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

ICES/OBI study examines the impact of 13 brain disorders in Ontario

Ng R, Maxwell CJ, Yates EA, Nylen K, Antflick J, Jetté N, Bronskill SE. Brain Disorders in Ontario: Prevalence, Incidence and Costs from Health Administrative Data. Toronto, ON: Institute for Clinical Evaluative Sciences; 2015.

ISSUE

The number of people living with brain disorders is expected to increase in the coming years; however, the collective impact of these conditions from the perspective of the health care system is lacking in Canada. This report, the result of collaboration between ICES and the Ontario Brain Institute, addresses knowledge gaps and provides insights into brain disorders across Ontario.

STUDY

Used health administrative data to examine 13 common brain disorders in Ontario from April 2004 to March 2011. For each disorder, described sociodemographic characteristics, provided estimates of prevalence and incidence over time, and presented an overview of costs associated with one year of provincial health system use.

KEY FINDINGS

  • Benign brain tumour, dementia (including Alzheimer’s disease), multiple sclerosis and spina bifida were most common in women. Primary malignant brain tumour, cerebral palsy, epilepsy, motor neuron disease, parkinsonism (including Parkinson’s disease), schizophrenia, spinal cord injury, stroke and/or transient ischemic attack, and traumatic brain injury were most common in men.
  • Across the province’s 14 Local Health Integration Networks, age- and sex-adjusted prevalence estimates in 2010/11 varied from 1.3-fold (for dementia) to 4.0-fold (for motor neuron disease).
  • Hospital care was the highest contributor to costs for more than half of the disorders (benign brain tumour, primary malignant brain tumour, epilepsy, motor neuron disease, schizophrenia, spina bifida, spinal cord injury, stroke and/or transient ischemic attack, and traumatic brain injury). For other brain disorders, long-term care (dementia, multiple sclerosis and parkinsonism) and home care (cerebral palsy) accounted for the greatest proportion of costs.

IMPLICATIONS

The report findings provide a foundation for future population-based research into brain disorders in Ontario. This knowledge can be used to track changes in the affected populations over time and better inform public health initiatives, clinical management and regional planning.
 
 

Prenatal screening rates in Ontario vary significantly based on where women live and who provides their care

Hayeems RZ, Campitelli M, Ma X, Huang T, Walker M, Guttmann A. Rates of prenatal screening across health care regions in Ontario, Canada: a retrospective cohort study. CMAJ Open. 2015; 3(2):E236–43.

ISSUE

The Society of Obstetrics and Gynecology of Canada recommends that all pregnant women be offered a range of prenatal screening tests to identify pregnancies at risk of specific chromosomal abnormalities and birth defects of the brain, spine or spinal cord. What are the screening rates for publicly insured prenatal screening tests in Ontario?

STUDY

Identified 264,737 pregnant Ontario women at or beyond 16 weeks’ gestation who had an estimated conception date between December 2007 and November 2009. Sixteen weeks’ gestation was selected as a cut-off date because guidelines suggest that most women should be offered prenatal screening at this point. Ascertained prenatal screening rates and examined maternal, provider and regional characteristics associated with screening uptake.

KEY FINDINGS

In total, 62.2% of women received prenatal screening. Uptake varied considerably by health care region, ranging from less than 40.0% in the southwest and northern regions to 80.3% in central Toronto. Overall, 50.0% of women initiated screening in their first trimester and 12.2% in their second trimester. Factors associated with low screening rates included living in a rural area (24.9% of women) versus an urban area (56.0%), receiving first trimester care from a family physician (53.4%) or midwife (26.8%) versus an obstetrician (66.0%), and being in a lower income quintile (42.3%) versus a higher income quintile (57.0%). 

IMPLICATIONS

With discrepancies expected to increase with the emergence of noninvasive prenatal tests paid for out of pocket by many women, policy efforts to reduce barriers to prenatal screening and optimize its availability are warranted. Specific attention will be needed to ensure access for women residing in rural areas and those who receive early prenatal care from nonobstetricians. 
 
 

Residents of car-dependent neighbourhoods 70% more likely to be obese than those living in “walker’s paradise”

Chiu M, Shah BR, Maclagan LC, Rezai MR, Austin PC, Tu JV. Walk Score® and the prevalence of utilitarian walking and obesity among Ontario adults: a cross-sectional study. Health Rep. 2015; 26(7):3–10.

ISSUE

The rising prevalence of obesity has led researchers to examine not only individual behaviours but the environmental factors that may be contributing to the increase. Is the prevalence of overweight and obesity in a neighbourhood associated with the area’s walkability? 

