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Richardson M, Sander B, Daneman N, Mighton C, Miller FA. Moving from intervention management to disease management: a qualitative study exploring a systems approach to health technology assessment in Canada. Int J Technol Assess Health Care 2023; 39:e67. [PMID: 37929295 DOI: 10.1017/s0266462323002696] [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] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
OBJECTIVES Health technology assessment (HTA) traditionally informs decision making for single health technologies, which could lead to ill-informed decisions, suboptimal care, and system inefficiencies. We explored opportunities for conceptualizing the decision space in HTA as a disease management question versus an intervention management question. METHODS Semistructured interviews were conducted between April 2022 and October 2022 with purposefully selected individuals from national and provincial HTA agencies and related organizations in Canada. We conducted manual line by line coding of data informed by our interview guide and sensitizing concepts from the literature. One author coded the data, and findings were independently verified by a second author who coded a subset of transcripts. RESULTS Twenty-four invitations were distributed, and eighteen individuals agreed to participate. A disease management approach to HTA was differentiated from traditional approaches as being disease-based, multi-interventional, and dynamic. There was general support for an explicit care pathway approach to HTA by informing discussions around patient choice and suboptimal care, creating a space where decision makers can collaborate on shared objectives, and in setting up a platform for open dialogue about managing high-cost and high-severity diseases. There are opportunities for a care pathway approach to be implemented that build on the strengths of the existing HTA system in Canada. CONCLUSIONS A disease management approach may enhance the impact of HTA by supporting dynamic decision making that could better inform a proactive, resilient, and sustainable healthcare system in Canada.
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Affiliation(s)
- Marina Richardson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON, Canada
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
| | - Nick Daneman
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Chloe Mighton
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Grundy Q, Hart D, Perkins-Meingast B, Heesters AM, Miller FA. Outsourcing practice-based education: The role of industry representatives and implications for clinical expertise. Healthc Manage Forum 2023; 36:351-356. [PMID: 37243610 PMCID: PMC10448116 DOI: 10.1177/08404704231173552] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In an era of significant human and fiscal constraints, hospitals increasingly rely on industry representatives to fill gaps related to practice-based education. Given their dual sales and support functions, the extent to which education and support functions are, or ought to be, fulfilled by industry representatives is unclear. We conducted an interpretive qualitative study at a large, academic medical centre in Ontario, Canada, during 2021-2022, interviewing 36 participants across the organization with direct and varied experiences with industry-delivered education. We found that ongoing fiscal and human resource challenges prompted hospital leaders to outsource practice-based education to industry representatives, which created an expanded role for industry beyond initial product rollouts. Outsourcing, however, generated downstream costs to the organization and undermined the goals of practice-based education. To attract and retain clinicians, participants advocated for re-investment in practice-based education in-house, with a limited and supervised role for industry representatives.
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Affiliation(s)
| | - Dana Hart
- University of Toronto, Toronto, Ontario, Canada
| | | | - Ann M. Heesters
- University Health Network, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Toronto, Ontario, Canada
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Varangu L, Cowan K, Amin O, Sarrazin M, Dawson M, Rubinstein E, Miller FA, Hirst L, Trbovich P, Waddington K. Reusable personal protective equipment in Canadian healthcare: Safe, secure, and sustainable. Healthc Manage Forum 2023:8404704231168752. [PMID: 37186690 DOI: 10.1177/08404704231168752] [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] [Indexed: 05/17/2023]
Abstract
Personal Protective Equipment (PPE) that was intentionally designed and manufactured as reusable, including gowns, goggles, face shields, and elastomeric respirators, took on a heightened role during the pandemic. Healthcare workers who had access to these products and infrastructure for cleaning and sterilizing them had a greater sense of confidence to undertake their jobs due to an increased sense of personal safety. Using multiple data sources, including a literature review, roundtables, interviews, surveys, and Internet-based research, the project team investigated the impact of disposable PPE and role of reusable PPE during the pandemic in Canada. This research supports the claim that adopting and supporting reusable PPE systems throughout the health sector can, if used appropriately on an ongoing basis, provide continuous access to reusable PPE while also contributing many co-benefits, including lower costs, domestic jobs, and improved environmental performance such as reduced waste and greenhouse gas emissions.
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Affiliation(s)
- Linda Varangu
- The Canadian Coalition for Green Healthcare, Verdun, Quebec, Canada
| | - Kady Cowan
- The Canadian Coalition for Green Healthcare, Verdun, Quebec, Canada
- Start Somewhere Sustainability Services, Toronto, Ontario, Canada
| | - Ozora Amin
- The Canadian Coalition for Green Healthcare, Verdun, Quebec, Canada
| | - Mia Sarrazin
- The Canadian Coalition for Green Healthcare, Verdun, Quebec, Canada
| | - Marianne Dawson
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | | | | | | | - Patricia Trbovich
- University of Toronto, Toronto, Ontario, Canada
- North York General Hospital, Toronto, Ontario, Canada
| | - Kent Waddington
- The Canadian Coalition for Green Healthcare, Verdun, Quebec, Canada
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Parker G, Hunter S, Ghazi S, Hayeems RZ, Rousseau F, Miller FA. Decision impact studies, evidence of clinical utility for genomic assays in cancer: A scoping review. PLoS One 2023; 18:e0280582. [PMID: 36897859 PMCID: PMC10004522 DOI: 10.1371/journal.pone.0280582] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 01/03/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Decision impact studies have become increasingly prevalent in cancer prognostic research in recent years. These studies aim to evaluate the impact of a genomic test on decision-making and appear to be a new form of evidence of clinical utility. The objectives of this review were to identify and characterize decision impact studies in genomic medicine in cancer care and categorize the types of clinical utility outcomes reported. METHODS We conducted a search of four databases, Medline, Embase, Scopus and Web of Science, from inception to June 2022. Empirical studies that reported a "decision impact" assessment of a genomic assay on treatment decisions or recommendations for cancer patients were included. We followed scoping review methodology and adapted the Fryback and Thornbury Model to collect and analyze data on clinical utility. The database searches identified 1803 unique articles for title/abstract screening; 269 articles moved to full-text review. RESULTS 87 studies met inclusion criteria. All studies were published in the last 12 years with the majority for breast cancer (72%); followed by other cancers (28%) (lung, prostate, colon). Studies reported on the impact of 19 different proprietary (18) and generic (1) assays. Across all four levels of clinical utility, outcomes were reported for 22 discrete measures, including the impact on provider/team decision-making (100%), provider confidence (31%); change in treatment received (46%); patient psychological impacts (17%); and costing or savings impacts (21%). Based on the data synthesis, we created a comprehensive table of outcomes reported for clinical utility. CONCLUSIONS This scoping review is a first step in understanding the evolution and uses of decision impact studies and their influence on the integration of emerging genomic technologies in cancer care. The results imply that DIS are positioned to provide evidence of clinical utility and impact clinical practice and reimbursement decision-making in cancer care. Systematic review registration: Open Science Framework osf.io/hm3jr.
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Affiliation(s)
- Gillian Parker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Hunter
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Samer Ghazi
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Robin Z. Hayeems
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Francois Rousseau
- Department of Molecular Biology, Medical Biochemistry, and Pathology, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Fiona A. Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Alami H, Lehoux P, Miller FA, Shaw SE, Fortin JP. An urgent call for the environmental sustainability of health systems: A 'sextuple aim' to care for patients, costs, providers, population equity and the planet. Int J Health Plann Manage 2023; 38:289-295. [PMID: 36734815 DOI: 10.1002/hpm.3616] [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] [Received: 04/22/2022] [Revised: 12/27/2022] [Accepted: 01/24/2023] [Indexed: 02/04/2023] Open
Abstract
Health systems have a duty to protect the health and well-being of individuals and populations. Yet, healthcare contributes about 4.6% of global greenhouse gas emissions. Health systems need to question and improve established practices, assume strong environmental leadership, and aim for ambitious, sometimes radical, actions in favour of the climate. In this paper, we interrogate the suitability and feasibility of integrating the aim of 'environmental sustainability' to form the 'Sextuple Aim.' Environmental sustainability may be in tension with, but also a potential lever to meet the other cardinal aims: (1) quality and experience of patient care; (2) population health; (3) quality of work and satisfaction of healthcare providers; (4) equity and inclusion; and (5) cost reduction. We propose policy and practical avenues to help move towards the Sextuple Aim.
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Affiliation(s)
- Hassane Alami
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Pascale Lehoux
- Department of Health Management, Evaluation and Policy, University of Montreal, Montreal, Quebec, Canada.,Center for Public Health Research of the University of Montreal, Montreal, Quebec, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Centre for Sustainable Health Systems, Toronto, Ontario, Canada
| | - Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jean-Paul Fortin
- VITAM Research Centre on Sustainable Health, Faculty of Medicine, Laval University, Quebec, Quebec, Canada
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Luo OD, Razvi Y, Kaur G, Lim M, Smith K, Carson JJK, Petrin-Desrosiers C, Haldane V, Simms N, Miller FA. A qualitative study of what motivates and enables climate-engaged physicians in Canada to engage in health-care sustainability, advocacy, and action. Lancet Planet Health 2023; 7:e164-e171. [PMID: 36754472 DOI: 10.1016/s2542-5196(22)00311-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 06/18/2023]
Abstract
Increasing numbers of health-care professionals are aware of the need to deliver low-carbon sustainable health systems. We aimed to explore how physicians can be motivated and supported to pursue this ambition by conducting an exploratory qualitative descriptive study that involved individual in-depth interviews with climate-engaged Canadian physicians participating in health-care sustainability advocacy and action. Interview transcripts were analysed to identify themes related to the actions that physicians can take to promote sustainable health care, and the motivators and enablers of physician engagement in sustainable health care. Participants (n=19) engaged in a spectrum of health-care sustainability initiatives ranging from reducing health-care waste to lobbying and political action. They were motivated to advance health-care sustainability by their concern about the health implications of climate change, frustration with health-care waste, and recognition of their locus of influence as physicians. Participants articulated that policy and system, organisational and team, and knowledge generation and translation supports are required to strengthen their capacity to advance health-care sustainability. These findings can provide inspiration for engagement opportunities in health-care sustainability, guide service delivery and educational innovations to promote health-care professionals' interest in becoming sustainability champions, and extend the capacity of health-care professionals to reduce the climate impact of health care.
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Affiliation(s)
- Owen Dan Luo
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, QC, Canada
| | - Yasmeen Razvi
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Gurleen Kaur
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michelle Lim
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kelti Smith
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jacob Joel Kirsh Carson
- Department of Pediatrics, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Claudel Petrin-Desrosiers
- Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Nicole Simms
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Centre for Sustainable Health Systems, University of Toronto, Toronto, ON, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Centre for Sustainable Health Systems, University of Toronto, Toronto, ON, Canada.
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Parker G, Hunter S, Hogarth S, Miller FA. Industry involvement in evidence production for genomic medicine: A bibliometric and funding analysis of decision impact studies. PLoS One 2023; 18:e0285122. [PMID: 37104298 PMCID: PMC10138259 DOI: 10.1371/journal.pone.0285122] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/15/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Decision impact studies have become increasingly prevalent in genomic medicine, particularly in cancer research. Such studies are designed to provide evidence of clinical utility for genomic tests by evaluating their impact on clinical decision-making. This paper offers insights into understanding of the origins and intentions of these studies through an analysis of the actors and institutions responsible for the production of this new type of evidence. METHODS We conducted bibliometric and funding analyses of decision impact studies in genomic medicine research. We searched databases from inception to June 2022. The datasets used were primarily from Web of Science. Biblioshiny, additional R-based applications, and Microsoft Excel were used for publication, co-authorship and co-word analyses. RESULTS 163 publications were included for the bibliometric analysis; a subset of 125 studies were included for the funding analysis. Included publications started in 2010 and increased steadily over time. Decision impact studies were primarily produced for proprietary genomic assays for use in cancer care. The author and affiliate analyses reveal that these studies were produced by 'invisible colleges' of researchers and industry actors with collaborations focused on producing evidence for proprietary assays. Most authors had an industry affiliation, and the majority of studies were funded by industry. While studies were conducted in 22 countries, the majority had at least one author from the USA. DISCUSSION This study is a critical step in understanding the role of industry in the production of new types of research. Based on the data collected, we conclude that decision impact studies are industry-conceived and -produced evidence. The findings of this study demonstrate the depth of industry involvement and highlight a need for further research into the use of these studies in decision-making for coverage and reimbursement.
