Richard H Glazier

Publications (88)354.57 Total impact

• Article: Implementation of electronic medical records: theory-informed qualitative study.

  Michelle Greiver, Jan Barnsley, Richard H Glazier, Rahim Moineddin, Bart J Harvey
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  ABSTRACT: To apply the diffusion-of-innovations theory to the examination of factors that are perceived by family physicians as influencing the implementation of electronic medical records (EMRs). Qualitative study with 2 focus groups 18 months after EMR implementation; participants also took part in a concurrent quantitative study examining EMR implementation and preventive services. Toronto, Ont. Twelve community-based family physicians. We employed a semistructured interview guide. The interviews were audiotaped and transcribed verbatim; 2 researchers independently categorized and coded the transcripts and then met to compare and contrast their findings, category mapping, and interpretations. Findings were then mapped to an existing theoretical framework. Multiple barriers to EMR implementation were described. These included lack of relative advantage for many processes, high complexity of the system, low compatibility with physician needs and past experiences, difficulty with adaptation of the EMR to the organization and adaptation of the organization to the EMR, and lack of organizational slack. Positive factors were the presence of a champion and relative advantages for some processes. Early EMR implementation experience is consistent with theoretical concepts associated with implementation of innovations. A problematic implementation process helps to explain, at least in part, the lack of improvement in preventive services in our quantitative results.
  Canadian family physician Medecin de famille canadien 10/2011; 57(10):e390-7. · 1.19 Impact Factor
• Article: A population-based study of the association between socioeconomic status and emergency department utilization in Ontario, Canada.

  Yasmin Khan, Richard H Glazier, Rahim Moineddin, Michael J Schull
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  ABSTRACT: The relative effects of socioeconomic status (SES) and health status on emergency department (ED) utilization are controversial. The authors examined this in a setting with universal health coverage. For Ontario participants age 20-74 years, Canadian Community Health Survey 2000 to 2001 responses were linked to Ontario Health Insurance Plan (OHIP) physician utilization data for 1999 to 2001 and the National Ambulatory Care Reporting System (NACRS) for ED utilization in 2002. SES was defined primarily according to high school completion and secondarily according to income. The primary outcome was less urgent ED visit, defined as Canadian Triage and Acuity Scale (CTAS) 4 or 5 and not admitted to hospital. The weighted sample was 9,323,217. Overall, 31.4% of the sample used an Ontario ED in 2002. The majority of visits (59.1%) were classified as less urgent. Fair or poor self-perceived health was the largest predictor of ED use, regardless of visit urgency. Respondents with low education were more likely to have both less urgent visits (odds ratio [OR] = 1.65, 95% confidence interval [CI] = 1.35 to 1.94) and more urgent visits (OR = 1.39, 95% CI = 1.09 to 1.68) after controlling for age, sex, income, self-perceived health, urban or rural location, regular doctor, and non-ED physician visits. Education was not associated with having less urgent versus more urgent visits (OR = 0.92, 95% CI = 0.68 to 1.14). In a setting with universal health insurance, worse health status is the largest predictor of ED utilization, but low SES is independently associated with increased use of the ED, regardless of visit urgency. This study lends support to findings in other health systems that those using EDs are more ill and more disadvantaged.
  Academic Emergency Medicine 08/2011; 18(8):836-43. · 1.86 Impact Factor
• Source

  Available from: PubMed Central

  Article: Did changing primary care delivery models change performance? A population based study using health administrative data.

