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MacDonald KV, Nguyen GC, Barker KL, Harris M, Sewitch MJ, Marshall DA. A68 HOW REAL ARE YOUR SURVEY RESPONDENTS? IDENTIFYING FRAUDULENT RESPONDENTS IN ONLINE SURVEYS – A CASE EXAMPLE IN INFLAMMATORY BOWEL DISEASE (IBD). J Can Assoc Gastroenterol 2023. [PMCID: PMC9991161 DOI: 10.1093/jcag/gwac036.068] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Social media and online surveys are commonly used to recruit and collect data from patients and physicians about GI diseases – they are efficient, convenient, and less resource intensive compared to traditional recruitment approaches and paper surveys. However, online data fraud is increasing and difficult to identify. Online data fraud can include intentional duplicate responses/straight-lining/inattention, bots/malicious software, and professional survey takers who provide fraudulent responses to meet study eligibility. Purpose 1) Illustrate challenges of identifying fraudulent respondents through an algorithm and verification process we developed for our survey in IBD. 2) Demonstrate potential impact of fraudulent respondents on data and results. Method Online survey of Canadian adults (>18 years) with IBD about healthcare processes for managing IBD hosted using Qualtrics. Recruitment was done in clinic and online (mailing lists, social media). A $25 giftcard was offered for participation due to low response after 3 months in field, after which a large influx of ‘respondents’ occurred. Most were fraudulent although not obvious at first. To mitigate further fraudulent responses, we added the following to our survey: reCAPTCHA score, repeated question (year of IBD diagnosis), duplicate ID score, fraud score and honeypot question. Our algorithm to identify fraudulent responses included 13 binary ‘red flag’ variables: age <18 years, year of diagnosis < year of birth, 2 different year of diagnosis, invalid postal code, survey duration <10 minutes, survey duration 10-15 minutes, suspicious comments for open text questions (x2), duplicate email, suspicious email, duplicate ID score ≥30, fraud score ≥30, and failed honeypot question. These variables were used to generate a fraudulent response score (range: 0-13; 13=most likely fraudulent). ‘Respondents’ with scores >3 were categorized as likely fraudulent. Respondents with scores ≤3 were reviewed individually. Respondents flagged as likely real or unsure were emailed and asked to verify their age; those who correctly verified age were considered likely real and included in the final sample. Result(s) Of the 4334 ‘respondents’ who started the survey, based on fraudulent response score we identified 75% (n=3258) as likely fraudulent, 17% (n=727) as unsure and 8% (n=349) as likely real. After age verification, 76% (n=3297) were considered likely fraudulent, 14% (n=592) remained unsure, 10% (n=442) were considered likely real, and <1% (n=3) were duplicates of likely real respondents. Conclusion(s) Despite convenience, social media and online surveys can be prone to fraudulent responses, especially when incentives are offered. We developed an algorithm and verification process to identify fraudulent responses using an IBD survey example. Given that only 10% of the full sample was considered likely real, researchers using social media and online surveys should carefully examine data for fraudulent responses and apply strategies to mitigate risks. Please acknowledge all funding agencies by checking the applicable boxes below CCC Disclosure of Interest None Declared
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Affiliation(s)
- K V MacDonald
- Community Health Sciences, University of Calgary, Calgary
| | - G C Nguyen
- University of Toronto,Mount Sinai Hospital, Toronto
| | - K L Barker
- Community Health Sciences, University of Calgary, Calgary
| | | | | | - D A Marshall
- Community Health Sciences, University of Calgary, Calgary
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Mirza RM, MacKean G, Shaffer SR, Sewitch MJ, Heisler C, McLeod J, Habashi P, MacDonald KV, Barker K, Nguyen GC, Marshall DA. Patient Experiences in the Management of Inflammatory Bowel Disease: A Qualitative Study. J Can Assoc Gastroenterol 2022; 5:261-270. [PMID: 36467596 PMCID: PMC9713627 DOI: 10.1093/jcag/gwac014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) can lead to substantial impairments of quality-of-life. Clinical guidelines and quality indicators aid physicians in practice but may not reflect the perspectives and experiences of patients with IBD. To address this, the objectives of this study were to understand patient experiences with IBD care and to explore priorities. METHODS Based on a convenience sample of 36 participants, five focus groups were completed at four sites across Canada. Data were analyzed using a deductive thematic analysis approach to assess emergent themes and variability in participants' experiences. RESULTS Our results are organized by themes of structure, process and outcomes to illustrate common issues with respect to how care is organized in the healthcare system, how patients receive and experience care and how patients perceive the outcomes of their care. Our results frame a health systems quality approach that signal needed improvements in access to care, the need for innovation with respect to virtual medicine, the potential expansion of multidisciplinary team-based care and the importance of addressing the psychosocial dimensions for patients with IBD and their caregivers in order to better deliver patient-centred care. CONCLUSIONS The issues identified have the potential to impact priority areas in the system, IBD care delivery, and how outcomes can be improved by focusing on 'lived experience' and patient-centred care. The differing values and perspectives of all those involved in caring for patients with IBD underscore the importance of good communication with patients, caregivers and family members, as well as staying responsive to evolving needs.
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Affiliation(s)
- Raza M Mirza
- University of Toronto, Factor-Inwentash Faculty of Social Work, Institute for Life Course and Aging, Canada
- National Initiative for the Care of the Elderly (NICE), Canada
| | - Gail MacKean
- Department of Community Health Sciences Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Seth R Shaffer
- University of Manitoba IBD Clinical and Research Center, Canada
- Internal Medicine, University of Manitoba, Canada
| | - Maida J Sewitch
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Canada
| | - Courtney Heisler
- Nova Scotia Collaborative IBD Program, Division of Digestive Care and Endoscopy, QEII Health Sciences Centre, Canada
| | - Justine McLeod
- Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto Department of Medicine, Canada
| | - Peter Habashi
- Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto Department of Medicine, Canada
| | - Karen V MacDonald
- Department of Community Health Sciences Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Karis Barker
- Department of Community Health Sciences Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Geoffrey C Nguyen
- Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto Department of Medicine, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences Cumming School of Medicine, University of Calgary, Calgary, Canada
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Hansen-Barkun C, Kherad O, Donovan AA, Prashad AJ, Sewitch MJ. Personal protective equipment portraits in the era of COVID-19. Eur J Intern Med 2022; 102:125-127. [PMID: 35660324 PMCID: PMC9132790 DOI: 10.1016/j.ejim.2022.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/27/2022]
Affiliation(s)
| | - Omar Kherad
- Department of Internal Medicine, Hôpital de la Tour and University of Geneva, Switzerland
| | | | | | - Maida J Sewitch
- Department of Medicine, McGill University, Montreal, Canada; Division of Clinical Epidemiology, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada.
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Harvey E, El Bizri M, Nguyen GC, Marshall DA, Mirza R, Sewitch MJ. Health Care Perspectives of Adult Patients with Lower Educational Attainment in Inflammatory Bowel Disease: A Qualitative Study. J Patient Exp 2022; 9:23743735221092557. [PMID: 35434295 PMCID: PMC9008868 DOI: 10.1177/23743735221092557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Patients with lower educational attainment are underrepresented in inflammatory bowel disease (IBD) research. To increase our understanding of the health care perspectives of patients with less than a university degree, semi-structured interviews were conducted among 23 outpatients at the McGill University Health Centre IBD Centre (Montreal, Canada). Thematic analysis was used to analyze the qualitative data. Perspectives focused on communication with health care professionals, access to care, symptoms and treatment, and outside support. Access to an IBD specialist was the most important aspect of care. Good care, kind and receptive staff, and a lengthy delay to diagnosis were frequently reported experiences. IBD specialists, nurses, and family and friends were most helpful in managing disease. Physical and emotional symptoms, reduced social engagement, and medications were difficult aspects of living with IBD. An ideal IBD clinic would provide access to traditional and non-traditional services and assist with obtaining support to help patients engage in social activities, increase affordability of care, and maintain employment. Study findings may be helpful in designing equitable models of health care delivery.
