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Govind Rao

Lack of safety standards for home cancer treatment puts patients at risk - Healthy Debate - 0 views

healthydebate.ca/...home-cancer-treatment

from heather home care drugs privatization

shared by Govind Rao on 14 May 15 - No Cached
  • by Wendy Glauser, Debra Bournes & Joshua Tepper (Show all posts by Wendy Glauser, Debra Bournes & Joshua Tepper) May 14, 2015
  • Ten years ago, almost all chemotherapy drugs were delivered intravenously at a hospital. Today, many cancer treatments are taken orally by patients, in their homes. The trend means patients enjoy the comfort of being in their own homes and avoid parking and transportation costs.  It is also much less costly for hospitals. But taking oral chemotherapy at home can be risky and some question whether health systems are doing enough to protect cancer patients.
  • In their interviews with health care providers and pharmacists, Gilbert heard anecdotes of patients purposefully self-adjusting doses at home. “Maybe they felt really unwell yesterday so they’ve lowered their dose on purpose. Or maybe they’re really scared and they figure more must be better so they take more on purpose.”
  • ...2 more annotations...
  • Patients can also incorrectly take their chemotherapy drugs at home because they don’t understand the complicated instructions, adds Melissa Griffin, who has been conducting research on oral chemotherapy delivery with the HumanEra project. With the drug Temozolomide, a brain cancer drug, for instance, “there are multiple different strengths of the pills that patients have to put together to make up the dose,” she says.
  • Another reason dosing errors can occur is that patients can be given the wrong dose due to an error by the prescriber or pharmacist distributing the drug. Education for patients and family members, along with better standards to avoid prescribing errors, reduce the risk of over- or under-doses of chemotherapy. But the safety standards, as well as the level of education and support patients on oral chemotherapy receive, differs vastly depending on where they live.
Doug Allan

Wynne vows to crack down on private preparation of cancer meds after error | CTV News - 0 views

www.ctvnews.ca/...cer-meds-after-error-1.1233366

privatization chemotherapy

shared by Doug Allan on 12 Apr 13 - No Cached
  • Ontario Premier Kathleen Wynne vowed Thursday to rectify the problems that led to diluted chemotherapy drugs being administered to cancer patients in two provinces, but she won't tell Ontario hospitals to go back to mixing their own medications.
  • There is a gap in oversight of companies like Marchese Hospital Solutions, which was contracted to prepare the cancer drugs for four hospitals in Ontario and one in New Brunswick, she acknowledged.
  • The college already oversees pharmacists, including those who may have worked for Marchese, but their powers could be expanded to give them complete authority over the facility.
  • ...6 more annotations...
  • It was a jurisdictional grey area, with both the college and Health Canada unable to agree on who was responsible for the facility.
  • The crisis has also raised questions about whether the privatization of health care has gone too far. The bags containing the chemotherapy drugs were filled with too much saline, watering down the medication by as much as 20 per cent. Some patients received the drugs for as long as a year. It's a grave warning that privatization has to stop, said New Democrat health critic France Gelinas.
  • "As those new companies spring up all over to do for-profit services for hospitals, the government basically stayed asleep at the switch," she said.
  • "They never looked at who was picking up this work to make sure that the level of oversight, the level of quality assurance that we had before were being transferred over. The work got transferred, the oversight did not."
  • A pharmacy expert, Jake Thiessen, will review the province's cancer drug system, Matthews said. A working group that includes doctors, Cancer Care Ontario, Health Canada and others are also looking at the problem.
  • ealth Canada and the Ontario College of Pharmacists are working to close that ga
  • Doug Allan on 12 Apr 13
     
    Ontario Premier Kathleen Wynne vowed Thursday to rectify the problems that led to diluted chemotherapy drugs being administered to cancer patients in two provinces, but she won't tell Ontario hospitals to go back to mixing their own medications.
Doug Allan

