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Kolla G, Khorasheh T, Dodd Z, Greig S, Altenberg J, Perreault Y, Bayoumi AM, Kenny KS. "Everybody is impacted. Everybody's hurting": Grief, loss and the emotional impacts of overdose on harm reduction workers. Int J Drug Policy 2024; 127:104419. [PMID: 38599035 DOI: 10.1016/j.drugpo.2024.104419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/10/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND The emotional impacts of witnessing and responding to overdose and overdose-related deaths have been largely overlooked during the drug toxicity overdose crisis in North America. Scarce research has analyzed these impacts on the health and well-being of harm reduction workers, and the broader determinants of harm reduction work. Our study investigates the experiences and impacts of witnessing and responding to frequent and escalating rates of overdose on harm reduction workers in Toronto, Canada. METHODS Using semi-structured interviews, 11 harm reduction workers recruited from harm reduction programs with supervised consumption services in Toronto, Canada, explored experiences with and reactions to overdose in both their professional and personal lives. They also provided insights on supports necessary to help people cope with overdose-related loss. We used thematic analysis to develop an initial coding framework, subsequent iterations of codes and emergent themes. RESULTS Results revealed that harm reductions workers experienced physical, emotional, and social effects from overdose-related loss and grief. While some effects were due to the toll of overdose response and grief from overdose-related losses, they were exacerbated by the lack of political response to the scale of the drug toxicity overdose crisis and the broader socio-economic-political environment of chronic underfunding for harm reduction services. Harm reduction workers described the lack of appropriate workplace supports for trauma from repeated overdose response and overdose-related loss, alongside non-standard work arrangements that resulted in a lack of adequate compensation or access to benefits. CONCLUSIONS Our study highlights opportunities for organizational practices that better support harm reduction workers, including formal emotional supports and community-based supportive care services. Improvement to the socio-economic-political determinants of work such as adequate compensation and access to full benefit packages are also needed in the harm reduction sector for all workers.
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Affiliation(s)
- Gillian Kolla
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, M5B 1W8, Canada; Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, V8N 5M8, Canada; Division of Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, A1B 3V6, Canada.
| | - Triti Khorasheh
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, M5B 1W8, Canada
| | - Zoe Dodd
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, M5B 1W8, Canada
| | - Sarah Greig
- South Riverdale Community Health Centre, Toronto, Ontario, M4M 3P3, Canada
| | - Jason Altenberg
- South Riverdale Community Health Centre, Toronto, Ontario, M4M 3P3, Canada
| | | | - Ahmed M Bayoumi
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, M5B 1W8, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, M5S 1A8, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, M5T 3M6, Canada
| | - Kathleen S Kenny
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 0W3, Canada
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Ledlie S, Tadrous M, Bayoumi AM, McCormack D, Cheng C, Besharah J, Munro C, Gomes T. Trends in opioid toxicities among people with and without opioid use disorder and the impact of the COVID-19 pandemic in Ontario, Canada: A population-based analysis. Int J Drug Policy 2024; 127:104392. [PMID: 38522177 DOI: 10.1016/j.drugpo.2024.104392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Across Canada, the COVID-19 pandemic occurred amidst an ongoing drug toxicity crisis. Although elevated rates of substance-related harms have been observed nationally, it remains unknown if the pandemic state of emergency led to disproportionate increases in opioid toxicities among people with opioid use disorder (OUD) compared to those without. METHODS We conducted a population-based repeated cross-sectional time series analysis of fatal and non-fatal opioid toxicities between January 1, 2014, and December 31, 2021, in Ontario, Canada. We used interventional autoregressive integrated moving average models to examine the impact of the pandemic on monthly rates of opioid toxicities per 100,000 Ontario residents stratified by people with and without OUD. RESULTS We identified 80,296 opioid toxicities of which 53.5 % occurred among people with OUD. Among 52,052 unique individuals, 60.5 % were male and 46.2 % were 25-44 years old. Between January 2014 and December 2021, the rate of opioid toxicities increased from 2.6 to 10.5 per 100,000 (rate ratio [RR]=4.07). The magnitude of this increase differed among people with OUD (0.8 to 7.4 per 100,000; RR=9.35) and without OUD (1.8 to 3.1 per 100,000; RR=1.74). We observed a significant ramp increase in the overall rate of opioid toxicities following the declaration of the pandemic emergency in March 2020 (+0.19 per 100,000 monthly, 95 % CI: 0.029, 0.36, p = 0.021). In a stratified analysis, we found a similar ramp increase among people with OUD (+0.19 per 100,000 monthly, 95 % CI: 0.10, 0.28, p < 0.001); however, this was not observed among people without OUD (p = 0.95). CONCLUSIONS The rate of opioid toxicities accelerated across Ontario following the pandemic-related state of emergency, with the majority of this increase among people with OUD. The important differences observed among people with OUD compared with those without, highlights the critical need for improved access to harm reduction and treatment interventions among this population.
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Affiliation(s)
- Shaleesa Ledlie
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada.
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Women's College Research Institute, Toronto, ON, Canada
| | - Ahmed M Bayoumi
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada; Division of General Internal Medicine, St. Michael's Hospital, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | | | - Clare Cheng
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Jes Besharah
- Ontario Drug Policy Research Network Lived Experience Advisory Group, Toronto, ON, Canada
| | - Charlotte Munro
- Ontario Drug Policy Research Network Lived Experience Advisory Group, Toronto, ON, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Greenwald ZR, Werb D, Feld JJ, Austin PC, Fridman D, Bayoumi AM, Gomes T, Kendall CE, Lapointe-Shaw L, Scheim AI, Bartlett SR, Benchimol EI, Bouck Z, Boucher LM, Greenaway C, Janjua NZ, Leece P, Wong WW, Sander B, Kwong JC. Validation of case-ascertainment algorithms using health administrative data to identify people who inject drugs in Ontario, Canada. J Clin Epidemiol 2024:111332. [PMID: 38522754 DOI: 10.1016/j.jclinepi.2024.111332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/12/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE Health administrative data can be used to improve the health of people who inject drugs by informing public health surveillance and program planning, monitoring, and evaluation. However, methodological gaps in the use of these data persist due to challenges in accurately identifying injection drug use at the population level. In this study, we validated case-ascertainment algorithms for identifying people who inject drugs using health administrative data in Ontario, Canada. STUDY DESIGN AND SETTING Data from cohorts of people with recent (past 12 month) injection drug use, including those participating in community-based research studies or seeking drug treatment were linked to health administrative data in Ontario from 1992-2020. We assessed the validity of algorithms to identify injection drug use over varying lookback periods (i.e., all years of data [1992 onwards] or within the past 1-5 years), including inpatient and outpatient physician billing claims for drug use, emergency department visits or hospitalizations for drug use or injection-related infections, and opioid agonist treatment (OAT). RESULTS Algorithms were validated using data from 15,241 people with recent IDU (918 in community cohorts, 14,323 seeking drug treatment). An algorithm consisting of ≥1 physician visit, emergency department visit or hospitalization for drug use, or OAT record could effectively identify IDU history (91.6% sensitivity, 94.2% specificity) and recent IDU (using 3 years lookback: 80.4% sensitivity, 99% specificity) among community cohorts. Algorithms were generally more sensitive among people who inject drugs seeking drug treatment. CONCLUSION Validated algorithms using health administrative data performed well in identifying people who inject drugs. Despite high sensitivity and specificity, the positive predictive value of these algorithms will vary depending on the underlying prevalence of injection drug use in the population in which they are applied.
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Affiliation(s)
- Zoë R Greenwald
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Dan Werb
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada,; Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, United States
| | - Jordan J Feld
- Department of Medicine, University of Toronto, Toronto, Canada; Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, Canada; University Health Network, Toronto, Canada
| | - Peter C Austin
- ICES, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | - Ahmed M Bayoumi
- ICES, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada,; Department of Medicine, University of Toronto, Toronto, Canada; Division of General Internal Medicine, St. Michael's Hospital, Unity Health Toronto,; MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto. Canada
| | - Tara Gomes
- ICES, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada,; MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto. Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada; Ontario Drug Policy Research Network, Toronto, Canada
| | - Claire E Kendall
- ICES, Toronto, Canada; Bruyère Research Institute, Ottawa, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Lauren Lapointe-Shaw
- ICES, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada,; Department of Medicine, University of Toronto, Toronto, Canada; University Health Network, Toronto, Canada
| | - Ayden I Scheim
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, United States; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Sofia R Bartlett
- British Columbia Centre for Disease Control, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Eric I Benchimol
- ICES, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada,; Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada; Department of Paediatrics, University of Toronto, Toronto, Canada; Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada
| | - Zachary Bouck
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto. Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | | | - Christina Greenaway
- Division of Infectious Diseases, Jewish General Hospital, Montreal, Canada; Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Canada; Department of Epidemiology and Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Centre for Health Evaluation & Outcome Sciences, St Paul's Hospital Vancouver, Vancouver, Canada
| | - Pamela Leece
- Public Health Ontario, Toronto, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - William Wl Wong
- ICES, Toronto, Canada; School of Pharmacy, University of Waterloo, Kitchener, Canada; Toronto Health Economics and Technology Assessment Collaborative, Toronto, Canada
| | - Beate Sander
- ICES, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada,; University Health Network, Toronto, Canada; Public Health Ontario, Toronto, Canada; Toronto Health Economics and Technology Assessment Collaborative, Toronto, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; University Health Network, Toronto, Canada; Public Health Ontario, Toronto, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
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Behrends CN, Leff JA, Lowry W, Li JM, Onuoha EN, Fardone E, Bayoumi AM, McCollister KE, Murphy SM, Schackman BR. Economic Evaluations of Establishing Opioid Overdose Prevention Centers in 12 North American cities: A Systematic Review. Value Health 2024:S1098-3015(24)00073-1. [PMID: 38401795 DOI: 10.1016/j.jval.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES Overdose prevention centers (OPCs) provide a safe place where people can consume preobtained drugs under supervision so that a life-saving medical response can be provided quickly in the event of an overdose. OPCs are programs that are established in Canada and have recently become legally sanctioned in only a few United States jurisdictions. METHODS We conducted a systematic review that summarizes and identifies gaps of economic evidence on establishing OPCs in North America to guide future expansion of OPCs. RESULTS We included 16 final studies that were evaluated with the Consolidated Health Economic Evaluation Reporting Standards and Drummond checklists. Eight studies reported cost-effectiveness results (eg, cost per overdose avoided or cost per quality-adjusted life-year), with 6 also including cost-benefit; 5 reported only cost-benefit results, and 3 cost offsets. Health outcomes primarily included overdose mortality outcomes or HIV/hepatitis C virus infections averted. Most studies used mathematical modeling and projected OPC outcomes using the experience of a single facility in Vancouver, BC. CONCLUSIONS OPCs were found to be cost-saving or to have favorable cost-effectiveness or cost-benefit ratios across all studies. Future studies should incorporate the experience of OPCs established in various settings and use a greater diversity of modeling designs.
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Affiliation(s)
- Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
| | - Jared A Leff
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Weston Lowry
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Jazmine M Li
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Erica N Onuoha
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Erminia Fardone
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ahmed M Bayoumi
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kathryn E McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
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5
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O'Brien KK, Erlandson KM, Brown DA, Carusone SC, Vera JH, Bergin C, Avery L, Bayoumi AM, Hanna SE, Harding R, Solomon P, Clair-Sullivan NS, O'Shea N, Murray C, Boffito M, Da Silva G, Torres B, McDuff K, Davis AM. Episodic disability questionnaire (EDQ) measurement properties among adults living with HIV in Canada, Ireland, United Kingdom, and United States. BMC Infect Dis 2024; 24:71. [PMID: 38200425 PMCID: PMC10782617 DOI: 10.1186/s12879-023-08958-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The Episodic Disability Questionnaire (EDQ) is a generic 35-item patient-reported outcome measure of presence, severity and episodic nature of disability. We assessed the measurement properties of the Episodic Disability Questionnaire (EDQ) with adults living with HIV. METHODS We conducted a measurement study with adults living with HIV in eight clinical settings in Canada, Ireland, United Kingdom, and United States. We electronically administered the EDQ followed by three reference measures (World Health Organization Disability Assessment Schedule; Patient Health Questionnaire; Social Support Scale) and a demographic questionnaire. We administered the EDQ only 1 week later. We assessed the internal consistency reliability (Cronbach's alpha; > 0.7 acceptable), and test-retest reliability (Intra Class Correlation Coefficient; > 0.7 acceptable). We estimated required change in EDQ domain scores to be 95% certain that a change was not due to measurement error (Minimum Detectable Change (MDC95%)). We evaluated construct validity by assessing 36 primary hypotheses of relationships between EDQ scores and scores on the reference measures (> 75% hypotheses confirmed indicated validity). RESULTS Three hundred fifty nine participants completed the questionnaires at time point 1, of which 321 (89%) completed the EDQ approximately 1 week later. Cronbach's alpha for internal consistency ranged from 0.84 (social domain) to 0.91 (day domain) for the EDQ severity scale, and 0.72 (uncertainty domain) to 0.88 (day domain) for the EDQ presence scale, and 0.87 (physical, cognitive, mental-emotional domains) to 0.89 (uncertainty domain) for the EDQ episodic scale. ICCs for test-retest reliability ranged from 0.79 (physical domain) to 0.88 (day domain) for the EDQ severity scale and from 0.71 (uncertainty domain) to 0.85 (day domain) for the EDQ presence scale. Highest precision was demonstrated in the severity scale for each domain (MDC95% range: 19-25 out of 100), followed by the presence (MDC95% range: 37-54) and episodic scales (MDC95% range:44-76). Twenty-nine of 36 (81%) construct validity hypotheses were confirmed. CONCLUSIONS The EDQ possesses internal consistency reliability, construct validity, and test-retest reliability, with limited precision when administered electronically with adults living with HIV across in clinical settings in four countries. Given the measurement properties, the EDQ can be used for group level comparisons for research and program evaluation in adults living with HIV.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, ON, Canada.
| | | | - Darren A Brown
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Soo Chan Carusone
- McMaster Collaborative for Health and Aging, McMaster University, Hamilton, ON, Canada
- Casey House, Toronto, ON, Canada
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Colm Bergin
- GUIDE Clinic, St. James's Hospital, Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Lisa Avery
- Biostatistics Department, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Ahmed M Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Steven E Hanna
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Natalie St Clair-Sullivan
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Noreen O'Shea
- GUIDE Clinic, St. James's Hospital, Hospital, Dublin, Ireland
| | | | - Marta Boffito
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - George Da Silva
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Brittany Torres
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Kiera McDuff
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Aileen M Davis
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, ON, Canada
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6
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Long C, Guimond T, Bayoumi AM, Firestone M, Strike C. The multiple makings of a supervised consumption service in a hospital setting. Int J Drug Policy 2024; 123:104260. [PMID: 38035448 DOI: 10.1016/j.drugpo.2023.104260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 11/08/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Whereas supervised consumption services (SCSs) are common in many community settings, they are seldomly found in acute care hospitals. As hospitals present unique circumstances that can shape the impacts of an SCS, careful consideration of local implementation contexts and practices is required. We explored the pre-implementation stage of an SCS, to examine how an SCS is made and made differently in relation to the material-discursive context of the hospital. METHODS We conducted 11 focus groups with 83 staff and clinicians at an inner-city hospital in Toronto, Canada. Data analysis followed principles of grounded theory and was informed by an 'evidence making interventions' framework. RESULTS While most participants indicated they would support the establishment of an SCS at the hospital, multiple enactments of an SCS emerged. An SCS was enacted: as a means to reduce drug-related risks for all people who use drugs, as an opportunity to intervene on patients' drug use, as a means to centralize drug use, and as a transformative intervention for the hospital. In our findings, harm reduction, abstinence, security, and risk mitigation goals existed closely together, yielding overlaying realities. CONCLUSION Our findings revealed various enactments of an SCS, some of which are likely to negatively affect people who use drugs and service access. As more hospitals consider the implementation of an SCS, understanding how an SCS is made in practice will be key to building a service that focuses on the needs of people who use drugs.
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Affiliation(s)
- Cathy Long
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.
| | - Tim Guimond
- Addictions Division, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, M6J 1H4, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, 6 Queen's Park Crescent West, ON, M5S 3H2, Canada
| | - Ahmed M Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, 6 Queen's Park Crescent West, ON, M5S 3H2, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7 Canada; Division of General Internal Medicine, Department of Medicine, St. Michael's Hospital, 36 Queen Street East, Toronto, ON, M5B 1W8
| | - Michelle Firestone
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada
| | - Carol Strike
- Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7 Canada
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7
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Young S, Gomes T, Kolla G, McCormack D, Dodd Z, Raboud J, Bayoumi AM. Initiations of safer supply hydromorphone increased during the COVID-19 pandemic in Ontario: An interrupted time series analysis. PLoS One 2023; 18:e0295145. [PMID: 38113220 PMCID: PMC10729949 DOI: 10.1371/journal.pone.0295145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/14/2023] [Indexed: 12/21/2023] Open
Abstract
AIMS Calls to prescribe safer supply hydromorphone (SSHM) as an alternative to the toxic drug supply increased during the COVID-19 pandemic but it is unknown whether prescribing behaviour was altered. We aimed to evaluate how the number of new SSHM dispensations changed during the pandemic in Ontario. METHODS We conducted a retrospective interrupted time-series analysis using provincial administrative databases. We counted new SSHM dispensations in successive 28-day periods from March 22, 2016 to August 30, 2021. We used segmented Poisson regression methods to test for both a change in level and trend of new dispensations before and after March 17, 2020, the date Ontario's pandemic-related emergency was declared. We adjusted the models to account for seasonality and assessed for over-dispersion and residual autocorrelation. We used counterfactual analysis methods to estimate the number of new dispensations attributable to the pandemic. RESULTS We identified 1489 new SSHM dispensations during the study period (434 [mean of 8 per 28-day period] before and 1055 [mean of 56 per 28-day period] during the pandemic). Median age of individuals initiating SSHM was 40 (interquartile interval 33-48) with 61.7% (N = 919) male sex. Before the pandemic, there was a small trend of increased prescribing (incidence rate ratio [IRR] per period 1.002; 95% confidence interval [95CI] 1.001-1.002; p<0.001), with a change in level (immediate increase) at the pandemic date (relative increase in IRR 1.674; 95CI 1.206-2.322; p = 0.002). The trend during the pandemic was not statistically significant (relative increase in IRR 1.000; 95CI 1.000-1.001; p = 0.251). We estimated 511 (95CI 327-695) new dispensations would not have occurred without the pandemic. CONCLUSION The pandemic led to an abrupt increase in SSHM prescribing in Ontario, although the rate of increase was similar before and during the pandemic. The absolute number of individuals who accessed SSHM remained low throughout the pandemic.
