1
|
Talukder MR, Islam MT, Mathew S, Perry C, Phung D, Rutherford S, Cass A. The effect of ambient temperatures on hospital admissions for kidney diseases in Central Australia. ENVIRONMENTAL RESEARCH 2024; 259:119502. [PMID: 38945510 DOI: 10.1016/j.envres.2024.119502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 06/02/2024] [Accepted: 06/25/2024] [Indexed: 07/02/2024]
Abstract
This study aimed to quantify risk of hospitalisations for kidney diseases related to ambient temperature in Central Australia, Northern Territory (NT). Daily hospitalisation data were extracted for Alice Springs Hospital, Central Australia, 2010-2021. The association between daily mean temperature and daily hospital admissions for total kidney and specific kidney conditions was assessed using a quasi-Poisson Generalized Linear Model combined with a distributed lag non-linear model. A total of 52,057 hospitalisations associated with kidney diseases were recorded. In general, risk of specific kidney related hospitalisations was immediate due to hot temperatures and prolonged due to cold temperatures. Relative to the minimum-risk temperature (5.1 °C), at 31 °C, cumulative relative risk (RR) of hospitalisations for total kidney disease (TKD) was 1.297 [95% CI 1.164,1.446] over lag0-1 days, for chronic kidney disease (CKD) cumulative RR was 1.269 [95% CI 1.115,1.444] and for kidney failure (KF) cumulative RR was 1.252 [95% CI 1.107,1.416] at lag 0, and for urinary tract infection (UTI) cumulative RR was 1.522 [95% CI 1.072,2.162] over lag0-7 days. At 16 °C and over lag0-7 days, cumulative RR of hospitalisations for TKD was 1.320 [95% CI 1.135,1.535], for CKD was 1.232 [95% CI 1.025,1.482], for RF was 1.233 [95% CI 1.035,1.470] and for UTI was 1.597 [95% CI 1.143, 2.231]. Both cold and hot temperatures were also associated with increased risks of kidney related total hospitalisations among First Nations Australians and women. Overall, temperature attributable to 13.7% (i.e. 7138 cases) of kidney related hospitalisations with higher attributable hospitalisations from cold temperature. Given the significant burden of kidney disease and projected increases in extreme temperatures associated with climate change in NT including Central Australia there is a need to implement public health and environmental health risk reduction strategies and awareness programs to mitigate potential adverse health effects of extreme temperatures.
Collapse
Affiliation(s)
- Mohammad Radwanur Talukder
- Leukaemia Foundation, Adelaide, SA, Australia; Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
| | - Md Tauhidul Islam
- Health Administration, Policy and Leadership Program, Murdoch Business School, Murdoch University, Perth, WA, Australia
| | - Supriya Mathew
- Menzies School of Health Research, Charles Darwin University, NT, Australia
| | - Chris Perry
- Aboriginal Medical Services Alliance Northern Territory, Alice Springs, NT, Australia
| | - Dung Phung
- School of Public Health, The University of Queensland, QLD, Australia; Queensland Alliance for Environmental Health Sciences, The University of Queensland, QLD, Australia
| | - Shannon Rutherford
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, NT, Australia
| |
Collapse
|
2
|
Ferguson B, Doan V, Shoker A, Abdelrasoul A. A comprehensive exploration of chronic kidney disease and dialysis in Canada's Indigenous population: from epidemiology to genetic influences. Int Urol Nephrol 2024:10.1007/s11255-024-04122-5. [PMID: 38898356 DOI: 10.1007/s11255-024-04122-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 06/13/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE This study aims to review the escalating prevalence of chronic kidney disease (CKD) and end-stage renal disease (ESRD) among Canada's Indigenous population, focusing on risk factors, hospitalization and mortality rates, and disparities in kidney transplantation. The study explores how these factors contribute to the health outcomes of this population and examines the influence of genetic variations on CKD progression. METHODS The review synthesizes data on prevalence rates, hospitalization and mortality statistics, and transplantation disparities among Indigenous individuals. It also delves into the complexities of healthcare access, including geographical, socioeconomic, and psychological barriers. Additionally, the manuscript investigates the impact of racial factors on blood characteristics relevant to dialysis treatment and the genetic predispositions influencing disease progression in Indigenous populations. RESULTS Indigenous individuals exhibit a higher prevalence of CKD and ESRD risk factors such as diabetes and obesity, particularly in regions like Saskatchewan. These patients face a 77% higher risk of death compared to their non-Indigenous counterparts and are less likely to receive kidney transplants. Genetic analyses reveal significant associations between CKD and specific genomic variations. Through analyses, we found that healthy Indigenous individuals may have higher levels of circulating inflammatory markers, which could become further elevated for those with CKD. In particular, they may have higher levels of C-reactive protein (CRP) fibrinogen, as well as genomic variations that affect IL-6 production and the function of von Willebrand Factor (vWF) which has critical potential influence on the compatibility with dialysis membranes contributing to complications in dialysis. CONCLUSION Indigenous people in Canada are disproportionately burdened by CKD and ESRD due to socioeconomic factors and potential genetic predispositions. While significant efforts have been made to assess the socioeconomic conditions of the Indigenous population, the genetic factors and their potential critical influence on compatibility with dialysis membranes, contributing to treatment complications, remain understudied. Further investigation into these genetic predispositions is essential.
Collapse
Affiliation(s)
- Braiden Ferguson
- Division of Biomedical Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK, S7N 5A9, Canada
| | - Victoria Doan
- Division of Biomedical Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK, S7N 5A9, Canada
| | - Ahmed Shoker
- Saskatchewan Transplant Program, St. Paul's Hospital, 1702 20Th Street West, Saskatoon, SK, S7M 0Z9, Canada
- Nephrology Division, College of Medicine, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, S7N 5E5, Canada
| | - Amira Abdelrasoul
- Division of Biomedical Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK, S7N 5A9, Canada.
- Department of Chemical and Biological Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK, S7N 5A9, Canada.
| |
Collapse
|
3
|
Ronksley PE, Scory TD, McRae AD, MacRae JM, Manns BJ, Lang E, Donald M, Hemmelgarn BR, Elliott MJ. Emergency Department Use Among Adults Receiving Dialysis. JAMA Netw Open 2024; 7:e2413754. [PMID: 38809552 PMCID: PMC11137633 DOI: 10.1001/jamanetworkopen.2024.13754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/27/2024] [Indexed: 05/30/2024] Open
Abstract
Importance People with kidney failure receiving maintenance dialysis visit the emergency department (ED) 3 times per year on average, which is 3- to 8-fold more often than the general population. Little is known about the factors that contribute to potentially preventable ED use in this population. Objective To identify the clinical and sociodemographic factors associated with potentially preventable ED use among patients receiving maintenance dialysis. Design, Setting, and Participants This cohort study used linked administrative health data within the Alberta Kidney Disease Network to identify adults aged 18 years or older receiving maintenance dialysis (ie, hemodialysis or peritoneal dialysis) between April 1, 2010, and March 31, 2019. Patients who had been receiving dialysis for more than 90 days were followed up from cohort entry (defined as dialysis start date plus 90 days) until death, outmigration from the province, receipt of a kidney transplant, or end of study follow-up. The Andersen behavioral model of health services was used as a conceptual framework to identify variables related to health care need, predisposing factors, and enabling factors. Data were analyzed in March 2024. Main Outcomes and Measures Rates of all-cause ED encounters and potentially preventable ED use associated with 4 kidney disease-specific ambulatory care-sensitive conditions (hyperkalemia, heart failure, volume overload, and malignant hypertension) were calculated. Multivariable negative binomial regression models were used to examine the association between clinical and sociodemographic factors and rates of potentially preventable ED use. Results The cohort included 4925 adults (mean [SD] age, 60.8 [15.5] years; 3071 males [62.4%]) with kidney failure receiving maintenance hemodialysis (3183 patients) or peritoneal dialysis (1742 patients) who were followed up for a mean (SD) of 2.5 (2.0) years. In all, 3877 patients had 34 029 all-cause ED encounters (3100 [95% CI, 2996-3206] encounters per 1000 person-years). Of these, 755 patients (19.5%) had 1351 potentially preventable ED encounters (114 [95% CI, 105-124] encounters per 1000 person-years). Compared with patients with a nonpreventable ED encounter, patients with a potentially preventable ED encounter were more likely to be in the lowest income quintile (38.8% vs 30.9%; P < .001); to experience heart failure (46.8% vs 39.9%; P = .001), depression (36.6% vs 32.5%; P = .03), and chronic pain (60.1% vs 54.9%; P = .01); and to have a longer duration of dialysis (3.6 vs 2.6 years; P < .001). In multivariable regression analyses, potentially preventable ED use was higher for younger adults (incidence rate ratio [IRR], 1.69 [95% CI, 1.33-2.15] for those aged 18 to 44 years) and patients with chronic pain (IRR, 1.35 [95% CI, 1.14-1.61]), greater material deprivation (IRR, 1.57 [95% CI, 1.16-2.12]), a history of hyperkalemia (IRR, 1.31 [95% CI, 1.09-1.58]), and historically high ED use (ie, ≥3 ED encounters in the prior year; IRR, 1.46 [95% CI, 1.23-1.73). Conclusions and Relevance In this study of adults receiving maintenance dialysis in Alberta, Canada, among those with ED use, 1 in 5 had a potentially preventable ED encounter; reasons for such encounters were associated with both psychosocial and medical factors. The findings underscore the need for strategies that address social determinants of health to avert potentially preventable ED use in this population.
Collapse
Affiliation(s)
- Paul E. Ronksley
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Tayler D. Scory
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew D. McRae
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer M. MacRae
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Braden J. Manns
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eddy Lang
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maoliosa Donald
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brenda R. Hemmelgarn
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Meghan J. Elliott
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
4
|
Hsiao R, Youngson E, Lafontaine A, Fathimani K, Williams DC. Comparison of outcomes after appendectomy in First Nations and non-First Nations patients in Northern Alberta. Can J Surg 2023; 66:E540-E549. [PMID: 37967970 PMCID: PMC10664803 DOI: 10.1503/cjs.011222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Internationally, Indigenous Peoples experience worse surgical outcomes than non-Indigenous patients, but equity of surgical care is less well studied in Canada. This study compares outcomes after appendectomy in First Nations and non-First Nations patients. METHODS In this population-based study, we reviewed administrative data of patients who underwent appendectomy between Apr. 1, 2004, and Mar. 31, 2017, in Northern Alberta. Demographic variables and characteristics of surgical care for First Nations and non-First Nations patients were collected. We identified adverse outcomes by the presence of predefined administrative codes. We identified variables related to a complex postoperative course (at least 1 of wound dehiscence, surgical site infection, abscess, bowel obstruction, pneumonia, deep vein thrombosis, sepsis, emergency department visit, readmission or death within 30 d after appendectomy) through a logistic regression model, and those related to longer length of stay using a Cox proportional hazards model. RESULTS A total of 28 453 patients met the selection criteria, of whom 1737 (6.1%) had First Nations status. Compared to non-First Nations patients, First Nations patients were younger, lived farther away from the hospital of their appendectomy, were in lower socioeconomic quintiles, and had higher rates of obesity and diabetes (all p < 0.001). After adjustment for age, sex, distance to hospital, socioeconomic deprivation and comorbidities, First Nations status remained independently associated with higher rates of adverse outcomes (odds ratio 1.548, 95% confidence interval [CI] 1.384-1.733) and longer lengths of stay (hazard ratio 0.877, 95% CI 0.832-0.924). CONCLUSION Although rurality, comorbidities and socioeconomic status contributed to worse outcomes after appendectomy for First Nations patients, First Nations status remained independently associated with worse surgical outcomes. Surgical care, an integral component of health care delivery, must be improved for First Nations patients in order to achieve equitable health care.
Collapse
Affiliation(s)
- Ralph Hsiao
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Hsiao, Fathimani, Williams); Data and Research Services, Alberta SPOR Support Unit, Edmonton, Alta. (Youngson); Provincial Research Data Services, Alberta Health Services, Edmonton, Alta. (Youngson); and the Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alta. (Lafontaine)
| | - Erik Youngson
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Hsiao, Fathimani, Williams); Data and Research Services, Alberta SPOR Support Unit, Edmonton, Alta. (Youngson); Provincial Research Data Services, Alberta Health Services, Edmonton, Alta. (Youngson); and the Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alta. (Lafontaine)
| | - Alika Lafontaine
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Hsiao, Fathimani, Williams); Data and Research Services, Alberta SPOR Support Unit, Edmonton, Alta. (Youngson); Provincial Research Data Services, Alberta Health Services, Edmonton, Alta. (Youngson); and the Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alta. (Lafontaine)
| | - Kamran Fathimani
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Hsiao, Fathimani, Williams); Data and Research Services, Alberta SPOR Support Unit, Edmonton, Alta. (Youngson); Provincial Research Data Services, Alberta Health Services, Edmonton, Alta. (Youngson); and the Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alta. (Lafontaine)
| | - David C Williams
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Hsiao, Fathimani, Williams); Data and Research Services, Alberta SPOR Support Unit, Edmonton, Alta. (Youngson); Provincial Research Data Services, Alberta Health Services, Edmonton, Alta. (Youngson); and the Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alta. (Lafontaine)
| |
Collapse
|
5
|
Effective primary care management of type 2 diabetes for indigenous populations: A systematic review. PLoS One 2022; 17:e0276396. [PMID: 36355789 PMCID: PMC9648771 DOI: 10.1371/journal.pone.0276396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 10/06/2022] [Indexed: 11/12/2022] Open
Abstract
Background Indigenous peoples in high income countries are disproportionately affected by Type 2 Diabetes. Socioeconomic disadvantages and inadequate access to appropriate healthcare are important contributors. Objectives This systematic review investigates effective designs of primary care management of Type 2 Diabetes for Indigenous adults in Australia, Canada, New Zealand, and the United States. Primary outcome was change in mean glycated haemoglobin. Secondary outcomes were diabetes-related hospital admission rates, treatment compliance, and change in weight or Body Mass Index. Methods Included studies were critically appraised using Joanna Briggs Institute appraisal checklists. A mixed-method systematic review was undertaken. Quantitative findings were compared by narrative synthesis, meta-aggregation of qualitative factors was performed. Results Seven studies were included. Three reported statistically significant reductions in means HbA1c following their intervention. Seven components of effective interventions were identified. These were: a need to reduce health system barriers to facilitate access to primary care (which the other six components work towards), an essential role for Indigenous community consultation in intervention planning and implementation, a need for primary care programs to account for and adapt to changes with time in barriers to primary care posed by the health system and community members, the key role of community-based health workers, Indigenous empowerment to facilitate community and self-management, benefit of short-intensive programs, and benefit of group-based programs. Conclusions This study synthesises a decade of data from communities with a high burden of Type 2 Diabetes and limited research regarding health system approaches to improve diabetes-related outcomes. Policymakers should consider applying the seven identified components of effective primary care interventions when designing primary care approaches to mitigate the impact of Type 2 Diabetes in Indigenous populations. More robust and culturally appropriate studies of Type 2 Diabetes management in Indigenous groups are needed. Trail registration Registered with PROSPERO (02/04/2021: CRD42021240098).
