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Projecting the Number of Posttransplant Clinic Visits With a Rise in the Number of Kidney Transplants: A Case Study From Ontario, Canada.

ABSTRACT: Background:In Ontario, kidney transplants have risen by 4% annually in recent years. An understanding of how this will affect the future annual number of posttransplant follow-up visits informs how to organize and deliver care. Objective:We projected the required number of annual posttransplant follow-up nephrology visits to inform posttransplant care delivery. Design:Population-based retrospective cohort study. Setting:Linked databases from Ontario, Canada (population 14 million). Patients:Incident kidney transplant recipients from years 2008 to 2013. Measurements:Frequency, distance traveled, and current and projected visits for posttransplant follow-up. Methods:Assuming a graft survival of 13 years and using the mean number of posttransplant clinic visits in years 1, 2, and 3, we forecasted the number of clinic visits needed in the year 2027. Results:Using data from 2443 recipients, the mean (SD) number of clinic visits per recipient was 14.0 (9.2) in the first year after transplant, and 3.9 (6.2) and 3.0 (5.3) in the second and third year, respectively. If transplant rates rise by 4% per year until 2027, the estimated annual visits number will increase from 30 622 to 43 948. The median (25th, 75th percentile) distance between transplant center and patient's home was 30 (13, 65) km. The median round-trip travel distance for these visits in the first year after transplantation was 603 km per recipient, and median driving cost was Can$344 (2017). Limitations:Regarding patient expense, limitations include that distances traveled were calculated orthodromically, and we did not account for patient cost of follow-up beyond that of vehicular travel. Regarding follow-up projections, limitations include the assumption that graft life span will not change, follow-up patterns do not differ between donor kidney type, and we did not survey stakeholders as to their preferred method of follow-up. Conclusion:We quantified the increase in posttransplant visits when regional annual rates of transplantation rise. Strategies recognizing the burden of these visits may enhance patient-centered care, as it is unclear how some patients manage costs, nor how the current health care system will manage the demand.

SUBMITTER: Mann S

PROVIDER: S-EPMC6984421 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Projecting the Number of Posttransplant Clinic Visits With a Rise in the Number of Kidney Transplants: A Case Study From Ontario, Canada.

Mann Shawna S Naylor Kyla L KL McArthur Eric E Kim S Joseph SJ Knoll Greg G Zaltzman Jeffrey J Treleaven Darin D Ouedraogo Alexandra A Jevnikar Anthony A Garg Amit X AX

Canadian journal of kidney health and disease 20200125

<h4>Background</h4>In Ontario, kidney transplants have risen by 4% annually in recent years. An understanding of how this will affect the future annual number of posttransplant follow-up visits informs how to organize and deliver care.<h4>Objective</h4>We projected the required number of annual posttransplant follow-up nephrology visits to inform posttransplant care delivery.<h4>Design</h4>Population-based retrospective cohort study.<h4>Setting</h4>Linked databases from Ontario, Canada (populati ...[more]

PMID: 32047642

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Project description:BackgroundA number of highly effective COVID-19 vaccines have been developed and approved for mass vaccination. We evaluated the impact of vaccination on COVID-19 outbreak and disease outcomes in Ontario, Canada.MethodsWe used an agent-based transmission model and parameterized it with COVID-19 characteristics, demographics of Ontario, and age-specific clinical outcomes. We implemented a two-dose vaccination program according to tested schedules in clinical trials for Pfizer-BioNTech and Moderna vaccines, prioritizing healthcare workers, individuals with comorbidities, and those aged 65 and older. Daily vaccination rate was parameterized based on vaccine administration data. Using estimates of vaccine efficacy, we projected the impact of vaccination on the overall attack rate, hospitalizations, and deaths. We further investigated the effect of increased daily contacts at different stages during vaccination campaigns on outbreak control.ResultsMaintaining non-pharmaceutical interventions (NPIs) with an average of 74% reduction in daily contacts, vaccination with Pfizer-BioNTech and Moderna vaccines was projected to reduce hospitalizations by 27.3% (95% CrI: 22.3% - 32.4%) and 27.0% (95% CrI: 21.9% - 32.6%), respectively, over a one-year time horizon. The largest benefits of vaccination were observed in preventing deaths with reductions of 31.5% (95% CrI: 22.5% - 39.7%) and 31.9% (95% CrI: 22.0% - 41.4%) for Pfizer-BioNTech and Moderna vaccines, respectively, compared to no vaccination. We found that an increase of only 10% in daily contacts at the end of lockdown, when vaccination coverage with only one dose was 6%, would trigger a surge in the outbreak. Early relaxation of population-wide measures could lead to a substantial increase in the number of infections, potentially reaching levels observed during the peak of the second wave in Ontario.ConclusionsVaccination can substantially mitigate ongoing COVID-19 outbreaks. Sustaining population-wide NPIs, to allow for a sufficient increase in population-level immunity through vaccination, is essential to prevent future outbreaks.

