Pub Date : 2021-05-21DOI: 10.1101/2021.05.20.21257349
M. Fralick, Neal Kaw, Ming-kai Wang, M. Mamdani, Ophyr Mourad
Background: The capacity of the general internal medicine clinical teaching units has been strained by decreasing resident supply and increasing patient demand. The objective of our study was to quantitatively compare the number of residents (supply) with the volume and duration of patient care activities (demand) to identify inefficiency. Methods: Using the most recently available data from an academic teaching hospital, we identified each occurrence of a set of patient care activities that took place on the clinical teaching unit. We completed a descriptive analysis of the frequencies of these activities and how the frequencies varied by hour, day, week, month, and year. Patient care activities included admissions, rounds, responding to pages, meeting with patients and their families, patient transfers, discharges, and responding to cardiac arrests. The estimated time to complete each task was based on the available data in our electronic healthcare system and interviews with general internal medicine physicians or trainees. To calculate resident utilization, the person-hours of patient care tasks was divided by the person-hours of resident supply. Resident utilization was computed for three scenarios corresponding to varying levels of resident absenteeism. Results: Between 2015 and 2019 there were 14,581 consultations to general internal medicine from the emergency department. Patient volumes tended to be highest during January and lowest during May and June; and highest on Monday morning and lowest on Friday night. Daily admissions into hospital from the emergency department were higher on weekdays than on weekends, and hourly admissions peaked at 8:00 AM and between 3:00 PM and 1:00 AM. Weekday resident utilization was generally highest between 8:00 AM and 2:00 PM and lowest between 1:00 AM and 8:00 AM. In a scenario where all residents were present apart from those who were post-call, resident utilization generally never exceeded 100%; in scenarios where at least one resident was absent due to illness and/or vacation, it was common for resident utilization to approach or exceed 100%, particularly during daytime working hours. Interpretation: Analyzing supply and demand on a general internal medicine ward has allowed us to identify periods where supply and demand are not aligned and to empirically demonstrate the vulnerability of current staffing models. These data have the potential to inform and optimize scheduling on an internal medicine ward.
{"title":"Analyzing supply and demand on a general internal medicine ward: a cross-sectional study","authors":"M. Fralick, Neal Kaw, Ming-kai Wang, M. Mamdani, Ophyr Mourad","doi":"10.1101/2021.05.20.21257349","DOIUrl":"https://doi.org/10.1101/2021.05.20.21257349","url":null,"abstract":"Background: The capacity of the general internal medicine clinical teaching units has been strained by decreasing resident supply and increasing patient demand. The objective of our study was to quantitatively compare the number of residents (supply) with the volume and duration of patient care activities (demand) to identify inefficiency. Methods: Using the most recently available data from an academic teaching hospital, we identified each occurrence of a set of patient care activities that took place on the clinical teaching unit. We completed a descriptive analysis of the frequencies of these activities and how the frequencies varied by hour, day, week, month, and year. Patient care activities included admissions, rounds, responding to pages, meeting with patients and their families, patient transfers, discharges, and responding to cardiac arrests. The estimated time to complete each task was based on the available data in our electronic healthcare system and interviews with general internal medicine physicians or trainees. To calculate resident utilization, the person-hours of patient care tasks was divided by the person-hours of resident supply. Resident utilization was computed for three scenarios corresponding to varying levels of resident absenteeism. Results: Between 2015 and 2019 there were 14,581 consultations to general internal medicine from the emergency department. Patient volumes tended to be highest during January and lowest during May and June; and highest on Monday morning and lowest on Friday night. Daily admissions into hospital from the emergency department were higher on weekdays than on weekends, and hourly admissions peaked at 8:00 AM and between 3:00 PM and 1:00 AM. Weekday resident utilization was generally highest between 8:00 AM and 2:00 PM and lowest between 1:00 AM and 8:00 AM. In a scenario where all residents were present apart from those who were post-call, resident utilization generally never exceeded 100%; in scenarios where at least one resident was absent due to illness and/or vacation, it was common for resident utilization to approach or exceed 100%, particularly during daytime working hours. Interpretation: Analyzing supply and demand on a general internal medicine ward has allowed us to identify periods where supply and demand are not aligned and to empirically demonstrate the vulnerability of current staffing models. These data have the potential to inform and optimize scheduling on an internal medicine ward.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46300688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Coffin, A. Ramji, C. Cooper, D. Miles, K. Doucette, P. Wong, E. Tam, D. Wong, A. Wong, Sylvester Ukabam, R. Bailey, K. Tsoi, B. Conway, Lisa P. Barrett, T. Michalak, S. Congly, G. Minuk, K. Kaita, E. Kelly, H. Ko, H. Janssen, J. Uhanova, B. Lethebe, S. Haylock-Jacobs, M. Ma, C. Osiowy, S. Fung
