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Niraparib was recently funded in Canada for the maintenance treatment of ovarian cancer following platinum-based chemotherapy. However, the drug's safety profile in the real world remains uncertain. We conducted a cohort study to describe the patient population using niraparib and the proportion that experienced adverse events between June 2019 and December 2022 in four Canadian provinces (Ontario, Alberta, British Columbia [BC], and Quebec). We used administrative data and electronic medical records from Ontario Health, Alberta Health Services, and BC Cancer, and registry data from Exactis Innovation. We summarized baseline characteristics using descriptive statistics and reported safety outcomes using cumulative incidence. We identified 514 patients receiving niraparib. Mean age was 67 years and most were initiated on a daily dose of 100 or 200 mg/day. Grade 3/4 anemia, neutropenia, and thrombocytopenia occurred in 11–16% of the cohort. In Ontario, the three-month cumulative incidence of grade 3/4 thrombocytopenia was 11.6% (95% CI, 8.3–15.4%), neutropenia was 7.1% (95% CI, 4.6–10.4%), and anemia was 11.3% (95% CI, 8.0–15.2%). Cumulative incidences in the remaining provinces were similar. Initial daily dose and proportions of hematological adverse events were low in the real world and may be related to cautious prescribing and close monitoring by clinicians. [ABSTRACT FROM AUTHOR]

Introduction: The aim of our study was to assess the initial impact of COVID-19 on total publicly-funded direct healthcare costs and health services use in two Canadian provinces, Ontario and British Columbia (BC). Methods: This retrospective repeated cross-sectional study used population-based administrative datasets, linked within each province, from January 1, 2018 to December 27, 2020. Interrupted time series analysis was used to estimate changes in the level and trends of weekly resource use and costs, with March 16–22, 2020 as the first pandemic week. Also, in each week of 2020, we identified cases with their first positive SARS-CoV-2 test and estimated their healthcare costs until death or December 27, 2020. Results: The resources with the largest level declines (95% confidence interval) in use in the first pandemic week compared to the previous week were physician services [Ontario: -43% (-49%,-37%); BC: -24% (-30%,-19%) (both p<0.001)] and emergency department visits [Ontario: -41% (-47%,-35%); BC: -29% (-35%,-23%) (both p<0.001)]. Hospital admissions declined by 27% (-32%,-23%) in Ontario and 21% (-26%,-16%) in BC (both p<0.001). Resource use subsequently rose but did not return to pre-pandemic levels. Only home care and dialysis clinic visits did not significantly decrease compared to pre-pandemic. Costs for COVID-19 cases represented 1.3% and 0.7% of total direct healthcare costs in 2020 in Ontario and BC, respectively. Conclusions: Reduced utilization of healthcare services in the overall population outweighed utilization by COVID-19 patients in 2020. Meeting the needs of all patients across all services is essential to maintain resilient healthcare systems. [ABSTRACT FROM AUTHOR]

Background: Many family medicine residency graduates indicate a desire to provide obstetric care, but a low proportion of family physicians (FPs) provide obstetric care within their practice. This suggests personal preference alone may not account for the low proportion of FPs who ultimately provide full obstetric care. If decisionmakers plan to augment the number of FPs providing obstetric care, barriers to the provision of such care must first be identified. Within this paper, we explore the perspectives of both family practice residents and early-career FPs on the factors that shaped their decision to provide obstetric care.Methods: In this qualitative study, we analyzed a subset of interview data from three Canadian provinces: British Columbia, Ontario, and Nova Scotia (n = 18 family practice residents; n = 39 early-career FPs). We used thematic analysis to analyze data relevant to obstetric care practice, applying the socio-ecological model and comparing themes across participant types, gender, and province.Results: Participants described influences affecting their decision about providing obstetric care. Key influencing factors aligned with the levels of the socio-ecological model of public policy (i.e., liability), community (i.e., community needs), organizational (e.g., obstetric care trade-offs, working in teams, sufficient exposure in training), interpersonal practice preferences (i.e., impact on family life, negative interactions with other healthcare professionals), and individual factors (i.e., defining comprehensive care as "everything but obstetrics"). Many participants were interested in providing obstetric care within their practice but did not provide such care. Participants' decision-making around providing or not providing obstetric care included considerations of personal preferences and outside influences.Conclusions: Individual-level factors alone do not account for the decrease in the type and amount of obstetric care offered by FPs. Instead, FPs' choice to provide or not provide obstetric care is influenced by factors at higher levels of the socio-ecological model. Policymakers who want to encourage obstetric practice by FPs should implement interventions at the public policy, community, organizational, interpersonal, and individual levels. [ABSTRACT FROM AUTHOR]