Collapse
|
6
|
Chong C, Campbell D, Elliott M, Aghajafari F, Ronksley P. Determining the Association Between Continuity of Primary Care and Acute Care Use in Chronic Kidney Disease: A Retrospective Cohort Study. Ann Fam Med 2022; 20:237-245. [PMID: 35606125 PMCID: PMC9199056 DOI: 10.1370/afm.2813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Acute care use is high among individuals with chronic kidney disease (CKD). It is unclear how relational continuity of primary care influences downstream acute care use. We aimed to determine if poor continuity of care is associated with greater rates of acute care use and decreased prescriptions for guideline-recommended drugs. METHODS We conducted a population-based retrospective cohort study of adults with stage 3-4 CKD and ≥3 visits to a primary care clinician during the period April 1, 2011 to March 31, 2014 in Alberta, Canada. Continuity was calculated using the Usual Provider Continuity index. Descriptive statistics were used to summarize patient and acute care encounter characteristics. Adjusted rates and incidence rate ratios for all-cause and CKD-related ambulatory care-sensitive condition (ACSC) hospitalizations and emergency department (ED) visits were estimated using negative binomial regression. Adjusted odds ratios for prescription use were estimated by multivariable logistic regression. RESULTS Among 86,475 patients with CKD, 51.3%, 30.0%, and 18.7% had high, moderate, and poor continuity of care, respectively. There were 77,988 all-cause hospitalizations, 6,489 ACSC-related hospitalizations, 204,615 all-cause ED visits, and 8,461 ACSC-related ED visits during a median follow-up of 2.3 years. Rates of all-cause and ACSC hospitalization and ED use increased with poorer continuity of care in a stepwise fashion across CKD stages. Patients with poor continuity were less likely to be prescribed a statin. CONCLUSIONS Poor continuity of care is associated with increased acute care use among patients with CKD. Targeted strategies that strengthen patient-physician relationships and guide physicians regarding guideline-recommended prescribing are needed.
Collapse
Affiliation(s)
- Christy Chong
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David Campbell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Meghan Elliott
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fariba Aghajafari
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
7
|
Kirwin E, MacDonald S, Simmonds K. Profiles in Epidemiology: Dr. Larry Svenson. Am J Epidemiol 2022. [PMID: 34850825 DOI: 10.1093/aje/kwab282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
8
|
Okpechi IG, Zaidi D, Ye F, Fradette M, Schick-Makaroff K, Berendonk C, Abdulrahman A, Braam B, Ghimire A, Hariramani VK, Jindal K, Khan M, Klarenbach S, Muneer S, Ringrose J, Scott-Douglas N, Shojai S, Slabu D, Sultana N, Tinwala MM, Thompson S, Padwal R, Bello AK. Telemonitoring and Case Management for Hypertensive and Remote-Dwelling Patients With Chronic Kidney Disease—The Telemonitoring for Improved Kidney Outcomes Study (TIKO): A Clinical Research Protocol. Can J Kidney Health Dis 2022; 9:20543581221077500. [PMID: 35186305 PMCID: PMC8848092 DOI: 10.1177/20543581221077500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/05/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Hypertension, together with poorly controlled blood pressure (BP) are known risk factors for kidney disease and progression to kidney failure as well as increased cardiovascular (CV) morbidity and mortality. Several studies in patients without kidney disease have demonstrated the efficacy of home BP telemonitoring (HBPT) for BP control. Objective: The primary aim of this study is to assess the mean difference in systolic BP (SBP) at 12 months, from baseline in remote dwelling patients with hypertension and chronic kidney disease (CKD) in Northern Alberta, Canada, comparing HBPT + usual care versus HBPT + a case manager. Other secondary objectives, including cost-effectiveness and acceptability of HBPT as well as occurrence of adverse events will also be assessed. Methods Design: This study is designed as a pragmatic randomized controlled trial (RCT) of HBPT plus clinical case management compared to HBPT with usual care. Setting: Peace River region in Northern Alberta Region, Canada. Patients: Primary care patients with CKD and hypertension. Measurements: Eligible patients will be randomized 1:1 to HBPT + BP case management versus HBPT + usual care. In the intervention arm, BP will be measured 4 times daily for 1 week, with medications titrated up or down by the study case manager until guideline targets (systolic BP [SBP]: <130 mmHg) are achieved. Once BP is controlled, (ie, to guideline-concordant targets), this 1-week protocol will be repeated every 3 months for 1 year. Patients in the control arm will also follow the same BP measurement protocol; however, there will be no interactions with the case manager; they will share their BP readings with their primary care physicians or nurse practitioners at scheduled visits. Limitations: Potential limitations of this study include the relatively short duration of follow-up, possible technological pitfalls, and need for patients to own a smartphone and have access to the internet to participate. Conclusions: As this study will focus on a high-risk population that has been characterized by a large care gap, it will generate important evidence that would allow targeted and effective population-level strategies to be implemented to improve health outcomes for high-risk hypertensive CKD patients in Canada’s remote communities. Trial Registration: www.clinicaltrials.gov (NCT number: NCT04098354)
Collapse
Affiliation(s)
- Ikechi G. Okpechi
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Deenaz Zaidi
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Miriam Fradette
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | | | | | - Abdullah Abdulrahman
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Branko Braam
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Anukul Ghimire
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Vinash Kumar Hariramani
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Kailash Jindal
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Scott Klarenbach
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Shezel Muneer
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Jennifer Ringrose
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Nairne Scott-Douglas
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Soroush Shojai
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Dan Slabu
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Naima Sultana
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Mohammed M. Tinwala
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Stephanie Thompson
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Raj Padwal
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
- Aminu K. Bello, Faculty of Medicine and Dentistry, Division of Nephrology and Immunology, University of Alberta, Edmonton, AB T6G 2R7 Canada.
| |
Collapse
|
9
|
Muller MK. Colonial Geographies: Indigenous Access to Primary Care in British Columbia. Med Anthropol 2022; 41:359-372. [PMID: 35041563 DOI: 10.1080/01459740.2021.2021901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This article considers the demonstrated lack of access to primary health services in remote Indigenous communities in British Columbia as a form of structural exclusion shaped by the history of settler colonialism. Drawing on collaborative research conducted with an Indigenous nursing organization, I link ethnographic case studies with historical research demonstrating how racially segregated health care developed within an assimilatory political mandate. I argue that access to and quality of care must be understood as two inter-related dimensions of health equity, which must be regarded by decision-makers as a key site for addressing the health disparities faced by Indigenous populations.
Collapse
Affiliation(s)
- Megan K Muller
- Department of Anthropology, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
10
|
Frejuk KL, Harasemiw O, Komenda P, Lavallee B, McLeod L, Chartrand C, Di Nella M, Ferguson TW, Martin H, Wicklow B, Dart AB. Impact of a screen, triage and treat program for identifying chronic disease risk in Indigenous children. CMAJ 2021; 193:E1415-E1422. [PMID: 34518342 PMCID: PMC8443280 DOI: 10.1503/cmaj.210507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis project was a point-of-care screening program in rural and remote First Nations communities in Manitoba that aimed to identify and treat hypertension, diabetes and chronic kidney disease. The program identified chronic disease in 20% of children screened. We aimed to characterize clinical screening practices before and after intervention in children aged 10-17 years old and compare outcomes with those who did not receive the intervention. METHODS This observational, prospective cohort study started with community engagement and followed the principles of ownership, control, access and possession (OCAP). We linked participant data to administrative data at the Manitoba Centre for Health Policy to assess rates of primary care and nephrology visits, disease-modifying medication prescriptions and laboratory testing (i.e., glycosylated hemoglobin [HbA1c], estimated glomerural filtration rate [eGFR] and urine albumin- or protein-to-creatinine ratio). We analyzed the differences in proportions in the 18 months before and after the intervention. We also conducted a 1:2 propensity score matching analysis to compare outcomes of children who were screened with those who were not. RESULTS We included 324 of 353 children from the screening program (43.8% male; median age 12.3 yr) in this study. After the intervention, laboratory testing increased by 5.8% (95% confidence interval [CI] 1.1% to 10.1%) for HbA1c, by 9.9% (95% CI 4.2% to 15.5%) for eGFR and by 6.2% (95% CI 2.3% to 10.0%) for the urine albumin- or protein-to-creatinine ratio. We observed significant improvements in laboratory testing in screened patients in the group who were part of the program, compared with matched controls. INTERPRETATION Chronic disease surveillance and care increased significantly in children after the implementation of a point-of-care screening program in rural and remote First Nation communities. Interventions such as active surveillance programs have the potential to improve the chronic disease care being provided to First Nations children.
Collapse
Affiliation(s)
- Kara L Frejuk
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Oksana Harasemiw
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Paul Komenda
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Barry Lavallee
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Lorraine McLeod
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Caroline Chartrand
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Michelle Di Nella
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Thomas W Ferguson
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Heather Martin
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Brandy Wicklow
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Allison B Dart
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man.
| |
Collapse
|
11
|
Huria T, Pitama SG, Beckert L, Hughes J, Monk N, Lacey C, Palmer SC. Reported sources of health inequities in Indigenous Peoples with chronic kidney disease: a systematic review of quantitative studies. BMC Public Health 2021; 21:1447. [PMID: 34301234 PMCID: PMC8299576 DOI: 10.1186/s12889-021-11180-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To summarise the evidentiary basis related to causes of inequities in chronic kidney disease among Indigenous Peoples. METHODS We conducted a Kaupapa Māori meta-synthesis evaluating the epidemiology of chronic kidney diseases in Indigenous Peoples. Systematic searching of MEDLINE, Google Scholar, OVID Nursing, CENTRAL and Embase was conducted to 31 December 2019. Eligible studies were quantitative analyses (case series, case-control, cross-sectional or cohort study) including the following Indigenous Peoples: Māori, Aboriginal and Torres Strait Islander, Métis, First Nations Peoples of Canada, First Nations Peoples of the United States of America, Native Hawaiian and Indigenous Peoples of Taiwan. In the first cycle of coding, a descriptive synthesis of the study research aims, methods and outcomes was used to categorise findings inductively based on similarity in meaning using the David R Williams framework headings and subheadings. In the second cycle of analysis, the numbers of studies contributing to each category were summarised by frequency analysis. Completeness of reporting related to health research involving Indigenous Peoples was evaluated using the CONSIDER checklist. RESULTS Four thousand three hundred seventy-two unique study reports were screened and 180 studies proved eligible. The key finding was that epidemiological investigators most frequently reported biological processes of chronic kidney disease, particularly type 2 diabetes and cardiovascular disease as the principal causes of inequities in the burden of chronic kidney disease for colonised Indigenous Peoples. Social and basic causes of unequal health including the influences of economic, political and legal structures on chronic kidney disease burden were infrequently reported or absent in existing literature. CONCLUSIONS In this systematic review with meta-synthesis, a Kaupapa Māori methodology and the David R Williams framework was used to evaluate reported causes of health differences in chronic kidney disease in Indigenous Peoples. Current epidemiological practice is focussed on biological processes and surface causes of inequity, with limited reporting of the basic and social causes of disparities such as racism, economic and political/legal structures and socioeconomic status as sources of inequities.
Collapse
Affiliation(s)
- Tania Huria
- Māori Indigenous Health Institute, University of Otago Christchurch, 2 Riccarton Ave, Christchurch, 8140, New Zealand.
| | - Suzanne G Pitama
- Māori Indigenous Health Institute, University of Otago Christchurch, 2 Riccarton Ave, Christchurch, 8140, New Zealand
| | - Lutz Beckert
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | | | - Nathan Monk
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Cameron Lacey
- Māori Indigenous Health Institute, University of Otago Christchurch, 2 Riccarton Ave, Christchurch, 8140, New Zealand
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| |
Collapse
|
12
|
Harasemiw O, Ferguson T, Lavallee B, McLeod L, Chartrand C, Rigatto C, Tangri N, Dart A, Komenda P. Impact of point-of-care screening for hypertension, diabetes and progression of chronic kidney disease in rural Manitoba Indigenous communities. CMAJ 2021; 193:E1076-E1084. [PMID: 34281964 PMCID: PMC8315205 DOI: 10.1503/cmaj.201731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In 2013-2015, we conducted point-of-care screening for hypertension, diabetes and chronic kidney disease in rural and remote Indigenous communities in Manitoba, Canada. In this study, we aimed to determine whether optimal follow-up care was provided, defined as proportion of individuals with appropriate kidney disease laboratory testing, medication prescriptions and physician visits. METHODS We linked screening data from participants to provincial administrative data sets to evaluate whether frequencies of laboratory testing, prescriptions of disease-modifying medications, and primary care and nephrology visits differed in the 18 months before and after screening. We also conducted a propensity score matching analysis to compare outcomes between screened and unscreened adults. RESULTS Of 1353 adults who received the screening intervention and who had complete administrative data available, 44% were at risk of kidney failure at screening. Among these individuals, frequencies of comprehensive laboratory testing (estimated glomerular filtration rate and urine albumin to creatinine ratio) improved by 17.0% (95% confidence interval [CI] 11.5 to 22.5), anti-hyperglycemic medications improved by 4.4% (95% CI 1.0 to 7.8), and nephrology visits for participants meeting referral criteria improved by 5.9% (95% CI 3.4 to 8.5). We observed significant improvements in laboratory testing, antihyperglycemic medications and nephrology visits in the screened group compared with the 1:1 matched comparison group. INTERPRETATION Point-of-care screening programs in rural and remote Indigenous communities are adaptable methods for increasing awareness, monitoring risk and treating chronic diseases. Interventions such as the development of a national screening program could improve chronic disease care in high-risk populations.
