Parkinson’s Disease in Primary Care: A Practical Canadian Primer
Parkinson’s disease (PD) is a progressive neurodegenerative disorder that is increasingly encountered in Canadian primary care. National surveillance data estimate that over 110,000 Canadians are living with Parkinsonism, with incidence rising steadily as the population ages. Approximately 80% of new diagnoses occur after the age of 65 years, making PD highly relevant to geriatric-focused primary care practice. For family physicians, PD represents not only a diagnostic challenge but also a longitudinal care responsibility that intersects with multimorbidity, polypharmacy, fall risk, and caregiver burden. The diagnosis of PD remains clinical. It requires recognition of Parkinsonism, defined as bradykinesia in combination with rest tremor and/or rigidity, and on an assessment of whether the clinical features support idiopathic PD versus alternative etiologies such as drug-induced, vascular, or atypical Parkinsonism. In primary care, a structured approach that incorporates a focused history, bedside motor examination, and screening for non-motor symptoms can significantly improve diagnostic accuracy. Management begins with patient education, early initiation of exercise, and symptom-guided pharmacotherapy. Levodopa remains the most effective treatment for motor symptoms and should not be delayed once functional impairment emerges. Primary care clinicians are well positioned to initiate therapy, monitor therapeutic response, and coordinate multidisciplinary care, particularly in regions where access to neurology is limited.
Copyright (c) 2026 Canadian Primary Care Today https://creativecommons.org/licenses/by-nc-nd/4.0
Refractive Surgery Primer for Primary Care
When a patient expresses a desire to become ‘glasses-free,’ the conversation that follows can quickly become overwhelming. Patients often have a specific procedure in mind (most commonly laser-assisted in-situ keratomileusis [LASIK]) and can become frustrated if this is not the primary option recommended. From the physician’s perspective, it can be challenging to simplify a vast array of options without confusing the patient. In this article, I aim to offer a simplified approach for navigating the many contemporary refractive surgery options. The goal is to provide both patients and physicians with an overview of the currently available treatment modalities and to elucidate the multiple variables that influence the surgical decision-making process, guiding the selection of the most appropriate surgery for each patient (Table 1).
Chronic Pain in Primary Care: A Practical Guide to What Works (and What Does Not)
Chronic non-cancer pain is a leading driver of disability worldwide. It is defined as pain persisting beyond normal tissue healing time (>3 months). Chronic pain is among the most prevalent conditions encountered in primary care. An estimated 7.6 million people, approximately 1 in 5, live with chronic pain. Pain affects many aspects of a person’s life, including their ability to work, attend school ,and participate in family and community life. Although multiple treatment options are available for the management of chronic pain, it is one of the most complex and difficult conditions to treat. Even with optimal treatment, complete alleviation of pain is not a realistic treatment goal. For most patients, the goals focus on minimizing suffering and maximizing functionality. Management is further complicated by the heterogeneity of chronic pain, as its sources can vary and therefore require different treatment options.
Over the past two decades, prescription rates for testosterone have risen sharply, due to direct‑to‑consumer advertising and the spread of online misinformation. As a result, the topic of andropause, or aging-associated testosterone deficiency, is increasingly encountered by Canadian primary care physicians. Despite its growing visibility, up to 25% of healthcare practitioners report challenges in accurately diagnosing and managing andropause. In this article, we clarify the common myths around andropause to better inform primary care physicians and their patients. We discuss the Canadian guidelines on diagnosis and management of testosterone deficiency. Finally, we provide insight into the safety of testosterone-replacement therapy. By implementing structured monitoring and shared decision making, primary care physicians can ensure safe, effective, and evidence-based care for aging Canadians.
