Clinical Profile of Persons with Multiple Sclerosis Across the Continuum of Care

Turcotte, Luke; Marrie, Ruth Ann; Patten, Scott B.; Hirdes, John P.

doi:10.1017/cjn.2017.274

Cited by 12 publications

(11 citation statements)

References 40 publications

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“…In this population-based cohort study, the prevalence of NH entry was 4.5%, which falls in the low end of previous reports of people with MS [3][4][5][6] but is high compared to the general population in Manitoba. 11 The NH entrants in our MS cohort were young compared to typical NH residents in the general population, with a greater burden of comorbidities over time compared to peers with MS, consistent with prior Canadian reports.…”

Section: Discussioncontrasting

confidence: 63%

“…11 The NH entrants in our MS cohort were young compared to typical NH residents in the general population, with a greater burden of comorbidities over time compared to peers with MS, consistent with prior Canadian reports. 5 Despite the large size of the study population and the known variability of MS, we identified relatively few trajectory groups for each of the health care services examined. There were low user groups throughout the entire period for all services.…”

Section: Discussionmentioning

confidence: 99%

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Ten-year trajectories of health care utilization by Manitobans with MS predict nursing home entry

et al. 2019

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BackgroundNursing home (NH) care is expensive and restrictive. Understanding trajectories to NH entry among people with multiple sclerosis (MS) could facilitate monitoring and early risk identification. We investigated 10-year trajectories of health care use in matched cohorts of people with MS who did and did not enter NH, the characteristics associated with trajectory group membership, and whether group membership predicted NH entry.MethodsWe used population-based administrative (health claims) data from Manitoba, Canada, to identify 226 NH entrants with MS between January 2005 and December 2012 and 896 age-, sex- and geographically matched non-NH entrants with MS. Using semiparametric group-based trajectory approaches, we described trajectories for 5 measures of health care utilization: physician visits, medications, hospital days and their intensity, and home care days. Using multivariable logistic models, we determined whether membership in a trajectory group predicted NH entry.ResultsMean (SD) age at MS diagnosis was 48.35 (13.25) years for NH entrants and 44.91 (11.58) for nonentrants. Most patients were female (NH entrant, 64%; nonentrant, 61%). Over the study period, trajectories for physician visits and medication use were relatively stable, while trajectories for hospital days and home care increased. High use trajectories for hospital days and medication use were associated with NH entry, while higher use of ambulatory physician visits was associated with a 40%–60% lower risk of NH entry.ConclusionComplex patterns of service use and underlying need contribute to NH entry among people with MS. An increasing number of hospital days is strongly associated with NH entry.

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Section: Discussioncontrasting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Ten-year trajectories of health care utilization by Manitobans with MS predict nursing home entry

et al. 2019

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“…In Canada, 8 of 10 persons with MS residing in long-term care require a wheelchair and have some degree of cognitive impairment, making long-term care admission a highly specific marker of severe disability. 19 We used ≥1 OHIP fee code for services delivered in long-term care or the long-term care code in the ODB to identify long-term care admissions 20 , 21 ; this definition has a positive predictive value of 93.2% and negative predictive value of 99.9%. 22 The earliest long-term care code identified constituted the date of disability in that setting.…”

