Browsing by Author "Currie, Gillian"
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- ItemOpen AccessA Multidisciplinary Clinic for Children with Problematic Severe Asthma: Assessment of Clinical Outcomes, Healthcare Utilization and Costs(2014-12-24) Kam, Karen; Currie, Gillian; Nettel-Aguirre, AlbertoBackground: The Intensive Management of Asthma Clinic (IMAC) at the Alberta Children’s Hospital is a novel multidisciplinary clinic for children with severe problematic asthma. Whether consolidating resources in this clinic is effective, compared to the regular asthma clinic, has not been studied. Methods: This quasi-experimental retrospective study compared the IMAC and regular asthma clinic. Data was collected in three categories: clinical outcomes, healthcare utilization, and costs (healthcare utilization, patient-borne). Primary analyses used linear mixed effects modeling, paired t-tests, and ANOVA. Results: Lung function improved more for IMAC patients. Quality of life scores, measured only in the IMAC, improved. Scheduled clinic visits increased, while ED visits decreased. The increased cost of the IMAC was greater than the total costs saved by subsequent decreased healthcare utilization; overall the IMAC was more expensive. Conclusion: The IMAC is effective in improving clinical outcomes and decreasing healthcare utilization; however, these benefits come at extra cost.
- ItemOpen AccessAn evaluation of costs and outcomes for middle to late stage dementia residents in traditional versus specialized care environments(2003) Mirza, Munsoor Ahmad; Currie, Gillian
- ItemOpen AccessAssessing Health Care Costs, Treatment Patterns, and Health-Related Quality of Life in Children with Juvenile Idiopathic Arthritis and their Caregivers.(2022-01-20) Grazziotin Lago, Luiza R.; Marshall, Deborah A.; Twilt, Marinka; Currie, Gillian; Koffijberg, HendrikJuvenile idiopathic arthritis (JIA) is an umbrella term that encompasses all forms of arthritis with onset before the age of 16 years and symptoms that persist for more than 6 weeks for which the cause is unknown. JIA can significantly affect the quality of life of children and their families, and the disease and its treatment can increase the economic burden for the health care system and families.This PhD thesis was focused on a research program that addressed four gaps in the literature: 1) assessment of the overall and JIA-related health care resource utilization and associated costs before and after rheumatology care; 2) evaluation of JIA treatment prescription patterns; 3) studies measuring health state utility scores of patients with JIA across their lifespan, including children, adults, and adolescents; and 4) measurement of caregiver health-related quality of life (HRQoL) and care-related quality of life (CRQoL) and investigation of the relationship of those measures with child HRQoL and other influencing factors.We conducted four studies to address those gaps. Two retrospective cohort studies using electronic medical records and administrative databases to assess health care resource use and costs, and sequences of treatment prescriptions in children with JIA in Canada, respectively. Our findings reveal that the care pathway for children with JIA including health care resource utilization, costs, and treatment prescription patterns can be expensive, and complex – and varies by JIA subtype. We then performed a systematic review, which was the first review seeking to identify and assess health utility scores in children, adolescents, and adults with history of JIA. Finally, our last study was the first to assess care-related quality of life in caregivers of children with JIA, and to evaluate factors associated with caregiver care- and health-related quality of life, which highlighted the need for an encompassing family-centred approach of care that goes beyond achieving inactive disease.
- ItemOpen AccessAssured Income for the Severely Handicapped (AISH): The Impact of Raising Employment Income Exemption Limits on Employment Rates – A Focus on Recipients with Schizophrenia(2013-08-30) Marriott, Brian; Currie, GillianAlberta’s Assured Income for the Severely Handicapped (AISH) program provides financial and health-related assistance to adults who have a permanent disability that prevents them from fully participating in the labour market. Recognizing the benefits of employment, AISH encourages its clients to work to the extent that they are able. However, employment income earned beyond a set exemption limit reduces the assistance received. In 2008, the upper threshold of the exemption limit increased by $500. This study explored the policy’s impact on AISH recipients with schizophrenia compared to those with other mental health disorders. As well, the personal characteristics associated with the level of employment among AISH recipients with schizophrenia were assessed. The findings suggest that employment did not increase after the policy-amendment for either group. Marital status, number of children, age, and place of residence were associated with employment income for AISH recipients with schizophrenia.