Primary Care Hypertension Guidelines: What’s New for Primary Care
Hypertension remains the leading modifiable risk factor for cardiovascular disease and mortality, yet recent data demonstrate declining rates of hypertension treatment and control in Canada. Because most hypertension care occurs in primary care, improving population-level outcomes requires guidance that is pragmatic, streamlined, and easily implemented into routine primary care practice. To address this need, Hypertension Canada has released a new Primary Care Hypertension Guideline, developed as part one of a two-part guideline strategy and informed by contemporary evidence and extensive input from primary care providers and patients. This article highlights the most clinically relevant updates from the 2025 Hypertension Canada Primary Care Guideline for front-line clinicians. Major changes include adoption of a lower blood pressure threshold (≥130/80 mmHg) to define hypertension, selective initiation of pharmacotherapy based on blood pressure level and cardiovascular risk, and a simplified target of systolic blood pressure <130 mmHg for most patients when tolerated. The guideline emphasizes accurate blood pressure measurement, routine use of out-of-office monitoring, and foundational lifestyle modification for all individuals with hypertension. Importantly, for patients requiring medication, early initiation of low-dose single-pill combination therapy is recommended to improve blood pressure control and reduce therapeutic inertia. These recommendations are embedded within the World Health Organization’s HEARTS framework, providing standardized diagnostic and treatment algorithms tailored to Canadian primary care. Together, these updates are intended to simplify hypertension management, enhance guideline uptake, and improve cardiovascular outcomes at the population level.
Continuous Glucose Monitoring: A Practical Overview for Primary Care Providers in Canada
Continuous glucose monitoring (CGM) is transforming diabetes care, yet its use in type 2 diabetes (T2DM) remains underutilized in primary care. Given that most individuals with diabetes in Canada have T2DM and are managed primarily by primary care providers, the ability to interpret and apply CGM data is essential. This review provides an overview of CGM technology, key metrics, benefits and limitations, and offers practical tips for implementation in primary care.
Copyright (c) 2025 Canadian Primary Care Today https://creativecommons.org/licenses/by-nc-nd/4.0
Harnessing Artificial Intelligence (AI) Tools in Primary Care: The Promise of Being Smarter, Safer, and More Present
Primary care clinicians (PCCs) are increasingly overwhelmed by the rising number of tasks, expanding patient rosters, and the ever‑growing volume of new data and studies. Artificial Intelligence (AI) has captured the attention of many clinicians for both personal and professional use. The College of Family Physicians of Canada (CFPC) AI Working Group has highlighted the growing role of AI in family medicine. These applications are emerging across prevention, decision support, and efficiency. However, most remain largely insufficiently tested in or validated for clinical practice, making careful implementation essential to maximize benefits and minimize harm. In the U.S., AI is already helping to reduce clerical burdens by drafting letters, simplifying forms, or explaining results, yet clinicians are cautioned against its unsupervised use in direct clinical decision-making due to risks such as bias and hallucination. This article focuses on exploring the evolving AI options available to PCCs. We aim to provide a practical framework for evaluating these tools, highlight key features worth considering, and suggest strategies for effective and safer implementation.
Applications of Canada’s Guidance on Alcohol and Health in Primary Care
Key Points • Given that alcohol is a leading preventable cause of death and social problems in Canada, it is important that primary care clinicians are empowered to provide the best advice to patients on alcohol use and health. • For long-term health, when it comes to consuming alcohol, the core message primary care clinicians should communicate to patients is “less is better.” • The health and safety risks associated with alcohol use are determined by the number of standard alcoholic drinks consumed per week and per occasion. A standard alcoholic drink contains approximately 13.5 grams of alcohol. • To foster supportive conversations or potentially screen for and treat alcohol use disorder when necessary, it is crucial for primary care clinicians to take a non-judgmental, equitable approach to advising patients about alcohol and health. • Anchor conversations about alcohol to the risk zones in Canada’s Guidance on Alcohol and Health: consuming 1–2 standard drinks per week is low risk, 3–6 standard drinks per week is moderate risk, and seven or more standard drinks per week is increasingly high risk. For drinks per occasion, more than two standard drinks increases short-term health risks. • Take into account special considerations about alcohol for young people under the legal drinking age, people who are pregnant, planning to become pregnant, or breastfeeding, as well as older adults. • Best practices for treating high-risk drinking and alcohol use disorder include prescribing anti-craving medications such as naltrexone and acamprosate, providing psychosocial counselling, and maintaining ongoing follow-up with patients.
Immunization represents one of the most significant achievements in medicine. Over the past 50 years, vaccines have prevented more deaths in Canada than any other public health intervention. Routine childhood immunization programs have dramatically reduced the incidence of highly transmissible infections, such as measles, mumps, rubella, and varicella. Furthermore, vaccination efforts have led to the global eradication of smallpox and the near elimination of poliomyelitis. However, declining vaccination coverage has facilitated the re‑emergence of vaccine-preventable diseases, as evidenced by the ongoing resurgence of measles outbreaks worldwide. Vaccination is the most effective and durable intervention for the prevention of numerous infectious diseases. Immunization programs provide substantial benefits for patients and communities from potentially life-threatening infectious diseases. Early-life vaccination is essential for children to develop robust immunity. Furthermore, immunization remains a critical preventive measure in older adults who exhibit increased vulnerability to infection and a higher likelihood of severe outcomes, including complications, hospitalizations, and deaths. The objective of this review is to provide information on immunization across all age groups and at‑risk populations.
