No abstract

Background The relapsing and remitting symptoms experienced by people with inflammatory bowel disease (IBD), including abdominal pain and diarrhea, may impact their employability and workplace productivity. Purpose Report the impact of IBD on missed work and its associated costs using population-representative data with the goal of understanding the population-level indirect costs of IBD in Canada. Method We used the 2010 and 2014 waves of the Canadian Community Health Survey (CCHS) to compare missed work and its associated costs among survey respondents aged 20 to 64 years with physician-diagnosed IBD compared to those without IBD. Students and those with non-IBD bowel disorders were excluded. The cost of missed work was derived from reported annual income and the number of workdays missed. Survey weights were used for descriptive statistics. Poisson regression modified for binary outcomes was used to compare employment within the past 3 months among those with and without IBD. Heckman models (two-stage models accounting for the likelihood of being employed) were used to compare the number of days missed and the cost of missed work in the two groups. Models were adjusted for age, sex, education, marital status, immigration status, visible minority status, number of non-IBD chronic conditions, and mood or anxiety disorder. All costs were inflation-adjusted to 2022 Canadian dollars. Result(s) Among 67,907 eligible respondents, 810 (weighted 1.0%) had IBD. Employment in the last 3 months was reported among 70% of people with IBD compared to 80% of people without IBD (RR 0.92, 95% CI 0.88 to 0.96). Among those employed in the prior 3 months, employed people with IBD missed an average of 1.6 (SD 4.4) days of work compared to 1.0 (SD 3.5) days missed among those without IBD, corresponding to $415 (SD 1315) in lost wages among those with IBD and $235 (SD 932) among those without IBD. Accounting for the higher rates of unemployment in those with IBD using Heckman models, people with IBD missed an additional 1.1 days (95% CI 0.7 to 1.5) of work and lost an additional $270 (95% CI 163 to 377) in income over 3 months. Extrapolating to the estimated 184,460 employed Canadians with IBD, the attributable indirect cost of missed work due to IBD is nearly $200 million annually. Conclusion(s) The economic burden of IBD resulting from missed work is substantial. Since IBD is often diagnosed during adolescence and early adulthood, employability and productivity are important long-term patient-centered outcomes. Novel interventions that could mitigate these attendant effects of IBD are urgently needed to improve patient outcomes. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Objective: This study evaluated the impact of a critical time intervention (CTI) adaptation on health care utilization outcomes among adults experiencing homelessness and mental health needs in a large urban center. Methods: Provincial population-based administrative data from Ontario, Canada, were used in a pre–post design for a cohort of 197 individuals who received the intervention between January 2013 and May 2014 and were matched to a cohort of adults experiencing homelessness who did not receive the intervention over the same time period. Changes in health care utilization outcomes in the year pre- and postintervention were evaluated using generalized estimating equations, and post hoc analyses evaluated differences between groups. Results: Pre–post analyses revealed statistically significant changes in health care utilization patterns among intervention recipients, including reduced inpatient service use and increased outpatient service use in the year following the intervention compared to the year prior. However, the matched cohort analysis found nonsignificant differences in health service use changes between a subgroup of intervention recipients and their matched counterparts. Conclusions: An adapted CTI model was associated with changes in health care utilization among people experiencing homelessness and mental health needs. However, changes were not different from those observed in a matched cohort. Rigorous study designs with adequate samples are needed to examine the effectiveness of CTI and local adaptations in diverse health care contexts.

Background Severe mental illness (SMI) comprises a range of chronic and disabling conditions, such as schizophrenia, bipolar disorder and other psychoses. Despite affecting a small percentage of the population, these disorders are associated with poor outcomes, further compounded by disparities in access, utilisation, and quality of care. Previous research indicates there is pro-poor inequality in the utilisation of SMI-related psychiatric inpatient care in England (in other words, individuals in more deprived areas have higher utilisation of inpatient care than those in less deprived areas). Our objective was to determine whether there is pro-poor inequality in SMI-related psychiatric admissions in Ontario, and understand whether these inequalities have changed over time. Methods We selected all adult psychiatric admissions from April 2006 to March 2011. We identified changes in socio-economic equity over time across deprivation groups and geographic units by modeling, through ordinary least squares, annual need-expected standardised utilisation as a function of material deprivation and other relevant variables. We also tested for changes in socio-economic equity of utilisation over years, where the number of SMI-related psychiatric admissions for each geographic unit was modeled using a negative binomial model. Results We found pro-poor inequality in SMI-related psychiatric admissions in Ontario. For every one unit increase in deprivation, psychiatric admissions increased by about 8.1%. Pro-poor inequality was particularly present in very urban areas, where many patients with SMI reside, and very rural areas, where access to care is problematic. Our main findings did not change with our sensitivity analyses. Furthermore, this inequality did not change over time. Conclusions Individuals with SMI living in more deprived areas of Ontario had higher psychiatric admissions than those living in less deprived areas. Moreover, our findings suggest this inequality has remained unchanged over time. Despite the debate around whether to make more or less use of inpatient versus other care, policy makers should seek to address suboptimal supply of primary, community or social care for SMI patients. This may potentially be achieved through the elimination of barriers to access psychiatrist care and the implementation of universal coverage of psychotherapy.