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Lebenbaum M, de Oliveira C, Gagnon F, Laporte A. Child health and its effect on adult social capital accumulation. Health Econ 2024; 33:844-869. [PMID: 38236659 DOI: 10.1002/hec.4792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 11/15/2023] [Accepted: 11/28/2023] [Indexed: 04/04/2024]
Abstract
Although studies have demonstrated important effects of poor health in childhood on stocks of human and health capital, little research has tested economic theories to investigate the effect of child health on social capital in adulthood. Studies on the influence of child health on adult social capital are mixed and have not used sibling fixed effects models to account for unmeasured family and genetic characteristics, that are likely to be important. Using the Add-Health sample, health in childhood was assessed as self-rated health, the occurrence of a physical health condition or mental health condition, while social capital in adulthood was measured as volunteering, religious service attendance, team sports participation, number of friends, social isolation, and social support. We used sibling fixed effects models, which attenuated several associations to non-significance. In sibling fixed effects models there was significant positive effects of greater self-rated health on participation in team sports and social support, and negative effect of mental health in childhood on social isolation in adulthood. These results suggest that children with poor health require additional supports to build and maintain their stock of social capital and highlight further potential benefits to efforts that address poor child health.
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Affiliation(s)
- Michael Lebenbaum
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Canadian Centre for Health Economics, Toronto, Ontario, Canada
- Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Canadian Centre for Health Economics, Toronto, Ontario, Canada
- Centre for Health Economics and the Hull York Medical School, University of York, York, UK
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - France Gagnon
- The Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, Ontario, Canada
| | - Audrey Laporte
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Canadian Centre for Health Economics, Toronto, Ontario, Canada
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2
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Obeid N, Coelho JS, Booij L, Dimitropoulos G, Silva-Roy P, Bartram M, Clement F, de Oliveira C, Katzman DK. Estimating additional health and social costs in eating disorder care for young people during the COVID-19 pandemic: implications for surveillance and system transformation. J Eat Disord 2024; 12:52. [PMID: 38671494 PMCID: PMC11047001 DOI: 10.1186/s40337-024-01003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The impact of the COVID-19 pandemic on young people with eating disorders (EDs) and their families was profound, with surging rates of hospitalizations and referrals reported internationally. This paper provides an account of the additional health and social costs of ED care for young people living in Canada incurred during the COVID-19 pandemic, drawing attention to the available data to inform these estimates while noting gaps in data capacities to account for a full view of the ED system of care. METHODS Three methodologies were used to capture costs: (1) provincial administrative data holdings available at the Canadian Institute of Health Information (CIHI) were used by Deloitte Access Economics to conduct analyses on costs related to hospitalizations, emergency room visits, outpatient visits with physicians and loss of well-being from being on a waitlist. These were examined across three fiscal years (April 1 to March 31, 2019-2022) to compare costs from one year before to two years after the onset of the pandemic, (2) data collected on support-based community ED organizations and, (3) costs identified by young people, caregivers and health care professionals. RESULTS Estimates of additional health care costs and social costs arising from ED care waitlists were estimated to have increased by 21% across the two years after the onset of the pandemic and is likely to represent an underestimate of costs. Costs related to some standard ED care services (e.g. day treatment programs) and support-based community ED organizations that saw a 118% increase in services during this time, are some examples of costs not captured in the current cost estimate. CONCLUSIONS This paper provides a first account of the additional health and social ED care costs associated with the pandemic, which indicate at minimum, a 21% increase. The results invite discussion for more investments in ED services for young people in Canada, as it is unclear if needs are expected to remain elevated. We suggest a call for a national surveillance strategy to improve data holdings to aid in managing services and informing policy. A robust strategy could open the door for much-needed, data-informed, system transformation efforts that can improve ED care for youth, families and clinicians.
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Affiliation(s)
- Nicole Obeid
- Eating Disorders Research Lab, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, K1H 8L1, Ottawa, ON, Canada.
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
| | - Jennifer S Coelho
- Provincial Specialized Eating Disorders Program for Children & Adolescents, BC Children's Hospital, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Linda Booij
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Gina Dimitropoulos
- Calgary Eating Disorder Program, Alberta Health Services, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Patricia Silva-Roy
- Eating Disorders Research Lab, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, K1H 8L1, Ottawa, ON, Canada
| | - Mary Bartram
- Mental Health Commission of Canada, Ottawa, ON, Canada
- School of Public Policy Administration, Carleton University, Ottawa, ON, Canada
| | - Fiona Clement
- Department of Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Debra K Katzman
- Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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Courtney DB, Barwick M, Amani B, Greenblatt AT, Aitken M, Krause KR, Andrade BF, Bennett K, Cleverley K, Uliaszek AA, de Oliveira C, Hawke LD, Henderson J, Wang W, Watson P, Gajaria A, Newton AS, Ameis S, Relihan J, Prebeg M, Chen S, Szatmari P. An Integrated Care Pathway for depression in adolescents: protocol for a Type 1 Hybrid Effectiveness-implementation, Non-randomized, Cluster Controlled Trial. BMC Psychiatry 2024; 24:193. [PMID: 38459453 PMCID: PMC10921633 DOI: 10.1186/s12888-023-05297-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/22/2023] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Our group developed an Integrated Care Pathway to facilitate the delivery of evidence-based care for adolescents experiencing depression called CARIBOU-2 (Care for Adolescents who Receive Information 'Bout OUtcomes, 2nd iteration). The core pathway components are assessment, psychoeducation, psychotherapy options, medication options, caregiver support, measurement-based care team reviews and graduation. We aim to test the clinical and implementation effectiveness of the CARIBOU-2 pathway relative to treatment-as-usual (TAU) in community mental health settings. METHODS AND ANALYSIS We will use a Type 1 Hybrid Effectiveness-Implementation, Non-randomized Cluster Controlled Trial Design. Primary participants will be adolescents (planned n = 300, aged 13-18 years) with depressive symptoms, presenting to one of six community mental health agencies. All sites will begin in the TAU condition and transition to the CARIBOU-2 intervention after enrolling 25 adolescents. The primary clinical outcome is the rate of change of depressive symptoms from baseline to the 24-week endpoint using the Childhood Depression Rating Scale-Revised (CDRS-R). Generalized mixed effects modelling will be conducted to compare this outcome between intervention types. Our primary hypothesis is that there will be a greater rate of reduction in depressive symptoms in the group receiving the CARIBOU-2 intervention relative to TAU over 24 weeks as per the CDRS-R. Implementation outcomes will also be examined, including clinician fidelity to the pathway and its components, and cost-effectiveness. ETHICS AND DISSEMINATION Research ethics board approvals have been obtained. Should our results support our hypotheses, systematic implementation of the CARIBOU-2 intervention in other community mental health agencies would be indicated.
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Affiliation(s)
- Darren B Courtney
- Centre for Addiction and Mental Health, Toronto, ON, Canada.
- University of Toronto, Toronto, ON, Canada.
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada.
| | - Melanie Barwick
- University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Bahar Amani
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada
| | - Andrea T Greenblatt
- University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Madison Aitken
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada
| | - Karolin R Krause
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada
| | - Brendan F Andrade
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Kathryn Bennett
- Department of Health Research Methods, Evidence, and Impact (Formerly Clinical Epidemiology and Biostatistics), McMaster University, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - Kristin Cleverley
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | | | | | - Lisa D Hawke
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Jo Henderson
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Priya Watson
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada
| | - Amy Gajaria
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Amanda S Newton
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Stephanie Ameis
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada
| | - Jacqueline Relihan
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada
| | - Matthew Prebeg
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Sheng Chen
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Cundill Centre for Child and Youth Depression, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
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4
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de Oliveira C, Tanner B. The Economic Burden of Chronic Psychotic Disorders: An Incidence-based Cost-of-Illness Approach. J Ment Health Policy Econ 2024; 27:13-21. [PMID: 38634394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/12/2023] [Indexed: 04/19/2024]
Abstract
BACKGROUND The economic burden of chronic psychotic disorders is substantial. However, few studies have employed an incidence based approach to estimate the economic burden of chronic psychotic disorders. Furthermore, the existing work has mainly used models populated with data obtained from published literature, making several assumptions to estimate incidence-based costs. AIMS OF THE STUDY The objective of this study was to estimate the direct cumulative mean health care costs of chronic psychotic disorders, using an incidence-based, cost-of-illness approach and real-world data from a single-payer health care system. METHODS Using health records from Ontario, Canada, all individuals with a valid health card number, residing in the province, and diagnosed with a chronic psychotic disorder between the ages of 16 and 45 from April 1st, 2006, to March 31st, 2021, were included in the analysis. Using a mix of bottom-up and top-down methodologies and a robust cost estimator, cumulative mean health care costs were estimated from diagnosis to death or the end of observation period. Cumulative mean health care costs, and respective 95% confidence intervals (CIs), were estimated for the 1-year period (i.e., first year post-diagnosis), overall, by sex, age groups and health service, and for the 5-, 10- and 15-periods, overall and by sex. RESULTS One-, 5-, 10- and 15-year total discounted cumulative mean health care costs were estimated at USD 24,441.16, 95% CI (USD 24,166.13, USD 24,716.19), USD 70,754.69, 95% CI (USD 69,827.48-USD 71,681.89), USD 117,136.88, 95% CI (USD 115,370.40-USD 118,903.35), and USD 157,829.01 95% CI (USD 155,599.32.-USD 160,058.70), respectively. Total mean 1-year costs post-diagnosis were higher for younger individuals. Although females had higher 1-year costs, males had higher 5-, 10- and 15-year costs. Psychiatric hospitalisations made up the largest component of total costs across all cost estimates. DISCUSSION These results suggest that the costs of chronic psychotic disorders are high in the year of diagnosis and then increase at a decreasing rate thereafter. Compared to previous work, the cost estimates from the present study suggest that the use of real-world data produces lower estimates of cumulative costs, albeit likely more accurate ones. However, these estimates do not account for costs of care provided in community-based agencies. IMPLICATIONS FOR HEALTH POLICIES These estimates will serve as important inputs for policymakers looking to make decisions around resource allocation. IMPLICATIONS FOR FUTURE RESEARCH Future research should seek to follow incident cases in administrative data over a longer time period to obtain cumulative costs of longer duration.
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Affiliation(s)
- Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Room T305, Toronto, Ontario M5S 2S1, Canada,
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Vijh R, Kouyoumdjian FG, Iwajomo T, Simpson AIF, Jones R, de Oliveira C, Kurdyak P. Chronic Psychotic Disorders and Correctional Involvement: A Population-Based Matched Case-Control Study in Ontario, Canada. Can J Psychiatry 2024; 69:196-206. [PMID: 37501606 PMCID: PMC10874599 DOI: 10.1177/07067437231189468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
OBJECTIVE Individuals with chronic psychotic disorders are overrepresented in correctional facilities, but little is known about factors that increase the risk of correctional involvement. The objective of this study was to compare individuals with chronic psychotic disorders who were released from correctional facilities in Ontario to individuals with chronic psychotic disorders but no correctional involvement on sociodemographic, clinical, and prior mental health-related health service utilization characteristics. METHOD All individuals with chronic psychotic disorders who were released from a provincial correctional facility in Ontario in 2010 were matched (1:2) by age and sex to Ontario residents with chronic psychotic disorders and no correctional involvement. Covariates included sociodemographic (rural residence, marginalization such as residential instability quintile, material deprivation quintile, dependency quintile, and ethnic concentration quintile) and clinical (duration of chronic psychotic disorder and comorbidities) characteristics, and mental health-related health service utilization characteristics (primary care physician, psychiatrist and emergency department visits, and hospitalizations) 1 and 3 years prior to correctional involvement. The association between correctional involvement and prior health service utilization was measured by estimating incidence rate ratios using Poisson and negative-binomial regressions. RESULTS Individuals with correctional involvement (N = 3,197) lived in neighbourhoods with higher material deprivation and residential instability, and had a shorter duration of illness, and more psychosocial comorbidities (e.g., behavioural issues and depression) than individuals without correctional involvement (N = 6,393). Adjusting for sociodemographic and clinical variables, individuals with correctional involvement had a higher rate of mental health-related primary care physician visits, emergency department visits, and hospitalizations but a lower rate of psychiatrist visits prior to correctional involvement, compared to individuals without correctional involvement. CONCLUSIONS Despite higher mental health-related comorbidities and higher rates of accessing acute mental health services among individuals with chronic psychotic disorders and correctional involvement, visits to psychiatrists prior to involvement were low.
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Affiliation(s)
- Ruchi Vijh
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Fiona G. Kouyoumdjian
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Tomisin Iwajomo
- ICES, Toronto, Ontario, Canada
- Institute of Mental Health Policy Research, CAMH, Toronto, Ontario, Canada
| | | | - Roland Jones
- Division of Forensic Psychiatry, CAMH, Toronto, Ontario, Canada
| | - Claire de Oliveira
- ICES, Toronto, Ontario, Canada
- Institute of Mental Health Policy Research, CAMH, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada
- Institute of Mental Health Policy Research, CAMH, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Courtney D, Mason J, Amani B, Rodak T, Szatmari P, Henderson J, de Oliveira C. Economic evaluations of treatment of depressive disorders in adolescents: Protocol for a scoping review. Early Interv Psychiatry 2024. [PMID: 38323501 DOI: 10.1111/eip.13498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/28/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024]
Abstract
AIM Depressive disorders in adolescents are common and impairing. Evidence-based treatments are available; however, at a cost. In the context of the COVID-19 pandemic, we anticipate increased demand for treatment services for adolescents with depression. We also anticipate that economic resources will be strained. Identifying cost-effective strategies to optimally treat depression in adolescents is imperative. This protocol for a scoping review aims to describe the literature with respect to economic evaluations of treatments for depression in adolescents. METHODS We will conduct a scoping review using established methods and reporting guidelines. MEDLINE, Embase, PsyclNFO, Econlit, and the International HTA Database will be searched from inception to June 13, 2023, with an update closer to time of manuscript submission, while the NHS Economic Evaluation Database archives will be searched from inception to December 2014. Publications that contain economic evaluations, in the context of a clinical trial or a model-based study, testing a treatment of depression in adolescents will be selected for inclusion. Extracted data items will include: economic evaluation perspectives, health outcome variables and costs used in economic evaluations, types of analyses performed, as well as quality of reporting and methodology. RESULT A narrative synthesis with summary tables will be used to describe our findings. CONCLUSION Our findings will help identify gaps in the literature with respect to economic analyses for the treatment of depression such that these gaps can be filled with future research. Policy-makers, funders and administrators may also use our findings to inform their decisions around provision of various treatments for depression in adolescents. REGISTRATION osf.io/5fteb (note that information on this link will be updated upon acceptance for publication based on reviewer comments).
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Affiliation(s)
- Darren Courtney
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Joyce Mason
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Bahar Amani
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Terri Rodak
- CAMH Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Szatmari
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jo Henderson
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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de Oliveira C, Matias MA, Jacobs R. Microsimulation Models on Mental Health: A Critical Review of the Literature. Value Health 2024; 27:226-246. [PMID: 37949353 DOI: 10.1016/j.jval.2023.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/20/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES To retrieve and synthesize the literature on existing mental health-specific microsimulation models or generic microsimulation models used to examine mental health, and to critically appraise them. METHODS All studies on microsimulation and mental health published in English in MEDLINE, Embase, PsycINFO, and EconLit between January 1, 2010, and September 30, 2022, were considered. Snowballing, Google searches, and searches on specific journal websites were also undertaken. Data extraction was done on all studies retrieved and the reporting quality of each model was assessed using the Quality Assessment Reporting for Microsimulation Models checklist, a checklist developed by the research team. A narrative synthesis approach was used to synthesize the evidence. RESULTS Among 227 potential hits, 19 studies were found to be relevant. Some studies covered existing economic-demographic models, which included a component on mental health and were used to answer mental-health-related research questions. Other studies were focused solely on mental health and included models that were developed to examine the impact of specific policies or interventions on specific mental disorders or both. Most models examined were of medium quality. The main limitations included the use of model inputs based on self-reported and/or cross-sectional data, small and/or nonrepresentative samples and simplifying assumptions, and lack of model validation. CONCLUSIONS This review found few high-quality microsimulation models on mental health. Microsimulation models developed specifically to examine mental health are important to guide healthcare delivery and service planning. Future research should focus on developing high-quality mental health-specific microsimulation models with wide applicability and multiple functionalities.
