Mental health and addiction service utilization among people living with chronic kidney disease.

BACKGROUND: Mental health problems, particularly anxiety and depression, are common in patients with chronic kidney disease (CKD), and negatively impact quality of life, treatment adherence, and mortality. However, the degree to which mental health and addictions services are utilized by those with CKD is unknown. We examined the history of mental health and addictions service use of individuals across levels of kidney function. METHODS: We performed a population-based cross-sectional study using linked healthcare databases from Ontario, Canada from 2009 to 2017. We abstracted the prevalence of individuals with mental health and addictions service use within the previous 3 years across levels of kidney function (eGFR$\ \ge $60, 45 to < 60, 30 to < 45, 15 to < 30, <15 mL/min per 1.73m2 and maintenance dialysis). We calculated prevalence ratios (PR) to compare prevalence across kidney function strata, while adjusting for age, sex, year of cohort entry, urban versus rural location, area-level marginalization, and Charlson comorbidity scores. RESULTS: Of 5 956 589 adults, 9% (n = 534 605) had an eGFR<60 mL/min per 1.73m2 or were receiving maintenance dialysis. Fewer individuals with eGFR < 60 had a history of any mental health and addictions service utilization (crude prevalence range 28% to 31%), compared to individuals with eGFR ≥ 60 (35%). Compared to eGFR ≥ 60, the lowest prevalence of individuals with any mental health and addictions service utilization was among those with eGFR 15 to < 30 (adjusted PR 0.86, 95% CI 0.85 to 0.88), eGFR < 15 (adjusted PR 0.81, 95% CI 0.76 to 0.86) and those receiving maintenance dialysis (adjusted PR 0.83, 95% CI 0.81 to 0.84). Less use of outpatient services accounted for differences in service utilization. CONCLUSIONS: Mental health and addictions service utilization is common but less so in individuals with advanced CKD in Ontario, Canada.

Alignment of Canadian Primary Care With the Patient Medical Home Model: A QUALICO-PC Study.

PURPOSE: The patient medical home (PMH) model aims to improve patient satisfaction and health outcomes in Canada, but since its introduction in 2009, there has been no evaluation of the extent to which primary care conforms with PMH attributes. Our objective was to compare current primary care across Canada with the 10 goals of the PMH model. METHODS: A cross-sectional survey of primary care organization and delivery was conducted in Canadian provinces to evaluate the PMH-based attributes of primary care practices. Family physician and patient responses were mapped to the 10 goals of the PMH model. We used regression models to describe the provinces' success in meeting the goals, taking specific practice characteristics into account. We created a PMH composite score by weighting each goal equally for each practice and aggregating these by province. The PMH score is the sum of the values for each goal, which were scored from 0 to 1; a score of 10 indicates that all 10 goals of the PMH model were achieved. RESULTS: Seven hundred seventy-two primary care practices and 7,172 patients participated in the survey. The average national PMH score was 5.36 (range 4.75-6.23) of 10. Ontario was the only province to score significantly higher than Canada as a whole, whereas Québec, Newfoundland/Labrador, and New Brunswick/Prince Edward Island scored below the national average. There was little variation, however, among provinces in achieving the 10 PMH goals. CONCLUSIONS: Provincial PMH scores indicate considerable room for improvement if the PMH goals are to be fully implemented in Canada.

Evaluation of a mentorship program to support chronic kidney disease care.

PROBLEM ADDRESSED: Primary care providers (PCPs) are ideally situated to detect and manage patients with chronic kidney disease (CKD), but they could use more support from nephrologists to accomplish this. OBJECTIVE OF PROGRAM: To improve early detection and management of CKD in primary care, and improve referrals to nephrologists through education and greater partnership between nephrologists and PCPs. PROGRAM DESCRIPTION: Nephrologists provided mentorship to PCPs in Ontario through a collaborative relationship. Nephrologists provided PCPs with educational orientation sessions and need-based advice on patient cases. CONCLUSION: Primary care providers with more than 5 years of experience were more likely to use the program. Primary care providers expressed high satisfaction with the program and reported that it was effective in supporting routine CKD screening efforts, management of early CKD, appropriate referrals, and building a collaborative relationship with nephrologists.

