Braden J Manns

The University of Calgary, Calgary, Alberta, Canada

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Publications (267)1718.96 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The prevalence of chronic kidney disease and end-stage renal disease requiring dialysis therapy continues to increase worldwide, and despite technological advances, treatment remains resource intensive. Thus, the increasing burden of dialysis therapy on finite health-care budgets is an important consideration. The principles of allocative efficiency and the concept of 'opportunity cost' can be used to assess whether dialysis is economically justified; if dialysis is to be provided, cost-minimization and cost-utility analyses can be used to identify the most efficient dialysis modality. Existing studies have examined the cost, and where relevant the effectiveness, of the various currently available peritoneal dialysis and haemodialysis modalities. In this Review, we discuss variations in the intrinsic costs of the available dialysis modalities as well as other factors, such as variation by country, available health-care infrastructures, the timing of dialysis initiation and renal transplantation. We draw on data from robust micro-costing studies of the various dialysis modalities in Canada to highlight key issues.
    Nature Reviews Nephrology 08/2014; · 7.94 Impact Factor
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    ABSTRACT: To improve quality of care and patient outcomes, health system decision-makers need to identify and implement effective interventions. An increasing number of systematic reviews document the effects of quality improvement programs to assist decision-makers in developing new initiatives. However, limitations in the reporting of primary studies and current meta-analysis methods (including approaches for exploring heterogeneity) reduce the utility of existing syntheses for health system decision-makers. This study will explore the role of innovative meta-analysis approaches and added value of enriched and updated data for increasing the utility of systematic reviews of complex interventions for health system decision-makers.
    Systematic reviews. 08/2014; 3(1):88.
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    ABSTRACT: In a recent randomized trial, weekly recombinant tissue plasminogen activator (rt-PA), 1 mg per lumen, once per week, and twice-weekly heparin as a locking solution (rt-PA/heparin) resulted in lower risks of hemodialysis catheter malfunction and catheter-related bacteremia compared with thrice-weekly heparin (heparin alone). We collected detailed costs within this trial to determine how choice of locking solution would affect overall health care costs, including the cost of locking solutions and all other relevant medical costs over the course of the 6-month trial. Nonparametric bootstrap estimates were used to derive 95% confidence intervals (CIs) and mean cost differences between the treatment groups. The cost of the locking solution was higher in patients receiving rt-PA/heparin, but this was partially offset by lower costs for managing complications. Overall, the difference in unadjusted mean cost for managing patients with rt-PA/heparin versus heparin alone was Can$323 (95% CI, -$935 to $1581; P=0.62). When the costs were extrapolated over a 1-year time horizon using decision analysis, assuming ongoing rt-PA effectiveness, the overall costs of the strategies were similar. This finding was sensitive to plausible variation in the frequency and cost of managing patients with catheter-related bacteremia, and whether the benefit of rt-PA on catheter-related bacteremia was maintained in the long term. In summary, we noted no significant difference in the mean overall cost of an rt-PA/heparin strategy as a locking solution for catheters compared with thrice-weekly heparin. Cost savings due to a lower risk of hospitalization for catheter-related bacteremia partially offset the increased cost of rt-PA.
    Journal of the American Society of Nephrology : JASN. 07/2014;
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    ABSTRACT: AimsTo determine the association between participation in a brief introductory didactic diabetes education programme and change in HbA1c among individuals with newly diagnosed diabetes.Methods We identified a population-based cohort of adults newly diagnosed with diabetes between October 2005 and June 2008 in Calgary, Canada, and conducted a retrospective cohort study by linking administrative and laboratory data with programme attendance data. We matched individuals who attended the programme within the first 6 months after diagnosis with those who did not attend, based on their propensity scores. We measured the change in HbA1c between time of diagnosis and 6–18 months later to determine the association between programme participation and change in HbA1c.ResultsHbA1c was measured at baseline and follow-up for 7793 individuals, including 803 programme participants. After propensity score matching, programme participation was associated with a significantly greater adjusted mean reduction in HbA1c between baseline and follow-up of 3.3 mmol/mol (95% CI 2.2–4.3) or 0.30% (95% CI 0.20–0.39). There was a significant interaction between baseline HbA1c and programme participation—the difference in adjusted mean reduction in HbA1c associated with programme participation ranged from 2.7 mmol/mol (0.25%) at baseline HbA1c of 53 mmol/mol (7%) to 6.2 mmol/mol (0.56%) at baseline HbA1c of 97 mmol/mol (11%).Conclusion Despite its brevity, participation in a diabetes education programme was associated with an additional reduction in HbA1c in newly diagnosed people that was comparable with that reported in trials of programmes targeted at those with prevalent diabetes.This article is protected by copyright. All rights reserved.
