Smoking inside Canadian acute care hospitals

OBJECTIVE:

To assess smoking policies at Canadian acute care hospitals.

METHOD:

A questionnaire was designed, piloted and faxed to all acute care hospitals in Canada. The questionnaire was designed to address the following: what is the current policy regarding patient smoking? Are staff and/or visitors allowed to smoke inside the hospital? Is there a separate policy for psychiatric patients? Are smoking cessation products available at the hospital pharmacy? Is the policy governed by regional or municipal legislation?

RESULTS:

A total of 852 hospitals were included in the study. Of these, 476 responded to the questionnaire, for an overall response rate of 56%. Twenty-seven per cent of respondents allowed patient smoking inside the hospital. While staff smoking was not allowed inside most hospitals (93%), 32% of hospitals in Quebec allowed staff to smoke inside the building. Thirty per cent of hospitals had a separate policy for psychiatric patients, and 27% of hospitals had provisions for visitor smoking. Sixty-seven per cent of hospitals were able to offer patients smoking cessation products while they were in hospital.

CONCLUSIONS:

Many Canadian hospitals continue to allow smoking inside their facilities. There is considerable variation in hospital smoking policies across the country.     

Management of atherothrombotic risk factors in high-risk Canadian outpatients

BACKGROUND:

The REduction of Atherothrombosis for Continued Health (REACH) Registry is an international, prospective cohort of 68,236 patients with established coronary artery, cerebrovascular or peripheral arterial disease, or three or more atherothrombotic risk factors. Baseline data from the 1976 Canadian patients in the REACH Registry provide opportunities to assess atherothrombotic risk and treatment in a real-world Canadian setting.

OBJECTIVES:

To present baseline characteristics of Canadian REACH Registry patients, and to compare cardiovascular risk and treatment among Canadian, United States (USA) and global patients.

METHODS:

Patients 45 years of age or older with established atherosclerotic vascular disease or three or more cardiovascular risk factors were enrolled during 2004. Baseline data were used in analyses of risk factor prevalence and control and medication use. Comparisons between the Canadian and USA populations, Canadian and global populations, and the Canadian regions were conducted.

RESULTS:

Of the 1976 Canadian REACH patients, 82.5% had documented vascular disease, 12.6% of whom had manifestations in more than one vascular bed (polyvascular disease). A high prevalence of hypercholesterolemia (84.4%), hypertension (76.6%) and diabetes mellitus (43.7%) were noted, and 75.1% of patients were overweight or obese. Of the 1976 Canadian REACH patients, 75.1% were at target cholesterol levels, 67.4% were at target fasting blood glucose levels and 60.6% were at target blood pressure levels. Significant differences existed in the prevalence of risk factors and their management among Canadian, USA and global REACH populations, as well as within Canada.

CONCLUSIONS:

Canada compared favourably with USA and global REACH populations in the use of proven risk-reducing medications.     

Inflammatory bowel disease: A Canadian burden of illness review

BACKGROUND:

Inflammatory bowel diseases (IBD) – Crohn’s disease (CD) and ulcerative colitis (UC) – significantly impact quality of life and account for substantial costs to the health care system and society.

OBJECTIVE:

To conduct a comprehensive review and summary of the burden of IBD that encompasses the epidemiology, direct medical costs, indirect costs and humanistic impact of these diseases in Canada.

METHODS:

A literature search focused on Canadian data sources. Analyses were applied to the current 2012 Canadian population.

RESULTS:

There are approximately 233,000 Canadians living with IBD in 2012 (129,000 individuals with CD and 104,000 with UC), corresponding to a prevalence of 0.67%. Approximately 10,200 incident cases occur annually. IBD can be diagnosed at any age, with typical onset occurring in the second or third decade of life. There are approximately 5900 Canadian children <18 years of age with IBD. The economic costs of IBD are estimated to be $2.8 billion in 2012 (almost $12,000 per IBD patient). Direct medical costs exceed $1.2 billion per annum and are driven by cost of medications ($521 million), hospitalizations ($395 million) and physician visits ($132 million). Indirect costs (society and patient costs) total $1.6 billion and are dominated by long-term work losses of $979 million. Compared with the general population, the quality of life patients experience is low across all dimensions of health.