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Affiliation(s)
- Gillian Parker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Hunter
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Stuart Hogarth
- Department of Sociology, University of Cambridge, Cambridge, United Kingdom
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Stigant CE, Rajan T, Barraclough KA, Miller FA. The Necessity of Environmentally Sustainable Kidney Care. Can J Kidney Health Dis 2023; 10:20543581231166484. [PMID: 37091496 PMCID: PMC10116004 DOI: 10.1177/20543581231166484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/27/2023] [Indexed: 04/25/2023] Open
Affiliation(s)
- Caroline E. Stigant
- Division of Nephrology, Island Health Authority, Department of Medicine, University of British Columbia, Vancouver, Canada
- Caroline E. Stigant, Division of Nephrology, Island Health Authority, Department of Medicine, University of British Columbia, #201-1990 Fort Street, Vancouver, BC V8R 6V4, Canada.
| | - Tasleem Rajan
- Division of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Katherine A. Barraclough
- Department of Nephrology, Royal Melbourne Hospital, Melbourne Health, Parkville, VIC, Australia
- School of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Fiona A. Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
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Holloway K, Miller FA. The Consultant's intermediary role in the regulation of molecular diagnostics in the US. Soc Sci Med 2022; 304:112929. [PMID: 32201019 DOI: 10.1016/j.socscimed.2020.112929] [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] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/28/2020] [Accepted: 03/12/2020] [Indexed: 11/17/2022]
Abstract
Molecular diagnostics are fast becoming a big business, with the promise of personalized medicine fueling the growth of "blockbuster" tests with high expectations for health system impact and commercial success. We investigate the polycentric regulatory regime for molecular diagnostics in the US, drawing attention to the prominent role of coverage and reimbursement systems in setting regulatory standards for this industry. We hone in on the private consultants who assist molecular diagnostics companies to gain broad clinical uptake of their products. Through a web-based search of consulting companies, analysis of their online materials, and 13 qualitative interviews with consultants, we describe the role of these actors in the coverage and reimbursement of novel diagnostics and highlight the production of evidence as a critical part of the process. We argue that consultants operate as regulatory intermediaries, helping to develop the evidentiary standards for payment decisions that ultimately benefit their clients, the manufacturers. We suggest that public policy discussions over how best to realize the promise of personalized medicine should be re-oriented to consider whose interests are represented in the regulatory regime governing access to these technologies.
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Holloway K, Simms N, Hayeems RZ, Miller FA. The Market in Noninvasive Prenatal Tests and the Message to Consumers: Exploring Responsibility. Hastings Cent Rep 2022; 52:49-57. [DOI: 10.1002/hast.1329] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Xie E, Howard C, Buchman S, Miller FA. Acting on climate change for a healthier future: Critical role for primary care in Canada. Can Fam Physician 2021; 67:725-730. [PMID: 34649894 DOI: 10.46747/cfp.6710725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Edward Xie
- Clinical Assistant Professor in the Department of Family and Community Medicine at the University of Toronto in Ontario and Clinician Investigator at the Toronto General Hospital Research Institute
| | - Courtney Howard
- Clinical Associate Professor in the Cumming School of Medicine at the University of Calgary in Alberta
| | - Sandy Buchman
- Associate Professor in the Department of Family and Community Medicine at the University of Toronto and Freeman Family Chair in Palliative Care at North York General Hospital
| | - Fiona A Miller
- Professor of Health Policy and Chair in Health Management Strategies in the Institute of Health Policy, Management and Evaluation at the University of Toronto
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12
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Carroll JC, Morrison S, Miller FA, Wilson BJ, Permaul JA, Allanson J. Anticipating the primary care role in genomic medicine: expectations of genetics health professionals. J Community Genet 2021; 12:559-568. [PMID: 34379295 DOI: 10.1007/s12687-021-00544-1] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/27/2021] [Indexed: 02/06/2023] Open
Abstract
Our purpose was to explore genetics health professionals' (GHPs) expectations of primary care providers' (PCPs) role in genomic medicine now and in the future. Focus groups/interviews were conducted with GHPs in Ontario, Canada. Recordings were transcribed and analysed using qualitative descriptive analysis. Five focus groups (6 clinical geneticists, 24 genetic counselors, 1 nurse, 4 laboratory staff, 3 genetics program administrators) and 3 interviews (nurses) were conducted. GHPs described a key role for PCPs in genomic medicine that could be enhanced if GHPs and PCPs worked together more effectively, making better use of GHPs as a scarce specialist resource, improving PCP knowledge and awareness of genomics, and increasing GHPs' understanding of primary care practice and how to provide PCPs meaningful education and support. Health system change is needed to facilitate the GHP/PCP relationship and improve care. This might include: PCPs ordering more genetic tests independently or with GHP guidance prior to GHP consultations, genomic expertise in primary care clinics or GHPs being accessible through buddy systems or virtually through telemedicine or electronic consultation, and developing educational materials and electronic decision support for PCPs. Our findings highlight need for change in delivering genomic medicine, which requires building the relationship between GHPs and PCPs, and creating new service delivery models to meet future needs.
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Affiliation(s)
- June C Carroll
- Department of Family and Community Medicine, Sinai Health, University of Toronto, Toronto, Canada.
| | | | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Brenda J Wilson
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - Joanne A Permaul
- Ray D. Wolfe Department of Family Medicine, Sinai Health, Toronto, ON, Canada
| | - Judith Allanson
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Canada
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Hayeems RZ, Miller FA, Barg CJ, Bombard Y, Chakraborty P, Potter BK, Patton S, Bytautas JP, Tam K, Taylor L, Kerr E, Davies C, Milburn J, Ratjen F, Guttmann A, Carroll JC. Primary care providers' role in newborn screening result notification for cystic fibrosis. Can Fam Physician 2021; 67:439-448. [PMID: 34127469 PMCID: PMC8202749 DOI: 10.46747/cfp.6706439] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore primary care providers' (PCPs') role in result notification for newborn screening (NBS) for cystic fibrosis (CF), given that expanded NBS has increased the number of positive screening test results, drawing attention to the role of PCPs in supporting families. DESIGN Cross-sectional survey and qualitative interviews. SETTING Ontario. PARTICIPANTS Primary care providers (FPs, pediatricians, and midwives) who received a positive CF NBS result for an infant in their practice in the 6 months before the study. MAIN OUTCOME MEASURES Whether the PCP notified the family of the initial positive CF screening result. RESULTS Data from 321 PCP surveys (response rate of 51%) are reported, including 208 FPs, 68 pediatricians, and 45 midwives. Interviews were completed with 34 PCPs. Most (65%) surveyed PCPs reported notifying the infant's family of the initial positive screening result; 81% agreed that they have an important role to play in NBS; and 88% said it was important for PCPs, rather than the NBS centre, to notify families of initial positive results. With support and information from NBS centres, 68% would be extremely or very confident in doing so; this dropped to 54% when reflecting on their recent reporting experience. More than half (58%) of all PCPs said written point-of-care information from the NBS centre was the most helpful format. Adjusted for relevant factors, written educational information was associated with a lower rate of notifying families than written plus verbal information (risk ratio of 0.79; 95% CI 0.69 to 0.92). In the interviews, PCPs emphasized the challenge of balancing required content knowledge with the desire for the news to come from a familiar provider. CONCLUSION Most PCPs notify families of NBS results and value this role. These data are relevant as NBS programs and other genomic services expand and consider ways of keeping PCPs confident and actively involved.
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Affiliation(s)
- Robin Z Hayeems
- Scientist in the Child Health Evaluative Sciences Program at the Hospital for Sick Children in Toronto, Ont, and Associate Professor in the Institute of Health Policy, Management and Evaluation at the University of Toronto.
| | - Fiona A Miller
- Professor of Health Policy and holds the Chair in Health Management Strategies at the Institute of Health Policy, Management and Evaluation at the University of Toronto
| | | | - Yvonne Bombard
- Scientist at the Li Ka Shing Knowledge Institute at St Michael's Hospital in Toronto and Associate Professor in the Institute of Health Policy, Management and Evaluation at the University of Toronto
| | - Pranesh Chakraborty
- Executive Director and Chief Medical Officer of Newborn Screening Ontario in Ottawa, a medical biochemist in the Department of Pediatrics at the Children's Hospital of Eastern Ontario in Ottawa, and Associate Professor of Pediatrics at the University of Ottawa
| | - Beth K Potter
- Associate Professor in the Department of Epidemiology and Community Medicine at the University of Ottawa and holds the University Research Chair in Health Services for Children with Rare Diseases
| | - Sarah Patton
- Research Officer in the Institute of Health Policy, Management and Evaluation at the University of Toronto at the time of the study
| | - Jessica Peace Bytautas
- Doctoral student in the Dalla Lana School of Public Health and a research assistant in the Institute of Health Policy, Management and Evaluation at the University of Toronto
| | - Karen Tam
- Certified genetic counselor and screening specialist at Newborn Screening Ontario
| | - Louise Taylor
- Nurse practitioner with expertise in caring for children with cystic fibrosis at the Hospital for Sick Children
| | - Elizabeth Kerr
- Clinical neuropsychologist and a scientist in the Department of Pediatrics, Division of Neurology, at the Hospital for Sick Children, and Adjunct Faculty in the Department of Pediatrics at the University of Toronto
| | | | | | - Felix Ratjen
- Division Chief of Pediatric Respiratory Medicine, Co-lead of the Cystic Fibrosis Centre, Senior Scientist at the Research Institute in the Translational Medicine research program, and Medical Director of the Clinical Research Unit, all at the Hospital for Sick Children, and Professor of Pediatrics at the University of Toronto
| | - Astrid Guttmann
- Clinician scientist in the Division of Pediatric Medicine at the Hospital for Sick Children, Chief Science Officer and Senior Scientist at ICES, and Professor of Pediatrics with a cross appointment at the Institute of Health Policy, Management and Evaluation and the Epidemiology Division of the Dalla Lana School of Public Health at the University of Toronto
| | - June C Carroll
- Family physician and clinician scientist, Professor, and Sydney G. Frankfort Chair in Family Medicine in the Department of Family and Community Medicine with the Sinai Health System and the University of Toronto
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14
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Carroll JC, Hayeems RZ, Miller FA, Barg CJ, Bombard Y, Chakraborty P, Potter BK, Bytautas JP, Tam K, Taylor L, Kerr E, Davies C, Milburn J, Ratjen F, Guttmann A. Newborn screening for cystic fibrosis: Role of primary care providers in caring for infants with positive screening results. Can Fam Physician 2021; 67:e144-e152. [PMID: 34127476 PMCID: PMC8202744 DOI: 10.46747/cfp.6706e144] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore primary care providers' (PCPs') preferred roles and confidence in caring for infants receiving a positive cystic fibrosis (CF) newborn screening (NBS) result, as well as management of CF family planning issues, given that expanded NBS has resulted in an increase in positive results. DESIGN Mailed questionnaire. SETTING Ontario. PARTICIPANTS Ontario FPs, pediatricians, and midwives identified by Newborn Screening Ontario as having had an infant with a positive CF NBS result in their practice in the previous 6 months. MAIN OUTCOME MEASURE Primary care providers' preferred roles in providing well-baby care for infants with positive CF screening results. RESULTS Overall, 321 of 628 (51%) completed surveys (208 FPs, 68 pediatricians, 45 midwives). For well-baby care for infants confirmed to have CF, 77% of PCPs indicated they would not provide total care (ie, 68% would share care with other specialists and 9% would refer to specialists completely); for infants with an inconclusive CF diagnosis, 50% of PCPs would provide total care, 45% would provide shared care, and 5% would refer to a specialist; for CF carriers, 89% of PCPs would provide total care, 9% would provide shared care, and 2% would refer. Half (54%) of PCPs were extremely or very confident in providing reassurance about CF carriers' health. Only 25% knew how to order parents' CF carrier testing; 67% knew how to refer for prenatal diagnosis. Confidence in reassuring parents about the health of CF carrier children was associated with providing total well-baby care for CF carriers (risk ratio of 1.50; 95% CI 1.14 to 1.97) and infants with an inconclusive diagnosis (risk ratio of 3.30; 95% CI 1.34 to 8.16). CONCLUSION Most PCPs indicated willingness to treat infants with a range of CF NBS results in some capacity. It is concerning that some indicated CF carriers should have specialist involvement and only half were extremely or very confident about reassuring families about carrier status. This raises issues about possible medicalization of those with carrier status, prompting the need for PCP education about genetic disorders and the meaning of genetic test results.
