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Mizushima D, Nagai Y, Mezzio D, Harada K, Piao Y, Barnieh L, El Moustaid F, Cawson M, Taniguchi T. Cost-effectiveness analysis of HIV pre-exposure prophylaxis in Japan. J Med Econ 2023:1-14. [PMID: 37421417 DOI: 10.1080/13696998.2023.2233824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND While global efforts have been made to prevent transmission of HIV, the epidemic persists. Men who have sex with men (MSM) are at high risk of infection. Despite evidence of its cost-effectiveness in other jurisdictions, pre-exposure prophylaxis (PrEP) for MSM is neither approved nor reimbursed in Japan. METHOD The cost-effectiveness analysis compared the use of once daily PrEP versus no PrEP among MSM over a 30-year time horizon from a national healthcare perspective. Epidemiological estimates for each of the 47 prefectures informed the model. Costs included HIV/AIDS treatment, HIV and testing for sexually transmitted infections, monitoring tests and consults, and hospitalization costs. Analyses included health and cost outcomes, as well as the incremental cost-effectiveness ratio (ICER) reported as the cost per quality-adjusted life year (QALY) for all of Japan and each prefecture. Sensitivity analyses were performed. FINDINGS The estimated proportion of HIV infections prevented with the use of PrEP ranged from 48% to 69% across Japan, over the time horizon. Cost savings due to lower monitoring costs and general medical costs were observed. Assuming 100% coverage, for Japan overall, daily use of PrEP costs less and was more effective; daily use of PrEP was cost-effective at a willingness to pay threshold of ¥5,000,000 per QALY in 32 of the 47 prefectures. Sensitivity analyses found that the ICER was most sensitive to the cost of PrEP. INTERPRETATION Compared to no PrEP use, once daily PrEP is a cost-effective strategy in Japanese MSM, reducing the clinical and economic burden associated with HIV.
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Affiliation(s)
- Daisuke Mizushima
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | | | | | | | - Yi Piao
- Gilead Sciences, Tokyo, Japan
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Jiang T, Youn B, Paradis AD, Beckerman R, Barnieh L, Johnson NB. A Critical Appraisal of Matching-Adjusted Indirect Comparisons in Spinal Muscular Atrophy. Adv Ther 2023; 40:2985-3005. [PMID: 37277563 PMCID: PMC10271880 DOI: 10.1007/s12325-023-02520-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/12/2023] [Indexed: 06/07/2023]
Abstract
In the absence of head-to-head trials, indirect treatment comparisons (ITCs) are often used to compare the efficacy of different therapies to support decision-making. Matching-adjusted indirect comparison (MAIC), a type of ITC, is increasingly used to compare treatment efficacy when individual patient data are available from one trial and only aggregate data are available from the other trial. This paper examines the conduct and reporting of MAICs to compare treatments for spinal muscular atrophy (SMA), a rare neuromuscular disease. A literature search identified three studies comparing approved treatments for SMA including nusinersen, risdiplam, and onasemnogene abeparvovec. The quality of the MAICs was assessed on the basis of the following principles consolidated from published MAIC best practices: (1) justification for the use of MAIC is clearly stated, (2) the included trials with respect to study population and design are comparable, (3) all known confounders and effect modifiers are identified a priori and accounted for in the analysis, (4) outcomes should be similar in definition and assessment, (5) baseline characteristics are reported before and after adjustment, along with weights, and (6) key details of a MAIC are reported. In the three MAIC publications in SMA to date, the quality of analysis and reporting varied greatly. Various sources of bias in the MAICs were identified, including lack of control for key confounders and effect modifiers, inconsistency in outcome definitions across trials, imbalances in important baseline characteristics after weighting, and lack of reporting key elements. These findings highlight the importance of evaluating MAICs according to best practices when assessing the conduct and reporting of MAICs.
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Affiliation(s)
- Tammy Jiang
- Biogen, 225 Binney Street, Cambridge, MA, 02142, USA
| | - Bora Youn
- Biogen, 225 Binney Street, Cambridge, MA, 02142, USA
| | | | - Rachel Beckerman
- Maple Health Group, 1740 Broadway, 15th Floor, New York, NY, 10019, USA
| | - Lianne Barnieh
- Maple Health Group, 1740 Broadway, 15th Floor, New York, NY, 10019, USA.
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Barnieh L, Beckerman R, Jeyakumar S, Hsiao A, Jarrett J, Gottlieb RL. Remdesivir for Hospitalized COVID-19 Patients in the United States: Optimization of Health Care Resources. Infect Dis Ther 2023:10.1007/s40121-023-00816-y. [PMID: 37222933 DOI: 10.1007/s40121-023-00816-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/27/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION In addition to significant morbidity and mortality, the coronavirus disease (COVID-19) has strained health care systems globally. This study investigated the cost-effectiveness of remdesivir + standard of care (SOC) for hospitalized COVID-19 patients in the USA. METHODS This cost-effectiveness analysis considered direct and indirect costs of remdesivir + SOC versus SOC alone among hospitalized COVID-19 patients in the US. Patients entered the model stratified according to their baseline ordinal score. At day 15, patients could transition to another health state, and on day 29, they were assumed to have either died or been discharged. Patients were then followed over a 1-year time horizon, where they could transition to death or be rehospitalized. RESULTS Treatment with remdesivir + SOC avoided, per patient, a total of 4 hospitalization days: two general ward days and a day for both the intensive care unit and the intensive care unit plus invasive mechanical ventilation compared to SOC alone. Treatment with remdesivir + SOC presented net cost savings due to lower hospitalization and lost productivity costs compared to SOC alone. In increased and decreased hospital capacity scenarios, remdesivir + SOC resulted in more beds and ventilators being available versus SOC alone. CONCLUSIONS Remdesivir + SOC alone represents a cost-effective treatment for hospitalized patients with COVID-19. This analysis can aid in future decisions on the allocation of healthcare resources.
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Affiliation(s)
| | | | | | | | - James Jarrett
- Gilead Sciences, 2 Roundwood Ave, Hayes, Uxbridge, UB11 1AF, UK.
| | - Robert L Gottlieb
- Baylor University Medical Center, Dallas, TX, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
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Ebner D, Kisiel J, Barnieh L, Sharma R, Smith NJ, Estes C, Vahdat V, Ozbay AB, Limburg P, Fendrick AM. The cost-effectiveness of non-invasive stool-based colorectal cancer screening offerings from age 45 for a commercial and medicare population. J Med Econ 2023; 26:1219-1226. [PMID: 37752872 DOI: 10.1080/13696998.2023.2260681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023]
Abstract
AIM The United States Preventive Services Taskforce (USPSTF) recently recommended lowering the age for average-risk colorectal cancer (CRC) screening from 50 to 45 years. While initiating screening at age 45 versus 50 provides a greater opportunity for CRC early detection and prevention, the full profile of benefits, risks, and cost-effectiveness of expanding the screen-eligible population requires further evaluation. MATERIALS AND METHODS The costs and clinical outcomes for screening at age 45 for triennial multi-target stool DNA [mt-sDNA], and other non-invasive stool-based modalities (annual fecal immunochemical test [FIT] and annual fecal-occult blood test [FOBT]), were estimated using the validated CRC-AIM microsimulation model over a lifetime horizon. Test sensitivity and specificity inputs were based on 2021 USPSTF modeling analyses; adherence rates were based on published real-world data and the costs of the screening test, follow-up colonoscopies, complications, and CRC care were included. Outcomes are reported from the perspective of a United States payer as clinical, life-years gained (LYG), and incremental cost-effectiveness ratio (ICER); stool-based and follow-up colonoscopy adherence ranges were explored in one-way, probabilistic and threshold analyses. RESULTS When compared to initiation of CRC screening at age 45 versus 50, all modalities reduced both the incidence of and mortality from CRC and increased LYG. Initiating CRC screening at age 45 was cost-effective with an ICER of $59,816 and $35,857 per quality-adjusted life year (QALY) for mt-sDNA versus FIT and FOBT, respectively. In the threshold analyses, at equivalent rates to stool-based screening, mt-sDNA was always cost-effective at a willingness-to-pay threshold of $100,000 per QALY versus FIT and FOBT. CONCLUSIONS Initiating average-risk CRC screening at age 45 instead of age 50 increases the estimated clinical benefit by reducing disease burden while remaining cost-effective. Among stool-based screening modalities, mt-sDNA provides the most clinical benefit in a Commercial and Medicare population.
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Affiliation(s)
- Derek Ebner
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - John Kisiel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | | | | | - A Mark Fendrick
- Center for Value Based Insurance Design, University of Michigan, Ann Arbor, MI, USA
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Fardellone P, Barnieh L, Quignot N, Gusto G, Khachatryan A, Kahangire DA, Worth G, O'Kelly J, Desamericq G. Exploring the treatment gap among patients with osteoporosis-related fractures in France. Arch Osteoporos 2022; 17:29. [PMID: 35113266 DOI: 10.1007/s11657-021-01041-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/11/2021] [Indexed: 02/03/2023]
Abstract
The use of anti-osteoporosis treatment following a diagnosis of osteoporosis with fracture or a relevant fragility fracture remains low in France. Initiating an anti-resorptive may reduce the incidence of a subsequent fracture by 60%. PURPOSE To describe real-world osteoporosis treatment patterns in individuals with a fragility fracture in France and to explore the impact of initiating treatment on the risk of subsequent fracture. METHODS A retrospective cohort study, using the national French Health Insurance claims database. Males and females 50 years and over, with a hospital discharge diagnosis of osteoporosis with fracture or a relevant fragility fracture between 2011 and 2014, were included and followed until death or the end of 2016, whichever came first. The primary outcome was the proportion of patients receiving anti-osteoporosis treatments prior to and post-index fracture. Change in fracture rates before and after treatment initiation was assessed in an exploratory analysis. RESULTS A total of 574,133 patients (138,567 males, 435,566 females) had a qualifying index fracture. The proportion of patients receiving any anti-osteoporosis treatment increased pre-index fracture to post-index fracture from 2.2 to 5.6% among males, and from 11.8 to 18.2% among females. Oral bisphosphonates were the most prescribed anti-osteoporosis treatment for both males and females among post-index fractures (60.6% and 68.8% of patients initiating treatment). Following initiation of anti-resorptives, the incidence of subsequent fracture was reduced by 60% (rate ratio (RR): 0.40, 95% confidence interval [CI]: 0.34-0.45). CONCLUSION Anti-osteoporosis treatment following an index fracture in France remains low. Improved identification and pharmacologic management of patients at risk of fragility fractures are necessary to reduce the risk of subsequent fractures.
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Affiliation(s)
- Patrice Fardellone
- Service de Rhumatologie, Hopital Nord - Place Victor Pauchet, CHU Amiens, Université de Picardie - Jules Verne, 80054, Amiens Cedex, France.
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Garcia-Ochoa C, Feldman LS, Nguan C, Monroy-Caudros M, Arnold JB, Barnieh L, Boudville N, Cuerden MS, Dipchand C, Gill JS, Karpinski M, Klarenbach S, Knoll G, Lok CE, Miller M, Prasad GVR, Sontrop JM, Storsley L, Garg AX. Impact of Perioperative Complications on Living Kidney Donor Health-Related Quality of Life and Mental Health: Results From a Prospective Cohort Study. Can J Kidney Health Dis 2021; 8:20543581211037429. [PMID: 34394947 PMCID: PMC8361543 DOI: 10.1177/20543581211037429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Although living kidney donation is safe, some donors experience perioperative complications. Objective: This study explored how perioperative complications affected donor-reported health-related quality of life, depression, and anxiety. Design: This research was a conducted as a prospective cohort study. Setting: Twelve transplant centers across Canada. Patients: A total of 912 living kidney donors were included in this study. Measurements: Short Form 36 health survey, Beck Depression Inventory and Beck Anxiety Inventory. Methods: Living kidney donors were prospectively enrolled predonation between 2009 to 2014. Donor perioperative complications were graded using the Clavien-Dindo classification system. Mental and physical health-related quality of life was assessed with the 3 measurements; measurements were taken predonation and at 3- and 12-months postdonation. Results: Seventy-four donors (8%) experienced a perioperative complication; most were minor (n = 67 [91%]), and all minor complications resolved before hospital discharge. The presence (versus absence) of a perioperative complication was associated with lower mental health-related quality of life and higher depression symptoms 3-month postdonation; neither of these differences persisted at 12-month. Perioperative complications were not associated with any changes in physical health-related quality of life or anxiety 3-month postdonation. Limitations: Minor complications may have been missed and information on complications postdischarge were not collected. No minimal clinically significant change has been defined for kidney donors across the 3 measurements. Conclusions: These findings highlight a potential opportunity to better support the psychosocial needs of donors who experience perioperative complications in the months following donation. Trial registration: NCT00319579 and NCT00936078.
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Affiliation(s)
| | - Liane S Feldman
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Chris Nguan
- The University of British Columbia, Vancouver, Canada
| | | | | | | | - Neil Boudville
- Medical School, Department of Renal Medicine, Sir Charles Gairdner Hospital, The University of Western Australia, Perth, Australia
| | | | | | - John S Gill
- The University of British Columbia, Vancouver, Canada
| | | | | | - Greg Knoll
- Division of Nephrology, Department of Medicine, University of Ottawa, ON, Canada
| | | | - Matthew Miller
- Division of Nephrology and Transplantation, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
| | | | - Jessica M Sontrop
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada
| | | | - Amit X Garg
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.,Department of Medicine, Western University, London, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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Lunney M, Ronksley PE, Weaver RG, Barnieh L, Blue N, Avey MT, Rolland-Harris E, Khan FM, Pang JXQ, Rafferty E, Scory TD, Svenson LW, Rodin R, Tonelli M. COVID-19 infection among international travellers: a prospective analysis. BMJ Open 2021; 11:e050667. [PMID: 34168036 PMCID: PMC8228575 DOI: 10.1136/bmjopen-2021-050667] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/01/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES This report estimates the risk of COVID-19 importation and secondary transmission associated with a modified quarantine programme in Canada. DESIGN AND PARTICIPANTS Prospective analysis of international asymptomatic travellers entering Alberta, Canada. INTERVENTIONS All participants were required to receive a PCR COVID-19 test on arrival. If negative, participants could leave quarantine but were required to have a second test 6 or 7 days after arrival. If the arrival test was positive, participants were required to remain in quarantine for 14 days. MAIN OUTCOME MEASURES Proportion and rate of participants testing positive for COVID-19; number of cases of secondary transmission. RESULTS The analysis included 9535 international travellers entering Alberta by air (N=8398) or land (N=1137) that voluntarily enrolled in the Alberta Border Testing Pilot Programme (a subset of all travellers); most (83.1%) were Canadian citizens. Among the 9310 participants who received at least one test, 200 (21.5 per 1000, 95% CI 18.6 to 24.6) tested positive. Sixty-nine per cent (138/200) of positive tests were detected on arrival (14.8 per 1000 travellers, 95% CI 12.5 to 17.5). 62 cases (6.7 per 1000 travellers, 95% CI 5.1 to 8.5; 31.0% of positive cases) were identified among participants that had been released from quarantine following a negative test result on arrival. Of 192 participants who developed symptoms, 51 (26.6%) tested positive after arrival. Among participants with positive tests, four (2.0%) were hospitalised for COVID-19; none required critical care or died. Contact tracing among participants who tested positive identified 200 contacts; of 88 contacts tested, 22 were cases of secondary transmission (14 from those testing positive on arrival and 8 from those testing positive thereafter). SARS-CoV-2 B.1.1.7 lineage was not detected in any of the 200 positive cases. CONCLUSIONS 21.5 per 1000 international travellers tested positive for COVID-19. Most (69%) tested positive on arrival and 31% tested positive during follow-up. These findings suggest the need for ongoing vigilance in travellers testing negative on arrival and highlight the value of follow-up testing and contact tracing to monitor and limit secondary transmission where possible.