CONCLUSIONS:

The present review documents a high burden of illness from IBD due to its high prevalence in Canada combined with high per-patient costs. Canada has among the highest prevalence and incidence rates of IBD in the world. Individuals with IBD face challenges in the current environment including lack of awareness of IBD as a chronic disease, late or inappropriate diagnosis, inequitable access to health care services and expensive medications, diminished employment prospects and limited community-based support.     

Second-hand smoke exposure in Canada: Prevalence, risk factors, and association with respiratory and cardiovascular diseases

OBJECTIVES:

The aims of the present study were to estimate the prevalence of second-hand smoke exposure in Canada, to identify sociodemographic risk factors for second-hand smoke exposure, and to examine the relationship between second-hand smoke exposure and respiratory and cardiovascular diseases.

METHODS:

Data from the 2000/2001 Statistics Canada Canadian Community Health Survey (n=130,880, aged 12 years or older) were analyzed. Second-hand smoke exposure was based on self-report within the past month. The presence of chronic health conditions was also based on self-report. Because ex-smokers would be expected a priori to have poorer health than never-smokers, the analysis was stratified by previous smoking status.

RESULTS:

Approximately 25% of never-smokers and 30% of ex-smokers self-reported recent second-hand smoke exposure. The following factors were identified as risk factors for second-hand smoke exposure: men; residences in Quebec, Atlantic Canada and the Territories; younger ages; nonimmigrant status; low education and income levels; social assistance receipt; and households without children younger than 12 years of age. After controlling for potential confounders, both never- and ex-smokers exposed to second-hand smoke had significantly higher odds of self-reporting asthma (20% to 30%) and chronic bronchitis (50%) than those not exposed to secondhand smoke. Among ex-smokers, those exposed to second-hand smoke also had significantly higher odds of self-reporting hypertension (20%) than those not exposed to second-hand smoke. No associations were observed between second-hand smoke exposure and emphysema or heart disease.

CONCLUSIONS:

Self-reported recent second-hand smoke exposure in Canada in 2000/2001 was high, and was associated with asthma, chronic bronchitis and hypertension in never- and ex-smokers. Potential causal associations and public health implications warrant additional research.     

The effects of outdoor air pollution on the respiratory health of Canadian children: A systematic review of epidemiological studies

BACKGROUND:

Outdoor air pollution is a global problem with serious effects on human health, and children are considered to be highly susceptible to the effects of air pollution.

OBJECTIVE:

To conduct a comprehensive and updated systematic review of the literature reporting the effects of outdoor air pollution on the respiratory health of children in Canada.

METHODS:

Searches of four electronic databases between January 2004 and November 2014 were conducted to identify epidemiological studies evaluating the effect of exposure to outdoor air pollutants on respiratory symptoms, lung function measurements and the use of health services due to respiratory conditions in Canadian children. The selection process and quality assessment, using the Newcastle-Ottawa Scale, were conducted independently by two reviewers.

RESULTS:

Twenty-seven studies that were heterogeneous with regard to study design, population, respiratory outcome and air pollution exposure were identified. Overall, the included studies reported adverse effects of outdoor air pollution at concentrations that were below Canadian and United States standards. Heterogeneous effects of air pollutants were reported according to city, sex, socioeconomic status and seasonality. The present review also describes trends in research related to the effect of air pollution on Canadian children over the past 25 years.

CONCLUSION:

The present study reconfirms the adverse effects of outdoor air pollution on the respiratory health of children in Canada. It will help researchers, clinicians and environmental health authorities identify the available evidence of the adverse effect of outdoor air pollution, research gaps and the limitations for further research.     

