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Bolea B. Prescribing therapeutic apps within National Health Services: The critical role of evaluation and monitoring. Eur Neuropsychopharmacol 2024; 84:3-4. [PMID: 38642436 DOI: 10.1016/j.euroneuro.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 03/14/2024] [Accepted: 03/16/2024] [Indexed: 04/22/2024]
Affiliation(s)
- Blanca Bolea
- Department of Psychiatry, University of Toronto, Toronto, Canada; Staff Psychiatrist SCOPE-MH program, Women's College Hospital, Toronto, Canada; Innovation fellow Women's College Hospital Institute for Health System's Solutions and Virtual Care (WIHV), Canada.
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Belon AP, Chew JL, Schwartz N, Storey KE, Smith BT, Pabayo R. Variability in public health programming and priorities to address health inequities across public health units in Ontario, Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024:10.17269/s41997-024-00896-4. [PMID: 38842770 DOI: 10.17269/s41997-024-00896-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 04/30/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE In 2018, Ontario Public Health Standards were updated to include the foundational Health Equity Standard to guide planning, implementation, and evaluation of public health programs and services. Public health units (PHUs), the regional public health bodies, are now required to address health equity through four requirements: (a) Assessing and Reporting; (b) Modifying and Orienting Public Health Interventions; (c) Engaging in Multi-sectoral Collaboration; and (d) Health Equity Analysis, Policy Development, and Advancing Healthy Public Policies. METHODS This qualitative descriptive study explored how the 27 participating PHUs (out of 34) serving urban (N = 10), mixed urban-rural (N = 15), and rural (N = 9) populations addressed the Health Equity Standard. Using document analysis, we inductively and deductively coded the content of 68 PHU Annual Service Plan and Budget Submissions from a 3-year period (2018-2020) received from the 27 PHUs. RESULTS Emergent categories were organized into the four requirements and one additional emergent theme: Organizational Implementation of Health Equity. The approaches of embedding health equity into PHUs' activities varied across groups. Urban PHUs presented more diverse strategies, including working with a larger number of organizations, and participating in academic research projects. We found more process standardization and greater discussion of capacity building in urban and mixed urban-rural PHUs. Rural PHUs strategically addressed the needs of their diverse populations through relationship building with Indigenous communities. CONCLUSION Findings suggest broad implementation of health equity approaches in public health independent of PHUs' geographic size and population dispersion, though strategies and key challenges differ across units.
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Affiliation(s)
- Ana Paula Belon
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Jo Lin Chew
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | | | - Kate E Storey
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Brendan T Smith
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Roman Pabayo
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
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Vervoort D, Afzal AM, Ruiz GZL, Mutema C, Wijeysundera HC, Ouzounian M, Fremes SE. Barriers to Access to Cardiac Surgery: Canadian Situation and Global Context. Can J Cardiol 2024; 40:1110-1122. [PMID: 37977275 DOI: 10.1016/j.cjca.2023.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023] Open
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Cardiovascular care spans primary, secondary, and tertiary prevention and care, whereby tertiary care is particularly prone to disparities in care. Challenges in access to care especially affect low- and middle-income countries (LMICs), however, multiple barriers also exist and persist across high-income countries. Canada is lauded for its universal health coverage but is faced with health care system challenges and substantial geographic barriers. Canada possesses 203 active cardiac surgeons, or 5.02 per million population, ranging from 3.70 per million in Newfoundland and Labrador to 7.48 in Nova Scotia. As such, Canada possesses fewer cardiac surgeons per million population than the average among high-income countries (7.15 per million), albeit more than the global average (1.64 per million) and far higher than the low-income country average (0.04 per million). In Canada, adult cardiac surgeons are active across 32 cardiac centres, representing 0.79 cardiac centres per million population, which is just above the global average (0.73 per million). In addition to centre and workforce variations, barriers to care exist in the form of waiting times, sociodemographic characteristics, insufficient virtual care infrastructure and electronic health record interoperability, and health care governance fragmentation. Meanwhile, Canada has highly favourable surgical outcomes, well established postacute cardiac care infrastructure, considerable spending on health, robust health administrative data, and effective health technology assessment agencies, which provides a foundation for continued improvements in care. In this narrative review, we describe successes and challenges surrounding access to cardiac surgery in Canada and globally.
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Affiliation(s)
- Dominique Vervoort
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Abdul Muqtader Afzal
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Gabriela Zamunaro Lopes Ruiz
- Division of Cardiovascular Surgery, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Chileshe Mutema
- Division of Cardiothoracic Surgery, National Heart Hospital, Lusaka, Zambia
| | - Harindra C Wijeysundera
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Maral Ouzounian
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Hoagland A, Kipping S. Challenges in Promoting Health Equity and Reducing Disparities in Access Across New and Established Technologies. Can J Cardiol 2024; 40:1154-1167. [PMID: 38417572 DOI: 10.1016/j.cjca.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024] Open
Abstract
Medical innovations and novel technologies stand to improve the return on high levels of health spending in developed countries, particularly in cardiovascular care. However, cardiac innovations also disrupt the landscape of accessing care, potentially creating disparities in who has access to novel and extant technologies. These disparities might disproportionately harm vulnerable groups, including those whose nonmedical conditions-including social determinants of health-inhibit timely access to diagnoses, referrals, and interventions. We first document the barriers to access novel and existing technologies in isolation, then proceed to document their interaction. Novel cardiac technologies might affect existing available services, and change the landscape of care for vulnerable patient groups who seek access to cardiology services. There is a clear need to identify and heed lessons learned from the dissemination of past innovations in the development, funding, and dissemination of future medical technologies to promote equitable access to cardiovascular care. We conclude by highlighting and synthesizing several policy implications from recent literature.
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Affiliation(s)
- Alex Hoagland
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Ontario Shores Centre for Mental Health Sciences, Toronto, Ontario, Canada.
| | - Sarah Kipping
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Ontario Shores Centre for Mental Health Sciences, Toronto, Ontario, Canada
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Mann U, Bal DS, Panchendrabose K, Brar R, Patel P. Risk of major adverse cardiovascular events in rural vs urban settings among patients with erectile dysfunction: a propensity-weighted retrospective cohort study of 430 621 men. J Sex Med 2024; 21:522-528. [PMID: 38600710 DOI: 10.1093/jsxmed/qdae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/27/2024] [Accepted: 02/28/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND The relationship between erectile dysfunction (ED) and cardiovascular (CV) events has been postulated, with ED being characterized as a potential harbinger of CV disease. Location of residence is another important consideration, as the impact of rural residence has been associated with worse health outcomes. AIM To investigate whether men from rural settings with ED are associated with a higher risk of major adverse CV events (MACEs). METHODS A propensity-weighted retrospective cohort study was conducted with provincial health administrative databases. ED was defined as having at least 2 ED prescriptions filled within 1 year. MACE was defined as the first hospitalization for an episode of acute myocardial infarction, heart failure, or stroke that resulted in a hospital visit >24 hours. We classified study groups into ED urban, ED rural, no ED urban, and no ED rural. A multiple logistic regression model was used to determine the propensity score. Stabilized inverse propensity treatment weighting was then applied to the propensity score. OUTCOMES A Cox proportional hazard model was used to examine our primary outcome of time to a MACE. RESULTS The median time to a MACE was 2731, 2635, 2441, and 2508 days for ED urban (n = 32 341), ED rural (n = 18 025), no ED rural (n = 146 358), and no ED urban (n = 233 897), respectively. The cohort with ED had a higher proportion of a MACE at 8.94% (n = 4503), as opposed to 4.58% (n = 17 416) for the group without ED. As compared with no ED urban, no ED rural was associated with higher risks of a MACE in stabilized time-varying comodels based on inverse probability treatment weighting (hazard ratio, 1.06-1.08). ED rural was associated with significantly higher risks of a MACE vs no ED rural, with the strength of the effect estimates increasing over time (hazard ratio, 1.10-1.74). CLINICAL IMPLICATIONS Findings highlight the need for physicians treating patients with ED to address CV risk factors for primary and secondary prevention of CV diseases. STRENGTHS AND LIMITATIONS This is the most extensive retrospective study demonstrating that ED is an independent risk factor for MACE. Due to limitations in data, we were unable to assess certain comorbidities, including obesity and smoking. CONCLUSIONS Our study confirms that ED is an independent risk factor for MACE. Rural men had a higher risk of MACE, with an even higher risk among those who reside rurally and are diagnosed with ED.
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Affiliation(s)
- Uday Mann
- Department of Surgery, Section of Urology, University of Manitoba, Winnipeg, MB, R3A 1R9, Canada
| | - Dhiraj S Bal
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0W2, Canada
| | - Kapilan Panchendrabose
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0W2, Canada
| | - Ranveer Brar
- Chronic Disease Innovation Center, Winnipeg, MB, R2V 3M3, Canada
| | - Premal Patel
- Department of Surgery, Section of Urology, University of Manitoba, Winnipeg, MB, R3A 1R9, Canada
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Kiran T, Daneshvarfard M, Wang R, Beyer A, Kay J, Breton M, Brown-Shreves D, Condon A, Green ME, Hedden L, Katz A, Keresteci M, Kovacina N, Lavergne MR, Lofters A, Martin D, Mitra G, Newbery S, Stringer K, MacLeod P, van der Linden C. Public experiences and perspectives of primary care in Canada: results from a cross-sectional survey. CMAJ 2024; 196:E646-E656. [PMID: 38772606 PMCID: PMC11104576 DOI: 10.1503/cmaj.231372] [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: 03/08/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Through medicare, residents in Canada are entitled to medically necessary physician services without paying out of pocket, but still many people struggle to access primary care. We conducted a survey to explore people's experience with and priorities for primary care. METHODS We conducted an online, bilingual survey of adults in Canada in fall 2022. We distributed an anonymous link through diverse channels and a closed link to 122 053 people via a national public opinion firm. We weighted completed responses to mirror Canada's population and adjusted for sociodemographic characteristics using regression models. RESULTS We analyzed 9279 completed surveys (5.9% response rate via closed link). More than one-fifth of respondents (21.8%) reported having no primary care clinician, and among those who did, 34.5% reported getting a same or next-day appointment for urgent issues. Of respondents, 89.4% expressed comfort seeing another team member if their doctor recommended it, but only 35.9%, 9.5%, and 12.4% reported that their practice had a nurse, social worker, or pharmacist, respectively. The primary care attribute that mattered most was having a clinician who "knows me as a person and considers all the factors that affect my health." After we adjusted for respondent characteristics, people in Quebec, the Atlantic region, and British Columbia had lower odds of reporting a primary care clinician than people in Ontario (adjusted odds ratio 0.30, 0.33, and 0.39, respectively; p < 0.001). We also observed large provincial variations in timely access, interprofessional care, and walk-in clinic use. INTERPRETATION More than 1 in 5 respondents did not have access to primary care, with large variation by province. Reforms should strive to expand access to relationship-based, longitudinal care in a team setting.
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Affiliation(s)
- Tara Kiran
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont.
| | - Maryam Daneshvarfard
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Ri Wang
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Alexander Beyer
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Jasmin Kay
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Mylaine Breton
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Danielle Brown-Shreves
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Amanda Condon
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Michael E Green
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Lindsay Hedden
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Alan Katz
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Maggie Keresteci
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Neb Kovacina
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - M Ruth Lavergne
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Aisha Lofters
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Danielle Martin
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Goldis Mitra
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Sarah Newbery
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Katherine Stringer
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Peter MacLeod
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Clifton van der Linden
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
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7
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Hurd L, Li LYK. "I Want to Grow Older With Dignity": Older LGBTQ+ Canadian Adults' Perceptions and Experiences of Aging. J Appl Gerontol 2024; 43:536-549. [PMID: 38105632 PMCID: PMC10981199 DOI: 10.1177/07334648231219414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/01/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023] Open
Abstract
The number of older LGBTQ+ adults is growing worldwide. Yet few studies outside of the United States have examined their experiences of aging. Drawing on the Health Equity Promotion Model and contextualized in Canada's unique socio-political history, our study used multiple, in-depth, qualitative interviews to examine 30 older Canadian LGBTQ+ adults' (aged 65-83) perceptions and experiences of growing older. Our descriptive thematic analysis identified three overarching categories: "Losses," "gains," and "needs." Losses referred to the changes in the participants' health, autonomy, and relationships that had occurred with age. Gains entailed positive later life changes, including increased wisdom, flexibility, and social connections. Finally, needs referred to those things that the participants deemed essential for aging well, namely, inclusive health care, meaningful activities, and supportive networks. We discuss the policy and practice implications of our findings for the fostering of health, well-being, and social inclusion amongst this often-marginalized population.