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Affiliation(s)
- Samantha Young
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Addiction Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Tara Gomes
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Gillian Kolla
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | | | - Zoë Dodd
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Janet Raboud
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed M. Bayoumi
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, St. Michael’s Hospital, Unity Health, Toronto, Ontario, Canada
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8
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Hu T, McCormack D, Juurlink DN, Campbell TJ, Bayoumi AM, Leece P, Kent JT, Gomes T. Initiation of opioid agonist therapy after hospital visits for opioid poisonings in Ontario. CMAJ 2023; 195:E1709-E1717. [PMID: 38110219 PMCID: PMC10727793 DOI: 10.1503/cmaj.231014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Emergency department visits and hospital admissions for opioid toxicity are opportunities to initiate opioid agonist therapy (OAT), which reduces morbidity and mortality in patients with opioid use disorder (OUD). The study objectives were to evaluate OAT initiation rates after a hospital encounter for opioid toxicity in Ontario, Canada, and determine whether publication of a 2018 Canadian OUD management guideline was associated with increased initiation. METHODS We conducted a retrospective, population-based serial cross-sectional study of hospital encounters for opioid toxicity among patients with OUD between Jan. 1, 2013, and Mar. 31, 2020, in Ontario, Canada. The primary outcome was OAT initiation (methadone, buprenorphine-naloxone, or slow-release oral morphine) within 7 days of discharge, measured quarterly. We examined the impact of the release of the OUD management guideline on OAT initiation rates using Autoregressive Integrated Moving Average models. RESULTS Among 20 702 hospital visits for opioid toxicity among patients with OUD, the median age was 35 years, and 65.1% were male. Over the study period, the percentage of visits leading to OAT initiation within 7 days rose from 1.7% or less (Q1 2013) to 5.6% (Q1 2020); however, the publication of the Canadian OUD management guideline was not associated with a significant increase in these rates (0.14% slope change, 95% confidence interval -0.11% to 0.38%; p = 0.3). INTERPRETATION Among hospital encounters for opioid toxicity, despite rising prevalence over time, only 1 in 18 patients were dispensed OAT within a week of discharge in early 2020. These findings highlight missed opportunities to initiate therapies proven to reduce mortality in patients with OUD.
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Affiliation(s)
- Tina Hu
- Department of Family and Community Medicine (Hu, Leece), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Family Medicine (Hu), McMaster University, Hamilton, Ont.; ICES (McCormack, Juurlink, Kent, Gomes), Toronto, Ont.; Sunnybrook Research Institute (Juurlink); MAP Centre for Urban Health Solutions (Campbell, Bayoumi, Gomes), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Bayoumi, Gomes), University of Toronto; Health Promotion, Chronic Disease and Injury Prevention (Leece), Public Health Ontario; Department of Emergency Medicine (Kent), University of Toronto, Toronto, Ont
| | - Daniel McCormack
- Department of Family and Community Medicine (Hu, Leece), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Family Medicine (Hu), McMaster University, Hamilton, Ont.; ICES (McCormack, Juurlink, Kent, Gomes), Toronto, Ont.; Sunnybrook Research Institute (Juurlink); MAP Centre for Urban Health Solutions (Campbell, Bayoumi, Gomes), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Bayoumi, Gomes), University of Toronto; Health Promotion, Chronic Disease and Injury Prevention (Leece), Public Health Ontario; Department of Emergency Medicine (Kent), University of Toronto, Toronto, Ont
| | - David N Juurlink
- Department of Family and Community Medicine (Hu, Leece), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Family Medicine (Hu), McMaster University, Hamilton, Ont.; ICES (McCormack, Juurlink, Kent, Gomes), Toronto, Ont.; Sunnybrook Research Institute (Juurlink); MAP Centre for Urban Health Solutions (Campbell, Bayoumi, Gomes), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Bayoumi, Gomes), University of Toronto; Health Promotion, Chronic Disease and Injury Prevention (Leece), Public Health Ontario; Department of Emergency Medicine (Kent), University of Toronto, Toronto, Ont
| | - Tonya J Campbell
- Department of Family and Community Medicine (Hu, Leece), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Family Medicine (Hu), McMaster University, Hamilton, Ont.; ICES (McCormack, Juurlink, Kent, Gomes), Toronto, Ont.; Sunnybrook Research Institute (Juurlink); MAP Centre for Urban Health Solutions (Campbell, Bayoumi, Gomes), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Bayoumi, Gomes), University of Toronto; Health Promotion, Chronic Disease and Injury Prevention (Leece), Public Health Ontario; Department of Emergency Medicine (Kent), University of Toronto, Toronto, Ont
| | - Ahmed M Bayoumi
- Department of Family and Community Medicine (Hu, Leece), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Family Medicine (Hu), McMaster University, Hamilton, Ont.; ICES (McCormack, Juurlink, Kent, Gomes), Toronto, Ont.; Sunnybrook Research Institute (Juurlink); MAP Centre for Urban Health Solutions (Campbell, Bayoumi, Gomes), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Bayoumi, Gomes), University of Toronto; Health Promotion, Chronic Disease and Injury Prevention (Leece), Public Health Ontario; Department of Emergency Medicine (Kent), University of Toronto, Toronto, Ont
| | - Pamela Leece
- Department of Family and Community Medicine (Hu, Leece), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Family Medicine (Hu), McMaster University, Hamilton, Ont.; ICES (McCormack, Juurlink, Kent, Gomes), Toronto, Ont.; Sunnybrook Research Institute (Juurlink); MAP Centre for Urban Health Solutions (Campbell, Bayoumi, Gomes), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Bayoumi, Gomes), University of Toronto; Health Promotion, Chronic Disease and Injury Prevention (Leece), Public Health Ontario; Department of Emergency Medicine (Kent), University of Toronto, Toronto, Ont
| | - Jessica T Kent
- Department of Family and Community Medicine (Hu, Leece), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Family Medicine (Hu), McMaster University, Hamilton, Ont.; ICES (McCormack, Juurlink, Kent, Gomes), Toronto, Ont.; Sunnybrook Research Institute (Juurlink); MAP Centre for Urban Health Solutions (Campbell, Bayoumi, Gomes), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Bayoumi, Gomes), University of Toronto; Health Promotion, Chronic Disease and Injury Prevention (Leece), Public Health Ontario; Department of Emergency Medicine (Kent), University of Toronto, Toronto, Ont
| | - Tara Gomes
- Department of Family and Community Medicine (Hu, Leece), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Family Medicine (Hu), McMaster University, Hamilton, Ont.; ICES (McCormack, Juurlink, Kent, Gomes), Toronto, Ont.; Sunnybrook Research Institute (Juurlink); MAP Centre for Urban Health Solutions (Campbell, Bayoumi, Gomes), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Bayoumi, Gomes), University of Toronto; Health Promotion, Chronic Disease and Injury Prevention (Leece), Public Health Ontario; Department of Emergency Medicine (Kent), University of Toronto, Toronto, Ont.
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9
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Guglielmin M, Shankardass K, O’Campo P, Bayoumi AM, Kokkinen L, Muntaner C. Developing a Research Agenda for HiAP Implementation: A Response to the Recent Commentaries. Int J Health Policy Manag 2023; 12:8326. [PMID: 38618764 PMCID: PMC10843367 DOI: 10.34172/ijhpm.2023.8326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/06/2023] [Indexed: 04/16/2024] Open
Affiliation(s)
- Maria Guglielmin
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Ketan Shankardass
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Patricia O’Campo
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ahmed M. Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Division of General Internal Medicine, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Lauri Kokkinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Carles Muntaner
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Bloomberg School of Nursing University of Toronto, Toronto, ON, Canada
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10
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Schmidt RA, Kaminski N, Kryszajtys DT, Rudzinski K, Perri M, Guta A, Benoit AC, Bayoumi AM, Challacombe L, Hales J, Kenny K, Kolla G, O'Reilly E, Sereda A, Rai N, Strike C. 'I don't chase drugs as much anymore, and I'm not dead': Client reported outcomes associated with safer opioid supply programs in Ontario, Canada. Drug Alcohol Rev 2023; 42:1825-1837. [PMID: 37718646 DOI: 10.1111/dar.13745] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/26/2023] [Accepted: 08/22/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION The ongoing opioid overdose crisis, which has killed over 30,000 people in Canada since 2016, is driven by the volatility of an unregulated opioid drug supply comprised primarily of fentanyl. The Canadian government has recently funded safer opioid supply (SOS) programs, which include off-label prescriptions of pharmaceutical-grade opioids to high risk individuals with the goal of reducing overdose deaths. METHODS In 2021, we examined the implementation and adaption of four SOS programs in Ontario. These programs use a primary care model and serve communities experiencing marginalisation. We conducted semi-structured interviews with program clients. We present the results of a thematic analysis with the aim of describing clients' self-reported impact of these programs on their health and well-being. RESULTS We interviewed 52 clients between June and October 2021 (mean age 47 years, 56% men, 17% self-identified Indigenous, 14% living with HIV). Our results indicate multifaceted pathways to improved self-reported health and well-being among clients including changes to drug use practices, fewer overdoses, reduced criminalised activity, improved trust and engagement in health care, and increased social stability (e.g., housing). DISCUSSION AND CONCLUSION Most clients reported that the intervention saved their life because of the reduced frequency of overdoses. Findings suggest that SOS programs improved clients' health outcomes and increase opportunities for engagement in health services. Our results provide insight into the mechanisms behind some of the emergent evidence on the impact of safer supply prescribing.
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Affiliation(s)
- Rose A Schmidt
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Nat Kaminski
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - David T Kryszajtys
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Katherine Rudzinski
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- School of Social Work, University of Windsor, Windsor, Canada
| | - Melissa Perri
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, Canada
| | - Anita C Benoit
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Health and Society, University of Toronto Scarborough, Scarborough, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Ahmed M Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada
| | | | - Jessica Hales
- Regent Park Community Health Centre, Toronto, Canada
| | - Kathleen Kenny
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Gillian Kolla
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Emmet O'Reilly
- South Riverdale Community Health Centre, Toronto, Canada
| | | | - Nanky Rai
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Parkdale Queen West Community Health Centre, Toronto, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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11
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Ali F, Russell C, Kaura A, Leslie P, Bayoumi AM, Hopkins S, Wells S. Client experiences using a new supervised consumption service in Sudbury, Ontario: A qualitative study. PLoS One 2023; 18:e0292862. [PMID: 37844109 PMCID: PMC10578573 DOI: 10.1371/journal.pone.0292862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023] Open
Abstract
Overdoses are increasing in the province of Ontario, Canada, where northern communities such as Sudbury have witnessed disproportionately elevated rates, with opioid-related deaths double that of the provincial average. To address this issue, governments have implemented supervised consumption services (SCS) where people who use drugs (PWUD) can use their pre-obtained substances onsite under trained supervision. In September 2022, the city of Sudbury opened its first SCS, 'The Spot', but the site's sustainability is contingent on demonstrating benefit to PWUD and the neighboring community. We undertook a qualitative study exploring experiences among clients who used the consumption service inside The Spot. In December 2022, clients of The Spot were invited to participate in a brief survey which collected socio-demographic information and substance use profiles, followed by an in-person semi-structured qualitative interview. Participant survey and interview data were combined with administrative site utilization data provided by site staff of all clients who accessed the consumption service from September 2022 to August 2023 to examine overall service utilization and uptake. Qualitative data were analyzed using iterative thematic analysis techniques, and results were informed by common responses to research questions. The responses were narratively presented. Administrative site utilization data highlighted a relatively stable increase in uptake and utilization of the site since its inception. A total of 20 clients participated in the survey and semi-structured interviews. Participants described the importance of the site in preventing and responding to overdoses, providing a safe and comfortable environment to consume their drugs, and decreasing public drug use, which they suggested may potentially reduce stigmatization in the community. However, clients also suggested challenges, including issues regarding site operational policies that hindered consumption room utilization. Service suggestions made by clients to improve site utilization include the addition of inhalation services, relocating the site to a location in downtown Sudbury where PWUD commonly congregate, and extending operational hours. Positive impacts and recommendations can be drawn on and considered by other northern or rural communities interested in implementing similar harm reduction services.
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Affiliation(s)
- Farihah Ali
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), Toronto, Ontario, Canada
| | - Cayley Russell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), Toronto, Ontario, Canada
| | - Ashima Kaura
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), Toronto, Ontario, Canada
| | - Peter Leslie
- Harm Reduction Worker, Co-chair Street Health Board of Directors, Founding Member of Toronto Overdose Prevention Society, Moss Park OPS and Toronto Harm Reduction Alliance, Toronto, Ontario, Canada
| | - Ahmed M. Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Shaun Hopkins
- The Works, Toronto Public Health, Toronto, Ontario, Canada
| | - Samantha Wells
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
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12
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Leung KHB, Yousefi N, Chan TCY, Bayoumi AM. Constrained Optimization for Decision Making in Health Care Using Python: A Tutorial. Med Decis Making 2023; 43:760-773. [PMID: 37480282 PMCID: PMC10625722 DOI: 10.1177/0272989x231188027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 06/08/2023] [Indexed: 07/23/2023]
Abstract
HIGHLIGHTS This tutorial provides a user-friendly guide to mathematically formulating constrained optimization problems and implementing them using Python.Two examples are presented to illustrate how constrained optimization is used in health applications, with accompanying Python code provided.
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Affiliation(s)
- K. H. Benjamin Leung
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
- Scottish Ambulance Service, Edinburgh, Scotland, UK
| | - Nasrin Yousefi
- Smith School of Business, Queen’s University, Kingston, ON, Canada
| | - Timothy C. Y. Chan
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Ahmed M. Bayoumi
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of General Internal Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
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13
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Butler A, Croxford R, Bodkin C, Akbari H, Bayoumi AM, Bondy SJ, Guenter D, McLeod KE, Gomes T, Kanagalingam T, Kiefer LA, Orkin AM, Owusu-Bempah A, Regenstreif L, Kouyoumdjian F. Burden of opioid toxicity death in the fentanyl-dominant era for people who experience incarceration in Ontario, Canada, 2015-2020: a whole population retrospective cohort study. BMJ Open 2023; 13:e071867. [PMID: 37164452 DOI: 10.1136/bmjopen-2023-071867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVES To describe mortality due to opioid toxicity among people who experienced incarceration in Ontario between 2015 and 2020, during the fentanyl-dominant era. DESIGN In this retrospective cohort study, we linked Ontario coronial data on opioid toxicity deaths between 2015 and 2020 with correctional data for adults incarcerated in Ontario provincial correctional facilities. SETTING Ontario, Canada. PARTICIPANTS Whole population data. MAIN OUTCOMES AND MEASURES The primary outcome was opioid toxicity death and the exposure was any incarceration in a provincial correctional facility between 2015 and 2020. We calculated crude death rates and age-standardised mortality ratios (SMR). RESULTS Between 2015 and 2020, 8460 people died from opioid toxicity in Ontario. Of those, 2207 (26.1%) were exposed to incarceration during the study period. Among those exposed to incarceration during the study period (n=1 29 152), 1.7% died from opioid toxicity during this period. Crude opioid toxicity death rates per 10 000 persons years were 43.6 (95% CI=41.8 to 45.5) for those exposed to incarceration and 0.95 (95% CI=0.93 to 0.97) for those not exposed. Compared with those not exposed, the SMR for people exposed to incarceration was 31.2 (95% CI=29.8 to 32.6), and differed by sex, at 28.1 (95% CI=26.7 to 29.5) for males and 77.7 (95% CI=69.6 to 85.9) for females. For those exposed to incarceration who died from opioid toxicity, 10.6% died within 14 days of release and the risk was highest between days 4 and 7 postrelease, at 288.1 per 10 000 person years (95% CI=227.8 to 348.1). CONCLUSIONS The risk of opioid toxicity death is many times higher for people who experience incarceration compared with others in Ontario. Risk is markedly elevated in the week after release, and women who experience incarceration have a substantially higher SMR than men who experience incarceration. Initiatives to prevent deaths should consider programmes and policies in correctional facilities to address high risk on release.
