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Papers by Amelie Quesnel-Vallee

BMC Health Services Research, 2022

Background Social inequalities in complications associated with diabetes mellitus persist. As a p... more Background Social inequalities in complications associated with diabetes mellitus persist. As a primary care sensitive condition (PCSC), this association could be related to differential access to primary care. Our objectives are to establish a typology of care trajectories following a new diagnosis, and to explore social determinants of trajectories. Methods We used the TorSaDe (The Care Trajectories-Enriched Data) cohort, which links Canadian Community Health Survey respondents to health administrative data. Care trajectories were mapped over a two-year period following a new diagnosis and analysed using state sequence and clustering methods. Associations between individual and geographic characteristics with trajectory types were assessed with multinomial logistic regression. Results Three trajectories were identified: Regular Family Physician (FP) Predominant, Specialist Physician Predominant, and Few Services. With Regular FP as the reference, males had higher odds of experienc...

Abstract: Objectives: Individuals living in deprived neighbourhoods have poor health outcomes, in... more Abstract: Objectives: Individuals living in deprived neighbourhoods have poor health outcomes, including human immunodeficiency virus (HIV) infection mortality. We assessed the association between individual and neighbourhood characteristics, and HIV testing across Canada. Methods: We used logistic regression modelling to evaluate this association in 2219 men and 2815 women, aged 18-54 years, in Canada, using data from the National Population Health Survey (1996/7),. Socio-economic characteristics and presence of a sexually transmitted infection (STI) were the individual level characteristics. Small area of residence was classified according to categories of material and social deprivation; these were the ’neighbourhood ’ variables in the model. Results: Ethnic minority women were less likely to report an HIV test than white women (OR 0.44, 95 % CI: 0.23 to 0.86). Women without a regular doctor were significantly less likely to report ever having had an HIV test (OR 0.57, 95 % CI: 0...

Innovation in Aging, 2020

Financial security is critical to overall well-being in retirement. Life course disruptions in wo... more Financial security is critical to overall well-being in retirement. Life course disruptions in work due to unemployment or disability may have lasting impacts on financial security in later life, and these effects may or may not be ameliorated by old age security programs and retirement benefits. Women are known to be particularly vulnerable for financial hardship in later life, making their life course experiences especially important in understanding financial well-being in retirement. We examine the Canadian Longitudinal and International Study of Adults (LISA) to assess later life financial insecurity in retirement, including 20 years of data on labor force experiences across adulthood drawn from linked tax records (N=2,353; N=1,079 men and N=1,274 women). The Canadian context is a useful complement to studies in the US due to its diverse and relatively generous public support programs, in addition to personal savings options for retirement. We find that among men, financial ins...

Dutch Crossing: Journal of Low Countries Studies, 2016

Notice: The project that is the subject of this report was undertaken with the approval of the Bo... more Notice: The project that is the subject of this report was undertaken with the approval of the Board of Directors of the Council of Canadian Academies (CCA). Board members are drawn from the Royal Society of Canada (RSC), the Canadian Academy of Engineering (CAE), and the Canadian Academy of Health Sciences (CAHS), as well as from the general public. The members of the expert panel responsible for the report were selected by the CCA for their special competencies and with regard for appropriate balance.

Humanities and Social Sciences Communications, 2021

Global convergence of public policies has been regarded as a defining feature of the late twentie... more Global convergence of public policies has been regarded as a defining feature of the late twentieth century. This study explores the generalizability of this thesis for three road safety measures: (i) road safety agencies; (ii) child restraint laws; and (iii) mandatory use of daytime running lights. This study analyzes cross-national longitudinal data using survival analysis for the years 1964–2015 in 181 countries. The first main finding is that only child restraint laws have globally converged; in contrast, the other two policies exhibit a fractured global convergence process, likely as the result of competing international and national forces. This finding may reflect the lack of necessary conditions, at the regional and national levels, required to accelerate the spread of policies globally, adding further nuance to the global convergence thesis. A second finding is that mechanisms of policy adoption, such as imitation/learning and competition, rather than coercion, explain more...