Collapse
Affiliation(s)
- Oksana Harasemiw
- Chronic Disease Innovation Centre (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Dart), University of Manitoba; Children's Hospital Research Institute of Manitoba (Dart), Winnipeg, Man
| | - Thomas Ferguson
- Chronic Disease Innovation Centre (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Dart), University of Manitoba; Children's Hospital Research Institute of Manitoba (Dart), Winnipeg, Man
| | - Barry Lavallee
- Chronic Disease Innovation Centre (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Dart), University of Manitoba; Children's Hospital Research Institute of Manitoba (Dart), Winnipeg, Man
| | - Lorraine McLeod
- Chronic Disease Innovation Centre (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Dart), University of Manitoba; Children's Hospital Research Institute of Manitoba (Dart), Winnipeg, Man
| | - Caroline Chartrand
- Chronic Disease Innovation Centre (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Dart), University of Manitoba; Children's Hospital Research Institute of Manitoba (Dart), Winnipeg, Man
| | - Claudio Rigatto
- Chronic Disease Innovation Centre (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Dart), University of Manitoba; Children's Hospital Research Institute of Manitoba (Dart), Winnipeg, Man
| | - Navdeep Tangri
- Chronic Disease Innovation Centre (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Dart), University of Manitoba; Children's Hospital Research Institute of Manitoba (Dart), Winnipeg, Man
| | - Allison Dart
- Chronic Disease Innovation Centre (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Dart), University of Manitoba; Children's Hospital Research Institute of Manitoba (Dart), Winnipeg, Man
| | - Paul Komenda
- Chronic Disease Innovation Centre (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Dart), University of Manitoba; Children's Hospital Research Institute of Manitoba (Dart), Winnipeg, Man.
| |
Collapse
|
13
|
Chong C, Wick J, Klarenbach S, Manns B, Hemmelgarn B, Ronksley P. Cost of Potentially Preventable Hospitalizations Among Adults With Chronic Kidney Disease: A Population-Based Cohort Study. Can J Kidney Health Dis 2021; 8:20543581211018528. [PMID: 34158964 PMCID: PMC8182215 DOI: 10.1177/20543581211018528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/13/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Prior studies report high hospitalization rates among patients with chronic kidney disease (CKD) and approximately 10% to 20.9% of hospitalizations are potentially preventable. OBJECTIVE To determine the rate, proportion, and cost of potentially preventable hospitalizations and whether this varied by CKD category. DESIGN Retrospective cohort study using population-based data. SETTING Alberta, Canada. PATIENTS All adults with an outpatient serum creatinine measurement between January 1 and December 31, 2017 in the Alberta Kidney Disease Network data repository. MEASUREMENTS CKD risk categories were based on measures of proteinuria (where available), eGFR, and use of dialysis. Patients were linked to administrative data to capture frequency and cost of hospital encounters and followed until death or end of study (December 31, 2018). The outcomes of interest were the rate and cost of potentially preventable hospitalizations, as identified using the Canadian Institute for Health Information (CIHI)-defined ambulatory care sensitive condition (ACSC) algorithm and a CKD-related ACSC algorithm. METHODS Unadjusted and adjusted rates per 1000-patient years, proportions, and cost attributable to preventable hospitalizations were identified for the cohort as a whole and for patients within each CKD risk category. RESULTS Of the 1,110,895 adults with eGFR and proteinuria measurements, 181,422 had CKD. During a median follow-up of 1 year, there were 62,023 hospitalizations among patients with CKD resulting in a total cost of $946 million CAD; 6907 (11.1%) of these hospitalizations were for CIHI-defined ACSCs while 4323 (7.0%) were for CKD-related ACSCs. Adjusted rates of hospitalization for ACSCs increased with CKD risk category and were highest among patients treated with dialysis. Among CKD patients, the total cost of potentially preventable hospitalizations was $79 million and $58 million CAD for CIHI-defined and CKD-related ACSCs (8.4% and 6.2% of total hospitalization cost, respectively). LIMITATIONS Based on the ACSC construct, we were unable to determine if these hospitalizations were truly preventable. CONCLUSIONS Potentially preventable hospitalizations have a substantial cost and burden on the health care system among people with CKD. Effective strategies that reduce preventable admissions among CKD patients may lead to significant cost savings. TRIAL REGISTRATION Not applicable-observational study design.
Collapse
Affiliation(s)
- Christy Chong
- Department of Community Health
Sciences, Cumming School of Medicine, University of Calgary, AB, Canada
| | - James Wick
- Department of Medicine, Cumming School
of Medicine, University of Calgary, AB, Canada
| | - Scott Klarenbach
- Faculty of Medicine and Dentistry,
University of Alberta, Edmonton, Canada
| | - Braden Manns
- Department of Community Health
Sciences, Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Medicine, Cumming School
of Medicine, University of Calgary, AB, Canada
| | - Brenda Hemmelgarn
- Faculty of Medicine and Dentistry,
University of Alberta, Edmonton, Canada
| | - Paul Ronksley
- Department of Community Health
Sciences, Cumming School of Medicine, University of Calgary, AB, Canada
| |
Collapse
|
14
|
Wilson D, Moloney E, Parr JM, Aspinall C, Slark J. Creating an Indigenous Māori-centred model of relational health: A literature review of Māori models of health. J Clin Nurs 2021; 30:3539-3555. [PMID: 34046956 PMCID: PMC8597078 DOI: 10.1111/jocn.15859] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/22/2021] [Accepted: 05/01/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES Identify the key concepts, principles and values embedded within Indigenous Māori models of health and wellbeing; and determine how these could inform the development of a Māori-centred relational model of care. BACKGROUND Improving health equity for Māori, similar to other colonised Indigenous peoples globally, requires urgent attention. Improving the quality of health practitioners' engagement with Indigenous Māori accessing health services is one area that could support improving Māori health equity. While the Fundamentals of Care framework offers a promising relational approach, it lacks consideration of culture, whānau or family, and spirituality, important for Indigenous health and wellbeing. DESIGN AND METHODS A qualitative literature review on Māori models of health and wellbeing yielded nine models to inform a Māori-centred relational model of care. We followed the PRISMA guidelines for reporting literature reviews. RESULTS Four overarching themes were identified that included dimensions of health and wellbeing; whanaungatanga (connectedness); whakawhanaungatanga (building relationships); and socio-political health context (colonisation, urbanisation, racism, and marginalisation). Health and wellbeing for Māori is a holistic and relational concept. Building relationships that include whānau (extended family) is a cultural imperative. CONCLUSIONS This study highlights the importance and relevance of relational approaches to engaging Māori and their whānau accessing health services. It signals the necessary foundations for health practitioners to build trust-based relationships with Māori. Key elements for a Māori-centred model of relational care include whakawhanaungatanga (the process of building relationships) using tikanga (cultural protocols and processes) informed by cultural values of aroha (compassion and empathy), manaakitanga (kindness and hospitality), mauri (binding energy), wairua (importance of spiritual wellbeing). RELEVANCE TO CLINICAL PRACTICE Culturally-based models of health and wellbeing provide indicators of important cultural values, concepts and practices and processes. These can then inform the development of a Māori-centred relational model of care to address inequity.
Collapse
Affiliation(s)
- Denise Wilson
- Taupua Waiora Māori Research Centre, Faculty of Health & Environmental Sciences, Auckland University of Technology, Manukau, Auckland, New Zealand
| | - Eleanor Moloney
- School of Nursing, University of Auckland, Grafton, Auckland, New Zealand
| | - Jenny M Parr
- Counties Manukau Health District Health Board, Middlemore Hospital, Auckland, New Zealand
| | - Cathleen Aspinall
- School of Nursing, University of Auckland, Grafton, Auckland, New Zealand.,Counties Manukau Health, Otahuhu, Auckland, New Zealand
| | - Julia Slark
- School of Nursing, University of Auckland, Grafton, Auckland, New Zealand
| |
Collapse
|
15
|
Erdmann R, Morrin L, Harvey R, Joya L, Clifford A, Soroka S. Canadian Senior Renal Leaders Community of Practice: Vulnerable Populations With Chronic Kidney Disease-Evidence to Inform Policy. Can J Kidney Health Dis 2020; 7:2054358120930977. [PMID: 32782812 PMCID: PMC7383632 DOI: 10.1177/2054358120930977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/14/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose: Low socioeconomic status, race, ethnicity, and rural/remote populations are all associated with disparities in access, care, and outcomes for chronic kidney disease (CKD). There have been different interventions supported by Canadian renal programs to address these disparities. This article reviews the evidence for impact of strategies to reduce inequities experienced by vulnerable populations living with or at risk of CKD and to collate and share interprovincial targeted interventions through the newly formed “Canadian Senior Renal Leaders Community of Practice” focused on translating evidence into clinical practice and policy. Source of Information: A literature search of Medline, CINAHL, PubMed, and Google Scholar from 2008 to 2018 identified 13 reports of processes and interventions that have been implemented in Australia, Canada, and the United States to reduce inequities in CKD care and can be categorized into 3 broad areas: (1) early screening and prevention, (2) disease management and dialysis, and (3) pretransplant. Web sites from each Canadian jurisdiction and from Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) Network were used to assess the current state of Canadian initiatives. Methods: Reviews were completed to gather information on renal initiatives for vulnerable populations, including (1) identification of populations that experience disparities in access to care or in outcomes in the context of CKD prevention and treatment and (2) interventions that have been implemented to reduce disparities in access, care, and outcomes for vulnerable populations with CKD. A current state summary of Canadian initiatives related to vulnerable populations was conducted through a review of publicly available information, including a review of renal program Web sites and a review of current projects related to vulnerable populations that are part of Can-SOLVE CKD. Can-SOLVE CKD is a Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR-SPOR) funded research network to transform the care of people affected by kidney disease. Key Findings: Interventions to improve inequities in access to CKD screening, disease management, and care are successful when developed with community engagement, provided to the patient in their own environment, and tailored to specific populations. Many provincial renal programs have implemented initiatives to support vulnerable populations with or at risk of CKD. Current projects funded through CIHR SPOR focus on underserved populations and involve partnerships with Indigenous populations. Many renal programs in Canada had or were in the process of implementing interventions to support vulnerable populations with CKD; however, information about the initiatives were not readily available online despite a strong interest and opportunity to support interprovincial knowledge sharing. Despite this common interest, little information is systematically shared between Canadian jurisdictions to support interprovincial sharing to promote evidence-informed policy and program development. Efforts will be made through the newly formed Canadian Senior Renal Leaders Community of Practice to collaborate and share learnings to inform future program and policy development, implementation, and evaluation. Limitations: As this was not a systematic review, literature search only encompassed studies published in English between 2008 and 2018. It is possible that populations and interventions were overlooked during the search and through the screening process. Furthermore, the controversial definition of “vulnerable” and literature that only came from Canada, the United States, and Australia limits the generalizability of this review.
Collapse
Affiliation(s)
| | | | | | - Lisa Joya
- Cancer Care Ontario, Toronto, Canada
| | | | - Steven Soroka
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, Canada
- Steven Soroka, Nova Scotia Health Authority, 5880 Dickson Building, 5820 University Ave, Halifax, NS, Canada B3H 1V8.
| |
Collapse
|
16
|
Elliott MJ, Love S, Donald M, Manns B, Donald T, Premji Z, Hemmelgarn BR, Grinman M, Lang E, Ronksley PE. Outpatient Interventions for Managing Acute Complications of Chronic Diseases: A Scoping Review and Implications for Patients With CKD. Am J Kidney Dis 2020; 76:794-805. [PMID: 32479925 DOI: 10.1053/j.ajkd.2020.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 04/02/2020] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Patients with chronic kidney disease (CKD) have high rates of emergency department (ED) use and hospitalization. Outpatient care may provide an alternative to ED and inpatient care in this population. We aimed to explore the scope of outpatient interventions used to manage acute complications of chronic diseases and highlight opportunities to adapt and test interventions in the CKD population. STUDY DESIGN Scoping review of quantitative and qualitative studies. SETTING & POPULATION Outpatient interventions for adults experiencing acute complications related to 1 of 5 eligible chronic diseases (ie, CKD, chronic respiratory disease, cardiovascular disease, cancer, and diabetes). SELECTION CRITERIA FOR STUDIES MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, grey literature, and conference abstracts were searched to December 2019. DATA EXTRACTION Intervention and study characteristics were extracted using standardized tools. ANALYTICAL APPROACH Quantitative data were summarized descriptively; qualitative data were summarized thematically. Our approach observed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) extension for scoping reviews. RESULTS 77 studies (25 randomized controlled trials, 29 observational, 12 uncontrolled before-after, 5 quasi-experimental, 4 qualitative, and 2 mixed method) describing 57 unique interventions were included. Of identified intervention types (hospital at home [n = 16], observation unit [n = 9], ED-based specialist service [n = 4], ambulatory program [n = 18], and telemonitoring [n = 10]), most were studied in chronic respiratory and cardiovascular disease populations. None targeted the CKD population. Interventions were delivered in the home, ED, hospital, and ambulatory setting by a variety of health care providers. Cost savings were demonstrated for most interventions, although improvements in other outcome domains were not consistently observed. LIMITATIONS Heterogeneity of included studies; lack of data for outpatient interventions for acute complications related to CKD. CONCLUSIONS Several interventions for outpatient management of acute complications of chronic disease were identified. Although none was specific to the CKD population, features could be adapted and tested to address the complex acute-care needs of patients with CKD.
Collapse
Affiliation(s)
- Meghan J Elliott
- Department of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
| | - Shannan Love
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Maoliosa Donald
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Bryn Manns
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Teagan Donald
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Zahra Premji
- Department of Libraries and Cultural Resources, University of Calgary, Calgary, AB, Canada
| | - Brenda R Hemmelgarn
- Department of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Michelle Grinman
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
17
|
Shah BR, Slater M, Frymire E, Jacklin K, Sutherland R, Khan S, Walker JD, Green ME. Use of the health care system by Ontario First Nations people with diabetes: a population-based study. CMAJ Open 2020; 8:E313-E318. [PMID: 32371525 PMCID: PMC7207033 DOI: 10.9778/cmajo.20200043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND First Nations people in Ontario have an increased prevalence of diabetes compared to other people in the province. This study examined use of health care services by First Nations people with diabetes and other people with diabetes in Ontario. METHODS Using linked health administrative databases, we identified all people in Ontario with diabetes as of Apr. 1, 2014. We identified First Nations people using the Indian Register. We looked at outcomes from Apr. 1, 2014, to Mar. 31, 2015. We determined the proportion of people with a regular family physician and their continuity of care with that physician. We also examined visits with specialists for diabetes care, hospital admissions for ambulatory-care-sensitive conditions, and emergency department visits for hypo- or hyperglycemia. RESULTS There were 1 380 529 people diagnosed with diabetes in Ontario as of Apr. 1, 2014, of whom 22 952 (1.7%) were First Nations people. First Nations people were less likely to have a regular family physician (85.3% v. 97.7%) and had lower continuity of care with that physician (mean score for continuity of care 74.6 v. 77.7) than other people in Ontario. They were also less likely to see specialists. First Nations people were more likely to be admitted to hospital for ambulatory-care-sensitive conditions (2.4% v. 1.2%) and to have an emergency department visit for hypo- or hyperglycemia (1.5% v. 0.8%). Disparities were particularly marked for those living in First Nations communities. INTERPRETATION First Nations people with diabetes in Ontario had poorer access to and use of primary care than other people with diabetes in the province. These findings may help explain continued disparities in the rates of complications related to diabetes.