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Affiliation(s)
- June C Carroll
- Family physician and clinician scientist, Professor, and Sydney G. Frankfort Chair in Family Medicine in the Department of Family and Community Medicine with the Sinai Health System and the University of Toronto in Ontario.
| | - Robin Z Hayeems
- Scientist in the Child Health Evaluative Sciences Program at the Hospital for Sick Children in Toronto and Associate Professor in the Institute of Health Policy, Management and Evaluation at the University of Toronto
| | - Fiona A Miller
- Professor of Health Policy and holds the Chair in Health Management Strategies at the Institute of Health Policy, Management and Evaluation at the University of Toronto
| | | | - Yvonne Bombard
- Scientist at the Li Ka Shing Knowledge Institute at St Michael's Hospital in Toronto and Associate Professor in the Institute of Health Policy, Management and Evaluation at the University of Toronto
| | - Pranesh Chakraborty
- Executive Director and Chief Medical Officer of Newborn Screening Ontario in Ottawa, a medical biochemist in the Department of Pediatrics at the Children's Hospital of Eastern Ontario in Ottawa and Associate Professor of Pediatrics at the University of Ottawa
| | - Beth K Potter
- Associate Professor in the Department of Epidemiology and Community Medicine at the University of Ottawa and holds the University Research Chair in Health Services for Children with Rare Diseases
| | - Jessica Peace Bytautas
- Doctoral student in the Dalla Lana School of Public Health and a research assistant in the Institute of Health Policy, Management and Evaluation at the University of Toronto
| | - Karen Tam
- Certified genetic counselor and screening specialist at Newborn Screening Ontario
| | - Louise Taylor
- Nurse practitioner with expertise in caring for children with cystic fibrosis at the Hospital for Sick Children
| | - Elizabeth Kerr
- Clinical neuropsychologist and a scientist in the Department of Pediatrics, Division of Neurology, at the Hospital for Sick Children, and Adjunct Faculty in the Department of Pediatrics at the University of Toronto
| | | | | | - Felix Ratjen
- Division Chief of Pediatric Respiratory Medicine, Co-lead of the Cystic Fibrosis Centre, Senior Scientist at the Research Institute in the Translational Medicine research program, and Medical Director of the Clinical Research Unit, all at the Hospital for Sick Children, and Professor of Pediatrics at the University of Toronto
| | - Astrid Guttmann
- Clinician scientist in the Division of Pediatric Medicine at the Hospital for Sick Children, Chief Science Officer and Senior Scientist at ICES, and Professor of Pediatrics with a cross appointment at the Institute of Health Policy, Management and Evaluation and the Epidemiology Division of the Dalla Lana School of Public Health at the University of Toronto
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Miller FA. The federal spending power: Building forward after the pandemic. Healthc Manage Forum 2021; 34:260-265. [PMID: 33998310 PMCID: PMC8129691 DOI: 10.1177/08404704211012725] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The phrase, “the federal spending power,” identifies the federal government’s ability to spend in areas beyond its constitutional authority to legislate—a power that has supported the development of a national system of universal healthcare coverage in Canada. Even before the COVID-19 pandemic, this power was critical to the expansion of Canada’s narrow but deep basket of universally covered services. The challenges exposed by the pandemic mean that still more federal investment will be required. Yet for traditionalists, the material basis of this power is now constrained: the federal government may possess the constitutional authority to invest, but it lacks the fiscal capacity; some form of belt tightening—even austerity—will be necessary. As debates over public spending intensify, health leaders will need to address these questions. Depending on how they do so, health leaders will either support or detract from a healthy recovery.
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Affiliation(s)
- Fiona A Miller
- Centre for Sustainable Health Systems, Institute of Health Policy, Management and Evaluation, 7938University of Toronto, Toronto, Ontario, Canada
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Cressman C, Miller FA, Guttmann A, Cairney J, Hayeems RZ. Policy Rogue or Policy Entrepreneur? The Forms and Impacts of "Joined-Up Governance" for Child Health. Children (Basel) 2021; 8:221. [PMID: 33805621 PMCID: PMC8001209 DOI: 10.3390/children8030221] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/30/2022]
Abstract
Joined-up governance (JUG) approaches have gained attention as mechanisms for tackling wicked policy problems, particularly in intersectoral areas such as child health, where multiple ministries that deliver health and social services must collaborate if they are to be effective. Growing attention to the need to invest in early childhood to improve health and developmental trajectories, including through developmental screening, illustrate the challenges of JUG for child health. Using a comparative case study design comprised of the qualitative analysis of documents and key informant interviews, this work sought to explain how and why visible differences in policy choices have been made across two Canadian jurisdictions (Ontario and Manitoba). Specifically, we sought to understand two dimensions of governance (structure and process) alongside an illustrative example-the case of developmental screening, including how insiders viewed the impacts of governance arrangements in this instance. The two jurisdictions shared a commitment to evidence-based policy making and a similar vision of JUG for child health. Despite this, we found divergence in both governance arrangements and outcomes for developmental screening. In Manitoba, collaboration was prioritized, interests were aligned in a structured decision-making process, evidence and evaluation capacity were inherent to agenda setting, and implementation was considered up front. In Ontario, interests were not aligned and instead decision making operated in an opaque and siloed manner, with little consideration of implementation issues. In these contexts, Ontario pursued developmental screening, whereas Manitoba did not. While both jurisdictions aimed at JUG, only Manitoba developed a coordinated JUG system, whereas Ontario operated as a non-system. As a result, Manitoba's governance system had the capacity to stop 'rogue' action, prioritizing investments in accordance with authorized evidence. In contrast, in the absence of a formal system in Ontario, policy 'entrepreneurs' were able to seize a window of opportunity to invest in child health.
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Affiliation(s)
- Celine Cressman
- Better Outcomes Registry and Network (BORN Ontario), Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada;
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (A.G.); (R.Z.H.)
| | - Fiona A. Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Astrid Guttmann
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (A.G.); (R.Z.H.)
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Institute for Clinical Evaluative Sciences (ICES), Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - John Cairney
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD 4072, Australia;
| | - Robin Z. Hayeems
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (A.G.); (R.Z.H.)
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
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Abstract
We are fortunate to have the reflections and wisdom of experts from multiple disciplines in this issue's discussion of healthcare sustainability. In the lead paper of this issue of Healthcare Papers, we issued a call to action drawing on the capacity of the Canadian health sector to address climate change (Miller and Xie 2020). Our colleagues agree on the need to deliver sustainable care and raise important questions about how such an aim can be achieved. In this response, we consider and revisit three themes: feasibility of a sustainable healthcare system, theories of change that support our recommendations and capacities that enable change.
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Affiliation(s)
- Edward Xie
- Clinical Assistant Professor, Department of Family and Community Medicine, University of Toronto, Toronto, ON
| | - Fiona A Miller
- Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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Miller FA, Young SB, Dobrow M, Shojania KG. Vulnerability of the medical product supply chain: the wake-up call of COVID-19. BMJ Qual Saf 2020; 30:331-335. [PMID: 33139342 DOI: 10.1136/bmjqs-2020-012133] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/17/2020] [Accepted: 10/22/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Steven B Young
- School of Environment, Enterprise and Development, University of Waterloo, Waterloo, Ontario, Canada
| | - Mark Dobrow
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Kaveh G Shojania
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Abstract
"Toward a Sustainable Health System: A Call to Action" speaks of the challenge that the climate crisis poses for health systems. The scale of the accelerating crisis will require that health systems adapt in response and also become visible champions for change, mitigating the environmental harms of their operation and mobilizing their social networks and leadership potential to build community resilience and transformative capacity. The authors pay principal attention to the issues of environmental sustainability and also review the linked challenges of social and economic sustainability, given the imperatives of environmental and social justice and the need for a revitalized economic vision to support livable futures. The authors' aim is to accelerate ambition in Canada, where coordinated effort and national leadership have been lacking. They close with recommendations to achieve a net-zero health system in Canada by or before 2050.
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Affiliation(s)
- Fiona A Miller
- Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Population Health, University of Toronto, Toronto, ON
| | - Edward Xie
- Clinical Assistant Professor, Department of Family and Community Medicine, University of Toronto, Toronto, ON
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Holloway K, Miller FA, Rousseau F, Gutierrez A, Hogarth S. Responses to "Health Canada needs to act on laboratory-developed diagnostics". CMAJ 2020; 192:E261. [PMID: 32152057 DOI: 10.1503/cmaj.74683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Kelly Holloway
- Postdoctoral fellow, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont
| | - Fiona A Miller
- Professor, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont
| | - François Rousseau
- Professor, Department of Molecular Biology, Medical Biochemistry and Pathology, Université Laval, Québec, Que
| | | | - Stuart Hogarth
- Lecturer, Department of Sociology, University of Cambridge, Cambridge, UK
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Affiliation(s)
- Kelly Holloway
- Institute of Health Policy, Management and Evaluation (Holloway, Miller), University of Toronto, Toronto, Ont.; Department of Molecular Biology, Medical Biochemistry and Pathology (Rousseau), Université Laval, Québec, Que.; NDA Partners, LLC (Gutierrez), Va.; Department of Sociology (Hogarth), University of Cambridge, Cambridge, UK
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation (Holloway, Miller), University of Toronto, Toronto, Ont.; Department of Molecular Biology, Medical Biochemistry and Pathology (Rousseau), Université Laval, Québec, Que.; NDA Partners, LLC (Gutierrez), Va.; Department of Sociology (Hogarth), University of Cambridge, Cambridge, UK
| | - François Rousseau
- Institute of Health Policy, Management and Evaluation (Holloway, Miller), University of Toronto, Toronto, Ont.; Department of Molecular Biology, Medical Biochemistry and Pathology (Rousseau), Université Laval, Québec, Que.; NDA Partners, LLC (Gutierrez), Va.; Department of Sociology (Hogarth), University of Cambridge, Cambridge, UK
| | - Alberto Gutierrez
- Institute of Health Policy, Management and Evaluation (Holloway, Miller), University of Toronto, Toronto, Ont.; Department of Molecular Biology, Medical Biochemistry and Pathology (Rousseau), Université Laval, Québec, Que.; NDA Partners, LLC (Gutierrez), Va.; Department of Sociology (Hogarth), University of Cambridge, Cambridge, UK
| | - Stuart Hogarth
- Institute of Health Policy, Management and Evaluation (Holloway, Miller), University of Toronto, Toronto, Ont.; Department of Molecular Biology, Medical Biochemistry and Pathology (Rousseau), Université Laval, Québec, Que.; NDA Partners, LLC (Gutierrez), Va.; Department of Sociology (Hogarth), University of Cambridge, Cambridge, UK
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Carroll JC, Allanson J, Morrison S, Miller FA, Wilson BJ, Permaul JA, Telner D. Informing Integration of Genomic Medicine Into Primary Care: An Assessment of Current Practice, Attitudes, and Desired Resources. Front Genet 2019; 10:1189. [PMID: 31824576 PMCID: PMC6882282 DOI: 10.3389/fgene.2019.01189] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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: 06/27/2019] [Accepted: 10/28/2019] [Indexed: 01/24/2023] Open
Abstract
Introduction: Preparing primary care providers for genomic medicine (GM) first requires assessment of their educational needs in order to provide clear, purposeful direction and justify educational activities. More understanding is needed about primary care providers’ perspectives on their role in newer areas of GM and what resources would be helpful in practice. Our objective was to determine family physicians’ (FP) current involvement and confidence in GM, attitudes regarding its clinical value, suggestions for integration of GM into practice, and resources and education required. Methods: A self-complete anonymous questionnaire was mailed to a random sample of 2,000 FPs in Ontario, Canada in September 2012. Results: Adjusted response rate was 26% (361/1,365), mean age was 51, and 53% were male. FPs reported many aspects of traditional GM as part of current practice (eliciting family history: 93%; deciding who to refer to genetics: 94%; but few reported confidence (44%, 32% respectively). Newer areas of GM were not part of most FPs’ current practice and confidence was low (pharmacogenetics: 28% part of practice, 5% confident; direct-to-consumer genetic testing: 14%/2%; whole genome sequencing: 8%/2%). Attitudes were mixed with 59% agreeing that GM would improve patient health outcomes, 41% seeing benefits to genetic testing, but only 36% agreeing it was their responsibility to incorporate GM into practice. Few could identify useful sources of genetic information (22%) or find information about genetic tests (21%). Educational resources participants anticipated would be useful included contact information for local genetics clinics (89%), summaries of genetic disorders (86%), and genetic referral (85%) and testing (86%) criteria. About 58% were interested in learning about new genetic technologies. Most (76%) wanted to learn through in-person teaching (lectures, seminars etc.), 66% wanted contact with a local genetic counselor to answer questions, and 59% were interested in a genetics education website. Conclusion: FPs lack confidence in GM skills needed for practice, particularly in emerging areas of GM. They see their role as making appropriate referrals, are somewhat optimistic about the contribution GM may make to patient care, but express caution about its current clinical benefits. There is a need for evidence-based educational resources integrated into primary care and improved communication with genetic specialists.