BACKGROUND Published Canadian epidemiologic data on hepatitis B virus (HBV) infection include single-centre studies or are focused on Indigenous populations. We performed a study to characterize the demographic and clinical features, liver disease status and treatment of people with chronic hepatitis B in Canada. METHODS In this descriptive, opportunistic, cross-sectional study, available data for people known to be monoinfected with HBV were collected by the Canadian HBV Network from existing clinical databases, with support from the National Microbiology Laboratory, Public Health Agency of Canada. Data were collected in all provinces with the exception of New Brunswick and Newfoundland and Labrador. We analyzed the data using parametric and nonparametric statistical methods, with a significance level of p < 0.05. RESULTS In the 9380 unique patient records reviewed, the median age was 48 years, and 5193 patients (55.4%) were male. Ethnicity information was available for 7858 patients, of whom 5803 (73.8%) were Asian, 916 (11.6%) were black and 914 (11.6%) were white. Most of those tested (5556/6796 [81.8%]) were negative for HBV e-antigen, and most of those with fibrosis data (3481/4260 [81.7%]) had minimal liver fibrosis, with more advanced fibrosis noted in older people (> 40 yr). Of the 980 patients with genotype data, 521 (53.2%) had genotype B or C infection. Most of the 9241 patients with known confirmed treatment status received tenofovir disoproxil fumarate (1655 [17.9%]), lamivudine (1434 [15.5%]) or entecavir (548 [5.9%]). INTERPRETATION Based on available data, Canadian patients with chronic hepatitis B are predominantly Asian and negative for HBV e-antigen, and have genotype B or C infection. Interprovincial variations were noted in antiviral treatment regimen. This multicentre nationwide study provides data regarding patients with chronic hepatitis B and may inform future studies on the epidemiologic features of HBV infection in Canada.
{"title":"Epidemiologic and clinical features of chronic hepatitis B virus infection in 8 Canadian provinces: a descriptive study by the Canadian HBV Network.","authors":"C. Coffin, A. Ramji, C. Cooper, D. Miles, K. Doucette, P. Wong, E. Tam, D. Wong, A. Wong, Sylvester Ukabam, R. Bailey, K. Tsoi, B. Conway, Lisa P. Barrett, T. Michalak, S. Congly, G. Minuk, K. Kaita, E. Kelly, H. Ko, H. Janssen, J. Uhanova, B. Lethebe, S. Haylock-Jacobs, M. Ma, C. Osiowy, S. Fung","doi":"10.9778/cmajo.20190103","DOIUrl":"https://doi.org/10.9778/cmajo.20190103","url":null,"abstract":"BACKGROUND\u0000Published Canadian epidemiologic data on hepatitis B virus (HBV) infection include single-centre studies or are focused on Indigenous populations. We performed a study to characterize the demographic and clinical features, liver disease status and treatment of people with chronic hepatitis B in Canada.\u0000\u0000\u0000METHODS\u0000In this descriptive, opportunistic, cross-sectional study, available data for people known to be monoinfected with HBV were collected by the Canadian HBV Network from existing clinical databases, with support from the National Microbiology Laboratory, Public Health Agency of Canada. Data were collected in all provinces with the exception of New Brunswick and Newfoundland and Labrador. We analyzed the data using parametric and nonparametric statistical methods, with a significance level of p < 0.05.\u0000\u0000\u0000RESULTS\u0000In the 9380 unique patient records reviewed, the median age was 48 years, and 5193 patients (55.4%) were male. Ethnicity information was available for 7858 patients, of whom 5803 (73.8%) were Asian, 916 (11.6%) were black and 914 (11.6%) were white. Most of those tested (5556/6796 [81.8%]) were negative for HBV e-antigen, and most of those with fibrosis data (3481/4260 [81.7%]) had minimal liver fibrosis, with more advanced fibrosis noted in older people (> 40 yr). Of the 980 patients with genotype data, 521 (53.2%) had genotype B or C infection. Most of the 9241 patients with known confirmed treatment status received tenofovir disoproxil fumarate (1655 [17.9%]), lamivudine (1434 [15.5%]) or entecavir (548 [5.9%]).\u0000\u0000\u0000INTERPRETATION\u0000Based on available data, Canadian patients with chronic hepatitis B are predominantly Asian and negative for HBV e-antigen, and have genotype B or C infection. Interprovincial variations were noted in antiviral treatment regimen. This multicentre nationwide study provides data regarding patients with chronic hepatitis B and may inform future studies on the epidemiologic features of HBV infection in Canada.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20190103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41627722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Slater, M. Green, B. Shah, Shahriar Khan, Carmen R. Jones, Roseanne Sutherland, K. Jacklin, Jennifer D. Walker
BACKGROUND To improve diabetes care, First Nations leaders and others need access to population-level health data. We provide details of the collaborative methods we used to describe the prevalence and incidence of diabetes in First Nations people in Ontario and present demographic data for this population compared to the rest of the Ontario population. METHODS To identify the population of First Nations people and other people in Ontario, we created annual cohorts of the Ontario population for each year between Apr. 1, 1995, and Mar. 31, 2015. Through a partnership between First Nations and academic researchers, we linked provincial population-based health administrative data stored at ICES with the Indian Register, which identifies all Status First Nations people. Our collaborative process was guided by the First Nations principles of ownership, control, access and possession (OCAP). RESULTS Demographic characteristics for the 2014/15 cohort (n = 13 406 684) are presented here. The cohort includes 158 241 Status First Nations people and 13 248 443 other people living in Ontario. Using postal codes, we were able to identify virtually all (99.9%) First Nations people in Ontario as living in (n = 55 311) or outside (n =102 889) a First Nations community. First Nations people were younger and more likely to live in semiurban or rural areas than the rest of Ontario's population. INTERPRETATION The collaborative methodology used in this study is applicable to many jurisdictions working with Indigenous groups who have access to similar data. The Ontario cohort defined here is being used to conduct analyses of health outcomes and use of health care services among First Nations people with diabetes in Ontario.