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Affiliation(s)
- Eric Harvey
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill
University Health Centre, Montreal, QC, Canada
| | - Maria El Bizri
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill
University Health Centre, Montreal, QC, Canada
| | - Geoffrey C. Nguyen
- Department of Medicine, Mount Sinai Hospital Centre for Inflammatory
Bowel Disease, University of Toronto, Toronto, ON, Canada
| | - Deborah A. Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Raza Mirza
- Institute for Life Course and Aging, University of Toronto, Toronto, ON, Canada
| | - Maida J. Sewitch
- Department of Medicine, McGill University and the Research
Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation, Montreal, QC,
Canada
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5
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El Bizri M, El Sheikh M, Lee GE, Sewitch MJ. Mobile health technologies supporting colonoscopy preparation: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2021; 16:e0248679. [PMID: 33735320 PMCID: PMC7971694 DOI: 10.1371/journal.pone.0248679] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 03/04/2021] [Indexed: 02/07/2023] Open
Abstract
Background Mobile health (mHealth) technologies are innovative solutions for delivering instructions to patients preparing for colonoscopy. Objective To systematically review the literature evaluating the effectiveness of mHealth technologies supporting colonoscopy preparation on patient and clinical outcomes. Methods MEDLINE, EMBASE, CINAHL and CENTRAL were searched for randomized controlled trials (RCTs) that evaluated the effectiveness of mHealth technologies for colonoscopy preparation on patient and clinical outcomes. Two reviewers independently assessed study eligibility, extracted data, and appraised methodological quality using the Cochrane Risk-of-Bias tool. Data were pooled using random effects models and when heterogeneity, assessed using I2, was statistically significant, a qualitative synthesis of the data was performed. Publication bias was assessed using a funnel plot. Results Ten RCTs (3,383 participants) met inclusion criteria. MHealth interventions included smartphone apps, SMS text messages, videos, camera apps, and a social media app. Outcomes were bowel cleanliness quality, user satisfaction, colonoscopy quality indicators (cecal intubation time, withdrawal time, adenoma detection rate), adherence to diet, and cancellation/no-show rates. MHealth interventions were associated with better bowel cleanliness scores on the Boston Bowel Preparation Scale [standardized mean difference (SMD) 0.57, 95%CI 0.37–0.77, I2 = 60%, p = 0.08] and the Ottawa Bowel Preparation Scale [SMD -0.39, 95%CI -0.59–0.19, I2 = 45%, p = 0.16], but they were not associated with rates of willingness to repeat the colonoscopy using the same regimen [odds ratio (OR) 1.88, 95%CI 0.85–4.15, I2 = 48%, p = 0.12] or cancellations/no-shows [OR 0.96, 95%CI 0.68–1.35, I2 = 0%]. Most studies showed that adequate bowel preparation, user satisfaction and adherence to diet were better in the intervention groups compared to the control groups, while inconsistent findings were observed for the colonoscopy quality indicators. All trials were at high risk of bias for lack of participant blinding. Visual inspection of a funnel plot revealed publication bias. Conclusions MHealth technologies show promise as a way to improve bowel cleanliness, but trials to date were of low methodological quality. High-quality research is required to understand the effectiveness of mHealth technologies on colonoscopy outcomes.
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Affiliation(s)
- Maria El Bizri
- Centre for Outcomes Research & Evaluation, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Mariam El Sheikh
- Centre for Outcomes Research & Evaluation, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Ga Eun Lee
- Centre for Outcomes Research & Evaluation, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Maida J Sewitch
- Centre for Outcomes Research & Evaluation, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Medicine, Division of Gastroenterology, McGill University, Montréal, Québec, Canada
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6
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El Sheikh M, Lee G, El Bizri M, Sewitch MJ. A159 ARE MOBILE HEALTH TECHNOLOGIES SUPPORTING COLONOSCOPY PREPARATION ASSOCIATED WITH BETTER PATIENT OUTCOMES: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.158] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Mobile health technologies are innovative solutions for delivering instructions to patients preparing for their colonoscopy appointments.
Aims
To systematically review the literature of the effect of smartphone-based technologies supporting colonoscopy appointment preparation on patient outcomes.
Methods
With the assistance of a librarian, one author searched MEDLINE, EMBASE, CINAHL and CENTRAL for randomized controlled trials (RCTs) that evaluated the effect of smartphone-based technologies for colonoscopy preparation on bowel cleanliness and user satisfaction. Two independent reviewers extracted data on patient and intervention characteristics and study outcomes, and appraised study quality using the Cochrane Risk-of-Bias tool. Summary statistics were generated using random effects models for the trials that used either the Boston Bowel Preparation Scale (BPPS) or the Ottawa Bowel Preparation Scale (OBPS). Statistical heterogeneity was assessed using I2.
Results
Ten RCTs met our inclusion criteria. Smartphone-based interventions included apps, SMS text messages, video clips, camera apps, and social media apps. Most studies showed smartphone-based interventions were associated with better quality bowel cleanliness scores and higher user satisfaction compared to usual care. Standardized mean differences for the BBPS and OBPS differed between the intervention and control groups [SMD 0.57, 95%CI 0.18, 0.95] and [SMD -0.39, 95%CI -0.59, -0.19], respectively. Statistically significant statistical heterogeneity was found for the meta-analyses for the trials employing the BBPS (I2=80%, p=0.03) but not for the trials using the OBPS (I2=45%, p=0.16). All RCTs were at high risk of bias from non-blinded participants, and most studies were at high or unclear risk of bias due to lack of allocation concealment. Funnel plots to evaluate publication bias were not generated as there were too few studies with sufficient data to analyze.
Conclusions
This systematic review found that smartphone-based technology users had better bowel cleanliness quality scores and higher satisfaction with the method of delivering instructions compared to patients given usual care. Given that all RCTs were at high risk of bias, high-quality RCTs that blind participants and conceal study group allocation are needed.
Funding Agencies
CIHRDepartment of Medicine, McGill University and the Research Institute of the McGill University Health Centre
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Affiliation(s)
- M El Sheikh
- Research Institute of the McGill University Health Centre and McGill University, Montreal, QC, Canada
| | - G Lee
- Research Institute of the McGill University Health Centre and McGill University, Montreal, QC, Canada
| | - M El Bizri
- Research Institute of the McGill University Health Centre and McGill University, Montreal, QC, Canada
| | - M J Sewitch
- Research Institute of the McGill University Health Centre and McGill University, Montreal, QC, Canada
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7
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Kay-Rivest E, Mascarella M, Sewitch MJ, Cloutier F, Mijovic T. Association between Smoking and 30-Day Outcomes in Otologic Surgery. Otolaryngol Head Neck Surg 2019; 162:108-113. [DOI: 10.1177/0194599819889622] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
ObjectiveTo determine the effect of current smoking status on 30-day postoperative adverse events in patients undergoing otologic surgery.Study DesignRetrospective cohort study.SettingDatabase of the American College of Surgeons National Surgical Quality Improvement Program from 2006 to 2016.Subjects and MethodsAdult patients undergoing middle ear and mastoid surgery were included. Preoperative smoking status was determined, and adverse events within 30 days of surgery were recorded. Descriptive statistics were used to characterize the study sample. Multivariable logistic regression was performed to identify the association between sociodemographic and clinical variables and postoperative adverse events. Population-attributable fractions were then calculated.ResultsA total of 10,684 patients who underwent otologic surgery were included, of whom 2036 (19.1%) were smokers. The most commonly performed surgery was tympanoplasty with and without ossicular chain reconstruction, followed by canal wall up tympanomastoidectomy. Adverse events occurred in 221 (2.1%) patients; the most common was superficial wound infections (n = 99, 0.9%). In smokers, the odds ratio for any adverse event was 1.97 (95% CI, 1.42-2.71). The odds ratios (95% CIs) for superficial wound infections, wound dehiscence, and 30-day readmission among smokers were 1.89 (1.32-2.86), 3.92 (1.26-11.60), and 1.84 (1.15-2.87), respectively. The population-attributable fraction for any adverse event in smokers was 15.5%.ConclusionsIn patients undergoing otologic surgery, smokers are more likely than nonsmokers to have postoperative adverse events—in particular, wound infections, wound dehiscence, and readmission to hospital.
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Affiliation(s)
- Emily Kay-Rivest
- Department of Otolaryngology–Head and Neck Surgery, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Marco Mascarella
- Department of Otolaryngology–Head and Neck Surgery, Royal Victoria Hospital, Montreal, Quebec, Canada
- Departments of Medicine, Epidemiology, Biostatistics and Occupational Health, and Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Maida J. Sewitch
- Departments of Medicine, Epidemiology, Biostatistics and Occupational Health, and Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - François Cloutier
- Department of Otolaryngology–Head and Neck Surgery, Pierre Boucher Hospital, Longueil, Quebec, Canada
| | - Tamara Mijovic
- Department of Otolaryngology–Head and Neck Surgery, Royal Victoria Hospital, Montreal, Quebec, Canada
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Sewitch MJ, Fallone CA, Ghali P, Lee GE. What Patients Want in a Smartphone App That Supports Colonoscopy Preparation: Qualitative Study to Inform a User-Centered Smartphone App. JMIR Mhealth Uhealth 2019; 7:e12242. [PMID: 31125310 PMCID: PMC6632098 DOI: 10.2196/12242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/25/2019] [Accepted: 05/01/2019] [Indexed: 12/13/2022] Open
Abstract
Background The preparation for colonoscopy is elaborate and complex. In the context of colorectal cancer screening, up to 11% of patients do not keep their colonoscopy appointments and up to 33% of those attending their appointments have inadequately cleansed bowels that can delay cancer diagnosis and treatment. A smartphone app may be an acceptable and wide-reaching tool to improve patient adherence to colonoscopy. Objective The aim of this qualitative study was to employ a user-centered approach to design the content and features of a smartphone app called colonAPPscopy to support individuals preparing for their colonoscopy appointments. Methods We conducted 2 focus group discussions (FGDs) with gastroenterology patients treated at the McGill University Health Centre in Montreal, Canada. Patients were aged 50 to 75 years, were English- or French-speaking, and had undergone outpatient colonoscopy in the previous 3 months; they did not have inflammatory bowel disease or colorectal cancer. FGDs were 75 to 90 min, conducted by a trained facilitator, and audiotaped. Participants discussed the electronic health support tools they might use to help them prepare for the colonoscopy, the content needed for colonoscopy preparation, and the features that would make the smartphone app useful. Recordings of FGDs were transcribed and analyzed using thematic analysis to identify key user-defined content and features to inform the design of colonAPPscopy. Results A total of 9 patients (7 male and 2 female) participated in one of 2 FGDs. Main content areas focused on bowel preparation instructions, medication restrictions, appointment logistics, communication, and postcolonoscopy expectations. Design features to make the app useful and engaging included minimization of data input, reminders and alerts for up to 7 days precolonoscopy, and visual aids. Participants wanted a smartphone app that comes from a trusted source, sends timely and tailored messages, provides reassurance, provides clear instructions, and is simple to use. Conclusions Participants identified the need for postcolonoscopy information as well as reminders and alerts in the week before colonoscopy, novel content, and features that had not been included in previous smartphone-based strategies for colonoscopy preparation. The ability to tailor instructions made the smartphone app preferable to other modes of delivery. Study findings recognize the importance of including potential users in the development phase of building a smartphone app.
