CMAJ open最新文献

{"title":"Partnering For Pain: a Priority Setting Partnership to identify patient-oriented research priorities for pediatric chronic pain in Canada.","authors":"K. Birnie, Katherine Dib, Carley Ouellette, Mary Anne Dib, Kimberly Nelson, Dolores Pahtayken, K. Baerg, J. Chorney, P. Forgeron, C. Lamontagne, M. Noel, P. Poulin, J. Stinson","doi":"10.9778/cmajo.20190060","DOIUrl":"https://doi.org/10.9778/cmajo.20190060","url":null,"abstract":"BACKGROUND\u0000Chronic pain affects 1-3 million Canadian children and adolescents and their families. The primary objective of the Partnering For Pain project was to collaboratively identify the top 10 research priorities in pediatric chronic pain.\u0000\u0000\u0000METHODS\u0000Partnering For Pain took a patient-oriented research approach and followed a modified James Lind Alliance Priority Setting Partnership (PSP) to identify the top research priorities in pediatric chronic pain according to people with lived experience (patients), family members and health care providers (clinicians). The PSP was completed in 4 phases between May and December 2018: 1) national survey of stakeholders, including those with lived experience with pediatric chronic pain, family members and clinicians who treat children with chronic pain, to gather priorities, 2) data processing, 3) interim prioritization by invited patients, family members and clinicians (former research participants or identified through pediatric chronic pain programs, patient partner organizations and steering committee member networks) and 4) in-person priority-setting workshop involving patients, family members and clinicians identified via steering committee networks and partner organizations, with evaluation of patient engagement. The process was led by a national steering committee of patient and parent partners, researchers and clinicians engaged in codesign, analysis and translation of project findings.\u0000\u0000\u0000RESULTS\u0000In phase 1, 215 Canadians (86 patients [40.0%], 56 family members [26.0%] and 73 clinicians [34.0%]) submitted 540 potential priorities that were developed into 112 unique research questions (phase 2). Of the 112 questions, 63 were rated for importance by 57 participants (19 patients [33%], 17 family members [30%] and 21 clinicians [37%]) in phase 3. In phase 4, 20 participants (6 patients [30%], 6 family members [30%] and 8 clinicians [40%]) discussed the 25 most highly rated questions and reached consensus on the final top 10.\u0000\u0000\u0000INTERPRETATION\u0000The final priorities address pediatric chronic pain prevention, impact and treatment, as well as delivery, access and coordination of care. The priorities reflect a directed and collaborative call to action to improve existing pediatric pain research and care.\u0000\u0000\u0000PLAIN LANGUAGE SUMMARY\u0000Chronic pain affects 1 in 5 children and teens. This means that 1-3 million Canadian youth deal with pain lasting months to years. This pain gets in the way of being active, sleeping, going to school, and getting along with friends and family. Youth with chronic pain and their families are experts on what it's like to live with pain, but, until now, research has not asked what issues they care about most. The goal of the Partnering For Pain project was to develop a list of the 10 most important things we still need to learn about chronic pain during childhood according to people who live with it, their families and health care providers. We did this in 4 steps: 1) a survey with 215","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20190060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45476764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescription medication nonadherence associated with food insecurity: a population-based cross-sectional study.","authors":"Fei Men,&nbsp;Craig Gundersen,&nbsp;Marcelo L Urquia,&nbsp;Valerie Tarasuk","doi":"10.9778/cmajo.20190075","DOIUrl":"https://doi.org/10.9778/cmajo.20190075","url":null,"abstract":"<p><strong>Background: </strong>Food insecurity, defined as inadequate access to food owing to financial constraints, has been associated with poor disease management. Because cost-related nonadherence to prescription drugs is a possible explanation for such association, we examined the link between food insecurity and cost-related medication nonadherence in Canada.</p><p><strong>Methods: </strong>Drawing on data for adult respondents (age ≥ 18 yr) who participated in the Canadian Community Health Survey 2016 Rapid Response module on prescription medication use, we assessed the association between household food insecurity and cost-related nonadherence to prescription drugs in the previous 12 months. We further examined the self-perceived health consequences of cost-related nonadherence among nonadherents. We applied Poisson models with bootstrap weights adjusting for sociodemographic characteristics.