{"title":"First Nations people with diabetes in Ontario: methods for a longitudinal population-based cohort study.","authors":"M. Slater, M. Green, B. Shah, Shahriar Khan, Carmen R. Jones, Roseanne Sutherland, K. Jacklin, Jennifer D. Walker","doi":"10.9778/cmajo.20190096","DOIUrl":"https://doi.org/10.9778/cmajo.20190096","url":null,"abstract":"BACKGROUND\u0000To improve diabetes care, First Nations leaders and others need access to population-level health data. We provide details of the collaborative methods we used to describe the prevalence and incidence of diabetes in First Nations people in Ontario and present demographic data for this population compared to the rest of the Ontario population.\u0000\u0000\u0000METHODS\u0000To identify the population of First Nations people and other people in Ontario, we created annual cohorts of the Ontario population for each year between Apr. 1, 1995, and Mar. 31, 2015. Through a partnership between First Nations and academic researchers, we linked provincial population-based health administrative data stored at ICES with the Indian Register, which identifies all Status First Nations people. Our collaborative process was guided by the First Nations principles of ownership, control, access and possession (OCAP).\u0000\u0000\u0000RESULTS\u0000Demographic characteristics for the 2014/15 cohort (n = 13 406 684) are presented here. The cohort includes 158 241 Status First Nations people and 13 248 443 other people living in Ontario. Using postal codes, we were able to identify virtually all (99.9%) First Nations people in Ontario as living in (n = 55 311) or outside (n =102 889) a First Nations community. First Nations people were younger and more likely to live in semiurban or rural areas than the rest of Ontario's population.\u0000\u0000\u0000INTERPRETATION\u0000The collaborative methodology used in this study is applicable to many jurisdictions working with Indigenous groups who have access to similar data. The Ontario cohort defined here is being used to conduct analyses of health outcomes and use of health care services among First Nations people with diabetes in Ontario.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20190096","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43504173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. You, D. Jayaraman, M. Swinton, Xuran Jiang, D. Heyland
BACKGROUND Inpatients are often prescribed cardiopulmonary resuscitation (CPR) without a shared decision-making process. Since implementation of decision aids into practice is highly sensitive to the clinical milieu, we performed a pilot study to refine our study procedures and to evaluate the acceptability and potential effectiveness of a shared decision-making intervention when implemented in a Canadian hospital setting. METHODS In this before-after pilot study, we recruited patients and family members on the medical wards of 2 Canadian teaching hospitals between September 2015 and March 2017. The intervention consisted of viewing a CPR decision video and completing a values-clarification worksheet; follow-up discussion with the physician was encouraged. The primary feasibility outcome was acceptability of the video, and the primary effectiveness outcome was change in the Decisional Conflict Scale score (lower scores being more desirable) after the intervention. Participants rated the extent of shared decision-making using the CollaboRATE instrument. RESULTS Of the 71 participants (43 patients with a mean age of 79.0 [standard deviation (SD) 11.4] yr and 28 family members with a mean age of 61.0 [SD 10.0] yr), 65 (92%) rated the CPR decision video as good to excellent. The intervention was associated with an improvement in knowledge about CPR (+2.7 points, 95% confidence interval [CI] 2.2 to 3.3, effect size 1.5) and a reduction in the Decisional Conflict Scale score (-18.1 points, 95% CI -21.8 to -14.3, effect size 1.4). The 36 participants who had a discussion with a physician about CPR after watching the video rated the extent of shared decision-making as 6.3 (SD 1.7) (possible maximum score 9). There was a nonsignificant decrease in the proportion of patients with a medical order for CPR after the intervention (71% before v. 63% after, p = 0.06). INTERPRETATION The CPR decision video was acceptable to patients and family members. Our decision-support intervention may improve knowledge, reduce decisional conflict and reduce the prevalence of medical orders for CPR in the Canadian hospital setting.