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Affiliation(s)
- Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Maria Ana Matias
- Centre for Health Economics, University of York, York, England, UK
| | - Rowena Jacobs
- Centre for Health Economics, University of York, York, England, UK
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Lebenbaum M, de Oliveira C, McKiernan J, Gagnon F, Laporte A. COVID-19 Pandemic, Physical Distancing Policies, and the Non-Profit Sector Volunteer Force. Nonprofit Volunt Sect Q 2024; 53:274-288. [PMID: 38250580 PMCID: PMC10116199 DOI: 10.1177/08997640231163782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Although COVID-19-related physical distancing has had large economic consequences, the impact on volunteerism is unclear. Using volunteer position postings data from Canada's largest volunteer center (Volunteer Toronto) from February 3, 2020, to January 4, 2021, we evaluated the impact of different levels of physical distancing on average views, total views, and total number of posts. There was about a 50% decrease in the total number of posts that was sustained throughout the pandemic. Although a more restrictive physical distancing policy was generally associated with fewer views, there was an initial increase in views during the first lockdown where total views were elevated for the first 4 months of the pandemic. This was driven by interest in COVID-19-related and remote work postings. This highlights the community of volunteers may be quite flexible in terms of adapting to new ways of volunteering, but substantial challenges remain for the continued operations of many non-profit organizations.
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Affiliation(s)
- Michael Lebenbaum
- University of Toronto, Ontario, Canada
- Canadian Centre for Health Economics, Toronto, Ontario, Canada
| | - Claire de Oliveira
- University of Toronto, Ontario, Canada
- Canadian Centre for Health Economics, Toronto, Ontario, Canada
- University of York, UK
| | | | | | - Audrey Laporte
- University of Toronto, Ontario, Canada
- Canadian Centre for Health Economics, Toronto, Ontario, Canada
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Mason J, Laporte A, McDonald JT, Kurdyak P, Fosse E, de Oliveira C. Assessing the "healthy immigrant effect" in mental health: Intra- and inter-cohort trends in mood and/or anxiety disorders. Soc Sci Med 2024; 340:116367. [PMID: 38039769 DOI: 10.1016/j.socscimed.2023.116367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 09/11/2023] [Accepted: 10/25/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND The healthy immigrant effect implies that, at the time of immigration, new immigrants are typically healthier than the Canadian-born population. Furthermore, this health advantage fades the longer cohorts of immigrants remain in the host country. METHODS Most studies assessing the healthy immigrant effect rely on strong, untestable assumptions to extract unique effects for length of stay (LOS) (i.e., how long an immigrant has been in a host country), period (i.e., year of observation), and cohort (i.e., year of immigration). Rather than attempting to parse out separate effects for LOS, period, and cohort, we adopt a descriptive, cohort-centric approach to study immigrant mental health, which examines intra- and inter-cohort trends, that is, joint LOS-period and cohort-period parameters, respectively. While intra-cohort trends show how immigrants' mental health change with LOS across periods, inter-cohort trends reveal how the mental health of successive cohorts of immigrants differ across time periods. To provide a thorough assessment of the healthy immigrant effect, we use both survey and administrative data on cohorts of Canadian immigrants from 2003 to 2013. RESULTS The survey data reveal that mental health declines steeply (i.e., there is an increase in mood and/or anxiety disorders) within and across immigrant cohorts, while the administrative data show little overall change in mental health care utilization within and across cohorts. The divergent results may reflect issues related to barriers in access to mental health services because the administrative data, which are based on health care utilization, do not the capture the increase in mental disorders seen in the survey data. CONCLUSION This study highlights the benefit of a cohort-based approach to assess the healthy immigrant effect as it pertains to mental health as well as the importance of using different types of data, which may be measuring different aspects of immigrant mental health and health care utilization.
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Affiliation(s)
- Joyce Mason
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Audrey Laporte
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Economics, University of Toronto, Toronto, Ontario, Canada
| | - James Ted McDonald
- Department of Economics, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ethan Fosse
- Department of Sociology, University of Toronto, Toronto, Ontario, Canada; Data Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
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Langer LK, Bayley MT, Levy C, Munce SEP, Lawrence DW, Tam A, de Oliveira C. Medical Care Among Individuals with a Concussion in Ontario: A Population-based Study. Can J Neurol Sci 2024; 51:87-97. [PMID: 36537153 DOI: 10.1017/cjn.2022.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Concussion affects 1.2% of the population annually; rural regions and children have higher rates of concussion. METHODS Using administrative health care linked databases, all residents of Ontario with a physician diagnosed concussion were identified using ICD-9 code 850 or ICD-10 code S06. Cases were tracked for 2 years for concussion-related health care utilization with relevant specialist physicians (i.e., neurology, otolaryngology, physiatry, psychiatry, ophthalmology). Billing codes, specialist codes, and time from index to visit were analyzed. Factors associated with increased specialist visits were also examined. RESULTS In total, 1,022,588 cases were identified between 2008 and 2014 with 2 years of post-concussion health care utilization available. Follow-up by physician within 3 days of injury occurred in only 14% of cases. Mean time between ED diagnosis and follow-up by a physician was 83.9 days, whereas for rural regions it was >100 days. About half of adults (51.9%) and children (50.3%) had at least 1 specialist visit following concussion. Mean time between injury and first specialist visit was 203.8 (SD 192.9) days for adults, 213.5 (SD 201.0) days for rural adults, and 276.0 (SD 202.6) days for children. There were 67,420 neurology visits, 70,404 psychiatry visits, 13,571 neurosurgery visits, 19,780 physiatry visits, 101,788 ENT visits, and 103,417 ophthalmology visits in the 2 years tracking period. Factors associated with more specialist use included age > 18 years, urban residence, and pre-injury psychiatric history. CONCLUSIONS There are discrepancies in post-concussion health care utilization based on age group and rural/urban residence. Addressing these risk factors could improve concussion care access.
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Affiliation(s)
| | - Mark Thedore Bayley
- KITE Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Charissa Levy
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Toronto ABI Network, Toronto, Canada
| | - Sarah Elizabeth Patricia Munce
- KITE Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - David Wyndham Lawrence
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
- Mt Sinai Hospital, New York, USA
| | - Alan Tam
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Claire de Oliveira
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Canada
- Centre for Health Economics and Hull York Medical School, University of York, UK
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11
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Lebenbaum M, Gagnon F, de Oliveira C, Laporte A. Genetic endowments for social capital: An investigation accounting for genetic nurturing effects. Econ Hum Biol 2024; 52:101316. [PMID: 38056316 DOI: 10.1016/j.ehb.2023.101316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 11/02/2023] [Accepted: 11/11/2023] [Indexed: 12/08/2023]
Abstract
Despite social capital having been shown to be important for health and well-being, relatively little research has examined genetic determinants. Genetic endowments for education have been shown to influence human, financial, and health capital, but few studies have examined social capital, and those conducted have yet to account for genetic nurturing. We used the Add-Health data to study the effect of genetic endowments on individual social capital using the education polygenic score (PGS). We used sibling fixed effects models and controlled for the family environment to account for genetic nurturing. After accounting for the family environment, we found moderately large significant associations between the education PGS and volunteering, but associations with religious service attendance and number of friends were completely attenuated in sibling fixed effects models. These findings highlight that genetic endowments play an important role in influencing volunteering and the importance of accounting for genetic nurturing.
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Affiliation(s)
- Michael Lebenbaum
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada; Canadian Centre for Health Economics, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada.
| | - France Gagnon
- The Dalla Lana School of Public Health (DLSPH), University of Toronto, 155 College St Room 500, Toronto, ON M5T 3M7, Canada
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada; Canadian Centre for Health Economics, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada; Centre for Health Economics and the Hull York Medical School, University of York, Heslington, York YO10 5DD, United Kingdom
| | - Audrey Laporte
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada; Canadian Centre for Health Economics, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada
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12
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de Oliveira C, Mason J, Luu L, Iwajomo T, Simbulan F, Kurdyak P, Pechlivanoglou P. The PSY-SIM Model: Using Real-World Data to Inform Health Care Policy for Individuals With Chronic Psychotic Disorders. Schizophr Bull 2023:sbad175. [PMID: 38104255 DOI: 10.1093/schbul/sbad175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND AND HYPOTHESIS Few microsimulation models have been developed for chronic psychotic disorders, severe and disabling mental disorders associated with poor medical and psychiatric outcomes, and high costs of care. The objective of this work was to develop a microsimulation model for individuals with chronic psychotic disorders and to use the model to examine the impact of a smoking cessation initiative on patient outcomes. STUDY DESIGN Using health records and survey data from Ontario, Canada, the PSY-SIM model was developed to simulate health and cost outcomes of individuals with chronic psychotic disorders. The model was then used to examine the impact of the Smoking Treatment for Ontario Patients (STOP) program from Ontario on the development of chronic conditions, life expectancy, quality of life, and lifetime health care costs. STUDY RESULTS Individuals with chronic psychotic disorders had a lifetime risk of 63% for congestive heart failure and roughly 50% for respiratory disease, cancer and diabetes, and a life expectancy of 76 years. The model suggests the STOP program can reduce morbidity and lead to survival and quality of life gains with modest increases in health care costs. At a long-term quit rate of 4.4%, the incremental cost-effectiveness ratio of the STOP program was $41,936/QALY compared with status quo. CONCLUSIONS Smoking cessation initiatives among individuals with chronic psychotic disorders can be cost-effective. These findings will be relevant for decision-makers and clinicians looking to improving health outcomes among this patient population.
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Affiliation(s)
- Claire de Oliveira
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Joyce Mason
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Linda Luu
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tomisin Iwajomo
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Frances Simbulan
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Petros Pechlivanoglou
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
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Abramovich A, Gould WA, Pang N, de Oliveira C, Iwajomo T, Vigny-Pau M, MacKinnon K, Lam JSH, Kurdyak P. Exploring Mediators of Mental Health Service Use Among Transgender Individuals in Ontario, Canada. Can J Psychiatry 2023; 68:933-948. [PMID: 37165522 PMCID: PMC10657585 DOI: 10.1177/07067437231171541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To determine if and to what degree neighbourhood-level marginalization mediates mental health service use among transgender individuals. METHODS This retrospective cohort study identified 2,085 transgender individuals through data obtained from 4 outpatient community and hospital clinics in 3 large cities in Ontario, which were linked with administrative health data between January 2015 and December 2019. An age-matched 1:5 comparison cohort was created from the general population of Ontario. Outcome measures were analysed from March 2020 to May 2022. The primary outcome was mental health service utilization, which included mental health-related visits to primary care providers, psychiatrists, mental health- and self-harm-related emergency department visits, and mental health hospitalizations. Mediation variables included ethnic concentration, residential instability, dependency, and material deprivation at the neighbourhood level and were derived from the Ontario Marginalization Index. RESULTS This study identified 2,085 transgender individuals from participating outpatient community and hospital clinics, who were matched to the general population (n = 10,425). Overall, neighbourhood-level marginalization did not clinically mediate mental health service use. However, transgender individuals were more likely to be exposed to all forms of neighbourhood-level marginalization, as well as having higher rates of health service use across all outcome measures. CONCLUSIONS In this study, mental health service use among transgender individuals was not clinically mediated by marginalization at the neighbourhood level. This study highlights the need to explore marginalization and mental health service use at the individual level to better understand the mental health disparities experienced by transgender individuals and to ensure that health-care services are inclusive and affirming.
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Affiliation(s)
- Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - W. Ariel Gould
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Nelson Pang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, Canada
- ICES University of Toronto, Mental Health and Addictions Research Program, Toronto, Canada
- Centre for Health Economics and Hull York Medical School, University of York, York, UK
| | - Tomisin Iwajomo
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- ICES University of Toronto, Mental Health and Addictions Research Program, Toronto, Canada
| | - Myriam Vigny-Pau
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - June Sing Hong Lam
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
- ICES University of Toronto, Mental Health and Addictions Research Program, Toronto, Canada
- General and Health Systems Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
- ICES University of Toronto, Mental Health and Addictions Research Program, Toronto, Canada
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14
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Tanner B, Kurdyak P, de Oliveira C. Adult Psychiatric Hospitalizations in Ontario, Canada Before and During the COVID-19 Pandemic. Can J Psychiatry 2023; 68:925-932. [PMID: 37006178 PMCID: PMC10657583 DOI: 10.1177/07067437231167386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
OBJECTIVE The impacts of the COVID-19 pandemic on psychiatric hospitalizations in Ontario are unknown. The purpose of this study was to identify changes to volumes and characteristics of psychiatric hospitalizations in Ontario during the COVID-19 pandemic. METHODS A time series analysis was done using psychiatric hospitalizations with admissions dates from July 2017 to September 2021 identified from provincial health administrative data. Variables included monthly volumes of hospitalizations as well as proportions of stays <3 days and involuntary admissions, overall and by diagnosis (mood, psychotic, addiction, and other disorders). Changes to trends during the pandemic were tested using linear regression. RESULTS A total of 236,634 psychiatric hospitalizations were identified. Volumes decreased in the first few months of the pandemic before returning to prepandemic volumes by May 2020. However, monthly hospitalizations for psychotic disorders increased by ∼9% compared to the prepandemic period and remained elevated thereafter. Short stays and involuntary admissions increased by approximately 2% and 7%, respectively, before trending downwards. CONCLUSION Psychiatric hospitalizations quickly stabilized in response to the COVID-19 pandemic. However, evidence suggested a shift towards a more severe presentation during this period.
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Affiliation(s)
- Bryan Tanner
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- ICES, Toronto, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- ICES, Toronto, Canada
- Institute of Mental Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- ICES, Toronto, Canada
- Institute of Mental Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
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15
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Milligan K, Tarasoff LA, Rodrigues ER, Iwajomo T, Gomes T, de Oliveira C, Brown HK, Urbanoski KA. Neonatal outcomes of pregnant women attending integrated and standard substance use treatment programs in Ontario, Canada. Birth 2023. [PMID: 37983747 DOI: 10.1111/birt.12784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/01/2023] [Accepted: 09/22/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Substance use in pregnancy raises concern given its potential teratogenic effects. Given the unique needs of parenting people and the potential impact for developing children, specialized substance use treatment programs are increasingly being implemented for this population. Substance use treatment is associated with more positive neonatal outcomes compared with no treatment, however treatment models vary limiting our understanding of key treatment components/modelsFew studies have explored the influence of treatment model type (i.e., integrated treatments designed for pregnant clients compared with standard treatment models) and no studies have examined the influence of treatment model on neonatal outcomes using Canadian data. METHOD We conducted a population-based cohort study of clients who were pregnant when initiating integrated (n = 564) and standard (n = 320) substance use treatment programs in Ontario, Canada. RESULTS Neonatal outcomes did not significantly differ by treatment type (integrated or standard), with rates of adverse neonatal outcomes higher than published rates for the general population, despite receipt of adequate levels of prenatal care. While this suggests no significant impact of treatment, it is notable that as a group, clients engaged in integrated treatment presented with more risk factors for adverse neonatal outcomes than those in standard treatment. While we controlled for these risks in our analyses, this may have obscured their influence in relation to treatment type. CONCLUSION Findings underscore the need for more nuanced research that considers the influence of client factors in interaction with treatment type. Pregnant clients engaged in any form of substance use treatment are at higher risk of having children who experience adverse neonatal outcomes. This underscores the urgent need for further investment in services and research to support maternal and neonatal health before and during pregnancy, as well as long-term service models that support women and children beyond the perinatal and early childhood periods.