</p><p><strong>Results: </strong>Of the 11 172 respondents in our sample, 930 (8.3%) reported cost-related nonadherence. Food insecurity affected 10.5% (95% confidence interval [CI] 9.1% to 11.8%) of adherents and 47.9% (95% CI 38.1% to 57.7%) of nonadherents. After adjustment for confounders, moderate and severe food insecurity were associated with 3.83 (95% CI 2.44 to 6.03) and 5.05 (95% CI 3.27 to 7.81) times higher prevalence of cost-related nonadherence, respectively, relative to food security. Despite being associated with lower probability of cost-related nonadherence, having drug insurance did not change the relation between food insecurity and cost-related nonadherence (<i>p</i> > 0.1 for all interactions). Severe food insecurity was correlated with higher prevalence of health deterioration and greater use of health care services as perceived consequences of cost-related nonadherence (<i>p</i> < 0.01 for both).</p><p><strong>Interpretation: </strong>Food-insecure adults in Canada have a higher likelihood of cost-related nonadherence to prescription medications than their food-secure counterparts, which may constitute a burden on their health and lead to greater use of health care services.</p>","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20190075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41223661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of chronic kidney disease and cardiovascular comorbidities in adults in First Nations communities in northwest Ontario: a retrospective observational study.","authors":"Len Kelly,&nbsp;Cai-Lei Matsumoto,&nbsp;Yoko Schreiber,&nbsp;Janet Gordon,&nbsp;Hannah Willms,&nbsp;Christopher Olivier,&nbsp;Sharen Madden,&nbsp;Josh Hopko,&nbsp;Sheldon W Tobe","doi":"10.9778/cmajo.20190040","DOIUrl":"https://doi.org/10.9778/cmajo.20190040","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of adult chronic kidney disease and cardiovascular comorbidities in Canadian Indigenous communities is largely unknown. We conducted a study to document the prevalence of chronic kidney disease and concurrent diabetes mellitus, hypertension and dyslipidemia in a First Nations population in northwest Ontario.</p><p><strong>Methods: </strong>In this observational study, we used retrospective data collected from regional electronic medical records of 16 170 adults (age ≥ 18 yr) from 26 First Nations communities in northwest Ontario from May 2014 to May 2017. Demographic and laboratory data included age, gender, prescribed medications, estimated glomerular filtration rate, urine albumin:creatinine ratio, low-density lipoprotein cholesterol (LDL-C) level and glycated hemoglobin (HbA_1c) concentration. We identified patients with diabetes by an HbA_1c concentration of 6.5% or higher, or the use of a diabetic medication, those with dyslipidemia by an elevated LDL-C level (≥ 2.0 mmol/L) or use of lipid-lowering medication, and those with hypertension by use of antihypertensive medication.</p><p><strong>Results: </strong>Of the 16 170 adults residing in the communities, 5224 unique patients (32.3%) had renal testing (albumin:creatinine ratio and/or estimated glomerular filtration rate). The age-adjusted prevalence of chronic kidney disease was 14.5%, and the prevalence of stage 3-5 chronic kidney disease (estimated glomerular filtration rate < 60 mL/min) was 7.0%. Most patients with chronic kidney disease (1487 [80.0%]) had at least 1 cardiovascular comorbidity. A total of 1332 patients (71.6%) had diabetes, 1313 (70.6%) had dyslipidemia, and 1098 (59.1%) had hypertension; all 3 comorbidities were present in 716 patients (38.5%).</p><p><strong>Interpretation: </strong>We document a high prevalence of advanced chronic kidney disease in this First Nations population, 7.0%, double the rate in the general population. High rates of cardiovascular comorbidities were also common in these patients with chronic kidney disease, which places them at increased risk for cardiovascular disease.</p>","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20190040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41223662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demographic characteristics and cost of treatment among oncology patients in a publicly funded system, the Ontario Trillium Drug Program: a retrospective cohort study.","authors":"Stephanie Y Cheng, F. Saxena, S. Seung, C. Earle, Kelvin K. W. Chan, N. Mittmann","doi":"10.9778/cmajo.20190011","DOIUrl":"https://doi.org/10.9778/cmajo.20190011","url":null,"abstract":"BACKGROUND\u0000The aim of this study was to characterize the demographic characteristics and investigate the cost of a publicly funded system, the Ontario Trillium Drug Program (TDP), for an oncology patient population.\u0000\u0000\u0000METHODS\u0000We ascertained all TDP claims between April 1997 and December 2016 from the Ontario Drug Benefit database to assess use and cost. Each drug was classified as a cancer treatment drug, cancer supportive therapy drug or noncancer drug. We also identified a cohort of patients with cancer with least 1 TDP claim, for whom we examined demographic and claims-related characteristics.\u0000\u0000\u0000RESULTS\u0000Over the study period, 50 975 293 TDP claims totalling $4.8 billion were made. Although the proportion of cancer claims among all TDP claims remained constant between 1997 and 2016, the total annual cost of cancer treatment drugs increased nearly 40-fold. Imatinib and lenalidomide together accounted for nearly half of the cost of all cancer treatment drugs. We identified a cohort of 49 892 patients with cancer, of whom 18 631 (37.3%) were enrolled in the TDP before their cancer diagnosis and 31 261 (62.7%) were enrolled after their diagnosis. The former were more likely than the latter to be in lower income quintiles and to have more chronic conditions. Significant differences were also found in the distribution of cancer diagnoses between the 2 groups.