Background: Substance use is common among people who visit emergency departments (EDs) frequently. We aimed to characterize subgroups within this cohort to better understand care needs/gaps, and generalizability of characteristics in three Canadian provinces.Methods: This was a retrospective cohort study (April 1st, 2013 to March 31st, 2016) of ED patients in Ontario, Alberta, and British Columbia (B.C.) We included patients ≥ 18 years with substance use-related healthcare contact during the study period and frequent ED visits, defined as those in the top 10% of ED utilization when all patients were ordered by annual ED visit number. We used linked administrative databases including ED visits and hospitalizations (all provinces); mental heath-related hospitalizations (Ontario and Alberta); and prescriptions, physician services, and mortality (B.C.). We compared to cohorts of people with (1) frequent ED visits and no substance use, and (2) non-frequent ED visits and substance use. We employed cluster analysis to identify subgroups with distinct visit patterns and clinical characteristics during index year, April 1st, 2014 to March 31st, 2015.Results: In 2014/15, we identified 19,604, 7,706, and 9,404 people with frequent ED visits and substance use in Ontario, Alberta, and B.C (median 37-43 years; 60.9-63.0% male), whose ED visits and hospitalizations were higher than comparison groups. In all provinces, cluster analyses identified subgroups with "extreme" and "moderate" frequent visits (median 13-19 versus 4-6 visits/year). "Extreme" versus "moderate" subgroups had more hospitalizations, mental health-related ED visits, general practitioner visits but less continuity with one provider, more commonly left against medical advice, and had higher 365-day mortality in B.C. (9.3% versus 6.6%; versus 10.4% among people with frequent ED visits and no substance use, and 4.3% among people with non-frequent ED visits and substance use). The most common ED diagnosis was acute alcohol intoxication in all subgroups.Conclusions: Subgroups of people with "extreme" (13-19 visits/year) and "moderate" (4-6 visits/year) frequent ED visits and substance use had similar utilization patterns and characteristics in Ontario, Alberta, and B.C., and the "extreme" subgroup had high mortality. Our findings suggest a need for improved evidence-based substance use disorder management, and strengthened continuity with primary and mental healthcare. [ABSTRACT FROM AUTHOR]

Background: Real world evidence about antipsychotics focuses on rehospitalization. Modeling the time course of pharmacotherapy would show patients' adherence to medications and physicians' adherence to medication guidelines. We aimed to calculate the cumulative time spent in second generation antipsychotics (SGAs), gaps, antipsychotic polypharmacy, and clozapine in discharged schizophrenia patients. Methods: Hospitalization and pharmacy dispensing data from 2008-2018 in Manitoba, Saskatchewan, and British Columbia were linked and an electronic cohort (N = 2,997) was created (mean follow-up: 49 months, SD = 38). Cohort members were required to have a minimum of 6 weeks medicated with aripiprazole, olanzapine, paliperidone, quetiapine, risperidone, or ziprasidone. Results: The multistate model predicted that schizophrenia patients accumulated 44 months in SGA monotherapy, 4 months in polypharmacy, 11 months in medication gaps and 17 days in clozapine over a 5-year period. The majority of transitions were between SGA and medication gap. Accumulated time in medication gaps was seven times as much as in clozapine. Each 10% delay in SGA initiation post-discharge was associated with a 2, 1, and 6% higher risk for polypharmacy (95% CI: 1.01-1.02), gap (95% CI: 1.01-1.01), and clozapine (95% CI: 1.04-1.08), respectively. Interpretation: Schizophrenia patients accumulated more time unmedicated and in polypharmacy compared to clozapine. Either treatment guidelines for schizophrenia are not followed, or real-world challenges hamper their implementation. [ABSTRACT FROM AUTHOR]

