Lee A. Green

Bio: Lee A. Green is an academic researcher from University of Alberta. The author has contributed to research in topics: Health care & Guideline. The author has an hindex of 37, co-authored 118 publications receiving 77246 citations. Previous affiliations of Lee A. Green include American Academy of Family Physicians & National Institutes of Health.

Assessing and Increasing Readiness for Patient-Centered Medical Home Implementation (Wise et al. 2011)

Abstract: “Implementing the PCMH model can be a major challenge, and many primary care practices may not be ready to undertake such a significant change in care delivery.” _______________ The current model of primary care in the United States is poorly designed and in need of repair (Grol and Grimshaw 2003; IOM 2001; McGlynn et al. 2003; Rosenthal 2008). It is designed to treat acute, episodic illness and limits physicians’ ability to provide proactive, preventive and consistent care over time. The Patient-Centered Medical Home (PCMH) model is designed to address these limitations in several ways:  Enhance outreach and engagement of patients  Better documentation and coordination of care (e.g., use of electronic medical records)  Increase use of population-based disease management (e.g., use of disease registries)  Improve quality of care, increase satisfaction with care, and lower cost of care

Eliciting Mental Models of Opioid Management: Comparison of Concept Mapping and Knowledge Audit Methods

Abstract:

Context:

The Collaborative Mentorship Network for Chronic Pain and Addiction (CMN) in Alberta has observed differences in understanding of opioid therapy between primary care physicians and pharmacists. We suspected that indicated that pharmacists and family physicians are approaching prescribing and managing opioid therapy with different mental models.

Objective:

To understand the systematic differences that exist between pharmacists’ and family physicians’ mental models of managing opioid therapy, as a guide to building common ground.

Study Design and Analysis:

Cross-sectional descriptive comparisons between groups. Framework-guided qualitative analysis.

Setting:

Family medicine and community pharmacy practices in Alberta, Canada.

Population Studied:

6 family physicians and 6 pharmacists who have some experience managing care for those using opioid therapy, recruited purposively for variation in age, years in practice, and geographic location across Alberta.

Intervention/Instrument:

Cognitive Task Analysis – Knowledge Audit (all participants, individually) and Concept Mapping (4 physicians, 4 pharmacists, in two mixed groups) methods.

Outcome Measures:

Detailed description of mental models of opioid therapy. Recommendations based on findings.

Results:

Mental models among pharmacists differed according to the context in which they work (chronic pain clinic, community pharmacy working closely with opioid dependency clinic, independent pharmacy, chain pharmacy). Mental models among family physicians differed based on their past experiences working with patients and pharmacists, as well as by when they were trained and the guidelines learned at that time. Mental model differences between family physicians and pharmacists were primarily in the decision making, continuity, and management of irregularity realms. The two concept maps differed greatly in richness and consistency, the more involved group’s map being richer and more consistent. Recommendations to the CMN program included different content and structure approaches based on target audience mental models.

Conclusions:

Concept Mapping and Knowledge Audit methods of CTA deliver somewhat different and complementary information about mental models. Understanding how different team members’ mental models differ is key to improving team functioning and care coordination.

Co-Designing Relational Continuity Interventions for Urban Underserved Patients Experiencing Hospital-Primary Care Transitions

Abstract: Co-Designing Relational Continuity Interventions for Urban Underserved Patients Experiencing Hospital-Primary Care Transitions 1st North American Conference on Integrated Care, Toronto, 4 7 October 2021 Ginetta Salvalaggio, Cara Brown, Teresa Cavett, Lee Green, Gayle Halas, Stephen Hwang, Elaine Hyshka, Jesse Jenkinson, Aisha Lofters, Stephanie Montesanti, Francesco Mosaico, Danielle Peebles, Andrew Pinto, Shanell Twan

Exploring the Longitudinal Work Patterns of Family Physicians From 2005-2019 – An Ontario Alberta Collaboration

Abstract:

Context:

There is growing concern about the supply and distribution of Family Physicians (FPs) in Canada. With an aging FP workforce and preference for part-time practice, securing access to care for remains a dilemma for patients and funders of health care in many parts of the country. Survey data suggests physicians are working in less in recent decades. Our study highlights the actual trend in health services provided by FPs and aims to inform policy discussions on FP supply.

Objective:

To determine the trend in service provision among 12,000 FPs in Ontario and 3500 in Alberta.

