Research Projects

The antibiotic management of gonorrhoea in Ontario, Canada following multiple changes in guidelines: an interrupted time-series analysis

Gonorrhea is a bacterial sexually transmitted infection (STI) that can affect any individual. In Ottawa, it is most commonly diagnosed in young people ages 20-29 years. 

With current trends in gonorrhea antimicrobial resistance, we may soon face untreatable multidrug resistant infections.  In response to rapidly evolving resistance patterns, gonorrhea treatment recommendations have changed frequently in Canada and in Ontario. 

Gonorrhea patients are seen and managed in a variety of settings: from sexual health and STI clinics to community primary care settings that infrequently manage STIs. With frequently changing recommendations, uptake of new guidelines is a concern, especially among clinicians who rarely treat gonorrhea. Clinicians may be struggling to keep up with fast changing guidelines.

This study assesses compliance with gonorrhea treatment guidelines in Ontario in relation to changes in guidelines. We analyzed treatment data for all gonorrhea cases reported in Ontario during 2006 - 2014 and determined whether cases received first-line treatment according to the Ontario clinical guidelines of the time. We found that adherence to first-line recommended treatment for gonorrhea in Ontario dropped following guideline changes. A small guideline change had minimal effect on adherence; however, after major changes, substantial reductions in adherence were noted. These reductions were both statistically and clinically significant; after each major change, fewer than 50% of cases received recommended treatment. Following these changes, adherence gradually increased but, by May 2014, guideline adherence remained well below the rates prior to 2011.

Canadian and Ontario STI guidelines have largely been disseminated through passive strategies, such as journal write-ups, webinars, conference presentations, web materials, and mobile applications. The slow uptake of new treatment recommendations seen in this study suggests the potential need for active dissemination and implementation strategies.

Dickson, C., Taljaard, M., Friedman, D. S., Metz, G., Wong, T., & Grimshaw, J. M. (2017). The antibiotic management of gonorrhoea in Ontario, Canada following multiple changes in guidelines: an interrupted time-series analysis. Sex Transm Infect.‎

Policy at play: The implementation of Healthy Eating and Active Living Guidelines in municipal child care settings 

In 2012, OPH partnered with the City of Ottawa Municipal Child Care (MCC) Services to develop evidence informed Child Care Healthy Eating and Active Living (HEAL) Guidelines for children up to five years of age. These Guidelines set consistent standards of practice in MCC sites and provided recommendations around the eating environment, daily physical activity, screen time and the actual food served to children while in care.  Implementation of the Guidelines consisted of: the completion of a self-assessment tool for child care sites; training sessions for child care employees (including cooks); ongoing consultation with a Registered Dietitian around menu planning; National Fundamental Movement Skills Training Certification through the Coaches Association of Ontario; and the provision of resources, menu's, and recipes for each site. An evaluation was conducted to assess how well the Guidelines were implemented and the utility of the accompanying training and resources. Environmental and programming changes that occurred following implementation were also assessed.

The evaluation demonstrated environmental and programming changes at the 10 sites. Parent satisfaction was high and preliminary findings showed no real changes in food costs. Following implementation, the cooks reported high compliance to the 6-week menu plans provided, and the number of sites offering 120 minutes or more of daily physical activity increased.  Further study on the impacts of healthy eating on child care food costs is currently ongoing.

Can J Public Health 2016;107(6):e556-e561 doi: 10.17269/CJPH.107.5561

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