Clinical Epidemiology Study Who benefits? How do we know? B Lynn Beattie MD FRCPC Professor Emeritus...
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Transcript of Clinical Epidemiology Study Who benefits? How do we know? B Lynn Beattie MD FRCPC Professor Emeritus...
Clinical Epidemiology Study Who benefits? How do we
know?
B Lynn Beattie MD FRCPCProfessor Emeritus
Div Geri Med, Dept Med, UBCMedical Director UBCH CARD
Low-income subset of the cohort from the Utilization and Cost Study
Policy begins
Low-income people*
ChEI use
No use: Historical Controls*On MSP premium subsidy
70% increase among poor
a) Impact on Low-income Cohort (n = 24,253)
…vs 30% increase in all BC
Rate of contacts with physicians: Low-income cohort vs all of BC
Low Income:Policy cohortHistorical control
All BC:Policy cohortHistorical control
No impact
BC linked data for 2006-2009
Rate of entry to long-term or palliative care:Low-income vs all of BC
Low Income:Policy cohortHistorical control
No impact
BC linked data for 2006-2009
Rate of hospitalizations: Low-income cohort vs all of BC
Low Income:Policy cohortHistorical control
No impact
BC linked data for 2006-2009
b) Special Authority data: Changes in Clinical Measures
New users of ChEI (naïve)
Continuing users (non-naïve)
Problem: No SMMSE data collected before policy.
Initial Special Authority Form
Renewal Special Authority Form –Overall Patient Assessment Rating
OPAR
Change in SMMSE scores over 6 mo
SMMSE Change
First SMMSE Low scorers, who score below 10 at 6 months, do not submit SA forms
High scorers cannot score much higher
Naïve: new users of ChEIs (n = 1094)
Middle of graph is relatively free of bias
Change in SMMSE scores over 6 mo
SMMSE Change
First SMMSE Low scorers, who score below 10 at 6 months, do not submit SA forms
High scorers cannot score much higher
Non-naïve: Continuing users (n = 1584)
Middle of graph is relatively free of bias
Changes in SMMSE scores
naïve
continuingSMMSE Change
+ 0.28
- 0.22
Difference: + 0.5(95% CI: 0.3-0.7)
SMMSE Change
Naïve improved by half a point more than Non-Naive.
Change in GDS by first SMMSE
naïve
continuing
Difference:0.05 (95% CI: 0.0-0.09)
GDS Change
+ 0.03
- 0.03
GDS Change
Naïve achieved 5% of a GDS point more than Non-Naïve
OPAR compared by first SMMSE
naïve
continuing
Difference: 0.23 (95% CI: 0.15-0.33)
OPAR
0.49
0.26
OPAR
Naive achieved a quarter of a point more on OPAR than Non-Naive
ConclusionsIn real-world usage of ChEIs, there is evidence of clinical improvement, based on measurements by frontline physicians.
This is consistent with the pivotal trials, most of which were 6 months RCTs.
Value of OPAR will be looked at further.
We look forward to the evidence on longer-term effects of ChEIs.