Collapse
Affiliation(s)
- Baiju R Shah
- ICES (Shah, Slater, Frymire, Khan, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green) and Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Sutherland), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont.
| | - Morgan Slater
- ICES (Shah, Slater, Frymire, Khan, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green) and Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Sutherland), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont
| | - Eliot Frymire
- ICES (Shah, Slater, Frymire, Khan, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green) and Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Sutherland), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont
| | - Kristen Jacklin
- ICES (Shah, Slater, Frymire, Khan, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green) and Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Sutherland), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont
| | - Roseanne Sutherland
- ICES (Shah, Slater, Frymire, Khan, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green) and Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Sutherland), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont
| | - Shahriar Khan
- ICES (Shah, Slater, Frymire, Khan, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green) and Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Sutherland), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont
| | - Jennifer D Walker
- ICES (Shah, Slater, Frymire, Khan, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green) and Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Sutherland), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont
| | - Michael E Green
- ICES (Shah, Slater, Frymire, Khan, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green) and Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Sutherland), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont
| |
Collapse
|
18
|
Silver SA, Bota SE, McArthur E, Clemens KK, Harel Z, Naylor KL, Sood MM, Garg AX, Wald R. Association of Primary Care Involvement with Death or Hospitalizations for Patients Starting Dialysis. Clin J Am Soc Nephrol 2020; 15:521-529. [PMID: 32139363 PMCID: PMC7133142 DOI: 10.2215/cjn.10890919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/22/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES It is uncertain whether primary care physician continuity of care associates with a lower risk of death and hospitalization among patients transitioning to maintenance dialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Using provincial-linked administrative databases in Ontario, Canada, we conducted a population-based study of incident patients who initiated maintenance dialysis between 2005 and 2014 and survived for at least 90 days. We defined high primary care physician continuity as both a high usual provider of care index (where >75% of primary care physician visits occurred with the same primary care physician) in the 2 years before dialysis (an established measure of primary care physician continuity) and at least one visit with the same primary care physician in the 90 days after dialysis initiation. We used propensity scores to match a group of patients with high and low continuity so that indicators of baseline health were similar. The primary outcome was all-cause mortality, and secondary outcomes included all-cause and disease-specific hospitalizations during the 2 years after maintenance dialysis initiation. RESULTS We identified 19,099 eligible patients. There were 6612 patients with high primary care physician continuity, of whom 6391 (97%) were matched to 6391 patients with low primary care physician continuity. High primary care physician continuity was not associated with a lower risk of mortality (14.5 deaths per 100 person-years versus 15.2 deaths per 100 person-years; hazard ratio, 0.96; 95% confidence interval, 0.89 to 1.02). There was no difference in the rate of all-cause hospitalizations (hazard ratio, 0.96; 95% confidence interval, 0.92 to 1.01), and high primary care physician continuity was not associated with a lower risk of any disease-specific hospitalization, except for those related to diabetes (hazard ratio, 0.88; 95% confidence interval, 0.80 to 0.97). CONCLUSIONS High primary care physician continuity before and during the transition to maintenance dialysis was not associated with a lower risk of mortality or all-cause hospitalization.
Collapse
Affiliation(s)
- Samuel A Silver
- Division of Nephrology, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada; .,ICES, Toronto, Ontario, Canada
| | | | | | - Kristin K Clemens
- ICES, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism and Department of Epidemiology and Biostatistics and
| | - Ziv Harel
- ICES, Toronto, Ontario, Canada.,Division of Nephrology and Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; and
| | | | - Manish M Sood
- ICES, Toronto, Ontario, Canada.,Department of Medicine and Clinical Epidemiology Program of the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Amit X Garg
- ICES, Toronto, Ontario, Canada.,Division of Nephrology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Ron Wald
- ICES, Toronto, Ontario, Canada.,Division of Nephrology and Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; and
| |
Collapse
|
19
|
Epidemiology research to foster improvement in chronic kidney disease care. Kidney Int 2020; 97:477-486. [DOI: 10.1016/j.kint.2019.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/12/2019] [Accepted: 11/15/2019] [Indexed: 11/24/2022]
|
20
|
Improving Cultural Safety of Diabetes Care in Indigenous Populations of Canada, Australia, New Zealand and the United States: A Systematic Rapid Review. Can J Diabetes 2019; 44:670-678. [PMID: 32029402 DOI: 10.1016/j.jcjd.2019.11.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/09/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Our aim in this study was to identify interventions that improve cultural safety for Indigenous people living with diabetes in the health-care setting, and their potential impact on patients and health-care professionals. METHODS Using a systematic approach, we conducted a rapid review of quantitative, qualitative and mixed studies between January 2000 and February 2018 in MEDLINE, Embase, Web of Science, ERIC, CINAHL and PsycINFO. Two reviewers independently identified, selected and reviewed studies relating to cultural safety in diabetes care for Indigenous populations in Canada, New Zealand, Australia and the United States. RESULTS Of the 406 studies identified, we retained 7 articles (2 strong quality, 5 moderate quality) for analysis. The included studies evaluated 3 main types of strategies to improve cultural safety: educating health professionals, fostering culturally safe practices by modifying clinical environments and integrating Indigenous health professionals in the workforce. Studies showed that culturally safe interventions had positive effects on clinical outcomes for patients, increased patient satisfaction and health professional confidence in providing care as well as patient access to health care. CONCLUSIONS Although based on a small number of studies, this review establishes moderate evidence that interventions to improve cultural safety can have positive effects on treatment of diabetes in Indigenous populations. Further research with stronger study designs should be conducted to further validate our conclusions.
Collapse
|
21
|
McGuire C, Kannathasan S, Lowe M, Dow T, Bezuhly M. Patient survival following renal transplantation in Indigenous populations: A systematic review. Clin Transplant 2019; 34:e13760. [PMID: 31788873 DOI: 10.1111/ctr.13760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 11/12/2019] [Accepted: 11/20/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inequities in health care predispose Indigenous populations to poor health outcomes. The objective of this study was to examine patient survival and other post-transplant outcomes of kidney transplantation among Indigenous patients compared with non-Indigenous populations. METHODS A systematic review of MEDLINE, EMBASE, and Google Scholar was undertaken from inception to September 30, 2019, using a computerized search. Publication descriptors and methodological and statistical details were extracted. Articles were assessed using the methodological index for non-randomized studies (MINORS) scale. RESULTS Twelve studies were included. All studies were retrospective and published between 2004 and 2018. Mean Indigenous patient age was 40 (range: 8-76), while non-Indigenous was 41 (range: 6-74). Mean sample size for Indigenous populations was 398 (range: 24-1459), while for non-Indigenous patients was 1102 (range: 53-7555). Eight studies examined indigenous populations in Australia, two in Canada, one in the United States, and one in New Zealand. All studies were considered of high methodological quality and clinically homogenous. Results indicated that patient survival, graft survival, and delayed graft function were significantly reduced among Indigenous populations compared with non-Indigenous populations. CONCLUSIONS Post-transplant outcomes among various Indigenous populations are significantly worse compared with non-Indigenous populations. The reasons for poor outcomes are likely multifactorial. Improved standardized reporting of transplant outcomes of Indigenous patients is necessary to better inform healthcare services and improve clinical outcomes.
Collapse
Affiliation(s)
- Connor McGuire
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Matthew Lowe
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd Dow
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Bezuhly
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
22
|
Quinn AE, Hemmelgarn BR, Tonelli M, McBrien KA, Edwards A, Senior P, Faris P, Au F, Ma Z, Weaver RG, Manns BJ. Association of Specialist Physician Payment Model With Visit Frequency, Quality, and Costs of Care for People With Chronic Disease. JAMA Netw Open 2019; 2:e1914861. [PMID: 31702800 PMCID: PMC6902778 DOI: 10.1001/jamanetworkopen.2019.14861] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Specialist physicians are key members of chronic care management teams; to date, however, little is known about the association between specialist payment models and outcomes for patients with chronic diseases. OBJECTIVE To examine the association of payment model with visit frequency, quality of care, and costs for patients with chronic diseases seen by specialists. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study using propensity-score matching in patients seen by a specialist physician was conducted between April 1, 2011, and September 31, 2014. The study was completed on March 31, 2015, and data analysis was conducted from June 2017 to February 2018 and finalized in August 2019. In a population-based design, 109 839 adults with diabetes or chronic kidney disease newly referred to specialists were included. Because patients seen by independent salary-based and fee-for-service (FFS) specialists were significantly different in observed baseline characteristics, patients were matched 1:1 on demographic, illness, and physician characteristics. EXPOSURES Specialist physician payment model (salary-based or FFS). MAIN OUTCOMES AND MEASURES Follow-up outpatient visits, guideline-recommended care delivery, adverse events, and costs. RESULTS A total of 90 605 patients received care from FFS physicians and 19 234 received care from salary-based physicians. Before matching, the patients seen by salary-based physicians had more advanced chronic kidney disease (2630 of 14 414 [18.2%] vs 6627 of 54 489 [12.2%]), and a higher proportion had 5 or more comorbidities (5989 of 19 234 [31.3%] vs 23 326 of 90 605 [25.7%]). Propensity-score matching resulted in a cohort of 31 898 patients (15 949 FFS, 15 949 salary-based) seeing 489 specialists. In the matched cohort, patients were similar (mean [SD] age, 61.3 [18.2] years; 17 632 women [55.3%]; 29 251 residing in urban settings [91.7%]). Patients seen by salary-based specialists had a higher follow-up visit rate compared with those seen by FFS specialists (1.74 visits; 95% CI, 1.58-1.92 visits vs 1.54 visits; 95% CI, 1.41-1.68 visits), but the difference was not significant (rate ratio, 1.13; 95% CI, 0.99-1.28; P = .06). There was no statistical difference in guideline-recommended care delivery, hospital or emergency department visits for ambulatory care-sensitive conditions, or costs between patients seeing FFS and salary-based specialists. The median association of physician clustering with health care use and quality outcomes was consistently greater than the association with the physician payment, suggesting variation between physicians (eg, median rate ratio for follow-up outpatient visit rate was 1.74, which is greater than the rate ratio of 1.13). CONCLUSIONS AND RELEVANCE Specialist physician payment does not appear to be associated with variation in visits, quality, and costs for outpatients with chronic diseases; however, there is variation in outcomes between physicians. This finding suggests the need to consider other strategies to reduce physician variation to improve the value of care and outcomes for people with chronic diseases.
Collapse
Affiliation(s)
- Amity E. Quinn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brenda R. Hemmelgarn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kerry A. McBrien
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alun Edwards
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Peter Senior
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Faris
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
| | - Flora Au
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Zhihai Ma
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robert G. Weaver
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Braden J. Manns
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
23
|
Sporinova B, Manns B, Tonelli M, Hemmelgarn B, MacMaster F, Mitchell N, Au F, Ma Z, Weaver R, Quinn A. Association of Mental Health Disorders With Health Care Utilization and Costs Among Adults With Chronic Disease. JAMA Netw Open 2019; 2:e199910. [PMID: 31441939 PMCID: PMC6714022 DOI: 10.1001/jamanetworkopen.2019.9910] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
IMPORTANCE A population-based study using validated algorithms to estimate the costs of treating people with chronic disease with and without mental health disorders is needed. OBJECTIVE To determine the association of mental health disorders with health care costs among people with chronic diseases. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study in the Canadian province of Alberta collected data from April 1, 2012, to March 31, 2015, among 991 445 adults 18 years and older with a chronic disease (ie, asthma, congestive heart failure, myocardial infarction, diabetes, epilepsy, hypertension, chronic pulmonary disease, or chronic kidney disease). Data analysis was conducted from October 2017 to August 2018. EXPOSURES Mental health disorder (ie, depression, schizophrenia, alcohol use disorder, or drug use disorder). MAIN OUTCOMES AND MEASURES Resource use, mean total unadjusted and adjusted 3-year health care costs, and mean total unadjusted 3-year costs for hospitalization and emergency department visits for ambulatory care-sensitive conditions. RESULTS Among 991 445 participants, 156 296 (15.8%) had a mental health disorder. Those with no mental health disorder were older (mean [SD] age, 58.1 [17.6] years vs 55.4 [17.0] years; P < .001) and less likely to be women (50.4% [95% CI, 50.3%-50.5%] vs 57.7% [95% CI, 57.4%-58.0%]; P < .001) than those with mental health disorders. For those with a mental health disorder, mean total 3-year adjusted costs were $38 250 (95% CI, $36 476-$39 935), and for those without a mental health disorder, mean total 3-year adjusted costs were $22 280 (95% CI, $21 780-$22 760). Having a mental health disorder was associated with significantly higher resource use, including hospitalization and emergency department visit rates, length of stay, and hospitalization for ambulatory care-sensitive conditions. Higher resource use by patients with mental health disorders was not associated with health care presentations owing to chronic diseases compared with patients without a mental health disorder (chronic disease hospitalization rate per 1000 patient days, 0.11 [95% CI, 0.11-0.12] vs 0.06 [95% CI, 0.06-0.06]; P < .001; overall hospitalization rate per 1000 patient days, 0.88 [95% CI, 0.87-0.88] vs 0.43 [95% CI, 0.43-0.43]; P < .001). CONCLUSIONS AND RELEVANCE This study suggests that mental health disorders are associated with substantially higher resource utilization and health care costs among patients with chronic diseases. These findings have clinical and health policy implications.