{"title":"Supporting shared decision-making about cardiopulmonary resuscitation using a video-based decision-support intervention in a hospital setting: a multisite before-after pilot study.","authors":"J. You, D. Jayaraman, M. Swinton, Xuran Jiang, D. Heyland","doi":"10.9778/cmajo.20190022","DOIUrl":"https://doi.org/10.9778/cmajo.20190022","url":null,"abstract":"BACKGROUND\u0000Inpatients are often prescribed cardiopulmonary resuscitation (CPR) without a shared decision-making process. Since implementation of decision aids into practice is highly sensitive to the clinical milieu, we performed a pilot study to refine our study procedures and to evaluate the acceptability and potential effectiveness of a shared decision-making intervention when implemented in a Canadian hospital setting.\u0000\u0000\u0000METHODS\u0000In this before-after pilot study, we recruited patients and family members on the medical wards of 2 Canadian teaching hospitals between September 2015 and March 2017. The intervention consisted of viewing a CPR decision video and completing a values-clarification worksheet; follow-up discussion with the physician was encouraged. The primary feasibility outcome was acceptability of the video, and the primary effectiveness outcome was change in the Decisional Conflict Scale score (lower scores being more desirable) after the intervention. Participants rated the extent of shared decision-making using the CollaboRATE instrument.\u0000\u0000\u0000RESULTS\u0000Of the 71 participants (43 patients with a mean age of 79.0 [standard deviation (SD) 11.4] yr and 28 family members with a mean age of 61.0 [SD 10.0] yr), 65 (92%) rated the CPR decision video as good to excellent. The intervention was associated with an improvement in knowledge about CPR (+2.7 points, 95% confidence interval [CI] 2.2 to 3.3, effect size 1.5) and a reduction in the Decisional Conflict Scale score (-18.1 points, 95% CI -21.8 to -14.3, effect size 1.4). The 36 participants who had a discussion with a physician about CPR after watching the video rated the extent of shared decision-making as 6.3 (SD 1.7) (possible maximum score 9). There was a nonsignificant decrease in the proportion of patients with a medical order for CPR after the intervention (71% before v. 63% after, p = 0.06).\u0000\u0000\u0000INTERPRETATION\u0000The CPR decision video was acceptable to patients and family members. Our decision-support intervention may improve knowledge, reduce decisional conflict and reduce the prevalence of medical orders for CPR in the Canadian hospital setting.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20190022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46358877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carina Iskander, E. McArthur, D. Nash, Sonja Gandhi-Banga, M. Weir, F. Muanda, A. Garg
BACKGROUND In 2007, an electronic repository called the Ontario Laboratories Information System (OLIS) was introduced to allow health care providers timely access to laboratory test results. Since not all laboratories began submitting their data to OLIS simultaneously, we sought to create a date-dependent table of geographic regions (forward sortation areas [FSAs]) from which people would likely present to a hospital linked to OLIS. METHODS In this descriptive study, we used administrative data to capture adults in Ontario who presented to the emergency department for any reason from 2007 to 2017. To assess changes over time, we classified all emergency department visits into fiscal quarters. The primary outcome measure was the proportion of people in a given FSA presenting to an emergency department at an OLIS-linked hospital (v. a hospital not linked to OLIS). To be included in the catchment area, at least 90% of all emergency department visits in a given quarter from a given FSA must have occurred at an OLIS-linked hospital. RESULTS By Dec. 31, 2017, 323 (61.4%) of 526 Ontario FSAs were in the catchment area (a population of about 8.5 million). There were no differences in selected demographic characteristics or comorbidities between people residing within the catchment area of OLIS-linked hospitals and those residing in the catchment area of unlinked hospitals on Dec. 31, 2017. We used the FSA information to construct a date-dependent table of geographic areas likely to have hospital laboratory data available in OLIS for future studies. INTERPRETATION We identified relevant Ontario geographic regions from which people would likely present to a hospital linked to OLIS. These geographic regions constitute a catchment area that may be used in future studies to capture adults who present to an OLIS-linked hospital with laboratory-defined conditions such as acute kidney injury, hyperkalemia and hyponatremia.
