Skip header and navigation

Refine By

35 records – page 1 of 4.

Accuracy of Canadian health administrative databases in identifying patients with rheumatoid arthritis: a validation study using the medical records of rheumatologists.

https://arctichealth.org/en/permalink/ahliterature114676
Source
Arthritis Care Res (Hoboken). 2013 Oct;65(10):1582-91
Publication Type
Article
Date
Oct-2013
Author
Jessica Widdifield
Sasha Bernatsky
J Michael Paterson
Karen Tu
Ryan Ng
J Carter Thorne
Janet E Pope
Claire Bombardier
Author Affiliation
University of Toronto, Toronto, Ontario, Canada.
Source
Arthritis Care Res (Hoboken). 2013 Oct;65(10):1582-91
Date
Oct-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Algorithms
Arthritis, Rheumatoid - diagnosis - epidemiology
Data Mining - statistics & numerical data
Databases, Factual - statistics & numerical data
Drug Prescriptions - statistics & numerical data
Fees and Charges - statistics & numerical data
Female
Hospitalization - statistics & numerical data
Humans
Male
Medical Records Systems, Computerized - statistics & numerical data
Middle Aged
Ontario - epidemiology
Reproducibility of Results
Retrospective Studies
Rheumatology - statistics & numerical data
Single-Payer System - statistics & numerical data
Abstract
Health administrative data can be a valuable tool for disease surveillance and research. Few studies have rigorously evaluated the accuracy of administrative databases for identifying rheumatoid arthritis (RA) patients. Our aim was to validate administrative data algorithms to identify RA patients in Ontario, Canada.
We performed a retrospective review of a random sample of 450 patients from 18 rheumatology clinics. Using rheumatologist-reported diagnosis as the reference standard, we tested and validated different combinations of physician billing, hospitalization, and pharmacy data.
One hundred forty-nine rheumatology patients were classified as having RA and 301 were classified as not having RA based on our reference standard definition (study RA prevalence 33%). Overall, algorithms that included physician billings had excellent sensitivity (range 94-100%). Specificity and positive predictive value (PPV) were modest to excellent and increased when algorithms included multiple physician claims or specialist claims. The addition of RA medications did not significantly improve algorithm performance. The algorithm of "(1 hospitalization RA code ever) OR (3 physician RA diagnosis codes [claims] with =1 by a specialist in a 2-year period)" had a sensitivity of 97%, specificity of 85%, PPV of 76%, and negative predictive value of 98%. Most RA patients (84%) had an RA diagnosis code present in the administrative data within ±1 year of a rheumatologist's documented diagnosis date.
We demonstrated that administrative data can be used to identify RA patients with a high degree of accuracy. RA diagnosis date and disease duration are fairly well estimated from administrative data in jurisdictions of universal health care insurance.
PubMed ID
23592598 View in PubMed
Less detail

Adverse events with intravitreal injection of vascular endothelial growth factor inhibitors: nested case-control study.

