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Aim: To assess the incremental cost-effectiveness ratio (ICER) of group transdiagnostic cognitive-behavioural therapy (tCBT) added to treatment as usual (TAU) for anxiety disorders compared to TAU only from the healthcare system perspective over a 1-year time horizon. Methods: Data from a pragmatic multisite randomized controlled trial where adults (18–65 years) with an anxiety disorder were randomized to tCBT + TAU (n = 117) or TAU (n = 114). Group tCBT is a 12-week (2h weekly sessions) community-based intervention. Health service utilization and related costs were captured from medico-administrative data and included those for the intervention, ambulatory visits, hospitalizations and medications. Effectiveness was based on quality-adjusted life years (QALYs). The study included measures at baseline, 4, 8, and 12 months. Intention-to-treat and complete case analyses were carried out. Missing data were imputed using multiple imputation analyses. Seemingly unrelated regression analyses were used to assess the effect of the intervention on total costs and QALYs while also adjusting for baseline confounders. The probability of cost-effectiveness of the intervention was assessed according to different willingness-to-pay (WTP) thresholds using the net benefit regression method. Results: The ICER of tCBT + TAU as compared to TAU in the intention-to-treat analysis was $6,581/QALY. Complete case analyses showed a similar ICER of $6,642/QALY. The probability at a WTP threshold of $20,000 and $40,000 that tCBT + TAU as compared to TAU is cost-effective is 93.0% and 99.9%. Conclusion: tCBT added to TAU appears to be cost-effective from the healthcare system perspective for treating adult patients with anxiety disorders. Larger trials including young and older adults as well as a range of anxiety disorders are needed to further investigate the cost-effectiveness of tCBT in different patient populations. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the association between anemia and depression and whether the treatment of anemia modifies the effect of the association between anemia and depression. Methods: This secondary data analysis is based on data from the Enquête sur la santé des aînés (ESA)‐Services study conducted in 2011–2013 on community‐dwelling older adults recruited in primary care and have given access to their medico‐administrative data (n = 1447). The presence of anemia was self‐reported, as was depression (major and minor) aligned with symptoms of the DSM‐5. Treated anemia was based on the presence of medications delivered to participants. Cross‐sectional associations were analyzed using multivariable logistic regression, controlling for confounders. Results: The prevalence of self‐reported anemia in our sample was estimated at 6.7%. Self‐reported anemia was associated with increased odds of depression. Individuals with untreated anemia had a 2.6‐fold increased odds of depression compared to those with no anemia. In contrast, the odds of depression in individuals with treated anemia were not different from individuals with no anemia. Conclusion: The findings underline the importance of treating anemia in older adults. Future longitudinal studies are needed to replicate the findings and further explore the role of treating anemia on symptoms of depression. [ABSTRACT FROM AUTHOR]

Objective: To assess the individual and health system factors and health-related outcomes associated with perceived need for mental health care in older adults consulting in primary care.Method: This longitudinal cohort study was conducted among 771 cognitively intact older adults aged ≥65 years recruited in primary care practices in Quebec between 2011 and 2013 and followed 4 years later. Predisposing, enabling and need factors were based on Andersen's framework on help-seeking behaviors. Health-related outcomes included course of common mental disorders (CMDs), change in quality of life and societal costs. Perceived need for care (PNC) was categorized as no need, met and unmet need. Multinomial regression analyses were conducted to assess the association between study variables and PNC in the overall and the subsample of participants with a CMD at baseline.Results: As compared with individuals reporting no need, those with an unmet need were more likely to have cognitive decline and lower continuity of care; while those with a met need were more likely to report decreased health-related quality of life. As compared with individuals with an unmet need, those reporting a met need were more likely to report ≥ 3 physical diseases and an incident and persistent CMD, and less likely to show cognitive decline. In participants with a CMD, individuals reporting a met as compared with no need were more likely to be categorized as receiving minimally adequate care and a persistent CMD. Need for care was not associated with societal costs related to health service use.Conclusions: Overall, physicians should focus on individuals with cognitive impairment and lower continuity of care which was associated with unmet mental health need. Improved follow-up in these populations may improve health care needs and outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study aims to present a proof of concept of a dashboard on a set of indicators of access to primary healthcare (PHC) based on electronic medical records (EMRs)., Methods: This research builds on a multi-method design study including (1) a systematic review, (2) a pilot phase and (3) the development of a dashboard., Results: Eight indicators were carefully selected and successfully extracted from EMRs obtained from 151 PHC providers. Indicators of access over time, as well as among providers and among clinics, have been enabled in the dashboard., Conclusion: EMR data enabled the development of a real-time dashboard on access, giving PHC providers a reliable portrait of their own practice, its evolution over time and how it compares with those of their peers., (Copyright © 2023 Longwoods Publishing.)

Background: Effective healthcare innovations are often not scaled up beyond their initial local context. Lack of practical knowledge on how to move from local innovations to large-system improvement hinders innovation and learning capacity in health systems. Studying scale-up processes can lead to a better understanding of how to facilitate the scale-up of interventions. eConsult is a digital health innovation that aims to connect primary care professionals with specialists through an asynchronous electronic consultation. The recent implementation of eConsult in the public health systems of four Canadian jurisdictions provides a unique opportunity to identify different enabling strategies and related factors that promote the scaling up of eConsult across jurisdictions., Methods: We conducted a narrative case study in four Canadian provinces, Quebec, Ontario, Manitoba, and Newfoundland & Labrador, over a 3-year period (2018-2021). We observed provincial eConsult committee meetings (n=65) and national eConsult forums (n=3), and we reviewed internal documents (n=93). We conducted semi-structured interviews with key actors in each jurisdiction (eg, researchers, primary care professionals, specialists, policy-makers, and patient partners) (n=40). We conducted thematic analysis guided by the literature on factors and strategies used to scale up innovations., Results: We identified a total of 31 strategies related to six key enabling factors to scaling up eConsult, including: (1) multi-actor engagement; (2) relative advantage; (3) knowledge transfer; (4) strong evidence base; (5) physician leadership; and (6) resource acquisition (eg, human, material, and financial resources). More commonly used strategies, such as leveraging research infrastructure and bringing together various actors, were used to address multiple enabling factors., Conclusion: Actors used various strategies to scale up eConsult within their respective contexts, and these helped address six key factors that seemed to be essential to the scale-up of eConsult., (© 2023 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)