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Affiliation(s)
- Meaghan Lunney
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robert G Weaver
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lianne Barnieh
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Norman Blue
- Office of the Chief Medical Officer of Health, Alberta Health, Government of Alberta, Edmonton, Alberta, Canada
| | - Marc T Avey
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | | | - Faisal M Khan
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jack X Q Pang
- Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Ellen Rafferty
- Analytics & Performance Reporting Branch, Alberta Health, Government of Alberta, Edmonton, Alberta, Canada
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Tayler D Scory
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lawrence W Svenson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Analytics & Performance Reporting Branch, Alberta Health, Government of Alberta, Edmonton, Alberta, Canada
- Division of Preventive Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Rachel Rodin
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Traversy G, Barnieh L, Akl EA, Allan GM, Brouwers M, Ganache I, Grundy Q, Guyatt GH, Kelsall D, Leng G, Moore A, Persaud N, Schünemann HJ, Straus S, Thombs BD, Rodin R, Tonelli M. Managing conflicts of interest in the development of health guidelines. CMAJ 2021; 193:E49-E54. [PMID: 33431547 PMCID: PMC7773042 DOI: 10.1503/cmaj.200651] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Gregory Traversy
- Centre for Communicable Diseases and Infection Control (Traversy, Rodin), Public Health Agency of Canada, Ottawa, Ont.; Department of Medicine, University of Calgary (Barnieh, Tonelli), Calgary, Alta.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; Department of Family Medicine (Allan), University of Alberta, Edmonton, Alta.; School of Epidemiology and Public Health (Brouwers), University of Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Que.; Lawrence S. Bloomberg Faculty of Nursing (Grundy), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence and Impact (Guyatt, Schünemann), McMaster University Faculty of Health Sciences, Hamilton, Ont.; CMAJ (Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), London, UK; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud) and Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Institut für Evidence in Medicine (Schünemann), Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lianne Barnieh
- Centre for Communicable Diseases and Infection Control (Traversy, Rodin), Public Health Agency of Canada, Ottawa, Ont.; Department of Medicine, University of Calgary (Barnieh, Tonelli), Calgary, Alta.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; Department of Family Medicine (Allan), University of Alberta, Edmonton, Alta.; School of Epidemiology and Public Health (Brouwers), University of Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Que.; Lawrence S. Bloomberg Faculty of Nursing (Grundy), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence and Impact (Guyatt, Schünemann), McMaster University Faculty of Health Sciences, Hamilton, Ont.; CMAJ (Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), London, UK; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud) and Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Institut für Evidence in Medicine (Schünemann), Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elie A Akl
- Centre for Communicable Diseases and Infection Control (Traversy, Rodin), Public Health Agency of Canada, Ottawa, Ont.; Department of Medicine, University of Calgary (Barnieh, Tonelli), Calgary, Alta.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; Department of Family Medicine (Allan), University of Alberta, Edmonton, Alta.; School of Epidemiology and Public Health (Brouwers), University of Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Que.; Lawrence S. Bloomberg Faculty of Nursing (Grundy), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence and Impact (Guyatt, Schünemann), McMaster University Faculty of Health Sciences, Hamilton, Ont.; CMAJ (Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), London, UK; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud) and Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Institut für Evidence in Medicine (Schünemann), Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - G Michael Allan
- Centre for Communicable Diseases and Infection Control (Traversy, Rodin), Public Health Agency of Canada, Ottawa, Ont.; Department of Medicine, University of Calgary (Barnieh, Tonelli), Calgary, Alta.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; Department of Family Medicine (Allan), University of Alberta, Edmonton, Alta.; School of Epidemiology and Public Health (Brouwers), University of Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Que.; Lawrence S. Bloomberg Faculty of Nursing (Grundy), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence and Impact (Guyatt, Schünemann), McMaster University Faculty of Health Sciences, Hamilton, Ont.; CMAJ (Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), London, UK; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud) and Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Institut für Evidence in Medicine (Schünemann), Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Melissa Brouwers
- Centre for Communicable Diseases and Infection Control (Traversy, Rodin), Public Health Agency of Canada, Ottawa, Ont.; Department of Medicine, University of Calgary (Barnieh, Tonelli), Calgary, Alta.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; Department of Family Medicine (Allan), University of Alberta, Edmonton, Alta.; School of Epidemiology and Public Health (Brouwers), University of Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Que.; Lawrence S. Bloomberg Faculty of Nursing (Grundy), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence and Impact (Guyatt, Schünemann), McMaster University Faculty of Health Sciences, Hamilton, Ont.; CMAJ (Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), London, UK; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud) and Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Institut für Evidence in Medicine (Schünemann), Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Isabelle Ganache
- Centre for Communicable Diseases and Infection Control (Traversy, Rodin), Public Health Agency of Canada, Ottawa, Ont.; Department of Medicine, University of Calgary (Barnieh, Tonelli), Calgary, Alta.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; Department of Family Medicine (Allan), University of Alberta, Edmonton, Alta.; School of Epidemiology and Public Health (Brouwers), University of Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Que.; Lawrence S. Bloomberg Faculty of Nursing (Grundy), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence and Impact (Guyatt, Schünemann), McMaster University Faculty of Health Sciences, Hamilton, Ont.; CMAJ (Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), London, UK; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud) and Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Institut für Evidence in Medicine (Schünemann), Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Quinn Grundy
- Centre for Communicable Diseases and Infection Control (Traversy, Rodin), Public Health Agency of Canada, Ottawa, Ont.; Department of Medicine, University of Calgary (Barnieh, Tonelli), Calgary, Alta.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; Department of Family Medicine (Allan), University of Alberta, Edmonton, Alta.; School of Epidemiology and Public Health (Brouwers), University of Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Que.; Lawrence S. Bloomberg Faculty of Nursing (Grundy), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence and Impact (Guyatt, Schünemann), McMaster University Faculty of Health Sciences, Hamilton, Ont.; CMAJ (Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), London, UK; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud) and Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Institut für Evidence in Medicine (Schünemann), Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gordon H Guyatt
- Centre for Communicable Diseases and Infection Control (Traversy, Rodin), Public Health Agency of Canada, Ottawa, Ont.; Department of Medicine, University of Calgary (Barnieh, Tonelli), Calgary, Alta.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; Department of Family Medicine (Allan), University of Alberta, Edmonton, Alta.; School of Epidemiology and Public Health (Brouwers), University of Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Que.; Lawrence S. Bloomberg Faculty of Nursing (Grundy), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence and Impact (Guyatt, Schünemann), McMaster University Faculty of Health Sciences, Hamilton, Ont.; CMAJ (Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), London, UK; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud) and Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Institut für Evidence in Medicine (Schünemann), Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Diane Kelsall
- Centre for Communicable Diseases and Infection Control (Traversy, Rodin), Public Health Agency of Canada, Ottawa, Ont.; Department of Medicine, University of Calgary (Barnieh, Tonelli), Calgary, Alta.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; Department of Family Medicine (Allan), University of Alberta, Edmonton, Alta.; School of Epidemiology and Public Health (Brouwers), University of Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Que.; Lawrence S. Bloomberg Faculty of Nursing (Grundy), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence and Impact (Guyatt, Schünemann), McMaster University Faculty of Health Sciences, Hamilton, Ont.; CMAJ (Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), London, UK; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud) and Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Institut für Evidence in Medicine (Schünemann), Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gillian Leng
- Centre for Communicable Diseases and Infection Control (Traversy, Rodin), Public Health Agency of Canada, Ottawa, Ont.; Department of Medicine, University of Calgary (Barnieh, Tonelli), Calgary, Alta.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; Department of Family Medicine (Allan), University of Alberta, Edmonton, Alta.; School of Epidemiology and Public Health (Brouwers), University of Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Que.; Lawrence S. Bloomberg Faculty of Nursing (Grundy), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence and Impact (Guyatt, Schünemann), McMaster University Faculty of Health Sciences, Hamilton, Ont.; CMAJ (Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), London, UK; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud) and Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Institut für Evidence in Medicine (Schünemann), Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ainsley Moore
- Centre for Communicable Diseases and Infection Control (Traversy, Rodin), Public Health Agency of Canada, Ottawa, Ont.; Department of Medicine, University of Calgary (Barnieh, Tonelli), Calgary, Alta.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; Department of Family Medicine (Allan), University of Alberta, Edmonton, Alta.; School of Epidemiology and Public Health (Brouwers), University of Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Que.; Lawrence S. Bloomberg Faculty of Nursing (Grundy), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence and Impact (Guyatt, Schünemann), McMaster University Faculty of Health Sciences, Hamilton, Ont.; CMAJ (Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), London, UK; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud) and Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Institut für Evidence in Medicine (Schünemann), Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Navindra Persaud
- Centre for Communicable Diseases and Infection Control (Traversy, Rodin), Public Health Agency of Canada, Ottawa, Ont.; Department of Medicine, University of Calgary (Barnieh, Tonelli), Calgary, Alta.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; Department of Family Medicine (Allan), University of Alberta, Edmonton, Alta.; School of Epidemiology and Public Health (Brouwers), University of Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Que.; Lawrence S. Bloomberg Faculty of Nursing (Grundy), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence and Impact (Guyatt, Schünemann), McMaster University Faculty of Health Sciences, Hamilton, Ont.; CMAJ (Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), London, UK; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud) and Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Institut für Evidence in Medicine (Schünemann), Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Holger J Schünemann
- Centre for Communicable Diseases and Infection Control (Traversy, Rodin), Public Health Agency of Canada, Ottawa, Ont.; Department of Medicine, University of Calgary (Barnieh, Tonelli), Calgary, Alta.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; Department of Family Medicine (Allan), University of Alberta, Edmonton, Alta.; School of Epidemiology and Public Health (Brouwers), University of Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Que.; Lawrence S. Bloomberg Faculty of Nursing (Grundy), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence and Impact (Guyatt, Schünemann), McMaster University Faculty of Health Sciences, Hamilton, Ont.; CMAJ (Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), London, UK; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud) and Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Institut für Evidence in Medicine (Schünemann), Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sharon Straus
- Centre for Communicable Diseases and Infection Control (Traversy, Rodin), Public Health Agency of Canada, Ottawa, Ont.; Department of Medicine, University of Calgary (Barnieh, Tonelli), Calgary, Alta.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; Department of Family Medicine (Allan), University of Alberta, Edmonton, Alta.; School of Epidemiology and Public Health (Brouwers), University of Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Que.; Lawrence S. Bloomberg Faculty of Nursing (Grundy), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence and Impact (Guyatt, Schünemann), McMaster University Faculty of Health Sciences, Hamilton, Ont.; CMAJ (Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), London, UK; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud) and Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Institut für Evidence in Medicine (Schünemann), Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Brett D Thombs
- Centre for Communicable Diseases and Infection Control (Traversy, Rodin), Public Health Agency of Canada, Ottawa, Ont.; Department of Medicine, University of Calgary (Barnieh, Tonelli), Calgary, Alta.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; Department of Family Medicine (Allan), University of Alberta, Edmonton, Alta.; School of Epidemiology and Public Health (Brouwers), University of Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Que.; Lawrence S. Bloomberg Faculty of Nursing (Grundy), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence and Impact (Guyatt, Schünemann), McMaster University Faculty of Health Sciences, Hamilton, Ont.; CMAJ (Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), London, UK; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud) and Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Institut für Evidence in Medicine (Schünemann), Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rachel Rodin
- Centre for Communicable Diseases and Infection Control (Traversy, Rodin), Public Health Agency of Canada, Ottawa, Ont.; Department of Medicine, University of Calgary (Barnieh, Tonelli), Calgary, Alta.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; Department of Family Medicine (Allan), University of Alberta, Edmonton, Alta.; School of Epidemiology and Public Health (Brouwers), University of Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Que.; Lawrence S. Bloomberg Faculty of Nursing (Grundy), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence and Impact (Guyatt, Schünemann), McMaster University Faculty of Health Sciences, Hamilton, Ont.; CMAJ (Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), London, UK; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud) and Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Institut für Evidence in Medicine (Schünemann), Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marcello Tonelli
- Centre for Communicable Diseases and Infection Control (Traversy, Rodin), Public Health Agency of Canada, Ottawa, Ont.; Department of Medicine, University of Calgary (Barnieh, Tonelli), Calgary, Alta.; Department of Internal Medicine (Akl), American University of Beirut, Beirut, Lebanon; Department of Family Medicine (Allan), University of Alberta, Edmonton, Alta.; School of Epidemiology and Public Health (Brouwers), University of Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Que.; Lawrence S. Bloomberg Faculty of Nursing (Grundy), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence and Impact (Guyatt, Schünemann), McMaster University Faculty of Health Sciences, Hamilton, Ont.; CMAJ (Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), London, UK; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud) and Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; Lady Davis Institute and Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Institut für Evidence in Medicine (Schünemann), Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Traversy G, Barnieh L, Akl EA, Allan GM, Brouwers M, Ganache I, Grundy Q, Guyatt GH, Kelsall D, Leng G, Moore A, Persaud N, Schünemann HJ, Straus S, Thombs BD, Rodin R, Tonelli M. Gestion des conflits d’intérêts durant l’élaboration de lignes directrices en santé. CMAJ 2021; 193:E324-E330. [PMID: 33649178 PMCID: PMC8034305 DOI: 10.1503/cmaj.200651-f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Gregory Traversy
- Centre de la lutte contre les maladies transmissibles et les infections (Traversy, Rodin), Agence de la santé publique du Canada, Ottawa, Ont.; Département de médecine, Université de Calgary ( Barnieh, Tonelli), Calgary, Alb.; Département de médecine interne (Akl), Université américaine de Beyrouth, Beyrouth, Liban; Département de médecine familiale (Allan), Université de l'Alberta, Edmonton, Alb.; École d'épidémiologie et de santé publique (Brouwers), Université d'Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Qué.; Faculté des sciences infirmières Lawrence S. Bloomberg (Grundy), Université de Toronto, Toronto, Ont.; Départements des méthodes, des données et de l'incidence de la recherche en santé (Guyatt, Schünemann), Faculté des sciences de la santé, Université McMaster, Hamilton, Ont.; CMAJ ( Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), Londres, Royaume-Uni; Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Département de médecine familiale et communautaire ( Persaud) et Institut du savoir Li Ka Shing (Straus), Hôpital St. Michael, Toronto, Ont.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qué.; Institut für Evidenz in der Medizin ( Schünemann), Centre médical et faculté de médecine, Université de Fribourg, Fribourg, Allemagne.