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Affiliation(s)
- Karen Milligan
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Lesley A Tarasoff
- Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Erica R Rodrigues
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Tomisin Iwajomo
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Tara Gomes
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hilary K Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Karen A Urbanoski
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
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Singla DR, de Oliveira C, Murphy SM, Patel V, Charlebois J, Davis WN, Dennis CL, Kim JJ, Kurdyak P, Lawson A, Meltzer-Brody S, Mulsant BH, Schoueri-Mychasiw N, Silver RK, Tschritter D, Vigod SN, Byford S. Protocol for an economic evaluation of scalable strategies to improve mental health among perinatal women: non-specialist care delivered via telemedicine vs. specialist care delivered in-person. BMC Psychiatry 2023; 23:817. [PMID: 37940930 PMCID: PMC10634150 DOI: 10.1186/s12888-023-05318-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Perinatal depression affects an estimated 1 in 5 women in North America during the perinatal period, with annualized lifetime costs estimated at $20.6 billion CAD in Canada and over $45.9 billion USD in the US. Access to psychological treatments remains limited for most perinatal women suffering from depression and anxiety. Some barriers to effective care can be addressed through task-sharing to non-specialist providers and through telemedicine platforms. The cost-effectiveness of these strategies compared to traditional specialist and in-person models remains unknown. This protocol describes an economic evaluation of non-specialist providers and telemedicine, in comparison to specialist providers and in-person sessions within the ongoing Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) trial. METHODS The economic evaluation will be undertaken alongside the SUMMIT trial. SUMMIT is a pragmatic, randomized, non-inferiority trial across five North American study sites (N = 1,226) of the comparable effectiveness of two types of providers (specialist vs. non-specialist) and delivery modes (telemedicine vs. in-person) of a behavioural activation treatment for perinatal depressive and anxiety symptoms. The primary economic evaluation will be a cost-utility analysis. The outcome will be the incremental cost-effectiveness ratio, which will be expressed as the additional cost required to achieve an additional quality-adjusted life-year, as assessed by the EuroQol 5-Dimension 5-Level instrument. A secondary cost-effectiveness analysis will use participants' depressive symptom scores. A micro-costing analysis will be conducted to estimate the resources/costs required to implement and sustain the interventions; healthcare resource utilization will be captured via self-report. Data will be pooled and analysed using uniform price and utility weights to determine cost-utility across all trial sites. Secondary country-specific cost-utility and cost-effectiveness analyses will also be completed. Sensitivity analyses will be conducted, and cost-effectiveness acceptability-curves will be generated, in all instances. DISCUSSION Results of this study are expected to inform key decisions related to dissemination and scale up of evidence-based psychological interventions in Canada, the US, and possibly worldwide. There is potential impact on real-world practice by informing decision makers of the long-term savings to the larger healthcare setting in services to support perinatal women with common mental health conditions.
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Affiliation(s)
- Daisy R Singla
- Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada.
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
- Department of Global Health and Population, Harvard Chan School of Public Health, Boston, USA
| | | | | | - Cindy-Lee Dennis
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - J Jo Kim
- Department of Obstetrics & Gynecology, NorthShore University HealthSystem, Evanston, USA
| | - Paul Kurdyak
- Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
| | - Andrea Lawson
- Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Samantha Meltzer-Brody
- Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, USA
| | - Benoit H Mulsant
- Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Richard K Silver
- Department of Obstetrics & Gynecology, NorthShore University HealthSystem, Evanston, USA
- Department of Obstetrics and Gynecology, University of Chicago Pritzker School of Medicine, Chicago, USA
| | - Dana Tschritter
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | - Simone N Vigod
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
| | - Sarah Byford
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Vyas MV, Fang J, de Oliveira C, Austin PC, Yu AYX, Kapral MK. Attributable Costs of Stroke in Ontario, Canada and Their Variation by Stroke Type and Social Determinants of Health. Stroke 2023; 54:2824-2831. [PMID: 37823307 DOI: 10.1161/strokeaha.123.043369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/14/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Estimates of attributable costs of stroke are scarce, as most prior studies do not account for the baseline health care costs in people at risk of stroke. We estimated the attributable costs of stroke in a universal health care setting and their variation across stroke types and several social determinants of health. METHODS We undertook a population-based administrative database-derived matched retrospective cohort study in Ontario, Canada. Community-dwelling adults aged ≥40 years with a stroke between 2003 and 2018 were matched (1:1) on demographics and comorbidities with controls without stroke. Using a difference-in-differences approach, we estimated the mean 1-year direct health care costs attributable to stroke from a public health care payer perspective, accounting for censoring with a weighted available sample estimator. We described health sector-specific costs and reported variation across stroke type and social determinants of health. RESULTS The mean 1-year attributable costs of stroke were Canadian dollars 33 522 (95% CI, $33 231-$33 813), with higher costs for intracerebral hemorrhage ($40 244; $39 193-$41 294) than ischemic stroke ($32 547; $32 252-$32 843). Most of these costs were incurred in acute care hospitals ($15 693) and rehabilitation facilities ($7215). Compared with all patients with stroke, the mean attributable costs were higher among immigrants ($40 554; $39 316-$41 793), those aged <65 years ($35 175; $34 533-$35 818), and those residing in low-income neighborhoods ($34 687; $34 054-$35 320) and lower among rural residents ($29 047; $28 362-$29 731). CONCLUSIONS Our findings of high attributable costs of stroke, especially in immigrants, younger patients, and residents of low-income neighborhoods, can be used to evaluate potential health care cost savings associated with different primary stroke prevention strategies.
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Affiliation(s)
- Manav V Vyas
- Division of Neurology, Department of Medicine (M.V.V., A.Y.X.Y.), University of Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health (M.V.V., C.d.O., P.C.A., A.Y.X.Y., M.K.K.), University of Toronto, Canada
- Division of Neurology, Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health Toronto, Canada (M.V.V.)
- ICES, Toronto, Canada (M.V.V., J.F., C.d.O., P.C.A., A.Y.X.Y., M.K.K.)
| | - Jiming Fang
- ICES, Toronto, Canada (M.V.V., J.F., C.d.O., P.C.A., A.Y.X.Y., M.K.K.)
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health (M.V.V., C.d.O., P.C.A., A.Y.X.Y., M.K.K.), University of Toronto, Canada
- Health Economics, Centre for Addictions and Mental Health, Toronto, Canada (C.d.O.)
- ICES, Toronto, Canada (M.V.V., J.F., C.d.O., P.C.A., A.Y.X.Y., M.K.K.)
| | - Peter C Austin
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health (M.V.V., C.d.O., P.C.A., A.Y.X.Y., M.K.K.), University of Toronto, Canada
- ICES, Toronto, Canada (M.V.V., J.F., C.d.O., P.C.A., A.Y.X.Y., M.K.K.)
| | - Amy Y X Yu
- Division of Neurology, Department of Medicine (M.V.V., A.Y.X.Y.), University of Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health (M.V.V., C.d.O., P.C.A., A.Y.X.Y., M.K.K.), University of Toronto, Canada
- ICES, Toronto, Canada (M.V.V., J.F., C.d.O., P.C.A., A.Y.X.Y., M.K.K.)
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada (A.Y.X.Y.)
| | - Moira K Kapral
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health (M.V.V., C.d.O., P.C.A., A.Y.X.Y., M.K.K.), University of Toronto, Canada
- Division of General Internal Medicine, Department of Medicine (M.K.K.), University of Toronto, Canada
- ICES, Toronto, Canada (M.V.V., J.F., C.d.O., P.C.A., A.Y.X.Y., M.K.K.)
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de Oliveira C, Tanner B. Estimating Cumulative Health Care Costs of Childhood and Adolescence Autism Spectrum Disorder in Ontario, Canada: A Population-Based Incident Cohort Study. Pharmacoecon Open 2023; 7:987-995. [PMID: 37755688 PMCID: PMC10721567 DOI: 10.1007/s41669-023-00441-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Few studies have estimated cumulative health care costs post-diagnosis for individuals with autism spectrum disorder (ASD). OBJECTIVES Using an incidence-based approach, the objective of this analysis was to estimate cumulative costs of ASD to the Ontario health care system of children and adolescents. METHODS Using administrative health records from Ontario, Canada's most populous province, a retrospective, population-based, incident cohort study of children and adolescents aged 0-19 years old diagnosed with ASD was undertaken to estimate cumulative health care costs of ASD to the health care system from 2010 to 2019. Cumulative health care costs in 2021 Canadian dollars (CAD) from diagnosis to death or end of observation period were estimated using a consistent estimator based on the inverse probability weighting technique. Cumulative health care costs (and respective 95% confidence intervals [CI]) were estimated for 1, 5 and 10 years post-diagnosis by sex, age group and health service. RESULTS In 2010, there were 2867 diagnosed cases of ASD; in 2019, the number of incident cases had risen to 6072. The first year (i.e., 1-year) post-diagnosis cost of ASD was $4710.18 CAD (95% CI 4560.28-4860.08); just under a third of costs were for physician services. Total cumulative 5- and 10-year discounted costs were $16,025.95 CAD (15,371.64-16,680.26) and $32,635.76 CAD (28,906.94-36,364.58), respectively. Mean costs were higher for females and older age groups. CONCLUSIONS These results suggest that costs of ASD are high in the year of diagnosis and then increase at a steady rate thereafter. This information will help with future resource planning within the health care sector to ensure individuals with ASD are supported once their diagnosis is established.
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Affiliation(s)
- Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- ICES, Toronto, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Bryan Tanner
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Canada
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Minian N, Saiva A, Ahad S, Gayapersad A, Zawertailo L, Veldhuizen S, Ravindran A, de Oliveira C, Mulder C, Baliunas D, Selby P. Primary healthcare provider experience of knowledge brokering interventions for mood management. Health Psychol Behav Med 2023; 11:2265136. [PMID: 37811314 PMCID: PMC10557557 DOI: 10.1080/21642850.2023.2265136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023] Open
Abstract
Background Knowledge brokering is a knowledge translation strategy used in healthcare settings to facilitate the implementation of evidence into practice. How healthcare providers perceive and respond to various knowledge translation approaches is not well understood. This qualitative study used the Theoretical Domains Framework to examine healthcare providers' experiences with receiving one of two knowledge translation strategies: a remote knowledge broker (rKB); or monthly emails, for encouraging delivery of mood management interventions to patients enrolled in a smoking cessation program. Methods Semi-structured interviews were conducted with 21 healthcare providers recruited from primary care teams. We used stratified purposeful sampling to recruit participants who were allocated to receive either the rKB, or a monthly email-based knowledge translation strategy as part of a cluster randomized controlled trial. Interviews were structured around domains of the Theoretical Domains Framework (TDF) to explore determinants influencing practice change. Data were coded into relevant domains. Results Both knowledge translation strategies were considered helpful prompts to remind participants to deliver mood interventions to patients presenting depressive symptoms. Neither strategy appeared to have influenced the health care providers on the domains we probed. The domains pertaining to knowledge and professional identity were perceived as facilitators to implementation, while domains related to beliefs about consequences, emotion, and environmental context acted as barriers and/or facilitators to healthcare providers implementing mood management interventions. Conclusion Both strategies served as reminders and reinforced providers' knowledge regarding the connection between smoking and depressed mood. The TDF can help researchers better understand the influence of specific knowledge translation strategies on healthcare provider behavior change, as well as potential barriers and facilitators to implementation of evidence-informed interventions. Environmental context should be considered to address challenges and facilitate the movement of knowledge into clinical practice.
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Affiliation(s)
- Nadia Minian
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Anika Saiva
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Canada
| | - Sheleza Ahad
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Canada
| | | | - Laurie Zawertailo
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Scott Veldhuizen
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Canada
| | - Arun Ravindran
- Departments of Psychiatry & Pharmacology and Toxicology, University of Toronto, Toronto, Canada
- Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Cambell Family Mental Health Research Centre, Centre for Addiction and Mental Health, Toronto, Canada
| | - Claire de Oliveira
- Cambell Family Mental Health Research Centre, Centre for Addiction and Mental Health, Toronto, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Carol Mulder
- Department of Family Medicine, Queen’s University, Kingston, Canada
| | - Dolly Baliunas
- School of Public Health, University of Queensland, Herston, Australia
- Addictions, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Peter Selby
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Addictions Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Departments of Family and Community Medicine and Psychiatry, and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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20
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Arpin E, de Oliveira C, Siddiqi A, Laporte A. Beyond the mean: Distributional differences in earnings and mental health in young adulthood by childhood health histories. SSM Popul Health 2023; 23:101451. [PMID: 37434657 PMCID: PMC10331842 DOI: 10.1016/j.ssmph.2023.101451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 07/13/2023] Open
Abstract
Research on the long-term effects of health in early life has predominantly relied on parametric methods to assess differences between groups of children. However, this approach leaves a wealth of distributional information untapped. The objective of this study was to assess distributional differences in earnings and mental health in young adulthood between individuals who suffered a chronic illness in childhood compared to those who did not using the non-parametric relative distributions framework. Using data from the Panel Study of Income Dynamics, we find that young adults who suffered a chronic illness in childhood fare worse in terms of earnings and mental health scores in adulthood, particularly for individuals reporting a childhood mental health/developmental disorder. Covariate decompositions suggest that chronic conditions in childhood may indirectly affect later outcomes through educational attainment: had the two groups had similar levels of educational attainment, the proportion of individuals with a report of a chronic condition in childhood in the lower decile of the relative earnings distribution would have been reduced by about 20 percentage points. Findings may inform policy aimed at mitigating longer run effects of health conditions in childhood and may generate hypotheses to be explored in parametric analyses.
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Affiliation(s)
- Emmanuelle Arpin
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
- Canadian Center for Health Economics, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
- Canadian Center for Health Economics, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
- Centre for Health Economics and Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 1000 Queen Street West, Toronto, ON, M6J 1H4, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, 155 College St 6th Floor, Toronto, ON, M5T 3M6, Canada
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina – Chapel Hill, Chapel Hill, NC, USA
| | - Audrey Laporte
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
- Canadian Center for Health Economics, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
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21
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Baliunas D, Voci S, Selby P, de Oliveira C, Kurdyak P, Rosella L, Zawertailo L, Fu L, Sutradhar R. Incidence of chronic disease following smoking cessation treatment: A matched cohort study using linked administrative healthcare data in Ontario, Canada. PLoS One 2023; 18:e0288759. [PMID: 37494345 PMCID: PMC10370896 DOI: 10.1371/journal.pone.0288759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/04/2023] [Indexed: 07/28/2023] Open
Abstract
Scarce evidence is available on the impact of real-world smoking cessation treatment on subsequent health outcomes, such as incidence of chronic disease. This study compared two cohorts of people that smoke-those that enrolled in a smoking cessation program, and a matched control that had not accessed the program-to assess the incidence of cancer, chronic obstructive pulmonary disease, diabetes, hypertension, and major cardiovascular events over a 5-year follow-up period. We selected five sub-cohorts with matched treatment-control pairs in which both individuals were at risk of the five chronic diseases. Incident chronic disease from index date until December 31, 2017, was determined through linkage with routinely collected healthcare data. The cumulative incidence of each chronic disease was estimated using the cumulative incidence function with death as a competing risk. Gray's test was used to test for a difference between matched treatment and control groups in the chronic disease-specific cumulative incidence function over follow-up. Analyses were stratified by sex. Among females, cumulative incidence of diabetes was higher over follow-up for the treatment group (5-year cumulative incidence 5.8% vs 4.2%, p = 0.004), but did not differ for the four other chronic diseases. Among males, cumulative incidence of chronic obstructive pulmonary disease (12.2% vs 9.1%, p < 0.001) and diabetes (6.7% vs 4.8%, p < 0.001) both had higher 5-year cumulative incidence for the treated versus control groups but did not differ for the other three chronic diseases. We conclude that accessing primary-care based smoking cessation treatment is associated with increased incidence of diabetes for both sexes, and chronic obstructive pulmonary disease for males (possibly due to under diagnosis prior to treatment), within 5 years of treatment. The associations detected require further research to understand causal relationships.
