17 research outputs found
Does socio-economic status influence the effect of multimorbidity on the frequent use of ambulatory care services in a universal healthcare system? A population-based cohort study
Background: Frequent healthcare users place a significant burden on health systems. Factors such as
multimorbidity and low socioeconomic status have been associated with high use of ambulatory care services
(emergency rooms, general practitioners and specialist physicians). However, the combined effect of these two
factors remains poorly understood. Our goal was to determine whether the risk of being a frequent user of
ambulatory care is influenced by an interaction between multimorbidity and socioeconomic status, in an entire
population covered by a universal health system.
Methods: Using a linkage of administrative databases, we conducted a population-based cohort study of all adults in
Quebec, Canada. Multimorbidity (defined as the number of different diseases) was assessed over a two-year period
from April 1st 2012 to March 31st 2014 and socioeconomic status was estimated using a validated material deprivation
index. Frequents users for a particular category of ambulatory services had a number of visits among the highest 5% in
the total population during the 2014â15 fiscal year. We used ajusted logistic regressions to model the association
between frequent use of health services and multimorbidity, depending on socioeconomic status.
Results: Frequent users (5.1% of the population) were responsible for 25.2% of all ambulatory care visits. The lower the
socioeconomic status, the higher the burden of chronic diseases, and the more frequent the visits to emergency
departments and general practitioners. Socioeconomic status modified the association between multimorbidity and
frequent visits to specialist physicians: those with low socioeconomic status visited specialist physicians less often. The
difference in adjusted proportions of frequent use between the most deprived and the least deprived individuals
varied from 0.1% for those without any chronic disease to 5.1% for those with four or more chronic diseases. No such
differences in proportions were observed for frequent visits to an emergency room or frequent visits to a general
practitioner
User's perspectives of barriers and facilitators to implementing quality colonoscopy services in Canada: a study protocol
<p>Abstract</p> <p>Background</p> <p>Colorectal cancer (CRC) represents a serious and growing health problem in Canada. Colonoscopy is used for screening and diagnosis of symptomatic or high CRC risk individuals. Although a number of countries are now implementing quality colonoscopy services, knowledge synthesis of barriers and facilitators perceived by healthcare professionals and patients during implementation has not been carried out. In addition, the perspectives of various stakeholders towards the implementation of quality colonoscopy services and the need of an efficient organisation of such services have been reported in the literature but have not been synthesised yet. The present study aims to produce a comprehensive synthesis of actual knowledge on the barriers and facilitators perceived by all stakeholders to the implementation of quality colonoscopy services in Canada.</p> <p>Methods</p> <p>First, we will conduct a comprehensive review of the scientific literature and other published documentation on the barriers and facilitators to implementing quality colonoscopy services. Standardised literature searches and data extraction methods will be used. The quality of the studies and their relevance to informing decisions on colonoscopy services implementation will be assessed. For each group of users identified, barriers and facilitators will be categorised and compiled using narrative synthesis and meta-analytical techniques. The principle factors identified for each group of users will then be validated for its applicability to various Canadian contexts using the Delphi study method. Following this study, a set of strategies will be identified to inform decision makers involved in the implementation of quality colonoscopy services across Canadian jurisdictions.</p> <p>Discussion</p> <p>This study will be the first to systematically summarise the barriers and facilitators to implementation of quality colonoscopy services perceived by different groups and to consider the local contexts in order to ensure the applicability of this knowledge to the particular realities of various Canadian jurisdictions. Linkages with strategic partners and decision makers in the realisation of this project will favour the utilisation of its results to support strategies for implementing quality colonoscopy services and CRC screening programs in the Canadian health system.</p
Combined impacts of multimorbidity and mental disorders on frequent emergency department visits : a retrospective cohort study in Quebec, Canada.
