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PubMed1996

Reliability of the recording of hysterectomy in the Saskatchewan health care system.

OBJECTIVE: To determine the validity of data pertaining to hysterectomy in the Saskatchewan health care utilisation datafiles. DESIGN: Retrospective analysis of routinely collected data covering hospital discharge records and practitioner claims for reimbursement of services, together with a review of clinical charts. SETTING: Province of Saskatchewan, Canada. SAMPLE: All 1905 cases of hysterectomy in one calendar year for analysis of datafiles and a random sample of 227 clinical charts for review. METHOD: Information in the hospitalisation datafile was validated through an external comparison with data extracted from a review of clinical charts, as well as an internal comparison with independent data from the practitioner claims file. Corresponding context data on drug use and performance of related procedures were also analysed. RESULTS: Concordance between hospital data and clinical charts was greater than 95% for those items of an administrative nature as well as type of hysterectomy and was around 85% for the diagnoses. When hospitalisation and practitioner claims data were compared, the concordance was 98% for type of hysterectomy but only 56% for diagnoses. CONCLUSIONS: The agreement between hospital data and clinical charts was excellent. The concordance between hospitalisation and practitioner claims data was almost exact for type of hysterectomy, while discrepancies in diagnoses between these files were mostly explainable on the basis of accepted clinical practice. Saskatchewan health care utilisation datafiles provide a source of valid data for research and evaluation studies.

Adolescent↗
PubMed2005

Tracking ancient pathways to a modern epidemic: diabetic end-stage renal disease in Saskatchewan aboriginal people.

BACKGROUND: Saskatchewan aboriginal people are experiencing an epidemic of type 2 diabetes (T2DM) and diabetic end-stage renal disease (DESRD). The purpose of these investigations was to study the role of the intrauterine environment in the emergence of these diseases. METHODS: Epidemiologic studies were carried out using data from the Provincial Department of Health databases, the Saskatoon Health Region obstetrical unit, the Saskatchewan Renal Transplant Program, surveys of Saskatchewan aboriginal communities, and the Canadian Organ Replacement Registry. Parameters analyzed included rates, risk factors, and outcomes of T2DM, gestational diabetes (GDM), and DESRD; birth registration information; anthropometric measurements; and human leukocyte antigen profiles. RESULTS: Aboriginal ethnicity is an independent predictor of GDM. High rates of GDM appear in remote aboriginal communities before the significant appearance of T2DM and are associated with increasing rates of high birth weight. A significant relationship between high-birth-weight rates and T2DM has strengthened over several decades. Finally, higher birth weights and older mother's age (both associated with GDM), and increased frequencies of the human leukocyte antigen-A2/DR4 and A2/DR8 haplotypes are associated with DESRD among aboriginal people. CONCLUSION: It is likely that diabetic pregnancies play a key role in the initiation, progression, and perpetuation of the T2DM epidemic among Canadian aboriginal peoples, and may additionally increase the risk for DESRD. We speculate that an ancient survival advantage that promoted caloric conservation in young women and their unborn children is now a risk factor for prepregnancy obesity, GDM, and excess fetal nutrition. Infants are often large and have an increased risk for T2DM and its complications (hefty fetal-type hypothesis).

Adult↗
PubMed1995

PCR-based study of conserved and variable DNA sequences of Tritrichomonas foetus isolates from Saskatchewan, Canada.