https://arctichealth.org/en/permalink/ahliterature122863
Source
BMJ. 2012;345:e4203
Publication Type
Article
Date
2012
Author
Robert J Campbell
Sudeep S Gill
Susan E Bronskill
J Michael Paterson
Marlo Whitehead
Chaim M Bell
Author Affiliation
Department of Ophthalmology, Queen's University, Kingston, ON, Canada.
Source
BMJ. 2012;345:e4203
Date
2012
Language
English
Publication Type
Article
Keywords
Aged
Angiogenesis Inhibitors - administration & dosage - adverse effects
Antibodies, Monoclonal, Humanized - administration & dosage - adverse effects
Brain Ischemia - chemically induced - epidemiology
Case-Control Studies
Female
Heart Failure - chemically induced
Humans
Intravitreal Injections - adverse effects
Logistic Models
Male
Myocardial Infarction - chemically induced - epidemiology
Ontario - epidemiology
Retinal Diseases - drug therapy
Risk factors
Stroke - chemically induced - epidemiology
Vascular Endothelial Growth Factor A - antagonists & inhibitors
Venous Thromboembolism - chemically induced - epidemiology
Abstract
To assess the risk of systemic adverse events associated with intravitreal injections of vascular endothelial growth factor inhibiting drugs.
Population based nested case-control study.
Ontario, Canada.
91,378 older adults with a history of physician diagnosed retinal disease identified between 1 April 2006 and 31 March 2011. Cases were 1477 patients admitted to hospital for ischaemic stroke, 2229 admitted for an acute myocardial infarction, 1059 admitted or assessed in an emergency department for venous thromboembolism, and 2623 admitted for congestive heart failure. Event-free controls (at a ratio of 5:1) were matched to cases on the basis of year of birth, sex, history of the outcome in the previous 5 years, and diabetes.
Exposure to vascular endothelial growth factor inhibiting drugs identified within 180 days before the index date.
After adjustment for potential confounders, participants who had ischaemic stroke, acute myocardial infarction, congestive heart failure, or venous thromboembolism were not more likely than control participants to have been exposed to either bevacizumab (adjusted odds ratios of 0.95 (95% confidence interval 0.68 to 1.34) for ischaemic stroke, 1.04 (0.77 to 1.39) for acute myocardial infarction, 0.81 (0.49 to 1.34) for venous thromboembolism, and 1.21 (0.91 to 1.62) for congestive heart failure) or ranibizumab (adjusted odds ratios 0.87 (0.68 to 1.10) for ischaemic stroke, 0.90 (0.72 to 1.11) for acute myocardial infarction, 0.88 (0.67 to 1.16) for venous thromboembolism, and 0.87 (0.70 to 1.07) for congestive heart failure). Similarly, a secondary analysis of exclusive users of bevacizumab or ranibizumab showed no differences in risk between the two drugs (adjusted odds ratios for bevacizumab relative to ranibizumab of 1.03 (0.67 to 1.60) for ischaemic stroke, 1.23 (0.85 to 1.77) for acute myocardial infarction, 0.92 (0.51 to 1.69) for venous thromboembolism, and 1.35 (0.93 to 1.95) for congestive heart failure). These findings were consistent for all but one outcome in subgroup analyses.
Intravitreal injections of bevacizumab and ranibizumab were not associated with significant risks of ischaemic stroke, acute myocardial infarction, congestive heart failure, or venous thromboembolism.
Notes
Cites: Am J Ophthalmol. 2004 Mar;137(3):486-9515013873
Cites: Ophthalmology. 2012 Jul;119(7):1399-41122578446
Cites: Med Care. 2005 Feb;43(2):182-815655432
Cites: Invest Ophthalmol Vis Sci. 2005 Feb;46(2):726-3315671306
Cites: BMC Med Res Methodol. 2005 Jan 25;5(1):515670334
Cites: N Engl J Med. 2006 Oct 5;355(14):1419-3117021318
Cites: N Engl J Med. 2006 Oct 5;355(14):1432-4417021319
Cites: Retina. 2006 Oct;26(8):859-7017031284
Cites: N Engl J Med. 2007 Feb 15;356(7):747-8; author reply 749-5017301310
Cites: Br J Cancer. 2007 Jun 18;96(12):1788-9517519900
Cites: J Natl Cancer Inst. 2007 Aug 15;99(16):1232-917686822
Cites: Can J Ophthalmol. 2007 Dec;42(6):836-4318026200
Cites: N Engl J Med. 2008 Jun 12;358(24):2606-1718550876
Cites: Ophthalmology. 2008 Oct;115(10):1837-4618929163
Cites: JAMA. 2008 Nov 19;300(19):2277-8519017914
Cites: JAMA. 2008 Nov 26;300(20):2417-919033592
Cites: Ophthalmology. 2009 Feb;116(2):36219187826
Cites: Surv Ophthalmol. 2009 May-Jun;54(3):339-4819422962
Cites: Arch Intern Med. 2009 May 11;169(9):867-7319433698
Cites: JAMA. 2009 May 20;301(19):1991-619454637
Cites: Target Oncol. 2009 Apr;4(2):67-7619373440
Cites: Am J Ophthalmol. 2009 Nov;148(5):647-5619712924
Cites: BMJ. 2010;340:b549320051468
Cites: Arch Ophthalmol. 2010 Mar;128(3):359-6220212208
Cites: J Am Geriatr Soc. 2010 Mar;58(3):510-720398120
Cites: Am J Epidemiol. 2001 Nov 1;154(9):854-6411682368
Cites: Diabetes Care. 2002 Mar;25(3):512-611874939
Cites: Circulation. 2003 Jun 17;107(23 Suppl 1):I4-812814979
Cites: Can J Clin Pharmacol. 2003 Summer;10(2):67-7112879144
Cites: Ophthalmology. 2003 Aug;110(8):1534-912917168
Cites: BMJ. 2010;340:c245920538634
Cites: Arch Ophthalmol. 2010 Oct;128(10):1273-920937996
Cites: J Clin Oncol. 2011 Feb 20;29(6):632-821205755
Cites: N Engl J Med. 2011 May 19;364(20):1897-90821526923
Cites: N Engl J Med. 2011 May 19;364(20):1966-721526924
Cites: Retina. 2011 Jun;31(6):1036-4221836410
Cites: Clin Experiment Ophthalmol. 2012 Jan-Feb;40(1):3-522304024
Cites: BMJ. 2012;344:e294122549055
Cites: Ophthalmology. 2012 Jul;119(7):1388-9822555112
Cites: Toxicol Pathol. 1999 Sep-Oct;27(5):536-4410528633
PubMed ID
22763393 View in PubMed
Less detail