Study Design and Analysis:

This was a descriptive observational study. We calculated the number of service days provided by FPs for each year in Ontario and Alberta using our previously published method. One service day is defined as 10 or more clinic visits per day valued at >20$.

Dataset:

De-identified linked FP claims from Alberta Health and the Ontario Health Insurance Program for 2005-2019 inclusive.

Population Studied:

All FPs in Ontario and Alberta were included if they had evidence of 10 or more billings 3 days per week for at least 46 weeks. FPs with no billings and Alberta FPs with shadow-billings were excluded.

Intervention/Instrument:

n/a.

Outcome Measures:

Average service days provided by FPs, and FP practice characteristics.

Results:

In both Ontario and Alberta, the average service days per provider decreased over time among both male and female providers, and across all levels of experience. The decline in service days per provider was most pronounced in those most experienced (30+ years). From 2005 to 2018, in Ontario and Alberta, respectively, female FPs on average reduced service days by 16.8 and 45.44; male providers reduced service days by 9.5 and 27 service days per year. The next most pronounced decline was among those with 10-19 years in practice in Ontario (25.6 male, 13.3 female) and those with 20-29 years experience in Alberta (8.56 male, 10.3 female). The smallest declines were found in new graduates (0-9 years in practice).

Conclusions:

Service days provided by FPs in Ontario and Alberta appear to be declining differentially across FP subgroups. These results highlight important implications for accessing care and FP supply planning.

Learning Objectives:

To understand the trend in primary care provider work supply based on service provision. To understand the utility of a service day definition to calculate physician supply.

Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

Abstract: The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount.

2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

Abstract: ABCD : Appropriate Blood pressure Control in Diabetes ABI : ankle–brachial index ABPM : ambulatory blood pressure monitoring ACCESS : Acute Candesartan Cilexetil Therapy in Stroke Survival ACCOMPLISH : Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension ACCORD : Action to Control Cardiovascular Risk in Diabetes ACE : angiotensin-converting enzyme ACTIVE I : Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events ADVANCE : Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation AHEAD : Action for HEAlth in Diabetes ALLHAT : Antihypertensive and Lipid-Lowering Treatment to Prevent Heart ATtack ALTITUDE : ALiskiren Trial In Type 2 Diabetes Using Cardio-renal Endpoints ANTIPAF : ANgioTensin II Antagonist In Paroxysmal Atrial Fibrillation APOLLO : A Randomized Controlled Trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly People ARB : angiotensin receptor blocker ARIC : Atherosclerosis Risk In Communities ARR : aldosterone renin ratio ASCOT : Anglo-Scandinavian Cardiac Outcomes Trial ASCOT-LLA : Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm ASTRAL : Angioplasty and STenting for Renal Artery Lesions A-V : atrioventricular BB : beta-blocker BMI : body mass index BP : blood pressure BSA : body surface area CA : calcium antagonist CABG : coronary artery bypass graft CAPPP : CAPtopril Prevention Project CAPRAF : CAndesartan in the Prevention of Relapsing Atrial Fibrillation CHD : coronary heart disease CHHIPS : Controlling Hypertension and Hypertension Immediately Post-Stroke CKD : chronic kidney disease CKD-EPI : Chronic Kidney Disease—EPIdemiology collaboration CONVINCE : Controlled ONset Verapamil INvestigation of CV Endpoints CT : computed tomography CV : cardiovascular CVD : cardiovascular disease D : diuretic DASH : Dietary Approaches to Stop Hypertension DBP : diastolic blood pressure DCCT : Diabetes Control and Complications Study DIRECT : DIabetic REtinopathy Candesartan Trials DM : diabetes mellitus DPP-4 : dipeptidyl peptidase 4 EAS : European Atherosclerosis Society EASD : European Association for the Study of Diabetes ECG : electrocardiogram EF : ejection fraction eGFR : estimated glomerular filtration rate ELSA : European Lacidipine Study on Atherosclerosis ESC : European Society of Cardiology ESH : European Society of Hypertension ESRD : end-stage renal disease EXPLOR : Amlodipine–Valsartan Combination Decreases Central Systolic Blood Pressure more Effectively than the Amlodipine–Atenolol Combination FDA : U.S. Food and Drug Administration FEVER : Felodipine EVent Reduction study GISSI-AF : Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation HbA1c : glycated haemoglobin HBPM : home blood pressure monitoring HOPE : Heart Outcomes Prevention Evaluation HOT : Hypertension Optimal Treatment HRT : hormone replacement therapy HT : hypertension HYVET : HYpertension in the Very Elderly Trial IMT : intima-media thickness I-PRESERVE : Irbesartan in Heart Failure with Preserved Systolic Function INTERHEART : Effect of Potentially Modifiable Risk Factors associated with Myocardial Infarction in 52 Countries INVEST : INternational VErapamil SR/T Trandolapril ISH : Isolated systolic hypertension JNC : Joint National Committee JUPITER : Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin LAVi : left atrial volume index LIFE : Losartan Intervention For Endpoint Reduction in Hypertensives LV : left ventricle/left ventricular LVH : left ventricular hypertrophy LVM : left ventricular mass MDRD : Modification of Diet in Renal Disease MRFIT : Multiple Risk Factor Intervention Trial MRI : magnetic resonance imaging NORDIL : The Nordic Diltiazem Intervention study OC : oral contraceptive OD : organ damage ONTARGET : ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial PAD : peripheral artery disease PATHS : Prevention And Treatment of Hypertension Study PCI : percutaneous coronary intervention PPAR : peroxisome proliferator-activated receptor PREVEND : Prevention of REnal and Vascular ENdstage Disease PROFESS : Prevention Regimen for Effectively Avoiding Secondary Strokes PROGRESS : Perindopril Protection Against Recurrent Stroke Study PWV : pulse wave velocity QALY : Quality adjusted life years RAA : renin-angiotensin-aldosterone RAS : renin-angiotensin system RCT : randomized controlled trials RF : risk factor ROADMAP : Randomized Olmesartan And Diabetes MicroAlbuminuria Prevention SBP : systolic blood pressure SCAST : Angiotensin-Receptor Blocker Candesartan for Treatment of Acute STroke SCOPE : Study on COgnition and Prognosis in the Elderly SCORE : Systematic COronary Risk Evaluation SHEP : Systolic Hypertension in the Elderly Program STOP : Swedish Trials in Old Patients with Hypertension STOP-2 : The second Swedish Trial in Old Patients with Hypertension SYSTCHINA : SYSTolic Hypertension in the Elderly: Chinese trial SYSTEUR : SYSTolic Hypertension in Europe TIA : transient ischaemic attack TOHP : Trials Of Hypertension Prevention TRANSCEND : Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease UKPDS : United Kingdom Prospective Diabetes Study VADT : Veterans' Affairs Diabetes Trial VALUE : Valsartan Antihypertensive Long-term Use Evaluation WHO : World Health Organization ### 1.1 Principles The 2013 guidelines on hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology …

