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Access to myocardial revascularization procedures: closing the gap with time?

https://arctichealth.org/en/permalink/ahliterature170348
Source
BMC Public Health. 2006;6:60
Publication Type
Article
Date
2006
Author
Alain Vanasse
Théophile Niyonsenga
Josiane Courteau
Abbas Hemiari
Author Affiliation
Family Medicine Department, Faculty of Medicine, Université de Sherbrooke, Sherbrooke (QC), J1H 5N4, Canada. alain.vanasse@usherbrooke.ca
Source
BMC Public Health. 2006;6:60
Date
2006
Language
English
Publication Type
Article
Keywords
Adult
Aged
Angioplasty, Balloon, Coronary - utilization
Cardiac Care Facilities - supply & distribution
Cohort Studies
Coronary Artery Bypass - utilization
Female
Geography
Health Services Accessibility - statistics & numerical data
Humans
Incidence
Male
Middle Aged
Myocardial Infarction - epidemiology - surgery
Myocardial Revascularization - utilization
Patient Discharge
Quebec - epidemiology
Registries
Time Factors
Abstract
Early access to revascularization procedures is known to be related to a more favorable outcome in myocardial infarction (MI) patients, but access to specialized care varies widely amongst the population. We aim to test if the early gap found in the revascularization rates, according to distance between patients' location and the closest specialized cardiology center (SCC), remains on a long term basis.
We conducted a population-based cohort study using data from the Quebec's hospital discharge register (MED-ECHO). The study population includes all patients 25 years and older living in the province of Quebec, who were hospitalized for a MI in 1999 with a follow up time of one year after the index hospitalization. The main variable is revascularization (percutaneous transluminal coronary angioplasty or a coronary artery bypass graft). The population is divided in four groups depending how close they are from a SCC ( or = 105 km). Revascularization rates are adjusted for age and sex.
The study population includes 11,802 individuals, 66% are men. The one-year incidence rate of MI is 244 individuals per 100,000 inhabitants. At index hospitalization, a significant gap is found between patients living close ( or = 32 km). During the first year, a gap reduction can be observed but only for patients living at an intermediate distance from the specialized center (64-105 km).
The gap observed in revascularization rates at the index hospitalization for MI is in favour of patients living closer (
Notes
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PubMed ID
16524458 View in PubMed
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The adequacy of pharmaceutical treatment of schizophrenia in Quebec varies with age, but is not influenced by sex or neighbourhood deprivation.

https://arctichealth.org/en/permalink/ahliterature107816
Source
Can J Psychiatry. 2013 Aug;58(8):456-65
Publication Type
Article
Date
Aug-2013
Author
Frederieke M Brouwers
Josiane Courteau
Jean-Pierre Grégoire
Jocelyne Moisan
Sophie Lauzier
Alain Lesage
Marie-Josée Fleury
Alain Vanasse
Author Affiliation
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec.
Source
Can J Psychiatry. 2013 Aug;58(8):456-65
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Antipsychotic Agents - therapeutic use
Cohort Studies
Drug Prescriptions - statistics & numerical data
Female
Humans
Male
Middle Aged
Quebec - epidemiology
Residence Characteristics - statistics & numerical data
Schizophrenia - drug therapy - epidemiology
Sex Factors
Socioeconomic Factors
Young Adult
Abstract
Though high discontinuation rates for antipsychotics (APs) by patients with schizophrenia are frequently reported, the percentage of patients receiving pharmaceutical treatment for schizophrenia in routine practice in accordance with international clinical guidelines is unknown. Further, it is unknown if these rates are influenced by levels of neighbourhood deprivation or by a patient's age or sex. Our study aims to investigate if inequalities in AP treatment could be observed between patients living in neighbourhoods with the highest levels of material and social deprivation and those with the lowest deprivation levels, between patients from different age groups, or between men and women.
We conducted a secondary analysis of medical-administrative data of a cohort of adult patients in the province of Quebec with a medical contact for schizophrenia in a 2-year period (2004-2005). We assessed the proportion of patients that filled at least 1 prescription for an AP and received adequate pharmaceutical treatment, defined as being in possession of APs at least 80% of the time as outpatients during a 2-year follow-up period.
Among the 30 544 study patients, 88.5% filled at least 1 prescription for an AP, and 67.5% of the treated patients received adequate treatment. Though no clinically significant differences were observed by deprivation or sex, younger age was associated with lower proportions of patients receiving adequate treatment (46% of treated patients aged between 18 and 29 years, compared with 72% aged between 30 and 64 years, and 77% aged 65 years and over).
In Quebec's routine practice, over 70% of treated patients aged 30 and over received adequate pharmacological treatment, regardless of sex or neighbourhood socioeconomic status. In contrast, in patients aged between 18 and 29 years this percentage was 47%. This is a discouraging finding, especially because optimal treatment in the early phase of disease is reported to result in the best long-term outcomes.
PubMed ID
23972107 View in PubMed
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Adherence to vascular protection drugs in diabetic patients in Quebec: a population-based analysis.