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Affiliation(s)
- Amanda Butler
- Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ruth Croxford
- Statistical Consultant, (freelance), Toronto, Ontario, Canada
| | - Claire Bodkin
- Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Hanaya Akbari
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Ahmed M Bayoumi
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan J Bondy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Dale Guenter
- Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Tara Gomes
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Tharsan Kanagalingam
- Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Lori A Kiefer
- Ontario Ministry of the Solicitor General, Toronto, Ontario, Canada
| | - Aaron Michael Orkin
- Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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14
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Bayoumi AM. Quantitative Assessment of Parent and Patient Preferences. JAMA Netw Open 2023; 6:e2313509. [PMID: 37184841 DOI: 10.1001/jamanetworkopen.2023.13509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Affiliation(s)
- Ahmed M Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, St Michael's Hospital, Toronto, Ontario, Canada
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15
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Tricco AC, Parker A, Hezam A, Nincic V, Yazdi F, Lai Y, Harris C, Bouck Z, Bayoumi AM, Straus SE. Controlled-release hydromorphone and risk of infection in adults: a systematic review. Harm Reduct J 2023; 20:60. [PMID: 37118805 PMCID: PMC10142404 DOI: 10.1186/s12954-023-00788-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 04/20/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Preliminary evidence suggests that people who inject drugs (PWID) may be at an increased risk of developing infective endocarditis (IE), hepatitis C virus (HCV) infection, and/or human immunodeficiency virus (HIV) infection from hydromorphone controlled-release formulation. The hypothesized mechanism is related to insolubility of the drug, which promotes reuse, leading to contamination of injecting equipment. However, this relationship has not been confirmed. We aimed to conduct a systematic review including adult PWID exposed to controlled-release hydromorphone and the risk of acquiring IE, HCV, and HIV. METHODS We searched MEDLINE, EMBASE, and Evidence Based Medicine reviews from inception until September 2021. Following pilot testing, two reviewers conducted all screening of citations and full-text articles, as well as abstracted data, and appraised risk of bias using the Newcastle-Ottawa scale and Effective Practice and Organization of Care tool. Equity issues were examined using the PROGRESS-PLUS framework. Discrepancies were resolved consistently by a third reviewer. Meta-analysis was not feasible due to heterogeneity across the studies. RESULTS After screening 3,231 citations from electronic databases, 722 citations from unpublished sources/reference scanning, and 626 full-text articles, five studies were included. Five were cohort studies, and one was a case-control study. The risk of bias varied across the studies. Two studies reported on gender, as well as other PROGRESS-PLUS criteria (race, housing, and employment). Three studies focused specifically on the controlled-release formulation of hydromorphone, whereas two studies focused on all formulations of hydromorphone. One retrospective cohort study found an association between controlled-release hydromorphone and IE, whereas a case-control study found no evidence of an association. One retrospective cohort study found an association between the number of hydromorphone controlled-release prescriptions and prevalence of HCV. None of the studies specifically reported on associations with HIV. DISCUSSION Very few studies have examined the risk of IE, HCV, and HIV infection after exposure to controlled-release hydromorphone. Very low-quality and scant evidence suggests uncertainty around the risks of blood-borne infections, such as HCV and IE to PWID using this medication.
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Affiliation(s)
- Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada.
- Epidemiology Division Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada.
- Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St Room 425, Toronto, ON, M5T 3M7, Canada.
- Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, School of Nursing, Queen's University, 99 University Ave, Kingston, ON, K7L 3N6, Canada.
| | - Amanda Parker
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Areej Hezam
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Vera Nincic
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Fatemeh Yazdi
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Yonda Lai
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Charmalee Harris
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Zachary Bouck
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
- Epidemiology Division Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada
| | - Ahmed M Bayoumi
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
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16
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O'Brien KK, Erlandson KM, Brown DA, Carusone SC, Vera JH, Bergin C, Avery L, Bayoumi AM, Hanna SE, Harding R, Solomon P, St Clair-Sullivan N, O'Shea N, Murray C, Boffito M, Da Silva G, Torres B, McDuff K, Davis AM. Episodic Disability Questionnaire (EDQ) measurement properties among adults living with HIV in Canada, Ireland, United Kingdom, and United States. Res Sq 2023:rs.3.rs-2758163. [PMID: 37066168 PMCID: PMC10104244 DOI: 10.21203/rs.3.rs-2758163/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Background The Episodic Disability Questionnaire (EDQ) is a generic 35-item patient-reported outcome measure of presence, severity and episodic nature of disability. We assessed the measurement properties of the Episodic Disability Questionnaire (EDQ) with adults living with HIV. Methods We conducted a measurement study with adults living with HIV in eight clinical settings in Canada, Ireland, United Kingdom, and United States. We electronically administered the EDQ followed by three reference measures (World Health Organization Disability Assessment Schedule; Patient Health Questionnaire; Social Support Scale) and a demographic questionnaire. We administered the EDQ only 1 week later. We assessed the internal consistency reliability (Cronbach's alpha; >0.7 acceptable), and test-retest reliability (Intra Class Correlation Coefficient; >0.7 acceptable). We estimated required change in EDQ domain scores to be 95% certain that a change was not due to measurement error (Minimum Detectable Change (MDC95%)). We evaluated construct validity by assessing 36 primary hypotheses of relationships between EDQ scores and scores on the reference measures (> 75% hypotheses confirmed indicated validity). Results 359 participants completed the questionnaires at time point 1, of which 321 (89%) completed the EDQ approximately 1 week later. Cronbach's alpha for internal consistency ranged from 0.84 (social domain) to 0.91 (day domain) for the EDQ severity scale, and 0.72 (uncertainty domain) to 0.88 (day domain) for the EDQ presence scale, and 0.87 (physical, cognitive, mental-emotional domains) to 0.89 (uncertainty domain) for the EDQ episodic scale. ICCs for test-retest reliability ranged from 0.79 (physical domain) to 0.88 (day domain) for the EDQ severity scale and from 0.71 (uncertainty domain) to 0.85 (day domain) for the EDQ presence scale. Highest precision was demonstrated in the severity scale for each domain (MDC95% range: 19-25 out of 100), followed by the presence (MDC95% range: 37-54) and episodic scales (MDC95% range:44-76). Twenty-nine of 36 (81%) construct validity hypotheses were confirmed. Conclusions The EDQ possesses internal consistency reliability, construct validity, and test-retest reliability, with limited precision when administered electronically with adults living with HIV across in clinical settings in four countries. Given the measurement properties, the EDQ can be used for group level comparisons for research and program evaluation in adults living with HIV.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marta Boffito
- Chelsea and Westminster Hospital NHS Foundation Trust
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Paul LA, Bayoumi AM, Chen C, Kocovska E, Smith BT, Raboud JM, Gomes T, Kendall C, Rosella LC, Bitonti-Bengert L, Rush B, Yu M, Spithoff S, Crichlow F, Wright A, Watford J, Besharah J, Munro C, Taha S, Nosyk B, Strike C, Manson H, Kahan M, Leece P. Evaluation of the gap in delivery of opioid agonist therapy among individuals with opioid-related health problems: a population-based retrospective cohort study. Addiction 2023; 118:686-697. [PMID: 36401610 DOI: 10.1111/add.16096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 10/17/2022] [Indexed: 11/21/2022]
Abstract
AIMS Although opioid-related harms have reached new heights across North America, the size of the gap in opioid agonist therapy (OAT) delivery for opioid-related health problems is unknown in most jurisdictions. This study sought to characterize the gap in OAT treatment using a cascade of care framework, and determine factors associated with engagement and retention in treatment. DESIGN A population-based retrospective cohort study. SETTING Ontario, Canada. PARTICIPANTS Individuals who sought medical care for opioid-related health problems or died from an opioid-related cause between 2005 and 2019. MEASUREMENTS Monthly treatment status for buprenorphine/naloxone or methadone OAT between 2013 and 2019 (i.e. 'off OAT', 'retained on OAT < 6 months', 'retained on OAT ≥ 6 months'). FINDINGS Of 122 811 individuals in the cohort, 97 516 (79.4%) received OAT at least once during the study period. There was decreasing 6-month treatment retention over time. Model results indicated that males had higher odds of being on OAT each month [odds ratio (OR) = 1.26, 95% confidence interval (CI) = 1.23-1.28] but lower odds of OAT retention (OR = 0.90, 95% CI = 0.88-0.92), while the reverse was observed for older individuals (monthly: OR = 0.76 per 10-year increase, 95% CI = 0.76-0.77; retention: OR = 1.36 per 10-year increase, 95% CI = 1.34-1.38) and individuals with higher neighbourhood income (e.g. highest income quintile, monthly: OR = 0.79, 95% CI = 0.77-0.82; highest income quintile, retention: OR = 1.15, 95% CI = 1.11-1.20). Individuals residing in rural areas and with a history of mental health diagnoses had poorer outcomes overall, including lower odds of being on OAT each month (rural: OR = 0.75, 95% CI = 0.73-0.78; mental health: OR = 0.89, 95% CI = 0.87-0.92) and OAT retention (rural: OR = 0.79, 95% CI = 0.77-0.82; mental health: OR = 0.81, 95% CI = 0.78-0.83), as well as higher risk of starting/stopping OAT [rural, starting OAT: hazard ratio (HR) = 1.07, 95% CI = 1.05-1.10; mental health, starting OAT: HR = 1.20, 95% CI: 1.18-1.23; rural, stopping OAT: HR = 1.24, 95% CI: = 1.22-1.26; mental health, stopping OAT: HR = 1.11, 95% CI = 1.09-1.13]. Individuals with a history of mental health diagnoses also had a higher risk of death, regardless of OAT status (off OAT death: HR = 1.49, 95% CI = 1.33-1.66; on OAT death: HR = 1.20, 95% CI = 1.09-1.31). CONCLUSIONS Factors influencing engagement and declining retention in treatment with opioid agonist therapy in Ontario's health system include age, sex and neighbourhood income, as well as mental health diagnoses or residing in rural regions.
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Affiliation(s)
- Lauren A Paul
- Health Protection, Public Health Ontario, Toronto, ON, Canada
| | - Ahmed M Bayoumi
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Cynthia Chen
- ICES, Toronto, ON, Canada.,Knowledge Services, Public Health Ontario, Toronto, ON, Canada
| | - Elena Kocovska
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON, Canada
| | - Brendan T Smith
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Janet M Raboud
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | | | - Laura C Rosella
- ICES, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Vector Institute, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, ON, Canada
| | | | - Brian Rush
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Homewood Research Institute, Guelph, ON, Canada
| | - Melissa Yu
- St Joseph's Health Centre, Toronto, ON, Canada.,St Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Sheryl Spithoff
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Women's College Hospital, Toronto, ON, Canada
| | | | - Amy Wright
- Ryerson University (renaming in process), Toronto, ON, Canada
| | | | - Jes Besharah
- Leeds, Grenville and Lanark District Health Unit, ON, Canada.,Lanark, Leeds and Grenville Addictions and Mental Health, Brockville, ON, Canada
| | - Charlotte Munro
- Ontario Drug Policy Research Network Lived Experience Advisory Group, St Michael's Hospital, ON, Canada
| | - Sheena Taha
- Canadian Centre on Substance Use and Addiction, Ottawa, ON, Canada
| | - Bohdan Nosyk
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Carol Strike
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Heather Manson
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON, Canada
| | - Meldon Kahan
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Substance Use Service, Women's College Hospital, Toronto, ON, Canada
| | - Pamela Leece
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Substance Use Service, Women's College Hospital, Toronto, ON, Canada
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O'Brien KK, Ibáñez-Carrasco F, Carusone SC, Bayoumi AM, Tang A, McDuff K, Jiancaro T, Da Silva G, Torres B, Loutfy MR, Islam S, Lindsay J, Price C, Zobeiry M, Pandovski Z, Illic I, Ahluwalia P, Brown DA, Avery L, Solomon P. Piloting an online telecoaching community-based exercise intervention with adults living with HIV: protocol for a mixed-methods implementation science study. BMJ Open 2023; 13:e067703. [PMID: 36997255 PMCID: PMC10069544 DOI: 10.1136/bmjopen-2022-067703] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Our aim is to evaluate the implementation of an online telecoaching community-based exercise (CBE) intervention with the goal of reducing disability and enhancing physical activity and health among adults living with HIV. METHODS AND ANALYSIS We will conduct a prospective longitudinal mixed-methods two-phased intervention study to pilot the implementation of an online CBE intervention with ~30 adults (≥18 years) living with HIV who consider themselves safe to participate in exercise. In the intervention phase (0-6 months), participants will take part in an online CBE intervention involving thrice weekly exercise (aerobic, resistance, balance and flexibility), with supervised biweekly personal training sessions with a fitness instructor, YMCA membership providing access to online exercise classes, wireless physical activity monitor to track physical activity and monthly online educational sessions on topics related to HIV, physical activity and health. In the follow-up phase (6-12 months), participants will be encouraged to continue independent exercise thrice weekly. Quantitative assessment: Bimonthly, we will assess cardiopulmonary fitness, strength, weight, body composition and flexibility, followed by administering self-reported questionnaires to assess disability, contextual factor outcomes (mastery, engagement in care, stigma, social support), implementation factors (cost, feasibility, technology), health status and self-reported physical activity. We will conduct a segmented regression analyses to describe the change in level and trend between the intervention and follow-up phases. Qualitative assessment: We will conduct online interviews with a subsample of ~10 participants and 5 CBE stakeholders at baseline (month 0), postintervention (month 6) and end of follow-up (month 12) to explore experiences, impact and implementation factors for online CBE. Interviews will be audiorecorded and analysed using content analytical techniques. ETHICS AND DISSEMINATION Protocol approved by the University of Toronto Research Ethics Board (Protocol # 40410). Knowledge translation will occur in the form of presentations and publications in open-access peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05006391.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | | | - Soo Chan Carusone
- McMaster Collaborative for Health and Aging, McMaster University, Hamilton, Ontario, Canada
| | - Ahmed M Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kiera McDuff
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tizneem Jiancaro
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - George Da Silva
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brittany Torres
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mona R Loutfy
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Shaz Islam
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Toronto, Ontario, Canada
| | - Joanne Lindsay
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Toronto, Ontario, Canada
| | - Colleen Price
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Ottawa, Ontario, Canada
| | - Mehdi Zobeiry
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | - Zoran Pandovski
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | - Ivan Illic
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | | | - Darren A Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Lisa Avery
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Biostatistics Department, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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19
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Saunders H, Anderson C, Feldman F, Holroyd-Leduc J, Jain R, Liu B, Macaulay S, Marr S, Silvius J, Weldon J, Bayoumi AM, Straus SE, Tricco AC, Isaranuwatchai W. Developing a fall prevention intervention economic model. PLoS One 2023; 18:e0280572. [PMID: 36706109 PMCID: PMC9882648 DOI: 10.1371/journal.pone.0280572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 01/03/2023] [Indexed: 01/28/2023] Open
Abstract
PURPOSE Model-based economic evaluations require conceptualization of the model structure. Our objectives were to identify important health states, events, and patient attributes to be included in a model-based cost-effectiveness analysis of fall prevention interventions, to develop a model structure to examine cost-effectiveness of fall prevention interventions, and to assess the face validity of the model structure. METHODS An expert panel comprising clinicians, health service researchers, health economists, a patient partner, and policy makers completed two rounds of online surveys to gain consensus on health states, events, and patient attributes important for fall prevention interventions. The surveys were informed by a literature search on fall prevention interventions for older adults (≥65 years) including economic evaluations and clinical practice guidelines. The results of the Delphi surveys and subsequent discussions can support the face validity of a state-transition model for an economic evaluation of fall prevention interventions. RESULTS In total, 11 experts rated 24 health states/events and 41 patient attributes. Consensus was achieved on 14 health states/events and 26 patient characteristics. The proposed model structure incorporated 12 of the 14 selected health states/events. Panelists confirmed the face validity of the model structure during teleconferences. CONCLUSIONS There is a dearth of studies presenting the model conceptualization process; consequently, this study involving multiple end user partners with opportunities for input at several stages adds to the literature as another case study. This process is an example of how a fall prevention economic model was developed using a modified Delphi process and assessed for face validity.
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Affiliation(s)
- Hailey Saunders
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital-Unity Health Toronto, Toronto, Ontario, Canada
| | | | - Fabio Feldman
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Ravi Jain
- Ontario Osteoporosis Strategy, Osteoporosis Canada, Toronto, Ontario, Canada
| | - Barbara Liu
- Geriatric Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan Macaulay
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital-Unity Health Toronto, Toronto, Ontario, Canada
- SPOR Evidence Alliance Project
| | - Sharon Marr
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - James Silvius
- Alberta Health Services, Edmonton, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer Weldon
- Ontario Osteoporosis Strategy, Osteoporosis Canada, Toronto, Ontario, Canada
| | - Ahmed M. Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Ontario, Canada
| | - Sharon E. Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital-Unity Health Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea C. Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital-Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Ontario, Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Wanrudee Isaranuwatchai
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital-Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Ontario, Canada
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Bangkok, Thailand
- * E-mail:
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20
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Kenny KS, Kolla G, Greig S, Bannerman M, Phillips D, Altenberg J, Strike C, Bayoumi AM. Association of Illicit Fentanyl Use with Injection Risk Practices Among People who Inject Drugs. AIDS Behav 2022; 27:1757-1765. [PMID: 36401145 DOI: 10.1007/s10461-022-03908-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 11/19/2022]
Abstract
We investigated the association between fentanyl injection frequency and sharing of injection equipment among people who inject drugs. We surveyed 249 people who inject drugs in Toronto in 2019. We estimated predicted probabilities of associations between fentanyl injection frequency and injection risk practices. In prior 6 months, 117 (47.0%) of participants injected fentanyl daily, 49 (19.7%) less than daily, and 78 (31.3%) did not inject fentanyl. Participants who injected fentanyl daily shared syringes more often than those not injecting fentanyl (25.0% vs. 4.9%; χ2 = 11.54, p = 0.0007). Participants who injected fentanyl daily (42.4% vs. 11.3%; χ2 = 18.05, p < 0.0001) and less than daily (37.2% vs. 11.3%; χ2 = 5.88 p = 0.02) shared cookers more often than those not injecting fentanyl. Participants who injected fentanyl daily (30.2% vs. 9.7%; χ2 = 9.05, p = 0.003) and less than daily (30.3% vs. 9.7%; χ2 = 4.11, p = 0.04) shared filters more often than those not injecting fentanyl. No differences in probabilities of sharing equipment were detected between participants who injected fentanyl daily and less than daily. People using fentanyl reported injection practices that increased risk for infectious disease transmission.
