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BACKGROUND: Disparities in atrial fibrillation ablation rates have been studied previously, with a focus on either patient characteristics or systems factors, rather than geographic factors. The impact of electrophysiology (EP) centre practice patterns on ablation rates has not been well studied. METHODS: This population-based cohort study used linked administrative datasets covering physician billing codes, hospitalizations, prescriptions, and census data. The study population consisted of patients who visited an emergency department with a new diagnosis of atrial fibrillation, in the period 2007-2016, in Ontario, Canada. Patient characteristics, including age, sex, medical history, comorbidities, socioeconomic factors, closest EP centre within 20 km, and distance to the nearest centre, were used as predictors in multivariable logistic regression models to assess the relationship between living in a location around specific EP centres and ablation rates. RESULTS: The cohort included 134,820 patients, of whom 9267 had an ablation treatment during the study period. Patients undergoing ablation treatment were younger, had a lower Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack (CHADS2) score, lived closer to EP centres, and had fewer comorbidities than those who did not receive ablation treatment. Wide variation occurred in ablation rates, with adjacent census divisions having ablation rates up to 2.6 times higher. Multivariate regression revealed significant differences in ablation rates for patients who lived in a location around certain EP centres. The odds ratios for living in a location closest to specific centres ranged from 0.78 (95% confidence interval: 0.68-0.89) to 1.60 (95% confidence interval:1.34-1.90). CONCLUSIONS: Living near specific EP centres may significantly affect a patients likelihood of receiving ablation treatment, regardless of factors such as age, gender, socioeconomic status, prior medical history, and distance to EP centres.

OBJECTIVE: Bans on evictions were implemented to reduce the spread of COVID-19 and to protect vulnerable populations during a public health crisis. Our objective was to examine how three bans on eviction enforcement impacted eviction filings from March 2020 through January 2022 in Ontario, Canada. METHODS: Data were derived from eviction application records kept by the Ontario Landlord and Tenant Board. We used segmented regression analysis to model changes in the average weekly filing rates for evictions due to non-payment of rent (L1 filings) and reasons other than non-payment of rent (L2 filings). RESULTS: The average number of weekly L1 and L2 applications dropped by 67.5 (95% CI: 55.2, 79.9) and 31.7 (95% CI: 26.7, 36.6) filings per 100,000 rental dwellings, respectively, following the first ban on eviction enforcement (p

Context: Naturally occurring retirement communities (NORCs) are unplanned communities with a high proportion of older residents. Mapping NORCs and understanding their unique sociodemographic characteristics and health utilization patterns can assist primary care teams in supporting older adults by: i) identifying geographical areas of high service need and, ii) developing neighborhood based programs. Study Design and Analysis Observational Design: Descriptive analysis identifying proportions of communities in the province of Ontario, Canada with [greater than or equal to] 40% of persons with >55 years of age (NORCs) and the sociodemographic characteristics (e.g., Ontario Marginalization Index), health utilization and primary care enrollment models were displayed in a series of maps. Maps offered a visual presentation of provincial patterns of high density of older adults . The forward sortation areas, geographical units based on the first 3 characters of the Canadian postal code, from the 2016 census year were used. Dataset: Linked administrative data at ICES, an independent, non-profit research institute that routinely collects sociodemographic and healthcare information for the residents in Ontario, Canada. Population: All resident of Ontario >55 years of age as of March 31, 2021 (N=4,663,813). Intervention/Instrument: Maps to depict the distribution of NORCs and the patterns of health. Outcome Measure: Geographical patterns of NORCs in Ontario, Canada. Results: The regional distribution of NORCs varies across the province, with a greater number of NORCs identified in the Eastern and Northern regions of Ontario. The majority of NORCs had high proportion of older adults enrolled in team based models of primary care. Patterns of health use and frailty varied across the province. Conclusions: This is the first known study to map health use and primary care enrollment in NORCs in a province and highlights the complex and varied patterns of regional distribution. Mapping NORCs is an important resource for decision makers and planners to leverage primary care in supporting older adults to age in their communities., Presenters Eliot Frymire, MA, BEd, Vincent DePaul, Peter Gozdyra, MA, Paul Nguyen, PhD, Catherine Donnelly, [...]