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Affiliation(s)
- Dolly Baliunas
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, Queensland, Australia
- Clinical Research - Addictions, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- School of Public Health, University of Queensland, Herston, Queensland, Australia
| | - Sabrina Voci
- Nicotine Dependence Service, INTREPID Lab, Addictions Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Selby
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Nicotine Dependence Service, INTREPID Lab, Addictions Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Centre for Health Economics and Hull York Medical School, University of York, Heslington, York, United Kingdom
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Laura Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Laurie Zawertailo
- Nicotine Dependence Service, INTREPID Lab, Addictions Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | | | - Rinku Sutradhar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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22
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Ma R, Romano E, Ashworth M, Yadegarfar ME, Dregan A, Ronaldson A, de Oliveira C, Jacobs R, Stewart R, Stubbs B. Multimorbidity clusters among people with serious mental illness: a representative primary and secondary data linkage cohort study. Psychol Med 2023; 53:4333-4344. [PMID: 35485805 PMCID: PMC10388332 DOI: 10.1017/s003329172200109x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND People with serious mental illness (SMI) experience higher mortality partially attributable to higher long-term condition (LTC) prevalence. However, little is known about multiple LTCs (MLTCs) clustering in this population. METHODS People from South London with SMI and two or more existing LTCs aged 18+ at diagnosis were included using linked primary and mental healthcare records, 2012-2020. Latent class analysis (LCA) determined MLTC classes and multinominal logistic regression examined associations between demographic/clinical characteristics and latent class membership. RESULTS The sample included 1924 patients (mean (s.d.) age 48.2 (17.3) years). Five latent classes were identified: 'substance related' (24.9%), 'atopic' (24.2%), 'pure affective' (30.4%), 'cardiovascular' (14.1%), and 'complex multimorbidity' (6.4%). Patients had on average 7-9 LTCs in each cluster. Males were at increased odds of MLTCs in all four clusters, compared to the 'pure affective'. Compared to the largest cluster ('pure affective'), the 'substance related' and the 'atopic' clusters were younger [odds ratios (OR) per year increase 0.99 (95% CI 0.98-1.00) and 0.96 (0.95-0.97) respectively], and the 'cardiovascular' and 'complex multimorbidity' clusters were older (ORs 1.09 (1.07-1.10) and 1.16 (1.14-1.18) respectively). The 'substance related' cluster was more likely to be White, the 'cardiovascular' cluster more likely to be Black (compared to White; OR 1.75, 95% CI 1.10-2.79), and both more likely to have schizophrenia, compared to other clusters. CONCLUSION The current study identified five latent class MLTC clusters among patients with SMI. An integrated care model for treating MLTCs in this population is recommended to improve multimorbidity care.
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Affiliation(s)
- Ruimin Ma
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Eugenia Romano
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Mark Ashworth
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Mohammad E. Yadegarfar
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Alexandru Dregan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
| | - Amy Ronaldson
- Health Services and Population Research Department, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | | | - Rowena Jacobs
- Centre for Health Economics, University of York, York, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- Physiotherapy Department, South London and Maudsley National Health Services Foundation Trust, London, SE5 8AB, UK
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23
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Barry R, Rehm J, de Oliveira C, Gozdyra P, Chen S, Kurdyak P. The relationship between rurality, travel time to care and death by suicide. BMC Psychiatry 2023; 23:345. [PMID: 37198612 DOI: 10.1186/s12888-023-04805-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 04/20/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND We previously found an association between rurality and death by suicide, where those living in rural areas were more likely to die by suicide. One potential reason why this relationship exists might be travel time to care. This paper examines the relationship between travel time to both psychiatric and general hospitals and suicide, and then determine whether travel time to care mediates the relationship between rurality and suicide. METHODS This is a population-based nested case-control study. Data from 2007 to 2017 were obtained from administrative databases held at ICES, which capture all hospital and emergency department visits across Ontario. Suicides were captured using vital statistics. Travel time to care was calculated from the resident's home to the nearest hospital based on the postal codes of both locations. Rurality was measured using Metropolitan Influence Zones. RESULTS For every hour in travel time a male resides from a general hospital, their risk of death by suicide doubles (AOR = 2.08, 95% CI = 1.61-2.69). Longer travel times to psychiatric hospitals also increases risk of suicide among males (AOR = 1.03, 95%CI = 1.02-1.05). Travel time to general hospitals is a significant mediator of the relationship between rurality and suicide among males, accounting for 6.52% of the relationship between rurality and increased risk of suicide. However, we also found that there is effect modification, where the relationship between travel time and suicide is only significant among males living in urban areas. CONCLUSIONS Overall, these findings suggest that males who must travel longer to hospitals are at a greater risk of suicide compared to those who travel a shorter time. Furthermore, travel time to care is a mediator of the association between rurality and suicide among males.
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Affiliation(s)
- Rebecca Barry
- University of Toronto, University Dr NW, Calgary, AB, T2N 1N4, Canada.
| | - Jürgen Rehm
- University of Toronto, University Dr NW, Calgary, AB, T2N 1N4, Canada
- Centre for Addiction and Mental Health, Moscow, Russian Federation
- Dresden University of Technology, Dresden, Germany
| | - Claire de Oliveira
- University of Toronto, University Dr NW, Calgary, AB, T2N 1N4, Canada
- Centre for Addiction and Mental Health, Moscow, Russian Federation
- Centre for Health Economics and Hull York Medical School, University of York, York, UK
| | | | | | - Paul Kurdyak
- University of Toronto, University Dr NW, Calgary, AB, T2N 1N4, Canada
- Centre for Addiction and Mental Health, Moscow, Russian Federation
- ICES, Toronto, Canada
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Arpin E, de Oliveira C, Siddiqi A, Laporte A. The "Long-arm" of chronic conditions in childhood: Evidence from Canada using linked survey-administrative data. Econ Hum Biol 2023; 50:101257. [PMID: 37348288 DOI: 10.1016/j.ehb.2023.101257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 04/17/2023] [Accepted: 05/01/2023] [Indexed: 06/24/2023]
Abstract
The objective of this study was to investigate the relationship between health conditions in childhood (ages 4-11), and health and socioeconomic outcomes in adulthood (ages 21-33). This study takes advantage of a new linkage between the National Longitudinal Survey of Children and Youth (NLSCY) and administrative tax data from the T1 Family File (T1FF) from Statistics Canada. The NLSCY includes rich longitudinal information on child development, while the T1FF includes administrative tax information on each child in adulthood (e.g., income, social assistance). The primary measures of child health relate to the diagnosis of a chronic condition, affecting the child's physical or mental/developmental health. The results suggest that mental/developmental health conditions in childhood more negatively influence adult health and socioeconomic conditions, compared to physical health conditions. Interaction models reveal modest heterogenous effects; for example, there is some evidence of a cushioning effect from higher household income in childhood, as well as an exacerbating negative effect from lower birth weight for mental/developmental health conditions. Using a covariate decomposition approach to explore underlying pathways, the results reveal that associations between health in early life and outcomes in adulthood are partially explained by differences in cognitive skills (i.e., mathematics test scores) in adolescence (ages 16-17). Results may encourage policy investments to mitigate the occurrence of health conditions in childhood and to ensure timely access to educational supports and health services for children with chronic conditions.
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Affiliation(s)
- Emmanuelle Arpin
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada; Canadian Center for Health Economics, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada.
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada; Canadian Center for Health Economics, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada; Centre for Health Economics and Hull York Medical School, University of York, Heslington, York YO10 5DD, UK; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 1000 Queen Street West, Toronto, ON M6J 1H4, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, 155 College St 6th Floor, Toronto, ON M5T 3M6, Canada; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Audrey Laporte
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada; Canadian Center for Health Economics, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada
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de Oliveira C, Iwajomo T, Kurdyak P. Mental Health Care Use Among Children and Adolescents With High Health Care Costs in Ontario, Canada. JAMA Netw Open 2023; 6:e2313172. [PMID: 37171817 PMCID: PMC10182426 DOI: 10.1001/jamanetworkopen.2023.13172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Importance Research on patients with high health care costs has examined mainly adults, with little focus on mental health care use. Objective To examine the characteristics and costs of children and adolescents with high health care costs who use mostly mental health care and whether and why they persist in the high-cost state. Design, Setting, and Participants This population-based, retrospective cohort study used health care records from Ontario, Canada, on all children and adolescents (age 0-17 years) covered under a universal health care system from January 1, 2012, to December 31, 2019. All children and adolescents in and above the 90th percentile of the cost distribution in 2012 for whom costs related to mental health care accounted for 50% or more of their costs were defined as patients with high mental health care costs. Data were analyzed from August 2019 to December 2022. Exposures High health care costs. Main Outcomes and Measures Patients with high mental health care costs were characterized in terms of their sociodemographic characteristics; chronic physical health, mental health, and behavioral conditions; and health care costs (in 2021 Canadian dollars) by health service and type of care (mental health care vs non-mental health care). Patients were followed up until 2019 to assess whether they persisted in the high-cost state and to examine factors associated with persisting in that state. Results In 2012, there were 273 490 children and adolescents with high health care costs (mean [SD] age, 6.43 [5.99] years; 55.8% male; mean cost, $7936.40; 95% CI, $7850.30-$8022.40). Of these, 20 463 (7.5%) were classified as having high mental health care costs (mean cost, $10 040.20; 95% CI, $9822.80-$10 257.50). Asthma (30.3%), attention-deficit/hyperactivity disorder (35.8%), and mood and/or anxiety disorders (94.9%) were the most common chronic physical, behavioral, or mental health conditions. Few patients with high mental health care costs persisted in the high-cost state beyond 3 years (19.0%). Mood and/or anxiety disorders (relative risk ratio [RRR], 6.17; 95% CI, 3.19-11.96) and schizophrenia spectrum disorders (RRR, 2.98; 95% CI, 2.14-4.14) were identified as the main factors associated with persistence in the high-cost state. Conclusions and Relevance In this cohort study of children and adolescents with high health care costs, some patients had high levels of mental health care use and high costs of care, but few of these persisted in the high-cost state for 3 or more years. These findings may help inform the development of care coordination interventions and service delivery models, such as youth integrated services, to reduce costs and improve outcomes for children and adolescents.
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Affiliation(s)
- Claire de Oliveira
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Tomisin Iwajomo
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Mental Health and Addictions Centre of Excellence, Ontario Health, Toronto, Ontario, Canada
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26
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Crawford A, Sockalingam S, Serhal E, Zhou C, Gambin A, de Oliveira C, Iwajomo T, Kurdyak P. Using "Big Data" to Provide Insights into Early Adopters of Continuing Professional Development: An Example from Project ECHO. J Contin Educ Health Prof 2023; Publish Ahead of Print:00005141-990000000-00066. [PMID: 37053580 DOI: 10.1097/ceh.0000000000000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Mental health care is often managed in primary care with limited specialist support, particularly in rural and remote communities. Continuing professional development programs (CPD) can offer a potential solution to further mental health training; however, engaging primary care organizations (PCOs) can be challenging. The use of "big data" to identify factors influencing engagement in CPD programs has not been well studied. Therefore, the aim of this project was to use administrative health data from Ontario, Canada to identify characteristics of PCOs associated with early engagement in a virtual CPD program, Project Extension for Community Healthcare Outcomes (ECHO) Ontario Mental Health (ECHO ONMH). METHODS Ontario health administrative data for fiscal year 2014 was used to compare the characteristics of ECHO ONMH-adopting PCOs, and their patients, to nonadopter organizations (N = 280 vs. N = 273 physicians). RESULTS ECHO-adopting PCOs did not differ with respect to physician age or years of practice, although PCOs with more female physicians were somewhat more likely to participate. ECHO ONMH adoption was more likely in regions with lower psychiatrist supply, among PCOs using partial salary payment models, and those with a greater interprofessional complement. Patients of ECHO-adopters did not differ on the basis of gender or health care utilization (physical or mental health); however, ECHO-adopting PCOs tended to have patients with less psychiatric comorbidity. CONCLUSION Models such as Project ECHO, which deliver CPD to primary care, are advanced to address lack of access to specialist health care. These findings support the use of administrative health data to assess the implementation, spread, and impact of CPD.
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Affiliation(s)
- Allison Crawford
- Allison Crawford, MD, FRCPC, PhD: Medical Director, Outreach and Virtual Care; Chief Medical Officer, Canada Suicide Prevention Service, Co-Chair ECHO Ontario Superhub and ECHO Ontario Mental Health, Clinician Scientist, Centre for Addiction and Mental Health, and Associate Professor, Department of Psychiatry, University of Toronto, Toronto, ON; Sanjeev Sockalingam, MD, MHPE, FRCPC, FACLP: VP, Education at the Centre for Addiction and Mental Health, CAMH Clinician Scientist; Professor of Psychiatry, University of Toronto, Toronto, ON; Eva Serhal, MBA, PhD: Senior Director of Virtual Mental Health, ECHO Ontario Mental Health, and Canadian Suicide Prevention Service, Centre for Addiction and Mental Health, Toronto, ON; Carrol Zhou, MD, FRCPC: Lecturer and Staff Psychiatrist, University of Toronto, Toronto, ON; Amanda Gambin, PhD: Research Coordinator, Virtual Mental Health, ECHO Ontario Mental Health, and Canadian Suicide Prevention Service, Centre for Addiction and Mental Health, Toronto, ON; Claire de Oliveira, PhD: Independent Scientist and Senior Health Economist, Centre for Addiction and Mental Health, and Associate Professor, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON; Tomisin Iwajomo, MPH: Research Coordinator, Institute for Mental Health Policy Research (CAMH), and Appointed Analyst, Mental Health and Addictions Research Program at the Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; and Paul Kurdyak, MD, PhD: Director of Health Outcomes and Performance Evaluation, Institute for Mental Health Policy Research, Medical Director of Performance Improvement at CAMH, Lead of the Mental Health and Addictions Research Program at the Institute for Clinical Evaluative Sciences (ICES), and Associate Professor, Department of Psychiatry, University of Toronto, Toronto, ON
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Mason J, Laporte A, McDonald JT, Kurdyak P, de Oliveira C. Health Reporting from Different Data Sources: Does it Matter for Mental Health? J Ment Health Policy Econ 2023; 26:33-57. [PMID: 37029904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 03/07/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Bipolar disorder is among the top 10 causes of disability worldwide. The Short-Form Six-Dimension (SF-6D) is a frequently BACKGROUND: Mental disorders are typically stigmatized conditions associated with negative stereotypes, which may lead individuals to underreport them. Thus, survey data may be subject to biases. Although administrative data has some limitations, it is an alternative data source that may be considered more objective. AIMS OF THE STUDY This study aimed to identify the degree of agreement between survey and administrative health care data for mental health conditions, factors affecting underreporting, and whether underreporting also occurs for physical health conditions. METHODS We used Ontario data from the Canadian Community Health Survey linked to health records to examine the presence of mental health conditions (i.e., schizophrenia and mood disorders) and select physical health conditions (i.e., diabetes and cancer). Using administrative data as the reference standard, we created four categories for each health condition based on the level of agreement between the two data sources: consistent cases and non-cases (i.e. individuals with concordant data based on their reported health condition), and people who were found to underreport and overreport a condition (i.e. where the condition was present in the administrative data, but not in the survey data and vice-versa, respectively). The overall level of agreement was assessed using Cohen's kappa statistic. Probit regressions were estimated to determine the factors affecting underreporting. RESULTS The Kappa statistics for mood disorder was fair (k= 0.26) and moderate for schizophrenia (k = 0.49). Physical health conditions had higher kappa values (diabetes, k = 0.81; ever having cancer, k = 0.68), with the exception of currently having cancer (k = 0.24). Underreporting was highest for the most stigmatizing condition, schizophrenia (63%), followed by mood disorders (39%) and cancer (39%), and lowest for diabetes (25%). Older age, being born in Africa and Asia, and being employed all increased the probability of underreporting among individuals identified in the administrative data; the opposite held for social assistance. DISCUSSION We extended previous work on mental health reporting by combining survey data with administrative data to examine the level of agreement between respondents' self-reported mental health and administrative records. The data include some mental disorders not studied previously. We examined the entire adult population; this is important because prevalence of schizophrenia may be less common among older population groups due to higher mortality among this patient population. Additionally, there may be potential age-related differences in stigma and mental health conditions. The administrative health data captured only health services covered by the public provincial health insurance plan and thus did not capture medical care provided by psychologists, social workers, and nurses. While this would affect Kappa statistic values, it does not directly affect the underreporting analyses. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE Our results suggest that disclosure of mental health conditions may differ by the level of stigma, which has implications for obtaining accurate estimates of mental health prevalence from self-reported data sources. IMPLICATIONS FOR HEALTH POLICIES AND IMPLICATIONS FOR FURTHER RESEARCH: It may be useful to use a combination of both survey and administrative data when estimating the prevalence of mental disorders. Future research should seek to examine overreporting and its determinants.