| | - Lianne Barnieh
- Centre de la lutte contre les maladies transmissibles et les infections (Traversy, Rodin), Agence de la santé publique du Canada, Ottawa, Ont.; Département de médecine, Université de Calgary ( Barnieh, Tonelli), Calgary, Alb.; Département de médecine interne (Akl), Université américaine de Beyrouth, Beyrouth, Liban; Département de médecine familiale (Allan), Université de l'Alberta, Edmonton, Alb.; École d'épidémiologie et de santé publique (Brouwers), Université d'Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Qué.; Faculté des sciences infirmières Lawrence S. Bloomberg (Grundy), Université de Toronto, Toronto, Ont.; Départements des méthodes, des données et de l'incidence de la recherche en santé (Guyatt, Schünemann), Faculté des sciences de la santé, Université McMaster, Hamilton, Ont.; CMAJ ( Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), Londres, Royaume-Uni; Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Département de médecine familiale et communautaire ( Persaud) et Institut du savoir Li Ka Shing (Straus), Hôpital St. Michael, Toronto, Ont.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qué.; Institut für Evidenz in der Medizin ( Schünemann), Centre médical et faculté de médecine, Université de Fribourg, Fribourg, Allemagne
| | - Elie A Akl
- Centre de la lutte contre les maladies transmissibles et les infections (Traversy, Rodin), Agence de la santé publique du Canada, Ottawa, Ont.; Département de médecine, Université de Calgary ( Barnieh, Tonelli), Calgary, Alb.; Département de médecine interne (Akl), Université américaine de Beyrouth, Beyrouth, Liban; Département de médecine familiale (Allan), Université de l'Alberta, Edmonton, Alb.; École d'épidémiologie et de santé publique (Brouwers), Université d'Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Qué.; Faculté des sciences infirmières Lawrence S. Bloomberg (Grundy), Université de Toronto, Toronto, Ont.; Départements des méthodes, des données et de l'incidence de la recherche en santé (Guyatt, Schünemann), Faculté des sciences de la santé, Université McMaster, Hamilton, Ont.; CMAJ ( Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), Londres, Royaume-Uni; Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Département de médecine familiale et communautaire ( Persaud) et Institut du savoir Li Ka Shing (Straus), Hôpital St. Michael, Toronto, Ont.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qué.; Institut für Evidenz in der Medizin ( Schünemann), Centre médical et faculté de médecine, Université de Fribourg, Fribourg, Allemagne
| | - G Michael Allan
- Centre de la lutte contre les maladies transmissibles et les infections (Traversy, Rodin), Agence de la santé publique du Canada, Ottawa, Ont.; Département de médecine, Université de Calgary ( Barnieh, Tonelli), Calgary, Alb.; Département de médecine interne (Akl), Université américaine de Beyrouth, Beyrouth, Liban; Département de médecine familiale (Allan), Université de l'Alberta, Edmonton, Alb.; École d'épidémiologie et de santé publique (Brouwers), Université d'Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Qué.; Faculté des sciences infirmières Lawrence S. Bloomberg (Grundy), Université de Toronto, Toronto, Ont.; Départements des méthodes, des données et de l'incidence de la recherche en santé (Guyatt, Schünemann), Faculté des sciences de la santé, Université McMaster, Hamilton, Ont.; CMAJ ( Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), Londres, Royaume-Uni; Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Département de médecine familiale et communautaire ( Persaud) et Institut du savoir Li Ka Shing (Straus), Hôpital St. Michael, Toronto, Ont.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qué.; Institut für Evidenz in der Medizin ( Schünemann), Centre médical et faculté de médecine, Université de Fribourg, Fribourg, Allemagne
| | - Melissa Brouwers
- Centre de la lutte contre les maladies transmissibles et les infections (Traversy, Rodin), Agence de la santé publique du Canada, Ottawa, Ont.; Département de médecine, Université de Calgary ( Barnieh, Tonelli), Calgary, Alb.; Département de médecine interne (Akl), Université américaine de Beyrouth, Beyrouth, Liban; Département de médecine familiale (Allan), Université de l'Alberta, Edmonton, Alb.; École d'épidémiologie et de santé publique (Brouwers), Université d'Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Qué.; Faculté des sciences infirmières Lawrence S. Bloomberg (Grundy), Université de Toronto, Toronto, Ont.; Départements des méthodes, des données et de l'incidence de la recherche en santé (Guyatt, Schünemann), Faculté des sciences de la santé, Université McMaster, Hamilton, Ont.; CMAJ ( Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), Londres, Royaume-Uni; Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Département de médecine familiale et communautaire ( Persaud) et Institut du savoir Li Ka Shing (Straus), Hôpital St. Michael, Toronto, Ont.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qué.; Institut für Evidenz in der Medizin ( Schünemann), Centre médical et faculté de médecine, Université de Fribourg, Fribourg, Allemagne
| | - Isabelle Ganache
- Centre de la lutte contre les maladies transmissibles et les infections (Traversy, Rodin), Agence de la santé publique du Canada, Ottawa, Ont.; Département de médecine, Université de Calgary ( Barnieh, Tonelli), Calgary, Alb.; Département de médecine interne (Akl), Université américaine de Beyrouth, Beyrouth, Liban; Département de médecine familiale (Allan), Université de l'Alberta, Edmonton, Alb.; École d'épidémiologie et de santé publique (Brouwers), Université d'Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Qué.; Faculté des sciences infirmières Lawrence S. Bloomberg (Grundy), Université de Toronto, Toronto, Ont.; Départements des méthodes, des données et de l'incidence de la recherche en santé (Guyatt, Schünemann), Faculté des sciences de la santé, Université McMaster, Hamilton, Ont.; CMAJ ( Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), Londres, Royaume-Uni; Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Département de médecine familiale et communautaire ( Persaud) et Institut du savoir Li Ka Shing (Straus), Hôpital St. Michael, Toronto, Ont.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qué.; Institut für Evidenz in der Medizin ( Schünemann), Centre médical et faculté de médecine, Université de Fribourg, Fribourg, Allemagne
| | - Quinn Grundy
- Centre de la lutte contre les maladies transmissibles et les infections (Traversy, Rodin), Agence de la santé publique du Canada, Ottawa, Ont.; Département de médecine, Université de Calgary ( Barnieh, Tonelli), Calgary, Alb.; Département de médecine interne (Akl), Université américaine de Beyrouth, Beyrouth, Liban; Département de médecine familiale (Allan), Université de l'Alberta, Edmonton, Alb.; École d'épidémiologie et de santé publique (Brouwers), Université d'Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Qué.; Faculté des sciences infirmières Lawrence S. Bloomberg (Grundy), Université de Toronto, Toronto, Ont.; Départements des méthodes, des données et de l'incidence de la recherche en santé (Guyatt, Schünemann), Faculté des sciences de la santé, Université McMaster, Hamilton, Ont.; CMAJ ( Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), Londres, Royaume-Uni; Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Département de médecine familiale et communautaire ( Persaud) et Institut du savoir Li Ka Shing (Straus), Hôpital St. Michael, Toronto, Ont.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qué.; Institut für Evidenz in der Medizin ( Schünemann), Centre médical et faculté de médecine, Université de Fribourg, Fribourg, Allemagne
| | - Gordon H Guyatt
- Centre de la lutte contre les maladies transmissibles et les infections (Traversy, Rodin), Agence de la santé publique du Canada, Ottawa, Ont.; Département de médecine, Université de Calgary ( Barnieh, Tonelli), Calgary, Alb.; Département de médecine interne (Akl), Université américaine de Beyrouth, Beyrouth, Liban; Département de médecine familiale (Allan), Université de l'Alberta, Edmonton, Alb.; École d'épidémiologie et de santé publique (Brouwers), Université d'Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Qué.; Faculté des sciences infirmières Lawrence S. Bloomberg (Grundy), Université de Toronto, Toronto, Ont.; Départements des méthodes, des données et de l'incidence de la recherche en santé (Guyatt, Schünemann), Faculté des sciences de la santé, Université McMaster, Hamilton, Ont.; CMAJ ( Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), Londres, Royaume-Uni; Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Département de médecine familiale et communautaire ( Persaud) et Institut du savoir Li Ka Shing (Straus), Hôpital St. Michael, Toronto, Ont.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qué.; Institut für Evidenz in der Medizin ( Schünemann), Centre médical et faculté de médecine, Université de Fribourg, Fribourg, Allemagne
| | - Diane Kelsall
- Centre de la lutte contre les maladies transmissibles et les infections (Traversy, Rodin), Agence de la santé publique du Canada, Ottawa, Ont.; Département de médecine, Université de Calgary ( Barnieh, Tonelli), Calgary, Alb.; Département de médecine interne (Akl), Université américaine de Beyrouth, Beyrouth, Liban; Département de médecine familiale (Allan), Université de l'Alberta, Edmonton, Alb.; École d'épidémiologie et de santé publique (Brouwers), Université d'Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Qué.; Faculté des sciences infirmières Lawrence S. Bloomberg (Grundy), Université de Toronto, Toronto, Ont.; Départements des méthodes, des données et de l'incidence de la recherche en santé (Guyatt, Schünemann), Faculté des sciences de la santé, Université McMaster, Hamilton, Ont.; CMAJ ( Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), Londres, Royaume-Uni; Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Département de médecine familiale et communautaire ( Persaud) et Institut du savoir Li Ka Shing (Straus), Hôpital St. Michael, Toronto, Ont.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qué.; Institut für Evidenz in der Medizin ( Schünemann), Centre médical et faculté de médecine, Université de Fribourg, Fribourg, Allemagne
| | - Gillian Leng
- Centre de la lutte contre les maladies transmissibles et les infections (Traversy, Rodin), Agence de la santé publique du Canada, Ottawa, Ont.; Département de médecine, Université de Calgary ( Barnieh, Tonelli), Calgary, Alb.; Département de médecine interne (Akl), Université américaine de Beyrouth, Beyrouth, Liban; Département de médecine familiale (Allan), Université de l'Alberta, Edmonton, Alb.; École d'épidémiologie et de santé publique (Brouwers), Université d'Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Qué.; Faculté des sciences infirmières Lawrence S. Bloomberg (Grundy), Université de Toronto, Toronto, Ont.; Départements des méthodes, des données et de l'incidence de la recherche en santé (Guyatt, Schünemann), Faculté des sciences de la santé, Université McMaster, Hamilton, Ont.; CMAJ ( Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), Londres, Royaume-Uni; Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Département de médecine familiale et communautaire ( Persaud) et Institut du savoir Li Ka Shing (Straus), Hôpital St. Michael, Toronto, Ont.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qué.; Institut für Evidenz in der Medizin ( Schünemann), Centre médical et faculté de médecine, Université de Fribourg, Fribourg, Allemagne
| | - Ainsley Moore
- Centre de la lutte contre les maladies transmissibles et les infections (Traversy, Rodin), Agence de la santé publique du Canada, Ottawa, Ont.; Département de médecine, Université de Calgary ( Barnieh, Tonelli), Calgary, Alb.; Département de médecine interne (Akl), Université américaine de Beyrouth, Beyrouth, Liban; Département de médecine familiale (Allan), Université de l'Alberta, Edmonton, Alb.; École d'épidémiologie et de santé publique (Brouwers), Université d'Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Qué.; Faculté des sciences infirmières Lawrence S. Bloomberg (Grundy), Université de Toronto, Toronto, Ont.; Départements des méthodes, des données et de l'incidence de la recherche en santé (Guyatt, Schünemann), Faculté des sciences de la santé, Université McMaster, Hamilton, Ont.; CMAJ ( Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), Londres, Royaume-Uni; Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Département de médecine familiale et communautaire ( Persaud) et Institut du savoir Li Ka Shing (Straus), Hôpital St. Michael, Toronto, Ont.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qué.; Institut für Evidenz in der Medizin ( Schünemann), Centre médical et faculté de médecine, Université de Fribourg, Fribourg, Allemagne
| | - Navindra Persaud
- Centre de la lutte contre les maladies transmissibles et les infections (Traversy, Rodin), Agence de la santé publique du Canada, Ottawa, Ont.; Département de médecine, Université de Calgary ( Barnieh, Tonelli), Calgary, Alb.; Département de médecine interne (Akl), Université américaine de Beyrouth, Beyrouth, Liban; Département de médecine familiale (Allan), Université de l'Alberta, Edmonton, Alb.; École d'épidémiologie et de santé publique (Brouwers), Université d'Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Qué.; Faculté des sciences infirmières Lawrence S. Bloomberg (Grundy), Université de Toronto, Toronto, Ont.; Départements des méthodes, des données et de l'incidence de la recherche en santé (Guyatt, Schünemann), Faculté des sciences de la santé, Université McMaster, Hamilton, Ont.; CMAJ ( Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), Londres, Royaume-Uni; Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Département de médecine familiale et communautaire ( Persaud) et Institut du savoir Li Ka Shing (Straus), Hôpital St. Michael, Toronto, Ont.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qué.; Institut für Evidenz in der Medizin ( Schünemann), Centre médical et faculté de médecine, Université de Fribourg, Fribourg, Allemagne
| | - Holger J Schünemann
- Centre de la lutte contre les maladies transmissibles et les infections (Traversy, Rodin), Agence de la santé publique du Canada, Ottawa, Ont.; Département de médecine, Université de Calgary ( Barnieh, Tonelli), Calgary, Alb.; Département de médecine interne (Akl), Université américaine de Beyrouth, Beyrouth, Liban; Département de médecine familiale (Allan), Université de l'Alberta, Edmonton, Alb.; École d'épidémiologie et de santé publique (Brouwers), Université d'Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Qué.; Faculté des sciences infirmières Lawrence S. Bloomberg (Grundy), Université de Toronto, Toronto, Ont.; Départements des méthodes, des données et de l'incidence de la recherche en santé (Guyatt, Schünemann), Faculté des sciences de la santé, Université McMaster, Hamilton, Ont.; CMAJ ( Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), Londres, Royaume-Uni; Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Département de médecine familiale et communautaire ( Persaud) et Institut du savoir Li Ka Shing (Straus), Hôpital St. Michael, Toronto, Ont.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qué.; Institut für Evidenz in der Medizin ( Schünemann), Centre médical et faculté de médecine, Université de Fribourg, Fribourg, Allemagne
| | - Sharon Straus
