Immigration factors and potentially avoidable hospitalizations in Canada

Objective Estimate the effect of immigration characteristics on the risk of a hospitalization for an ambulatory care sensitive condition (ACSC). Research design We analyzed data on the Canadian resident adult population aged 18 to 74 years who responded to the 2006 long form Census. The Census data were linked to the Canadian Institute for Health Information (CIHI)’s Discharge Abstract Database (DAD) for fiscal years 2006–2007, 2007–2008, and 2008–2009. We conducted a logistic regression on the binary variable we created for an ACSC admission. Measures The CIHI definition of ACSC hospitalizations was used to identify potentially avoidable hospitalizations in the DAD. Immigration factors analyzed included years in Canada, ethnic origin, and ability to speak one of the official languages. Results There were 3,342,450 respondents aged between 18 and 74. Using the Canadian at birth as our reference population, recent immigrants (up to five years in Canada) had lower odds of an ACSC hospitalization, regardless of their ethnic origins, with the exception of immigrants from Oceania and from other North American countries for whom the effect was not significant. The protective effect was still present in children of immigrants (AOR=0.89). Immigrants from the Caribbean, from Southern, Eastern, and Western Europe, as well as those from East Asia had lower odds across categories of time spent in Canada. The protective effect was stronger in immigrants from East Asia and lower in those of Oceanic and other North American countries. Conclusions Our results suggest that the healthy immigrant effect dissipates with time in Canada but remains even in children of immigrants. The protective effect differs depending on the ethnic origin of the immigrant

La catastrophe écologique de la région de Mercier : une analyse socio-historique des interventions écocitoyennes, 1968 à 2007

Située dans une zone rurale de la Montérégie près de Montréal, le site des « lagunes de Mercier» comprend une nappe phréatique contaminée depuis 1968 par des déversements d'hydrocarbures et d'autres composés toxiques. Ces déversements autorisés jusqu'en 1972 par les pouvoirs publics, ont été suivis de déversements illégaux pendant plusieurs années, par la firme opérant l'incinérateur de déchets dangereux, chargée de décontaminer ces lagunes... Après bientôt quatre décennies de mal gestion environnementale, la contamination des eaux souterraines s'étend désormais sur près de 35 kilomètres carrés, alors que les émanations de cet incinérateur, le seul incinérateur industriel de produits liquides dangereux au Québec et le plus vieux au Canada, contribuent à la contamination de l'air, des sols et de l'eau de ce milieu déjà lourdement éprouvé, Dans ce mémoire, nous désignerons la contamination des « lagunes» et celle liée à l'incinérateur de déchets dangereux par l'expression «catastrophe écologique de la région de Mercier» en rappelant qu'elle est considérée comme l'une des plus grandes catastrophes écologiques du Québec, voire d'Amérique du Nord. Bien que plusieurs recherches, études et rapports aient été réalisés sur ce dossier bien connu des milieux environnementaux, ce mémoire est le premier à aborder cette problématique sous l'angle des sciences sociales avec pour objectif d'analyser, dans une approche écosanté, l'histoire socio-politique de ce dossier de contamination majeure qui, amorcé en 1968, perdure encore en 2007. Notre intention est de comprendre pourquoi ce dossier, malgré l'importance des coûts socio-environnementaux engendrés, ainsi que toutes les crises sociopolitiques et les mobilisations collectives suscitées, non seulement n'a pas été résorbé au cours des quatre dernières décennies, mais s'est au contraire complexifié. Cela témoigne-t-il de l'échec du rôle de protection de la santé et de l'environnement dévolu à l'État qui, responsable au premier chef n'a jamais réussi, en 38 ans, à résoudre ce dossier de façon durable et satisfaisante? Ce mémoire s'appuie sur une revue de littérature, sur une imposante analyse documentaire (analyses techniques, rapports publics, revue de presse, archives. municipales et privées, etc.) et sur une quinzaine d'entretiens semi-directifs avec des acteurs-clés de cette longue saga socio-environnementale (citoyens, écologistes, agriculteurs, élus municipaux et industriels). Pour mieux comprendre l'évolution de ce dossier et les différents épisodes de mobilisations collectives qui ont marqué l'histoire de cette catastrophe écologique, nous en avons analysé les dynamiques sociales et les différentes stratégies d'intervention, les types d'organisation et les intérêts en jeu, au fil de l'évolution du contexte socio-politique. Une demande récurrente a été, depuis 38 ans, au coeur de toutes les revendications citoyennes, celle de connaître les risques écologiques et sociosanitaires de la contamination et d'assurer la décontamination du site et éventuellement la fermeture de l'incinérateur. La crainte des risques socioéconomiques, bien que moins présente, explique parfois l'inaction, le silence, voire certains gestes d'intimidations à l'égard de certains citoyens. Enfin, nous examinons l'actuelle mobilisation collective, qui, issue d'un urgent besoin de suivi environnemental et sanitaire, a incité le démarrage d'une recherche universitaire Diagnostic Écosanté Mercier sous la direction d'une équipe du CINBIOSE de l'UOAM. Menée en étroite collaboration avec la communauté et incluant un volet de surveillance communautaire de la pollution par une coalition d'acteurs sociaux, celle-ci a pour objectif de documenter ce dossier de contamination de façon rigoureuse et indépendante afin d'inviter les différents responsables à prendre les mesures appropriées pour résoudre enfin cet épineux dossier. ______________________________________________________________________________ MOTS-CLÉS DE L’AUTEUR : Lagunes de Mercier, Catastrophe écologique, Sociologie de l'environnement, Pollution, Déchets industriels, Hydrocarbures, Mobilisations collectives, Approche écosanté, Approche écosystémique, Écocitoyen

