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Age-sex differences in medicinal self-poisonings: a population-based study of deliberate intent and medical severity.

https://arctichealth.org/en/permalink/ahliterature156960
Source
Soc Psychiatry Psychiatr Epidemiol. 2008 Aug;43(8):642-52
Publication Type
Article
Date
Aug-2008
Author
Anne E Rhodes
Jennifer Bethell
Julie Spence
Paul S Links
David L Streiner
R Liisa Jaakkimainen
Author Affiliation
Suicide Studies Unit, St Michael's Hospital, 2 Shuter Wing (2010f), 30 Bond Street, Toronto, ON, M5B 1W8, Canada. rhodesa@smh.toronto.on.ca
Source
Soc Psychiatry Psychiatr Epidemiol. 2008 Aug;43(8):642-52
Date
Aug-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Child
Female
Humans
Male
Middle Aged
Nonprescription Drugs - poisoning
Ontario - epidemiology
Poisoning - epidemiology
Prescription Drugs - poisoning
Sex Factors
Suicide, Attempted - statistics & numerical data
Young Adult
Abstract
Deliberate self-harm (DSH) is related to suicide and DSH repetition is common. DSH hospital presentations are often self-poisonings with medicinal agents. While older age and male sex are known risk factors for suicide, it is unclear how these factors are related to the nature and severity of medicinal self-poisoning (SP). Such knowledge can guide prevention strategies emphasizing detecting and treating mental illness and controlling access to means.
Medicinal SP presentations by 18,383 residents of Ontario, Canada, aged 12 years and older, who presented to a hospital emergency department in that province between April 1, 2001-March 31, 2002 were characterized by the agents taken, identification of deliberate intent and medical severity.
We found distinct age-sex differences in the nature and severity of medicinal SP. In youths, aged 12-17, about 40% of presentations involved analgesics, typically not prescribed and most often the acetaminophen agent-group. Females aged 12-64 were identified as deliberate more often than their male counterparts and this pattern occurred in most agent-groups, even among those who took antidepressants. The acetaminophen agent-group was most consistently associated with medical severity and this effect was strongest among female youths. Although medicinal SP was less frequent in the elderly, these presentations tended to be more medically serious and less often identified deliberate.
The high proportion of medicinal SP in youths involving agents typically not prescribed and the medical severity of the acetaminophen agent-group underscore how prevention strategies must extend beyond controlling access to antidepressants. Despite a higher risk for suicide, males and the elderly may not have their deliberate intent detected and therefore, may not receive appropriate treatment. The emergency department can serve as important link to mental health care and usage patterns can provide feedback about the need for system-level enhancements and DSH surveillance.
PubMed ID
18511993 View in PubMed
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Assessing methods for measurement of clinical outcomes and quality of care in primary care practices.

https://arctichealth.org/en/permalink/ahliterature122368
Source
BMC Health Serv Res. 2012;12:214
Publication Type
Article
Date
2012
Author
Michael E Green
William Hogg
Colleen Savage
Sharon Johnston
Grant Russell
R Liisa Jaakkimainen
Richard H Glazier
Janet Barnsley
Richard Birtwhistle
Author Affiliation
Department of Family Medicine, Queen's University, Kingston, Ontario, Canada. michael.green@dfm.queensu.ca
Source
BMC Health Serv Res. 2012;12:214
Date
2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Chronic Disease - epidemiology - therapy
Cross-Sectional Studies
Diagnosis-Related Groups - statistics & numerical data
Female
Health Knowledge, Attitudes, Practice
Health Surveys
Humans
Male
Medical Audit - methods
Middle Aged
Ontario - epidemiology
Outcome Assessment (Health Care) - methods
Patient Acceptance of Health Care - psychology - statistics & numerical data
Patient Credit and Collection
Patients - psychology
Physicians, Family - psychology - standards
Preventive Health Services - economics - standards - statistics & numerical data
Primary Health Care - standards
Quality Indicators, Health Care
Social Class
Abstract
To evaluate the appropriateness of potential data sources for the population of performance indicators for primary care (PC) practices.
This project was a cross sectional study of 7 multidisciplinary primary care teams in Ontario, Canada. Practices were recruited and 5-7 physicians per practice agreed to participate in the study. Patients of participating physicians (20-30) were recruited sequentially as they presented to attend a visit. Data collection included patient, provider and practice surveys, chart abstraction and linkage to administrative data sets. Matched pairs analysis was used to examine the differences in the observed results for each indicator obtained using multiple data sources.
Seven teams, 41 physicians, 94 associated staff and 998 patients were recruited. The survey response rate was 81% for patients, 93% for physicians and 83% for associated staff. Chart audits were successfully completed on all but 1 patient and linkage to administrative data was successful for all subjects. There were significant differences noted between the data collection methods for many measures. No single method of data collection was best for all outcomes. For most measures of technical quality of care chart audit was the most accurate method of data collection. Patient surveys were more accurate for immunizations, chronic disease advice/information dispensed, some general health promotion items and possibly for medication use. Administrative data appears useful for indicators including chronic disease diagnosis and osteoporosis/ breast screening.
Multiple data collection methods are required for a comprehensive assessment of performance in primary care practices. The choice of which methods are best for any one particular study or quality improvement initiative requires careful consideration of the biases that each method might introduce into the results. In this study, both patients and providers were willing to participate in and consent to, the collection and linkage of information from multiple sources that would be required for such assessments.
Notes
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PubMed ID
22824551 View in PubMed
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Assessing the validity of using administrative data to identify patients with epilepsy.