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Affiliation(s)
- Maida J Sewitch
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada
| | - Carlo A Fallone
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada
| | - Peter Ghali
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada
| | - Ga Eun Lee
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
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9
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Harvey E, Nguyen GC, Marshall D, Mirza R, Sewitch MJ. A119 UNDERSTANDING THE PERSPECTIVES OF PATIENTS WITH LOW EDUCATIONAL ATTAINMENT IN IBD: RESULTS OF A QUALITATIVE STUDY. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.118] [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: 11/13/2022] Open
Affiliation(s)
- E Harvey
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - G C Nguyen
- Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - D Marshall
- University of Calgary, Calgary, AB, Canada
| | - R Mirza
- University of Toronto, Toronto, ON, Canada
| | - M J Sewitch
- Research Institute of the McGill University Health Centre and McGill University, Montreal, QC, Canada
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10
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Soucy JPR, Kutcher SA, MacLean E, Sewitch MJ. You Only Die Twice. Am J Public Health 2019; 109:e9. [PMID: 32941749 DOI: 10.2105/ajph.2018.304822] [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] [Indexed: 11/04/2022]
Affiliation(s)
- Jean-Paul R Soucy
- Jean-Paul R. Soucy, Stephen A. Kutcher, and Emily MacLean are with the Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. Maida J. Sewitch is with the Department of Medicine, McGill University, and the Research Institute of the McGill University Health Centre, Montreal, Quebec
| | - Stephen A Kutcher
- Jean-Paul R. Soucy, Stephen A. Kutcher, and Emily MacLean are with the Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. Maida J. Sewitch is with the Department of Medicine, McGill University, and the Research Institute of the McGill University Health Centre, Montreal, Quebec
| | - Emily MacLean
- Jean-Paul R. Soucy, Stephen A. Kutcher, and Emily MacLean are with the Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. Maida J. Sewitch is with the Department of Medicine, McGill University, and the Research Institute of the McGill University Health Centre, Montreal, Quebec
| | - Maida J Sewitch
- Jean-Paul R. Soucy, Stephen A. Kutcher, and Emily MacLean are with the Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. Maida J. Sewitch is with the Department of Medicine, McGill University, and the Research Institute of the McGill University Health Centre, Montreal, Quebec
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11
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Huang YQ, Traore K, Ibrahim B, Sewitch MJ, Nguyen LHP. Reporting quality of randomized controlled trials in otolaryngology: review of adherence to the CONSORT statement. J Otolaryngol Head Neck Surg 2018; 47:34. [PMID: 29764496 PMCID: PMC5952888 DOI: 10.1186/s40463-018-0277-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 04/29/2018] [Indexed: 11/30/2022] Open
Abstract
Background Randomized controlled trials are the gold standard in medical and surgical research to assess the efficacy of therapeutic interventions. The reporting of these trials should be of high quality to allow readers’ appropriate interpretation and application. Methods The objectives of our study were to assess the extent to which the recent Otolaryngology – Head and Neck Surgery (ORL-HNS) randomized control trials in the top nine journals and in the top Canadian journal comply with the Consolidated Standards of Reporting Trials (CONSORT) statement, and to identify the CONSORT items most in need of improvement. Based on the impact factor and circulation number of 2014, the top nine Otolaryngology journals and the top Canadian Otolaryngology journal were selected and were searched to identify RCTs published in English and between 2010 and 2014. Two authors independently reviewed and extracted data using a standardized data extraction form constructed with the help of a medical librarian. Our outcome was to assess the adherence of articles reporting to the CONSORT items. Descriptive statistics were used. Results One hundred and eighty-two Otolaryngologic RCTs were identified in the top nine international journals and in the top Canadian journal. The inter-rater reliability between two raters was 0.32. The extent of adherence to CONSORT Statement ranged from 25 to 93.5% with a mean of 59.0% and a median of 59.4%. Only 6.5% of RCTs described the individual responsible for enrolling and assigning subjects and method of randomization; 32.4% reported the estimated effect size and precision; 40.6% reported a sample size calculation and 32.4% mentioned external validity or implications of the findings. Conclusion Findings revealed that the reporting of RCTs in the top nine ORL-HNS journals and in the top Canadian ORL-HNS journal is suboptimal. The quality of reporting can be improved by addressing the three CONSORT items found most deficient in this study namely, sample size calculations, estimated effect size and precision, and external validity.
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Affiliation(s)
- Yu Qing Huang
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Badr Ibrahim
- Department of Otolaryngology - Head and Neck Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Maida J Sewitch
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada. .,Center for Medical Education, McGill University, Montreal, Quebec, Canada. .,Department of ORL-HNS, Montreal Children's Hospital, 1001 Boulevard Décarie, Montréal, Quebec, H4A 3J1, Canada.
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12
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Sewitch MJ, Zhao L, Li J, Wang X. A260 AGREEMENT BETWEEN COLONOSCOPY-DETECTED AND PATHOLOGY-CONFIRMED COLORECTAL CANCER IN THE 2012 TIANJIN COLORECTAL CANCER SCREENING PROGRAM. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.260] [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: 11/12/2022] Open
Affiliation(s)
- M J Sewitch
- Medicine, McGill University, Montreal, QC, Canada
| | - L Zhao
- Tianjin Nankai Hospital, Tianjin, China
| | - J Li
- Tianjin Nankai Hospital, Tianjin, China
| | - X Wang
- Tianjin Nankai Hospital, Tianjin, China
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Sewitch MJ, Fallone C, Ghali P, Soulellis CA, Wong P. A72 BUILDING A SMARTPHONE APPLICATION FOR COLONOSCOPY PREPARATION USING A PATIENT-CENTERED APPROACH. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.073] [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: 11/13/2022] Open
Affiliation(s)
- M J Sewitch
- McGill University and the Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - C Fallone
- McGill University and the McGill University Health Centre, Montreal, QC, Canada
| | - P Ghali
- McGill University and the McGill University Health Centre, Montreal, QC, Canada
| | - C A Soulellis
- McGill University and the McGill University Health Centre, Montreal, QC, Canada
| | - P Wong
- McGill University and the McGill University Health Centre, Montreal, QC, Canada
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Battat R, Kopylov U, Byer J, Sewitch MJ, Rahme E, Nedjar H, Zelikovic E, Dionne S, Bessissow T, Afif W, Waters PJ, Seidman E, Bitton A. Vitamin B12 deficiency in inflammatory bowel disease: a prospective observational pilot study. Eur J Gastroenterol Hepatol 2017; 29:1361-1367. [PMID: 28953003 DOI: 10.1097/meg.0000000000000970] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Diagnostic and management guidelines for vitamin B12 (cobalamin, Cbl) deficiency in inflammatory bowel disease (IBD) are lacking. True deficiency is defined as Cbl concentrations below reference range combined with elevated methylmalonic acid (MMA) concentrations. Studies analyzing Cbl status in IBD use only Cbl concentrations without confirmatory MMA. This study aims to determine the proportion of IBD patients with Cbl concentrations below reference range and their predisposing clinical and genetic characteristics. We then compared this to the proportion with true deficiency. PATIENTS AND METHODS In a prospective observational pilot study of adult IBD outpatients, Cbl concentrations, MMA levels, and fucosyltransferase 2 mutations were measured at clinic visits. RESULTS A total of 66 Crohn's disease (CD) and 30 ulcerative colitis (UC) patients were recruited. Mean Cbl concentrations (pmol/l) in CD (253.7) were not significantly lower than UC (320.5, P=0.24). Serum Cbl below reference range (<148) was observed in 7.6 and 10% of CD and UC patients, respectively (P=0.70). True deficiency in CD and UC was 3 and 3.3%, respectively (P=1.0). Patients with ileal resections more than 30 cm had lower mean Cbl concentrations (177, P=0.02) and a trend toward higher proportions with Cbl levels below reference range (40%, P=0.06), but not increased deficiency rates (0%, P=1.0). Disease location, severity, and fucosyltransferase 2 mutations were not associated with altered Cbl status. CONCLUSION True Cbl deficiency was rare in IBD patients in this study. A disparity in Cbl status exists when confirmatory MMA levels are used compared with Cbl concentrations alone. Asymptomatic IBD patients with low serum Cbl require confirmatory tests to guide management and avoid unnecessary treatment.
