Annals of Family Medicine

NOVEMBER 20, 2024

Context: The Transitional Care Management (TCM) clinic visit is a uniquely billed visit type to review a recently discharged patient’s hospital course, reconcile medications, and continue ongoing workup. Objective: Our objective was to improve the TCM clinic no-show rate and thereby improve patient outcomes.

Appointment 130

Appointment Hospital Management DO 130

Integrated Care News by CFHA

MARCH 21, 2025

Enhance Care Coordination Across Both Models Establish workflows that integrate care coordination efforts between PCBH teams and CCBHC case managers to ensure smooth transitions between brief interventions in primary care and longer-term behavioral health services when necessary. Culture, culture, culture!

Behavioral Health Services 130

Behavioral Health Services Primary Care Integrated Care Mental Health 130

Canadian Family Physician

MAY 14, 2025

Objective To determine the major themes among clinical questions asked to addiction medicine specialists sent by primary care providers (PCPs) via the Champlain Building Access to Specialists through the eConsultation (BASE™) electronic consultation (eConsult) service and the PCP-perceived benefits of this service.

Primary Care 52

Primary Care Consulting Electronics Provider 52

Physician's Weekly

JUNE 25, 2025

Caring for patients with multiple chronic conditions requires identifying those at risk, clear communication, and coordinated care to improve outcomes. Many of these patients are clinically complex and receive care from multiple professionals—which creates unique management hurdles.

Chronic Condition 52

Chronic Condition Patients Management Primary Care Physician 52

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Primary care providers in Canada face significant workload challenges, including managing prescriptions, referrals, and laboratory tests alongside patient visits. This study aims to analyze electronic medical record (EMR) data to understand these workload dynamics. 0.9SD) encounters per patient since 2007.

Primary Care 130

Primary Care Referral Provider Electronics 130

Dr. Zaar

JUNE 1, 2025

Managing Type 2 diabetes requires more than just medication—it demands a long-term partnership with a skilled healthcare provider who understands your individual needs. Choosing the right diabetes doctor can make a major difference in how effectively your condition is managed, your quality of life, and your long-term health outcomes.

Diabetes 52

Diabetes Board-Certified Management Internal Medicine 52

GeriPal

SEPTEMBER 7, 2023

Does it improve outcomes that patients, caregivers, and clinicians care about? hint: 80% can be done in advance by patients or caregivers) Why is it that some oncologists are resistant to conducting a geriatric assessment, yet have no problem ordering tests that cost thousands of dollars? Welcome back, William. William: Thanks so much.

Patient-Centered 130

Patient-Centered IT Patients Clinic 130