https://arctichealth.org/en/permalink/ahliterature144306
Source
Diab Vasc Dis Res. 2010 Apr;7(2):167-71
Publication Type
Article
Date
Apr-2010
Author
Shabnam Asghari
Josiane Courteau
Catherine Drouin
Jean-Pierre Grégoire
André C Carpentier
Mariane Pâquet
Alain Vanasse
Author Affiliation
PRIMUS Group, Centre de recherche clinique Etienne-Le Bel, CHUS, Sherbrooke (QC), Canada.
Source
Diab Vasc Dis Res. 2010 Apr;7(2):167-71
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Aged
Angiotensin II Type 1 Receptor Blockers - therapeutic use
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Aspirin - therapeutic use
Diabetic Angiopathies - prevention & control
Female
Humans
Male
Medication Adherence - statistics & numerical data
Middle Aged
Multivariate Analysis
Quebec
Retrospective Studies
Abstract
The purpose of this study was to assess adherence to vascular protection drugs in diabetic patients using a cohort of diabetic patients aged >or=30 years, covered by the public drug insurance in the province of Quebec, excluding gestational diabetes and patients who were hopitalized or died during the 1-year follow-up. Drug adherence was measured using the medication possession ratio. Multivariate analyses, including logit and multinomial logit were used. Of the 170,381 diabetics (mean age: 62 +/- 14 years), 18% and 32% were regular users of ASA and ACEIs/ARBs, respectively. Regular use increased with age (p
PubMed ID
20382781 View in PubMed
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Attractiveness of family medicine for medical students: influence of research and debt.

https://arctichealth.org/en/permalink/ahliterature133734
Source
Can Fam Physician. 2011 Jun;57(6):e216-27
Publication Type
Article
Date
Jun-2011
Author
Alain Vanasse
Maria Gabriela Orzanco
Josiane Courteau
Sarah Scott
Author Affiliation
University of Sherbrooke, and Clinical Research Centre, Sherbrooke University Hospital, 3001 12th Ave N, Sherbrooke, QC J1H 5N4. alain.vanasse@usherbrooke.ca
Source
Can Fam Physician. 2011 Jun;57(6):e216-27
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Canada
Career Choice
Education, Medical, Undergraduate - economics
Family Practice
Female
Humans
Intention
Internship and Residency
Male
Multivariate Analysis
Questionnaires
Regression Analysis
Research
Students, Medical
Abstract
To examine the association between students' personal characteristics, backgrounds, and medical schools and their intention to enter a family medicine (FM) specialty.
Descriptive study using data from the 2007 National Physician Survey.
Canada.
Clinical (n=1109) and preclinical (n=829) medical student respondents to the 2007 National Physician Survey.
The main variable was hoping to enter an FM specialty, and 40 independent variables were included in regression and classification-tree models.
Fewer than 1 medical student in 3 (30.2% at the preclinical level and 31.4% at the clinical level) hoped to enter into an FM career. Those who did were more likely to be female, were slightly older, were more frequently married or living with partners, were typically born in Canada, and were more likely to have previous exposure to non-urban environments. The most important predictor for both populations was the debt related to medical studies, which acted in the opposite direction of whether or not students were interested in research. Students interested in research were attracted by specialties with high earning potential, while those not interested in research looked for short residency programs, such as FM, so they could begin to pay off debt sooner. Therefore, the interest in research appears to be inversely related to the choice of FM.
Less than one-third of medical students were looking for residencies in FM in Canada. This is far below the goals of 45% set at the national level and 50% set by some provinces like Quebec. Debt and interest in research have strong influences on the choice of residency by medical students.
Notes
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PubMed ID
21673198 View in PubMed
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Bone mineral density measurement and osteoporosis treatment after a fragility fracture in older adults: regional variation and determinants of use in Quebec.

