Suchergebnisse

ObjectiveVirtual interventions show promise for meeting growing mental health (MH) service demands. In 2020, Ontario launched Internet-delivered Cognitive Behavioural Therapy (iCBT), an evidence-based, self-led, asynchronous intervention for anxiety and depression. While its efficacy has been demonstrated in randomized controlled trials, we examine its real-world reach and treatment completion in routine care.
ApproachLinking iCBT records with health-administrative databases, we examined the characteristics (clinical, sociodemographic, health service use) of individuals receiving iCBT (via a pilot program), compared to fully-synchronous CBT (standard of care), ascertained who is more likely to receive either modality, and determined factors associated with treatment completion using Logistic regressions adjusted for sociodemographics, baseline depression (PHQ-9) and anxiety (GAD-7), and outpatient and acute MH-related service use one year prior to enrollment.
ResultsAmong N=167 individuals receiving iCBT at the Centre for Addiction and Mental Health (Jan 2020-Aug 2021) and N=300 controls receiving fully-synchronous CBT via Ontario's Structured Psychotherapy Program, we found that older individuals, those with lower baseline anxiety, and those with greater prior MH service use were more likely to receive iCBT. Intervention modality was the only significant predictor for treatment completion, with 51% lesser odds among iCBT clients (ORadjusted=0.49, 95%CI 0.31-0.76).
ConclusionsWhile certain demographic characteristics differentiate iCBT recipients from those receiving standard CBT, treatment adherence is lower in self-led, asynchronous therapy.
ImplicationsThis study examines iCBT in routine care and informs its wider implementation so it can reach the target population, ease access burdens, and improve MH service delivery. Future work will examine treatment effectiveness.

BackgroundThe linkage of records across administrative databases has become a powerful tool to increase information available to undertake research and analytics in a privacy protective manner.
ObjectiveThe objective of this paper was to describe the data integration strategy used to link the Ontario Ministry of Children, Community and Social Services (MCCSS)-Social Assistance (SA) database with administrative health care data.
MethodsDeterministic and probabilistic linkage methods were used to link the MCCSS-SA database (2003-2016) to the Registered Persons Database, a population registry containing data on all individuals issued a health card number in Ontario, Canada. Linkage rates were estimated, and the degree of record linkage and representativeness of the dataset were evaluated by comparing socio-demographic characteristics of linked and unlinked records.
ResultsThere were a total of 2,736,353 unique member IDs in the MCCSS-SA database from the 1st January 2003 to 31st December 2016; 331,238 (12.1%) were unlinked (linkage rate = 87.9%). Despite 16 passes, most record linkages were obtained after 2 deterministic (76.2%) and 14 probabilistic passes (11.7%). Linked and unlinked samples were similar for most socio-demographic characteristics (i.e., sex, age, rural dwelling), except migrant status (non-migrant versus migrant) (standardized difference of 0.52). Linked and unlinked records were also different for SA program-specific characteristics, such as social assistance program, Ontario Works and Ontario Disability Support Program (standardized difference of 0.20 for each), data entry system, Service Delivery Model Technology only and both Service Delivery Model Technology and Social Assistance Management System (standardized difference of 0.53 and 0.52, respectively), and months on social assistance (standardized difference of 0.43).
ConclusionsAdditional techniques to account for sub-optimal linkage rates may be required to address potential biases resulting from this data linkage. Nonetheless, the linkage between administrative social assistance and health care data will provide important findings on the social determinants of health.