Health Economists on Involving Patients in Modeling: Potential Benefits, Harms, and Variables of Interest.

BACKGROUND: Patient involvement in health economics modeling has been advocated on numerous grounds, including as a way to better manage social and ethical value judgments in the modeling process. However, some have pointed to potential risks and variables that could influence the overall benefit of involvement. To inform future research, there is a need to generate knowledge on potential benefits, harms, and variables relevant to patient involvement in health economics modeling. METHODS: This analysis used data from a qualitative study in which 22 health economists were asked their views on the possibility of involving patients in the modeling process. Using qualitative methods, the authors organized participants' responses into theory-driven categories ("potential benefits", "potential harms", "variables of interest") and identified data-driven themes and subthemes within those categories. RESULTS: Findings point to potential benefits and harms to the model, modeler, patient, and modeling process. Variables of interest relevant to future research included patients' specific roles, modeler and patient characteristics, the goals of modeling, dynamics among participators, and features of high-level procedures. The findings raise a number of specific questions that may be fruitful to explore in future research on patient involvement in health economics modeling.

Social, ethical, and other value judgments in health economics modelling.

Modelling is a major method of inquiry in health economics. In other modelling-intensive fields, such as climate science, recent scholarship has described how social and ethical values influence model development. However, no similar work has been done in health economics. This study explored the role of social, ethical, and other values in health economics modelling using philosophical theory and qualitative interviews in British Columbia, Canada. Twenty-two professionals working in health economics modelling were interviewed between February and May, 2019. The study findings provide support for four philosophical arguments positing an essential role for social and ethical values throughout scientific inquiry and demonstrate how these arguments apply to health economics modelling. It highlights the role of social values in informing early modelling decisions, shaping model assumptions, making trade-offs between desirable model features, and setting standards of evidence. These results point to several decisions in the modelling process that warrant focus in future health economics research, particularly that which aims to incorporate patient and public values.

Stimulants and Cannabis Use Among a Marginalized Population in British Columbia, Canada: Role of Trauma and Incarceration.

High rates of substance use, especially cannabis and stimulant use, have been associated with homelessness, exposure to trauma, and involvement with the criminal justice system. This study explored differences in substance use (cannabis vs. stimulants) and associations with trauma and incarceration among a homeless population. Data were derived from the BC Health of the Homeless Study (BCHOHS), carried out in three cities in British Columbia, Canada. Measures included sociodemographic information, the Maudsley Addiction Profile (MAP), the Childhood Trauma Questionnaire (CTQ), and the Mini International Neuropsychiatric Interview (MINI) Plus. Stimulant users were more likely to be female (43%), using multiple substances (3.2), and engaging in survival sex (14%). Cannabis users had higher rates of lifetime psychotic disorders (32%). Among the incarcerated, cannabis users had been subjected to greater emotional neglect (p < .05) and one in two cannabis users had a history of lifetime depressive disorders (p < .05). Childhood physical abuse and Caucasian ethnicity were also associated with greater crack cocaine use. One explanation for the results is that a history of childhood abuse may lead to a developmental cascade of depressive symptoms and other psychopathology, increasing the chances of cannabis dependence and the development of psychosis.

eMental health experiences and expectations: a survey of youths' Web-based resource preferences in Canada.