Prevalence,risk factors,activity limitation and health care utilization of an obese population-based sample with chronic obstructive pulmonary disease

OBJECTIVE:

To estimate the prevalence and determine the risk factors and health associations among individuals with combined chronic obstructive pulmonary disease and obesity.

METHODS:

Canadian national health survey data from 1994 to 2007 (n=650,000) were used. The presence of COPD was based on health professional-diagnosed self-report. The presence of obesity, defined by body mass index ≥30 kg/m², was identified using self-reported and measured height and weight. Hospitalization, homecare use, physical activity assessments and socioeconomic data were all self-reported.

RESULTS:

In 2005, the prevalence of obesity in COPD (n=3470) and non-COPD (n=92,237) individuals was 24.6% and 17.1%, respectively (P<0.0001). In contrast to the non-COPD group, in which obesity prevalence increased by 38% over 14 years, obesity prevalence increased by only 5% in people with COPD over this same time period. Female sex was the only independent risk factor for obesity in COPD. Previous smoking, residing in Atlantic Canada and the Territories, and low education level were independent risk factors for obesity in the non-COPD group, but not in the COPD group. The odds of physical activity limitation and health care utilization were significantly higher among obese individuals with COPD compared with nonobese COPD and obese non-COPD groups.

CONCLUSIONS:

The prevalence of obesity was higher in COPD, and exceeded that of the larger non-COPD group throughout the 13-year observation period. The presence of obesity in COPD was associated with significantly higher risk of severe activity limitation and increased health care utilization. The combination of obesity and COPD has major implications for health care delivery that has not been previously appreciated.     

Opposing trends in the prevalence of health professional-diagnosed asthma by sex: A Canadian National Population Health Survey study

BACKGROUND:

The prevalence of asthma is on the rise worldwide, with large variations in prevalence existing between and within countries. Little is known regarding the variation in asthma prevalence in adults living in rural and urban settings.

OBJECTIVES:

Using questionnaire data from the Canadian National Population Health Survey, the prevalence of asthma at four time periods (1994/1995 [cycle 1], 1996/1997 [cycle 2], 1998/1999 [cycle 3] and 2000/2001 [cycle 4]) was compared between rural and urban populations stratified by sex, smoking status and age group. Asthma was defined as a positive response to the question: “Do you have asthma diagnosed by a health professional?”

METHODS:

To account for the complexity of the survey design, the bootstrap method was used to calculate prevalences and 95% CIs.

RESULTS:

Overall, the prevalence of asthma increased from 7.3% (cycle 1) to 7.5% (cycle 4). After stratifying by sex, the asthma prevalence decreased among men, but in women, there was a steady increase. Asthma prevalence increased for both the rural population and the urban population. After stratifying each cycle by sex and location (rural or urban), both rural and urban men showed a decrease in asthma prevalence. On dividing according to age groups (0 to 14 years, 15 to 34 years, 35 to 64 years, and 65 years and older), the prevalence of asthma was greatest in the 15- to 34-year age group of urban and rural women.

CONCLUSIONS:

Asthma prevalence increased among rural and urban women. The prevalence of asthma was highest among female smokers and male nonsmokers when stratified by smoking status. Based on these findings, the rate of increase in asthma prevalence is different for men and women.     

Home blood pressure monitoring among Canadian adults with hypertension: Results from the 2009 Survey on Living with Chronic Diseases in Canada

BACKGROUND:

Canadians with hypertension are recommended to use home blood pressure monitoring (HBPM) on a regular basis.

OBJECTIVES:

To characterize the use of HBPM among Canadian adults with hypertension.

METHODS:

Respondents to the 2009 Survey on Living with Chronic Diseases in Canada who reported diagnosis of hypertension by a health professional (n=6142) were asked about blood pressure monitoring practices, sociodemographic characteristics, management of hypertension and blood pressure control.

