Jeffrey A Johnson

University of Alberta, Edmonton, Alberta, Canada

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Publications (169)629.36 Total impact

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    ABSTRACT: The purpose of this study was to assess the relationship between diabetic ketoacidosis (DKA) hospitalization and driving distance from home to outpatient diabetes care in adults with type 1 diabetes mellitus. We identified adults with type 1 diabetes using clinical and administrative databases living in Calgary, Alberta. The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, codes were used to identify DKA hospitalizations, and geographic information systems were used to obtain road distance. Multivariate logistic regression was used to assess the association between driving distance (exposure) to diabetes care sites and the outcome of DKA hospitalization. We identified 1467 patients (151 patients with DKA) with type 1 diabetes. Patients with DKA hospitalizations were younger (35.6 vs. 41.0 years), had shorter duration of diabetes (13.6 vs. 18.7 years) and higher glycated hemoglobin (9.2% vs. 8.4%). Driving distance from home to diabetes centre 1 (adjusted odds ratio 1.02 per 1 km; 95% confidence interval, 0.96 to 1.07), diabetes centre 2 (adjusted odds ratio 1.01; 95% confidence interval, 0.99 to 1.04) or closest general practitioner (adjusted odds ratio 0.9; 95% confidence interval, 0.63 to 1.25) was not associated with DKA hospitalization. Driving distance was also not associated with glycemic control. Within a large urban city, driving distance to diabetes centres does not appear to be protective of DKA hospitalization. However, this work does not preclude the role of local travel distance and diabetes outcomes. More research is required to explore the role of other individual, neighbourhood and community factors that influence DKA hospitalization.
    Canadian Journal of Diabetes 05/2014; · 0.46 Impact Factor
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    ABSTRACT: Objectif Le but de cette étude était d’évaluer la relation entre l’hospitalisation pour une acidocétose diabétique (ACD), et la distance routière entre le domicile et le centre de soins ambulatoires pour les diabétiques chez les adultes souffrant du diabète sucré de type 1. Méthodes Nous avons identifié les adultes souffrant du diabète de type 1 et vivant à Calgary, en Alberta à partir des bases de données cliniques et administratives. Les codes de la Classification statistique internationale des maladies et des problèmes de santé connexes, dixième révision, ont été utilisés pour identifier les hospitalisations pour une ACD, et les systèmes d’information géographique ont été utilisés pour obtenir la distance routière. La régression logistique multivariée a été utilisée pour évaluer le lien entre la distance routière (exposition) et les centres de soins aux patients diabétiques, et les résultats de l’hospitalisation pour une ACD. Résultats Nous avons identifié 1467 patients (dont 151 patients souffrent d’ACD) souffrant du diabète de type 1. Les patients ayant subi des hospitalisations pour une ACD étaient plus jeunes (35,6 vs 41,0 ans), souffraient d’un diabète depuis moins longtemps (13,6 vs 18,7 ans) et avaient une hémoglobine glyquée plus élevée (9,2 % vs 8,4 %). La distance routière du domicile au centre de diabète 1 (ratio d’incidence approché ajusté 1,02 au 1 km; intervalle de confiance à 95 %, 0,96 à 1,07), au centre de diabète 2 (ratio d’incidence approché ajusté 1,01; intervalle de confiance à 95 %, 0,99 à 1,04) ou à l’omnipraticien le plus proche (ratio d’incidence approché ajusté 0,9; intervalle de confiance à 95 %, 0,63 à 1,25) n'a pas été associée à l’hospitalisation pour une ACD. La distance routière n'a également pas été associée à la régulation de la glycémie. Conclusions Au sein d’une grande région urbaine, la distance routière vers les centres de diabète ne semble pas faire éviter l’hospitalisation pour une ACD. Cependant, ces travaux n’excluent pas le rôle de la distance de déplacement local et les résultats liés au diabète. Plus de recherches sont nécessaires pour étudier le rôle d’autres facteurs individuels, de proximité et communautaires qui influencent l’hospitalisation pour une ACD.