\u0000\u0000\u0000INTERPRETATION\u0000In the TDP, use increased over time and differed across cancer diagnoses and drugs. These results have public health and policy implications as antineoplastic drug costs continue to rise and place a burden on patients.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20190011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44955713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access to cannabis retail stores across Canada 6 months following legalization: a descriptive study.","authors":"D. Myran, Catherine R L Brown, P. Tanuseputro","doi":"10.9778/cmajo.20190012","DOIUrl":"https://doi.org/10.9778/cmajo.20190012","url":null,"abstract":"BACKGROUND\u0000On Oct. 17, 2018, Canada legalized recreational cannabis with the dual goals of reducing youth use and eliminating the illicit cannabis market. We examined factors associated with access to physical cannabis stores across Canada 6 months following legalization.\u0000\u0000\u0000METHODS\u0000We extracted the address and operating hours of all legal cannabis stores in Canada from online government and private listings. We conducted a descriptive study examining the association between private/hybrid (mixture of government and private stores) and government-only retail models with 4 measures of physical access to cannabis: store density, weekly hours of operation, median distance to the nearest school and relative availability of cannabis stores between low- and high-income neighbourhoods.\u0000\u0000\u0000RESULTS\u0000Six months after legalization, there were 260 cannabis retail stores across Canada: 181 privately run stores, 55 government-run stores and 24 stores in the hybrid retail system. Compared to jurisdictions with a government-run model, jurisdictions with a private/hybrid retail model had 49% (95% confidence interval 10%-200%) more stores per capita, retailers were open on average 9.2 more hours per week, and stores were located closer to schools (median 166.7 m). In both retail models, there was over twice the concentration of cannabis stores in neighbourhoods in the lowest income quintile compared to the highest income quintile.\u0000\u0000\u0000INTERPRETATION\u0000Marked differences in physical access to cannabis retail are emerging between jurisdictions with private/hybrid retail models and those with government-only retail models. Ongoing surveillance including monitoring differences in cannabis use and harms across jurisdictions is needed.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20190012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44963896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the approaches of non-Indigenous researchers to Indigenous research: a qualitative study.","authors":"Alexandra Kilian, T. K. Fellows, Ryan Giroux, Jason Pennington, A. Kuper, C. Whitehead, Lisa Richardson","doi":"10.9778/cmajo.20180204","DOIUrl":"https://doi.org/10.9778/cmajo.20180204","url":null,"abstract":"BACKGROUND\u0000Given the history of unethical research in Indigenous communities, there is often apprehension among Indigenous communities toward research carried out by non-Indigenous researchers. We examined the approaches, experiences and motivations among non-Indigenous researchers at a research-intensive Canadian university conducting research with Indigenous communities to understand approaches to ethical research with Indigenous peoples.\u0000\u0000\u0000METHODS\u0000We performed a critical constructivist qualitative study incorporating decolonizing methodologies. We conducted semistructured interviews with 8 non-Indigenous University of Toronto researchers with a research focus/interest related to Indigenous health between August and October 2017. The interviews were transcribed and thematically analyzed through an iterative process. Shared experiences among the researchers were arranged into primary themes.\u0000\u0000\u0000RESULTS\u0000We identified 4 primary themes related to the conduct of Indigenous research by non-Indigenous researchers: 1) relationships with communities are foundational to the research process, 2) non-Indigenous researchers experience a personal self-reflective journey grounded in reconciliation, allyship and privilege, 3) accepted knowledge frameworks in Indigenous research are familiar to most but are inconsistently applied and 4) institutions act as barriers to and facilitators of ethical conduct of Indigenous research. Four core principles - relationships, trust, humility and accountability - unified the primary themes.\u0000\u0000\u0000INTERPRETATION\u0000We identified strengths and areas for improvement of current policies and practices in Indigenous research by non-Indigenous researchers. Although non-Indigenous researchers value relationships, and their research is informed by Indigenous knowledge, institutional barriers to implementing recommended elements exist, and certain policy statements such as the Tri-Council Policy Statement 2 lack applicability to secondary data analysis for some non-Indigenous researchers.