RESULTS:

Among Canadian adults with hypertension, 45.9% (95% CI 43.5% to 48.3%) monitor their own blood pressure at home, 29.7% (95% CI 41.1% to 46.3%) receive health professional instruction and 35.9% (95% CI 33.5% to 38.4%) share the results with their health professional. However, fewer than one in six Canadian adults diagnosed with hypertension monitor their own blood pressure at home regularly, with health professional instruction, and communicate results to a health professional. Regular HBPM was more likely among older adults (45 years of age and older); individuals who believed they had a plan for how to control their blood pressure; and those who had been shown how to perform HBPM by a health professional – with the latter factor most strongly associated with regular HBPM (prevalence rate ratio 2.8; 95% CI 2.4 to 3.4).

CONCLUSIONS:

Although many Canadians with hypertension measure their blood pressure between health care professional visits, a minority do so according to current recommendations. More effective knowledge translation strategies are required to support self-management of hypertension through home measurement of blood pressure.     

Digestive symptoms in older adults: Prevalence and associations with institutionalization and mortality

BACKGROUND:

Digestive symptoms are common in adults. However, little is known about their prevalence in older adults and the association of digestive symptoms with institutionalization and mortality in community-dwelling older adults.

OBJECTIVE:

To determine the prevalence of digestive symptoms among older adults in Canada and whether they are associated with increased risk of institutionalization and mortality, independent of the effect of potential confounders.

METHODS:

The present study was a secondary analysis of data collected from community-dwelling participants 65 years of age and older in the Canadian Study of Health and Aging. Measures incuded age, sex, presence of digestive symptoms, cognition, impairment in activities of daily living (ADL) and self-reported health. Outcome measures included death or institutionalization over the 10 years of follow-up.

RESULTS:

Digestive symptoms were found in 2288 (25.6%) of the 8949 subjects. Those with digestive symptoms were older, with a mean difference in age of six months (P=0.007). Digestive symptoms were more common among women (28.4%) than men (20.3%), among individuals with poor self-reported health and those with an increased number of impairments in their ADLs (P<0.001). The presence of digestive symptoms was associated with higher mortality (HR 1.15 [95% CI 1.05 to 1.25] adjusted for age, sex, cognitive function and ADL impairment); however, this association was not statistically significant after adjusting for self-reported health.

CONCLUSION:

Although digestive symptoms were associated with increased mortality independent of age and sex, cognition and function, this association was largely explained by poor self-assessed health. Digestive symptoms were not associated with institutionalization     

The determinants of chronic bronchitis in Aboriginal children and youth

BACKGROUND:

There is limited knowledge concerning chronic bronchitis (CB) in Canadian Aboriginal peoples.

OBJECTIVE:

To determine the prevalence (crude and adjusted) of CB and its associated risk factors in Canadian Aboriginal children and youth six to 14 years of age.

METHODS:

Data from the cross-sectional Aboriginal Peoples Survey were analyzed in the present study. Logistic regression analysis was used to determine risk factors influencing the prevalence of CB among Aboriginal children and youth. The balanced repeated replication method was used to compute standard errors of regression coefficients to account for clustering inherent in the study design. The outcome of interest was based on the question: “Have you been told by a doctor, nurse or other health professional that you have chronic bronchitis?” Demographics, environment and population characteristics (predisposing and enabling resources) were tested for an association with CB.

RESULTS:

The prevalence of CB was 3.1% for boys and 2.8% for girls. Other significant risk factors of CB were age (OR 1.38 [95% CI 1.24 to 1.52] for 12 to 14 year olds versus six to eight year olds), income (OR 2.28 [95% CI 2.02 to 2.59] for income category <$25,000/year versus ≥$85,000/year), allergies (OR 1.96 [95% CI 1.78 to 2.16] for having allergies versus no allergies), asthma (OR 7.61 [ 95% CI 6.91 to 8.37] for having asthma versus no asthma) and location of residence (rural/urban and geographical location). A significant two-way interaction between sex and body mass index indicated that the relationship between the prevalence of CB and body mass index was modified by sex.