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Affiliation(s)
- Joyce Mason
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health , Rm T304, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada,
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de Oliveira C, Saka M, Bone L, Jacobs R. The Role of Mental Health on Workplace Productivity: A Critical Review of the Literature. Appl Health Econ Health Policy 2023; 21:167-193. [PMID: 36376610 PMCID: PMC9663290 DOI: 10.1007/s40258-022-00761-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Mental health disorders in the workplace have increasingly been recognised as a problem in most countries given their high economic burden. However, few reviews have examined the relationship between mental health and worker productivity. OBJECTIVE To review the relationship between mental health and lost productivity and undertake a critical review of the published literature. METHODS A critical review was undertaken to identify relevant studies published in MEDLINE and EconLit from 1 January 2008 to 31 May 2020, and to examine the type of data and methods employed, study findings and limitations, and existing gaps in the literature. Studies were critically appraised, namely whether they recognised and/or addressed endogeneity and unobserved heterogeneity, and a narrative synthesis of the existing evidence was undertaken. RESULTS Thirty-eight (38) relevant studies were found. There was clear evidence that poor mental health (mostly measured as depression and/or anxiety) was associated with lost productivity (i.e., absenteeism and presenteeism). However, only the most common mental disorders were typically examined. Studies employed questionnaires/surveys and administrative data and regression analysis. Few studies used longitudinal data, controlled for unobserved heterogeneity or addressed endogeneity; therefore, few studies were considered high quality. CONCLUSION Despite consistent findings, more high-quality, longitudinal and causal inference studies are needed to provide clear policy recommendations. Moreover, future research should seek to understand how working conditions and work arrangements as well as workplace policies impact presenteeism.
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Affiliation(s)
- Claire de Oliveira
- Centre for Health Economics, University of York, York, UK.
- Hull York Medical School, Hull and York, UK.
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | | | | | - Rowena Jacobs
- Centre for Health Economics, University of York, York, UK
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Husain MI, Umer M, Asif M, Khoso AB, Kiran T, Ansari M, Aslam H, Bhatia MR, Dogar FA, Husain MO, Khan HA, Mufti AA, Mulsant BH, Naeem F, Naqvi HA, de Oliveira C, Siddiqui MS, Tamizuddin A, Wang W, Zaheer J, Husain N, Chaudhry N, Chaudhry IB. Culturally adapted psychoeducation for bipolar disorder in a low-resource setting: protocol for a multicentre randomised controlled trial - ERRATUM. BJPsych Open 2023; 9:e11. [PMID: 36810130 PMCID: PMC9970177 DOI: 10.1192/bjo.2023.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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de Oliveira C, Tanner B, Colton P, Kurdyak P. Understanding the scope of preventable acute care spending among patients with eating disorders. Int J Eat Disord 2023. [PMID: 36757092 DOI: 10.1002/eat.23910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE The economic burden of eating disorders is substantial. One potential way to reduce costs, without sacrificing care, may be to target preventable (i.e., potentially unnecessary) acute care. This study sought to determine the amount and proportion of preventable and non-preventable acute care spending among individuals with eating disorders. METHOD We undertook a population-based, cross-sectional study of all individuals over the age of 17 with eating disorders (diagnosed through hospitalization) in Ontario, Canada, to determine potentially preventable and non-preventable acute care spending. Preventable acute care (i.e., preventable emergency department visits and hospitalizations) was defined using previously validated algorithms. We undertook analyses for the full sample, by sex and by eating disorder diagnosis (anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified, multiple). RESULTS Among 7547 individuals with eating disorders, 15% of all acute care spending (i.e., $1.33 million) was considered preventable; this figure was higher for females (14%) and those with bulimia nervosa (21%). Among emergency department visits, 25% of visits were considered preventable; the largest proportions were for non-emergent (11%) and primary care treatable (10%) conditions. Among hospitalizations, 9% were considered preventable; the highest proportions of preventable care spending were for short-term diabetes complications (1.8%) and urinary tract infections (1.8%). DISCUSSION Although the economic burden of eating disorders is substantial, there is some scope to decrease acute care spending among this patient population. Care coordination and improved access to primary care and disease prevention, particularly related to diabetes, may help prevent the occurrence of some acute care episodes. PUBLIC SIGNIFICANCE Many jurisdictions have implemented strategies to reduce costs and improve the quality of care among patients with high health care needs, such as those with eating disorders; however, it is unclear whether any costs can be reduced and, if so, which costs. Cost-savings resulting from the reduction of unnecessary care could provide further economic justification for increased investment in outpatient care for individuals with eating disorders.
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Affiliation(s)
- Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Bryan Tanner
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Patricia Colton
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Barry R, Rehm J, de Oliveira C, Gozdyra P, Chen S, Kurdyak P. Help-seeking behavior among adults who attempted or died by suicide in Ontario, Canada. Suicide Life Threat Behav 2023; 53:54-63. [PMID: 36098239 DOI: 10.1111/sltb.12921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study aims to determine the relationship between rurality and help-seeking behavior prior to a suicide or suicide attempt. METHODS Data from 2007 to 2017 were obtained from administrative databases held at ICES, which capture all hospital, emergency department (ED), and general practitioner (GP) visits across Ontario. Rurality was defined using the Rurality Index of Ontario scores. Help-seeking was based on accessing health services 1 year prior to the event. RESULTS Among those who died by suicide (N = 9848), those living in rural areas were less likely to seek help from a psychiatrist (rural males: AOR = 0.42, 95% CI = 0.31-0.57; rural females: AOR = 0.46, 95% CI = 0.29-0.97) compared with those living in urban areas. We found a similar association among those who attempted suicide (N = 82,480) (rural males: AOR = 0.49, 95% CI = 0.43-0.56; rural females: AOR = 0.51, 95% CI = 0.46-0.57). Rural males and females were more likely to seek care from an ED for mental health reasons compared with urban males and females. CONCLUSIONS Among people who died by suicide, those living in rural areas are generally less likely to access psychiatrists and GPs and more likely to access EDs, suggesting that people living in rural areas may have less access to care than their urban counterparts.
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Affiliation(s)
| | - Jürgen Rehm
- University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dresden University of Technology, Dresden, Germany.,I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Claire de Oliveira
- University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Centre for Health Economics and Hull York Medical School, University of York, York, UK
| | | | | | - Paul Kurdyak
- University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
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Baliunas D, Selby P, de Oliveira C, Kurdyak P, Rosella L, Zawertailo L, Fu L, Sutradhar R. Primary care-based smoking cessation treatment and subsequent healthcare service utilisation: a matched cohort study of smokers using linked administrative healthcare data. Tob Control 2023; 32:72-79. [PMID: 34083493 PMCID: PMC9763184 DOI: 10.1136/tobaccocontrol-2021-056522] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/10/2021] [Accepted: 04/27/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND No research has assessed the individual-level impact of smoking cessation treatment delivered within a general primary care patient population on multiple forms of subsequent healthcare service use. OBJECTIVE We aimed to compare the rate of outpatient visits, emergency department (ED) visits and hospitalisations during a 5-year follow-up period among smokers who had and had not accessed a smoking cessation treatment programme. METHODS The study was a retrospective matched cohort study using linked demographic and administrative healthcare databases in Ontario, Canada. 9951 patients who accessed smoking cessation services between July 2011 and December 2012 were matched to a smoker who did not access services, obtained from the Canadian Community Health Survey, using a combination of hard matching and propensity score matching. Outcomes were rates of healthcare service use from index date (programme enrolment or survey response) to March 2017. RESULTS After controlling for potential confounders, patients in the overall treatment cohort had modestly greater rates of the outcomes: outpatient visits (rate ratio (RR) 1.10, 95% CI: 1.06 to 1.14), ED visits (RR 1.08, 95% CI: 1.03 to 1.13) and hospitalisations (RR 1.09, 95% CI: 1.02 to 1.18). Effect modification of the association between smoking cessation treatment and healthcare service use by prevalent comorbidity was found for outpatient visits (p=0.006), and hospitalisations (p=0.050), but not ED visits. CONCLUSIONS Patients who enrolled in smoking cessation treatment offered through primary care clinics in Ontario displayed a modest but significantly greater rate of outpatient visits, ED visits and hospitalisations over a 5-year follow-up period.
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Affiliation(s)
- Dolly Baliunas
- School of Public Health, The University of Queensland, Herston, Queensland, Australia,Clinical Research Addictions, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Peter Selby
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Centre for Health Economics and Hull York Medical School, University of York, York, UK,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Laura Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada
| | - Laurie Zawertailo
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Pharmacology and Toxicology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | | | - Rinku Sutradhar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Division of Biostatistics, University of Toronto, Toronto, Ontario, Canada
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Quilty LC, Wardell JD, Garner G, Elison-Davies S, Davies G, Klekovkina E, Corman M, Alfonsi J, Crawford A, de Oliveira C, Weekes J. Peer support and online cognitive behavioural therapy for substance use concerns: protocol for a randomised controlled trial. BMJ Open 2022; 12:e064360. [PMID: 36523236 PMCID: PMC9748960 DOI: 10.1136/bmjopen-2022-064360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Hazardous alcohol and drug use is associated with substantial morbidity, mortality and societal cost worldwide. Yet, only a minority of those struggling with substance use concerns receive specialised services. Numerous barriers to care exist, highlighting the need for scalable and engaging treatment alternatives. Online interventions have exhibited promise in the reduction of substance use, although studies to date highlight the key importance of patient engagement to optimise clinical outcomes. Peer support may provide a way to engage patients using online interventions. The goal of this study is to evaluate the efficacy and cost-effectiveness of Breaking Free Online (BFO), an online cognitive-behavioural intervention for substance use, delivered with and without peer support. METHODS AND ANALYSIS A total of 225 outpatients receiving standard care will be randomised to receive clinical monitoring with group peer support, with BFO alone, or with BFO with individual peer support, in an 8-week trial with a 6-month follow-up. The primary outcome is substance use frequency; secondary outcomes include substance use problems, depression, anxiety, quality of life, treatment engagement and cost-effectiveness. Mixed effects models will be used to test hypotheses, and thematic analysis of qualitative data will be undertaken. ETHICS AND DISSEMINATION The protocol has received approval by the Centre for Addiction and Mental Health Research Ethics Board. Results will help to optimise the effectiveness of structured online substance use interventions provided as an adjunct to standard care in hospital-based treatment programmes. Findings will be disseminated through presentations and publications to scholarly and knowledge user audiences. TRIAL REGISTRATION NUMBER NCT05127733.
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Affiliation(s)
- Lena C Quilty
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey D Wardell
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, York University, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Gord Garner
- Community Addictions Peer Support Association, Ottawa, Ontario, Canada
| | | | | | - Elizaveta Klekovkina
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Michael Corman
- School of Culture, Media, and Society, University of the Fraser Valley, Abbotsford, British Columbia, Canada
| | - Jeffrey Alfonsi
- Schulich School of Medicine & Dentisty, University of Western Ontario, City of London, Ontario, Canada
| | - Allison Crawford
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - John Weekes
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
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Sinyor M, Mallia E, de Oliveira C, Schaffer A, Niederkrotenthaler T, Zaheer J, Mitchell R, Rudoler D, Kurdyak P. Emergency department visits for self-harm in adolescents after
release of the Netflix series ‘13 Reasons Why’. Aust N Z J Psychiatry 2022; 56:1434-1442. [PMID: 34963338 PMCID: PMC9597162 DOI: 10.1177/00048674211065999] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine whether the release of the first season of the Netflix series '13 Reasons Why' was associated with changes in emergency department presentations for self-harm. METHODS Healthcare utilization databases were used to identify emergency department and outpatient presentations according to age and sex for residents of Ontario, Canada. Data from 2007 to 2018 were used in autoregressive integrated moving average models for time series forecasting with a pre-specified hypothesis that rates of emergency department presentations for self-harm would increase in the 3-month period following the release of 13 Reasons Why (1 April 2017 to 30 June 2017). Chi-square and t tests were used to identify demographic and health service use differences between those presenting to emergency department with self-harm during this epoch compared to a control period (1 April 2016 to 30 June 2016). RESULTS There was a significant estimated excess of 75 self-harm-related emergency department visits (+6.4%) in the 3 months after 13 Reasons Why above what was predicted by the autoregressive integrated moving average model (standard error = 32.4; p = 0.02); adolescents aged 10-19 years had 60 excess visits (standard error = 30.7; p = 0.048), whereas adults demonstrated no significant change. Sex-stratified analyses demonstrated that these findings were largely driven by significant increases in females. There were no differences in demographic or health service use characteristics between those who presented to emergency department with self-harm in April to June 2017 vs April to June 2016. CONCLUSIONS This study demonstrated a significant increase in self-harm emergency department visits associated with the release of 13 Reasons Why. It adds to previously published mortality, survey and helpline data collectively demonstrating negative mental health outcomes associated with 13 Reasons Why.