https://arctichealth.org/en/permalink/ahliterature174228
Source
BMC Musculoskelet Disord. 2005;6:33
Publication Type
Article
Date
2005
Author
Alain Vanasse
Pierre Dagenais
Théophile Niyonsenga
Jean-Pierre Grégoire
Josiane Courteau
Abbas Hemiari
Author Affiliation
Department of Family Medicine, Faculty of Medicine, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke (QC), J1H 5N4, Canada. alain.vanasse@usherbrooke.ca
Source
BMC Musculoskelet Disord. 2005;6:33
Date
2005
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Bone Density
Cohort Studies
Diagnostic Tests, Routine - statistics & numerical data
Female
Fractures, Bone - etiology
Health Services Accessibility
Humans
Male
Osteoporosis - complications - diagnosis - drug therapy - therapy
Quebec
Retrospective Studies
Sex Factors
Abstract
Osteoporosis (OP) is a skeletal disorder characterized by reduced bone strength and predisposition to increased risk of fracture, with consequent increased risk of morbidity and mortality. It is therefore an important public health problem. International and Canadian associations have issued clinical guidelines for the diagnosis and treatment of OP. In this study, we identified potential predictors of bone mineral density (BMD) testing and OP treatment, which include place of residence.
Our study was a retrospective population-based cohort study using data from the Quebec Health Insurance Board. The studied population consisted of all individuals 65 years and older for whom a physician claimed a consultation for a low velocity vertebral, hip, wrist, or humerus fracture in 1999 and 2000. Individuals were considered to have undergone BMD testing if there was a claim for such a procedure within two years following a fracture. They were considered to have received an OP treatment if there was at least one claim to Quebec's health insurance plan (RAMQ) for OP treatment within one year following a fracture. We performed descriptive analyses and logistic regressions by gender. Predictors included age, site of fracture, social status, comorbidity index, prior BMD testing, prior OP treatment, long-term glucocorticoid use, and physical distance to BMD device.
The cohort, 77% of which was female, consisted of 25,852 individuals with fragility fractures. BMD testing and OP treatment rates were low and gender dependent (BMD: men 4.6%; women 13.1%; OP treatment: men 9.9%; women 29.7%). There was an obvious regional variation, particularly in BMD testing, ranging from 0 to 16%. Logistic regressions demonstrate that individuals living in long term care facilities received less BMD testing. Patients who had suffered from vertebral fractures, or who had received prior OP treatment or BMD testing, regardless of gender, subsequently received more BMD testing and OP treatments. Furthermore, increasing the distance between a patient's residence and BMD facility precluded likelihood of BMD testing.
BMD testing rate was extremely low but not completely explained by reduced physical access; gender, age, social status, prior BMD testing and OP treatment were all important predictors for future BMD testing and OP treatment.
Notes
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PubMed ID
15969760 View in PubMed
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Canadian family physicians' intentions to migrate: associated factors.

https://arctichealth.org/en/permalink/ahliterature151529
Source
Can Fam Physician. 2009 Apr;55(4):396-397.e6
Publication Type
Article
Date
Apr-2009
Author
Alain Vanasse
Sarah Scott
Josiane Courteau
Maria Gabriela Orzanco
Author Affiliation
Department of Family Medicine, University of Sherbrooke, 3001-12th Ave N., Sherbrooke, Québec. alain.vanasse@usherbrooke.ca
Source
Can Fam Physician. 2009 Apr;55(4):396-397.e6
Date
Apr-2009
Language
English
Publication Type
Article
Keywords
Adult
Cross-Sectional Studies
Female
Humans
Job Satisfaction
Logistic Models
Male
Medicine - statistics & numerical data
Middle Aged
Personnel Turnover - trends
Physician's Practice Patterns - trends
Physicians, Family - statistics & numerical data
Probability
Professional Practice Location - trends
Quebec
Questionnaires
Rural Health Services - manpower
Specialization
Urban Health Services - manpower
Abstract
To ascertain the short-term intentions of Canadian clinically active family physicians (CAFPs) to change their practice locations.
Secondary analysis of the 2004 National Physician Survey (NPS) data.
Canada.
All Canadian CAFPs who responded to the 2004 NPS survey.
Physicians' self-reported intentions to move their practice locations to other provinces or other countries. Variables included age, sex, marital status, having children, professional satisfaction, practice region (British Columbia, Alberta, the Prairies [Saskatchewan and Manitoba], Ontario, Quebec, or the Atlantic Provinces) and work setting (urban, small town, rural, etc). Logistic and regression tree analyses were used to find predictors of intention to move out of province.
The 2004 NPS was completed by 21 296 physicians, 11 041 of whom were family physicians. Of these, 8537 satisfied our study inclusion criteria. A total of 3.6% of those CAFPs planned to relocate their practices to other provinces and 3.0% planned to relocate to other countries within the next 2 years (from the time of the survey). Practising in the Prairies and, to a lesser extent, in the Atlantic Provinces were the most powerful predictors of planned interprovincial migration. Dissatisfaction with professional life was the most powerful predictor of planning migration abroad as well as being a predictor of planned interprovincial migration. Other common and statistically significant predictors of interprovincial migration and migration abroad were age, sex, and marital status.
Patients in the Prairie and Atlantic regions are at greater risk of having their family physicians migrate to other provinces than those in British Columbia, Ontario, and Quebec are. As interprovincial migration profiles differ according to region of practice, they could be used by provincial health human resource planners to understand and predict the movement of health care workers out of their respective provinces.
Notes
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PubMed ID
19366952 View in PubMed
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Disparities between rural and urban areas for osteoporosis management in the province of Quebec following the Canadian 2002 guidelines publication.

