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  INSTITUTE FOR CLINICAL EVALUATIVE SCIENCES
JANUARY 2015
 
At a Glance
  MONTHLY HIGHLIGHTS OF ICES RESEARCH FINDINGS FOR STAKEHOLDERS  
 

Only one-third of Ontario pharmacies participate in smoking cessation program

Wong L, Burden AM, Liu YY, Tadrous M, Pojskic N, Dolovich L, Calzavara A, Cadarette SM. Initial uptake of the Ontario Pharmacy Smoking Cessation Program. Can Pharm J. 2015; 148(1):29–40.

ISSUE

The Ontario Pharmacy Smoking Cessation Program provides remuneration to community pharmacists for smoking cessation assessment and counselling for social assistance recipients and adults aged 65 and older. How effective has the program been in enrolling patients and providing follow-up services since its launch in September 2011?

STUDY

Identified beneficiaries receiving and pharmacies participating in pharmacy smoking cessation services in Ontario from September 2011 to September 2013. Evaluated program enrollment rates and service use by patient age, sex, income, health region and drug plan group.

KEY FINDINGS

Of 7,767 enrolled patients, 28% were seniors (mean age 69.9; 53% male) and 72% were social assistance recipients (mean age 44.4; 48% male). Cumulative patient enrollment increased over time with an average of 311 new patients per month and one-third of pharmacies (n=1,253) participating by the end of September 2013. Among patients with six-month follow-up data, 56% received follow-up counselling (60% of seniors, 55% of social assistance recipients), 74% received a prescription smoking cessation medication, and 7% had their quit status reported (reporting is optional and not remunerated).

IMPLICATIONS

Further research is needed to better understand the barriers, facilitators and drivers of smoking cessation services and to identify strategies to optimize the role of community pharmacists in promoting and assisting patients with smoking cessation.
 
 

No change in proportion of spinal cord injury patients assessed by a urologist in a decade

Welk B, Tran KC, Liu K, Shariff S. The pattern of urologic care among traumatic spinal cord injured patients. Can Urol Assoc J. 2014; 8(11–12):e805–9.

ISSUE

Patients with traumatic spinal cord injury (TSCI) often seek emergency medical attention for preventable secondary health conditions, such as bladder-related dysfunction. How has the level of involvement of urologists in the management of TSCI changed over time?

STUDY

Identified 1,551 adult TSCI patients admitted to a rehabilitation hospital in Ontario between April 2002 and March 2012 and determined first clinical assessment by a urologist from the date of their injury. All patients were followed for at least one year post-injury.

KEY FINDINGS

Overall, 74% of patients were male, and the mean age at time of TSCI was 48 years. Across each fiscal year from 2002 to 2012, the median proportion of patients seen by a urologist for the first time within one year of injury was 55.1%, with no significant trend over the 10 years. Over the entire study period, 66% of patients were assessed at least once by a urologist. The median time between TSCI and first urologic assessment was 0.7 years. Patients who were female or over age 65 were significantly less likely to be referred to a urologist. Eleven urologists in the province saw 70% of these patients.

IMPLICATIONS

A significant proportion of TSCI patients do not see a urologist. The impact of this practice pattern on their urologic health requires further study.
 
 

Prevalence of ankylosing spondylitis nearly tripled in Ontario in 20 years

Haroon NN, Paterson JM, Li P, Haroon N. Increasing proportion of female patients with ankylosing spondylitis: a population-based study of trends in the incidence and prevalence of AS. BMJ Open. 2014; 4(12):e006634.

ISSUE

Ankylosing spondylitis (AS), an inflammatory disease of the spine, is often overlooked in its initial stages due to the nonspecific nature of back pain. What is the incidence and prevalence of diagnosed AS in Ontario?

STUDY

Identified 24,976 Ontario residents aged 15 years or older diagnosed with AS between 1995 and 2010 and calculated age- and sex-standardized incidence and prevalence rates for the disease.