Collapse
Affiliation(s)
- Barbora Sporinova
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Braden Manns
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
- Libin Cardiovascular Institute, O’Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, O’Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brenda Hemmelgarn
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, O’Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Frank MacMaster
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Strategic Clinical Network for Addictions and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
| | - Nicholas Mitchell
- Strategic Clinical Network for Addictions and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Flora Au
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Zhihai Ma
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robert Weaver
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amity Quinn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
24
|
Waheed A, Djurdjev O, Dong J, Gill J, Barbour S. Validation of Self-Reported Race in a Canadian Provincial Renal Administrative Database. Can J Kidney Health Dis 2019; 6:2054358119859528. [PMID: 31308951 PMCID: PMC6604118 DOI: 10.1177/2054358119859528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 05/20/2019] [Indexed: 11/18/2022] Open
Abstract
Background: Administrative data are commonly used to study clinical outcomes in renal
disease. Race is an important determinant of renal health delivery and
outcomes in Canada but is not validated in most administrative data, and the
correlation with census-based definitions of race is unknown. Objectives: Validation of self-reported race (SRR) in a Canadian provincial renal
administrative database (Patient Records and Outcome Management Information
System [PROMIS]) and comparison with the Canadian census categories of
race. Design: Prospective patient survey study to validate SRR in PROMIS. Setting: British Columbia, Canada. Patients: Adult patients registered in PROMIS. Measurements: Survey SRR was used as gold standard to validate SRR in PROMIS. Self-reported
race in PROMIS was compared with census race categories. Methods: This is a cross-sectional telephone survey of a random sample of all adults
in PROMIS conducted between February 2016 and November 2016. Responders
selected a race category from PROMIS and from the Canadian census.
Sensitivity (Sn) and specificity (Sp) were calculated with 95% confidence
intervals (CIs). Results: A total of 21 039 patients met inclusion criteria, 1677 were selected for the
survey and 637 participated (38% response rate). There were no differences
between the PROMIS, sampled, and responder populations. PROMIS SRR had an
accuracy of 95.3% (95% CI: 94.2%-97.0%) when validated against the survey
SRR with Sn and Sp ≥90% in all race groups except in Aboriginals (Sn 87.5%).
The positive and negative predictive values were ≥95%, except in very low
and high–prevalence groups, respectively. The Canadian census had an
accuracy of 95.7% (95% CI: 94.4%-97.6%) when validated against PROMIS SRR
with Sn and Sp ≥90%. The results did not differ in subgroups based on age,
sex, birth outside Canada, or renal group (glomerulonephritis, chronic
kidney disease, hemodialysis, peritoneal dialysis, transplant recipients, or
live donors). Limitations: Analysis of minority groups and lower prevalence groups is limited by sample
size. Results may not be generalizable to other administrative
databases. Conclusions: We have shown high accuracy of PROMIS SRR that validates its use in the
secondary analysis of administrative data for research. There is high
correlation between PROMIS and census race categories which allows linkage
with other data sources that use census-based definitions of race.
Collapse
Affiliation(s)
- Aiza Waheed
- The University of British Columbia, Vancouver, Canada
| | | | | | - Jagbir Gill
- The University of British Columbia, Vancouver, Canada.,BC Provincial Renal Agency, Vancouver, Canada
| | - Sean Barbour
- The University of British Columbia, Vancouver, Canada.,BC Provincial Renal Agency, Vancouver, Canada
| |
Collapse
|
25
|
Kelly L, Matsumoto CL, Schreiber Y, Gordon J, Willms H, Olivier C, Madden S, Hopko J, Tobe SW. Prevalence of chronic kidney disease and cardiovascular comorbidities in adults in First Nations communities in northwest Ontario: a retrospective observational study. CMAJ Open 2019; 7:E568-E572. [PMID: 31501170 PMCID: PMC6768774 DOI: 10.9778/cmajo.20190040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The prevalence of adult chronic kidney disease and cardiovascular comorbidities in Canadian Indigenous communities is largely unknown. We conducted a study to document the prevalence of chronic kidney disease and concurrent diabetes mellitus, hypertension and dyslipidemia in a First Nations population in northwest Ontario. METHODS In this observational study, we used retrospective data collected from regional electronic medical records of 16 170 adults (age ≥ 18 yr) from 26 First Nations communities in northwest Ontario from May 2014 to May 2017. Demographic and laboratory data included age, gender, prescribed medications, estimated glomerular filtration rate, urine albumin:creatinine ratio, low-density lipoprotein cholesterol (LDL-C) level and glycated hemoglobin (HbA1c) concentration. We identified patients with diabetes by an HbA1c concentration of 6.5% or higher, or the use of a diabetic medication, those with dyslipidemia by an elevated LDL-C level (≥ 2.0 mmol/L) or use of lipid-lowering medication, and those with hypertension by use of antihypertensive medication. RESULTS Of the 16 170 adults residing in the communities, 5224 unique patients (32.3%) had renal testing (albumin:creatinine ratio and/or estimated glomerular filtration rate). The age-adjusted prevalence of chronic kidney disease was 14.5%, and the prevalence of stage 3-5 chronic kidney disease (estimated glomerular filtration rate < 60 mL/min) was 7.0%. Most patients with chronic kidney disease (1487 [80.0%]) had at least 1 cardiovascular comorbidity. A total of 1332 patients (71.6%) had diabetes, 1313 (70.6%) had dyslipidemia, and 1098 (59.1%) had hypertension; all 3 comorbidities were present in 716 patients (38.5%). INTERPRETATION We document a high prevalence of advanced chronic kidney disease in this First Nations population, 7.0%, double the rate in the general population. High rates of cardiovascular comorbidities were also common in these patients with chronic kidney disease, which places them at increased risk for cardiovascular disease.
Collapse
Affiliation(s)
- Len Kelly
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont.
| | - Cai-Lei Matsumoto
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Yoko Schreiber
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Janet Gordon
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Hannah Willms
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Christopher Olivier
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Sharen Madden
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Josh Hopko
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Sheldon W Tobe
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| |
Collapse
|
26
|
Quinn AE, Edwards A, Senior P, McBrien KA, Hemmelgarn BR, Tonelli M, Au F, Ma Z, Weaver RG, Manns BJ. The association between payment model and specialist physicians' selection of patients with diabetes: a descriptive study. CMAJ Open 2019; 7:E109-E116. [PMID: 30782774 PMCID: PMC6380900 DOI: 10.9778/cmajo.20180171] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND As the number of people with chronic diseases increases, understanding the impact of payment model on the types of patients seen by specialists has implications for improving the quality and value of care. We sought to determine if there is an association between specialist physician payment model and the types of patients seen. METHODS In this descriptive study, we used administrative data to compare demographic characteristics, illness severity and visit indication of patients with diabetes seen by fee-for-service and salary-based internal medicine and diabetes specialists in Calgary and Edmonton between April 2011 and September 2014. The study cohort included all newly referred adults with diabetes (no appointment with a specialist in prior 4 yr). Diabetes was identified using a validated algorithm that excludes gestational diabetes. RESULTS Patients managed by salary-based physicians (n = 2736) were sicker than those managed by fee-for-service physicians (n = 21 218). Patients managed by salary-based specialists were more likely to have 5 or more comorbidities (23.0% [n = 628] v. 18.1% [n = 3843]) and to have been admitted to hospital or seen in an emergency department for an ambulatory care sensitive condition in the year before their index visit, probably reflecting poorer disease control or barriers to optimal outpatient care. A higher proportion of visits to salary-based physicians were for appropriate indications (65.2% [n = 744] v. 55.6% [n = 5553]; risk ratio 1.17, 95% confidence interval 1.09-1.27). INTERPRETATION Salary-based specialists were more likely to see patients with a clear indication for a specialist visit, while fee-for-service specialists were more likely to see healthier patients. Future research is needed to determine if the differences in types of patients are attributable to payment model or other provider- or system-level factors.
Collapse
Affiliation(s)
- Amity E Quinn
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Alun Edwards
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Peter Senior
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Kerry A McBrien
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Brenda R Hemmelgarn
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Marcello Tonelli
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Flora Au
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Zhihai Ma
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Robert G Weaver
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Braden J Manns
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta.
| |
Collapse
|
27
|
Conway J, Lawn S, Crail S, McDonald S. Indigenous patient experiences of returning to country: a qualitative evaluation on the Country Health SA Dialysis bus. BMC Health Serv Res 2018; 18:1010. [PMID: 30594208 PMCID: PMC6311048 DOI: 10.1186/s12913-018-3849-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/19/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Rates of End-Stage Kidney Disease among Aboriginal and Torres Strait Islander (Indigenous) Australians in remote areas are disproportionately high; however, haemodialysis is not currently offered in most remote areas. People must therefore leave their 'Country' (with its traditions and supports) and relocate to metropolitan or regional centres, disrupting their kinship and the cultural ties that are important for their wellbeing. The South Australian Mobile Dialysis Truck is a service which visits remote communities for one to two week periods; allowing patients to have dialysis on 'Country', reuniting them with their friends and family, and providing a chance to take part in cultural activities. The aims of the study were to qualitatively evaluate the South Australian Mobile Dialysis Truck program, its impact on the health and wellbeing of Indigenous dialysis patients, and the facilitators and barriers to using the service. METHODS Face to face semi-structured interviews were conducted with 15 Indigenous dialysis patients and 10 nurses who had attended trips across nine dialysis units. Realist evaluation methodology and thematic analysis established patient and nursing experiences with the Mobile Dialysis Truck. RESULTS The consequences of leaving Country included grief and loss. Barriers to trip attendance included lower trip frequencies, ineffective trip advertisement, lack of appropriate or unavailable accommodation for staff and patients and poor patient health. Benefits of the service included the ability to fulfil cultural commitments, minimisation of medical retrievals from patients missing dialysis to return to remote areas, improved trust and relationships between patients and staff, and improved patient quality of life. The bus also provided a valuable cultural learning opportunity for staff. Facilitators to successful trips included support staff, clinical back-up and a co-ordinator role. CONCLUSIONS The Mobile Dialysis Truck was found to improve the social and emotional wellbeing of Indigenous patients who have had to relocate for dialysis, and build positive relationships and trust between metropolitan nurses and remote patients. The trust fostered improved engagement with associated health services. It also provided valuable cultural learning opportunities for nursing staff. This format of health service may improve cultural competencies with nursing staff who provide regular care for Indigenous patients.
Collapse
Affiliation(s)
| | - Sharon Lawn
- Flinders Human Behaviour and Health Research Unit, Department of Psychiatry, Flinders University, Adelaide, Australia
| | - Susan Crail
- Central Adelaide Renal and Transplantation Service, Adelaide, Australia
| | - Stephen McDonald
- Country Health SA Local Health Network, SA Health and Medical Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| |
Collapse
|
28
|
Nelson SE, Wilson K. Understanding barriers to health care access through cultural safety and ethical space: Indigenous people's experiences in Prince George, Canada. Soc Sci Med 2018; 218:21-27. [DOI: 10.1016/j.socscimed.2018.09.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 08/20/2018] [Accepted: 09/14/2018] [Indexed: 10/28/2022]
|
29
|
Dalla Zuanna T, Spadea T, Milana M, Petrelli A, Cacciani L, Simonato L, Canova C. Avoidable hospitalization among migrants and ethnic minority groups: a systematic review. Eur J Public Health 2018; 27:861-868. [PMID: 28957490 DOI: 10.1093/eurpub/ckx113] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background The numbers of migrants living in Europe are growing rapidly, and has become essential to assess their access to primary health care (PHC). Avoidable Hospitalization (AH) rates can reflect differences across migrant and ethnic minority groups in the performance of PHC. We aimed to conduct a systematic review of all published studies on AH comparing separately migrants with natives or different racial/ethnic groups, in Europe and elsewhere. Methods We ran a systematic search for original articles indexed in primary electronic databases on AH among migrants or ethnic minorities. Studies presenting AH rates and/or rate ratios between at least two different ethnic minority groups or between migrants and natives were included. Results Of the 35 papers considered in the review, 28 (80%) were conducted in the United States, 4 in New Zealand, 2 in Australia, 1 in Singapore, and none in Europe. Most of the studies (91%) used a cross-sectional design. The exposure variable was defined in almost all articles by ethnicity, race, or a combination of the two; country of birth was only used in one Australian study. Most of the studies found significant differences in overall AH rates, with minorities (mainly Black and Hispanics) showing higher rates than non-Hispanic Whites. Conclusions AH has been used, mostly in the US, to compare different racial/ethnic groups, while it has never been used in Europe to assess migrants' access to PHC. Studies comparing AH rates between migrants and natives in European settings can be helpful in filling this lack of evidence.
Collapse
Affiliation(s)
- Teresa Dalla Zuanna
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padova, Padova, Italy
| | - Teresa Spadea
- Epidemiology Unit, Regione Piemonte, Grugliasco (TO) ASL TO3, Italy
| | - Marzio Milana
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padova, Padova, Italy
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Laura Cacciani
- Lazio Regional Health Service, Department of Epidemiology, Rome, Italy
| | - Lorenzo Simonato
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padova, Padova, Italy
| | - Cristina Canova
- Department of Molecular Medicine, University of Padova, Padova, Italy
| |
Collapse
|
30
|
Dart A, Lavallee B, Chartrand C, McLeod L, Ferguson TW, Tangri N, Gordon A, Blydt-Hansen T, Rigatto C, Komenda P. Screening for kidney disease in Indigenous Canadian children: The FINISHED screen, triage and treat program. Paediatr Child Health 2018; 23:e134-e142. [PMID: 30374222 DOI: 10.1093/pch/pxy013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Indigenous populations are disproportionately affected by kidney failure at younger ages than other ethnic groups in Canada. As symptoms do not occur until disease is advanced, early kidney disease risk is often unrecognized. Objectives We sought to evaluate the yield of community-based screening for early risk factors for kidney disease in youth from rural Indigenous communities in Canada. Methods The FINISHED project screened 11 rural First Nations communities in Manitoba, Canada after community and school engagement. The results for the 10- to 17-year olds are reported here. Body mass index (BMI), blood pressure, estimated glomerular filtration rate (eGFR), hemoglobin A1c's (HbA1c) and urine albumin-to-creatinine ratios (ACR) were assessed. All children were triaged and referred to either primary or tertiary care, depending on risk. Results A total of 353 were screened (estimated 22.4% of population). The median age was 12 years (IQR 10 to 13), 55% were female and 55% were overweight or obese. Overall, 21.8% of children had at least one abnormality. Hypertension was identified in 5.4% and 11.9% had prehypertension. None of the children had an eGFR < 60 ml/min/1.73 m2 however 10.5% had an ACR > 3 mg/mmol and 6.2% had an eGFR < 90 ml/min/1.73 m2 suggestive of early kidney disease. Diabetes was identified in 1.4%, and 1.4% had HbA1c's between 6.1% and 6.49%. Conclusions Risk factors for chronic kidney disease are highly prevalent in rural Indigenous children. More research is required to confirm the persistence of these findings, and to evaluate the efficacy of screening children to prevent or delay progression to kidney failure.