DISCUSSION:

The prevalence of CB was related to well-known risk factors among adults, including older age and lower annual income.     

Epidemiological and economic burden of pneumococcal diseases in Canadian children

BACKGROUND:

With the arrival of a new conjugate pneumococcal vaccine, it is important to estimate the burden of pneumococcal diseases in Canadian children. The epidemiological data and the economic cost of these diseases are crucial elements in evaluating the relevance of a vaccination program.

METHODS:

Using provincial databases, ad hoc surveys and published data, age-specific incidence rates of pneumococcal infections were estimated in a cohort of 340,000 children between six months and nine years of age. The costs of these diseases to the health system and to families were also evaluated using data from Quebec and Manitoba.

RESULTS:

Cumulative risks were one in 5000 for pneumococcal meningitis, one in 500 for bacteremia and one in 20 for pneumonia, leading to 16 deaths in the cohort. About 262,000 otitis media episodes and 32,000 cases of myringotomy with ventilation tube insertion were attributable to Streptococcus pneumoniae. Societal costs were estimated at $125 million, of which 32% was borne by the health system and 68% was borne by families. Invasive infections represented only 2% of total costs, while 84% were generated by otitis media.

CONCLUSION:

Pneumococcal infections represent a significant burden for Canadian children and society that could be significantly reduced through immunization. Key Words: Canada, Economics, Epidemiology, Pneumococcal infectionsStreptococcus pneumoniae is an important cause of serious illness in young children in developed countries (1). A 7-valent pneumococcal conjugate vaccine (PCV-7) has recently been licensed in Canada. This vaccine is now being used in publicly funded programs for all children in Alberta and Nunavut. Some Canadian provinces (Quebec, Prince Edward Island and Saskatchewan) have implemented programs limited to some high-risk groups and others are still considering its use in their provincial programs (2,3). Evaluation of the epidemiological and economic burden of pneumococcal disease is an important criterion in decision making and is a prerequisite for the analysis of the cost-effectiveness of routine and catch-up immunization programs. Epidemiological data collected in the United States may not be valid for Canada because of possible differences in the prevalence of risk factors. Extrapolation is even more problematic for economic parameters because of variations in the composition of families, availability of natural caregivers, employment rates, incomes and costs of health services. The aim of this study is to estimate the incidence and societal costs of pneumococcal disease in Canadian children between six months and nine years of age.     

Management of hepatitis B: a longitudinal national survey - impact of the Canadian Hepatitis B Consensus Guidelines

BACKGROUND:

The Canadian Association for the Study of the Liver, and The Association of Medical Microbiology and Infectious Diseases Canada, jointly developed the Canadian Chronic Hepatitis B (HBV) Consensus Guidelines to assist practitioners involved in the management of this complex disease. These guidelines were published in The Canadian Journal of Gastroenterology in June 2007 and distributed to all Canadian gastroenterologists and hepatologists.

OBJECTIVE:

To assess the degree to which Canadian specialist physicians were able to incorporate the recommendations from the Canadian HBV Consensus Guidelines into their daily practice.

METHODS:

A 30 min telephone survey probing the management strategies of 80 key HBV specialists was completed on three occasions, eight months apart, to longitudinally assess the impact of the Canadian HBV Consensus Guidelines on the management of HBV. The questionnaire detailed HBV practice patterns, the impact of the Canadian HBV Consensus Guidelines on clinical practice and HBV management.

RESULTS:

The majority of specialists incorporated many of the published recommendations outlined in the Canadian HBV Consensus Guidelines into their daily practice for patients with HBV. However, because public drug coverage is a major hurdle in the management of HBV, patients are provided markedly different HBV treatments depending on whether they have public or private drug insurance coverage.

CONCLUSIONS:

The management of HBV is growing in complexity and continues to evolve rapidly. The Canadian HBV Consensus Guidelines have served as a valuable tool for many physicians in the management of HBV. However, effective treatment algorithms continue to be rendered irrelevant by restrictive drug coverage issues. Coverage for effective therapies and, therefore, management of HBV, differs widely across Canada depending on therapy reimbursement criteria rather than patient characteristics.     