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Affiliation(s)
- Laura Hurd
- School of Kinesiology, The University of British Columbia, Vancouver, BC, Canada
| | - Lynda Y. K. Li
- Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada
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8
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Omar A, Williams RG, Whelan J, Noble J, Brent MH, Giunta M, Olivier S, Lhor M. Diabetic Disease of the Eye in Canada: Consensus Statements from a Retina Specialist Working Group. Ophthalmol Ther 2024; 13:1071-1102. [PMID: 38526804 DOI: 10.1007/s40123-024-00923-0] [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: 01/31/2024] [Accepted: 02/29/2024] [Indexed: 03/27/2024] Open
Abstract
Despite advances in systemic care, diabetic disease of the eye (DDE) remains the leading cause of blindness worldwide. There is a critical gap of up-to-date, evidence-based guidance for ophthalmologists in Canada that includes evidence from recent randomized controlled trials. Previous guidance has not always given special consideration to applying treatments and managing DDE in the context of the healthcare system. This consensus statement aims to assist practitioners in the field by providing a spectrum of acceptable opinions on DDE treatment and management from recognized experts in the field. In compiling evidence and generating consensus, a working group of retinal specialists in Canada addressed clinical questions surrounding the four themes of disease, patient, management, and collaboration. The working group reviewed literature representing the highest level of evidence on DDE and shared their opinions on topics surrounding the epidemiology and pathophysiology of diabetic retinopathy and diabetic macular edema; diagnosis and monitoring; considerations around diabetes medication use; strategic considerations for management given systemic comorbidities, ocular comorbidities, and pregnancy; treatment goals and modalities for diabetic macular edema, non-proliferative and proliferative diabetic retinopathy, and retinal detachment; and interdisciplinary collaboration. Ultimately, this work highlighted that the retinal examination in DDE not only informs the treating ophthalmologist but can serve as a global index for disease progression across many tissues of the body. It highlighted further that DDE can be treated regardless of diabetic control, that a systemic approach to patient care will result in the best health outcomes, and prevention of visual complications requires a multidisciplinary management approach. Ophthalmologists must tailor their clinical approach to the needs and circumstances of individual patients and work within the realities of their healthcare setting.
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Affiliation(s)
- Amer Omar
- Medical Retina Institute of Montreal, 2170 René-Lévesque Blvd Ouest, Bureau 101, Montréal, QC, H3H 2T8, Canada.
| | - R Geoff Williams
- Calgary Retina Consultants, University of Calgary, Calgary, AB, Canada
| | - James Whelan
- Faculty of Medicine, Memorial University, St. John's, NF, Canada
| | - Jason Noble
- Department of Ophthalmology and Vision Science, University of Toronto, Toronto, ON, Canada
| | - Michael H Brent
- Department of Ophthalmology and Vision Science, University of Toronto, Toronto, ON, Canada
| | - Michel Giunta
- Department of Ophthalmology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Sébastien Olivier
- Centre Universitaire d'ophtalmologie, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Mustapha Lhor
- Medical and Scientific Affairs Ophthalmology, Bayer Inc., Mississauga, ON, Canada
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O'Dwyer B, Macaulay K, Murray J, Jaana M. Improving Access to Specialty Pediatric Care: Innovative Referral and eConsult Technology in a Specialized Acute Care Hospital. Telemed J E Health 2024; 30:1306-1316. [PMID: 38100321 DOI: 10.1089/tmj.2023.0444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
Background: The COVID-19 pandemic has exacerbated wait times for pediatric specialty care. Transformative technologies such as electronic referral (eReferral-automation of patient information) and electronic consultations (eConsult-asynchronous request for specialized advice by primary care providers) have the potential to increase timely access to specialist care. The objective of this study was to present an overview of the current state and characteristics of referrals directed to a pediatric ambulatory medical surgery center, with an emphasis on the innovative use of an eConsult system and to indicate key considerations for system improvement. Methods: This cross-sectional study was conducted at a specialized pediatric acute care hospital in Ottawa, Ontario. Secondary data were obtained over a 2-year period during the COVID-19 pandemic (2019-2022). To gain insights and identify areas of improvement related to the factors pertaining to referrals and eConsults at the process and system levels, quality improvement (QI) methodologies were employed. Descriptive statistics provide a summary of the trends and characteristics of referrals and the utilization of eConsult. Results: Among the 113,790 referrals received, 31,430 were denied. Most common reasons for referral denial were other/null (e.g., unspecified) (29.3%), inappropriate referrals (12.6%), and duplicate referrals (12.4%). Four clinics (e.g., endocrinology, cardiology, neurology, and neurosurgery) reported a total of 277 eConsults, with endocrinology accounting for 95.0% of all eConsults. QI findings revealed the need for standardized workflows among specialties and ensuring that eConsult options are accessible and integrated within the electronic medical record (EMR). Conclusions: Refining the pediatric referral management process and optimizing eConsult through existing clinical systems have the potential to improve the timeliness and quality of specialty care. The results inform future research initiatives targeting improved access to pediatric specialty care and serve as a benchmark for hospitals utilizing EMRs and eConsult.
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Affiliation(s)
- Brynn O'Dwyer
- Telfer School of Management, University of Ottawa, Ottawa, Canada
| | | | | | - Mirou Jaana
- Telfer School of Management, University of Ottawa, Ottawa, Canada
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Parsons Leigh J, Moss SJ, Mizen SJ, Sriskandarajah C, FitzGerald EA, Quinn AE, Clement F, Farkas B, Dodds A, Columbus M, Stelfox HT. "We're sinking": a qualitative interview-based study on stakeholder perceptions of structural and process limitations to the Canadian healthcare system. Arch Public Health 2024; 82:56. [PMID: 38664761 PMCID: PMC11044548 DOI: 10.1186/s13690-024-01279-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Despite longstanding efforts and calls for reform, Canada's incremental approach to healthcare changes has left the country lagging behind other OECD nations. Reform to the Canadian healthcare system is essential to develop a higher performing system. This study sought to gain a deeper understanding of the views of Canadian stakeholders on structural and process deficiencies and strategies to improve the Canadian healthcare system substantially and meaningfully. METHODS We conducted individual, ~ 45-minute, semi-structured virtual interviews from May 2022 to August 2022. Using existing contacts and snowball sampling, we targeted one man and one woman from five regions in Canada across four stakeholder groups: (1) public citizens; (2) healthcare leaders; (3) academics; and (4) political decision makers. Interviews centered on participants' perceptions of the state of the current healthcare system, including areas where major improvements are required, and strategies to achieve suggested enhancements; Donabedian's Model (i.e., structure, process, outcomes) was the guiding conceptual framework. Interviews were audio-recorded, transcribed verbatim, and de-identified, and inductive thematic analysis was performed independently and in duplicate according to published methods. RESULTS The data from 31 interviews with 13 (41.9%) public citizens, 10 (32.3%) healthcare leaders, 4 (12.9%) academics, and 4 (12.9%) political decision makers resulted in three themes related to the structure of the healthcare system (1. system reactivity; 2. linkage with the Canadian identity; and 3. political and funding structures), three themes related to healthcare processes (1. staffing shortages; 2. inefficient care; and 3. inconsistent care), and three strategies to improve short- and long-term population health outcomes (1. delineating roles and revising incentives; 2. enhanced health literacy; 3. interdisciplinary and patient-centred care). CONCLUSION Canadians in our sample identified important structural and process limitations to the Canadian healthcare system. Meaningful reforms are needed and will require addressing the link between the Canadian identity and our healthcare system to facilitate effective development and implementation of strategies to improve population health outcomes.
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Affiliation(s)
- Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada.
| | - Stephana Julia Moss
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Sara J Mizen
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Cynthia Sriskandarajah
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Emily A FitzGerald
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Amity E Quinn
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Fiona Clement
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Brenlea Farkas
- O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alexandra Dodds
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Melanie Columbus
- O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Henry T Stelfox
- O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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11
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Mak S, Thomas A, Razack S, Root K, Hunt M. Unraveling attrition and retention: A qualitative study with rehabilitation professionals. Work 2024:WOR230531. [PMID: 38669505 DOI: 10.3233/wor-230531] [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: 04/28/2024] Open
Abstract
BACKGROUND Health human resources are scarce worldwide. In occupational therapy (OT), physical therapy (PT), and speech-language pathology (S-LP), attrition and retention issues amplify this situation and contribute to the precarity of health systems. OBJECTIVE To investigate the phenomena of attrition and retention with OTs, PTs and S-LPs who stayed in, or left their profession. METHODS Cultural-historical activity theory provided the theoretical scaffolding for this interpretive description study. We used purposeful sampling (maximum variation approach) to recruit OTs, PTs, and S-LPs from Quebec, Canada. Individual interviews were conducted with 51 OTs, PTs, and S-LPs from Quebec, Canada, in English or French (2019-2020). Inductive and deductive approaches, and constant comparative techniques were used for data analysis. RESULTS Six themes were developed: 1) characteristics of work that made it meaningful; 2) aspects of work that practitioners appreciate; 3) factors of daily work that weigh on a practitioner; 4) factors that contribute to managing work; 5) relationships with different stakeholders that shape daily work; and 6) perceptions of the profession. Meaningfulness was tied to participants' sense that their values were reflected in their work. Factors outside work shaped participants' work experiences. Recurrent negative experiences led some to leave their profession. CONCLUSION Findings underscore a critical need to address contributing factors to attrition and retention which are essential to ensuring the availability of OTs, PTs and SLPs for present and future rehabilitation needs.
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Affiliation(s)
- Susanne Mak
- School of Physical and Occupational Therapy, McGill University, Pine Avenue West, Montréal, Québec, Canada
- Institute of Health Sciences Education, McGill University, Pine Avenue West, Montréal, Québec, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut Universitaire Sur la Réadaptation en Déficence Physique de Montréal (Lindsay Pavillon), Hudson, Montréal, Québec, Canada
| | - Aliki Thomas
- School of Physical and Occupational Therapy, McGill University, Pine Avenue West, Montréal, Québec, Canada
- Institute of Health Sciences Education, McGill University, Pine Avenue West, Montréal, Québec, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut Universitaire Sur la Réadaptation en Déficence Physique de Montréal (Lindsay Pavillon), Hudson, Montréal, Québec, Canada
| | - Saleem Razack
- Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
- Centre for Health Education Scholarship, University of British Columbia, P. A. Woodward Instructional Resources Centre (IRC), Health Sciences Mall, Vancouver, British Columbia, Canada
| | - Kelly Root
- School of Communication Sciences and Disorders, Dalhousie University, College Street, Halifax, Nova Scotia, Canada
| | - Matthew Hunt
- School of Physical and Occupational Therapy, McGill University, Pine Avenue West, Montréal, Québec, Canada
- Institute of Health Sciences Education, McGill University, Pine Avenue West, Montréal, Québec, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut Universitaire Sur la Réadaptation en Déficence Physique de Montréal (Lindsay Pavillon), Hudson, Montréal, Québec, Canada
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12
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Brooks SP, Sidhu K, Cooper E, Michelle Driedger S, Gisenya L, Kaur G, Kniseley M, Jardine CG. The influence of health service interactions and local policies on vaccination decision-making in immigrant women: A multi-site Canadian qualitative study. Vaccine 2024; 42:2793-2800. [PMID: 38514354 DOI: 10.1016/j.vaccine.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/15/2024] [Accepted: 03/05/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES Research on immigrant and refugee vaccination uptake in Canada shows that immunization decisions vary by vaccine type, location, age and migration status. Despite their diversity, these studies often treat immigrant and refugee populations as a single group relative to other Canadians. In this comparative study, we explored how previous risk communication and immunization experiences influence immunization decisions by immigrant and refugee women from three communities across Canada. METHODS Participants included women from the Punjabi immigrant community located in Surrey and Abbotsford, British Columbia (n = 36), the Nigerian immigrant community located in Winnipeg, Manitoba (n = 43), and the Congolese refugee community in Edmonton, Alberta (n = 18). Using focus groups guided by focused ethnography methodology, we sought to understand immunization experiences in Canada and before arrival, and what information sources influenced the immunization decision-making process by the women in the three communities. RESULTS Participants had differing past experiences in Canada and before their arrival that influenced how they used information in their vaccination decisions. Clear vaccination communications and dialogue with Canadian health care providers increased trust in Canadian health care and the likelihood of vaccine uptake. By contrast, weak vaccine recommendations and antivaccination information in the community prompted participants to decline future vaccines. CONCLUSION Given our participants' different communication preferences and needs, we argue that a one-size-fits-all communication approach is inappropriate for immigrant and refugee populations. Instead, multi-pronged communication strategies are required to reach participants and respond to previous experiences and information that may lead to vaccination hesitancy.
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Affiliation(s)
- Stephanie P Brooks
- School of Public Health, University of Alberta, 3-300 Edmonton Clinical Health Academy, 11405 - 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada.
| | - Kamaljit Sidhu
- Faculty of Health Sciences, University of the Fraser Valley, 45190 Caen Ave, Chilliwack, B.C. V2R 0N3, Canada.
| | - Elizabeth Cooper
- Faculty of Kinesiology and Health Sciences, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada.
| | - S Michelle Driedger
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB R3E 0W3, Canada.
| | - Linda Gisenya
- School of Public Health, University of Alberta, 3-300 Edmonton Clinical Health Academy, 11405 - 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada.
| | - Gagandeep Kaur
- Faculty of Health Sciences, University of the Fraser Valley, 45190 Caen Ave, Chilliwack, B.C. V2R 0N3, Canada.
| | - Marinel Kniseley
- Faculty of Health Sciences, University of the Fraser Valley, 45190 Caen Ave, Chilliwack, B.C. V2R 0N3, Canada.
| | - Cynthia G Jardine
- Faculty of Health Sciences, University of the Fraser Valley, 45190 Caen Ave, Chilliwack, B.C. V2R 0N3, Canada.
