Copy
 
Is this email not displaying correctly? View it in your browser.
  INSTITUTE FOR CLINICAL EVALUATIVE SCIENCES
SEPTEMBER 2014
 
At a Glance
  MONTHLY HIGHLIGHTS OF ICES RESEARCH FINDINGS FOR STAKEHOLDERS  
 

Ontario physicians more likely than general population to register for organ donation

Li AH, Dixon S, Prakash V, Kim SJ, Knoll GA, Lam NN, Garg AX. Physician registration for deceased organ donation. JAMA. 2014; 312(3):291–3.

ISSUE

Organ and tissue donation in Ontario is part of quality end-of-life care. A common fear held by the public is that physicians will not take all measures to save the life of a registered donor; showing that many doctors sign up for donation would dispel this myth. 

STUDY

Among the 60% of physicians who had consented to the release of their information for the purposes of research, identified 15,233 active physicians from the ICES physician database who could be linked to the Registered Persons Database to obtain demographic information and donor registration status, and matched them to 60,932 Ontarians on age, sex, income and residential neighbourhood as of May 2013. Compared the proportion of physicians registered for organ donation with the matched citizens and with the general public. 

KEY FINDINGS

A total of 6,595 physicians (43.3%) were registered for organ donation, compared with 17,975 (29.5%) matched citizens and 2,596,766 (23.9%) of the general public. Physicians were 47% more likely to be registered for organ donation than matched citizens. Physician factors associated with higher donor registration included younger age, sex (female), living in a rural community, specializing in emergency medicine, internal medicine, pediatrics or psychiatry (vs. family medicine); and graduating from a Canadian (vs. foreign) medical school.

IMPLICATIONS

While the majority of physicians are not registered for organ donation, their high rate of registration when compared to the general public demonstrates their confidence and trust in the donation and transplantation system. This finding could help dispel the common myth that physicians don’t work as hard to save the lives of registered organ donors. 
 
 

Testosterone replacement therapy in older men has tripled in 15 years

Piszczek J, Mamdani M, Antoniou T, Juurlink DN, Gomes T. The impact of drug reimbursement policy on rates of testosterone replacement therapy among older men. PLoS One. 2014; 9(7):e98003.

ISSUE

Despite a lack of data demonstrating its long-term efficacy and safety, testosterone prescribing has increased with the availability of topical formulations. What has been the impact of introducing prescribing restrictions on the use of testosterone products by older men?

STUDY

Identified 28,477 men aged 66 and older who were dispensed testosterone in Ontario between January 1997 and March 2012. Examined the impact of a restrictive drug reimbursement policy imposed in 2006 on the use of injectable, oral, and topical testosterone products, as well as overall.

KEY FINDINGS

Rates of testosterone use rose 286% between 1997 and 2003 (from 3.6 to 10.2 men per 1,000 eligible population). Testosterone prescribing declined 27.9% in the six months following implementation of the restriction policy (from 9.5 to 6.9 men per 1,000). However, the decrease was temporary, and testosterone use exceeded pre-policy levels by the end of the study period (11.0 men per 1,000); the increase was driven by the use of the newer topical form of testosterone. Only 6.3% of men taking testosterone had a diagnosis of hypogonadism, the main criteria for reimbursement under the new policy.

IMPLICATIONS

The resurgence in testosterone use among older men, despite the restriction policy, is of concern because they carry a significant burden of illness, and there is a lack of data regarding the long-term effectiveness and safety of the drug among men with multiple comorbidities and high medication use.
 
 

Physician payment incentives do little to improve Ontario’s cancer screening rate

Kiran T, Wilton AS, Moineddin R, Paszat L, Glazier RH. Effect of payment incentives on cancer screening in Ontario primary care. Ann Fam Med. 2014; 12(4):317–23. 

ISSUE

Governments are trying to align physician financial incentives with desired health system goals. Has the introduction of a pay-for-performance program for primary care physicians in Ontario contributed to increased cancer screening rates? 

STUDY

Calculated annual cervical, breast and colorectal cancer screening rates and physician incentive costs in Ontario from 1999/2000 to 2009/10 and examined the change in screening rates after financial incentives were introduced in April 2006.