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Affiliation(s)
- June C Carroll
- Sinai Health System, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Judith Allanson
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Shawna Morrison
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Brenda J Wilson
- Division of Community Health and Humanities, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Joanne A Permaul
- Sinai Health System, Ray D Wolfe Department of Family Medicine, Toronto, ON, Canada
| | - Deanna Telner
- South East Toronto Family Health Team, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Goh ESY, Miller FA, Marshall DA, Ungar WJ. Genetic counselors' preferences for coverage of preimplantation genetic diagnosis: A discrete choice experiment. Clin Genet 2019; 95:684-692. [PMID: 30859557 DOI: 10.1111/cge.13531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 11/28/2022]
Abstract
Preimplantation genetic diagnosis (PGD) allows couples to test for a genetically affected embryo prior to implantation. Patient access to this ethically complex and expensive technology differs markedly across jurisdictions, with differences in private/public insurance coverage and variations in patient inclusion and diagnostic criteria. The objective of the study was to identify trade-offs regarding PGD coverage decisions amongst genetic counselors. To quantify stated preferences for PGD coverage, we conducted a discrete choice experiment with Canadian genetic counselors (GC) considering attributes regarding the scope of testing (PGD indication, risk of the condition and number of cycles covered) and patient inclusion criteria (fertility status and family history). Multinomial logit regression was used to estimate trade-offs amongst attributes using part-worth utilities and importance scores. The completed response rate was 41% with 126 GC completing the survey. Risk of the genetic condition was the most important attribute. Overall, GC were more responsive to the scope of testing criteria including the condition's risk (importance score of 42%) and PGD indication (31%) rather than family history (11%) and fertility status (8%). Based on this study's attributes and levels, condition characteristics are prioritized even above patient characteristics for PGD coverage.
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Affiliation(s)
- Elaine Suk-Ying Goh
- Trillium Health Partners, Department of Laboratory Medicine and Genetics, Mississauga, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Wendy J Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children (Sickkids) Research Institute, Toronto, Ontario, Canada
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Affiliation(s)
- Kelly Holloway
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | - Stuart Hogarth
- Department of Sociology, University of Cambridge, Cambridge, UK
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Gagliardi AR, Dunn S, Foster A, Grace SL, Green CR, Khanlou N, Miller FA, Stewart DE, Vigod S, Wright FC. How is patient-centred care addressed in women's health? A theoretical rapid review. BMJ Open 2019; 9:e026121. [PMID: 30765411 PMCID: PMC6398665 DOI: 10.1136/bmjopen-2018-026121] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Efforts are needed to reduce gendered inequities and improve health and well-being for women. Patient-centred care (PCC), an approach that informs and engages patients in their own health, is positively associated with improved care delivery, experiences and outcomes. This study aimed to describe how PCC for women (PCCW) has been conceptualised in research. METHODS We conducted a theoretical rapid review of PCCW in four health conditions. We searched MEDLINE, EMBASE, CINAHL, SCOPUS, Cochrane Library and Joanna Briggs index for English-language articles published from January 2008 to February 2018 inclusive that investigated PCC and involved at least 50% women aged 18 or older. We analysed findings using a six-domain PCC framework, and reported findings with summary statistics and narrative descriptions. RESULTS After screening 2872 unique search results, we reviewed 51 full-text articles, and included 14 (five family planning, three preventive care, four depression, one cardiovascular disease and one rehabilitation). Studies varied in how they assessed PCC. None examined all six PCC framework domains; least evaluated domains were addressing emotions, managing uncertainty and enabling self-management. Seven studies that investigated PCC outcomes found a positive association with appropriate health service use, disease remission, health self-efficacy and satisfaction with care. Differing views about PCC between patients and physicians, physician PCC attitudes and geographic affluence influenced PCC. No studies evaluated the influence of patient characteristics or tested interventions to support PCCW. CONCLUSION There is a paucity of research that has explored or evaluated PCCW in the conditions of interest. We excluded many studies because they arbitrarily labelled many topics as PCC, or simply concluded that PCC was needed. More research is needed to fully conceptualise and describe PCCW across different characteristics and conditions, and to test interventions that improve PCCW. Policies and incentives may also be needed to stimulate greater awareness and delivery of PCCW.
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Affiliation(s)
- Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Sheila Dunn
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Angel Foster
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Sherry L Grace
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Courtney R Green
- Society of Obstetricians and Gynecologists of Canada, Ottawa, Ontario, Canada
| | - Nazilla Khanlou
- Society of Obstetricians and Gynecologists of Canada, Ottawa, Ontario, Canada
- Faculty of Health/School of Nursing, York University, Toronto, Ontario, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Donna E Stewart
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Simone Vigod
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Frances C Wright
- Louise Temerty Breast Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Barg CJ, Miller FA, Hayeems RZ, Bombard Y, Cressman C, Painter-Main M. What's Involved with Wanting to Be Involved? Comparing Expectations for Public Engagement in Health Policy across Research and Care Contexts. ACTA ACUST UNITED AC 2018; 13:40-56. [PMID: 29274226 PMCID: PMC5749523 DOI: 10.12927/hcpol.2017.25323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives: We explored public preferences for involvement in health policy decisions, across the contexts of medical research and healthcare. Approach: We e-surveyed a sample of Canadians, categorizing respondents by preferences for decision control: (1) more authority; (2) more input; (3) status quo. Two generalized ordered logistic regressions assessed influences on preferences. Results: The participation rate was 94%; 1,102 completed responses met quality criteria. The dominant preference was for more input (average = 52.0%), followed by status quo (average = 24.9%) and more authority (average = 21.1%), though preferences for more control were higher in healthcare (57.2%) than medical research (46.8%). Preferences for greater control were associated with constructs related to reduced trust in healthcare systems. Conclusion: The public expects health policy to account for public views, but not base decisions primarily on these views. More involvement was expected in healthcare than medical research policy. As opportunities for public involvement in health research grow, we anticipate increased desired involvement.
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Affiliation(s)
- Carolyn J Barg
- Research Officer, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Fiona A Miller
- Professor, Chair in Health Management Strategies, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Robin Z Hayeems
- Scientist-Track Investigator, Assistant Professor, Centre for Genetic Medicine, Hospital for Sick Children Research Institute, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Yvonne Bombard
- Scientist, Assistant Professor, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Céline Cressman
- PhD Candidate, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Michael Painter-Main
- Research Assistant, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
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Peckham A, Morton-Chang F, Williams AP, Miller FA. Rebalancing health systems toward community-based care: The role of subsectoral politics. Health Policy 2018; 122:1260-1265. [PMID: 30278991 DOI: 10.1016/j.healthpol.2018.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/16/2018] [Accepted: 09/20/2018] [Indexed: 10/28/2022]
Abstract
There has been increased policy discourse urging a "rebalancing" of health systems from institutionally-based to community-based approaches. This paper offers an analysis of the subsectoral dynamics that condition opportunities to strengthen community-based care relative to acute care. We report on the results of a policy study in Ontario, Canada that explored factors impacting on the capacity to expand community-based care. In so doing, we highlight the challenges associated with the community subsector's ability to develop 'critical' status and challenge the dominance of the acute subsector. We conclude that attempts to rebalance health systems toward community-based care should begin by understanding that health care is not a monolithic policy sector, but rather a collection of proximate policy sub-sectors, inclusive of community care, acute care, and institutional care, each with their own internal characteristics and dynamics that impact sectoral directions.
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Affiliation(s)
- Allie Peckham
- Institute of Health Policy, Management and Evaluation, University of Toronto College St, Suite 425, Toronto, Ontario M5T 3M6, Canada; North American Observatory on Health Systems and Policies College St, Suite 425, Toronto, Ontario M5T 3M6, Canada.
| | - Frances Morton-Chang
- Institute of Health Policy, Management and Evaluation, University of Toronto College St, Suite 425, Toronto, Ontario M5T 3M6, Canada.
| | - A Paul Williams
- Institute of Health Policy, Management and Evaluation, University of Toronto College St, Suite 425, Toronto, Ontario M5T 3M6, Canada.
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto College St, Suite 425, Toronto, Ontario M5T 3M6, Canada.
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Axler RE, Miller FA, Lehoux P, Lemmens T. The institutional workers of biomedical science: Legitimizing academic entrepreneurship and obscuring conflicts of interest. Sci Public Policy 2018; 45:404-415. [PMID: 29937617 PMCID: PMC6003607 DOI: 10.1093/scipol/scx075] [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] [Indexed: 06/08/2023]
Abstract
Given growing initiatives incentivizing academic researchers to engage in 'entrepreneurial' activities, this article examines how these academic entrepreneurs claim value in their entrepreneurial engagements, and navigate concerns related to conflicts of interest. Using data from qualitative interviews with twenty-four academic entrepreneurs in Canada, we show how these scientists value entrepreneurial activities for providing financial and intellectual resources to academic science, as well as for their potential to create impact through translation. Simultaneously, these scientists claimed to maintain academic norms of disinterested science and avoid conflicts of interest. Using theories of institutional work, we demonstrate how entrepreneurial scientists engage in processes of institutional change-through-maintenance, drawing on the maintenance of academic norms as institutional resources to legitimize entrepreneurial activities. As entrepreneurial scientists work to legitimize new zones of academic scientific practice, there is a need to carefully regulate and scrutinize these activities so that their potential harms do not become obscured.