    Canadian Journal of Diabetes 01/2014; · 0.46 Impact Factor
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    ABSTRACT: The role of obesity in the prevalence and clustering of multimorbidity, the occurrence of two or more chronic conditions, is understudied. We estimated the prevalence of multimorbidity by obesity status, and the interaction of obesity with other predictors of multimorbidity. Data from adult respondents (18 years and over) to the Health Quality Council of Alberta 2012 Patient Experience Survey were analyzed. Multivariable regression models were fitted to test for associations. The survey sample included 4803 respondents; 55.8% were female and the mean age was 47.8 years (SD, 17.1). The majority (62.0%) of respondents reported having at least one chronic condition. The prevalence of multimorbidity, including obesity, was 36.0% (95% CI, 34.8 -- 37.3). The prevalence of obesity alone was 28.1% (95% CI 26.6 -- 29.5). Having obesity was associated with more than double the odds of multimorbidity (odds ratio = 2.2, 95% CI 1.9 -- 2.7) compared to non-obese. The prevalence of multimorbidity in the general population is high, but even higher in obese than non-obese persons. These findings may be relevant for surveillance, prevention and management strategies for multimorbidity.
    BMC Public Health 12/2013; 13(1):1161. · 2.08 Impact Factor
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    ABSTRACT: This study aimed to (1) describe the profile of adults with type 2 diabetes (T2D) in Canada and (2) assess the uptake of clinical care best practices, as defined by the Canadian Diabetes Association (CDA) Clinical Practice Guidelines (CPGs). We used data from the 2011 Survey on Living with Chronic Diseases in Canada - Diabetes component. Participants were aged 20 years and older, living in the 10 Canadian provinces, with self-reported T2D. Descriptive analyses present the prevalence of complications and comorbidities, as well as the level of clinical monitoring and self-monitoring/lifestyle management recommendations participants received. We included 2335 participants with T2D, a mean age of 62.9 years, and high prevalence of complications/comorbidities and prescription medication use. Most participants reported being monitored as recommended for eye disease (73.9%), weight (81.0%), blood pressure (89.0%) and blood cholesterol levels (94.3%), but only 65.5% reported having at least two HbA1c tests during the last year and 46.5% reported an annual foot examination by a health professional. About two-thirds of the participants reported having received recommendations on weight management (59.9%) and physical activity (64.7%) from a health professional in the previous year; only 47.8% of the participants reported having received diet counseling to improve diabetes control. Although the uptake of CDA CPGs for clinical and self-monitoring was high, with the majority of the participants reporting meeting most indicators, it was lower for HbA1c measurement and foot examination. Uptake of lifestyle management recommendations provided by health professionals was also significantly lower.
    Diabetes research and clinical practice 12/2013; · 2.74 Impact Factor
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    ABSTRACT: Objectives: The incidence of gestational diabetes mellitus (GDM) is increasing. However, less is known about the incidence of preeclampsia (PE) and whether it is affected by the presence of GDM. We sought to document the population-level incidence of GDM and PE during the last decade and examine the association between GDM and PE after accounting for established risk factors. Methods: We selected a population-based cohort retrospectively using data from the Alberta Perinatal Health Program registry. Logistic regression was used to examine the association between GDM and PE after adjusting for baseline characteristics. Results: Of 426 296 deliveries between 2000 and 2009, 422 672 were in women without pre-existing diabetes. Among these women, the incidence of GDM increased from 3.1% in 2000 to 4.6% in 2009 (P < 0.01), while the incidence of PE remained stable at approximately 1.3% per year. The incidence of PE was significantly higher in women with GDM than in those without GDM (2.6% vs. 1.2%; P < 0.01). After adjustment, women with GDM had a 90% higher risk of PE than those without GDM (OR 1.9; 95% CI 1.7 to 2.1). Other significant risk factors for PE were age, obesity, nulliparity, multifetal gestation, pre-existing hypertension, and chronic kidney disease. Conclusion: In this contemporary population-based study spanning 10 years, there was a significant increase in the incidence of GDM over time. The higher incidence of PE in women with GDM than in normoglycemic women suggests a need for heightened surveillance and monitoring of women with GDM for the development of PE.
    Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 11/2013; 35(11):986-994.