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Gerhold K, Al-Azazi S, El-Matary W, Katz LY, Lim LSH, Marks SD, Lix LM. Health Care Utilization and Direct Costs Prior to Subspecialty Care in Children with Chronic Pain Compared with Other Chronic Childhood Diseases: A Cohort Study. J Pediatr 2024; 271:114046. [PMID: 38582149 DOI: 10.1016/j.jpeds.2024.114046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVES To understand the burden associated with pediatric chronic pain (CP) on the health care system compared with other costly chronic diseases prior to subspecialty care. STUDY DESIGN In this retrospective cohort study, we assessed all-cause health care utilization and direct health care costs associated with pediatric CP (n = 91) compared with juvenile arthritis (n = 135), inflammatory bowel disease (n = 90), type 1 diabetes (n = 475) or type 2 diabetes (n = 289), anxiety (n = 7193), and controls (n = 273) 2 and 5 years prior to patients entering subspecialty care in Manitoba, Canada. Linked data from physician encounters, emergency department visits, hospitalizations, and prescriptions were extracted from administrative databases. Differences in health care utilization and direct health care costs associated with CP vs the other conditions were tested using negative binomial and zero-inflated negative binomial regression models, respectively. RESULTS After adjustment for age at diagnosis, sex, location of residence, and socioeconomic status, CP continued to be associated with the highest number of consulted physicians and subspecialists and the highest number of physician billings compared with all other conditions (P < .01, respectively). CP was significantly associated with higher physician costs than juvenile arthritis, inflammatory bowel disease, type 1 diabetes, type 2 diabetes, or controls (P < .01, respectively); anxiety was associated with the highest physician and prescription costs among all cohorts (P < .01, respectively). CONCLUSION Compared with chronic inflammatory and endocrinologic conditions, pediatric CP and anxiety were associated with substantial burden on the health care system prior to subspecialty care, suggesting a need to assess gaps and resources in the management of CP and mental health conditions in the primary care setting.
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Affiliation(s)
- Kerstin Gerhold
- Rady Faculty of Health Sciences, Department of Pediatrics and Child Health, Max Rady College of Medicine, Children's Hospital Research Institute of Manitoba, University of Manitoba, Manitoba, CA; Mississippi Center for Advanced Medicine, Madison, MS.
| | - Saeed Al-Azazi
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Manitoba, CA
| | - Wael El-Matary
- Rady Faculty of Health Sciences, Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Manitoba, CA
| | - Laurence Y Katz
- Rady Faculty of Health Sciences, Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Manitoba, CA
| | - Lily S H Lim
- Rady Faculty of Health Sciences, Department of Pediatrics and Child Health, Max Rady College of Medicine, Children's Hospital Research Institute of Manitoba, University of Manitoba, Manitoba, CA
| | - Seth D Marks
- Rady Faculty of Health Sciences, Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Manitoba, CA
| | - Lisa M Lix
- Rady Faculty of Health Sciences, Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Manitoba, CA
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14
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Nantais J, Baxter NN, Saskin R, Calzavara A, Gomez D. Short- and long-term outcomes of acute diverticulitis in patients with transplanted kidneys. Colorectal Dis 2024; 26:734-744. [PMID: 38459424 DOI: 10.1111/codi.16941] [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: 09/26/2023] [Revised: 01/09/2024] [Accepted: 01/30/2024] [Indexed: 03/10/2024]
Abstract
AIM The safety of nonoperative treatment for patients with transplanted kidneys who develop acute diverticulitis is unclear. Our primary aim was to examine the long-term sequelae of nonoperative management in this group. METHOD We performed a population-based retrospective cohort study using linked administrative databases housed at ICES in Ontario, Canada. We included adult (≥18 years) patients admitted with acute diverticulitis between April 2002 and December 2019. Patients with a functioning kidney transplant were compared with those without a transplant. The primary outcome was failure of conservative management (operation, drainage procedure or death due to acute diverticulitis) beyond 30 days. The cumulative incidence function and a Fine-Grey subdistribution hazard model were used to evaluate this outcome accounting for competing risks. RESULTS We examined 165 patients with transplanted kidneys and 74 095 without. Patients with transplanted kidneys were managed conservatively 81% of the time at the index event versus 86% in nontransplant patients. Short-term outcomes were comparable, but cumulative failure of conservative management at 5 years occurred in 5.6% (95% CI 2.3%-11.1%) of patients with transplanted kidneys versus 2.1% (95% CI 2.0%-2.3%) in those without. Readmission for acute diverticulitis was also higher in transplanted patients at 5 years at 16.7% (95% CI 10.1%-24.7%) versus 11.6% (95% CI 11.3%-11.9%). Adjusted analyses showed increased failure of conservative management [subdistribution hazard ratio (sHR) 3.24, 95% CI 1.69-6.22] and readmissions (sHR 1.55, 95% CI 1.02-2.36) for patients with transplanted kidneys. CONCLUSION Most patients with transplanted kidneys are managed conservatively for acute diverticulitis. Although long-term readmission and failure of conservative management is higher for this group than the nontransplant population, serious outcomes are infrequent, substantiating the safety of this approach.
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Affiliation(s)
- Jordan Nantais
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nancy N Baxter
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - David Gomez
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Division of General Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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15
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Tammemägi MC, Darling GE, Schmidt H, Walker MJ, Langer D, Leung YW, Nguyen K, Miller B, Llovet D, Evans WK, Buchanan DN, Espino-Hernandez G, Aslam U, Sheppard A, Lofters A, McInnis M, Dobranowski J, Habbous S, Finley C, Luettschwager M, Cameron E, Bravo C, Banaszewska A, Creighton-Taylor K, Fernandes B, Gao J, Lee A, Lee V, Pylypenko B, Yu M, Svara E, Kaushal S, MacNiven L, McGarry C, Della Mora L, Koen L, Moffatt J, Rey M, Yurcan M, Bourne L, Bromfield G, Coulson M, Truscott R, Rabeneck L. Risk-based lung cancer screening performance in a universal healthcare setting. Nat Med 2024; 30:1054-1064. [PMID: 38641742 DOI: 10.1038/s41591-024-02904-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/01/2024] [Indexed: 04/21/2024]
Abstract
Globally, lung cancer is the leading cause of cancer death. Previous trials demonstrated that low-dose computed tomography lung cancer screening of high-risk individuals can reduce lung cancer mortality by 20% or more. Lung cancer screening has been approved by major guidelines in the United States, and over 4,000 sites offer screening. Adoption of lung screening outside the United States has, until recently, been slow. Between June 2017 and May 2019, the Ontario Lung Cancer Screening Pilot successfully recruited 7,768 individuals at high risk identified by using the PLCOm2012noRace lung cancer risk prediction model. In total, 4,451 participants were successfully screened, retained and provided with high-quality follow-up, including appropriate treatment. In the Ontario Lung Cancer Screening Pilot, the lung cancer detection rate and the proportion of early-stage cancers were 2.4% and 79.2%, respectively; serious harms were infrequent; and sensitivity to detect lung cancers was 95.3% or more. With abnormal scans defined as ones leading to diagnostic investigation, specificity was 95.5% (positive predictive value, 35.1%), and adherence to annual recall and early surveillance scans and clinical investigations were high (>85%). The Ontario Lung Cancer Screening Pilot provides insights into how a risk-based organized lung screening program can be implemented in a large, diverse, populous geographic area within a universal healthcare system.
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Affiliation(s)
- Martin C Tammemägi
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada.
- Brock University, St. Catharines, ON, Canada.
| | - Gail E Darling
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Heidi Schmidt
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | - Deanna Langer
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Yvonne W Leung
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Kathy Nguyen
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Beth Miller
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Diego Llovet
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | | | | | - Usman Aslam
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | - Aisha Lofters
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | | | - Steven Habbous
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | | | - Erin Cameron
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Caroline Bravo
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | | | | | - Julia Gao
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Alex Lee
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Van Lee
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | - Monica Yu
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Erin Svara
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | - Lynda MacNiven
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | | | - Liz Koen
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | - Michelle Rey
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Marta Yurcan
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Laurie Bourne
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | | | | | | | - Linda Rabeneck
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
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Taqi KM, Lee CW, Zhang JW, Hawley P, Cheifetz R. Practicing Surgeons' Perception of Barriers to Palliative Care Delivery in British Columbia. Cureus 2024; 16:e58061. [PMID: 38738150 PMCID: PMC11088467 DOI: 10.7759/cureus.58061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Utilization of palliative care remains low among surgical patients. We aim to characterize general surgeons' perceptions of barriers to access palliative care in British Columbia (BC). METHODS Semi-structured interviews were carried out with a total of 11 surgeons in BC. Interviews were transcribed for thematic analysis via interpretive description. Dominant themes were identified and agreed upon between the authors. RESULTS Several barriers were identified, which include system and institution, communication and surgical workflow barriers. At the system and institutional level, there were difficulties accessing patient information and continuity of care. Themes in the communication included patient misconceptions about palliative care and communication challenges with consulting services. Surgical workflow barriers influenced the overall perceived role of surgeons when caring for patients with palliative care needs. CONCLUSION Understanding surgeons' perspectives on barriers to palliative care is an important step in changing management. This can aid in the development of strategies that ease access to palliative care.
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Affiliation(s)
- Kadhim M Taqi
- Department of Surgery, University of British Columbia, Vancouver, CAN
| | - Christina W Lee
- Department of Surgery, University of British Columbia, Vancouver, CAN
| | - Jenny W Zhang
- Department of Surgery, University of British Columbia, Vancouver, CAN
| | - Philippa Hawley
- Department of Medicine, University of British Columbia, Vancouver, CAN
| | - Rona Cheifetz
- Department of Surgery, University of British Columbia, Vancouver, CAN
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Olanlesi-Aliu A, Kemei J, Alaazi D, Tunde-Byass M, Renzaho A, Sekyi-Out A, Mullings DV, Osei-Tutu K, Salami B. COVID-19 among Black people in Canada: a scoping review. Health Promot Chronic Dis Prev Can 2024; 44:112-125. [PMID: 38501682 PMCID: PMC11092311 DOI: 10.24095/hpcdp.44.3.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
INTRODUCTION The COVID-19 pandemic exacerbated health inequities worldwide. Research conducted in Canada shows that Black populations were disproportionately exposed to COVID-19 and more likely than other ethnoracial groups to be infected and hospitalized. This scoping review sought to map out the nature and extent of current research on COVID-19 among Black people in Canada. METHODS Following a five-stage methodological framework for conducting scoping reviews, studies exploring the effects of the COVID-19 pandemic on Black people in Canada, published up to May 2023, were retrieved through a systematic search of seven databases. Of 457 identified records, 124 duplicates and 279 additional records were excluded after title and abstract screening. Of the remaining 54 articles, 39 were excluded after full-text screening; 2 articles were manually picked from the reference lists of the included articles. In total, 17 articles were included in this review. RESULTS Our review found higher rates of COVID-19 infections and lower rates of COVID-19 screening and vaccine uptake among Black Canadians due to pre-COVID-19 experiences of institutional and structural racism, health inequities and a mistrust of health care professionals that further impeded access to health care. Misinformation about COVID-19 exacerbated mental health issues among Black Canadians. CONCLUSIONS Our findings suggest the need to address social inequities experienced by Black Canadians, particularly those related to unequal access to employment and health care. Collecting race-based data on COVID-19 could inform policy formulation to address racial discrimination in access to health care, quality housing and employment, resolve inequities and improve the health and well-being of Black people in Canada.
