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More than 1,300 Canadians are diagnosed with cervical cancer annually, which is nearly preventable through human papillomavirus (HPV) immunization. Across Canada, coverage rates remain below the 90% target set out by the Action Plan for... more
More than 1,300 Canadians are diagnosed with cervical cancer annually, which is nearly preventable through human papillomavirus (HPV) immunization. Across Canada, coverage rates remain below the 90% target set out by the Action Plan for the Elimination of Cervical Cancer in Canada (2020–2030). To support this Plan, the Canadian Partnership Against Cancer has commissioned the Urban Public Health Network (UPHN) to coordinate a quality improvement project with Canada’s school-based HPV immunization programs. In Alberta, the UPHN partnered with Alberta Health Services (AHS) for this work. This study has one overarching research question: what are parent/guardian and program stakeholder perceived barriers, enablers and opportunities to immunization for youth as part of the school-based HPV immunization program in Alberta? This study uses a mixed-methods sequential explanatory design. A survey will be emailed to a sample of Albertans with children aged 11–17 years. Questions will be based...
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PurposeOrganizational context influences the effect of facilitation efforts on research use in care settings. The interactions of these factors are complex. Therefore, the use of traditional statistical methods to examine their... more
PurposeOrganizational context influences the effect of facilitation efforts on research use in care settings. The interactions of these factors are complex. Therefore, the use of traditional statistical methods to examine their interrelationships is often impractical. Big Data analytics can automatically detect patterns within the data. We applied the chi‐squared automatic interaction detection (CHAID) algorithm and classification tree technique to explore the dynamic and interdependent relationships between the implementation science concepts—context, facilitation, and research use.DesignObservational, cross‐sectional study based on survey data collected from a representative sample of nursing homes in western Canada.MethodsWe assessed three major constructs: (a) Conceptual research utilization (CRU) using the CRU scale; (b) facilitation of research use measured by the frequency of contacts between the frontline staff and a clinical educator, or person who brings new ideas to the c...
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OBJECTIVES To describe trends in blood glucose test strip (TS) utilization and cost in Saskatchewan. METHODS A retrospective analysis of TS use between January 1, 1996, and December 31, 2013, was conducted using population-based health... more
OBJECTIVES To describe trends in blood glucose test strip (TS) utilization and cost in Saskatchewan. METHODS A retrospective analysis of TS use between January 1, 1996, and December 31, 2013, was conducted using population-based health administrative databases in Saskatchewan. The prescription drug database was used to describe the annual number of TS dispensations, the number of strips dispensed, the number of unique beneficiaries and the total costs. A patient-level analysis was also carried out to describe the patterns of TS use (i.e. light, moderate or heavy) by the entire cohort and by diabetes treatments. Potential cost savings due to a newly implemented restriction policy were estimated based on the most recent data (2013). RESULTS TS utilization increased dramatically between 1996 and 2013 in terms of the number of users and the average number of TSs received. The percentage of TS users receiving fewer than 4 TSs per week (i.e. light users) decreased by 20%, while the percentage of heavy users (i.e. those receiving more than 8 TSs per week) increased by 19%. During the same period, the use of high-risk oral hypoglycemic medications declined by 30% among all TS users. Heavy TS use was observed in at least one-third of all users, irrespective of treatment type. CONCLUSIONS If Saskatchewan's newly imposed coverage limits had been applied in 2013, the costs of strips exceeding those limits would have totalled $2.5 million. Although TS use aligns with chronic disease care paradigms, the substantial costs and lack of evidence of patient outcomes demand better strategies to help reduce unnecessary use.
