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Willis C.D.,University of British Columbia | Willis C.D.,University of Adelaide | Best A.,Vancouver Coastal Health Research Institute | Riley B.,University of Waterloo | And 3 more authors.
Evidence and Policy | Year: 2014

Incremental approaches to introducing change in Canada's health systems have not sufficiently improved the quality of services and outcomes. Further progress requires 'large system transformation', considered to be the systematic effort to generate coordinated change across organisations sharing a common vision and goal. This essay draws on ongoing dialogue relating to transformation, and examines transformative efforts in the Saskatchewan health system. We aim to build a shared understanding of systems thinking in the context of transformation, and to outline examples of how systems thinking perspectives, with an emphasis on the role of evidence, may inform strategy for complex change initiatives. © Policy Press 2014.


Amuah J.E.,Canadian Institute for Health Information | Amuah J.E.,University of Ottawa | Hogan D.B.,University of Calgary | Eliasziw M.,University of Calgary | And 4 more authors.
Pharmacoepidemiology and Drug Safety | Year: 2010

Purpose: To estimate the risk (and determinants) of discontinuing cholinesterase inhibitors (ChEIs) in a population-based sample of Alzheimer's disease (AD) patients. Methods: This is a retrospective cohort study based on linked de-identified administrative health data from the province of Saskatchewan, Canada. The cohort included all AD patients receiving a ChEI prescription during the first year of provincial coverage (2000-2001). Persistence was defined as no gap of 60+ days between depletion and subsequent refill of a ChEI prescription. Kaplan-Meier analysis was used to estimate the risk of discontinuation over 40 months. Cox regression with time-varying covariates was used to assess risk factors for ChEI discontinuation. Results: The sample included 1080 patients (64% female, average age 80 ± 7 years). Baseline mean (SD) Mini-Mental State Examination (MMSE) and Functional Activities Questionnaire (FAQ) scores were 20.8 (4.4) and 17.5 (7.7), respectively. Over 40 months, 84% discontinued therapy. The 1-year risk of discontinuation was 66.4% (95%CI 63.5-69.3%). Discontinuation was significantly more likely for females (adjusted HR 1.34, 95%CI 1.16-1.55) and among those with lower MMSE scores (2.52, 2.01-3.17 if <15), not receiving social assistance (1.25, 1.07-1.45), and paying at least 65% of total prescription costs (1.51, 1.30-1.74). It was significantly less likely for patients with frequent physician visits (0.78, 0.66-0.93, for 7-19 vs. <7 visits), higher Chronic Disease Scores (0.74, 0.61-0.89, for 7+ vs. <4), and FAQ scores of 9+ (0.82, 0.69-0.99). Conclusion: The likelihood of discontinuing ChEI therapy was high in this real-world sample of AD patients. Significant predictors included clinical, socioeconomic, and practice factors. Copyright © 2010 John Wiley & Sons, Ltd.


PubMed | University of Calgary, Public Health Agency of Canada, Canadian Institute for Health Information, University of Toronto and 7 more.
Type: Journal Article | Journal: The Canadian journal of cardiology | Year: 2014

The surveillance of heart failure (HF) is currently conducted using either survey or hospital data, which have many limitations. Because Canada is collecting medical information in administrative health data, the present study seeks to propose methods for the national surveillance of HF using linked population-based data.Linked administrative data from 5 Canadian provinces were analyzed to estimate prevalence, incidence, and mortality rates for persons with HF between 1996/1997 and 2008/2009 using 2 case definitions: (1) 1 hospitalization with an HF diagnosis in any field (H_Any) and (2) 1 hospitalization in any field or at least 2 physician claims within a 1-year period (H_Any_2P). One hospitalization with an HF diagnosis code in the most responsible diagnosis field (H_MR) was also compared. Rates were calculated for individuals aged 40 years.In 2008/2009, combining the 5 provinces (approximately 82% of Canadas total population), both age-standardized HF prevalence and incidence were underestimated by 39% and 33%, respectively, with H_Any when compared with H_Any_2P. Mortality was higher in patients with H_MR compared with H_Any. The degree of underestimation varied by province and by age, with older age groups presenting the largest differences. Prevalence estimates were stable over the years, especially for the H_Any_2P case definition.The prevalence and incidence of HF using inpatient data alone likely underestimates the population rates by at least 33%. The addition of physician claims data is likely to provide a more inclusive estimate of the burden of HF in Canada.