Inside Ontario's chemotherapy scandal | Toronto Star - 0 views

www.thestar.com/...rios_chemotherapy_scandal.html

privatization drugs

shared by Doug Allan on 15 Jul 13 - No Cached
  • Claudia den Boer Grima, vice-president of cancer services for the hospital and the region, is on the other end of the line. “There is a problem with a chemo drug,” she says. “It looks like the wrong dose has been given. We don’t know how many.”
  • Peterborough Regional Health Centre, where the problem that affected all four hospitals had been discovered exactly seven days earlier.
  • It would be another seven days before she would learn that all her treatments involving this drug had been diluted by as much as 20 per cent.
  • ...31 more annotations...
  • Their trust would be further hit. Within two weeks, the Star reported that health-care companies are allowed to mix drugs for hospitals without federal or provincial oversight, prompting top health officials — Ontario health minister Deb Matthews and federal health minister Leona Aglukkaq — to scramble to close that regulatory grey area.
  • Since the crisis, all the hospitals involved have stopped outsourcing gemcitabine and cyclophosphamide mixtures and brought it in-house, mixing their own medications.
  • The federal government has new rules defining who can be a drug producer, adding that any facility supervised by a licensed pharmacist can do the job. The province has said that hospitals can only purchase drugs from accredited suppliers.
  • The Ontario College of Pharmacists has passed legislation that allows it to inspect any premises where a pharmacist works — not just licensed pharmacies.
  • All of the changes taken together would have seen Marchese Hospital Solutions still able to supply drugs as it did but subject to inspection by the college.
  • This week Jake Thiessen, the founding director of the University of Waterloo school of pharmacy, submitted a final report of his investigation into the issue. There has been no formal indication when it will be made public. Hospital administrators say they have been told it will be two to three weeks before they or the public see this report.
  • There is very little clinical evidence to indicate what might happen to a cancer patient who receives an underdose of chemotherapy.
  • At the same time, many of the more recent advances in chemotherapy have been in drugs that alleviate side effects like nausea.
  • In an oncology pharmacy, strange is not good. And on March 20, one week before Marley’s last cyclophosphamide treatment, Craig Woudsma, a 28-year-old pharmacy assistant, and a colleague at the Peterborough Regional Health Centre, had a bad feeling.
  • In this case, it was a shipment of new gemcitabine chemotherapy bags that required refrigeration, according to the label. Previous batches, from a different supplier, had not.
  • When preparing the solution, staff at Marchese Hospital Solutions, in Mississauga, Ont., dissolved the medication into a pre-filled 100 mL bag of saline. These bags typically contain between 3 to 20 per cent more solution than 100 mL,
  • The new bag’s label did not contain enough information for him to accurately mix the patient’s dose. He needed to know the specific concentration.
  • Woudsma noticed more differences. The bags from Marchese only had a total volume and concentration on the label — 4 grams of gemcitabine in 100 mL of saline — instead of the specific concentration, the amount of drug per single mL of saline, as the old bags indicated.
  • “I told the pharmacist in the area. And then it kind of went above me at that point ... They came to me saying, this is kind of a big deal; teleconferencing with the minister of health, that kind of stuff,” said recently, sitting on the front steps of his red-brick, semi-detached home in the village of Millbrook, Ont. “It’s kind of a foreign concept, to think that what we do, in our corner of the hospital, is going to get that kind of exposure.”
  • referred to in the industry as overfill, included to account for possible evaporation.
  • People have asked Woudsma why he was able to catch a problem that went undetected at other hospitals for more than a year. Simple, he says. He had something to compare it to.
  • The company’s pharmacy workers did not remove the known overfill when mixing the medication because they thought each bag was going to a single patient
  • This means that the bag Woudsma was holding contained 4 grams of gemcitabine in more than 100 mL of solution. The concentration of the medication wasn’t what the label would have made him think. It was weaker than advertised.
  • The hospital had switched that very day to a new supplier — Marchese Hospital Solutions. A bag of the old supply from Baxter CIVA was still on site.
  • Medbuy, a group purchasing company for hospitals, starting in 2008, had a contract with Baxter Central Intravenous Admixtures to provide drug-mixing services. The two drugs in question, cyclophosphamide and gemcitabine, were outsourced because they come in powder form and are tricky to mix. It takes about four hours to reconstitute them in liquid, and in that time they must be shaken every 20 minutes.
  • As that contract was about to expire, Medbuy issued a request for proposals for drug-mixing services: Baxter CIVA, which wanted its contract renewed, Quebec-based Gentes & Bolduc and Marchese all stepped forward.
  • Marita Zaffiro, president of Marchese, testified at Queen’s Park that the Medbuy contract did not indicate the hospitals wanted the labels on these drugs to cite a specific concentration. The reason she included it that way in the RFP was simply to show what could be done.
  • The details of the new arrangement remain known only to Medbuy. It was founded in 1989 to get better deals for hospitals buying products like scalpels, bed pans and even some medications in bulk. The company’s 28 member hospital organizations in Ontario, New Brunswick and Prince Edward Island spent a combined $626-million on contract purchases in 2012.
  • Sobel ran the calculations in his office. For a single patient to require a 4,000 mg dose of cyclophosphamide, on a common breast cancer treatment regime, that patient would need to be about 7 feet tall and weigh 2,200 lbs.
  • “The chance of 1,200 patients getting 4,000 mg exactly — it’s just impossible.”
  • Four Marchese pharmacists who played a role in the new contract work revealed to the Queen's Park committee in June that they had either limited or no background in oncology.
  • Marchese Hospital Solutions began as Marchese Pharmacy, a Hamilton-area community drugstore that expanded beginning in 1998 when Zaffiro became president. In 1999 the company obtained a contract to supply the Hamilton Niagara Haldimand Brant Community Care Access Centres, business they did until the contract expired in 2011, shortly before it was awarded the Medbuy contract.
  • It lost the CCAC contract in 2011, shortly before the Medbuy deal, and shed employees. Fifty-seven were either laid off or left the company during this troubled time, according to internal newsletters. But then things started looking up.
  • Zaffiro attempted to get accreditation for the site, according to her Queen’s Park testimony, approaching both the Ontario College of Pharmacists and Health Canada, neither of which took steps to regulate the fledgling business because each thought the other had jurisdiction.
  • Medbuy, Marchese and Jake Thiessen have maintained that cost was not a factor in the error. Marchese’s bid on the request for proposal came in at about a quarter of the cost of previous supplier Baxter Corporation. Bags from Marchese cost from $5.60 to $6.60; Baxter charged $21 to $34.
  • CEO David Musyj thinks about what went wrong. The problems, he says, go far beyond Marchese and Medbuy. “All of us are culpable,” he says. “We could have done some things internally that could have prevented this. We could have weighed the bags when they came in.”
  • Doug Allan on 15 Jul 13
     