{"title":"Identifying Ontario geographic regions to assess adults who present to hospital with laboratory-defined conditions: a descriptive study.","authors":"Carina Iskander, E. McArthur, D. Nash, Sonja Gandhi-Banga, M. Weir, F. Muanda, A. Garg","doi":"10.9778/cmajo.20190065","DOIUrl":"https://doi.org/10.9778/cmajo.20190065","url":null,"abstract":"BACKGROUND\u0000In 2007, an electronic repository called the Ontario Laboratories Information System (OLIS) was introduced to allow health care providers timely access to laboratory test results. Since not all laboratories began submitting their data to OLIS simultaneously, we sought to create a date-dependent table of geographic regions (forward sortation areas [FSAs]) from which people would likely present to a hospital linked to OLIS.\u0000\u0000\u0000METHODS\u0000In this descriptive study, we used administrative data to capture adults in Ontario who presented to the emergency department for any reason from 2007 to 2017. To assess changes over time, we classified all emergency department visits into fiscal quarters. The primary outcome measure was the proportion of people in a given FSA presenting to an emergency department at an OLIS-linked hospital (v. a hospital not linked to OLIS). To be included in the catchment area, at least 90% of all emergency department visits in a given quarter from a given FSA must have occurred at an OLIS-linked hospital.\u0000\u0000\u0000RESULTS\u0000By Dec. 31, 2017, 323 (61.4%) of 526 Ontario FSAs were in the catchment area (a population of about 8.5 million). There were no differences in selected demographic characteristics or comorbidities between people residing within the catchment area of OLIS-linked hospitals and those residing in the catchment area of unlinked hospitals on Dec. 31, 2017. We used the FSA information to construct a date-dependent table of geographic areas likely to have hospital laboratory data available in OLIS for future studies.\u0000\u0000\u0000INTERPRETATION\u0000We identified relevant Ontario geographic regions from which people would likely present to a hospital linked to OLIS. These geographic regions constitute a catchment area that may be used in future studies to capture adults who present to an OLIS-linked hospital with laboratory-defined conditions such as acute kidney injury, hyperkalemia and hyponatremia.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20190065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46150062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. McBrien, Candice Luo, N. Sanger, L. Zielinski, Meha Bhatt, Xi Ming Zhu, D. Marsh, L. Thabane, Z. Samaan
BACKGROUND Rates of cannabis use among patients receiving methadone maintenance therapy are high, and cannabis use may be associated with outcomes of methadone maintenance therapy. We examined the effect of cannabis use on opioid use in patients receiving methadone maintenance therapy to test the hypothesis that cannabis use is associated with a reduction in opioid use. METHODS In this systematic review, we searched MEDLINE/PubMed, Embase, PsycINFO, CINAHL and ProQuest Dissertations and Theses Global from inception to July 12, 2018. We summarized the effects of cannabis use on opioid use during methadone maintenance therapy and treatment retention. We conducted meta-analyses using a random effects model. RESULTS We included 23 studies in our review. We performed a meta-analysis of 6 studies, with a total number of participants of 3676, examining use of cannabis and opioids during methadone maintenance therapy. Owing to high heterogeneity, we described the studies qualitatively but provide the forest plots as supplemental material. The overall quality of evidence was very low, with a high risk of bias, owing to the nature of observational studies. INTERPRETATION We found no consensus among studies that cannabis use is associated with reduced opioid use or longer treatment retention when used during methadone maintenance therapy in patients with opioid use disorder. PROSPERO Registration: CRD42015029372.
{"title":"Cannabis use during methadone maintenance treatment for opioid use disorder: a systematic review and meta-analysis.","authors":"H. McBrien, Candice Luo, N. Sanger, L. Zielinski, Meha Bhatt, Xi Ming Zhu, D. Marsh, L. Thabane, Z. Samaan","doi":"10.9778/cmajo.20190026","DOIUrl":"https://doi.org/10.9778/cmajo.20190026","url":null,"abstract":"BACKGROUND\u0000Rates of cannabis use among patients receiving methadone maintenance therapy are high, and cannabis use may be associated with outcomes of methadone maintenance therapy. We examined the effect of cannabis use on opioid use in patients receiving methadone maintenance therapy to test the hypothesis that cannabis use is associated with a reduction in opioid use.\u0000\u0000\u0000METHODS\u0000In this systematic review, we searched MEDLINE/PubMed, Embase, PsycINFO, CINAHL and ProQuest Dissertations and Theses Global from inception to July 12, 2018. We summarized the effects of cannabis use on opioid use during methadone maintenance therapy and treatment retention. We conducted meta-analyses using a random effects model.\u0000\u0000\u0000RESULTS\u0000We included 23 studies in our review. We performed a meta-analysis of 6 studies, with a total number of participants of 3676, examining use of cannabis and opioids during methadone maintenance therapy. Owing to high heterogeneity, we described the studies qualitatively but provide the forest plots as supplemental material. The overall quality of evidence was very low, with a high risk of bias, owing to the nature of observational studies.\u0000\u0000\u0000INTERPRETATION\u0000We found no consensus among studies that cannabis use is associated with reduced opioid use or longer treatment retention when used during methadone maintenance therapy in patients with opioid use disorder. PROSPERO Registration: CRD42015029372.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20190026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47389506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Kronfli, C. Dussault, M. Klein, B. Lebouché, G. Sebastiani, J. Cox