Approach to Inflammatory Arthritis for Primary Care Physicians
Inflammatory arthritis is a common condition encountered in primary care clinics but its diagnosis can be challenging because of the many conditions that can present with similar clinical features. As the differential diagnosis is broad, clinicians need to consider the most common entities and adopt a structured approach to establish the most likely diagnosis to help with initiating appropriate investigations and treatment. Rheumatoid arthritis (RA), observed in 0.9% of the population, and psoriatic arthritis (PsA) affecting 0.5–2%, are the most common types of inflammatory arthritis. Ankylosing Spondylitis (AS) occurs at approximately half the frequency, with a prevalence of approximately 0.5% in the general population.
Autologous Protein Solution (nSTRIDE) as a Novel Therapeutic Option in Osteoarthritis: Implications for Clinical Practice
Osteoarthritis (OA) is a disabling disease affecting hundreds of millions of people globally. It develops through a combination of mechanical stress and aging, leading to chondrocyte dysfunction and an imbalance between matrix degradation and synthesis. This imbalance is driven by upregulation of matrix metalloproteinases and pro-inflammatory cytokines. The joint degeneration causes inflammation, pain, limited mobility, and a negative impact on one’s quality of life. There are a variety of treatments for OA, including lifestyle changes, physiotherapy, intra-articular injections, and more invasively, arthroplasty. Common intra-articular injections include corticosteroids, hyaluronic acid (HA), and platelet-rich plasma (PRP).
Practical Recommendations for Hypnotic Switching in Insomnia Management: A Canadian Expert Clinical Framework
Insomnia disorder is a complex condition in which patients experience difficulties with sleep initiation, sleep maintenance, or early morning awakening. Chronic insomnia is defined as dissatisfying sleep quality or quantity, occurring at least three times per week, that has persisted for at least three months. Insomnia is common, with a higher incidence in certain subpopulations, including older adults (≥65 years of age) and patients with psychiatric and physical comorbidities, such as depression, anxiety, dementia, restless leg syndrome, obstructive sleep apnea, chronic pain, and alcohol or substance use disorders. Individuals experiencing insomnia often have disrupted sleep architecture, with polysomnography showing reduced time spent in the rejuvenating slow wave and rapid eye movement (REM) sleep stages. As such, insomnia can seriously impair daytime functioning, cognition, and quality of life. Further, insomnia may result in a higher risk of various conditions, including cardiovascular disease, obesity, and diabetes, though the association between insomnia and these comorbidities is likely bi-directional. Unfortunately, for a variety of reasons, the diagnosis is often missed or trivialized in medical practice. Given the profound impact of chronic insomnia, a proactive diagnosis and successful treatment is essential. The primary non-pharmacologic treatment option available for insomnia is cognitive behavioural therapy for insomnia (CBT-I), which focuses on sleep hygiene techniques, sleep restriction, circadian rhythm therapy, and cognitive therapy. Although CBT-I is the first-line treatment for insomnia and should always be recommended, it may not always be available in a timely manner, it can be costly and not every patient can afford it, some patients choose to opt out, and may not be sufficient as a single therapy approach. Thus, in many cases, pharmacotherapy may be needed in addition to or instead of CBT-I to treat insomnia and improve daytime functioning and associated cardiovascular and metabolic risks. Of note, patients also often self-medicate with over-the-counter medications, including cannabis products. Currently, commonly prescribed medications for insomnia include benzodiazepine receptor agonists (BZDs; e.g., lorazepam, clonazepam) and Z-drugs (e.g., zolpidem, zopiclone, eszopiclone).10 In addition, despite their risks, antidepressants (e.g., trazodone, mirtazapine), and antipsychotics (e.g., quetiapine) have also been used to treat insomnia despite being off-label and promoting sleep indirectly.