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Affiliation(s)
| | - Janet Kemei
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Dominic Alaazi
- Health and Immigration Policies and Practices Research Program (HIPP), University of Alberta, Edmonton, Alberta, Canada
| | - Modupe Tunde-Byass
- Black Physicians of Ontario, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Ontario, Toronto, Ontario, Canada
| | - Andre Renzaho
- Translational Health Research Institute, School of Medicine, Campbell Town Campus, Western Sydney University, Australia
| | | | - Delores V Mullings
- School of Social Work, Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Kannin Osei-Tutu
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bukola Salami
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Health and Immigration Policies and Practices Research Program (HIPP), University of Alberta, Edmonton, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Chai L. Perceived Community Belonging as a Moderator of the Association Between Sexual Orientation and Health and Well-Being. Am J Health Promot 2024; 38:325-338. [PMID: 37789687 PMCID: PMC10903136 DOI: 10.1177/08901171231204472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
PURPOSE This study examines the moderating role of perceived community belonging in the association between sexual orientation and various health and well-being outcomes. DESIGN A national cross-sectional survey. SETTING Confidential microdata from the 2021 Canadian Community Health Survey. SUBJECTS Individuals aged 15 and older, with a sample size ranging from 43,000 to 44,100. MEASURES Sexual orientation, health and well-being outcomes, and sense of community belonging were all self-reported. Outcomes included self-rated general and mental health, depressive symptoms, and life satisfaction. ANALYSIS A series of multiple linear regression models. RESULTS Compared to heterosexual individuals, bisexual individuals reported poorer self-rated general health (b = .402, P < .001 for men; b = .454, P < .001 for women) and mental health (b = .520, P < .001 for men; b = .643, P < .001 for women), higher depressive symptoms (b = 2.140, P < .001 for men; b = 2.685, P < .001 for women), and lower life satisfaction (b = .383, P < .05 for men; b = .842, P < .001 for women). Few disparities were observed among gay men and lesbians. Contrary to some recent findings, no disparities were observed among individuals uncertain about their sexual orientation or those who chose not to disclose it, even without controlling for covariates. A stronger sense of community belonging mitigated the disadvantages associated with self-rated general health (b = -.276, P < .01) and depressive symptoms (b = -.983, P < .01) for gay men, and life satisfaction (b = -.621, P < .01) for lesbians. CONCLUSION This study is among the first to highlight the stress-buffering role of community belonging in the association between sexual orientation and health and well-being outcomes.
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Affiliation(s)
- Lei Chai
- Department of Sociology, University of Toronto, Toronto, ON, Canada
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Ng QX, Ong C, Yaow CYL, Chan HW, Thumboo J, Wang Y, Koh GCH. Cost-of-illness studies of inherited retinal diseases: a systematic review. Orphanet J Rare Dis 2024; 19:93. [PMID: 38424595 PMCID: PMC10905859 DOI: 10.1186/s13023-024-03099-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/21/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND While health care and societal costs are routinely modelled for most diseases, there is a paucity of comprehensive data and cost-of-illness (COI) studies for inherited retinal diseases (IRDs). This lack of data can lead to underfunding or misallocation of resources. A comprehensive understanding of the COI of IRDs would assist governmental and healthcare leaders in determining optimal resource allocation, prioritizing funding for research, treatment, and support services for these patients. METHODS Following PRISMA guidelines, a literature search was conducted using Medline, EMBASE and Cochrane databases, from database inception up to 30 Jun 2023, to identify COI studies related to IRD. Original studies in English, primarily including patients with IRDs, and whose main study objective was the estimation of the costs of IRDs and had sufficiently detailed methodology to assess study quality were eligible for inclusion. To enable comparison across countries and studies, all annual costs were standardized to US dollars, adjusted for inflation to reflect their current value and recalculated on a "per patient" basis wherever possible. The review protocol was registered in PROSPERO (registration number CRD42023452986). RESULTS A total of nine studies were included in the final stage of systematic review and they consistently demonstrated a significant disease burden associated with IRDs. In Singapore, the mean total cost per patient was roughly US$6926/year. In Japan, the mean total cost per patient was US$20,833/year. In the UK, the mean total cost per patient with IRD ranged from US$21,658 to US$36,549/year. In contrast, in the US, the mean total per-patient costs for IRDs ranged from about US$33,017 to US$186,051 per year. In Canada, these mean total per-patient costs varied between US$16,470 and US$275,045/year. Non-health costs constituted the overwhelming majority of costs as compared to healthcare costs; 87-98% of the total costs were due to non-health costs, which could be attributed to diminished quality of life, poverty, and increased informal caregiving needs for affected individuals. CONCLUSION IRDs impose a disproportionate societal burden outside health systems. It is vital for continued funding into IRD research, and governments should incorporate societal costs in the evaluation of cost-effectiveness for forthcoming IRD interventions, including genomic testing and targeted therapies.
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Affiliation(s)
- Qin Xiang Ng
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore.
| | - Clarence Ong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Clyve Yu Leon Yaow
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hwei Wuen Chan
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Julian Thumboo
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Gerald Choon Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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20
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Spithoff S, McPhail B, Vesely L, Rowe RK, Mogic L, Grundy Q. How the commercial virtual care industry gathers, uses and values patient data: a Canadian qualitative study. BMJ Open 2024; 14:e074019. [PMID: 38331904 PMCID: PMC10860095 DOI: 10.1136/bmjopen-2023-074019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES To understand and report on the direct-to-consumer virtual care industry in Canada, focusing on how companies collect, use and value patient data. DESIGN Qualitative study using situational analysis methodology. SETTING Canadian for-profit virtual care industry. PARTICIPANTS 18 individuals employed by or affiliated with the Canadian virtual care industry. METHODS Semistructured interviews were conducted between October 2021 and January 2022 and publicly available documents on websites of commercial virtual care platforms were retrieved. Analysis was informed by situational analysis, a constructivist grounded theory methodology, with a continuous and iterative process of data collection and analysis; theoretical sampling and creation of theoretical concepts to explain findings. RESULTS Participants described how companies in the virtual care industry highly valued patient data. Companies used data collected as patients accessed virtual care platforms and registered for services to generate revenue, often by marketing other products and services. In some cases, virtual care companies were funded by pharmaceutical companies to analyse data collected when patients interacted with a healthcare provider and adjust care pathways with the goal of increasing uptake of a drug or vaccine. Participants described these business practices as expected and appropriate, but some were concerned about patient privacy, industry influence over care and risks to marginalised communities. They described how patients may have agreed to these uses of their data because of high levels of trust in the Canadian health system, problematic consent processes and a lack of other options for care. CONCLUSIONS Patients, healthcare providers and policy-makers should be aware that the direct-to-consumer virtual care industry in Canada highly values patient data and appears to view data as a revenue stream. The industry's data handling practices of this sensitive information, in the context of providing a health service, have implications for patient privacy, autonomy and quality of care.
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Affiliation(s)
- Sheryl Spithoff
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Brenda McPhail
- Faculty of Social Sciences, McMaster University, Toronto, Ontario, Canada
| | | | - Robyn K Rowe
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Lana Mogic
- Women's College Hospital, Toronto, Ontario, Canada
| | - Quinn Grundy
- Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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21
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Norris CM, Mullen KA, Foulds HJ, Jaffer S, Nerenberg K, Gulati M, Parast N, Tegg N, Gonsalves CA, Grewal J, Hart D, Levinsson AL, Mulvagh SL. The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 7: Sex, Gender, and the Social Determinants of Health. CJC Open 2024; 6:205-219. [PMID: 38487069 PMCID: PMC10935698 DOI: 10.1016/j.cjco.2023.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/31/2023] [Indexed: 03/17/2024] Open
Abstract
Women vs men have major differences in terms of risk-factor profiles, social and environmental factors, clinical presentation, diagnosis, and treatment of cardiovascular disease. Women are more likely than men to experience health issues that are complex and multifactorial, often relating to disparities in access to care, risk-factor prevalence, sex-based biological differences, gender-related factors, and sociocultural factors. Furthermore, awareness of the intersectional nature and relationship of sociocultural determinants of health, including sex and gender factors, that influence access to care and health outcomes for women with cardiovascular disease remains elusive. This review summarizes literature that reports on under-recognized sex- and gender-related risk factors that intersect with psychosocial, economic, and cultural factors in the diagnosis, treatment, and outcomes of women's cardiovascular health.
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Affiliation(s)
- Colleen M. Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kerri-Anne Mullen
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather J.A. Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Shahin Jaffer
- Department of Medicine/Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kara Nerenberg
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Martha Gulati
- Barbra Streisand Women’s Heart Centre, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Nazli Parast
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Nicole Tegg
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jasmine Grewal
- Department of Medicine/Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna Hart
- Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | | | - Sharon L. Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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22
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Giosa JL, Kalles E, McAiney C, Oelke ND, Aubrecht K, McNeil H, Habib-Perez O, Holyoke P. Co-designing action-oriented mental health conversations between care providers and ageing Canadians in the community: a participatory mixed-methods study protocol. BMJ Open 2024; 14:e079653. [PMID: 38296303 PMCID: PMC10831463 DOI: 10.1136/bmjopen-2023-079653] [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: 09/07/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION The mental health of ageing Canadians is a growing concern, particularly post-pandemic. Older adults face systemic ageism and mental health stigma as pervasive barriers to seeking needed mental health support, care and treatment within health and social care systems. These barriers are exacerbated when service providers focus on physical healthcare needs or lack the skills and confidence to talk about and/or address mental health during routine visits. This study aims to co-design and test an evidence-based approach to mental health conversations at the point-of-care in home and community settings with older adults, family and friend caregivers and health and social care providers that could facilitate help-seeking activities and care access. METHODS AND ANALYSIS A participatory mixed-methods study design will be applied, guided by a Working Group of experts-by-experience (n=30). Phase 1 engages ageing Canadians in four online workshops (n=60) and a national survey (n=1000) to adapt an evidence-based visual model of mental health for use with older adults in home and community care. Phase 2 includes six co-design workshops with community providers (n=90) in rural and urban sites across three Canadian provinces to co-design tools, resources and processes for enabling the use of the adapted model as a conversation guide. Phase 3 involves pilot and feasibility testing the co-designed conversations with older adult clients of providers from Phase 2 (n=180). ETHICS AND DISSEMINATION Phases 1 and 2 of this study have received ethics clearance at the University of Waterloo (ORE #44187), University of British Columbia (#H22-02306) and St. Francis Xavier University (#26075). While an overview of Phase 3 is included, details will rely on Phase 2 outcomes. Knowledge mobilisation activities will include peer-reviewed publications, conference presentations, webinars, newsletters, infographics and policy briefs. Interested audiences may include community organisations, policy and decision-makers and health and social care providers.
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Affiliation(s)
- Justine L Giosa
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- SE Research Centre, Saint Elizabeth Health Care, Markham, Ontario, Canada
| | - Elizabeth Kalles
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- SE Research Centre, Saint Elizabeth Health Care, Markham, Ontario, Canada
| | - Carrie McAiney
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Nelly D Oelke
- School of Nursing, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
- Rural Coordination Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Katie Aubrecht
- Department of Sociology, St. Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Heather McNeil
- SE Research Centre, Saint Elizabeth Health Care, Markham, Ontario, Canada
| | - Olinda Habib-Perez
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Paul Holyoke
- SE Research Centre, Saint Elizabeth Health Care, Markham, Ontario, Canada
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23
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Janus M, Brownell M, Reid-Westoby C, Pottruff M, Forer B, Guhn M, Duku E. Neighbourhood-level socioeconomic status and prevalence of teacher-reported health disorders among Canadian kindergarten children. Front Public Health 2024; 11:1295195. [PMID: 38303964 PMCID: PMC10830680 DOI: 10.3389/fpubh.2023.1295195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/22/2023] [Indexed: 02/03/2024] Open
Abstract
Background The evidence on the association between neighborhood-level socioeconomic status (SES) and health disorders in young children is scarce. This study examined the prevalence of health disorders in Canadian kindergarten (5-6 years old) children in relation to neighborhood SES in 12/13 Canadian jurisdictions. Methods Data on child development at school entry for an eligible 1,372,980 children out of the total population of 1,435,428 children from 2004 to 2020, collected using the Early Development Instrument (EDI), were linked with neighborhood sociodemographic data from the 2006 Canadian Census and the 2005 Taxfiler for 2,058 neighborhoods. We examined the relationship using linear regressions. Children's HD included special needs, functional impairments limiting a child's ability to participate in classroom activities, and diagnosed conditions. Results The neighborhood prevalence of health disorders across Canada ranged from 1.8 to 46.6%, with a national average of 17.3%. The combined prevalence of health disorders was 16.4%, as 225,711 children were identified as having at least one health disorder. Results of an unadjusted linear regression showed a significant association between neighborhood-level SES and prevalence of health disorders (F(1, 2051) = 433.28, p < 0.001), with an R2 of 0.17. When province was added to the model, the R2 increased to 0.40 (F(12, 2040) = 115.26, p < 0.001). The association was strongest in Newfoundland & Labrador and weakest in Ontario. Conclusion Our study demonstrated that the prevalence of health disorders among kindergarten children was higher in lower SES neighborhoods and varied by jurisdiction in Canada, which has implications for practice and resource allocation.
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Affiliation(s)
- Magdalena Janus
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Caroline Reid-Westoby
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Molly Pottruff
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Barry Forer
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Martin Guhn
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Eric Duku
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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Rao S. The Access Paradox: unmet healthcare needs among young adults in Alberta - an exploratory study of the systemic ironies in healthcare accessibility. Int J Ment Health Nurs 2024. [PMID: 38183386 DOI: 10.1111/inm.13285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024]
Abstract
There is a pressing need to investigate how young adults' access to healthcare, including how delayed help-seeking behaviours and the complexities inherent in traditional healthcare systems, exacerbate the challenges they face. This study explores the associations among functional impairments, self-perceptions of health, anxiety and mood disorders and their potential relationship to unmet healthcare needs among young adults aged 20-29. This cross-sectional study used data from the 2017-2018 Canadian Community Health Survey to analyse a sample of 1636 young adults from Alberta, Canada. Central to the analysis was the application of conceptual framework of access to health care, as it offers a comprehensive view of healthcare access. Among the sampled young adults, 7.0% reported unmet healthcare needs. Self-perceived unmet healthcare needs were significantly associated with anxiety disorders, functional impairments-specifically cognitive and social skills, and self-perceptions of poor or fair mental health, as opposed to those perceiving their mental health as excellent. Multivariable analyses incorporating extraneous variables were not statistically significant, emphasising the critical role of systemic and structural factors in healthcare access. The study presents preliminary insights into the intricate dynamics shaping unmet healthcare needs. These insights can guide future research and practice advances, particularly in developing targeted interventions that effectively reduce healthcare disparities and enhance access to healthcare services for young adults.
