Examples of primary care research

This section includes examples of primary care research projects from DFM faculty. These examples were selected to show a range of scale, methodology and topic. We also wanted to show the different stages and progression of a research project. We have included examples of DFM pilot projects that led to additional funding and publications. We have also shown the progression of some of our larger research projects from pilot stage to scale up.

Learner mistreatment & abuse –  Meredith Vanstone, Amanda Bell

This program of research began with a DFM pilot project (2016–2017) exploring how the structure of clerkship and residency influences medical learner mistreatment. Early findings highlighted important gaps in understanding and reporting, leading to additional funding to examine barriers to reporting mistreatment among medical students (2017–2018).

Building on this work, a larger funded study (2017–2019) investigated how clinical workplace environments shape unprofessional and abusive behaviours, and how these experiences influence the development of future health leaders.

The team’s research generated key insights, published in Medical Education (2020, 2023), on why learners often do not report mistreatment and how both learners and educators define what constitutes mistreatment. Beyond academic outputs, this work contributed to meaningful institutional change, including the establishment of the Office of Learner Experience and Mistreatment at McMaster, the introduction of a new reporting system, and visible prompts encouraging reporting.

This research demonstrates how early exploratory work can lead to deeper inquiry, influence policy, and drive cultural change in medical education.

Second Heart program – Robin Lennox

• Pilot project: Lennox R. What makes a good peer support worker to support people who inject drugs after hospitalization? DFM pilot funding. $4,980. 2018-2019 
• Publication: Lennox R, Lamarche L. & O’Shea T. (2021). Peer support workers as a bridge: a qualitative study exploring the role of peer support workers in the care of people who use drugs during and after hospitalization. Harm Reduct J 18, 19.  
• Grant: Lennox R (co-PI), Martin L (co-PI), Lamarche L, O’Shea T, Whitlock R, Belley-Cote E, Regenstreif L, Kouyoumjian F, Neary J, You J, Mertz D. The Second Heart Program: A peer-focused, multidisciplinary harm reduction intervention to improve outcomes for people who inject drugs after admission for infective endocarditis. Hamilton Academic Health Sciences Organization (HAHSO). $187,000. April 2020 to September 2022 

Advance Care Planning – Dale Guenter, Michelle Howard 

• Pilot project: Testing and Improving a Training Module for Advance Care Planning Among Primary Care Clinicians and Trainees. DFM pilot funding. $5,000. 2017-2018 
• Additional funding: Howard M (PI). Improving advance care planning for frail elderly Canadians, Canadian Frailty Network, Transformative Grant. $365,390.70. April 2017 to March 2020. 
• Publication: Hafid A, Howard M, Guenter D, Elston D, Fikree S, Gallagher E, Winemaker S, Waters H. Advance care planning conversations in primary care: a quality improvement project using the Serious Illness Care Program. BMC Palliative Care 2021; 20, 122. 

TAPER – Dee Mangin

• 2 pilot projects
  • Mangin D, Dolovich L, Agarwal G, Siu H. Deprescribing to optimize medicine use and safety in seniors. DFM pilot funding. $5,000. 2014-2015 
  • Mangin D. Retrospective analysis of legacy drug prescribing patterns and associations. DFM pilot funding. $5,000. 2016-2017. 
• Other funding: CFN, CIHR, Labarge 
• Publications informing the development of TAPER
  • Mangin D, Stephen G, Bismah V, et al. Making patient values visible in healthcare: a systematic review of tools to assess patient treatment priorities and preferences in the context of multimorbidity. BMJ Open 2016;6:e010903.  
  • Mangin D, Lawson J, Cuppage J, Shaw E, Ivanyi K, Davis A, Risdon C. Legacy Drug-Prescribing Patterns in Primary Care. Annals of Family Medicine November 2018; 16(6): 515-520  
  • Lamarche L, Tejpal A, Mangin D. Self-efficacy for medication management. Patient Preference and Adherence 2018; 12: 1279-1287. 
  • Mangin D, Parascandalo J, Khudoyarova O, Agarwal G, Bismah V, Orr S. Multimorbidity, eHealth and implications for equity: a cross-sectional survey of patient perspectives on eHealth. BMJ Open 2019; 9(2):e023731.  
  • Mangin D, Risdon C, Lamarche L, Langevin J, Ali A, Parascandalo J, Stephen G, Trimble J. ‘I think this medicine actually killed my wife’: Patient and family perspectives on shared decision-making to optimize medications and safety. Therapeutic Advances in Drug Safety 2019; 10:1-12.  