Online survey to assess parents’ experience and preferences for follow-up visits for children living with type 1 diabetes in Quebec, Canada : a study protocol

Introduction It is accepted that although patients may initiate a visit to a healthcare provider, follow-up visits are often based on recommendations from providers. This suggests that follow-up care, since not initiated by patients, may not reflect patients' perception of a need for care. However, few studies have examined the burden of regular follow-up care and patients' perceived value of such care. For parents of children with type 1 diabetes (T1D), follow-up visits are scheduled regardless of how well controlled the diabetes is. Our study examines how benefits and burden from the parents' perspective could affect their preferences in regard to the frequency of regular follow-up care. Methods We aim to develop an online patient survey to be distributed to parents of children living with T1D in the province of Quebec, Canada. The survey will be available in French and English, and distributed through diabetes clinics, on social media groups and forums for parents of children with T1D. The survey will be developed in collaboration with parents of children with T1D to ensure that it appropriately reflects the services in regular followup care and that the language is understandable and clear. Ethics and dissemination All participants will be informed of the requirements and objectives of the survey at the beginning of the questionnaire and that the data collected will remain anonymous and confidential. Ethics approval for the study was obtained from the research ethics committee of the CHU de Québec-Université Laval. Results of the study will be shared with relevant stakeholders with the aim of improving practices and better meeting patients' and families' needs

Parents’ preferences for follow-up care in a type 1 diabetes paediatric population : a survey-based study in Quebec, Canada

Objectives: Examine variations in parent’s preferences for their child’s type 1 diabetes (T1D) follow-up care and the determinants of the preferred intensity of care. Clinical guidelines recommend multidisciplinary management of T1D, with follow-up visits with an endocrinologist at least every 3 months in the paediatric population. However, there could be heterogeneity in parents’ needs, and preferences in terms of care management may deviate from clinical guidelines. Setting: Not applicable. Participants: Parents who have a child living with T1D and who reside in Quebec, Canada. Intervention: In collaboration with a patient-partner (a parent of a child with T1D), we developed a survey to collect data from parents of children living with T1D. Our primary outcome of interest was the preferred time in months between two appointments. We ran a probit model to analyse longer time (over 3 months between appointments), compared with the standard of care (3 months or less). Results: Results suggest that about one-third (33%) of parents want to deviate from the guideline. Parents who want to increase the time between appointments are more experienced in the management of the disease and have higher costs than those who wish to follow the 3-month guideline. The number of years since the diagnosis is positively associated with a preference for a longer time between appointments, while the perceived useful of information provided during the consultation, and a parent having made a change in their professional life were negatively associated with a desire to space out appointments. The child’s gender is not a significant factor in parents’ preferences. Conclusions: Adapting visit protocols could make the health system more efficient to respond to T1D patients and their parent’s needs

