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Characteristics of people living with HIV who use community-based services in Ontario, Canada: implications for service providers.

https://arctichealth.org/en/permalink/ahliterature171033
Source
J Assoc Nurses AIDS Care. 2005 Jul-Aug;16(4):50-63
Publication Type
Article
Author
Peter Williams
Lea Narciso
Gina Browne
Jacqueline Roberts
Robin Weir
Amiram Gafni
Author Affiliation
Ontario AIDS Network, Toronto, Ontario, Canada.
Source
J Assoc Nurses AIDS Care. 2005 Jul-Aug;16(4):50-63
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Chi-Square Distribution
Community Health Services - economics - utilization
Cross-Sectional Studies
Depression - virology
Female
Financing, Personal - statistics & numerical data
HIV Infections - complications - epidemiology - psychology
Health Care Surveys
Health Expenditures - statistics & numerical data
Health services needs and demand
Health status
Health Surveys
Humans
Karnofsky Performance Status
Male
Ontario - epidemiology
Patient Acceptance of Health Care - psychology - statistics & numerical data
Poverty - psychology - statistics & numerical data
Quality of Life
Questionnaires
Social Work - statistics & numerical data
Socioeconomic Factors
Abstract
Community-based AIDS service organizations (CBAOs) direct services to multiple-needs people living with HIV/AIDS who are less likely to use mainstream health promotion services. As people live longer with HIV, the potential to enhance quality of life increases, yet little is known about who uses CBAOs or how this use affects other health and social services. This study of people living with AIDS in Ontario, Canada (n = 297) examined the demographic and health-related characteristics of people with AIDS who do and do not use CBAOs and their patterns of mainstream service utilization. It found that users of CBAOs were significantly less healthy, less able to sustain normal activities, and more often depressed. They reported physical disabilities significantly more often. Their quality of life was also lower along certain dimensions. They were significantly poorer and more reliant on government income supports. They consumed significantly more nonhospital health and social services and had significantly higher out-of-pocket costs. These results suggest CBAOs are being accessed appropriately by those most vulnerable. In an effort to strengthen CBAO capacity to recognize and address depression and physical health problems prevalent among their clients, links to other mainstream health promotion and social services is recommended.
PubMed ID
16435530 View in PubMed
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A comparison of the cost-effectiveness of stroke care provided in London and Copenhagen.

https://arctichealth.org/en/permalink/ahliterature72117
Source
Int J Technol Assess Health Care. 2000;16(2):684-95
Publication Type
Article
Date
2000
Author
R. Grieve
V. Porsdal
J. Hutton
C. Wolfe
Author Affiliation
Guy's, King's, and St. Thomas' School of Medicine.
Source
Int J Technol Assess Health Care. 2000;16(2):684-95
Date
2000
Language
English
Publication Type
Article
Keywords
Aged
Cerebrovascular Accident - economics - therapy
Community Health Services - economics - utilization
Comparative Study
Cost-Benefit Analysis
Cross-Cultural Comparison
Denmark
Diagnostic Services - economics - utilization
Female
Health Care Costs - statistics & numerical data
Hospital Units - economics - utilization
Humans
Length of Stay - economics
London
Male
Middle Aged
Patient transfer
Regression Analysis
Rehabilitation Centers - economics - utilization
Research Support, Non-U.S. Gov't
Value of Life
Abstract
OBJECTIVES: This study compared the relative cost-effectiveness of stroke care provided in London and Copenhagen. METHODS: Hospitalized stroke patients at centers in London (1995-96) and Copenhagen (1994-95) were included. Each patient's use of hospital and community health services was recorded for 1 year after stroke. Center-specific unit costs were collected and converted into dollars using the Purchasing Power Parity Index. An incremental cost-effectiveness ratio (ICER) was calculated comparing a Copenhagen model of stroke care to a London model, using regression analysis to adjust for case-mix differences. RESULTS: A total of 625 patients (297 in Copenhagen, 328 in London) were included in the analysis. Most patients in London (85%) were admitted to general medical wards, with 26% subsequently transferred to a stroke unit. In Copenhagen, 57% of patients were directly admitted to a stroke or neurology unit, with 23% then transferred to a separate rehabilitation hospital. The average length of total hospital stay was 11 days longer in Copenhagen. Patients in Copenhagen were less likely to die than those in London; for patients with cerebral infarction the hazard ratio after case-mix adjustment was 0.53 (95% CI from 0.35 to 0.80). However, a lower proportion of patients with hemorrhagic stroke died in London. The ICER of using the Copenhagen compared with the London model of care ranged from $21,579 to $37,444 per life-year gained for patients with cerebral infarctions. CONCLUSIONS: The ICERs of the Copenhagen compared with the London model of care were within a range generally regarded as cost-effective.
PubMed ID
10932433 View in PubMed
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Estimating the economic costs of antidepressant discontinuation during pregnancy.