    Since the crisis, all the hospitals involved have stopped outsourcing gemcitabine and cyclophosphamide mixtures and brought it in-house, mixing their own medications. This week Jake Thiessen, the founding director of the University of Waterloo school of pharmacy, submitted a final report of his investigation into the issue. There has been no formal indication when it will be made public. Four Marchese pharmacists who played a role in the new contract work revealed to the Queen's Park committee in June that they had either limited or no background in oncology."The chance of 1,200 patients getting 4,000 mg exactly - it's just impossible." Marchese lost the CCAC contract in 2011, shortly before the Medbuy deal, and shed employees. Fifty-seven were either laid off or left the company during this troubled time, according to internal newsletters. But then things started looking up. Medbuy, Marchese and Jake Thiessen have maintained that cost was not a factor in the error.
Doug Allan

Diluted chemotherapy supplier regulations are unclear - Toronto - CBC News - 0 views

www.cbc.ca/...chemotherapy-underdose.html

privatization chemotherapy

shared by Doug Allan on 11 Apr 13 - No Cached
  • "Marchese Hospital Solutions does not have a licence," as an accredited pharmacy, Lori DeCou, manager of communications for the Ontario College of Pharmacists, said Wednesday.
  • There also questions about federal jurisdiction regarding whether Marchese was operating as a drug manufacturer.
  • "We're looking into the activities that Marchese Hospital Solutions performs, and we're looking to see which activities of which part of this company actually falls under provincial versus federal jurisdiction," said Dr. Supriya Sharma, a senior medical advisor at Health Canada in Ottawa. "We're still in the process of finding that out."
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  • "This is a new way of doing business so we need to sort which activities are being done and then who has the overall oversight over them."
  • "My reaction was, 'I can't believe this happened to me'," Kaiman said from her dress shop in Woodstock, Ont. "They told me my chemo was watered down and that basically he thinks it may not affect me, but there are no guarantees."
  • Marchese has said the problem arose not from how the bags were prepared but in how they were administered at the hospitals.
  • We need answers and I am going to make sure the College of Pharmacists gets the tools they need."
  • Doug Allan on 11 Apr 13
     