    Diabetic Medicine 06/2014; · 3.24 Impact Factor
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    ABSTRACT: People with chronic conditions who do not achieve therapeutic targets have a higher risk of adverse health outcomes. Failure to meet these targets may be due to a variety of barriers. This article examines self-reported financial barriers to health care among people with cardiovascular-related chronic conditions.
    Health reports. 05/2014; 25(5):3-12.
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    ABSTRACT: With increasing emphasis among health care providers and funders on patient-centered care, it follows that patients and their caregivers should be included when priorities for research are being established. This study sought to identify the most important unanswered questions about the management of kidney failure from the perspective of adult patients on or nearing dialysis, their caregivers, and the health care professionals who care for these patients. Research uncertainties were identified through a national Canadian survey of adult patients on or nearing dialysis, their caregivers, and health care professionals. Uncertainties were refined by a steering committee that included patients, caregivers, researchers, and clinicians to assemble a short-list of the top 30 uncertainties. Thirty-four people (11 patients; five caregivers; eight physicians; six nurses; and one social worker, pharmacist, physiotherapist, and dietitian each) from across Canada subsequently participated in a workshop to determine the top 10 research questions. In total, 1570 usable research uncertainties were received from 317 respondents to the survey. Among these, 259 unique uncertainties were identified; after ranking, these were reduced to a short-list of 30 uncertainties. During the in-person workshop, the top 10 research uncertainties were identified, which included questions about enhanced communication among patients and providers, dialysis modality options, itching, access to kidney transplantation, heart health, dietary restrictions, depression, and vascular access. These can be used alongside the results of other research priority-setting exercises to guide researchers in designing future studies and inform health care funders.
    Clinical Journal of the American Society of Nephrology 05/2014; · 5.07 Impact Factor
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    ABSTRACT: ABSTRACT BACKGROUND Malignant pleural effusion is associated with short life expectancy and significant morbidity. A recent randomized controlled trial comparing indwelling pleural catheters with talc pleurodesis found that indwelling pleural catheters reduced time in hospital and need for additional procedures but were associated with excess adverse events. METHODS Using data from the clinical trial, we compared costs associated with use of indwelling pleural catheters and with talc pleurodesis. Resource use and adverse events were captured through case report forms over the 1-year trial follow up. Costs for outpatient and inpatient visits, diagnostic imaging, nursing and doctor time were obtained from the NHS reference costs and University of Kent's Unit Costs of Health and Social Care 2011 and inflated to 2013 using the UK Consumer Price Index. Procedure supply costs were obtained from the manufacturer. Difference in mean costs was compared using non-parametric bootstrapping. All costs were converted to US dollars using the OECD Purchasing Power Parity Index. RESULTS Overall mean cost (SD) for managing patients with indwelling pleural catheters and talc pleurodesis was $4993 (5529) and $4581 (4359) respectively. The incremental mean cost difference was $401 with a 95% CI (-1387 to 2261). The mean cost related to ongoing drainage in the indwelling pleural catheter group was $1011 (732) versus $57 (213) in the talc pleurodesis group (p=0.001). This included the cost of drainage bottles, dressing changes in the first month and catheter removal. There was no significant difference in cost of the initial intervention or adverse events between the groups. For patients with survival less than 14 weeks, IPC is significantly less costly than talc pleurodesis with mean cost difference of -$1719(95% CI -3376 to -85). CONCLUSION There is no significant difference in mean cost of managing patients with indwelling pleural catheters compared with talc pleurodesis. For patients with limited survival, IPC appears less costly. isrctn.org Identifier: ISRCTN87514420.
    Chest 05/2014; · 5.85 Impact Factor
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    ABSTRACT: The optimal time at which to initiate chronic dialysis remains unknown. Using a contemporary knowledge translation approach (the knowledge-to-action framework), a pan-Canadian collaboration (CANN-NET) set out to study the scope of the problem, then develop and disseminate evidence-based guidelines addressing the timing of dialysis initiation. The purpose of this review is to summarize the key findings and describe the planned Canadian knowledge translation strategy for improving knowledge and practices pertaining to the timing dialysis initiation. New research has provided considerable insights regarding the initiation of dialysis. A Canadian cohort study identified significant variation in the estimated glomerular filtration rate level at dialysis initiation, and a survey of providers identified related knowledge gaps that might be amenable to knowledge translation interventions. A recent knowledge synthesis/guideline concluded that early dialysis initiation is costly, and provides no measureable clinical benefits. A systematic knowledge translation intervention including a multifaceted approach may aid in reducing variation in practice and improving the quality of care. Utilizing the knowledge-to-action framework, we identified practice variation and key barriers to the optimal timing for dialysis initiation that may be amenable to knowledge translation strategies.