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The association between incretin-based drugs, such as dipeptidyl peptidase 4 (DPP-4) inhibitors and glucagon-like peptide 1 (GLP-1) agonists, and acute pancreatitis is controversial. To determine whether the use of incretin-based drugs,... more
The association between incretin-based drugs, such as dipeptidyl peptidase 4 (DPP-4) inhibitors and glucagon-like peptide 1 (GLP-1) agonists, and acute pancreatitis is controversial. To determine whether the use of incretin-based drugs, compared with the use of 2 or more other oral antidiabetic drugs, is associated with an increased risk of acute pancreatitis. A large, international, multicenter, population-based cohort study was conducted using combined health records from 7 participating sites in Canada, the United States, and the United Kingdom. An overall cohort of 1 532 513 patients with type 2 diabetes initiating the use of antidiabetic drugs between January 1, 2007, and June 30, 2013, was included, with follow-up until June 30, 2014. Current use of incretin-based drugs compared with current use of at least 2 oral antidiabetic drugs. Nested case-control analyses were conducted including hospitalized patients with acute pancreatitis matched with up to 20 controls on sex, age, c...
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The lowest level at which fish farmers ordinarily make management decisions is the individual holding unit. To identify factors associated with chemotherapeutic treatment initiation at the holding-unit level, we created a unit of... more
The lowest level at which fish farmers ordinarily make management decisions is the individual holding unit. To identify factors associated with chemotherapeutic treatment initiation at the holding-unit level, we created a unit of measurement called the "farm-tank-lot" (FTL), which allowed the movements and mixing of groups of fish to be followed during an entire production cycle. Each FTL was comprised of fish with a common history housed in a specific holding unit. Our 21-month prospective observational study (conducted on 14 land-based trout farms in Ontario, Canada) showed that the FTL was a biologically meaningful unit of concern and a feasible unit of measurement on land-based trout farms.Multivariable logistic and Poisson regressions revealed that fish size and growth rate both were associated negatively with the probability and frequency of treatment. FTLs that existed for longer periods of time were more likely to be treated and treated more often. There was a significant farm effect. Future field studies of disease in cultured fish should incorporate these factors into their design and analysis.
Research Interests: Biology, Fish Diseases, Medicine, Logistic Regression, Preventive Veterinary Medicine, and 12 moreAnimals, Poisson regression, Data Collection, Ontario, Longitudinal Studies, Rainbow trout, Trout, Veterinary Sciences, Observational Study, Poisson Distribution, Logistic Models, and Decision Support Techniques
Research Interests: Program Evaluation, Nursing, Medicine, Trauma, Counseling, and 13 moreHumans, The, Clinical Sciences, Urban Population, Guidance and Counseling Intervention Programs, Clinical Protocols, Wounds and Injuries, Substance-Related Disorders, Emergency Department, Trauma Centers, mass Screening, Referral and consultation, and Referral
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PurposeThe Canadian Network for Observational Drug Effect Studies (CNODES), a network of pharmacoepidemiologists and other researchers from seven provincial sites, provides evidence on the benefits and risks of drugs used by Canadians.... more
PurposeThe Canadian Network for Observational Drug Effect Studies (CNODES), a network of pharmacoepidemiologists and other researchers from seven provincial sites, provides evidence on the benefits and risks of drugs used by Canadians. The Knowledge Translation Team, one of CNODES' four main teams, evaluates the impact of its efforts using an iterative and emergent approach. This article shares key lessons from early evaluation phases, including identifying stakeholders and their evaluation needs, choosing evaluation theories and approaches, and developing evaluation questions, designs, and methods appropriate for the CNODES context.MethodsStakeholder analysis was conducted using documentary analysis to determine key contextual factors and research evidence needs of decision maker partners and other stakeholders. Selected theories and frameworks from the evaluation and knowledge translation literature informed decisions about evaluation design and implementation. A developmental...
