A living critical interpretive synthesis to yield a framework on the production and dissemination of living evidence syntheses for decision-making.

Background: The COVID-19 pandemic has had an unprecedented impact in the global research production and has also increased research waste. Living evidence syntheses (LESs) seek to regularly update a body of evidence addressing a specific question. During the COVID-19 pandemic, the production and dissemination of LESs emerged as a cornerstone of the evidence infrastructure.

A taxonomy of demand-driven questions for use by evidence producers, intermediaries and decision-makers: results from a cross-sectional survey.

Background: Globally, a growing number of calls to formalize and strengthen evidence-support systems have been released, all of which emphasize the importance of evidence-informed decision making. To achieve this, it is critical that evidence producers and decision-makers interact, and that decision-makers' evidence needs can be efficiently translated into questions to which evidence producers can respond. This paper aims to create a taxonomy of demand-driven questions for use by evidence producers, intermediaries (i.

The Trajectory of Agency-Employed Nurses in Ontario, Canada: A Longitudinal Analysis (2011-2021).

In Canada, reports of nursing staff shortages, job vacancies and the use of private agency nurses, especially in hospitals, have increased since the start of the COVID-19 pandemic. Media reports suggest the pandemic exacerbated nursing shortages among other issues, and nurses are leaving their traditional positions to work at such agencies. Public spending on agency nurses has increased appreciably.

Long-term trends in the work hours of physicians in Canada.

Background: Physician work hours directly influence patient access to health care services and play a vital role in physician human resource planning. We sought to evaluate long-term trends in hours worked by physicians in Canada, overall and by subgroup.

Methods: We used Statistics Canada's Labour Force Survey to identify physicians via occupation and industry coding information.

Matching the right study design to decision-maker questions: Results from a Delphi study.

Research evidence can play an important role in each stage of decision-making, evidence-support systems play a key role in aligning the demand for and supply of evidence. This paper provides guidance on what type of study designs most suitably address questions asked by decision-makers. This study used a two-round online Delphi approach, including methodological experts in different areas, disciplines, and geographic locations.

Characterizing No-shows in the Omani Primary Healthcare Setting.

Objectives: Patient 'no-shows' (failure to keep or cancel appointments) is a global problem that impacts healthcare systems by delaying patient access to healthcare, reducing quality of care, and wasting resources. The no-show phenomenon has not yet been studied in Oman despite it having grown in importance ever since the appointments system was implemented in 2014. This study aimed to characterize the no-shows in primary healthcare facilities in Oman.

Multiple jobholding and part-time work among nurses in long-term care homes compared to other healthcare sectors: Evidence from Ontario.

About two-thirds of Canadian COVID-19 related deaths occurred in long-term care homes (LTCHs). Multiple jobholding and excessive part-time work among staff have been discussed as vectors of transmission. Using an administrative census of registered nurses (RNs) and registered practical nurses (RPNs) in the Canadian province of Ontario, this paper contrasts the prevalence of multiple jobholding, part-time/casual work, and other job and worker characteristics across health sectors in 2019 and 2020 to establish whether the LTCH sector deviates from the norms in Ontario healthcare.

The gender earnings gap in medicine: Evidence from Canada.

Despite the gender gap in physician earnings being of concern to many in Canada, its existence is far from universally accepted and there are no studies covering all physicians/regions or addressing earnings rather than billings. This may explain the lack of serious consideration or remedial action by medical associations and governments in negotiations, or tariff and compensation processes. Our study employs 2016 Canadian Census data linked to Canada Revenue Agency taxation records.

Inequity in insurance coverage for prescription drugs in New Brunswick, Canada.

Objectives: To describe the extent to which New Brunswick residents reported having drug insurance coverage supplementary to Canadian Medicare; to examine associations between socioeconomic and demographic characteristics, health status, language identity, and having reported such coverage; and to document any changes in coverage associated with the introduction of the New Brunswick Drug Plan in 2014.

Methods: We used repeated cross-sectional data for New Brunswick from eight cycles of the Canadian Community Health Survey from 2007 to 2017 and undertook logistic regression analysis.

Results: We found statistically significant, substantial and policy-relevant socioeconomic differences in the reporting of prescription drug insurance coverage among those 25-64 years and those ≥ 65 years of age, and an increasing reliance on private drug insurance over time.

Associations of health services utilization by prescription drug coverage and immigration category in Ontario, Canada.

Canada is the only high-income country with a universal healthcare system that does not provide prescription drug coverage for all its residents. This study examines whether Canadians' prescription drug coverage status is associated with their health services use and how this association differs by gender across non-migrants and three categories of migrants: economic immigrants, family-class immigrants, and refugees. Very few studies have examined differences across these migrant groups, and there is a need to do so as they experience varying health disparities.

Exploring the Results of the Ontario Home Care Minimum Wage Change.

Background: :In 2014, Ontario increased its "minimum wage" for personal support workers (PSWs) in publicly funded home care.

Objective: The objective of this article is to determine the short-term results of this policy for home care PSWs' wages, hours and job stability.

Methods: This study uses descriptive graphs and ordinary least squares and unconditional quantile regressions, using PSWs across Canada as comparison groups.