    Current Opinion in Nephrology and Hypertension 05/2014; 23(3):321-7. · 3.96 Impact Factor
  • Gihad Nesrallah, Braden Manns
    Clinical Journal of the American Society of Nephrology 04/2014; · 5.07 Impact Factor
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    ABSTRACT: Elucidation of the relationship between age, kidney function, and absolute coronary risk would facilitate efforts to promote chronic kidney disease (CKD) as a high-risk state for future vascular events and justify current recommendations for statin treatment in CKD. Population-based study. 1,268,538 people with data for estimated glomerular filtration rate and albuminuria who were treated in a single Canadian province. CKD risk groups (G1, G2, G3a, G3b, and G4 had estimated glomerular filtration rate≥90, 60-89.9, 45-59.9, 30-44.9, and 15-29.9mL/min/1.73m(2), respectively; A1, A2, and A3 had albuminuria with albumin-creatinine ratio [ACR]<30mg/g or dipstick urinalysis negative, ACR of 30-300mg/g or dipstick trace or 1+, and ACR>300mg/g or dipstick ≥ 2+, respectively) and age (<40, 40-49, ≥50 years). Rates of coronary death or nonfatal myocardial infarction (expressed per 1,000 person-years), stratified by age, sex, and CKD stage. The first available serum creatinine value and the corresponding date were set as the index serum creatinine value and index date, respectively. ACR or dipstick urinalysis data were obtained from the periods defined by 6 months before and after the index creatinine value. Absolute rates of coronary death or nonfatal myocardial infarction were consistently greater than 10 per 1,000 person-years for people with CKD and 50 years or older, regardless of CKD stage. However, absolute rates of the composite outcome were consistently less than 10 per 1,000 person-years for those younger than 50 years. Single Canadian province, median follow-up only 4.0 years. People with CKD who are 50 years or older should be considered at the highest risk of coronary events. In contrast, consideration of other risk factors will be required when assessing future risk among people with CKD who are younger than 50 years.
    American Journal of Kidney Diseases 04/2014; · 5.29 Impact Factor
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    ABSTRACT: This analysis explores barriers to the receipt of health care from a primary care physician for management of chronic conditions. A population-based survey was administered to adults in Manitoba, Saskatchewan, Alberta and British Columbia who had hypertension, diabetes, heart disease or stroke (n=1,849). Associations between socio-demographic factors and barriers to receipt of primary care were identified. Most respondents with chronic conditions required care from a primary care physician in the past year and had no difficulty receiving it; about 10% reported a barrier. Barriers were most commonly reported by respondents with diabetes (16%) and were related to initiation of care or waiting too long to get care. A small percentage of adults with chronic conditions report barriers to receiving care from a primary care physician.
    Health reports / Statistics Canada, Canadian Centre for Health Information = Rapports sur la santé / Statistique Canada, Centre canadien d'information sur la santé 04/2014; 25(4):3-10. · 4.28 Impact Factor
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    ABSTRACT: Ambulatory care-sensitive conditions have been described as those that (if appropriately managed in an outpatient setting) generally do not require subsequent hospitalization. Our goal was to identify clinical populations of people who are at the highest risk of ambulatory care-sensitive conditions related to chronic kidney disease (CKD). Retrospective cohort study. 2,003,054 adults (including 238,747 adults with CKD) residing in Alberta, Canada, with at least one serum creatinine measurement between 2002 and 2009. Estimated glomerular filtration rate and albuminuria categories, CKD status, demographics, and clinical characteristics. Hospitalization with heart failure, hyperkalemia, volume overload, or malignant hypertension. We used the Alberta Kidney Disease Network database, which incorporates data from Alberta Health, the Northern and Southern Alberta Renal Programs, and clinical laboratories in Alberta. During a median follow-up of 4.1 years, 43,863 participants were hospitalized for heart failure; 6,274 participants, for hyperkalemia; 2,035 participants, for volume overload; and 481 participants, for malignant hypertension. All 4 conditions were more common at lower estimated glomerular filtration rates and in the presence of albuminuria. In the subset of participants with CKD, heart failure, hyperkalemia, and volume overload were associated most strongly with older age, diabetes, chronic liver disease, and prior heart failure. Malignant hypertension was associated with prior hypertension, aboriginal status, and peripheral vascular disease. Remote-dwelling participants were more likely to experience heart failure and malignant hypertension than those living closer to providers. No data for medication use or potentially important process-based outcomes for study participants. Our findings suggest that future studies seeking to determine how to prevent ambulatory care-sensitive conditions in people with CKD should target remote dwellers and those with comorbid conditions such as concomitant heart failure and liver disease.