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21
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O'Brien KK, Solomon P, Carusone SC, Erlandson KM, Bergin C, Bayoumi AM, Hanna SE, Harding R, Brown DA, Vera JH, Boffito M, Murray C, Aubry R, O'Shea N, St Clair-Sullivan N, Boyd M, Swinton M, Torres B, Davis AM. Assessing the sensibility and utility of a short-form version of the HIV Disability Questionnaire in clinical practice settings in Canada, Ireland and the USA: a mixed methods study. BMJ Open 2022; 12:e062008. [PMID: 36175103 PMCID: PMC10098270 DOI: 10.1136/bmjopen-2022-062008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES The Short-Form HIV Disability Questionnaire (SF-HDQ) was developed to measure the presence, severity and episodic nature of health challenges across six domains. Our aim was to assess the sensibility, utility and implementation of the SF-HDQ in clinical practice. DESIGN Mixed methods study design involving semistructured interviews and questionnaire administration. PARTICIPANTS We recruited adults living with HIV and HIV clinicians in Canada, Ireland and the USA. METHODS We electronically administered the SF-HDQ followed by a Sensibility Questionnaire (face and content validity, ease of usage, format) and conducted semistructured interviews to explore the utility and implementation of the SF-HDQ in clinical practice. The threshold for sensibility was a median score of >5/7 (adults living with HIV) and>4/7 (HIV clinicians) for ≥80% of items. Qualitative interview data were analysed using directed content analysis. RESULTS Median sensibility scores were >5 (adults living with HIV; n=29) and >4 (HIV clinicians; n=16) for 18/19 (95%) items. Interview data indicated that the SF-HDQ represents the health-related challenges of living with HIV and other concurrent health conditions; captures the daily episodic nature of HIV; and is easy to use. Clinical utility included measuring health challenges and change over time, guiding referral to specialists and services, setting goals, facilitating communication and fostering a multidisciplinary approach to care. Considerations for implementation included flexible, person-centred approaches to administration, and communicating scores based on personal preferences. CONCLUSIONS The SF-HDQ possesses sensibility and utility for use in clinical settings with adults living with HIV and HIV clinicians in three countries.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Instiute (RSI), University of Toronto, Toronto, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Soo Chan Carusone
- McMaster Collaborative for Health and Aging, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Casey House, Toronto, Ontario, Canada
| | | | - Colm Bergin
- Department of Genitourinary and Infectious Diseases (GUIDE) Clinic, St James's Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Ahmed M Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Steven E Hanna
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Darren A Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Marta Boffito
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Rachel Aubry
- Department of Physical Therapy, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Noreen O'Shea
- Department of Genitourinary and Infectious Diseases (GUIDE) Clinic, St James's Hospital, Dublin, Ireland
| | | | - Mallory Boyd
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marilyn Swinton
- Department of Physical Therapy, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Brittany Torres
- Department of Physical Therapy, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Aileen M Davis
- Department of Physical Therapy, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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22
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Talaat H, Bashayan S, J N Raymakers A, Bayoumi AM, Papatheodorou S, Sediqzadah S. Health-related quality of life measures in incarcerated populations: protocol for a scoping review. BMJ Open 2022; 12:e052800. [PMID: 35470181 PMCID: PMC9039373 DOI: 10.1136/bmjopen-2021-052800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Incarcerated populations represent a vulnerable and marginalised segment of society, with increased health needs and a higher burden of communicable and non-communicable diseases. Traditional population health outcomes do not capture physical, mental, emotional and social well-being. Health-related quality of life (HRQoL) outcomes attempt to measure these important parameters. To date, there has not been a scoping review to summarise the HRQoL literature in the incarcerated population. Thus, we aim to perform such a review to inform health policy decisions in incarcerated populations and support health economic evaluations of interventions in incarcerated populations. METHODS AND ANALYSIS We will conduct a scoping review of the literature on the HRQoL in the incarcerated population informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the corresponding PRISMA Extension for Scoping Reviews. The submissions records of six electronic databases with peer-reviewed literature and three health technology assessment agencies will be searched. The search strategy was informed by recommendations for HRQoL reviews. We will include studies that report HRQoL, health state utility values or reference to quality adjusted life years or quality-adjusted life expectancies of incarcerated populations. No assessments of items' quality will be made, as the purpose of this scoping review is to synthesise and describe the coverage of the evidence. We will also identify knowledge gaps on the HRQoL in the incarcerated population. ETHICS AND DISSEMINATION Research ethics approval is not required as primary data will not be collected. The findings of this scoping review will be used to inform health economic analyses for the incarcerated population and will be disseminated through peer-reviewed publications and conference presentations.
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Affiliation(s)
- Habeba Talaat
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Seniyyeh Bashayan
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Adam J N Raymakers
- Faculty of Health Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Ahmed M Bayoumi
- Centre for Research on Inner City Health, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Saadia Sediqzadah
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, St Michael's Hospital, Toronto, Ontario, Canada
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23
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Paul LA, Li Y, Leece P, Gomes T, Bayoumi AM, Herring J, Murray R, Brown P. Identifying the changing age distribution of opioid-related mortality with high-frequency data. PLoS One 2022; 17:e0265509. [PMID: 35442953 PMCID: PMC9020746 DOI: 10.1371/journal.pone.0265509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background Opioid-related mortality continues to rise across North America, and mortality rates have been further exacerbated by the COVID-19 pandemic. This study sought to provide an updated picture of trends of opioid-related mortality for Ontario, Canada between January 2003 and December 2020, in relation to age and sex. Methods Using mortality data from the Office of the Chief Coroner for Ontario, we applied Bayesian Poisson regression to model age/sex mortality per 100,000 person-years, including random walks to flexibly capture age and time effects. Models were also used to explore how trends might continue into 2022, considering both pre- and post-COVID-19 courses. Results From 2003 to 2020, there were 11,633 opioid-related deaths in Ontario. A shift in the age distribution of mortality was observed, with the greatest mortality rates now among younger individuals. In 2003, mortality rates reached maximums at 5.5 deaths per 100,000 person-years (95% credible interval: 4.0–7.6) for males around age 44 and 2.2 deaths per 100,000 person-years (95% CI: 1.5–3.2) for females around age 51. As of 2020, rates have reached maximums at 67.2 deaths per 100,000 person-years (95% CI: 55.3–81.5) for males around age 35 and 16.8 deaths per 100,000 person-years (95% CI: 12.8–22.0) for females around age 37. Our models estimate that opioid-related mortality among the younger population will continue to grow, and that current conditions could lead to male mortality rates that are more than quadruple those of pre-pandemic estimations. Conclusions This analysis may inform a refocusing of public health strategy for reducing rising rates of opioid-related mortality, including effectively reaching both older and younger males, as well as young females, with health and social supports such as treatment and harm reduction measures.
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Affiliation(s)
- Lauren A. Paul
- Health Protection, Public Health Ontario, Toronto, Ontario, Canada
| | - Ye Li
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Knowledge Services, Public Health Ontario, Toronto, Ontario, Canada
- * E-mail:
| | - Pamela Leece
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
- Substance Use Service, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed M. Bayoumi
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jeremy Herring
- Knowledge Services, Public Health Ontario, Toronto, Ontario, Canada
| | - Regan Murray
- Office of the Chief Coroner for Ontario, Toronto, Ontario, Canada
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Patrick Brown
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
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24
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Kendall CE, Boucher LM, Donelle J, Martin A, Marshall Z, Boyd R, Oickle P, Diliso N, Pineau D, Renaud B, LeBlanc S, Tyndall M, Bayoumi AM. Cohort study of team-based care among marginalized people who use drugs in Ottawa. Can Fam Physician 2022; 68:117-127. [PMID: 35177504 PMCID: PMC9842166 DOI: 10.46747/cfp.6802117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To describe team-based care use among a cohort of people who use drugs (PWUD) and to determine factors associated with receipt of team-based care. DESIGN A cohort study using survey data collected between March and December 2013. These data were then linked to provincial-level health administrative databases to assess patterns of primary care among PWUD in the 2 years before survey completion. SETTING Ottawa, Ont. PARTICIPANTS Marginalized PWUD 16 years of age or older. MAIN OUTCOME MEASURES Patients were assigned to primary care models based on survey responses and then were categorized as attached to team-based medical homes, attached to non-team-based medical homes, not attached to a medical home, and no primary care. Descriptive statistics and multinomial logistic regression were used to determine associations between PWUD and medical home models. RESULTS Of 663 total participants, only 162 (24.4%) received team-based care, which was associated with high school level of education (adjusted odds ratio [AOR] = 2.18; 95% CI 1.13 to 4.20), receipt of disability benefits (AOR = 2.47; 95% CI 1.22 to 5.02), and HIV infection (AOR = 2.88; 95% CI 1.28 to 6.52), and was inversely associated with recent overdose (AOR = 0.49; 95% CI 0.25 to 0.94). In comparison, 125 (18.8%) received non-team-based medical care, which was associated with university or college education (AOR = 2.31; 95% CI 1.04 to 5.15) and mental health comorbidity (AOR = 4.18; 95% CI 2.33 to 7.50), and was inversely associated with being detained in jail in the previous 12 months (AOR = 0.51; 95% CI 0.28 to 0.90). CONCLUSION Although team-based, integrated models of care will benefit disadvantaged groups the most, few PWUD receive such care. Policy makers should mitigate barriers to physician care and improve integration across health and social services.
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Affiliation(s)
- Claire E. Kendall
- Associate Professor in the Department of Family Medicine and is cross-appointed to the School of Epidemiology and Public Health at the University of Ottawa in Ontario; Senior Investigator at the Bruyère Research Institute in Ottawa; a practising family physician with the Bruyère Family Health Team; Adjunct Scientist at ICES in Toronto, Ont; Affiliate Investigator in the Clinical Epidemiology Program at the Ottawa Hospital Research Institute; Affiliate Scientist in the Li Ka Shing Knowledge Institute at St Michael’s Hospital in Toronto; and Associate Dean of Social Accountability in the Faculty of Medicine at the University of Ottawa.,Correspondence Dr Claire E. Kendall; e-mail
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25
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O’Brien KK, Davis AM, Chan Carusone S, Avery L, Tang A, Solomon P, Aubry R, Zobeiry M, Ilic I, Pandovski Z, Bayoumi AM. Examining the impact of a community-based exercise intervention on cardiorespiratory fitness, cardiovascular health, strength, flexibility and physical activity among adults living with HIV: A three-phased intervention study. PLoS One 2021; 16:e0257639. [PMID: 34559851 PMCID: PMC8462727 DOI: 10.1371/journal.pone.0257639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/02/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Our aim was to examine the impact of a community-based exercise (CBE) intervention on cardiorespiratory fitness, cardiovascular health, strength, flexibility, and physical activity outcomes among adults living with HIV. METHODS We conducted a longitudinal intervention study with community-dwelling adults living with HIV in Toronto, Canada. We measured cardiopulmonary fitness (V̇O2peak (primary outcome), heart rate, blood pressure), strength (grip strength, vertical jump, back extension, push-ups, curl ups), flexibility (sit and reach test), and self-reported physical activity bimonthly across three phases. Phase 1 included baseline monitoring (8 months); Phase 2 included the CBE Intervention (6 months): participants were asked to exercise (aerobic, strength, balance and flexibility training) for 90 minutes, 3 times/week, with weekly supervised coaching at a community-based fitness centre; and Phase 3 included follow-up (8 months) where participants were expected to continue with thrice weekly exercise independently. We used segmented regression (adjusted for baseline age and sex) to assess the change in trend (slope) among phases. Our main estimates of effect were the estimated change in slope, relative to baseline values, over the 6 month CBE intervention. RESULTS Of the 108 participants who initiated Phase 1, 80 (74%) started and 67/80 (84%) completed the intervention and 52/67 (77%) completed the study. Most participants were males (87%), with median age of 51 years (interquartile range (IQR): 45, 59). Participants reported a median of 4 concurrent health conditions in addition to HIV (IQR: 2,7). Participants attended a median of 18/25 (72%) weekly supervised sessions. Change in V̇O2peak attributed to the six-month Phase 2 CBE intervention was 0.56 ml/kg/min (95% Confidence Interval (CI): -1.27, 2.39). Significant effects of the intervention were observed for systolic blood pressure (-5.18 mmHg; 95% CI: -9.66, -0.71), push-ups (2.30 additional push-ups; 95% CI: 0.69, 3.91), curl ups (2.89 additional curl ups; 95% CI: 0.61, 5.17), and sit and reach test (1.74 cm; 95% CI: 0.21, 3.28). More participants engaged in self-reported strength (p<0.001) and flexibility (p = 0.02) physical activity at the end of intervention. During Phase 3 follow-up, there was a significant reduction in trend of benefits observed during the intervention phase for systolic blood pressure (1.52 mmHg/month; 95% CI: 0.67, 2.37) and sit and reach test (-0.42 cm/month; 95% CI: -0.68, -0.16). CONCLUSION Adults living with HIV who engaged in this six-month CBE intervention demonstrated inconclusive results in relation to V̇O2peak, and potential improvements in other outcomes of cardiovascular health, strength, flexibility and self-reported physical activity. Future research should consider features tailored to promote uptake and sustained engagement in independent exercise among adults living with HIV. CLINICALTRIALS.GOV IDENTIFIER NCT02794415. https://clinicaltrials.gov/ct2/show/record/NCT02794415.
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Affiliation(s)
- Kelly K. O’Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | - Aileen M. Davis
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | | | - Lisa Avery
- University Health Network, Toronto, Ontario, Canada
- Avery Information, Oshawa, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Rachel Aubry
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | - Ivan Ilic
- Central Toronto YMCA, Toronto, Ontario, Canada
| | | | - Ahmed M. Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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26
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Mighton C, Clausen M, Sebastian A, Muir SM, Shickh S, Baxter NN, Scheer A, Glogowski E, Schrader KA, Thorpe KE, Kim THM, Lerner-Ellis J, Kim RH, Regier DA, Bayoumi AM, Bombard Y. Patient and public preferences for being recontacted with updated genomic results: a mixed methods study. Hum Genet 2021; 140:1695-1708. [PMID: 34537903 DOI: 10.1007/s00439-021-02366-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/05/2021] [Indexed: 01/14/2023]
Abstract
Variants of uncertain significance (VUS) are frequently reclassified but recontacting patients with updated results poses significant resource challenges. We aimed to characterize public and patient preferences for being recontacted with updated results. A discrete choice experiment (DCE) was administered to representative samples of the Canadian public and cancer patients. DCE attributes were uncertainty, cost, recontact modality, choice of results, and actionability. DCE data were analyzed using a mixed logit model and by calculating willingness to pay (WTP) for types of recontact. Qualitative interviews exploring recontact preferences were analyzed thematically. DCE response rate was 60% (n = 1003, 50% cancer patient participants). 31 participants were interviewed (11 cancer patients). Interviews revealed that participants expected to be recontacted. Quantitatively, preferences for how to be recontacted varied based on certainty of results. For certain results, WTP was highest for being recontacted by a doctor with updates ($1075, 95% CI: $845, $1305) and for contacting a doctor to request updates ($1038, 95% CI: $820, $1256). For VUS results, WTP was highest for an online database ($1735, 95% CI: $1224, $2247) and for contacting a doctor ($1705, 95% CI: $1102, $2307). Qualitative data revealed that preferences for provider-mediated recontact were influenced by trust in healthcare providers. Preferences for a database were influenced by lack of trust in providers and desire for control. Patients and public participants support an online database (e.g. patient portal) to recontact for VUS, improving feasibility, and provider-mediated recontact for certain results, consistent with usual care.