- Centre de la lutte contre les maladies transmissibles et les infections (Traversy, Rodin), Agence de la santé publique du Canada, Ottawa, Ont.; Département de médecine, Université de Calgary ( Barnieh, Tonelli), Calgary, Alb.; Département de médecine interne (Akl), Université américaine de Beyrouth, Beyrouth, Liban; Département de médecine familiale (Allan), Université de l'Alberta, Edmonton, Alb.; École d'épidémiologie et de santé publique (Brouwers), Université d'Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Qué.; Faculté des sciences infirmières Lawrence S. Bloomberg (Grundy), Université de Toronto, Toronto, Ont.; Départements des méthodes, des données et de l'incidence de la recherche en santé (Guyatt, Schünemann), Faculté des sciences de la santé, Université McMaster, Hamilton, Ont.; CMAJ ( Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), Londres, Royaume-Uni; Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Département de médecine familiale et communautaire ( Persaud) et Institut du savoir Li Ka Shing (Straus), Hôpital St. Michael, Toronto, Ont.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qué.; Institut für Evidenz in der Medizin ( Schünemann), Centre médical et faculté de médecine, Université de Fribourg, Fribourg, Allemagne
| | - Brett D Thombs
- Centre de la lutte contre les maladies transmissibles et les infections (Traversy, Rodin), Agence de la santé publique du Canada, Ottawa, Ont.; Département de médecine, Université de Calgary ( Barnieh, Tonelli), Calgary, Alb.; Département de médecine interne (Akl), Université américaine de Beyrouth, Beyrouth, Liban; Département de médecine familiale (Allan), Université de l'Alberta, Edmonton, Alb.; École d'épidémiologie et de santé publique (Brouwers), Université d'Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Qué.; Faculté des sciences infirmières Lawrence S. Bloomberg (Grundy), Université de Toronto, Toronto, Ont.; Départements des méthodes, des données et de l'incidence de la recherche en santé (Guyatt, Schünemann), Faculté des sciences de la santé, Université McMaster, Hamilton, Ont.; CMAJ ( Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), Londres, Royaume-Uni; Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Département de médecine familiale et communautaire ( Persaud) et Institut du savoir Li Ka Shing (Straus), Hôpital St. Michael, Toronto, Ont.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qué.; Institut für Evidenz in der Medizin ( Schünemann), Centre médical et faculté de médecine, Université de Fribourg, Fribourg, Allemagne
| | - Rachel Rodin
- Centre de la lutte contre les maladies transmissibles et les infections (Traversy, Rodin), Agence de la santé publique du Canada, Ottawa, Ont.; Département de médecine, Université de Calgary ( Barnieh, Tonelli), Calgary, Alb.; Département de médecine interne (Akl), Université américaine de Beyrouth, Beyrouth, Liban; Département de médecine familiale (Allan), Université de l'Alberta, Edmonton, Alb.; École d'épidémiologie et de santé publique (Brouwers), Université d'Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Qué.; Faculté des sciences infirmières Lawrence S. Bloomberg (Grundy), Université de Toronto, Toronto, Ont.; Départements des méthodes, des données et de l'incidence de la recherche en santé (Guyatt, Schünemann), Faculté des sciences de la santé, Université McMaster, Hamilton, Ont.; CMAJ ( Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), Londres, Royaume-Uni; Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Département de médecine familiale et communautaire ( Persaud) et Institut du savoir Li Ka Shing (Straus), Hôpital St. Michael, Toronto, Ont.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qué.; Institut für Evidenz in der Medizin ( Schünemann), Centre médical et faculté de médecine, Université de Fribourg, Fribourg, Allemagne
| | - Marcello Tonelli
- Centre de la lutte contre les maladies transmissibles et les infections (Traversy, Rodin), Agence de la santé publique du Canada, Ottawa, Ont.; Département de médecine, Université de Calgary ( Barnieh, Tonelli), Calgary, Alb.; Département de médecine interne (Akl), Université américaine de Beyrouth, Beyrouth, Liban; Département de médecine familiale (Allan), Université de l'Alberta, Edmonton, Alb.; École d'épidémiologie et de santé publique (Brouwers), Université d'Ottawa, Ottawa, Ont.; Institut national d'excellence en santé et en services sociaux (Ganache), Montréal, Qué.; Faculté des sciences infirmières Lawrence S. Bloomberg (Grundy), Université de Toronto, Toronto, Ont.; Départements des méthodes, des données et de l'incidence de la recherche en santé (Guyatt, Schünemann), Faculté des sciences de la santé, Université McMaster, Hamilton, Ont.; CMAJ ( Kelsall), Ottawa, Ont.; National Institute for Health and Care Excellence (NICE) (Leng), Londres, Royaume-Uni; Département de médecine familiale (Moore), Université McMaster, Hamilton, Ont.; Département de médecine familiale et communautaire ( Persaud) et Institut du savoir Li Ka Shing (Straus), Hôpital St. Michael, Toronto, Ont.; Institut Lady Davis et Département de psychiatrie (Thombs), Hôpital général juif et Université McGill, Montréal, Qué.; Institut für Evidenz in der Medizin ( Schünemann), Centre médical et faculté de médecine, Université de Fribourg, Fribourg, Allemagne
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10
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Habbous S, Barnieh L, Klarenbach S, Manns B, Sarma S, Begen MA, Litchfield K, Lentine KL, Singh S, Garg AX. Evaluating multiple living kidney donor candidates simultaneously is more cost-effective than sequentially. Kidney Int 2020; 98:1578-1588. [DOI: 10.1016/j.kint.2020.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/13/2020] [Accepted: 06/04/2020] [Indexed: 01/11/2023]
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11
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Habbous S, Barnieh L, Litchfield K, McKenzie S, Reich M, Lam NN, Mucsi I, Bugeja A, Yohanna S, Mainra R, Chong K, Fantus D, Prasad GVR, Dipchand C, Gill J, Getchell L, Garg AX. A RAND-Modified Delphi on Key Indicators to Measure the Efficiency of Living Kidney Donor Candidate Evaluations. Clin J Am Soc Nephrol 2020; 15:1464-1473. [PMID: 32972951 PMCID: PMC7536753 DOI: 10.2215/cjn.03780320] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/16/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Many patients, providers, and potential living donors perceive the living kidney donor evaluation process to be lengthy and difficult to navigate. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We sought consensus on key terms and process and outcome indicators that can be used to measure how efficiently a transplant center evaluates persons interested in becoming a living kidney donor. Using a RAND-modified Delphi method, 77 participants (kidney transplant recipients or recipient candidates, living kidney donors or donor candidates, health care providers, and health care administrators) completed an online survey to define the terms and indicators. The definitions were then further refined during an in-person meeting with ten stakeholders. RESULTS We identified 16 process indicators (e.g., average time to evaluate a donor candidate), eight outcome indicators (e.g., annual number of preemptive living kidney donor transplants), and two measures that can be considered both process and outcome indicators (e.g., average number of times a candidate visited the transplant center for the evaluation). Transplant centers wishing to implement this set of indicators will require 22 unique data elements, all of which are either readily available or easily collected prospectively. CONCLUSIONS We identified a set of indicators through a consensus-based approach that may be used to monitor and improve the performance of a transplant center in how efficiently it evaluates persons interested in becoming a living kidney donor.
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Affiliation(s)
- Steven Habbous
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada .,Quality, Measurement, and Evaluation, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Lianne Barnieh
- Department of Nephrology, London Health Sciences Centre, London, Ontario, Canada
| | - Kenneth Litchfield
- Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease, Canada
| | - Susan McKenzie
- Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease, Canada
| | - Marian Reich
- Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease, Canada
| | - Ngan N Lam
- Division of Nephrology, University of Calgary, Calgary, Alberta, Canada
| | - Istvan Mucsi
- Kidney Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Ann Bugeja
- Division of Nephrology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Seychelle Yohanna
- Division of Nephrology, McMaster University, Hamilton, Ontario, Canada
| | - Rahul Mainra
- Saskatchewan Transplant Program, Saskatoon Health Region, Saskatoon, Saskatchewan, Canada
| | - Kate Chong
- Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease, Canada
| | - Daniel Fantus
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - G V Ramesh Prasad
- Kidney Transplant Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Christine Dipchand
- Division of Nephrology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jagbir Gill
- Division of Nephrology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Leah Getchell
- Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease, Canada
| | - Amit X Garg
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,Department of Nephrology, London Health Sciences Centre, London, Ontario, Canada
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12
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Yang CW, Harris DC, Luyckx VA, Nangaku M, Hou FF, Garcia Garcia G, Abu-Aisha H, Niang A, Sola L, Bunnag S, Eiam-Ong S, Tungsanga K, Richards M, Richards N, Goh BL, Dreyer G, Evans R, Mzingajira H, Twahir A, McCulloch MI, Ahn C, Osafo C, Hsu HH, Barnieh L, Donner JA, Tonelli M. Global case studies for chronic kidney disease/end-stage kidney disease care. Kidney Int Suppl (2011) 2020; 10:e24-e48. [PMID: 32149007 PMCID: PMC7031689 DOI: 10.1016/j.kisu.2019.11.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/11/2019] [Accepted: 11/07/2019] [Indexed: 01/13/2023] Open
Abstract
The prevalence of chronic kidney disease and its risk factors is increasing worldwide, and the rapid rise in global need for end-stage kidney disease care is a major challenge for health systems, particularly in low- and middle-income countries. Countries are responding to the challenge of end-stage kidney disease in different ways, with variable provision of the components of a kidney care strategy, including effective prevention, detection, conservative care, kidney transplantation, and an appropriate mix of dialysis modalities. This collection of case studies is from 15 countries from around the world and offers valuable learning examples from a variety of contexts. The variability in approaches may be explained by country differences in burden of disease, available human or financial resources, income status, and cost structures. In addition, cultural considerations, political context, and competing interests from other stakeholders must be considered. Although the approaches taken have often varied substantially, a common theme is the potential benefits of multistakeholder engagement aimed at improving the availability and scope of integrated kidney care.
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Affiliation(s)
- Chih-Wei Yang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - David C.H. Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Valerie A. Luyckx
- Institute of Biomedical Ethics and the History of Medicine, University of Zurich, Zurich, Switzerland
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Masaomi Nangaku
- Division of Nephrology, The University of Tokyo School of Medicine, Hongo, Japan
| | - Fan Fan Hou
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guillermo Garcia Garcia
- Servicio de Nefrologia, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Hospital 278, Guadalajara, Jalisco, Mexico
| | | | - Abdou Niang
- Department of Nephrology, Dalal Jamm Hospital, Cheikh Anta Diop University Teaching Hospital, Dakar, Senegal
| | - Laura Sola
- Dialysis Unit, CASMU-IAMPP, Montevideo, Uruguay
| | - Sakarn Bunnag
- Division of Nephrology, Department of Internal Medicine, Rajavithi Hospital, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Department of Medicine, Chulalongkorn Hospital, Bangkok, Thailand
| | - Kriang Tungsanga
- Division of Nephrology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Bhumirajanagarindra Kidney Institute, Bangkok, Thailand
| | | | - Nick Richards
- SEHA Dialysis Services, Abu Dhabi, United Arab Emirates
| | - Bak Leong Goh
- Department of Nephrology and Clinical Research Centre, Hospital Serdang, Jalan Puchong, Kajang, Selangor, Malaysia
| | - Gavin Dreyer
- Department of Nephrology, Barts Health NHS Trust, London, UK
| | - Rhys Evans
- Centre for Nephrology, University College London, London, UK
| | - Henry Mzingajira
- Malawi Ministry of Health, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Ahmed Twahir
- Parklands Kidney Centre, Nairobi, Kenya
- Department of Medicine, The Aga Khan University Hospital, Nairobi, Kenya
| | - Mignon I. McCulloch
- Paediatric Intensive and Critical Unit, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
| | - Curie Ahn
- Division of Nephrology, College of Medicine, Seoul National University, Seoul, Korea
| | - Charlotte Osafo
- School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Hsiang-Hao Hsu
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Lianne Barnieh
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Pan American Health Organization/World Health Organization’s Coordinating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Jo-Ann Donner
- International Society of Nephrology, Brussels, Belgium
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Pan American Health Organization/World Health Organization’s Coordinating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
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13
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Mann BS, Manns BJ, Barnieh L, Oliver MJ, Devoe D, Lorenzetti D, Pauly R, Quinn RR. Peritoneal Dialysis: A Scoping Review of Strategies to Maximize pd Utilization. Perit Dial Int 2020; 37:159-164. [DOI: 10.3747/pdi.2016.00057] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 12/15/2022] Open
Abstract
The percentage of end-stage renal disease (ESRD) patients treated with peritoneal dialysis (PD) has declined in many countries since the mid-1990s. Barriers to PD have been reviewed extensively in the literature, but evidence about strategies to address these barriers and maximize the safe and effective use of PD is lacking. We therefore decided to conduct a scoping review identifying strategies to maximize PD use in adults with ESRD. Our search strategy included the following online databases: MEDLINE (OVID), EMBASE, PubMed, Cochrane Controlled Trials Register, Current Controlled Trials, and Cochrane Database of Systematic Reviews for articles published from 1974 to November 2013. Experts in the field were contacted for information about other ongoing or unpublished studies. A complementary search was conducted in the gray literature. Websites of national, provincial or regional agencies were searched for documents regarding policies surrounding the use of PD. Individual dialysis centers need to identify barriers to increasing PD in their program and direct targeted strategies to maximize PD utilization. Our review highlights some effective strategies that may be used. Our review also highlights the need for further research into strategies to maximize PD utilization.