- ItemEmbargoEconomic evaluation of diagnostic strategies for obstructive sleep apnea(2003) Dort, Leslie; Currie, Gillian
- ItemOpen AccessFactors associated with care- and health-related quality of life of caregivers of children with juvenile idiopathic arthritis(2022-07-23) Grazziotin, Luiza R.; Currie, Gillian; Twilt, Marinka; IJzerman, Maarten J.; Kip, Michelle M. A.; Koffijberg, Hendrik; Bonsel, Gouke; Benseler, Susanne M.; Swart, Joost F.; Vastert, Sebastiaan J.; Wulffraat, Nico M.; Yeung, Rae S. M.; Armbrust, Wineke; van den Berg, J. M.; Marshall, Deborah A.Abstract Objective This study investigates the relationship of child, caregiver, and caring context measurements with the care-related quality of life (CRQoL) and health-related quality of life (HRQoL) of caregivers of children with juvenile idiopathic arthritis (JIA). Methods We performed a cross-sectional analysis of baseline data on caregivers of children with JIA from Canada and the Netherlands collected for the “Canada-Netherlands Personalized Medicine Network in Childhood Arthritis and Rheumatic Diseases” study from June 2019 to September 2021. We used the CRQoL questionnaire (CarerQoL), adult EQ-5D-5L, and proxy-reported Youth 5-Level version of EuroQoL (EQ-5D-5L-Y) to assess caregiver CRQoL, caregiver HRQoL, and child HRQoL, respectively. We used a multivariate analysis to assess the relationship between both caregiver CRQoL and HRQoL and patient, caregiver, and caring context measurements. Results A total of 250 caregivers were included in this study. Most of the caregivers were from the Netherlands (n = 178, 71%) and 77% were females (n = 193). The mean CarerQoL scores was 82.7 (standard deviation (SD) 11.4) and the mean EQ-5D-5L utility score was 0.87 (SD 0.16). Child HRQoL and employment had a positive relationship with both caregiver CarerQoL and EQ-5D-5L utility scores (p < 0.05), while receiving paid or unpaid help had a negative relationship with both scores (p < 0.05). Conclusion Our findings indicated that to understand the impact of JIA on families, we need to consider socio-economic factors, such as employment and support to carry caregiving tasks, in addition to child HRQoL.
- ItemOpen AccessPreference for breast cancer risk reduction hormonal thearpay in postmenopausal women 50-69 years attending screening mammography(2008) Lupichuk, Sasha Michelle; Bryant, Heather E.; Currie, Gillian
- ItemOpen AccessPreference For Breast Cancer Risk Reduction Hormonal Therapy In Postmenopausal Women 50 -69 Years Attending Screening Mammography(2008) Lupichuk, Sasha Michelle; Bryant, Heather; Currie, Gillian
- ItemOpen AccessReal-world data reveals the complexity of disease modifying anti-rheumatic drug treatment patterns in juvenile idiopathic arthritis: an observational study(2022-04-11) Grazziotin, Luiza R.; Currie, Gillian; Twilt, Marinka; Ijzerman, Maarten J.; Kip, Michelle M. A.; Koffijberg, Hendrik; Benseler, Susanne M.; Swart, Joost F.; Vastert, Sebastiaan J.; Wulffraat, Nico M.; Yeung, Rae S. M.; Marshall, Deborah A.Abstract Objective Pharmacological treatment is a cornerstone of care for children with juvenile idiopathic arthritis (JIA). The objective of this study is to evaluate prescription patterns of conventional and biologic disease modifying anti-rheumatic drugs (c-DMARDs and b-DMARDs) for patients with JIA. Methods We conducted a retrospective cohort study of children diagnosed with JIA at a rheumatology pediatric clinic. Eligibility criteria were defined as children and youth newly diagnosed with enthesis-related arthritis, polyarticular, or oligoarticular JIA between 2011 and 2019, with at least one year of observation. Data on c-DMARDs and b-DMARDs prescriptions were obtained from electronic medical charts. We used descriptive statistics, Kaplan–Meier