The Canadian Task Force on Preventive Health Care (CTFPHC) is composed of experts who develop recommendations for clinical preventive services delivered by Canadian primary care practitioners. The CTFPHC is responsible for prioritizing the topics that will be reviewed and works with the Global Health and Guidelines Division (GHGD) of the Public Health Agency of Canada to define the analytic framework and scope of each topic. In the preparation of evidence reviews and the development
of recommendations for each topic, the CTFPHC collaborates with two evidence review and synthesis centres and the GHGD. The CTFPHC also leads knowledge translation (KT) activities to promote guideline reach and uptake.
Message From the Chair
Greetings! In this issue, I am pleased to share information about a number of ongoing activities to help clinicians understand and implement guidelines. Earlier this month we released one of our newest clinical practice guidelines. In September 2017, the CMAJ published the CTFPHC’s Recommendations on screening for Abdominal Aortic Aneurysm (AAA) in primary care. For more information about the AAA Guideline, systemic review, and associated KT Tools, please visit the CTFPHC AAA guideline page. Other exciting news involves our new Obesity Prevention and management e-learning module that is now available along with our Screening for Cervical Cancer e-learning CME module – see below for more information. The CTFPHC has also launched a new article series, Prevention in Practice, within Canadian Family Physician – see below for more information and to access the first three parts of the series.
I am also happy to announce that the CTFPHC will attend three upcoming conference events: Congrès annuel de médecine in October 2017 and Family Medicine Forum and Practising Wisely Day in November 2017. We look forward to connecting with practitioners at these events.
This marks my last newsletter as chair of the CTFPHC; my term is complete at the end of September 2017. It has been a tremendous privilege to serve as chair for the last eight years and I am very proud at what we have accomplished together. The CTFPHC is in excellent hands with incoming chair Brett Thombs and vice-chair Gabriela Lewin, and I fully anticipate that the CTFPHC will continue to thrive under their leadership.
As always, we appreciate your interest in the CTFPHC and we encourage you to stay up to date on our work by visiting our website at www.canadiantaskforce.ca.
Sincerely,
Marcello Tonelli, MD SM
Chair, CTFPHC
Release of the CTFPHC’s Abdominal Aortic Aneurysm (AAA) Guideline
Earlier this month, the CMAJ published the CTFPHC’s fifteenth guideline. This latest guideline addresses screening for an abdominal aortic aneurysm (AAA) in primary care. An AAA results from a weakening in a section of the aortic wall in the abdomen which bulges due to pressure from blood flow, forming an aneurysm. The aneurysm may grow and eventually rupture causing death from hemorrhage. It is estimated that each year 20,000 Canadians are diagnosed with an AAA. Additionally, between 2009 and 2013 approximately 1,244 died each year from an AAA. Since an AAA is usually asymptomatic before rupture, screening can provide an opportunity to identify, monitor, and treat to prevent a rupture. Risk factors for AAA include male sex, older age, family history of AAA, and smoking.
The CTFPHC recommends one-time screening with ultrasonography for AAA in men 65 to 80 years of age. This is a weak recommendation based on moderate quality of evidence. The CTFPHC determined its recommendation based on the evidence showing that screening men 65 to 80 years of age has a sufficiently positive impact on reducing mortality, rupture, and emergency surgeries.
We recommend not screening men older than 80 years of age for AAA. This is a weak recommendation based on low quality of evidence. While the prevalence of AAA increases with age, in the judgment of the CTFPHC, the benefit of screening men over 80 years of age would be less because they are more likely to experience medical conditions that increase their risk of adverse events from elective procedures to repair an AAA.
Lastly, the CTFPHC recommends not screening women for AAA. This is a strong recommendation based on very low quality of evidence. Even in the era when AAA was more common, women experienced lower rates of AAA and if an AAA did occur it tended to happen later in women’s lives than for men, so any potential for benefit is very small.
Resources
To accompany the AAA Guideline, the CTFPHC developed a clinician algorithm and a 1000-person tool. The clinician algorithm provides a summary of the guideline recommendations along with answers to some common questions that clinicians may have about AAA screening. Copies of the clinician algorithm and the 1000-person tool are available to download for free on the CTFPHC AAA guideline webpage. As always, the CTFPHC encourages members of the public to discuss screening for AAA with their primary care provider, who is aware of their health background.
New: The Obesity Prevention and Management e-learning module
The Obesity Prevention and Management e-learning module, developed by the Centre for Effective Practice (CEP), expands on the CTFPHC’s 2015 guidelines on the prevention and management of obesity in adults and in youth and children. The module is intended to help primary care providers better understand the impact of obesity on patients; explains measures for assessing and monitoring obesity in adults, youth, and children; and provides an overview of behavioural and pharmacotherapeutic interventions available to patients. This Self-Learning program has been certified by the College of Family Physicians of Canada for up to 1 Mainpro+ credits.
New: Screening for Cervical Cancer e-learning CME module
The CTFPHC is pleased to offer the accredited e-learning CME module “Screening for Cervical Cancer with the 2013 Canadian Task Force on Preventive Health Care (CTFPHC) Guidelines.”