KEY FINDINGS

Colon cancer screening was increasing at a rate of 3.0% per year before the incentives were introduced and 4.7% per year after. Annual screening rates for breast and cervical cancer did not change significantly before or after the incentives were introduced. Between 2006/07 and 2009/10, $28.3 million, $31.3 million and $50.0 million were spent on financial incentives for cervical, breast and colorectal cancer, respectively.

IMPLICATIONS

Despite substantial expenditure, the pay-for-performance program has had little effect. Policy makers should consider other strategies for improving rates of cancer screening.
 
 

Heart failure patients have worse outcomes at hospitals with low admission rates

Bhatia RS, Austin PC, Stukel TA, Schull MJ, Chong A, Tu JV, Lee DS. Outcomes in patients with heart failure treated in hospitals with varying admission rates: population-based cohort study. BMJ Qual Saf. 2014 Jul 30 [Epub ahead of print]. 

ISSUE

Heart failure (HF) is associated with high rates of hospital admission and readmission. Do patients cared for and discharged from emergency departments (EDs) with lower hospital admission rates have higher rates of repeat ED visits and hospitalizations for recurrent HF?

STUDY

Analyzed data from 89,878 HF patients aged 18 and older who visited one of 162 EDs in Ontario with HF hospitalization rates of less than 67% (low), 67% to 75% (medium), and more than 75% (high) between April 2004 and March 2010.

KEY FINDINGS

Patients who were treated at hospitals with low rates of HF admission were more likely to have repeat ED visits and hospitalizations for HF within 30 days, repeat ED visits and hospitalizations for cardiovascular diseases within 30 days, and less likely to have post-discharge follow-up from a cardiac specialist. Low-admission-rate institutions were more likely to be smaller hospitals with fewer acute care and intensive care unit beds, as well as reduced access to specialist care in the hospital and the community.

IMPLICATIONS

These findings emphasize the need for hospitals to re-examine their rationale for admission and discharge decisions for acute HF.
 
 

Increasing the number of psychiatrists may not improve patient access to psychiatric care

Kurdyak P, Stukel TA, Goldbloom D, Kopp A, Zagorski BM, Mulsant BH. Universal coverage without universal access: a study of psychiatrist supply and practice patterns in Ontario. Open Med. 2014; 8(3):e81-93.

ISSUE

Poor access to psychiatrists could lead to the assumption that there are not enough to meet population needs. What is the relationship between psychiatrist supply, practice patterns and access among Ontario’s Local Health Integration Networks (LHINs)?

STUDY

Analyzed the practice patterns of 1,379 full-time psychiatrists, as well as the post-discharge care of patients admitted to hospital for psychiatric care, by LHIN psychiatrist supply in 2009. Measured the characteristics of psychiatrists’ patient panels, as well as the rates of psychiatrist visits, readmissions, and visits to the emergency department within 30 and 180 days after discharge for 21,123 patients admitted to hospital with schizophrenia, bipolar disorder or major depression.

KEY FINDINGS

Psychiatrist supply varied from 7.2 to 62.7 per 100,000 residents across the 14 LHINs. Outpatient and inpatient visit rates and psychiatric admission rates increased with LHIN psychiatrist supply. As psychiatrist supply increased, the outpatient panel size for psychiatrists decreased: Toronto psychiatrists had 58% smaller outpatient panels and saw 57% fewer new outpatients relative to the lowest-supply LHINs. As supply increased, annual outpatient visit frequency increased, with 7.0 and 3.9 visits per patient for Toronto psychiatrists and those in low-supply LHINs, respectively. One-quarter of Toronto psychiatrists and 2% of those in the lowest-supply LHINs saw their outpatients more than 16 times per year. Follow-up care with a psychiatrist after hospital discharge was low, with slightly higher rates in LHINs with high supply.

IMPLICATIONS

There is a need to clarify the role of the psychiatrist in Ontario’s publicly funded system to ensure that access to specialist care is equitable and based on need. Instead of simply increasing the supply of psychiatrists, addressing the fee schedule and the lack of criteria constraining the frequency of, duration of and indications for psychotherapy may be required.
 
 
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 © 2014 Institute for Clinical Evaluative Sciences. All rights reserved.