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Affiliation(s)
- Robert Battat
- aDivision of Gastroenterology, Department of Medicine, McGill University Health Centre bDivision of Clinical Epidemiology, Department of Medicine, Research Institute of the McGill University Health Centre cDepartment of Medicine, McGill University dDivision of Gastroenterology, Department of Medicine, Jewish General Hospital, Montreal eMedical Genetics Service, Department of Medicine, Centre Hospitalier Universitaire de Sherbrooke (CHUS), University of Sherbrooke, Sherbrooke fDepartment of Gastroenterology, Sheba Medical Center Tel Hashomer and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lefebvre C, Malhamé I, Sewitch MJ. Questions Regarding Study Design and Analysis in "Previous Suicide Attempt and its Association With Method Used in a Suicide Death". Am J Prev Med 2017; 53:e191. [PMID: 29054244 DOI: 10.1016/j.amepre.2017.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 04/17/2017] [Accepted: 05/11/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Claire Lefebvre
- General Pediatrics Department Centre Hospitalier Universitaire Sainte-Justine Montreal, Canada
| | | | - Maida J Sewitch
- Department of Medicine McGill University Montreal, Canada; Research Institute of the McGill University Health Centre, Montreal, Canada
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El Sabbagh NG, Sewitch MJ, Bezdjian A, Daniel SJ. Intratympanic dexamethasone in sudden sensorineural hearing loss: A systematic review and meta-analysis. Laryngoscope 2016; 127:1897-1908. [DOI: 10.1002/lary.26394] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Nagi G. El Sabbagh
- Department of Otolaryngology, Head and Neck Surgery; Faculty of Medicine, McGill University; Montreal Quebec Canada
| | - Maida J. Sewitch
- Department of Medicine ; McGill University; Montreal Quebec Canada
| | - Aren Bezdjian
- Department of Otolaryngology-Head and Neck Surgery; Faculty of Medicine; Montreal Quebec Canada
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Sewitch MJ, Rossignol M, Bellavance F, Leclaire R, Esdaile JM, Suissa S, Proulx R, Dupuis M. First Lifetime Back Pain and Physiatry Treatment. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/216507990004800506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sewitch MJ, Hosseina M. Cancelled and Missed Colonoscopy Appointments Not Easy to Measure. Clin Gastroenterol Hepatol 2016; 14:485-6. [PMID: 26435070 DOI: 10.1016/j.cgh.2015.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 09/17/2015] [Accepted: 09/28/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Maida J Sewitch
- Department of Medicine, McGill University, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
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Affiliation(s)
- Zeinab F N Slim
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Maida J Sewitch
- Department of Medicine, McGill University, Montreal, Quebec, Canada
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Sewitch MJ, Jiang M, Fon Sing M, Barkun A, Joseph L. Screening polypectomy rates below quality benchmarks: A prospective study. World J Gastroenterol 2014; 20:16300-16305. [PMID: 25473187 PMCID: PMC4239521 DOI: 10.3748/wjg.v20.i43.16300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 05/05/2014] [Accepted: 06/13/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To estimate and compare sex-specific screening polypectomy rates to quality benchmarks of 40% in men and 30% in women.
METHODS: A prospective cohort study was undertaken of patients aged 50-75, scheduled for colonoscopy, and covered by the Québec universal health insurance plan. Endoscopist and patient questionnaires were used to obtain screening and non-screening colonoscopy indications. Patient self-report was used to obtain history of gastrointestinal conditions/symptoms and prior colonoscopy. Sex-specific polypectomy rates (PRs) and 95%CI were calculated using Bayesian hierarchical logistic regression.
RESULTS: In total, 45 endoscopists and 2134 (mean age = 61, 50% female) of their patients participated. According to patients, screening PRs in males and females were 32.4% (95%CI: 23.8-41.8) and 19.4% (95%CI: 13.1-25.4), respectively. According to endoscopists, screening PRs in males and females were 30.2% (95%CI: 27.0-41.9) and 16.6% (95%CI: 16.3-28.6), respectively. Sex-specific PRs did not meet quality benchmarks at all ages except for: males aged 65-69 (patient screening indication), and males aged 70-74 (endoscopist screening indication). For all patients aged 50-54, none of the CI included the quality benchmarks.
CONCLUSION: Most sex-specific screening PRs in Québec were below quality benchmarks; PRs were especially low for all 50-54 year olds.
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Sewitch MJ, Jiang M, Grad R, Yaffe M, Pavilanis A, Joseph L, Barkun AN, Roper M. Feasibility of a call-in centre to deliver colorectal cancer screening in primary care. Can Fam Physician 2013; 59:e550-e557. [PMID: 24336560 PMCID: PMC3860945] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the feasibility of a call-in centre to deliver colorectal cancer (CRC) screening in primary care through self-administered fecal occult blood testing (FOBT). DESIGN Four-month intervention study (September 2010 to January 2011) with randomly selected follow-up interviews. SETTING The family medicine clinics of 3 hospitals in Montreal, Que. PARTICIPANTS Letters from doctors invited their patients to contact the call-in centre (N = 761). Eligible patients agreeing to FOBT were sent testing kits that could be returned by mail (N = 100). Randomly selected patients (N = 36) were interviewed to explore the reasons why they did not contact the call-in centre, or why they did or did not adhere to FOBT. MAIN OUTCOME MEASURES Feasibility was assessed by the proportions of patients who contacted the call-in centre, who were eligible for FOBT, and who adhered to FOBT; and by the time between invitation mail-out and contact with the call-in centre, initial telephone contact and receipt of the signed consent form, and FOBT kit mail-out and receipt of the kit by the laboratory. Hierarchical logistic regression evaluated the effect of patient characteristics on feasibility indicators, adjusting for clustering by physician and centre. RESULTS Of 761 patients (61.6% female, mean age 61.0 years), 250 (32.9%) contacted the call-in centre, of whom 100 (40.0%) were eligible for and consented to FOBT; 62 (62.0%) of these patients adhered to FOBT. Median (interquartile range) time from invitation mail-out to call-in centre contact was 21 (7 to 29) days, from initial telephone contact to receipt of the signed consent form was 24 (10 to 38) days, and from FOBT kit mail-out to receipt at the laboratory was 23 (18 to 32) days. With the exception of previous cancer diagnosis, patient characteristics were not associated with feasibility indicators. Of the 115 (46.0%) patients determined to be ineligible for FOBT screening, 111 (96.5%) were up to date with or already scheduled for screening. CONCLUSION Feasibility of the call-in centre was demonstrated. Targeting screening-eligible individuals or coupling a call-in service with another evidence-based CRC screening improvement strategy might further improve uptake of fecal testing.
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Affiliation(s)
- Maida J Sewitch
- McGill University, Medicine, 687 Pine Ave W, V-Building, Montreal, QC H3A 1A1.
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Charters TJ, Strumpf EC, Sewitch MJ. Effectiveness of an organized colorectal cancer screening program on increasing adherence in asymptomatic average-risk Canadians. BMC Health Serv Res 2013; 13:449. [PMID: 24168208 PMCID: PMC4231607 DOI: 10.1186/1472-6963-13-449] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 09/27/2013] [Indexed: 01/22/2023] Open
Abstract
Background Colorectal cancer (CRC) is the third most commonly diagnosed cancer and second highest cause of cancer-related mortality in Canada. Despite the availability of screening services and establishment of guidelines, utilization of colorectal cancer screening in Canada remains low. In 2008, the province of Ontario launched ColonCancerCheck, an organized colorectal cancer screening program aimed at increasing CRC screening adherence. In this study, we adopt a quasi-experimental approach to estimate and describe the impact of ColonCancerCheck on screening behavior in the asymptomatic average risk population. Methods Annual screening rates from the target population were estimated using five cycles of the Canadian Community Health Survey, a cross-sectional nationally representative survey of health status, healthcare use, and determinants of health in the Canadian population. We used a difference-in-differences design to measure the overall impact of ColonCancerCheck on past-year fecal occult blood testing (FOBT) and endoscopy in Ontario relative to the rest of Canada. Several verification tests validated the suitability of our model specification. Results The difference-in-differences analysis shows that ColonCancerCheck increased FOBT screening in the average risk population by 5.2 percentage points (95% CI [3.2, 7.2]), an increase of 33% relative to pre-program screening rates. The program had no observed effect on endoscopy screening and we found no evidence that ColonCancerCheck differentially altered the screening practices of population sub-groups. Conclusions Our findings suggest ColonCancerCheck has been successful at increasing use of FOBT in the asymptomatic average risk population.
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Affiliation(s)
- Thomas J Charters
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall 41, 1020 Pine Ave, West, Montreal, QC H3A 1A2, Canada.
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Abstract
Background Some studies have shown that endoscopist specialty is associated with colorectal cancers missed by colonoscopy. We sought to examine the relationship between endoscopist specialty and polypectomy rate, a colonoscopy quality indicator. Polypectomy rate is defined as the proportion of colonoscopies that result in the removal of one or more polyps. Methods A cross-sectional study was conducted of endoscopists and their patients from 7 Montreal and 2 Calgary endoscopy clinics. Eligible patients were aged 50–75 and covered by provincial health insurance. A patient questionnaire assessed family history of colorectal cancer, history of large bowel conditions and symptoms, and previous colonoscopy. The outcome, polypectomy status, was obtained from provincial health administrative databases. For each city, Bayesian hierarchical logistic regression was used to estimate the odds ratio for polypectomy comparing surgeons to gastroenterologists. Model covariates included patient age, sex, family history of colorectal cancer, colonoscopy indication, and previous colonoscopy. Results In total, 2,113 and 538 colonoscopies were included from Montreal and Calgary, respectively. Colonoscopies were performed by 38 gastroenterologists and 6 surgeons in Montreal, and by 31 gastroenterologists and 5 surgeons in Calgary. The adjusted odds ratios comparing surgeons to gastroenterologists were 0.48 (95% CI: 0.32–0.71) in Montreal and 0.73 (95% CI: 0.43–1.21) in Calgary. Conclusions An association between endoscopist specialty and polypectomy was observed in both cities after adjusting for patient-level covariates. Results from Montreal suggest that surgeons are half as likely as gastroenterologists to remove polyps, while those from Calgary were associated with a wide, non-significant Bayesian credible interval. However, residual confounding from patient-level variables is possible, and further investigation is required.