  R Liisa Jaakkimainen, Jan Barnsley, Julie Klein-Geltink, Alexander Kopp, Richard H Glazier
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  ABSTRACT: Primary care reform in Ontario, Canada started with the introduction of new enrollment models, the two largest of which are Family Health Networks (FHNs), a capitation-based model, and Family Health Groups (FHGs), a blended fee-for-service model. The purpose of this study was to evaluate differences in performance between FHNs and FHGs and to compare performance before and after physicians joined these new primary care groups. This study used Ontario administrative claims data to compare performance measures in FHGs and FHNs. The study population included physicians who belonged to a FHN or FHG for at least two years. Patients were included in the analyses if they enrolled with a physician in the two years after the physician joined a FHN or FHG, and also if they saw the physician in a two year period prior to the physician joining a FHN or FHG. Performance was derived from the administrative data, and included measures of preventive screening for cancer (breast, cervical, colorectal) and chronic disease management (diabetes, heart failure, asthma). Performance measures did not vary consistently between models. In some cases, performance approached current benchmarks (Pap smears, mammograms). In other cases it was improving in relation to previous measures (colorectal cancer screening). There were no changes in screening for cervical cancer or breast cancer after joining either a FHN or FHG. Colorectal cancer screening increased in both FHNs and FHGs. After enrolling in either a FHG or a FHN, prescribing performance measures for diabetes care improved. However, annual eye examinations decreased for younger people with diabetes after joining a FHG or FHN. There were no changes in performance measures for heart failure management or asthma care after enrolling in either a FHG or FHN. Some improvements in preventive screening and diabetes management which were seen amongst people after they enrolled may be attributed to incentive payments offered to physicians within FHGs and FHNs. However, these primary care delivery models need to be compared with other delivery models and fee for service practices in order to describe more specifically what aspects of model delivery and incentives affect care.
  BMC Family Practice 06/2011; 12:44. · 1.80 Impact Factor
• Article: Number of HbA1c tests unrelated to quality of diabetes control: an electronic medical record data linkage study.

  Richard H Glazier, Stewart B Harris, Jordan W Tompkins, Andrew S Wilton, Vijaya Chevendra, Moira A Stewart, Amardeep Thind
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  ABSTRACT: Process measures are heavily relied on to assess physician performance/quality of diabetes control. A unique primary care electronic medical record-health administrative database linkage found no clinically meaningful relationship between control (HbA1c value) and number of tests performed, casting doubt on the usefulness in diabetes performance and quality of care assessment.
  Diabetes research and clinical practice 05/2011; 93(1):e37-40. · 2.16 Impact Factor
• Source

  Available from: PubMed Central

  Article: Is there an impact of public smoking bans on self-reported smoking status and exposure to secondhand smoke?

  Alisa B Naiman, Richard H Glazier, Rahim Moineddin
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  ABSTRACT: Implementation of smoke free policies has potentially substantial effects on health by reducing secondhand smoke exposure. However little is known about whether the introduction of anti-smoking legislation translates into decreased secondhand smoke exposure. We examined whether smoking bans impact rates of secondhand smoke exposure in public places and rates of complete workplace smoking restriction. Canadian Community Health Survey was used to obtain secondhand smoking exposure rates in 15 Ontario municipalities. Data analysis included descriptive summaries and 95% confidence intervals were calculated and compared across groups Across all studied municipalities, secondhand smoke exposure in public places decreased by 4.7% and workplace exposure decreased by 2.3% between the 2003 and 2005 survey years. The only jurisdiction to implement a full ban from no previous ban was also the only setting that experienced significant decreases in both individual exposure to secondhand smoke in a public place (-17.3%, 95% CI -22.8, -11.8) and workplace exposure (-18.1%, 95% CI -24.9, -11.3). Exposures in vehicles and homes declined in almost all settings over time. Implementation of a full smoking ban was associated with the largest decreases in secondhand smoke exposure while partial bans and changes in existing bans had inconsistent effects. In addition to decreasing exposure in public places as would be expected from legislation, bans may have additional benefits by decreasing rates of current smokers and decreasing exposures to secondhand smoke in private settings.
  BMC Public Health 03/2011; 11:146. · 2.00 Impact Factor
• Source

  Available from: sogc.org

  Article: Adverse pregnancy outcomes among foreign-born Canadians.