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Affiliation(s)
- Renata E Axler
- World Health Innovation Network, Odette School of Business, University of Windsor, 401 Sunset Avenue, Windsor, ON N9B 3P4, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada
| | - Pascale Lehoux
- Institute of Public Health Research of University of Montreal (IRSPUM), Department of Health Administration, School of Public Health, University of Montreal, 7101 Avenue du Parc, Suite 3082, Montreal, QC H3C 3J7, Canada
| | - Trudo Lemmens
- Faculty of Law, University of Toronto, 78 Queen's Park, Room J448, Toronto, ON M5S 2C3, Canada
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Lehoux P, Miller FA, Grimard D, Gauthier P. Anticipating health innovations in 2030-2040: Where does responsibility lie for the publics? Public Underst Sci 2018; 27:276-293. [PMID: 28795612 DOI: 10.1177/0963662517725715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 06/07/2023]
Abstract
Considering that public engagement is pivotal to the mission of Responsible Research and Innovation, this article's aim is to examine how members of the public conceive of the relationship between responsibility and prospective health technologies. We organized four face-to-face deliberative workshops and an online forum wherein participants were invited to comment on scenarios involving three fictional technologies in 2030 and 2040. Our analyses describe how participants anticipated these technologies' impacts and formulated two conditions for their use: they should (1) be embedded within professional care and services and (2) include social protection of individual freedom and privacy. By clarifying what technological direction shall be avoided and who shall act responsibly, these conditions emphasize our participants' understanding of society as much as their understanding of science. For new technologies to be deployed in socially responsible ways, public engagement methods should be developed alongside public governance and regulatory strategies.
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Affiliation(s)
- Pascale Lehoux
- University of Montreal, Canada
- University of Montreal, Canada
| | - Fiona A Miller
- University of Toronto, Canada
- University of Montreal, Canada
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Hayeems RZ, Miller FA, Vermeulen M, Potter BK, Chakraborty P, Davies C, Carroll JC, Ratjen F, Guttmann A. False-Positive Newborn Screening for Cystic Fibrosis and Health Care Use. Pediatrics 2017; 140:peds.2017-0604. [PMID: 29025964 DOI: 10.1542/peds.2017-0604] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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] [Accepted: 08/11/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Evidence is mixed regarding the impact of false-positive (FP) newborn bloodspot screening (NBS) results on health care use. Using cystic fibrosis (CF) as an example, we determined the association of FP NBS results with health care use in infants and their mothers in Ontario, Canada. METHODS We conducted a population-based cohort study of all infants with FP CF results (N = 1564) and screen-negative matched controls (N = 6256) born between April 2008 and November 2012 using linked health administrative data. Outcomes included maternal and infant physician and emergency visits and inpatient hospitalizations from the infant's third to 15th month of age. Negative binomial regression tested associations of NBS status with outcomes, adjusting for infant and maternal characteristics. RESULTS A greater proportion of infants with FP results had >2 outpatient visits (16.2% vs 13.2%) and >2 hospital admissions (1.5% vs 0.7%) compared with controls; CF-related admissions and emergency department visits were not different from controls. Differences persisted after adjustment, with higher rates of outpatient visits (relative risk 1.39; 95% confidence interval 1.20-1.60) and hospital admissions (relative risk 1.67; 95% confidence interval 1.21-2.31) for FP infants. Stratified models indicated the effect of FP status was greater among those whose primary care provider was a pediatrician. No differences in health care use among mothers were detected. CONCLUSIONS Higher use of outpatient services among FP infants may relate to a lengthy confirmatory testing process or follow-up carrier testing. However, increased rates of hospitalization might signal heightened perceptions of vulnerability among healthy infants.
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Affiliation(s)
- Robin Z Hayeems
- Child Health Evaluative Sciences Program and .,Institute of Health Policy, Management and Evaluation
| | | | | | - Beth K Potter
- School of Epidemiology, Public Health and Preventive Medicine and
| | - Pranesh Chakraborty
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada; and.,Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Christine Davies
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - June C Carroll
- Department of Family and Community Medicine and Sinai Health System, and
| | - Felix Ratjen
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Astrid Guttmann
- Child Health Evaluative Sciences Program and.,Institute of Health Policy, Management and Evaluation.,Institute for Clinical Evaluative Sciences, Toronto, Canada.,Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
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Lehoux P, Miller FA, Daudelin G, Denis JL. Providing Value to New Health Technology: The Early Contribution of Entrepreneurs, Investors, and Regulatory Agencies. Int J Health Policy Manag 2017; 6:509-518. [PMID: 28949463 PMCID: PMC5582437 DOI: 10.15171/ijhpm.2017.11] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 10/20/2016] [Accepted: 01/21/2017] [Indexed: 11/10/2022] Open
Abstract
Background: New technologies constitute an important cost-driver in healthcare, but the dynamics that lead to
their emergence remains poorly understood from a health policy standpoint. The goal of this paper is to clarify how
entrepreneurs, investors, and regulatory agencies influence the value of emerging health technologies.
Methods: Our 5-year qualitative research program examined the processes through which new health technologies
were envisioned, financed, developed and commercialized by entrepreneurial clinical teams operating in Quebec’s
(Canada) publicly funded healthcare system.
Results: Entrepreneurs have a direct influence over a new technology’s value proposition, but investors actively
transform this value. Investors support a technology that can find a market, no matter its intrinsic value for clinical
practice or healthcare systems. Regulatory agencies reinforce the "double" value of a new technology—as a health
intervention and as an economic commodity—and provide economic worth to the venture that is bringing the
technology to market.
Conclusion: Policy-oriented initiatives such as early health technology assessment (HTA) and coverage with evidence
may provide technology developers with useful input regarding the decisions they make at an early stage. But to foster
technologies that bring more value to healthcare systems, policy-makers must actively support the consideration of
health policy issues in innovation policy.
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Affiliation(s)
- Pascale Lehoux
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, Montréal, QC, Canada.,Institute of Public Health Research of University of Montreal (IRSPUM), Montréal, QC, Canada.,University of Montreal Chair on Responsible Innovation in Health Montreal, Montréal, QC, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Geneviève Daudelin
- Institute of Public Health Research of University of Montreal (IRSPUM), Montréal, QC, Canada
| | - Jean-Louis Denis
- École Nationale d'administration publique (ENAP), Quebec City, QC, Canada.,Department of Management, Faculty of Social Science & Public Policy, King's College, London, UK
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Hayeems RZ, Miller FA, Barg CJ, Bombard Y, Carroll JC, Tam K, Kerr E, Chakraborty P, Potter BK, Patton S, Bytautas JP, Taylor L, Davies C, Milburn J, Price A, Gonska T, Keenan K, Ratjen F, Guttmann A. Psychosocial Response to Uncertain Newborn Screening Results for Cystic Fibrosis. J Pediatr 2017; 184:165-171.e1. [PMID: 28279431 DOI: 10.1016/j.jpeds.2017.01.049] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 08/18/2016] [Revised: 12/15/2016] [Accepted: 01/19/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To explore the psychosocial implications of diagnostic uncertainty that result from inconclusive results generated by newborn bloodspot screening (NBS) for cystic fibrosis (CF). STUDY DESIGN Using a mixed methods prospective cohort study of children who received NBS for CF, we compared psychosocial outcomes of parents whose children who received persistently inconclusive results with those whose children received true positive or screen-negative results. RESULTS Mothers of infants who received inconclusive results (n = 17), diagnoses of CF (n = 15), and screen-negative results (n = 411) were surveyed; 23 parent interviews were completed. Compared with mothers of infants with true positive/screen-negative results, mothers of infants with inconclusive results reported greater perceived uncertainty (P < .006) but no differences in anxiety or vulnerability (P > .05). Qualitatively, parents valued being connected to experts but struggled with the meaning of an uncertain diagnosis, worried about their infant's health-related vulnerability, and had mixed views about surveillance. CONCLUSION Inconclusive CF NBS results were not associated with anxiety or vulnerability but led to health-related uncertainty and qualitative concerns. Findings should be considered alongside efforts to optimize protocols for CF screening and surveillance. Educational and psychosocial supports are warranted for these families.
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Affiliation(s)
- Robin Z Hayeems
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Carolyn J Barg
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Yvonne Bombard
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada
| | - June C Carroll
- Department of Family and Community Medicine, Mount Sinai Hospital, Sinai Health System, University of Toronto, Toronto, Canada
| | - Karen Tam
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Elizabeth Kerr
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Beth K Potter
- School of Epidemiology, Public Health & Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Sarah Patton
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Jessica P Bytautas
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Louise Taylor
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Christine Davies
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Jennifer Milburn
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - April Price
- Department of Pediatric Respirology, Children's Hospital of Western Ontario, London, Canada
| | - Tanja Gonska
- Division of Gastroenterology, Department of Pediatrics The Hospital for Sick Children, Toronto, Canada; Physiology and Experimental Medicine, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Katherine Keenan
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Felix Ratjen
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Astrid Guttmann
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada; Health System Planning & Evaluation Research Program, Institute for Clinical Evaluative Sciences, Toronto, Canada
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Dobrow MJ, Miller FA, Frank C, Brown AD. Understanding relevance of health research: considerations in the context of research impact assessment. Health Res Policy Syst 2017; 15:31. [PMID: 28412937 PMCID: PMC5392970 DOI: 10.1186/s12961-017-0188-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 03/07/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND With massive investment in health-related research, above and beyond investments in the management and delivery of healthcare and public health services, there has been increasing focus on the impact of health research to explore and explain the consequences of these investments and inform strategic planning. Relevance is reflected by increased attention to the usability and impact of health research, with research funders increasingly engaging in relevance assessment as an input to decision processes. Yet, it is unclear whether relevance is a synonym for or predictor of impact, a necessary condition or stage in achieving it, or a distinct aim of the research enterprise. The main aim of this paper is to improve our understanding of research relevance, with specific objectives to (1) unpack research relevance from both theoretical and practical perspectives, and (2) outline key considerations for its assessment. APPROACH Our approach involved the scholarly strategy of review and reflection. We prepared a draft paper based on an exploratory review of literature from various fields, and gained from detailed and insightful analysis and critique at a roundtable discussion with a group of key health research stakeholders. We also solicited review and feedback from a small sample of expert reviewers. CONCLUSIONS Research relevance seems increasingly important in justifying research investments and guiding strategic research planning. However, consideration of relevance has been largely tacit in the health research community, often depending on unexplained interpretations of value, fit and potential for impact. While research relevance seems a necessary condition for impact - a process or component of efforts to make rigorous research usable - ultimately, relevance stands apart from research impact. Careful and explicit consideration of research relevance is vital to gauge the overall value and impact of a wide range of individual and collective research efforts and investments. To improve understanding, this paper outlines four key considerations, including how research relevance assessments (1) orientate to, capture and compare research versus non-research sources, (2) consider both instrumental versus non-instrumental uses of research, (3) accommodate dynamic temporal-shifting perspectives on research, and (4) align with an intersubjective understanding of relevance.
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Affiliation(s)
- Mark J. Dobrow
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 4th Floor, Toronto, ON M5T 3M6 Canada
| | - Fiona A. Miller
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 4th Floor, Toronto, ON M5T 3M6 Canada
| | - Cy Frank
- Alberta Innovates - Health Solutions, Edmonton, Alberta Canada
| | - Adalsteinn D. Brown
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 4th Floor, Toronto, ON M5T 3M6 Canada
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Shulman R, Stukel TA, Miller FA, Newman A, Daneman D, Guttmann A. Insulin pump use and discontinuation in children and teens: a population-based cohort study in Ontario, Canada. Pediatr Diabetes 2017; 18:33-44. [PMID: 26748950 DOI: 10.1111/pedi.12353] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 08/19/2015] [Revised: 12/04/2015] [Accepted: 12/12/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe insulin pump use by youth since introduction of universal funding in Ontario, Canada and to explore the relationship between pump use and pediatric diabetes center characteristics and the relationship between discontinuation and center and patient characteristics. RESEARCH DESIGN AND METHODS Observational, population-based cohort study of youth with type 1 diabetes (<19 yr) who received pump funding from 2006 to 2013 (n = 3700). We linked 2012 survey data from 33 pediatric diabetes centers to health administrative databases. We tested the relationship between center-level pump uptake and center characteristics (center type, physician model, and availability of 24-h support) using an adjusted negative binomial model; we studied center- and patient-level factors (socioeconomic status and baseline glycemic control) associated with discontinuation using a Cox proportional hazards model with generalized estimating equations. RESULTS Pump users were more likely to be in the highest income quintile than non-pump users (29.6 vs. 19.1%, p < 0.0001). In 2012, mean percent pump use was 38.0% with variability across centers. There was no association between uptake and center characteristics. Discontinuation was low (0.42/100 person-yr) and was associated with being followed at a small community center [hazard ratio (HR): 2.24 (1.05-4.76)] and being more deprived [HR: 2.36 (1.14-1.48)]. Older age was associated with a lower rate of discontinuation [HR: 0.31 (0.14-0.66)]. CONCLUSIONS Rates of pump use have increased since 2006 and discontinuation is rare. Large variation in uptake across centers was not explained by the factors we examined but may reflect variation in patient populations or practice patterns, and should be further explored.
