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Community-based care for people with severe mental illness in Canada.

https://arctichealth.org/en/permalink/ahliterature173174
Source
Int J Law Psychiatry. 2005 Sep-Oct;28(5):561-73
Publication Type
Article
Author
Eric Latimer
Author Affiliation
Douglas Hospital Research Centre, and Department of Psychiatry, McGill University, Montreal, Canada. eric.latimer@douglas.mcgill.ca
Source
Int J Law Psychiatry. 2005 Sep-Oct;28(5):561-73
Language
English
Publication Type
Article
Keywords
Acute Disease
Canada
Case Management
Community Mental Health Services - organization & administration
Evidence-Based Medicine
Humans
Mental Disorders - rehabilitation - therapy
National Health Programs
Rehabilitation, Vocational
Abstract
The development of mental health services for people with severe mental illness has in many ways paralleled that in other countries, particularly the United States. As reliance on inpatient psychiatric care has been sharply reduced, a wide range of community supports have been developed. Several distinct institutional and legal features have contributed to shaping the nature of these community supports, which are described herein. At present, the result is a highly fragmented system of care. Key evidence-based practices, notably assertive community treatment, supported employment, and integrated treatment for concurrent severe mental illness and substance use disorder, achieve considerable integration at the clinical level, but remain relatively unavailable in most provinces. The policy of regionalization of services risks inhibiting the development of such practices, which require more centralized technical assistance and monitoring. An evolutionary approach of gradually introducing integrated, evidence-based programs may provide the most feasible strategy for improving the system.
PubMed ID
16125776 View in PubMed
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Cost-effectiveness of a brief two-stage emergency department intervention for high-risk elders: results of a quasi-randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature187147
Source
Ann Emerg Med. 2003 Jan;41(1):45-56
Publication Type
Article
Date
Jan-2003
Author
Jane McCusker
Philip Jacobs
Nandini Dendukuri
Eric Latimer
Pierre Tousignant
Josée Verdon
Author Affiliation
Department of Clinical Epidemiology and Community Studies, St Mary's Hospital, Montreal, Quebec, Canada. jane.mccusker@mcgill.ca
Source
Ann Emerg Med. 2003 Jan;41(1):45-56
Date
Jan-2003
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Caregivers
Cognition Disorders - diagnosis
Continuity of Patient Care
Cost-Benefit Analysis
Costs and Cost Analysis
Depression - diagnosis
Emergency Service, Hospital - economics
Family
Female
Follow-Up Studies
Geriatric Assessment
Humans
Male
Nursing Assessment - economics
Outcome Assessment (Health Care)
Quebec
Questionnaires
Referral and Consultation
Regression Analysis
Risk assessment
Time Factors
Abstract
: We determine the cost-effectiveness of a 2-stage emergency department intervention in addition to usual ED care compared with that of usual care alone.
The intervention comprises 2 steps: (1) identification of high-risk patients by using a screening tool and (2) a brief standardized nursing assessment to identify unresolved problems, followed by referral to an appropriate community provider. The patient population was composed of individuals aged 65 years and older to be released from the EDs of 4 Montreal hospitals. Patients were randomized by day of ED visit. The perspective of the study is societal, including patients, caregivers, and the formal health care (government-funded) system. Outcomes, measured from randomization to 4 months after randomization, included (1) functional decline, as measured by an activities of daily living instrument, or death, and (2) changes in depressive symptoms. Costs include post-ED care, including hospitalization, physician services, community care, outpatient drugs, and patient and caregiver costs. Cost items were measured with administrative databases and self-reported questionnaires. Unit costs for these items were either province-wide rates or else were estimated directly by using provider data. Cost-effectiveness is assessed in qualitative terms, such that outcomes and costs are compared separately.
The intervention was associated with a reduced rate of functional decline (including death) at 4 months. There was no effect of the intervention on change in the patient's depressive symptoms at 4 months relative to baseline. The estimated ratio of overall costs per patient in the intervention versus the control group, adjusted for covariates, was 0.94 (95% credible interval 0.75 to 1.17). Among patients who had visited the ED during the 30 days before the index visit, the ratio was 0.66 (95% credible interval 0.44 to 0.97).
In this study setting, the intervention is preferred over usual care because beneficial functional outcomes were observed, and overall societal costs were no higher than if usual care only was given.
PubMed ID
12514682 View in PubMed
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Cost effectiveness of mesh prophylaxis to prevent parastomal hernia in patients undergoing permanent colostomy for rectal cancer.