The protozoan parasite Tritrichomonas foetus causes infertility and spontaneous abortion in cattle. In Saskatchewan, Canada, the culture prevalence of trichomonads was 65 of 1,048 (6%) among 1,048 bulls tested within a 1-year period ending in April 1994. Saskatchewan was previously thought to be free of the parasite. To confirm the culture results, possible T. foetus DNA presence was determined by the PCR. All of the 16 culture-positive isolates tested were PCR positive by a single-band test, but one PCR product was weak. DNA fingerprinting by both T17 PCR and randomly amplified polymorphic DNA PCR revealed genetic variation or polymorphism among the T. foetus isolates. T17 PCR also revealed conserved loci that distinguished these T. foetus isolates from Trichomonas vaginalis, from a variety of other protozoa, and from prokaryotes. TCO-1 PCR, a PCR test designed to sample DNA sequence homologous to the 5' flank of a highly conserved cell division control gene, detected genetic polymorphism at low stringency and a conserved, single locus at higher stringency. These findings suggested that T. foetus isolates exhibit both conserved genetic loci and polymorphic loci detectable by independent PCR methods. Both conserved and polymorphic genetic loci may prove useful for improved clinical diagnosis of T. foetus. The polymorphic loci detected by PCR suggested either a long history of infection or multiple lines of T. foetus infection in Saskatchewan. Polymorphic loci detected by PCR may provide data for epidemiologic studies of T. foetus.

Abortion, Veterinary↗
PubMed1995

Clinical education in Saskatchewan: a needs assessment.

Clinical education or fieldwork requires a collaborative relationship and coordinated effort between the university and the clinic. Although the literature notes the increased recognition and responsibility given to clinicians as a teaching resource, minimal attention has been given to describing the clinical educator's perspective or in preparing clinicians for the role of educator. The purpose of this study was to explore the support and educational needs of Saskatchewan occupational therapists as they related to providing clinical education. Focus group interviews were conducted with 70% participation of the practicing registered occupational therapists in Saskatchewan. Emerging themes related to the participants (needs and responsibilities of the student, the clinical educator, the facility and the university), the process (positive and negative elements of communication, placement coordination and student evaluation), and the environment (clinical education models, length and number of placements). Recommendations were made for enhancing the clinical education experience in Saskatchewan.

Clinical Clerkship↗
PubMed2000

A survey of the use of community treatment orders by psychiatrists in Saskatchewan.

OBJECTIVE: To determine the pattern of use and satisfaction with community treatment orders (CTOs) by psychiatrists in Saskatchewan. METHOD: All psychiatrists who were licensed to practise by the College of Physicians and Surgeons of Saskatchewan were surveyed by mail in July 1998. RESULTS: The response rate was 72%. The responding psychiatrists were treating 14 patients on CTOs at the time of the survey. Psychiatrists were generally satisfied with the operation of CTOs, though many felt that commitment of only of 3 months before mandatory renewal was too short a period. Almost one-half expected their use of treatment orders to increase. CONCLUSION: While CTOs are used for only a small number of patients in Saskatchewan, they are a clinically useful tool for dealing with a group of otherwise difficult-to-treat patients.

Catchment Area, Health↗
PubMed2006

Reporting for learning and improvement: the Manitoba and Saskatchewan experience.

Both Saskatchewan and Manitoba have embarked on major provincial quality improvement endeavours that include a mandatory reporting and learning process aimed at enhancing patient safety by reducing the potential for recurrence of critical incidents. This move from a voluntary, less comprehensive process signals a commitment from policy makers that substantial improvements to safety will occur only when adverse events are addressed systemically within the healthcare system. Saskatchewan took the lead with the passage of legislative requirements to report, investigate and share learnings arising from critical incidents as of September 15, 2004. Manitoba is due to implement similar requirements in 2006. The focus of legislation in both provinces is aimed at reporting for learning in order to strive for further improvements in patient safety. By empowering staff and physicians to actively participate in risk identification and mitigation, both provinces have become leaders in patient safety. Saskatchewan and Manitoba have taken an innovative and collaborative approach to strive for substantive system changes, seeking out best practices in the areas of quality and patient safety.

Humans↗
PubMed1998

Prevalence of physician-diagnosed asthma in Saskatchewan, 1981 to 1990.