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Affiliation(s)
- Rayzel Shulman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Therese A Stukel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, Canada
| | - Alice Newman
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Denis Daneman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Astrid Guttmann
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
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Shulman R, Miller FA, Stukel TA, Daneman D, Guttmann A. Pediatric Insulin Pump Therapy: Reflecting on the First 10 Years of a Universal Funding Program in Ontario. Healthc Q 2017; 19:6-9. [PMID: 28130944 DOI: 10.12927/hcq.2017.25019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We evaluated the universal funding program for pediatric insulin pumps in Ontario by examining the dynamics underlying patterns of pump use and adverse events using population-based health administrative data available at the Institute for Clinical Evaluative Sciences (ICES), supplemented by other data. We found that (1) pump use has increased steadily since 2006 with variation across centres and disparity in use by socioeconomic status; (2) pump discontinuation is uncommon; (3) physicians value pump therapy in numerous ways that provide important insights into patterns of uptake; and (4) the safety profile of pump therapy is, in general, very good; however, individuals of lower socioeconomic status are at an increased risk of acute diabetes complications, most frequently diabetic ketoacidosis. This comprehensive mixed-methods evaluation reveals the need to understand and intervene to reduce social disparities in the use and adverse outcomes of technologies used for diabetes management.
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Affiliation(s)
- Rayzel Shulman
- Staff physician in the Division of Endocrinology at The Hospital for Sick Children; an assistant professor in the Department of Pediatrics at the University of Toronto; and a postdoctoral fellow at ICES
| | - Fiona A Miller
- Associate professor of health policy in the Institute of Health Policy, Management and Evaluation; director of the Division of Health Policy and Ethics at the Toronto Health Economics and Technology Assessment Collaborative (THETA); and a member of the Joint Centre for Bioethics at the University of Toronto
| | - Thérèse A Stukel
- Senior core scientist at ICES and a professor at the Institute of Health Policy, Management and Evaluation, University of Toronto
| | - Denis Daneman
- Professor and chair emeritus of pediatrics at the University of Toronto and pediatrician-in-chief emeritus at The Hospital for Sick Children in Toronto
| | - Astrid Guttmann
- Chief science officer at ICES, a staff pediatrician in the Division of Paediatric Medicine at The Hospital for Sick Children, and an associate professor in the Department of Paediatrics and the Institute of Health Policy, Management and Evaluation at the University of Toronto
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Lehoux P, Jimenez-Pernett J, Miller FA, Williams-Jones B. Assessment of a multimedia-based prospective method to support public deliberations on health technology design: participant survey findings and qualitative insights. BMC Health Serv Res 2016; 16:616. [PMID: 27784317 PMCID: PMC5081965 DOI: 10.1186/s12913-016-1870-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 01/13/2016] [Accepted: 10/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background Using a combination of videos and online short stories, we conducted four face-to-face deliberative workshops in Montreal (Quebec, Canada) with members of the public who later joined additional participants in an online forum to discuss the social and ethical implications of prospective technologies. This paper presents the participants’ appraisal of our intervention and provides novel qualitative insights into the use of videos and online tools in public deliberations. Methods We applied a mixed-method study design. A self-administered survey contained open- and close-ended items using a 5-level Likert-like scale. Absolute frequencies and proportions for the close-ended items were compiled. Qualitative data included field notes, the transcripts of the workshops and the participants’ contributions to the online forum. The qualitative data were used to flesh out the survey data describing the participants’ appraisal of: 1) the multimedia components of our intervention; 2) its deliberative face-to-face and online processes; and 3) its perceived effects. Results Thirty-eight participants contributed to the workshops and 57 to the online forum. A total of 46 participants filled-in the survey, for a response rate of 73 % (46/63). The videos helped 96 % of the participants to understand the fictional technologies and the online scenarios helped 98 % to reflect about the issues raised. Up to 81 % considered the arguments of the other participants to be well thought-out. Nearly all participants felt comfortable sharing their ideas in both the face-to-face (89 %) and online environments (93 %), but 88 % preferred the face-to-face workshop. As a result of the intervention, 85 % reflected more about the pros and cons of technology and 94 % learned more about the way technologies may transform society. Conclusions This study confirms the methodological feasibility of a deliberative intervention whose originality lies in its use of videos and online scenarios. To increase deliberative depth and foster a strong engagement by all participants, face-to-face and online components need to be well integrated. Our findings suggest that online tools should be designed by considering, one the one hand, the participants’ self-perceived ability to share written comments and, on the other hand, the ease with which other participants can respond to such contributions.
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Affiliation(s)
- P Lehoux
- Department of Health Management, Evaluation and Policy, University of Montreal, Institute of Public Health Research of University of Montreal (IRSPUM), University of Montreal Research Chair on Responsible Innovation in Health, Branch Centre-ville, P.O. Box 6128, Montreal, QC, H3C 3 J7, Canada.
| | - J Jimenez-Pernett
- Department of Health Management, Evaluation and Policy, University of Montreal, IRSPUM, Montreal, Canada
| | - F A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - B Williams-Jones
- Department of Social and Preventive Medicine, University of Montreal, IRSPUM, Montreal, Canada
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Bombard Y, Miller FA, Barg CJ, Patton SJ, Carroll JC, Chakraborty P, Potter BK, Tam K, Taylor L, Kerr E, Davies C, Milburn J, Ratjen F, Guttmann A, Hayeems RZ. A secondary benefit: the reproductive impact of carrier results from newborn screening for cystic fibrosis. Genet Med 2016; 19:403-411. [PMID: 27608173 PMCID: PMC5319861 DOI: 10.1038/gim.2016.125] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/12/2016] [Indexed: 12/03/2022] Open
Abstract
Purpose Newborn screening (NBS) for cystic fibrosis (CF) can identify carriers, which is considered a benefit that enables reproductive planning. We examined the reproductive impact of carrier result disclosure from NBS for CF. Methods We surveyed mothers of carrier infants after NBS (Time-1) and one-year later (Time-2) to ascertain intended and reported communication of their infants’ carrier results to relatives, carrier testing for themselves/other children and reproductive decisions. A sub-sample of mothers was also interviewed at Time-1 and Time-2. Results Response rate was 54%. Just over half (55%) of mothers carrier tested at Time-1; a further 40% of those who intended to test at Time-1 tested at Time-2. Carrier result communication to relatives was high (92%), but a majority of participants did not expect the results to influence family planning (65%). All interviewed mothers valued learning their infants’ carrier results. Some had carrier testing and shared results with family. Others did not use the results or used them in unintended ways. Conclusion While mothers valued learning carrier results from NBS, they reported moderate uptake of carrier testing and limited influence on family planning. Our study highlights the secondary nature of the benefit from disclosing carrier results from NBS.
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Affiliation(s)
- Yvonne Bombard
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Carolyn J Barg
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sarah J Patton
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - June C Carroll
- Department of Family and Community Medicine, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Beth K Potter
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Karen Tam
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Louise Taylor
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth Kerr
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christine Davies
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jennifer Milburn
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Felix Ratjen
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Division of Paediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Robin Z Hayeems
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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Hayeems RZ, Miller FA, Barg CJ, Bombard Y, Kerr E, Tam K, Carroll JC, Potter BK, Chakraborty P, Davies C, Milburn J, Patton S, Bytautas JP, Taylor L, Price A, Gonska T, Keenan K, Ratjen F, Guttmann A. Parent Experience With False-Positive Newborn Screening Results for Cystic Fibrosis. Pediatrics 2016; 138:peds.2016-1052. [PMID: 27485696 DOI: 10.1542/peds.2016-1052] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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] [Accepted: 06/16/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The risk of psychosocial harm in families of infants with false-positive (FP) newborn bloodspot screening (NBS) results for cystic fibrosis (CF) is a longstanding concern. Whether well designed retrieval and confirmatory testing systems can mitigate risks remains unknown. METHODS Using a mixed-methods cohort design, we obtained prospective self-report data from mothers of infants with FP CF NBS results 2 to 3 months after confirmatory testing at Ontario's largest follow-up center, and from a randomly selected control sample of mothers of screen negative infants from the same region. Mothers completed a questionnaire assessing experience and psychosocial response. A sample of mothers of FP infants completed qualitative interviews. RESULTS One hundred thirty-four mothers of FP infants (response rate, 55%) and 411 controls (response rate, 47%) completed questionnaires; 54 mothers of FP infants were interviewed. Selected psychosocial response measures did not detect psychosocial distress in newborns or 1 year later (P > .05). Mothers recalled distress during notification of the positive result and in the follow-up testing period related to fear of chronic illness, but valued the screening system of care in mitigating concerns. CONCLUSIONS Although immediate distress was reported among mothers of FP infants, selected psychometric tools did not detect these concerns. The NBS center from which mothers were recruited minimizes delay between notification and confirmatory testing and ensures trained professionals are communicating results and facilitating follow-up. These factors may explain the presence of minimal psychosocial burden. The screening system reflected herein may be a model for NBS programs working to minimize FP-related psychosocial harm.
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Affiliation(s)
- Robin Z Hayeems
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Canada; Institute of Health Policy, Management and Evaluation,
| | | | | | - Yvonne Bombard
- Institute of Health Policy, Management and Evaluation, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada
| | | | - Karen Tam
- Divisions of Clinical and Metabolic Genetics
| | - June C Carroll
- Family and Community Medicine, Sinai Health System, University of Toronto, Toronto, Canada
| | - Beth K Potter
- School of Epidemiology, Public Health & Preventive Medicine
| | - Pranesh Chakraborty
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Christine Davies
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Jennifer Milburn
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Sarah Patton
- Institute of Health Policy, Management and Evaluation
| | - Jessica P Bytautas
- Institute of Health Policy, Management and Evaluation, Department of Public Health, University of Helsinki, Helsinki, Finland
| | | | - April Price
- Children's Hospital of Western Ontario, London, Ontario, Canada; and
| | | | | | - Felix Ratjen
- Departments of Pediatrics and Pediatric Medicine, and Respiratory Medicine, Departments of Pediatrics and
| | - Astrid Guttmann
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Canada; Institute of Health Policy, Management and Evaluation, Departments of Pediatrics and Pediatric Medicine, and Institute for Clinical Evaluative Sciences, Toronto, Canada
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Hayeems RZ, Miller FA, Barg CJ, Bombard Y, Cressman C, Painter-Main M, Wilson B, Little J, Allanson J, Avard D, Giguere Y, Chakraborty P, Carroll JC. Using Newborn Screening Bloodspots for Research: Public Preferences for Policy Options. Pediatrics 2016; 137:peds.2015-4143. [PMID: 27244855 DOI: 10.1542/peds.2015-4143] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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] [Accepted: 03/25/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Retaining residual newborn screening (NBS) bloodspots for medical research remains contentious. To inform this debate, we sought to understand public preferences for, and reasons for preferring, alternative policy options. METHODS We assessed preferences among 4 policy options for research use of residual bloodspots through a bilingual national Internet survey of a representative sample of Canadians. Fifty percent of respondents were randomly assigned to select reasons supporting these preferences. Understanding of and attitudes toward screening and research concepts, and demographics were assessed. RESULTS Of 1102 respondents (94% participation rate; 47% completion rate), the overall preference among policy options was ask permission (67%); this option was also the most acceptable choice (80%). Assume permission was acceptable to 46%, no permission required was acceptable to 29%, and no research allowed was acceptable to 26%. The acceptability of the ask permission option was reduced among participants assigned to the reasoning exercise (84% vs 76%; P = .004). Compared with assume/no permission required, ordered logistic regression showed a significant reduction in preference for the ask permission option with greater understanding of concepts (odds ratio, 0.87; P < .001), greater confidence in science (odds ratio, 0.16; P < .001), and a perceived responsibility to contribute to research (odds ratio, 0.39; P < .001). CONCLUSIONS Surveyed Canadians prefer that explicit permission is sought for storage and research use of NBS bloodspots. This preference was diminished when reasons supporting and opposing routine storage, and other policy options, were presented. Findings warrant consideration as NBS communities strategize to respond to shifting legislative contexts.