Comparative Study of Ferrous Fumarate, Ferrous Ascorbate, and Polysaccharide Iron for Treating Iron Deficiency Anemia in Adults
Iron deficiency anemia (IDA) is a highly prevalent condition encountered in clinical practice and represents a major global health concern, affecting an estimated 1.92 billion individuals worldwide. Despite its prevalence and the availability of various oral iron formulations with wide cost variations, comparative data on their efficacy and tolerability remain limited. This randomized, open-label trial conducted across two centres evaluated the efficacy, tolerability, and adherence of three oral iron supplements in improving hemoglobin and ferritin levels in adults with IDA. The study compared ferrous fumarate (Eurofer, 100 mg elemental iron, $15.87 for 90 tablets), ferrous ascorbate (EBMfer, 100 mg elemental iron, $68.97 for 90 tablets), and polysaccharide iron (FeraMAX, 150 mg elemental iron, $77.97 for 90 tablets). A total of 111 participants aged ≥18 years were randomly assigned into one of three treatment groups and monitored over a 12-week period. Both ferrous fumarate (p=0.001) and ferrous ascorbate (p<0.001) demonstrated significantly greater hemoglobin and ferritin levels compared to polysaccharide iron. Specifically, ferrous fumarate led to mean increases in hemoglobin and ferritin of 11.59 g/L (95% confidence interval [CI]: 7.87–15.3, standard deviation [SD]: 10.7) and 19.21 µg/L (95% CI: 7.82–28.6, SD: 29.8), respectively. Ferrous ascorbate showed mean increases in hemoglobin and ferritin levels of 17.14 g/L (95% CI: 13.5–20.8, SD: 10.7) and 23.51 µg/L (95% CI: 16.5–30.5, SD: 20.3), respectively. Polysaccharide iron showed mean increases in hemoglobin and ferritin of 3.56 g/L (95% CI: -0.06–7.18, SD: 10.4) and 3.21 µg/L (95% CI: -0.07–6.48, SD: 9.39), respectively. Adverse events occurred more frequently with ferrous fumarate (13 events) compared with ferrous ascorbate (8 events) and polysaccharide iron (6 events). The most commonly reported side effects across all groups were constipation and bloating, well-documented side effects of iron supplements. These findings demonstrate that ferrous fumarate and ferrous ascorbate significantly outperformed polysaccharide iron in improving hemoglobin and ferritin levels. Given its lower cost and comparable efficacy, ferrous fumarate may be the most cost-effective option and warrants consideration in updates to Canadian treatment guidelines.
Acne Therapies for the Primary Care Physician: What’s New and What’s Practical
Acne vulgaris is the most common dermatologic condition worldwide, affecting people across a broad range of ages and skin phototypes. There are a variety of pathophysiological processes involved in the formation of acne lesions, with available anti-acne therapies targeting such pathways. Herein, we provide a review of important acne treatment classes and present novel topical, oral and energy-based interventions.
Clinical Spotlight for Primary Care: Five Things to Know About Women and Girls with Bleeding Disorders
Although common, HMB is often an underrecognized symptom, and affects up to 39% of individuals diagnosed with a bleeding disorder. Taking a structured medical history is key. Tools such as the Pictorial Blood Assessment Chart and the Menorrhagia Screening Tool can aid in identifying HMB. Screening for iron deficiency, even in the absence of anemia, is essential, as low iron can impact cognition, energy, and quality of life.
Managing Gout in the Clinic: Pearls for Family Medicine Specialists
Gout is the most common form of inflammatory arthritis worldwide, often presenting diagnostic and management challenges. However, it can also be gratifying to treat, as successful treatment provides relief from an extremely painful arthritis, and proper preventive strategies can lead to a gout free future. We will begin with a case from my clinical practice.
Update on Early Prenatal Screening in 2025
Advances in prenatal screening over the last three decades have delivered methods which broadly focus on genetics, fetal well-being, and preeclampsia screening, offering early insights in pregnancy to enable better risk management and planning strategies.
