Copy
 
Is this email not displaying correctly? View it in your browser.
  INSTITUTE FOR CLINICAL EVALUATIVE SCIENCES

JANUARY 2016

 
At a Glance
  MONTHLY HIGHLIGHTS OF ICES RESEARCH FINDINGS FOR STAKEHOLDERS  
 

Quality of mental health services varies across Ontario: ICES/HQO report

Brien S, Grenier L, Kapral M, Kurdyak P, Vigod S. Taking Stock: A Report on the Quality of Mental Health and Addictions Services in Ontario. An HQO/ICES Report. Toronto, ON: Health Quality Ontario and Institute for Clinical Evaluative Sciences; 2015.

ISSUE

While most Ontarians report being in good mental health, about two million residents are affected by a wide variety of mental illnesses or addictions each year. What is the impact of mental illness and addictions in Ontario and are Ontarians with these illnesses receiving high-quality care?

STUDY

Examines the prevalence of the most common categories of mental health disorders — substance abuse or substance-related disorders (including alcohol), anxiety disorders (including obsessive-compulsive disorder and phobias), mood disorders, schizophrenia and other psychotic disorders — as measured by five indicators, including hospital admissions for mental illness or addiction, doctor visits within seven days of hospital discharge for mental illness or addiction, readmission rates for mental illness or addiction, use of physical restraints in acute mental health care, and suicide rates.

KEY FINDINGS

There are roughly seven million visits to physicians’ offices in Ontario each year for mental illness or addiction, accounting for about 10% of all visits. People with the lowest incomes are less likely to have a follow-up visit with a physician within seven days of hospital discharge for mental illness or addiction compared to those with the highest incomes (26.9% vs. 32.5%). Residents of rural areas are less likely to have a follow-up visit with a physician within seven days after leaving hospital, compared to those in urban centres (23.1% vs. 30.4%). Access to a psychiatrist also depends on where a patient lives. The number of psychiatrists per 100,000 residents varies widely, ranging from 4.7 per 100,000 in the Central West Local Health Integration Network (LHIN) to 62.7 per 100,000 in the Toronto Central LHIN. The average wait time for community addiction treatment programs improved to 16 days in 2012/13 from 26 days in 2008/09.

IMPLICATIONS

Not all Ontarians are receiving timely mental health and addictions care. Finding ways to improve access to care will not only improve the immediate mental health of Ontarians, it will also ease the future burden of care for individual patients and their families, as well as for the system overall.
 
 

Fast food “swamps” linked to high obesity rates when healthier choices crowded out

Polsky JY, Moineddin R, Dunn JR, Glazier RH, Booth GL. Absolute and relative densities of fast-food versus other restaurants in relation to weight status: does restaurant mix matter? Prev Med. 2016; 82:28–34.

ISSUE

Overweight and obesity account for a major share of disease burden in North America and worldwide. Fast-food restaurants (FFR) are the most important source of away-from-home eating, and policy makers are increasingly targeting the local food environment as a means of promoting healthy food choices and healthy weights. What is the association between the number of restaurants within walking distance of an individual’s home and the individual’s weight status? Does exposure to a higher proportion of FFR matter more or less in areas with a higher overall volume of restaurants?

STUDY

Identified 10,199 Ontarians aged 18 or older living in Toronto, Brampton, Mississauga or Hamilton who participated in Canadian Community Health Surveys in 2005, 2007/08 and 2009/10. Examined their demographic characteristics, obesity prevalence and body mass index (BMI), and evaluated the walkability of participants’ neighbourhoods by considering factors such as population density, street connectivity and the availability of amenities within a 10-minute walk. Identified the number of fast-food, full-service and other restaurants in the walkable area and measured the proportion of fast-food outlets relative to all restaurants.

KEY FINDINGS

There was a direct relationship between the proportion of FFR relative to all restaurants, and excess weight. People were as much as 2.5 times more likely to be obese when their neighbourhoods had a disproportionately high volume of FFR and few healthier choices (compared to residents who also lived near many fast-food outlets but had more healthful choices nearby).

IMPLICATIONS

These findings suggest that along with encouraging neighbourhood walkability and ready availability of healthy food, policies that achieve a better balance of restaurant types with more alternatives to fast food could go much further in encouraging healthy weights.
 
 

Safe injection facilities would be cost-effective in Toronto and Ottawa

Enns EA, Zaric GS, Strike CJ, Jairam JA, Kolla G, Bayoumi AM. Potential cost-effectiveness of supervised injection facilities in Toronto and Ottawa, Canada. Addiction. 2015; Nov 30 [Epub ahead of print].

ISSUE

Supervised injection facilities (legally sanctioned spaces for supervised consumption of illicitly obtained drugs) are controversial public health interventions that provide clients with sterile drug use equipment and an array of ancillary services. Evaluations of such facilities in Vancouver identified not only health benefits, but economic benefits, predominantly by averting HIV infections. What would be the costs and benefits of establishing supervised injection facilities in Toronto and Ottawa, and how many facilities should be created to achieve maximum cost-effectiveness?

