Randomized Trials Using Provincial Health Numbers for Group Assignment.

Purpose: Using data from Ontario, Canada, this report shows how provincial government-assigned health card numbers can be used for individual-level randomization in large pragmatic trials. We describe how health card numbers are assigned and analyze the distribution of health card digits in a trial setting. We then provide an example of how they can be used for randomization and discuss the methodological and practical considerations of the approach.

Social licence and the general public's attitudes toward research based on linked administrative health data: a qualitative study.

Background: Both the research literature and headline news stories indicate that the public cares about how their health data are used. The objective of this study was to learn more about the general public's attitudes toward users and uses of linked administrative health data held by ICES in Ontario, Canada.

Methods: Eight focus groups, with a total of 65 members of the general public, were conducted in urban and northern settings in Ontario, Canada, in 2015 and 2017 using qualitative market research panels established by a market research/public opinion research firm.

Validity of vascular trauma codes at major trauma centres.

Background: The use of administrative databases in vascular injury research has been increasing, but the validity of the diagnosis codes used in this research is uncertain. We assessed the positive predictive value (PPV) of International Classification of Diseases, tenth revision (ICD-10), vascular injury codes in administrative claims data in Ontario.

Methods: We conducted a retrospective validation study using the Canadian Institute for Health Information Discharge Abstract Database, an administrative database that records all hospital admissions in Canada.

Authors' self-declared financial conflicts of interest do not impact the results of major cardiovascular trials.

Objectives: This study assessed whether the results of major, potentially practice-altering cardiovascular trials were influenced by the authors' self-declared financial conflicts of interest (FCOI). Secondary objectives included assessment of trial outcomes by source of funding, by FCOI subtype, and by trial endpoints.

Background: Financial conflicts of interest, ubiquitous in cardiovascular medicine because of significant investigator-industry collaborations, potentially can influence trial outcomes.

Fabry's disease: a prospective multicenter cohort study in young adults with cryptogenic stroke.

Background: Stroke in young adults is etiologically diverse and may represent a diagnostic challenge remaining cryptogenic in one-fourth of cases. Limited information is available on the prevalence of Fabry's disease, a treatable multisystem inherited lysosomal storage disorder, and disability in young patients with cryptogenic stroke.

Design And Methods: The Canadian Fabry Stroke Screening Initiative (CFSSI) is a prospective multicenter cohort study of young adults (age 18-55) presenting with an ischemic stroke, transient ischemic attack, or intracerebral haemorrhage of unknown etiology to stroke centres across Canada.

Narcotic analgesic utilization amongst injured workers: using concept mapping to understand current issues from the perspectives of physicians and pharmacists.

Background: Work-related injuries result in considerable morbidity, as well as social and economic costs. Pain associated with these injuries is a complex, contested topic, and narcotic analgesics (NA) remain important treatment options. Factors contributing to NA utilization patterns are poorly understood.

Cardiovascular outcomes after a change in prescription policy for clopidogrel.

Background: Drug-reimbursement policies may have an adverse effect on patient outcomes if they interfere with timely access to efficacious medications for acute medical conditions. Clopidogrel in combination with aspirin is the recommended standard of care for patients receiving coronary stents to prevent thrombosis. We examined the population-level effect of a change by a Canadian provincial government in a pharmacy-benefits program from a prior-authorization policy to a less restrictive, limited-use policy on access to clopidogrel among patients undergoing percutaneous coronary intervention (PCI) with stenting after acute myocardial infarction.

Cardiovascular disease and hypertension risk in living kidney donors: an analysis of health administrative data in Ontario, Canada.

Background: Knowledge of any harm associated with living kidney donation guides informed consent and living donor follow-up. Risk estimates in the literature are variable, and most studies did not use a healthy control group to assess outcomes attributable to donation.

Methods: We observed a retrospective cohort using health administrative data for donations which occurred in Ontario, Canada between the years 1993 and 2005.

Suboptimal use of statin therapy in elderly patients with atherosclerosis: a population-based study.

Background: Current evidence suggests that statin use plays an important role in improving adverse cardiovascular outcomes in patients with atherosclerosis. However, limited population-based data are available on use of statin therapy in these patients in Canada. We sought to study trends in statin use to treat these patients in Ontario during a 10-year period.

Antipsychotic therapy and short-term serious events in older adults with dementia.

Background: Antipsychotic therapy is widely used to treat behavioral problems in older adults with dementia. Cohort studies evaluating the safety of antipsychotic therapy generally focus on a single adverse event. We compared the rate of developing any serious event, a composite outcome defined as an event serious enough to lead to an acute care hospital admission or death within 30 days of initiating antipsychotic therapy, to better estimate the overall burden of short-term harm associated with these agents.

Challenges to evidence-based prescribing in clinical practice.

Although there appears to be widespread support of evidence-based medicine as a basis for rational prescribing, the challenges to it are significant and often justified. A multitude of factors other than evidence drive clinical decision-making, including patient preferences and social circumstances, presence of disease-drug and drug-drug interactions, clinical experience, competing demands from more pressing clinical conditions, marketing and promotional activity, and system-level drug policies.

Comparison of provincial prescription drug plans and the impact on patients' annual drug expenditures.

Background: Reimbursement for outpatient prescription drugs is not mandated by the Canada Health Act or any other federal legislation. Provincial governments independently establish reimbursement plans. We sought to describe variations in publicly funded provincial drug plans across Canada and to examine the impact of this variation on patients' annual expenditures.

Angiotensin receptor blockers vs. angiotensin converting enzyme inhibitors and acute coronary syndrome outcomes in elderly patients: a population-based cohort study (UMPIRE study results).

Inhibitors of the renin-angiotensin system remain a cornerstone of cardiovascular pharmacotherapy. Although angiotensin converting enzyme inhibitors (ACEIs) have been demonstrated to afford cardiovascular risk reduction in patients with atherosclerosis and preserved left ventricular function, at the present time it is unclear if angiotensin receptor blockers (ARBs) exert similar benefits. We performed a population-based comparative study to compare the rates of hospital admission for acute coronary syndromes between users of ARBs relative to the use of ACEIs.

Does statin therapy decrease the risk for bleeding in patients who are receiving warfarin?

Purpose: Recent observations in patients with atrial fibrillation who are receiving warfarin suggest that concomitant treatment with a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) decreases the risk for bleeding.

Methods: We conducted a population-based, nested case-control study using the linked administrative databases of Ontario, Canada, to assess whether statin use decreases the risk of bleeding in warfarin users. Eligible patients were Ontario residents, age 66 years or more, with atrial fibrillation who were prescribed warfarin between April 1, 1994, and December 31, 2001.

Rates and patterns of chronic obstructive pulmonary disease exacerbations.

Background: Acute exacerbations of chronic obstructive pulmonary disease (COPD) are believed to be a common occurrence in patients with COPD and are known to be associated with considerable morbidity.

Objective: To describe the frequency of treated COPD exacerbations in a large population-based cohort.

Subjects And Methods: A cohort of newly treated patients with COPD was formed from the administrative databases of Saskatchewan Health.