https://arctichealth.org/en/permalink/ahliterature106255
Source
J Am Coll Surg. 2014 Jan;218(1):82-91
Publication Type
Article
Date
Jan-2014
Author
Lawrence Lee
Abdulaziz Saleem
Tara Landry
Eric Latimer
Prosanto Chaudhury
Liane S Feldman
Author Affiliation
Steinberg-Bernstein Centre for Minimally-Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada; Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
Source
J Am Coll Surg. 2014 Jan;218(1):82-91
Date
Jan-2014
Language
English
Publication Type
Article
Keywords
Canada
Colostomy - economics - instrumentation - methods
Cost-Benefit Analysis
Health Care Costs - statistics & numerical data
Hernia, Ventral - economics - etiology - prevention & control
Humans
Markov Chains
Middle Aged
Models, Economic
Neoplasm Staging
Postoperative Complications - economics - prevention & control
Quality-Adjusted Life Years
Rectal Neoplasms - pathology - surgery
Surgical Mesh - economics
Surgical Stomas
Abstract
Parastomal hernia (PSH) is common after stoma formation. Studies have reported that mesh prophylaxis reduces PSH, but there are no cost-effectiveness data. Our objective was to determine the cost effectiveness of mesh prophylaxis vs no prophylaxis to prevent PSH in patients undergoing abdominoperineal resection with permanent colostomy for rectal cancer.
Using a cohort Markov model, we modeled the costs and effectiveness of mesh prophylaxis vs no prophylaxis at the index operation in a cohort of 60-year-old patients undergoing abdominoperineal resection for rectal cancer during a time horizon of 5 years. Costs were expressed in 2012 Canadian dollars (CAD$) and effectiveness in quality-adjusted life years. Deterministic and probabilistic sensitivity analyses were performed.
In patients with stage I to III rectal cancer, prophylactic mesh was dominant (less costly and more effective) compared with no mesh. In patients with stage IV disease, mesh prophylaxis was associated with higher cost (CAD$495 more) and minimally increased effectiveness (0.05 additional quality-adjusted life years), resulting in an incremental cost-effectiveness ratio of CAD$10,818 per quality-adjusted life year. On sensitivity analyses, the decision was sensitive to the probability of mesh infection and the cost of the mesh, and method of diagnosing PSH.
In patients undergoing abdominoperineal resection with permanent colostomy for rectal cancer, mesh prophylaxis might be the less costly and more effective strategy compared with no mesh to prevent PSH in patients with stage I to III disease, and might be cost effective in patients with stage IV disease.
PubMed ID
24210147 View in PubMed
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Costs and caregiver consequences of early supported discharge for stroke patients.

https://arctichealth.org/en/permalink/ahliterature186750
Source
Stroke. 2003 Feb;34(2):528-36
Publication Type
Article
Date
Feb-2003
Author
Josephine Teng
Nancy E Mayo
Eric Latimer
Jim Hanley
Sharon Wood-Dauphinee
Robert Côté
Susan Scott
Author Affiliation
Joint Department of Biostatistics and Epidemiology and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
Source
Stroke. 2003 Feb;34(2):528-36
Date
Feb-2003
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Caregivers - economics
Cost of Illness
Cost-Benefit Analysis
Disability Evaluation
Female
Health Resources - economics - utilization
Humans
Length of Stay - economics - statistics & numerical data
Male
Middle Aged
Outcome and Process Assessment (Health Care) - economics
Patient Discharge - economics - statistics & numerical data
Patient Readmission - statistics & numerical data
Quebec
Social Support
Stroke - economics - rehabilitation
Abstract
Early supported discharge (ESD) for stroke has been shown to yield outcomes similar to or better than those of conventional care, but there is less information on the impact on costs and on the caregiver. The purpose of this study is to estimate the costs associated with an ESD program compared with those of usual care.
We conducted a randomized controlled trial of stroke patients who required rehabilitation services and who had a caregiver at home.
Acute-care costs incurred before randomization when patients were medically ready for discharge averaged $3251 per person. The costs for the balance of the acute-care stay, from randomization to discharge, were $1383 for the home group and $2220 for the usual care group. The average cost of providing the 4-week home intervention service was $943 per person. The total cost generated by persons assigned to the home group averaged $7784 per person, significantly lower than the $11 065 per person for those assigned to usual care. A large proportion of the cost differential between the 2 groups arose from readmissions, for which the usual care group generated costs more than quadruple those of the home intervention group.
Providing care at home was no more (or less) expensive for those with greater functional limitation than for those with less. Caregivers in the ESD group scored consistently lower on the Burden Index than caregivers with usual care, even caregivers of persons with major functional limitations. For persons recovering from stroke and their families, ESD provides a cost-effective alternative to usual care.
PubMed ID
12574571 View in PubMed
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The costs associated with antidepressant use in depression and anxiety in community-living older adults.