STUDY

Used simulated populations of Toronto and Ottawa to estimate the potential costs and health effects of establishing one to five supervised injection facilities in each city over a 20-year time horizon. Focused on health effects related to HIV and hepatitis C virus (HCV) infection and projected future prevalence based on current published estimates. Divided the population of 15-64 year olds in each city into model compartments based on sexual behaviour, drug use and HIV and HCV infection status. Quantified health effects in terms of the number of HIV and HCV infections averted and the number of quality-adjusted life years (QALYs) gained. Determined the optimal number of supervised injection facilities in each city by calculating the incremental cost-effectiveness ratio of establishing each additional facility and comparing this ratio to cost-effectiveness thresholds of $50,000 and $100,000 per QALY gained.

KEY FINDINGS

There was an 86% chance that establishing one or more supervised injection facilities would be cost-effective in Toronto and a 90% chance in Ottawa. At the $50,000 QALY threshold, up to three supervised injection sites in Toronto and up to two facilities in Ottawa would be cost-effective. At the $100,000 QALY threshold, the optimal number of facilities increased to five in Toronto and three in Ottawa.

IMPLICATIONS

These findings contribute to the demonstration of ‘local conditions indicating a need’ for a facility in Toronto and Ottawa, a factor identified by Canada’s Supreme Court as necessary for granting facilities with exemptions from federal drug laws. However, decisions regarding the number and locations of facilities require integrating cost-effectiveness results with community concerns.
 
 

Use of common antibiotic increases risk for tendon rupture and aortic aneurysm

Daneman N, Lu H, Redelmeier DA. Fluoroquinolones and collagen associated severe adverse events: a longitudinal cohort study. BMJ Open. 2015; 5(11):e010077.

ISSUE

Fluoroquinolones are among the most frequently prescribed antibiotics; however, disruptions in collagen content within the body, leading to cases of tendon rupture, have been cited as a potential complication. It has been suggested that fluoroquinolone-associated collagen toxicity also has the potential to cause retinal detachment and even aortic aneurysm by reducing the strength of the aortic wall. What is the association between fluoroquinolones and tendon rupture, as well as more severe collagen-associated events such as retinal detachment and aortic aneurysms?

STUDY

Identified 1,744,360 Ontarians aged 65 or older between April 1997 and March 2012. All participants were followed until the end of the study period (March 2014), death, or until they experienced severe collagen-associated adverse events diagnosed in hospitals and emergency departments.

KEY FINDINGS

Among the eligible patients, 38% received at least one fluoroquinolone during follow-up, amounting to 22.3 million days of fluoroquinolone treatment. Adverse events included tendon ruptures (2.1% of patients), aortic aneurysms (1.1%) and retinal detachments (0.2%). Aortic aneurysms were clinically important given that 68% were coded as primary diagnoses and 53% were emergency admissions. All three adverse outcomes were more common among patients who received at least one fluoroquinolone prescription than among those who did not receive this prescription.

IMPLICATIONS

Findings suggest a novel association between fluoroquinolone and aortic aneurysms. Patients receiving fluoroquinolone could be warned about this rare but potentially lethal risk, and clinicians could consider reducing unnecessary fluoroquinolone prescriptions or prescribing alternative agents.
 
 

Many Ontarians with dementia do not get rehabilitative care following hip fracture surgery

Seitz DP, Gill SS, Austin PC, Bell CM, Anderson GM, Gruneir A, Rochon PA. Rehabilitation of older adults with dementia after hip fractures. J Am Geriatr Soc. 2016; 64(1):47–54.

ISSUE

Older adults with dementia are at high risk for hip fractures and comprise a large proportion of individuals who sustain hip fractures. Dementia is associated with poor outcomes following hip fracture including an increased risk of functional decline, long-term care (LTC) admission and an increased risk of mortality. Access to rehabilitation programs is considered to be one of the key postoperative care processes that can reduce the possibility of poor outcomes. What is the association between access to postoperative rehab and the risk of LTC admission and mortality?

STUDY

Identified 11,200 community-dwelling Ontarians aged 65 and older with dementia who underwent hip fracture surgery between 2003 and 2011. Categorized these individuals into four groups: those receiving no rehabilitation and those receiving complex continuing care (CCC), home care rehabilitation (HCR) or inpatient rehabilitation (IPR). Tracked their health outcomes over time, including admission to long-term care and death.

KEY FINDINGS

In total, 40% of individuals did not receive any rehabilitation. The rehabilitation setting for the remainder included 22% in CCC, 10% in HCR, and 27% in IPR. After one year, two-thirds of individuals in the no rehabilitation group had been admitted to long-term care, compared to approximately half of those receiving CCC and one-quarter of those receiving HCR or IPR. Mortality at one year was 44% for the no rehabilitation group, 31% for CCC, 13% for IPR and 15% for HCR.

IMPLICATIONS

Improved access to rehabilitation services is required for older adults with hip fractures and dementia. These findings may assist patients, families, care providers and health planners with decision-making as they seek to select the rehabilitation model that best supports an individual’s health and quality of life following surgery.
 
 
ICES is a not-for-profit research institute encompassing a community of research, data and clinical experts, and a secure and accessible array of Ontario's health-related data.
 
 
Follow ICES on:  Twitter  Facebook

Unsubscribe | Update preferences
ICES
G1 06, 2075 Bayview Avenue
Toronto, Ontario
M4N 3M5 Canada

communications@ices.on.ca | www.ices.on.ca
 
 
  Copyright © 2016 Institute for Clinical Evaluative Sciences. All rights reserved.