  Rajiv R Shah, Joel G Ray, Nathan Taback, Filomena Meffe, Richard H Glazier
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  ABSTRACT: Numerous non-Canadian studies have shown that immigrant women experience higher rates of adverse maternal and perinatal events than the general non-immigrant population. Limited information about the pregnancy outcomes of immigrant Canadian women is available. We conducted a retrospective cohort study at St. Michael's Hospital between October 2002 and June 2006 to estimate the risk of adverse obstetrical and perinatal outcomes among foreign-born women residing in Toronto. The main study outcomes were the incidences of preterm delivery between 32 and 36 completed weeks' gestation, low infant birth weight, and delivery by Caesarean section. Compared with Canadian-born women, those who were foreign-born had an associated adjusted odds ratio of 0.85 (95% CI 0.64 to 1.14) for preterm delivery, 1.92 (95% CI 1.29 to 2.85) for low infant birth weight, and 1.16 (95% CI 1.01 to 1.34) for delivery by Caesarean section. In this study, foreign-born women had a non-significantly lower risk of preterm birth, but a significantly higher risk of low birth weight infants and Caesarean section than Canadian-born women. In this urban setting, recent immigrant women have worse pregnancy outcomes, warranting increased attention to this group during antenatal and intrapartum care.
  Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 03/2011; 33(3):207-15.
• Article: Influence of neighborhood deprivation, gender and ethno-racial origin on smoking behavior of Canadian youth.

  Flora I Matheson, Marie C LaFreniere, Heather L White, Rahim Moineddin, James R Dunn, Richard H Glazier
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  ABSTRACT: Deprived neighborhoods play an important role in adult smoking behavior, but little research exists about youth on this topic. This study explored the relationship between deprivation and youth smoking to examine whether this association differs by gender and ethno-racial origin. Individual-level data from the Canadian Community Health Survey (2000-2005) were combined with neighborhood-level data from the 2001 Canada Census to assess smoking among youth aged 12-18 (n = 15,615). Youth who were female (OR = 1.27, 95%CI:1.16-1.38), White (OR = 1.95, 95%CI:1.71-2.21) and living in deprived neighborhoods (OR = 1.22, 95%CI:1.16-1.28) were more likely to smoke. In multilevel models, White females were more likely to smoke relative to non-White females and males (OR = 1.42, 95%CI:1.06-1.89). Youth with a strong sense of community belonging and living in deprived neighborhoods were at increased risk of smoking (OR = 1.18, 95%CI:1.06-1.32). The individual-level risk factor, household smoker, contributed substantially to youth smoking reducing the bivariate association between material deprivation and smoking by 33%. White females, youth cohabiting with other smokers and youth living in poor neighborhoods with a strong sense of community belonging, are at an increased risk of smoking. Future anti-smoking efforts might have greater impact if they target at-risk youth as well as household members who cohabit with youth.
  Preventive Medicine 02/2011; 52(5):376-80. · 3.22 Impact Factor
• Article: Drinking in context: the influence of gender and neighbourhood deprivation on alcohol consumption.

  Flora I Matheson, Heather L White, Rahim Moineddin, James R Dunn, Richard H Glazier
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  ABSTRACT: Findings from contextual studies have shown that living in both poor and affluent neighbourhoods increases the risk of drinking and drug use, but few studies have examined the connection between neighbourhood context and drinking from a gender perspective. We investigated the association between gender, neighbourhood deprivation and weekly drinking behaviour (number of drinks) in a national sample of 93 457 Canadians using multilevel zero-inflated Poisson regression. A cross-level interaction between gender and neighbourhood deprivation was examined while controlling for other potential risk factors. 53% of Canadians reported having at least one drink in the last year (men=61%; women=46%). Among respondents who were drinkers, the average number of drinks per week was 6.4 with male drinkers reporting an average of 7.9 and female drinkers reporting an average of 4.6. Neighbourhood material deprivation was independently associated with weekly drinking. Findings from multilevel analysis showed a u-shaped curve between neighbourhood deprivation and drinking, but only for men. Men living in the poorest neighbourhoods drank more weekly (8.5 drinks) than men living in neighbourhoods of wealthy (4.5 drinks) and mid-range deprivation (3.7 drinks). No difference in drinking by neighbourhood material deprivation was observed among women. Men, like women, experience gender-specific health difficulties (eg, alcohol-related problems) suggesting the need for a gendered focus on policies and services related to women's and men's health. The challenge for public health and primary care is to work together to target risk-taking behaviours among men through treatment, prevention and cultural/educational messages aimed at building healthy lifestyles.
  Journal of epidemiology and community health 02/2011; 66(6):e4. · 3.04 Impact Factor
• Source

  Available from: PubMed Central

  Article: Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures.