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Affiliation(s)
- Robin Z Hayeems
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada;
| | - Carolyn J Barg
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Yvonne Bombard
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Celine Cressman
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael Painter-Main
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Brenda Wilson
- School of Epidemiology, Public Health & Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Julian Little
- School of Epidemiology, Public Health & Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Judith Allanson
- Departments of Genetics, Children's Hospital of Eastern Ontario, and Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Denise Avard
- Centre for Genomics and Policy, Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Yves Giguere
- Departments of Medical Biology, CHU de Québec, and Molecular Biology, Medical Biochemistry and Pathology, Université Laval, Montreal, Quebec, Canada; and
| | - Pranesh Chakraborty
- Departments of Genetics, Children's Hospital of Eastern Ontario, and Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - June C Carroll
- Department of Family and Community Medicine, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
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Lehoux P, Miller FA, Daudelin G. How does venture capital operate in medical innovation? ACTA ACUST UNITED AC 2016; 2:111-117. [PMID: 27547447 PMCID: PMC4975839 DOI: 10.1136/bmjinnov-2015-000079] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 12/11/2015] [Accepted: 03/09/2016] [Indexed: 11/04/2022]
Abstract
While health policy scholars wish to encourage the creation of technologies that bring more value to healthcare, they may not fully understand the mandate of venture capitalists and how they operate. This paper aims to clarify how venture capital operates and to illustrate its influence over the kinds of technologies that make their way into healthcare systems. The paper draws on the international innovation policy scholarship and the lessons our research team learned throughout a 5-year fieldwork conducted in Quebec (Canada). Current policies support the development of technologies that capital investors identify as valuable, and which may not align with important health needs. The level of congruence between a given health technology-based venture and the mandate of venture capital is highly variable, explaining why some types of innovation may never come into existence. While venture capitalists' mandate and worldview are extraneous to healthcare, they shape health technologies in several, tangible ways. Clinical leaders and health policy scholars could play a more active role in innovation policy. Because certain types of technology are more likely than others to help tackle the intractable problems of healthcare systems, public policies should be equipped to promote those that address the needs of a growing elderly population, support patients who are afflicted by chronic diseases and reduce health disparities.
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Affiliation(s)
- P Lehoux
- Department of Health Administration , University of Montreal, School of Public Health of University of Montreal (ESPUM) , Montréal, Quebec , Canada
| | - F A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, Ontario , Canada
| | - G Daudelin
- School of Public Health of University of Montreal (ESPUM) , Montreal, Quebec , Canada
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Abstract
BACKGROUND The Network of Ontario Pediatric Diabetes Programs was established in 2001 to provide access to specialized pediatric diabetes care. Universal funding for pediatric insulin pump therapy has been available in Ontario since 2006. The objective of this study was to describe the distribution of patients, resources and insulin pump use across centres within the network, now called the Ontario Paediatric Diabetes Network. METHODS We conducted a cross-sectional survey in 2012 of the 35 pediatric diabetes centres in Ontario to measure centre characteristics, patient volume and available clinical and social resources. We used health administrative data from the provincial Assistive Devices Program to describe patients aged 18 years or less using insulin pumps by centre as a measure of technology uptake. RESULTS All 35 centres participated, reporting a total of 6676 children with type 1 diabetes and 368 with type 2 diabetes. Most (> 80%) children with type 1 diabetes were followed at tertiary (n = 5) or large community (n = 14) centres. Nursing patient load was similar between centre types, but there was a large range across centres within any type. Overall, percent insulin pump use was 38.1% and varied widely across centres (5.3%-66.7%). Funded 24-hour support for pump users was available at 5 (36%) small community centres, 3 (19%) large community centres and 2 (40%) tertiary centres. INTERPRETATION Our study showed differences in access to specialized and after-hours care for children with diabetes in Ontario. Pump use varied widely across centres. Further research is needed to assess the impact of these observed differences on quality of care and outcomes.
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Affiliation(s)
- Rayzel Shulman
- Department of Pediatrics (Shulman, Daneman, Guttmann), The Hospital for Sick Children, University of Toronto; Institute of Health Policy, Management and Evaluation (Shulman, Miller, Stukel, Guttmann), University of Toronto; Institute for Clinical Evaluative Sciences (Shulman, Stukel, Guttmann); Toronto Health Economics and Technology Assessment (THETA) Collaborative (Miller), University of Toronto, Toronto, Ont
| | - Fiona A Miller
- Department of Pediatrics (Shulman, Daneman, Guttmann), The Hospital for Sick Children, University of Toronto; Institute of Health Policy, Management and Evaluation (Shulman, Miller, Stukel, Guttmann), University of Toronto; Institute for Clinical Evaluative Sciences (Shulman, Stukel, Guttmann); Toronto Health Economics and Technology Assessment (THETA) Collaborative (Miller), University of Toronto, Toronto, Ont
| | - Therese A Stukel
- Department of Pediatrics (Shulman, Daneman, Guttmann), The Hospital for Sick Children, University of Toronto; Institute of Health Policy, Management and Evaluation (Shulman, Miller, Stukel, Guttmann), University of Toronto; Institute for Clinical Evaluative Sciences (Shulman, Stukel, Guttmann); Toronto Health Economics and Technology Assessment (THETA) Collaborative (Miller), University of Toronto, Toronto, Ont
| | - Denis Daneman
- Department of Pediatrics (Shulman, Daneman, Guttmann), The Hospital for Sick Children, University of Toronto; Institute of Health Policy, Management and Evaluation (Shulman, Miller, Stukel, Guttmann), University of Toronto; Institute for Clinical Evaluative Sciences (Shulman, Stukel, Guttmann); Toronto Health Economics and Technology Assessment (THETA) Collaborative (Miller), University of Toronto, Toronto, Ont
| | - Astrid Guttmann
- Department of Pediatrics (Shulman, Daneman, Guttmann), The Hospital for Sick Children, University of Toronto; Institute of Health Policy, Management and Evaluation (Shulman, Miller, Stukel, Guttmann), University of Toronto; Institute for Clinical Evaluative Sciences (Shulman, Stukel, Guttmann); Toronto Health Economics and Technology Assessment (THETA) Collaborative (Miller), University of Toronto, Toronto, Ont
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Karaceper MD, Chakraborty P, Coyle D, Wilson K, Kronick JB, Hawken S, Davies C, Brownell M, Dodds L, Feigenbaum A, Fell DB, Grosse SD, Guttmann A, Laberge AM, Mhanni A, Miller FA, Mitchell JJ, Nakhla M, Prasad C, Rockman-Greenberg C, Sparkes R, Wilson BJ, Potter BK. The health system impact of false positive newborn screening results for medium-chain acyl-CoA dehydrogenase deficiency: a cohort study. Orphanet J Rare Dis 2016; 11:12. [PMID: 26841949 PMCID: PMC4741015 DOI: 10.1186/s13023-016-0391-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/19/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is no consensus in the literature regarding the impact of false positive newborn screening results on early health care utilization patterns. We evaluated the impact of false positive newborn screening results for medium-chain acyl-CoA dehydrogenase deficiency (MCADD) in a cohort of Ontario infants. METHODS The cohort included all children who received newborn screening in Ontario between April 1, 2006 and March 31, 2010. Newborn screening and diagnostic confirmation results were linked to province-wide health care administrative datasets covering physician visits, emergency department visits, and inpatient hospitalizations, to determine health service utilization from April 1, 2006 through March 31, 2012. Incidence rate ratios (IRRs) were used to compare those with false positive results for MCADD to those with negative newborn screening results, stratified by age at service use. RESULTS We identified 43 infants with a false positive newborn screening result for MCADD during the study period. These infants experienced significantly higher rates of physician visits (IRR: 1.42) and hospitalizations (IRR: 2.32) in the first year of life relative to a screen negative cohort in adjusted analyses. Differences in health services use were not observed after the first year of life. CONCLUSIONS The higher use of some health services among false positive infants during the first year of life may be explained by a psychosocial impact of false positive results on parental perceptions of infant health, and/or by differences in underlying health status. Understanding the impact of false positive newborn screening results can help to inform newborn screening programs in designing support and education for families. This is particularly important as additional disorders are added to expanded screening panels, yielding important clinical benefits for affected children but also a higher frequency of false positive findings.
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Affiliation(s)
- Maria D Karaceper
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8 M5, Canada.
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
| | - Doug Coyle
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8 M5, Canada.
| | - Kumanan Wilson
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. .,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Jonathan B Kronick
- Department of Pediatrics, Division of Clinical & Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Steven Hawken
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Christine Davies
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
| | - Marni Brownell
- Manitoba Centre for Health Policy, Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Linda Dodds
- Departments of Obstetrics & Gynecology and Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Annette Feigenbaum
- Department of Pediatrics, Division of Clinical & Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Deshayne B Fell
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada.
| | - Scott D Grosse
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia, USA.
| | - Astrid Guttmann
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. .,Department of Pediatrics, Division of Paediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Anne-Marie Laberge
- Medical Genetics, CHU Sainte-Justine and Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada.
| | - Aizeddin Mhanni
- Department of Paediatrics and Child Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - John J Mitchell
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
| | - Meranda Nakhla
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
| | - Chitra Prasad
- Genetics, Metabolism and Pediatrics, London Health Sciences Centre, Western University, London, Ontario, Canada.
| | - Cheryl Rockman-Greenberg
- Department of Paediatrics and Child Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Rebecca Sparkes
- Department of Paediatrics, Section of Clinical Genetics, Alberta Children's Hospital, Calgary, Alberta, Canada.
| | - Brenda J Wilson
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8 M5, Canada.
| | - Beth K Potter
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8 M5, Canada.
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Khangura SD, Tingley K, Chakraborty P, Coyle D, Kronick JB, Laberge AM, Little J, Miller FA, Mitchell JJ, Prasad C, Siddiq S, Siriwardena K, Sparkes R, Speechley KN, Stockler S, Trakadis Y, Wilson BJ, Wilson K, Potter BK. Child and family experiences with inborn errors of metabolism: a qualitative interview study with representatives of patient groups. J Inherit Metab Dis 2016. [PMID: 26209272 PMCID: PMC4710640 DOI: 10.1007/s10545-015-9881-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Patient-centered health care for children with inborn errors of metabolism (IEM) and their families is important and requires an understanding of patient experiences, needs, and priorities. IEM-specific patient groups have emerged as important voices within these rare disease communities and are uniquely positioned to contribute to this understanding. We conducted qualitative interviews with IEM patient group representatives to increase understanding of patient and family experiences, needs, and priorities and inform patient-centered research and care. METHODS We developed a sampling frame of patient groups representing IEM disease communities from Canada, the United States, and United Kingdom. With consent, we interviewed participants to explore their views on experiences, needs, and outcomes that are most important to children with IEM and their families. We analyzed the data using a qualitative descriptive approach to identify key themes and sub-themes. RESULTS We interviewed 18 organizational representatives between February 28 and September 17, 2014, representing 16 IEMs and/or disease categories. Twelve participants voluntarily self-identified as parents and/or were themselves patients. Three key themes emerged from the coded data: managing the uncertainty associated with raising and caring for a child with a rare disease; challenges associated with the affected child's life transitions, and; the collective struggle for improved outcomes and interventions that rare disease communities navigate. CONCLUSION Health care providers can support children with IEM and their families by acknowledging and reducing uncertainty, supporting families through children's life transitions, and contributing to rare disease communities' progress toward improved interventions, experiences, and outcomes.