    "Marchese Hospital Solutions does not have a licence," as an accredited pharmacy, Lori DeCou, manager of communications for the Ontario College of Pharmacists, said Wednesday.
Govind Rao

Health Canada should regulate hospital pharmacies CBC - 0 views

www.cbc.ca/...ugs-expert-review-results.html

from heather hospital drugs

shared by Govind Rao on 07 Aug 13 - No Cached
  • Govind Rao on 07 Aug 13
     
    Health Canada should regulate hospital pharmacies, study finds Ontario wants College of Pharmacists to inspect, license hospital pharmacies The Canadian Press Posted: Aug 7, 2013 6:57 AM ET Last Updated: Aug 7, 2013 3:20 PM ET Health Canada should regulate all entities that mix drugs outside a licensed pharmacy, an expert that looked into the chemotherapy drug scare that rocked two provinces recommended Wednesday. It also urged Ontario to bring in stronger rules for licensed pharmacies, by inspecting and licensing those in the province's clinics and hospitals as well as pharmacies that prepare large volumes of drug mixtures. The recommendations come four months after it was discovered that 1,202 patients in Ontario and New Brunswick - including 40 children - received diluted chemo drugs, some for as long as a year.
Govind Rao

Hamilton's Marchese Health Care cleared in chemo drugs scandal - Latest Hamilton news -... - 0 views

www.cbc.ca/...-chemo-drugs-scandal-1.2595274

from heather drugs pharmacare safety

shared by Govind Rao on 09 Apr 14 - No Cached
  • Ontario committee report on diluted chemotherapy drugs places blame with Medbuy
  • Apr 02, 2014
  • Marchese Health Care in Hamillton allegedly supplied four hospitals in Ontario and one in New Brunswick with watered down chemotherapy treatments, according to Cancer Care Ontario.
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  • National group purchasing organization Medbuy is ultimately responsible for 1,202 cancer patients in Ontario and New Brunswick receiving diluted chemotherapy drugs in 2012, an Ontario legislative committee has concluded. The company didn't do its due diligence in arranging a $2.6-million contract with Marchese Health Care, which provided the diluted drug mixtures, the all-party committee said in a report released late Tuesday.
Govind Rao