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Affiliation(s)
- Chloe Mighton
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Marc Clausen
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Agnes Sebastian
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Sarah M Muir
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Salma Shickh
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Nancy N Baxter
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Adena Scheer
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Kasmintan A Schrader
- BC Cancer, Vancouver, BC, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Kevin E Thorpe
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Theresa H M Kim
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Jordan Lerner-Ellis
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada
| | - Raymond H Kim
- University Health Network, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada.,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dean A Regier
- BC Cancer, Vancouver, BC, Canada.,School of Population and Public Health (SPPH), University of British Columbia, Vancouver, BC, Canada
| | - Ahmed M Bayoumi
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of General Internal Medicine, Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Yvonne Bombard
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. .,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
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27
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O'Brien KK, Bayoumi AM, Carusone SC, Davis AM, Aubry R, Avery L, Solomon P, Erlandson KM, Bergin C, Harding R, Brown DA, Vera JH, Hanna S. Disability and Self-care Living Strategies Among Adults Living With HIV During the COVID-19 Pandemic. Res Sq 2021. [PMID: 34545356 PMCID: PMC8452102 DOI: 10.21203/rs.3.rs-868864/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BackgroundEvents associated with the COVID-19 pandemic, such as physical distancing, closure of community services, postponement of health appointments, and loss of employment can lead to social isolation, financial uncertainty, and interruption of antiretroviral adherence, resulting in additional health-related challenges (disability) experienced among adults living with chronic illness such as HIV. 'Living strategies' is a concept derived from the perspective of people living with HIV, defined as behaviors, attitudes and beliefs adopted by people living with HIV to help deal with disability associated with HIV and multi-morbidity. Our aim was to describe disability among adults living with HIV and self-care living strategies used during the COVID-19 pandemic. MethodsAdults living with HIV in Toronto, Ontario, Canada, including some with pre-pandemic HIV Disability Questionnaire (HDQ) data, completed a cross-sectional web-based survey between June-August 2020. The survey included the HDQ and questions about self-care living strategy use during the pandemic. We compared disability (HDQ) scores prior to versus during the pandemic using paired t-tests. We reported the proportion of participants who engaged in various living strategies at least 'a few times a week' or 'everyday' during the pandemic. ResultsOf the 63 respondents, 84% were men, median age 57 years, and 62% lived alone. During the pandemic the greatest disability severity was in the uncertainty (median 30; Interquartile range (IQR): 16, 43) and mental-emotional (25; IQR: 14, 41) domains. Among the 51 participants with pre-pandemic data, HDQ severity scores were significantly greater (worse) during the pandemic (vs prior) in all domains. Greatest change from prior to during the pandemic was in the mental-emotional domain for presence (17.7; p<0.001), severity (11.4; p<0.001), and episodic nature (9.3; p<0.05) of disability. Most participants (>60%) reported engaging a 'few times a week' or 'everyday' in self-care strategies associated with maintaining sense of control and adopting positive attitudes and beliefs. ConclusionsPeople living with HIV reported high levels of uncertainty and mental-emotional health challenges during the pandemic. Disability increased across all HDQ dimensions, with the greatest worsening in the mental-emotional health domain. Results provide an understanding of disability and self-care strategy use during the COVID-19 pandemic.
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Perri M, Kaminski N, Bonn M, Kolla G, Guta A, Bayoumi AM, Challacombe L, Gagnon M, Touesnard N, McDougall P, Strike C. A qualitative study on overdose response in the era of COVID-19 and beyond: how to spot someone so they never have to use alone. Harm Reduct J 2021; 18:85. [PMID: 34353323 PMCID: PMC8339679 DOI: 10.1186/s12954-021-00530-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spotting is an informal practice among people who use drugs (PWUD) where they witness other people using drugs and respond if an overdose occurs. During COVID-19 restrictions, remote spotting (e.g., using a telephone, video call, and/or a social media app) emerged to address physical distancing requirements and reduced access to harm reduction and/or sexually transmitted blood borne infection (STBBI's) prevention services. We explored spotting implementation issues from the perspectives of spotters and spottees. METHODS Research assistants with lived/living expertise of drug use used personal networks and word of mouth to recruit PWUD from Ontario and Nova Scotia who provided or used informal spotting. All participants completed a semi-structured, audio-recorded telephone interview about spotting service design, benefits, challenges, and recommendations. Recordings were transcribed and thematic analysis was used. RESULTS We interviewed 20 individuals between 08/2020-11/2020 who were involved in informal spotting. Spotting was provided on various platforms (e.g., telephone, video calls, and through texts) and locations (e.g. home, car), offered connection and community support, and addressed barriers to the use of supervised consumption sites (e.g., location, stigma, confidentiality, safety, availability, COVID-19 related closures). Spotting calls often began with setting an overdose response plan (i.e., when and who to call). Many participants noted that, due to the criminalization of drug use and fear of arrest, they preferred that roommates/friends/family members be called instead of emergency services in case of an overdose. Both spotters and spottees raised concerns about the timeliness of overdose response, particularly in remote and rural settings. CONCLUSION Spotting is a novel addition to, but not replacement for, existing harm reduction services. To optimize overdose/COVID-19/STBBI's prevention services, additional supports (e.g., changes to Good Samaritan Laws) are needed. The criminalization of drug use may limit uptake of formal spotting services.
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Affiliation(s)
- Melissa Perri
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- MAP Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Natalie Kaminski
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Canadian Association of People Who Use Drugs, Dartmouth, NS, Canada
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, NS, Canada
- Canadian Students for Sensible Drug Policy, Toronto, Canada
| | - Gillian Kolla
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, ON, Canada
| | - Ahmed M Bayoumi
- MAP Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of General Internal Medicine, Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Marilou Gagnon
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | | | | | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- MAP Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
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29
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Tan DHS, Tavangar F, Fusca L, Ross P, Hull MW, Grennan T, Bayoumi AM, Burchell AN. Interest in Hypothetical Preexposure Prophylaxis Against Herpes Simplex Virus: A Cross-Sectional Survey. Sex Transm Dis 2021; 48:e105-e108. [PMID: 34110756 PMCID: PMC8284350 DOI: 10.1097/olq.0000000000001342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/19/2020] [Indexed: 11/25/2022]
Abstract
ABSTRACT We surveyed 383 men who have sex with men attending sexual health clinics regarding interest in hypothetical preexposure prophylaxis against herpes simplex virus. Overall interest was 62.5% and was associated with the number of different sexually transmitted infections previously diagnosed (adjusted odds ratio, 1.9; 95% confidence interval, 1.5-2.6) and previous HIV preexposure prophylaxis use (adjusted odds ratio, 2.9; 95% confidence interval, 1.1-8.3).
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Affiliation(s)
- Darrell H. S. Tan
- From the Division of Infectious Diseases
- MAP Centre for Urban Health Solutions, St Michael’s Hospital
- Department of Medicine
- Institute of Health Policy, Management and Evaluation, University of Toronto
| | | | - Laura Fusca
- MAP Centre for Urban Health Solutions, St Michael’s Hospital
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Patrick Ross
- BC Centre for Excellence in HIV/AIDS, Department of Medicine, University of British Columbia
| | - Mark W. Hull
- BC Centre for Excellence in HIV/AIDS, Department of Medicine, University of British Columbia
| | - Troy Grennan
- BC Centre for Disease Control
- Department of Medicine and Division of Infectious Diseases, University of British Columbia, Vancouver, British Columbia
| | - Ahmed M. Bayoumi
- MAP Centre for Urban Health Solutions, St Michael’s Hospital
- Department of Medicine
- Institute of Health Policy, Management and Evaluation, University of Toronto
- Department of Medicine, St Michael’s Hospital
| | - Ann N. Burchell
- MAP Centre for Urban Health Solutions, St Michael’s Hospital
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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30
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Harris MTH, Young S, Barocas J, Bayoumi AM, Caudarella A, Laurence G, Tomanovich M, Komaromy M. A Descriptive Comparison of Substance Use Services in Recovery and Isolation Sites for People Experiencing Homelessness During the COVID-19 Pandemic, Boston and Toronto. Public Health Rep 2021; 136:532-537. [PMID: 34269625 DOI: 10.1177/00333549211032974] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Miriam T H Harris
- 1836 Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA.,Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.,Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Samantha Young
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,10071 Division of General Internal Medicine, Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Joshua Barocas
- 1836 Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA.,Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA
| | - Ahmed M Bayoumi
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,10071 Division of General Internal Medicine, Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Alexander Caudarella
- 204352 Department of Community and Family Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gab Laurence
- Parkdale Queen West Community Health Centre, Toronto, Ontario, Canada
| | - Mary Tomanovich
- 1836 Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Miriam Komaromy
- 1836 Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA.,Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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31
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Rowlands Snyder EC, Boucher LM, Bayoumi AM, Martin A, Marshall Z, Boyd R, LeBlanc S, Tyndall M, Kendall CE. A cross-sectional study of factors associated with unstable housing among marginalized people who use drugs in Ottawa, Canada. PLoS One 2021; 16:e0253923. [PMID: 34197552 PMCID: PMC8248707 DOI: 10.1371/journal.pone.0253923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/15/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Housing affects an individual’s physical and mental health, particularly among people who use substances. Understanding the association between individual characteristics and housing status can inform housing policy and help optimize the care of people who use drugs. The objective of this study was to explore the factors associated with unstable housing among people who use drugs in Ottawa. Methods This is a cross-sectional analysis of data from 782 participants in the Participatory Research in Ottawa: Understanding Drugs (PROUD) Study. PROUD is a prospective cohort study of people who use drugs in Ottawa. Between March and December 2013, participants were recruited through peer-based recruitment on the streets and in social services settings and completed a peer-administered questionnaire that explored socio-demographic information, drug use patterns, community integration, experiences with police and incarceration, and access to health care and harm reduction services. Eligibility criteria included age of 16 years or older, self-reported illicit drug use within the past 12 months and having lived in Ottawa for at least 3 months. Housing status was determined by self-report. “Stable housing” was defined as residence in a house or apartment and “unstable housing” was defined as all other residence types. Exploratory multivariable logistic regression analyses of the association between characteristics of people who use drugs and their housing status were conducted. Results Factors that were associated with unstable housing included: recent incarceration; not having a regular doctor; not having received support from a peer worker; low monthly income; income source other than public disability support payments; and younger age. Gender, language, ethnicity, education level, opioid use and injection drug use were not independently associated with housing status. Conclusions People who use drugs face significant barriers to stable housing. These results highlight key areas to address in order to improve housing stability among this community.
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Affiliation(s)
| | - Lisa M. Boucher
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Ahmed M. Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of General Internal Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Alana Martin
- Somerset West Community Health Centre, Ottawa, Ontario, Canada
- PROUD Community Advisory Committee, Ottawa, Ontario, Canada
| | - Zack Marshall
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Rob Boyd
- Sandy Hill Community Health Centre, Ottawa, Ontario, Canada
| | - Sean LeBlanc
- PROUD Community Advisory Committee, Ottawa, Ontario, Canada
- Drug Users Advocacy League, Ottawa, Ontario, Canada
| | - Mark Tyndall
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Claire E. Kendall
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- * E-mail:
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Perri M, Guta A, Gagnon M, Bonn M, Leece P, Bayoumi AM, Rai N, Touesnard N, Strike C. Developing a digital health strategy for people who use drugs: Lessons from COVID-19. Digit Health 2021; 7:20552076211028404. [PMID: 34262782 PMCID: PMC8243112 DOI: 10.1177/20552076211028404] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 06/09/2021] [Indexed: 12/12/2022] Open
Abstract
COVID-19 has significantly exacerbated negative health and social outcomes for people who use drugs (PWUD) around the world. The closure of harm reduction services, ongoing barriers to employment and housing, and pre-existing physical and mental health conditions have increased harms for diverse communities of PWUD. Adapting current models of health and human service delivery to better meet the needs of PWUD is essential in minimizing not only COVID-19 but also drug-related morbidity and mortality. This article draws on research, practice, and advocacy experiences, and discusses the potential for digital health tools such as remote monitoring and telecare to improve the continuum of care for PWUD. We call for a digital health strategy for PWUD and provide recommendations for future program development and implementation.
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Affiliation(s)
- Melissa Perri
- Dalla Lana School of Public Health, University of Toronto,
Toronto, Canada
- MAP Center for Urban Health Solutions, St. Michael’s Hospital,
Toronto, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, Windsor,
Canada
| | - Marilou Gagnon
- Canadian Institute for Substance Use Research, Victoria,
Canada
| | - Matt Bonn
- Canadian Association of People Who Use Drugs, Dartmouth,
Canada
- Canadian Students for Sensible Drug Policy, Ottawa, Canada
| | - Pamela Leece
- Dalla Lana School of Public Health, University of Toronto,
Toronto, Canada
- Public Health Ontario, Toronto, Canada
- Department of Family and Community Medicine, University of
Toronto Faculty of Medicine, Toronto, Canada
| | - Ahmed M Bayoumi
- MAP Center for Urban Health Solutions, St. Michael’s Hospital,
Toronto, Canada
- Institute of Health Policy, Management and Evaluation,
University of Toronto, Toronto, Canada
| | - Nanky Rai
- Department of Family and Community Medicine, University of
Toronto Faculty of Medicine, Toronto, Canada
| | | | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto,
Toronto, Canada
- MAP Center for Urban Health Solutions, St. Michael’s Hospital,
Toronto, Canada
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Latimer EA, Rabouin D, Cao Z, Ly A, Powell G, Aubry T, Distasio J, Hwang SW, Somers JM, Bayoumi AM, Mitton C, Moodie EEM, Goering PN. Cost-Effectiveness of Housing First With Assertive Community Treatment: Results From the Canadian At Home/Chez Soi Trial. Psychiatr Serv 2020; 71:1020-1030. [PMID: 32838679 DOI: 10.1176/appi.ps.202000029] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The At Home/Chez Soi trial for homeless individuals with mental illness showed scattered-site Housing First with Assertive Community Treatment (ACT) to be more effective than treatment as usual. This study evaluated the cost-effectiveness of Housing First with ACT and treatment as usual. METHODS Between October 2009 and June 2011, a total of 950 homeless individuals with serious mental illness were recruited in five Canadian cities: Vancouver, Winnipeg, Toronto, Montreal, and Moncton. Participants were randomly assigned to Housing First (N=469) or treatment as usual (N=481) and followed up for up to 24 months. The intervention consisted of scattered-site Housing First, using rent supplements, with ACT. The treatment-as-usual group had access to all other services. The perspective of society was adopted for the cost-effectiveness analysis. Days of stable housing served as the outcome measure. Retrospective questionnaires captured service use data. RESULTS Most (69%) of the costs of the intervention were offset by savings in other costs, such as emergency shelters, reducing the net annual cost of the intervention to about Can$6,311 per person. The incremental cost-effectiveness ratio was Can$41.73 per day of stable housing (95% confidence interval=Can$1.96-$83.70). At up to Can$60 per day, Housing First had more than an 80% chance of being cost-effective, compared with treatment as usual. Cost-effectiveness did not vary by participant characteristics. CONCLUSIONS Housing First with ACT appeared about as cost-effective as Housing First with intensive case management for people with moderate needs. The optimal mix between the two remains to be determined.
