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Access to care in the Indian Health Service.

https://arctichealth.org/en/permalink/ahliterature6178
Source
Health Aff (Millwood). 1993;12(3):224-33
Publication Type
Article
Date
1993
Author
P J Cunningham
Author Affiliation
Center for General Health Services Intramural Research, Agency for Health Care Policy and Research, Rockville, MD.
Source
Health Aff (Millwood). 1993;12(3):224-33
Date
1993
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Child
Child, Preschool
Eligibility Determination
Employment
Female
Health Care Reform
Health Services Accessibility - statistics & numerical data
Humans
Indians, North American - statistics & numerical data
Infant
Male
Middle Aged
Socioeconomic Factors
United States
United States Indian Health Service - utilization
Abstract
The Indian Health Service (IHS) is unique among U.S. private and public health programs in that free comprehensive health services are provided to eligible American Indians and Alaska Natives regardless of their ability to pay. However, resource limitations may compel some eligible persons to go outside of the IHS system to receive health care. Although IHS eligibles have comparatively low rates of private or public health care coverage, and much of this population lives in underserved areas, over half of IHS-eligible persons had some type of out-of-plan use in 1987. Furthermore, services received through private providers appear to supplement those received through IHS-sponsored providers. Overall, persons who use both IHS and non-IHS providers have higher levels of health care use than do those who rely exclusively on the IHS.
PubMed ID
8244235 View in PubMed
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Adult liver transplant survey: policies towards eligibility criteria in Canada and the United States 2007.

https://arctichealth.org/en/permalink/ahliterature154959
Source
Liver Int. 2008 Nov;28(9):1250-5
Publication Type
Article
Date
Nov-2008
Author
Karen I Kroeker
Vincent G Bain
Thomas Shaw-Stiffel
Tse-Ling Fong
Eric M Yoshida
Author Affiliation
Department of Medicine, University of Alberta, Edmonton, AB, Cananda.
Source
Liver Int. 2008 Nov;28(9):1250-5
Date
Nov-2008
Language
English
Publication Type
Article
Keywords
Canada
Eligibility Determination
Humans
Liver Transplantation - contraindications
Questionnaires
United States
Abstract
To assess the current practice patterns of liver transplant centres in Canada and the USA regarding transplant eligibility.
Liver transplantation is an evolving field and today remains the only life-sustaining treatment for end-stage liver disease. Issues of allocation and transplant eligibility are important factors in the ethical practice of medicine.
Questionnaires were mailed to liver transplant programme directors in Canada and the USA inquiring about current practices regarding recipient eligibility.
This study demonstrates that there is consensus in the use of other eligibility criteria, including non-compliance, social status, abstinence from alcohol and methadone and cocaine use. Interestingly, literature is lacking to support the use of these parameters as eligibility criteria with the exception of alcohol. There is a lack in consensus regarding marijuana use, human immunodeficiency virus status, ability to accept blood transfusions and prisoner status. The literature suggests that liver transplantation in select patients who refuse blood transfusions results in good outcomes.
Important decisions regarding transplant eligibility still have to be made empirically in the absence of scientific literature about various social issues. While consensus among transplant programmes is useful, it is important that we continue to use the evidence in the literature to revise these eligibility criteria, keeping in mind ethical principles applied to the access and allocation of a scarce resource.
Notes
Comment In: Liver Int. 2008 Nov;28(9):1186-918822075
PubMed ID
18822078 View in PubMed
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Agreement among Canadian retina specialists in the determination of treatment eligibility for photodynamic therapy in age-related macular degeneration.

https://arctichealth.org/en/permalink/ahliterature155906
Source
Retina. 2008 Nov-Dec;28(10):1421-6
Publication Type
Article
Author
Rajeev H Muni
Michael Altaweel
Matthew Tennant
Bruce Weaver
Peter J Kertes
Author Affiliation
Department of Ophthalmology and Vision Sciences, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Source
Retina. 2008 Nov-Dec;28(10):1421-6
Language
English
Publication Type
Article
Keywords
Canada
Choroidal Neovascularization - classification - diagnosis - drug therapy
Eligibility Determination - standards
Fluorescein Angiography - standards
Humans
Macular Degeneration - classification - diagnosis - drug therapy
Medicine
Observer Variation
Ophthalmology - standards
Photochemotherapy
Specialization
Abstract
To determine inter- and intraobserver agreement among Canadian retina specialists in their angiographic classification of choroidal neovascularization and their decision to treat with photodynamic therapy. Agreement was also determined between retina specialists and a Reading Center.
Forty retina specialists graded 24 cases of exudative age-related macular degeneration on two occasions separated by 6 months. Participants were asked to categorize the choroidal neovascularization and indicate if they would treat with photodynamic therapy. Agreement was determined for decision to treat and for interpretation of the fluorescein angiogram. Angiographic interpretation by participants was compared with that of the Reading Center.
The kappas among the 40 participants for lesion categorization and treatment decision were 0.43 (95% confidence interval: 0.36-0.52) and 0.29 (95% confidence interval: 0.18-0.42), respectively. The kappa for intraobserver agreement was 0.57 (95% confidence interval: 0.50-0.64) for lesion categorization and 0.58 (95% confidence interval: 0.43-0.74) for treatment decision. The mean percent agreement with the Reading Center for lesion categorization was 65.4%.
There was moderate interobserver agreement for choroidal neovascularization categorization and poor agreement among Canadian retina specialists for decision to treat with photodynamic therapy. There was moderate intraobserver agreement for both treatment decision and lesion categorization. There was moderate agreement between observers and the Reading Center for angiographic choroidal neovascularization categorization.
PubMed ID
18667952 View in PubMed
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Antibodies to hepatitis B core in Danish blood donors: a surrogate marker for 'high-risk' behaviour?