Project description:ImportanceMaintaining a healthy physician workforce includes the routine use of primary care physician (PCP) services; however, physicians may face barriers to attaining formal care.ObjectiveTo analyze access to and frequency of visits to PCPs among physicians compared with nonphysicians.Design, setting, and participantsThis population-based, retrospective cohort study used registration data from the College of Physicians and Surgeons of Ontario, Canada, from January 1, 1990, to March 31, 2018. Data for all newly practicing physicians as of March 31, 2018, were linked to Ontario health administrative databases. Data were analyzed from August 25, 2020, to August 6, 2021.Main outcomes and measuresThe main outcomes were enrollment in a PCP practice and visits with a PCP. Generalized estimating equations compared primary care visits between physicians and nonphysicians, matched 1:5 based on age, sex, neighborhood income quintile, and health region.ResultsAmong 19 581 physicians (mean [SD] age, 43.99 [8.94] years; 53.27% male) matched to 97 905 nonphysicians, physicians were less likely to be enrolled with a PCP than were nonphysicians (81.8% vs 86.4%; absolute difference, 4.6%; adjusted odds ratio [OR], 0.75; 95% CI, 0.72-0.79) and had fewer primary care visits during the preceding 2 years (median [IQR], 2 [0-4] vs 4 [1-7]; adjusted relative rate ratio [RRR], 0.59; 95% CI, 0.58-0.60). Physicians aged 40 years or older and male physicians were less likely to be rostered (ages 40-44 years: OR, 0.70 [95% CI, 0.64-0.77]; male: OR, 0.60 [95% CI, 0.57-0.63]) and more likely to have a lower frequency of PCP visits (ages 40-44 years: RRR, 0.53 [95% CI, 0.51-0.56]; male: RRR, 0.50 [95% CI, 0.50-0.51]) compared with nonphysicians.Conclusions and relevanceIn this retrospective cohort study, enrollment with a PCP practice and frequency of visits were lower among physicians compared with a matched general population of nonphysicians. Individual, system, and medical cultural factors associated with these results need to be better understood so that physicians can take better care of themselves and their patients.