Delisting eye examinations from public health insurance: Empirical evidence from Canada regarding impacts on patients and providers.

This paper examines the impacts of delisting routine eye exam services on patient eye care utilization and on providers' labour market outcomes in a public healthcare system. Provincial governments in Canada started to de-insure routine eye examinations from the basket of publicly insured healthcare services in the early 1990s. We explore these policy changes across Canadian provinces to estimate the impacts of delisting from the supply- and demand-sides.

Socioeconomic differences in prescription drug supplemental coverage in Canada: A repeated cross-sectional study.

Background: Efforts to achieve universal healthcare coverage are fraught with challenges, not only in low- and middle-income countries but also in high-income ones. Canada, for example, is the only high-income country with universal health insurance that does not include universal coverage for prescription drugs. We first described the extent to which Canadians reported supplementary drug insurance coverage (public or private).

Payment models in primary health care: A driver of the quantity and quality of medical laboratory utilization.

Physician payment models' incentives regarding many aspects of primary health care are not well understood. We focus on the case of medical laboratory utilization and examine how physicians' laboratory test ordering patterns change following a switch to a blended capitation payment model from one with fee for service enhanced with pay for performance. Also, within blended capitation, we examine differences between traditional staffing and interdisciplinary teams.

Measuring Physicians' Incomes with a Focus on Canadian-Controlled Private Corporations.

Understanding physician remuneration and its growth is extremely complex, much more so than for a typical worker. Highlighting one narrow aspect of this issue, this paper focuses on governments' increased incentives for physicians to incorporate and the ensuing physician response in the period 1996-2011. Nationally, incorporation rates increased for both general practitioners and specialists between 1996 and 2011.

Blended capitation and incentives: Fee codes inside and outside the capitated basket.

Blended capitation physician payment models incorporating fee-for-service (FFS), pay-for-performance and/or other payment elements seek to avoid the extremes of both FFS and capitation. However, evidence is limited regarding physicians' responses to blended models, and potential shifts in service provision across payment categories within the practice. We examine the switch from FFS to a blended capitation-FFS model for primary care physicians in group practice.

Rates of inappropriate laboratory test utilization in Ontario.

Background: Medical laboratory tests ordered redundantly represent one of the targets for reducing diagnostic testing without negatively, and possibly positively, affecting patient care. We study a clearly defined category of excessive laboratory utilization for nine analytes where inappropriate diagnostic testing is defined in terms of the time interval between tests; that is, ordering a test too soon following the previous order of the same test.

Methods: Population data from the near universal public Ontario Health Insurance Plan for the years 2006-2010 are employed where the tests are fulfilled by community medical laboratories.

Ontario primary care models: a descriptive study.

Background: Between 2001 and 2006, the Ontario government introduced a menu of new primary care models, with elements such as patient enrolment and minimum group sizes, and various combinations of fee-for-service, capitation, pay-for-performance and salary. From the statistical perspective of physicians, as opposed to patients, we looked at the distribution of physician characteristics, group size and patient visit patterns across models to describe primary care practice in Ontario.

Methods: Using administrative data for fiscal year 2010/11 containing information on physician characteristics, patient rostering status, patient visits and other practice information, we described similarities and differences across primary care models.

Mandatory universal drug plan, access to health care and health: Evidence from Canada.

This paper examines the impacts of a mandatory, universal prescription drug insurance program on health care utilization and health outcomes in a public health care system with free physician and hospital services. Using the Canadian National Population Health Survey from 1994 to 2003 and implementing a difference-in-differences estimation strategy, we find that the mandatory program substantially increased drug coverage among the general population. The program also increased medication use and general practitioner visits but had little effect on specialist visits and hospitalization.

Optometry services in Ontario: supply - and demand-side factors from 2011 to 2036.

Optometric labour market projections are provided. First, population growth and ageing-based estimates of the rate of increase of eye-care services in Ontario from 2011 to 2$ are presented, holding the age-sex structure of utilization constant. Then, using data on the 2011 supply and working hours of Ontario's optometrists, the number of optometrists needed to keep the level of optometric services per age-sex-adjusted person comparable over time is estimated.

Gender, family status and physician labour supply.

With the increasing participation of women in the physician workforce, it is important to understand the sources of differences between male and female physicians' market labour supply for developing effective human resource policies in the health care sector. Gendered associations between family status and physician labour supply are explored in the Canadian labour market, where physicians are paid according to a common fee schedule and have substantial discretion in setting their hours of work. Canadian 1991, 1996, 2001 and 2006 twenty percent census files with 22,407 physician observations are used for the analysis.

Challenges and strategies for determining workforce requirements in plastic surgery.

Background: Accurate projections of the future plastic surgeon workforce are essential to provide a high standard of care and to properly allocate scarce health care resources. This is not a straightforward task. Longstanding concerns over physician surpluses have been replaced by fears of physician shortages.

Plastic surgery wait times in Ontario: A potential surrogate for workforce demand.

Background: Accurate projections of plastic surgeon workforce requirements are essential to ensure a high standard of care and to properly allocate health care resources. Wait-time data were used to identify geographical areas that may benefit from additional plastic surgeons.

Methods: Plastic surgery wait times were analyzed using data from Ontario's Wait Time Information System for 2009 to 2010.