https://arctichealth.org/en/permalink/ahliterature105330
Source
Epilepsia. 2014 Feb;55(2):335-43
Publication Type
Article
Date
Feb-2014
Author
Karen Tu
Myra Wang
R Liisa Jaakkimainen
Debra Butt
Noah M Ivers
Jacqueline Young
Diane Green
Nathalie Jetté
Author Affiliation
Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto Western Hospital Family Health Team, University Health Network, Toronto, Ontario, Canada.
Source
Epilepsia. 2014 Feb;55(2):335-43
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Adult
Databases, Factual - standards
Electronic Health Records - standards
Epilepsy - diagnosis - epidemiology
Female
Humans
Male
Middle Aged
Ontario - epidemiology
Retrospective Studies
Abstract
Previous validation studies assessing the use of administrative data to identify patients with epilepsy have used targeted sampling or have used a reference standard of patients in the neurologist, hospital, or emergency room setting. Therefore, the validity of using administrative data to identify patients with epilepsy in the general population has not been previously assessed. The purpose of this study was to determine the validity of using administrative data to identify patients with epilepsy in the general population.
A retrospective chart abstraction study was performed using primary care physician records from 83 physicians distributed throughout Ontario and contributing data to the Electronic Medical Record Administrative data Linked Database (EMRALD) A random sample of 7,500 adult patients, from a possible 73,014 eligible, was manually chart abstracted to identify patients who had ever had epilepsy. These patients were used as a reference standard to test a variety of administrative data algorithms.
An algorithm of three physician billing codes (separated by at least 30 days) in 2 years or one hospitalization had a sensitivity of 73.7% (95% confidence interval [CI] 64.8-82.5%), specificity of 99.8% (95% CI 99.6-99.9%), positive predictive value (PPV) of 79.5% (95% CI 71.1-88.0%), and negative predictive value (NPV) of 99.7% (95% CI 99.5-99.8%) for identifying patients who had ever had epilepsy.
The results of our study showed that administrative data can reasonably accurately identify patients who have ever had epilepsy, allowing for a "lifetime" population prevalence determination of epilepsy in Ontario and the rest of Canada with similar administrative databases. This will facilitate future studies on population level patterns and outcomes of care for patients living with epilepsy.
PubMed ID
24417710 View in PubMed
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Depression and mental health visits to physicians--a prospective records-based study.

https://arctichealth.org/en/permalink/ahliterature173421
Source
Soc Sci Med. 2006 Feb;62(4):828-34
Publication Type
Article
Date
Feb-2006
Author
Anne Rhodes
R Liisa Jaakkimainen
Susan Bondy
Kinwah Fung
Author Affiliation
St. Michael's Hospital, Suicide Studies & The Inner City, The Arthur Sommer Rotenberg Chair in Health Research Unit, 30 Bond Street, Toronto, Ont., Canada M5B 1W8. rhodesa@smh.toronto.on.ca
Source
Soc Sci Med. 2006 Feb;62(4):828-34
Date
Feb-2006
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Cross-Sectional Studies
Depressive Disorder - epidemiology - therapy
Family Characteristics
Female
Health Care Surveys
Health Surveys
Humans
Male
Medical Records
Mental Health Services - economics - utilization
Mental Recall
Middle Aged
National Health Programs - utilization
Ontario - epidemiology
Patient Acceptance of Health Care - statistics & numerical data
Primary Health Care - economics - utilization
Prospective Studies
Psychiatry - economics - statistics & numerical data
Abstract
Previous studies of access to care for depression have been based on cross-sectional surveys of self-reported use of mental health service use. As the recall of use may be differentially biased by mood states, inferences about how well persons with depression are accessing services in comparison to other groups may be misleading. Accordingly, we estimated the magnitude of the depression-use associations in relation to key covariates based on prospective records of mental health visits to physicians. The sample, N = 23,063, of persons 12 years and older, was drawn from the 1996/97 Ontario Health Survey and linked to their administrative mental health care records 24 months forward in time. We found that depression-use associations were in the expected direction but similar in magnitude to associations for gender and education unlike previous self-reported use surveys. Female gender was positively related to the use of a primary care physician but negatively related to seeing a psychiatrist as opposed to a primary care physician. Those who had attained higher levels of education were more likely to be seen by physicians than those with lower education levels. The meaning behind these findings bears further study as it may have implications for primary care reform and the design of future studies of access.
PubMed ID
16084633 View in PubMed
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Did changing primary care delivery models change performance? A population based study using health administrative data.