Doctors should collaborate with traditional healers - 0 views

www.cmaj.ca/...E153

from heather aboriginal doctors

shared by Govind Rao on 16 Mar 15 - No Cached
  • CMAJ March 17, 2015 vol. 187 no. 5 First published February 9, 2015, doi: 10.1503/cmaj.109-4989
  • Laura Eggertson
  • An Aboriginal doctor who testified in the case of a Mohawk girl whose family opted out of chemotherapy is urging physicians to work more collaboratively with traditional healers and to respect their practices.
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  • Traditional medicine is a system of medicine in the same way that Western medicine is a system, in the same way naturopathic medicine is a system,” says Dr. Karen Hill, who shares a practice with traditional healer Elva Jamieson on the Six Nations of the Grand River First Nation in Ohsweken, Ont. “Because it doesn’t look the same, I think physicians don’t know how to receive it.”
  • Hill, who is Mohawk, believes a clash of cultures influenced the decision of doctors at the McMaster Children’s Hospital in Hamilton, Ont., to ask Judge Gethin Edward of the Ontario Court of Justice to compel cancer treatment for J.J, an 11-year-old Mohawk girl who has acute lymphoblastic leukemia. Although Hill neither confirmed nor denied that she and Jamieson are treating J.J., Hill did testify in the case. Edward ruled in November 2014 that J.J.’s mother, the girl’s substitute decision-maker, had a constitutionally guaranteed right to practise traditional medicine.
  • On Jan. 19, 2015, Makayla Sault, another 11-year-old Aboriginal girl with leukemia, died following a stroke. Makayla and her family, who are from the neighbouring Mississaugas of the New Credit First Nation, had also stopped chemotherapy at McMaster. Makayla’s death has drawn international attention to the issue of consent to treatment and whether Aboriginal rights may potentially clash with a child’s best interests and right to life.
  • Both cases have also raised the question of how doctors should respond to an Aboriginal patient’s desire to pursue traditional or other types of medicine over Western medical treatment. “The big message is that this is not just about medical choice,” Hill told CMAJ. “This is about indigenous people reclaiming their wholeness as people. This isn’t about religion; it isn’t about choice. It’s about being who we are.”
  • Choosing one type of treatment over the other is not the only option, say Hill and Dr. Veronica McKinney, a Cree/Métis woman who is on the executive of the Indigenous Physicians Association of Canada.
  • “More and more people are coming to understand that you can have a blend (of treatments),” says McKinney, who is the director of Northern Medical Services at the University of Saskatchewan. “I have a number of patients where this is the case, and I support that.”
  • In J.J.’s case, McMaster made an effort to permit the family to pursue its traditional practices, says Daphne Jarvis, McMaster’s lawyer. “There was a ceremony that took place in the hospital that the family arranged and they seemed very appreciative of that,” she told CMAJ. “With respect to the use of traditional medicines, I think the caveat was: ‘as long as it doesn’t interfere with the chemotherapy’ — so that was perceived to be hierarchical, which it wasn’t intended to be.”
  • Hill, who graduated from McMaster University medical school, and Jamieson, who apprenticed with her mother on Six Nations, often work together with patients to plan a combination of traditional and Western medical treatment.
  • Practitioners need a trusting relationship with their patients that includes self-reflection, respect for other world views, and reciprocity that acknowledges the patient’s contribution to healing, says McKinney. “When you are the one making all the decisions aside from the patient, you’re going off-track. It doesn’t matter whether we’re talking cancer or high blood pressure ... that completely does not match patient-centred care.”
  • There are few medical institutions in Canada, McKinney says, that support the positive contributions of traditional medicine, which includes plant-based medicines, ritual and ceremonies, alongside efforts to establish mental, spiritual, emotional and physical balance.
  • Doctors continue to have a responsibility to report similar situations to child welfare authorities, says Jarvis. Those authorities should conduct sufficient investigation to satisfy themselves that families are pursuing a sincerely held practice of indigenous medicine, she adds. It’s up to child welfare authorities, not doctors, to determine how sincerely held are the beliefs in traditional medicine, she cautions.
  • It was clear during the hearing that J.J’s mother is a traditional Mohawk woman accessing indigenous medicines within the Six Nations community, Jarvis says. She calls media reports about the alternative treatment the family was pursuing at the Hippocrates Health Institute in Florida, “a red herring.” J.J.’s care in Florida was in addition to the traditional treatment she was getting on Six Nations, not instead of it, Jarvis says. Hill also visited the institute to help re-establish a connection to plant-based food, which is an important part of traditional healing.
  • Indigenous physicians can bridge the gap in understanding between the traditional and Western medical systems, says Hill. She hopes to help design a protocol for physicians about beginning that dialogue with patients and traditional healers.
  • Hill understands the angst both Makayla and J.J.’s cases have caused. But she hopes the medical community will understand that Makayla’s choice was about more than just medical treatment.
  • “It is about living and being Indigenous people, trusting our own medicines in the way we did for centuries before Western medicine. Behaving as indigenous people is what the mainstream finds difficult to understand and what the medical community needs to start working out in relationship with our people.”
Doug Allan