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20180204","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44406371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast cancer risk and breast screening for trans people: an integration of 3 systematic reviews.","authors":"Olivia Meggetto, L. Peirson, M. Yakubu, Mufiza Farid-Kapadia, Michelle Costa-Fagbemi, S. Baidoobonso, J. Moffatt, Lauren Chun, A. Chiarelli, D. Muradali","doi":"10.9778/cmajo.20180028","DOIUrl":"https://doi.org/10.9778/cmajo.20180028","url":null,"abstract":"BACKGROUND\u0000Trans people face uncertain risk for breast cancer and barriers to accessing breast screening. Our objectives were to identify and synthesize primary research evidence on the effect of cross-sex hormones (CSHs) on breast cancer risk, prognosis and mortality among trans people, the benefits and harms of breast screening in this population, and existing clinical practice recommendations on breast screening for trans people.\u0000\u0000\u0000METHODS\u0000We conducted 2 systematic reviews of primary research, 1 on the effect of CSHs on breast cancer risk, prognosis and mortality, and the other on the benefits and harms of breast screening, and a third systematic review of guidelines on existing screening recommendations for trans people. We searched PubMed, MEDLINE, Embase, CINAHL, the Cochrane Database of Systematic Reviews and grey literature sources for primary research, guidelines and position statements published in English between 1997 and 2017. Citations were screened by 2 independent reviewers. One reviewer extracted data and assessed methodological quality of included articles; a second reviewer verified these in full. The results were synthesized narratively.\u0000\u0000\u0000RESULTS\u0000Four observational studies, 6 guidelines and 5 position statements were included. Observational evidence of very low certainty did not show an effect of CSHs on breast cancer risk in trans men or trans women. Among trans women, painfulness of mammography and ultrasonography was low. There was no evidence on the effect of CSHs on breast cancer prognosis and mortality, or on benefits and other harms of screening. Existing clinical practice documents recommended screening for distinct trans subpopulations; however, recommendations varied.\u0000\u0000\u0000INTERPRETATION\u0000The limited evidence does not show an effect of CSHs on breast cancer risk. Although there is insufficient evidence to determine the potential benefits and harms of breast screening, existing clinical practice documents generally recommend screening for trans people; further large-scale prospective comparative research is needed.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20180028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42902104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unplanned index hospital admissions among new older high-cost health care users in Ontario: a population-based matched cohort study.","authors":"S. Muratov, Justin Lee, A. Holbrook, J. Michael Paterson, J. R. Guertin, L. Mbuagbaw, T. Gomes, W. Khuu, P. Pequeno, J. Tarride","doi":"10.9778/cmajo.20180185","DOIUrl":"https://doi.org/10.9778/cmajo.20180185","url":null,"abstract":"BACKGROUND\u0000Most health care spending is concentrated within a small group of high-cost health care users. To inform health policies, we examined the characteristics of index hospital admissions and their predictors among incident older high-cost users compared to older non-high-cost users in Ontario.\u0000\u0000\u0000METHODS\u0000Using Ontario administrative data, we identified incident high-cost users aged 66 years or more and matched them 1:3 on age, gender and Local Health Integration Network with non-high-cost users aged 66 years or more. We defined high-cost users as patients within the top 5% most costly high-cost users during fiscal year 2013/14 but not during 2012/13. An index hospital admission, the main outcome, was defined as the first unplanned hospital admission during 2013/14, with no hospital admissions in the preceding 12 months. Descriptively, we analyzed the attributes of index hospital admissions, including costs. We identified predictors of index hospital admissions using stratified logistic regression.\u0000\u0000\u0000RESULTS\u0000Over half (95 375/175 847 [54.2%]) of all high-cost users had an unplanned index hospital admission, compared to 8838/527 541 (1.7%) of non-high-cost users. High-cost users had a poorer health status, longer acute length of stay (mean 7.5 d v. 2.9 d) and more frequent designation as alternate level of care before discharge (20.8% v. 1.7%) than did non-high-cost users. Ten diagnosis codes accounted for roughly one-third of the index hospital admission costs in both cohorts. Although many predictors were similar between the cohorts, a lower risk of an index hospital admission was associated with residence in long-term care, attachment to a primary care provider and recent consultation by a geriatrician among high-cost users.\u0000\u0000\u0000INTERPRETATION\u0000The high prevalence of index hospital admissions and the corresponding costs are a distinctive feature of incident older high-cost users. Improved access to specialist outpatient care, home-based social care and long-term care when required are worth further investigation.