https://arctichealth.org/en/permalink/ahliterature133982
Source
BMC Fam Pract. 2011;12:44
Publication Type
Article
Date
2011
Author
R Liisa Jaakkimainen
Jan Barnsley
Julie Klein-Geltink
Alexander Kopp
Richard H Glazier
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. liisa.jaakkimainen@ices.on.ca
Source
BMC Fam Pract. 2011;12:44
Date
2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cross-Sectional Studies
Delivery of Health Care - standards
Female
Humans
Male
Middle Aged
Models, Theoretical
Ontario
Primary Health Care - standards
Quality of Health Care
Young Adult
Abstract
Primary care reform in Ontario, Canada started with the introduction of new enrollment models, the two largest of which are Family Health Networks (FHNs), a capitation-based model, and Family Health Groups (FHGs), a blended fee-for-service model. The purpose of this study was to evaluate differences in performance between FHNs and FHGs and to compare performance before and after physicians joined these new primary care groups.
This study used Ontario administrative claims data to compare performance measures in FHGs and FHNs. The study population included physicians who belonged to a FHN or FHG for at least two years. Patients were included in the analyses if they enrolled with a physician in the two years after the physician joined a FHN or FHG, and also if they saw the physician in a two year period prior to the physician joining a FHN or FHG. Performance was derived from the administrative data, and included measures of preventive screening for cancer (breast, cervical, colorectal) and chronic disease management (diabetes, heart failure, asthma).
Performance measures did not vary consistently between models. In some cases, performance approached current benchmarks (Pap smears, mammograms). In other cases it was improving in relation to previous measures (colorectal cancer screening). There were no changes in screening for cervical cancer or breast cancer after joining either a FHN or FHG. Colorectal cancer screening increased in both FHNs and FHGs. After enrolling in either a FHG or a FHN, prescribing performance measures for diabetes care improved. However, annual eye examinations decreased for younger people with diabetes after joining a FHG or FHN. There were no changes in performance measures for heart failure management or asthma care after enrolling in either a FHG or FHN.
Some improvements in preventive screening and diabetes management which were seen amongst people after they enrolled may be attributed to incentive payments offered to physicians within FHGs and FHNs. However, these primary care delivery models need to be compared with other delivery models and fee for service practices in order to describe more specifically what aspects of model delivery and incentives affect care.
Notes
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PubMed ID
21639883 View in PubMed
Less detail

The impact of rural residence on medically serious medicinal self-poisonings.

