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The authors developed and validated an algorithm using health administrative data to identify patients who are attached or uncertainly attached to a primary care provider (PCP) using patient responses to a survey conducted in Ontario, Canada.

The authors conducted a validation study using as a reference standard respondents to a community-based survey who indicated they did or did not have a PCP. The authors developed and tested health administrative algorithms against this reference standard. The authors calculated the sensitivity, specificity positive predictive value (PPV) and negative predictive value (NPV) on the final patient attachment algorithm. The authors then applied the attachment algorithm to the 2017 Ontario population.

The patient attachment algorithm had an excellent sensitivity (90.5%) and PPV (96.8%), though modest specificity (46.1%) and a low NPV (21.3%). This means that the algorithm assigned survey respondents as being attached to a PCP and when in fact they said they had a PCP, yet a significant proportion of those found to be uncertainly attached had indicated they did have a PCP. In 2017, most people in Ontario, Canada (85.4%) were attached to a PCP but 14.6% were uncertainly attached.

Administrative data for nurse practitioner's encounters and other interprofessional care providers are not currently available. The authors also cannot separately identify primary care visits conducted in walk in clinics using our health administrative data. Finally, the definition of hospital-based healthcare use did not include outpatient specialty care.

Uncertain attachment to a primary health care provider is a recurrent problem that results in inequitable access in health services delivery. Providing annual reports on uncertainly attached patients can help evaluate primary care system changes developed to improve access. This algorithm can be used by health care planners and policy makers to examine the geographic variability and time trends of the uncertainly attached population to inform the development of programs to improve primary care access.

As primary care is an essential component of a person's medical home, identifying regions or high need populations that have higher levels of uncertainly attached patients will help target programs to support their primary care access and needs. Furthermore, this approach will be useful in future research to determine the health impacts of uncertain attachment to primary care, especially in view of a growing body of the literature highlighting the importance of primary care continuity.

This patient attachment algorithm is the first to use existing health administrative data validated with responses from a patient survey. Using patient surveys alone to assess attachment levels is expensive and time consuming to complete. They can also be subject to poor response rates and recall bias. Utilizing existing health administrative data provides more accurate, timely estimates of patient attachment for everyone in the population.

Anthropology was a late‐comer to the Caribbean and only after World War II did the study of Caribbean culture and societies become less exceptional. Early in this century when anthropology was first making itself over as an ethnographic science, anthropologists concentrated on tribal peoples. For most of the post‐Columbian era, the Caribbean region, with a few minor exceptions, was without indigenous tribal societies. Even after anthropology turned its attention to the study of peasantries, Caribbean peasantries were ignored in favor of more stable and tradition‐oriented peasant societies in other parts of Latin America. When anthropologists began to study Caribbean peoples in a more serious and systematic fashion, they found that they had to develop new concepts to explain the variation, flexibility, and heterogeneity that characterized regional culture. These concepts have had a significant impact on social and cultural theory and on the broader contemporary dialogue about cultural diversity and multiculturalism.

TO many of us it is a matter for regret that we are not able to keep ourselves so closely in touch with library affairs in other parts of the world as we would wish. With American happenings we are, of course, fairly well acquainted, but Colonial effort has not received the attention which is its due. In many places in the Empire methods are, in certain ways, in advance of ours—in more than one country the legislation has been more enlightened than it was in England until quite recently—and everywhere the experience of keen progressive librarians facing their own particular problems must prove of interest and value to those in the home country. Therefore we believe that by devoting this issue to a discussion of some phases of Colonial librarianship we are but answering the large demand for such information.

As in any managerial function, the Director of Internal Audit must be cognisant of necessary administrative responsibilities to enable the proper functioning of an internal auditing department. Not only must the generic managerial responsibilities be in existence but also those functions which are conducive to internal audit. The administrative responsibilities of the Director of Internal Audit as they pertain to the administration of the Internal Audit Department are explored – the planning process; reporting audit issues and recommendations and the major issues facing the Audit Director.

WITH this issue we are commencing the twenty‐seventh year of our career as an independent Library Journal and trust that we shall carry on the tradition of our illustrious founder and continue to criticise or praise without fear or favour. During the past twelve months our editorial staff has successfully produced special numbers dealing with Bookbinding, Book Selection, Children's Departments, Classification, and Colonial Libraries. Judging by the correspondence we have received, our efforts have been greatly appreciated by the majority of our readers. Naturally we have not pleased everybody and we have even been dubbed the “little contemporary” in some quarters. However, we can point to an unbroken record of twenty‐six years' endeavour to serve the library profession and we ourselves are justly proud of the contemptible “little contemporary” that did not cease to appear even during the darkest hours of the dread war period.

IN wishing our readers the compliments of the New Year, we can congratulate them and ourselves upon the manner in which libraries of all kinds have survived one of the mo difficult economic times in memory. It is true that the Great War furnished many library authorities with a pretext, perhaps to some extent justified, to reduce their library activity. But of late they have had the authority of a Government demand for retrenchment in actual money, which was likely to have had a severe influence upon libraries. Fortunately, as Lord Irwin pointed out at the opening of Chaucer House, public libraries escaped the universal axe which was applied to other departments—at any rate in a measure; although, indeed, there were places, like Sheffield, where the cut was not reasonable. Nevertheless, on the whole it may be said that public libraries came out of the difficult situation with happier results than most institutions. It is not accurate to say that the crisis is over, but it is quite true that its worst time has passed, and that there is a definite opening out of financial possibilities throughout Great Britain. “We see not yet the full day here, but we behold the waning night,” is a quotation which we may apply to the present situation.

HIS holidays over, before the individual and strenuous winter work of his library begins, the wise librarian concentrates for a few weeks on the Annual Meeting of the Library Association. This year the event is of unusual character and of great interest. Fifty years of public service on the part of devoted workers are to be commemorated, and there could be no more fitting place for the commemoration than Edinburgh. It is a special meeting, too, in that for the first time for many years the Library Association gathering will take a really international complexion. If some too exacting critics are forward to say that we have invited a very large number of foreign guests to come to hear themselves talk, we may reply that we want to hear them. There is a higher significance in the occasion than may appear on the surface—for an effort is to be made in the direction of international co‐operation. In spite of the excellent work of the various international schools, we are still insular. Now that the seas are open and a trip to America costs little more than one to (say) Italy, we hope that the way grows clearer to an almost universal co‐working amongst libraries. It is overdue. May our overseas guests find a real atmosphere of welcome, hospitality and friendship amongst us this memorable September!