Health Economics, Policy and Law, 2021

Canada's experience with the coronavirus disease-2019 (COVID-19) pandemic has been characteri... more Canada's experience with the coronavirus disease-2019 (COVID-19) pandemic has been characterized by considerable regional variation, as would be expected in a highly decentralized federation. Yet, the country has been beset by challenges, similar to many of those documented in the severe acute respiratory syndrome outbreak of 2003. Despite a high degree of pandemic preparedness, the relative success with flattening the curve during the first wave of the pandemic was not matched in much of Canada during the second wave. This paper critically reviews Canada's response to the COVID-19 pandemic with a focus on the role of the federal government in this public health emergency, considering areas within its jurisdiction (international borders), areas where an increased federal role may be warranted (long-term care), as well as its technical role in terms of generating evidence and supporting public health surveillance, and its convening role to support collaboration across the cou...

BMJ Open, 2020

IntroductionIn 2019, the United Nations signalled a substantial rise in the number of internation... more IntroductionIn 2019, the United Nations signalled a substantial rise in the number of international migrants, up to 272 million globally, about half of which move to only 10 countries, including 8 member nations of the Organization for Economic Co-operation and Development (OECD). Migrants in OECD countries are often at higher risk for acquiring HIV and have a higher frequency of delayed HIV diagnosis. The barriers and facilitators that migrant people living with HIV (PLWH) in OECD countries face in relation to HIV care are insufficiently understood. The five-step HIV Care Cascade Continuum (HCCC) is an effective model to identify gaps, barriers and facilitators associated with HIV care. The purpose of this study is to generate a comprehensive, multilevel understanding of barriers and facilitators regarding the five steps of the HCCC model in OECD countries by migration status.Methods and analysisA systematic mixed studies review using a data-based convergent design will be conducte...

Health Science Inquiry, Jun 1, 2019

The primary policy objective of the Canada Health Act is to maintain and improve the health of Ca... more The primary policy objective of the Canada Health Act is to maintain and improve the health of Canadians [1]. Under this Act all residents are entitled to reasonable and equitable access to all medically necessary hospital and physician care, free at the point of service. In practice, however, universal and equal health care access is challenged in Canada by a variety of factors, including di culties in sta ng availability and providing cost-e↵ective services in rural and remote areas. Maternity care is one such medically necessary service that is not always reasonably and equally accessible. In the current health care delivery model, patients in remote areas of Canada often need to travel long-distances between communities or go south to access both specialized and standard maternity care. Since the 1980s, pregnant women in most Inuit communities, regardless of health risk, are flown to southern cities such as Iqaluit, Winnipeg, Ottawa, and Yellowknife to deliver approximately four to six weeks prior to their due date [2, 3]. The costs of this obstetric evacuation policy are high in terms of the emotional, social and cultural costs to mothers and their communities. The costs of air travel to these remote regions mean that pregnant women usually travel alone, separated from their support system while they wait to deliver their child. For women who travel to Manitoba, Ontario or Quebec to deliver, there is the added stress of adapting to a di↵erent culture and language. Women have reported isolation, anxiety, stress, sadness and loneliness associated with this policy [4, 5]. Reported instances of women hiding their pregnancies, lying about due dates, refusing to leave the community and deciding to give birth on their own, demonstrate a preference for delivering within the community. Furthermore, although this policy certainly improved outcomes for high-risk pregnancies, no conclusive evaluation of the e↵ects of this policy exists for non-high-risk pregnancies. Although there is some evidence that there have been improvements in pregnancy outcomes associated with the policy, its implementation coincided with the provision

Current Oncology, 2019

Prescription drug coverage is a significant problem in Canada.[...]

Social Science & Medicine, 2017

Poor self-rated health has been consistently demonstrated as a reliable predictor for mortality, ... more Poor self-rated health has been consistently demonstrated as a reliable predictor for mortality, often exceeding the predictive power of other "objective" medical factors. Drawing from a theoretical framework for the cognitive processes underlying the self-assessment of health, this study seeks to test the knowledge mechanisms that moderate the predictive power of poor selfrated health. Using nationally-representative longitudinal data from the Canadian National Population Health Survey (NPHS) from 1994-2010, this study tests the effects of physiciandiagnosed disease for the life course trajectory of self-rated health, and as a moderator for the power of poor self-rated health to predict proximate mortality. Disruptions to self-rated health trajectories are measured using an interrupted time-series analysis. Predictive power is modelled using generalized estimating equation (GEE) logistic regression. Findings show that physiciandiagnosed diseases cause a negative shock to self-rated health, even accounting for endogeneity. Furthermore, a major portion of the predictive power of poor self-rated health in the final years of life is explained by respondents' knowledge of the disease conditions which eventually cause their death. This novel finding supports one of the foremost theories putting cognition and knowledge at the root of why poor self-rated health is such a robust predictor of mortality.

