September, 2013
Quantifying Health Services Use for Chronic Obstructive Pulmonary Disease
Andrea S. Gershon, MD1,2,3,4, Jun Guan, MSc2, J. Charles Victor, MSc2,3, Roger Goldstein, MD4,5, Teresa To, PhD2,3,4.
1Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada, 2Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, 3>University of Toronto, Toronto, Ontario, Canada,
4The Hospital For Sick Children, Toronto, Ontario, Canada, and 5Westpark Healthcare Centre, Toronto, Ontario, Canada.
Rationale: Chronic obstructive pulmonary disease (COPD), a common manageable condition, is a leading cause of death. A better understanding of its impact on health care systems would inform strategies to reduce its burden.
Objective: To quantify health services use in a large, North American COPD population.
Methods: We conducted a cohort study using health administrative data from Ontario, a province with a population of 13 million and universal health care insurance. All individuals with physician diagnosed COPD in 2008 were identified and followed for 3 years. Proportions of all hospital visits, emergency department visits, ambulatory care visits, long term care residence places, and homecare by people made or used with COPD were determined and rates of each compared between people with and without COPD.
Measurements and Main Results: A total of 853,438 individuals with COPD (11.8% of the population age 35 and older) were responsible for 24% of hospitalizations, 24% of emergency department visits, 21% of ambulatory care visits and filled 35% of long term care places and used 30% of homecare services. After adjusting for several factors, people with COPD had rates of hospital, emergency department and ambulatory care visits that were, respectively, 63%, 85%, and 48% higher rates than the rest of the population. Their rates of long term care and homecare use were 56% and 59% higher.
Conclusions : Individuals with COPD use large and disproportionate amounts of health services. Strategies that target this group are needed to improve their health and minimize their need for health services.
For more information please contact: Dr. Andrea Gershon E-mail: andrea.gershon@ices.on.ca
October, 2013
Emigration Pattern Of Canadian Physicians to the United States: Dramatic Change
T. R. Freeman*, S. Petterson**, A. Bazemore**, S. Finnegan**
* Centre for Studies in Family Medicine, Department of Family Medicine, Western University, London, Ontario.
** The Robert Graham Center for Policy Research in Family Medicine and Primary Care, Washington, D.C.
Background: Graduates of Canadian medical schools immigrating to the United States for purposes such as post-graduate training or permanent residence have been a fixture in medical human resource planning for decades. Research published in 2007 found that the equivalent of the graduating classes of two average sized medical schools in Canada were leaving for the United States each year. Changes in the medical landscape of both countries prompted this review which is relevant to health human resource planning.
Methods: We conducted a cross-sectional analysis of the 2012 American Medical Association (AMA) Masterfile to identify and locate any graduates of Canadian schools of medicine that were working in the United States in direct patient care. The AMA Masterfile captures data on all physicians working in the United States, including demographics, origins, working addresses and location of training. We conducted frequency analysis by birth country, rural/urban practice location and school. We reviewed annual reports of the Canadian Resident Matching Service (CaRMS); the Canadian Post-MD Education Programs (CAPER); and the Canadian Collaborative Centre for Physician Resources (C3PR).
Results: Beginning in the early 1990s the number of Canadian medical school graduates locating in the U.S. reached an all-time high and then abruptly dropped off in 1995. Just over 50% of Canadian graduates in the U.S. came from one of four medical schools (McGill, University of Toronto, University of Alberta and University of Manitoba. Canadian medical graduates are going to the U.S. for post-graduate training in smaller numbers and, those who do train there, are less likely to remain there than at any time since the 1970’s.
Interpretation: Canadian medical graduates decision to emigrate to the U.S. may be influenced by both ‘push’ and ‘pull’ factors. The relative strength of these factors changed and by 2004, more Canadian medical graduates were returning from abroad than were leaving and the current outflow is negligible. Both countries face current and projected shortages of physicians of all types, particularly in primary care, and the relative strengths of these factors will be critical to medical resource planning.
For more information please contact: Dr. Tom Freeman tfreeman@uwo.ca
November, 2013
Nursing Contributions to Chronic Disease Management in Primary Care Within Ontario, Canada
Authors: Lukewich, J. RN, PhD(Student), Edge, D. S. RN, PhD, VanDenKerkhof, E. RN, DrPH, Tranmer, J. RN, PhD
Affiliation: School of Nursing, Queen’s University, Kingston, Ontario
Statement of Purpose: Chronic diseases are most effectively managed within primary care. Nurses are well positioned within primary care to enhance the planning and delivery of healthcare resources. Although nurses of each regulatory designation working within primary care play important roles in the management of patients with chronic diseases, their specific roles and activities are not well understood. Therefore, the purpose of this study was to determine the roles and activities performed by nurses and the extent to which chronic disease management strategies have been implemented within primary care settings in Ontario, Canada.
Methods: A cross-sectional survey design was used. A questionnaire was administered to a random sample of primary care nurses, including registered practical nurses, registered nurses, and nurse practitioners, within Ontario, Canada, between May and July, 2011.
Results: Nurses engaged in a wide range of clinical activities related to chronic disease management. The percentage of nurse practitioners performing a given task was consistently higher than that of registered nurses and registered practical nurses and there was considerable overlap between the activities that registered nurses and registered practical nurses undertook. The implementation of chronic disease management strategies is not uniform across primary care practices in which the nurses worked.
Conclusions: As team-based primary care structures are becoming more prominent, it is important to clearly understand the nursing contribution to chronic disease management to optimize their role within interprofessional teams. It is also important to further explore the implementation of chronic disease management strategies within primary care across Canada.
For more information please contact: j.lukewich@gmail.com