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Affiliation(s)
- Mengzhu Jiang
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, 687 Pine Avenue West, V Building, Room V2.15, Montreal, QC H3A 1A1, Canada
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Sewitch MJ, Jiang M, Joseph L, Hilsden RJ, Bitton A. Developing model-based algorithms to identify screening colonoscopies using administrative health databases. BMC Med Inform Decis Mak 2013; 13:45. [PMID: 23574795 PMCID: PMC3637812 DOI: 10.1186/1472-6947-13-45] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [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: 08/10/2012] [Accepted: 04/05/2013] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Algorithms to identify screening colonoscopies in administrative databases would be useful for monitoring colorectal cancer (CRC) screening uptake, tracking health resource utilization, and quality assurance. Previously developed algorithms based on expert opinion were insufficiently accurate. The purpose of this study was to develop and evaluate the accuracy of model-based algorithms to identify screening colonoscopies in health administrative databases. METHODS Patients aged 50-75 were recruited from endoscopy units in Montreal, Quebec, and Calgary, Alberta. Physician billing records and hospitalization data were obtained for each patient from the provincial administrative health databases. Indication for colonoscopy was derived using Bayesian latent class analysis informed by endoscopist and patient questionnaire responses. Two modeling methods were used to fit the data, multivariate logistic regression and recursive partitioning. The accuracies of these models were assessed. RESULTS 689 patients from Montreal and 541 from Calgary participated (January to March 2007). The latent class model identified 554 screening exams. Multivariate logistic regression predictions yielded an area under the curve of 0.786. Recursive partitioning using the latent outcome had sensitivity and specificity of 84.5% (95% CI: 81.5-87.5) and 63.3% (95% CI: 59.7-67.0), respectively. CONCLUSIONS Model-based algorithms using administrative data failed to identify screening colonoscopies with sufficient accuracy. Nevertheless, the approach of constructing a latent reference standard against which model-based algorithms were evaluated may be useful for validating administrative data in other contexts where there lacks a gold standard.
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Affiliation(s)
- Maida J Sewitch
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Mengzhu Jiang
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Lawrence Joseph
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Robert J Hilsden
- Departments of Medicine/Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Alain Bitton
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
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Sewitch MJ, Dubé C, Brien S, Jiang M, Hilsden RJ, Barkun AN, Armstrong D. Patient-identified quality indicators for colonoscopy services. Can J Gastroenterol 2013; 27:25-32. [PMID: 23378980 PMCID: PMC3545623 DOI: 10.1155/2013/574956] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 06/04/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND Current quality improvement tools for endoscopy services, such as the Global Rating Scale (GRS), emphasize the need for patient-centred care. However, there are no studies that have investigated patient expectations and/or perceptions of quality indicators in endoscopy services. OBJECTIVES To identify quality indicators for colonoscopy services from the patient perspective; to rate indicators of importance; to determine factors that influence indicator ratings; and to compare the identified indicators with those of the GRS. METHODS A two-phase mixed methods study was undertaken in Montreal (Quebec), Calgary (Alberta) and Hamilton (Ontario) among patients ≥18 years of age who spoke and read English or French. In phase 1, focus group participants identified quality indicators that were then used to construct a survey questionnaire. In phase 2, survey questionnaires, which were completed immediately after colonoscopy, prompted respondents to rate the 20 focus group-derived indicators according to their level of importance (low, medium, high) and to list up to nine additional items. Multiple logistic regression analysis was used to determine the factors that influenced focus group-derived indicator ratings. Patient-identified indicators were compared with those used in the GRS to identify novel indicators. RESULTS Three quality indicator themes were identified by 66 participants in 12 focus groups: communication, comfort and service environment. Of the 828 surveys distributed, 402 (48.6%) were returned and 65% of focus group-derived indicators were rated highly important by at least 55% of survey respondents. Indicator ratings differed according to age, sex, site and perceived colorectal cancer risk. Of the 29 patient-identified indicators, 17 (58.6%) were novel. CONCLUSIONS Patients identified 17 novel quality indicators, suggesting that patients and health professionals differ in their perspectives with respect to quality in colonoscopy services.
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Affiliation(s)
- Maida J Sewitch
- Department of Medicine, McGill University, Montreal, Quebec.
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Abstract
BACKGROUND The frequency of polypectomy is an important indicator of quality assurance for population-based colorectal cancer screening programs. Although administrative databases of physician claims provide population-level data on the performance of polypectomy, the accuracy of the procedure codes has not been examined. We determined the level of agreement between physician claims for polypectomy and documentation of the procedure in endoscopy reports. METHODS We conducted a retrospective cohort study involving patients aged 50-80 years who underwent colonoscopy at seven study sites in Montréal, Que., between January and March 2007. We obtained data on physician claims for polypectomy from the Régie de l'Assurance Maladie du Québec (RAMQ) database. We evaluated the accuracy of the RAMQ data against information in the endoscopy reports. RESULTS We collected data on 689 patients who underwent colonoscopy during the study period. The sensitivity of physician claims for polypectomy in the administrative database was 84.7% (95% confidence interval [CI] 78.6%-89.4%), the specificity was 99.0% (95% CI 97.5%-99.6%), concordance was 95.1% (95% CI 93.1%-96.5%), and the kappa value was 0.87 (95% CI 0.83-0.91). INTERPRETATION Despite providing a reasonably accurate estimate of the frequency of polypectomy, physician claims underestimated the number of procedures performed by more than 15%. Such differences could affect conclusions regarding quality assurance if used to evaluate population-based screening programs for colorectal cancer. Even when a high level of accuracy is anticipated, validating physician claims data from administrative databases is recommended.
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Affiliation(s)
- Jonathan M Wyse
- Division of Gastroenterology, Department of Medicine, Jewish General Hospital, McGill University, Montréal, Canada.
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Sewitch MJ, Yaffe M, Maisonneuve J, Prchal J, Ciampi A. Use of complementary and alternative medicine by cancer patients at a Montreal hospital. Integr Cancer Ther 2011; 10:305-11. [PMID: 21382961 DOI: 10.1177/1534735410395136] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To assess feasibility of methods for a future study of complementary and alternative medicine (CAM) use by cancer patients treated in conventional health care settings. METHODS Patients aged 18 years and older, fluent in English or French, and diagnosed with cancer from St. Mary's Hospital Center, Montreal, Canada participated. Feasibility was measured by the rates of participation and CAM use in the past 1 and 12 months. Following the survey, one patient focus group was held to better understand cancer patient perspectives on discussions of CAM that occur or not with their family physicians. RESULTS Of 103 patients approached, 100 (97.1%; 77% female, 87% white) participated. Overall, 86% and 91% of respondents used at least one CAM in the past 1 and 12 months, respectively. More patients with breast compared with colorectal and other cancers (90.2%, 86.2%, and 80%, respectively) used CAM in the previous year. In the past 1 and 12 months, natural health products were used by 70% and 80% of respondents, respectively; mind-body therapies by 61% and 64%, respectively, and CAM practitioners by 11% and 29%, respectively. More than 98% of patients used CAM to improve quality of life and 68% disclosed CAM use to their physicians. Four of 5 focus group participants used CAM. Patient-physician CAM discussions varied from receiving a CAM referral to complete dismissal of the topic. CONCLUSION Recruitment methods were well accepted but a sampling strategy stratified by sex and ethnicity will ensure sufficient representation by males and non-whites. Whereas disclosure of natural health products use is occurring, informative CAM discussion is not.
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Sewitch MJ, Rajput Y. A literature review of complementary and alternative medicine use by colorectal cancer patients. Complement Ther Clin Pract 2010; 16:52-6. [DOI: 10.1016/j.ctcp.2009.10.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Accepted: 10/02/2009] [Indexed: 10/20/2022]
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Blais R, Partlová H, Lachaine J, Sewitch MJ. La conformité aux guides de traitement de la dépression est-elle associée à une réduction des coûts des services de santé ? ACTA ACUST UNITED AC 2010. [DOI: 10.3917/pos.414.0349] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Sewitch MJ, Bexton B, Rahme E, Galarneau S, Blais R. Cross‐generational comparison of dispensed pharmacotherapy for depression. Int J Health Care Qual Assur 2009; 22:300-12. [DOI: 10.1108/09526860910953566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sewitch MJ, Cepoiu M, Rigillo N, Sproule D. A Literature Review of Health Care Professional Attitudes Toward Complementary and Alternative Medicine. ACTA ACUST UNITED AC 2008. [DOI: 10.1177/1533210108325549] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. To summarize health care professionals' attitudes toward complementary and alternative medicine (CAM). Methods. In October 2006, we searched Allied and Complementary Medicine Database (AMED; 1985—2006), Excerpta Medica Database (EMBASE; 1980—2006), and MED-LINE (1960—2006) for Canadian or US studies of health care professionals' attitudes toward CAM, published in English or French. Results. A total of 21 surveys of physicians, nurses, public health professionals, dietitians, social workers, medical/nursing school faculty, and pharmacists were included that focused on beliefs about CAM efficacy, personal use, clinical practice use and referrals, communication with patients about CAM, level of knowledge, and the need for information regarding various CAM therapies. Physicians were more negative compared to other health care professionals. Positive attitudes toward CAM did not correlate with CAM referral or prescription patterns. Health care professionals of all disciplines wanted more information about CAM. Conclusions. Heterogeneity in the CAM definition and questionnaire items precluded summarizing health care professionals' attitudes toward CAM. Providing CAM education to health care professionals may help to integrate CAM into mainstream medical care.
