Health Services Research Commons^™

The Impact Of Financial Incentives For Cervical Cancer Screening In Ontario's Primary Care Delivery Models, Ciara Pendrith

Electronic Thesis and Dissertation Repository

Physicians practicing in capitation-based Family Health Organizations and fee-for-service-based Family Health Groups receive bonuses for delivering preventive care, including cervical cancer screening, while those practicing in the traditional fee-for-service model do not. Financial incentives were introduced to increase Ontario’s cervical screening rate to 85%. To date, the impact of incentives for cervical screening on screening rate and cost-effectiveness have not been assessed. Patient-level data obtained from the Institute for Clinical Evaluative Sciences were used to estimate primary care model screening rates and cancer treatment costs. A microsimulation model was developed from published cervical cancer natural history models and parameterized using …

Exploring Health Care Access For Gay, Bisexual, And Other Men Who Have Sex With Men Living In Middlesex County, Ontario, Todd A. Coleman

Electronic Thesis and Dissertation Repository

Published research suggests gay, bisexual, and other men who have sex with men (GB-MSM) present in health care with additional, distinct psychosocial and sexual health concerns compared to heterosexual men, emphasizing the importance of access to health care for these groups.

This exploratory thesis used data from the online survey (n=202) of the Health in Middlesex Men Matters (HiMMM) Project – a community-based study examining health care access for GB-MSM living in Middlesex County, Ontario. For each manuscript, blockwise modified Poisson regression models were fit sequentially with predisposing, enabling, and need variables, as theorized by the Behavioral Model of Health …

Access To The Local Aids Service Organization Among African, Caribbean And Other Black Residents Of Middlesex-London, Ontario, Canada, Soraya Blot

Electronic Thesis and Dissertation Repository

The migration of people from HIV-endemic countries has altered the demographics of the HIV epidemic in high-income countries. In Canada, most people from HIV-endemic countries are of African descent. While they are an established priority group for HIV-related services, they can face access difficulties. This study uses quantitative data from the Black, African and Caribbean Canadian Health Study to evaluate AIDS service organization access in Middlesex-London, Ontario, using the Andersen-Gelberg model for vulnerable populations and an overarching intersectionality framework. In bivariate analysis, older age, having a primary care provider, less inappropriate fear of contagion and less time in Canada were …

Primary Health Service Use By Mothers And Children From London-Middlesex, Ontario, Catherine Holtz

Electronic Thesis and Dissertation Repository

Primary health service use (P-HSU) may be influenced by predisposing and enabling factors measured at individual- and contextual-levels but is equitable when driven by need factors. Objectives: 1) Estimate the effect of residential location on maternal and child P-HSU; 2) Assess P-HSU inequity by determining whether the effects of need factors on P-HSU are dependent on predisposing and enabling factors; 3) Describe perceived unmet healthcare needs in the maternal-child population observed to have inequitable P-HSU. Methodology: The sample of 1451 mother-child pairs was from a prenatal cohort recruited from London, Ontario between 2002 and 2004, with follow-up until children were …

Economic Evaluation Of Potential Applications Of Gene Expression Profiling In Clinical Oncology, Malek Hannouf

Electronic Thesis and Dissertation Repository

Histopathological analysis of tumor is currently the main tool used to guide cancer management. Gene expression profiling may provide additional valuable information for both classification and prognostication of individual tumors. A number of gene expression profiling assays have been developed recently to inform therapy decisions in women with early stage breast cancer and help identify the primary tumor site in patients with metastatic cancer of unknown primary. The impact of these assays on health and economic outcomes, if introduced into general practice, has not been determined. I aimed to conduct an economic evaluation of regulatory-approved gene expression profiling assays for …

The Association Between Women's Autonomy And Women's Hiv/Aids Knowledge And Attitudes In Ethiopia, Fadumo Rirash

Electronic Thesis and Dissertation Repository

Low autonomy resulting from gender inequalities in women has been identified as a contributing factor to the disproportionate impact of HIV/AIDS on women, especially in Sub-Saharan Africa.

This study explored the association between women’s autonomy and HIV/AIDS knowledge and attitudes in Ethiopia using the 2005 and 2011 Ethiopia Demographic and Health Surveys. The women’s spouses’ perceptions of the women’s autonomy and socio-demographic variables associated with HIV/AIDS knowledge and attitudes identified by the literature were included in the analyses. Multiple linear regression identified positive associations between women’s autonomy (and men’s perception of women’s autonomy), socio-demographic variables including education and mass media …

Trends In The Utilization Of Antiglaucoma Medication: An Analysis Of Canadian Drug Insurance Claims, Kwun (Bryan) Hung Chan

Electronic Thesis and Dissertation Repository

Objectives: To assess: i) utilization of generic anti-glaucoma drugs in Canada; ii) the impact of the 2010 Ontario Drug System Reform on generic anti-glaucoma drug usage in Ontario.

Methods: Monthly drug insurance cost and claims from January 2001 to January 2013 were used as proxies for drug utilization. Evaluation of the impact of the 2010 reform was conducted using interrupted time series analysis with ARIMA models.

Results: Generic antiglaucoma medication utilization increased in Ontario during Quarter 3, 2006. Increases in utilization across study provinces were observed in Quarter 4, 2011. The 2010 reform was not associated with …