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Affiliation(s)
- Sandy Rao
- Faculty of Social Work, University of Calgary, Calgary, Canada
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25
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Dewart G, Muller J, Phillips JC, Banaszak D, Caine V. Interventions in maternal syphilis care globally: A scoping review. Health Care Women Int 2024:1-20. [PMID: 38180353 DOI: 10.1080/07399332.2023.2294815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 12/10/2023] [Indexed: 01/06/2024]
Abstract
Infectious and Congenital Syphilis rates continue to rise globally. Current recommendations for syphilis screening and treatment may be insufficient, and there is a pressing need for improved programs and services to address the increase in cases. A scoping review was conducted to examine approaches to maternal syphilis screening and treatment. Theoretical underpinnings and the key characteristics of these interventions were studied to identify gaps in the existing literature to guide future research. Developing a modified version of the socio-ecological model to guide data analysis, we included 33 academic studies spanning 31 years, covering a range of interventions, programs, and policies globally. We highlight key facets of interventions aligning with the five levels of the modified model that include: individual, interpersonal, institutional, community and policy. In this review, we provide valuable insights into the characteristics and principles of maternal syphilis screening and treatment interventions.
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Affiliation(s)
- Georgia Dewart
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Jessica Muller
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - J Craig Phillips
- School of Nursing, Faculty of Health Sciences, Université d'Ottawa | University of Ottawa, Ottawa, Ontario, Canada
| | - Danielle Banaszak
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Vera Caine
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
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26
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Kreindler SA, Hunter M, Lea GW, Archibald M, Rieger K, West C, Hasan SM. Lifting the curtain on the emergency department crisis: a multi-method reception study of Larry Saves the Canadian Healthcare System. BMC Health Serv Res 2024; 24:13. [PMID: 38178141 PMCID: PMC10765753 DOI: 10.1186/s12913-023-10512-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Despite growing evidence of the potential of arts-based modalities to translate knowledge and spark discussion on complex issues, applications to health policy are rare. This study explored the potential of a research-based theatrical video to increase public capacity and motivation to engage with the complex issues that make Emergency Department wait times such an intractable problem. METHODS Larry Saves the Canadian Healthcare System is a digital musical micro-series developed from extensive research examining system-level causes of Emergency crowding and the ineffectiveness of prevailing approaches. We released individual episodes and a revised full-length version on YouTube, using organic promotion strategies and paid advertising. We used YouTube Analytics to track views, engagement and viewer demographics, and content-analyzed viewer comments. We also conducted five university-based screenings; 92 students completed questionnaires, rating Larry on 16 descriptors using a 7-point Likert scale. RESULTS From June 2022 through May 2023, Larry garnered over 100,000 views (76,752 of the full-length version, 35,535 of episodes), 1329 likes, 2780 shares, and 139 comments. Views and watch time were higher among women and positively associated with age. Among YouTube comments, the predominating themes were praise for the video and criticism of the healthcare system. Many commenters applauded the show's accuracy, humor, and/or resonance with their experience; several shared healthcare horror stories. Students overwhelmingly agreed with all positive and disagreed with all negative descriptors, and nearly unanimously deemed the video informative, thought-provoking, and entertaining. Most also affirmed that it had increased their knowledge, interest, and confidence to participate in discussions about healthcare issues. Neither gender, primary language, nor employment in healthcare predicted ratings, but graduate students and those 25+ years old evaluated the video most positively. DISCUSSION These findings highlight the promise of research-informed musical satire to inform and invigorate discourse on an urgent health policy problem. Larry has reached tens of thousands of viewers, garnered excellent feedback, and received high student ratings. Further research should directly assess educational and behavioural outcomes and explore what facilitative strategies could maximize this knowledge translation product's potential to foster informed, impactful policy dialogue.
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Affiliation(s)
- Sara A Kreindler
- Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB, R3E 0W, Canada.
| | - Mikayla Hunter
- Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB, R3E 0W, Canada
| | - Graham W Lea
- Faculty of Education, University of Manitoba, 71 Curry Pl, Winnipeg, MB, R3T 2N2, Canada
| | - Mandy Archibald
- College of Nursing, University of Manitoba, 99 Curry Pl, Winnipeg, MB, R3T 2M6, Canada
| | - Kendra Rieger
- School of Nursing, Trinity Western University, 22500 University Drive, Neufeld Science Building, Langley, BC, V2Y 1Y1, Canada
| | - Christina West
- College of Nursing, University of Manitoba, 99 Curry Pl, Winnipeg, MB, R3T 2M6, Canada
| | - Shaikh Mehdi Hasan
- Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB, R3E 0W, Canada
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Zeitouny S, McGrail K, Tadrous M, Wong ST, Cheng L, Law M. Impact of the COVID-19 pandemic on prescription drug use and costs in British Columbia: a retrospective interrupted time series study. BMJ Open 2024; 14:e070031. [PMID: 38176877 PMCID: PMC10773331 DOI: 10.1136/bmjopen-2022-070031] [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: 11/16/2022] [Accepted: 12/06/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVES To assess the impact of the COVID-19 pandemic on prescription drug use and costs. DESIGN Interrupted time series analysis of comprehensive administrative health data linkages in British Columbia, Canada, from 1 January 2018 to 28 March 2021. SETTING Retrospective population-based analysis of all prescription drugs dispensed in community pharmacies and outpatient hospital pharmacies and irrespective of the drug insurance payer. PARTICIPANTS Between 4.30 and 4.37 million individuals (52% women) actively registered with the publicly funded medical services plan. INTERVENTION COVID-19 pandemic and associated mitigation measures. MAIN OUTCOME MEASURES Weekly dispensing rates and costs, both overall and stratified by therapeutic groups and pharmacological subgroups, before and after the declaration of the public health emergency related to the COVID-19 pandemic. Relative changes in post-COVID-19 outcomes were expressed as ratios of observed to expected rates. RESULTS After the onset of the pandemic and subsequent COVID-19 mitigation measures, overall medication dispensing rates dropped by 2.4% (p<0.01), followed by a sustained weekly increase to return to predicted levels by the end of January 2021. We observed abrupt level decreases in antibacterials (30.3%, p<0.01) and antivirals (22.4%, p<0.01) that remained below counterfactuals over the first year of the pandemic. In contrast, there was a week-to-week trend increase in nervous system drugs, yielding an overall increase of 7.3% (p<0.01). No trend changes in the dispensing of respiratory system agents, ACE inhibitors, antidiabetic drugs and antidepressants were detected. CONCLUSION The COVID-19 pandemic impact on prescription drug dispensing was heterogeneous across medication subgroups. As data become available, dispensing trends in nervous system agents, antibiotics and antivirals warrant further monitoring and investigation.
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Affiliation(s)
- Seraphine Zeitouny
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mina Tadrous
- University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lucy Cheng
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
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Leslie M, Hansen B, Abboud R, Claussen C, Aghajafari F. Thinking and Enacting the Patient Medical Home Under Pandemic Conditions: A Qualitative Study From Primary Care in Alberta, Canada. J Prim Care Community Health 2024; 15:21501319241236007. [PMID: 38627966 PMCID: PMC11022528 DOI: 10.1177/21501319241236007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The COVID-19 (C19) pandemic shocked primary care systems around the world. Those systems responded by supporting patients in the community, and acute care facilities in crisis. In Canada, the Patient Medical Home (PMH) is a widely adopted care model that aims to operationalize the tenets and principles of Primary Health Care (PHC) as developed since the Alma-Ata Declaration. This paper describes how personnel working in and with Primary Care Networks (PCNs) in Alberta, Canada deployed the PMH model and its underlying PHC principles to frame and respond to the C19 shock. METHODS Using purposive and snowball sampling techniques, we interviewed 57 participants who worked in public health and primary care, including community-based family physicians. We used interpretive description to analyze the interviews. RESULTS PCN staff and physicians described how the PMH model was foundational to normal operations, and how C19 responses were framed by the patient-centric, team-delivered, and continuous care principles the model shares with PHC. Specifically, participants described ensuring access to care, addressing the social determinants of health, being patient centered, and redeploying and expanding PHC teams to accomplish these goals. DISCUSSION Delivering PHC through the PMH allowed physicians and allied health staff to deliver patient-centered, team-based, holistic bio-medical services to Albertans. In tailoring services to meet the specific social and health needs of the populations served by each PCN, healthcare providers were able to ensure relevant support remained available and accessible.
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Affiliation(s)
| | | | - Rida Abboud
- Co-RIG Project Consultant, Calgary, AB, Canada
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29
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Nawfal ES, Gray A, Sheehan DM, Ibañez GE, Trepka MJ. A Systematic Review of the Impact of HIV-Related Stigma and Serostatus Disclosure on Retention in Care and Antiretroviral Therapy Adherence Among Women with HIV in the United States/Canada. AIDS Patient Care STDS 2024; 38:23-49. [PMID: 38150524 PMCID: PMC10794841 DOI: 10.1089/apc.2023.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
This systematic review explores the roles of HIV stigma and disclosure of HIV serostatus in antiretroviral therapy (ART) adherence and retention in care (RIC) among women with HIV (WHIV) in the United States and Canada. We conducted a systematic search of electronic databases (PubMed, Embase, CINAHL, PsycINFO, and Google scholar) to identify peer-reviewed articles published between January 1996 and December 2022. The search yielded 1120 articles after duplicates were removed. Of these, 27 articles met the inclusion criteria. The majority (89%) of the studies were conducted in the United States. The studies included WHIV from diverse racial/ethnic groups, residing in both urban and rural areas. Most of the studies suggested that internalized stigma, perceived community stigma, and fear of disclosure were important barriers to ART adherence and RIC among WHIV. HIV-related stigma experienced within the health care setting was also reported as a factor impacting health care utilization. A few studies identified mental health distress as a potential mechanism accounting for the association and suggested that social support and resilience may buffer the negative effects of stigma and disclosure on ART adherence and RIC among WHIV. Our review indicates that stigma and concerns about disclosure continue to significantly affect HIV health outcomes for WHIV in high-income countries. It underscores the importance of integrated HIV care services and interventions targeting mental health, resilience building, and improved patient-provider relationships for WHIV to enhance ART adherence and RIC. Longitudinal studies and investigations into additional mechanisms are needed to advance understanding and inform women-centered interventions.
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Affiliation(s)
- Ekpereka Sandra Nawfal
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Aaliyah Gray
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
| | - Gladys E. Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
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Burnside J, Thomas T, Sebastiani G, Saeed S. Geographical disparities in gastroenterologists and transient elastography across Canada. CANADIAN LIVER JOURNAL 2023; 6:417-424. [PMID: 38152324 PMCID: PMC10751006 DOI: 10.3138/canlivj-2023-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/28/2023] [Indexed: 12/29/2023]
Abstract
Background In the next decade, the incidence and prevalence of advanced liver disease are expected to increase across Canada. However, little is known about the country's resources for monitoring patients requiring specialized care. A resource assessment was conducted to evaluate regional disparities of specialists and transient elastography machines across Canada. Methods Demographic data on licenced gastroenterologists were obtained from Scott's Medical Directory as of October 2022. The primary location of each specialist was linked to 2016 Statistics Canada to obtain the population size and density of provinces/territories and census division (CD). Results were summarized per 100,000 persons. CDs were classified as resource scare or approaching resource scarcity. A list of transient elastography (TE) was provided by KNS Canada Inc. and summarized per 1,000,000 persons by province. Results Eight hundred fifty-three specialists were identified. Rates of gastroenterologists per 100,000 people ranged from 0 in the territories to 2.9 in Quebec. Half the provinces had fewer than 2.0 gastroenterologists per 100,000 persons. Gastroenterologists were concentrated in 24% (71/293) of the CDs across Canada. We identified resource-scarce CDs as areas with no gastroenterologists and in the highest tercile of population density, which accounted for 33% (1 of 3) in Prince Edward Island, 32% in Quebec, 25% in Ontario, 7% in British Columbia, and 4% in Manitoba. Only 94 TEs were identified nationwide. Conclusion We found significant variation in liver-specific resources across Canada. Given the increasing number of people living with liver disease, policies must be implemented to address access to specialized care.