The British journal of psychiatry : the journal of mental science, Oct 1, 2016

Numerous studies report an association between social support and protection from depression, but... more Numerous studies report an association between social support and protection from depression, but no systematic review or meta-analysis exists on this topic. To review systematically the characteristics of social support (types and source) associated with protection from depression across life periods (childhood and adolescence; adulthood; older age) and by study design (cross-sectional v cohort studies). A systematic literature search conducted in February 2015 yielded 100 eligible studies. Study quality was assessed using a critical appraisal checklist, followed by meta-analyses. Sources of support varied across life periods, with parental support being most important among children and adolescents, whereas adults and older adults relied more on spouses, followed by family and then friends. Significant heterogeneity in social support measurement was noted. Effects were weaker in both magnitude and significance in cohort studies. Knowledge gaps remain due to social support measurem...

The Gerontologist, 2016

In contrasting health care structures, we each served as caregivers to elderly parents where a sh... more In contrasting health care structures, we each served as caregivers to elderly parents where a shared and unexpected theme in our experiences was the substantial burden of negotiating and managing long-term care (LTC) services within our respective health and social care systems. In this article, we introduce and elucidate an under recognized source of caregiver burden in the United States and Canada: the structural burden of caregiving. We draw on shared and unique experiences cross-nationally, along with the literature, to illustrate that (a) today's caregiving is increasingly characterized by interactions with formal health and social systems in negotiating and managing services, (b) these systems are hampered by discontinuous and fragmented care which increase caregiver stress, and (c) this structural burden likely exacerbates inequity for both care recipients and caregivers. In conclusion, we call for theoretical models of caregiving to highlight health and social systems as creating burden and for measurement of caregiver burden to explicitly consider the time and stress stemming from interactions with formal health and social systems. Finally, we call for future policy evaluation to incorporate structural burden as an additional outcome in considering changes to LTC provisions and funding.

BMC Health Services Research, 2016

Background: We aimed to synthesize the evidence of a causal effect and draw inferences about whet... more Background: We aimed to synthesize the evidence of a causal effect and draw inferences about whether Canadian primary care reforms improved health system performance based on measures of health service utilization, processes of care, and physician productivity. Methods: We searched the Embase, PubMed and Web of Science databases for records from 2000 to September 2015. We based our risk of bias assessment on the Grading of Recommendations Assessment, Development and Evaluation guidelines. Full-text studies were synthesized and organized according to the three outcome categories: health service utilization, processes of care, and physician costs and productivity. Results: We found moderate quality evidence that team-based models of care led to reductions in emergency department use, but the evidence was mixed for hospital admissions. We also found low quality evidence that team-based models, blended capitation models and pay-for-performance incentives led to small and sometimes non-significant improvements in processes of care. Studies examining new payment models on physician costs and productivity were of high methodological quality and provided a coherent body of evidence assessing enhanced fee-for-service and blended capitation payment models. Conclusion: A small number of studies suggested that team-based models contributed to reductions in emergency department use in Quebec and Alberta. Regarding processes of diabetes care, studies found higher rates of testing for blood glucose levels, retinopathy and cholesterol in Alberta's team-based primary care model and in practices eligible for pay-for-performance incentives in Ontario. However pay-for-performance in Ontario was found to have null to moderate effects on other prevention and screening activities. Although blended capitation payment in Ontario contributed to decreases in the number of services delivered and patients seen per day, the number of enrolled patients and number of days worked in a year was similar to that of enhanced fee-for-service practices.