Ontario, N.B. premiers discuss diluted chemo drugs | Globalnews.ca - 0 views

globalnews.ca/...rs-discuss-diluted-chemo-drugs

privatization chemotherapy

shared by Doug Allan on 16 Apr 13 - No Cached
  • Marchese, a Mississauga, Ont.-based company, was contracted to prepare the chemotherapy drugs for four hospitals in Ontario and one in New Brunswick, where about 186 patients received the weaker-than-prescribed drugs. Too much saline was added to the bags containing cyclophosphamide and gemcitabine, in effect watering down the prescribed drug concentrations by up to 20 per cent. Some patients were given the drugs for up to a year
  • Neil Johnson, vice-president of cancer care at the hospital, said oncologists reviewed the cases and “they are confident that there is no causal link between the underdosing and the deaths,” Matthews said in the legislature. “He’s saying it didn’t contribute to their deaths,” she added.
  • The company falls into a jurisdictional grey area, with the Ontario College of Pharmacists and Health Canada unable to agree on who was responsible for the facility.
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  • Manufacturing includes producing or selling a product by a third party, it said. The paper suggests that if there’s a question about whether the activity is manufacturing or compounding, it should be raised with federal or provincial bodies, who can then determine who’s responsible.
  • A 2009 policy paper by Health Canada cited “a need to develop a Canada-wide consistency in approach to ensure that drug compounding and manufacturing are each regulated by the appropriate authorities.”
  • The college oversees pharmacists, including those who may have worked independently for Marchese Hospital Solutions. Health Canada oversees drug manufacturing. But Marchese wasn’t considered a pharmacy or a drug manufacturer. The need for clarity about who is responsible for what is an issue Health Canada has been dealing with for more than a decade.
  • “In situations where the provincial/territorial regulatory authority decides that an activity does not fall within its jurisdiction, the activity is likely to be manufacturing and the parties involved must follow the federally regulated drug approval process for manufacturing drugs,” it said.
  • The services provided by Marchese to hospitals appear to be something that has been traditionally done within a hospital pharmacy, which would fall under provincial supervision, said Health Canada spokeswoman Leslie Meerburg. “This non-traditional business model takes a different approach,” she said in an email.
  • In the meantime, the college is stepping in to provide oversight of new compounding facilities like Marchese.
  • Doug Allan on 16 Apr 13
     
    The services provided by Marchese to hospitals appear to be something that has been traditionally done within a hospital pharmacy, which would fall under provincial supervision, said Health Canada spokeswoman Leslie Meerburg.
Doug Allan

Newsroom : Ontario Safeguarding Drug Supply for Hospital Patients - 0 views

news.ontario.ca/...ply-for-hospital-patients.html

privatization chemotherapy

shared by Doug Allan on 22 Apr 13 - No Cached
  • The government is posting a new regulation under the Public Hospitals Act to ensure that hospitals purchase drugs only from accredited, licensed or otherwise approved suppliers.
  • In addition, the government has written to businesses in Ontario that may be selling compounded drugs to obtain more information about their activities, and has asked all Ontario hospitals to confirm that quality assurance processes are in place for all drugs either purchased externally or prepared in the hospital.
  • The province is also working with the Ontario College of Pharmacists on a regulation to give the College the power to inspect premises where pharmacists and pharmacy technicians practice, including where drugs are prepared. 
  • ...1 more annotation...
  • The proposed changes were prompted by the recent discovery of under-dosing of chemotherapy drugs supplied by an independent company to four hospitals in Ontario and one hospital in New Brunswick.
Govind Rao

August 14, 2013Health Canada should license companies that mix drugs, says report CMAJ - 0 views

www.cmaj.ca/...at_mix_drugs_says_report.xhtml

from heather drugs

shared by Govind Rao on 14 Aug 13 - No Cached
  • Govind Rao on 14 Aug 13
     
    Health Canada should regulate businesses that mix drugs outside of licensed pharmacies, recommends an expert who investigated why 1202 patients, including 40 children, in Ontario and New Brunswick received diluted chemotherapy drugs between February 2012 and March of this year. In the Ontario government-commissioned report, "A Review of the Oncology Under-Dosing Incident," Jake Thiessen, founding director of the School of Pharmacy at the University of Waterloo, Ont., makes 12 recommendations to clarify who regulates what and to improve the supply chain that hospitals use to procure drugs."The entire incident was preventable," he writes in the report.
Doug Allan

CMAJ: Too many patients with cancer die in acute care hospitals despite palliative opti... - 1 views