From diagnosis to routine care in type 1 diabetes in children : parents' experiences

Having a child who lives with a Type 1 Diabetes (T1D) can represent a high burden for parents. The objective of our study is to identify and analyze the main challenges expressed by parents so that health care services better meet the needs of parents of T1D children. Semi-structured interviews were conducted with parents of 19 T1D children regarding detection and diagnosis, initial management at the hospital, post-discharge adaptation including daycare or school reintegration, and long-term T1D monitoring. Data analysis was performed following an inductive approach. The results showed a lack of knowledge regarding T1D in the society, especially for parents and educators. Furthermore, most parents felt overwhelmed at the hospital, and not ready for the intense self-management education (SME). They suggested it could be split over an extended period and discussed from a more practical perspective. Parents' burden is highest in the post-discharge adaptation stage especially for school reintegration, management of blood glucose levels and calculation of carbohydrates. Finally, returning to a social life was difficult, but contacts with diabetic families was a relief. In conclusion, the SME ought to be flexible and adapted to parents' needs. Spreading it over a longer period would ease families' experience. Efforts should also be made to alleviate the parents' burden on the post-discharge adaptation perceived as the most difficult stage, especially for school reintegration where training and resources on T1D should be given to key staff. Public education campaigns would raise awareness and ensure better knowledge of T1D by general population

Private insurance versus medicaid and adherence to medication in older adults with fibromyalgia

Background: Fibromyalgia, defined as chronic, wide-spread musculoskeletal pain, affects 4 to 10 million Americans and up to 6% of the world population. Medication nonadherence results in $100 to$300 billion in US health expenditures annually. Previous studies have examined medication adherence in commercial health plans or public health plans, but relatively few have compared both populations. The purpose of this study was to estimate the effect of type of insurance on adherence to medication for older adults with fibromyalgia. Methods: The retrospective cohort study analyzed medical claims of fibromyalgia patients collected between January 1, 2005 to June 30, 2011 from the Blue Cross Blue Shield South Carolina State Health Plan (BCBS) and Medicaid data. Older adults age 60 and older were included if they were prescribed duloxetine, milnacipran, or pregabalin (N=3,187). The primary outcome, medication adherence, was defined as having a medication possession ratio (MPR) of ≥ 80%. Independent variables included health insurance, FMS medication, selected comorbidities (FMS-related, musculoskeletal pain, or neuropathic pain), gender, age, and the interaction between health insurance type and treatment. Results: Logistic regression showed older adults with fibromyalgia on Medicaid were over 3 times more likely to be adherent when compared to BCBS in both unadjusted (OR: 3.21, p<0.0001) and adjusted models (OR: 3.74, p<0.0001). Conclusion: Most states do not require a Medicaid prescription co-pay; whereas, private insurers, like Blue Cross Blue Shield, require more out-of-pocket costs. Our study suggests that the co-pays for medications in private plans may present a barrier to patient adherence

From diagnosis to routine care in type 1 diabetes in children: Parents’ experiences