Diagnosis and Management of the Metabolic Syndrome An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement

Abstract: The metabolic syndrome has received increased attention in the past few years. This statement from the American Heart Association (AHA) and the National Heart, Lung, and Blood Institute (NHLBI) is intended to provide up-to-date guidance for professionals on the diagnosis and management of the metabolic syndrome in adults. The metabolic syndrome is a constellation of interrelated risk factors of metabolic origin— metabolic risk factors —that appear to directly promote the development of atherosclerotic cardiovascular disease (ASCVD).1 Patients with the metabolic syndrome also are at increased risk for developing type 2 diabetes mellitus. Another set of conditions, the underlying risk factors , give rise to the metabolic risk factors. In the past few years, several expert groups have attempted to set forth simple diagnostic criteria to be used in clinical practice to identify patients who manifest the multiple components of the metabolic syndrome. These criteria have varied somewhat in specific elements, but in general they include a combination of both underlying and metabolic risk factors. The most widely recognized of the metabolic risk factors are atherogenic dyslipidemia, elevated blood pressure, and elevated plasma glucose. Individuals with these characteristics commonly manifest a prothrombotic state and a pro-inflammatory state as well. Atherogenic dyslipidemia consists of an aggregation of lipoprotein abnormalities including elevated serum triglyceride and apolipoprotein B (apoB), increased small LDL particles, and a reduced level of HDL cholesterol (HDL-C). The metabolic syndrome is often referred to as if it were a discrete entity with a single cause. Available data suggest that it truly is a syndrome, ie, a grouping of ASCVD risk factors, but one that probably has more than one cause. Regardless of cause, the syndrome identifies individuals at an elevated risk for ASCVD. The magnitude of the increased risk can vary according to which components of the syndrome are …

2007 Guidelines for the Management of Arterial Hypertension : The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

Abstract: 2007 Guidelines for the Management of Arterial Hypertension : The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).