https://arctichealth.org/en/permalink/ahliterature56634
Source
Vox Sang. 2002 Apr;82(3):161; author reply 161
Publication Type
Article
Date
Apr-2002
Author
C. Moore
J. Barbara
P. Hewitt
Source
Vox Sang. 2002 Apr;82(3):161; author reply 161
Date
Apr-2002
Language
English
Publication Type
Article
Keywords
Biological Markers - analysis
Blood Donors
Denmark
Eligibility Determination
Female
Hepatitis B Antibodies - analysis
Humans
Male
Prostitution
Risk-Taking
Tattooing
Notes
Comment On: Vox Sang. 1997;72(4):207-109228709
Comment On: Vox Sang. 2001 Nov;81(4):222-711903997
PubMed ID
11952992 View in PubMed
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Availability of services in Ontario hospices and hospitals providing inpatient palliative care.

https://arctichealth.org/en/permalink/ahliterature125136
Source
J Palliat Med. 2012 May;15(5):527-34
Publication Type
Article
Date
May-2012
Author
Kathryn Towns
Elizabeth Dougherty
Nanor Kevork
David Wiljer
Dori Seccareccia
Gary Rodin
Lisa W Le
Camilla Zimmermann
Author Affiliation
Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Ontario, Canada.
Source
J Palliat Med. 2012 May;15(5):527-34
Date
May-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Eligibility Determination
Health Care Surveys
Health Services Accessibility
Hospice Care
Hospitals, Public
Humans
Middle Aged
Ontario
Palliative Care
Personnel Staffing and Scheduling
Young Adult
Abstract
Most Canadians die in inpatient settings. Our aim was to determine the availability of medical services, programs, and care for common palliative procedures, in hospices, palliative care units (PCUs), and hospital medical wards (MWs) providing inpatient palliative care in Ontario, Canada.
We identified facilities providing inpatient palliative care using the Ontario Hospital Association (OHA) and Hospice Association of Ontario (HAO) websites. An electronic survey was sent to the person responsible for palliative care at each facility. We compared services available among the three types of units, using Fisher's exact and Kruskal-Wallis tests.
Of 128 surveys sent, 102 (80%) were completed and returned, from 58 MWs, 31 PCUs, and 13 hospices. MWs were the most common location of palliative care overall, particularly in rural areas. PCUs were most likely to provide care for common procedures (e.g., tracheostomy, nephrostomy; p
PubMed ID
22512831 View in PubMed
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Awareness of indications for device therapy among a broad range of physicians: a survey study.