STUDY OBJECTIVE: To examine trends in asthma prevalence in the Province of Saskatchewan using the Medical Claim Insurance Branch (MCIB) database. DESIGN: For each calendar year from 1981 to 1990, first visits to physicians for asthma were identified from the MCIB database. Age- and sex-specific prevalence rates were obtained for each calendar year by dividing the number of first asthma visits by the number of subjects in the age- and sex-specific group insured by the Provincial Government of Saskatchewan in that calendar year. RESULTS: Asthma prevalence increased in children and adults from 1981 to 1990. In the calendar year 1990, the prevalence of asthma was 5.1% in children < or = 4 years old, 4.4% in children 5 to 14 years old, 2.2% in young adults 15 to 34 years old, and 1.9% in adults 35 to 64 years old. Boys had higher asthma prevalence than girls in the age groups 0 to 4 years and 5 to 14 years, but it was reversed in older age groups, with women having greater asthma prevalence than men. Asthma diagnoses were verified by checking for asthma-related drug purchase in the Prescription Drug Plan database. Among the 0- to 4-year-old children with physician-diagnosed asthma, 57.3% purchased at least one asthma-related drug in 1981 and 72.3% purchased that in 1990. Among adults, asthma-related drug purchase was >73% in 1990. CONCLUSIONS: Asthma prevalence increased in children and adults in the province of Saskatchewan. Reasons for the increase are not clear and further studies are required to determine factors related to the increase.

Adolescent↗
PubMed2003

Diet, obesity and education in three age groups of Saskatchewan women.

Research on relationships between socioeconomic status and Canadians' diet is limited. The current study investigated differences by education in dietary variables shown to be related to obesity; it included three age groups of Saskatchewan women who participated in the 1992 to 1993 Heart Health Intervention Evaluation baseline study. Multistage sampling was used to select randomly from the Saskatchewan Health Insurance Registration File. The overall response rate was 42.6%; a sample representative of the general Saskatchewan population was obtained. Three-day estimated food records and demographic information from 396 women aged 18 to 74 years were subdivided into three age categories: 18 to 34 years, 35 to 54 years, and 55 to 74 years. For the 18- to 34-year group, obesity was significantly more prevalent with lower education; trends were similar for the older age groups. Under-reporting of energy intake (indicated by an energy intake:basal metabolic rate ratio of <1.1) was related to obesity but not to education. The greatest differences in diet between educational groups were observed in the 18- to 34-year group; fewer differences existed in the 35- to 54-year group, and none in the 55- to 74-year group. Health promotion efforts need to be targeted appropriately, and based on differences in dietary intakes by socioeconomic group. Research should help promote an understanding of the reasons for differences in diet by socioeconomic status.

Adolescent↗
PubMed1999

Saskatchewan physicians' attitudes and knowledge regarding assessment of medical fitness to drive.

BACKGROUND: Although legislation has been introduced in Saskatchewan for mandatory reporting by physicians of patients considered medically unfit to drive, little is known about physicians' attitudes, knowledge or resources with regard to evaluating medical fitness to drive. METHODS: The objective of this study was to determine Saskatchewan physicians' attitudes, knowledge, training, resources and current educational needs with regard to evaluating medical fitness to drive. A questionnaire survey of all physicians in the province who were identified as likely to be involved in determining medical fitness to drive was conducted between October and December 1996. RESULTS: Of the 1102 physicians who received a questionnaire, 690 (62.6%) responded, of whom 167 were excluded because they were not involved in assessing fitness to drive. Thus, 523 (55.9%) of the 935 eligible physicians surveyed completed the questionnaire. Most (57.6% [298/517]) of the respondents indicated that they do not hesitate to report patients medically unfit to drive; however, 59.5% (307/516) felt that the physician-patient relationship is negatively affected by reporting. Overall, 85.5% (444/519) of the respondents felt that restricted licensing is a fair alternative for people who might otherwise be denied a full licence. The availability of restricted licensing positively influenced the decision to report for 60.3% (313/519) of the respondents. Significantly more rural physicians than urban physicians believed that the need to drive was greater for rural residents than for urban dwellers (81.2% [95/117] v. 64.2% [257/400], p < 0.001). Physician knowledge regarding specific medical conditions and fitness to drive was generally poor. The resource most commonly used in determining medical fitness to drive was the Physicians' Guide to Driver Examination (71.1% [361/508] of respondents). The most useful continuing medical education methods indicated by physicians for assessing medical fitness to drive included conference presentations, workshops and journal articles. INTERPRETATION: Most of the Saskatchewan physicians surveyed supported restricted licensing, and the availability of restricted licensing made them more likely to report patients considered medically unfit to drive. The physician-patient relationship was felt to be negatively affected by reporting.