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Affiliation(s)
| | - Braden J. Manns
- Cumming School of Medicine, Calgary, AB, Canada
- University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Calgary, AB, Canada
- University of Calgary, Calgary, AB, Canada; Alberta Kidney Disease Network, Calgary, AB, Canada
| | - Lianne Barnieh
- University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Calgary, AB, Canada
| | - Matthew J. Oliver
- Calgary, AB, Canada; Sunnybrook Health Sciences Centre, Calgary, AB, Canada
| | - Daniel Devoe
- University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Calgary, AB, Canada
| | - Dianne Lorenzetti
- University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Calgary, AB, Canada
| | - Robert Pauly
- University of Toronto, Toronto, ON, Canada; Department of Medicine, and University of Alberta, Calgary, AB, Canada
| | - Robert R. Quinn
- Cumming School of Medicine, Calgary, AB, Canada
- University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Calgary, AB, Canada
- University of Calgary, Calgary, AB, Canada; Alberta Kidney Disease Network, Calgary, AB, Canada
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Barnieh L, Klarenbach S, Arnold J, Cuerden M, Knoll G, Lok C, Sontrop JM, Miller M, Ramesh Prasad GV, Przech S, Garg AX. Nonreimbursed Costs Incurred by Living Kidney Donors: A Case Study From Ontario, Canada. Transplantation 2019; 103:e164-e171. [PMID: 31246933 DOI: 10.1097/tp.0000000000002685] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Living donors may incur out-of-pocket costs during the donation process. While many jurisdictions have programs to reimburse living kidney donors for expenses, few programs have been evaluated. METHODS The Program for Reimbursing Expenses of Living Organ Donors was launched in the province of Ontario, Canada in 2008 and reimburses travel, parking, accommodation, meals, and loss of income; each category has a limit and the maximum total reimbursement is $5500 CAD. We conducted a case study to compare donors' incurred costs (out-of-pocket and lost income) with amounts reimbursed by Program for Reimbursing Expenses of Living Organ Donors. Donors with complete or partial cost data from a large prospective cohort study were linked to Ontario's reimbursement program to determine the gap between incurred and reimbursed costs (n = 159). RESULTS The mean gap between costs incurred and costs reimbursed to the donors was $1313 CAD for out-of-pocket costs and $1802 CAD for lost income, representing a mean reimbursement gap of $3115 CAD. Nondirected donors had the highest mean loss for out-of-pocket costs ($2691 CAD) and kidney paired donors had the highest mean loss for lost income ($4084 CAD). There were no significant differences in the mean gap across exploratory subgroups. CONCLUSIONS Reimbursement programs minimize some of the financial loss for living kidney donors. Opportunities remain to remove the financial burden of living kidney donors.
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Affiliation(s)
- Lianne Barnieh
- Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, ON, Canada
| | - Scott Klarenbach
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jennifer Arnold
- Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, ON, Canada
| | - Meaghan Cuerden
- Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, ON, Canada
| | - Greg Knoll
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Charmaine Lok
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jessica M Sontrop
- Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, ON, Canada
| | - Matthew Miller
- Division of Nephrology and Transplantation, McMaster University, Hamilton, ON, Canada
| | | | - Sebastian Przech
- Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, ON, Canada
| | - Amit X Garg
- Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, ON, Canada
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15
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Desveaux L, McBrien K, Barnieh L, Ivers NM. Mapping variation in intervention design: a systematic review to develop a program theory for patient navigator programs. Syst Rev 2019; 8:8. [PMID: 30621796 PMCID: PMC6323765 DOI: 10.1186/s13643-018-0920-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/18/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND There is a great deal of variation in the design and delivery of patient navigator (PN) programs, making it difficult to design or adopt these interventions in new contexts. We (1) systematically reviewed the literature to generate a preliminary program theory to describe how patient navigator interventions are designed and delivered; and (2) describe how the resulting program theory was applied in context to inform a prototype for a patient navigator program. METHODS The current study includes a secondary review of a larger systematic review. We reviewed studies included in the primary review to identify those that designed and evaluated programs to assist patients in accessing and/or adhering to care. We conducted a content analysis of included publications to describe the barriers targeted by PN interventions and the navigator activities addressing those barriers. A program theory was constructed by mapping patient navigator activities to corresponding constructs within the capability-opportunity-motivation model of behavior change (COM-B) model of behavior change. The program theory was then presented to individuals with chronic disease, healthcare providers, and system stakeholders, and refined iteratively based on feedback. RESULTS Twenty one publications describing 19 patient navigator interventions were included. A total of 17 unique patient navigator activities were reported. The most common included providing education, facilitating referrals, providing social and emotional support, and supporting self-management. The majority of navigator activities targeted barriers to physical opportunity, including facilitating insurance claims, assistance with scheduling, and providing transportation. Across all interventions, navigator activities were designed to target a total of 20 patient barriers. Among interventions reporting positive effects, over two thirds targeted knowledge barriers, problems with scheduling, proactive re-scheduling following a missed appointment, and insurance. The final program design included a total of 13 navigator activities-10 informed by the original program theory and 3 unique activities informed by stakeholders. CONCLUSIONS There is considerable heterogeneity in intervention content across patient navigator interventions. Our results provide a schema from which to develop PN interventions and illustrate how an evidence-based model was used to develop a real-world PN intervention. Our findings also highlight a critical need to improve the reporting of intervention components to facilitate translation. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42013005857.
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Affiliation(s)
- Laura Desveaux
- Women's College Research Institute and Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave Toronto, Toronto, Ontario, M5S 1B2, Canada. .,Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College St, Toronto, Ontario, Canada.
| | - Kerry McBrien
- Department of Family Medicine, University of Calgary, G012, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4 N1, Canada.,Department of Community Health Sciences, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Lianne Barnieh
- Department of Medicine, University of Calgary, 1403 29th Street NW, Calgary, Alberta, T2N 2 T9, Canada
| | - Noah M Ivers
- Women's College Research Institute and Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave Toronto, Toronto, Ontario, M5S 1B2, Canada.,Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College St, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Women's College Hospital and University of Toronto, 76 Grenville Ave, Toronto, Ontario, Canada
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16
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Barnieh L, Kanellis J, McDonald S, Arnold J, Sontrop JM, Cuerden M, Klarenbach S, Garg AX, Boudville N. Direct and indirect costs incurred by Australian living kidney donors. Nephrology (Carlton) 2018; 23:1145-1151. [DOI: 10.1111/nep.13205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Lianne Barnieh
- Division of Nephrology; Western University; London Ontario Canada
| | - John Kanellis
- Department of Nephrology, Monash Health and Centre for Inflammatory Diseases, Department of Medicine; Monash University; Melbourne Victoria Australia
| | - Stephen McDonald
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Jennifer Arnold
- Division of Nephrology; Western University; London Ontario Canada
| | - Jessica M. Sontrop
- Department of Epidemiology and Biostatistics; Western University; London Ontario Canada
| | - Meaghan Cuerden
- Division of Nephrology; Western University; London Ontario Canada
| | | | - Amit X. Garg
- Division of Nephrology; Western University; London Ontario Canada
- Department of Epidemiology and Biostatistics; Western University; London Ontario Canada
| | - Neil Boudville
- Medical School, Faculty of Medicine, Dentistry and Health Sciences; University of Western; Crawley Western Australia Australia
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17
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Przech S, Garg AX, Arnold JB, Barnieh L, Cuerden MS, Dipchand C, Feldman L, Gill JS, Karpinski M, Knoll G, Lok C, Miller M, Monroy M, Nguan C, Prasad GVR, Sarma S, Sontrop JM, Storsley L, Klarenbach S. Financial Costs Incurred by Living Kidney Donors: A Prospective Cohort Study. J Am Soc Nephrol 2018; 29:2847-2857. [PMID: 30404908 DOI: 10.1681/asn.2018040398] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/07/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Approximately 40% of the kidneys for transplant worldwide come from living donors. Despite advantages of living donor transplants, rates have stagnated in recent years. One possible barrier may be costs related to the transplant process that potential willing donors may incur for travel, parking, accommodation, and lost productivity. METHODS To better understand and quantify the financial costs incurred by living kidney donors, we conducted a prospective cohort study, recruiting 912 living kidney donors from 12 transplant centers across Canada between 2009 and 2014; 821 of them completed all or a portion of the costing survey. We report microcosted total, out-of-pocket, and lost productivity costs (in 2016 Canadian dollars) for living kidney donors from donor evaluation start to 3 months after donation. We examined costs according to (1) the donor's relationship with their recipient, including spousal (donation to a partner), emotionally related nonspousal (friend, step-parent, in law), or genetically related; and (2) donation type (directed, paired kidney, or nondirected). RESULTS Living kidney donors incurred a median (75th percentile) of $1254 ($2589) in out-of-pocket costs and $0 ($1908) in lost productivity costs. On average, total costs were $2226 higher in spousal compared with emotionally related nonspousal donors (P=0.02) and $1664 higher in directed donors compared with nondirected donors (P<0.001). Total costs (out-of-pocket and lost productivity) exceeded $5500 for 205 (25%) donors. CONCLUSIONS Our results can be used to inform strategies to minimize the financial burden of living donation, which may help improve the donation experience and increase the number of living donor kidney transplants.
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Affiliation(s)
- Sebastian Przech
- Department of Medicine and Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Amit X Garg
- Department of Medicine and Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Jennifer B Arnold
- Department of Medicine and Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Lianne Barnieh
- Department of Medicine and Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Meaghan S Cuerden
- Department of Medicine and Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Christine Dipchand
- Division of Nephrology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Liane Feldman
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - John S Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Karpinski
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Greg Knoll
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Charmaine Lok
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Miller
- Division of Nephrology and Transplantation, McMaster University, Hamilton, Ontario, Canada
| | - Mauricio Monroy
- Department of Surgery, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
| | - Chris Nguan
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - G V Ramesh Prasad
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada; and
| | - Sisira Sarma
- Department of Medicine and Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Jessica M Sontrop
- Department of Medicine and Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Leroy Storsley
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Scott Klarenbach
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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18
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McBrien KA, Ivers N, Barnieh L, Bailey JJ, Lorenzetti DL, Nicholas D, Tonelli M, Hemmelgarn B, Lewanczuk R, Edwards A, Braun T, Manns B. Patient navigators for people with chronic disease: A systematic review. PLoS One 2018; 13:e0191980. [PMID: 29462179 PMCID: PMC5819768 DOI: 10.1371/journal.pone.0191980] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 01/14/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND People with chronic diseases experience barriers to managing their diseases and accessing available health services. Patient navigator programs are increasingly being used to help people with chronic diseases navigate and access health services. OBJECTIVE The objective of this review was to summarize the evidence for patient navigator programs in people with a broad range of chronic diseases, compared to usual care. METHODS We searched MEDLINE, EMBASE, CENTRAL, CINAHL, PsycINFO, and Social Work Abstracts from inception to August 23, 2017. We also searched the reference lists of included articles. We included original reports of randomized controlled trials of patient navigator programs compared to usual care for adult and pediatric patients with any one of a defined set of chronic diseases. RESULTS From a total of 14,672 abstracts, 67 unique studies fit our inclusion criteria. Of these, 44 were in cancer, 8 in diabetes, 7 in HIV/AIDS, 4 in cardiovascular disease, 2 in chronic kidney disease, 1 in dementia and 1 in patients with more than one condition. Program characteristics varied considerably. Primary outcomes were most commonly process measures, and 45 of 67 studies reported a statistically significant improvement in the primary outcome. CONCLUSION Our findings indicate that patient navigator programs improve processes of care, although few studies assessed patient experience, clinical outcomes or costs. The inability to definitively outline successful components remains a key uncertainty in the use of patient navigator programs across chronic diseases. Given the increasing popularity of patient navigators, future studies should use a consistent definition for patient navigation and determine which elements of this intervention are most likely to lead to improved outcomes. TRIAL REGISTRATION PROSPERO #CRD42013005857.
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Affiliation(s)
- Kerry A. McBrien
- Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Noah Ivers
- Department of Family and Community Medicine, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Lianne Barnieh
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jacob J. Bailey
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Diane L. Lorenzetti
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - David Nicholas
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brenda Hemmelgarn
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Richard Lewanczuk
- Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
| | - Alun Edwards
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ted Braun
- Department of Family Medicine, Alberta Health Services, Calgary, Alberta, Canada
| | - Braden Manns
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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19
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Hemmelgarn BR, Pannu N, Ahmed SB, Elliott MJ, Tam-Tham H, Lillie E, Straus SE, Donald M, Barnieh L, Chong GC, Hillier DR, Huffman KT, Lei AC, Villanueva BV, Young DM, Fowler EA, Manns BJ, Laupacis A. Determining the research priorities for patients with chronic kidney disease not on dialysis. Nephrol Dial Transplant 2018; 32:847-854. [PMID: 27190349 DOI: 10.1093/ndt/gfw065] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 02/23/2016] [Indexed: 01/12/2023] Open
Abstract
Background The importance of engaging key stakeholders, and patients in particular, in determining research priorities has been recognized. We sought to identify the top 10 research priorities for patients with non-dialysis chronic kidney disease (CKD), their caregivers, and the clinicians and policy-makers involved in their care. Methods We used the four-step James Lind Alliance process to establish the top 10 research priorities. A national survey of patients with non-dialysis CKD (estimated glomerular filtration rate <45 mL/min/1.73 m 2 ), their caregivers, and the clinicians and policy-makers involved in their care was conducted to identify research uncertainties. A Steering Group of patients, caregivers, clinicians and researchers combined and reduced these uncertainties to 30 through a series of iterations. Finally, a workshop with participants from across Canada (12 patients, 6 caregivers, 3 physicians, 2 nurses, 1 pharmacist and 1 policy-maker) was held to determine the top 10 research priorities, using a nominal group technique. Results Overall, 439 individuals responded to the survey and identified 1811 uncertainties, from which the steering group determined the top 30 uncertainties to be considered at the workshop. The top 10 research uncertainties prioritized at the workshop included questions about treatments to prevent progression of kidney disease (including diet) and to treat symptoms of CKD, provider- and patient-targeted strategies for managing CKD, the impact of lifestyle on disease progression, harmful effects of medications on disease progression, optimal strategies for treatment of cardiovascular disease in CKD and for early identification of kidney disease, and strategies for equitable access to care for patients with CKD. Conclusions We identified the top 10 research priorities for patients with CKD that can be used to guide researchers, as well as inform funders of health-care research.
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Affiliation(s)
- Brenda R Hemmelgarn
- Department of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Neesh Pannu
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Sofia B Ahmed
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | | | - Helen Tam-Tham
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Erin Lillie
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Maoliosa Donald
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lianne Barnieh
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | | | | | | | | | | | - Braden J Manns
- Department of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Andreas Laupacis
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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20
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Barnieh L, Collister D, Manns B, Lam NN, Shojai S, Lorenzetti D, Gill JS, Klarenbach S. A Scoping Review for Strategies to Increase Living Kidney Donation. Clin J Am Soc Nephrol 2017; 12:1518-1527. [PMID: 28818845 PMCID: PMC5586566 DOI: 10.2215/cjn.01470217] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/12/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The literature on strategies to increase the number of potential living kidney donors is extensive and has yet to be characterized. Scoping reviews are a novel methodology for systematically assessing a wide breadth of a given body of literature and may be done before conducting a more targeted systematic review. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We performed a scoping review and summarized the evidence for existing strategies to increase living kidney donation. RESULTS Our review identified seven studies that tested interventions using rigorous methods (i.e., randomized, controlled trials) and outcome measures, all of which focused on using education targeted at potential recipients to increase living donation. Of these, two studies that targeted the potential recipients' close social network reported statistically significant results. Other interventions were identified, but their effect was assessed through quasiexperimental or observational study designs. CONCLUSIONS We identified an important gap in the literature for evidence-based strategies to increase living kidney donation. From the limited data available, strategies directed at potential recipients and their social networks are the most promising. These results can inform transplant programs that are considering strategies to increase living kidney donation and highlight the need for conduct of high-quality study to increase living donation.