BACKGROUND: Due to the high prevalence of psychological disorders and the lack of access to care among Canadian youth, the development of accessible services is increasingly important. eMental Health is an expanding field that may help to meet this need through the provision of mental health care using technology. OBJECTIVE: The primary goals of the study are to explore youth experiences with traditional and online mental health resources, and to investigate youth expectations for mental health websites. METHODS: A Web-based survey containing quantitative and qualitative questions was delivered to youth aged 17-24 years. Participants were surveyed to evaluate their use of mental health resources as well as their preferences for various components of a potential mental health website. RESULTS: A total of 521 surveys were completed. Most participants (61.6%, 321/521) indicated that they had used the Internet to seek information or help for feelings they were experiencing. If they were going through a difficult time, 82.9% (432/521) of participants were either "somewhat likely" or "very likely" to use an information-based website and 76.8% (400/521) reported that they were either "somewhat unlikely" or "very unlikely" to visit social media websites for information or help-seeking purposes during this time. Most (87.7%, 458/521) participants rated their online privacy as very important. Descriptions of interventions and treatments was the most highly rated feature to have in a mental health-related website, with 91.9% (479/521) of participants regarding it as "important" or "very important". When presented a select list of existing Canadian mental health-related websites, most participants had not accessed any of the sites. Of the few who had, the Canadian Mental Health Association website was the most accessed website (5.8%, 30/521). Other mental health-related websites were accessed by only 10.9% of the participants (57/521). CONCLUSIONS: The findings suggest that despite interest in these tools, current eMental Health resources either do not meet the needs of or are not widely accessed by youth with mental health problems. In order to improve access to these resources for Canadian youth, Web-based platforms should provide information about mental health problems, support for these problems (peer and professional), and information about resources (self-help as well as ability to locate nearby resources), while protecting the privacy of the user. These findings will not only assist in the development of new mental health platforms but may also help improve existing ones.

Help-Seeking Experiences of Youth with Suicidal Ideations.

Approximately 28 percent of Canadians begin to experience a mental health issue during their youth. In this article, we explore patients' perceptions of their mental healthcare experiences within a sample of youth who reported anxiety or depressive symptoms and past suicidal ideations. The study data is taken from in-depth interviews with 23 youth in British Columbia. Interview topics included support systems, help-seeking behavior and healthcare experiences. Our findings indicate that participant experiences were most positive when experiences were neither dismissive nor stigmatizing. Important factors for participants were respect, acknowledgement, information and choice. Our results generated the concept that treatment perceptions for youth with suicidal behaviours can be placed on a theoretical spectrum, which may be a useful tool for self reflection for those who support individuals with mental health conditions professionally or personally.

Optimal timing of influenza vaccination in patients with human immunodeficiency virus: a Markov cohort model based on serial study participant hemoagglutination inhibition titers.

BACKGROUND: Seasonal influenza vaccination offers one of the best population-level protections against influenza-like illness (ILI). For most people, a single dose prior to the flu season offers adequate immunogenicity. HIV+ patients, however, tend to exhibit a shorter period of clinical protection, and therefore may not retain immunogenicity for the entire season. Building on the work of Nosyk et al. (2011) that determined a single dose is the optimal dosing strategy for HIV+ patients, we investigate the optimal time to administer this vaccination. METHODS: Using data from the "single dose" treatment arm of an RCT conducted at 12 CIHR Canadian HIV Trials Network sites we estimated semimonthly clinical seroprotection levels for a cohort (N=93) based on HAI titer levels. These estimates were combined with CDC attack rate data for the three main strains of seasonal influenza to estimate instances of ILI over different vaccination timing strategies. Using bootstrap resampling of the cohort, nine years of CDC data, and parameter distributions, we developed a Markov cohort model that included probabilistic sensitivity analysis. Cost, quality adjusted life-years (QALYs), and net monetary benefits are presented for each timing strategy. RESULTS: The beginning of December is the optimal time for HIV+ patients to receive the seasonal influenza vaccine. Assuming a willingness-to-pay threshold of $50,000, the net monetary benefit associated with a Dec 1 vaccination date is $19,501.49 and the annual QALY was 0.833744. INTERPRETATION: Our results support a policy of administering the seasonal influenza vaccination for this population in the middle of November or beginning of December, assuming nothing is know about the upcoming flu season. But because the difference in between this strategy and the CDC guideline is small-12 deaths averted per year and a savings of $60 million across the HIV+ population in the US-more research is needed concerning strategies for subpopulations.

Research on a vulnerable neighborhood-the vancouver downtown eastside from 2001 to 2011.

The Downtown Eastside (DTES) of Vancouver is the subject of considerable research due to high rates of drug use, poverty, crime, infectious disease, and mental illness. This paper first presents a brief background to the DTES and then presents a survey of literature addressing the issues in this area from 2001 to 2011. The literature surveyed includes a range of publications such as those from peer-reviewed journals and the grey literature of reports and dissertations. This survey investigates the themes and outcomes of the extant literature and highlights the notable lack of research on mental health in the DTES.