Background: Timely follow-up after hospitalization for a schizophrenia spectrum disorder (SSD) is an important quality indicator. We examined the proportion of individuals who received physician follow-up within 7 and 30 days post-discharge by health region and estimated the effect of distance between a person's residence and discharging hospital on follow-up. Methods: We created a retrospective population-based cohort of incident hospitalizations with a discharge diagnosis of a SSD between 01/01/2012 and 30/03/2019. The proportion of follow-up with a psychiatrist and family physician within 7 and 30 days were calculated for each region. The effect of distance between a person's residence and discharging hospital on follow-up was estimated using adjusted multilevel logistic regression models. Results: We identified 6,382 incident hospitalizations for a SSD. Only 14.2% and 49.2% of people received follow-up care with a psychiatrist within 7 and 30 days of discharge, respectively, and these proportions varied between regions. Although distance from hospital was not associated with follow-up within 7 days of discharge, increasing distance was associated with lower odds of follow-up with a psychiatrist within 30 days. Conclusion: Post-discharge follow-up is poor across the province. Geospatial factors may impact post-discharge care and should be considered in further evaluation of quality of care. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to determine the relationship between rurality and help‐seeking behavior prior to a suicide or suicide attempt. Methods: Data from 2007 to 2017 were obtained from administrative databases held at ICES, which capture all hospital, emergency department (ED), and general practitioner (GP) visits across Ontario. Rurality was defined using the Rurality Index of Ontario scores. Help‐seeking was based on accessing health services 1 year prior to the event. Results: Among those who died by suicide (N = 9848), those living in rural areas were less likely to seek help from a psychiatrist (rural males: AOR = 0.42, 95% CI = 0.31–0.57; rural females: AOR = 0.46, 95% CI = 0.29–0.97) compared with those living in urban areas. We found a similar association among those who attempted suicide (N = 82,480) (rural males: AOR = 0.49, 95% CI = 0.43–0.56; rural females: AOR = 0.51, 95% CI = 0.46–0.57). Rural males and females were more likely to seek care from an ED for mental health reasons compared with urban males and females. Conclusions: Among people who died by suicide, those living in rural areas are generally less likely to access psychiatrists and GPs and more likely to access EDs, suggesting that people living in rural areas may have less access to care than their urban counterparts. [ABSTRACT FROM AUTHOR]

Purpose: Many rural communities experience poor family physician retention. We examined the association between community‐level physician retention and hospitalization for all causes and ambulatory care‐sensitive conditions (ACSCs) in 2017 among residents of rural communities in Ontario, Canada. Methods: We conducted a population‐based cross‐sectional study by linking administrative data from the public health insurance program in Ontario. To create the physician retention measure for each rural community, we divided the number of family physicians who worked in the community in both 2016 and 2017 by the total number of unique family physicians in the community in either year. We grouped retention level by tertile and added a fourth category, "no physician" to include communities that did not have any residing physicians in either 2016 or 2017. Outcomes were all‐cause hospitalization and ACSC hospitalization between April 1, 2017 and March 31, 2018. Findings: Among 1,436,794 rural residents, there were 93,752 all‐cause hospitalizations and 8,691 ACSC hospitalizations in 2017. After controlling for other predictors, compared to residents in low‐retention communities, residents of medium‐ and high‐retention communities were 0.888 (95% CI: 0.868‐0.909) and 0.937 (95% CI: 0.915‐0.960) times as likely to have all‐cause hospitalization, and residents of high‐retention communities were 0.918 (95% CI: 0.858‐0.981) times as likely to have ACSC hospitalization in 2017. Conclusions: Community‐level physician retention is significantly associated with all cause and ACSC hospitalization in rural communities in Ontario, and may serve as an alternate measure to assess the impact of disrupted continuity of care. [ABSTRACT FROM AUTHOR]

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This paper presents the main findings from a collaborative community/university research project in Canada. The goal of the project was to improve access to community health information, and in so doing, enhance our knowledge of the development of community health information resources and community/university collaboration. The project built on a rich history of community/university collaboration in Southeast Toronto (SETO), and employed an interdisciplinary applied research and action design. Specific project objectives were to: (1) develop via active community/university collaboration a geographic information system (GIS) for ready access to routinely collected health data, and to study logistical, conceptual and technical problems encountered during system development; and (2) to document and analyze issues that can emerge in the process of community/university research collaboration. System development involved iteration through community user assessment of need, development or refinement of the GIS, and assessment of the GIS by community users. Collaborative process assessment entailed analysis of archival material, interviews with investigators and participant observation. Over the course of the project, a system was successfully developed, and favorably assessed by users. System development problems fell into four main areas: maintaining user involvement in system development, understanding and integrating data, bringing disparate data sources together, and making use of assembled data. Major themes emerging from the community/university collaborative research process included separate community and university cultures, time as an important issue for all involved, and the impact of uncertainty and ambiguity on the collaborative process. Keywords: Community health; Research collaboration; Community/university partnership; Interdisciplinary; Geographic information systems; Medical informatics; Canada