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Affiliation(s)
- Maida J. Sewitch
- Department of Medicine, McGill University, Department of Clinical Epidemiology and Community Studies,
St. Mary's Hospital,
| | - Monica Cepoiu
- Department of Clinical Epidemiology and Community Studies,
St. Mary's Hospital
| | - Nicole Rigillo
- Department of Clinical Epidemiology and Community Studies,
St. Mary's Hospital
| | - Donald Sproule
- Department of Family Medicine McGill University, Montreal,
Quebec, Canada, Department of Family Medicine St. Mary's Hospital, Montreal,
Quebec, Canada
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Bitton A, Dobkin PL, Edwardes MD, Sewitch MJ, Meddings JB, Rawal S, Cohen A, Vermeire S, Dufresne L, Franchimont D, Wild GE. Predicting relapse in Crohn's disease: a biopsychosocial model. Gut 2008; 57:1386-92. [PMID: 18390994 DOI: 10.1136/gut.2007.134817] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.8] [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: 12/13/2022]
Abstract
BACKGROUND Crohn's disease (CD) is a chronic relapsing inflammatory bowel disorder. Both biological and psychosocial factors may modulate the illness experience. AIM The aim of this study was to identify clinical, biological and psychosocial parameters as predictors of clinical relapse in quiescent CD. METHODS Patients in medically induced remission were followed prospectively for 1 year, or less if they relapsed. Disease characteristics were determined at baseline. Serum cytokines, anti-Saccharomyces cerevisiae antibodies, C-reactive protein (CRP), erythrocyte sedimentation rate and intestinal permeability were measured every 3 months. Psychological distress, perceived stress, minor life stressors and coping strategies were measured monthly. A time-dependent multivariate Cox regression model determined predictors of time to relapse. RESULTS 101 patients (60 females, 41 males) were recruited. Fourteen withdrew and 37 relapsed. CRP (HR = 1.5 per 10 mg/l, 95% CI 1.1 to 1.9, p = 0.007), fistulising disease (HR = 3.2, 95% CI, 1.1 to 9.4, p = 0.04), colitis (HR = 3.5 95% CI 1.2 to 9.9, p = 0.02) and the interaction between perceived stress and avoidance coping (HR = 7.0 per 5 unit increase for both scales, 95% CI 2.3 to 21.8, p = 0.003) were predictors of earlier relapse. CONCLUSIONS In quiescent CD, a higher CRP, fistulising disease behaviour and disease confined to the colon were independent predictors of relapse. Moreover, patients under conditions of low stress and who scored low on avoidance coping (ie, did not engage in social diversion or distraction) were least likely to relapse. This study supports a biopsychosocial model of CD exacerbation.
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Affiliation(s)
- A Bitton
- McGill University Health Centre, 687 Pine Avenue West, Montreal, Quebec, Canada, H3A 1A1.
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Sewitch MJ, Cole M, McCusker J, Ciampi A, Dyachenko A. Medication use and nonadherence to psychoactive medication for mental health problems by community-living Canadian seniors with depression. Can J Psychiatry 2008; 53:609-20. [PMID: 18801224 DOI: 10.1177/070674370805300908] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the relation between level of depression and psychoactive medication use and nonadherence in Canadian seniors, given that late-life depression is a common, serious mental health problem in Canada. METHODS Canadian Community Health Survey-Mental Health and Well-Being respondents aged 65 years and older (n = 7,736) comprised the study sample. Using the Composite International Diagnostic Interview to assess depressive symptoms, we created 4 depression levels to capture a spectrum of depressive disorders and (or) symptoms: major depression, comorbid major depression, depressive symptoms, and no depressive symptoms. Psychoactive medications assessed included sleep aids, anxiolytics, and mood stabilizers and (or) antidepressants (AD). Nonadherence was defined as either not taking medication as recommended or taking medication at a lower dosage than prescribed. RESULTS In total, 22.5% of respondents took psychoactive medication for a mental health problem in the previous 12 months. Psychoactive medication use was 46.8% for major depression, 43.1% for comorbid major depression, 34.0% for depressive symptoms, and 17.6% for no depressive symptoms. Rates of psychoactive medication use ranged from 46.5% of those with major depression, to 17.6% of those with no depressive symptoms. Overall, the rate of nonadherence to psychoactive medication was 31%; rates were highest among those with depressive symptoms (37.4%) and lowest among those with no depressive symptoms (27.4%). All 3 depressive categories were associated with greater odds of use and nonadherence. CONCLUSION All 3 depression categories were associated with increased use of and nonadherence to psychoactive medication; however, rates of AD and (or) mood stabilizer use for clinically significant depression were low.
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Affiliation(s)
- Maida J Sewitch
- Department of Medicine, McGill University, Montreal, Quebec.
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Russillo B, Sewitch MJ, Cardinal L, Brassard N. Comparing Rates of Trial of Labour Attempts, VBAC Success, and Fetal and Maternal Complications Among Family Physicians and Obstetricians. Journal of Obstetrics and Gynaecology Canada 2008; 30:123-128. [DOI: 10.1016/s1701-2163(16)32735-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sewitch MJ, Fournier C, Ciampi A, Dyachenko A. Colorectal cancer screening in Canada: results of a national survey. Chronic Dis Can 2008; 29:9-21. [PMID: 19036219] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Canadian guidelines recommend colorectal-cancer (CRC) screening for individuals aged 50 to 74 years. The study objective was to estimate rates of CRC screening according to individual and geographical characteristics, and of adherence to current CRC screening guidelines. Respondents to the 2003 Canadian Community Health Survey Cycle 2.1 (aged >or= 50 years, without past or present CRC) participated. Fecal occult blood test (FOBT) and endoscopy utilization and screening rates were calculated. The sample included 16,747 residents of Newfoundland, Ontario, Saskatchewan and British Columbia. Overall, the FOBT screening rate was 7.7% in the past year, and the endoscopy screening rate was 8.8% in the past 5 years. FOBT screening rates were higher in older and male respondents; endoscopy screening rates were higher in older respondents. Individuals aged 50 to 59 and over 90 years were least likely to have been screened. Approximately 70% of respondents were non-adherent to current CRC screening guidelines. Non-adherence rates were higher in most health regions of British Columbia. National survey data suggest CRC screening in Canada is low; younger persons and residents of British Columbia were least likely to report CRC screening.
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Affiliation(s)
- M J Sewitch
- Department of Medicine, McGill University, Montreal, QC.
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Abstract
BACKGROUND Non-adherence to therapy is a widespread problem, with typical adherence rates for prescribed medications being approximately 50%. An estimated 20% to 50% of patients with ulcerative colitis (UC) do not take their medications as prescribed, resulting in higher disease-recurrence rates and potentially higher health care costs. OBJECTIVE To characterize the problem of non-adherence in UC, to review the many factors affecting compliance and persistence in this population, and to discuss practical strategies to improve adherence in these patients. SUMMARY Adherence to and persistence with medication are complex and multifactorial behaviors. Factors shown to affect adherence in UC patients include disease extent and duration, cost of medications, fear of adverse effects, individual psychosocial variables, and the patient-physician relationship. In contrast, recent data do not support an important role for treatment-related factors such as daily dose, regimen, and formulation in influencing adherence in this population, particularly with longer duration of use. Strategies to improve adherence should involve the patient, the provider, and the health care delivery system. For UC patients, knowledge and discussion of the rationale for supporting persistence, such as recent data regarding agents that have a potential chemoprotective benefit, may encourage persistence, even during periods of quiescence. The patient-physician relationship is critical in encouraging adherence, particularly with respect to education, open communication, and agreement regarding the value of the assigned treatment. Health care delivery systems can improve adherence by encouraging the participation of multidisciplinary teams, providing reporting and tracking systems, and eliminating financial barriers where possible.
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Affiliation(s)
- Sunanda V Kane
- Mayo Clinic College of Medicine, Division of Gastroenterology and Hepatology, 200 First Street, Sw, 19th Floor, Rochester, MN 55905, USA.
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Abstract
BACKGROUND To identify correlates of adherence to colorectal cancer (CRC) screening guidelines in average-risk Canadians. METHODS 2003 Canadian Community Health Survey Cycle 2.1 respondents who were at least 50 years old, without past or present CRC and living in Ontario, Newfoundland, Saskatchewan, and British Columbia were included. Outcomes, defined according to current CRC screening guidelines, included adherence to: i) fecal occult blood test (FOBT) (in prior 2 years), ii) endoscopy (colonoscopy/sigmoidoscopy) (prior 10 years), and iii) adherence to CRC screening guidelines, defined as either (i) or (ii). Generalized estimating equations regression was employed to identify correlates of the study outcomes. RESULTS Of the 17,498 respondents, 70% were non-adherent CRC screening to guidelines. Specifically, 85% and 79% were non-adherent to FOBT and endoscopy, respectively. Correlates for all outcomes were: having a regular physician (OR = (i) 2.68; (ii) 1.91; (iii) 2.39), getting a flu shot (OR = (i) 1.59; (ii) 1.51; (iii) 1.55), and having a chronic condition (OR = (i) 1.32; (ii) 1.48; (iii) 1.43). Greater physical activity, higher consumption of fruits and vegetables and smoking cessation were each associated with at least 1 outcome. Self-perceived stress was modestly associated with increased odds of adherence to endoscopy and to CRC screening guidelines (OR = (ii) 1.07; (iii) 1.06, respectively). CONCLUSION Healthy lifestyle behaviors and factors that motivate people to seek health care were associated with adherence, implying that invitations for CRC screening should come from sources that are independent of physicians, such as the government, in order to reduce disparities in CRC screening.