Attitude of Health Personnel↗
PubMed1998

Facilitating an integrated approach to primary health care in Saskatchewan.

It is unlikely that truly integrated primary health care will become a reality unless health professionals actively strive to foster integration. Dialogue about integration barriers and opportunities has begun between the nursing, pharmacy, social work, emergency medical services, and medical professions. This dialogue should be expanded to include all of the professions with a potential role in an integrated system. The dialogue will also need to include government leaders as key public policy decisions will significantly influence the success or failure of integrated primary health service delivery strategies. As well, dialogue needs to occur with communities so that citizens can understand, value and help shape and maintain this kind of service delivery. Public education needs to emphasize that an integrated approach to primary health care in Saskatchewan is the best kind of service that can be provided. The Integrated Primary Health Care Working Group believes that the principles of primary health care require health professionals in Saskatchewan to develop an integrated approach to health services delivery in Saskatchewan. An exploration of possible barriers to this integrated approach is an important first step in eliminating barriers and facilitating effective health care service delivery to meet population health needs.

Delivery of Health Care, Integrated↗
PubMed2001

Devolution to democratic health authorities in Saskatchewan: an interim report.

BACKGROUND: In 1995 Saskatchewan adopted a district health board structure in which two-thirds of members are elected and the rest are appointed. This study examines the opinions of board members about health care reform and devolution of authority from the province to the health districts. METHODS: All 357 members of Saskatchewan district health boards were surveyed in 1997; 275 (77%) responded. Analyses included comparisons between elected and appointed members and between members with experience as health care providers and those without such experience, as well as comparisons with hypotheses about how devolution would develop, which were advanced in a 1997 report by another group. RESULTS: Most respondents felt that devolution had resulted in increased local control and better quality of decisions. Ninety-two percent of respondents believed extensive reforms were necessary and 83% that changes made in the previous 5 years had been for the best. However, 56% agreed that there was no clear vision of the reformed system. A small majority (59%) perceived health care reform as having been designed to improve health rather than reduce spending, contrary to a previous hypothesis. Many respondents (76%) thought that boards were legally responsible for things over which they had insufficient control, and 63% perceived that they were too restricted by rules laid down by the provincial government, findings that confirm the expectation of tensions surrounding the division of authority. Respondents with current or former experience as health care providers were less likely than nonprovider respondents to believe that nonphysician health care providers support decisions made by the regional health boards (45% v. 63%, p = 0.02), a result that confirmed the contention that the role of health care providers on the boards would be a source of tension. INTERPRETATION: Members of Saskatchewan district health boards supported the general goals of health care reform and believed that changes already undertaken had been positive. There were few major differences in views between appointed and elected members and between provider and nonprovider members. However, tensions related to authority and representation will require resolution.

Adult↗
PubMed1992

A population-wide profile of prescription drug use in Saskatchewan, 1989.