Blood glucose test strips: options to reduce usage.

https://arctichealth.org/en/permalink/ahliterature146575
Source
CMAJ. 2010 Jan 12;182(1):35-8
Publication Type
Article
Date
Jan-12-2010
Author
Tara Gomes
David N Juurlink
Baiju R Shah
J Michael Paterson
Muhammad M Mamdani
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, Ont.
Source
CMAJ. 2010 Jan 12;182(1):35-8
Date
Jan-12-2010
Language
English
Publication Type
Article
Keywords
Blood Glucose Self-Monitoring - economics
Cross-Sectional Studies
Diabetes Mellitus, Type 1 - blood - economics
Diabetes Mellitus, Type 2 - blood - economics
Health Expenditures
Humans
Insurance, Pharmaceutical Services - economics
Middle Aged
Ontario
Abstract
Recent evidence suggests that, despite widespread use, self-monitoring of blood glucose levels has little clinical benefit in many patients with diabetes. The impact of more focused public-payer policies for the use of blood glucose test strips may be substantial.
We conducted a cross-sectional analysis of annual prescription claims for test strips between 1997 and 2008 for patients in Ontario aged 65 and older with diabetes. Patients were stratified into 1 of 4 hierarchical groups according to the most intensive glucose-lowering treatment received during each calendar year. Test strip use was calculated annually for each group over the study period, and the effects of 5 hypothetical policy scenarios of more selective test strip use were assessed.
Test strip use increased by almost 250% from 1997 to 2008, with 52.6% (n = 263,513) of included patients receiving a prescription during 2008. Almost half of these patients were at low risk for drug-induced hypoglycemia. In 2008, over 117 million test strips were dispensed in Ontario; however, more focused policy scenarios could have reduced this number by between 9.5 million and 74.5 million test strips.
Many people who self-monitor their blood glucose are at relatively low risk for drug-induced hypoglycemia. The economic benefits associated with more selective testing could be redirected to more effective interventions for patients with diabetes.
Notes
Cites: Diabetes Care. 2001 Jun;24(6):977-811375355
Cites: Diabetes Care. 2002 Mar;25(3):512-611874939
Cites: Can J Clin Pharmacol. 2003 Summer;10(2):67-7112879144
Cites: Diabetes Metab. 2003 Dec;29(6):587-9414707887
Cites: Diabetes Care. 1997 Sep;20(9):1482-69283802
Cites: Am J Med. 2005 Apr;118(4):422-515808142
Cites: Pharmacoepidemiol Drug Saf. 2009 Aug;18(8):756-6019399918
Cites: Diabetologia. 2007 Mar;50(3):510-517237940
Cites: BMJ. 2007 Jul 21;335(7611):13217591623
Cites: BMJ. 2008 May 24;336(7654):1174-718420662
Cites: BMC Health Serv Res. 2008;8:11118501012
Cites: Diabetes Care. 2009 Jan;32 Suppl 1:S13-6119118286
Cites: Endocr Pract. 2006 Jan-Feb;12 Suppl 1:110-716627393
PubMed ID
20026624 View in PubMed
Less detail