  • Canadian Journal of Diabetes 10/2013; 37S4:S4. · 0.46 Impact Factor
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    ABSTRACT: OBJECTIVE To investigate whether the risk of bladder cancer in individuals with newly diagnosed type 2 diabetes is influenced by the frequency of physician visits before diagnosis as a measure of detection bias.RESEARCH DESIGN AND METHODS With the use of linked administrative databases from 1996 to 2006, we established a cohort of 185,100 adults from British Columbia, Canada, with incident type 2 diabetes matched one to one with nondiabetic individuals on age, sex, and index date. Incidence rates and adjusted hazard ratios (aHRs) for bladder cancer were calculated during annual time windows following the index date. Analyses were stratified by number of physician visits in the 2 years before diabetes diagnosis and adjusted for age, sex, year of cohort entry, and socioeconomic status.RESULTSThe study population was 54% men and had an average age of 60.7 ± 13.5 years; 1,171 new bladder cancers were diagnosed over a median follow-up of 4 years. In the first year after diabetes diagnosis, bladder cancer incidence in the diabetic cohort was 85.3 (95% CI 72.0-100.4) per 100,000 person-years and 66.1 (54.5-79.4) in the control cohort (aHR 1.30 [1.02-1.67], P = 0.03). This first-year increased bladder cancer risk was limited to those with the fewest physician visits 2 years before the index date (≤12 visits, aHR 2.14 [1.29-3.55], P = 0.003). After the first year, type 2 diabetes was not associated with bladder cancer.CONCLUSIONS The results suggest that early detection bias may account for an overestimation in previously reported increased risks of bladder cancer associated with type 2 diabetes.
    Diabetes care 08/2013; · 7.74 Impact Factor
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    ABSTRACT: There are 2 major forms of diabetes mellitus: types 1 and 2. A major limitation of most current population-based diabetes surveillance systems is the classification of diabetes types. Our objective was to examine the concordance of self-reported diabetes type with a previously developed classification algorithm, using a nationally representative survey sample. Self-reported data were available from 2 544 adults with self-reported diabetes, aged ≥20 years and older, who responded to the diabetes component of the 2011 Survey of Living with Chronic Diseases in Canada. We examined the concordance of self-reported diabetes type with an algorithm based on self-reported, but objective, respondent characteristics, such as age of diagnosis and treatment patterns. Concordance was measured using kappa coefficients. Sensitivity, specificity and positive and negative predictive values were calculated using the algorithm as the reference "standard." Approximately 11% of the estimated population did not self-report diabetes type; almost all of these respondents would be classified as having type 2 diabetes by the algorithm. Of those self-reporting diabetes type, we found moderate overall agreement between the algorithm and self-reported type (kappa, 0.52; 95% confidence interval [CI], 0.52 to 0.53). Perfect agreement was noted in the youngest age group (kappa, 1.0; 95% CI, 1.0-1.0) but agreement was poor for the oldest age group (kappa, 0.20; 95% CI, 0.19 to 0.20). An algorithm based on self-reported, objective characteristics related to diabetes diagnosis and treatment patterns may have the potential to overcome limitations of simple self-report diabetes type for the classification of diabetes type in older adults.
    Canadian Journal of Diabetes 08/2013; 37(4):249-53. · 0.46 Impact Factor
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    ABSTRACT: For insulin-treated patients with type 2 diabetes mellitus (T2DM), self-monitoring of blood glucose (SMBG) may be vital in adjusting insulin dosages. For patients who do not use insulin, evidence supporting the use of SMBG is inconclusive. The prevalence, frequency and correlates of SMBG are examined. Data pertain to 2,682 individuals aged 20 or older with T2DM who responded to the 2011 Survey on Living with Chronic Diseases in Canada. Multivariate prevalence rate ratios for associations between respondents' characteristics and their use of SMBG were derived using binomial regression models. A large majority of the study population (87.8%) reported SMBG. No difference in the prevalence of SMBG was observed between oral medication users compared with insulin users; however, the frequency of SMBG was lower for those taking oral medication only. Significant determinants of SMBG were a health professional's recommendation, having insurance coverage, and receiving an A1C test from a health professional. The use of SMBG by adults with T2DM is common, and does not differ between those taking oral medication only and those treated with insulin.
