Browsing by Author "Campbell, David John Thomas"

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    A Systematic Review and Theoretical Economic Analysis of the Impacts of Providing Material Benefits to Improve Food Access in People with Diabetes
    (2023-07-21) Steer, Kieran James Daniel; Spackman, Eldon; Olstad, Dana Lee; Beall, Reed Francis; Campbell, David John Thomas
    Background: Providing material benefits to increase access to healthy food (e.g., food coupons/vouchers, free food, or financial subsidies/incentives) for people with diabetes may be an effective healthcare intervention to improve food insecurity, dietary patterns, clinical parameters, and ultimately health outcomes. There are several studies that have investigated the impact of providing material benefits to improve food access among people with diabetes. There is also interest in Alberta, Canada in potentially implementing a healthy food prescription incentive for people with type 2 diabetes mellitus (T2DM) and food insecurity, which is being investigated in the “Food Rx” trial (NCT04725630). However, there has not been a systematic review or cost-effectiveness analysis on the impacts of providing material benefits to improve food access among people with diabetes. Thesis studies: a systematic review on the impacts of providing material benefits to improve food access on food insecurity, dietary patterns, and clinical parameters in people with diabetes; and a theoretical economic analysis to determine the minimum A1C improvement required for the Food Rx intervention to be cost-effective from the third-party healthcare payer perspective. Results: The systematic review showed that providing material benefits to improve food access for people with diabetes may improve household food insecurity, fruit and vegetable intake, and overall diet quality but is less likely to change clinical parameters and whole grain intake. The evidence from randomized controlled trials was limited to only six studies at high risk of bias, most commonly due to unblinded subjective outcomes measurement and high participant attrition. The economic threshold analysis showed that providing a healthy food prescription incentive to people with T2DM and food insecurity was unlikely to be cost-effective at $50,000/QALY, when projecting health outcomes from improvements in A1C and diabetes-related clinical parameters. Conclusion: The evidence of clinical effectiveness from providing material benefits to improve food access among people with T2DM is highly uncertain, and a healthy food prescription incentive for people with T2DM and food insecurity in Alberta has a low likelihood of cost-effectiveness, when measuring outcomes from improvements in diabetes-related clinical parameters
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    Assessing the Impact of Financial Barriers on Care and Outcomes for Patients with Cardiovascular-Related Chronic Diseases
    (2017) Campbell, David John Thomas; Manns, Braden; King-Shier, Kathryn; Hemmelgarn, Brenda; Sanmartin, Claudia
    Patients with cardiovascular-related chronic diseases, such as coronary artery disease and diabetes may face numerous barriers to accessing the complex care that they require. Even in Canada, which has a universal healthcare system, some patients may face financial barriers to accessing important goods and services. Our objective was to enhance the understanding of financial barriers and their impact on clinical outcomes. This thesis is comprised of four reports of three independent studies that form an overarching sequential mixed methods program of research. The first study was a population-weighted survey of Western Canadians with cardiovascular-related chronic conditions in which we found that 1 in 10 respondents perceived having financial barriers to accessing goods and services required for their chronic disease. Those who reported having a financial barrier self-reported being 70% more likely to require hospital or emergency department care than those who did not perceive having financial barriers. In the second study, we built on this by linking data for patients self-reporting financial barriers within a series of national health surveys to outcomes available within administrative data sources. Those who perceived having a financial barrier to any aspect of their care had a hospitalization rate and mortality rate that was 36% and 24% higher, respectively, than those who denied having financial barriers. In the third study, we explored patients’ experiences with financial barriers using grounded theory methodology. We developed a conceptual framework for understanding how financial barriers impact patients’ lives. We outlined protective, predisposing, and modifying factors that ultimately determine how resilient an individual can be in the face of financial barriers. Finally, we undertook a qualitative descriptive analysis to describe the aspects of care to which patients most commonly experience financial barriers. These include: non-insured goods and services, items required to support self-management and incidental expenses associated with insured services. Many Canadians with chronic diseases face financial barriers to care, which are associated with adverse health outcomes. Interventions to address the prevalence and impact of financial barriers are possible but have never been tested in rigorous trials. Such studies would inform important policy reform at all levels of government.