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Affiliation(s)
| | - Caroline Fournier
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Center, Montreal, Canada
| | - Antonio Ciampi
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Alina Dyachenko
- Department of Epidemiology and Community Studies, St. Mary's Hospital Center, Montreal, Canada
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Sewitch MJ, Fournier C, Dawes M, Yaffe M, Snell L, Roper M, Zanelli P, Pavilanis A. Do physician recommendations for colorectal cancer screening differ by patient age? Can J Gastroenterol 2007; 21:435-8. [PMID: 17637945 PMCID: PMC2657963 DOI: 10.1155/2007/938978] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Colorectal cancer screening is underutilized, resulting in preventable morbidity and mortality. In the present study, age-related and other disparities associated with physicians' delivery of colorectal cancer screening recommendations were examined. The present cross-sectional study included 43 physicians and 618 of their patients, aged 50 to 80 years, without past or present colorectal cancer. Of the 285 screen-eligible patients, 45% received a recommendation. Multivariate analyses revealed that, compared with younger nondepressed patients, older depressed patients were less likely to receive fecal occult blood test recommendations, compared with no recommendation (OR=0.31, 95% CI 0.09 to 1.02), as well as less likely to receive colonoscopy recommendations, compared with no recommendation (OR=0.14; 95% CI 0.03 to 0.66). Comorbidity and marital status were associated with delivery of fecal occult blood test and colonoscopy recommendations, respectively, compared with no recommendation. In summary, patient age and other characteristics appeared to influence physicians' delivery of colorectal cancer screening and choice of modality.
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Affiliation(s)
- Maida J Sewitch
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
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Sewitch MJ, Blais R, Rahme E, Bexton B, Galarneau S. Receiving guideline-concordant pharmacotherapy for major depression: impact on ambulatory and inpatient health service use. Can J Psychiatry 2007; 52:191-200. [PMID: 17479528 DOI: 10.1177/070674370705200311] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aimed to determine the associations between guideline-concordant pharmacotherapy for depression and the use of health services in the year following diagnosis. METHOD This population-based, retrospective cohort study examined Quebec drug plans between 1999 and 2002. We included beneficiaries aged 18 to 64 years who were newly diagnosed with an episode of depression by primary care physicians and psychiatrists between October 1, 2000, and March 31, 2001, and who made at least one psychotropic pharmacy claim within 31 days of diagnosis. We defined guideline concordance as the receipt of recommended medication, starting dosage, and treatment duration as defined by the Canadian Network for Mood and Anxiety Treatments guidelines. We measured outcomes on use of ambulatory (number of visits to prescribing physician, other physicians, or emergency departments) and inpatient (hospitalization) services. RESULTS There were 2742 patients (mean age 42 years; 64% female patients) who met the study criteria. Of the 2047 (75%) patients to whom an antidepressant was dispensed, 1958 (71%) received a recommended first-line medication, 1297 (63%) received a recommended starting dosage, and 304 (15%) received a recommended duration. According to the 3 criteria, only 8% were treated appropriately; 21% received benzodiazepines rather than antidepressants. There were 2 median visits (inferquartile range [IQR] 1 to 3) to prescribing physicians, 0 visits (IQR 0 to 1) to other physicians, and 0 visits (IQR 0 to 0) to emergency departments; 497 (18%) patients were hospitalized. In separate multivariate models for repeated measures, recommended first-line medication, dosage, and duration were associated with more prescribing physician visits. Recommended first-line medication reduced the odds of hospitalization. CONCLUSION Guideline concordance was associated with more visits to prescribing physicians and lower odds of hospitalization.
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Affiliation(s)
- Maida J Sewitch
- Department of Medicine, McGill University, Montreal, Quebec.
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Sewitch MJ, Burtin P, Dawes M, Yaffe M, Snell L, Roper M, Zanelli P, Pavilanis A. Colorectal cancer screening: physicians' knowledge of risk assessment and guidelines, practice, and description of barriers and facilitators. Can J Gastroenterol 2006; 20:713-8. [PMID: 17111053 PMCID: PMC2660826 DOI: 10.1155/2006/609746] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Accepted: 03/02/2006] [Indexed: 02/06/2023]
Abstract
BACKGROUND Physician nonadherence to colorectal cancer (CRC) screening recommendations contributes to underuse of screening. OBJECTIVE To assess physicians' knowledge of CRC screening guidelines for average-risk individuals, perceived barriers to screening and practice behaviours. METHODS Between October 2004 and March 2005, staff physicians working in three university-affiliated hospitals in Montreal, Quebec, were surveyed. Self-administered questionnaires assessed knowledge of risk classification and current guidelines for average-risk individuals, as well as perceptions of barriers to screening and practice behaviours. RESULTS All 65 invited physicians participated in the survey, including 46 (70.8%) family medicine physicians and 19 (29.2%) general internists. Most physicians knew that screening should begin at 50 years of age, all knew to screen men and women and 92% said they screened average-risk patients. Fifty-seven (87.7%) physicians correctly identified three common characteristics associated with high risk for developing CRC. Physicians who screened average-risk patients preferred fecal occult blood testing (88.3%) and colonoscopy (88.3%) to flexible sigmoidoscopy (10.0%) and double-contrast barium enema (30.0%). Most physicians knew the correct screening periodicity for fecal occult blood testing (87.6%), but only 40% or fewer could identify correct screening periodicities for the other modalities. Barriers and facilitators focused on health care delivery system improvements, better evidence on which to base recommendations and development of practical screening modalities. CONCLUSIONS Physicians lacked knowledge of the recommended screening modalities and periodicities to appropriately screen average-risk individuals. Because CRC screening can reduce mortality, efforts to improve physician delivery should focus on physician knowledge and changes to the health care delivery system.
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Affiliation(s)
- Maida J Sewitch
- Department of Medicine, McGill University, Montreal, Canada.
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Sewitch MJ, Yaffe MJ, McCusker J, Ciampi A. Helping family doctors detect vulnerable caregivers after an emergency department visit for an elderly relative: results of a longitudinal study. BMC Fam Pract 2006; 7:46. [PMID: 16854239 PMCID: PMC1559627 DOI: 10.1186/1471-2296-7-46] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Accepted: 07/19/2006] [Indexed: 11/10/2022]
Abstract
BACKGROUND Family doctors have been ascribed a role in monitoring patients and their informal caregivers. Little is known about the factors that might alert physicians to changing circumstances or needs of the caregivers. The study objective was to examine changes in family caregivers' quality of life following an emergency department (ED) visit by an older community-dwelling relative that might cue doctors to subsequent caregiver distress. METHODS A longitudinal study with follow-up at 1- and 4-months was conducted in the EDs of 4 hospitals in Montreal, Canada. Caregivers reported on demographics and quality of life (SF-36). Patients reported on demographics and functional disability. Multiple linear regression for repeated measures was used to evaluate changes in caregiver quality of life and factors related to these changes. RESULTS 159 caregivers (60.5 yrs +/- 15.8%; 73.0% female), including 68 (42.8%) spouses, 60 (37.7%) adult children, and 31 (19.5%) other relatives participated. Following an initial ED visit by older relatives, caregiver general health and physical functioning declined over time, while mental health status improved. Compared to the other relative caregiver group, spouses were at increased risk for decline in general health, mental health, and physical functioning at 1 month, while adult children were at increased risk for decline in physical health at 1 month. CONCLUSION Spouses were most at risk for decline in quality of life. Primary care physicians who become aware of an ED visit by an elderly person may be alerted to possible subsequent deterioration in family caregivers, especially spouses.
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Affiliation(s)
- Maida J Sewitch
- Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, and Department of Medicine, McGill University, Montreal, Canada
| | - Mark J Yaffe
- Department of Family Medicine, St. Mary's Hospital, and Department of Family Medicine, McGill University, Montreal, Canada
| | - Jane McCusker
- Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Montreal, Canada
| | - Antonio Ciampi
- Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
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Sewitch MJ, Blais R, Rahme E, Galarneau S, Bexton B. Pharmacologic response to a diagnosis of late-life depression: A population study in Quebec. Can J Psychiatry 2006; 51:363-70. [PMID: 16786817 DOI: 10.1177/070674370605100605] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To identify predictors of receiving psychoactive medication and receiving recommended first-line pharmacotherapy in individuals with newly diagnosed late-life depression. METHODS We undertook a retrospective database cohort study of 5258 beneficiaries of the Quebec provincial health insurance plan between 1999 and 2002. Subjects were aged 65 to 84 years and diagnosed with depression by primary care physicians or psychiatrists between October 2000 and March 2001; they had no depression diagnosis in the previous year. We defined receipt of psychoactive medication as having a pharmacy claim in the year following the depression diagnosis. We determined receipt of recommended first-line pharmacotherapy from the first psychoactive medication dispensed following diagnosis and defined it accordingly; we defined first-line pharmacotherapy according to the 2001 Canadian Psychiatric Association guidelines. We used multivariate generalized estimating equations models to identify the determinants of the 2 outcomes. RESULTS A total of 4421 (84.1%) patients received psychoactive medication following diagnosis; 2623 (59.3%) patients had not received antidepressants in the previous year. Of these, 1310 (49.9%) received recommended first-line pharmacotherapy. Independent predictors of receiving psychoactive medication were female sex, depression not otherwise specified (NOS), increasing comorbidity, and living in rural areas. Independent predictors of receiving recommended first-line pharmacotherapy were male sex, depression NOS, receiving medication in the month following diagnosis, and having the same physician diagnosing and treating the patient. CONCLUSION Male sex and continuity of care predicted that patients had the recommended medication dispensed.
