Browsing by Author "Fabreau, Gabriel E."

Now showing 1 - 3 of 3
  • Thumbnail Image
    ItemOpen Access
    20-year trends in multimorbidity by race/ethnicity among hospitalized patient populations in the United States
    (2023-07-24) Mohamud, Mursal A.; Campbell, David J.; Wick, James; Leung, Alexander A.; Fabreau, Gabriel E.; Tonelli, Marcello; Ronksley, Paul E.
    Abstract Background The challenges presented by multimorbidity continue to rise in the United States. Little is known about how the relative contribution of individual chronic conditions to multimorbidity has changed over time, and how this varies by race/ethnicity. The objective of this study was to describe trends in multimorbidity by race/ethnicity, as well as to determine the differential contribution of individual chronic conditions to multimorbidity in hospitalized populations over a 20-year period within the United States. Methods This is a serial cross-sectional study using the Nationwide Inpatient Sample (NIS) from 1993 to 2012. We identified all hospitalized patients aged ≥ 18 years old with available data on race/ethnicity. Multimorbidity was defined as the presence of 3 or more conditions based on the Elixhauser comorbidity index. The relative change in the proportion of hospitalized patients with multimorbidity, overall and by race/ethnicity (Black, White, Hispanic, Asian/Pacific Islander, Native American) were tabulated and presented graphically. Population attributable fractions were estimated from modified Poisson regression models adjusted for sex, age, and insurance type. These fractions were used to describe the relative contribution of individual chronic conditions to multimorbidity over time and across racial/ethnic groups. Results There were 123,613,970 hospitalizations captured within the NIS between 1993 and 2012. The prevalence of multimorbidity increased in all race/ethnic groups over the 20-year period, most notably among White, Black, and Native American populations (+ 29.4%, + 29.7%, and + 32.0%, respectively). In both 1993 and 2012, Black hospitalized patients had a higher prevalence of multimorbidity (25.1% and 54.8%, respectively) compared to all other race/ethnic groups. Native American populations exhibited the largest overall increase in multimorbidity (+ 32.0%). Furthermore, the contribution of metabolic diseases to multimorbidity increased, particularly among Hispanic patients who had the highest population attributable fraction values for diabetes without complications (15.0%), diabetes with complications (5.1%), and obesity (5.8%). Conclusions From 1993 to 2012, the secular increases in the prevalence of multimorbidity as well as changes in the differential contribution of individual chronic conditions has varied substantially by race/ethnicity. These findings further elucidate the racial/ethnic gaps prevalent in multimorbidity within the United States. Prior presentations Preliminary finding of this study were presented at the Society of General Internal Medicine (SGIM) Annual Conference, Washington, DC, April 21, 2017.
  • Thumbnail Image
    ItemOpen Access
    Being a member of a novel transitional case management team for patients with unstable housing: an ethnographic study
    (2022-02-19) Garcia-Jorda, Dailys; Fabreau, Gabriel E.; Li, Queenie K. W.; Polachek, Alicia; Milaney, Katrina; McLane, Patrick; McBrien, Kerry A.
    Abstract Background Homeless and unstably housed individuals face barriers in accessing healthcare despite experiencing greater health needs than the general population. Case management programs are effectively used to provide care for this population. However, little is known about the experiences of providers, their needs, and the ways they can be supported in their roles. Connect 2 Care (C2C) is a mobile outreach team that provides transitional case management for vulnerable individuals in a major Canadian city. Using an ethnographic approach, we aimed to describe the experiences of C2C team members and explore their perceptions and challenges. Methods We conducted participant observations and semi-structured interviews with C2C team members. Data analysis consisted of inductive thematic analysis to identify themes that were iteratively discussed. Results From 36 h of field observations with eight team members and 15 semi-structured interviews with 12 team members, we identified five overarching themes: 1) Hiring the right people & onboarding: becoming part of C2C; 2) Working as a team member: from experience to expertise; 3) Proud but unsupported: adding value but undervalued; 4) Team-initiated coping: satisfaction in the face of emotional strain, and; 5) Likes and dislikes: committed to challenges. Conclusions A cohesive team of providers with suitable personal and professional characteristics is essential to care for this complex population. Emotional support and inclusion of frontline workers in operational decisions are important considerations for optimal care and program sustainability.
  • Thumbnail Image
    ItemOpen Access
    Cost-effectiveness of screening and treatment for schistosomiasis among refugees coming to Canada
    (2019-01-14) Webb, John Angus; McBrien, Kerry Alison; Spackman, David Eldon; Vaughan, Stephen; Heitman, Steven James; Fabreau, Gabriel E.
    Background: Depending on their countries of origin, between 12% and 73% of resettled refugees and asylum seekers from endemic countries are infected with schistosomiasis when they arrive in Canada. Many are asymptomatic, but they are at risk for complications that may develop decades later. In Canada, clinicians previously practiced watchful waiting, treating patients if they developed symptoms; but in 2011 new guidelines recommended screening and treatment instead. In the United States, refugees from Africa are presumptively treated for schistosomiasis before they leave their country of origin. The cost-effectiveness of screening or presumptive treatment for schistosomiasis has never been studied. Methods: We constructed a decision-tree model to examine the cost-effectiveness of three management strategies: watchful waiting; screening and treatment; and presumptive treatment. We obtained model data from the literature and other sources, predicting deaths and chronic complications caused by schistosomiasis; as well as costs, and net monetary benefit. Results: Presumptive treatment was cost-saving if the prevalence of schistosomiasis in the target population was greater than 2.4%. In our base case analysis, presumptive treatment was associated with an increase of 0.15 quality-adjusted life years and a cost savings of $383 per person, compared to watchful waiting. It was also more effective and less costly than screening and treatment. Interpretation: Presumptive treatment for schistosomiasis among recently resettled refugees and asylum claimants to Canada is less costly and more effective than watchful waiting or screening and treatment, in groups with prevalence greater than 2.4%. Our results support a revision of the current Canadian guidelines.