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Affiliation(s)
- Jessica Burnside
- Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Tyler Thomas
- Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | | | - Sahar Saeed
- Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
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Graf J, Ng HS, Zhu F, Zhao Y, Wijnands JMA, Evans C, Fisk JD, Marrie RA, Tremlett H. Multiple sclerosis disease-modifying drug use by immigrants: a real-world study. Sci Rep 2023; 13:21235. [PMID: 38040796 PMCID: PMC10692166 DOI: 10.1038/s41598-023-46313-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 10/30/2023] [Indexed: 12/03/2023] Open
Abstract
Little is known about disease-modifying drug (DMD) initiation by immigrants with multiple sclerosis (MS) in countries with universal health coverage. We assessed the association between immigration status and DMD use within 5-years after the first MS-related healthcare encounter. Using health administrative data, we identified MS cases in British Columbia (BC), Canada. The index date was the first MS-related healthcare encounter (MS/demyelinating disease-related diagnosis or DMD prescription filled), and ranged from 01/January/1996 to 31/December/2012. Those included were ≥ 18 years old, BC residents for ≥ 1-year pre- and ≥ 5-years post-index date. Persons becoming permanent residents 1985-2012 were defined as immigrants, all others were long-term residents. The association between immigration status and any DMD prescription filled within 5-years post-index date (with the latest study end date being 31/December/2017) was assessed using logistic regression, reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). We identified 8762 MS cases (522 were immigrants). Among immigrants of lower SES, odds of filling any DMD prescription were reduced, whereas they did not differ between immigrants and long-term residents across SES quintiles (aOR 0.96; 95%CI 0.78-1.19). Overall use (odds) of a first DMD within 5 years after the first MS-related encounter was associated with immigration status.
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Affiliation(s)
- Jonas Graf
- Division of Neurology, Department of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Huah Shin Ng
- Division of Neurology, Department of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Feng Zhu
- Division of Neurology, Department of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Yinshan Zhao
- Division of Neurology, Department of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - José M A Wijnands
- Division of Neurology, Department of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - John D Fisk
- Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Helen Tremlett
- Division of Neurology, Department of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.
- Division of Neurology, Department of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia Vancouver, Rm S126, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
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Wang Q, Liu S, Nie Z, Zhu Z, Fu Y, Zhang J, Wei X, Yang L, Wei X. The pan-Canadian Tiered Pricing Framework and Chinese National Volume-Based Procurement: A comparative study using Donabedian's structure-process-outcome framework. J Glob Health 2023; 13:04137. [PMID: 37947028 PMCID: PMC10636597 DOI: 10.7189/jogh.13.04137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
Background Generic drugs have been seen as a potentially powerful way to alleviate the financial burden on patients and health care systems. Two strategies for achieving rational prices of generic drugs are tiered pricing framework and pooled purchasing power. We compare the pan-Canadian Tiered Pricing Framework (TPF) and the Chinese National Volume-Based Procurement (NVBP) as comparators to explore the similarities and differences between the two mechanisms and summarise lessons for other jurisdictions. Methods This comparative study applies Donabedian's structure-process-outcome framework to systematically analyse the macro contexts, procedures, and long- and short-term results of each pricing mechanism, and the interactions between them. Results Structure: TPF is an upstream initiative aimed at lowering the prices of generic drugs and increasing coverage and price consistency. NVBP is a downstream national initiative prioritised for reducing drug prices to achieve value-based purchasing. Process: By associating the number of manufacturers with price cuts, TPF leaves the choice to manufacturers to decide if they want to enter a specific market. In contrast, the Chinese government determines NVBP list and has the authority to choose manufacturer(s) with the lowest price(s). TPF provides clear price information to potential suppliers with unclear order quantity. The NVBP drug price is determined by tendering, while procurement volume is clear and massive. Outcome: The effectiveness of TPF and NVBP is similar, with both achieving a 53% price cut. Both TPF and NVBP experienced efficiency improvement since their establishment, with 98 and 86 drugs priced per year. By comparing 60 drugs covered by both programmes, the NVBP price is 57% of that of the TPF counterpart on average (1.1 to 301.6%), by purchase power parity. Conclusions The tiered pricing scheme is feasible in regions with a stable and mature pharmaceutical market, typically seen in high-income countries, while tendering is more workable in low- and middle-income countries where the pharmaceutical market is weak and unstable. Experience in the two countries shows that a coordinated pricing mechanism involves many piecemeal interactive problems, which a sophisticated system with a robust long-range plan may address better.
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Affiliation(s)
- Quan Wang
- School of Public Health, Peking University, Beijing, China
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Siqi Liu
- Center of Health System and Policy, Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Zhijie Nie
- School of Public Health, Peking University, Beijing, China
| | - Zheng Zhu
- School of Public Health, Peking University, Beijing, China
| | - Yaqun Fu
- School of Public Health, Peking University, Beijing, China
| | - Jiawei Zhang
- School of Public Health, Peking University, Beijing, China
| | - Xia Wei
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, England, UK
| | - Li Yang
- School of Public Health, Peking University, Beijing, China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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McKay M, Brown R, Mallam K, MacDonald Green A, Bernard A. Engaging the collective voice of physicians: Optimizing participation in research and policy development in the context of COVID-19 and physician burnout. Healthc Manage Forum 2023; 36:378-381. [PMID: 37671740 DOI: 10.1177/08404704231199083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Physicians and governments work collaboratively to determine optimal healthcare policy options. Physicians are also engaged by health researchers to participate in studies. Physician engagement can be impeded by limits on physician time and remuneration for engagement, and the impact of physician burnout (exacerbated by COVID-19). Doctors Nova Scotia engaged physicians on various research and policy items throughout the pandemic. Strategies included integrating physicians into research teams, remunerating engagement activities, and leveraging existing tools and networks. Health researchers and policy-makers can improve physician engagement through physician champions, reduction of research duplication, valuing of physician contributions, and integrating networks.
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Affiliation(s)
| | - Ryan Brown
- Doctors Nova Scotia, Dartmouth, Nova Scotia, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Katie Mallam
- Doctors Nova Scotia, Dartmouth, Nova Scotia, Canada
| | | | - André Bernard
- Doctors Nova Scotia, Dartmouth, Nova Scotia, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
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Austin Z, Crown N. Health human resources planning in Canada-Part I: Opportunities and challenges for pharmacy. Can Pharm J (Ott) 2023; 156:309-315. [PMID: 38024458 PMCID: PMC10655802 DOI: 10.1177/17151635231201802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Zubin Austin
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
- Institute for Health Policy, Management and Evaluation – Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Natalie Crown
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
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Horváth K, Túri G, Kaposvári C, Cseh B, Dózsa CL. Challenges and opportunities for improvement in the management and financing system of Health Promotion Offices in Hungary. Front Public Health 2023; 11:1219186. [PMID: 37965520 PMCID: PMC10641462 DOI: 10.3389/fpubh.2023.1219186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Background One hundred ten Health Promotion Offices (HPOs) have started operating in Hungary in response to public health challenges. Many of them have been active for almost 10 years, yet their operational experience has not been evaluated. The specific objectives of our study were: (1) to describe the current operational and funding system of HPOs, (2) to identify challenges related to the current management and funding practices, and (3) to formulate recommendations for improvement based on gathered experience and international experience. Design In order to gain a deeper insight into the operational experience of HPOs, an online survey was conducted with the professional or economic managers of HPOs. A scoping review was carried out to gather international experiences about best practices to formulate recommendations for improvement in developing the operational and financing scheme for HPOs. Results We found that current HPO network in Hungary faces three main challenges: a deficient management system, inflexible financing scheme, and unequal ability to purchase or provide services for the population. Conclusions Based on the survey complemented by international experiences, we propose the overhaul of the professional management system and switching toa combination of fixed and performance-based financing scheme for the HPOs in Hungary.
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Affiliation(s)
- Krisztián Horváth
- Department of Public Health, Semmelweis University, Budapest, Hungary
- Med-Econ Human Services Ltd., Budapest, Hungary
- Synthesis Health Research Foundation, Budapest, Hungary
| | - Gergo Túri
- Med-Econ Human Services Ltd., Budapest, Hungary
- Synthesis Health Research Foundation, Budapest, Hungary
| | - Csilla Kaposvári
- Med-Econ Human Services Ltd., Budapest, Hungary
- Synthesis Health Research Foundation, Budapest, Hungary
- Faculty of Health Sciences, Doctoral School, University of Pécs, Pécs, Hungary
| | - Borbála Cseh
- Med-Econ Human Services Ltd., Budapest, Hungary
- Doctoral School of Medical Sciences, Semmelweis University, Budapest, Hungary
| | - Csaba László Dózsa
- Med-Econ Human Services Ltd., Budapest, Hungary
- Department of Theoretical Health Sciences, Faculty of Health Sciences, University of Miskolc, Miskolc, Hungary
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Matheson FI, McLuhan A, Croxford R, Hahmann T, Ferguson M, Mejia-Lancheros C. Health status and health-care utilization among men recently released from a superjail: a matched prospective cohort study. Int J Prison Health 2023; ahead-of-print. [PMID: 37658480 DOI: 10.1108/ijph-01-2023-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
PURPOSE Continuity of care and access to primary care have been identified as important contributors to improved health outcomes and reduced reincarceration among people who are justice-involved. While the disproportionate burden of health concerns among incarcerated populations is well documented, less is known about their health service utilization, limiting the potential for effective improvements to current policy and practice. This study aims to examine health status and health care utilization among men recently released from a superjail in a large metropolitan area to better understand patterns of use, risk factors and facilitators. DESIGN/METHODOLOGY/APPROACH Participants included adult men (n = 106) matched to a general population group (n = 530) in Ontario, Canada, linked to medical records (88.5% linkage) to examine baseline health status and health utilization three-months post-release. The authors compared differences between the groups in baseline health conditions and estimated the risk of emergency department, primary care, inpatient hospitalization and specialist ambulatory care visits. FINDINGS Superjail participants had a significantly higher prevalence of respiratory conditions, mental illness, substance use and injuries. Substance use was a significant risk factor for all types of visits and emergency department visits were over three times higher among superjail participants. ORIGINALITY/VALUE This empirical case is illustrative of an emerging phenomenon in some regions of the world where emergency departments serve as de facto "walk-in clinics" for those with criminal justice involvement. Strategic approaches to health services are required to meet the complex social and health needs and disparities in access to care experienced by men released from custody.
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Affiliation(s)
- Flora I Matheson
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; ICES, Toronto, Canada and Dalla Lana School of Public Health and Centre for Criminology and Socio-Legal Studies, University of Toronto, Toronto, Canada
| | - Arthur McLuhan
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | | | - Tara Hahmann
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Max Ferguson
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Cilia Mejia-Lancheros
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
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McCracken RK, Hedden L. What can publicly funded schools teach us about how to fix the family doctor shortage? Healthc Manage Forum 2023; 36:322-326. [PMID: 37335553 PMCID: PMC10447178 DOI: 10.1177/08404704231183175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Recent estimates suggest that up to 22% of Canadians over 18 do not have regular access to a family doctor or nurse practitioner. This lack of access is often characterized as a "family doctor shortage" and has been making headlines for decades. However, we have more family doctors than ever before, and in fact, the lack of primary care access is less about a shortage of physicians and more a need to develop a modern infrastructure and new way of funding and organizing care. Real change will require a paradigm shift from doctor- to clinic-organized care. The example of how schools are organized for public education may hold answers about how to make that paradigm shift and with investment in infrastructure see improvements in access to care across the country.
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Affiliation(s)
- Rita K. McCracken
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Lindsay Hedden
- Simon Fraser University, Burnaby, British Columbia, Canada
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Lin S(L. Inequities in Mental Health Care Facing Racialized Immigrant Older Adults With Mental Disorders Despite Universal Coverage: A Population-Based Study in Canada. J Gerontol B Psychol Sci Soc Sci 2023; 78:1555-1571. [PMID: 36842070 PMCID: PMC10461535 DOI: 10.1093/geronb/gbad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Indexed: 02/27/2023] Open
Abstract
OBJECTIVES Contemporary immigration scholarship has typically treated immigrants with diverse racial backgrounds as a monolithic population. Knowledge gaps remain in understanding how racial and nativity inequities in mental health care intersect and unfold in midlife and old age. This study aims to examine the joint impact of race, migration, and old age in shaping mental health treatment. METHODS Pooled data were obtained from the Canadian Community Health Survey (2015-2018) and restricted to respondents (aged ≥45 years) with mood or anxiety disorders (n = 9,099). Multivariable logistic regression was performed to estimate associations between race-migration nexus and past-year mental health consultations (MHC). Classification and regression tree (CART) analysis was applied to identify intersecting determinants of MHC. RESULTS Compared to Canadian-born Whites, racialized immigrants had greater mental health needs: poor/fair self-rated mental health (odds ratio [OR] = 2.23, 99% confidence interval [CI]: 1.67-2.99), perceived life stressful (OR = 1.49, 99% CI: 1.14-1.95), psychiatric comorbidity (OR = 1.42, 99% CI: 1.06-1.89), and unmet needs for care (OR = 2.02, 99% CI: 1.36-3.02); in sharp contrast, they were less likely to access mental health services across most indicators: overall past-year MHC (OR = 0.54, 99% CI: 0.41-0.71) and consultations with family doctors (OR = 0.67, 99% CI: 0.50-0.89), psychologists (OR = 0.54, 99% CI: 0.33-0.87), and social workers (OR = 0.37, 99% CI: 0.21-0.65), with the exception of psychiatrist visits (p = .324). The CART algorithm identifies three groups at risk of MHC service underuse: racialized immigrants aged ≥55 years, immigrants without high school diplomas, and linguistic minorities who were home renters. DISCUSSION To safeguard health care equity for medically underserved communities in Canada, multisectoral efforts need to guarantee culturally responsive mental health care, multilingual services, and affordable housing for racialized immigrant older adults with mental disorders.