OBJECTIVE: To measure the prevalence of prescription drug use in Saskatchewan in 1989. DESIGN: Retrospective study. PARTICIPANTS: A total of 961,203 Saskatchewan residents (including those who died or were born during the study year) who were eligible for coverage under the Saskatchewan Prescription Drug Plan. The study population represented 94% of the province's total population; those excluded were mostly status Indians (for whom a federal plan is available). MAIN RESULTS: At least one prescription was received by 66.0% of the study population in 1989. The mean number of prescriptions per patient was 8.2, and the mean cost of drug material per prescription was $13.95. Females received substantially more prescriptions than males; the difference was particularly notable for cardiovascular agents, antidepressants and benzodiazepines. In the senior population 80.8% received at least one prescription; the mean number of prescriptions per patient was 18.4. The most commonly dispensed drug for the entire study population was amoxicillin (290 prescriptions per 1000 people); triazolam was the most frequently dispensed central nervous system drug (74 prescriptions per 1000 people). Regional variation in overall drug use was remarkably small, although it increased at the drug-class level, especially for tranquillizers. The use of cardiovascular drugs was 27% to 32% higher (depending on how use was measured) per Regina resident than per Saskatoon resident. Benzodiazepines were commonly used on a long-term basis, despite recommendations to the contrary. CONCLUSIONS: The results quantify the prevalence of prescription drug use, underscore the importance of careful management of drug therapy by physicians and pharmacists (especially for seniors), illustrate substantial variation in drug therapy strategies and raise questions about utilization of benzodiazepines and cardiovascular drugs.

Age Factors↗
PubMedDate not supplied

An investigation of the impact of supplementary health benefits for low-income families in Saskatchewan.

OBJECTIVES: To examine the changes in health service use by recipients of Family Health Benefits, a supplementary benefits program that was introduced to lower-income, working families in Saskatchewan beginning in July 1998. These benefits reduced or eliminated fees for prescription drugs and for chiropractic, optometric and dental services. METHODS: The study population included program beneficiaries between July 1998 and January 2000. Administrative data maintained by Saskatchewan Health were used to capture information on changes in benefits coverage and use of hospital, physician, prescription drug, chiropractic and optometric services from 1997 to 2000. Demographic characteristics of the study population were described. Utilization rates were compared for periods prior to and following introduction of the program. RESULTS: Almost three quarters of Family Health Benefit beneficiaries had not had any form of prior supplementary health coverage in the previous year. A large proportion of these beneficiaries lived in rural Saskatchewan. Distinct demographic characteristics were observed for rural and urban beneficiaries. While utilization of physician and hospitalization services was lower following the introduction of the program, utilization of prescription drugs, and both chiropractic and optometric services increased. CONCLUSIONS: The reduction in user fees for non-insured services resulted in an increased use of these health services, suggesting that user fees can act as a barrier to the use of medical services by low-income families.

Family Health↗
PubMed1979

Drug prescribing for the elderly in Saskatchewan during 1976.

Over 11% of Saskatchewan's population is 65 years of age or older. To study patterns of prescribing for the elderly a computer file of more than 3.6 million prescriptions filled in Saskatchewan in 1976 was reviewed. The elderly population (aged 65 years or more) that year was 102 070, and 77.3% received at least one prescription drug listed in the Saskatchewan Formulary. In comparison with a "middle-aged" group (persons between the ages of 35 and 54 years) the elderly showed moderately higher average numbers of prescriptions filled and drugs used per person that year. However, the prescription of antihypertensive agents and diuretics increased dramatically with age, and barbiturates, in view of their potential toxicity, appeared to be overprescribed for the elderly.

Adult↗
PubMed1983

Tularaemia transmitted by ticks (Dermacentor andersoni) in Saskatchewan.

Common wood ticks (Dermacentor andersoni) collected from Saskatchewan Landing Provincial Park, Saskatchewan in the spring of 1982 transmitted a lethal tularaemia infection to four of six rabbits. Francisella tularensis organisms were isolated from tissues taken from the dead rabbits and identified from subcultures using an indirect immunofluorescent antibody assay. One human associated with the animals developed symptoms of tularaemia and, after successful therapy, had a significant increase in titre of specific antibodies to F. tularensis. This is the first time tick-transmitted tularaemia has been reported in Saskatchewan in more than 25 years.

Animals↗
PubMedDate not supplied

Menopausal hormone use and colorectal cancer in Saskatchewan: a record linkage cohort study.