https://arctichealth.org/en/permalink/ahliterature150292
Source
Can J Psychiatry. 2009 Jun;54(6):399-408
Publication Type
Article
Date
Jun-2009
Author
Lisa O'Brien
Audrey Laporte
Gideon Koren
Author Affiliation
Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Ontario. lobrien14@gmail.com
Source
Can J Psychiatry. 2009 Jun;54(6):399-408
Date
Jun-2009
Language
English
Publication Type
Article
Keywords
Antidepressive Agents - contraindications - economics - therapeutic use
Community Health Services - economics - utilization
Cross-Sectional Studies
Depression, Postpartum - economics - epidemiology
Depressive Disorder, Major - drug therapy - economics - epidemiology
Female
Humans
Infant, Low Birth Weight
Infant, Newborn
Obstetric Labor, Premature - economics
Ontario
Pregnancy
Pregnancy Complications - drug therapy - economics - epidemiology
Recurrence - prevention & control
Risk assessment
Abstract
Depression is a major public health concern that results in a wide range of economic costs to people, their families, and the health care system. Our study sought to determine the direct medical costs incurred by the Ontario government owing to cessation of antidepressant therapy during pregnancy.
We conducted an economic evaluation by making assumptions based on data obtained from Statistics Canada, federal and provincial government reports, and relevant depression literature. The analysis included the number of pregnant women with depression residing in Ontario and, subsequently, the number of those women who experienced depressive relapse during pregnancy owing to discontinuation of antidepressant medication. The cost of physician services, hospitalizations, and the birth of preterm and low birth weight infants (2 adverse outcomes associated with untreated depression during pregnancy) were also taken into consideration.
An estimated 2953 pregnant women with depression in Ontario annually discontinue antidepressant therapy and subsequently have a depressive relapse. An estimated $20 546 982 is spent annually in Ontario on untreated maternal depression in pregnancy; this is the total after subtracting the cost of risks associated with treated depression during pregnancy ($3 144 053).
Safe treatment options for the management of depression during pregnancy should be actively explored as treated depression translates into cost savings for the Ontario government and society as a whole. Beyond this cost, depression interferes with the quality of childrearing, maternal responsiveness to infants, and other determinants essential for optimal child development.
PubMed ID
19527560 View in PubMed
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Socio-economic differences in daycare arrangements and use of medical care and antibiotics in Swedish preschool children.

https://arctichealth.org/en/permalink/ahliterature32462
Source
Acta Paediatr. 2000 Oct;89(10):1250-6
Publication Type
Article
Date
Oct-2000
Author
A. Hjern
B. Haglund
F. Rasmussen
M. Rosén
Author Affiliation
Department of Clinical Sciences, Huddinge University Hospital, Karolinska Institutet, Stockholm, Sweden.
Source
Acta Paediatr. 2000 Oct;89(10):1250-6
Date
Oct-2000
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Anti-Bacterial Agents - economics - therapeutic use
Child Day Care Centers - economics - utilization
Child, Preschool
Community Health Services - economics - utilization
Drug Utilization - economics
Female
Health Policy - economics
Humans
Infant
Infant, Newborn
Male
Middle Aged
Population Surveillance
Questionnaires
Socioeconomic Factors
Sweden
Abstract
In this study we describe socio-economic patterns of daycare enrolment, medical care and antibiotics in children, 0-5 y, whose parents participated in the Swedish Survey of Living Conditions 1996-97. Children in families with low socio-economic status and unemployed parents were less often enrolled in out-of-home care. Multivariate analyses (adjusted for various sociodemographic indicators, type of daycare and chronic morbidity) demonstrated that children 1-5 y in families with low social status (low parental education and/or low SES) were less likely to have paid a visit to a physician because of an acute infection during the previous 3 mo [odds ratio (OR) 0.6 (0.4-0.8)] or to have consumed antibiotics during the previous 12 mo [OR 0.8 (0.6-1.0)] compared to children with a higher social status. Children in out-of-home care more often had paid a visit to a physician because of an acute infection during the previous 3 mo [OR 1.5 (1.2-1.9)] and more often had consumed antibiotics during the previous 12 mo [OR 1.7 (1.3-2.1)] than children in home care. The effect of out-of-home care on use of medical care and antibiotics decreased with increasing age of the child, and deviated from the null hypothesis in children 1-3 y only. CONCLUSION: Preschool children in families with a low social status consume less medical care and are less likely to attend out-of-home care compared to children with a higher social status in Swedish society. This inequity needs to be addressed in social and health policy.
PubMed ID
11083384 View in PubMed
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Socioeconomic differences in use of medical care and antibiotics among schoolchildren in Sweden.

