Impact of an addiction medicine consult team intervention in a Canadian inner city hospital on acute care utilization: a pragmatic quasi-experimental study.

BACKGROUND: Inner city patients have a higher illness burden and need for care, but experience more unmet care needs. Hospital Addiction Medicine Consult Teams (AMCTs) are a promising emerging intervention. The objective of this study was to assess the impact of a Canadian AMCT-like intervention for inner city patients on reduction in high emergency department (ED) use, hospital admission, and inpatient length of stay. METHODS: Using a community-engaged, two-arm, pre-post, longitudinal quasi-experimental study design, 572 patients reporting active substance use, unstable housing, unstable income, or a combination thereof (302 at intervention site, 270 at control sites) were enrolled. Survey and administrative health service data were collected at baseline, six months post-enrolment, and 12 months post-enrolment. Multivariable regression models tested the intervention effect, adjusting for clinically important covariables (inpatient status at enrolment, medical complexity, age, gender, Indigenous identity, shelter use, opioid use). RESULTS: Initial bivariable analyses demonstrated an intervention effect on reduction in admissions and length of stay, however, this effect was no longer significant after adjusting for covariables. There was no evidence of reduction in high ED use on either bivariable or subsequent multivariable analysis. CONCLUSIONS: After adjusting for covariables, no AMCT intervention effect was detected for reduction in high ED use, inpatient admission, or hospital length of stay. Further research is recommended to assess other patient-oriented intervention outcomes.

[Reluctant partner: Canada's relationship with the Pan American Health Organization (PAHO)]. / Parceiro relutante: as relações do Canadá com a Organização Pan-Americana de Saúde (OPAS).

Despite a strong commitment to multilateralism and international health cooperation in the post World War II era, Canada refrained form joining the Pan American Health Organization - PAHO until 1971. Drawing on letters and memos sent between Canadian diplomats and government representatives, this paper explores official Canadian accounts of the factors that delayed Canada's membership in PAHO. These factors include the initial lack of official relations between Canada and Latin America, US hegemony in the region, and budgetary constraints. Canada's cautious position regarding PAHO is also placed within the context of Canada's overall foreign policy to the region, emphasizing the parallels between Canada's reluctant association with PAHO and the evolution of Canada's engagement with the region as a whole.

Parceiro relutante: as relações do Canadá com a Organizaçäo Pan-Americana da Saúde (OPAS) / Reluctant partner: Canada's relationship with the Pan American Health Organization (PAHO)

Apesar do forte compromisso ao multilateralismo e à cooperaçäo internacional em saúde na era pós-Segunda Guerra Mundial, o Canadá absteve-se de ingressar na Organizaçäo Pan-Americana da Saúde - OPAS até 1971. Este artigo examina as explanações oficiais canadenses relativas aos fatores que retardaram esse ingresso, utilizando como fonte de análise cartas e memorandos trocados entre diplomatas e representantes governamentais canadenses. Esses fatores incluem a carência inicial de relações oficiais entre o Canadá e a América Latina, a hegemonia dos Estados Unidos na regiäo, e restrições orçamentárias. A posiçäo cautelosa do Canadá em relaçäo à OPAS também é analisada no contexto da política externa geral do Canadá para a regiäo, enfatizando as linhas paralelas entre a relutância do Canadá em associar-se à OPAS e a evoluçäo do compromisso do Canadá com a regiäo como um todo.(AU)Despite a strong commitment to multilateralism and international health cooperation in the post World War II era, Canada refrained from joining the Pan American Health Organization - PAHO until 1971. Drawing on letters and memos sent between Canadian diplomats and government representatives, this paper explores official Canadian accounts of the factors that delayed Canada's membership in PAHO. These factors include the initial lack of official relations between Canada and Latin America, US hegemony in the region, and budgetary constraints. Canada's cautious position regarding PAHO is also placed within the context of Canada's overall foreign policy to the region, emphasizing the parallels between Canada's reluctant association with PAHO and the evolution of Canada's engagement with the region as a whole.(AU)

Parceiro relutante: as relações do Canadá com a Organização Pan-Americana da Saúde (OPAS) / Reluctant partner: Canada's relationship with the Pan American Health Organization (PAHO)

Apesar do forte compromisso ao multilateralismo e à cooperação internacional em saúde na era pós-Segunda Guerra Mundial, o Canadá absteve-se de ingressar na Organização Pan-Americana da Saúde - OPAS até 1971. Este artigo examina as explanações oficiais canadenses relativas aos fatores que retardaram esse ingresso, utilizando como fonte de análise cartas e memorandos trocados entre diplomatas e representantes governamentais canadenses. Esses fatores incluem a carência inicial de relações oficiais entre o Canadá e a América Latina, a hegemonia dos Estados Unidos na região, e restrições orçamentárias. A posição cautelosa do Canadá em relação à OPAS também é analisada no contexto da política externa geral do Canadá para a região, enfatizando as linhas paralelas entre a relutância do Canadá em associar-se à OPAS e a evolução do compromisso do Canadá com a região como um todo.

Despite a strong commitment to multilateralism and international health cooperation in the post World War II era, Canada refrained from joining the Pan American Health Organization - PAHO until 1971. Drawing on letters and memos sent between Canadian diplomats and government representatives, this paper explores official Canadian accounts of the factors that delayed Canada's membership in PAHO. These factors include the initial lack of official relations between Canada and Latin America, US hegemony in the region, and budgetary constraints. Canada's cautious position regarding PAHO is also placed within the context of Canada's overall foreign policy to the region, emphasizing the parallels between Canada's reluctant association with PAHO and the evolution of Canada's engagement with the region as a whole.

Juggling demands: Canadian health aid to Latin America since World War II.

BACKGROUND: Since the development of the Commonwealth's 1950 Colombo Plan (Canada's first official aid program), health-related development assistance has been an important instrument of Canadian foreign policy, allowing it to gain a presence in a range of countries and help to shape international affairs. This pattern is evident in the history of Canadian multilateral and bilateral health aid to Latin America. METHODS: This analysis draws on historical material from the Departments of External Affairs and National Health and Welfare held at the Library and National Archives of Canada regarding Canadian involvement with the Pan American Health Organization (PAHO), and program information from the Canadian International Development Agency's (CIDA) Corporate Reporting Services Group. FINDINGS: Canada was initially a tentative player in the region. However, as Canadian foreign policy interests shifted towards the region in the 1970s, Canada used both multilateral and bilateral health aid to establish a presence in Latin America that was independent from, yet unthreatening to, United States hegemony in the region. CONCLUSION: The impact of Canada's provision of health aid to Latin America via PAHO and CIDA has been largely symbolic, allowing Canada to pursue an independent foreign policy in the region and to foster a positive international image for itself with minimal spending.