Background: Focused practice within family medicine may be increasing globally, but there is limited research on the factors contributing to decisions to focus practice. Aim: To examine the factors influencing resident and early-career family physician choices of focused practice across three Canadian provinces. Design and setting: A subset of qualitative interview data were analysed from a study across British Columbia, Ontario, and Nova Scotia, Canada. Method: Included in the analysis were a total of 22 resident family physicians and 38 early-career family physicians in their first 10 years of practice who intend to or currently practise in a focused area. Comparisons were made for participant types, provinces, and the degree of focused practice, while identifying themes related to factors influencing the pursuit of focused practice. Results: Three key themes were identified of factors contributing to choices of focused practice: self-preservation within the current structure of the healthcare system; support from colleagues; and training experiences in medical school and/or residency. Minor themes included: alignment of practice with skills, personal values, or ability to derive professional satisfaction; personal lived experiences; and having many attractive opportunities for focused practice. Conclusion: Both groups of participants unanimously viewed focused practice as a way to circumvent the burnout or exhaustion they associated with comprehensive practice in the current structure of the healthcare system. This finding, in addition to other influential factors, was consistent across the three provinces. More research is needed to understand the implications of resident and early-career family physician choices of focused practice within the physician workforce. [ABSTRACT FROM AUTHOR]

Deploying negative emission technologies has become crucial for limiting the global temperature rise to approximately 1.5 °C above preindustrial levels. DAC technologies are being explored as one of the prospective options. These technologies have been thoroughly investigated as a potential project to capture CO 2 emissions and provide purified air, natural gas, or fuel oil. An applied approach, on the other hand, was not taken into consideration while evaluating the influence that this technology has on emissions. For this reason, British Columbia provides a substantial chance to examine emissions that were produced after the DAC actions were put into place in 2015. In this study, the difference-in-differences methodology is employed for the very first time to compare the emissions that are produced by the transport sectors in British Columbia with those emitted by other provinces in Canada. The role that GDP and population play in the release of emissions is also taken into consideration in this paper. Based on the research results, it can be observed that the implementation of DAC initiatives has yielded notable effects. Evidence shows that the DAC effort has led to an average reduction of 0.08 in logarithmic CO 2 emissions in the transport sector. By accounting for GDP and population, the empirical results indicate that DAC technology reduced CO 2 emissions in British Columbia compared to provinces without DAC facilities. DAC initiatives are expected to become increasingly prevalent between the mid-2030s and 2040s. Overall policy implications suggest that there is a need for DAC technologies to collaborate with alternative mitigation technologies, or alternative technologies should collaborate with DAC technologies that are more efficient to achieve the targeted goals in a short time. • The study offers empirical evidence of DAC technology's impact, providing insights beyond theoretical conjectures. • Based on the research results, it can be seen that the implementation of DAC facilities has yielded notable effects. • DAC technology in British Columbia has led to a significant and negative impact on CO 2 emissions compared to other provinces without DAC facilities. • The study highlights the differential effectiveness of DAC across transport sectors, pointing toward a need for tailored implementation strategies. [ABSTRACT FROM AUTHOR]