Prevalence of antimicrobial use in a network of Canadian hospitals in 2002 and 2009

BACKGROUND:

Increasing antimicrobial resistance has been identified as an important global health threat. Antimicrobial use is a major driver of resistance, especially in the hospital sector. Understanding the extent and type of antimicrobial use in Canadian hospitals will aid in developing national antimicrobial stewardship priorities.

METHODS:

In 2002 and 2009, as part of one-day prevalence surveys to quantify hospital-acquired infections in Canadian Nosocomial Infection Surveillance Program hospitals, data were collected on the use of systemic antimicrobial agents in all patients in participating hospitals. Specific agents in use (other than antiviral and antiparasitic agents) on the survey day and patient demographic information were collected.

RESULTS:

In 2002, 2460 of 6747 patients (36.5%) in 28 hospitals were receiving antimicrobial therapy. In 2009, 3989 of 9953 (40.1%) patients in 44 hospitals were receiving antimicrobial therapy (P<0.001). Significantly increased use was observed in central Canada (37.4% to 40.8%) and western Canada (36.9% to 41.1%) but not in eastern Canada (32.9% to 34.1%). In 2009, antimicrobial use was most common on solid organ transplant units (71.0% of patients), intensive care units (68.3%) and hematology/oncology units (65.9%). Compared with 2002, there was a significant decrease in use of first-and second-generation cephalosporins, and significant increases in use of carbapenems, antifungal agents and vancomycin in 2009. Piperacillin-tazobactam, as a proportion of all penicillins, increased from 20% in 2002 to 42.8% in 2009 (P<0.001). There was a significant increase in simultaneous use of >1 agent, from 12.0% of patients in 2002 to 37.7% in 2009.

CONCLUSION:

From 2002 to 2009, the prevalence of antimicrobial agent use in Canadian Nosocomial Infection Surveillance Program hospitals significantly increased; additionally, increased use of broad-spectrum agents and a marked increase in simultaneous use of multiple agents were observed.     

Assessing response to therapy in idiopathic pulmonary arterial hypertension: a consensus survey of Canadian pulmonary hypertension physicians

BACKGROUND:

Many treatment options are now available for patients with idiopathic pulmonary arterial hypertension (IPAH). Data regarding the optimal combination of therapies are lacking, as is consensus on how to assess response to therapy and when to change therapeutic regimens.

OBJECTIVES:

To gather the opinions of Canadian pulmonary hypertension (PH) experts regarding standard practice in the care of IPAH patients after therapy is initiated.

METHODS:

Canadian PH physicians were surveyed using short questionnaires to assess their opinions and practices in the care of IPAH patients. A Delphi forecasting approach was used to gain consensus among Canadian physicians on the most important clinical parameters to consider when assessing patients after the initiation of therapy.

RESULTS:

Twenty-six of 37 Canadian PH experts who were invited to participate completed the study. All endorsed the use of combination therapy for IPAH patients despite the lack of universal provincial coverage for this approach. By consensus, WHO functional class, 6 min walk distance and hospitalization for right heart failure were the most important clinical parameters. The most highly rated physical examination parameters were jugular venous pressure, peripheral edema, the presence of ascites and body weight.

CONCLUSIONS:

The overall approach to care of IPAH patients is similar across PH centres in Canada. A limited number of clinical and physical examination parameters were considered to be most important to reassess patients after therapy is initiated. These parameters, along with definition of threshold values, will facilitate the development of standard practice guidelines for IPAH patients in Canada.     

Comparison of Canadian versus United States emergency department visits for chronic obstructive pulmonary disease exacerbation

INTRODUCTION:

Despite the frequency of emergency department (ED) visits for chronic obstructive pulmonary disease (COPD) exacerbation, little is known about practice variation in EDs.