    Health reports / Statistics Canada, Canadian Centre for Health Information = Rapports sur la santé / Statistique Canada, Centre canadien d'information sur la santé 06/2013; 24(6):3-8. · 4.28 Impact Factor
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    ABSTRACT: BACKGROUND: Lifestyle behavior modification is an essential component of self-management of type 2 diabetes. We evaluated the prevalence of engagement in lifestyle behaviors for management of the disease, as well as the impact of healthcare professional support on these behaviors. METHODS: Self-reported data were available from 2682 adult respondents, age 20 years or older, to the 2011 Survey on Living with Chronic Diseases in Canada's diabetes component. Associations with never engaging in and not sustaining self-management behaviors (of dietary change, weight control, exercise, and smoking cessation) were evaluated using binomial regression models. RESULTS: The prevalence of reported dietary change, weight control/loss, increased exercise and smoking cessation (among those who smoked since being diagnosed) were 89.7%, 72.1%, 69.5%, and 30.6%, respectively. Those who reported not receiving health professional advice in the previous 12 months were more likely to report never engaging in dietary change (RR = 2.7, 95% CI 1.8 -- 4.2), exercise (RR = 1.7, 95% CI 1.3 -- 2.1), or weight control/loss (RR = 2.2, 95% CI 1.3 -- 3.6), but not smoking cessation (RR = 1.0; 95% CI: 0.7 -- 1.5). Also, living with diabetes for more than six years was associated with not sustaining dietary change, weight loss and smoking cessation. CONCLUSION: Health professional advice for lifestyle behaviors for type 2 diabetes self-management may support individual actions. Patients living with the disease for more than 6 years may require additional support in sustaining recommended behaviors.
    BMC Public Health 05/2013; 13(1):451. · 2.08 Impact Factor
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    ABSTRACT: BACKGROUND: Guidelines recommend influenza vaccinations in all diabetic adults, but there is limited evidence to support vaccinating working-age adults (<65 years) with diabetes. We examined the effectiveness of influenza vaccine in this subgroup, compared with elderly adults (≥65 years) for whom vaccination recommendations are well accepted. METHODS: We identified all adults with diabetes, along with a sample of age-matched and sex-matched comparison subjects without diabetes, from 2000 to 2008, using administrative data from Manitoba, Canada. With multivariable Poisson regression, we estimated vaccine effectiveness (VE) on influenza-like illnesses (ILIs), pneumonia and influenza (PI) hospitalisations and all-cause (ALL) hospitalisations during periods of known circulating influenza. Analyses were replicated outside of influenza season to rule out residual confounding. RESULTS: We included 543 367 person-years of follow-up, during which 223 920 ILI, 5422 PI and 94 988 ALL occurred. The majority (58%) of adults with diabetes were working age. In this group, influenza vaccination was associated with relative reductions in PI (43%, 95% CI 28% to 54%) and ALL (28%, 95% CI 24% to 32%) but not ILI (-1%, 95% CI -3% to 1%). VE was similar in elderly adults for ALL (33-34%) and PI (45-55%), although not ILI (12-13%). However, similar estimates of effectiveness were also observed for all three groups during non-influenza control periods. CONCLUSIONS: Working-age adults with diabetes experience similar benefits from vaccination as elderly adults, supporting current diabetes-specific recommendations. However, these benefits were also manifest outside of influenza season, suggesting residual bias. Vaccination recommendations in all high-risk adults would benefit from randomised trial evidence.