This paper presents a comprehensive analysis of e-waste collection and management trends across six Canadian provinces, focusing on e-waste collection rates, provincial stewardship model attributes, program strategies and budget allocations from 2013 to 2020. Temporal and regression analyses were conducted using data from Electronic Product Recycling Association reports. A group characterization based on geographical proximity is proposed, aiming to explore the potential outcomes of fostering collaboration among neighboring provinces. The analysis emphasizes the significant impact of stewardship model attributes on e-waste collection rates, with Quebec emerging as a standout case, showcasing a remarkable 61.5% surge in collection rates. Findings from group analysis reveal a positive correlation between per capita e-waste collection rate and the growth of businesses and collection sites in Western Canada (Group A - British Columbia, Saskatchewan, and Manitoba). This highlights the potential benefits of a coordinated waste management approach, emphasizing the importance of shared resources and collaborative policies. Saskatchewan and Manitoba allocated only 6.6% and 7.0% of their respective budgets to e-waste transfer and storage. British Columbia's observed steady decrease of e-waste collection rate. In Group A, stewards handled 2.18–13.95 tonnes of e-waste during the study period. The cost per tonne of e-waste tended to be lower when more e-waste is managed per steward, suggesting the potential benefits of an integrated e-waste collection and management system. [Display omitted] • Six Canadian e-waste stewardship models from 2013 to 2020 were examined. • E-waste collection rates were gradually declining in Canada jurisdictions. • Collection site density, expenditure, efficiency may have affected collection rates. • Eastern and western stewardships had different operational characteristics. • Region-specific collaborative approach may improve stewardship effectiveness. [ABSTRACT FROM AUTHOR]

Calf rearing practices differ among farms, including feeding and weaning methods. These differences may relate to how dairy producers view these practices and evaluate their own success. The aim of this study was to investigate perspectives of dairy producers on calf rearing, focusing on calf weaning and how they characterized weaning success. We interviewed dairy producers from 16 farms in Western Canada in the following provinces: British Columbia (n = 12), Manitoba (n = 2), and Alberta (n = 2). Participants were asked to describe their heifer calf weaning and rearing practices, and what they viewed as successes and challenges in weaning and rearing calves. Interviews were recorded, transcribed, and subjected to qualitative analysis from which we identified the following 4 major themes: (1) reliance on calf-based measures (e.g., health, growth, and behavior), (2) management factors and personal experiences (e.g., ease, consistency, and habit), (3) environmental factors (e.g., facilities and equipment), and (4) external support (e.g., advice and educational opportunities). These results provided insight into how dairy producers view calf weaning and rearing, and may help inform the design of future research and knowledge transfer projects aimed at improving management practices on dairy farms. [ABSTRACT FROM AUTHOR]

In Canada, greenhouse gas (GHG) emissions continue to remain high despite the federal government's commitment to reduce GHG emissions. Environmental policy across Canadian provinces has largely lacked consistency with some provinces implementing targeted policy such as carbon taxes while others have strongly resisted the federal government's attempts to encourage such policy. This study examines the impact of environmental policy on GHG gas emissions across Canadian provinces with policy uniquely measured by public and business sector spending on environmental protection as well as notable province-specific policies. An extended STIRPAT model is specified with the inclusion of proxies for environmental policy using panel data from Canada's ten provinces from 1995 to 2019. The cointegration and the error correction modelling approaches are employed to estimate the non-stationary panel data. A pooled mean group estimation is applied to provide short run and long run coefficients. The findings indicate that although per capita GDP is the main driver of GHG emissions in Canada, environmental policy has a significant mitigating effect, as shown by the negative association between emissions and private and public sector spending on environmental protection in the long run. Furthermore, provinces with targeted policies, such as Ontario's coal phase-out and British Columbia's carbon tax, experienced significant emissions reductions. The theoretical implication is the successful addition of policy variables to the STIRPAT model, providing the model a new application for future research. [Display omitted] • Assess the impact of environmental protection policies on per capita greenhouse gas emissions in Canada. • Utilize public and private expenditures on environmental protection, along with provincial policies. • Extend the STIRPAT model to incorporate environmental protection policies in an empirical model. • Demonstrate a significant negative relationship between environmental protection policies and GHG emissions. • Offer insights with implications for global environmental sustainability efforts. [ABSTRACT FROM AUTHOR]