Essential Interstitial Lung Disease Management for the Primary Care Provider
Interstitial lung diseases (ILDs) encompass a diverse group of disorders characterized by inflammation and fibrosis of the lung parenchyma. Despite their classification as rare, increasing evidence suggests ILDs are more prevalent than previously thought. Patients often present with respiratory symptoms such as exertional dyspnea, persistent cough, and fatigue. However, asymptomatic patients with incidental findings on imaging (e.g., interstitial lung abnormalities) are also common. Diagnosis relies on high-resolution CT (HRCT), pulmonary function tests, and detailed clinical evaluation. Respirology consultation is important for comprehensive management. The evolving ILD nomenclature, including progressive pulmonary fibrosis, aids in disease characterization and treatment planning. Management strategies include corticosteroids and steroid-sparing agents for inflammatory subtypes, while antifibrotic therapies (nintedanib, pirfenidone) are used for fibrotic and progressive disease. Non-pharmacological interventions, including pulmonary rehabilitation, smoking cessation, and vaccination, are critical for improving patient outcomes. Primary care providers play a pivotal role in early disease recognition, facilitating diagnostic testing, managing comorbidities, and coordinating specialist care. This review highlights the importance of timely diagnosis, evolving classifications, and emerging therapies, offering a collaborative framework for optimizing ILD care and outcomes.
Chronic Cough, a New Disease, Not Just An Old Problem
Chronic cough is defined as a cough persisting for longer than 8 weeks. Chronic cough is common, with an approximate prevalence of 10% of the global population. In Canada, recent estimates indicate that the prevalence of cough is 16% among adults aged 45-85 years. Chronic cough can interrupt work, sleep, and social interactions, making it very troubling for patients, with impacts on physical, social, and psychological health. Cough is one of the leading causes of visits to primary care practitioners. The peak incidence for presentation to primary care is among individuals in the 50-60 years age group and it is twice as frequent in women. Currently, most clinicians address cough as a symptom of other medical conditions, which leads to trials of treatments for diseases that may not be present. This approach can lead to unnecessary costs, frustration for both clinicians and patients, and potential harms from the therapies prescribed. Instead, a diagnostic work up needs to be performed to identify refractory chronic cough as a distinct disease entity, resulting from afferent neuronal hypersensitivity and central nervous system dysfunction. The secondary factors that aggravate chronic cough (smoking, asthma, gastro-esophageal reflux, among others) should be considered as treatable traits associated with the primary disease process rather than only the direct causes of the cough.
Menopause is, in fact, a single day officially marked one year after the cessation of menses. It is followed by post menopause which can last for half of a women’s adult life! Menopause typically occurs between the ages of 46 and 52 years with an average age of 51. It signifies the end of reproductive function, and is marked by fluctuating and declining hormone levels, which can lead to a range of often distressing symptoms. The perimenopause is the transition phase that precedes menopause, lasting up to 10 years. For many women, menopausal symptoms may first appear later in the perimenopause. While we use the term “women”, guidance applies to all patients who experience menopause, even if they do not identify as a woman. When people use the term “menopause” they are usually referring to the “climacteric”, a period which includes the perimenopause, menopause, and early post menopause stages. In Canada, over 2.5 million women are between the ages of 45 and 55, and up to 80% of them will experience menopause-related symptoms. There are now over 30 validated symptoms of menopause, some of which can have a significant impact on function and quality of life. A recent study by the Menopause Foundation of Canada reported that up to 10% of women will leave the workforce due to unmanaged menopausal symptoms. The most impactful symptoms of menopause include vasomotor symptoms (VMS) which include hot flashes and night sweats, sleep and mood disturbances, memory issues, muscle and joint pains, and symptoms of the Genitourinary Syndrome of Menopause (GSM) such as vaginal dryness, bladder issues, and sexual dysfunction. Recent evidence has shown that frequent or severe menopausal vasomotor symptoms are linked to a higher risk for illnesses including cardiovascular disease and diabetes.
The Global Health Compass: Steering Your Patients Through Travel Risks and Pandemic Concerns
Canadian-resident trips abroad continued to increase in 2024 and surpassed their 2023 levels by 10.0%. Overseas trips by Canadians increased by 30.9% from 2023 and now exceed pre-pandemic numbers. Although international travellers are an important group for the world economy, they are at increased risk of exposure to infectious diseases while they are outside their home country and may possibly spread these diseases from one country to another. SARS-CoV-2, Ebola, Zika, and antimicrobial resistant pathogens are examples of health threats whose spread has been facilitated by international travellers. Climate change is also impacting infectious disease risk. Rising temperatures are expanding the regions where vector-borne diseases (e.g., dengue, malaria, Chikungunya, Zika) can thrive, as well as increasing the risk of zoonotic (e.g., Avian influenza) and waterborne diseases (e.g., Vibrio, E. coli). As more Canadians travel, clinicians play a critical role in making travel recommendations. This article will focus on simple recommendations that can be made to reduce travel risks and highlight potential future pandemic concerns.
