A comparison of health care in Canada and the United States: the case of Pap smears

Mapping childcare support for patients at a sample of North American hospitals and cancer centers: an environmental scan

PURPOSE

Approximately a quarter of cancer patients are parents to young children. One unique challenge faced by this patient group is the difficulty of accessing childcare support during medical appointments. Hospital-based childcare options could represent a solution to this problem, but to this point, no comprehensive scans have described existing on-site childcare centers. The purpose of this study is to identify and characterize on-site childcare services available to patients at selected North American hospitals. This information could inform the development of similar programs for cancer patients.

METHODS

Using publicly available information, an environmental scan of the grey literature was conducted to investigate Canadian and American hospitals for the presence of childcare services. A standardized data collection tool was used to extract center characteristics.

RESULTS

Twenty-six childcare centers were identified across 161 hospitals in both Canada and the USA, with 8/55 Canadian hospitals and 18/106 American hospitals having patient-accessible on-site services. The majority of the centers were associated with pediatric hospitals (77%). Only a single childcare center was associated with a cancer hospital. All centers accommodated children between the ages of 3 and 8. Most centers were open for over 30 h per week (77%) and were free of charge to users (89%). Other characteristics, including capacity and staffing, varied widely.

CONCLUSIONS

These results represent an inventory of patient-accessible, on-site childcare services currently available at selected North American hospitals. Cancer patients who are also parents may especially benefit from this kind of support.

The Use of Decomposition Methods in Real-World Treatment Benefits Evaluation for Patients with Type 2 Diabetes Initiating Different Injectable Therapies: Findings from the INITIATOR Study

BACKGROUND

Determining characteristics of patients likely to benefit from a particular treatment could help physicians set personalized targets.

OBJECTIVES

To use decomposition methodology on real-world data to identify the relative contributions of treatment effects and patients' baseline characteristics.

METHODS

Decomposition analyses were performed on data from the Initiation of New Injectable Treatment Introduced after Antidiabetic Therapy with Oral-only Regimens (INITIATOR) study, a real-world study of patients with type 2 diabetes started on insulin glargine (GLA) or liraglutide (LIRA). These analyses investigated relative contributions of differences in baseline characteristics and treatment effects to observed differences in 1-year outcomes for reduction in glycated hemoglobin A_1c (HbA_1c) and treatment persistence.

RESULTS

The greater HbA_1c reduction seen with GLA compared with LIRA (-1.39% vs. -0.74%) was primarily due to differences in baseline characteristics (HbA_1c and endocrinologist as prescribing physician; P < 0.050). Patients with baseline HbA_1c of 9.0% or more or evidence of diagnosis codes related to mental illness achieved greater HbA_1c reductions with GLA, whereas patients with baseline polypharmacy (6-10 classes) or hypogylcemia achieved greater reductions with LIRA. Decomposition analyses also showed that the higher persistence seen with GLA (65% vs. 49%) was mainly caused by differences in treatment effects (P < 0.001). Patients 65 years and older, those with HbA_1c of 9.0% or more, those taking three oral antidiabetes drugs, and those with polypharmacy of more than 10 classes had higher persistence with GLA; patients 18 to 39 years and those with HbA_1c of 7.0% to less than 8.0% had higher persistence with LIRA.

CONCLUSIONS

Although decomposition does not demonstrate causal relationships, this method could be useful for examining the source of differences in outcomes between treatments in a real-world setting and could help physicians identify patients likely to respond to a particular treatment.