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Affiliation(s)
- Eric A Latimer
- Department of Psychiatry, McGill University, Montreal (Latimer); Douglas Research Centre, Montreal (Latimer, Rabouin, Cao); Montreal West Island Integrated University Health and Social Services Centre, Montreal (Ly); Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal (Powell, Moodie); Department of Psychology, University of Ottawa, Ottawa (Aubry); Department of Geography, University of Winnipeg, Winnipeg, Manitoba (Distasio); Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto (Hwang); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Hwang, Bayoumi); Department of Psychiatry, Simon Fraser University, Burnaby, British Columbia (Somers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bayoumi); School of Population and Public Health, University of British Columbia, Vancouver (Mitton); Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto (Goering, who died in May 2016)
| | - Daniel Rabouin
- Department of Psychiatry, McGill University, Montreal (Latimer); Douglas Research Centre, Montreal (Latimer, Rabouin, Cao); Montreal West Island Integrated University Health and Social Services Centre, Montreal (Ly); Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal (Powell, Moodie); Department of Psychology, University of Ottawa, Ottawa (Aubry); Department of Geography, University of Winnipeg, Winnipeg, Manitoba (Distasio); Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto (Hwang); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Hwang, Bayoumi); Department of Psychiatry, Simon Fraser University, Burnaby, British Columbia (Somers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bayoumi); School of Population and Public Health, University of British Columbia, Vancouver (Mitton); Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto (Goering, who died in May 2016)
| | - Zhirong Cao
- Department of Psychiatry, McGill University, Montreal (Latimer); Douglas Research Centre, Montreal (Latimer, Rabouin, Cao); Montreal West Island Integrated University Health and Social Services Centre, Montreal (Ly); Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal (Powell, Moodie); Department of Psychology, University of Ottawa, Ottawa (Aubry); Department of Geography, University of Winnipeg, Winnipeg, Manitoba (Distasio); Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto (Hwang); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Hwang, Bayoumi); Department of Psychiatry, Simon Fraser University, Burnaby, British Columbia (Somers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bayoumi); School of Population and Public Health, University of British Columbia, Vancouver (Mitton); Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto (Goering, who died in May 2016)
| | - Angela Ly
- Department of Psychiatry, McGill University, Montreal (Latimer); Douglas Research Centre, Montreal (Latimer, Rabouin, Cao); Montreal West Island Integrated University Health and Social Services Centre, Montreal (Ly); Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal (Powell, Moodie); Department of Psychology, University of Ottawa, Ottawa (Aubry); Department of Geography, University of Winnipeg, Winnipeg, Manitoba (Distasio); Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto (Hwang); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Hwang, Bayoumi); Department of Psychiatry, Simon Fraser University, Burnaby, British Columbia (Somers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bayoumi); School of Population and Public Health, University of British Columbia, Vancouver (Mitton); Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto (Goering, who died in May 2016)
| | - Guido Powell
- Department of Psychiatry, McGill University, Montreal (Latimer); Douglas Research Centre, Montreal (Latimer, Rabouin, Cao); Montreal West Island Integrated University Health and Social Services Centre, Montreal (Ly); Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal (Powell, Moodie); Department of Psychology, University of Ottawa, Ottawa (Aubry); Department of Geography, University of Winnipeg, Winnipeg, Manitoba (Distasio); Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto (Hwang); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Hwang, Bayoumi); Department of Psychiatry, Simon Fraser University, Burnaby, British Columbia (Somers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bayoumi); School of Population and Public Health, University of British Columbia, Vancouver (Mitton); Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto (Goering, who died in May 2016)
| | - Tim Aubry
- Department of Psychiatry, McGill University, Montreal (Latimer); Douglas Research Centre, Montreal (Latimer, Rabouin, Cao); Montreal West Island Integrated University Health and Social Services Centre, Montreal (Ly); Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal (Powell, Moodie); Department of Psychology, University of Ottawa, Ottawa (Aubry); Department of Geography, University of Winnipeg, Winnipeg, Manitoba (Distasio); Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto (Hwang); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Hwang, Bayoumi); Department of Psychiatry, Simon Fraser University, Burnaby, British Columbia (Somers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bayoumi); School of Population and Public Health, University of British Columbia, Vancouver (Mitton); Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto (Goering, who died in May 2016)
| | - Jino Distasio
- Department of Psychiatry, McGill University, Montreal (Latimer); Douglas Research Centre, Montreal (Latimer, Rabouin, Cao); Montreal West Island Integrated University Health and Social Services Centre, Montreal (Ly); Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal (Powell, Moodie); Department of Psychology, University of Ottawa, Ottawa (Aubry); Department of Geography, University of Winnipeg, Winnipeg, Manitoba (Distasio); Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto (Hwang); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Hwang, Bayoumi); Department of Psychiatry, Simon Fraser University, Burnaby, British Columbia (Somers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bayoumi); School of Population and Public Health, University of British Columbia, Vancouver (Mitton); Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto (Goering, who died in May 2016)
| | - Stephen W Hwang
- Department of Psychiatry, McGill University, Montreal (Latimer); Douglas Research Centre, Montreal (Latimer, Rabouin, Cao); Montreal West Island Integrated University Health and Social Services Centre, Montreal (Ly); Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal (Powell, Moodie); Department of Psychology, University of Ottawa, Ottawa (Aubry); Department of Geography, University of Winnipeg, Winnipeg, Manitoba (Distasio); Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto (Hwang); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Hwang, Bayoumi); Department of Psychiatry, Simon Fraser University, Burnaby, British Columbia (Somers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bayoumi); School of Population and Public Health, University of British Columbia, Vancouver (Mitton); Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto (Goering, who died in May 2016)
| | - Julian M Somers
- Department of Psychiatry, McGill University, Montreal (Latimer); Douglas Research Centre, Montreal (Latimer, Rabouin, Cao); Montreal West Island Integrated University Health and Social Services Centre, Montreal (Ly); Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal (Powell, Moodie); Department of Psychology, University of Ottawa, Ottawa (Aubry); Department of Geography, University of Winnipeg, Winnipeg, Manitoba (Distasio); Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto (Hwang); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Hwang, Bayoumi); Department of Psychiatry, Simon Fraser University, Burnaby, British Columbia (Somers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bayoumi); School of Population and Public Health, University of British Columbia, Vancouver (Mitton); Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto (Goering, who died in May 2016)
| | - Ahmed M Bayoumi
- Department of Psychiatry, McGill University, Montreal (Latimer); Douglas Research Centre, Montreal (Latimer, Rabouin, Cao); Montreal West Island Integrated University Health and Social Services Centre, Montreal (Ly); Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal (Powell, Moodie); Department of Psychology, University of Ottawa, Ottawa (Aubry); Department of Geography, University of Winnipeg, Winnipeg, Manitoba (Distasio); Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto (Hwang); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Hwang, Bayoumi); Department of Psychiatry, Simon Fraser University, Burnaby, British Columbia (Somers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bayoumi); School of Population and Public Health, University of British Columbia, Vancouver (Mitton); Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto (Goering, who died in May 2016)
| | - Craig Mitton
- Department of Psychiatry, McGill University, Montreal (Latimer); Douglas Research Centre, Montreal (Latimer, Rabouin, Cao); Montreal West Island Integrated University Health and Social Services Centre, Montreal (Ly); Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal (Powell, Moodie); Department of Psychology, University of Ottawa, Ottawa (Aubry); Department of Geography, University of Winnipeg, Winnipeg, Manitoba (Distasio); Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto (Hwang); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Hwang, Bayoumi); Department of Psychiatry, Simon Fraser University, Burnaby, British Columbia (Somers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bayoumi); School of Population and Public Health, University of British Columbia, Vancouver (Mitton); Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto (Goering, who died in May 2016)
| | - Erica E M Moodie
- Department of Psychiatry, McGill University, Montreal (Latimer); Douglas Research Centre, Montreal (Latimer, Rabouin, Cao); Montreal West Island Integrated University Health and Social Services Centre, Montreal (Ly); Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal (Powell, Moodie); Department of Psychology, University of Ottawa, Ottawa (Aubry); Department of Geography, University of Winnipeg, Winnipeg, Manitoba (Distasio); Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto (Hwang); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Hwang, Bayoumi); Department of Psychiatry, Simon Fraser University, Burnaby, British Columbia (Somers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bayoumi); School of Population and Public Health, University of British Columbia, Vancouver (Mitton); Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto (Goering, who died in May 2016)
| | - Paula N Goering
- Department of Psychiatry, McGill University, Montreal (Latimer); Douglas Research Centre, Montreal (Latimer, Rabouin, Cao); Montreal West Island Integrated University Health and Social Services Centre, Montreal (Ly); Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal (Powell, Moodie); Department of Psychology, University of Ottawa, Ottawa (Aubry); Department of Geography, University of Winnipeg, Winnipeg, Manitoba (Distasio); Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto (Hwang); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Hwang, Bayoumi); Department of Psychiatry, Simon Fraser University, Burnaby, British Columbia (Somers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bayoumi); School of Population and Public Health, University of British Columbia, Vancouver (Mitton); Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto (Goering, who died in May 2016)
| | -
- Department of Psychiatry, McGill University, Montreal (Latimer); Douglas Research Centre, Montreal (Latimer, Rabouin, Cao); Montreal West Island Integrated University Health and Social Services Centre, Montreal (Ly); Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal (Powell, Moodie); Department of Psychology, University of Ottawa, Ottawa (Aubry); Department of Geography, University of Winnipeg, Winnipeg, Manitoba (Distasio); Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto (Hwang); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Hwang, Bayoumi); Department of Psychiatry, Simon Fraser University, Burnaby, British Columbia (Somers); Dalla Lana School of Public Health, University of Toronto, Toronto (Bayoumi); School of Population and Public Health, University of British Columbia, Vancouver (Mitton); Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto (Goering, who died in May 2016)
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Kendall CE, Boucher LM, Donelle J, Martin A, Marshall Z, Boyd R, Oickle P, Diliso N, Pineau D, Renaud B, LeBlanc S, Tyndall M, Bayoumi AM. Engagement in primary health care among marginalized people who use drugs in Ottawa, Canada. BMC Health Serv Res 2020; 20:837. [PMID: 32894114 PMCID: PMC7487534 DOI: 10.1186/s12913-020-05670-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There may be less primary health care engagement among people who use drugs (PWUD) than among the general population, even though the former have greater comorbidity and more frequent use of emergency department care. We investigated factors associated with primary care engagement among PWUD. METHODS The Participatory Research in Ottawa: Understanding Drugs (PROUD) cohort study meaningfully engaged and trained people with lived experience to recruit and survey marginalized PWUD between March-December 2013. We linked this survey data to provincial-level administrative databases held at ICES. We categorized engagement in primary care over the 2 years prior to survey completion as: not engaged (< 3 outpatient visits to the same family physician) versus engaged in care (3+ visits to the same family physician). We used multivariable logistic regression to determine factors associated with engagement in primary care. RESULTS Characteristics of 663 participants included a median age of 43 years, 76% men, and 67% living in the two lowest income quintile neighborhoods. Despite high comorbidity and a median of 4 (interquartile range 0-10) primary care visits in the year prior to survey completion, only 372 (56.1%) were engaged in primary care. Engagement was most strongly associated with the following factors: receiving provincial benefits, including disability payments (adjusted odds ratio [AOR] 4.14 (95% confidence interval [CI] 2.30 to 7.43)) or income assistance (AOR 3.69 (95% CI 2.00 to 6.81)), having ever taken methadone (AOR 3.82 (95% CI 2.28 to 6.41)), mental health comorbidity (AOR 3.43 (95% CI 2.19 to 5.38)), and having stable housing (AOR 2.09 (95% CI 1.29 to 3.38)). CONCLUSIONS Despite high comorbidity, engagement in primary care among PWUD was low. Our findings suggest that social care (housing, disability, and income support) and mental health care are associated with improved primary care continuity; integration of these care systems with primary care and opioid substitution therapy may lessen the significant morbidity and acute care use among PWUD.
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Affiliation(s)
- Claire E. Kendall
- Bruyère Research Institute, 43 Bruyère Street, Annex E, Ottawa, Ontario K1N 5C8 Canada
| | - Lisa M. Boucher
- Bruyère Research Institute, 43 Bruyère Street, Annex E, Ottawa, Ontario K1N 5C8 Canada
| | - Jessy Donelle
- ICES, Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Box 684, Administrative Services Building, 1st Floor, Ottawa, Ontario K1Y 4E9 Canada
| | - Alana Martin
- Somerset West Community Health Centre, 55 Eccles Street, Ottawa, Ontario K1R 6S3 Canada
- PROUD Community Advisory Committee, Ottawa, Ontario Canada
| | - Zack Marshall
- School of Social Work, McGill University, 3506 University Street, Room 421, Montreal, Quebec H3A 2A7 Canada
| | - Rob Boyd
- Sandy Hill Community Health Centre, 221 Nelson Street, Ottawa, Ontario, K1N 1C7 Canada
| | - Pam Oickle
- Ottawa Public Health, 179 Clarence Street, Ottawa, Ontario, K1N 1B3 Canada
| | - Nicola Diliso
- PROUD Community Advisory Committee, Ottawa, Ontario Canada
| | - Dave Pineau
- PROUD Community Advisory Committee, Ottawa, Ontario Canada
| | - Brad Renaud
- PROUD Community Advisory Committee, Ottawa, Ontario Canada
| | - Sean LeBlanc
- PROUD Community Advisory Committee, Ottawa, Ontario Canada
- Drug Users Advocacy League, Ottawa, Ontario Canada
| | - Mark Tyndall
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Ahmed M. Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael’s Hospital; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, 30 Bond Street, Toronto, Ontario M5B 1W8 Canada
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Ahmad F, Othman N, Hynie M, Bayoumi AM, Oda A, McKenzie K. Depression-level symptoms among Syrian refugees: findings from a Canadian longitudinal study. J Ment Health 2020; 30:246-254. [PMID: 32438842 DOI: 10.1080/09638237.2020.1765998] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Canada launched the Syrian Refugee Resettlement Initiative in 2015 and resettled over 40,000 refugees. AIM To evaluate the prevalence of depression-level symptoms at baseline and one year post-resettlement and analyze its predictors. METHODS Data come from the Syrian Refugee Integration and Long-term Health Outcomes in Canada study (SyRIA.lth) involving 1924 Syrian refugees recruited through a variety of community-based strategies. Data were collected using structured interviews in 2017 and 2018. Depression symptoms were measured using Patient Health Questionnaire 9 (PHQ-9). Analysis for associated factors was executed using multinomial logistic regression. RESULTS Mean age was 38.5 years (SD 13.8). Sample included 49% males and 51% females settled in Ontario (48%), Quebec (36%) and British Columbia (16%). Over 74% always needed an interpreter, and only 23% were in employment. Prevalence of depression-level symptoms was 15% at baseline and 18% in year-2 (p < 0.001). Significant predictors of depression-level symptoms at year-2 were baseline depression, sponsorship program, province, poor language skills, lack of satisfaction with housing conditions and with health services, lower perceived control, lower perceived social support and longer stay in Canada. CONCLUSION Increase in depression-level symptoms deserves attention through focusing on identified predictors particularly baseline depression scores, social support, perceived control and language ability.
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Affiliation(s)
- Farah Ahmad
- School of Health Policy and Management, York University, Toronto, Canada
| | - Nasih Othman
- School of Health Policy and Management, York University, Toronto, Canada
| | - Michaela Hynie
- Department of Psychology/Centre for Refugee Studies, York University, Toronto, Canada
| | - Ahmed M Bayoumi
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Anna Oda
- Centre for Refugee Studies, Refugee Integration and Long-term Health Outcomes in Canada, York University, Toronto, Canada
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Younger J, Raboud J, Szadkowski L, Harrigan R, Walmsley S, Bayoumi AM, Klein MB, Cooper C, Burchell AN, Loutfy M, Hull M, Wong A, Thomas R, Hogg R, Montaner J, Tsoukas C, Antoniou T. Tenofovir and emtricitabine resistance among antiretroviral-naive patients in the Canadian Observational Cohort Collaboration: implications for PrEP. Antivir Ther 2020; 24:211-220. [PMID: 30873953 DOI: 10.3851/imp3302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The real-world effectiveness of pre-exposure prophylaxis (PrEP) may be influenced by circulating HIV strains resistant to either tenofovir or emtricitabine. Yet, few studies have examined rates of resistance to these drugs in clinical settings. METHODS We conducted a retrospective cohort study of antiretroviral-naive participants in the Canadian Observational Cohort collaboration who initiated antiretroviral therapy between 2006 and 2014. In separate analyses, we determined the prevalence of pretherapy resistance and cumulative incidence of follow-up resistance to tenofovir and emtricitabine. We used multivariable proportional hazards models to examine associations between baseline variables and the development of resistance. RESULTS We studied 6,622 antiretroviral-naive participants initiating therapy, of whom 5,428 (82.0%) had a baseline resistance test. Baseline resistance to tenofovir and emtricitabine was observed in 83 (1.5%) and 21 (0.4%) patients, respectively. Among patients without baseline resistance, the cumulative incidence of resistance to tenofovir and emtricitabine 5 years following treatment initiation was 0.0070 (95% CI 0.0046, 0.0095) and 0.033 (95% CI 0.028, 0.038), respectively. Following multivariable analysis, a baseline viral load ≥100,000 copies/ml was associated with emergence of tenofovir (hazard ratio [HR] 2.88; 95% CI 1.35, 6.15) and emtricitabine (HR 2.27; 95% CI 1.64, 3.15) resistance. Initiating an integrase inhibitor-based regimen and CD4+ T-cell count below 200 cells/mm3 were also associated with resistance to each drug. CONCLUSIONS We observed a low prevalence of baseline resistance and a low incidence of emergence of resistance to tenofovir and emtricitabine among antiretroviral-naive patients in routine clinical care.
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Affiliation(s)
- Jaime Younger
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada
| | - Janet Raboud
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Leah Szadkowski
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada
| | - Richard Harrigan
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sharon Walmsley
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
| | - Ahmed M Bayoumi
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Marina B Klein
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada.,Department of Medicine, McGill University Health Centre Research Institute, Montréal, QC, Canada
| | - Curtis Cooper
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ann N Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,CIHR Canadian HIV Trials Network, Vancouver, BC, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, St Michael's Hospital and University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Mona Loutfy
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,CIHR Canadian HIV Trials Network, Vancouver, BC, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Maple Leaf Medical Clinic, Toronto, ON, Canada
| | - Mark Hull
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,CIHR Canadian HIV Trials Network, Vancouver, BC, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Alex Wong
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada.,Division of Infectious Diseases, Department of Medicine, University of Saskatchewan, Regina, SK, Canada
| | | | - Robert Hogg
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Julio Montaner
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Chris Tsoukas
- Faculty of Medicine, McGill University Health Centre, Montréal, QC, Canada
| | - Tony Antoniou
- Department of Family and Community Medicine, St Michael's Hospital and University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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Fusca L, Hull M, Ross P, Grennan T, Burchell AN, Bayoumi AM, Tan DHS. High Interest in Syphilis Pre-exposure and Post-exposure Prophylaxis Among Gay, Bisexual and Other Men Who Have Sex With Men in Vancouver and Toronto. Sex Transm Dis 2020; 47:224-231. [PMID: 31977974 PMCID: PMC7077973 DOI: 10.1097/olq.0000000000001130] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 12/13/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND We assessed the acceptability of doxycycline-based syphilis pre-exposure and post-exposure prophylaxis (PrEP/PEP) as well as human immunodeficiency virus (HIV) PrEP/PEP in gay, bisexual, and other men who have sex with men (gbMSM). METHODS We recruited gbMSM from Toronto and Vancouver sexually transmitted infection (STI) clinics during routine visits from June 2018 to August 2018. We analyzed data using descriptive statistics and constructed multivariable logistic regression models for willingness to use syphilis and HIV PrEP and PEP respectively. RESULTS Among 424 participants (56.4% Toronto, 43.6% Vancouver), median (interquartile range [IQR]) age was 31.0 years (26.0-39.0 years), 61.7% had completed postsecondary education and 54.4% were white. Median (IQR) number of male partners in the past 6 months was 6.0 (3.0-13.0), and 18.2% had 1 or more prior syphilis diagnosis. 60.1%/44.1% indicated willingness to use syphilis PEP/PrEP; 36.6% were unwilling to use either. Among HIV-negative participants, 74.0% and 75.2% were willing to use HIV PrEP and PEP, respectively. Most participants were familiar with antibiotic resistance (89.0%) and agreed that syphilis rates are rising in Canada (68.2%), but only 55.4% believed they were at risk for syphilis. Agreement with the latter statement was associated with willingness to use syphilis PrEP (adjusted odds ratio [aOR], 1.6; 95% confidence interval [95%CI], 1.0-2.5), as was previous/existing HIV PrEP use (aOR, 2.2; 95% CI, 1.1-4.3) and being "very concerned" about STI acquisition (aOR, 1.9; 95% CI, 1.0-3.4). Odds of being willing to use syphilis PEP were higher in Toronto versus Vancouver (aOR, 2.0; 95% CI, 1.2-3.4) and increased with the number of different STIs previously diagnosed (aOR, 1.4; 95% CI, 1.2,1.7). CONCLUSIONS There is considerable interest in syphilis PrEP/PEP in gbMSM attending Toronto/Vancouver STI clinics.