Collapse
Affiliation(s)
- Allison Dart
- Department of Pediatrics and Child Health, University of Manitoba and Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Barry Lavallee
- Centre for Aboriginal Health Education, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | - Thomas W Ferguson
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Navdeep Tangri
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Audrey Gordon
- Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Tom Blydt-Hansen
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Claudio Rigatto
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Komenda
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
31
|
Mathew AT, Park J, Sachdeva M, Sood MM, Yeates K. Barriers to Peritoneal Dialysis in Aboriginal Patients. Can J Kidney Health Dis 2018; 5:2054358117747261. [PMID: 29326842 PMCID: PMC5757429 DOI: 10.1177/2054358117747261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/18/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Aboriginal people in Canada have an unduly high burden of end-stage kidney disease (ESKD) and many live in rural settings. Peritoneal dialysis (PD) is a home-based dialysis modality that may provide a valuable alternative to in-center hemodialysis which is relatively underutilized by the Aboriginal population. OBJECTIVE We aim to assess the barriers to PD utilization in Aboriginal patients with ESKD. DESIGN This article is a prospective observational cohort study. SETTING The setting involves 3 predialysis clinics in Winnipeg, Kingston, and Moose Factory. PATIENTS The patients were 99 individuals (67 non-Aboriginal and 32 Aboriginal) who were at least 18 years of age with an estimated glomerular filtration rate of less than 30 mL/min/1.73m2, and were enrolled in one of the 3 study sites from April 2011 to October 2013. MEASUREMENTS Patient demographics and comorbidities were documented. Barriers to PD, PD as modality choice, and Aboriginal status were assessed via patient survey upon study enrollment. PD use as the initial dialysis modality was assessed via monthly patient follow-up for 1 year after enrollment in the study. METHODS The patient survey was created based on literature review of known barriers to PD, repaired based on direct patient feedback, and tested for reliability via the test-retest method. Differences in PD choice, barriers to PD, and PD use between Aboriginal and non-Aboriginal patients were determined by chi-square test and logistic regression. RESULTS All patients enrolled in the study completed the survey. Mean age was 65.5 versus 54.6 years for non-Aboriginals and Aboriginals, respectively. Barriers to PD significantly associated with Aboriginal status were lack of money (odds ratio [OR]: 21.3; 95% confidence interval [CI]: 5.3-86.4; P < .0001) and anxiety (OR: 2.8; 95% CI: 1.1-7.1; P = .03). There was no difference in PD choice between non-Aboriginals and Aboriginals (66.7% vs 68.8%, respectively; P = .83). One of 67 non-Aboriginals (1.5%) and 5 of 32 Aboriginals (15.6%) died prior to initiating dialysis (P = .013). No significant difference was observed between non-Aboriginals (33%) and Aboriginals (28%) in use of PD (P = .81). LIMITATIONS Small sample size was a limitation of this study. CONCLUSIONS Aboriginal people in Canada have a disproportionately large burden of ESKD, and PD could provide an alternative to in-center hemodialysis for those living in rural areas. Our study identified anxiety and lack of money as barriers to PD significantly associated with Aboriginal status. When choosing dialysis modality, shared decision making between physicians and patient is of key importance to weigh all potential benefits and risks and emphasize the Aboriginal patient's values and preferences. These results can be used to guide future research and to help devise interventions targeting barriers to PD in Aboriginals.
Collapse
Affiliation(s)
| | - Joonho Park
- Zucker School of Medicine at Hofstra/Northwell Health, Great Neck, NY, USA
| | - Mala Sachdeva
- Zucker School of Medicine at Hofstra/Northwell Health, Great Neck, NY, USA
| | - Manish M. Sood
- The Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
| | - Karen Yeates
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| |
Collapse
|
32
|
Kulhawy-Wibe S, King-Shier KM, Barnabe C, Manns BJ, Hemmelgarn BR, Campbell DJT. Exploring structural barriers to diabetes self-management in Alberta First Nations communities. Diabetol Metab Syndr 2018; 10:87. [PMID: 30524507 PMCID: PMC6276258 DOI: 10.1186/s13098-018-0385-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/09/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Type 2 diabetes is highly prevalent in Canadian First Nations (FN) communities. FN individuals with diabetes are less likely to receive guideline recommended care and access specialist care. They are also less likely to be able to engage in optimal self-management behaviours. While the systemic and racial contributors to this problem have been well described, individuals' experiences with structural barriers to care and self-management remain under-characterized. METHODS We utilized qualitative methods to gain insight into the structural barriers to self-management experienced by FN individuals with diabetes. We conducted a qualitative descriptive analysis of a subcohort of patients with diabetes from FN communities (n = 5) from a larger qualitative study. Using detailed semi-structured telephone interviews, we inquired about participants' diabetes and barriers to diabetes self-management. Inductive thematic analysis was performed in duplicate using NVivo 10. RESULTS The structural barriers faced by this population were substantial yet distinct from those described by non-FN individuals with diabetes. For example, medication costs, which are usually cited as a barrier to care, are covered for FN persons with status. The barriers to diabetes self-management that were commonly experienced in this cohort included transportation-related difficulties, financial barriers to uninsured health services, and lack of accessible diabetes education and resultant knowledge gaps. CONCLUSIONS FN Albertans with diabetes face a myriad of barriers to self-management, which are distinct from the Non-FN population. In addition to the barriers introduced by colonialism and historical injustices, finances, geographic isolation, and lack of diabetes education each impede optimal management of diabetes. Programs targeted at addressing FN-specific barriers may improve aspects of diabetes self-management in this population.
Collapse
Affiliation(s)
- Stephanie Kulhawy-Wibe
- Department of Medicine, Cumming School of Medicine, University of Calgary, North Tower, 9th Floor, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Kathryn M. King-Shier
- Department of Community Health Sciences, Cumming School of Medicine, O’Brien Institute for Public Health, Libin Cardiovascular Institute of Alberta, Faculty of Nursing, University of Calgary, TRW 3rd Floor, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, O’Brien Institute for Public Health, Libin Cardiovascular Institute of Alberta, University of Calgary, North Tower, 9th Floor, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Braden J. Manns
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, O’Brien Institute for Public Health, Libin Cardiovascular Institute of Alberta, University of Calgary, North Tower, 9th Floor, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Brenda R. Hemmelgarn
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, O’Brien Institute for Public Health, Libin Cardiovascular Institute of Alberta, University of Calgary, North Tower, 9th Floor, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - David J. T. Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, 1820 Richmond Road SW, Calgary, AB T2N 4N1 Canada
| |
Collapse
|
33
|
Jung JJ, Pinto R, Zarychanski R, Cook DJ, Jouvet P, Marshall JC, Kumar A, Long J, Rodin R, Fowler RA. 2009-2010 Influenza A(H1N1)-related critical illness among Aboriginal and non-Aboriginal Canadians. PLoS One 2017; 12:e0184013. [PMID: 29049285 PMCID: PMC5648104 DOI: 10.1371/journal.pone.0184013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 08/16/2017] [Indexed: 11/24/2022] Open
Abstract
Background Preliminary studies suggested that Aboriginal Canadians had disproportionately higher rates of infection, hospitalization, and critical illness due to pandemic Influenza A(H1N1)pdm09. Methods We used a prospective cohort study of critically ill patients with laboratory confirmed or probable H1N1 infection in Canada between April 16 2009 and April 12 2010. Baseline characteristics, medical interventions, clinical course and outcomes were compared between Aboriginal and non-Aboriginal patients. The primary outcome was hospital mortality. Results Of 647 critically ill adult patients with known ethnicity, 81 (12.5%) were Aboriginal, 566 (87.5%) were non-Aboriginal. Aboriginal patients were younger (mean [SD] age 40.7[13.7] v. 49.0[14.9] years, p < 0.001) and more frequently female (64.2% v. 51.1%, p = 0.027). Rates of any co-morbid illnesses (Aboriginal v. non-Aboriginal, 92.6% v. 91.0%, p = 0.63), time from symptom onset to hospital admission (median [interquartile range] 4 [2–7] v. 4 [2–7] days, p = 0.84), time to ICU admission (5 [3–8] v.5 [3–8] days, p = 0.91), and severity of illness (mean APACHE II score (19.9 [9.6] v. 21.1 [9.9], p = 0.33) were similar. A similar proportion of Aboriginal patients received antiviral medication before ICU admission than non-Aboriginal patients (91.4% v. 93.8%, p = 0.40). Among Aboriginal versus non-Aboriginal patients, the need for mechanical ventilation (93.8% v. 88.6%, p = 0.15), ventilator-free days (14 [3–23] v. 17 [0–24], p = 0.62), durations of stay in ICU (13[7-19.5] v. 11 [5–8] days, p = 0.05), hospital (19 [12.5-33.5] v. 18 [11-35] days, p = 0.63), and hospital mortality were similar (19.8% v. 22.6%, p = 0.56). In multiple logistic regression analyses, higher APACHE II score (1.06; 1.04-1.09, p<0.001) was independently associated with an increased risk of death; antiviral treatment with a lower risk of death (0.34; 0.15 – 0.78, p = 0.01). Ethnicity was not associated with mortality. Interpretation During the 2009-2010 Influenza A (H1N1) pandemic, Aboriginal and non-Aboriginal Canadians with H1N1-related critical illness had a similar risk of death, after adjusting for potential confounding factors.
Collapse
Affiliation(s)
- James J. Jung
- University of Toronto, Faculty of Medicine. Department of Critical Care Medicine; Sunnybrook Hospital; Toronto, Ontario, Canada
| | - Ruxandra Pinto
- Department of Critical Care Medicine; Sunnybrook Hospital; Toronto, Ontario, Canada
| | | | - Deborah J. Cook
- Departments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Philippe Jouvet
- Le Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | | | - Anand Kumar
- University of Manitoba Health Sciences Centre, Section of Critical Care Medicine, Winnipeg MB, Canada
| | - Jennifer Long
- Department of Critical Care Medicine; Sunnybrook Hospital; Toronto, Ontario, Canada
| | | | - Robert A. Fowler
- University of Toronto Departments of Medicine and Critical Care Medicine; Sunnybrook Hospital Toronto, Ontario, Canada
- * E-mail:
| | | |
Collapse
|
34
|
Gomes SC, Esperidião MA. [Indigenous peoples' access to health services in Cuiabá, Mato Grosso State, Brazil]. CAD SAUDE PUBLICA 2017; 33:e00132215. [PMID: 28614451 DOI: 10.1590/0102-311x00132215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 06/24/2016] [Indexed: 11/22/2022] Open
Abstract
This study aimed to evaluate indigenous peoples' access to medium and high-complexity health services in the municipality of Cuiabá, Mato Grosso State, Brazil, through the Casa de Saúde Indígena or Indigenous Peoples' Clinic (CASAI Cuiabá). A single case study with a qualitative approach was conducted at CASAI Cuiabá. Data were obtained from observation of the work routines at CASAI Cuiabá, semi-structured interviews with health professionals and administrators from the Cuiabá Special Indigenous Health District (DSEI) and CASAI Cuiabá, and document analysis. Data analysis used a matrix derived from the theoretical and logical model of accessibility, validated by the Delphi method with a group of experts on indigenous peoples' health. Despite advances achieved by CASAI in improving indigenous peoples' access, there are persistent social, organizational, cultural, and geographic barriers in access to medium and high-complexity health services in Cuiabá. The study highlights the need for specific strategies to improve access to health services by indigenous peoples in Mato Grosso State.
Collapse
|
35
|
Screening for chronic kidney disease in Canadian indigenous peoples is cost-effective. Kidney Int 2017; 92:192-200. [PMID: 28433383 DOI: 10.1016/j.kint.2017.02.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/23/2017] [Accepted: 02/02/2017] [Indexed: 01/02/2023]
Abstract
Canadian indigenous (First Nations) have rates of kidney failure that are 2- to 4-fold higher than the non-indigenous general Canadian population. As such, a strategy of targeted screening and treatment for CKD may be cost-effective in this population. Our objective was to assess the cost utility of screening and subsequent treatment for CKD in rural Canadian indigenous adults by both estimated glomerular filtration rate and the urine albumin-to-creatinine ratio. A decision analytic Markov model was constructed comparing the screening and treatment strategy to usual care. Primary outcomes were presented as incremental cost-effectiveness ratios (ICERs) presented as a cost per quality-adjusted life-year (QALY). Screening for CKD was associated with an ICER of $23,700/QALY in comparison to usual care. Restricting the model to screening in communities accessed only by air travel (CKD prevalence 34.4%), this ratio fell to $7,790/QALY. In road accessible communities (CKD prevalence 17.6%) the ICER was $52,480/QALY. The model was robust to changes in influential variables when tested in univariate sensitivity analyses. Probabilistic sensitivity analysis found 72% of simulations to be cost-effective at a $50,000/QALY threshold and 93% of simulations to be cost-effective at a $100,000/QALY threshold. Thus, targeted screening and treatment for CKD using point-of-care testing equipment in rural Canadian indigenous populations is cost-effective, particularly in remote air access-only communities with the highest risk of CKD and kidney failure. Evaluation of targeted screening initiatives with cluster randomized controlled trials and integration of screening into routine clinical visits in communities with the highest risk is recommended.
Collapse
|
36
|
Webster AC, Nagler EV, Morton RL, Masson P. Chronic Kidney Disease. Lancet 2017; 389:1238-1252. [PMID: 27887750 DOI: 10.1016/s0140-6736(16)32064-5] [Citation(s) in RCA: 2052] [Impact Index Per Article: 293.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/29/2016] [Accepted: 07/19/2016] [Indexed: 02/08/2023]
Abstract
The definition and classification of chronic kidney disease (CKD) have evolved over time, but current international guidelines define this condition as decreased kidney function shown by glomerular filtration rate (GFR) of less than 60 mL/min per 1·73 m2, or markers of kidney damage, or both, of at least 3 months duration, regardless of the underlying cause. Diabetes and hypertension are the main causes of CKD in all high-income and middle-income countries, and also in many low-income countries. Incidence, prevalence, and progression of CKD also vary within countries by ethnicity and social determinants of health, possibly through epigenetic influence. Many people are asymptomatic or have non-specific symptoms such as lethargy, itch, or loss of appetite. Diagnosis is commonly made after chance findings from screening tests (urinary dipstick or blood tests), or when symptoms become severe. The best available indicator of overall kidney function is GFR, which is measured either via exogenous markers (eg, DTPA, iohexol), or estimated using equations. Presence of proteinuria is associated with increased risk of progression of CKD and death. Kidney biopsy samples can show definitive evidence of CKD, through common changes such as glomerular sclerosis, tubular atrophy, and interstitial fibrosis. Complications include anaemia due to reduced production of erythropoietin by the kidney; reduced red blood cell survival and iron deficiency; and mineral bone disease caused by disturbed vitamin D, calcium, and phosphate metabolism. People with CKD are five to ten times more likely to die prematurely than they are to progress to end stage kidney disease. This increased risk of death rises exponentially as kidney function worsens and is largely attributable to death from cardiovascular disease, although cancer incidence and mortality are also increased. Health-related quality of life is substantially lower for people with CKD than for the general population, and falls as GFR declines. Interventions targeting specific symptoms, or aimed at supporting educational or lifestyle considerations, make a positive difference to people living with CKD. Inequity in access to services for this disease disproportionally affects disadvantaged populations, and health service provision to incentivise early intervention over provision of care only for advanced CKD is still evolving in many countries.