https://arctichealth.org/en/permalink/ahliterature264326
Source
Europace. 2014 Nov;16(11):1580-6
Publication Type
Article
Date
Nov-2014
Author
Hübinette C
Lund LH
Gadler F
Stahlberg M
Source
Europace. 2014 Nov;16(11):1580-6
Date
Nov-2014
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Awareness
Cardiac Resynchronization Therapy - utilization
Cardiac Resynchronization Therapy Devices - utilization
Death, Sudden, Cardiac - etiology - prevention & control
Defibrillators, Implantable - utilization
Electric Countershock - instrumentation - utilization
Eligibility Determination
Female
Guideline Adherence
Health Care Surveys
Health Knowledge, Attitudes, Practice
Heart Failure - complications - diagnosis - physiopathology - therapy
Humans
Male
Middle Aged
Physician's Practice Patterns
Physicians - psychology
Practice Guidelines as Topic
Primary Prevention - instrumentation - methods
Questionnaires
Referral and Consultation
Sweden
Abstract
Cardiac resynchronization therapy (CRT) and primary prophylactic implantable cardioverter-defibrillators (ICDs) are underutilized in heart failure (HF). This may originate from an unawareness of device benefits and indications among physicians responsible for HF care and referral. We aimed to describe the awareness of indications for device therapy in a generalized sample of Swedish physicians.
A randomly selected sample of Swedish physicians specializing in cardiology, internal medicine, and family medicine and interns (5% of eligible physicians, n = 519) was invited to fill in a 23-item survey, testing their awareness of indications for device therapy and, as comparison, pharmacological therapy. Acceptable awareness (AA) of CRT indication was predefined as recognizing that a left bundle branch block on ECG warrants further evaluation for CRT. Acceptable awareness of ICD indication was predefined as recognizing that ejection fraction =35% alone, without a history of ventricular tachycardia, is sufficient to warrant a primary prophylactic ICD. The response rate was 37% (n = 168). Overall, 32% met AA of CRT indication, and significantly less (15%) met AA of ICD indication. Specialist certification in cardiology was the only significant predictor for AA [odds ratio (95% confidence interval): 37 (10-138)]. However, even among cardiologists, awareness of ICD indications was low (61% with AA). Guideline-recommended indications for pharmacological therapy were conceived significantly better (P = 0.02) than device therapy [median (interquartile range) of correct answers: 50% (33-50) compared with 36% (14-57)].
The study identified an important and substantial awareness gap in the medical community that may explain some of the previously reported low referral rates and utilization of device therapy in HF.
PubMed ID
24451291 View in PubMed
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The born identity: prescription drug coverage by eligibility group.

https://arctichealth.org/en/permalink/ahliterature131273
Source
Can Fam Physician. 2011 Sep;57(9):1016-8
Publication Type
Article
Date
Sep-2011
Author
Fok-Han Leung
Rachael Frankford
Author Affiliation
Family Practice Unit, St Michael's Hospital, Toronto, ON M5B 1W8, Canada. fokhan.leung@utoronto.ca
Source
Can Fam Physician. 2011 Sep;57(9):1016-8
Date
Sep-2011
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Birth Certificates
Canada
Diabetes Mellitus, Type 2 - drug therapy - economics
Eligibility Determination
Emigrants and Immigrants
Female
Humans
Insurance, Pharmaceutical Services - economics - legislation & jurisprudence
Middle Aged
Notes
Cites: Arch Intern Med. 2000 Jun 26;160(12):1825-3310871977
Cites: CMAJ. 2008 Feb 12;178(4):405-918268266
Cites: Healthc Q. 2004;7(4):suppl 13-915540402
Cites: Med Care. 2001 Apr;39(4):315-2611329519
PubMed ID
21918145 View in PubMed
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Canada's northern food subsidy Nutrition North Canada: a comprehensive program evaluation.

https://arctichealth.org/en/permalink/ahliterature290437
Source
Int J Circumpolar Health. 2017; 76(1):1279451
Publication Type
Journal Article
Date
2017
Author
Tracey Galloway
Author Affiliation
a Department of Anthropology , University of Toronto Mississauga , Mississauga , Canada.
Source
Int J Circumpolar Health. 2017; 76(1):1279451
Date
2017
Language
English
Publication Type
Journal Article
Keywords
Arctic Regions
Canada
Commerce
Eligibility Determination
Food Assistance - economics - legislation & jurisprudence - organization & administration - statistics & numerical data
Food Supply - economics - statistics & numerical data
Humans
Program Evaluation
Abstract
Nutrition North Canada (NNC) is a retail subsidy program implemented in 2012 and designed to reduce the cost of nutritious food for residents living in Canada's remote, northern communities. The present study evaluates the extent to which NNC provides access to perishable, nutritious food for residents of remote northern communities.
Program documents, including fiscal and food cost reports for the period 2011-2015, retailer compliance reports, audits of the program, and the program's performance measurement strategy are examined for evidence that the subsidy is meeting its objectives in a manner both comprehensive and equitable across regions and communities.
NNC lacks price caps or other means of ensuring food is affordable and equitably priced in communities. Gaps in food cost reporting constrain the program's accountability. From 2011-15, no adjustments were made to community eligibility, subsidy rates, or the list of eligible foods in response to information provided by community members, critics, the Auditor General of Canada, and the program's own Advisory Board. Measures to increase program accountability, such as increasing subsidy information on point-of-sale receipts, make NNC more visible but do nothing to address underlying accountability issues Conclusions: The current structure and regulatory framework of NNC are insufficient to ensure the program meets its goal. Both the volume and cost of nutritious food delivered to communities is highly variable and dependent on factors such as retailers' pricing practices, over which the program has no control. It may be necessary to consider alternative forms of policy in order to produce sustainable improvements to food security in remote, northern communities.
Notes
Cites: Int J Circumpolar Health. 2016 Jul 05;75:31127 PMID 27388896
PubMed ID
28151097 View in PubMed
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110 records – page 1 of 11.