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Affiliation(s)
- Mark Sinyor
- Department of Psychiatry, Sunnybrook
Health Sciences Centre, Toronto, ON, Canada,Department of Psychiatry, University of
Toronto, Toronto, ON, Canada,Mark Sinyor, Department of Psychiatry,
Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, FG52, Toronto, ON M4N
3M5, Canada.
| | - Emilie Mallia
- Institute for Mental Health Policy
Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy
Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada,Centre for Health Economics and Hull
York Medical School, University of York, York, UK,ICES, Toronto, ON, Canada,Institute of Health Policy, Management
and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook
Health Sciences Centre, Toronto, ON, Canada,Department of Psychiatry, University of
Toronto, Toronto, ON, Canada
| | - Thomas Niederkrotenthaler
- Unit Suicide Research & Mental
Health Promotion, Department of Social and Preventive Medicine, Center for Public
Health, Medical University of Vienna, Vienna, Austria
| | - Juveria Zaheer
- Department of Psychiatry, University of
Toronto, Toronto, ON, Canada,General and Health Systems Psychiatry,
Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Rachel Mitchell
- Department of Psychiatry, Sunnybrook
Health Sciences Centre, Toronto, ON, Canada,Department of Psychiatry, University of
Toronto, Toronto, ON, Canada
| | - David Rudoler
- ICES, Toronto, ON, Canada,Institute of Health Policy, Management
and Evaluation, University of Toronto, Toronto, ON, Canada,Faculty of Health Sciences, Ontario
Tech University, Oshawa, ON, Canada
| | - Paul Kurdyak
- Department of Psychiatry, University of
Toronto, Toronto, ON, Canada,Institute for Mental Health Policy
Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada,ICES, Toronto, ON, Canada,Institute of Health Policy, Management
and Evaluation, University of Toronto, Toronto, ON, Canada
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Abstract
OBJECTIVE This study aims to examine rural and urban differences in attempted suicide and death by suicide in Ontario, Canada. METHOD This is a population-based nested case-control study. Data were obtained from administrative databases held at ICES, which capture all hospital and emergency department visits across Ontario between 2007 and 2017. All adults living in Ontario who attempted suicide or died by suicide are included in the study, and controls were matched by sex and age. Suicides were captured using vital statistics. Suicide attempts were determined using emergency department service codes. RESULTS Rurality is a risk factor for attempted suicide and death by suicide. Rural males are more likely to die by suicide compared with urban males (adjusted odds ratio(AOR) = 1.70, 95% confidence interval (CI), 1.49 to 1.95), and the odds of death by suicide increase with increasing levels of rurality. Rural males and females have an increased risk of attempted suicide compared with their urban counterparts (males: AOR = 1.37, 95% CI, 1.24 to 1.50) (females: AOR = 1.26, 95% CI, 1.14 to 1.39), with a pattern of increasing risk of suicide attempts with increasing rurality. Rural females are not at increased risk of suicide compared with urban females (AOR = 1.08, 95% CI, 0.80 to 1.45). Sensitivity analyses corroborated the results. CONCLUSIONS Rural males are almost two times more likely to die by suicide compared with urban males, and both rural males and females have an elevated risk of suicide attempts compared with urban residents. Future research should examine potential mediators of the relationship between rurality and suicide.
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Affiliation(s)
- Rebecca Barry
- University of Toronto, Toronto, Ontario
- Rebecca Barry, University of Toronto, 33
Russell Street, Toronto, ON, Canada M5S 2S1.
| | - Jürgen Rehm
- University of Toronto, Toronto, Ontario
- Centre for Addiction and Mental Health,
Toronto, Ontario, Canada
- Dresden University of Technology,
Dresden, Germany
| | - Claire de Oliveira
- University of Toronto, Toronto, Ontario
- Centre for Addiction and Mental Health,
Toronto, Ontario, Canada
- Centre for Health Economics and Hull York Medical School, University of York, York, United Kingdom
| | | | | | - Paul Kurdyak
- University of Toronto, Toronto, Ontario
- Centre for Addiction and Mental Health,
Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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Baliunas D, Voci S, de Oliveira C, Selby P, Kurdyak P, Rosella L, Zawertailo L, Fu L, Sutradhar R. Association Between Smoking Cessation Treatment and Healthcare Costs in a Single-Payer Public Healthcare System. Nicotine Tob Res 2022; 25:86-93. [PMID: 35792868 PMCID: PMC9717383 DOI: 10.1093/ntr/ntac166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/02/2022] [Accepted: 07/04/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION There has been little investigation of whether the clinical effectiveness of smoking cessation treatments translates into differences in healthcare costs, using real-world cost data, to determine whether anticipated benefits of smoking cessation treatment are being realized. AIMS AND METHODS We sought to determine the association between smoking cessation treatment and healthcare costs using linked administrative healthcare data. In total, 4752 patients who accessed a smoking cessation program in Ontario, Canada between July 2011 and December 2012 (treatment cohort) were each matched to a smoker who did not access these services (control cohort). The primary outcome was total healthcare costs in Canadian dollars, and secondary outcomes were sector-specific costs, from one year prior to the index date until December 31, 2017, or death. Costs were partitioned into four phases: pretreatment, treatment, posttreatment, and end-of-life for those who died. RESULTS Among females, total healthcare costs were similar between cohorts in pretreatment and posttreatment phases, but higher for the treatment cohort during the treatment phase ($4,554 vs. $3,237, p < .001). Among males, total healthcare costs were higher in the treatment cohort during pretreatment ($3,911 vs. $2,784, p < .001), treatment ($4,533 vs. $3,105, p < .001) and posttreatment ($5,065 vs. $3,922, p = .001) phases. End-of-life costs did not differ. Healthcare sector-specific costs followed a similar pattern. CONCLUSIONS Five-year healthcare costs were similar between females who participated in a treatment program versus those that did not, with a transient increase during the treatment phase only. Among males, treatment was associated with persistently higher healthcare costs. Further study is needed to address the implications with respect to long-term costs. IMPLICATIONS The clinical effectiveness of pharmacological and behavioral smoking cessation treatments is well established, but whether such treatments are associated with healthcare costs, using real-world data, has received limited attention. Our findings suggest that the use of a smoking cessation treatment offered by their health system is associated with persistent higher healthcare costs among males but a transient increase among females. Given increasing access to evidence-based smoking cessation treatments is an important component in national tobacco control strategies, these data highlight the need for further exploration of the relations between smoking cessation treatment engagement and healthcare costs.
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Affiliation(s)
- Dolly Baliunas
- Corresponding Author: Dolly Baliunas, PhD, School of Public Health, Level 3, Public Health Building, 288 Herston Rd, The University of Queensland, Herston, QLD 4006, Australia, Telephone: 61 7 3346 5106; Fax: 61 (7) 3365 5442; E-mail:
| | - Sabrina Voci
- Nicotine Dependence Service, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Claire de Oliveira
- Centre for Health Economics and Hull York Medical School, University of York, Heslington, York, UK,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada,ICES, Toronto, ON, Canada
| | - Peter Selby
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Nicotine Dependence Service, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada,ICES, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Laura Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,ICES, Toronto, ON, Canada
| | - Laurie Zawertailo
- Nicotine Dependence Service, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | | | - Rinku Sutradhar
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada,ICES, Toronto, ON, Canada,Division of Biostatistics, University of Toronto, Toronto, ON, Canada
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de Oliveira C, Kouyoumdjian FG, Iwajomo T, Jones R, Simpson AIF, Kurdyak P. Health Care Costs of Individuals With Chronic Psychotic Disorders Who Experience Incarceration in Ontario. Psychiatr Serv 2022; 73:760-767. [PMID: 34932392 DOI: 10.1176/appi.ps.202100150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Little is known about the health care costs of individuals with chronic psychotic disorders who experience incarceration. This study sought to address this knowledge gap. METHODS The authors analyzed linked 2007-2010 correctional and administrative health care data on sex- and age-matched individuals with chronic psychotic disorders with and without known incarceration in prison for up to 2 years in the Ontario correctional system. Mean 1-year health care costs (overall and by sex) in the year before incarceration (when release occurred in 2010) were estimated from third-party payer data and compared between the two groups. Costs were calculated in 2018 Canadian dollars. RESULTS Individuals who experienced incarceration (N=3,197) had mean 1-year costs of $15,728 in the year before incarceration, whereas those who did not (N=6,393) had 1-year costs of $11,588. This difference was mostly due to costs arising from psychiatric hospitalizations, emergency department visits, and physician services. The main factors associated with the difference were incarceration in the following year (increase of $4,827, p<0.001), being age 18-29 years compared with ages 30-39 or 40-49 (increase of $4,448 and $4,218, respectively, p<0.001), and chronic psychotic disorder duration of 1-2 years compared with ≤1 year duration (increase of $6,812, p=0.004). Women who experienced incarceration had higher costs than incarcerated men ($20,648 vs. $14,763). CONCLUSIONS Individuals with chronic psychotic disorders who experienced incarceration had higher health care costs than comparable individuals who did not. These higher health care costs may signal the need for interventions and policies that help individuals with psychotic disorders avoid criminal justice system involvement.
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Affiliation(s)
- Claire de Oliveira
- ICES, Toronto (de Oliveira, Kouyoumdjian, Iwajomo, Kurdyak); Institute for Mental Health Policy Research (de Oliveira, Iwajomo, Kurdyak) and Division of Forensic Psychiatry (Jones, Simpson), Centre for Addiction and Mental Health, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario (Kouyoumdjian); Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto (Jones, Simpson)
| | - Fiona G Kouyoumdjian
- ICES, Toronto (de Oliveira, Kouyoumdjian, Iwajomo, Kurdyak); Institute for Mental Health Policy Research (de Oliveira, Iwajomo, Kurdyak) and Division of Forensic Psychiatry (Jones, Simpson), Centre for Addiction and Mental Health, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario (Kouyoumdjian); Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto (Jones, Simpson)
| | - Tomisin Iwajomo
- ICES, Toronto (de Oliveira, Kouyoumdjian, Iwajomo, Kurdyak); Institute for Mental Health Policy Research (de Oliveira, Iwajomo, Kurdyak) and Division of Forensic Psychiatry (Jones, Simpson), Centre for Addiction and Mental Health, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario (Kouyoumdjian); Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto (Jones, Simpson)
| | - Roland Jones
- ICES, Toronto (de Oliveira, Kouyoumdjian, Iwajomo, Kurdyak); Institute for Mental Health Policy Research (de Oliveira, Iwajomo, Kurdyak) and Division of Forensic Psychiatry (Jones, Simpson), Centre for Addiction and Mental Health, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario (Kouyoumdjian); Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto (Jones, Simpson)
| | - Alexander I F Simpson
- ICES, Toronto (de Oliveira, Kouyoumdjian, Iwajomo, Kurdyak); Institute for Mental Health Policy Research (de Oliveira, Iwajomo, Kurdyak) and Division of Forensic Psychiatry (Jones, Simpson), Centre for Addiction and Mental Health, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario (Kouyoumdjian); Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto (Jones, Simpson)
| | - Paul Kurdyak
- ICES, Toronto (de Oliveira, Kouyoumdjian, Iwajomo, Kurdyak); Institute for Mental Health Policy Research (de Oliveira, Iwajomo, Kurdyak) and Division of Forensic Psychiatry (Jones, Simpson), Centre for Addiction and Mental Health, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario (Kouyoumdjian); Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto (Jones, Simpson)
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Fuller AE, Zaffar N, Cohen E, Pentland M, Siddiqi A, Vandermorris A, Van Den Heuvel M, Birken CS, Guttmann A, de Oliveira C. Cash transfer programs and child health and family economic outcomes: a systematic review. Can J Public Health 2022; 113:433-445. [PMID: 35088347 PMCID: PMC8794041 DOI: 10.17269/s41997-022-00610-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022]
Abstract
Objectives Family income is an important determinant of child and parental health. In Canada, cash transfer programs to families with children have existed since 1945. This systematic review aimed to examine the association between cash transfer programs to families with children and health outcomes in Canadian children (ages 0 to 18) as well as family economic outcomes. Methods We reviewed academic and grey literature published up to November 2021. Additional studies were identified through reference review. We included any study that examined children 0–18 years old and/or their parents, took place in Canada and reported Canada-specific data, and reported child, youth and/or parental health outcomes, as well as family economic outcomes. Risk of bias was assessed by two reviewers using a modified Newcastle-Ottawa Scale. Synthesis Our search yielded 23 studies meeting the inclusion criteria out of 7052 identified. Eight studies in total measured child health outcomes, including birth outcomes, child overall health, and developmental and behavioural outcomes, and four directly addressed parental health, including mental health, injuries, and obesity. Most studies reported generally positive associations, though some findings were specific to certain subgroups. Some studies also examined fertility and labour force participation outcomes, which described varying effects. Conclusion Cash transfer programs to families with children in Canada are associated with better child and parental health outcomes. Additional research is needed to evaluate the mechanisms of effects, and to identify which types and levels of government transfers are most effective, and target populations, to optimize the positive effects of these benefits. Supplementary Information The online version contains supplementary material available at 10.17269/s41997-022-00610-2.
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Affiliation(s)
- Anne E Fuller
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
- Department of Health Research Methods, Evidence and Impact, McMaster University, Toronto, Ontario, Canada.
| | - Nusrat Zaffar
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Eyal Cohen
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Arjumand Siddiqi
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Ashley Vandermorris
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Meta Van Den Heuvel
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Catherine S Birken
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
- ICES, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Health Economics and Hull York Medical School, University of York, York, UK
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Dai WF, Beca JM, Nagamuthu C, Liu N, de Oliveira C, Earle CC, Trudeau M, Chan KKW. Cost-effectiveness Analysis of Pertuzumab With Trastuzumab in Patients With Metastatic Breast Cancer. JAMA Oncol 2022; 8:597-606. [PMID: 35201264 PMCID: PMC8874900 DOI: 10.1001/jamaoncol.2021.8049] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE The initial assessment of pertuzumab use for treatment of metastatic breast cancer by health technology assessment agencies suggested that pertuzumab was not cost-effective. In Ontario, Canada, pertuzumab became funded in November 2013 based on the substantial clinical benefit. To date, there is a paucity of analysis of pertuzumab using real-world data for cost-effectiveness. OBJECTIVE To assess the cost-effectiveness of pertuzumab, trastuzumab, and chemotherapy vs trastuzumab and chemotherapy for patients with metastatic breast cancer. DESIGN, SETTING, AND PARTICIPANTS A population-based retrospective economic evaluation was conducted in Ontario, Canada. Patients who received first-line treatments for metastatic breast cancer from January 1, 2008, to March 31, 2018, were identified. Patients were followed up from the start of treatment up to 5 years, with maximum follow-up to March 31, 2019. Patients were identified from the Ontario Cancer Registry and linked to the New Drug Funding Program database to identify receipt of first-line treatment (N = 1158). INTERVENTIONS Treatment with pertuzumab, trastuzumab, and chemotherapy after public funding (November 25, 2013) compared with treatment with trastuzumab and chemotherapy before funding. MAIN OUTCOMES AND MEASURES Cost-effectiveness, from a public payer perspective, was estimated from administrative data with a 5-year time horizon, adjusted for censoring, and discounted (1.5%). Incremental cost-effectiveness ratios for life-years gained and quality-adjusted life year (QALY) with bootstrapped 95% CIs were calculated. Sensitivity analysis with price reduction of pertuzumab alone or in combination with trastuzumab was conducted. RESULTS A total of 579 pairs of matched patients receiving pertuzumab and controls were included. The mean (SD) age of the matched study cohort was 58 (12.97) years; 1151 were women (99.4%). Pertuzumab resulted in 0.61 life-years gained and 0.44 QALYs gained at an incremental cost of $192 139 (all costs measured in Canadian dollar values, CAD) with an incremental cost-effectiveness ratio of $316 203 per life-year gained and $436 679 per QALY. The main factors associated with cost included the cost of pertuzumab (60%), outpatient cancer treatment delivery (24%), and trastuzumab (15%). With 100% price reduction of pertuzumab, the incremental cost-effectiveness ratio was $174 027 per QALY. When the price of pertuzumab and trastuzumab were both reduced by more than 71%, the incremental cost-effectiveness ratio decreased below $100 000 per QALY. CONCLUSIONS AND RELEVANCE The findings of this population-based study suggest that pertuzumab may increase survival for patients with metastatic breast cancer but would not be considered cost-effective, even after 100% price reduction, under conventional thresholds.