https://arctichealth.org/en/permalink/ahliterature153850
Source
Gen Hosp Psychiatry. 2008 Nov-Dec;30(6):552-60
Publication Type
Article
Author
Anne Rhodes
Jennifer Bethell
R Liisa Jaakkimainen
Julie Thurlow
Julie Spence
Paul S Links
David L Streiner
Author Affiliation
Suicide Studies Unit, St. Michael's Hospital, Toronto, ON, Canada M5B 1W8. rhodesa@smth.toronto.on.ca
Source
Gen Hosp Psychiatry. 2008 Nov-Dec;30(6):552-60
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Alcohol-Related Disorders - epidemiology
Alcoholism - epidemiology
Analgesics - poisoning
Child
Cohort Studies
Comorbidity
Cross-Sectional Studies
Emergency Service, Hospital - statistics & numerical data
Female
Health Resources - statistics & numerical data
Health Surveys
Humans
Male
Mental Health Services - utilization
Middle Aged
Ontario
Patient Admission - statistics & numerical data
Poisoning - epidemiology
Prescription Drugs - poisoning
Rural Population - statistics & numerical data
Self-Injurious Behavior - epidemiology
Suicide, Attempted - psychology - statistics & numerical data
Utilization Review - statistics & numerical data
Young Adult
Abstract
Suicide rates are often high in rural areas. Despite the strong association between deliberate self-harm (DSH) and suicide, few have studied rural residence and DSH. Self-poisonings dominate DSH hospital presentations. We investigate a previously reported association between rural residence and medical severity (defined as a subsequent medical/surgical inpatient stay) among emergency department presentations for medicinal self-poisoning (SP) to determine whether differences in agents taken, mental health service use or hospital-level resources explain the relationship.
A cohort of n=16,294 12-64-year olds presenting with SP to hospital emergency departments in Ontario, Canada, in 2001/2002 was linked to their service records over time.
The rural-medical severity association was best explained by differences in hospital resources; presenting to hospitals providing inpatient psychiatric services appeared to reduce medical/surgical inpatient stays in favor of psychiatric ones. Among those with a recent psychiatric admission, more intensive ambulatory psychiatric contact may be protective of a psychiatric inpatient stay subsequent to the SP presentation. Compared to nonrural residents, deliberate intent was identified less often in rural residents, particularly males.
The rural-medical severity association was best explained by disparities in the delivery systems serving rural and nonrural residents, important to rural suicide prevention efforts.
PubMed ID
19061682 View in PubMed
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Office-based procedures among urban and rural family physicians in Ontario.

https://arctichealth.org/en/permalink/ahliterature119868
Source
Can Fam Physician. 2012 Oct;58(10):e578-87
Publication Type
Article
Date
Oct-2012
Author
R Liisa Jaakkimainen
Priya R Sood
Susan E Schultz
Author Affiliation
Department of Family and Community Medicine, University of Toronto, 2075 Bayview Ave, G Wing, Toronto, ON M4N 3M5. liisa.jaakkimainen@ices.on.ca
Source
Can Fam Physician. 2012 Oct;58(10):e578-87
Date
Oct-2012
Language
English
Publication Type
Article
Keywords
Ambulatory Surgical Procedures - statistics & numerical data
Cohort Studies
Diagnostic Tests, Routine - statistics & numerical data
Electrocardiography - statistics & numerical data
General Practice - statistics & numerical data
Humans
Injections - statistics & numerical data
Insurance Claim Reporting - classification - statistics & numerical data
Ontario
Phlebotomy - statistics & numerical data
Physician's Practice Patterns - statistics & numerical data
Primary Health Care - statistics & numerical data
Rural Health Services - statistics & numerical data
Urban Health Services - statistics & numerical data
Abstract
To compare FP and GP performance of office-based procedures between urban and rural practices.
Descriptive cohort study using health administrative data.
Ontario.
All FPs and GPs who billed the Ontario Health Insurance Plan for at least 1 office-based procedure between January 1 and December 31, 2006 (N = 8648).
Ontario Health Insurance Plan billings for office-based procedures were adjusted by full-time equivalent (FTE) so that the means are for 1 FTE. Office-based procedures were grouped into 1) surgical procedures, 2) injections and immunizations, 3) electrocardiograms (ECGs), and 4) venipunctures and laboratory tests. The analyses were stratified for FP and GP age, sex, rurality of practice, and participation in a primary care model.
There were no substantial differences between FPs and GPs in rural practices compared with those in more urban practices with respect to surgical procedures. Rural FPs and GPs had lower mean numbers of injections and immunizations, ECGs, and venipunctures and laboratory tests than FPs and GPs practising in urban areas. Family physicians and GPs in primary care models had a lower mean number of surgical procedures but a higher adjusted mean number of injections and immunizations, ECGs, and venipunctures and laboratory tests.
For those procedures that are not dependent on specialist backup or access to more advanced technology, there were no substantial differences between rural and urban FPs and GPs. All comprehensive FPs and GPs should be able to provide these services to their patients. Training programs for all family medicine residents should ensure future FPs and GPs are able to perform these procedures.
Notes
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PubMed ID
23064937 View in PubMed
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The rising burden of rheumatoid arthritis surpasses rheumatology supply in Ontario.