survival methods, and Sankey diagrams to describe treatment prescription patterns. Results A total of 325 patients with JIA were included, with a median observation time of 3.7 years. The most frequently prescribed c-DMARD and b-DMARD were methotrexate and etanercept, respectively. Within the first year of rheumatology care, 62% and 21% of patients had a c-DMARD and a b-DMARD prescribed, respectively. These proportions varied greatly by JIA subtype. Among the 147 (147/325, 45%) patients that had at least one b-DMARD prescribed, 24% were prescribed a second, and 7% a third-line of b-DMARD. A total of 112 unique treatment sequences were observed, with c-DMARD monotherapy followed by the addition of either a b-DMARD (56%) or another c-DMARD (30%) being the two most prevalent patterns in this cohort. Conclusion We observed a variety of treatment trajectories, with many patients experiencing multiple treatment lines, illustrating the complexity of the overall JIA treatment path.
- ItemOpen AccessSeeking the state of the art in standardized measurement of health care resource use and costs in juvenile idiopathic arthritis: a scoping review(2019-05-06) Kip, Michelle M A; Currie, Gillian; Marshall, Deborah A; Grazziotin Lago, Luiza; Twilt, Marinka; Vastert, Sebastiaan J; Swart, Joost F; Wulffraat, Nico; Yeung, Rae S M; Benseler, Susanne M; IJzerman, Maarten JAbstract Background This study aims to describe current practice in identifying and measuring health care resource use and unit costs in economic evaluations or costing studies of juvenile idiopathic arthritis (JIA). Methods A scoping review was conducted (in July 2018) in PubMed and Embase to identify economic evaluations, costing studies, or resource utilization studies focusing on patients with JIA. Only English language peer-reviewed articles reporting primary research were included. Data from all included full-text articles were extracted and analysed to identify the reported health care resource use items. In addition, the data sources used to obtain these resource use and unit costs were identified for all included articles. Results Of 1176 unique citations identified by the search, 20 full-text articles were included. These involved 4 full economic evaluations, 5 cost-outcome descriptions, 8 cost descriptions, and 3 articles reporting only resource use. The most commonly reported health care resource use items involved medication (80%), outpatient and inpatient hospital visits (80%), laboratory tests (70%), medical professional visits (70%) and other medical visits (65%). Productivity losses of caregivers were much more often incorporated than (future) productivity losses of patients (i.e. 55% vs. 15%). Family borne costs were not commonly captured (ranging from 15% for school costs to 50% for transportation costs). Resource use was mostly obtained from family self-reported questionnaires. Estimates of unit costs were mostly based on reimbursement claims, administrative data, or literature. Conclusions Despite some consistency in commonly included health care resource use items, variability remains in including productivity losses, missed school days and family borne costs. As these items likely substantially influence the full cost impact of JIA, the heterogeneity found between the items reported in the included studies limits the comparability of the results. Therefore, standardization of resource use items and unit costs to be collected is required. This standardization will provide guidance to future research and thereby improve the quality and comparability of economic evaluations or costing studies in JIA and potentially other childhood diseases. This would allow better understanding of the burden of JIA, and to estimate how it varies across health care systems.
