Browsing by Author "Sanmartin, Claudia"
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Item Open Access 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, ClaudiaPatients 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.Item Open Access Association of Metabolic Markers with self-reported osteoarthritis among middle-aged BMI-defined non-obese individuals: a cross-sectional study(2018-09-03) Collins, Kelsey H; Sharif, Behnam; Reimer, Raylene A; Sanmartin, Claudia; Herzog, Walter; Chin, Rick; Marshall, Deborah AAbstract Background Osteoarthritis (OA) is a chronic degenerative joint disease. While it is well-established that obesity affects OA through increased axial loading on the joint cartilage, the indirect effect of obesity through metabolic processes among the body mass index (BMI)-defined non-obese population, i.e., BMI < 30 kg/m2, is less known. Our goal was to evaluate the association of metabolic markers including body fat percentage (BF%), waist circumference, maximum weight gain during adulthood and serum creatinine with self-reported OA to establish if such measures offer additional information over BMI among the non-obese population between 40 and 65 years of age. Methods Cross-sectional data from two cycles of the Canadian Health Measures Survey (CHMS) in 2007–2009 and 2009–2011 were analyzed. Sex-specific logistic regression models were developed to evaluate the association of self-reported OA with metabolic markers. Models were separately adjusted for age, BMI categories and serum creatinine, and a stratified analysis across BM categories was performed. In a secondary analysis, we evaluated the association of self-reported OA, cardiovascular diseases and hypertension across BF% categories. Results Of 2462 individuals, 217 (8.8%) self-reported OA. After adjusting for age and BMI, those within BF%-defined overweight/obese category had 2.67 (95% CI: 1.32–3.51) and 2.11(95% CI: 1.38–3.21) times higher odds of reporting self-reported OA compared to those within BF%-defined athletic/acceptable category for females and males, respectively. BF% was also significantly associated with self-reported OA after adjusting for age and serum creatinine only among females (OR: 1.47, 95%CI: 1.12–1.84). Furthermore, among the BMI-defined overweight group, the age-adjusted odds of self-reported OA was significantly higher for overweight/obese BF% compared to athletic/acceptable BF% in both females and males. In a secondary analysis, we showed that the association of self-reported OA and hypertension/cardiovascular diseases is significantly higher among BF% overweight/obese (OR: 1.37, 95%CI: 1.19–3.09) compared to BF% athletic/acceptable (OR: 1.13, 95%CI: 0.87–2.82). Conclusion Our results provide corroborating evidence for a relationship between body fat and OA in a population-based study, while no significant independent correlates were found between other metabolic markers and OA prevalence. Future investigation on the longitudinal relationship between BF and OA among this sub-population may inform targeted prevention opportunities.Item Open Access Financial barriers and adverse clinical outcomes among patients with cardiovascular-related chronic diseases: a cohort study(2017-02-15) Campbell, David J T; Manns, Braden J; Weaver, Robert G; Hemmelgarn, Brenda R; King-Shier, Kathryn M; Sanmartin, ClaudiaAbstract Background Some patients with cardiovascular-related chronic diseases such as diabetes and heart disease report financial barriers to achieving optimal health. Previous surveys report that the perception of having a financial barrier is associated with self-reported adverse clinical outcomes. We sought to confirm these findings using linked survey and administrative data to determine, among patients with cardiovascular-related chronic diseases, if there is an association between perceived financial barriers and the outcomes of: (1) disease-related hospitalizations, (2) all-cause mortality and (3) inpatient healthcare costs. Methods We used ten cycles of the nationally representative Canadian Community Health Survey (administered between 2000 and 2011) to identify a cohort of adults aged 45 and older with hypertension, diabetes, heart disease or stroke. Perceived financial barriers to various aspects of chronic disease care and self-management were identified (including medications, healthful food and home care) from the survey questions, using similar questions to those used in previous studies. The cohort was linked to administrative data sources for outcome ascertainment (Discharge Abstract Database, Canadian Mortality Database, Patient Cost Estimator). We utilized Poisson regression techniques, adjusting for potential confounding variables (age, sex, education, multimorbidity, smoking status), to assess for associations between perceived financial barriers and disease-related hospitalization and all-cause mortality. We used gross costing methodology and a variety of modelling approaches to assess the impact of financial barriers on hospital costs. Results We identified a cohort of 120,752 individuals over the age of 45 years with one or more of the following: hypertension, diabetes, heart disease or stroke. One in ten experienced financial barriers to at least one aspect of their care, with the two most common being financial barriers to accessing medications and healthful food. Even after adjustment, those with at least one financial barrier had an increased rate of disease-related hospitalization and mortality compared to those without financial barriers with adjusted incidence rate ratios of 1.36 (95% CI: 1.29–1.44) and 1.24 (1.16–1.32), respectively. Furthermore, having a financial barrier to care was associated with 30% higher inpatient costs compared to those without financial barriers. Discussion This study, using novel linked national survey and administrative data, demonstrates that chronic disease patients with perceived financial barriers have worse outcomes and higher resource utilization, corroborating the findings from prior self-report studies. The overall exposure remained associated with the primary outcome even in spite of adjustment for income. This suggests that a patient’s perception of a financial barrier might be used in clinical and research settings as an additional measure along with standard measures of socioeconomic status (ie. income, education, social status). Conclusions After adjusting for relevant covariates, perceiving a financial barrier was associated with increased rates of hospitalization and mortality and higher hospital costs compared to those without financial barriers. The demonstrable association with adverse outcomes and increased costs seen in this study may provide an impetus for policymakers to seek to invest in interventions which minimize the impact of financial barriers.Item Open Access Wait time management strategies for total joint replacement surgery: sustainability and unintended consequences(2017-09-07) Pomey, Marie-Pascale; Clavel, Nathalie; Amar, Claudia; Sabogale-Olarte, Juan C; Sanmartin, Claudia; De Coster, Carolyn; Noseworthy, Tom