  Heather L White, Richard H Glazier
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  ABSTRACT: Despite more than a decade of research on hospitalists and their performance, disagreement still exists regarding whether and how hospital-based physicians improve the quality of inpatient care delivery. This systematic review summarizes the findings from 65 comparative evaluations to determine whether hospitalists provide a higher quality of inpatient care relative to traditional inpatient physicians who maintain hospital privileges with concurrent outpatient practices. Articles on hospitalist performance published between January 1996 and December 2010 were identified through MEDLINE, Embase, Science Citation Index, CINAHL, NHS Economic Evaluation Database and a hand-search of reference lists, key journals and editorials. Comparative evaluations presenting original, quantitative data on processes, efficiency or clinical outcome measures of care between hospitalists, community-based physicians and traditional academic attending physicians were included (n = 65). After proposing a conceptual framework for evaluating inpatient physician performance, major findings on quality are summarized according to their percentage change, direction and statistical significance. The majority of reviewed articles demonstrated that hospitalists are efficient providers of inpatient care on the basis of reductions in their patients' average length of stay (69%) and total hospital costs (70%); however, the clinical quality of hospitalist care appears to be comparable to that provided by their colleagues. The methodological quality of hospitalist evaluations remains a concern and has not improved over time. Persistent issues include insufficient reporting of source or sample populations (n = 30), patients lost to follow-up (n = 42) and estimates of effect or random variability (n = 35); inappropriate use of statistical tests (n = 55); and failure to adjust for established confounders (n = 37). Future research should include an expanded focus on the specific structures of care that differentiate hospitalists from other inpatient physician groups as well as the development of better conceptual and statistical models that identify and measure underlying mechanisms driving provider-outcome associations in quality.
  BMC Medicine 01/2011; 9:58. · 6.03 Impact Factor
• Source

  Available from: PubMed Central

  Article: Predictors of low cervical cancer screening among immigrant women in Ontario, Canada.

  Aisha K Lofters, Rahim Moineddin, Stephen W Hwang, Richard H Glazier
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  ABSTRACT: Disparities in cervical cancer screening are known to exist in Ontario, Canada for foreign-born women. The relative importance of various barriers to screening may vary across ethnic groups. This study aimed to determine how predictors of low cervical cancer screening, reflective of sociodemographics, the health care system, and migration, varied by region of origin for Ontario's immigrant women. Using a validated billing code algorithm, we determined the proportion of women who were not screened during the three-year period of 2006-2008 among 455,864 identified immigrant women living in Ontario's urban centres. We created eight identical multivariate Poisson models, stratified by eight regions of origin for immigrant women. In these models, we adjusted for various sociodemographic, health care-related and migration-related variables. We then used the resulting adjusted relative risks to calculate population-attributable fractions for each variable by region of origin. Region of origin was not a significant source of effect modification for lack of recent cervical cancer screening. Certain variables were significantly associated with lack of screening across all or nearly all world regions. These consisted of not being in the 35-49 year age group, residence in the lowest-income neighbourhoods, not being in a primary care patient enrolment model, a provider from the same region, and not having a female provider. For all women, the highest population-attributable risk was seen for not having a female provider, with values ranging from 16.8% [95% CI 14.6-19.1%] among women from the Middle East and North Africa to 27.4% [95% CI 26.2-28.6%] for women from East Asia and the Pacific. To increase screening rates across immigrant groups, efforts should be made to ensure that women have access to a regular source of primary care, and ideally access to a female health professional. Efforts should also be made to increase the enrolment of immigrant women in new primary care patient enrolment models.
  BMC Women s Health 01/2011; 11:20.
• Source

  Available from: PubMed Central

  Article: Validation of case-finding algorithms derived from administrative data for identifying adults living with human immunodeficiency virus infection.