Cardiovascular Health Awareness Program (CHAP): a community cluster-randomised trial among elderly Canadians.

https://arctichealth.org/en/permalink/ahliterature158054
Source
Prev Med. 2008 Jun;46(6):537-44
Publication Type
Article
Date
Jun-2008
Author
Janusz Kaczorowski
Larry W Chambers
Tina Karwalajtys
Lisa Dolovich
Barbara Farrell
Beatrice McDonough
Rolf Sebaldt
Cheryl Levitt
William Hogg
Lehana Thabane
Karen Tu
Ron Goeree
J Michael Paterson
Mamdouh Shubair
Tracy Gierman
Shannon Sullivan
Megan Carter
Author Affiliation
Department of Family Practice, University of British Columbia, Canada. janusz.kaczorowski@familymed.ubc.ca
Source
Prev Med. 2008 Jun;46(6):537-44
Date
Jun-2008
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Awareness
Canada
Cardiovascular Diseases - prevention & control
Cardiovascular System
Cluster analysis
Community Medicine
Female
Health Knowledge, Attitudes, Practice
Health promotion
Humans
Hypertension - prevention & control
Male
Program Evaluation
Social Marketing
Abstract
High blood pressure is an important and modifiable cardiovascular disease risk factor that remains under-detected and under-treated. Community-level interventions that address high blood pressure and other modifiable risk factors are a promising strategy to improve cardiovascular health in populations. The present study is a community cluster-randomised trial testing the effectiveness of CHAP (Cardiovascular Health Awareness Program) on the cardiovascular health of older adults.
Thirty-nine mid-sized communities in Ontario, Canada were stratified by geographic location and size of the population aged >or=65 years and randomly allocated to receive CHAP or no intervention. In CHAP communities, residents aged >or=65 years were invited to attend cardiovascular risk assessment sessions held in pharmacies over 10 weeks in Fall, 2006. Sessions included blood pressure measurement and feedback to family physicians. Trained volunteers delivered the program with support from pharmacists, community nurses and local organisations.
The primary outcome measure is the relative change in the mean annual rate of hospital admission for acute myocardial infarction, congestive heart failure and stroke (composite end-point) among residents aged >or=65 years in intervention and control communities, using routinely collected, population-based administrative health data.
This paper highlights considerations in design, implementation and evaluation of a large-scale, community-wide cardiovascular health promotion initiative.
PubMed ID
18372036 View in PubMed
Less detail

Case selection for statins was similar in two Canadian provinces: BC and Ontario.

https://arctichealth.org/en/permalink/ahliterature166136
Source
J Clin Epidemiol. 2007 Jan;60(1):73-8
Publication Type
Article
Date
Jan-2007
Author
J Michael Paterson
Greg Carney
Geoffrey M Anderson
Ken Bassett
Gary Naglie
Andreas Laupacis
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. paterson@ices.on.ca
Source
J Clin Epidemiol. 2007 Jan;60(1):73-8
Date
Jan-2007
Language
English
Publication Type
Article
Keywords
Aged
British Columbia - epidemiology
Coronary Disease - epidemiology - etiology - prevention & control
Drug Prescriptions - statistics & numerical data
Drug Utilization - statistics & numerical data
Epidemiologic Methods
Female
Hospitalization - statistics & numerical data
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage - therapeutic use
Hyperlipidemias - complications - drug therapy - epidemiology
Male
Ontario - epidemiology
Patient Selection
Physician's Practice Patterns - statistics & numerical data
Abstract
Though statins are fully reimbursed by the public drug programs for seniors in British Columbia (BC) and Ontario, Canada, population-based rates of statin prescription are markedly higher in Ontario. We aimed to assess whether new statin users in BC and Ontario differ in terms of their risk for future coronary heart disease (CHD) events.
We collected information for 1998-2001 on demographics, outpatient prescriptions, physician visits, hospital admissions, and vital status from administrative databases to compare the proportions of new statin users aged 66 years and older who had evidence of an acute coronary syndrome (ACS), chronic CHD, neither ACS nor CHD but diabetes, or none of the above.
Approximately 15% and 20% of BC and Ontario seniors, respectively, had filled a statin prescription by 2001. Among new statin users in the two provinces, virtually identical proportions had evidence of ACS (8%), chronic CHD (25%), and diabetes (14%), for an overall proportion of roughly 50% at high risk for CHD events.
New statin users in BC and Ontario were at similar risk for future CHD events. Poorer case selection is unlikely to explain the relatively higher rates of statin prescription in Ontario.
PubMed ID
17161757 View in PubMed
Less detail