CP@clinic – Gina Agarwal

• Pilot – Quantitative: Agarwal G, Angeles RN, McDonough B, McLeod B, Marzanek F, Pirrie M, Dolovich L. Development of a community health and wellness pilot in a subsidised seniors’ apartment building in Hamilton Ontario: Community Health Awareness Program delivered by Emergency Medical Services (CHAP-EMS). BMC Research Notes. 2015; 8(8): 113.  
• Pilot – Qualitative: Brydges M, Denton M, Agarwal G. The CHAP-EMS health promotion program: a qualitative study on participants’ views of the role of paramedics. BMC Health Services Research. 2016; 16:435.  
• Hamilton RCT: Agarwal G, Angeles R, Pirrie M, McLeod B, Marzanek F, Parascandalo J, Thabane L. Evaluation of a community paramedicine health promotion and lifestyle risk assessment program for older adults who live in social housing: a cluster randomized trial. CMAJ 2018. May 28;190(21):E638-E47.  
• Multi-community RCT: Agarwal G, Angeles R, Pirrie M, McLeod B, Marzanek F, Parascandalo J, Thabane L. Reducing 9-1-1 emergency medical service calls by implementing a community paramedicine program for vulnerable older adults in public housing in Canada: A multi-site cluster randomized controlled trial. Prehospital Emergency Care 2019;23(5):718-729.  
• Cost-effectiveness analysis: Agarwal G, Pirrie M, Angeles R, Marzanek F, Thabane L, O’Reilly D. Cost-effectiveness analysis of a community paramedicine programme for low-income seniors living in subsidised housing: the community paramedicine at clinic programme (CP@clinic). BMJ Open 2020;10:e037386. 

Health TAPESTRY – Dee Mangin, Doug Oliver, David Price

• Feasibility study: Javadi, D., Lamarche, L., Avilla, E. et al. Feasibility study of goal setting discussions between older adults and volunteers facilitated by an eHealth application: development of the Health TAPESTRY approach. Pilot Feasibility Stud 4, 184 (2018).  
• 1^st RCT results: Dolovich L, Oliver D, Lamarche L, Thabane L, Valaitis R, Agarwal G, Carr T, Foster G, Griffith L, Javadi D, Kastner M, Mangin D, Papaioannou A, Ploeg J, Raina P, Richardson J, Risdon C, Santaguida P, Straus S, Price D. Combining volunteers and primary care teamwork to support health goals and needs of older adults: a pragmatic randomized controlled trial. Canadian Medical Association Journal 2019; 191(18): e491-500. 
• Qualitative evaluation: Gaber J, Oliver D, Valaitis R, Cleghorn L, Lamarche L, Avilla E, et al. Experiences of integrating community volunteers as extensions of the primary care team to help support older adults at home: a qualitative study. BMC Family Practice 2020; 21, 92. 
• Qualitative using a framework (Normalization Process Theory): Valaitis, R., Cleghorn, L., Dolovich, L. et al. Examining Interprofessional teams structures and processes in the implementation of a primary care intervention (Health TAPESTRY) for older adults using normalization process theory. BMC Fam Pract 21, 63 (2020). 
• Scale-up protocol: Mangin D, Lamarche L, Oliver D et al. Health TAPESTRY Ontario: protocol for a randomized controlled trial to test reproducibility and implementation. Trials 2020; 21, 714.