  Tony Antoniou, Brandon Zagorski, Mona R Loutfy, Carol Strike, Richard H Glazier
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  ABSTRACT: We sought to validate a case-finding algorithm for human immunodeficiency virus (HIV) infection using administrative health databases in Ontario, Canada. We constructed 48 case-finding algorithms using combinations of physician billing claims, hospital and emergency room separations and prescription drug claims. We determined the test characteristics of each algorithm over various time frames for identifying HIV infection, using data abstracted from the charts of 2,040 randomly selected patients receiving care at two medical practices in Toronto, Ontario as the reference standard. With the exception of algorithms using only a single physician claim, the specificity of all algorithms exceeded 99%. An algorithm consisting of three physician claims over a three year period had a sensitivity and specificity of 96.2% (95% CI 95.2%-97.9%) and 99.6% (95% CI 99.1%-99.8%), respectively. Application of the algorithm to the province of Ontario identified 12,179 HIV-infected patients in care for the period spanning April 1, 2007 to March 31, 2009. Case-finding algorithms generated from administrative data can accurately identify adults living with HIV. A relatively simple "3 claims in 3 years" definition can be used for assembling a population-based cohort and facilitating future research examining trends in health service use and outcomes among HIV-infected adults in Ontario.
  PLoS ONE 01/2011; 6(6):e21748. · 4.09 Impact Factor
• Article: Neighbourhood deprivation and regional inequalities in self-reported health among Canadians: Are we equally at risk?

  Heather L. White, Flora I. Matheson, Rahim Moineddin, James R. Dunn, Richard H. Glazier
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  ABSTRACT: Individual-level data from the Canadian Community Health Survey was combined with area-level data from the 2001 Canada Census to explore the relationship between neighbourhood deprivation and regional inequalities in self-reported health (n=120,290). While neighbourhood deprivation was a significant predictor of fair/poor health in all geographic regions (OR=1.11; 95% CI: 1.08, 1.14), living on the Atlantic and Pacific coasts exacerbated the detrimental effects of neighbourhood deprivation on the perceived health of respondents (OR=1.21; 1.28). By failing to explore regional variations in risk, we could fail to identify areas where provincial policies may interact with neighbourhood factors to reinforce health inequalities amongst deprived communities.
  Health & Place 12/2010; · 2.67 Impact Factor
• Article: From places to flows. International secondary migration and birth outcomes.

  Marcelo L Urquia, John W Frank, Richard H Glazier
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  ABSTRACT: Research on the health status of international migrants to industrialised countries in general, and on perinatal outcomes in particular, has assumed an interpretative model based on primary migration, characterised by one permanent cross-border movement from the migrant's country of birth. However, many migrants experience more complex migration patterns that may also be associated with human health. Secondary migration, defined as a migration from a country of residence other than the country where the immigrant was born, has been growing during the last two decades, favoured by globalisation. The purpose of this study was to examine the association between secondary migration and preterm birth (PTB) and infant birthweight at term (BW) using a Canadian official immigration database to build a cohort of immigrants to Ontario, Canada, who obtained their permanent residence in the years 1985-2000. The study population comprised 320,398 singleton live infants born to immigrant women during 1988-2007. Primary and secondary migrants were categorised according to whether they were born in an industrialised country or not. Secondary migrants were further subdivided according to whether the country from which they migrated to Canada was industrialised or not. We found that compared to primary migrants, secondary migrants to Canada born in non-industrialised countries had lower odds of PTB and higher mean BW at term. However, such a protective effect was not observed among secondary migrants born in industrialised countries. In a cross-classified multilevel model restricted to secondary migrants, 5.2% of the variation in birthweight was explained by migrants' countries of birth and 0.8% by migrants' countries of last permanent residence. These findings are consistent with the so-called healthy migrant effect, implying that selective migration from non-industrialised countries is associated with protective individual characteristics.
  Social Science [?] Medicine 11/2010; 71(9):1620-6. · 2.70 Impact Factor
• Article: Cervical cancer screening among urban immigrants by region of origin: a population-based cohort study.

  Aisha K Lofters, Stephen W Hwang, Rahim Moineddin, Richard H Glazier
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  ABSTRACT: We compared the prevalence of appropriate cervical cancer screening among screening-eligible immigrant women from major geographic regions of the world and native-born women. We determined the proportion of women who were screened during the three-year period of 2006-2008 among 2.9 million screening-eligible women living in urban centres in Ontario, Canada. In multivariate analyses, we adjusted for numerous variables including age, neighbourhood-level income, and prenatal visits during the study period. 61.3% of women were up-to-date on cervical cancer screening. Screening rates were lowest among women from South Asia when compared to the referent group (Canadian-born women and immigrants who arrived before 1985) (adjusted rate ratio 0.81, 95% CI [0.80-0.82] among women aged 18-49 years, adjusted rate ratio 0.67 [0.65-0.69] among women aged 50-66 years). Of the older South Asian women living in the lowest-income neighbourhoods and not in a primary care enrollment model, 21.9% had been appropriately screened. In contrast, among Canadian-born women living in the highest-income neighbourhoods and in a primary care enrollment model, 79.0% had been appropriately screened. Efforts to reduce cervical cancer screening disparities should focus on women living in the lowest-income neighbourhoods and women from South Asia.
  Preventive Medicine 10/2010; 51(6):509-16. · 3.22 Impact Factor
• Article: Low rates of cervical cancer screening among urban immigrants: a population-based study in Ontario, Canada.