BACKGROUND Hepatitis C virus (HCV) microelimination efforts must target people in prison; however, although some inmates may qualify for treatment in provincial prisons, it may not be routinely provided. Our aim was to characterize the cascade of HCV care in Quebec's largest provincial prison. METHODS We conducted a retrospective study of all HCV-related laboratory tests requested at the Établissement de détention de Montréal (men's prison with on-demand screening), between July 1, 2017, and June 30, 2018. We defined 8 HCV care cascade steps: 1) total sentenced inmates, 2) screened for HCV (via HCV antibody [HCV Ab]), 3) HCV Ab positive, 4) tested for HCV RNA, 5) HCV RNA positive, 6) linked to care, 7) HCV treatment initiated and 8) achieved sustained virologic response. We measured proportions of inmates at each step using denominator-numerator linkage. We also calculated the proportion screened among inmates with a sentence duration of at least 1 month, during which time screening should be feasible. RESULTS Of the 4931 sentenced inmates, 344 (7%) were screened for HCV, of whom 38 (11%) were HCV Ab positive. Thirty-five (92%) of the 38 received HCV RNA testing, which showed positivity in 16 (46%). Ten (62%) of the 16 inmates were linked to care; treatment was initiated in 3 (30%), 2 of whom (67%) achieved a sustained virologic response. Among inmates with a sentence duration of at least 1 month (n = 1972), the proportion screened increased to 17%. INTERPRETATION A small proportion (7%) of men at a Canadian provincial prison with on-demand HCV testing were screened, and rates of treatment initiation were low in the absence of formal HCV cure pathways. To eliminate HCV in this subpopulation, opt-out HCV testing should be considered.
{"title":"The hepatitis C virus cascade of care in a Quebec provincial prison: a retrospective cohort study.","authors":"N. Kronfli, C. Dussault, M. Klein, B. Lebouché, G. Sebastiani, J. Cox","doi":"10.9778/cmajo.20190068","DOIUrl":"https://doi.org/10.9778/cmajo.20190068","url":null,"abstract":"BACKGROUND\u0000Hepatitis C virus (HCV) microelimination efforts must target people in prison; however, although some inmates may qualify for treatment in provincial prisons, it may not be routinely provided. Our aim was to characterize the cascade of HCV care in Quebec's largest provincial prison.\u0000\u0000\u0000METHODS\u0000We conducted a retrospective study of all HCV-related laboratory tests requested at the Établissement de détention de Montréal (men's prison with on-demand screening), between July 1, 2017, and June 30, 2018. We defined 8 HCV care cascade steps: 1) total sentenced inmates, 2) screened for HCV (via HCV antibody [HCV Ab]), 3) HCV Ab positive, 4) tested for HCV RNA, 5) HCV RNA positive, 6) linked to care, 7) HCV treatment initiated and 8) achieved sustained virologic response. We measured proportions of inmates at each step using denominator-numerator linkage. We also calculated the proportion screened among inmates with a sentence duration of at least 1 month, during which time screening should be feasible.\u0000\u0000\u0000RESULTS\u0000Of the 4931 sentenced inmates, 344 (7%) were screened for HCV, of whom 38 (11%) were HCV Ab positive. Thirty-five (92%) of the 38 received HCV RNA testing, which showed positivity in 16 (46%). Ten (62%) of the 16 inmates were linked to care; treatment was initiated in 3 (30%), 2 of whom (67%) achieved a sustained virologic response. Among inmates with a sentence duration of at least 1 month (n = 1972), the proportion screened increased to 17%.\u0000\u0000\u0000INTERPRETATION\u0000A small proportion (7%) of men at a Canadian provincial prison with on-demand HCV testing were screened, and rates of treatment initiation were low in the absence of formal HCV cure pathways. To eliminate HCV in this subpopulation, opt-out HCV testing should be considered.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20190068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44166733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Nethery, L. Schummers, K. S. Maginley, S. Dunn, W. Norman
BACKGROUND Low socioeconomic status is one of many barriers that may limit access to family planning services. We aimed to examine the relation between household income and contraceptive methods among female youth in Canada. METHODS Our study population included sexually active females aged 15-24 who were trying to avoid pregnancy. We used cross-sectional data from the 2009-2010 and 2013-2014 cycles of the Canadian Community Health Survey to compare household income and other sociodemographic covariates for those using oral contraceptives, injectable contraceptives, condoms or a dual method (condoms plus oral or injectable contraceptives). RESULTS Of female youth at risk for unintended pregnancy, 59.2% reported using oral contraceptives, 29.0% used dual methods, 16.8% used condoms only, 2.5% used injectable contraceptives and 13.6% did not use contraception. In multiple regression models, lower annual household income (< $80 000) was associated with decreased use of oral contraceptives (relative risk [RR] 0.85, 95% confidence interval [CI] 0.80-0.91) and dual methods (RR 0.81, 95% CI 0.71-0.91), increased use of condoms (RR 1.36, 95% CI 1.11-1.67) and injectable contraceptives (RR 1.69, 95% CI 0.98-2.92), and a greater risk of contraceptive nonuse (RR 1.19, 95% CI 0.94-1.50). INTERPRETATION We found that lower household income was associated with decreased use of oral contraceptives and increased reliance on injectable contraceptives and condoms only. Young, low-income females may face barriers to accessing the full range of contraceptive methods available in Canada. Easier access to affordable contraception may decrease the number of female youth at risk for unintended pregnancy due to financial barriers.