- ItemOpen AccessTesting the feasibility of eliciting preferences for health states from adolescents using direct methods(2018-06-22) Crump, R. Trafford; Lau, Ryan; Cox, Elizabeth; Currie, Gillian; Panepinto, JulieAbstract Background Measuring adolescents’ preferences for health states can play an important role in evaluating the delivery of pediatric healthcare. However, formal evaluation of the common direct preference elicitation methods for health states has not been done with adolescents. Therefore, the purpose of this study is to test how these methods perform in terms of their feasibility, reliability, and validity for measuring health state preferences in adolescents. Methods This study used a web-based survey of adolescents, 18 years of age or younger, living in the United States. The survey included four health states, each comprised of six attributes. Preferences for these health states were elicited using the visual analogue scale, time trade-off, and standard gamble. The feasibility, test-retest reliability, and construct validity of each of these preference elicitation methods were tested and compared. Results A total of 144 participants were included in this study. Using a web-based survey format to elicit preferences for health states from adolescents was feasible. A majority of participants completed all three elicitation methods, ranked those methods as being easy, with very few requiring assistance from someone else. However, all three elicitation methods demonstrated weak test-retest reliability, with Kendall’s tau-a values ranging from 0.204 to 0.402. Similarly, all three methods demonstrated poor construct validity, with 9–50% of all rankings aligning with our expectations. There were no significant differences across age groups. Conclusions Using a web-based survey format to elicit preferences for health states from adolescents is feasible. However, the reliability and construct validity of the methods used to elicit these preferences when using this survey format are poor. Further research into the effects of a web-based survey approach to eliciting preferences for health states from adolescents is needed before health services researchers or pediatric clinicians widely employ these methods.
- ItemOpen AccessThe Development of a Framework to Evaluate the Organisational and Policy Impacts of the Community Health Information Tracking System (CHITS) in the Philippines(2010) Premji, Shainur; Scott, Richard; Currie, Gillian
- ItemOpen AccessThe economics of healthy eating(2012-07-24) Lee, Helen; Currie, GillianObesity is a significant public health issue, and many public health programs and interventions have been developed to address it. Healthy eating at the workplace is a key component of obesity prevention, however, evidence of its cost and effectiveness is largely missing. This dissertation took a multi-faceted approach to the evaluation of a workplace healthy-eating intervention implemented in the Alberta Health Services: Calgary Area in September 2006. The first epidemiological study provides a snapshot of the relationship between healthy eating and obesity at the Canadian population level. National dietary patterns were derived from the Canadian Community Health Survey (CCHS) Cycle 2.2 in 2004 and the relationship between obesity and healthy eating, as reflected by the adherence to the Canada’s Food Guide (CFG) in the CCHS sample, was explored. Over-consumption of Meat and Alternatives was prevalent, and positively associated with obesity. The second and third studies examined the immediate impact of the Healthy Eating Initiative (HEI). An online survey was developed to explore employees’ dietary patterns at work and at home. The survey did not find evidence that employees were changing their consumption of non-recommended food at work and at home. In addition, employees who ate healthily at work also ate healthily at home. The third study used cafeteria sales data to explore the impact of HEI on employees’ food purchases, especially on those items that were targeted by the Initiative. The results showed that cafeteria sales revenue did not decrease, and that sales of targeted healthy food items increased during the HEI period, after controlling for price and time. The last study modelled the effect of healthy eating in the long run using decision analysis incorporating data from the literature and the aforementioned three studies. The baseline Incremental Cost Utility Ratio (ICUR) was $9,360 per Quality Adjusted Life Years (QALY), but was very sensitive to changes in certain parameters, especially those that affected QALY, such as the relative risk (RR) of weight gain from healthy eating. This thesis provided some evidence about the impact of the HEI, and identified issues in the evaluation of such interventions that could be used to develop stronger evaluations in future.