https://arctichealth.org/en/permalink/ahliterature31949
Source
Eur J Public Health. 2001 Sep;11(3):280-3
Publication Type
Article
Date
Sep-2001
Author
A. Hjern
B. Haglund
M. Rosén
Author Affiliation
Department of Clinical Sciences, Huddinge University Hospital, Karolinska Institutet, Stockholm, Sweden. anders.hjern@sos.se
Source
Eur J Public Health. 2001 Sep;11(3):280-3
Date
Sep-2001
Language
English
Publication Type
Article
Keywords
Adolescent
Anti-Bacterial Agents - economics - therapeutic use
Child
Community Health Services - economics - utilization
Cross-Sectional Studies
Drug Utilization - economics
Female
Humans
Logistic Models
Male
Socioeconomic Factors
Sweden
Abstract
BACKGROUND: Studies of mortality among children and adults in Sweden have demonstrated considerable socioeconomic differences. This paper describes socioeconomic patterns of physical morbidity and use of medical care and antibiotics in schoolchildren in Sweden. METHODS: A cross-sectional study based on parent interviews from the Swedish Survey of Living Conditions in 1996-1997 was used. The study population consisted of 3,557 children aged 6-15 years. RESULTS: Forty-five percent of the schoolchildren in the study were reported to have been absent from school because of illness at least once during the previous three months, 8% were taking regular medication and 10% had ever suffered from a chronic disorder. There were no indications of socioeconomic differences according to the education of the responding parent in morbidity or use of consultations with a physician. However, children in families where the responding parents had primary education only consumed antibiotics less often (OR 0.7 and CI: 0.5-0.9) when compared to children in families with post-secondary education. Children in rural areas used consultations with a physician less often and consumed less antibiotics (adjusted OR 0.7 and CI: 0.4-0.9 and 0.7 and CI: 0.5-0.9 respectively). CONCLUSION: No obvious patterns of socioeconomic inequality in physical morbidity or use of medical care were identified among schoolchildren in Sweden. Further studies are needed in order to explain the social inequality in consumption of antibiotics among schoolchildren in Sweden and to describe social and regional patterns of psychiatric, behavioural and psychosomatic morbidity.
PubMed ID
11582607 View in PubMed
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Use of medical care after a community-based health promotion program: a quasi-experimental study.

https://arctichealth.org/en/permalink/ahliterature214570
Source
Am J Health Promot. 1995 Sep-Oct;10(1):47-53; discussion 54
Publication Type
Article
Author
M. Cousins
I. McDowell
Author Affiliation
Department of Epidemiology and Community Medicine, University of Ottawa, Ontario, Canada.
Source
Am J Health Promot. 1995 Sep-Oct;10(1):47-53; discussion 54
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Case-Control Studies
Chi-Square Distribution
Community Health Services - economics - utilization
Health Behavior
Health promotion
Humans
Longitudinal Studies
Ontario
Program Evaluation
Abstract
To assess the effects of health promotion on the use of medical care services in a community setting.
Quasi-experimental, multiple time points, case-comparison group.
Community health center in Ottawa, Canada.
520 volunteer participants in a health promotion program and 932 matched comparison subjects.
The health promotion program consisted of a weekend workshop on health behaviors, lifestyle assessment, and identification of weekly goals for change. This was followed by 18 months of support (5 group sessions, weekly telephone calls, and optional individual sessions).
Computerized data on health care use 6 months before, 18 months during, and 6 months after the program were obtained from Ontario's universal Health Insurance Plan (OHIP). These data were used to determine the number and system costs of visits made by participants and comparisons.
When controlling for baseline differences through analysis of covariance, program participants were found to have higher costs and more visits for ambulatory care during the first year (p
PubMed ID
10155658 View in PubMed
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6 records – page 1 of 1.