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Affiliation(s)
- Lianne Barnieh
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - David Collister
- Division of Nephrology, Department of Medicine, McMaster University, St. Joseph’s Hospital, Hamilton, Ontario, Canada
| | - Braden Manns
- Department of Community Health Sciences and
- Department of Medicine, Institute of Public Health and Libin Cardiovascular Institute, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada; and
| | - Ngan N. Lam
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Soroush Shojai
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Diane Lorenzetti
- Department of Medicine, Institute of Public Health and Libin Cardiovascular Institute, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada; and
| | - John S. Gill
- Division of Nephrology, Centre for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott Klarenbach
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
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21
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Altman D, Clement F, Barnieh L, Manns B, Penz E. Cost-Effectiveness of Universally Funding Smoking Cessation Pharmacotherapy. Chest 2016. [DOI: 10.1016/j.chest.2016.08.1418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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22
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Devoe DJ, Wong B, James MT, Ravani P, Oliver MJ, Barnieh L, Roberts DJ, Pauly R, Manns BJ, Kappel J, Quinn RR. Patient Education and Peritoneal Dialysis Modality Selection: A Systematic Review and Meta-analysis. Am J Kidney Dis 2016; 68:422-33. [DOI: 10.1053/j.ajkd.2016.02.053] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 02/22/2016] [Indexed: 11/11/2022]
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23
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Kelly E, Ivers N, Zawi R, Barnieh L, Manns B, Lorenzetti DL, Nicholas D, Tonelli M, Hemmelgarn B, Lewanczuk R, Edwards A, Braun T, McBrien KA. Patient navigators for people with chronic disease: protocol for a systematic review and meta-analysis. Syst Rev 2015; 4:28. [PMID: 25874724 PMCID: PMC4375835 DOI: 10.1186/s13643-015-0019-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 02/25/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Individuals with chronic diseases may have difficulty optimizing their health and getting the care they need due to a combination of patient, provider, and health system level barriers. Patient navigator programs, in which trained personnel assess and assist patients in overcoming barriers to care, may improve care and outcomes for patients with chronic disease by providing an alternative approach to conventional information and support resources. METHODS This systematic review will evaluate the evidence for patient navigator programs, compared to usual care, in patients with chronic disease. We will include RCTs, cluster RCTs, and quasi-randomized RCTs that study the effects of patient navigator programs on clinical outcomes, patient experience, and markers of adherence to care. Studies will be identified by searching MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, PsycINFO, Social Work Abstracts, and the references of included studies. Two authors will screen titles and abstracts independently. Full texts will be reviewed for relevance and data extraction will be done independently by two authors. Studies will be included if they assess patients of any age with one or more chronic diseases. Outcomes will be categorized into groups characterized by their proximity to mechanism of action of the intervention: patient-level outcomes, intermediate outcomes, and process outcomes. Descriptive data about the elements of the patient navigator intervention will also be collected for potential subgroup analyses. Risk of bias will be assessed using the Effective Practice and Organisation of Care Group (EPOC) risk of bias tool. Data will be analyzed using random effects meta-analysis (relative risk for dichotomous data and mean difference for continuous data), if appropriate. DISCUSSION A comprehensive review of patient navigator programs, including a summary of the elements of programs that are associated with a successful intervention, does not yet exist. This systematic review will synthesize the evidence of the effect of patient navigator interventions on clinical and patient-oriented outcomes in populations across a comprehensive set of chronic diseases. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42013005857 .
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Affiliation(s)
- Elizabeth Kelly
- Department of Family Medicine, University of Calgary, G012, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4 N1, Canada.
| | - Noah Ivers
- Department of Family and Community Medicine, Women's College Hospital, University of Toronto, 77 Grenville Street 4th Floor, Toronto, Ontario, M5S 1B3, Canada.
| | - Rami Zawi
- Department of Family and Community Medicine, Women's College Hospital, University of Toronto, 77 Grenville Street 4th Floor, Toronto, Ontario, M5S 1B3, Canada.
| | - Lianne Barnieh
- Department of Medicine, University of Calgary, 1403 29th Street NW, Calgary, AB, T2N 2 T9, Canada.
| | - Braden Manns
- Department of Medicine, University of Calgary, 1403 29th Street NW, Calgary, AB, T2N 2 T9, Canada. .,Department of Community Health Sciences, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Diane L Lorenzetti
- Department of Community Health Sciences, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - David Nicholas
- Faculty of Social Work, University of Calgary, 2800 University Way NW, Calgary, AB, T2N 1 N4, Canada.
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, 1403 29th Street NW, Calgary, AB, T2N 2 T9, Canada.
| | - Brenda Hemmelgarn
- Department of Medicine, University of Calgary, 1403 29th Street NW, Calgary, AB, T2N 2 T9, Canada. .,Department of Community Health Sciences, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Richard Lewanczuk
- Department of Medicine, University of Alberta, 362 HMRC, Edmonton, AB, T6G 2S2, Canada. .,Alberta Health Services, 10030-107 Street NW, Edmonton, AB, T5J 3E4, Canada.
| | - Alun Edwards
- Department of Medicine, University of Calgary, 1403 29th Street NW, Calgary, AB, T2N 2 T9, Canada. .,Alberta Health Services, 10030-107 Street NW, Edmonton, AB, T5J 3E4, Canada.
| | - Ted Braun
- Department of Family Medicine, Alberta Health Services, Sheldon M. Chumir Health Centre, 8th Floor, 1213 - 4th Street SW, Calgary, AB, T2R 0X7, Canada.
| | - Kerry A McBrien
- Department of Family Medicine, University of Calgary, G012, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4 N1, Canada. .,Department of Community Health Sciences, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
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Abstract
There is an increasing level of emphasis being placed on health care providers and funders to incorporate patient-centered care into research. Involving patients and caregivers in establishing research priorities ensures the relevance of the research produced. Priority setting is a process that can be used to produce a robust set of research questions that researchers can address over the coming years. One of the methods for determining research priorities that involves patients, caregivers and clinicians is the James Lind Alliance priority setting partnership model. This method is focused on being exclusive, transparent, and evidence-based. Using a recent example of patients on or nearing dialysis, we highlight the key steps to assess research priorities in patients, caregivers and clinicians: (i) formation of a steering committee to guide the overall process; (ii) form priority setting partnerships; (iii) identify and gather research uncertainties; (iv) process and collate submitted research uncertainties; and (v) final priority setting workshop to determine the top 10 research priorities.
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Affiliation(s)
- Lianne Barnieh
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Interdisciplinary Chronic Disease Collaboration, Calgary, Alberta, Canada
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Abstract
PURPOSE OF REVIEW Publicly funded health care systems are increasingly confronted with fiscal and demographic challenges and face pressure to constrain resource use without impacting clinical outcomes. FINDINGS Clinicians routinely make decisions in the care of their patients that use finite health care resources. Aligning the goal of caring for their patients with ensuring that effective interventions are available for patients who are most likely to benefit is critical to sustaining the publicly funded health care system. IMPLICATIONS Balancing the needs of patients with health care prioritization will require changes to be made across the health care system. Incorporating costs and value for money when caring for patients and making decisions will play an important role in efficiency and value in the health system.
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Affiliation(s)
- Lianne Barnieh
- Department of Medicine, University of Calgary, Calgary, AB T2N 2T9 Canada
| | - Cam Donaldson
- Yunus Centre for Social Business & Health, Glasgow Caledonian University, Glasgow, Scotland ; Institutes for Applied Health Research and Society & Social Justice Research, Glasgow, Scotland
| | - Braden Manns
- Department of Medicine, University of Calgary, Calgary, AB T2N 2T9 Canada ; Department of Community Health Sciences, University of Calgary, Calgary, Canada ; Institute for Public Health, University of Calgary, Calgary, Canada
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Abstract
Background Kidney transplant improves quality of life and survival compared with dialysis. Despite advances in immunosuppressant regimens and the prevention and treatment of acute rejection, graft survival rates have not improved significantly in the past decade. Although the clinical effectiveness of these regimens has been studied, the impact of changes over time on cost has not. Methods Costs of kidney transplant were compared between 2 periods demarcated by a programmatic change from cyclosporine (early) to tacrolimus (late) and from nonroutine induction (early) to routine induction (late) therapy in adult patients receiving a first kidney-only transplant in Calgary, Alberta, Canada, in an 8-year period. Results Complete costs for 3 years after transplant was available for 344 patients, including 161 adult recipients in the early period (April 1, 1998-December 31, 2001) and 183 adult recipients in the late period (January 1, 2002-March 31, 2006). The mean total 3-year cost of transplant for recipients was Can$100 034 in the early period and Can$144 712 in the late period largely attributed to increases in the cost of immunosuppressants ( P < .001). Conclusions Given that the cost of transplant has increased significantly over time, the cost-effectiveness of these and other immunosuppressive regimens should be evaluated carefully.
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Affiliation(s)
- Lianne Barnieh
- University of Calgary (LB, SY, KM, BRH, BJM), University of Alberta (SK), Canada
| | - Serdar Yilmaz
- University of Calgary (LB, SY, KM, BRH, BJM), University of Alberta (SK), Canada
| | - Kevin McLaughlin
- University of Calgary (LB, SY, KM, BRH, BJM), University of Alberta (SK), Canada
| | - Brenda R. Hemmelgarn
- University of Calgary (LB, SY, KM, BRH, BJM), University of Alberta (SK), Canada
| | - Scott Klarenbach
- University of Calgary (LB, SY, KM, BRH, BJM), University of Alberta (SK), Canada
| | - Braden J. Manns
- University of Calgary (LB, SY, KM, BRH, BJM), University of Alberta (SK), Canada
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Tang KL, Barnieh L, Mann B, Clement F, Campbell DJT, Hemmelgarn BR, Tonelli M, Lorenzetti D, Manns BJ. A systematic review of value-based insurance design in chronic diseases. Am J Manag Care 2014; 20:e229-e241. [PMID: 25326932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Value-based insurance design (V-BID) is an insurance cost-sharing model in which patients pay less for medications deemed to be of higher value. Our objective was to determine the association between V-BID and medication adherence, clinical outcomes, healthcare utilization, and spending in patients with or at risk for cardiovascular chronic diseases, compared with no differential lowering of drug co-payments. STUDY DESIGN Systematic review. METHODS We searched PubMed, MEDLINE, EMBASE, CINAHL, Cochrane Controlled Trials Register, Current Controlled Trials, and reference lists of included studies and relevant reviews up to September 2012. Two reviewers independently identified primary research studies with the following study designs: randomized controlled trial, interrupted time series, and controlled before-after studies. Two reviewers independently extracted data and assessed quality. RESULTS Ten studies were identified: 1 high-quality randomized controlled trial, 1 interrupted time series analysis, and 8 controlled before-and-after studies. Heterogeneity in study populations and interventions, overall low study quality, and lack of standard error reporting precluded meta-analysis. All reported improvement in medication adherence for medications subject to V-BID, of between 2 and 5 percentage points. Impact on clinical outcomes was unclear, with only 1 study reporting on this, noting no difference in the primary outcome, but a reduction in adverse secondary outcomes with V-BID. Of the four studies that examined the impact of VBID on healthcare expenditures, V-BID tended to increase overall prescription drug spending, though three of the four studies reported similar overall healthcare costs due to decreased non drug medical spending. CONCLUSIONS V-BID is associated with improved medication adherence but its effects on clinical outcomes, healthcare utilization, and spending remain uncertain.
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Barnieh L, King-Shier K, Hemmelgarn B, Laupacis A, Manns L, Manns B. Views of Canadian patients on or nearing dialysis and their caregivers: a thematic analysis. Can J Kidney Health Dis 2014; 1:4. [PMID: 25780599 PMCID: PMC4346298 DOI: 10.1186/2054-3581-1-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 01/02/2014] [Accepted: 02/24/2014] [Indexed: 02/03/2023] Open
Abstract
Background Quality of life of patients receiving dialysis has been rated as poor. Objective To synthesize the views of Canadian patients on or nearing dialysis, and those who care for them. Design Secondary analysis of a survey, distributed through dialysis centres, social media and the Kidney Foundation of Canada. Setting Pan-Canadian convenience sample. Participants Patients, their caregivers and health-care providers. Measurements Text responses to open-ended questions on topics relevant to end-stage renal disease. Methods Statements related to needs, beliefs or feelings were identified, and were analysed by thematic content analysis. Results A total of 544 relevant statements from 189 respondents were included for the thematic content analysis. Four descriptive themes were identified through the content analysis: gaining knowledge, maintaining quality of life, sustaining psychosocial wellbeing and ensuring appropriate care. Respondents primarily identified a need for more information, better communication, increased psychosocial and financial support for patients and their families and a strong desire to maintain their previous lifestyle. Limitations Convenience sample; questions were originally asked with a different intent (to identify patient-important research issues). Conclusions Patients on or nearing dialysis and their caregivers identified four major themes, gaining knowledge, maintaining quality of life, sustaining psychosocial wellbeing and ensuring appropriate care, several of which could be addressed by the health care system without requiring significant resources. These include the development of patient materials and resources, or sharing of existing resources across Canadian renal programs, along with adopting better communication strategies. Other concerns, such as the need for increased psychosocial and financial support, require consideration by health care funders.