BACKGROUND: Multimorbidity and mental disorders are independently associated with frequent visits to the emergency department (â„ 3 visits/yr), but their interaction has been little studied. We aimed to measure the interaction between mental disorders and physical multimorbidity with respect to frequent visits to the emergency department. METHODS: We conducted a populationbased cohort study of adults in Quebec from 2012 to 2016, using the Quebec Integrated Chronic Disease Surveillance System. We assessed multimorbidity as the number of physical illnesses and mental disorders as serious (psychotic or bipolar disorders), common or absent, using data from 2012 to 2014. We counted emergency department visits from 2014 to 2015. We used logistic regression to estimate interaction on frequent visits to the emergency department from 2 perspectives: of public health (additive scale as differences in risk) and of individual patients (multiplicative scale as odds ratios). RESULTS: Each additional physical illness was associated with a greater increase in the absolute risk of frequent visits to the emergency department for people with mental disorders. Between 0 and â„ 4 physical conditions, the absolute risk increased more for individuals with serious mental disorders (16.2%) than common (15.3%) or no disorders (11.4%). On the relative scale, for people with no mental disorders and â„ 4 physical conditions, odds of frequent visits to the emergency department were 6.2 (95% confidence interval [CI] 6.08â6.35) times the odds for people with no physical conditions. For individuals with common and serious mental illnesses, corresponding odds ratios were 4.75 (95% CI 4.60â4.90) and 3.7 (95% CI 3.18â3.57), respectively. INTERPRETATION: Mental disorders interact with physical multimorbidity to increase the odds of frequent visits to the emergency department. More research is needed on interventions that promote high-quality care for mental illness, especially in the context of physical multimorbidity
Lâeffet combinĂ© de la multimorbiditĂ© et des troubles mentaux sur les admissions frĂ©quentes Ă lâurgence chez les adultes quĂ©bĂ©cois
Les travaux prĂ©sentĂ©s dans ce feuillet visent Ă dĂ©terminer si la multimorbiditĂ© physique et les troubles mentaux agissent en synergie pour augmenter le risque dâadmissions frĂ©quentes Ă lâurgence. Les objectifs spĂ©cifiques sont de : 1) estimer la prĂ©valence des troubles mentaux selon le nombre de maladies chroniques physiques; 2) quantifier lâeffet des maladies chroniques physiques et des troubles mentaux sur les admissions frĂ©quentes Ă lâurgence.
La prévalence des troubles mentaux est de 11,6 % en absence de maladie chronique physique et augmente à 31,4 % en présence de quatre maladies chroniques physiques ou plus.
La prĂ©sence de troubles mentaux et la multimorbiditĂ© physique sont toutes deux associĂ©es Ă une augmentation des admissions frĂ©quentes Ă lâurgence.
Chez les individus avec trouble mental sĂ©vĂšre, lorsque le nombre de maladies chroniques physiques varie dâaucune Ă quatre ou plus, la proportion dâutilisateurs frĂ©quents de lâurgence passe de 9,2 % Ă 25,4 % (soit une augmentation de 16,2 points de pourcentage). Cette augmentation est moindre (11,4 points de pourcentage) chez les individus sans trouble mental.
Notre Ă©tude populationnelle dĂ©montre lâimportance primordiale de la santĂ© mentale comme contributeur aux admissions frĂ©quentes Ă lâurgence, un problĂšme majeur dans le contexte quĂ©bĂ©cois et ailleurs dans le monde. Tant pour les individus que pour le systĂšme de santĂ©, les troubles mentaux augmentent le risque dâadmissions frĂ©quentes de maniĂšre significative. Une amĂ©lioration dans la prise en charge des individus avec des troubles mentaux pourrait avoir un double impact (par lâeffet direct des troubles mentaux et de leur synergie avec les maladies chroniques physiques) sur la rĂ©duction des admissions frĂ©quentes Ă lâurgence. Une meilleure comprĂ©hension des causes sous-jacentes de cette synergie serait utile dans la planification des soins, par exemple pour cibler des personnes Ă risque pour des programmes de suivi et des soins intĂ©grĂ©s qui prendraient en compte les besoins particuliers des patients multimorbides avec des troubles mentaux
De la biologie Ă la clinique : le dĂ©cĂšs dĂ» au cancer de la prostate peut-il maintenant ĂȘtre une exception ?
