Approximately 1.5% of Ontario' s population, represented by the top 5% highest cost-incurring users of Ontario' s hospital and home care services, account for 61% of hospital and home care costs. Similar studies from other jurisdictions also show that a relatively small number of people use a high proportion of health system resources. Understanding these high-cost users (HCUs) can inform local healthcare planners in their efforts to improve the quality of care and reduce burden on patients and the healthcare system. To facilitate this understanding, we created a profile of HCUs using demographic and clinical characteristics. The profile provides detailed information on HCUs by care type, geography, age, sex and top clinical conditions. RésuméEnviron 1,5 % de la population ontarienne, qui correspond à 5 % des usagers qui génèrent le plus de coûts pour les services hospitaliers et les soins à domicile en Ontario, comptent pour 61 % des frais hospitaliers et de frais pour les soins à domicile. Des études semblables menées ailleurs montrent également qu'un nombre relativement petit de personnes utilisent une grande partie des ressources du système de santé. Une meilleure compréhension des usagers qui coûtent cher peut aider les planificateurs à améliorer la qualité des services et à réduire le fardeau sur les patients et sur le système de santé. Afin de faciliter cette compréhension, nous avons brossé un profil des usagers qui coûtent cher à l' aide de caractéristiques cliniques et démographiques. Ce profil donne des renseignements détaillés sur ces patients, en fonction du type de soins, de la géographie, de l' âge, du sexe et des principaux états cliniques.

To measure primary care access on an ongoing basis, the Ontario ministry of Health and Long-Term Care implemented the Primary Care Access survey (PCAs) in 2006. The PCAs, a cross-sectional telephone survey, samples approximately 8,400 Ontario adults each year. It collects information on access to a family doctor, use of services, health status and socio-demographics. Analysis of the -2008 shows that 7.1% of Ontario' s adults were without a family doctor (i.e., unattached). The attached and unattached populations differed on socio-demographic and health characteristics. Emergency department use was similar between the two groups, but walk-in clinic use was higher among the unattached. The unattached were less likely to have used care for immediate issues but accessed care in a more timely fashion than the attached. This initial exploration of the PCAs provides a better understanding of some of the differences between the attached and unattached populations in Ontario.

Incentive-based smoking cessation programs that target an entire community have the advantage of reaching a large and diverse group of smokers. They may, however, attract only smokers who are already motivated to quit. Realistically, incentive-based programs aimed at the general population can expect 1% of all their smokers to quit smoking. Quit rates among participants may initially be high (i.e., mean quit rate of 34% at 1-month follow-up) but decrease over time (i.e., mean rate of 23% at 1 year). The results of this review suggest a continued need to establish standard and valid criteria for the evaluation of smoking cessation interventions. Methodological differences among existing studies make them difficult to compare and interpret.

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