https://arctichealth.org/en/permalink/ahliterature144655
Source
J Eval Clin Pract. 2010 Jun;16(3):438-44
Publication Type
Article
Date
Jun-2010
Author
Pierre Dagenais
Alain Vanasse
Josiane Courteau
Maria Gabriela Orzanco
Shabnam Asghari
Author Affiliation
Agence d'évaluation des technologies et des modes d'intervention en santé (AETMIS), Montréal, QC, Canada.
Source
J Eval Clin Pract. 2010 Jun;16(3):438-44
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Bone Density
Disease Management
Female
Guidelines as Topic
Healthcare Disparities
Humans
Male
Observation
Osteoporosis - diagnosis - drug therapy
Physician's Practice Patterns
Quebec
Retrospective Studies
Rural Population
Urban Population
Abstract
Clinical guidelines have been seen as a tool for improving management of osteoporosis in order to prevent fragility fractures. However, the impact of guidelines on clinical management of osteoporosis has not been measured. We examined medical investigation and treatment before and after the 2002 Canadian guidelines publication and examined if practice changes were different between rural and urban areas.
We conducted a retrospective population-based observational study using secondary data analysis. Two studied populations were selected; one before, the other after the publication of Canadian practice guidelines. The studied populations consisted of all individuals 65 years or older from Quebec (Canada) for whom a physician claimed a consultation or have been hospitalized for fragility fracture between the two predefined periods.
There was no significant difference in the rate of bone mineral density testing for women before and after guidelines publication. For men a statistically significant increase was observed but remained very low. A significant increase in bisphosphonates prescribing, but no increased in the reporting of a diagnosis of osteoporosis were observed. A significant reduction of hormonal replacement therapy was seen during the year following guidelines publication. The strongest significant increases were mostly seen in urban regions compared to rural areas.
Very small changes were observed for diagnostic recognition by physicians, diagnostic testing and some recommended drugs prescribing following guidelines publication. This suggests low guidelines impact on medical practice for osteoporosis in patients suffering fragility fractures.
PubMed ID
20337832 View in PubMed
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Does elapsed time between first diagnosis of schizophrenia and migration between health territories vary by place of residence? A survival analysis approach.

https://arctichealth.org/en/permalink/ahliterature116633
Source
Health Place. 2013 Mar;20:66-74
Publication Type
Article
Date
Mar-2013
Author
André Ngamini Ngui
Alan A Cohen
Josiane Courteau
Alain Lesage
Marie-Josée Fleury
Jean-Pierre Grégoire
Jocelyne Moisan
Alain Vanasse
Author Affiliation
Groupe PRIMUS, Centre de recherche clinique Étienne-Le Bel, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC, Canada, J1H 5N4. ngaminingui@gmail.com
Source
Health Place. 2013 Mar;20:66-74
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Cohort Studies
Emigration and Immigration
Female
Humans
Male
Middle Aged
Quebec - epidemiology
Schizophrenia - diagnosis - epidemiology
Survival Analysis
Time Factors
Transients and Migrants - psychology
Young Adult
Abstract
Migration of patients with schizophrenia might influence health care access and utilization. However, the time between diagnosis and migration of these patients has not yet been explored. We studied the first migration between health territories of 6873 patients newly diagnosed with schizophrenia in Quebec in 2001, aiming to describe the pattern of migration and assess the influence of the place of residence on migration. Between 2001 and 2007, 34.5% of patients migrated between health territories; those living in metropolitan areas were more likely to migrate than others but tended to remain in metropolitan areas. Migrant patients were also more likely to stay in or migrate to the most socially or materially deprived territories.
PubMed ID
23376731 View in PubMed
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Evaluation of clinical innovation: a gray zone in the ethics of modern clinical practice?