Journal of evaluation in clinical practice, Jan 30, 2016

The Family Medicine Group (FMG) model of primary care in Quebec, Canada, was driven by the volunt... more The Family Medicine Group (FMG) model of primary care in Quebec, Canada, was driven by the voluntary implementation of family physicians. Our main objective was to measure the effect of FMG enrolment on avoidable use of the emergency department (ED) by diabetic patients. We also sought to determine if effects differed according to whether patients were infrequent or frequent users of the ED and according to high- versus low-regional levels of enrolment. We used data from provincial health administrative databases to identify the diabetic patient population over the age of 20 years for each fiscal year between 2003-2004 and 2011-2012. We used fixed effects and marginal structural models to estimate the effect of enrolment in FMGs on avoidable use of the ED. Our results indicated that for every 10-percentage point increase in the population enrolled with an FMG in the year prior to an event, there was a 3% reduction in avoidable visits to the ED made by an individual (RR = 0.97; 95% C...

BMC family practice, Jan 29, 2016

Family Medicine Groups (FMG) were introduced in Quebec in 2002 to re-organize primary care practi... more Family Medicine Groups (FMG) were introduced in Quebec in 2002 to re-organize primary care practices and encourage inter-professional service delivery. We measured visits to the emergency department (ED) for acute complications related to diabetes as a proxy for access to and quality of primary care, before and after the reform using an open cohort of individuals diagnosed with type 1 and type 2 diabetes. The weekly rate of ED visits between April 1, 2000 and March 31, 2012 were derived from administrative databases. We performed an interrupted segmented regression analysis to obtain the estimated and predicted rates of visits in the years following the introduction of the reform. An outcome control series of diabetic patients visiting the ED to treat appendicitis was incorporated to strengthen the study's internal validity. After 9 years of reform implementation, we observed a statistically significant absolute decrease of 2.12 and 2.25 ED visits per 10,000 diabetic patients pe...

Handbook of Aging and the Social Sciences, 2016

BMC Health Services Research, 2022

Innovation in Aging, 2020

Dutch Crossing: Journal of Low Countries Studies, 2016

Humanities and Social Sciences Communications, 2021

Health Economics, Policy and Law, 2021

BMJ Open, 2020

Health Science Inquiry, Jun 1, 2019

Current Oncology, 2019

Prescription drug coverage is a significant problem in Canada.[...]

Social Science & Medicine, 2017

The British journal of psychiatry : the journal of mental science, Oct 1, 2016

The Gerontologist, 2016

BMC Health Services Research, 2016

Journal of evaluation in clinical practice, Jan 30, 2016

BMC family practice, Jan 29, 2016

Handbook of Aging and the Social Sciences, 2016

Canadian Journal of Public Health , 2008

This is a copy of the author's post-print: It may differ from final published version. Please use... more This is a copy of the author's post-print: It may differ from final published version. Please use the final publication for citation purposes. Copyrights belong to the author and may have been transferred to the final publication venue. Please consult http://www.mcgill.ca/iris/members/quesnel-vallee/ for the reference to the final published version.

1 This is a copy of the author's post-print: It may differ from final published version. Please u... more 1 This is a copy of the author's post-print: It may differ from final published version. Please use the final publication for citation purposes. Copyrights belong to the author and may have been transferred to the final publication venue. Please consult http://www.mcgill.ca/iris/members/quesnel-vallee/ for the reference to the final published version.

The Lancet, 2018

Access to health care based on need rather than ability to pay was the founding principle of the ... more Access to health care based on need rather than ability to pay was the founding principle of the Canadian health-care system. Medicare was born in one province in 1947. It spread across the country through federal cost sharing, and eventually was harmonised through standards in a federal law, the Canada Health Act of 1984. The health-care system is less a true national system than a decentralised collection of provincial and territorial insurance plans covering a narrow basket of services, which are free at the point of care. Administration and service delivery are highly decentralised, although coverage is portable across the country. In the setting of geographical and population diversity, long waits for elective care demand the capacity and commitment to scale up effective and sustainable models of care delivery across the country. Profound health inequities experienced by Indigenous populations and some vulnerable groups also require coordinated action on the social determinants of health if these inequities are to be effectively addressed. Achievement of the high aspirations of Medicare's founders requires a renewal of the tripartite social contract between governments, health-care providers, and the public. Expansion of the publicly funded basket of services and coordinated effort to reduce variation in outcomes will hinge on more engaged roles for the federal government and the physician community than have existed in previous decades. Public engagement in system stewardship will also be crucial to achieve a high-quality system grounded in both evidence and the Canadian values of equity and solidarity.