www.cmaj.ca/...spite-palliative-options.xhtml

hospital palliative

shared by Doug Allan on 27 May 13 - No Cached
  • The institute’s End-of-Life Hospital Care for Cancer Patients examined hospital data for 25 114 cancer patients from all provinces except Quebec. The study reviewed the final 28 days of patients age 20 or older, and found palliative care was the main reason 53% of all patients with cancer were in hospital. But acute care hospitals are not generally designed to provide the specialized care required by patients who are terminally ill with cancer require, the report points out.
  • The report also found a wide variance in the percentage of people with cancer who died in acute-care settings, depending upon the province in which they died.
  • The likelihood of a patient with terminal cancer dying in hospital was 39% in British Columbia and 40% in Ontario,
  • ...7 more annotations...
  • for example, compared to 66% in New Brunswick and 69% in Manitoba.
  • Differences among provinces also reflect different types of hospital care, says Kathleen Morris, the institute’s director of system analysis and emerging issues. Palliative units exist in most Manitoba hospitals, for example, and the study’s data did not specify what units patients were admitted to when they died.
  • Cancer is the leading cause of death for Canadians. About one-third of all deaths, or an estimated 75 700, were attributed to cancer in 2012.
  • The report does contain some good news about patient care, says Morris. Unlike past practice, acute care hospitals are not subjecting patients to overly aggressive treatment in their last weeks of life.
  • “We’re seeing some really encouraging news about what happens to patients when they’re in hospital,” Morris says. “Many worry it’s a very high-tech, inhuman end of life. We looked for clues of that, and saw that only about one in 10 cancer patients were in the [intensive care unit] during last few weeks.”
  • Additionally, only 3% of patients with cancer received chemotherapy in the last two weeks of life.
  • Morris hopes the report will help open more palliative care options so people have more control over where and how they spend their final days. She also hopes it will prompt more “good, frank discussions” about what patients want at the end of life.
  • Doug Allan on 27 May 13
     
    45% of cancer deaths occur in hospitals, lower in BC and Ontario.  Some provinces have palliative units in hospitals
Doug Allan

Weak chemo treatments a 'national' problem: minister - Infomart - 0 views

www.fpinfomart.ca/...166319398

privatization chemotherapy

shared by Doug Allan on 18 Apr 13 - No Cached
  • "Health Canada has responsibility for the manufacturing of drugs. The College of Pharmacists have the authority to oversee prescribing," she said. "There is this newish business model where drugs are being compounded outside of the hospital and outside of what we would all consider to be pharmacies. So that is where the grey area is. "Health Canada has pretty clear abilities to move into that area," Matthews said.
  • Hospital budgets are being squeezed by the government and officials are looking to outsource to save money, she said.
  • "One of those things is mixing drugs. The work is done somewhere else and the oversight doesn't get outsourced," Horwath said. The NDP leader said the health ministry still does not have a clear handle on which hospitals are turning to private companies in this way.
  • Doug Allan on 18 Apr 13
     
    Deb Matthews suggests Health Canada should oversee private drug mixers
Govind Rao

Lack of awareness is troubling | Windsor Star - 0 views

blogs.windsorstar.com/...lack-of-awareness-is-troubling

from heather hospital cupe Ontario

shared by Govind Rao on 20 Sep 13 - No Cached
  • Sep 19, 2013 - 3:21 PM EDT
  • Re: Hospitals had concerns about chemo solution supplier, by Claire Brownell, Sept. 13.
  • Your story notes that hospitals had concerns about the private company supplying the problematic chemotherapy mixtures. That is as it should be. But it is very troubling that the affected hospitals were “unaware” of the lack of regulatory oversight of the private supplier.
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  • The same lack of awareness was also true of provincial government. That is a shocking lack of due diligence. But unfortunately, this is not the first time our government has rushed in to privatization, leaving us to pick up the pieces. Almost all of the recent scandals the government has faced are connected with its drive to privatize public services: the secrecy and costs associated with the commercialization and privatization of Ornge, the scandalous payments to private contractors at e-Health, and the absurdly high penalties and interest costs arising from the cancelled public-private partnership gas plants. MICHAEL HURLEY, President, Ontario Council of Hospital Unions/CUPE, Toronto
Govind Rao

Cytotoxic Drugs | Canadian Union of Public Employees - 0 views

cupe.ca/cytotoxic-drugs

from heather cupe health and safety drugs

shared by Govind Rao on 11 Jun 14 - No Cached
  • Cytotoxic drugs inhibit or prevent the function of cells. Cytotoxic drugs are primarily used to treat cancer, frequently as part of a chemotherapy regime. Recently, their uses have expanded to treat certain skin conditions (e.g., psoriasis), rheumatoid and juvenile rheumatoid arthritis, and steroid-resistant muscle conditions. The most common forms of cytotoxic drugs are known as antineoplastic. The terms ‘antineoplastic’ and ‘cytotoxic’ are often used interchangeably.
  • What are the risks of occupational exposure to cytotoxic drugs?
Govind Rao