Having a child who lives with a Type 1 Diabetes (T1D) can represent a high burden for parents. The objective of our study is to identify and analyze the main challenges expressed by parents so that health care services better meet the needs of parents of T1D children. Semi-structured interviews were conducted with parents of 19 T1D children regarding detection and diagnosis, initial management at the hospital, post-discharge adaptation including daycare or school reintegration, and long-term T1D monitoring. Data analysis was performed following an inductive approach. The results showed a lack of knowledge regarding T1D in the society, especially for parents and educators. Furthermore, most parents felt overwhelmed at the hospital, and not ready for the intense self-management education (SME). They suggested it could be split over an extended period and discussed from a more practical perspective. Parents’ burden is highest in the post-discharge adaptation stage especially for school reintegration, management of blood glucose levels and calculation of carbohydrates. Finally, returning to a social life was difficult, but contacts with diabetic families was a relief. In conclusion, the SME ought to be flexible and adapted to parents\u27 needs. Spreading it over a longer period would ease families’ experience. Efforts should also be made to alleviate the parents’ burden on the post-discharge adaptation perceived as the most difficult stage, especially for school reintegration where training and resources on T1D should be given to key staff. Public education campaigns would raise awareness and ensure better knowledge of T1D by general population. Experience Framework This article is associated with the Quality & Clinical Excellence lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens

Rapport de colloque : financement axé sur le patient : quelles considérations pour le Québec?

Le colloque « Financement des établissements de soins axé sur le patient: quelles considérations pour le Québec? » s'est tenu le 21 novembre 2018 à l'Université Laval. Il avait pour objectif de présenter aux décideurs, aux chercheurs, aux étudiants et aux gestionnaires d'établissements de services de santé les connaissances issues d'expériences étrangères concernant l'introduction du financement axé sur le patient (FAP) dans les établissements de soins. La présentation des expériences françaises, australiennes, ontariennes et québécoises a ainsi permis de mettre en lumière des enjeux récurrents concernant l'implantation de modèles de FAP. L'information recueillie soutiendra l'orientation des prochaines étapes de la réforme du financement des services de santé au Québec. À la suite des présentations des conférenciers invités, le ministère de la Santé et des Services sociaux (MSSS) a présenté trois enjeux prioritaires concernant la transformation du modèle de financement sur lesquels il souhaitait obtenir l'avis des acteurs du réseau de la santé. Les discussions qui ont suivi ont permis d'identifier les points importants pour les participants à propos des modalités de financement des patients, de la prise en considération de la performance et du financement de paniers de services

Hospitalizations for ambulatory care sensitive conditions across primary care models in Ontario, Canada

The study analyzes the relationship between the risk of a hospitalization for an ambulatory care sensitive condition (ACSC), and the primary care payment and the organizational model used by the patient (fee-for-service, enhanced fee-for-service, blended capitation, blended capitation with interdisciplinary teams).The study used linked patient-level health administrative databases and census data housed at the Institute for Clinical Evaluative Sciences in Ontario. Since the province provides universal health care, the data capture all patients in Ontario, Canada's most populous province, with about 13 million inhabitants. All Ontario patients diagnosed with an ACSC prior to April 1, 2012, who had at least one visit with a physician between April 1, 2012, and March 31. 2013, were included in the study (n=1,710,310). Each patient was assigned to the primary care model of his/her physician. The different models were categorized as Fee-forService (FFS), enhanced-FFS, blended capitation, and interdisciplinary team. A logistic regression was used to model the risk of having an ACSC hospitalization during the one-year observation period. Adjustments were made for patient characteristics (age, sex, health status, and socio-economic status) and for the geographic location of the practice. Using patients belonging to FFS models as the reference group, the risk of an ACSC hospitalization was higher for patients belonging to the blended-capitation model using interdisciplinary teams (Adjusted Odds Ratio [AOR] = 1.06, 95% confidence interval [CI] = 1.00-1.12) and lower for enhancedFFS (AOR = 0.78, CI= 0.74-0.82) and blended capitation patients (AOR = 0.91, CI= 0.86-0.96). Using patients with hypertension as the reference group, the odds of an ACSC hospitalization were much higher for patients with any other ACSC and increased with patients' morbidity. The risk was lower for patients of higher socio-economic status (AOR=0.63, CI=0.60-0.67) in the highest neighborhood income quintile