    American Journal of Kidney Diseases 04/2014; · 5.29 Impact Factor
  • Journal of clinical epidemiology 04/2014; 67(4):482-3. · 5.33 Impact Factor
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    ABSTRACT: Health care providers have shown considerable interest in using information technologies such as email, text messages and video conferencing to facilitate the management of chronic noncommunicable diseases such as hypertension, diabetes mellitus and vascular disease. We sought to determine whether these technologies are available and appealing to the target population.
    CMAJ open. 04/2014; 2(2):E51-9.
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    ABSTRACT: Management of chronic diseases requires patients to adhere to recommended health behavior change and complete tests for monitoring. While studies have shown an association between low income and lack of adherence, the reasons why people with low income may be less likely to adhere are unclear. We sought to determine the association between household income and receipt of health behavior change advice, adherence to advice, receipt of recommended monitoring tests, and self-reported reasons for non-adherence/non-receipt. We conducted a population-weighted survey, with 1849 respondents with cardiovascular-related chronic diseases (heart disease, hypertension, diabetes, stroke) from Western Canada (n = 1849). We used log-binomial regression to examine the association between household income and the outcome variables of interest: receipt of advice for and adherence to health behavior change (sodium reduction, dietary improvement, increased physical activity, smoking cessation, weight loss), reasons for non-adherence, receipt of recommended monitoring tests (cholesterol, blood glucose, blood pressure), and reasons for non-receipt of tests. Behavior change advice was received equally by both low and high income respondents. Low income respondents were more likely than those with high income to not adhere to recommendations regarding smoking cessation (adjusted prevalence rate ratio (PRR): 1.55, 95%CI: 1.09-2.20), and more likely to not receive measurements of blood cholesterol (PRR: 1.72, 95%CI 1.24-2.40) or glucose (PRR: 1.80, 95%CI: 1.26-2.58). Those with low income were less likely to state that non-adherence/non-receipt was due to personal choice, and more likely to state that it was due to an extrinsic factor, such as cost or lack of accessibility. There are important income-related differences in the patterns of health behavior change and disease monitoring, as well as reasons for non-adherence or non-receipt. Among those with low income, adherence to health behavior change and monitoring may be improved by addressing modifiable barriers such as cost and access.
    PLoS ONE 01/2014; 9(4):e94007. · 3.73 Impact Factor
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    ABSTRACT: Prescription drugs are used in people with hypertension, diabetes, and cardiovascular disease to manage their illness. Patient cost sharing strategies such as copayments and deductibles are often employed to lower expenditures for prescription drug insurance plans, but the impact on health outcomes in these patients is unclear. To determine the association between drug insurance and patient cost sharing strategies on medication adherence, clinical and economic outcomes in those with chronic diseases (defined herein as diabetes, hypertension, hypercholesterolemia, coronary artery disease, and cerebrovascular disease). Studies were included if they examined various cost sharing strategies including copayments, coinsurance, fixed copayments, deductibles and maximum out-of-pocket expenditures. Value-based insurance design and reference based pricing studies were excluded. Two reviewers independently identified original intervention studies (randomized controlled trials, interrupted time series, and controlled before-after designs). MEDLINE, EMBASE, Cochrane Library, CINAHL, and relevant reference lists were searched until March 2013. Two reviewers independently assessed studies for inclusion, quality, and extracted data. Eleven studies, assessing the impact of seven policy changes, were included: 2 separate reports of one randomized controlled trial, 4 interrupted time series, and 5 controlled before-after studies. Outcomes included medication adherence, clinical events (myocardial infarction, stroke, death), quality of life, healthcare utilization, or cost. The heterogeneity among the studies precluded meta-analysis. Few studies reported the impact of cost sharing strategies on mortality, clinical and economic outcomes. The association between patient copayments and medication adherence varied across studies, ranging from no difference to significantly lower adherence, depending on the amount of the copayment. Lowering cost sharing in patients with chronic diseases may improve adherence, but the impact on clinical and economic outcomes is uncertain.
    PLoS ONE 01/2014; 9(3):e89168. · 3.73 Impact Factor
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    ABSTRACT: Peritoneal dialysis is associated with similar survival and similar improvement in quality of life and is less costly compared with in-centre hemodialysis. We examined facility and geographic variation in the use of peritoneal dialysis in Canada.
    CMAJ open. 01/2014; 2(1):E36-44.