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20180185","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41991393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of opioid prescribing by dentists in a pediatric population: a retrospective observational study.","authors":"D. Matthews, M. Brillant, K. Jimoh, W. Singleton, Pam R McLean-Veysey, I. Sketris","doi":"10.9778/cmajo.20190021","DOIUrl":"https://doi.org/10.9778/cmajo.20190021","url":null,"abstract":"BACKGROUND\u0000Dentists are regular prescribers of opioid analgesic medications; however, there are few published data on their prescribing practices for children. The aim of this study was to assess opioid prescribing practices of dentists for pediatric patients.\u0000\u0000\u0000METHODS\u0000We conducted a retrospective study (2011/12 to 2017/18) using administrative health data of opioid prescribing practices of dentists in Nova Scotia for children and adolescents (age < 18 yr). The main variables of interest were opioid \"type\" and \"load\" dentists prescribed (number of dispensed prescriptions/yr, days supplied/prescription and dosage/d per prescription in milligrams of morphine equivalents [MME]).\u0000\u0000\u0000RESULTS\u0000Dentists accounted for a mean of 18.3% (standard deviation 1.5%) of all opioid prescribers for the pediatric population annually but were responsible for 59.9% of all opioid prescriptions and 48.6% of total MME dispensed during the 7-year study period. Oral and maxillofacial surgeons were responsible for 80.7% of all dental-related opioids dispensed. Codeine was most frequently prescribed (78.6% of total MME), followed by oxycodone (11.1%). There were significant downward trends over the study period in the total amount of opioid analgesics dispensed (r = -0.903, p < 0.01), primarily due to a reduction in the total amount of codeine dispensed and number of days supplied per prescription (r = -0.837, p < 0.05). Few opioids were dispensed to children less than 12 years.\u0000\u0000\u0000INTERPRETATION\u0000Dentists in Nova Scotia reduced prescriptions of opioids in the pediatric population between 2011/12 and 2017/18, which may indicate that current opioid prescribing principles are influencing dentists' prescribing habits. Nonetheless, patients and parents should receive appropriate counselling as to the proper use, risks, storage and potential for misuse of opioids when prescribed.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20190021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41570441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients' and caregivers' perspectives on factors that influence understanding of and adherence to hospital discharge instructions: a qualitative study.","authors":"Karen Okrainec, Shoshana Hahn-Goldberg, H. Abrams, C. Bell, C. Soong, M. Hart, B. Shea, S. Schmidt, Amy Troup, L. Jeffs","doi":"10.9778/cmajo.20180208","DOIUrl":"https://doi.org/10.9778/cmajo.20180208","url":null,"abstract":"BACKGROUND\u0000Many patients have difficulty understanding and adhering to discharge instructions once home from hospital. We assessed patient and family caregiver perspectives on factors that influence understanding of and adherence to discharge instructions.\u0000\u0000\u0000METHODS\u0000We conducted a qualitative study using semistructured interviews of participants aged 18 years or more enrolled in a multicentre mixed-methods study who were discharged from 3 acute care hospitals across Ontario with a diagnosis of congestive heart failure, chronic obstructive pulmonary disease or pneumonia. Patients were recruited between March and November 2016. We used directed content analysis to derive themes and subthemes.\u0000\u0000\u0000RESULTS\u0000Twenty-seven participants (16 patients and 11 family members) described 5 themes that affected their understanding of and adherence to discharge instructions: 1) the role of caregivers, 2) relationships with inpatient and outpatient health care providers, 3) previous hospital stay, 4) barriers to accessing postdischarge care and 5) system-level processes. Subthemes highlighted the importance participants attributed to who provides the instructions, the development of resilience and advocacy through previous admissions, the benefits of addressing language and physical disability barriers, reviewing instructions in a unhurried manner, and ensuring that written instructions are meaningful and actionable.\u0000\u0000\u0000INTERPRETATION\u0000Care transition interventions targeting improved communication are unlikely to improve understanding of and adherence to discharge instructions on their own. A patient-centred framework that promotes positive relationships with a patient's circle of care, reflects previous experiences with discharge, addresses equity barriers, and enhances strategies for patient and caregiver engagement at the time of discharge may optimize understanding and adherence once the patient is home.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.9778/cmajo.20180208","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46793615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}