Changes in rates of upper gastrointestinal hemorrhage after the introduction of cyclooxygenase-2 inhibitors in British Columbia and Ontario.

https://arctichealth.org/en/permalink/ahliterature166254
Source
CMAJ. 2006 Dec 5;175(12):1535-8
Publication Type
Article
Date
Dec-5-2006
Author
Muhammad Mamdani
Leanne Warren
Alex Kopp
J Michael Paterson
Andreas Laupacis
Ken Bassett
Geoffrey M Anderson
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Source
CMAJ. 2006 Dec 5;175(12):1535-8
Date
Dec-5-2006
Language
English
Publication Type
Article
Keywords
Aged
Anti-Inflammatory Agents, Non-Steroidal - adverse effects - therapeutic use
British Columbia - epidemiology
Cross-Sectional Studies
Cyclooxygenase Inhibitors - adverse effects - therapeutic use
Female
Gastrointestinal Hemorrhage - chemically induced - epidemiology
Health Policy
Hospitalization - statistics & numerical data
Humans
Male
Ontario - epidemiology
Prevalence
Retrospective Studies
Abstract
Population rates of upper gastrointestinal (GI) hemorrhage have been observed to increase with the introduction and rapid uptake of selective cyclooxygenase-2 (COX-2) inhibitors. Changes in COX-2 inhibitor use and upper GI bleeding rates in regions with relatively restrictive drug policies (e.g., British Columbia) have not been compared with changes in regions with relatively less restrictive drug policies (e.g., Ontario).
We collected administrative data for about 1.4 million people aged 66 years and older in British Columbia and Ontario for the period January 1996 to November 2002. We examined temporal changes in the prevalence of NSAID use and admissions to hospital because of upper GI hemorrhage in both provinces using cross-sectional time series analysis.
During the period studied, the prevalence of NSAID use in British Columbia's population of older people increased by 25% (from 8.7% to 10.9%; p
Notes
Cites: N Engl J Med. 2000 Nov 23;343(21):1520-8, 2 p following 152811087881
Cites: BMJ. 2002 Sep 21;325(7365):62412242172
Cites: Epidemiology. 1996 Jan;7(1):101-48664388
Cites: Pharmacoepidemiol Drug Saf. 2004 Mar;13(3):153-715072114
Cites: BMJ. 2004 Jun 12;328(7453):1415-615138157
Cites: CMAJ. 2002 Nov 12;167(10):1125-612427703
PubMed ID
17146090 View in PubMed
Less detail

CNODES: the Canadian Network for Observational Drug Effect Studies.

