Population aging in Canada is expected to result in a sharp increase in the use of health services by the aged. The purpose of this thesis, is to enhance the knowledge of the utilization of the health system by the elderly. For this, an analysis of the utilization of three health services was pursued, using data from two health surveys, and two general social surveys in a statistical examination; to describe age-use; identify the major determinants of utilization; and to discover the sources of change in use. The results show that the aged were the highest users of health services among all age groups. Use increased for some services, and decreased for others. Changes in how people were managed by the health system, and to a lesser extent a rise in disease prevalence, were the primary sources of variations in utilization. There was no conclusive evidence of the presence of supplier induced demand. Population aging was not a significant determinant of changes in health service use, but rather factors associated with the management of the elderly by the health system; this includes technological changes in medicine, and changes in treatment patterns.

In the face of ever increasing atmospheric CO₂ a better understanding of soil properties and processes and the effect of management practices, such as the application of nitrogen fertilizer is of importance and could potentially improve our ability to sustainably manage forestry systems. With that in mind this study was conducted in order to investigate the effects of tree species and fertilization on soil carbon and the soil microbial community. To this end, soil from fertilized and unfertilized plots at Berwick forest, under stands of Pinus radiata and Sequoia sempervirens at Hanmer and under six different tree species at Holt forest was sampled. Two glasshouse pot trials were established using soil collected from the Hanmer and Berwick forest sites and seedlings of Pinus radiata, Sequoia sempervirens, and Eucalyptus nitens were grown. Soil properties were determined from both the field sites and pot trials including soil organic matter, carbon, nitrogen, and microbial biomass by chloroform fumigation extraction. Biolog ecoplates were used to determine the relative differences in diversity based on substrate utilization patterns of the soil microbial communities in soil sampled from the glasshouse pot trials. Soil microbial biomass carbon, nitrogen and the ratio of microbial biomass carbon:nitrogen differed significantly between Pinus radiata and the other tree species sampled at Holt forest. Significant effects of fertilization and tree species on soil carbon and microbial biomass were observed in both pot trials. Soil carbon differed significantly between Eucalyptus nitens and both Pinus radiata and Sequoia sempervirens in the first pot trial and relative to both, E. nitens contributed significantly more carbon. No significant effect of either fertilization or tree species on the catabolic diversity of the soil microbial community in both glasshouse pot trials was observed. The results demonstrated the effects that fertilization and tree species can have. Particularly notable was the short-time period in which tree species effects became apparent coupled with the absence of any aboveground inputs to the soil.

This study investigates if companies that actively use export information have higher export growth rates or greater satisfaction with export performance measures than non-users. Organizational communication structures relating to information flow to decision makers is investigated to provide further insight into the role of export information. The study is based upon the knowledge utilization theory which states company/user characteristics are as important to information utilization as the characteristics of the specific piece of information. Bivariate analysis does not indicate a direct relationship between information use and reported higher export growth rates over the past four years. However, there are indications of divergence in how information users and non-users view and utilize information. One critical finding is that information users have a statistically significant relationship toward symbolic utilization of export information. Additional differences were observed in third-party information use versus monitoring world news to evaluate export operations. The study investigates company characteristics against the three components of knowledge utilization (instrumental, conceptual and symbolic use) and the five components of information use (competitive advantage, information acquisition/need, influence of information on decisionmaking, organizational learning and organizational knowledge/information processing).

The purpose of this descriptive correlational study was to examine the relationship between admission disability and length of stay obtained from the records of neurological and orthopedic acute rehabilitation adult inpatients. The research question was, "Is there a relationship between the admission disability and length of stay?" Orem's self-care theory was used as the framework of the study. The sample consisted of 118 records of patients dismissed from a freestanding midwestern rehabilitation hospital during July 1, 1996 to November 30, 1996. Admission disability was measured with the Functional Independence Measure (FIM'''*1) instrument that was available in the patient's record. Length of stay was the number of days in the rehabilitation facility. Motor disability was significantly and negatively correlated with length of stay (r= -0.249, p=.006). Implications for practice were discussed. / School of Nursing

The need to utilize research in decision making is considered critical in the present health care environment. For health research to be applied, it must have value. However, the question of the value of research has not been fully explored in the literature. The purpose of this study is to gain an understanding of occupational therapists’ perceptions of the value of research. Semi-structured interviews were completed in Winnipeg, Manitoba with 10 occupational therapists. The four themes in the study influencing their perceptions of the value of research were their experiences with research, the purpose of research, the resources to support research and the clinician and researcher culture. A number of elements were identified which may have informed the occupational therapists’ perceptions of the value of research. Having an understanding of the elements that may influence the perceptions of the value of research may assist with developing effective research utilization programs.

Palliative radiotherapy (PRT) is proven to be effective in palliation of symptoms for end-stage cancer patients. However, little is known about its utilization at the end of life. This research aims to examine the utilization and the practice patterns of PRT at the end of life for cancer patients in British Columbia using population-based data. The pattern observed for PRT1Y dose-fractionation practice in BC are in line with published clinical guidelines and evidence from the literature, which advises “proper” use of PRT in BC as delivered to cancer patients at the end of life. However, after controlling for age, primary cancer site, and survival time, geographic access is found to be significantly associated with PRT1Y utilization. Variations found in PRT1Y rates by geographic access, which is operationalized by the Health Services Delivery Area (HSDA) and travel time, suggests potential underutilization of PRT1Y for patients with suboptimal access. / Graduate / 0992 / 0769 / 0574 / jinhuang@uvic.ca