KEY FINDINGS

The number of patients with AS more than tripled over the study period, from 6,930 in 1995 to 24,976 in 2010. AS prevalence per 100,000 population increased from 79 in 1995 to 213 in 2010. Men had higher prevalence than women, but the male/female prevalence ratio decreased from 1.70 in 1995 to 1.21 in 2010. The annual incidence of AS remained relatively stable over the 15-year study period at between 14 and 16 per 100,000 population. Annual incidence rates revealed increasing diagnosis of AS among women after 2003.

IMPLICATIONS

Earlier diagnosis and longer survival could have resulted in the increase in prevalence of AS despite stable incidence rates.
 
 

Increased number of Ontario children and youth being treated for concussion

Macpherson A, Fridman L, Scolnik M, Corallo A, Guttmann A. A population-based study of paediatric emergency department and office visits for concussions from 2003 to 2010. Paediatr Child Health. 2014; 19(10):543–6.

ISSUE

Concussions (mild traumatic brain injury) may lead to impaired neurological functioning, headaches and memory deficits. What are the current trends in paediatric concussion in Ontario?

STUDY

Identified all concussion-related visits to EDs and physician offices in Ontario by individuals aged 3 to 18 years between April 2003 and March 2011. Determined concussion rates by age and sex and described the causes of concussions diagnosed in the ED.

KEY FINDINGS

In 2003, 8,736 concussions were treated in either an ED or physician office, compared with 14,886 in 2010. Between 2003 and 2010, the concussion rate per 100,000 increased from 466.7 to 754.3 for boys and from 208.6 to 440.7 for girls. For both boys and girls, the number of visits to EDs and physician offices for concussion peaked until 15 years of age. Falls were the most common cause of concussion in an ED (34.0% of all visits), followed by exposure to force (being hit or crushed) (25.5%) and motor vehicle collisions (12.3%). Hockey/skating was the most common specific cause of paediatric concussions.

IMPLICATIONS

The increasing use of health care services for concussions is likely related to changes in incidence over time and increased awareness of concussion as a health issue. Evidence-based prevention initiatives to help reduce the incidence of concussion are warranted, particularly in sports and recreation programs.
 
 

Salivary gland cancer surgery rates in Ontario vary significantly by health region

Eskander A, Irish J, Freeman J, Gullane P, Gilbert R, Groome PA, Hall SF, Urbach DR, Goldstein DP. Overview of major salivary gland cancer surgery in Ontario (2003–2010). J Otolaryngol Head Neck Surg. 2014; 43:50.

ISSUE

Salivary gland cancers account for approximately 7% of all head and neck cancers. What variations exist in incidence and surgical rates for patients diagnosed with this disease in Ontario?

STUDY

Identified 1,240 adults aged 18 and older diagnosed with non-lymphoma salivary gland cancer in Ontario between January 2003 and December 2010. Compared variations in incidence, resection and dissection rates, and radiotherapy use by age group, sex, income, community size, health region and physician specialty.

KEY FINDINGS

Over the eight-year period, incidence rates per 100,000 population varied significantly by age (18–54 years: 6.7; 75+ years: 53.4), sex (female: 9.7; male: 15.5), neighbourhood income (lowest quintile: 11.8; highest quintile: 13.7), and community size (population greater than 1.5 million: 10.6; less than 100,000: 14.7). An examination of Ontario’s 14 Local Health Integration Networks by region of residence revealed significant variation with regard to incidence (6.4 to 13.3 per 100,000), resection rates (71.7% to 88.5%), neck dissection rates (37.2% to 62.5%) and radiotherapy use (46.5% to 77.3%). 

IMPLICATIONS

These variations are significantly greater than for other cancers in Ontario. They warrant further evaluation to determine if there is access inequity or if there are quality-of-care improvements that can be made in the treatment of salivary gland cancer.
 
 
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