- ItemOpen AccessThe economics of healthy eating(2012) Lee, Helen; Currie, GillianObesity is a significant public health issue, and many public health programs and interventions have been developed to address it. Healthy eating at the workplace is a key component of obesity pr??vention, however, evidence of its cost and effectiveness is largely missing. This dissertation took a multi-faceted approach to the evaluation of a workplace healthy-eating intervention implemented in the Alberta Health Services: Calgary Area in September 2006. The first epidemiological study provides a snapshot of the relationship between healthy eating and obesity at the Canadian population level. National dietary patterns were derived from the Canadian Community Health Survey (CCHS) Cycle 2.2 in 2004 and the relationship between obesity and healthy eating, as reflected by the adherence to the Canada's Food Guide (CFG) in the CCHS sample, was explored. Over-consumption of Meat and Alternatives was prevalent, and positively associated with obesity. The second and third studies examined the immediate impact of the Healthy Eating Initiative (HEI). An online survey was developed to explore employees' dietary patterns at work and at home. The survey did not find evidence that employees were changing their consumption of non-recommended food at work and at home. In addition, employees who ate healthily at work also ate healthily at home. The third study used cafeteria sales data to explore the impact of HEI on employees' food purchases, especially on those items that were targeted by the Initiative. The results showed that cafeteria sales revenue did not decrease, and that sales of targeted healthy food items increased during the HEI period, after controlling for price and time. The last study modelled the effect of healthy eating in the long run using decision analysis incorporating data from the literature and the aforementioned three studies. The baseline Incremental Cost Utility Ratio (ICUR) was $9,360 per Quality Adjusted Life Years (QAL Y), but was very sensitive to changes in certain parameters, especially those that affected QALY, sucli as the relative risk (RR) of weight gain from healthy eating. This thesis provided some evidence about the impact of the HEI, and identified issues in the evaluation of such interventions that could be used to develop stronger evaluations in future.
- ItemOpen AccessThe effect of cost and value information on embedding in contingent valuation(2006) Spackman, Eldon; Currie, Gillian
- ItemOpen AccessWithdrawing biologics in non-systemic JIA: what matters to pediatric rheumatologists?(2023-07-11) van Til, Janine A.; Kip, Michelle M. A.; Schatorjé, Ellen J. H.; Currie, Gillian; Twilt, Marinka; Benseler, Susanne M.; Swart, Joost F.; Vastert, Sebastiaan J.; Wulffraat, Nico; Yeung, Rae S. M.; Groothuis-Oudshoorn, C. G. M. (.; Warta, Sanne; Marshall, Deborah A.; IJzerman, Maarten J.Abstract Objective Approximately one third of children with JIA receive biologic therapy, but evidence on biologic therapy withdrawal is lacking. This study aims to increase our understanding of whether and when pediatric rheumatologists postpone a decision to withdraw biologic therapy in children with clinically inactive non-systemic JIA. Methods A survey containing questions about background characteristics, treatment patterns, minimum treatment time with biologic therapy, and 16 different patient vignettes, was distributed among 83 pediatric rheumatologists in Canada and the Netherlands. For each vignette, respondents were asked whether they would withdraw biologic therapy at their minimum treatment time, and if not, how long they would continue biologic therapy. Statistical analysis included descriptive statistics, logistic and interval regression analysis. Results Thirty-three pediatric rheumatologists completed the survey (40% response rate). Pediatric rheumatologists are most likely to postpone the decision to withdraw biologic therapy when the child and/or parents express a preference for continuation (OR 6.3; p < 0.001), in case of a flare in the current treatment period (OR 3.9; p = 0.001), and in case of uveitis in the current treatment period (OR 3.9; p < 0.001). On average, biologic therapy withdrawal is initiated 6.7 months later when the child or parent prefer to continue treatment. Conclusion Patient’s and parents' preferences were the strongest driver of a decision to postpone biologic therapy withdrawal in children with clinically inactive non-systemic JIA and prolongs treatment duration. These findings highlight the potential benefit of a tool to support pediatric rheumatologists, patients and parents in decision making, and can help inform its design.