Risk Prediction for Chronic Kidney Disease: Considerations for Primary Care
Chronic Kidney Disease (CKD) affects more than one in ten Canadians and is largely managed in primary care. Diabetes is the leading cause of CKD, and primary care providers often manage the underlying causes and comorbid conditions related to kidney disease, as well as the adverse consequences of CKD itself. It is important to recognize that CKD has a variable course. While most adults lose approximately 1 mL/min of kidney function every year after the age of 40, some patients lose kidney function rapidly, leading to hospitalizations due to heart failure and progression to kidney failure, whereas others remain stable for decades, requiring minimal additional intervention. Recent advances in risk prediction for CKD allows all providers to accurately identify high risk individuals. These innovations enable the use of highly effective therapies that slow down, and in many cases, normalize the rate of kidney function loss, leading to potential lifetime risk reduction for kidney failure. (Figure 1). This review will cover key considerations in screening, risk stratification, and treatment of CKD in primary care, with an emphasis on tools that are readily available in clinical settings. We believe that a screen-triage-treat paradigm for CKD can lead to optimal outcomes for patients and health systems.
The Evolving Approach to Breast Cancer Screening and Treatment in Canada: Implications for Primary Care Providers
Nearly 30,000 Canadians are diagnosed with breast cancer annually, and while its mortality has decreased by over 55% since the 1970s due to modernized screening technologies and advances in systemic therapy, 5,500 Canadians are estimated to die of the disease every year. Primary care providers are critical through all steps of a patient’s breast cancer journey, from facilitating routine screening, to identifying breast cancer risk factors, ensuring expedient referrals, and recognizing acute or chronic treatment toxicities and their impact on overall physical and psychological health.
Copyright (c) 2024 Canadian Primary Care Today https://creativecommons.org/licenses/by-nc-nd/4.0
The Spectrum of Management for Psoriasis: From the Known to New Alternatives
Psoriasis is a chronic, immune-mediated systemic condition characterized by inflammatory changes that may involve the skin and joints. It is relatively common, with a prevalence rate of 2–4% in North America, and a global prevalence rate of up to 11.4%. Years ago, affected patients may have ranged in age from 18–39 to 50–69 due to bimodal distribution. While initially thought to be a dermatologic disease, it is now a recognized multisystem condition with a genetic predisposition. The complex pathophysiology is thought to originate from dysregulation between the innate and adaptive immune systems. T-lymphocytes, dendritic cells, cytokines such as interleukin (IL) 23, IL-17, and tumor necrosis factor (TNF) have all been implicated in and contribute to the inflammatory sequelae. The chronicity and pathogenesis of disease may predispose patients to significant functional impairments, associated comorbidities such as metabolic syndrome and cardiovascular disease, and diminished quality of life. This has prompted novel approaches to management with the introduction of biologics and small molecule therapies that address the underlying immune dysregulation. There are multiple clinical manifestations including plaque psoriasis, guttate psoriasis, erythrodermic psoriasis, and pustular psoriasis. Among the most common is plaque psoriasis which typically presents as symmetrically distributed, well demarcated, erythematous, scaly plaques or patches that may be pruritic. Common sites of involvement include the extensor surfaces of the elbows, knees, the trunk, gluteal cleft, and scalp. Guttate psoriasis is typically preceded by upper respiratory infections and represents approximately 2% of all cases of psoriasis. It involves several small (<1 cm) confetti-like papules and plaques. A severe, although uncommon form is erythrodermic psoriasis which results in widely distributed erythema, scales and exfoliation of a large surface area of the skin. Due to the widespread loss of the epidermal, dermal barrier and associated risk of fluid loss, electrolyte disturbances and infection, it is considered a dermatologic emergency. Pustular psoriasis is also an uncommon, potentially severe, clinical variant, with possible complications secondary to acute widespread erythema and development of multiple pustules.
The Family Physician’s Unique Role in Heart Failure Management
Heart failure (HF) is an epidemic with a prognosis that is worse than some cancers. Prevention, early diagnosis, coordination, and implementation of guideline-directed medical therapy (GDMT) are imperative to stem this tsunami wave. The family physician stands in a unique, critical, and first-line position to be able to offer all 3. Their understanding and implementation of these roles are crucial for success in the battle against HF. This review offers a perspective on the role of family physicians in managing HF.