    Thorax 03/2013; · 8.38 Impact Factor
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    ABSTRACT: BACKGROUND: -There is ongoing controversy regarding the safety and effectiveness of metformin in the setting of heart failure (HF). Therefore, we undertook a systematic review of the trial and non-trial evidence for metformin in patients with diabetes and HF. METHODS AND RESULTS: -We conducted a comprehensive search for controlled studies evaluating the association between metformin and morbidity and mortality in people with diabetes and HF. Two reviewers independently identified citations, extracted data, and evaluated quality. Risk estimates were abstracted and pooled where appropriate. As measures of overall safety we examined all-cause mortality and all-cause hospitalizations. Nine cohort studies were included; no RCTs were identified. Most (5 of 9) studies were published in 2010, and were of good quality. Metformin was associated with reduced mortality compared to controls (mostly sulfonylurea therapy): 23% vs 37%, pooled adjusted risk estimates 0.80, 0.74-0.87; I(2)=15%, P<0.001). No increased risk was observed for metformin in those with reduced left ventricular ejection fraction (mortality pooled adjusted risk estimate 0.91, 0.72 to 1.14, I(2)=0%, P=0.34) nor in those with HF and chronic kidney disease (pooled adjusted risk estimate 0.81, 0.64-1.02, P=0.08). Metformin was associated with a small reduction in all-cause hospitalizations (pooled estimate 0.93, 0.89-0.98, I(2)=0%, P=0.01). Metformin was not associated with increased risk of lactic acidosis. CONCLUSIONS: -The totality of evidence indicates that metformin is at least as safe as other glucose lowering treatments in patients with diabetes and HF, even in those with reduced left ventricular ejection fraction or concomitant chronic kidney disease (CKD). Until trial data becomes available, metformin should be considered the treatment of choice for those with diabetes and HF.
    Circulation Heart Failure 03/2013; · 6.68 Impact Factor
  • Denise L Campbell-Scherer, Jeffrey A Johnson
    Evidence-based medicine 03/2013;
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    ABSTRACT: PURPOSE: Administrative databases that only capture records for benefit-approved prescriptions may underestimate exposure because they do not capture non-benefit prescriptions. Using a natural experiment, we illustrate the impact of automating a prior-authorization policy on the completeness of drug exposure. METHODS: Using Saskatchewan (Canada) databases, weekly counts of benefit-approved and total prescription records in 2006 for new users of antidiabetic agents were examined across four categories: thiazolidinediones (TZDs), metformin, glyburide, and insulin. On July 1, 2006, Saskatchewan's public drug plan implemented an automated, online-adjudicated, prior-authorization process for TZDs; previously, prior approval was paper based. No such policy changes occurred for other drugs. We estimated the effect of this policy change on drug exposure using interrupted time-series analyses. RESULTS: We examined 223 552 prescription records: 19% were for TZDs, 48% for metformin, 20% for glyburide, and 13% for insulin. Prior to automation, there were, on average, 571 benefit-approved TZD records per week; however, the number of benefit-approved TZD records increased immediately after the automated process was introduced by 240 prescriptions per week (95% CI 200-280, p < 0.001). The average proportion of TZD benefit-approved records was 73% before and increased to 93% immediately following policy change (20% absolute change, 95% CI 18.7-20.4%). No changes were observed for metformin, glyburide, or insulin (p > 0.1 for all). CONCLUSIONS: Automating prior authorization for TZDs immediately increased the proportion of captured TZD records, suggesting in our study that one-fifth of TZD exposure was previously misclassified. If replicable, this indicates that even subtle changes in reimbursement policy may affect the validity of drug exposure data. Copyright © 2013 John Wiley & Sons, Ltd.
    Pharmacoepidemiology and Drug Safety 03/2013; · 2.90 Impact Factor
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    ABSTRACT: BACKGROUND: Vertebral fractures detected "incidentally" by chest radiograph usually do not trigger osteoporosis treatment in older patients. In a 3-arm controlled trial we reported that both physician-directed and enhanced (physician plus patient activation) interventions increased treatment rates more than 10-fold (15%-20% absolute increases) compared with usual care; the cost-effectiveness of these interventions is unknown. METHODS: Incremental cost-effectiveness of these 2 interventions compared with usual care was assessed using a Markov decision-analytic model, populated with 1-year outcomes data and direct intervention costs from the trial. Costs were expressed in 2009 Canadian dollars and effectiveness based on quality-adjusted life years (QALYs) gained. The perspective was health care payer; horizon was projected lifetime; costs and benefits were discounted at 3%; and deterministic and probabilistic sensitivity analyses were conducted. RESULTS: Per patient, the physician and enhanced interventions cost $34 and $42, respectively. Compared with usual care, for every 1000 patients exposed to the physican intervention there were 4 fewer fractures, 8 more QALYs gained, and $282,000 saved. Compared with physician interventions, for every 1000 patients exposed to enhanced interventions there were 6 fewer fractures, 6 more QALYs gained, and $339,000 saved. Both interventions dominated usual care and were cost-effective in ∼80% of 10,000 probabilistic simulations. Although the enhanced intervention cost $8 more per patient, it still dominated the physician intervention and usual care, and was the most economically attractive option. CONCLUSIONS: Pragmatic and inexpensive interventions directed at patients with incidentally detected vertebral fractures and their physicians are highly cost-effective at improving osteoporosis treatment, and in most circumstances also are cost-saving.
