Clinical factors associated with recent medical care visits in nursing homes: a multi-site cross-sectional study.

OBJECTIVES: We examined which resident-level clinical factors influence the provision of a recent medical care visit in nursing homes (NHs). DESIGN: Multi-site cross-sectional. SETTING AND PARTICIPANTS: We extracted data on 3,556 NH residents from 18 NH facilities in Ontario, Canada, who received at minimum, an admission and first-quarterly assessment with the Resident Assessment Instrument Minimum Data Set (MDS) 2.0 between November 1, 2009, and October 31, 2017. METHODS: We conducted a secondary analysis of routinely collected MDS 2.0 data. The provision of a recent medical care visit by a physician (or authorized clinician) was assessed in the 14-day period preceding a resident's first-quarterly MDS 2.0 assessment. We utilized best-subset multivariable logistic regression to model the adjusted associations between resident-level clinical factors and a recent medical care visit. RESULTS: Two thousand eight hundred fifty nine (80.4%) NH residents had one or more medical care visits prior to their first-quarterly MDS 2.0 assessment. Six clinically relevant factors were identified to be associated with recent medical care visits in the final model: exhibiting wandering behaviours (OR = 1.34, 95% CI 1.09 - 1.63), presence of a pressure ulcer (OR = 1.37, 95% CI 1.05 - 1.78), a urinary tract infection (UTI) (OR = 1.52, 95% CI 1.06 - 2.18), end-stage disease (OR = 9.70, 95% CI 1.32 - 71.02), new medication use (OR = 1.31, 95% CI 1.09 - 1.57), and analgesic use (OR = 1.24, 95% CI 1.03 - 1.49). CONCLUSIONS AND IMPLICATIONS: Our findings suggest that resident-level clinical factors drive the provision of medical care visits following NH admission. Clinical factors associated with medical care visits align with the minimum competencies expected of physicians in NH practice, including managing safety risks, infections, medications, and death. Ensuring that NH physicians have opportunities to acquire and strengthen these competencies may be transformative to meet the ongoing needs of NH residents.

Is vaccine hesitancy justified? Benchmarking post-market vaccine risks with five commonly used medicinal products in Canada.

OBJECTIVE: Although vaccines are one of the most cost-effective, low-risk healthcare approaches that save thousands of lives every year, paradoxical fear about vaccine safety is a major roadblock for achieving widespread vaccination coverage. The objective of this study is to change public perception of vaccine safety by presenting real-world incidence of adverse events following immunization (AEFIs). METHODS: In this study, we used Canadian post-market adverse events data to estimate the real-world risk of AEFI and benchmarked them against five commonly used drug types-ACE inhibitors, beta2 adrenergic receptors, penicillins, proton pump inhibitors, and HMG-CoA reductase inhibitors. RESULTS: Our analysis shows that post-market AEFIs are rare, and vaccination generally carries a significantly lower risk compared to some commonly used medicinal product types. CONCLUSION: Despite some limitations with using post-trial adverse events data, we believe that the evidence presented in this study, especially the comparative risk analysis between vaccines and medicinal products, when communicated through proper channels, can help vaccine-hesitant individuals overcome their perceived safety concerns with regard to vaccines.

RéSUMé: OBJECTIFS: Bien que les vaccins soient l'une des approches de soins de santé les plus rentables et à faible risque qui sauvent des milliers de vies chaque année, la peur paradoxale de la sécurité des vaccins est un obstacle majeur à la réalisation d'une couverture vaccinale généralisée. L'objectif de cette étude est de changer la perspective publique de la sécurité des vaccins en présentant l'incidence actuelle des événements indésirables post-commercialisation après la vaccination. MéTHODES: Dans cette étude, nous avons utilisé les données canadiennes sur les événements indésirables post-commercialisation pour estimer le risque réel d'événements indésirables après la vaccination et les avons comparés à cinq types de médicaments couramment utilisés ­ inhibiteurs de l'ECA (enzyme de conversion de l'angiotensine), récepteur bêta-2-adrénergique, pénicillines, inhibiteurs de la pompe à protons et inhibiteurs de l'HMG-CoA réductase. RéSULTATS: Notre analyse montre que les événements indésirables post-commercialisation après la vaccination sont rares et que la vaccination comporte généralement un risque significativement plus faible par rapport à certains types de médicaments couramment utilisés. CONCLUSION: Malgré certaines limites à l'utilisation des données sur les événements indésirables post-essai, nous pensons que les preuves présentées dans cette étude, en particulier l'analyse comparative des risques entre les vaccins et les médicaments, lorsqu'elle est communiquée par des canaux appropriés, peuvent aider les personnes hésitantes à surmonter leurs préoccupations perçues en matière d'innocuité des vaccins.