Chen C.-C.,University of Saskatchewan | Epp T.,University of Saskatchewan | Jenkins E.,University of Saskatchewan | Waldner C.,University of Saskatchewan | And 2 more authors.
International Journal of Environmental Research and Public Health | Year: 2013

The Canadian prairie provinces of Alberta, Saskatchewan, and Manitoba have generally reported the highest human incidence of West Nile virus (WNV) in Canada. In this study, environmental and biotic factors were used to predict numbers of Culex tarsalis Coquillett, which is the primary mosquito vector of WNV in this region, and prevalence of WNV infection in Cx. tarsalis in the Canadian prairies. The results showed that higher mean temperature and elevated time lagged mean temperature were associated with increased numbers of Cx. tarsalis and higher WNV infection rates. However, increasing precipitation was associated with higher abundance of Cx. tarsalis and lower WNV infection rate. In addition, this study found that increased temperature fluctuation and wetland land cover were associated with decreased infection rate in the Cx. tarsalis population. The resulting monthly models can be used to inform public health interventions by improving the predictions of population abundance of Cx. tarsalis and the transmission intensity of WNV in the Canadian prairies. Furthermore, these models can also be used to examine the potential effects of climate change on the vector population abundance and the distribution of WNV.© 2013 by the authors; licensee MDPI, Basel, Switzerland.


Chen C.-C.,University of Saskatchewan | Epp T.,University of Saskatchewan | Jenkins E.,University of Saskatchewan | Waldner C.,University of Saskatchewan | And 2 more authors.
Journal of Medical Entomology | Year: 2012

West Nile virus (WNV) spread across most of North America within a short time period after its incursion into the Western Hemisphere. The Canadian prairies had the highest human incidence of WNV disease in Canada, particularly in 2007. Statistical modeling and geographic information systems can be used to develop a predictive model and facilitate the mobilization of targeted disease management strategies. Using data collected between 2005 and 2008, we constructed models integrating abiotic and biotic factors to predict the WNV infection rate in female Culex tarsalis Coquillett, the primary vector of WNV in the Canadian prairies. During the study period, the highest mean Cx. tarsalis infection rate was during week 34 (late August). The Cx. tarsalis infection rate increased with increasing Cx. tarsalis abundance and mean temperature lagged from 1 to 8 wk, but decreased with increasing mean precipitation lagged from 2 to 6 wk. Furthermore, precipitation was a 'distorter variable' that altered the association between Cx. tarsalis abundance and the WNV infection rate. Our model clarified how weather influenced the Cx. tarsalis infection rate in the Canadian prairies, a newly and highly WNV endemic region of North America. An understanding of the role of lagged weather variables was essential for providing sufficient lead time to predict WNV occurrence, and for implementing disease control and prevention strategies. Furthermore, it is a useful tool for assessing the potential effects of future climate change on WNV in areas near its northern distributional limit. © 2012 Entomological Society of America.


Chen C.C.,University of Saskatchewan | Jenkins E.,University of Saskatchewan | Epp T.,University of Saskatchewan | Waldner C.,University of Saskatchewan | And 2 more authors.
International Journal of Environmental Research and Public Health | Year: 2013

The Canadian prairie provinces of Manitoba, SK, and Alberta have reported the highest human incidence of clinical cases of West Nile virus (WNV) infection in Canada. The primary vector for WVN in this region is the mosquito Culex tarsalis. This study used constructed models and biological thresholds to predict the spatial and temporal distribution of Cx. tarsalis and WNV infection rate in the prairie provinces under a range of potential future climate and habitat conditions. We selected one median and two extreme outcome scenarios to represent future climate conditions in the 2020 (2010-2039), 2050 (2040-2069) and 2080 (2070-2099) time slices. In currently endemic regions, the projected WNV infection rate under the median outcome scenario in 2050 raised 17.91 times (ranged from 1.29-27.45 times for all scenarios and time slices) comparing to current climate conditions. Seasonal availability of Cx. tarsalis infected with WNV extended from June to August to include May and September. Moreover, our models predicted northward range expansion for Cx. tarsalis (1.06-2.56 times the current geographic area) and WNV (1.08-2.34 times the current geographic area). These findings predict future public and animal health risk of WNV in the Canadian prairie provinces. © 2013 by the authors; licensee MDPI, Basel, Switzerland.