This e-learning CME module represents a unique learning opportunity for primary care providers to develop a deeper understanding of the 2013 national guidelines on cervical cancer screening (the previous guidelines were released in 1994) and some of the nuances of how they should be applied in clinical practice. This Self-Learning program has been certified by the College of Family Physicians of Canada for up to 1 Mainpro+ credits.
New: Canadian Family Physician – Prevention in Practice Article Series
The CTFPHC is pleased to launch a new article series, Prevention in Practice, within Canadian Family Physician. The series is intended to equip primary care providers with concrete advice on how to implement preventive health evidence into their work and engage in shared, informed decision making.
The article series will cover topics such as communicating the balance between benefits and harms, shared decision making, measures of outcome, effect size, assessing guidelines, eliciting patient values and preferences, and KT tools.
Read the first three parts of the series:
- Introduction
- Better decision making in preventive health screening: Balancing benefits and harms
- Shared decision making in preventive health care: What it is; what it is not
Conferences
Attending key conferences is an important component of the CTFPHC’s strategy for ensuring that primary care providers have direct access to our clinical practice guidelines, KT tools, and other resources. We look forward to connecting with clinicians at the Congrès annuel de médecine, Family Medicine Forum, and Practising Wisely Day, in October and November, 2017.
Congrès annuel de médecine
Montreal, Quebec
October 25 – 27, 2017
The CTFPHC will exhibit at the Congrès annuel de médecine from October 25 to October 27, 2017. The conference will be hosted by the Médecins francophones du Canada in Montreal, Quebec. For more information about this conference, please visit: www.medecinsfrancophones.ca.
Family Medicine Forum
Montreal, Quebec
November 8 – 11, 2017
The CTFPHC will exhibit at the Family Medicine Forum from November 8 to November 11, 2017. The conference will be hosted by the College of Family Physicians of Canada in Montreal, Quebec. For more information about this conference, please visit: fmf.cfpc.ca.
Practising Wisely Day
Toronto, Ontario
November 22, 2017
The CTFPHC will exhibit at the Practising Wisely Day on November 22, 2017. The Practising Wisely Day will be hosted by the Ontario College of Family Physicians’ in Toronto, Ontario. For more information about this pre-conference event, please visit: http://events.r20.constantcontact.com/register/ event?llr=xmbso8pab&oeidk=a07edvlulhd343be507.
Announcements
Clinical Prevention Leaders Network Update
The Clinical Prevention Leaders Network is a 2-year pilot initiative and research study aimed at developing and evaluating a network of clinical prevention leaders, with expertise in CTFPHC guideline development and implementation, across Canada. The purpose of this network will be to promote the uptake of evidence-based guidelines and to address barriers to guideline implementation at a local level through educational outreach and other KT activities.
For more information on this initiative, please contact Ajay Ram (Research Coordinator) (RamA@smh.ca) with the subject line ‘CPL Network’.
GRADE Update
The CTFPHC develops its guidelines using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method. This is an internationally recognized method for evaluating systematic review evidence to develop clinical practice guidelines.
As part of its KT activities, the CTFPHC is conducting a research project to identify the best ways to organize and present guideline recommendations and content to Canadian primary care providers. Data collection and analysis is now complete. The results will inform how the CTFPHC presents recommendations and guideline information in its guidelines and KT tools.
For more information on how the CTFPHC applies the GRADE method in its guideline development work, visit www. canadiantaskforce.ca/methods/grade.
Opportunities for Engagement
Patient Engagement in Guideline Development
The CTFPHC engages patients in its guideline development process. Specifically, the CTFPHC recruits patients to provide input at up to three stages of the guideline development process:
(1) when outcomes are selected for inclusion in the systematic review protocol; (2) when the final guideline recommendations and KT tools are developed; and (3) when patient KT tools are usability tested. The CTFPHC uses feedback provided by patients to guide the search for evidence on the harms and benefits of preventive health care interventions and to develop KT tools to accompany the guidelines.
Usability Testing of Practitioner Tools
The CTFPHC produces practitioner tools to support each of its guidelines. To ensure that the content, layout, navigation, and aesthetics of these tools are appropriate and useful for practice, we conduct usability testing with practitioners. If you are interested in reviewing and providing feedback on one of our upcoming guideline tools, please email Rossella Scoleri, research assistant, at scolerir@smh.ca for more information.
Note that we offer $100 compensation for a one-hour telephone interview.
Guidelines in Progress
Forthcoming guidelines developed by the CTFPHC will focus on the following topics:
- Screening for asymptomatic bacteriuria in pregnancy
- Screening for impaired visual acuity
- Screening for esophageal cancer
Topic Suggestions
Is there a preventive health topic that you would like to see the CTFPHC develop a clinical practice guideline for? Let us know what you are passionate about! We accept topic suggestions on a rolling basis and would love to hear from you. To submit a suggestion, please email us at info@canadiantaskforce.ca with the subject line “Topic Suggestions” or complete the online form.
Suggestions for the next newsletter
Is there a subject that you would like to see addressed in the next issue of the CTFPHC newsletter? Let us know what you’d like to see covered! We are always accepting suggestions. To submit a suggestion, please email Rossella Scoleri, research assistant, at scolerir@smh.ca with the subject line “Newsletter Suggestions”.