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| 279 rates. Health professionals and policy-makers need to be aware of the increased risk for diabetes and opportunities for prevention in women and young people belonging to specific ethnic groups. Indigenous communities and ethnicity... more
| 279 rates. Health professionals and policy-makers need to be aware of the increased risk for diabetes and opportunities for prevention in women and young people belonging to specific ethnic groups. Indigenous communities and ethnicity issues No conflict of interest
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Objective COPD is a high-cost disease and results in frequent contacts with the healthcare system. The study objective was to compare the accuracy of classification models with different covariates for classifying COPD patients into cost... more
Objective COPD is a high-cost disease and results in frequent contacts with the healthcare system. The study objective was to compare the accuracy of classification models with different covariates for classifying COPD patients into cost groups. Methods Linked health administrative databases from Saskatchewan, Canada, were used to identify a cohort of newly diagnosed COPD patients (April 1, 2007 to March 31, 2011) and their episodes of healthcare encounters for disease exacerbations. Total costs of the first and follow-up episodes were computed and patients were categorized as persistently high cost, occasionally high cost, and persistently low cost based on cumulative cost distribution ranking using the 75th percentile cutoff for high-cost status. Classification accuracy was compared for seven multinomial logistic regression models containing socio-demographic characteristics (i.e., base model), and socio-demographic and prior healthcare use characteristics (i.e., comparator models...
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Background Colorectal cancer (CRC) is one of the leading causes of cancer death globally. CRC screening can reduce the incidence and mortality of CRC. However, socially disadvantaged groups may disproportionately benefit less from... more
Background Colorectal cancer (CRC) is one of the leading causes of cancer death globally. CRC screening can reduce the incidence and mortality of CRC. However, socially disadvantaged groups may disproportionately benefit less from screening programs due to their limited access to healthcare. This poor access to healthcare services is further aggravated by intersecting, cumulative social factors associated with their sociocultural background and living conditions. This rapid review systematically reviewed and synthesized evidence on the effectiveness of Fecal Immunochemical Test (FIT) programs in increasing CRC screening in populations who do not have a regular healthcare provider or who have limited healthcare system access.Methods We used three databases: Ovid MEDLINE, Embase, and EBSCOhost CINAHL. We searched for systematic reviews, meta-analysis, and quantitative and mixed-methods studies focusing on effectiveness of FIT programs (request or receipt of FIT kit, completion rates o...
PRISMA-P 2015 Checklist. (DOCX 37 kb)
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Research Interests: Usability, Health Care, Implementation Science, Health Services Research, Knowledge Translation, and 10 moreHealth Administration, Medicine, Nursing Research, Humans, Feedback, Data Collection, Translational Medical Research, Health Personnel, Health services for the aged, and Medical and Health Sciences
Research Interests: Knowledge Management, Long Term Care, Data Analysis, Case Study Research, Implementation Science, and 15 moreHealth Services Research, Knowledge Translation, Health Administration, Medicine, Case Study, Focus Group, Data Collection, Implementation, Participant Observation, Multiple Case Study, Empirical evidence, Instrument Design, Mixed Method, Minimum Data Set, and Medical and Health Sciences
There is a growing need for an integrated health information system to be used in community, institutional and hospital based settings. For example, changes in the structure, process and venues of service delivery mean that individuals... more
There is a growing need for an integrated health information system to be used in community, institutional and hospital based settings. For example, changes in the structure, process and venues of service delivery mean that individuals with similar needs may be cared for in a variety of different settings. Moreover, as people make transitions from one sector of the healthcare system to another, there is a need for comparable information to ensure continuity of care and reduced assessment burden. The RAI/MDS series of assessment instruments comprise an integrated health information system because they have consistent terminology, common core items, and a common conceptual basis in a clinical approach that emphasizes the identification of functional problems.
