Group has been established and has conducted a scoping review. The CTFPHC reviewed preliminary PICO and exclusions and provided preliminary thoughts on key questions and other issues such as the role of schools and day cares. It was also noted that this issue is closely connected to the social determinants of health.

4. Childhood and Adult Obesity Working Group Update

4.1 Screening, Prevention, and Treatment of Overweight and Obesity

Paula Brauer provided an update on the ongoing development of guidelines on screening, prevention, and treatment of overweight/obesity for adults. The analytic framework on prevention and treatment interventions for normal weight, overweight, and obese adults has been revised and key questions have also been refined. Analysis is expected to take place in August and draft recommendations should be ready for the October 2013 CTFPHC meeting.

4.2 Primary Prevention in Normal Weight Children

Patricia Parkin reviewed the key questions and reported that the ERSC has completed draft forest and funnel plots and draft GRADE tables.

5. Colorectal Cancer Working Group Update

Maria Bacchus provided an update regarding the work of the colorectal cancer working group. The protocol review has been completed and the final protocol has been developed based on feedback from reviewers and CTFPHC members. Ongoing work is underway to determine a relationship with potential partners.

6. eHealth/EMR Working Group

Rick Birtwhistle reported that there have been a number of issues regarding the CTFPHC mobile app and it is not yet ready for usability testing. More discussion is needed regarding the purpose of the mobile app and its specifications.

7. ERSC Update

Donna Ciliska and Donna Fitzpatrick-Lewis provided an update on the work of the ERSC including the publication of ERSC papers.

8. Depression Debrief

A debrief was held regarding the release of the updated guideline on depression screening in primary care settings. The guideline was published in the CMAJ on Monday May 13, 2013 and distributed to national media on the same day. Coverage from the outreach totalled more than 25 million media impressions across Canada. The coverage was balanced with key messages, spokesperson quotes, and guideline changes prominent in the stories.

9. Endorsement and Critical Appraisal

A new format has been generated for appraisals and existing reports have been reformatted. 10 additional topics have been selected from the 2013 top 1 topic list.

The CTFPHC reviewed and discussed several completed appraisals as follows:

9.1 Screening for Fragility Fractures—Osteoporosis Canada, 2010

This guideline was placed on hold for further development.

9.2 Atrial Fibrillation—Canadian Cardiovascular Society, 2012

This guideline was placed on hold until further adjustments could be made.

9.3 Screening for Ovarian Cancer—USPSTF, 2012

It was unanimously agreed that this guideline would be adopted.

9.4 Screening for Skin Cancer—New Zealand Guidelines Group, 2009

This guideline will not be definitively endorsed. More detail will be added and linkages made with the existing guideline.

9.5 Screening for Intimate Partner Violence and Abuse of Elderly and Vulnerable—USPSTF, 2013

There was discussion about the harms and benefits of recommending this guideline and agreed that comments will be send to the USPSTF.

9.6 Screening for HIV—USPSTF, 2013

Further work will be carried out on this guideline (e.g., it should be suggested that practitioners remain alert to people with undetected risk factors).

9.7 Screening for Chlamydia—SIGN, 2009

Although this is an important guideline for family physicians, it was agreed that this guideline was not well-founded for use in Canada.

9.8 Screening for Vitamin D Deficiency—The Endocrine Society, 2011

This guideline did not meet CTFPHC criteria for high quality due to a lack of systematic review.

9.9 Smoking Cessation—CAN-ADAPTT, 2011

This guideline did not meet CTFPHC criteria for high quality.

10. Methods Working Group Update

Sarah Connor Gorber reviewed the list of published guidelines since the last CTFPHC meeting as well as those in progress. She also outlined recent presentations and topic under consideration, such as costing, scope, the use of GRADE tables, and surrogate outcomes.

Amanda Shane reviewed the current system for literature surveillance and shared a sample summary report.

11. Prostate Cancer Working Group Update

Neil Bell and Ali Usman provided an extensive review of the evidence regarding the prostate cancer screening Key Questions. It was noted that there is a lack of research studies that meet the inclusion criteria and the CTFPHC members discussed a range of issues, such as alternate screening tools, harms/benefits, and possible options for recommendations. It was noted that mortality from prostate cancer has dropped however it is difficult to determine what proportion is due to screening or improvements in treatment.

12. KT WG Update

Julia Moore provided an update on the work of the Knowledge Translation Working Group including the development of tools regarding the depression and type 2 diabetes guidelines. They also reported that an internal evaluation is underway to assess CTFPHC activities and impact. Dawn provided an overview of website hits from June 2012 to June 2013.

13. Topics Working Group Update

Sarah Connor Gorber reviewed the top 10 topics 2013 rankings noting that lung cancer and cognitive impairment were carried over from 2012. The development of recommendations on screening for lung cancer and cognitive impairment is currently on hold for a USPSTF update.

Cardiovascular disease CVD was placed at the top of the prioritization list for future topics to be developed by the CTFPHC. A two-month scoping exercise regarding cardiovascular disease has been completed and some options have emerged regarding how to approach a CVD guideline. It was noted that the C-CHANGE Initiative was underway and will have an impact at the provincial and national level.

14. E-Infrastructure and Timelines

Alejandra Jaramillo confirmed that SharePoint was selected as the new file sharing system and the CTFPHC was provided with an overview and walk-through from Joel Hill, Executive Director. Aljeandra reviewed two reports: a Gantt chart with current estimated completion and launch dates and adjustments to timeline from September 2012 to June 2013. She also provided a summary of time adjustments for each guideline.

15. USPSTF and GRADE Discussion

Kevin Pottie provided a brief presentation regarding his attendance at a meeting of the USPSTF. Karen Grimsrud also presented information about her recent visit to the USPSTF/ARHQ in March 2013. A meeting was held with ARHQ staff to discuss the processes used to support the USPSTF and potential areas of collaboration between the CTFPHC and USPSTF. It was agreed that the CTFPHC consider ways to better connect on joint projects with the USPSTF.

16. Patient/Public Input

Karen Grimsrud reviewed a document entitled “Towards developing an approach to incorporating patient and public involvement in CTFPHC’s clinical practice guidelines” and members reviewed options to increase the input of public/patients into the work of the CTFPHC.

17. Update on Cervical Cancer Guideline

Jim Dickinson and Marcello Tonelli provided a brief update regarding the ongoing issue of cervical cancer guidelines.

18. Progress to Date

Marcello Tonello pointed out that there were two membership vacancies on the CTFPHC and a number of applicants and potential applicants were under review. Marcello also thanked Liz and Michel for their hard work and participation at past meetings.

Marcello reminded members that there had been suggestions for some changes to make meetings more effective. Members discussed this issue and made a number of suggestions.

19. Next Steps and Adjournment

Marcello Tonelli and Richard Birtwhistle thanked all present for their hard work and contributions. The next meeting will take place in Ottawa on October 7–8.