Millins C.,University of Saskatchewan | Reid A.,Ontario Veterinary College | Curry P.,Saskatchewan Ministry of Health | Drebot M.A.,Public Health Agency of Canada | And 3 more authors.
Vector-Borne and Zoonotic Diseases | Year: 2011

This study evaluated the use of house sparrow (Passer domesticus) nestlings as sentinels of West Nile virus (WNV) in the prairie grasslands of Saskatchewan. In the summer of 2006, 600 house sparrow nestlings were collected and pooled tissues tested by reverse transcriptase-polymerase chain reaction. All tested negative for WNV. During the same period, no WNV was detected by mosquito surveillance in the study area and 15 WNV-infected pools were collected from the nearby city of Estevan. Six percent of avian carcasses collected from Regina, a city 100 km from the study area in the same ecozone, were infected with WNV. In 2007, 200 house sparrow nestlings were collected and 4 tested positive for WNV, a prevalence of 2%. Ninety-seven house sparrow eggs were also collected and WNV antibodies were measured in the yolk. Seven eggs had measurable titers, a prevalence of 7.2%. Combined WNV surveillance showed high levels of WNV transmission in 2007; 112 WNV-infected mosquito pools were collected from nearby cities of Estevan and Weyburn, and the proportion of WNV infected avian carcasses from Regina was 78%. There were 1456 human cases of WNV in Saskatchewan in 2007, compared to 19 cases in 2006. The study concluded that house sparrow nestlings are not useful as an early warning of WNV circulation, or as a measure of the intensity of WNV activity in the prairie grasslands. Also, the study determined that maternally derived antibody did not have a significant limiting effect on WNV transmission to house sparrow nestlings in 2007, a year of epidemic WNV activity in the study area. © Copyright 2011, Mary Ann Liebert, Inc.


Dergousoff S.J.,University of Saskatchewan | Galloway T.D.,University of Manitoba | Lindsay L.R.,Public Health Agency of Canada | Curry P.S.,Saskatchewan Ministry of Health | Chilton N.B.,University of Saskatchewan
Journal of Medical Entomology | Year: 2013

Distributional ranges of the ticks Dermacentor andersoni Stiles and Dermacentor variabilis (Say) in the Canadian Prairies were determined by passive surveillance and active collection. These findings were compared with historical records of both species, particularly in the province of Saskatchewan, where the northern distributional limits of both tick species occur. Before the 1960s, D. variabilis and D. andersoni were allopatric in Saskatchewan; however, since then, the distribution of D. variabilis has expanded westward and northward. Although the range of D. andersoni has remained relatively stable, range expansion of D. variabilis has resulted in a zone of sympatry at least 200 km wide. Twenty-nine species of mammals and three species of birds were identified as hosts for different life stages of these ticks. © 2013 Entomological Society of America.


Epp T.,University of Saskatchewan | Waldner S.,University of Saskatchewan | Wright J.,Public Health Services | Curry P.,Saskatchewan Ministry of Health | And 2 more authors.
Vaccine | Year: 2010

This study examines health care personnel's knowledge of West Nile virus (WNv) and attitudes towards a proposed chimeric yellow fever/WNv vaccine within the province of Saskatchewan. Telephone and in-person interviews with medical health officers and public health nurses provided information with which to assess the acceptability of implementing vaccination as a component for prevention of WNv within the province with the highest number of WNv cases to date in western Canada. The majority of health care professionals felt confident in the potential efficacy of vaccination for prevention of WNv but suggested that targeted vaccination programs could be most effective. © 2010 Elsevier Ltd. All rights reserved.


Brossart B.,Health Quality Council | Donnelly L.,Saskatchewan Ministry of Health
Healthcare Papers | Year: 2012

There is no disputing that the key to any high-performing healthcare system is a high-performing primary healthcare system. As health systems around the globe grapple with aging, sicker populations, variable quality of care and unsustainable growth in health expenditures, the overhauling of primary healthcare cannot be put off any longer. Patient centred. Community designed. Team delivered. These are the tenets behind Saskatchewan's recently released framework for achieving a high-performing primary healthcare system. It has much in common with the primary healthcare framework offered by Kates and colleagues; and given its promising genesis, perhaps (finally) what has eluded many health systems so far can be achieved in the province that 50 years ago led the country in healthcare innovation.

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