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Affiliation(s)
- Lianne Barnieh
- Department of Medicine, University of Calgary, Calgary, Alberta Canada ; Interdisciplinary Chronic Disease Collaboration, Kragujevac, Alberta Canada
| | - Kathryn King-Shier
- Department of Community Health Sciences, University of Calgary, Calgary, Canada ; Faculty of Nursing, University of Calgary, Calgary, Alberta Canada
| | - Brenda Hemmelgarn
- Department of Medicine, University of Calgary, Calgary, Alberta Canada ; Interdisciplinary Chronic Disease Collaboration, Kragujevac, Alberta Canada ; Department of Community Health Sciences, University of Calgary, Calgary, Canada ; Libin Cardiovascular Institute and Institute of Public Health, University of Calgary, Calgary, Canada
| | - Andreas Laupacis
- Keenan Research Centre, Li-Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario Canada ; Faculty of Medicine, University of Toronto, Kragujevac, Ontario Canada
| | - Liam Manns
- Department of Medicine, University of Calgary, Calgary, Alberta Canada ; Interdisciplinary Chronic Disease Collaboration, Kragujevac, Alberta Canada
| | - Braden Manns
- Department of Medicine, University of Calgary, Calgary, Alberta Canada ; Interdisciplinary Chronic Disease Collaboration, Kragujevac, Alberta Canada ; Department of Community Health Sciences, University of Calgary, Calgary, Canada ; Libin Cardiovascular Institute and Institute of Public Health, University of Calgary, Calgary, Canada ; Foothills Medical Centre, 1403 29th St., NW, Calgary, Alberta T2N 2T9 Canada
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Nesrallah GE, Mustafa RA, Clark WF, Bass A, Barnieh L, Hemmelgarn BR, Klarenbach S, Quinn RR, Hiremath S, Ravani P, Sood MM, Moist LM. Canadian Society of Nephrology 2014 clinical practice guideline for timing the initiation of chronic dialysis. CMAJ 2014; 186:112-7. [PMID: 24492525 DOI: 10.1503/cmaj.130363] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Mann BS, Barnieh L, Tang K, Campbell DJT, Clement F, Hemmelgarn B, Tonelli M, Lorenzetti D, Manns BJ. Association between drug insurance cost sharing strategies and outcomes in patients with chronic diseases: a systematic review. PLoS One 2014; 9:e89168. [PMID: 24667163 PMCID: PMC3965394 DOI: 10.1371/journal.pone.0089168] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 09/13/2013] [Accepted: 01/16/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Prescription drugs are used in people with hypertension, diabetes, and cardiovascular disease to manage their illness. Patient cost sharing strategies such as copayments and deductibles are often employed to lower expenditures for prescription drug insurance plans, but the impact on health outcomes in these patients is unclear. OBJECTIVE To determine the association between drug insurance and patient cost sharing strategies on medication adherence, clinical and economic outcomes in those with chronic diseases (defined herein as diabetes, hypertension, hypercholesterolemia, coronary artery disease, and cerebrovascular disease). METHODS Studies were included if they examined various cost sharing strategies including copayments, coinsurance, fixed copayments, deductibles and maximum out-of-pocket expenditures. Value-based insurance design and reference based pricing studies were excluded. Two reviewers independently identified original intervention studies (randomized controlled trials, interrupted time series, and controlled before-after designs). MEDLINE, EMBASE, Cochrane Library, CINAHL, and relevant reference lists were searched until March 2013. Two reviewers independently assessed studies for inclusion, quality, and extracted data. Eleven studies, assessing the impact of seven policy changes, were included: 2 separate reports of one randomized controlled trial, 4 interrupted time series, and 5 controlled before-after studies. FINDINGS Outcomes included medication adherence, clinical events (myocardial infarction, stroke, death), quality of life, healthcare utilization, or cost. The heterogeneity among the studies precluded meta-analysis. Few studies reported the impact of cost sharing strategies on mortality, clinical and economic outcomes. The association between patient copayments and medication adherence varied across studies, ranging from no difference to significantly lower adherence, depending on the amount of the copayment. CONCLUSION Lowering cost sharing in patients with chronic diseases may improve adherence, but the impact on clinical and economic outcomes is uncertain.
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Affiliation(s)
| | - Lianne Barnieh
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Interdisciplinary Chronic Disease Collaboration Team, Calgary, Alberta, Canada
| | - Karen Tang
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David J. T. Campbell
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Interdisciplinary Chronic Disease Collaboration Team, Calgary, Alberta, Canada
| | - Fiona Clement
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Brenda Hemmelgarn
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Interdisciplinary Chronic Disease Collaboration Team, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Marcello Tonelli
- Interdisciplinary Chronic Disease Collaboration Team, Calgary, Alberta, Canada
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Diane Lorenzetti
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Braden J. Manns
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Interdisciplinary Chronic Disease Collaboration Team, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
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Barnieh L, Clement F, Harris A, Blom M, Donaldson C, Klarenbach S, Husereau D, Lorenzetti D, Manns B. A systematic review of cost-sharing strategies used within publicly-funded drug plans in member countries of the organisation for economic co-operation and development. PLoS One 2014; 9:e90434. [PMID: 24618721 PMCID: PMC3949707 DOI: 10.1371/journal.pone.0090434] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [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: 09/09/2013] [Accepted: 01/31/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Publicly-funded drug plans vary in strategies used and policies employed to reduce continually increasing pharmaceutical expenditures. We systematically reviewed the utilization of cost-sharing strategies and physician-directed prescribing regulations in publicly-funded formularies within member nations of the Organization of Economic Cooperation and Development (OECD). METHODS & FINDINGS Using the OECD nations as the sampling frame, a search for cost-sharing strategies and physician-directed prescribing regulations was done using published and grey literature. Collected data was verified by a system expert within the prescription drug insurance plan in each country, to ensure the accuracy of key data elements across plans. Significant variation in the use of cost-sharing mechanisms was seen. Copayments were the most commonly used cost-containment measure, though their use and amount varied for those with certain conditions, most often chronic diseases (in 17 countries), and by socio-economic status (either income or employment status), or with age (in 15 countries). Caps and deductibles were only used by five systems. Drug cost-containment strategies targeting physicians were also identified in 24 countries, including guideline-based prescribing, prescription monitoring and incentive structures. CONCLUSIONS There was variable use of cost-containment strategies to limit pharmaceutical expenditures in publicly funded formularies within OECD countries. Further research is needed to determine the best approach to constrain costs while maintaining access to pharmaceutical drugs.
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Affiliation(s)
- Lianne Barnieh
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fiona Clement
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Anthony Harris
- Centre for Health Economics, Monash University, Melbourne, Australia
| | - Marja Blom
- Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Cam Donaldson
- Yunus Centre for Social Business & Health, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Scott Klarenbach
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Don Husereau
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Diane Lorenzetti
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Braden Manns
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Gill JS, Klarenbach S, Barnieh L, Caulfield T, Knoll G, Levin A, Cole EH. Financial Incentives to Increase Canadian Organ Donation: Quick Fix or Fallacy? Am J Kidney Dis 2014; 63:133-40. [DOI: 10.1053/j.ajkd.2013.08.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 08/05/2013] [Indexed: 11/11/2022]
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Barnieh L, Manns B, Harris A, Blom M, Donaldson C, Klarenbach S, Husereau D, Lorenzetti D, Clement F. A synthesis of drug reimbursement decision-making processes in organisation for economic co-operation and development countries. Value Health 2014; 17:98-108. [PMID: 24438723 DOI: 10.1016/j.jval.2013.10.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 10/10/2013] [Accepted: 10/23/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND The use of a restrictive formulary, with placement determined through a drug-reimbursement decision-making process, is one approach to managing drug expenditures. OBJECTIVE To describe the processes in drug reimbursement decision-making systems currently used in national publicly funded outpatient prescription drug insurance plans. METHODS By using the Organisation for Economic Co-operation and Development (OECD) nations as the sampling frame, a search was done in the published literature, followed by the gray literature. Collected data were verified by a system expert within the prescription drug insurance plan in each country to ensure the accuracy of key data elements across countries. RESULTS All but one country provided at least one publicly funded prescription drug formulary. Many systems have adopted similar processes of drug reimbursement decision making. All but three systems required additional consideration of clinical evidence within the decision-making process. Transparency of recommendations varied between systems, from having no information publicly available (three systems) to all information available and accessible to the public (16 systems). Only four countries did not consider cost within the drug reimbursement decision-making process. CONCLUSIONS There were similarities in the decision-making process for drug reimbursement across the systems; however, only five countries met the highest standard of transparency, requirement of evidence, and ability to appeal. Future work should focus on examining how these processes may affect formulary listing decisions for drugs between countries.
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Affiliation(s)
- Lianne Barnieh
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Braden Manns
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anthony Harris
- Centre for Health Economics, Monash University, Victoria, Australia
| | - Marja Blom
- Division of Social Pharmacy, University of Helsinki, Helsinki, Finland
| | - Cam Donaldson
- Yunus Centre for Social Business & Health, Glasgow Caledonian University, Glasgow, UK
| | | | - Don Husereau
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | - Diane Lorenzetti
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Fiona Clement
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Barnieh L, Gill JS, Klarenbach S, Manns BJ. The cost-effectiveness of using payment to increase living donor kidneys for transplantation. Clin J Am Soc Nephrol 2013; 8:2165-73. [PMID: 24158797 DOI: 10.2215/cjn.03350313] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND OBJECTIVES For eligible candidates, transplantation is considered the optimal treatment compared with dialysis for patients with ESRD. The growing number of patients with ESRD requires new strategies to increase the pool of potential donors. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Using decision analysis modeling, this study compared a strategy of paying living kidney donors to waitlisted recipients on dialysis with the current organ donation system. In the base case estimate, this study assumed that the number of donors would increase by 5% with a payment of $10,000. Quality of life estimates, resource use, and costs (2010 Canadian dollars) were based on the best available published data. RESULTS Compared with the current organ donation system, a strategy of increasing the number of kidneys for transplantation by 5% by paying living donors $10,000 has an incremental cost-savings of $340 and a gain of 0.11 quality-adjusted life years. Increasing the number of kidneys for transplantation by 10% and 20% would translate into incremental cost-savings of $1640 and $4030 and incremental quality-adjusted life years gain of 0.21 and 0.39, respectively. CONCLUSION Although the impact is uncertain, this model suggests that a strategy of paying living donors to increase the number of kidneys available for transplantation could be cost-effective, even with a transplant rate increase of only 5%. Future work needs to examine the feasibility, legal policy, ethics, and public perception of a strategy to pay living donors.
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Affiliation(s)
- Lianne Barnieh
- Departments of Medicine and, ‖Community Health Sciences, University of Calgary, Calgary, Alberta, Canada;, †Department of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada;, ‡Department of Medicine, University of Alberta, Edmonton, Alberta, Canada, §Alberta Kidney Disease Network, Calgary, Alberta, Canada
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Gill JS, Gill J, Barnieh L, Dong J, Rose C, Johnston O, Tonelli M, Klarenbach S. Income of living kidney donors and the income difference between living kidney donors and their recipients in the United States. Am J Transplant 2012; 12:3111-8. [PMID: 22882723 DOI: 10.1111/j.1600-6143.2012.04211.x] [Citation(s) in RCA: 31] [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: 01/25/2023]
Abstract
Disincentives for living kidney donation are common but are poorly understood. We studied 54 483 living donor kidney transplants in the United States between 2000 and 2009, limiting to those with valid zip code data to allow determination of median household income by linkage to the 2000 U.S. Census. We then determined the income and income difference of donors and recipients. The median household income in donors and recipients was $46 334 ±$17 350 and $46 439 ±$17 743, respectively. Donation-related expenses consume ≥ 1 month's income in 76% of donors. The mean ± standard deviation income difference between recipients and donors in transplants involving a wealthier recipient was $22 760 ± 14 792 and in 90% of transplants the difference was <$40 000 dollars. The findings suggest that the capacity for donors to absorb the financial consequences of donation, or of recipients to reimburse allowable expenses, is limited. There were few transplants with a large difference in recipient and donor income, suggesting that the scope and value of any payment between donors and recipients is likely to be small. We conclude that most donors and recipients have similar modest incomes, suggesting that the costs of donation are a significant burden in the majority of living donor transplants.
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Affiliation(s)
- J S Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
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Barnieh L, Klarenbach S, Gill JS, Caulfield T, Manns B. Attitudes toward strategies to increase organ donation: views of the general public and health professionals. Clin J Am Soc Nephrol 2012; 7:1956-63. [PMID: 23024166 DOI: 10.2215/cjn.04100412] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVE The acceptability of financial incentives for organ donation is contentious. This study sought to determine (1) the acceptability of expense reimbursement or financial incentives by the general public, health professionals involved with organ donation and transplantation, and those with or affected by kidney disease and (2) for the public, whether financial incentives would alter their willingness to consider donation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Web-based survey administered to members of the Canadian public, health professionals, and people with or affected by kidney disease asking questions regarding acceptability of strategies to increase living and deceased kidney donation and willingness to donate a kidney under various financial incentives. RESULTS Responses were collected from 2004 members of the Canadian public October 11-18, 2011; responses from health professionals (n=339) and people with or affected by kidney disease (n=268) were collected during a 4-week period commencing October 11, 2011. Acceptability of one or more financial incentives to increase deceased and living donation was noted in >70% and 40% of all groups, respectively. Support for monetary payment for living donors was 45%, 14%, and 27% for the public, health professionals, and people with or affected by kidney disease, respectively. Overall, reimbursement of funeral expenses for deceased donors and a tax break for living donors were the most acceptable. CONCLUSION The general public views regulated financial incentives for living and deceased donation to be acceptable. Future research needs to examine the impact of financial incentives on rates of deceased and living donors.
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Affiliation(s)
- Lianne Barnieh
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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McBrien K, Rabi DM, Campbell N, Barnieh L, Clement F, Hemmelgarn BR, Tonelli M, Leiter LA, Klarenbach SW, Manns BJ. Intensive and Standard Blood Pressure Targets in Patients With Type 2 Diabetes Mellitus: Systematic Review and Meta-analysis. Arch Intern Med 2012; 172:1296-303. [PMID: 22868819 DOI: 10.1001/archinternmed.2012.3147] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Treatment of hypertension in patients with diabetes mellitus (DM) has been shown to improve cardiovascular outcomes; however, the value of intensive blood pressure (BP) targets remains uncertain. We sought to determine the effectiveness and safety of treating BP to intensive targets (upper limit of 130 mm Hg systolic and 80 mm Hg diastolic) compared with standard targets (upper limit of 140-160 mm Hg systolic and 85-100 mm Hg diastolic) in patients with type 2 DM. METHODS Using electronic databases, bibliographies, and clinical trial registries, we conducted a systematic review and meta-analysis to identify randomized trials enrolling adults diagnosed as having type 2 DM and comparing prespecified BP targets. Data on study characteristics, risk for bias, and outcomes were collected. Random-effects models were used to pool relative risks and risk differences for mortality, myocardial infarction, and stroke. RESULTS The use of intensive BP targets was not associated with a significant decrease in the risk for mortality (relative risk difference, 0.76; 95% CI, 0.55-1.05) or myocardial infarction (relative risk difference, 0.93; 95% CI, 0.80-1.08) but was associated with a decrease in the risk for stroke (relative risk, 0.65; 95% CI, 0.48-0.86). The pooled analysis of risk differences associated with the use of intensive BP targets demonstrated a small absolute decrease in the risk for stroke (absolute risk difference, -0.01; 95% CI, -0.02 to -0.00) but no statistically significant difference in the risk for mortality or myocardial infarction. CONCLUSION Although the use of intensive compared with standard BP targets in patients with type 2 DM is associated with a small reduction in the risk for stroke, evidence does not show that intensive targets reduce the risk for mortality or myocardial infarction.