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Research Interests: Business, Knowledge Management, Organizational Culture, Long Term Care, Evidence Based Medicine, and 15 moreHealth Care, Knowledge Transfer, Capacity Building, Health Care Management, Medicine, Learning, Humans, Business and Management, Nursing Homes, Diffusion of Innovation, Ontario, Innovation Adoption, Contingency Theory, GuideLine, and Guideline Adherence
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Research Interests: Health Informatics, Long Term Care, Health Administration, Medicine, Quality of Care, and 15 moreNursing Research, Library and Information Studies, Humans, Information Quality, Systematic review, Aged, Questionnaires, Public health systems and services research, Reproducibility of Results, Geriatric Assessment, Pressure Ulcer, Observational Study, Literature Search, Minimum Data Set, and Reliability and validity
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Background The overall impact of physician prescribers on population-level adherence rates are unknown. We aimed to quantify the influence of general practitioner (GP) physician prescribers on the outcome of optimal statin medication... more
Background The overall impact of physician prescribers on population-level adherence rates are unknown. We aimed to quantify the influence of general practitioner (GP) physician prescribers on the outcome of optimal statin medication adherence. Methods We conducted a retrospective cohort study using health administrative databases from Saskatchewan, Canada. Participants included physician prescribers and their patients beginning a new statin medication between January 1, 2012 and December 31, 2017. We grouped prescribers based on the prevalence of optimal adherence (i.e., proportion of days covered ≥ 80%) within their patient group. Also, we constructed multivariable logistic regression analyses on optimal statin adherence using two-level non-linear mixed-effects models containing patient and prescriber-level characteristics. An intraclass correlation coefficient was used to estimate the physician effect. Results We identified 1,562 GPs prescribing to 51,874 new statin users. The me...
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Published reports suggest that there is considerable variation in improvement capacity and capability among participants in quality improvement collaboratives. Generating knowledge about why these complex initiatives do or do not work in... more
Published reports suggest that there is considerable variation in improvement capacity and capability among participants in quality improvement collaboratives. Generating knowledge about why these complex initiatives do or do not work in different contexts requires both qualitative and quantitative approaches. Time-series analysis using line graphs and statistical process control is a rigorous quantitative approach with relatively unexplored potential in evaluating complex quality improvement interventions. The purpose of this study was to apply and illustrate the use of line graphs and statistical process control to identify variation in improvement among practices participating in the Saskatchewan Chronic Disease Management Collaborative. The authors used line graphs and regression analysis to determine whether improvement occurred at the aggregate level, and small multiples, rational ordering and rational subgrouping to examine differences in the level and rate of improvement amo...
Research Interests: Computer Graphics, Quality Management, Quality Improvement, Stratification, Medicine, and 15 moreStatistical Process Control, Chronic disease management, Humans, Diabetes mellitus, Data Display, Regression Analysis, Sampling strategy, Public health systems and services research, Super Line Graph, Control chart, Curriculum and Pedagogy, Quality and safety in health care, Saskatchewan, Cooperative Behavior, and quality assurance in health care
Research Interests: Program Evaluation, Nursing, Quality Management, Organizational Culture, Health Informatics, and 15 moreQuality Improvement, Qualitative Research, Health Administration, Medicine, Motivation, Nursing Research, Library and Information Studies, Humans, Female, Male, Focus Group, Adult, Public health systems and services research, Saskatchewan, and Interviews as topic
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Although administrative health care databases have long been used to evaluate adverse drug effects, responses to drug safety signals have been slow and uncoordinated. We describe the establishment of the Canadian Network for Observational... more
Although administrative health care databases have long been used to evaluate adverse drug effects, responses to drug safety signals have been slow and uncoordinated. We describe the establishment of the Canadian Network for Observational Drug Effect Studies (CNODES), a collaborating centre of the Drug Safety and Effectiveness Network (DSEN). CNODES is a distributed network of investigators and linked databases in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec and Nova Scotia. Principles of operation are as follows: (1) research questions are prioritized by the coordinating office of DSEN; (2) the linked data stay within the provinces; (3) for each question, a study team formulates a detailed protocol enabling consistent analyses in each province; (4) analyses are "blind" to results obtained elsewhere; (5) protocol deviations are permitted for technical reasons only; (6) analyses using multivariable methods are lodged centrally with a methods team, whic...