https://arctichealth.org/en/permalink/ahliterature115077
Source
Can J Psychiatry. 2013 Apr;58(4):201-9
Publication Type
Article
Date
Apr-2013
Author
Helen-Maria Vasiliadis
Eric Latimer
Pierre-Alexandre Dionne
Michel Préville
Author Affiliation
Université de Sherbrooke, Sherbrooke, Quebec.
Source
Can J Psychiatry. 2013 Apr;58(4):201-9
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Antidepressive Agents - economics - therapeutic use
Anxiety Disorders - drug therapy - economics - epidemiology
Cross-Sectional Studies
Depressive Disorder - drug therapy - economics - epidemiology
Depressive Disorder, Major - drug therapy - economics - epidemiology
Drug Costs - statistics & numerical data
Female
Health Care Costs - statistics & numerical data
Humans
Male
National Health Programs - economics
Quebec - epidemiology
Abstract
To determine the costs associated with antidepressant (AD) use by depression and anxiety status in a public-managed health care system.
Data were obtained from a population-based health survey of 1869 older adults. Depression and anxiety were based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria and measured at 2 time points 1 year apart. AD and health service use and costs were identified from provincial administrative databases and included hospitalizations, physician fees, outpatient medications, and ambulatory visits. Patient costs considered were related to drug copayments, transportation, and time spent seeking medical care. Annual costs associated with AD use were studied as a function of mental health status at baseline and follow-up interviews (persistence, incidence, remission, or no illness). Generalized linear models with a gamma distribution were used to control for individual factors.
The costs incurred by participants using ADs as a whole (17.8%) reached $6678 (95% CI $5449 to $8182), significantly more than in participants not using ADs ($4698; 95% CI $3710 to $5949). AD use was associated with greater total adjusted costs among respondents with no depression (adjusted difference = $1769; 95% CI $236 to $3702) and no anxiety (adjusted difference = $1845; 95% CI $203 to $3486).
The results showed that AD use was not associated with cost savings in any group, and indeed with greater costs among participants who were neither depressed nor anxious at any time point. Future cost studies may consider the analyses of different AD classes regarding the different clinical mental health profiles in older adults.
PubMed ID
23547643 View in PubMed
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Does depression in older medical inpatients predict mortality?

https://arctichealth.org/en/permalink/ahliterature167603
Source
J Gerontol A Biol Sci Med Sci. 2006 Sep;61(9):975-81
Publication Type
Article
Date
Sep-2006
Author
Jane McCusker
Martin Cole
Antonio Ciampi
Eric Latimer
Sylvia Windholz
Eric Belzile
Author Affiliation
Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, 3830 Lacombe, Montreal (Quebec), Canada. jane.mccusker@mcgill.ca
Source
J Gerontol A Biol Sci Med Sci. 2006 Sep;61(9):975-81
Date
Sep-2006
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Antidepressive Agents - therapeutic use
Cognition Disorders - epidemiology
Cohort Studies
Depression - drug therapy - mortality
Depressive Disorder - drug therapy - mortality
Drug Utilization - statistics & numerical data
Female
Hospitalization
Humans
Male
Multivariate Analysis
Psychiatric Status Rating Scales
Quebec - epidemiology
Severity of Illness Index
Abstract
Previous studies of the effect of depression on mortality among older medical inpatients have yielded inconsistent results. We examined the effects on mortality of both a diagnosis of depression at hospital admission and a history of previous depression, taking into account potential sources of bias (sample selection and confounding).
Medical inpatients aged 65+ with at most mild cognitive impairment were recruited at two Montreal hospitals and were screened for depression. All those with a diagnosis of major or minor depression (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV] criteria) and a random sample of nondepressed patients were invited to participate. Baseline data included: history of previous depression, severity of physical illness, comorbidity, and health services utilization. Cox proportional hazards methods were used to analyze survival during the 16- to 52-month follow-up period.
Five hundred patients were enrolled; 116 (23.2%) had a history of previous depression. After adjustment for demographic factors, physical illness, cognitive impairment, and prior service utilization, the only depression group with significantly different mortality was patients with both current major depression and a history of depression, who had lower mortality than all other patient groups (hazard ratio 0.42; 95% confidence interval: 0.25, 0.70).
Among patients with no history of depression, a diagnosis of depression was not associated with mortality after adjustment for confounding by physical illness and other factors. Coincident major depression and history of depression was associated with decreased mortality.
Notes
Comment In: J Gerontol A Biol Sci Med Sci. 2007 Jul;62(7):796-7; author reply 79817634330
PubMed ID
16960030 View in PubMed
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Economic impact of inappropriate benzodiazepine prescribing and related drug interactions among elderly persons.