  Aisha K Lofters, Rahim Moineddin, Stephen W Hwang, Richard H Glazier
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  ABSTRACT: Women who are immigrants or socioeconomically disadvantaged have been found to have significantly lower cervical cancer screening rates than their peers in Toronto, Ontario, Canada. The objective of this study was to examine rates of appropriate cervical cancer screening among women living in Ontario, Canada, using recent registration with Ontario's universal health insurance plan as an indicator of immigrant status. This retrospective cohort study included 2,273,995 screening-eligible women aged 25 to 69 years, who resided in Ontario's metropolitan areas during the calendar years 2003, 2004, and 2005. A validated algorithm was applied to the Ontario-wide physicians' claims database to determine which women had undergone cervical cancer screening with a Pap test during the 3-year period. Appropriate cervical cancer screening occurred for 61.1% of women. Despite adjustment for physician contact and pregnancy rates, cervical cancer screening rates were especially low among: women aged 50 to 69 years; women living in low-income areas; and women who had registered with Ontario's universal health insurance plan within the preceding 10 years, a group consisting largely of recent immigrants. Women with all 3 of these characteristics had a screening rate of 31.0% compared with 70.5% among women with none of these characteristics. Within a system of universal health insurance, appropriate cervical cancer screening is significantly lower among women who are older, living in low-income areas, or recent immigrants. Efforts to reduce disparities in cervical cancer screening should focus on women with these characteristics.
  Medical care 07/2010; 48(7):611-8. · 3.24 Impact Factor
• Source

  Available from: usherbrooke.ca

  Article: Trimethoprim-sulfamethoxazole-induced hyperkalemia in patients receiving inhibitors of the renin-angiotensin system: a population-based study.

  Tony Antoniou, Tara Gomes, David N Juurlink, Mona R Loutfy, Richard H Glazier, Muhammad M Mamdani
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  ABSTRACT: Trimethoprim therapy can cause hyperkalemia and is often coprescribed with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs). The objective of this study was to characterize the risk of hyperkalemia-associated hospitalization in elderly patients who were being treated with trimethoprim-sulfamethoxazole along with either an ACEI or an ARB. We conducted a population-based, nested case-control study of a cohort of elderly patients 66 years or older who were residents of Ontario, Canada, and who were receiving continuous therapy with either an ACEI or an ARB. Case patients were those with a hyperkalemia-associated hospitalization within 14 days of receiving a prescription for trimethoprim-sulfamethoxazole, amoxicillin, ciprofloxacin, norfloxacin, or nitrofurantoin. For each case, we identified up to 4 control patients from the same cohort matched for age, sex, and presence or absence of chronic renal disease and diabetes. Odds ratios were determined for the association between hyperkalemia-associated hospitalization and previous antibiotic use. During the 14-year study period, we identified 4148 admissions involving hyperkalemia, 371 of which occurred within 14 days of antibiotic exposure. Compared with amoxicillin, the use of trimethoprim-sulfamethoxazole was associated with a nearly 7-fold increased risk of hyperkalemia-associated hospitalization (adjusted odds ratio, 6.7; 95% confidence interval, 4.5-10.0). No such risk was found with the use of comparator antibiotics. Among older patients treated with ACEIs or ARBs, the use of trimethoprim-sulfamethoxazole is associated with a major increase in the risk of hyperkalemia-associated hospitalization relative to other antibiotics. Alternate antibiotic therapy should be considered in these patients when clinically appropriate.
  Archives of internal medicine 06/2010; 170(12):1045-9. · 11.46 Impact Factor
• Source

  Available from: pnhpcalifornia.org

  Article: Building the patient-centered medical home in Ontario.