Context: In recent years, there has been a global decline in the provision of comprehensive care by family physicians, and a shift towards focused practice, defined as part- or full-time work in a specific clinical area such as hospitalist or emergency medicine. Previous research has identified some of the factors contributing to this trend, such as focused practice being perceived as stimulating or financially lucrative, yet few studies have undertaken an in-depth exploration of the factors influencing choices of focus practice. Objective: To examine factors influencing family medicine resident and early-career physician choices of focused practice across three Canadian provinces. Study Design: Analysis of qualitative interview data collected as part of a mixed-methods study. Setting: Three Canadian provinces: British Columbia, Ontario, and Nova Scotia. Population studied: Family medicine residents and early-career family physicians (defined as first 10 years of practice). Results: Interviews were conducted with 31 residents and 63 early-career family physicians. In total, 21 (71%) residents and 38 (60%) physicians intended to, or currently practice, in a focused area. Transcripts of this focused practice sub-group were analyzed using an inductive, thematic analysis approach. Three major themes influencing focused practice choices were identified across both participant groups. The most salient theme was the interest in focused practice being motivated by a desire for self-preservation within the current health care system. Focused practice was chosen to avoid many of the negative factors associated with comprehensive family medicine practice: burnout and exhaustion; inadequate compensation, particularly in the fee-for-service payment model; and limited work-life balance. Other major themes included support from colleagues in focused practice settings, and experiences during training. Minor themes included: alignment with skills, values, or ability to feel professional satisfaction; personal lived experiences; and the presence of existing opportunities in focused practice. Conclusions: This study found a number of system-level and personal factors that appeared to influence both resident and early-career physician choices of focused areas of practice. Further work is needed to understand the impact of this shift toward focused practice on the family physician workforce, and health policy considerations. [ABSTRACT FROM AUTHOR]

Antimicrobials are among the most prescribed medications in Canada, with over 90% of antibiotics prescribed in outpatient settings. Seniors prescribed antimicrobials are particularly vulnerable to adverse drug events and antimicrobial resistance. The extent of inappropriate antibiotic prescribing in outpatient Canadian medical practice, and the potential long-term trends in this practice, are unknown. This study is the first in Canada to examine prescribing quality across two large-scale provincial healthcare systems to compare both quantity and quality of outpatient antibiotic use in seniors. Population-based analyses using administrative health databases were conducted in British Columbia (BC) and Ontario (ON), and all outpatient, oral antimicrobials dispensed to seniors (≥65 years) from 1 January 2000 to 31 December 2018 were identified. Antimicrobials were linked to an indication using a 3-tiered hierarchy. Tier 1 indications, which always require antibiotics, were given priority, followed by Tier 2 indications that sometimes require antibiotics, then Tier 3, which never require antibiotics. Prescription rates were calculated per 1000 population, and trends were examined overall, by drug class, and by patient demographics. Prescribing remained steady in both provinces, with 11,166,401 prescriptions dispensed overall in BC, and 27,656,014 overall in ON. BC prescribed at slightly elevated rates (range: 790 to 930 per 1000 residents), in comparison to ON (range: 745 to 785 per 1000 residents), throughout the study period. For both provinces, a Tier 3 diagnosis was the most common reason for antibiotic use, accounting for 50% of all indication-associated antibiotic prescribing. Although Tier 3 indications remained the most prescribed-for diagnoses throughout the study period, a declining trend over time is encouraging, with much room for improvement remaining. Elevated prescribing to seniors continues across Canadian outpatient settings, and prescribing quality is of high concern, with 50% of all antimicrobials prescribed inappropriately for common infections that do not require antimicrobials. [ABSTRACT FROM AUTHOR]