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To quantify an association between acute kidney injury and use of high potency statins versus low potency statins. Retrospective observational analysis of administrative databases, using nine population based cohort studies and... more
To quantify an association between acute kidney injury and use of high potency statins versus low potency statins. Retrospective observational analysis of administrative databases, using nine population based cohort studies and meta-analysis. We performed as treated analyses in each database with a nested case-control design. Rate ratios for different durations of current and past statin exposure to high potency or low potency statins were estimated using conditional logistic regression. Ratios were adjusted for confounding by high dimensional propensity scores. Meta-analytic methods estimated overall effects across participating sites. Seven Canadian provinces and two databases in the United Kingdom and the United States. 2,067,639 patients aged 40 years or older and newly treated with statins between 1 January 1997 and 30 April 2008. Each person hospitalized for acute kidney injury was matched with ten controls. A dispensing event was new if no cholesterol lowering drug or niacin ...
Research Interests: Patient Safety, Acute kidney injury, Medicine, Humans, Hospitalization, and 15 moreFemale, Male, Confidence intervals, Hypercholesterolemia, Incidence, British Columbia, Aged, Great Britain, Middle Aged, Adult, Public health systems and services research, Odds ratio, BMJ, Logistic Models, and Cohort Studies
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Instructions Please circle the one response that is closest to what you think about your experience as a rehabilitation in-patient. The program staff includes all of the nursing staff, therapists, and physicians working in your in-patient... more
Instructions Please circle the one response that is closest to what you think about your experience as a rehabilitation in-patient. The program staff includes all of the nursing staff, therapists, and physicians working in your in-patient rehabilitation program. Please circle one response for each question. If this question does not apply to you, please circle the last column. It is okay to ask for assistance in answering questions as long as the answers represent your own feelings. There are no right or wrong answers. How strongly do you agree or disagree with the following statements? Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Does not apply 1. The program staff and I decided together what would help me. 1 2 3 4 5 Does not apply 2. I had difficulty getting the health care information I needed. 1 2 3 4 5 Does not apply 3. I was kept well-informed about my progress in areas that were important to me. 1 2 3 4 5 Does not apply 4. My family/friends were given the support that they needed by the program staff.
Over the past decade, governments and the non-profit, private, academic, and philanthropic sectors have begun thinking differently about how human and social services are organized and delivered. Across Canada, a range of integrated... more
Over the past decade, governments and the non-profit, private, academic, and philanthropic sectors have begun thinking differently about how human and social services are organized and delivered. Across Canada, a range of integrated health and social care practices are being developed, adapted, and implemented to meet local needs. The Hub (or Situation Table as it is more commonly known in Ontario) model is one such approach. The Hub model is a multi-sector, collaborative, risk-driven intervention that mobilizes multi-sectoral human services for the purpose of rapid risk mitigation focused on the immediate needs of persons experiencing acutely elevated risk of harmful safety or well-being outcomes. Over the past eight years, the model has been adopted in over 115 communities across Canada.While the model has benefited from developmental and formative evaluations, it is now timely to undertake a systematic multi-site evaluation of the generalizable impacts (e.g., clients, system, cos...
Background: In 2007, a drug benefit plan for Seniors (SDP) was launched in Saskatchewan, Canada. SDP capped out-of-pocket costs at $15 per prescription for individuals aged 65 and older. Objectives: To quantify the impact of the SDP on... more
Background: In 2007, a drug benefit plan for Seniors (SDP) was launched in Saskatchewan, Canada. SDP capped out-of-pocket costs at $15 per prescription for individuals aged 65 and older. Objectives: To quantify the impact of the SDP on chronic medication adherence. Methods: A retrospective cohort study was conducted for participants aged 65 or older who were eligible to the SPD, controlled by a younger group aged 40 to 64 who were ineligible. Adherence was measured over 365 days using medication possession ratio (MPR). MPRs were compared between age groups, and between pre and post SDP-launch periods. The odds ratio of optimal adherence (i.e., MPR≥80%) was estimated using logistic regression models with generalized estimating equations (GEE). Results: Between 2005 and 2009, 353,568 adherence observations were observed from 188,109 unique patients. Comparing the post-SDP period vs before, the increase in the odds of optimal medication adherence was significant (OR=1.08, 95% CI: 1.04...