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Affiliation(s)
- Laura Fusca
- From the Dalla Lana School of Public Health, University of Toronto, Toronto
| | - Mark Hull
- British Columbia Centre for Disease Control
- Faculty of Medicine, University of British Columbia, Vancouver
| | - Patrick Ross
- Faculty of Medicine, University of British Columbia, Vancouver
| | - Troy Grennan
- British Columbia Centre for Disease Control
- Faculty of Medicine, University of British Columbia, Vancouver
| | - Ann N. Burchell
- From the Dalla Lana School of Public Health, University of Toronto, Toronto
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute
- Department of Family and Community Medicine, St. Michael's Hospital
- Faculty of Medicine
| | - Ahmed M. Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute
- Faculty of Medicine
- Institute of Health Policy, Management and Evaluation, University of Toronto
- Division of General Internal Medicine
| | - Darrell H. S. Tan
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute
- Faculty of Medicine
- Institute of Health Policy, Management and Evaluation, University of Toronto
- Division of Infectious Diseases, St. Michael's Hospital
- Division of Infectious Diseases, University Health Network, Toronto, Canada
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Oliveira C, de Silva NT, Ungar WJ, Bayoumi AM, Avitzur Y, Hoch JS, Maxwell J, Wales PW. Health-related quality of life in neonates and infants: a conceptual framework. Qual Life Res 2020; 29:1159-1168. [PMID: 31997081 DOI: 10.1007/s11136-020-02432-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE With reduced mortality of neonatal conditions, health-related quality of life (HRQOL) has become an important clinical outcome. However, since the meaning of HRQOL in dependent, non-autonomous infants and neonates remains largely undefined, HRQOL measurement and economic evaluation are limited due to the lack of age-specific methodology. The objective was to construct a conceptual framework of neonatal and infant HRQOL (NIHRQOL) which identifies factors relevant to the neonate and infant, their relationship with each other and the caregiving environment. METHODS Using qualitative methods, a concept was developed based on in-depth analysis of verbatim records of two focus groups (6 caregivers, 6 healthcare providers) and five interviews with caregivers of chronically ill neonates/infants (n = 2), and healthcare professionals of a pediatric tertiary healthcare center (n = 3). Two analysts independently performed thematic analysis using an inductive and contextual approach. RESULTS The majority of participants regarded NIHRQOL as an individual entity, which was closely related and strongly influenced by caregivers and family. It may be gauged by the perceived degree of effort required to achieve expected normalcy in everyday life for the neonate/infant and its family. The importance of individual HRQOL factors is developmental stage-dependent. CONCLUSION Neonatal and infant HRQOL is a multidimensional, multilayered and interconnected concept, where the child's needs contribute most directly, and the caregiver's and society's ability to meet those needs characterize the interdependence between the child and its caregiving environment. Developmental stage-specific HRQOL instruments for premature and mature neonates, and infants are warranted to allow for valid HRQOL measurement.
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Affiliation(s)
- Carol Oliveira
- Group for Improvement of Intestinal Function and Treatment Program (GIFT), The Hospital for Sick Children, Toronto, Canada.,Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Nicole T de Silva
- Group for Improvement of Intestinal Function and Treatment Program (GIFT), The Hospital for Sick Children, Toronto, Canada.,Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Ahmed M Bayoumi
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Centre for Research On Inner City Health, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada
| | - Yaron Avitzur
- Group for Improvement of Intestinal Function and Treatment Program (GIFT), The Hospital for Sick Children, Toronto, Canada.,Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada
| | - Jeffrey S Hoch
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Centre for Excellence in Economic Analysis Research (CLEAR), St. Michael's Hospital, Toronto, Canada
| | - Julia Maxwell
- Group for Improvement of Intestinal Function and Treatment Program (GIFT), The Hospital for Sick Children, Toronto, Canada
| | - Paul W Wales
- Group for Improvement of Intestinal Function and Treatment Program (GIFT), The Hospital for Sick Children, Toronto, Canada.,Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Strike C, Watson TM, Altenberg J, Barnaby L, Bayoumi AM, Challacombe L, Demel G, Hopkins S, Wright A. Challenges, Skepticism, and Recommendations from Police about Working in Collaboration with Supervised Consumption Services. Subst Use Misuse 2020; 55:1919-1924. [PMID: 32660302 DOI: 10.1080/10826084.2020.1781177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The operation of supervised consumption services (SCS), programs that offer supervised locations for the consumption of drugs such as heroin, other opioids, cocaine, other stimulants, and other drugs, is contingent on cooperative relationships with police. In this manuscript, we focus on an under studied topic: how active duty police officers understand their role with respect to SCS, and their recommendations for improving relationships with these programs. Methods: During 2018, we audio-recorded and transcribed focus group discussions conducted in four police divisions with 26 police constables and 3 officers of other ranks in Toronto, Canada. Officers were asked about their roles relative to SCS, perceived training needs, and how to build cooperative relationships with SCS. We followed an iterative thematic approach to analyze the data. Results: Participants in three divisions were unclear about their roles, duties, and policy governing policing of SCS. Participants in the fourth division had received instructions from the division commander to observe a "distance and discretion policy". However, these participants believed that developing familiarity with the new SCS, instead of keeping a distance, would be a more effective approach to building working relationships with staff, clients, and the local community. There was nearly unanimous skepticism about the willingness of SCS workers to work cooperatively with the police. These perceptions were commonly linked to previous negative experiences with harm reduction workers and, in some cases, staff at the new SCS. Several participants also linked problems in communication to fundamental differences between the philosophies or worldviews of SCS staff versus those of police. Conclusions: Building collaborative SIS-police relationships can be assisted by demystifying the operation of SCS for police, articulating policies, and working toward mutual respect.
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Affiliation(s)
- Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Tara Marie Watson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jason Altenberg
- South Riverdale Community Health Centre, Toronto, Ontario, Canada
| | - Lorraine Barnaby
- Parkdale Queen West Community Health Centre, Toronto, Ontario, Canada
| | - Ahmed M Bayoumi
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Geoff Demel
- The Works, Toronto Public Health, Toronto, Ontario, Canada
| | - Shaun Hopkins
- The Works, Toronto Public Health, Toronto, Ontario, Canada
| | - Amy Wright
- The Works, Toronto Public Health, Toronto, Ontario, Canada
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40
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Grewal R, Allen VG, Bayoumi AM, Gardner SL, Kaul R, Mazzulli T, Moravan V, OʼNeill T, Raboud J, Rourke SB, Tan DHS, Burchell AN. Brief Report: Syphilis Coinfection Is Not Associated With an Increased Risk of Virologic Failure Among HIV-Positive Men Who Have Sex With Men on Antiretroviral Therapy. J Acquir Immune Defic Syndr 2019; 80:585-589. [PMID: 30730358 DOI: 10.1097/qai.0000000000001962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Incidence of syphilis continues to increase among HIV-positive men who have sex with men (MSM) in Ontario. Our objective was to determine the effect of acute syphilis on virologic failure (VF) among virally suppressed HIV-positive MSM taking antiretroviral therapy (ART) and determine if the relationship is confounded by drug use. SETTING The OHTN Cohort Study is a voluntary cohort of people receiving HIV care in Ontario. Syphilis and viral load (VL) data were retrieved via linkage with the provincial laboratory. METHODS Analyses included 2632 MSM from 2008 to 2015, on ART, with ≥1 questionnaire and 2 consecutive VL of <50 copies per milliliter 6 months apart. VF was defined as (1) VL of ≥1000 copies per milliliter or (2) 2 consecutive VLs of ≥200 copies per milliliter ≥1 month apart. We modeled acute syphilis as a time-varying covariate on VF using Poisson regression. Time-varying drug use was assessed for confounding using an iterative process where potential confounders were removed and then reintroduced into the model. Our model allowed for repeat observations using generalized estimating equations. RESULTS VF incidence was 3.5 per 100 person-years [95% confidence interval (CI): 3.4 to 4.2]. The rate ratio for VF for acute syphilis was 1.5 (95% CI: 0.9 to 2.4) in the unadjusted model; 1.6 (95% CI: 1.0 to 2.4) in the model adjusted for age, education, region, and income; and 1.2 (95% CI: 0.7 to 1.9) in the final model with additional adjustment for drug use. CONCLUSIONS Acute syphilis was not associated with VF among virologically suppressed MSM on ART. Consequently, ART may still reduce HIV transmission risk to sexual partners.
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Affiliation(s)
- Ramandip Grewal
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Vanessa G Allen
- Public Health Laboratories, Public Health Ontario, Toronto, Ontario, Canada
| | - Ahmed M Bayoumi
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sandra L Gardner
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Kunin-Lunenfeld Centre for Applied Research and Evaluation, Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Tony Mazzulli
- Public Health Laboratories, Public Health Ontario, Toronto, Ontario, Canada.,Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Veronika Moravan
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Tyler OʼNeill
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Janet Raboud
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Sean B Rourke
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Darrell H S Tan
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.,Division of Infectious Diseases, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ann N Burchell
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
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Leece P, Khorasheh T, Corace K, Strike C, Bayoumi AM, Taha S, Marks E, Pach B, Ahamad K, Grennell E, Holowaty M, Manson H, Straus SE. Barriers and facilitators to buprenorphine use for opioid agonist treatment: protocol for a scoping review. BMJ Open 2019; 9:e032285. [PMID: 31843837 PMCID: PMC6924699 DOI: 10.1136/bmjopen-2019-032285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In the context of the opioid crisis in North America, the benefits of evidence-based opioid agonist treatments such as buprenorphine/naloxone have not been optimised due to low uptake. Numerous factors contribute to the underuse of buprenorphine, and theory-informed approaches to identify and address implementation barriers and facilitators are needed. This scoping review aims to characterise the barriers and facilitators at the patient, healthcare professional, organisation and system level according to the Theoretical Domains Framework (TDF), and identify gaps to inform practice and policy. METHODS AND ANALYSIS We will conduct a scoping review using established methods and follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. We will identify English and French-language peer-reviewed literature by searching five electronic bibliographic databases (MEDLINE, Embase, PsychINFO, CINAHL, and SocINDEX), from inception and use Google, websites of key organisations, and two or more custom search engines to identify relevant grey literature. Eligible records will be quantitative or qualitative studies that examine barriers and facilitators to buprenorphine use at the patient, healthcare professional, organisation and system level, and involve participants with diagnosis of opioid use disorder or professionals involved in their care. Two reviewers will be involved in independently screening, reviewing and charting the data and calibration exercises will be conducted at each stage. We will conduct descriptive analysis for the charted data, and deductively code barriers and facilitators using the TDF. ETHICS AND DISSEMINATION As a scoping review of the literature, this study does not require ethics approval. Our dissemination strategy will focus on developing tailored activities to meet the needs of diverse knowledge user audiences. Barriers and facilitators mapped to the TDF can be linked to evidence-based strategies for change to improve buprenorphine use and access, and enable practice to reduce opioid-related harms.
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Affiliation(s)
- Pamela Leece
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
| | - Triti Khorasheh
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
| | - Kimberly Corace
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed M Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sheena Taha
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
| | - Elisabeth Marks
- Knowledge Services, Public Health Ontario, Toronto, Ontario, Canada
| | - Beata Pach
- Knowledge Services, Public Health Ontario, Toronto, Ontario, Canada
| | - Keith Ahamad
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Erin Grennell
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Melissa Holowaty
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Heather Manson
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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Behrends CN, Paone D, Nolan ML, Tuazon E, Murphy SM, Kapadia SN, Jeng PJ, Bayoumi AM, Kunins HV, Schackman BR. Estimated impact of supervised injection facilities on overdose fatalities and healthcare costs in New York City. J Subst Abuse Treat 2019; 106:79-88. [DOI: 10.1016/j.jsat.2019.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/23/2019] [Accepted: 08/13/2019] [Indexed: 12/20/2022]
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Masindi KI, Jembere N, Kendall CE, Burchell AN, Bayoumi AM, Loutfy M, Raboud J, Rourke SB, Luyombya H, Antoniou T. Co-morbid Non-communicable Diseases and Associated Health Service Use in African and Caribbean Immigrants with HIV. J Immigr Minor Health 2019; 20:536-545. [PMID: 29209931 DOI: 10.1007/s10903-017-0681-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We sought to characterize non-communicable disease (NCD)-related and overall health service use among African and Caribbean immigrants living with HIV between April 1, 2010 and March 31, 2013. We conducted two population-based analyses using Ontario's linked administrative health databases. We studied 1525 persons with HIV originally from Africa and the Caribbean. Compared with non-immigrants with HIV (n = 11,931), African and Caribbean immigrants had lower rates of hospital admissions, emergency department visits and non-HIV specific ambulatory care visits, and higher rates of health service use for hypertension and diabetes. Compared with HIV-negative individuals from these regions (n = 228,925), African and Caribbean immigrants with HIV had higher rates of health service use for chronic obstructive pulmonary disease [rate ratio (RR) 1.78; 95% confidence interval (CI) 1.36-2.34] and malignancy (RR 1.20; 95% CI 1.19-1.43), and greater frequency of hospitalizations for mental health illness (RR 3.33; 95% CI 2.44-4.56), diabetes (RR 1.37; 95% CI 1.09-1.71) and hypertension (RR 1.85; 95% CI 1.46-2.34). African and Caribbean immigrants with HIV have higher rates of health service use for certain NCDs than non-immigrants with HIV. The evaluation of health services for African and Caribbean immigrants with HIV should include indicators of NCD care that disproportionately affect this population.
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Affiliation(s)
- Khatundi-Irene Masindi
- Department of Family and Community Medicine, St. Michael's Hospital, 410 Sherbourne Street, Toronto, ON, M4X 1K2, Canada
| | | | - Claire E Kendall
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.,CT Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ann N Burchell
- Department of Family and Community Medicine, St. Michael's Hospital, 410 Sherbourne Street, Toronto, ON, M4X 1K2, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Ahmed M Bayoumi
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Mona Loutfy
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Janet Raboud
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Sean B Rourke
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada.,Ontario HIV Treatment Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Tony Antoniou
- Department of Family and Community Medicine, St. Michael's Hospital, 410 Sherbourne Street, Toronto, ON, M4X 1K2, Canada. .,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. .,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
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Boucher LM, Bayoumi AM, Mark AE, Cooper C, Martin A, Marshall Z, Boyd R, Oickle P, Diliso N, Pineau D, Renaud B, LeBlanc S, Tyndall M, Lee OM, Kendall CE. Hepatitis C Testing, Status and Treatment among Marginalized People Who Use Drugs in an Inner City Setting: An Observational Cohort Study. Subst Use Misuse 2019; 54:18-30. [PMID: 29932800 DOI: 10.1080/10826084.2018.1485699] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Chronic hepatitis C virus (HCV) infection is common among people who inject drugs (PWID) and is associated with morbidity and premature death. Although HCV can be cured, treatment may be inaccessible. We studied HCV testing, status and treatment among marginalized people who use drugs in Ottawa, Canada, a setting with universal insurance coverage for physician services. METHODS We analyzed data from the Participatory Research in Ottawa: Understanding Drugs study, a cross-sectional, peer-administered survey of people who use drugs from 2012 to 2013. We linked responses to population-based health administrative databases and used multivariable Poisson regression to identify factors independently associated with self-reported HCV testing, self-reported positive HCV status, and database-determined engagement in HCV treatment. RESULTS Among 663 participants, 562 (84.8%) reported testing for HCV and 258 (45.9%) reported HCV-positive status. In multivariable analysis, HCV-positive status was associated with female gender (RR 1.27; 95%CI 1.04 to 1.55), advancing age (RR 1.03/year; 95%CI 1.02 to 1.04), receiving disability payments (RR 1.42; 95%CI 1.06 to 1.91), injecting drugs (RR 5.11; 95%CI 2.64 to 9.91), ever injecting with a used needle (RR 1.30; 95%CI 1.12 to 1.52), and ever having taken methadone (RR 1.26; 95%CI 1.05 to 1.52). Of HCV positive participants, 196 (76%) were engaged in primary care but only 23 (8.9%) had received HCV therapy. Conclusions/Importance: Although HCV testing and positive status rates are high among PWID in our study, few have received HCV treatment. Innovative initiatives to increase access to HCV treatment for PWID are urgently needed.