https://arctichealth.org/en/permalink/ahliterature118088
Source
Psychiatr Serv. 2013 Apr 1;64(4):331-8
Publication Type
Article
Date
Apr-1-2013
Author
Pierre-Alexandre Dionne
Helen-Maria Vasiliadis
Eric Latimer
Djamal Berbiche
Michel Preville
Author Affiliation
Department of Community Health Sciences, University of Sherbrooke, 150 Place Charles-Lemoyne, Bureau 200, Longueuil, Quebec J4K 0A8, Canada. pierre-alexandre.dionne@usherbrooke.ca
Source
Psychiatr Serv. 2013 Apr 1;64(4):331-8
Date
Apr-1-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Benzodiazepines - economics - therapeutic use
Canada
Drug Interactions
Female
Health Care Costs
Health Services - economics - utilization
Humans
Inappropriate Prescribing - economics
Logistic Models
Male
Physician's Practice Patterns - economics
Retrospective Studies
Abstract
The purpose of this study was to describe, from a health care system perspective, potentially inappropriate benzodiazepine prescribing among elderly persons in a publicly funded health system in Canada as well as health service use and costs associated with such prescriptions and the related drug interactions.
The sample (N=2,320) was representative of Quebec's community-dwelling elderly population (= 65 years) and consisted of respondents to the 2006 ESA survey (Enquête sur la Santé des Aînés, or Survey on the Health of the Elderly). The definition of potentially inappropriate benzodiazepine prescription was based on Beers criteria and on the potential for benzodiazepine-related drug interactions. Using a retrospective design, logistic regressions tested the association between inappropriate prescribing and health service use incurred over 12 months. The cost analysis used a generalized linear model with a gamma distribution.
Thirty-two percent (N=744) had received a benzodiazepine prescription, and 44% of this group received at least one potentially inappropriate prescription. Participants susceptible to benzodiazepine-related drug interactions, unlike those with inappropriate prescriptions according to Beers criteria, had a greater risk of hospitalizations and of emergency department and outpatient visits and higher health care costs ($3,076 higher per year, p
PubMed ID
23242458 View in PubMed
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Major depression in older medical inpatients predicts poor physical and mental health status over 12 months.

https://arctichealth.org/en/permalink/ahliterature162834
Source
Gen Hosp Psychiatry. 2007 Jul-Aug;29(4):340-8
Publication Type
Article
Author
Jane McCusker
Martin Cole
Antonio Ciampi
Eric Latimer
Sylvia Windholz
Eric Belzile
Author Affiliation
Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, Montreal (Quebec), Canada H3T 1M5. jane.mccusker@mcgill.ca
Source
Gen Hosp Psychiatry. 2007 Jul-Aug;29(4):340-8
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Depression - complications
Female
Health Status Indicators
Health Surveys
Humans
Inpatients - psychology
Linear Models
Male
Prospective Studies
Quebec - epidemiology
Abstract
The aim of this study was to determine the 12-month effects upon physical and mental health status of a diagnosis of major or minor depression among older medical inpatients.
Patients 65 years and older, admitted to the medical wards of two university-affiliated hospitals, with at most mild cognitive impairment, were screened for major and minor depression (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria). All depressed patients and a random sample of nondepressed patients were invited to participate. The physical functioning and mental health subscales of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were measured at baseline and at 3, 6 and 12 months.
Two hundred ten patients completed the SF-36 at baseline and at one or more follow-ups. In multiple linear regression analysis for longitudinal data, adjusting for baseline level of the SF-36 subscale outcome, severity of physical illness, premorbid disability, age, sex and other covariates, patients with major depression at baseline had lower SF-36 scores at follow-up, in comparison to patients with no depression [physical health, 9.22 (95% CI -15.52 to -2.93); mental health, 6.28 (95% CI -11.76 to -0.79)].
A diagnosis of major depression in cognitively intact older medical inpatients is associated with sustained poor physical and mental health status over the following 12 months.
PubMed ID
17591511 View in PubMed
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A pan-Canadian evaluation of supported employment programs dedicated to people with severe mental disorders.