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    ABSTRACT: The use of a restrictive formulary, with placement determined through a drug-reimbursement decision-making process, is one approach to managing drug expenditures. To describe the processes in drug reimbursement decision-making systems currently used in national publicly funded outpatient prescription drug insurance plans. By using the Organisation for Economic Co-operation and Development (OECD) nations as the sampling frame, a search was done in the published literature, followed by the gray literature. Collected data were verified by a system expert within the prescription drug insurance plan in each country to ensure the accuracy of key data elements across countries. All but one country provided at least one publicly funded prescription drug formulary. Many systems have adopted similar processes of drug reimbursement decision making. All but three systems required additional consideration of clinical evidence within the decision-making process. Transparency of recommendations varied between systems, from having no information publicly available (three systems) to all information available and accessible to the public (16 systems). Only four countries did not consider cost within the drug reimbursement decision-making process. There were similarities in the decision-making process for drug reimbursement across the systems; however, only five countries met the highest standard of transparency, requirement of evidence, and ability to appeal. Future work should focus on examining how these processes may affect formulary listing decisions for drugs between countries.
    Value in Health 01/2014; 17(1):98-108. · 2.19 Impact Factor
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    ABSTRACT: For adults with chronic conditions, access to primary care, including multidisciplinary care, is associated with better outcomes. Few studies have assessed barriers to such care. We sought to describe barriers to primary care, including care from allied health professionals, for adults with chronic conditions.
    CMAJ open. 01/2014; 2(1):E27-34.
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    ABSTRACT: Publicly-funded drug plans vary in strategies used and policies employed to reduce continually increasing pharmaceutical expenditures. We systematically reviewed the utilization of cost-sharing strategies and physician-directed prescribing regulations in publicly-funded formularies within member nations of the Organization of Economic Cooperation and Development (OECD). Using the OECD nations as the sampling frame, a search for cost-sharing strategies and physician-directed prescribing regulations was done using published and grey literature. Collected data was verified by a system expert within the prescription drug insurance plan in each country, to ensure the accuracy of key data elements across plans. Significant variation in the use of cost-sharing mechanisms was seen. Copayments were the most commonly used cost-containment measure, though their use and amount varied for those with certain conditions, most often chronic diseases (in 17 countries), and by socio-economic status (either income or employment status), or with age (in 15 countries). Caps and deductibles were only used by five systems. Drug cost-containment strategies targeting physicians were also identified in 24 countries, including guideline-based prescribing, prescription monitoring and incentive structures. There was variable use of cost-containment strategies to limit pharmaceutical expenditures in publicly funded formularies within OECD countries. Further research is needed to determine the best approach to constrain costs while maintaining access to pharmaceutical drugs.
    PLoS ONE 01/2014; 9(3):e90434. · 3.73 Impact Factor

Publication Stats

6k Citations
1,718.96 Total Impact Points

Institutions

  • 1998–2014
    • The University of Calgary
      • • Department of Medicine
      • • Faculty of Medicine
      • • Department of Critical Care Medicine
      • • Department of Community Health Sciences
      Calgary, Alberta, Canada
  • 2013
    • London Health Sciences Centre
      London, Ontario, Canada
  • 2003–2013
    • University of Alberta
      • • Division of Nephrology
      • • Department of Medicine
      Edmonton, Alberta, Canada
  • 2012
    • Alberta Health Services
      Calgary, Alberta, Canada
  • 2007–2011
    • Humber River Regional Hospital
      Toronto, Ontario, Canada
    • University of Toronto
      • Department of Medicine
      Toronto, Ontario, Canada
    • University of Sydney
      • Northern Clinical School
      Sydney, New South Wales, Australia
  • 2010
    • Glenrose Rehabilitation Hospital
      Edmonton, Alberta, Canada
  • 2008–2010
    • University of British Columbia - Vancouver
      • Department of Medicine
      Vancouver, British Columbia, Canada
    • Canadian Agency For Drugs And Technologies In Health
      Ottawa, Ontario, Canada
    • Hôpital du Sacré-Coeur de Montréal
      Montréal, Quebec, Canada
    • The University of Western Ontario
      • Department of Medicine
      London, Ontario, Canada
  • 2006–2009
    • Institute of Health Economics
      Edmonton, Alberta, Canada
  • 2001–2005
    • McMaster University
      • • Department of Clinical Epidemiology and Biostatistics
      • • Department of Medicine
      Hamilton, Ontario, Canada
    • Dalhousie University
      • Department of Medicine
      Halifax, Nova Scotia, Canada
  • 2002
    • Mayo Foundation for Medical Education and Research
      • Department of Medicine
      Scottsdale, AZ, United States