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Affiliation(s)
- Shen (Lamson) Lin
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong Special Administrative Region, China
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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Wilton-Clark H, Al-aghbari A, Yang J, Yokota T. Advancing Epidemiology and Genetic Approaches for the Treatment of Spinal and Bulbar Muscular Atrophy: Focus on Prevalence in the Indigenous Population of Western Canada. Genes (Basel) 2023; 14:1634. [PMID: 37628685 PMCID: PMC10454234 DOI: 10.3390/genes14081634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/10/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Spinal and bulbar muscular atrophy (SBMA), also known as Kennedy's disease, is a debilitating neuromuscular disease characterized by progressive muscular weakness and neuronal degeneration, affecting 1-2 individuals per 100,000 globally. While SBMA is relatively rare, recent studies have shown a significantly higher prevalence of the disease among the indigenous population of Western Canada compared to the general population. The disease is caused by a pathogenic expansion of polyglutamine residues in the androgen receptor protein, which acts as a key transcriptional regulator for numerous genes. SBMA has no cure, and current treatments are primarily supportive and focused on symptom management. Recently, a form of precision medicine known as antisense therapy has gained traction as a promising therapeutic option for numerous neuromuscular diseases. Antisense therapy uses small synthetic oligonucleotides to confer therapeutic benefit by acting on pathogenic mRNA molecules, serving to either degrade pathogenic mRNA transcripts or helping to modulate splicing. Recent studies have explored the suitability of antisense therapy for the treatment of SBMA, primarily focused on gene therapy and antisense-mediated mRNA knockdown approaches. Advancements in understanding the pathogenesis of SBMA and the development of targeted therapies offer hope for improved quality of life for individuals affected by this debilitating condition. Continued research is essential to optimize these genetic approaches, ensuring their safety and efficacy.
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Affiliation(s)
- Harry Wilton-Clark
- Department of Medical Genetics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Ammar Al-aghbari
- Department of Biological Sciences, Faculty of Science, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Jessica Yang
- Department of Immunology, Department of Pharmacology and Toxicology, Faculty of Arts and Science, University of Toronto, Toronto, ON M5S 1A1, Canada;
| | - Toshifumi Yokota
- Department of Medical Genetics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada;
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Spithoff S, Mogic L. Enterprise Healthcare Physician Services in Canada: An Environmental Scan. Healthc Policy 2023; 19:71-80. [PMID: 37695709 PMCID: PMC10519332 DOI: 10.12927/hcpol.2023.27155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
Employers in Canada are increasingly offering physician services to their employees through third-party "enterprise" virtual care platforms. In our environmental scan, we identified nine enterprise healthcare companies offering physician services to millions of Canadian employees via enterprise platforms. All platforms offered rapid access to virtual physician services. Some offered in-person visits, access to specialists, health system navigation and sharing of information with an employee's regular care provider. Almost half shared aggregate or de-identified health data with employers. These platforms provide rapid and convenient access to physician services but also disrupt the continuity of care, pose risks to employee privacy and expand two-tiered healthcare.
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Affiliation(s)
- Sheryl Spithoff
- Assistant Professor Department of Family and Community Medicine University of Toronto Scientist Women's College Hospital Research Institute Women's College Hospital, Toronto, ON
| | - Lana Mogic
- Research Assistant Department of Family and Community Medicine Women's College Hospital Toronto, ON
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Gatov E, Strudwick G, Wiljer D, Kurdyak P. E-Mental Health Services in Canada: Can They Close the Access Gap? Healthc Policy 2023; 19:40-48. [PMID: 37695705 PMCID: PMC10519335 DOI: 10.12927/hcpol.2023.27159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
With significant unmet needs for mental healthcare in Canada, there is a growing interest in e-mental health (e-MH) services to meet gaps in access. While the policy window appears to be open, it is unclear how best to implement e-MH services due to health system barriers that create unmet needs in the first place. We explore the financing, organization and delivery of Canadian mental health services and discuss the promise of e-MH services for alleviating access barriers, highlighting increased policy attention during the COVID-19 pandemic. We consider how evidence-based e-MH services have successfully scaled in other publicly funded healthcare systems and note potential issues in the Canadian context.
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Affiliation(s)
- Evgenia Gatov
- Candidate Health Services Research - Health Informatics Institute of Health Policy, Management and Evaluation University of Toronto Toronto, ON
| | - Gillian Strudwick
- Associate Professor Institute of Health Policy, Management and Evaluation University of Toronto Senior Scientist and Chief Clinical Informatics Officer Centre for Addiction and Mental Health Toronto, ON
| | - David Wiljer
- Professor Institute of Health Policy, Management and Evaluation University of Toronto Executive Director Education, Technology and Innovation University Health Network Toronto, ON
| | - Paul Kurdyak
- Medical Director Performance Improvement Centre for Addiction and Mental Health Professor and Co-Director Division of Adult Psychiatry and Health Systems Department of Psychiatry University of Toronto, Toronto, ON
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Bubela T, Flood CM, McGrail K, Straus SE, Mishra S. How Canada's decentralised covid-19 response affected public health data and decision making. BMJ 2023; 382:e075665. [PMID: 37487604 DOI: 10.1136/bmj-2023-075665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Affiliation(s)
- Tania Bubela
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Colleen M Flood
- Faculty of Law, Queen's University, Kingston, Ontario, Canada
| | - Kimberlyn McGrail
- School of Population and Public Health, University of British Columbia, British Columbia, Canada
| | - Sharon E Straus
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada
| | - Sharmistha Mishra
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada
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Clark J, Straus SE, Houston A, Abbasi K. The world expected more of Canada. BMJ 2023; 382:p1634. [PMID: 37487602 DOI: 10.1136/bmj.p1634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Affiliation(s)
| | - Sharon E Straus
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Adam Houston
- Human Rights Research and Education Centre, University of Ottawa, Ottawa, Canada
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Petrie S, Peters P. Health Service Implementation and Antifragile Characteristics in Rural Communities: A Dirt Research Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6418. [PMID: 37510650 PMCID: PMC10379114 DOI: 10.3390/ijerph20146418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
The implementation of health and care services within rural communities requires necessary sensitivity to the unique facets of rural places. Often, rural service implementation is executed with inappropriate frameworks based on assumptions derived from urban centres. To understand the characteristics of rural communities that can facilitate successful program implementation better, ethnographic accounts of rural health and care services were compiled in rural communities within Canada, Australia, and Iceland. Ethnographic accounts are presented in the first and third person, with an accompanying reflexive analysis immediately following these accounts. Antifragility was the guiding concept of interest when investigating rural implementation environments, a concept that posits that a system can gain stability from uncertainty rather than lose integrity. These ethnographic accounts provide evidence of antifragile operators such as optionality, hybrid leadership, starting small, nonlinear evaluation, and avoiding suboptimisation. It is shown that the integration of these antifragile operators allows programs to function better in complex rural systems. Further, the presence of capable individuals with sufficient knowledge in several disciplines and with depth in a single discipline allows for innovative local thinking initiatives.
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Affiliation(s)
- Samuel Petrie
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Paul Peters
- Department of Health Sciences, Carleton University, Ottawa, ON K1S 5B6, Canada
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Leslie M, Fadaak R, Pinto N. Doing primary care integration: a qualitative study of meso-level collaborative practices. BMC PRIMARY CARE 2023; 24:149. [PMID: 37460971 PMCID: PMC10353261 DOI: 10.1186/s12875-023-02104-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND The integration of Primary Care (PC) into broader health systems has been a goal in jurisdictions around the world. Efforts to achieve integration at the meso-level have drawn particular attention, but there are few actionable recommendations for how to enact a 'pro-integration culture' amongst government and PC governance bodies. This paper describes pragmatic integration activity undertaken by meso-level participants in Alberta, Canada, and suggests ways this activity may be generalizable to other health systems. METHODS 11 semi-structured interviews with nine key informants from meso-level organizations were selected from a larger qualitative study examining healthcare policy development and implementation during the COVID-19 pandemic. Selected interviews focused on participants' experiences and efforts to 'do' integration as they responded to Alberta's first wave of the Omicron variant in September 2021. An interpretive descriptive approach was used to identify repeating cycles in the integration context, and pragmatic integration activities. RESULTS As Omicron arrived in Alberta, integration and relations between meso-level PC and central health system participants were tense, but efforts to improve the situation were successfully made. In this context of cycling relationships, staffing changes made in reaction to exogenous shocks and political pressures were clear influences on integration. However, participants also engaged in specific behaviours that advanced a pro-integration culture. They did so by: signaling value through staffing and resource choices; speaking and enacting personal and group commitments to collaboration; persevering; and practicing bi-directional communication through formal and informal channels. CONCLUSIONS Achieving PC integration involves not just the reactive work of responding to exogenous factors, but also the proactive work of enacting cultural, relationship, and communication behaviors. These behaviors may support integration regardless of the shocks, staff turnover, and relational freeze-thaw cycles experienced by any health system.
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Affiliation(s)
- Myles Leslie
- School of Public Policy, University of Calgary, 906 8 Ave SW 5th floor T2P 1H9, Calgary, AB, Canada.
- Cumming School of Medicine, Department of Community Health Sciences. 3D10, University of Calgary, 3280 Hospital Drive NW Calgary, Calgary, Alberta, Alberta, T2N 4Z6, Canada.
| | - Raad Fadaak
- School of Public Policy, University of Calgary, 906 8 Ave SW 5th floor T2P 1H9, Calgary, AB, Canada
| | - Nicole Pinto
- School of Public Policy, University of Calgary, 906 8 Ave SW 5th floor T2P 1H9, Calgary, AB, Canada
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Abdelrehim M, Ravaghi V, Quiñonez C, Singhal S. Trends in self-reported cost barriers to dental care in Ontario. PLoS One 2023; 18:e0280370. [PMID: 37418457 PMCID: PMC10328358 DOI: 10.1371/journal.pone.0280370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 06/16/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND The affordability of dental care continues to receive attention in Canada. Since most dental care is privately financed, the use of dental care is largely influenced by insurance coverage and the ability to pay-out-of pocket. OBJECTIVES i) to explore trends in self-reported cost barriers to dental care in Ontario; ii) to assess trends in the socio-demographic characteristics of Ontarians reporting cost barriers to dental care; and iii) to identify the trend in what attributes predicts reporting cost barriers to dental care in Ontario. METHODS A secondary data analysis of five cycles (2003, 2005, 2009-10, 2013-14 and 2017-18) of the Canadian Community Health Survey (CCHS) was undertaken. The CCHS is a cross-sectional survey that collects information related to health status, health care utilization, and health determinants for the Canadian population. Univariate and bivariate analyses were conducted to determine the characteristics of Ontarians who reported cost barriers to dental care. Poisson regression was used to calculate unadjusted and adjusted prevalence ratios to determine the predictors of reporting a cost barrier to dental care. RESULTS In 2014, 34% of Ontarians avoided visiting a dental professional in the past three years due to cost, up from 22% in 2003. Having no insurance was the strongest predictor for reporting cost barriers to dental care, followed by being 20-39 years of age and having a lower income. CONCLUSION Self-reported cost barriers to dental care have generally increased in Ontario but more so for those with no insurance, low income, and aged 20-39 years.