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Affiliation(s)
- Wei Fang Dai
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
| | - Jaclyn M. Beca
- Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada,Ontario Health, Ontario, Canada
| | | | | | - Claire de Oliveira
- ICES, Ontario, Canada,Centre for Health Economics and Hull York Medical School, University of York, York, United Kingdom
| | | | | | - Kelvin K. W. Chan
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada,Ontario Health, Ontario, Canada,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Davies SJC, Rudoler D, de Oliveira C, Huang A, Kurdyak P, Iaboni A. Comparative safety of chronic versus intermittent benzodiazepine prescribing in older adults: A population-based cohort study. J Psychopharmacol 2022; 36:460-469. [PMID: 35102786 PMCID: PMC9066681 DOI: 10.1177/02698811211069096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Benzodiazepine treatment recommendations for older adults differ markedly between guidelines, especially their advice on the acceptability of long-term use. AIMS Using population-based data we compared risks associated with chronic versus intermittent benzodiazepine usage in older adults. The primary outcome was falls resulting in hospital/emergency department visits. METHODS We undertook a retrospective population-based cohort study using linked healthcare databases in adults aged ⩾ 66 years in Ontario, Canada, with a first prescription for benzodiazepines. Chronic and intermittent benzodiazepine users, based on the 180 days from index prescription, were matched (1:2 ratio) by sex, age and propensity score, then followed for up to 360 days. Hazard ratios (HRs) for outcomes were calculated from Cox regression models. RESULTS A total of 57,041 chronic and 113,839 matched intermittent users were included. Hospitalization/emergency department visits for falls occurred during follow up in 4.6% chronic versus 3.2% intermittent users (HR = 1.13, 95% confidence interval (CI): 1.08 to 1.19; p < 0.0001). There were significant excess risks in chronic users for most secondary outcomes: hip fractures, hospitalizations/emergency department visits, long-term care admission and death, but not wrist fractures. Adjustment for benzodiazepine dosage had minimal impact on HRs. CONCLUSION Our study demonstrates evidence of significant excess risks associated with chronic benzodiazepine use compared to intermittent use. The excess risks may inform decision-making by older adults and clinicians about whether short- or long-term benzodiazepine use is a reasonable option for symptom management.
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Affiliation(s)
- Simon JC Davies
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada,Simon JC Davies, Geriatric Psychiatry Division, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON M6J 1H4, Canada.
| | - David Rudoler
- Centre for Addiction and Mental Health, Toronto, ON, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada,Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | - Claire de Oliveira
- Centre for Addiction and Mental Health, Toronto, ON, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada,ICES, Toronto, ON, Canada,Centre for Health Economics, Hull York Medical School, University of York, York, UK
| | | | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada,Centre for Addiction and Mental Health, Toronto, ON, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada,ICES, Toronto, ON, Canada
| | - Andrea Iaboni
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada,KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
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de Oliveira C, Iwajomo T, Kurdyak P. Health Care Expenditures Among Individuals With Chronic Psychotic Disorders in Ontario: An Analysis Over Time. Front Health Serv 2022; 2:848072. [PMID: 36925777 PMCID: PMC10012663 DOI: 10.3389/frhs.2022.848072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/22/2022] [Indexed: 06/18/2023]
Abstract
Chronic psychotic disorders are severe and disabling mental disorders associated with poor psychiatric and medical outcomes, and among the most costly mental disorders to treat. Understanding trends in aggregate health care expenditures over time, and respective drivers, can provide relevant insights for decision makers, namely around appropriate allocation of scarce resources within the health care sector. Using administrative health care times series data from Ontario, this analysis examined trends in aggregate public health care expenditures and activity from 2012 to 2019 among all individuals with a diagnosis of a chronic psychotic disorder. Total aggregate health care expenditures for individuals with a chronic psychotic disorder in Ontario increased at a moderate rate over this time period, in line with the growth of the number of people diagnosed, and thus not likely driven by unit costs or resource use. Psychiatric hospitalizations made up the largest share of health care expenditures (~30%). Nonetheless, among all health services, expenditures of acute medical hospitalizations, outpatient prescription drugs and home care saw the largest growth over time. Mean/per capita health care expenditures were greater for females, and increased with age as well as with the presence of comorbidities/chronic conditions. In particular, mean/per capita health care expenditures increased steadily with the number of comorbidities and were highest for individuals with 5 or more comorbidities and those with congestive heart failure, highlighting the ever-increasing importance of addressing physical health conditions among this patient population. These findings will have important implications for decision makers, namely around the appropriate allocation of health care resources for patients with chronic psychotic disorders. Future research should continue to monitor health care expenditures for individuals with chronic psychotic disorders as well as extend this analysis beyond 2019 to understand how the COVID-19 pandemic, and resulting lockdowns, has impacted aggregate health care expenditures and outcomes for patients living with chronic psychotic disorders.
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Affiliation(s)
- Claire de Oliveira
- Centre for Health Economics and Hull York Medical School, University of York, York, United Kingdom
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Tomisin Iwajomo
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Mental Health and Addictions Centre of Excellence, Ontario Health, Toronto, ON, Canada
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de Oliveira C, Gatov E, Rosella L, Chen S, Strauss R, Azimaee M, Paterno E, Guttmann A. Describing the linkage between administrative social assistance and health care databases in Ontario, Canada. Int J Popul Data Sci 2022; 7:1689. [PMID: 35310557 PMCID: PMC8900651 DOI: 10.23889/ijpds.v6i1.1689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background The linkage of records across administrative databases has become a powerful tool to increase information available to undertake research and analytics in a privacy protective manner. Objective The objective of this paper was to describe the data integration strategy used to link the Ontario Ministry of Children, Community and Social Services (MCCSS)-Social Assistance (SA) database with administrative health care data. Methods Deterministic and probabilistic linkage methods were used to link the MCCSS-SA database (2003-2016) to the Registered Persons Database, a population registry containing data on all individuals issued a health card number in Ontario, Canada. Linkage rates were estimated, and the degree of record linkage and representativeness of the dataset were evaluated by comparing socio-demographic characteristics of linked and unlinked records. Results There were a total of 2,736,353 unique member IDs in the MCCSS-SA database from the 1st January 2003 to 31st December 2016; 331,238 (12.1%) were unlinked (linkage rate = 87.9%). Despite 16 passes, most record linkages were obtained after 2 deterministic (76.2%) and 14 probabilistic passes (11.7%). Linked and unlinked samples were similar for most socio-demographic characteristics (i.e., sex, age, rural dwelling), except migrant status (non-migrant versus migrant) (standardized difference of 0.52). Linked and unlinked records were also different for SA program-specific characteristics, such as social assistance program, Ontario Works and Ontario Disability Support Program (standardized difference of 0.20 for each), data entry system, Service Delivery Model Technology only and both Service Delivery Model Technology and Social Assistance Management System (standardized difference of 0.53 and 0.52, respectively), and months on social assistance (standardized difference of 0.43). Conclusions Additional techniques to account for sub-optimal linkage rates may be required to address potential biases resulting from this data linkage. Nonetheless, the linkage between administrative social assistance and health care data will provide important findings on the social determinants of health.
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Affiliation(s)
- Claire de Oliveira
- ICES, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Centre for Health Economics and Hull York Medical School, University of York, York, United Kingdom,Corresponding author: Claire de Oliveira
| | | | - Laura Rosella
- ICES, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Ontario, Canada,Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada,Public Health Ontario, Toronto, Ontario, Canada
| | | | | | | | - Elizabeth Paterno
- Business Intelligence and Practice Division, Ministry of Children, Community and Social Services, Toronto, Ontario, Canada
| | - Astrid Guttmann
- ICES, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada,Division of Paediatric Medicine and Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada,Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Ministry of Children, Community and Social Services-ICES Working Group (Nelson Chong, Peter Lonescu, Sean Ji, Alexander Kopp, Annie Lan, Charlotte Ma, Miranda Pring, Priyanka Raj, Steven Ryan, Refik Saskin, Fiona Wong)
- ICES, Toronto, Ontario, Canada,Business Intelligence and Practice Division, Ministry of Children, Community and Social Services, Toronto, Ontario, Canada
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Dai WF, Beca JM, Nagamuthu C, Liu N, de Oliveira C, Earle CC, Trudeau M, Mercer RE, Chan KKW. Comparative Effectiveness and Safety of Pertuzumab and Trastuzumab Plus Chemotherapy vs Trastuzumab Plus Chemotherapy for Treatment of Metastatic Breast Cancer. JAMA Netw Open 2022; 5:e2145460. [PMID: 35226087 PMCID: PMC8886524 DOI: 10.1001/jamanetworkopen.2021.45460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE To date, limited studies have examined the comparative outcomes of pertuzumab treatment in the real-world setting. End-of-study analyses of the CLEOPATRA trial found median overall survival (OS) of 57.1 months in patients receiving pertuzumab compared with 40.8 months in control patients, a benefit of 16.3 months. However, studies examining the real-world use of pertuzumab have found conflicting results. OBJECTIVE To assess the real-world comparative effectiveness and safety of pertuzumab, trastuzumab, and chemotherapy for patients with metastatic breast cancer in Ontario, Canada. DESIGN, SETTING, AND PARTICIPANTS A population-based retrospective comparative effectiveness research study was conducted. Patients receiving first-line treatments for metastatic breast cancer from January 1, 2008, to March 31, 2018, in Ontario were identified. Data analysis was performed from November 13, 2019, to August 1, 2021. Thirteen patients had received treatment before diagnosis or were not Ontario residents and were excluded from the analysis. Of the remaining 1823 patients identified, 912 received pertuzumab and 911 were control patients. Using propensity-score methods, 579 pairs of patients receiving pertuzumab were matched to those in the control group, resulting in a total of 1158 patients in the final cohort. EXPOSURES Patients in the case group received pertuzumab with trastuzumab and chemotherapy and those in the control group received trastuzumab and chemotherapy. MAIN OUTCOMES AND MEASURES Overall survival (the primary outcome) and hazard ratios (HRs) were calculated using Kaplan-Meier and Cox proportional hazards regression methods. Secondary outcomes included cumulative incidence of safety end points including resource use and adverse events. Follow-up duration was up to 5 years from the start of therapy, with maximum follow-up to March 31, 2019. RESULTS Of the 1158 matched patients (579 pairs) receiving pertuzumab and controls, 1151 (99%) were women (mean [SD] age, 58.2 [12.97] years). The median OS was higher in patients receiving pertuzumab (40.2; 95% CI, 35.6-47.8 months) than in the control patients (25.3; 95% CI, 22.8-27.6 months), a median OS improvement of 14.9 months. Pertuzumab was associated with reduced mortality (HR, 0.66; 95% CI, 0.57-0.79). The cumulative incidence of direct hospitalization at 1 year was lower among patients receiving pertuzumab (11.7%) compared with the control patients (19.0%) (P < .001). CONCLUSIONS AND RELEVANCE Although the median OS in both the pertuzumab and control groups were shorter in this study than those observed in the CLEOPATRA trial, there appears to be a similar significant OS benefit with pertuzumab in the real-world setting.
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Affiliation(s)
- Wei Fang Dai
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
| | - Jaclyn M. Beca
- Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
- Ontario Health–Cancer Care Ontario, Ontario, Canada
| | | | | | - Claire de Oliveira
- ICES, Ontario, Canada
- Centre for Health Economics and Hull York Medical School, York
| | | | | | - Rebecca E. Mercer
- Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
- Ontario Health–Cancer Care Ontario, Ontario, Canada
| | - Kelvin K. W. Chan
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
- Ontario Health–Cancer Care Ontario, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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de Oliveira C, Mondor L, Wodchis WP, Rosella LC. Looking beyond Administrative Health Care Data: The Role of Socioeconomic Status in Predicting Future High-cost Patients with Mental Health and Addiction. Can J Psychiatry 2022; 67:140-152. [PMID: 33792407 PMCID: PMC8892069 DOI: 10.1177/07067437211004882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Previous research has shown that the socioeconomic status (SES)-health gradient also extends to high-cost patients; however, little work has examined high-cost patients with mental illness and/or addiction. The objective of this study was to examine associations between individual-, household- and area-level SES factors and future high-cost use among these patients. METHODS We linked survey data from adult participants (ages 18 and older) of 3 cycles of the Canadian Community Health Survey to administrative health care data from Ontario, Canada. Respondents with mental illness and/or addiction were identified based on prior mental health and addiction health care use and followed for 5 years for which we ascertained health care costs covered under the public health care system. We quantified associations between SES factors and becoming a high-cost patient (i.e., transitioning into the top 5%) using logistic regression models. For ordinal SES factors, such as income, education and marginalization variables, we measured absolute and relative inequalities using the slope and relative index of inequality. RESULTS Among our sample, lower personal income (odds ratio [OR] = 2.11, 95% confidence interval [CI], 1.54 to 2.88, for CAD$0 to CAD$14,999), lower household income (OR = 2.11, 95% CI, 1.49 to 2.99, for lowest income quintile), food insecurity (OR = 1.87, 95% CI, 1.38 to 2.55) and non-homeownership (OR = 1.34, 95% CI, 1.08 to 1.66), at the individual and household levels, respectively, and higher residential instability (OR = 1.72, 95% CI, 1.23 to 2.42, for most marginalized), at the area level, were associated with higher odds of becoming a high-cost patient within a 5-year period. Moreover, the inequality analysis suggested pro-high-SES gradients in high-cost transitions. CONCLUSIONS Policies aimed at high-cost patients with mental illness and/or addiction, or those concerned with preventing individuals with these conditions from becoming high-cost patients in the health care system, should also consider non-clinical factors such as income as well as related dimensions including food security and homeownership.
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Affiliation(s)
- Claire de Oliveira
- Centre for Health Economics, University of York, United Kingdom.,Hull York Medical School, University of York, United Kingdom.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Health System Performance Network (HSPN), Toronto, Ontorio, Canada
| | - Luke Mondor
- ICES, Toronto, Ontario, Canada.,Health System Performance Network (HSPN), Toronto, Ontorio, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Health System Performance Network (HSPN), Toronto, Ontorio, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Laura C Rosella
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.,Population Health Analytics Laboratory, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
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Reid N, Mason J, Kurdyak P, Nisenbaum R, de Oliveira C, Hwang S, Stergiopoulos V. Evaluating the Impact of a Critical Time Intervention Adaptation on Health Care Utilization among Homeless Adults with Mental Health Needs in a Large Urban Center. Can J Psychiatry 2022; 67:57-66. [PMID: 33611924 PMCID: PMC8811242 DOI: 10.1177/0706743721996114] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study evaluated the impact of a critical time intervention (CTI) adaptation on health care utilization outcomes among adults experiencing homelessness and mental health needs in a large urban center. METHODS Provincial population-based administrative data from Ontario, Canada, were used in a pre-post design for a cohort of 197 individuals who received the intervention between January 2013 and May 2014 and were matched to a cohort of adults experiencing homelessness who did not receive the intervention over the same time period. Changes in health care utilization outcomes in the year pre- and postintervention were evaluated using generalized estimating equations, and post hoc analyses evaluated differences between groups. RESULTS Pre-post analyses revealed statistically significant changes in health care utilization patterns among intervention recipients, including reduced inpatient service use and increased outpatient service use in the year following the intervention compared to the year prior. However, the matched cohort analysis found nonsignificant differences in health service use changes between a subgroup of intervention recipients and their matched counterparts. CONCLUSIONS An adapted CTI model was associated with changes in health care utilization among people experiencing homelessness and mental health needs. However, changes were not different from those observed in a matched cohort. Rigorous study designs with adequate samples are needed to examine the effectiveness of CTI and local adaptations in diverse health care contexts.