低社会经济地位是限制获得计划生育服务的诸多障碍之一。我们的目的是研究加拿大女性青年家庭收入和避孕方法之间的关系。方法我们的研究人群包括15-24岁试图避免怀孕的性活跃女性。我们使用2009-2010年和2013-2014年加拿大社区健康调查周期的横断面数据，比较使用口服避孕药、注射避孕药、避孕套或双重方法(避孕套加口服或注射避孕药)的家庭收入和其他社会人口统计学协变量。结果意外怀孕高危女性青年中，59.2%报告使用口服避孕药，29.0%报告使用双避孕方法，16.8%报告仅使用避孕套，2.5%报告使用注射避孕药，13.6%报告未使用避孕措施。在多元回归模型中，较低的家庭年收入(< 8万美元)与口服避孕药的使用减少(相对危险度[RR] 0.85, 95%可信区间[CI] 0.80-0.91)和双重方法(RR 0.81, 95% CI 0.71-0.91)、避孕套的使用增加(RR 1.36, 95% CI 1.11-1.67)和注射避孕药的使用增加(RR 1.69, 95% CI 0.98-2.92)以及不使用避孕药的风险增加(RR 1.19, 95% CI 0.94-1.50)相关。我们发现，较低的家庭收入与口服避孕药的使用减少和对注射避孕药和避孕套的依赖增加有关。在加拿大，低收入的年轻女性在获得各种避孕方法方面可能面临障碍。更容易获得负担得起的避孕措施可能会减少由于经济障碍而面临意外怀孕风险的女性青年人数。
{"title":"Household income and contraceptive methods among female youth: a cross-sectional study using the Canadian Community Health Survey (2009-2010 and 2013-2014).","authors":"E. Nethery, L. Schummers, K. S. Maginley, S. Dunn, W. Norman","doi":"10.9778/cmajo.20190087","DOIUrl":"https://doi.org/10.9778/cmajo.20190087","url":null,"abstract":"BACKGROUND\u0000Low socioeconomic status is one of many barriers that may limit access to family planning services. We aimed to examine the relation between household income and contraceptive methods among female youth in Canada.\u0000\u0000\u0000METHODS\u0000Our study population included sexually active females aged 15-24 who were trying to avoid pregnancy. We used cross-sectional data from the 2009-2010 and 2013-2014 cycles of the Canadian Community Health Survey to compare household income and other sociodemographic covariates for those using oral contraceptives, injectable contraceptives, condoms or a dual method (condoms plus oral or injectable contraceptives).\u0000\u0000\u0000RESULTS\u0000Of female youth at risk for unintended pregnancy, 59.2% reported using oral contraceptives, 29.0% used dual methods, 16.8% used condoms only, 2.5% used injectable contraceptives and 13.6% did not use contraception. In multiple regression models, lower annual household income (< $80 000) was associated with decreased use of oral contraceptives (relative risk [RR] 0.85, 95% confidence interval [CI] 0.80-0.91) and dual methods (RR 0.81, 95% CI 0.71-0.91), increased use of condoms (RR 1.36, 95% CI 1.11-1.67) and injectable contraceptives (RR 1.69, 95% CI 0.98-2.92), and a greater risk of contraceptive nonuse (RR 1.19, 95% CI 0.94-1.50).\u0000\u0000\u0000INTERPRETATION\u0000We found that lower household income was associated with decreased use of oral contraceptives and increased reliance on injectable contraceptives and condoms only. Young, low-income females may face barriers to accessing the full range of contraceptive methods available in Canada. Easier access to affordable contraception may decrease the number of female youth at risk for unintended pregnancy due to financial barriers.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20190087","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49041086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Canada does not have universal public coverage for prescription drugs, which leaves an important role for private insurance plans. However, we do not have recent data on the characteristics of Canadians who report holding such coverage, particularly differences based on household income. We performed a study to examine the relation between household income and private drug insurance coverage in Canada. METHODS We used data from the 2015-2016 cycle of the Canadian Community Health Survey to investigate the relation between household income and holding private drug insurance. We constructed modified multivariate Poisson regression models with robust error variances, including several potential confounders. RESULTS Overall, 59.4% of respondents reported having private drug insurance. We found a strong dose-response relation between household income level and private drug insurance coverage: 19.8% of those with a household income less than $20 000 reported private coverage, compared to 76.2% of those with a household income of $80 000 or more. INTERPRETATION Higher-income households are much more likely to hold private drug insurance coverage in Canada. This likely contributes to differential access to medicines and health outcomes by different income groups.