    The American journal of medicine 02/2013; 126(2):169.e9-169.e17. · 5.30 Impact Factor
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    ABSTRACT: BACKGROUND:Antiplatelet therapy is recommended as part of a strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. However, compliance with these guideline-recommended therapies appears to be less than ideal.OBJECTIVE:To assess the effect of adding pharmacists to primary care teams on initiation of guideline-concordant antiplatelet therapy in type 2 diabetic patients.METHODS:Prespecified secondary analysis of randomized trial data. In the main study, the pharmacist intervention included a complete medication history, limited physical examination, provision of guideline-concordant recommendations to the physician to optimize drug therapy, and 1-year follow-up. Controls received usual care without pharmacist interactions. Patients with an indication for antiplatelet therapy, but not using an antiplatelet drug at randomization were included in this substudy. The primary outcome was the proportion of patients using an antiplatelet drug at 1 year.RESULTS:At randomization, 257 of 260 study patients had guideline-concordant indications for antiplatelet therapy, but less than half (121; 47%) were using an antiplatelet drug. Overall, 136 patients met inclusion criteria for the substudy (71 intervention and 65 controls): 60% were women, with mean (SD) age 58.0 (11.9) years, diabetes duration 5.3 (6.0) years, and hemoglobin A(1c) 7.6% (1.5). Sixteen(12%) had established cardiovascular disease at enrollment. At 1 year, 43 (61%) intervention patients and 15 (23%) controls were using an antiplatelet drug (38% absolute difference; number needed to treat, 3; relative increase, 2.6; 95% CI 1.5-4.7; p < 0.001). Of these 58 patients, 52 (90%) were using aspirin 81 mg daily.CONCLUSIONS:Adding pharmacists to primary care teams significantly and substantially increased the proportion of type 2 diabetic patients using guideline-concordant antiplatelet therapy.
    Annals of Pharmacotherapy 01/2013; · 2.57 Impact Factor
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    ABSTRACT: The main objective of this review was to systematically review, assess, and report on the studies that have assessed health related quality of life (HRQOL) after VATS and thoracotomy for resection of lung cancer. We performed a systematic review of six databases. The Downs and Black tool was used to assess the risk of bias. Five studies were included. In general, patients undergoing VATS have a better HRQOL when compared to thoracotomy; however, there was a high risk of bias in the included studies. The consistent use of a lung cancer specific questionnaire for measuring HRQOL after surgery is encouraged.
    The Scientific World Journal 01/2013; 2013:789625. · 1.73 Impact Factor
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    ABSTRACT: PURPOSE Influenza and pneumococcal vaccination rates remain below national targets. We systematically reviewed the effectiveness of quality improvement interventions for increasing the rates of influenza and pneumococcal vaccinations among community-dwelling adults. METHODS We included randomized and nonrandomized studies with a concurrent control group. We estimated pooled odds ratios using random effects models, and used the Downs and Black tool to assess the quality of included studies. RESULTS Most studies involved elderly primary care patients. Interventions were associated with improvements in the rates of any vaccination (111 comparisons in 77 studies, pooled odds ratio [OR] = 1.61, 95% CI, 1.49-1.75), and influenza (93 comparisons, 65 studies, OR = 1.46, 95% CI, 1.35-1.57) and pneumococcal (58 comparisons, 35 studies, OR = 2.01, 95% CI, 1.72-2.3) vaccinations. Interventions that appeared effective were patient financial incentives (influenza only), audit and feedback (influenza only), clinician reminders, clinician financial incentives (influenza only), team change, patient outreach, delivery site changes (influenza only), clinician education (pneumococcus only), and case management (pneumococcus only). Patient outreach was more effective if personal contact was involved. Team changes were more effective where nurses administered influenza vaccinations independently. Heterogeneity in some pooled odds ratios was high, however, and funnel plots showed signs of potential publication bias. Study quality varied but was not associated with outcomes. CONCLUSIONS Quality improvement interventions, especially those that assign vaccination responsibilities to nonphysician personnel or that activate patients through personal contact, can modestly improve vaccination rates in community-dwelling adults. To meet national policy targets, more-potent interventions should be developed and evaluated.