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Affiliation(s)
- Lisa M Boucher
- a Bruyere Research Institute , Ottawa , Ontario , Canada.,b Department of Epidemiology and Public Health , University of Ottawa , Ottawa , Ontario , Canada
| | - Ahmed M Bayoumi
- c Division of General Internal Medicine , St. Michael's Hospital , Ontario , Canada.,d Department of Medicine and Institute of Health Policy, Management, and Evaluation , University of Toronto , Toronto , Ontario , Canada
| | - Amy E Mark
- e Institute for Clinical Evaluative Sciences , Toronto , Canada
| | - Curtis Cooper
- f Clinical Epidemiology Program , Ottawa Hospital Research Institute , Ottawa , Ontario , Canada
| | - Alana Martin
- f Clinical Epidemiology Program , Ottawa Hospital Research Institute , Ottawa , Ontario , Canada
| | - Zack Marshall
- g School of Social Work , McGill University , Montreal , Quebec , Canada
| | - Rob Boyd
- h Sandy Hill Community Health Centre , Ottawa , Ontario , Canada
| | - Pam Oickle
- i Ottawa Public Health , Ottawa , Ontario , Canada
| | - Nicola Diliso
- j PROUD Community Advisory Committee , Ottawa , Ontario , Canada
| | - Dave Pineau
- j PROUD Community Advisory Committee , Ottawa , Ontario , Canada
| | - Brad Renaud
- j PROUD Community Advisory Committee , Ottawa , Ontario , Canada
| | - Sean LeBlanc
- k Drug Users Advocacy League , Ottawa , Ontario , Canada
| | - Mark Tyndall
- l BC Centre for Disease Control , Vancouver , British Columbia , Canada
| | - Olivia M Lee
- b Department of Epidemiology and Public Health , University of Ottawa , Ottawa , Ontario , Canada
| | - Claire E Kendall
- a Bruyere Research Institute , Ottawa , Ontario , Canada.,b Department of Epidemiology and Public Health , University of Ottawa , Ottawa , Ontario , Canada.,m Li Ka Shing Knowledge Institute of St. Michael's Hospital , Ontario , Canada
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45
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Barnett C, Bril V, Bayoumi AM. EQ-5D-5L and SF-6D health utility index scores in patients with myasthenia gravis. Eur J Neurol 2018; 26:452-459. [PMID: 30315714 DOI: 10.1111/ene.13836] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/08/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Health utilities are a preference-based method of valuing health states that are used in healthcare research, such as economic evaluations. There are limited health utility valuation data for patients with myasthenia gravis (MG). The aim of the study was to describe health utilities for patients with MG and different health states, using the EQ-5D-5L and SF-6D utility instruments, and to explore clinical and demographic determinants of utilities in this population. METHODS Patients completed the EQ-5D-5L and SF-6D. In addition, patients were assessed with the Myasthenia Gravis Foundation of America classification, Myasthenia Gravis Impairment Index and MG-QOL15 as disease-specific measures, and the Neuro-QoL Fatigue scale. We calculated mean utilities for each Myasthenia Gravis Foundation of America severity class. We built regression models for the EQ-5D-5L and SF-6D to determine the clinical and demographic factors that determine patients' valuation of their health state. RESULTS Among 254 patients, mean EQ-5D-5L health utilities were as follows: Remission, 0.94 ± 0.03; Minimal Manifestations, 0.92 ± 0.04; Class I, 0.89 ± 0.06; Class II, 0.78 ± 0.16; Class III, 0.58 ± 0.24 and Class IV, 0.61 ± 0.22. Mean SF-6D health utilities were as follows: Remission, 0.83 ± 0.07; Minimal Manifestations, 0.86 ± 0.14; Class I, 0.82 ± 0.14; Class II, 0.67 ± 0.12; Class III, 0.56 ± 0.11 and Class IV, 0.50 ± 0.10. The limb/axial scores were more highly correlated to health utilities than ocular or bulbar scores. CONCLUSIONS We present estimates of health utilities for patients with MG that can be used in cost-utility and decision analyses. Limb/axial symptoms had a higher impact on health utilities than ocular or bulbar symptoms, which might reflect the impact of mobility on health valuation.
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Affiliation(s)
- C Barnett
- Division of Neurology, Department of Medicine, University of Toronto and University Health Network, Toronto, ON.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - V Bril
- Division of Neurology, Department of Medicine, University of Toronto and University Health Network, Toronto, ON
| | - A M Bayoumi
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON.,Division of General Internal Medicine, Department of Medicine, St, Michael's Hospital, Toronto, ON.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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46
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Watson TM, Bayoumi AM, Hopkins S, Wright A, Naraine R, Khorasheh T, Challacombe L, Strike C. Creating and sustaining cooperative relationships between supervised injection services and police: A qualitative interview study of international stakeholders. Int J Drug Policy 2018; 61:1-6. [PMID: 30290363 DOI: 10.1016/j.drugpo.2018.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/27/2018] [Accepted: 08/06/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Supervised injection services (SIS) operate with special exemptions from drug law enforcement. Given the expansion of SIS and the opioid overdose crisis in numerous jurisdictions, now is a critical time to examine factors that contribute to cooperative SIS-police relationships. We sought to learn about SIS-police relationships from international jurisdictions with well-established as well as newer SIS. METHODS We conducted 16 semi-structured telephone interviews with SIS managers (n = 10) and police liaisons (n = 6) from 10 cities in seven different countries (Australia, Canada, Denmark, France, Germany, Netherlands, and Spain). All participants provided informed consent. We focused our coding and analysis on themes that emerged from the data. RESULTS Five key contributors to cooperative SIS-police relationships emerged from the data: early engagement and dialogues; supportive police chiefs; dedicated police liaisons; negotiated boundary agreements; and regular face-to-face contact. Most participants perceived the less formalised, on-the-ground approach to relationship-building between police and SIS adopted in their city to be working well in general. SIS managers and police participants reported a lack of formal police training on harm reduction, and some thought that training was unnecessary given the relatively positive local SIS-police relationships they reported. CONCLUSION Our qualitative study provides new, in-depth empirical examples of how police in varied international jurisdictions can come to accept and work cooperatively with, not against, SIS staff and clients. Investing ongoing effort in SIS-police relationships, in a manner that best suits local needs, may hold greater and more sustainable public health value than delivering specific curricula to police.
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Affiliation(s)
- Tara Marie Watson
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.
| | - Ahmed M Bayoumi
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada; Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M6, Canada; Division of General Internal Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada.
| | - Shaun Hopkins
- The Works, Toronto Public Health, 277 Victoria Street, Toronto, Ontario, M5B 1W2, Canada.
| | - Amy Wright
- The Works, Toronto Public Health, 277 Victoria Street, Toronto, Ontario, M5B 1W2, Canada.
| | - Renuka Naraine
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.
| | - Triti Khorasheh
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.
| | - Laurel Challacombe
- CATIE, 555 Richmond Street West, Suite 505, Toronto, Ontario, M5V 3B1, Canada.
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.
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47
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Yoong D, Bayoumi AM, Robinson L, Rachlis B, Antoniou T. Public prescription drug plan coverage for antiretrovirals and the potential cost to people living with HIV in Canada: a descriptive study. CMAJ Open 2018; 6:E551-E560. [PMID: 30482757 PMCID: PMC6276936 DOI: 10.9778/cmajo.20180058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Antiretrovirals are expensive and people living with HIV may experience a range of financial burdens when accessing these medications. Our aim was to describe the policy of all Canadian public drug insurance programs for antiretroviral drugs and illustrated how these policies might affect patients' annual out-of-pocket expenditures. METHODS In December 2017, we reviewed public drug programs offering antiretroviral coverage in Canada using government websites to summarize eligibility criteria. We estimated the annual out-of-pocket costs incurred by people living with HIV by applying the cost-sharing rules to 2 hypothetical cases, a single man and a married woman with a net household income of $39 000 and $80 000, respectively, receiving identical prescriptions in different jurisdictions. RESULTS We observed substantial variation in the subsidy provided based mainly on geography, income and age. All 5 federal programs and 6 of 13 provincial and territorial jurisdictions offered universal coverage. In the remaining regions, patients spend up to several thousand dollars annually depending on income (Manitoba), age and income (Ontario, Saskatchewan) and age, income and drug costs (Quebec and Newfoundland and Labrador). We found the greatest variation for our higher income case, with out-of-pocket expenses ranging from 0 to over 50% of the antiretroviral cost. INTERPRETATION There is considerable inter- and intra-jurisdiction heterogeneity in the cost-sharing policies for antiretrovirals across Canada's public drug programs. Policy reforms that either eliminate or set national standards for copayments, deductibles or premiums would minimize variation and could reduce the risk of cost-associated non-adherence to HIV therapy.
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Affiliation(s)
- Deborah Yoong
- Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Department of Medicine (Bayoumi), University of Toronto, Toronto, Ont.; Department of Pharmacy (Robinson), Windsor Regional Hospital, Windsor, Ont.; Ontario HIV Treatment Network (Rachlis), Toronto, Ont.; Department of Family and Community Medicine (Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont.
| | - Ahmed M Bayoumi
- Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Department of Medicine (Bayoumi), University of Toronto, Toronto, Ont.; Department of Pharmacy (Robinson), Windsor Regional Hospital, Windsor, Ont.; Ontario HIV Treatment Network (Rachlis), Toronto, Ont.; Department of Family and Community Medicine (Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Linda Robinson
- Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Department of Medicine (Bayoumi), University of Toronto, Toronto, Ont.; Department of Pharmacy (Robinson), Windsor Regional Hospital, Windsor, Ont.; Ontario HIV Treatment Network (Rachlis), Toronto, Ont.; Department of Family and Community Medicine (Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Beth Rachlis
- Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Department of Medicine (Bayoumi), University of Toronto, Toronto, Ont.; Department of Pharmacy (Robinson), Windsor Regional Hospital, Windsor, Ont.; Ontario HIV Treatment Network (Rachlis), Toronto, Ont.; Department of Family and Community Medicine (Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Tony Antoniou
- Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Department of Medicine (Bayoumi), University of Toronto, Toronto, Ont.; Department of Pharmacy (Robinson), Windsor Regional Hospital, Windsor, Ont.; Ontario HIV Treatment Network (Rachlis), Toronto, Ont.; Department of Family and Community Medicine (Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
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Shankardass K, O'Campo P, Muntaner C, Bayoumi AM, Kokkinen L. Ideas for Extending the Approach to Evaluating Health in All Policies in South Australia Comment on "Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia". Int J Health Policy Manag 2018; 7:755-757. [PMID: 30078296 PMCID: PMC6077279 DOI: 10.15171/ijhpm.2018.25] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/07/2018] [Indexed: 11/09/2022] Open
Abstract
Since 2008, the government of South Australia has been using a Health in All Policies (HiAP) approach to achieve their strategic plan (South Australia Strategic Plan of 2004). In this commentary, we summarize some of the strengths and contributions of the innovative evaluation framework that was developed by an embedded team of academic researchers. To inform how the use of HiAP is evaluated more generally, we also describe several ideas for extending their approach, including: deeper integration of interdisciplinary theory (eg, public health sciences, policy and political sciences) to make use of existing knowledge and ideas about how and why HiAP works; including a focus on implementation outcomes and using developmental evaluation (DE) partnerships to strengthen the use of HiAP over time; use of systems theory to help understand the complexity of social systems and changing contexts involved in using HiAP; integrating economic considerations into HiAP evaluations to better understand the health, social and economic benefits and trade-offs of using HiAP.
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Affiliation(s)
- Ketan Shankardass
- Wilfrid Laurier University, Waterloo, ON, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowedge Institute, Toronto, ON, Canada
| | - Patricia O'Campo
- Centre for Urban Health Solutions, Li Ka Shing Knowedge Institute, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Carles Muntaner
- Bloomberg School of Nursing, University of Toronto, Toronto, ON, Canada
| | - Ahmed M Bayoumi
- Centre for Urban Health Solutions, Li Ka Shing Knowedge Institute, Toronto, ON, Canada.,Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Lauri Kokkinen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland.,Finnish Institute of Occupational Health, Tampere, Finland
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Isaranuwatchai W, Bayoumi AM, Renahy E, Cheff R, O'Campo P. Using decision methods to examine the potential impact of intersectoral action programs. BMC Res Notes 2018; 11:506. [PMID: 30053829 PMCID: PMC6062875 DOI: 10.1186/s13104-018-3609-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/17/2018] [Indexed: 11/25/2022] Open
Abstract
Objectives In public health today, there is a widespread call for intersectoral action (ISA) programs, in which two or more sectors cooperate to address a problem. This trend raises a question of how to appropriately assess the effectiveness and cost-effectiveness of ISA programs. To assess the impact of ISA, evaluation methods should provide a framework for simultaneously considering the impact of two or more interventions when selecting from a portfolio of programs. There is a gap in literature on such methods. In this research note, from a narrative review, we report and describe methods that could be useful for evaluating ISA programs. Subsequently, we present a hypothetical case study to demonstrate the use of these methods. Results We identified four methods that have potential to assess the joint impact of multiple interventions: economic evaluation, portfolio analysis, multiple-criteria decision analysis, and programme budgeting and marginal analysis. To keep pace with the desire to use strong evidence to inform the selection and design of ISA programs, methods must evolve to support these initiatives. This research note seeks to begin a dialogue on existing decision methods which may be used to assist decision makers with funding and resource allocation decisions of ISA programs. Electronic supplementary material The online version of this article (10.1186/s13104-018-3609-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wanrudee Isaranuwatchai
- Centre for Excellence in Economic Analysis Research (CLEAR), The HUB, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada.
| | - Ahmed M Bayoumi
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Department of Medicine, University of Toronto, 27 King's College Cir, Toronto, ON, M5S 1A1, Canada.,Division of General Internal Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Emilie Renahy
- Lea Roback Research Centre on Social Inequalities and Health, 1301, rue Sherbrooke Est, Montreal, QC, H2L 1M3, Canada.,Département de médecine sociale et préventive, Université de Montréal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
| | - Rebecca Cheff
- Wellesley Institute, 10 Alcorn Ave, Toronto, ON, M4V 3B1, Canada
| | - Patricia O'Campo
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Dalla Lana School of Public Health, University of Toronto, 27 King's College Cir, Toronto, ON, M5S 1A1, Canada
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50
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Sharma M, Chris A, Chan A, Knox DC, Wilton J, McEwen O, Mishra S, Grace D, Rogers T, Bayoumi AM, Maxwell J, Shahin R, Bogoch I, Gilbert M, Tan DHS. Decentralizing the delivery of HIV pre-exposure prophylaxis (PrEP) through family physicians and sexual health clinic nurses: a dissemination and implementation study protocol. BMC Health Serv Res 2018; 18:513. [PMID: 29970087 PMCID: PMC6029110 DOI: 10.1186/s12913-018-3324-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 06/25/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Gay, bisexual and other men who have sex with men (gbMSM) in Canada continue to experience high rates of incident HIV. Pre-exposure prophylaxis (PrEP, the regular use of anti-HIV medication) reduces HIV acquisition and could reduce incidence. However, there are too few physicians with expertise in HIV care to meet the projected demand for PrEP. To meet demand and achieve greater public health impact, PrEP delivery could be 'decentralized' by incorporating it into front-line prevention services provided by family physicians (FPs) and sexual health clinic nurses. METHODS This PrEP decentralization project will use two strategies. The first is an innovative knowledge dissemination approach called 'Patient-Initiated CME' (PICME), which aims to empower individuals to connect their family doctors with online, evidence-based, continuing medical education (CME) on PrEP. After learning about the project through community agencies or social/sexual networking applications, gbMSM interested in PrEP will use a uniquely coded card to access an online information module that includes coaching on how to discuss their HIV risk with their FP. They can provide their physician a link to the accredited CME module using the same card. The second strategy involves a pilot implementation program, in which gbMSM who do not have a FP may bring the card to designated sexual health clinics where trained nurses can deliver PrEP under a medical directive. These approaches will be evaluated through quantitative and qualitative methods, including: questionnaires administered to patients and physicians at baseline and at six months; focus groups with patients, FPs, and sexual health clinic staff; and review of sexual health clinic charts. The primary objective is to quantify the uptake of PrEP achieved using each decentralization strategy. Secondary objectives include a) characterizing barriers and facilitators to PrEP uptake for each strategy, b) assessing fidelity to core components of PrEP delivery within each strategy, c) measuring patient-reported outcomes including satisfaction with clinician-patient relationships, and d) conducting a preliminary costing analysis. DISCUSSION This study will assess the feasibility of a novel strategy for disseminating knowledge about evidence-based clinical interventions, and inform future strategies for scale-up of an underutilized HIV prevention tool.
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Affiliation(s)
- Malika Sharma
- Division of Infectious Diseases, St. Michael’s Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Maple Leaf Medical Clinic, Toronto, Canada
| | | | - Arlene Chan
- Scarborough Sexual Health Clinic, Toronto, Canada
| | - David C. Knox
- Department of Medicine, University of Toronto, Toronto, Canada
| | | | - Owen McEwen
- Gay Men’s Sexual Health Alliance, Toronto, Canada
| | - Sharmistha Mishra
- Division of Infectious Diseases, St. Michael’s Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Center for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Tim Rogers
- Canadian Treatment Information Exchange (CATIE), Toronto, Canada
| | - Ahmed M. Bayoumi
- Department of Medicine, University of Toronto, Toronto, Canada
- Center for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, St. Michael’s Hospital, Toronto, Canada
| | | | | | - Isaac Bogoch
- Department of Medicine, University of Toronto, Toronto, Canada
- Division of Infectious Diseases, University Health Network, Toronto, Canada
| | - Mark Gilbert
- British Columbia Center for Disease Control, Vancouver, Canada
| | - Darrell H. S. Tan
- Division of Infectious Diseases, St. Michael’s Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Center for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Division of Infectious Diseases, University Health Network, Toronto, Canada
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