  Richard H Glazier, Donald A Redelmeier
  JAMA The Journal of the American Medical Association 06/2010; 303(21):2186-7. · 30.03 Impact Factor
• Article: Age- and sex-related prevalence of diabetes mellitus among immigrants to Ontario, Canada.

  Maria Isabella Creatore, Rahim Moineddin, Gillian Booth, Doug H Manuel, Marie DesMeules, Sarah McDermott, Richard H Glazier
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  ABSTRACT: The majority of immigrants to Canada originate from the developing world, where the most rapid increase in prevalence of diabetes mellitus is occurring. We undertook a population-based study involving immigrants to Ontario, Canada, to evaluate the distribution of risk for diabetes in this population. We used linked administrative health and immigration records to calculate age-specific and age-adjusted prevalence rates among men and women aged 20 years or older in 2005. We compared rates among 1,122,771 immigrants to Ontario by country and region of birth to rates among long-term residents of the province. We used logistic regression to identify and quantify risk factors for diabetes in the immigrant population. After controlling for age, immigration category, level of education, level of income and time since arrival, we found that, as compared with immigrants from western Europe and North America, risk for diabetes was elevated among immigrants from South Asia (odds ratio [OR] for men 4.01, 95% CI 3.82-4.21; OR for women 3.22, 95% CI 3.07-3.37), Latin America and the Caribbean (OR for men 2.18, 95% CI 2.08-2.30; OR for women 2.40, 95% CI: 2.29-2.52), and sub-Saharan Africa (OR for men 2.31, 95% CI 2.17-2.45; OR for women 1.83, 95% CI 1.72-1.95). Increased risk became evident at an early age (35-49 years) and was equally high or higher among women as compared with men. Lower socio-economic status and greater time living in Canada were also associated with increased risk for diabetes. Recent immigrants, particularly women and immigrants of South Asian and African origin, are at high risk for diabetes compared with long-term residents of Ontario. This risk becomes evident at an early age, suggesting that effective programs for prevention of diabetes should be developed and targeted to immigrants in all age groups.
  Canadian Medical Association Journal 05/2010; 182(8):781-9. · 8.22 Impact Factor
• Article: Many Canadians feel healthcare needs are not being met.

  Lyn M Sibley, Richard H Glazier
  Healthcare quarterly (Toronto, Ont.) 01/2010; 13(3):19-22.
• Source

  Available from: PubMed Central

  Article: Investigating concordance in diabetes diagnosis between primary care charts (electronic medical records) and health administrative data: a retrospective cohort study.

  Stewart B Harris, Richard H Glazier, Jordan W Tompkins, Andrew S Wilton, Vijaya Chevendra, Moira A Stewart, Amardeep Thind
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  ABSTRACT: Electronic medical records contain valuable clinical information not readily available elsewhere. Accordingly, they hold important potential for contributing to and enhancing chronic disease registries with the goal of improving chronic disease management; however a standard for diagnoses of conditions such as diabetes remains to be developed. The purpose of this study was to establish a validated electronic medical record definition for diabetes. We constructed a retrospective cohort using health administrative data from the Institute for Clinical Evaluative Sciences Ontario Diabetes Database linked with electronic medical records from the Deliver Primary Healthcare Information Project using data from 1 April 2006-31 March 2008 (N = 19,443). We systematically examined eight definitions for diabetes diagnosis, both established and proposed. The definition that identified the highest number of patients with diabetes (N = 2,180) while limiting to those with the highest probability of having diabetes was: individuals with ≥2 abnormal plasma glucose tests, or diabetes on the problem list, or insulin prescription, or ≥2 oral anti-diabetic agents, or HbA1c ≥6.5%. Compared to the Ontario Diabetes Database, this definition identified 13% more patients while maintaining good sensitivity (75%) and specificity (98%). This study establishes the feasibility of developing an electronic medical record standard definition of diabetes and validates an algorithm for use in this context. While the algorithm may need to be tailored to fit available data in different electronic medical records, it contributes to the establishment of validated disease registries with the goal of enhancing research, and enabling quality improvement in clinical care and patient self-management.
  BMC Health Services Research 01/2010; 10:347. · 1.66 Impact Factor