STUDY

Utilized the Street Smart Walk Score, a composite measure of neighbourhood walkability. The Walk Score ranges from 0 to 100 and is sorted into five categories ranging from very car-dependent (almost all errands require a car) to “walker’s paradise” (daily errands do not require a car). Identified 106,337 people aged 20 or older living in urban and suburban Ontario who participated in the National Population Health Survey and the Canadian Community Health Survey from 1996/1997 to 2008. Grouped individuals into one of five neighbourhood walkability categories based on their postal code and examined weight-related variables across the five categories.

KEY FINDINGS

Compared with residents of “walker’s paradise” areas, those in very car-dependent areas had significantly higher odds of being overweight or obese. Despite similar levels of physical leisure activity among residents of all areas, those in “walker’s paradise” areas reported more utilitarian walking and weighed, on average, 3 kg less than those in very car-dependent areas.

IMPLICATIONS

Results indicate the importance of walkable neighbourhoods on the health of Canadians. Urban planners and policy makers can do their part by designing neighbourhoods that are more pedestrian-friendly, so that the healthier choice of walking instead of driving is more convenient and enjoyable.
 
 

Residents of nursing homes with high antibiotic use are at higher risk of antibiotic-related adverse events

Daneman N, Bronskill SE, Gruneir A, Newman AM, Fischer HD, Rochon PA, Anderson GM, Bell CM. Variability in antibiotic use across nursing homes and the risk of antibiotic-related adverse outcomes for individual residents. JAMA Intern Med. 2015; Jun 29 [Epub ahead of print].

ISSUE

Antibiotics are the most commonly prescribed medications among nursing home residents. Many of these prescriptions are inappropriate or unnecessarily prolonged, thereby directly exposing residents to antibiotic-related harms, including residents who did not receive antibiotic treatments. Is residence in a nursing home with high antibiotic use associated with a greater risk of antibiotic-related adverse outcomes for individual residents?

STUDY

Identified 110,656 adults aged 66 or older residing in 607 Ontario nursing homes and followed them from January 1, 2010, or until their new arrival at a nursing home (whichever came last) to December 31, 2011, or death (whichever came first). Nursing home–level antibiotic use was defined as use-day per 1,000 resident days, and facilities were classified as high, medium or low use. Adverse outcomes examined included C. difficile, diarrhea, gastroenteritis, antibiotic-resistant organisms (which can directly affect recipients and indirectly affect nonrecipients), allergic reactions and general medication adverse events.

KEY FINDINGS

Antibiotic treatment was provided on 2,783,000 of the 50,953,000 resident-days (55 antibiotic-days per 1,000 resident-days). Antibiotic use among nursing homes varied from 20.4 to 192.9 antibiotic-days per 1,000 resident-days. Antibiotic-related adverse events were more common among residents of high-use homes (13.3%) than those in medium-use (12.4%) or low-use homes (11.4%).

IMPLICATIONS

Findings suggest that improved antibiotic stewardship within nursing homes could potentially improve patient safety.
 
 

Repeat colonoscopies overused, especially in patients at low risk for colorectal cancer

Hol L, Sutradhar R, Gu S, Baxter NN, Rabeneck L, Tinmouth JM, Paszat LF; the investigators of the Ontario Cancer Screening Research Network. Repeat colonoscopy after a colonoscopy with a negative result in Ontario: a population-based cohort study. CMAJ Open. 2015; 3(2):E244–50.

ISSUE

Screening and surveillance colonoscopies in excess of guideline recommendations have been reported among patients with a low probability of benefit and those who have low-risk findings at baseline colonoscopy. What is the frequency of early repeat colonoscopy following a colonoscopy with a negative result in Ontario, and what are the associated patient- and endoscopist-related factors?

STUDY

Identified 546,467 patients aged 50–79 years who underwent an outpatient colonoscopy with a negative result between January 2000 and December 2007. A colonoscopy performed within 5.5 years after the index colonoscopy was considered an early repeat colonoscopy. Determined the association of patient, endoscopist and endoscopy setting characteristics with an early repeat colonoscopy. 

KEY FINDINGS

Despite current guidelines recommending repeat screening after 10 years, 33.7% of patients had a repeat colonoscopy within 5.5 years after an index colonoscopy. However, the proportion of patients undergoing early repeat colonoscopy decreased from 44% to 20% between 2000 and 2007. Women were more likely to undergo an early repeat colonoscopy than men. General surgeons were associated with a higher risk of early repeat colonoscopy than gastroenterologists. Endoscopists practicing in a private clinic or office were more likely to perform an early repeat colonoscopy than endoscopists practicing at a hospital. 

IMPLICATIONS

These findings can be used to develop targeted educational interventions among subgroups of endoscopists with higher rates of early repeat colonoscopy.
 
 
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