https://arctichealth.org/en/permalink/ahliterature128363
Source
Open Med. 2012;6(4):e134-40
Publication Type
Article
Date
2012
Author
Samy Suissa
David Henry
Patricia Caetano
Colin R Dormuth
Pierre Ernst
Brenda Hemmelgarn
Jacques Lelorier
Adrian Levy
Patricia J Martens
J Michael Paterson
Robert W Platt
Ingrid Sketris
Gary Teare
Author Affiliation
Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, 2075 Bayview Ave.,Toronto ON M4N 3M5, Canada.
Source
Open Med. 2012;6(4):e134-40
Date
2012
Language
English
Publication Type
Article
Keywords
Adverse Drug Reaction Reporting Systems - organization & administration
Canada
Community Networks
Drug-Related Side Effects and Adverse Reactions - prevention & control
Humans
Medical Record Linkage - methods
Medication Therapy Management - organization & administration
Organizational Objectives
Outcome Assessment (Health Care)
Research Design
Risk assessment
Abstract
Although administrative health care databases have long been used to evaluate adverse drug effects, responses to drug safety signals have been slow and uncoordinated. We describe the establishment of the Canadian Network for Observational Drug Effect Studies (CNODES), a collaborating centre of the Drug Safety and Effectiveness Network (DSEN). CNODES is a distributed network of investigators and linked databases in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec and Nova Scotia. Principles of operation are as follows: (1) research questions are prioritized by the coordinating office of DSEN; (2) the linked data stay within the provinces; (3)?for each question, a study team formulates a detailed protocol enabling consistent analyses in each province; (4) analyses are "blind" to results obtained elsewhere; (5) protocol deviations are permitted for technical reasons only; (6)?analyses using multivariable methods are lodged centrally with a methods team, which is responsible for combining the results to provide a summary estimate of effect. These procedures are designed to achieve high internal validity of risk estimates and to eliminate the possibility of selective reporting of analyses or outcomes. The value of a coordinated multi-provincial approach is illustrated by projects studying acute renal injury with high-potency statins, community-acquired pneumonia with proton pump inhibitors, and hyperglycemic emergencies with antipsychotic drugs. CNODES is an academically based distributed network of Canadian researchers and data centres with a commitment to rapid and sophisticated analysis of emerging drug safety signals in study populations totalling over 40 million.
Notes
Cites: N Engl J Med. 2000 Nov 23;343(21):1520-8, 2 p following 152811087881
Cites: Arch Intern Med. 2003 Feb 24;163(4):481-612588209
Cites: Pharmacoepidemiol Drug Saf. 2012 Jan;21 Suppl 1:1-822262586
Cites: PLoS Med. 2011 May;8(5):e100102621559325
Cites: Aliment Pharmacol Ther. 2010 Jun;31(11):1165-7720222914
Cites: Clin Pharmacol Ther. 1985 Oct;38(4):359-643899458
Cites: N Engl J Med. 1992 Feb 20;326(8):501-61346340
Cites: JAMA. 1998 Apr 15;279(15):1200-59555760
Cites: Br J Clin Pharmacol. 1998 May;45(5):419-259643612
Cites: CMAJ. 1999 Feb 9;160(3):350-110065078
Cites: Lancet. 2005 Jan 1-7;365(9453):82-9315639683
Cites: Ann Intern Med. 2005 Apr 5;142(7):481-915809459
Cites: JAMA. 2006 Oct 4;296(13):1633-4416968831
Cites: Ann Intern Med. 2007 Jun 5;146(11):775-8617548409
Cites: N Engl J Med. 2007 Jun 14;356(24):2457-7117517853
Cites: CMAJ. 2008 Aug 12;179(4):319-2618695179
Cites: PLoS One. 2008;3(8):e308118769481
Cites: Eval Health Prof. 2008 Dec;31(4):370-8919000980
Cites: Pharmacoepidemiol Drug Saf. 2009 Nov;18(11):1016-2519718696
PubMed ID
23687528 View in PubMed
Less detail

Concordance between discharge prescriptions and insurance claims in post-myocardial infarction patients.