OBJECTIVES:

To examine the differences between Canadian and United States (US) COPD patients, and the ED management they receive.

METHODS:

A prospective multicentre cohort study was conducted involving 29 EDs in the US and Canada. Using a standard protocol, consecutive ED patients with COPD exacerbations were interviewed, their charts reviewed and a two-week telephone follow-up completed. Comparisons between Canadian and US patients, as well as their treatment and outcomes, were made. Predictors of antibiotic use were determined by multivariate logistic regression.

RESULTS:

Of 584 patients who had physician-diagnosed COPD, 397 (68%) were enrolled. Of these, 63 patients (16%) were from Canada. Canadians were older (73 years versus 69 years; P=0.002), more often white (97% versus 65%; P<0.001), less educated (P=0.003) and more commonly insured (P<0.001) than the US patients. US patients more commonly used the ED for their usual COPD medications (17% versus 3%; P=0.005). Although Canadian patients had fewer pack-years of smoking (45 pack-years versus 53 pack-years; P=0.001), current COPD medications and comorbidities were similar. At ED presentation, Canadian patients were more often hypoxic and symptomatic. ED treatment with inhaled beta-agonists (approximately 90%) and systemic corticosteroids (approximately 65%) were similar; Canadians received more antibiotics (46% versus 25%; P<0.001) and other treatments (29% versus 11%; P=0.002). Admission rates were similar in both countries (approximately 65%), although Canadian patients remained in the ED longer than the US patients (10 h versus 5 h, respectively; P<0.001).

CONCLUSIONS:

Overall, patients with acute COPD in Canada and the US appear to have similar history, ED treatment and outcomes; however, Canadian patients are older and receive more aggressive treatment in the ED. In both countries, the prolonged length of stay and high admission rate contribute to the ED overcrowding crisis facing EDs.     

2006 Ontario Survey on the Prevalence and Control of Hypertension (ON-BP): rationale and design of a community-based cross-sectional survey

BACKGROUND:

The presently available Canadian data, based on direct measurements of blood pressure (BP) from the Canadian Heart Health Surveys, are more than 15 years old. In view of major changes in the demographics and health status of the Ontario population, there is an urgent need to update this information. On the initiative of the Heart and Stroke Foundation of Ontario, the University of Ottawa Heart Institute, jointly with Statistics Canada, designed and implemented a population-based cross-sectional survey of hypertension in the Province of Ontario: the 2006 Ontario Survey on the Prevalence and Control of Hypertension (ON-BP).

OBJECTIVES:

To establish the prevalence of hypertension in the Ontario adult population between the ages of 20 and 79 years; to assess the awareness, current status and management of hypertension; and to gather respondent information about sex, age, physical measurements, personal health practices, socioeconomic measures, ethnicity and comorbidities.

METHODS:

The present paper describes the background history and the successive steps undertaken during the implementation of this project.

CONCLUSIONS:

The authors’ experiences from the ON-BP indicate that close co-operation between research scientists, statisticians, governmental and nongovernmental organizations – in the present case, the Heart and Stroke Foundation of Ontario – is essential to conduct a successful, large-scale survey of BP distribution.     

Past,present and future of respiratory research: A survey of Canadian health care professionals

BACKGROUND:

The Canadian Respiratory Health Professionals (CRHP) is the multidisciplinary health care professional group of the Canadian Lung Association. Although the CRHP has a growing number of highly qualified researchers, the landscape of their research in Canada has not been described.

OBJECTIVES:

To describe the level of respiratory research engagement; identify barriers and facilitators to research engagement; describe the experience and interest in developing research skills; and identify priority areas of future respiratory research among health care professionals.

METHODS:

An online survey of CRHP members was used to collect demographic information; barriers and facilitators to conducting research; future directions in respiratory research; and research funding and mentorship. Experience with and interest in ‘upskilling’ research skills were also evaluated.