La dĂ©couverte la plus consĂ©quente de la deuxiĂšme moitiĂ© du xxe siĂšcle dans le domaine du traitement du cancer de la prostate est probablement la mise en Ă©vidence que la prostate humaine, de mĂȘme que de nombreux autres tissus pĂ©riphĂ©riques, fabriquent localement une quantitĂ© importante dâandrogĂšnes Ă partir de prĂ©curseurs surrĂ©naliens inactifs, essentiellement la dĂ©hydroĂ©piandrostĂ©rone (DHEA) et son sulfate DHEA-S. ParallĂšlement Ă ces observations, deux autres dĂ©couvertes importantes de notre groupe sont maintenant appliquĂ©es en clinique Ă travers le monde. Ainsi, les agonistes de la LH-RH (luteinizing hormone-releasing hormone) sont utilisĂ©s pour obtenir un blocage complet des androgĂšnes dâorigine testiculaire alors que, simultanĂ©ment, les androgĂšnes produits au niveau de la prostate Ă partir de la DHEA sont bloquĂ©s dans leur accĂšs au rĂ©cepteur des androgĂšnes par un antiandrogĂšne pur de la classe du flutamide. Ce traitement, appelĂ© blocage androgĂ©nique combinĂ©, est dâailleurs le premier traitement dĂ©montrĂ© comme prolongeant la vie dans le cancer de la prostate. Alors que les premiĂšres Ă©tudes ont Ă©tĂ© effectuĂ©es chez des patients ayant un cancer avancĂ©, nos donnĂ©es rĂ©centes indiquent un niveau dâefficacitĂ© remarquable de ce mĂȘme traitement appliquĂ© au stade localisĂ© du cancer, avec une possibilitĂ© de guĂ©rison de lâordre de 90%. Toutefois, afin de pouvoir traiter le cancer de la prostate au stade localisĂ©, un diagnostic prĂ©coce est un prĂ©requis. La premiĂšre Ă©tude randomisĂ©e effectuĂ©e Ă grande Ă©chelle sur le dĂ©pistage du cancer de la prostate a dĂ©montrĂ© que 99% des cancers de la prostate peuvent ĂȘtre diagnostiquĂ©s au stade localisĂ© ou potentiellement guĂ©rissable, grĂące Ă la simple mesure annuelle de lâAPS (antigĂšne prostatique spĂ©cifique). Ainsi, la simple application des moyens diagnostiques et thĂ©rapeutiques actuellement disponibles peut faire en sorte que le dĂ©cĂšs dĂ» au cancer de la prostate devienne une exception.The most significant discovery of the second half of the xxth century in the field of prostate cancer therapy is probably the observation that the human prostate, as well as many other peripheral human tissues, synthesize locally an important amount of androgens from the inactive steroid precursors dehydroepiandrosterone (DHEA) and its sulfate DHEA-S. In parallel with these observations, two important discoveries also made by our group are applied in the clinic worlwide, namely the use of LHRH (luteininizing hormone-releasing hormone) agonists to completely block testicular androgens, while, simultaneously, the androgens made locally in the prostate from DHEA are blocked in their access to the androgen receptor by a pure antiandrogen of the class of flutamide. This treatment, called combined androgen blockade, has been the first treatment demonstrated to prolong life in prostate cancer. While the first studies were performed in patients with advanced and metastatic disease, our recent data indicate a remarkable level of efficacy of the same treatment applied to localized prostate cancer, namely a 90% possibility of cure. However, in order to be able to treat localized prostate cancer, early diagnosis must be achieved. In the first large-scale randomized study of prostate cancer screening, we have demonstrated that 99% of prostate cancers can be diagnosed at the localized or potentially curable stage, using simple annual measurement of PSA (prostatic specific antigen). Todayâs data show that with the simple application of the available diagnostic and therapeutic tools, death from prostate cancer should be an exception
Additional file 1: of Understanding cancer networks better to implement them more effectively: a mixed methods multi-case study
Partnership structure of the study. Partnership structure for integrated knowledge transfer. (DOCX 61 kb