It has been suggested that usage of menopausal estrogens may be associated with risk of colorectal cancer. This association was examined in a record linkage cohort study using the Saskatchewan Health Plan Databases. All women ages 43-49 who were residents in Saskatchewan in 1976 were identified from the Saskatchewan Health master registration file. These 33,003 women were linked by registration beneficiary number to the Prescription Drug Plan Database for the period January 1976 through June 1987, and to the Provincial Cancer Registry Database for the period March 1960 through December 1990. Thirty women in the cohort had colon or rectal cancer diagnosed before 1976 and were omitted from the analysis; exposures within 3.5 years of diagnosis or end of follow-up were also omitted. Between 1976 and 1990, 230 first primary colorectal cancer cases occurred. Women who took estrogens had nonsignificantly elevated risk of colon cancer in general (age-adjusted relative risk = 1.29; 95% confidence interval, 0.86-1.93) and of cancer of the distal colon (relative risk = 1.51; 95% confidence interval, 0.90-2.54). Women who took p.o. contraceptives during this follow-up period seemed to be at higher risk of cancer of the proximal colon (relative risk = 2.12; 95% confidence interval, 1.00-4.53), though this apparent association could very well have occurred by chance. No associations were seen between hormone use and risk of rectal cancer. This study provides little evidence that usage of menopausal hormones may be related to risk of colorectal cancer (either positively or negatively), though further follow-up of the cohort appears warranted.

Adult↗
PubMed1994

Rates and outcomes of diabetic end-stage renal disease among registered native people in Saskatchewan.

OBJECTIVE: To determine the rates and outcomes of diabetic end-stage renal disease (ESRD) among registered native people and non-native people in Saskatchewan. DESIGN: Retrospective population-based study using data from the Canadian Organ Replacement Registry. SETTING: Saskatchewan. PATIENTS: All patients with diabetic ESRD diagnosed between Jan. 1, 1981, and Dec. 31, 1990. MAIN OUTCOME MEASURES: Incidence rates of diabetic ESRD in the general population, rates of diabetic ESRD among patients with diabetes mellitus, nature of initial dialysis treatment, length of survival from start of dialysis, cause of death and renal transplant rates. RESULTS: The 10-year incidence rates of diabetic ESRD were higher among all age groups among registered native people than among non-native people. The overall relative risk ratio for native people was 16.2. When a higher prevalence of diabetes among native people was taken into account, native diabetic people were still seven times as likely as non-native diabetic people to manifest diabetic ESRD. The median survival from start of dialysis was under 2 years in both groups, but more native people died of stroke and more non-native people died of heart disease. Non-native diabetic people were more likely than native diabetic people to receive renal transplants. CONCLUSIONS: Although the overall incidence of diabetic ESRD in Saskatchewan is increasing, registered native people have a disproportionate risk for this serious complication.

Adult↗
PubMedDate not supplied

Diabetes prevalence rates among First Nations adults on Saskatchewan reserves in 1990: comparison by tribal grouping, geography and with non-First Nations people.

OBJECTIVE: To determine age-specific, sex-specific and total prevalence rates of diabetes mellitus among Saskatchewan First Nations adults and to compare these rates by tribal grouping, geography and with non-First Nations people. DESIGN: A point prevalence study of all Saskatchewan reserves in 1990. RESULTS: Age-adjusted rates of diabetes mellitus were higher (risk ratio 1.8) among First Nations adults (9.7%) than among non-First Nations adults (6.1%). These racial differences were greater between women (12.1 vs 6.6%) than men (7.2 vs 5.6%). First Nations diabetes rates were highest among individuals with Saulteaux and Sioux ancestry, and among those living on southern reserves. CONCLUSIONS: The prevalence of diabetes mellitus among Saskatchewan First Nations people has increased from 0% to almost 10% within the adult population since 1934 and has more than doubled from 1980 to 1990. This epidemic manifests itself to a greater extent among women and certain tribal groups, possibly due to differences in exposure to non-traditional lifestyles.

Adult↗