Healthcare utilization and telemedicine: An evaluation using linked administrative data from Manitoba.

INTRODUCTION: This research examines utilization patterns for patients using telemedicine compared to those receiving treatment conventionally. Administrative data from 2007-2016 is linked to records from the Manitoba Telehealth programme to conduct a population-level study. METHODS: Using a high dimensional propensity-weighted regression model, the study compares four utilization measures between telemedicine users and non-users. These include: ambulatory visits (number of visits to any physician), visits to primary care physicians, visits to specialists and the number of hospitalizations. RESULTS: Compared to non-users, telemedicine patients showed a higher number of in-person visits. Specifically, using incidence-rate ratios, telemedicine users had 1.32 more ambulatory visits (p < 0.001; 95% confidence interval, 1.23-1.41), 1.26 more visits to primary care practitioners (p<0.001; 95% confidence interval, 1.17-1.35), 1.38 more visits to specialists (p < 0.001; 95% confidence interval, 1.19-1.61) and 1.14 more hospitalizations (p>0.1; 95% confidence interval, 0.91-1.43). These results were robust to restricted analyses for distance, regions, and chronic conditions. Those patients with frequent virtual encounters with a specialist showed a decrease of the frequency of in-person visits of the same type of care (incidence-rate ratio=0.48, p < 0.001; 95% confidence interval, 0.44-0.54). DISCUSSION: Patterns in utilization vary between telemedicine users and non-users, with users showing a higher number of in-person visits than non-users, and only frequent users of telemedicine showing reduced in-person visits. Future investigation linking utilization patterns with patient care outcomes and costs will inform healthcare policy and clinical treatment plans.

Electronic medical records and primary care quality: Evidence from Manitoba.

Improvements in quality of care through supporting decision-making processes and increased efficiency have prompted widespread implementation of electronic medical records (EMRs) in Canada. Using a set of indicators of preventive care, chronic disease management, and hospitalizations due to ambulatory care sensitive conditions (ACSC), this study measures the effect of EMR adoption on quality of primary care measures. Population-based data for the Canadian province of Manitoba are used in a difference-in-differences approach with patient- and time-fixed effects. Evidence of changes in the selected quality-of-care indicators is weak, with preventive care, management of asthma, and hospitalizations showing no significant change due to EMR adoption. A statistically significant increase in the quality of diabetes care was found for EMR users, changes being larger for late EMR adopters which is possibly explained by a network effect. This research demonstrates that measuring whether EMRs prompt changes in the quality of care confronts serious challenges. The rapid evolution and gradual adoption of EMR technology, the inevitable learning/acceptance process by individual health practitioners, and its potential reflection on different patient populations create unmeasurable variables that confound EMRs' impact. This study also underscores the importance of data development to support the economic value of EMRs.

An ultra-low energy method for rapidly pre-concentrating microalgae.

This study demonstrates that Nannochloropsis sp. can be effectively separated from its growth medium (0.2-0.3g/L) using electro-coagulation-flocculation in a 100mL batch reactor with nickel electrodes and a treatment time of only 4s. Minimum energy density input for effective separation is 0.03 kWh/m(3). Both energy input and treatment time are much smaller than reported elsewhere. The process results in rapid separation of microalgae (over 90% in 120 min) with minimal damage to algal cells (>90% still alive after processing). At around 4V input, algae can be effectively separated even in very low concentrations. Pulsing is equally effective in separating microalgae as continuous direct current of same magnitude and total exposure time. Algae can separate from their growth medium even if the suspension itself is not treated, but is mixed with treated saltwater with same conductivity. The described method has significant advantages including applicability to continuous processing and water reuse.