https://arctichealth.org/en/permalink/ahliterature159448
Source
J Gen Intern Med. 2008 Jan;23 Suppl 1:27-31
Publication Type
Article
Date
Jan-2008
Author
Johane Patenaude
Andrew M Grant
Marianne Xhignesse
Frédéric Leblanc
Josiane Courteau
Author Affiliation
Department of Surgery, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada. Johane.Patenaude@USherbrooke.ca
Source
J Gen Intern Med. 2008 Jan;23 Suppl 1:27-31
Date
Jan-2008
Language
English
Publication Type
Article
Keywords
Canada
Clinical Medicine - standards
Clinical Protocols - standards
Decision Making
Ethics Committees, Research - ethics
Ethics, Medical
Evaluation Studies as Topic
Female
Health Services Research
Humans
Male
Physician's Practice Patterns - ethics
Pilot Projects
Probability
Total Quality Management
Abstract
Various stakeholders can have differing opinions regarding ethical review when introducing new procedures with patients.
This pilot study examines the way in which Research Ethics Boards (REBs; Institutional Review Boards) and clinical biochemists (CBs; laboratory medicine specialists) differ in their interpretation of what is research and what should be considered common practice versus innovation versus experimentation when introducing new procedures with patients. It also explores whether these groups agree on who is responsible for the ethical review of new procedures.
A validated case scenario for the introduction of a new diagnostic test into clinical practice was sent to CBs and REBs across Canada. Participants were asked to determine whether the scenario constituted research; whether the test procedure should be considered as experimental, innovative, or commonly accepted care; and whether the project required approval by a REB and, if not, who should be responsible for ethical review.
Results showed 81% of 37 CBs and 52% of 27 REBs identified the scenario as research. Responsibility for ethical review was assigned to REBs by 44% of REBs and 54% of CBs. Of all participants, 53% classified the test procedure as 'innovative', 8% as 'experimental', whereas 17% classified it as 'commonly accepted'.
This pilot study indicates a substantial variation in the ethical assessment of innovation in clinical care. This suggests the need to further elaborate on the types of innovation in health care and categorize the nature of the risks associated with each.
Notes
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PubMed ID
18095040 View in PubMed
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[Health inequities in mood disorders based on material and social deprivation in dwelling sectors ].

https://arctichealth.org/en/permalink/ahliterature118243
Source
Can J Psychiatry. 2012 Dec;57(12):772-81
Publication Type
Article
Date
Dec-2012
Author
Alain Vanasse
Josiane Courteau
Alain Lesage
Marie-Josée Fleury
Jean-Pierre Grégoire
Jocelyne Moisan
Sophie Lauzier
Claude Bergeron
Author Affiliation
Département de médecine de famille, Université de Sherbrooke, Sherbrooke, Canada.
Source
Can J Psychiatry. 2012 Dec;57(12):772-81
Date
Dec-2012
Language
French
Publication Type
Article
Keywords
Adult
Cohort Studies
Comorbidity
Female
Health Services - utilization
Humans
Male
Mood Disorders - drug therapy - epidemiology
Poverty - psychology - statistics & numerical data
Prescription Drugs - therapeutic use
Quebec - epidemiology
Social Isolation - psychology
Social Marginalization - psychology
Substance-Related Disorders - epidemiology
Abstract
To compare mood disorder (MD) prevalence in Quebec in 2006, and compare health services and medication use, mortality and morbidity in patients with MD based on sex and the dwelling sector level of material and social deprivation. The objective was also to identify subgroups of individuals using health services in a larger proportion and having a higher risk of morbidity and mortality.
We conducted a secondary analysis of the Régie de l’assurance maladie du Québec medico-administrative data. The cohort is composed of adults diagnosed with MD and living in Quebec in 2006. Variables include: physician consultation, medication demand, consultation for substance or alcohol abuse, emergency visit, hospitalization for a mental disorder, and death. Dwelling sector types are defined by crossing Pampalon material and social deprivation quintiles.
MD prevalence in 2006 was 3.06% (177 850 patients), with prevalence in women 1.7-fold with respect to men. Findings show a higher MD prevalence as well as a higher mortality and morbidity rate in materially and socially deprived dwelling sectors. Young men also represent a specifically vulnerable subgroup for many study variables.
Public policies aimed at improving material conditions (income, education, employment) and breaking out social isolation would have an important impact on the population mental health. Public health program development should pay close attention to young men population.
PubMed ID
23228237 View in PubMed
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