Background: To curb the transmission of HIV/AIDS and other infectious diseases several studies indicate the need for improved access to medical care for injection drug users (IDUs) including those already linked to syringe exchange programs (SEPs). However, availability and access to services remains a problem for many IDUs. This study seeks to examine perceptions of medical care access among a pharmacy-based sample of IDUs, utilization of medical services among IDUs and, identify barriers to accessing health care services to help ensure that IDUs receive appropriate care when needed and reduce the transmission of diseases. Methods: Data was obtained from the Pharmacists As Resources Making Links to Community Services (PHARM-Link) study. Dependent variables: health care access to the same provider and receiving care a usual source, health care utilization of services including the emergency room, clinic, medical office, medical mobile unit and hospital; and health care barriers categorized as personal or structural. Independent variables were insurance status, homelessness in the prior six months, case management, drug treatment and socio-demographic characteristics such as age, sex, income, education and employment status. Descriptive statistics analysis and logistic regression were performed using SAS version 9.4 (2013) with significance set at p<0.05. Results: Our sample included 615 IDUs participating in the PHARM-Link study. Overall, IDUs accessed health services and having the same provider remained statistically higher among those with legal income above $5,000 OR: 1.60 (95% CI: 1.03- 2.48), the insured OR: 4.11 (95% CI: 2.48-6.79), and those with positive HIV status OR: 7.64 (95% CI: 3.18 – 18.36), while those who were homeless reported lower access to the same provider OR: 0.63 (95% CI: 0.43 – 0.92). Only the older age group OR: 2.85 (95% CI: 1.42-5.73) and the insured OR: 3.42 (95% CI: 1.81-6.46) remained significantly associated with more access to receiving health needs at the same location. Those with some college education had less frequent visits to the clinic OR: 0.59 (95% CI: 0.38-0.92) and medical office OR: 0.64 (95% CI: 0.41-0.99), while the homeless were more likely to visit the emergency room OR: 1.49 (95% CI: 1.06-2.11). Females were less likely to go to a mobile unit OR; 0.52 (95% CI: 0.33-0.83) and married people were more likely OR: 1.95 (95% CI: 0.28-0.91). Visit to the hospital were less likely among females OR: 0.54 (95% CI: 0.36-0.81) and among those with some college education OR: 0.63 (95% CI: 0.41-0.96). Those with legal income above $5,000 were less likely to have any personal barriers OR: 0.64 (95% CI: 0.45 – 0.92). Structural barriers remained more likely among those who were homeless OR: 1.62 (95% CI: 1.13-2.39), but less likely among those 44 years and older OR: 0.58 (95% CI: 0.40-0.85), the insured OR: 0.60 (95% CI: 0.38-0.94), those with positive HIV status OR: 0.53 (95% CI: 0.28-0.99), as well as Non-Hispanic Blacks OR: 0.47 (95% CI: 0.14-0.83) and Latinos OR: 0.47 (95% CI: 0.25-0.86). Conclusion: Our results suggest that most IDUs linked to care through pharmacy-based SEP programs established to expand health services and improve health, did access available health services. However, some continue to experience difficulties such as structural barriers among the homeless as well as few reported visits to the clinic, medical office and the hospital among the employed believed to have resources to pay for such services. These services may have been underutilized because the participants were unsatisfied with the services provided. Therefore, interventions should target structural barriers such as homelessness among IDUs as well as health insurance coverage to help increase access to and utilization of health services.

Health care spending in Canada has been increasing faster than the rate of gross domestic product (GDP). A disproportionate amount of the health care spending is allocated to care of older adults. Non-elective abdominal surgery is an expensive area of care for older adults. Despite this, the factors associated with cost in this patient population remain unclear. OBJECTIVES The primary objective of this study was to estimate the association between perioperative factors (age, American Society of Anesthetists (ASA) classification, operative severity (OS), frailty index (FI), complication severity) and health care costs among older adults undergoing non-elective abdominal surgery. The secondary objectives were: 1. to provide a comprehensive description of costs based on patient-level resource utilization; and 2. to examine the relationship between hospital costs and adverse events (non-fatal complication severity, mortality, and change in living arrangement). METHODS This study was an observational prospective cohort study. Over a 15 month period all patients 70 years or older who underwent non-elective abdominal surgery at the QEII Health Sciences Centre, Nova Scotia, were enrolled. Data were collected on patient demographics, investigations, treatments, and outcomes. Direct hospital health care costs (2012 $CAD) were calculated by tabulating patient-level resource use and assigning specific costs. The association between five perioperative factors and costs were analyzed using univariate non-parametric tests and multiple linear regression. The associations between adverse events and costs were assessed using univariate non-parametric tests and multiple linear regression. RESULTS During the study period, 212 patients who underwent abdominal surgery (median age 78 years (range 70-97)) were enrolled. The median costs of care were $9,166 (range $1,993-$104,403). The largest proportions of spending were non-procedural costs (65% [$2,176,875]) and intensive care costs (16% [$554,523]). The perioperative factors ASA classification (p=0.0010), OS (p<0.0001), FI (p=0.0002) and complication severity (p<0.0001) were all independently associated with health care costs, while age was not (p=0.5330). The following adverse events were independently associated with health care costs: non-fatal complication severity (p<0.0001), change in living arrangement (p=0.0002), and mortality (p=0.0337). Non-fatal complications had the strongest association with hospital costs (standardized β coefficient = 0.3931). CONCLUSION Four perioperative factors (ASA, OS, FI and complication severity) are associated with costs; therefore, representing a potential cost prediction model for this patient group. This study is important for health care administrators, identifying targets for cost reduction. Cost reduction strategies and research should concentrate on mitigating or preventing complications and high cost areas, such as non-procedural costs and intensive care, in order to achieve cost savings.

Thesis (MBuilding) -- University of South Australia, 1998

Thesis (PhD) -- University of South Australia, 1997