Project description:ImportanceOpioids can impair motor skills and may affect the ability to drive; however, the association of opioid use with driving ability is not well established.ObjectiveTo examine the risk of motor vehicle collisions (MVCs) among drivers starting opioid therapy compared with that among drivers starting nonsteroidal anti-inflammatory drug (NSAID) therapy.Design, setting, and participantsThis population-based, retrospective cohort study included all residents of Ontario aged 17 years or older who started new prescription analgesic therapy between March 1, 2008, and March 17, 2019.ExposuresInitiation of opioid therapy or NSAID therapy, ascertained through prescription dispensing records in administrative data.Main outcomes and measuresThe primary outcome was an emergency department visit for injuries sustained as a driver in an MVC during the 14 days after starting analgesic therapy. Inverse probability treatment weighting was used to balance baseline covariates, and weighted Cox proportional hazards regression models were used to assess the association between new analgesic therapy and hazard of an emergency department visit after an MVC.ResultsOf the 1 454 824 individuals included in the study, 765 464 (52.6%) were new opioid recipients and 689 360 (47.4%) were new NSAID recipients. Most participants were aged 65 years or older (75.2%), and 55.2% were women. Of 194 individuals who had emergency department visits for injuries from an MVC within 14 days of initiating therapy, 98 (50.5%) were opioid recipients (3.41 per 1000 person-years; 95% CI, 2.80-4.15 per 1000 person-years) and 96 (49.5%) were NSAID recipients (3.64 per 1000 person-years; 95% CI, 2.98-4.45 per 1000 person-years). There was no significant difference in the risk of an emergency department visit for MVC injuries between opioid and NSAID recipients (weighted hazard ratio, 0.94; 95% CI, 0.70-1.25).Conclusions and relevanceThe findings of this study suggest that the hazard of an emergency department visit for injuries relating to an MVC as a driver is similar between individuals starting prescription opioids and those starting prescription NSAIDs. These results may be useful for patients, clinicians, and caregivers when considering new analgesic therapy.

Project description:ImportancePrior research suggests that the legalization of recreational cannabis is associated with increases in cannabis hyperemesis syndrome (CHS), but it is unclear how cannabis commercialization (ie, greater retail store access as well as increased variety and potency of cannabis products) may be associated with these changes.ObjectivesTo examine changes in the number and characteristics of CHS emergency department (ED) visits from before to after legalization of cannabis in Ontario, Canada.Design, setting, and participantsThis repeated cross-sectional study used interrupted time-series analyses to examine immediate and gradual changes in ED visits for CHS in Ontario, Canada, during 3 time periods: prelegalization (January 2014-September 2018), legalization with product and retail store restrictions (October 2018-February 2020), and commercialization with new products and expanded stores, which coincided with the COVID-19 pandemic (March 2020-June 2021). Data were obtained from routinely collected and linked health administrative databases. All individuals aged at least 15 years and who were eligible for Ontario's Universal Health Coverage were included. Data were analyzed between March and July 2022.Main outcomes and measuresMonthly counts of ED visits for CHS per capita.ResultsThere were 12 866 ED visits for CHS from 8140 individuals during the study. Overall, the mean (SD) age was 27.4 (10.5) years, with 2834 individuals (34.8%) aged 19 to 24 years, 4163 (51.5%) females, and 1353 individuals (16.6%) with a mental health ED visit or hospitalization in the 2 years before their first CHS ED visit. Nearly 10% of visits (1135 visits [8.8%]) led to hospital admissions. Monthly rates of CHS ED visits increased 13-fold during the 7.5-year study period, from 0.26 visits per 100 000 population in January 2014 to 3.43 visits per 100 000 population in June 2021. Legalization was not associated with an immediate or gradual change in rates of ED visits for CHS; however, commercialization during the COVID-19 pandemic period was associated with an immediate increase in rates of CHS ED visits (incidence rate ratio [IRR], 1.49; 95% CI, 1.31-1.70). During commercialization, rates of CHS ED visits increased more in women (IRR, 1.49; 95% CI, 1.16-1.92) and individuals older than the legal age of cannabis purchase (eg, age 19-24 years: IRR, 1.60; 95% CI, 1.19-2.16) than men (IRR, 1.08; 95% CI, 0.85-1.37) and individuals younger than the legal age of purchase (IRR, 0.78; 95% CI, 0.42-1.45).Conclusions and relevanceThis cross-sectional study found large increases in CHS ED visits during the period of time when the market commercialized and the COVID-19 pandemic occurred. Greater awareness of CHS symptoms by ED staff in regions where legal commercialized cannabis markets exist is indicated.

Dataset Information

Projecting the Number of Posttransplant Clinic Visits With a Rise in the Number of Kidney Transplants: A Case Study From Ontario, Canada.

Publications

Projecting the Number of Posttransplant Clinic Visits With a Rise in the Number of Kidney Transplants: A Case Study From Ontario, Canada.

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