Assessing the Impact of Financial Barriers on Care and Outcomes for Patients with Cardiovascular-Related Chronic Diseases
AuthorCampbell, David John Thomas
Committee MemberHemmelgarn, Brenda
Access to Care
Barriers to Care
SubjectSocial Structure and Development
Health Care Management
Medicine and Surgery
MetadataShow full item record
AbstractPatients 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.
CitationCampbell, D. J. (2017). Assessing the Impact of Financial Barriers on Care and Outcomes for Patients with Cardiovascular-Related Chronic Diseases (Unpublished doctoral thesis). University of Calgary, Calgary, AB. doi:10.11575/PRISM/25022
University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.