Section: Methodsmentioning

confidence: 99%

Colorectal Cancer Survival in Multiple Sclerosis

et al. 2021

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Background and Objectives:We tested the hypothesis that overall and cancer-specific survival following colorectal cancer diagnosis is lower in persons with multiple sclerosis (MS) than without MS, using a retrospective matched cohort design.Methods:Using population-based administrative data in Manitoba and Ontario we identified persons with MS using a validated case definition, and linked these cohorts to cancer registries to identify those with colorectal cancer. We selected persons with colorectal cancer and without MS matching 4:1 on birth year, sex, cancer diagnosis year and region. We used Cox proportional hazards regression to compare all-cause survival between cohorts adjusting for age at cancer diagnosis, cancer diagnosis year, income, region, and Elixhauser comorbidity score. We compared cancer-specific survival between cohorts using a cause-specific hazards model. We pooled findings across provinces using random-effects meta-analysis. Complementary analyses using a subcohort from Ontario adjusted for cancer stage and disability status, as measured based on the use of home care or long-term care services.Results:We included 338 MS cases and 1352 controls with colorectal cancer. The mean (SD) age at cancer diagnosis was 64.7 (11.1) years. After adjustment, MS was associated with an increased hazard for all-cause death which was highest six months post-diagnosis (hazard ratio [HR] 1.45; 95%CI: 1.19-1.76), then declined over time (HR [95%CI] 1 year: 1.34 [1.09-1.63], 2 years: 1.24 [0.99-1.56]; 5 years: 1.10 [0.80-1.50]). MS was associated with increased cancer-specific death at 6 months post-diagnosis only (HR 1.29; 95%CI: 1.04-1.61). After adjusting for cancer stage, MS was associated with an increased hazard of death due to any cause (1.60; 95%CI: 1.16, 2.21) and with cancer-specific death (HR 1.47; 95%CI: 1.02, 2.12). The association of MS and all cause death was partially attenuated after adjustment for disability status (HR 1.37; 95%CI: 0.97, 1.92), as was the association with cancer-specific death (HR 1.34; 95%CI: 0.91, 1.97).Discussion:Overall and cancer-specific survival was lower in persons with than without MS in the early period following colorectal cancer diagnosis. Further study is warranted to determine what factors underlie these worse outcomes.

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“…A summary of pain-related data extracted from each of these peer-reviewed journal articles is provided in Table 1 . Pain prevalence rates within Canadian LTC facilities ranged from 27.1 to 75.6%, but it is important to note that methodological differences in definitions of pain, instruments used to measure pain, and populations examined existed [ 40 , 51 , 60 , 64 , 69 ]. Pain has also been shown to increase from admission to the end of residents’ stay in LTC [ 47 ].…”

Section: Resultsmentioning

confidence: 99%

Provincial legislative and regulatory standards for pain assessment and management in long-term care homes: a scoping review and in-depth case analysis

et al. 2020

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Background Among Canadian residents living in long-term care (LTC) facilities, and especially among those with limited ability to communicate due to dementia, pain remains underassessed and undermanaged. Although evidence-based clinical guidelines for the assessment and management of pain exist, these clinical guidelines are not widely implemented in LTC facilities. A relatively unexplored avenue for change is the influence that statutes and regulations could exert on pain practices within LTC. This review is therefore aimed at identifying the current landscape of policy levers used across Canada to assess and manage pain among LTC residents and to evaluate the extent to which they are concordant with evidence-based clinical guidelines proposed by an international consensus group consisting of both geriatric pain and public policy experts. Methods Using scoping review methodology, a search for peer-reviewed journal articles and government documents pertaining to pain in Canadian LTC facilities was carried out. This scoping review was complemented by an in-depth case analysis of Alberta, Saskatchewan, and Ontario statutes and regulations. Results Across provinces, pain was highly prevalent and was associated with adverse consequences among LTC residents. The considerable benefits of using a standardized pain assessment protocol, along with the barriers in implementing such a protocol, were identified. For most provinces, pain assessment and management in LTC residents was not specifically addressed in their statutes or regulations. In Alberta, Saskatchewan, and Ontario, regulations mandate the use of the interRAI suite of assessment tools for the assessment and reporting of pain. Conclusion The prevalence of pain and the benefits of implementing standardized pain assessment protocols has been reported in the research literature. Despite occasional references to pain, however, existing regulations do not recommend assessments of pain at the frequency specified by experts. Insufficient direction on the use of specialized pain assessment tools (especially in the case of those with limited ability to communicate) that minimize reliance on subjective judgements was also identified in current regulations. Existing policies therefore fail to adequately address the underassessment and undermanagement of pain in older adults residing in LTC facilities in ways that are aligned with expert consensus.

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Clinical Profile of Persons with Multiple Sclerosis Across the Continuum of Care

Cited by 12 publications

References 40 publications

Ten-year trajectories of health care utilization by Manitobans with MS predict nursing home entry

Ten-year trajectories of health care utilization by Manitobans with MS predict nursing home entry

Colorectal Cancer Survival in Multiple Sclerosis

Provincial legislative and regulatory standards for pain assessment and management in long-term care homes: a scoping review and in-depth case analysis

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