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Abstract
OBJECTIVES The goal of this study was to identify predictors of general and medication adherence in women with fibromyalgia (FM). METHODS Participants were 142 women recruited from tertiary care hospitals or the community and 10 rheumatologists. Participants' demographic, clinical, and psychosocial characteristics, as well as patient-physician discordance, were assessed at the index visit. Adherence was assessed 6 months later. Multivariable generalized estimating equations were used to identify predictors of general adherence and adherence to medication. RESULTS The average age of participants was 50.9 years (SD=10.2) and the median duration of FM was 32 months. Participants reported extensive use of health services and medications. The mean score for general adherence was 61.0 (SD=22.4; range 0-100) and 52.9% of the cohort reported at least one form of behavior reflecting nonadherence to medications. More general adherence was significantly predicted by lower patient-physician discordance on patient well-being and lower patient psychological distress. Medication adherence was significantly predicted by higher affective pain and lower patient psychological distress. CONCLUSIONS Adherence is influenced by both clinical (patient-physician discordance and pain) and psychological (distress) factors in women with FM. Improvements in these domains may improve adherence in FM.
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Affiliation(s)
- Patricia L Dobkin
- Department of Medicine, McGill University, Montreal, Quebec, Canada.
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Abstract
OBJECTIVES The purpose of this study was to identify determinants of use of psychoactive medication and receipt of selective serotonin reuptake inhibitors (SSRIs) among adolescents with a diagnosis of new-onset depression. METHODS A population-based retrospective cohort study was conducted among 447 adolescents enrolled in the Quebec drug plan who had new episodes of depression diagnosed between October 2000 and March 2001 by pediatricians, general practitioners, or psychiatrists. The main outcomes were use of psychoactive medication in the year after diagnosis and receipt of SSRIs at the first visit during which pharmacotherapy was prescribed. Receipt of SSRIs was assessed by the initial psychoactive dispensing claim following the diagnosis of depression. RESULTS In the year after diagnosis, 258 adolescents (58 percent) received psychoactive medications, of whom 135 (52 percent) initially received SSRIs. Diagnosing pediatricians were the least likely to prescribe psychoactive medication. Patients of psychiatrists were less likely than those of primary care physicians to receive antidepressants for dysthymia or adjustment disorder accompanied by depressed mood (26 percent compared with 42 percent). Being female, having a diagnosing general practitioner or pediatrician, and having the same diagnosing and treating physician were associated with higher odds of receiving SSRIs. Being a welfare recipient and living in a rural area rather than an urban area were associated with lower odds. CONCLUSIONS Adolescent males, those receiving welfare, and those living in rural areas were less likely to receive treatment that was recommended at the time of the study and thus may need special attention from mental health care providers.
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Affiliation(s)
- Maida J Sewitch
- Department of Medicine of McGill University and the Research Institute of McGill University Health Center, 1650 Cedar Avenue, Room L10-409, Division of Clinical Epidemiology, Montreal, Quebec, Canada H3G 1A4.
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Sewitch MJ, Biais R, Rahme E, Galarneau S, Bexton B. 493: Predictors of Duration of Antidepressant Therapy for Major Depression in Quebec. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s124] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- M J Sewitch
- McGill University Health Centre, Montreal, QC Canada
| | - R Biais
- McGill University Health Centre, Montreal, QC Canada
| | - E Rahme
- McGill University Health Centre, Montreal, QC Canada
| | - S Galarneau
- McGill University Health Centre, Montreal, QC Canada
| | - B Bexton
- McGill University Health Centre, Montreal, QC Canada
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Abstract
OBJECTIVES To examine the relationship between depression among medically ill, frail elders and family caregivers' hours of care, health status, and quality of life. DESIGN AND METHODS A cross-sectional study of 193 family caregivers of seniors treated in the emergency department (ED) was conducted. Measures included patient depression (Geriatric Depression Scale-15), and caregivers' hours of care, mental health and physical functioning (SF-36), and quality of life (EQ-5D). RESULTS Mean caregiver age was 60.0 +/- 16.1 years and 70.5% were female. More caregivers of depressed seniors provided more care in the previous month (37.3% vs 22.4%, p = 0.03), had poor mental health (63.5% vs 47.0%, p = 0.03), and poor perceived quality of life (63.5% vs 50.4%, p = 0.04) compared to caregivers of non-depressed seniors. Multiple logistic regression analyses indicated that patient depression was associated with poor caregiver quality of life (OR = 3.15, 95% CI 1.48, 6.73), and poor mental health in spousal and adult child caregivers (OR = 2.72, 95% CI = 0.88, 8.39, and OR = 3.29, 95% CI = 1.10, 9.86, respectively). CONCLUSIONS Psychosocial support may be needed for caregivers of depressed seniors.
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Affiliation(s)
- Maida J Sewitch
- Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, and Department of Medicine, McGill University, Montreal, Canada.
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Sewitch MJ, Leffondré K, Dobkin PL. Clustering patients according to health perceptions: relationships to psychosocial characteristics and medication nonadherence. J Psychosom Res 2004; 56:323-32. [PMID: 15046970 DOI: 10.1016/s0022-3999(03)00508-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2002] [Accepted: 07/03/2003] [Indexed: 11/22/2022]
Abstract
BACKGROUND Little is known about how patients rate their health perceptions. Our objectives were to identify systematic multivariate patterns of perceptions using cluster analysis, and to investigate associations among the clusters, psychosocial characteristics and medication nonadherence. METHODS Demographic, clinical and psychosocial data on 200 patients with inflammatory bowel disease (IBD) were collected prior to the index office visit and health perceptions were collected afterwards. Cluster analysis using a k-means method was used to identify subgroups of patients based on their responses to the Patient-Physician Discordance Scales (PPDS), an instrument that assesses perceptions of health status and of the clinical visit. RESULTS We identified five different patient groups: a "healthy, not distressed, good communication, low expectation for medication/testing" group; a "healthy, relatively distressed, good communication, high expectation for medication, low expectation for testing" group; a "symptomatic, distressed, good communication, high expectation for medication/testing" group; a "healthy, not distressed, good communication, high expectation for medication/testing" group; and a "relatively healthy, relatively distressed, poor communication, low expectation for medication/testing" group. After adjustment for age, sex, language, form of IBD, and disease activity, statistically significant between-clusters differences were found in psychological distress, social support satisfaction and medication nonadherence. CONCLUSIONS Distinct patterns of patients' health perceptions correlated with psychological health and adherence to treatment. This categorization may be used to help identify patients at higher risks for ineffective communication and nonadherence to medication.
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Affiliation(s)
- Maida J Sewitch
- Groupe de recherche interdisciplinaire en santé, Faculté de médecine, Université de Montréal C.P. 6128, succ. Centre-ville, Montreal, Québec, Canada, H3C 3J7.
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Abstract
OBJECTIVE To identify the determinants of medication non-adherence in women with fibromyalgia (FM). METHODS Participants included 10 rheumatologists and 127 women recruited from tertiary care hospitals and the community. Demographic, clinical and psychosocial characteristics and patient-physician discordance were assessed at the baseline visit. Non-adherence was assessed 2 weeks later. Multivariable generalized estimating equations were used to identify determinants of non-adherence to medication. RESULTS The average age of the women was 50.4 (s.d. 10.5) yr and the mean disability score was 60.3 (16.0) yr. Sixty (47.2%) women were non-adherent to medication; 20 (33.3%) of these were intentionally non-adherent, 24 (40.0%) were unintentionally non-adherent, and the remaining subjects were both. Overall non-adherence was predicted by higher patient-physician discordance. Unintentional non-adherence was predicted by community subjects, not being under a rheumatologist's care, less disease activity, less use of instrumental coping, and higher patient-physician discordance. Intentional non-adherence was predicted by shorter duration under a rheumatologist's care and higher patient-physician discordance. CONCLUSION The therapeutic relationship, in addition to clinical and psychosocial characteristics, influenced non-adherence to medication.
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Affiliation(s)
- M J Sewitch
- Department of Medicine, McGill University, Montreal, Quebec, Canada.
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Abstract
OBJECTIVES To determine the association between psychosocial characteristics and time to relapse in patients with inactive ulcerative colitis. METHODS Sixty patients with clinically and endoscopically inactive ulcerative colitis were followed for 1 yr, or less if they relapsed. Demographic, psychosocial, and clinical data were obtained. Stressful life events (Psychiatric Epidemiology Research Interview Life Events Scale), psychological distress (Symptom Checklist-90R), and perceived stress (Perceived Stress Scale) were recorded monthly by self-report. Multivariate time-dependent Cox regression was used to identify the independent determinants of earlier time to clinical relapse. RESULTS The patients' mean age was 39 yr (SD = 9.4), 37 (62%) were female, and 22 (37%) relapsed during the 1-yr follow-up. Univariate Cox regression indicated a weak association between number of stressful events in the preceding month and time to relapse (p = 0.09). This association strengthened in multivariate analysis (p = 0.02, hazard ratio = 1.26 per event, 95% CI = 1.04-1.53) after adjustment for significant covariates. CONCLUSIONS After controlling for demographic and clinical variables, more recent stressful events were associated with earlier time to relapse. These findings, which support a biopsychosocial model of disease, might help clinicians identify patients who might benefit from more intensive maintenance medical therapy and behavioral medicine interventions to reduce stress and improve coping.
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Affiliation(s)
- Alain Bitton
- Department of Medicine, McGill University, Montréal, Québec, Canada
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