RESULTS:

A total of 119 surveys were completed (22% response rate), of which 69 (58%) respondents were engaged in respiratory research. Reasons for not being involved in respiratory research were lack of mentorship, support and funding. The top research areas were chronic obstructive pulmonary disease (74%) and asthma (41%). The top facilitators for research engagement were amount of funding (29%) and mentorship (28%). Respondents in research positions rated their experience in research skills as high; those in nonresearch positions as low. However, both groups expressed interest in improving their research skills.

CONCLUSIONS:

Areas of development, such as research skills, greater funding opportunities and mentorship to increase the research capacity of health care professionals in respiratory health were identified. Health professional researchers have an important role in the national respiratory research strategy to increase interdisciplinary engagement and build collaborative teams.     

Comparison of Canadian versus American emergency department visits for acute asthma

BACKGROUND:

Acute asthma is a common emergency department (ED) presentation in both Canada and the United States.

OBJECTIVE:

To compare ED asthma management and outcomes between Canada and the United States.

MEHODS:

A prospective cohort study of 69 American and eight Canadian EDs was conducted. Patients aged two to 54 years who presented with acute asthma underwent a structured ED interview and telephone follow-up two weeks later.

RESULTS:

A total of 3031 patients were enrolled. Canadian patients were more likely to be white (89% versus 22%; P<0.001), have health insurance (100% versus 69%; P<0.001) and identify a primary care provider (89% versus 64%; P<0.001) than American patients. In addition, Canadian patients were more likely to be using inhaled corticosteroids (63% versus 44%; P<0.001) and had higher initial peak expiratory flow (61% versus 48%; P<0.001). In the ED, Canadians received fewer beta-agonist (one versus two; P<0.001) and more anticholinergic (two versus one; P<0.001) treatments in the first hour; use of systemic corticosteroids was similar (60% versus 68%; P=0.13). Canadians were less likely to be hospitalized (11% versus 21%; P=0.02). Corticosteroids were prescribed similarly at discharge (60% versus 69%; P=0.13); however, Canadians were discharged more commonly on inhaled corticosteroids (63% versus 11%; P<0.001) and relapses were similar.

CONCLUSIONS:

Canadian patients with acute asthma have fewer barriers to primary care and are more likely to be on preventive medications, both before the ED visit and following discharge. Admissions rates are higher in the United States; however, relapse after discharge is similar between countries. These findings highlight the influences of preventive practices and heath care systems on ED visits for asthma.     

Pulmonary rehabilitation in Canada: A report from the Canadian Thoracic Society COPD Clinical Assembly

BACKGROUND:

Pulmonary rehabilitation (PR) is a recommended intervention in the management of individuals with chronic lung disease. It is important to study the characteristics and capacity of programs in Canada to confirm best practices and identify future areas of program improvement and research.

OBJECTIVE:

To identify all Canadian PR programs, regardless of setting, and to comprehensively describe all aspects of PR program delivery. The present article reports the results of the survey related to type of program, capacity and program characteristics.

METHODS:

All hospitals in Canada were contacted to identify PR programs. A representative from each program completed a 175-item online survey encompassing 16 domains, 10 of which are reported in the present article.

RESULTS:

A total of 155 facilities in Canada offered PR, of which 129 returned surveys (83% response rate). PR programs were located in all provinces, but none in the three territories. Most (60%) programs were located in hospital settings, 24% were in public health units and 8% in recreation centres. The national capacity of programs was estimated to be 10,280 patients per year, resulting in 0.4% of all Canadians with chronic obstructive pulmonary disease (COPD) and 0.8% of Canadians with moderate to severe COPD having access to PR. COPD, interstitial lung disease, and asthma were the most common diagnoses of patients. The majority of programs had at least four health care professionals involved; 9% had only one health care professional involved.

CONCLUSION:

The present comprehensive survey of PR in Canada reports an increase in the number of programs and the total number of patients enrolled since the previous survey in 2005. However, PR capacity has not kept pace with demand, with only 0.4% of Canadians with COPD having access.