Provincial Needs Assessment to Determine the Current State of Glomerulonephritis Care in Ontario.

BACKGROUND: Despite its relative rarity, glomerulonephritis (GN) accounts for 20% of prevalent end-stage renal disease patients in Ontario. Early identification and appropriate management of GN to delay progression of disease can reduce patient morbidity and health system costs. As such, a provincial GN needs assessment was conducted to inform on the development of the provincial GN strategic framework in Ontario. OBJECTIVE: To understand the current state of GN care in Ontario from nephrologist, hospital administrator, and patient and family perspectives. DESIGN: Cross-sectional. SETTINGS: 26 regional renal programs in Ontario. PATIENTS: 23 patients and family members living with GN who do not require renal replacement therapy. MEASUREMENTS: Patient and family member interviews as well as a survey of nephrologists. METHODS: The study included 3 components: (1) interviews with patients and family members, (2) a survey of nephrologists, and (3) interviews with regional renal programs. The Ontario Renal Network provincial office developed the needs assessment questions and the physician survey questions after consultation with practicing nephrologists and hospital administrators. Thematic analysis was used to assess interview data and descriptive statistics to assess survey data. RESULTS: Interviews with patients and family members (n = 23) identified gaps in care related to diagnosis and referral to nephrology care, education and decision-making, and psychosocial supports. The survey of nephrologists (n = 74) identified various issues that contribute to unstandardized GN care across Ontario, including a lack of provincial expertise in providing complex GN care, access to medication, multidisciplinary team support as well as patient education, and psychosocial supports. Interviews with regional renal programs aligned with interview and survey findings (n = 11). LIMITATIONS: Interviews with patients and family members were facilitated by 1 interviewer and limited to 20 interviews due to resource limitations. All nephrologists, patients, and family members who participated in the survey and interviews were volunteers and English-speaking, which may have resulted in self-selection bias. CONCLUSIONS: The provincial GN needs assessment emphasized the necessity to develop and implement a provincial GN strategy. The strategic framework includes 4 objectives: (1) ensure patients are supported to make informed decisions, (2) establish a provincial model of care, (3) leverage data to enable planning, decision-making, and monitoring of outcomes, and (4) ensure appropriate access to medication. This is the first Ontario strategy to address provincial gaps in GN care.

CONTEXTE: Malgré sa relative rareté, les glomérulonéphrites (GN) représentent 20 % des cas prévalents d'insuffisance rénale terminale en Ontario. Un diagnostic précoce et une prise en charge adéquate des GN pourraient réduire la morbidité pour les patients et les coûts pour le système de santé. Une analyse des besoins provinciaux (Ontario) en matière de soins des GN a été réalisée pour guider l'élaboration d'un cadre stratégique de gestion de la maladie. OBJECTIF: Connaître l'état actuel des soins en contexte de GN, en Ontario, du point de vue des néphrologues, des directions d'établissements, des patients et de leurs proches. TYPE D'ÉTUDE: Étude transversale. CADRE: 26 programmes régionaux de lutte contre la maladie rénale en Ontario. SUJETS: Un total de 23 individus, soit des patients atteints de GN, mais ne nécessitant pas de thérapie de remplacement rénal, et des membres de leur entourage. MESURES: Des interviews de patients et de membres de leur entourage, ainsi qu'un sondage auprès de néphrologues. MÉTHODOLOGIE: L'étude comportait trois volets: (1) interview des patients et de leur entourage; (2) sondage auprès des néphrologues; (3) entretiens avec les responsables des programmes régionaux de lutte contre la maladie rénale. Le Réseau rénal de l'Ontario a mis au point les questions du sondage et les questions relatives à l'évaluation des besoins après avoir consulté des néphrologues en pratique et des administrateurs d'hôpitaux. Les données recueillies ont été traitées par analyses thématiques (interviews) et par statistiques descriptives (sondage). RÉSULTATS: L'interview des patients et de leur entourage (n = 23) a mis en évidence des lacunes dans les procédures liées au diagnostic et à l'aiguillage en néphrologie, de même que concernant l'éducation des patients, la prise de décisions et le soutien psychosocial. Le sondage des néphrologues (n = 74) a permis de déceler diverses lacunes contribuant à une prestation de soins non normalisée en Ontario, notamment vis-à-vis l'expertise provinciale dans la prestation de soins complexes en GN, l'accès aux médicaments, le soutien d'une équipe multidisciplinaire, l'éducation et le soutien psychosocial des patients. Les entretiens avec les responsables des programmes régionaux de lutte contre la maladie rénale (n = 11) concordaient avec les résultats des deux autres volets. LIMITES: Les interviews avec les patients et leur entourage ont été effectuées par une seule personne et restreintes à une vingtaine en raison de ressources limitées. Les néphrologues, patients et membres de leur entourage étaient tous anglophones et ont participé à l'étude sur une base volontaire, ce qui pourrait introduire un biais d'auto-sélection. CONCLUSION: L'évaluation des besoins provinciaux en matière de soins pour les GN a mis en lumière la nécessité d'élaborer et de mettre en œuvre une stratégie provinciale. Le cadre stratégique comprend quatre objectifs: (1) garantir aux patients le soutien nécessaire pour prendre des décisions éclairées, (2) établir un modèle de soins provincial, (3) exploiter les données pour permettre la planification, la prise de décision et le suivi des résultats, et (4) assurer un accès adéquat aux médicaments. Il s'agit de la première stratégie visant à combler les lacunes provinciales en matière de soins pour les GN en Ontario.