https://arctichealth.org/en/permalink/ahliterature105073
Source
Can J Public Health. 2013 Nov-Dec;104(7):e450-5
Publication Type
Article
Author
Jessica Widdifield
J Michael Paterson
Sasha Bernatsky
Karen Tu
J Carter Thorne
Vandana Ahluwalia
Noah Ivers
Debra Butt
R Liisa Jaakkimainen
George Tomlinson
Claire Bombardier
Author Affiliation
University of Toronto. jessica.widdifield@utoronto.ca.
Source
Can J Public Health. 2013 Nov-Dec;104(7):e450-5
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Arthritis, Rheumatoid - epidemiology
Cost of Illness
Databases, Factual
Female
Humans
Incidence
Male
Middle Aged
Ontario - epidemiology
Physicians - supply & distribution
Prevalence
Rheumatology - manpower
Young Adult
Abstract
Accurate data on the burden of rheumatoid arthritis (RA) are scarce, but critical in helping health care providers and decision makers to optimize clinical and public health strategies for disease management. We quantified the burden of RA in Ontario from 1996 to 2010 by age, sex and health planning region.
We used the Ontario Rheumatoid Arthritis administrative Database (ORAD), a validated population-based cohort of all Ontarians with RA, to estimate the crude prevalence and incidence of RA among men and women, and by age group from 1996 to 2010. Burden by area of patient residence and rheumatology supply also were determined.
The number of RA patients increased over time, from 42,734 Ontarians (0.5%) in 1996 to 97,499 (0.9%) in 2010. On average 5,830 new RA patients were diagnosed each year. In 2010, the burden was higher among females (1.3%) than males (0.5%) and increased with age, with almost half of all RA patients aged 65 years and older. The burden was higher in northern communities (1.0%) than in southern urban areas (0.7%). During the study period, the number of rheumatologists practicing in Ontario remained unchanged (approximately 160).
Over a 15-year period, the number of RA patients more than doubled with no concomitant increase in the number of practicing rheumatologists. We observed considerable regional variation in burden, with the highest rates observed in the north. Our findings highlight the need for regional approaches to the planning and delivery of RA care in order to manage the growing burden.
PubMed ID
24495819 View in PubMed
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Tracking family medicine graduates. Where do they go, what services do they provide and whom do they see?

https://arctichealth.org/en/permalink/ahliterature125796
Source
BMC Fam Pract. 2012;13:26
Publication Type
Article
Date
2012
Author
R Liisa Jaakkimainen
Susan E Schultz
Richard H Glazier
Caroline Abrahams
Sarita Verma
Author Affiliation
Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada. liisa.jaakkimainen@ices.on.ca
Source
BMC Fam Pract. 2012;13:26
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
Cohort Studies
Comprehensive Health Care - statistics & numerical data
Education, Medical, Graduate
Family Practice - education - manpower
Female
Health planning
Health services needs and demand
Humans
Male
Middle Aged
Ontario
Physicians, Family - supply & distribution - trends
Professional Practice Location
Workload - statistics & numerical data
Abstract
There are continued concerns over an adequate supply of family physicians (FPs) practicing in Canada. While most resource planning has focused on intake into postgraduate education, less information is available on what postgraduate medical training yields. We therefore undertook a study of Family Medicine (FM) graduates from the University of Toronto (U of T) to determine the type of information for physician resource planning that may come from tracking FM graduates using health administrative data. This study compared three cohorts of FM graduates over a 10 year period of time and it also compared FM graduates to all Ontario practicing FPs in 2005/06. The objectives for tracking the three cohorts of FM graduates were to: 1) describe where FM graduates practice in the province 2) examine the impact of a policy introduced to influence the distribution of new FM graduates in the province 3) describe the services provided by FM graduates and 4) compare workload measures. The objectives for the comparison of FM graduates to all practicing FPs in 2005/06 were to: 1) describe the patient population served by FM graduates, 2) compare workload of FM graduates to all practicing FPs.
The study cohort consisted of all U of T FM postgraduate trainees who started and completed their training between 1993 and 2003. This study was a descriptive record linkage study whereby postgraduate information for FM graduates was linked to provincial health administrative data. Comprehensiveness of care indicators and workload measures based on administrative data where determined for the study cohort.
From 1993 to 2003 there were 857 University of Toronto FM graduates. While the majority of U of T FM graduates practice in Toronto or the surrounding Greater Toronto Area, there are FM graduates from U of T practicing in every region in Ontario, Canada. The proportion of FM graduates undertaking further emergency training had doubled from 3.6% to 7.8%. From 1993 to 2003, a higher proportion of the most recent FM graduates did hospital visits, emergency room care and a lower proportion undertook home visits. Male FM graduates appear to have had higher workloads compared with female FM graduates, though the difference between them was decreasing over time. A 1997 policy initiative to discount fees paid to new FPs practicing in areas deemed over supplied did result in a decrease in the proportion of FM graduates practicing in metropolitan areas.
We were able to profile the practices of FM graduates using existing and routinely collected population-based health administrative data. Further work tracking FM graduates could be helpful for physician resource forecasting and in examining the impact of policies on family medicine practice.
Notes
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