Collapse
Affiliation(s)
- Angela C Webster
- Sydney School of Public Health, University of Sydney, NSW, Australia; Centre for Transplant and Renal research, Westmead Hospital, Westmead, NSW, Australia.
| | - Evi V Nagler
- Renal Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Philip Masson
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| |
Collapse
|
37
|
Barnabe C, Jones CA, Bernatsky S, Peschken CA, Voaklander D, Homik J, Crowshoe LF, Esdaile JM, El-Gabalawy H, Hemmelgarn B. Inflammatory Arthritis Prevalence and Health Services Use in the First Nations and Non-First Nations Populations of Alberta, Canada. Arthritis Care Res (Hoboken) 2017; 69:467-474. [PMID: 27333120 DOI: 10.1002/acr.22959] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/06/2016] [Accepted: 06/14/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To estimate prevalence of rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic disease (PsD), and crystal-related arthritis and health care use for inflammatory arthritis in First Nations and non-First Nations patients in Alberta, Canada. METHODS Population-based cohorts of adults with RA, AS, PsD, and crystal-related arthritis were defined, with First Nations determination by premium payer status, to estimate prevalence rates. Rates of outpatient primary care, specialist visits, and hospitalizations (all-cause, inflammatory-arthritis specific) were estimated. RESULTS RA affected 3 times as many First Nations residents compared to non-First Nations residents (standardized rate ratio [SRR] 3.2, 95% confidence interval [95% CI] 2.9-3.4). AS and PsD were more prevalent in First Nations (AS 0.6 per 100 residents; SRR 2.7, 95% CI 2.3-3.2 and PsD 0.3 per 100 residents; SRR 1.5, 95% CI 1.3-1.9), whereas crystal-related arthritis was less prevalent (SRR 0.7, 95% CI 0.6-0.7). First Nations patients were more likely to have primary care visits (SRR 1.7, 95% CI 1.6-1.8) and less likely to have specialist visits (SRR 0.6, 95% CI 0.6-0.7) for RA relative to non-First Nations individuals. In PsD and crystal-related arthritis, First Nations people had higher rates of cause-specific hospitalizations. CONCLUSION The estimated prevalence of RA, AS, and PsD was higher in the First Nations population, while crystal-related arthritis was less prevalent compared to the non-First Nations population. First Nations people were more likely to see primary care physicians and were less likely to see specialists for inflammatory arthritis care.
Collapse
Affiliation(s)
| | | | - Sasha Bernatsky
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Joanne Homik
- University of Alberta, Edmonton, Alberta, Canada
| | | | - John M Esdaile
- University of British Columbia, Vancouver, Canada, Arthritis Research Centre of Canada, Richmond, British Columbia, Canada, and University of Queensland, Australia
| | | | | |
Collapse
|
38
|
Ronksley PE, Tonelli M, Manns BJ, Weaver RG, Thomas CM, MacRae JM, Ravani P, Quinn RR, James MT, Lewanczuk R, Hemmelgarn BR. Emergency Department Use among Patients with CKD: A Population-Based Analysis. Clin J Am Soc Nephrol 2017; 12:304-314. [PMID: 28119410 PMCID: PMC5293336 DOI: 10.2215/cjn.06280616] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/19/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Although prior studies have observed high resource use among patients with CKD, there is limited exploration of emergency department use in this population and the proportion of encounters related to CKD care specifically. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We identified all adults (≥18 years old) with eGFR<60 ml/min per 1.73 m2 (including dialysis-dependent patients) in Alberta, Canada between April 1, 2010 and March 31, 2011. Patients with CKD were linked to administrative data to capture clinical characteristics and frequency of emergency department encounters and followed until death or end of study (March 31, 2013). Within each CKD category, we calculated adjusted rates of overall emergency department use as well as rates of potentially preventable emergency department encounters (defined by four CKD-specific ambulatory care-sensitive conditions: heart failure, hyperkalemia, volume overload, and malignant hypertension). RESULTS During mean follow-up of 2.4 years, 111,087 patients had 294,113 emergency department encounters; 64.2% of patients had category G3A CKD, and 1.6% were dialysis dependent. Adjusted rates of overall emergency department use were highest among patients with more advanced CKD; 5.8% of all emergency department encounters were for CKD-specific ambulatory care-sensitive conditions, with approximately one third resulting in hospital admission. Heart failure accounted for over 80% of all potentially preventable emergency department events among patients with categories G3A, G3B, and G4 CKD, whereas hyperkalemia accounted for almost one half (48%) of all ambulatory care-sensitive conditions among patients on dialysis. Adjusted rates of emergency department events for heart failure showed a U-shaped relationship, with the highest rates among patients with category G4 CKD. In contrast, there was a graded association between rates of emergency department use for hyperkalemia and CKD category. CONCLUSIONS Emergency department use is high among patients with CKD, although only a small proportion of these encounters is for potentially preventable CKD-related care. Strategies to reduce emergency department use among patients with CKD will, therefore, need to target conditions other than CKD-specific ambulatory care-sensitive conditions.
Collapse
Affiliation(s)
| | - Marcello Tonelli
- Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Braden J. Manns
- Departments of Community Health Sciences and
- Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robert G. Weaver
- Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Chandra M. Thomas
- Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer M. MacRae
- Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Pietro Ravani
- Departments of Community Health Sciences and
- Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robert R. Quinn
- Departments of Community Health Sciences and
- Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthew T. James
- Departments of Community Health Sciences and
- Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Richard Lewanczuk
- Provincial Primary Health Care, Alberta Health Services, Edmonton, Alberta, Canada; and
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Brenda R. Hemmelgarn
- Departments of Community Health Sciences and
- Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
39
|
Fink JC. Are Ambulatory Care-Sensitive Conditions the Fulcrum of Hospitalizations for CKD Patients? Clin J Am Soc Nephrol 2016; 11:1927-1928. [PMID: 27821635 PMCID: PMC5108203 DOI: 10.2215/cjn.09160816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Affiliation(s)
- Jeffrey C Fink
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| |
Collapse
|
40
|
Ronksley PE, Hemmelgarn BR, Manns BJ, Wick J, James MT, Ravani P, Quinn RR, Scott-Douglas N, Lewanczuk R, Tonelli M. Potentially Preventable Hospitalization among Patients with CKD and High Inpatient Use. Clin J Am Soc Nephrol 2016; 11:2022-2031. [PMID: 27821636 PMCID: PMC5108197 DOI: 10.2215/cjn.04690416] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/28/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Although patients with CKD are commonly hospitalized, little is known about those with frequent hospitalization and/or longer lengths of stay (high inpatient use). The objective of this study was to explore clinical characteristics, patterns of hospital use, and potentially preventable acute care encounters among patients with CKD with at least one hospitalization. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We identified all adults with nondialysis CKD (eGFR<60 ml/min per 1.73 m2) in Alberta, Canada between January 1 and December 31, 2009, excluding those with prior kidney failure. Patients with CKD were linked to administrative data to capture clinical characteristics and frequency of hospital encounters, and they were followed until death or end of study (December 31, 2012). Patients with one or more hospital encounters were categorized into three groups: persistent high inpatient use (upper 5% of inpatient use in 2 or more years), episodic high use (upper 5% in 1 year only), or nonhigh use (lower 95% in all years). Within each group, we calculated the proportion of potentially preventable hospitalizations as defined by four CKD-specific ambulatory care sensitive conditions: heart failure, hyperkalemia, volume overload, and malignant hypertension. RESULTS During a median follow-up of 3 years, 57,007 patients with CKD not on dialysis had 118,671 hospitalizations, of which 1.7% of patients were persistent high users, 12.3% were episodic high users, and 86.0% were nonhigh users of hospital services. Overall, 24,804 (20.9%) CKD-related ambulatory care sensitive condition encounters were observed in the cohort. The persistent and episodic high users combined (14% of the cohort) accounted for almost one half (45.5%) of the total ambulatory care sensitive condition hospitalizations, most of which were attributed to heart failure and hyperkalemia. Risk of hospitalization for any CKD-specific ambulatory care sensitive condition was higher among older patients, higher CKD stage, lower income, registered First Nations status, and those with poor attachment to primary care. CONCLUSIONS Many hospitalizations among patients with CKD and high inpatient use are ambulatory care sensitive condition related, suggesting opportunities to improve outcomes and reduce cost by focusing on better community-based care for this population.
Collapse
Affiliation(s)
| | - Brenda R. Hemmelgarn
- Departments of Community Health Sciences and
- Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Braden J. Manns
- Departments of Community Health Sciences and
- Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - James Wick
- Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Matthew T. James
- Departments of Community Health Sciences and
- Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Pietro Ravani
- Departments of Community Health Sciences and
- Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Robert R. Quinn
- Departments of Community Health Sciences and
- Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | | | - Richard Lewanczuk
- Provincial Primary Health Care, Alberta Health Services, Edmonton, Alberta, Canada; and
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Marcello Tonelli
- Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| |
Collapse
|
41
|
Campbell DJT, Tonelli M, Hemmelgarn B, Mitchell C, Tsuyuki R, Ivers N, Campbell T, Pannu R, Verkerke E, Klarenbach S, King-Shier K, Faris P, Exner D, Chaubey V, Manns B. Assessing outcomes of enhanced chronic disease care through patient education and a value-based formulary study (ACCESS)-study protocol for a 2×2 factorial randomized trial. Implement Sci 2016; 11:131. [PMID: 27671037 PMCID: PMC5037634 DOI: 10.1186/s13012-016-0491-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/08/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Chronic diseases result in significant morbidity and costs. Although medications and lifestyle changes are effective for improving outcomes in chronic diseases, many patients do not receive these treatments, in part because of financial barriers, patient and provider-level knowledge gaps, and low patient motivation. The Assessing outcomes of enhanced chronic disease care through patient education and a value-based formulary study (ACCESS) will determine the impact of two interventions: (1) a value-based formulary which eliminates copayment for high-value preventive medications; and (2) a comprehensive self-management support program aimed at promoting health behavior change and medication adherence, combined with relay of information on medication use to healthcare providers, on cardiovascular events and/or mortality in low-income seniors with elevated cardiovascular risk. METHODS The ACCESS study will use a parallel, open label, factorial randomized trial design, with blinded endpoint evaluation in 4714 participants who are over age >65 (and therefore have drug insurance provided by Alberta Blue Cross with 30 % co-payment); are at a high risk for cardiovascular events based on a history of any one of the following: coronary heart disease, prior stroke, chronic kidney disease, heart failure, or any two of the following: current cigarette smoking, diabetes mellitus, hypertension, or hypercholesterolemia; and have a household income DISCUSSION Given identified gaps in care in chronic disease, and the frequency of financial and knowledge-related barriers in low-income Albertans, this study will test the impact of providing free high-value preventive medications (i.e., value-based insurance) and a tailored self-management education and facilitated relay strategy on outcomes and costs. By measuring the impact on both health outcomes and costs, as well as the impact on reducing health inequities in this vulnerable population, our study will facilitate informed policy decisions. TRIAL REGISTRATION Clinicaltrials.gov: NCT02579655 . Registered Oct 15, 2015.
Collapse
Affiliation(s)
- David J. T. Campbell
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Marcello Tonelli
- Departments of Medicine and Community Health Sciences, Libin Institute and Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Brenda Hemmelgarn
- Departments of Medicine and Community Health Sciences, Libin Institute and Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Ross Tsuyuki
- Department of Pharmaceutical Sciences, University of Alberta, Edmonton, Canada
| | - Noah Ivers
- Department of Family Medicine, University of Toronto, Toronto, Canada
| | - Tavis Campbell
- Department of Psychology, University of Calgary, Calgary, Canada
| | | | | | | | | | | | - Derek Exner
- Departments of Medicine and Community Health Sciences, Libin Institute and Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Vikas Chaubey
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Braden Manns
- Departments of Medicine and Community Health Sciences, Libin Institute and Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Foothills Medical Centre, 1403 29th St. NW, Calgary, Alberta Canada T2N 2T9
| | - On behalf of the Interdisciplinary Chronic Disease Collaboration
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Departments of Medicine and Community Health Sciences, Libin Institute and Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Alberta Health, Edmonton, Canada
- Department of Pharmaceutical Sciences, University of Alberta, Edmonton, Canada
- Department of Family Medicine, University of Toronto, Toronto, Canada
- Department of Psychology, University of Calgary, Calgary, Canada
- Emergence Creative, New york, USA
- Department of Medicine, University of Alberta, Edmonton, Canada
- Faculty of Nursing, University of Calgary, Calgary, Canada
- Alberta Health Services, Edmonton, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Foothills Medical Centre, 1403 29th St. NW, Calgary, Alberta Canada T2N 2T9
| |
Collapse
|
42
|
Fraser SL, Nadeau L. Experience and representations of health and social services in a community of Nunavik. Contemp Nurse 2016; 51:286-300. [PMID: 27063599 DOI: 10.1080/10376178.2016.1171728] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The study aims to explore representations and experiences with health and social services in an Inuit community of Nunavik. METHODS A total of 15 semi-structured interviews were conducted with Inuit adults from a community of Northern Quebec. Informal interviews and participatory observation was conducted on six visits over two years. A thematic inductive analysis of data was conducted. RESULTS Participants' experiences with care were largely related to the nature of interactions with service providers, and feelings about whether perceived needs were being met. Often these needs were socio-economic. Perceptions of services were based on concepts of trust, privacy and fear of consequences of divulging information, three intrinsically related themes. CONCLUSIONS Reflections must be made on how to address the socio-economic needs of patients and how to go beyond the immediate requests to hear the psychosocial needs that patients might not feel safe to talk about.