https://arctichealth.org/en/permalink/ahliterature150224
Source
Community Ment Health J. 2010 Feb;46(1):44-55
Publication Type
Article
Date
Feb-2010
Author
Marc Corbière
Nathalie Lanctôt
Tania Lecomte
Eric Latimer
Paula Goering
Bonnie Kirsh
Elliot M Goldner
Daniel Reinharz
Matthew Menear
Jane Mizevich
Tanya Kamagiannis
Author Affiliation
Rehabilitation School, University of Sherbrooke, Longueuil, QC, Canada. marc.corbiere@usherbrooke.ca
Source
Community Ment Health J. 2010 Feb;46(1):44-55
Date
Feb-2010
Language
English
Publication Type
Article
Keywords
Canada
Combined Modality Therapy - standards
Community Mental Health Services - standards
Delivery of Health Care, Integrated - standards
Employment, Supported - standards
Evidence-Based Practice - standards
Health Services Research
Humans
Mental Disorders - psychology - rehabilitation
Patient Care Team - standards
Program Evaluation - standards
Quality Assurance, Health Care - standards
Rehabilitation, Vocational - standards
Abstract
Supported employment (SE) is an evidence-based practice that helps people with severe mental disorders obtain competitive employment. The implementation of SE programs in different social contexts has led to adaptations of the SE components, therefore impacting the fidelity/quality of these services. The objective of this study was to assess the implementation of SE services in three Canadian provinces by assessing the fidelity and describing components of SE services using the Quality of Supported Employment Implementation Scale. About 23 SE programs participated in this study. Cluster analyses revealed six profiles of SE programs that varied from high to low level of fidelity with a stronger focus on a particular component, and reflected the reality of service delivery settings. Future investigations are warranted to evaluate relationships between the levels of implementation of SE components and work outcomes while considering individual characteristics of people registered in SE programs.
PubMed ID
19536650 View in PubMed
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Predictors of psychological distress in low-income populations of Montreal.

https://arctichealth.org/en/permalink/ahliterature160079
Source
Can J Public Health. 2007 Jul-Aug;98 Suppl 1:S35-44
Publication Type
Article
Author
Jean Caron
Eric Latimer
Michel Tousignant
Author Affiliation
Douglas Hospital Research Centre, Department of Psychiatry, McGill University, Canada. jean.caron@uqat.ca
Source
Can J Public Health. 2007 Jul-Aug;98 Suppl 1:S35-44
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Cross-Sectional Studies
Data Collection
Emotions
Female
Humans
Interviews as Topic
Male
Mental health
Middle Aged
Poverty
Psychological Tests
Psychometrics
Quality of Life
Quebec
Residence Characteristics
Social Support
Social Welfare
Socioeconomic Factors
Stress, Psychological
Abstract
THEORETICAL PERSPECTIVE: Many epidemiologic studies agree that low-income populations are the groups most vulnerable to mental health problems. However, not all people in economic difficulty show symptoms, and it appears that having a social support network plays a role in protecting against the chronic stress resulting from conditions such as poverty.
The aim of the study is to clarify the relative contribution of social support to the mental health of low-income populations in two neighbourhoods in the southwest of Montreal: Pointe-Saint Charles and Saint-Henri.
A random sample of 416 social assistance recipients in southwest Montreal and another sample of 112 people, drawn at random from the general population, were interviewed. The psychological distress scale used was the Indice de détresse psychologique--Enquête Santê Quêbec (IDPESQ). The availability of social support components was assessed by using the Social Provisions Scale. Data were collected during interviews in the respondents' homes. Social support measures were entered into a multidimensional model including many variables identified as being associated with mental health. Multiple regression analysis identified the best predictors of psychological distress for the low-income population.
Among the 30 variables included in a multiple regression analysis, emotional support and the presence of persons perceived as stressful together accounted for most of the variance in distress predicted by the model. Although younger people, people experiencing food insecurity and people with poorer numeracy show a higher level of distress, these variables make a fairly marginal contribution compared with that of social relations.
PubMed ID
18047159 View in PubMed
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14 records – page 1 of 2.