, 2002). It is estimated that over 90% of personal health services are delivered in communitybased primary care (White et al., 1961) and yet such services account for only about 35% of health service costs (Ontario Health Services Restructuring Commission, 2000). In international comparisons, a higher quality of primary care services has been shown to correlate with better health status indicators, higher satisfaction of the population, and lower costs of the health system (Starfield, 1994; 1998). Recent reviews (Macinko et al., 2003; Schoen et al., 2004) confirm the central role of primary care and indicate important issues to be addressed. Thus the rationale for developing a stronger and more integrated comprehensive primary health care system in Canada is on a firm foundation. Canadian family physicians/general practitioners (FPs/GPs) provide first contact or primary care services in their offices for patients who choose to access these services. Patients are not required to enrol or

Objective: This study set out to identify the perspectives of family physicians (FP/ GPs) on the quality and capacity of the services they provide and of the system in which they work, to assess their responsiveness to potential changes and to determine their suggestions for future directions to enhance primary care services. Methods: Thematic results from prior focus groups with FP/GPs provided direction for a questionnaire sent to practitioners in the urban study area. Seventy-four questions, most using a five-point Likert scale, were grouped into 10 sections: physician issues (based on themes from the focus groups), access to specialist services, workload, scope of practice, primary care physician networks, interdisciplinary collaborative practice, complexities and challenges of family practice, future directions, comments and demographics. Results: Five hundred and eighty-three FP/GPs were surveyed, and 300 responses (52%) were analyzed for frequencies and comparisons using SPSS. In addition to informative responses to the various survey sections noted above, specific physician suggestions for future directions to improve quality and capacity were identified. These included access to specialists/consultants, teamwork/collaborative practice, access to diagnostics, electronic records/technology, time and remuneration. Conclusions: The identified suggestions by FP/GPs to enhance the quality and capacity of health services contribute to a framework for policy development at national, provincial/territorial and regional levels and can be used as a reference point for the progress of primary care reform initiatives. RésuméObjectif : L' étude vise à déterminer le point de vue des médecins de famille (MF/MG) sur la qualité et la capacité des services qu'ils offrent et sur le système dans lequel ils travaillent, à évaluer leur souplesse face aux changements potentiels et à déterminer leurs suggestions sur les orientations futures en vue d' améliorer les services de soins primaires. Méthodes : Les résultats thématiques découlant de groupes de travail antérieurs avec les MF/MG ont déterminé l' orientation du questionnaire envoyé aux praticiens de

Informatics has a key characteristic of a new discipline in a technically transient environment--there is no universal definition of it. This is not surprising, given its complex and diverse nature. In a broad sense informatics is the interface between developing technologies and the decision sciences, in particular clinical sciences. Telemedicine has no universally accepted definition either. Telemedicine requires the use of electronic communication networks for the transmission of information and data related to the diagnosis and treatment of, as well as education about, medical conditions. The debate ensues over whether it is or is not a subset of medical informatics. The care of the elderly diploma programme is a telemedicine project within the department of family medicine at the University of Alberta; it is a distance learning programme directed towards educating and training physicians in rural Alberta. This project provided us with the practical experience of addressing both informatics and telemedicine issues jointly.

Introduction: The Evidence-Based Care of the Elderly Health Guide is a clinical guide with cross-references for care recommendations. This guide is an innovative adaptation of the Rourke Baby Record to support elderly care. In 2003, the guide was published with an endorsement from the Health Care-of-the-Elderly Committee of the College of Family Physicians of Canada. Since then, physicians have used the guide as a checklist and a monitoring tool for care to elderly patients. Objective: We will update the 2003 Care-of-the-Elderly Health Guide with current published evidence-based recommendations. Methods: This was a mixed methods study consisting of (1) the creation of a list of topics and corresponding guidelines or recommendations, (2) two focus group discussions among family physicians (n = 12) to validate the list for relevance to practice, and (3) a modified Delphi technique in a group of ten experts in Care of the Elderly and geriatrics to attain consensus on whether the guidelines/recommendations represent best practice and be included. Results: The initial list contained 43 topics relevant to family practice, citing 49 published guidelines or recommendations. The focus group participants found the list of topics and guidelines potentially useful in clinical practice and emphasized the need for user-friendliness and clinical applicability. In the first online survey of the modified Delphi technique, 93% (63/66) of the references attained consensus that these represented standards of care. The other references (3/66) attained consensus in the second online survey. The final list contained 47 topics, citing 66 references. Conclusion: The Care-of-the-Elderly Health Guide is a quick reference to geriatric care, reviewed for relevance by family physicians and a panel of experts. The Guide is intended to be used in primary care practice.

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