{"title":"Income-related disparities in private prescription drug coverage in Canada.","authors":"T. Bolatova, M. Law","doi":"10.9778/cmajo.20190085","DOIUrl":"https://doi.org/10.9778/cmajo.20190085","url":null,"abstract":"BACKGROUND\u0000Canada does not have universal public coverage for prescription drugs, which leaves an important role for private insurance plans. However, we do not have recent data on the characteristics of Canadians who report holding such coverage, particularly differences based on household income. We performed a study to examine the relation between household income and private drug insurance coverage in Canada.\u0000\u0000\u0000METHODS\u0000We used data from the 2015-2016 cycle of the Canadian Community Health Survey to investigate the relation between household income and holding private drug insurance. We constructed modified multivariate Poisson regression models with robust error variances, including several potential confounders.\u0000\u0000\u0000RESULTS\u0000Overall, 59.4% of respondents reported having private drug insurance. We found a strong dose-response relation between household income level and private drug insurance coverage: 19.8% of those with a household income less than $20 000 reported private coverage, compared to 76.2% of those with a household income of $80 000 or more.\u0000\u0000\u0000INTERPRETATION\u0000Higher-income households are much more likely to hold private drug insurance coverage in Canada. This likely contributes to differential access to medicines and health outcomes by different income groups.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20190085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45405479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alyson Campbell, L. Hartling, Samantha Louie-Poon, S. Scott
BACKGROUND Bronchiolitis affects more than one-third of children less than age 2 years and can cause substantial anxiety for parents, leading them to seek information on how to care for their sick child. The aim of our qualitative study was to explore the information needs and preferences of parents caring for a child with bronchiolitis. METHODS We used a qualitative descriptive approach. Participants were recruited by means of purposive sampling from Oct. 1, 2017, to Mar. 15, 2018 from the Stollery Children's Hospital emergency department, a specialized pediatric emergency department in Edmonton. Individual semistructured interviews were conducted. RESULTS Fifty-three parents were recruited to participate, of whom 30 could not be reached after 4 contact attempts and 8 refused. Thus, 15 parents participated (16 children). Three major themes were identified: 1) parents' information needs about bronchiolitis, 2) parents' preferred information sources and 3) parents' preferred information delivery formats. Participants indicated that they want and require credible, easy-to-understand information about bronchiolitis in a variety of formats, and especially valued information obtained directly from a health care professional or an evidence-based website. INTERPRETATION This study provides important information about parents' information needs concerning bronchiolitis in children. Identifying the information that parents want and value in relation to acute pediatric illnesses is imperative to developing innovative educational approaches for parents that reflect patient-centred care.
{"title":"Parents' information needs and preferences related to bronchiolitis: a qualitative study.","authors":"Alyson Campbell, L. Hartling, Samantha Louie-Poon, S. Scott","doi":"10.9778/cmajo.20190092","DOIUrl":"https://doi.org/10.9778/cmajo.20190092","url":null,"abstract":"BACKGROUND\u0000Bronchiolitis affects more than one-third of children less than age 2 years and can cause substantial anxiety for parents, leading them to seek information on how to care for their sick child. The aim of our qualitative study was to explore the information needs and preferences of parents caring for a child with bronchiolitis.\u0000\u0000\u0000METHODS\u0000We used a qualitative descriptive approach. Participants were recruited by means of purposive sampling from Oct. 1, 2017, to Mar. 15, 2018 from the Stollery Children's Hospital emergency department, a specialized pediatric emergency department in Edmonton. Individual semistructured interviews were conducted.\u0000\u0000\u0000RESULTS\u0000Fifty-three parents were recruited to participate, of whom 30 could not be reached after 4 contact attempts and 8 refused. Thus, 15 parents participated (16 children). Three major themes were identified: 1) parents' information needs about bronchiolitis, 2) parents' preferred information sources and 3) parents' preferred information delivery formats. Participants indicated that they want and require credible, easy-to-understand information about bronchiolitis in a variety of formats, and especially valued information obtained directly from a health care professional or an evidence-based website.\u0000\u0000\u0000INTERPRETATION\u0000This study provides important information about parents' information needs concerning bronchiolitis in children. Identifying the information that parents want and value in relation to acute pediatric illnesses is imperative to developing innovative educational approaches for parents that reflect patient-centred care.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20190092","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43698300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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