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Affiliation(s)
- Mona Abdelrehim
- Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Vahid Ravaghi
- Faculty of Dentistry, University of Toronto, Toronto, Canada
- School of Dentistry, University of Birmingham, Birmingham, United Kingdom
| | - Carlos Quiñonez
- Faculty of Dentistry, University of Toronto, Toronto, Canada
- Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Sonica Singhal
- Faculty of Dentistry, University of Toronto, Toronto, Canada
- Public Health Ontario, Toronto, Canada
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d'Entremont MA, Ko D, Yan AT, Goodman SG, Ni J, Poirier P, Tardif JC, Grégoire JC, Couture ÉL, Nguyen M, Thanassoulis G, Sharma A, Huynh T. Race and Ethnicity With Atherosclerotic Cardiovascular Disease Outcomes Within a Universal Health Care System: Insights From the CARTaGENE Study. Can J Cardiol 2023; 39:925-932. [PMID: 36914033 DOI: 10.1016/j.cjca.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 02/20/2023] [Accepted: 03/07/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND It remains unclear whether racial and ethnic disparities for atherosclerotic cardiovascular disease (ASCVD) persist within universal health care systems. We aimed to explore long-term ASCVD outcomes within a single-payer health care system with extensive drug coverage in Québec, Canada. METHODS CARTaGENE (CaG) is a population-based prospective cohort study of individuals aged 40 to 69 years. We included only participants without previous ASCVD. The primary composite endpoint was time to the first ASCVD event (cardiovascular death, acute coronary syndrome, ischemic stroke-transient ischemic attack, or peripheral arterial vascular event). RESULTS The study cohort included 18,880 participants followed for a median of 6.6 years (2009 to 2016). The mean age was 52 years, and 52.4% were female. After further adjustment for socioeconomic and cardiovascular factors, the increase in ASCVD risk for South Asians (SAs) was attenuated (hazard ratio [HR], 1.41; 95% confidence interval [CI], 0.75, 2.67), whereas Black participants' risk was lower (HR, 0.52; 95% CI, 0.29, 0.95) compared with White participants. After similar adjustments, there were no significant differences in ASCVD outcomes among the Middle Eastern, Hispanic, East-Southeast Asian, Indigenous, and mixed race-ethnicities participants and the White participants. CONCLUSIONS After adjustment for CV risk factors, the risk of ASCVD was attenuated in the SA CaG participants. Intensive risk-factor modification may mitigate the ASCVD risk of the SAs. Within a universal health care context and comprehensive drug coverage, the ASCVD risk was lower among Black compared with White CaG participants. Future studies are needed to confirm whether universal and liberal access to health care and medications can reduce the rates of ASCVD among the Black population.
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Affiliation(s)
- Marc-André d'Entremont
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Québec, Canada; Population Health Research Institute, Hamilton, Ontario, Canada
| | - Dennis Ko
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | | | - Shaun G Goodman
- St Michael's Hospital, Toronto, Ontario, Canada; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Jiayi Ni
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, Montréal, Québec, Canada; Montreal Heart Institute Research Center, Montréal, Québec, Canada
| | - Jean C Grégoire
- Montreal Heart Institute, Montréal, Québec, Canada; Montreal Heart Institute Research Center, Montréal, Québec, Canada
| | - Étienne L Couture
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Québec, Canada
| | - Michel Nguyen
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Québec, Canada
| | | | - Abhinav Sharma
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada; McGill University Health Centre, Montréal, Québec, Canada
| | - Thao Huynh
- McGill University Health Centre, Montréal, Québec, Canada.
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Guilcher SJT, Bai YQ, Wodchis WP, Bronskill SE, Kuluski K. An interrupted time series study using administrative health data to examine the impact of the COVID-19 pandemic on alternate care level acute hospitalizations in Ontario, Canada. CMAJ Open 2023; 11:E621-E629. [PMID: 37437954 PMCID: PMC10356004 DOI: 10.9778/cmajo.20220086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Many health systems struggle with delayed discharges (known as alternate level of care [ALC] in Canada). Our objectives were to describe and compare patient and hospitalization characteristics by ALC status, and to examine the impact of the initial period of the COVID-19 pandemic on ALC rates in Ontario, Canada. METHODS We conducted an interrupted time series using linked administrative data for acute care hospital discharges in Ontario between Feb. 28, 2018, and Nov. 30, 2020. We measured the monthly ALC rate among discharges before and after the onset of the COVID-19 pandemic (Mar. 1, 2020). We used interrupted time series regressions to examine the association between the onset of the pandemic and average ALC monthly rates. RESULTS We identified no meaningful differences in patient and admission characteristics, irrespective of time; however, differences were identified by ALC status. The overall average monthly rate of ALC discharges before the COVID-19 pandemic was 4.9% and after the onset of the pandemic was 5.0%. These discharges dropped to 4.3% (n = 3558) in March 2020 but then rebounded to their peak of 5.8% (n = 3915). There was no significant change in the average level of ALC rates per month after the onset of the pandemic (increase of 0.36% average per month, 95% confidence interval [CI] -0.11% to 0.83%) or monthly rate of change (slope) after the onset of the pandemic (-0.08%, 95% CI -0.15 to 0). INTERPRETATION We identified a continued high rate of hospital discharges with an ALC component despite the considerable efforts in hospital to reduce hospital occupancy during the COVID-19 pandemic. Future research should examine why ALC rates remain high despite hospital efforts.
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Affiliation(s)
- Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy (Guilcher), University of Toronto; ICES UofT (Guilcher, Bai, Wodchis); ICES Central (Bronskill); Institute of Health Policy, Management and Evaluation (Guilcher, Bai, Wodchis, Bronskill, Kuluski), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis, Kuluski), Trillium Health Partners, Mississauga, Ont.
| | - Yu Qing Bai
- Leslie Dan Faculty of Pharmacy (Guilcher), University of Toronto; ICES UofT (Guilcher, Bai, Wodchis); ICES Central (Bronskill); Institute of Health Policy, Management and Evaluation (Guilcher, Bai, Wodchis, Bronskill, Kuluski), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis, Kuluski), Trillium Health Partners, Mississauga, Ont
| | - Walter P Wodchis
- Leslie Dan Faculty of Pharmacy (Guilcher), University of Toronto; ICES UofT (Guilcher, Bai, Wodchis); ICES Central (Bronskill); Institute of Health Policy, Management and Evaluation (Guilcher, Bai, Wodchis, Bronskill, Kuluski), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis, Kuluski), Trillium Health Partners, Mississauga, Ont
| | - Susan E Bronskill
- Leslie Dan Faculty of Pharmacy (Guilcher), University of Toronto; ICES UofT (Guilcher, Bai, Wodchis); ICES Central (Bronskill); Institute of Health Policy, Management and Evaluation (Guilcher, Bai, Wodchis, Bronskill, Kuluski), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis, Kuluski), Trillium Health Partners, Mississauga, Ont
| | - Kerry Kuluski
- Leslie Dan Faculty of Pharmacy (Guilcher), University of Toronto; ICES UofT (Guilcher, Bai, Wodchis); ICES Central (Bronskill); Institute of Health Policy, Management and Evaluation (Guilcher, Bai, Wodchis, Bronskill, Kuluski), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis, Kuluski), Trillium Health Partners, Mississauga, Ont
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Leslie M, Fadaak R, Lethebe BC, Szostakiwskyj JH. Assessing the appropriateness of community-based antibiotic prescribing in Alberta, Canada, 2017-2020, using ICD-9-CM codes: a cross-sectional study. CMAJ Open 2023; 11:E579-E586. [PMID: 37402557 PMCID: PMC10325582 DOI: 10.9778/cmajo.20220114] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Antimicrobial resistance is a rising threat to human health, and, with up to 90% of antibiotics prescribed in the community, it is critical to examine Canadian antibiotic stewardship practices in outpatient settings. We carried out a large-scale analysis of appropriateness in community-based prescribing of antibiotics to adults in Alberta, reporting on 3 years of data from physicians practising in the province. METHODS The study cohort was composed of all adult (age 18-65 yr) Alberta residents who filled at least 1 antibiotic prescription written by a community-based physician between Apr. 1, 2017, and Mar. 6, 2020. We linked diagnosis codes from the clinical modification of the International Classification of Diseases, 9th Revision (ICD-9-CM), as used for billing purposes by the province's fee-for-service community physicians, to drug dispensing records, as maintained in the province's pharmaceutical dispensing database. We included physicians practising in community medicine, general practice, generalist mental health, geriatric medicine and occupational medicine. Following an approach used in previous research, we linked diagnosis codes with antibiotic drug dispensations, classified across a spectrum of appropriateness (always, sometimes never, no diagnosis code). RESULTS We identified 3 114 400 antibiotic prescriptions dispensed to 1 351 193 adult patients by 5577 physicians. Of these prescriptions, 253 038 (8.1%) were "always appropriate," 1 168 131 (37.5%) were "potentially appropriate," 1 219 709 (39.2%) were "never appropriate," and 473 522 (15.2%) were not associated with an ICD-9-CM billing code. Among all dispensed antibiotic prescriptions, amoxicillin, azithromycin and clarithromycin were the most commonly prescribed drugs labelled "never appropriate." INTERPRETATION We found that nearly 40% of prescriptions dispensed to 1.35 million adult patients in Alberta's community-based settings over a 35-month period were inappropriate. This finding suggests that additional policies and programs to improve stewardship among physicians prescribing antibiotics for adult outpatients in Alberta may be warranted.
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Affiliation(s)
- Myles Leslie
- School of Public Policy (Leslie, Fadaak) Cumming School of Medicine, University of Calgary; Department of Community Health Sciences (Leslie) Cumming School of Medicine, University of Calgary; Clinical Research Unit (Lethebe, Hart Szostakiwskyj), Cumming School of Medicine, University of Calgary, Calgary, Alta.
| | - Raad Fadaak
- School of Public Policy (Leslie, Fadaak) Cumming School of Medicine, University of Calgary; Department of Community Health Sciences (Leslie) Cumming School of Medicine, University of Calgary; Clinical Research Unit (Lethebe, Hart Szostakiwskyj), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Brendan Cord Lethebe
- School of Public Policy (Leslie, Fadaak) Cumming School of Medicine, University of Calgary; Department of Community Health Sciences (Leslie) Cumming School of Medicine, University of Calgary; Clinical Research Unit (Lethebe, Hart Szostakiwskyj), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Jessie Hart Szostakiwskyj
- School of Public Policy (Leslie, Fadaak) Cumming School of Medicine, University of Calgary; Department of Community Health Sciences (Leslie) Cumming School of Medicine, University of Calgary; Clinical Research Unit (Lethebe, Hart Szostakiwskyj), Cumming School of Medicine, University of Calgary, Calgary, Alta
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Pradhan P, Lavallee M, Akinola S, Escobar Gimenes FR, Berard A, Methot J, Piche ME, Gonella JM, Cloutier L, Leclerc J. Causality assessment of adverse drug reaction: A narrative review to find the most exhaustive and easy-to-use tool in post-authorization settings. J Appl Biomed 2023; 21:59-66. [PMID: 37376882 DOI: 10.32725/jab.2023.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The core motive of pharmacovigilance is the detection and prevention of adverse drug reactions (ADRs), to improve the risk-benefit balance of the drug. However, the causality assessment of ADRs remains a major challenge among clinicians, and none of the available tools of causality assessment used for assessing ADRs have been universally accepted. OBJECTIVE To provide an up-to-date overview of the different causality assessment tools. METHODS We conducted electronic searches in MEDLINE, EMBASE, and the Cochrane database. The eligibility of each tool was screened by three reviewers. Each eligible tool was then scrutinized for its domains (the reported specific set of questions/areas used for calculating the likelihood of cause-and-effect relation of an ADR) to discover the most comprehensive tool. Finally, we subjectively assessed the tool's ease-of-use in a Canadian, Indian, Hungarian, and Brazilian clinical context. RESULTS Twenty-one eligible causality assessment tools were retrieved. Naranjo's tool and De Boer's tool appeared the most comprehensive among all the tools, covering 10 domains each. Regarding "ease-of-use" in a clinical setting, we judged that many tools were hard to implement in a clinical context because of their complexity and/or lengthiness. Naranjo's tool, Jones's tool, Danan and Benichou's tool, and Hsu and Stoll's tool appeared to be the easiest to implement into various clinical contexts. CONCLUSION Among the many tools identified, 1981 Naranjo's scale remains the most comprehensive and easy to use for performing causality assessment of ADRs. Upcoming analysis should compare the performance of each ADR tool in clinical settings.
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Affiliation(s)
- Pallavi Pradhan
- University of Quebec at Trois-Rivieres, Department of Anatomy, Trois-Rivieres, Canada
- University Institute of Cardiology and Pulmonology of Quebec - Laval University, Centre of Research, Laval, Canada
| | - Maude Lavallee
- University Institute of Cardiology and Pulmonology of Quebec - Laval University, Centre of Research, Laval, Canada
- Laval University, Faculty of Pharmacy, Laval, Canada
| | - Samuel Akinola
- University of Pecs, Faculty of Health Sciences, Department of Nursing, Pecs, Hungary
| | | | - Anick Berard
- University Hospital Center, Research Center of Sainte-Justine, Montreal, Canada
- University of Montreal, Faculty of Pharmacy, Montreal, Canada
| | - Julie Methot
- University Institute of Cardiology and Pulmonology of Quebec - Laval University, Centre of Research, Laval, Canada
- Laval University, Faculty of Pharmacy, Laval, Canada
| | - Marie-Eve Piche
- University Institute of Cardiology and Pulmonology of Quebec - Laval University, Centre of Research, Laval, Canada
- Laval University, Faculty of Medicine, Laval, Canada
| | | | - Lyne Cloutier
- University of Quebec at Trois-Rivieres, Department of Nursing, Trois-Rivieres, Canada
| | - Jacinthe Leclerc
- University Institute of Cardiology and Pulmonology of Quebec - Laval University, Centre of Research, Laval, Canada
- Laval University, Faculty of Pharmacy, Laval, Canada
- University of Quebec at Trois-Rivieres, Department of Nursing, Trois-Rivieres, Canada
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