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Affiliation(s)
- Sara D Khangura
- Faculty of Medicine, School of Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Kylie Tingley
- Faculty of Medicine, School of Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Ottawa, ON, Canada
- Division of Metabolics and Newborn Screening, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Faculty of Medicine, Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Doug Coyle
- Faculty of Medicine, School of Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Jonathan B Kronick
- Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | | | - Julian Little
- Faculty of Medicine, School of Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | | | - Shabnaz Siddiq
- Faculty of Medicine, School of Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | | | | | | | | | | | - Brenda J Wilson
- Faculty of Medicine, School of Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | | | - Beth K Potter
- Faculty of Medicine, School of Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
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Shulman R, Stukel TA, Miller FA, Newman A, Daneman D, Wasserman JD, Guttmann A. Low socioeconomic status is associated with adverse events in children and teens on insulin pumps under a universal access program: a population-based cohort study. BMJ Open Diabetes Res Care 2016; 4:e000239. [PMID: 27547416 PMCID: PMC4932320 DOI: 10.1136/bmjdrc-2016-000239] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/24/2016] [Accepted: 05/31/2016] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To describe adverse events in pediatric insulin pump users since universal funding in Ontario and to explore the role of socioeconomic status and 24-hour support. RESEARCH DESIGN AND METHODS Population-based cohort study of youth (<19 years) with type 1 diabetes (n=3193) under a universal access program in Ontario, Canada, from 2006 to 2013. We linked 2012 survey data from 33 pediatric diabetes centers to health administrative databases. The relationship between patient and center-level characteristics and time to first diabetic ketoacidosis (DKA) admission or death was tested using a Cox proportional hazards model and the rate of diabetes-related emergency department visits and hospitalizations with a Poisson model, both using generalized estimating equations. RESULTS The rate of DKA was 5.28/100 person-years and mortality 0.033/100 person-years. Compared with the least deprived quintile, the risk of DKA or death for those in the most deprived quintile was significantly higher (HR 1.58, 95% CI 1.05 to 2.38) as was the rate of diabetes-related acute care use (RR 1.60, 95% CI 1.27 to 2.00). 24-hour support was not associated with these outcomes. Higher glycated hemoglobin, prior DKA, older age, and higher nursing patient load were associated with a higher risk of DKA or death. CONCLUSIONS The safety profile of pump therapy in the context of universal funding is similar to other jurisdictions and unrelated to 24-hour support. Several factors including higher deprivation were associated with an increased risk of adverse events and could be used to inform the design of interventions aimed at preventing poor outcomes in high-risk individuals.
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Affiliation(s)
- Rayzel Shulman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Sickkids Research Institute
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Therese A Stukel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, Ontario, Canada
| | - Alice Newman
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Denis Daneman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Sickkids Research Institute
| | - Jonathan D Wasserman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Sickkids Research Institute
| | - Astrid Guttmann
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Sickkids Research Institute
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Shulman R, Miller FA, Daneman D, Guttmann A. Valuing technology: A qualitative interview study with physicians about insulin pump therapy for children with type 1 diabetes. Health Policy 2015; 120:64-71. [PMID: 26563632 DOI: 10.1016/j.healthpol.2015.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 09/28/2015] [Accepted: 10/16/2015] [Indexed: 11/24/2022]
Abstract
Insulin pumps for children with type 1 diabetes have been broadly adopted despite equivocal evidence about comparative effectiveness. To understand why and inform policy related to public funding for new technologies, we explored how physicians interpret the value of pumps. We conducted open-ended, semi-structured interviews with 16 physicians from a pediatric diabetes network in Ontario, Canada, and analyzed the data using interpretive description. Respondents recognized that pumps fell short of expectations because they required hard work, as well as family and school support. Yet, pumps were valued for their status as new technologies and as a promising step in developing future technology. In addition, they were valued for their role within a therapeutic relationship, given the context of chronic childhood disease. These findings identify the types of beliefs that influence the adoption and diffusion of technologies. Some beliefs bear on hopes for new technology that may inappropriately hasten adoption, creating excess cost with little benefit. On the other hand, some beliefs identify potential benefits that are not captured in effectiveness studies, but may warrant consideration in resource allocation decisions. Still others suggest the need for remediation, such as those bearing on disparity in pump use by socioeconomic status. Understanding how technologies are valued can help stakeholders decide how to address such beliefs and expectations in funding decisions and implementation protocols.
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Affiliation(s)
- Rayzel Shulman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, Canada.
| | - Denis Daneman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Miller FA, Hayeems RZ, Bombard Y, Cressman C, Barg CJ, Carroll JC, Wilson BJ, Little J, Allanson J, Chakraborty P, Giguère Y, Regier DA. Public Perceptions of the Benefits and Risks of Newborn Screening. Pediatrics 2015; 136:e413-23. [PMID: 26169426 DOI: 10.1542/peds.2015-0518] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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] [Accepted: 05/06/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Growing technological capacity and parent and professional advocacy highlight the need to understand public expectations of newborn population screening. METHODS We administered a bilingual (French, English) Internet survey to a demographically proportional sample of Canadians in 2013 to assess preferences for the types of diseases to be screened for in newborns by using a discrete choice experiment. Attributes were: clinical benefits of improved health, earlier time to diagnosis, reproductive risk information, false-positive (FP) results, and overdiagnosed infants. Survey data were analyzed with a mixed logit model to assess preferences and trade-offs among attributes, interaction between attributes, and preference heterogeneity. RESULTS On average, respondents were favorable toward screening. Clinical benefits were the most important outcome; reproductive risk information and early diagnosis were also valued, although 8% disvalued early diagnosis, and reproductive risk information was least important. All respondents preferred to avoid FP results and overdiagnosis but were willing to accept these to achieve moderate clinical benefit, accepting higher rates of harms to achieve significant benefit. Several 2-way interactions between attributes were statistically significant: respondents were willing to accept a higher FP rate for significant clinical benefit but preferred a lower rate for moderate benefit; similarly, respondents valued early diagnosis more when associated with significant rather than moderate clinical benefit. CONCLUSIONS Members of the public prioritized clinical benefits for affected infants and preferred to minimize harms. These findings suggest support for newborn screening policies prioritizing clinical benefits over solely informational benefits, coupled with concerted efforts to avoid or minimize harms.
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Affiliation(s)
- Fiona A Miller
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada;
| | - Robin Z Hayeems
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Canada
| | - Yvonne Bombard
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
| | - Céline Cressman
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Carolyn J Barg
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - June C Carroll
- Department of Family and Community Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | | | - Julian Little
- Departments of Epidemiology and Community Medicine and
| | - Judith Allanson
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Pediatrics, University of Ottawa, Ottawa, Canada
| | - Pranesh Chakraborty
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Pediatrics, University of Ottawa, Ottawa, Canada
| | - Yves Giguère
- Department of Medical Biology, Centre Hospitalier Universitaire de Quebec, University of Laval, Quebec City, Canada
| | - Dean A Regier
- School of Population and Public Health, University of British Columbia, Vancouver, Canada; and Canadian Centre for Applied Research in Cancer Control, BC Cancer Agency, Vancouver, Canada
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Burnett HF, Ungar WJ, Regier DA, Feldman BM, Miller FA. Parents' willingness to pay for biologic treatments in juvenile idiopathic arthritis. Value Health 2014; 17:830-837. [PMID: 25498778 DOI: 10.1016/j.jval.2014.08.2668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 01/24/2014] [Revised: 07/22/2014] [Accepted: 08/21/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Biologic therapies are considered the standard of care for children with the most severe forms of juvenile idiopathic arthritis (JIA). Inconsistent and inadequate drug coverage, however, prevents many children from receiving timely and equitable access to the best treatment. OBJECTIVE The objective of this study was to evaluate parents' willingness to pay (WTP) for biologic and nonbiologic disease-modifying antirheumatic drugs (DMARDs) used to treat JIA. METHODS Utility weights from a discrete choice experiment were used to estimate the WTP for treatment characteristics including child-reported pain, participation in daily activities, side effects, days missed from school, drug treatment, and cost. Conditional logit regression was used to estimate utilities for each attribute level, and expected compensating variation was used to estimate the WTP. Bootstrapping was used to generate 95% confidence intervals for all WTP estimates. RESULTS Parents had the highest marginal WTP for improved participation in daily activities and pain relief followed by the elimination of side effects of treatment. Parents were willing to pay $2080 (95% confidence interval $698-$4065) more for biologic DMARDs than for nonbiologic DMARDs if the biologic DMARD was more effective. CONCLUSIONS Parents' WTP indicates their preference for treatments that reduce pain and improve daily functioning without side effects by estimating the monetary equivalent of utility for drug treatments in JIA. In addition to evidence of safety and efficacy, assessments of parents' preferences provide a broader perspective to decision makers by helping them understand the aspects of drug treatments in JIA that are most valued by families.
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Affiliation(s)
- Heather F Burnett
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Dean A Regier
- Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Brian M Feldman
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Rheumatology, The Hospital for Sick Children, and Departments of Pediatrics and Medicine, University of Toronto, Toronto, Ontario, Canada; The Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Fiona A Miller
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
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50
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Bombard Y, Miller FA, Hayeems RZ, Barg C, Cressman C, Carroll JC, Wilson BJ, Little J, Avard D, Painter-Main M, Allanson J, Giguere Y, Chakraborty P. Public views on participating in newborn screening using genome sequencing. Eur J Hum Genet 2014; 22:1248-54. [PMID: 24549052 PMCID: PMC4200434 DOI: 10.1038/ejhg.2014.22] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/17/2014] [Accepted: 01/22/2014] [Indexed: 01/28/2023] Open
Abstract
Growing discussion on the use of whole-genome or exome sequencing (WG/ES) in newborn screening (NBS) has raised concerns regarding the generation of incidental information on millions of infants annually. It is unknown whether integrating WG/ES would alter public expectations regarding participation in universal NBS. We assessed public willingness to participate in NBS using WG/ES compared with current NBS. Our secondary objective was to assess the public's beliefs regarding a parental responsibility to participate in WG/ES-based NBS compared with current NBS. We examined self-reported attitudes regarding willingness to participate in NBS using a cross-sectional national survey of Canadian residents recruited through an internet panel, reflective of the Canadian population by age, gender and region. Our results showed that fewer respondents would be willing to participate in NBS using WG/ES compared with NBS using current technologies (80 vs 94%, P<0.001), or perceived a parental responsibility to participate in WG/ES-based NBS vs current NBS (30 vs 48%, P<0.001). Our findings suggest that integrating WG/ES into NBS might reduce participation, and challenge the moral authority that NBS programmes rely upon to ensure population benefits. These findings point to the need for caution in the untargeted use of WG/ES in public health contexts.
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Affiliation(s)
- Yvonne Bombard
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Robin Z Hayeems
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Carolyn Barg
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Celine Cressman
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - June C Carroll
- Department of Family and Community Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Brenda J Wilson
- Department of Epidemiology and Community Medicine, University of Ottawa, Toronto, Ontario, Canada
| | - Julian Little
- Department of Epidemiology and Community Medicine, University of Ottawa, Toronto, Ontario, Canada
| | - Denise Avard
- Centre for Genomics and Policy, Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Michael Painter-Main
- Department of Political Science, University of Toronto, Toronto, Ontario, Canada
| | - Judith Allanson
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Yves Giguere
- Quebec Blood Newborn Screening Program, Department of Medical Biology, CHU de Quebec, Charlesbourg, Quebec, Canada
- Department of Molecular Biology, Medical Biochemistry and Pathology, University of Laval, Quebec, Quebec, Canada
| | - Pranesh Chakraborty
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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