https://arctichealth.org/en/permalink/ahliterature168215
Source
Pharmacoepidemiol Drug Saf. 2007 Feb;16(2):207-15
Publication Type
Article
Date
Feb-2007
Author
Cynthia A Jackevicius
J Michael Paterson
Gary Naglie
Author Affiliation
University Health Network, Toronto, ON, Canada. cynthia.jackevicius@uhn.on.ca
Source
Pharmacoepidemiol Drug Saf. 2007 Feb;16(2):207-15
Date
Feb-2007
Language
English
Publication Type
Article
Keywords
Aged
Cardiovascular Agents - administration & dosage
Clinical Pharmacy Information Systems - statistics & numerical data
Drug Prescriptions - statistics & numerical data
Drug Utilization - statistics & numerical data
Female
Hospitals, Teaching - statistics & numerical data
Humans
Insurance Claim Reporting - statistics & numerical data
Male
Myocardial Infarction - drug therapy
Ontario
Patient compliance
Patient Discharge - statistics & numerical data
Retrospective Studies
Time Factors
Abstract
To assess the degree of concordance between the information (drug quantity, days' supply, and daily dose) recorded on hospital discharge prescriptions and what appears in a public drug insurance electronic claims database.
A retrospective chart audit of hospital discharge prescriptions with linkage to a prescription claims database was conducted. Three hundred and forty-five post-myocardial infarction patients discharged from an Ontario university-affiliated teaching hospital were included. The percentage of linkable records with perfect agreement between the written prescription and the insurance claim was our measure of concordance.
Seventy-seven per cent and 82% of discharge prescriptions were filled within 7 days, and 120 days post-discharge, respectively. Of those dispensed and that contained adequate information, concordance was perfect for days' supply, quantity, and daily dose for 70.7% (95%CI 67.9-73.4%), 65.9% (95%CI 63.2-68.7%), and 75.9% (95%CI 73.2-78.6%) of prescriptions, respectively. For cardiac drugs, which comprised the majority of filled prescriptions, concordance was greater for daily dose and days' supply than for quantity (75.7% [95%CI 72.7-78.6%] and 75.5% [95%CI 72.6-78.4%] vs. 65.3% [95%CI 62.3-68.4%]). Concordance varied by medication type.
Most hospital discharge prescriptions were filled within 1 week. Among the data elements studied, concordance between written prescriptions and insurance claims was greatest for daily dose. Concordance was greater for scheduled cardiac medications than for other medications.
PubMed ID
16862605 View in PubMed
Less detail

Economic appraisal of a community-wide cardiovascular health awareness program.

https://arctichealth.org/en/permalink/ahliterature117071
Source
Value Health. 2013 Jan-Feb;16(1):39-45
Publication Type
Article
Author
Ron Goeree
Camilla von Keyserlingk
Natasha Burke
Jing He
Janusz Kaczorowski
Larry Chambers
Lisa Dolovich
J. Michael Paterson
Brandon Zagorski
Author Affiliation
Programs for Assessment of Technology in Health Research Institute, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada. goereer@mcmaster.ca
Source
Value Health. 2013 Jan-Feb;16(1):39-45
Language
English
Publication Type
Article
Keywords
Aged
Cardiovascular Diseases - economics - etiology - prevention & control
Cluster analysis
Community Health Services - economics - organization & administration
Databases, Factual
Health Care Costs - statistics & numerical data
Health Knowledge, Attitudes, Practice
Health Promotion - economics - methods
Hospital Costs - statistics & numerical data
Hospitalization - economics - statistics & numerical data
Humans
Ontario
Program Development
Program Evaluation
Risk factors
Abstract
Cardiovascular disease (CVD) is a leading cause of hospitalizations, death, and health care costs. Although studies have shown that modifying CVD risk factors at the patient level improves patient prognosis, the effect of community-wide interventions at the population level has been uncertain.
To evaluate the resource use and cost consequences of a community-wide Cardiovascular Health Awareness Program (CHAP).
Thirty-nine medium-sized communities in Ontario, Canada, participated in a community cluster randomized controlled trial stratified by population size and geographic location. All community-dwelling elderly residents (>65 years) in each community were included. Family physicians, pharmacists, community nurses, local organizations, and volunteers in the intervention communities implemented the program. Rates and costs of CVD hospitalizations, all hospitalizations, emergency department visits, physician visits, and prescription medication use in the year before and after the intervention were compared for the 19 control and 20 CHAP communities by using province-wide linked administrative databases. The cost of implementing and administrating CHAP in each community was combined with total community health care cost to determine the net cost effect.
CHAP was associated with a reduction in CVD hospitalization costs. There were no differences in utilization rates or costs for overall hospitalizations, in visits to emergency rooms, physicians, or specialists, or in the use of prescription medications. Results were robust over a range of cost assumptions.
A community-wide CVD awareness program can be implemented and can reduce CVD-related hospitalization costs at the level of the community without a corresponding increase in overall health care costs.
PubMed ID
23337214 View in PubMed
Less detail

35 records – page 1 of 4.