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Thomson BKA, MacRae JM, Barnieh L, Zhang J, MacKay E, Manning MA, Hemmelgarn BR. Evaluation of an electronic warfarin nomogram for anticoagulation of hemodialysis patients. BMC Nephrol 2011; 12:46. [PMID: 21943221 PMCID: PMC3189863 DOI: 10.1186/1471-2369-12-46] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 01/27/2011] [Accepted: 09/26/2011] [Indexed: 11/20/2022] Open
Abstract
Background Warfarin nomograms to guide dosing have been shown to improve control of the international normalized ratio (INR) in the general outpatient setting. However, the effectiveness of these nomograms in hemodialysis patients is unknown. We evaluated the effectiveness of anticoagulation using an electronic warfarin nomogram administered by nurses in outpatient hemodialysis patients, compared to physician directed therapy. Methods Hemodialysis patients at any of the six outpatient clinics in Calgary, Alberta, treated with warfarin anticoagulation were included. Two five-month time periods were compared: prior to and post implementation of the nomogram. The primary endpoint was adequacy of anticoagulation (proportion of INR measurements within range ± 0.5 units). Results Overall, 67 patients were included in the pre- and 55 in the post-period (with 40 patients in both periods). Using generalized linear mixed models, the adequacy of INR control was similar in both periods for all range INR levels: in detail, range INR 1.5 to 2.5 (pre 93.6% (95% CI: 88.6% - 96.5%); post 95.6% (95% CI: 89.4% - 98.3%); p = 0.95); INR 2.0 to 3.0 (pre 82.2% (95% CI: 77.9% - 85.8%); post 77.4% (95% CI: 72.0% - 82.0%); p = 0.20); and, INR 2.5 to 3.5 (pre 84.3% (95% CI: 59.4% - 95.1%); post 66.8% (95% CI: 39.9% - 86.0%); p = 0.29). The mean number of INR measurements per patient decreased significantly between the pre- (30.5, 95% CI: 27.0 - 34.0) and post- (22.3, 95% CI: 18.4 - 26.1) (p = 0.003) period. There were 3 bleeding events in each of the periods. Conclusions An electronic warfarin anticoagulation nomogram administered by nurses achieved INR control similar to that of physician directed therapy among hemodialysis patients in an outpatient setting, with a significant reduction in frequency of testing. Future controlled trials are required to confirm the efficacy of this nomogram.
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Barnieh L, McLaughlin K, Manns BJ, Klarenbach S, Yilmaz S, Taub K, Hemmelgarn BR. Evaluation of an education intervention to increase the pursuit of living kidney donation: a randomized controlled trial. Prog Transplant 2011. [PMID: 21485941 DOI: 10.7182/prtr.21.1.e008266m25jtr77v] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Many transplant candidates have concerns about living donation. OBJECTIVE To determine whether a structured educational session increased eligible kidney transplant candidates' pursuit of living donation. DESIGN AND INTERVENTION Eligible transplant candidates were randomized to standard of care (n = 50) or to the educational intervention (n = 50), which included both written materials and a 2-hour education session. The primary outcome was having a living donor contact the transplant program to express interest in donation for a patient, and a secondary outcome was the candidates' preference for treatment of end-stage renal disease; both outcomes were determined at 3 months after enrollment. RESULTS Of the 100 patients randomized, 4 in the intervention group and 2 in the standard of care group had a living donor contact the program (P = .45). Within-group changes in treatment preference from baseline were seen in the education intervention group (P = .02), but not in the standard of care group (P = .37). CONCLUSIONS This educational intervention did not increase the likelihood of a potential donor contacting the transplant program, compared with standard care. However, patients who received the educational intervention were more likely to change their treatment preference to living donation at study completion. Research investigating other methods of increasing living transplant rates is urgently required.
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Schorr M, Manns BJ, Culleton B, Walsh M, Klarenbach S, Tonelli M, Sauve L, Chin R, Barnieh L, Hemmelgarn BR. The Effect of Nocturnal and Conventional Hemodialysis on Markers of Nutritional Status: Results From a Randomized Trial. J Ren Nutr 2011; 21:271-6. [DOI: 10.1053/j.jrn.2010.04.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Indexed: 11/11/2022] Open
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Barnieh L, McLaughlin K, Manns BJ, Klarenbach S, Yilmaz S, Taub K, Hemmelgarn BR. Evaluation of an Education Intervention to Increase the Pursuit of Living Kidney Donation: A Randomized Controlled Trial. Prog Transplant 2011; 21:36-42. [DOI: 10.1177/152692481102100105] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Context Many transplant candidates have concerns about living donation. Objective To determine whether a structured educational session increased eligible kidney transplant candidates' pursuit of living donation. Design and Intervention Eligible transplant candidates were randomized to standard of care (n = 50) or to the educational intervention (n = 50), which included both written materials and a 2-hour education session. The primary outcome was having a living donor contact the transplant program to express interest in donation for a patient, and a secondary outcome was the candidates' preference for treatment of end-stage renal disease; both outcomes were determined at 3 months after enrollment. Results Of the 100 patients randomized, 4 in the intervention group and 2 in the standard of care group had a living donor contact the program ( P = .45). Within-group changes in treatment preference from baseline were seen in the education intervention group ( P = .02), but not in the standard of care group (P = .37). Conclusions This educational intervention did not increase the likelihood of a potential donor contacting the transplant program, compared with standard care. However, patients who received the educational intervention were more likely to change their treatment preference to living donation at study completion. Research investigating other methods of increasing living transplant rates is urgently required.
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Affiliation(s)
- Lianne Barnieh
- University of Calgary, Calgary, Alberta, Canada (LB, KM, BJM, SY, KT, BRH), University of Alberta, Edmonton, Alberta, Canada (SK)
| | - Kevin McLaughlin
- University of Calgary, Calgary, Alberta, Canada (LB, KM, BJM, SY, KT, BRH), University of Alberta, Edmonton, Alberta, Canada (SK)
| | - Braden J. Manns
- University of Calgary, Calgary, Alberta, Canada (LB, KM, BJM, SY, KT, BRH), University of Alberta, Edmonton, Alberta, Canada (SK)
| | - Scott Klarenbach
- University of Calgary, Calgary, Alberta, Canada (LB, KM, BJM, SY, KT, BRH), University of Alberta, Edmonton, Alberta, Canada (SK)
| | - Serdar Yilmaz
- University of Calgary, Calgary, Alberta, Canada (LB, KM, BJM, SY, KT, BRH), University of Alberta, Edmonton, Alberta, Canada (SK)
| | - Ken Taub
- University of Calgary, Calgary, Alberta, Canada (LB, KM, BJM, SY, KT, BRH), University of Alberta, Edmonton, Alberta, Canada (SK)
| | - Brenda R. Hemmelgarn
- University of Calgary, Calgary, Alberta, Canada (LB, KM, BJM, SY, KT, BRH), University of Alberta, Edmonton, Alberta, Canada (SK)
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Barnieh L, Manns BJ, Klarenbach S, McLaughlin K, Yilmaz S, Hemmelgarn BR. A description of the costs of living and standard criteria deceased donor kidney transplantation. Am J Transplant 2011; 11:478-88. [PMID: 21299831 DOI: 10.1111/j.1600-6143.2010.03425.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Kidney transplantation improves quality of life and survival and is associated with lower health care costs compared with dialysis. We described and compared the costs of living and standard criteria for deceased donor kidney transplantation. Patients included adult recipients of a first kidney-only transplant between April 1, 1998, and March 31, 2006, as well as their donor information. All costs (outpatient care, diagnostic imaging, inpatient care, physician claims, laboratory tests and transplant medications) for 2 years after transplant for recipients and transplant-related costs prior to transplant (donor workup and management) were included. Complete cost information was available for 357 recipients. The mean total 2-year cost of transplantation, including donor costs, for recipients of living and deceased donors was $118 347 (95% confidence interval [CI], 110 395-126 299) and $121 121 (95% CI 114 287-127 956), respectively (p = 0.7). The mean cost for a living donor was $18 129 (95% CI 16 845-19 414) and for a deceased donor was $36 989 (95% CI 34 421-39 558). Living donor kidney transplantation has similar costs at 2 years compared with deceased donor transplantation. These results can be used by health care decision makers to inform strategies to increase donation.
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Affiliation(s)
- L Barnieh
- Department of Community Health Sciences Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Barnieh L, McLaughlin K, Manns BJ, Klarenbach S, Yilmaz S, Hemmelgarn BR. Barriers to living kidney donation identified by eligible candidates with end-stage renal disease. Nephrol Dial Transplant 2010; 26:732-8. [DOI: 10.1093/ndt/gfq388] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Khangura J, Culleton BF, Manns BJ, Zhang J, Barnieh L, Walsh M, Klarenbach SW, Tonelli, M, Sarna M, Hemmelgarn BR. Association between routine and standardized blood pressure measurements and left ventricular hypertrophy among patients on hemodialysis. BMC Nephrol 2010; 11:13. [PMID: 20576127 PMCID: PMC2901323 DOI: 10.1186/1471-2369-11-13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 06/24/2010] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Left ventricular (LV) hypertrophy is common among patients on hemodialysis. While a relationship between blood pressure (BP) and LV hypertrophy has been established, it is unclear which BP measurement method is the strongest correlate of LV hypertrophy. We sought to determine agreement between various blood pressure measurement methods, as well as identify which method was the strongest correlate of LV hypertrophy among patients on hemodialysis. METHODS This was a post-hoc analysis of data from a randomized controlled trial. We evaluated the agreement between seven BP measurement methods: standardized measurement at baseline; single pre- and post-dialysis, as well as mean intra-dialytic measurement at baseline; and cumulative pre-, intra- and post-dialysis readings (an average of 12 monthly readings based on a single day per month). Agreement was assessed using Lin's concordance correlation coefficient (CCC) and the Bland Altman method. Association between BP measurement method and LV hypertrophy on baseline cardiac MRI was determined using receiver operating characteristic curves and area under the curve (AUC). RESULTS Agreement between BP measurement methods in the 39 patients on hemodialysis varied considerably, from a CCC of 0.35 to 0.94, with overlapping 95% confidence intervals. Pre-dialysis measurements were the weakest predictors of LV hypertrophy while standardized, post- and inter-dialytic measurements had similar and strong (AUC 0.79 to 0.80) predictive power for LV hypertrophy. CONCLUSIONS A single standardized BP has strong predictive power for LV hypertrophy and performs just as well as more resource intensive cumulative measurements, whereas pre-dialysis blood pressure measurements have the weakest predictive power for LV hypertrophy. Current guidelines, which recommend using pre-dialysis measurements, should be revisited to confirm these results.
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Affiliation(s)
- Jaspreet Khangura
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Braden J Manns
- Department of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Jianguo Zhang
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Lianne Barnieh
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Michael Walsh
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | | | | | - Magdalena Sarna
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Brenda R Hemmelgarn
- Department of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
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Barnieh L, McLaughlin K, Manns B, Klarenbach S, Yilmaz S, Hemmelgarn B. Development of a survey to identify barriers to living donation in kidney transplant candidates. Prog Transplant 2009. [DOI: 10.7182/prtr.19.4.e227513768045169] [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: 11/13/2022]
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Barnieh L, McLaughlin K, Manns B, Klarenbach S, Yilmaz S, Hemmelgarn B. Development of a Survey to Identify Barriers to Living Donation in Kidney Transplant Candidates. Prog Transplant 2009; 19:304-11. [DOI: 10.1177/152692480901900404] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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]
Abstract
Background Kidney transplantation from living donors, compared with deceased donors, has improved health care outcomes for patients with end-stage renal disease; however, less than 40% of transplants come from living donors. Numerous barriers may impede the identification of, and transplantation from, living donors. Objective To develop and validate a survey to identify barriers that transplant candidates may encounter when seeking a living donor for kidney transplantation. Methods The survey was developed in 3 phases: item identification by using persons with a stake in the process to identify key components; survey refinement, including assessment of content and face validity; and assessment of test-retest reliability by using the kappa coefficient and percent agreement for each of the scaled response items. Results The final survey contained 10 items with a Likert scale response and 5 open-ended questions. Expert nephrologists in the field confirmed face validity and content validity of the survey. The overall kappa coefficient for the scale was 0.76, reflecting excellent agreement, with an overall percent agreement of 88.7%. Conclusion We developed a survey to identify barriers that kidney transplant candidates may experience when seeking a living donor, which demonstrated content and face validity as well as reproducibility. This survey can by used by end-stage renal disease programs to identify barriers in candidates seeking a transplant. The results of the survey can be used to develop interventions to overcome such barriers with an ultimate goal of increasing rates of living kidney donation.
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Abstract
The escalating number and cost of treating patients with end-stage renal disease is a considerable economic concern for health care systems and societies globally. Compared with dialysis, kidney transplantation leads to improved patient survival and quality of life, as well as cost savings to the health payer. Despite efforts to increase kidney transplantation, the gap between supply and demand continues to grow. In this article we explore the economic consideration of both living and deceased transplantation. Although living kidney donation has several advantages from an economic perspective, efforts to increase both deceased and living donation are required. Strategies to increase kidney donation are underfunded, and even costly strategies are likely to lead to net health care savings. However, demonstration of efficacy of these strategies is required to ensure efficient use of resources.
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Affiliation(s)
- Scott Klarenbach
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, T6G 2G3 Canada.
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Barnieh L, Baxter D, Boiteau P, Manns B, Doig C. Benchmarking performance in organ donation programs: Dependence on demographics and mortality rates. Can J Anaesth 2006; 53:727-31. [PMID: 16803922 DOI: 10.1007/bf03021633] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Donors whose diagnosis of death is based upon neurologic criteria are the primary source of organs for human transplantation. The current measure of effectiveness of organ donation programs is the crude statistic, donors per million population (DPMP). This statistic represents the number of available donors, divided by the potential donor population. Comparisons between transplantation programs are done using the DPMP statistic. We sought to determine if variance in organ donation rates, reported as DPMP could be accounted for by differences in population demographics, specifically age and gender-specific mortality rates. METHODS We obtained the population distribution and deaths for the year 2000 for the Calgary Health Region (CHR) and the country of Spain. Expected deaths were then calculated by standardizing the sample, based upon weighted averages of age, gender and cause-specific mortality rates. RESULTS In 2000, Spain reported a crude organ donation rate of 33.9 DPMP. Standardizing the observed deaths in Spain using the CHR population distribution and calculating expected deaths based on the CHR rates, resulted in an adjusted rate of 19.2 DPMP (P < 0.05). CONCLUSIONS These results bring into question the reliability of using crude DPMP as a measure of organ and tissue donation program performance. Alternative measures of benchmarking performance in organ donation programs should be considered.
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Affiliation(s)
- Lianne Barnieh
- Community Health Sciences, The University of Calgary, Alberta, Canada
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