    The Annals of Family Medicine 11/2012; 10(6):538-546. · 4.61 Impact Factor
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    ABSTRACT: BACKGROUND: Low health literacy is considered a potential barrier to improving health outcomes in people with diabetes and other chronic conditions, although the evidence has not been previously systematically reviewed. OBJECTIVE: To identify, appraise, and synthesize research evidence on the relationships between health literacy (functional, interactive, and critical) or numeracy and health outcomes (i.e., knowledge, behavioral and clinical) in people with diabetes. METHODS: English-language articles that addressed the relationship between health literacy or numeracy and at least one health outcome in people with diabetes were identified by two reviewers through searching six scientific databases, and hand-searching journals and reference lists. FINDINGS: Seven hundred twenty-three citations were identified and screened, 196 were considered, and 34 publications reporting data from 24 studies met the inclusion criteria and were included in this review. Consistent and sufficient evidence showed a positive association between health literacy and diabetes knowledge (eight studies). There was a lack of consistent evidence on the relationship between health literacy or numeracy and clinical outcomes, e.g., A1C (13 studies), self-reported complications (two studies), and achievement of clinical goals (one study); behavioral outcomes, e.g., self-monitoring of blood glucose (one study), self-efficacy (five studies); or patient-provider interactions (i.e., patient-physician communication, information exchange, decision-making, and trust), and other outcomes. The majority of the studies were from US primary care setting (87.5 %), and there were no randomized or other trials to improve health literacy. CONCLUSIONS: Low health literacy is consistently associated with poorer diabetes knowledge. However, there is little sufficient or consistent evidence suggesting that it is independently associated with processes or outcomes of diabetes-related care. Based on these findings, it may be premature to routinely screen for low health literacy as a means for improving diabetes-related health-related outcomes.
    Journal of General Internal Medicine 10/2012; · 3.28 Impact Factor
  • Jeffrey A Johnson, Isabelle N Colmers
    Diabetes research and clinical practice 09/2012; 98(1):1-2. · 2.74 Impact Factor

Publication Stats

4k Citations
629.36 Total Impact Points


  • 1997–2014
    • University of Alberta
      • • Department of Public Health Sciences
      • • School of Public Health
      • • Department of Medicine
      • • Department of Surgery
      • • Faculty of Medicine and Dentistry
      • • Faculty of Pharmacy and Pharmaceutical Sciences
      Edmonton, Alberta, Canada
  • 2013
    • Memorial University of Newfoundland
      St. John's, Newfoundland and Labrador, Canada
  • 2010–2013
    • Statistics Canada
      • Division of Health Analysis
      Ottawa, Ontario, Canada
  • 2012
    • Athabasca University
      • Centre for Nursing and Health Studies
      Athabasca, Alberta, Canada
  • 2010–2012
    • The University of Calgary
      • • Faculty of Medicine
      • • Faculty of Education
      Calgary, Alberta, Canada
  • 2007–2009
    • University of Illinois at Chicago
      • • Center for Pharmacoeconomic Research
      • • Department of Pharmacy Administration
      Chicago, IL, United States
    • Canadian Agency For Drugs And Technologies In Health
      Ottawa, Ontario, Canada
    • National University of Singapore
      • Centre for Health Services Research
      Singapore, Singapore
  • 2008
    • Oxford Outcomes
      Oxford, England, United Kingdom
  • 2003–2008
    • Institute of Health Economics
      Edmonton, Alberta, Canada
  • 2005
    • National Cancer Institute (USA)
      • Division of Cancer Control and Population Sciences
      Bethesda, MD, United States
    • The University of Western Ontario
      • Department of Medicine
      London, Ontario, Canada
    • QualityMetric
      Providence, Rhode Island, United States