Efficacy and consumer preferences for different approaches to calorie labeling on menus.

OBJECTIVE: To evaluate the efficacy and consumer preferences of calorie labeling on menus. DESIGN: Between-group experiment. Participants were randomized to view menu items according to 1 of 4 experimental conditions: no calorie information, calorie-only information, calorie plus health statement (HS), and calorie plus the Physical Activity Scale. Participants selected a snack and then rated menus from all conditions on the level of understanding and perceived effectiveness. SETTING: University of Waterloo, Canada. PARTICIPANTS: A total of 213 undergraduate university students recruited from classrooms. MAIN OUTCOME MEASURES: The calorie amount of menu selection and ratings of understandability and perceived effectiveness. ANALYSIS: Linear regression models and chi-square tests. RESULTS: Participants who selected items from menus without calorie information selected snacks with higher calorie amounts than participants in the calorie-only condition (P = .002) and the calorie plus HS condition (P = .001). The calorie plus HS menu was perceived as most understandable and the calorie plus calorie plus Physical Activity Scale menu was perceived as most effective in helping to promote healthy eating. CONCLUSIONS AND IMPLICATIONS: Calorie labeling on menus may assist consumers in making healthier choices, with consumer preference for menus that include contextual health statements.

A multicenter assessment of the adequacy of cancer pain treatment using the pain management index.

PURPOSES: Determine adequacy of management of pain secondary to bone metastases by physicians referring to specialized outpatient palliative radiotherapy (RT) clinics in Canada; compare geographic differences in adequacy of pain management and pain severity between these cohorts; compare results with published international literature. METHODS: Prospectively collected data from three participating centers were used to calculate the Pain Management Index (PMI) by subtracting the patient-rated pain score at time of initial clinic visit from the analgesic score. Scores were 0, 1, 2, and 3 when patients reported no pain (0), mild (1-4), moderate (5-6), or severe pain (7-10), respectively, on the Edmonton Symptom Assessment System or Brief Pain Inventory. Analgesic scores of 0, 1, 2, and 3 were assigned for no pain medication, nonopioids, weak opioids, and strong opioids respectively. A negative PMI suggests inadequate pain management. RESULTS: Overall incidence of negative PMI and moderate to severe pain was 25.1% and 70.9% respectively for 2011 patients. Comparing the three participating centers, the incidence of negative PMI was 31.0%, 20.0%, and 16.8% (p < 0.0001), and severe pain was 55.5%, 48.2% and 43.4% (p < 0.0001), these correlated with a negative PMI. Patients referred to our clinics were less likely to be undertreated for their pain when compared to study results from international countries. CONCLUSION: Geographic differences in adequacy of analgesic management for painful bone metastases exist between Canadian specialized outpatient palliative RT clinics and between centers globally. Investigating reasons for these differences may provide insight into solutions to improve quality of life for these patients.