Collapse
Affiliation(s)
- Sarah L Fraser
- a Department of Psychoeducation , Université de Montréal - Pavillon Marie-Victorin , CP 6128, succ. Centre-Ville, Montreal , QC , Canada H3C 3J7
| | - Lucie Nadeau
- b Division of Social and Cultural Psychiatry , McGill University , Youth Mental Health, CSSS de la Montagne (CLSC Parc Extension), 7085 Hutchison, salle 204.10, Montreal , QC , Canada H3N 1Y9
| |
Collapse
|
43
|
Levack WM, Jones B, Grainger R, Boland P, Brown M, Ingham TR. Whakawhanaungatanga: the importance of culturally meaningful connections to improve uptake of pulmonary rehabilitation by Māori with COPD - a qualitative study. Int J Chron Obstruct Pulmon Dis 2016; 11:489-501. [PMID: 27022255 PMCID: PMC4790504 DOI: 10.2147/copd.s97665] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Pulmonary rehabilitation is known to improve function and quality of life for people with chronic obstructive pulmonary disease (COPD). However, little research has been conducted on the influence of culture on experiences of pulmonary rehabilitation. This study examined factors influencing uptake of pulmonary rehabilitation by Māori with COPD in New Zealand. Method Grounded theory nested within kaupapa Māori methodology. Transcripts were analyzed from interviews and focus groups with 15 Māori and ten New Zealand non-Māori invited to attend pulmonary rehabilitation for COPD. Māori participants had either attended a mainstream hospital-based program, a community-based program designed “by Māori, for Māori”, or had experienced both. Results Several factors influencing uptake of pulmonary rehabilitation were common to all participants regardless of ethnicity: 1) participants’ past experiences (eg, of exercise; of health care systems), 2) attitudes and expectations, 3) access issues (eg, time, transport, and conflicting responsibilities), and 4) initial program experiences. These factors were moderated by the involvement of family and peers, interactions with health professionals, the way information on programs was presented, and by new illness events. For Māori, however, several additional factors were also identified relating to cultural experiences of pulmonary rehabilitation. In particular, Māori participants placed high value on whakawhanaungatanga: the making of culturally meaningful connections with others. Culturally appropriate communication and relationship building was deemed so important by some Māori participants that when it was absent, they felt strongly discouraged to attend pulmonary rehabilitation. Only the more holistic services offered a program in which they felt culturally safe and to which they were willing to return for ongoing rehabilitation. Conclusion Lack of attention to cultural factors in the delivery of pulmonary rehabilitation may be a barrier to its uptake by indigenous, minority ethnic groups, such as New Zealand Māori. Indigenous-led or culturally responsive health care interventions for COPD may provide a solution to this issue.
Collapse
Affiliation(s)
- William Mm Levack
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Bernadette Jones
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Pauline Boland
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Melanie Brown
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Tristram R Ingham
- Department of Medicine, University of Otago, Wellington, New Zealand
| |
Collapse
|
44
|
Implementation and Operational Research: Engagement in HIV Care Among Persons Enrolled in a Clinical HIV Cohort in Ontario, Canada, 2001-2011. J Acquir Immune Defic Syndr 2015; 70:e10-9. [PMID: 26322672 PMCID: PMC4623844 DOI: 10.1097/qai.0000000000000690] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is Available in the Text. Ensuring that people living with HIV are accessing and staying in care is vital to achieving optimal health outcomes including antiretroviral therapy (ART) success. We sought to characterize engagement in HIV care among participants of a large clinical cohort in Ontario, Canada, from 2001 to 2011.
Collapse
|
45
|
Gillis J, Bayoumi AM, Burchell AN, Cooper C, Klein MB, Loutfy M, Machouf N, Montaner JS, Tsoukas C, Hogg RS, Raboud J. Factors associated with the frequency of monitoring of liver enzymes, renal function and lipid laboratory markers among individuals initiating combination antiretroviral therapy: a cohort study. BMC Infect Dis 2015; 15:453. [PMID: 26496954 PMCID: PMC4620739 DOI: 10.1186/s12879-015-1206-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 10/12/2015] [Indexed: 11/11/2022] Open
Abstract
Background As the average age of the HIV-positive population increases, there is increasing need to monitor patients for the development of comorbidities as well as for drug toxicities. Methods We examined factors associated with the frequency of measurement of liver enzymes, renal function tests, and lipid levels among participants of the Canadian Observational Cohort (CANOC) collaboration which follows people who initiated HIV antiretroviral therapy in 2000 or later. We used zero-inflated negative binomial regression models to examine the associations of demographic and clinical characteristics with the rates of measurement during follow-up. Generalized estimating equations with a logit link were used to examine factors associated with gaps of 12 months or more between measurements. Results Electronic laboratory data were available for 3940 of 7718 CANOC participants. The median duration of electronic follow-up was 3.5 years. The median (interquartile) rates of tests per year were 2.76 (1.60, 3.73), 2.55 (1.44, 3.38) and 1.42 (0.50, 2.52) for liver, renal and lipid parameters, respectively. In multivariable zero-inflated negative binomial regression models, individuals infected through injection drug use (IDU) were significantly less likely to have any measurements. Among participants with at least one measurement, rates of measurement of liver, renal and lipid tests were significantly lower for younger individuals and Aboriginal Peoples. Hepatitis C co-infected individuals with a history of IDU had lower rates of measurement and were at greater risk of having 12 month gaps between measurements. Conclusions Hepatitis C co-infected participants infected through IDU were at increased risk of gaps in testing, despite publicly funded health care and increased risk of comorbid conditions. This should be taken into consideration in analyses examining factors associated with outcomes based on laboratory parameters.
Collapse
Affiliation(s)
- Jennifer Gillis
- Toronto General Research Institute, University Health Network, Toronto, Canada. .,University of Toronto, Toronto, Canada.
| | - Ahmed M Bayoumi
- University of Toronto, Toronto, Canada. .,Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
| | - Ann N Burchell
- University of Toronto, Toronto, Canada. .,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. .,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.
| | - Curtis Cooper
- University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Marina B Klein
- McGill University Health Centre, McGill University, Montreal, Canada.
| | - Mona Loutfy
- University of Toronto, Toronto, Canada. .,Women's College Research Institute, Toronto, Canada. .,Maple Leaf Medical Clinic, Toronto, Canada.
| | | | - Julio Sg Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
| | - Chris Tsoukas
- McGill University Health Centre, McGill University, Montreal, Canada.
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada. .,Simon Fraser University, Burnaby, Canada.
| | - Janet Raboud
- Toronto General Research Institute, University Health Network, Toronto, Canada. .,University of Toronto, Toronto, Canada.
| | | |
Collapse
|
46
|
Abstract
PURPOSE OF REVIEW Racial, ethnic and socioeconomic disparities in chronic kidney disease (CKD) have been documented for decades, yet little progress has been made in mitigating them. Several recent studies offer new insights into the root causes of these disparities, point to areas in which future research is warranted, and identify opportunities for changes in policy and clinical practice. RECENT FINDINGS Recently published evidence suggests that geographic disparities in CKD prevalence exist and vary by race. CKD progression is more rapid for racial and ethnic minority groups compared with whites and may be largely, but not completely, explained by genetic factors. Stark socioeconomic disparities in outcomes for dialysis patients exist and vary by race, place of residence, and treatment facility. Disparities in access to living kidney donation may be driven primarily by the socioeconomic status of the donor as opposed to recipient factors. SUMMARY Recent studies highlight opportunities to eliminate disparities in CKD, including efforts to direct resources to areas and populations where disparities are most prevalent, efforts to understand how to best use emerging information on the contribution of genetic factors to disparities, and continued work to identify modifiable environmental, social, and behavioral factors for targeted interventions among high-risk populations.
Collapse
|
47
|
Barnabe C, Hemmelgarn B, Jones CA, Peschken CA, Voaklander D, Joseph L, Bernatsky S, Esdaile JM, Marshall DA. Imbalance of Prevalence and Specialty Care for Osteoarthritis for First Nations People in Alberta, Canada. J Rheumatol 2014; 42:323-8. [DOI: 10.3899/jrheum.140551] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To estimate the population-based prevalence and healthcare use for osteoarthritis (OA) by First Nations (FN) and non-First Nations (non-FN) in Alberta, Canada.Methods.A cohort of adults with OA (≥ 2 physician claims in 2 yrs or 1 hospitalization with ICD-9-Clinical Modification code 715x or ICD-10-Canadian Adaptation code M15-19, 1993–2010) was defined with FN determination by premium payer status. Prevalence rates (2007/8) were estimated from the cohort and the population registered with the Alberta Health Care Insurance Plan. Rates of outpatient primary care and specialist visits (orthopedics, rheumatology, internal medicine), arthroplasty (hip and knee), and all-cause hospitalization were estimated.Results.OA prevalence in FN was twice that of the non-FN population [16.1 vs 7.8 cases/100 population, standardized rate ratio (SRR) adjusted for age and sex 2.06, 95% CI 2.00–2.12]. The SRR (adjusted for age, sex, and location of residence) for primary care visits for OA was nearly double in FN compared with non-FN (SRR 1.88, 95% CI 1.87–1.89), and internal medicine visits were increased (SRR 1.25, 95% CI 1.25–1.26). Visit rates with an orthopedic surgeon (SRR 0.49, 95% CI 0.48–0.50) or rheumatologist (SRR 0.62, 95% CI 0.62–0.63) were substantially lower in FN with OA. Hip and knee arthroplasties were performed less frequently in FN with OA (SRR 0.48, 95% CI 0.47–0.49), but all-cause hospitalization rates were higher (SRR 1.59, 95% CI 1.58–1.60).Conclusion.We estimate a 2-fold higher prevalence of OA in the FN population with differential healthcare use. Reasons for higher use of primary care and lower use of specialty services and arthroplasty compared with the general population are not yet understood.
Collapse
|
48
|
Cunningham CT, Cai P, Topps D, Svenson LW, Jetté N, Quan H. Mining rich health data from Canadian physician claims: features and face validity. BMC Res Notes 2014; 7:682. [PMID: 25270407 PMCID: PMC4193126 DOI: 10.1186/1756-0500-7-682] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 09/26/2014] [Indexed: 11/30/2022] Open
Abstract
Background Physician claims data are one of the largest sources of coded health information unique to Canada. There is skepticism from data users about the quality of this data. This study investigated features of diagnostic codes used in the Alberta physician claims database. Methods Alberta physician claims from January 1 to March 31, 2011 are analyzed. Claims contain coded diagnoses using the International Classification of Diseases, 9th revision (ICD-9), procedures, physician specialty and service-fee type. Descriptive statistics examined the diversity and frequency of unique ICD-9 diagnostic codes used and the level of code extension (e.g. 3- or 4-digit coding). Results A total of 7,441,005 claims by 6,601 physicians were analyzed. The average number of claims per physician was 1,079, with ranges between 1,330 for family medicine, 690 for internal medicine, 722 for surgery, 516 for pediatrics and 409 for neurology. Family physicians used an average of 121 diagnostic codes, internal medicine physicians 32, surgery 36, pediatrics 46 and neurology 27. Overall, 43.5% of claims had a more detailed diagnosis (ICD code with >3 digits). Physicians on a fee-for-service plan submitted 1,184 claims and used 88 unique diagnosis codes on average compared to 438 claims and 44 unique diagnosis codes from physicians on an alternative payment plan (APP). Conclusions Face validity of diagnosis coded in physician claims is substantially high and the features of diagnosis codes seem to reasonably reflect the clinical specialty. Physicians submit a diverse array of ICD 9 diagnostic codes and nearly half of the ICD-9 diagnostic codes examined were more detailed than required (i.e. ICD code with >3 digits). Finally, guidelines and policies should be explored to assess the submission of shadow billings for physicians on APPs.
Collapse
Affiliation(s)
| | | | | | | | | | - Hude Quan
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr, NW, Calgary, Alberta T2N 4Z6, Canada.
| |
Collapse
|
49
|
Understanding inequalities in access to health care services for aboriginal people: a call for nursing action. ANS Adv Nurs Sci 2014; 37:E1-E16. [PMID: 25102218 DOI: 10.1097/ans.0000000000000039] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We present findings from an Access Research Initiative to reduce health disparities and promote equitable access with Aboriginal peoples in Canada. We employed Indigenous, interpretive, and participatory research methodologies in partnership with Aboriginal people. Participants reported stories of bullying, fear, intimidation, and lack of cultural understanding. This research reveals the urgent need to enhance the delivery of culturally appropriate practices in emergency. As nurses, if we wish to affect equity of access, then attention is required to structural injustices that act as barriers to access such as addressing the stigma, stereotyping, and discrimination experienced by Aboriginal people in this study.
Collapse
|
50
|
Bresee LC, Knudtson ML, Zhang J, Crowshoe LL, Ahmed SB, Tonelli M, Ghali WA, Quan H, Manns B, Fabreau G, Hemmelgarn BR. Likelihood of coronary angiography among First Nations patients with acute myocardial infarction. CMAJ 2014; 186:E372-80. [PMID: 24847149 DOI: 10.1503/cmaj.131667] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Morbidity due to cardiovascular disease is high among First Nations people. The extent to which this may be related to the likelihood of coronary angiography is unclear. We examined the likelihood of coronary angiography after acute myocardial infarction (MI) among First Nations and non-First Nations patients. METHODS Our study included adults with incident acute MI between 1997 and 2008 in Alberta. We determined the likelihood of angiography among First Nations and non-First Nations patients, adjusted for important confounders, using the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database. RESULTS Of the 46,764 people with acute MI, 1043 (2.2%) were First Nations. First Nations patients were less likely to receive angiography within 1 day after acute MI (adjusted odds ratio [OR] 0.73, 95% confidence interval [CI] 0.62-0.87). Among First Nations and non-First Nations patients who underwent angiography (64.9%), there was no difference in the likelihood of percutaneous coronary intervention (PCI) (adjusted hazard ratio [HR] 0.92, 95% CI 0.83-1.02) or coronary artery bypass grafting (CABG) (adjusted HR 1.03, 95% CI 0.85-1.25). First Nations people had worse survival if they received medical management alone (adjusted HR 1.38, 95% CI 1.07-1.77) or if they underwent PCI (adjusted HR 1.38, 95% CI 1.06-1.80), whereas survival was similar among First Nations and non-First Nations patients who received CABG. INTERPRETATION First Nations people were less likely to undergo angiography after acute MI and experienced worse long-term survival compared with non-First Nations people. Efforts to improve access to angiography for First Nations people may improve outcomes.
Collapse
Affiliation(s)
- Lauren C Bresee
- Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass
| | - Merril L Knudtson
- Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass
| | - Jianguo Zhang
- Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass
| | - Lynden Lindsay Crowshoe
- Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass
| | - Sofia B Ahmed
- Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass
| | - Marcello Tonelli
- Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass
| | - William A Ghali
- Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass
| | - Hude Quan
- Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass
| | - Braden Manns
- Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass
| | - Gabriel Fabreau
- Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass
| | - Brenda R Hemmelgarn
- Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass.
| | | |
Collapse
|