Clinical Epidemiology Study Who benefits? How do we know? B Lynn Beattie MD FRCPC Professor Emeritus Div Geri Med, Dept Med, UBC Medical Director UBCH.

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Presentation transcript:

Clinical Epidemiology Study Who benefits? How do we know? B Lynn Beattie MD FRCPC Professor Emeritus Div Geri Med, Dept Med, UBC Medical Director UBCH CARD

Low-income subset of the cohort from the Utilization and Cost Study Policy begins Low-income people* ChEI use No use: Historical Controls *On MSP premium subsidy

70% increase among poor a) Impact on Low-income Cohort (n = 24,253) …vs 30% increase in all BC

Rate of contacts with physicians: Low-income cohort vs all of BC Low Income: Policy cohort Historical control All BC: Policy cohort Historical control No impact BC linked data for

Rate of entry to long-term or palliative care: Low-income vs all of BC Low Income: Policy cohort Historical control No impact BC linked data for

Rate of hospitalizations: Low-income cohort vs all of BC Low Income: Policy cohort Historical control No impact BC linked data for

b) Special Authority data: Changes in Clinical Measures New users of ChEI (naïve) Continuing users (non-naïve) Problem: No SMMSE data collected before policy.

Initial Special Authority Form

Renewal Special Authority Form – Overall Patient Assessment Rating OPAR

Change in SMMSE scores over 6 mo SMMSE Change First SMMSE Low scorers, who score below 10 at 6 months, do not submit SA forms High scorers cannot score much higher Naïve: new users of ChEIs (n = 1094) Middle of graph is relatively free of bias

Change in SMMSE scores over 6 mo SMMSE Change First SMMSE Low scorers, who score below 10 at 6 months, do not submit SA forms High scorers cannot score much higher Non-naïve: Continuing users (n = 1584) Middle of graph is relatively free of bias

Changes in SMMSE scores naïve continuing SMMSE Change Difference : (95% CI: ) SMMSE Change Naïve improved by half a point more than Non-Naive.

Change in GDS by first SMMSE naïve continuing Difference:0.05 (95% CI: ) GDS Change GDS Change Naïve achieved 5% of a GDS point more than Non-Naïve

OPAR compared by first SMMSE naïve continuing Difference: 0.23 (95% CI: ) OPAR OPAR Naive achieved a quarter of a point more on OPAR than Non-Naive

Conclusions In real-world usage of ChEIs, there is evidence of clinical improvement, based on measurements by frontline physicians. This is consistent with the pivotal trials, most of which were 6 months RCTs. Value of OPAR will be looked at further. We look forward to the evidence on longer- term effects of ChEIs.