Insomnia is a common clinical issue with varying definitions depending on the source. The DSM-V defines insomnia disorder as one or more of: difficulty initiating sleep, maintaining sleep, or early morning wakening with an inability to fall back asleep. These problems occur despite adequate time allowed for sleep (7 hours), cause dysfunction, and are not attributed to another disorder. The DSM-V then classifies insomnia as either episodic (at least 1 month but less than 3 months), persistent (lasting 3 months or more) and recurrent (2 or more episodes within a year), and considers potential contributing comorbidities. According to the International Classification of Sleep Disorders (ICSD-3) classification system, symptoms must occur at least 3 times per week, and insomnia is categorized as either short term or chronic. Short-term insomnia disorder in this paradigm (ICSD-3) occurs when the sleep problems have lasted more than 1 but less than 3 months, while chronic insomnia disorder occurs when symptoms persist for more than 3 months.
Adult ADHD: What It Is and How to Assess and Treat It
4.4% of the adult population, and is also prevalent in 10% of those with depressive or anxiety disorders and in 20% of those with chronic low mood. Among patients referred for treatment-resistant depression, one in three may have undiagnosed ADHD. Overall, ADHD is poorly understood, significantly undertreated, and a common reason for poor response to treatment in mood and anxiety disorders. ADHD is not a consequence of poor parenting, indulged laziness, or excessive consumption of sugar or food dyes. It is a neurodevelopmental disorder, a “hardwiring” problem, marked by delayed maturation of the Prefrontal Cortex and allied subcortical regions that constitute the “adult” brain. When we are young, we have limited self-control: we take what we want, say what we think, get excited, cry, and live in the moment. As our brains mature, we learn to control our behaviours, manage our emotional reactions, prioritize tasks, plan, and follow through on those plans. In individuals with ADHD, this maturation is delayed and too often remains incomplete.
Essential Osteoporosis Management for the Primary Care Provider
Most individuals will experience deterioration in bone with advancing age, with consequent increases in fragility fractures. In addition, falls become more frequent with age, further increasing fracture risk. It is important to note that osteoporotic fractures impair quality of life and lead to increased dependency to a much greater degree in elderly individuals. Because of menopause-related declines in estrogen, women have greater bone loss and increases in fragility fracture compared to men. Our increased understanding of osteoporosis, its epidemiology, fracture risk, and expanding management options provide excellent opportunities for clinicians to benefit patients and maintain quality of life in aging individuals.
The Latest Updates in Obesity Management in Primary Care
The Canadian Obesity Clinical Practice Guidelines, published in 2020, have significantly shifted the dialogue around obesity management. These guidelines place substantial emphasis on patient-centered care, reducing stigma and bias, and recognizing obesity as a chronic disease, and have set a new global standard for obesity management. Most recently, Ireland and Chile have adapted these guidelines in their own countries
COPD 2024: Applying the Canadian Thoracic Society (CTS) 2023 Chronic Obstructive Pulmonary Disease (COPD) Guideline for Preventing Exacerbations, Improving Health Status, and Preventing Mortality
Chronic Obstructive Pulmonary Disease (COPD) is a common, chronic respiratory condition that is associated with the risk of morbidity and mortality. Approximately 2 million Canadians live with COPD, and as many as 1 million suffer while remaining undiagnosed and untreated. COPD exacerbations represent the most expensive cause of hospitalization with the highest likelihood of hospital readmission. Exacerbations are the primary driver of mortality in patients with COPD. These exacerbations are the second leading cause of hospitalization in Canada with an average length of stay of 7 days. In fact, 1 in 5 patients with COPD will die within 1 year of their first hospitalization due to an exacerbation. For those 65 or older in Ontario, the overall 365-day mortality stands at nearly 28% following their first hospitalization due to an exacerbation. The best indicator of the risk of future exacerbations is a history of exacerbations. The time has come to end the stepwise pharmacologic escalation that has defined the treatment paradigm in COPD. The call to action is to shift from the slow promotion of inhaled pharmacotherapy based on exacerbations to a direct escalation to inhaled pharmacotherapy with demonstrated evidence to prevent the exacerbations.