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http://hdl.handle.net/11375/29915
Title: | Comprehensive Needs Assessment for Deep Brain Stimulation in Canada, A Health Service Research Perspective |
Authors: | Lannon, Melissa |
Advisor: | Sharma, Sunjay |
Department: | Health Research Methodology |
Keywords: | Neurosurgery;Deep Brain Stimulation |
Publication Date: | 2024 |
Abstract: | BACKGROUND: The Canadian healthcare system is subject to national standards that may be challenging to meet, given the evolution and integration of technology in healthcare in disciplines like functional neurosurgery, utilizing therapies such as deep brain stimulation (DBS), whereby implanted devices have provided benefit for patients with movement disorders. A comprehensive assessment of the need for this service to match with the delivery of DBS has not been performed. This thesis comprises a series of studies that aim to address this knowledge gap through the quadruple aim of health service research. METHODS: The first study is a systematic review and meta-analysis including economic evaluations comparing DBS for movement disorders with medical management only. The second is a mixed methods survey of Canadian stakeholders for DBS. The final study is a nationwide retrospective cohort study of DBS patients from 2019-2022 to determine factors that may influence access. RESULTS: Through analysis of 14 economic evaluations, DBS appears to be a cost-effective treatment when considered across the remaining lifespan of the patient with positive incremental net benefit for DBS with a mean difference of 40,504.81USD (95% CI 2,422.42; 78,587.19). Additionally, 220 responses from all DBS stakeholder groups revealed that costs associated with travel, waitlists, lack of specific resources, poor understanding of movement disorders and DBS indications, and referral pathways were barriers to accessing DBS. Finally, preliminary results identified 162 DBS patients. Potential factors that may increase access to DBS were indication (Parkinson’s disease), higher socioeconomic status, and race. CONCLUSIONS: While DBS is a cost-effective therapy for patients with movement disorders, the current delivery of this service needs significant improvement. This includes improved education, streamlined referral pathways, and policy change at a governmental level, with further investigation to determine regions of the country where need for DBS far exceeds current access. |
URI: | http://hdl.handle.net/11375/29915 |
Appears in Collections: | Open Access Dissertations and Theses |
Files in This Item:
File | Description | Size | Format | |
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Lannon_Melissa_M_2024June_PhD.pdf | 11.87 MB | Adobe PDF | View/Open |
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