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Affiliation(s)
- Nadine Reid
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Joyce Mason
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Mental Health and Addictions Research Program, ICES, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Mental Health and Addictions Research Program, ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Rosane Nisenbaum
- Li Ka Shing Knowledge Institute, 10071St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Mental Health and Addictions Research Program, ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Centre for Health Economics, Hull York Medical School, University of York, York, UK
| | - Stephen Hwang
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, 10071St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Populations and Public Health Research Program, ICES, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, 10071St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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de Oliveira C, Macpherson A, Hepburn CM, Huang A, Strauss R, Liu N, Fiksenbaum L, Pageau P, Gomez D, Saunders NR. Healthcare utilization and costs following non-fatal powdered and non-powdered firearm injuries for children and youth. Eur J Pediatr 2022; 181:2329-2342. [PMID: 35246737 PMCID: PMC9110444 DOI: 10.1007/s00431-022-04429-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 02/02/2023]
Abstract
Little is known about the healthcare and economic burdens of non-fatal firearm injuries for children/youth beyond the initial admission. This study sought to estimate healthcare utilization and total direct healthcare costs of non-fatal powdered and non-powdered (air gun) firearm injuries 1-year post-injury. Using administrative data from 2003 to 2018 on all children/youth 0-24 years old in Ontario, Canada, a matched 1:2 cohort study was conducted to compare children/youth who experienced powdered and non-powdered firearm injuries with those who did not. Mean and median number of healthcare encounters and costs, and respective 95% confidence intervals (CIs) and interquartile ranges (IQRs), were estimated for both weapon type groups and controls and by intent. Children/youth who experienced a powdered and non-powdered firearm injury had a higher number of healthcare encounters and costs per year than those who did not. Mean 1-year costs for those with powdered and non-powdered firearm injuries were $8825 ($8007-$9643) and $2349 ($2118-$2578), respectively, versus $812 ($567-$1058) and $753 ($594-$911), respectively, for those without. Mean 1-year costs were highest for handgun injuries ($12,875 [95% CI $9941-$15,808]), and for intentional assault-related ($13,498 [$11,843-$15,153]; $3287 [$2213-$4362]), and intentional self-injuries ($14,773 [$6893-$22,652]; $6005 [$2193-$9817]) for both powdered and non-powdered firearm injuries, respectively. Conclusion: Firearm injuries have substantial healthcare and economic burdens beyond the initial injury-related admission; this should be accounted for when examining the overall impact of firearm injuries. What is Known: • Child/youth firearm injuries have significant health and economic burdens. • However, existing work has mainly examined healthcare utilization and costs of initial admissions and/or have been limited to single-center studies and no studies have provide cost estimates by weapon type and intent. What is New: • Children/youth who suffered powdered firearm injuries had higher mean healthcare utilization and costs than those with non-powdered firearm injuries as well as comparable healthy children/youth. • Mean 1-year costs were highest for handgun injuries ($12,875), and for intentional assault-related ($13,498; $3287), and intentional self-injuries ($14,773; $6005) for powdered and non-powdered firearm injuries, respectively.
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Affiliation(s)
- Claire de Oliveira
- ICES, Toronto, Canada ,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada ,Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada ,Centre for Health Economics and Hull York Medical School, University of York, York, UK
| | - Alison Macpherson
- ICES, Toronto, Canada ,School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Canada
| | - Charlotte Moore Hepburn
- The Hospital for Sick Children, Toronto, ON Canada ,Department of Pediatrics, University of Toronto, Toronto, Canada ,Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | | | - Ning Liu
- ICES, Toronto, Canada ,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Lisa Fiksenbaum
- The Hospital for Sick Children, Toronto, ON Canada ,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
| | - Paul Pageau
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - David Gomez
- ICES, Toronto, Canada ,Temerty Faculty of Medicine, University of Toronto, Toronto, Canada ,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada ,Division of General Surgery, St Michael’s Hospital, Unity Health Toronto, Toronto, Canada ,Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, Canada
| | - Natasha Ruth Saunders
- ICES, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. .,The Hospital for Sick Children, Toronto, ON, Canada. .,Department of Pediatrics, University of Toronto, Toronto, Canada. .,Temerty Faculty of Medicine, University of Toronto, Toronto, Canada. .,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada.
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Saunders NR, Moore Hepburn C, Huang A, de Oliveira C, Strauss R, Fiksenbaum L, Pageau P, Liu N, Gomez D, Macpherson A. Firearm injury epidemiology in children and youth in Ontario, Canada: a population-based study. BMJ Open 2021; 11:e053859. [PMID: 34794997 PMCID: PMC8603258 DOI: 10.1136/bmjopen-2021-053859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Despite firearms contributing to significant morbidity and mortality globally, firearm injury epidemiology is seldom described outside of the USA. We examined firearm injuries among youth in Canada, including weapon type, and intent. DESIGN Population-based, pooled cross-sectional study using linked health administrative and demographic databases. SETTING Ontario, Canada. PARTICIPANTS All children and youth from birth to 24 years, residing in Ontario from 1 April 2003 to 31 March 2018. EXPOSURE Firearm injury intent and weapon type using the International Classification of Disease-10 CM codes with Canadian enhancements. Secondary exposures were sociodemographics including age, sex, rurality and income. MAIN OUTCOMES Any hospital or death record of a firearm injury with counts and rates of firearm injuries described overall and stratified by weapon type and injury intent. Multivariable Poisson regression stratified by injury intent was used to calculate rate ratios of firearm injuries by weapon type. RESULTS Of 5486 children and youth with a firearm injury (annual rate: 8.8/100 000 population), 90.7% survived. Most injuries occurred in males (90.1%, 15.5/100 000 population). 62.3% (3416) of injuries were unintentional (5.5/100 000 population) of which 1.9% were deaths, whereas 26.5% (1452) were assault related (2.3/100 00 population) of which 18.7% were deaths. Self-injury accounted for 3.7% (204) of cases of which 72.0% were deaths. Across all intents, adjusted regression models showed males were at an increased risk of injury. Non-powdered firearms accounted for half (48.6%, 3.9/100 000 population) of all injuries. Compared with handguns, non-powdered firearms had a higher risk of causing unintentional injuries (adjusted rate ratio (aRR) 14.75, 95% CI 12.01 to 18.12) but not assault (aRR 0.84, 95% CI 0.70 to 1.00). CONCLUSIONS Firearm injuries are a preventable public health problem among youth in Ontario, Canada. Unintentional injuries and those caused by non-powdered firearms were most common and assault and self-injury contributed to substantial firearm-related deaths and should be a focus of prevention efforts.
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Affiliation(s)
- Natasha Ruth Saunders
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | | | | | | | | | - Lisa Fiksenbaum
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Paul Pageau
- Department of Emergency Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | | | - David Gomez
- ICES, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Alison Macpherson
- ICES, Toronto, Ontario, Canada
- School of Kinesiology and Health Science, York University Faculty of Health, Toronto, Ontario, Canada
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Abstract
BACKGROUND Individuals with eating disorders have a high mortality risk. Few population-based studies have estimated this risk in eating disorders other than anorexia nervosa. AIMS To investigate all-cause mortality in a population-based cohort of individuals who received hospital-based care for an eating disorder (anorexia nervosa, bulimia nervosa or eating disorder not otherwise specified) in Ontario, Canada. METHOD We conducted a retrospective cohort study of 19 041 individuals with an eating disorder from 1 January 1990 to 31 December 2013 using administrative healthcare data. The outcome of interest was death. Excess mortality was assessed using standardised mortality ratios (SMRs) and potential years of life lost (PYLL). Cox proportional hazards regression models were used to examine sociodemographic and medical comorbidities associated with greater mortality risk. RESULTS The cohort had 17 108 females (89.9%) and 1933 males (10.1%). The all-cause mortality for the entire cohort was five times higher than expected compared with the Ontario population (SMR = 5.06; 95% CI 4.82-5.30). SMRs were higher for males (SMR = 7.24; 95% CI 6.58-7.96) relative to females (SMR = 4.59; 95% CI 4.34-4.85) overall, and in all age groups in the cohort. For both genders, the cohort PYLL was more than six times higher than the expected PYLL in the Ontario population. CONCLUSIONS Patients with eating disorders diagnosed in hospital settings experience five to seven times higher mortality rates compared with the overall population. There is an urgent need to understand the mortality risk factors to improve health outcomes among individuals with eating disorders.
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Affiliation(s)
- Tomisin Iwajomo
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto; and ICES, Toronto, Ontario, Canada
| | - Susan J Bondy
- ICES, Toronto; and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto; and ICES, Toronto; and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario; Canada
| | - Patricia Colton
- University Health Network, Toronto; and Department of Psychiatry, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Kathryn Trottier
- University Health Network, Toronto; and Department of Psychiatry, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto; and ICES, Toronto; and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto; and Department of Psychiatry, Faculty of Medicine, University of Toronto, Ontario, Canada
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de Oliveira C, Mason J, Jacobs R. Examining equity in the utilisation of psychiatric inpatient care among patients with severe mental illness (SMI) in Ontario, Canada. BMC Psychiatry 2021; 21:420. [PMID: 34425787 PMCID: PMC8381537 DOI: 10.1186/s12888-021-03419-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 08/09/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Severe mental illness (SMI) comprises a range of chronic and disabling conditions, such as schizophrenia, bipolar disorder and other psychoses. Despite affecting a small percentage of the population, these disorders are associated with poor outcomes, further compounded by disparities in access, utilisation, and quality of care. Previous research indicates there is pro-poor inequality in the utilisation of SMI-related psychiatric inpatient care in England (in other words, individuals in more deprived areas have higher utilisation of inpatient care than those in less deprived areas). Our objective was to determine whether there is pro-poor inequality in SMI-related psychiatric admissions in Ontario, and understand whether these inequalities have changed over time. METHODS We selected all adult psychiatric admissions from April 2006 to March 2011. We identified changes in socio-economic equity over time across deprivation groups and geographic units by modeling, through ordinary least squares, annual need-expected standardised utilisation as a function of material deprivation and other relevant variables. We also tested for changes in socio-economic equity of utilisation over years, where the number of SMI-related psychiatric admissions for each geographic unit was modeled using a negative binomial model. RESULTS We found pro-poor inequality in SMI-related psychiatric admissions in Ontario. For every one unit increase in deprivation, psychiatric admissions increased by about 8.1%. Pro-poor inequality was particularly present in very urban areas, where many patients with SMI reside, and very rural areas, where access to care is problematic. Our main findings did not change with our sensitivity analyses. Furthermore, this inequality did not change over time. CONCLUSIONS Individuals with SMI living in more deprived areas of Ontario had higher psychiatric admissions than those living in less deprived areas. Moreover, our findings suggest this inequality has remained unchanged over time. Despite the debate around whether to make more or less use of inpatient versus other care, policy makers should seek to address suboptimal supply of primary, community or social care for SMI patients. This may potentially be achieved through the elimination of barriers to access psychiatrist care and the implementation of universal coverage of psychotherapy.
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Affiliation(s)
- Claire de Oliveira
- Centre for Health Economics, University of York, Alcuin A Block, Heslington, York, YO10 5DD, UK. .,Hull York Medical School, University of York, Alcuin A Block, Heslington, York, YO10 5DD, UK. .,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, M5S 2S1, Canada. .,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, M5T 3M6, Canada. .,ICES, Toronto, Ontario, M4N 3M5, Canada.
| | - Joyce Mason
- grid.155956.b0000 0000 8793 5925Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario M5S 2S1 Canada ,grid.418647.80000 0000 8849 1617ICES, Toronto, Ontario M4N 3M5 Canada
| | - Rowena Jacobs
- grid.5685.e0000 0004 1936 9668Centre for Health Economics, University of York, Alcuin A Block, Heslington, York, YO10 5DD UK
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50
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Vigod SN, Slyfield Cook G, Macdonald K, Hussain-Shamsy N, Brown HK, de Oliveira C, Torshizi K, Benipal PK, Grigoriadis S, Classen CC, Dennis CL. Mother Matters: Pilot randomized wait-list controlled trial of an online therapist-facilitated discussion board and support group for postpartum depression symptoms. Depress Anxiety 2021; 38:816-825. [PMID: 33949762 DOI: 10.1002/da.23163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/15/2021] [Accepted: 04/17/2021] [Indexed: 11/05/2022] Open
Abstract
METHODS In a pilot randomized waitlist-controlled trial (Ontario, Canada), individuals aged ≥18 years with Edinburgh Postnatal Depression Scale (EPDS) scores greater than 9 and who self-identified as a mother to a child aged 0-12 months were randomized 1:1 to Mother Matters (intervention) or usual care (control), with an opportunity to receive the intervention after the study was complete. The primary outcome was protocol feasibility, evaluated through recruitment feasibility, intervention acceptability, and adherence to study follow-up measures. Secondarily, postintervention EPDS scores and remission rates (EPDS < 10) were compared between groups. RESULTS Ninety-eight participants were randomized (n = 50 intervention; n = 48 control) and seventy-seven (78.6%) completed postintervention questionnaires. About 88% of the intervention group (n = 44) logged into Mother Matters. Almost all topics were rated highly for relevance, there was good group cohesion and good satisfaction with the intervention. Mean (SD) EPDS scores decreased from 14.5 (4.07) to 11.3 (4.54) in the intervention group and 15.0 (3.56) to 12.0 (4.79) among controls (adjusted mean difference [aMD] -0.58, 95% confidence interval [CI]: -2.68 to 1.52), with remission in 37.8% versus 25.0% for intervention group and controls, respectively (χ2 = 1.48; p = .224). Among those with EPDS ≥ 16, the aMD was -3.66 (95% CI: -6.65 to -0.67) with remission in 41.2% in the intervention group versus 10.0% among controls (χ2 = 4.50; p = .06). CONCLUSION This study supports the pursuit of online, therapist-facilitated, discussion board support group strategies for PPD. A large-scale efficacy and cost-effectiveness evaluation of Mother Matters is warranted.
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Affiliation(s)
- Simone N Vigod
- Department of Psychiatry, Women's College Hospital and Women's College Research Institute, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Greer Slyfield Cook
- Department of Psychiatry, Women's College Hospital and Women's College Research Institute, Toronto, Ontario, Canada
| | - Kaeli Macdonald
- Department of Psychiatry, Women's College Hospital and Women's College Research Institute, Toronto, Ontario, Canada
| | - Neesha Hussain-Shamsy
- Department of Psychiatry, Women's College Hospital and Women's College Research Institute, Toronto, Ontario, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Hilary K Brown
- Department of Psychiatry, Women's College Hospital and Women's College Research Institute, Toronto, Ontario, Canada.,Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kiana Torshizi
- Department of Psychiatry, Women's College Hospital and Women's College Research Institute, Toronto, Ontario, Canada
| | - Pardeep K Benipal
- Department of Psychiatry, Women's College Hospital and Women's College Research Institute, Toronto, Ontario, Canada
| | - Sophie Grigoriadis
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Sunnbrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Catherine C Classen
- Department of Psychiatry, Women's College Hospital and Women's College Research Institute, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cindy-Lee Dennis
- Department of Psychiatry, Women's College Hospital and Women's College Research Institute, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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