Newsletter & Upcoming events: June 16 & 17 - 0 views

us4.campaign-archive2.com/?u=2760c4a3e274be4ee17d7eb97&id=1ecdc6b5cd&e=d27bd4039c

from heather NS coalition refugees canada

shared by Govind Rao on 12 Jun 14 - No Cached
  • Monday, June 16th, 12pm, National Day of Action to stop Cuts to Refugee Health Care Dalhousie Tupper Medical Building, 5850 College St, Halifax For 3 years now, many refugees have been denied access to vital health care. Cut health care services include: prenatal care for pregnant women, chemotherapy and access to mental health care. At noon in the courtyard in front the Tupper Medical building, come show the federal government that Canadians will stand up for our most vulnerable!  Click here for more info and to invite your friends
Govind Rao

St. Catharines asks Ambrose to intervene in shutdown of cancer-drug maker - The Globe a... - 0 views

www.theglobeandmail.com/...article18655063

from heather drugs safety

shared by Govind Rao on 14 May 14 - No Cached
  • Kelly Grant - HEALTH REPORTER
  • The Globe and Mail
  • May. 14 2014
  • ...4 more annotations...
  • A southern Ontario city is calling on the federal Health Minister to intervene in her department’s decision to suspend the licence of one of only two companies in Canada that sells a commonly used chemotherapy drug.
  • Biolyse Pharma Corp.
  • generic drug maker
  • “I found that, actually, pretty strange,” said Joel Lexchin, a professor in the school of Health Policy and Management at York University and an emergency room doctor at Toronto’s University Health Network. “If they think that the plant should no longer be manufacturing it, then I don’t know why they wouldn’t recall the drugs that the plant had been making.”
Govind Rao

Horizon doctors plead for action on hospital congestion - CBC News - Latest Canada, Wor... - 0 views

www.cbc.ca/...-hospital-congestion-1.3070919

from heather NB hospital cuts

shared by Govind Rao on 14 May 15 - No Cached
  • Health network's 5 acute care facilities in 'overcapacity gridlock,' say physicians in letter to officials
  • May 12, 2015
  • Doctors at the five largest hospitals in Horizon Health Network say the hospitals are operating "in a state of overcapacity gridlock" and are demanding the health authority and provincial government do something to ease the stress within the system.
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  • Patients who are dying aren't given the dignity of a private room for them and their family because there are no rooms — a patient dying of cancer is separated by a thin curtain from someone receiving their chemotherapy for treatment of their cancer.
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'We have the evidence ... Why aren't we providing evidence-based care?'; Mental illness... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150523|221089241

from heather mental health privatization

shared by Govind Rao on 26 May 15 - No Cached
  • The Globe and Mail Sat May 23 2015
  • It's 4:30 on a Friday afternoon at her Sherbrooke, Que., clinic and Marie Hayes takes a deep breath before opening the door to her final patient of the day, who has arrived without an appointment. The 32-year-old mother immediately lists her complaints: She feels dizzy. She has abdominal pain. "It is always physical and always catastrophic," Dr. Hayes will later tell me. In the exam room, she runs through the standard checkup, pressing on the patient's abdomen, recording her symptoms, just as she has done almost every week for months. "There's something wrong with me," the patient says, with a look of panic. Dr. Hayes tries to reassure her, to no avail. In any case, the doctor has already reached her diagnosis: severe anxiety. Dr. Hayes prescribed medication during a previous visit, but the woman stopped taking it after two days because it made her nauseated and dizzy. She needs structured psychotherapy - a licensed therapist trained to bring her anxiety under control. But the wait list for public care is about a year, says Dr. Hayes, and the patient can't afford the cost of private sessions.
  • Meanwhile, the woman is paying a steep personal price: At home, she says, she spends most days in bed. She is managing to care for her two young children - for now - but her husband also suffers from anxiety, and the situation is far from ideal. Dr. Hayes does her best, spending a full hour trying to calm her down, and the woman is less agitated when she leaves. But the doctor knows she will be back next week. And that their meeting will go much the same as it did today. In its broad strokes, this is a scene that repeats itself in thousands of doctors' offices every day, right across the country. It is part and parcel of a system that denies patients the best scientific-based care, and comes with a massive price tag, to the economy, families and the health care system. Canadian physicians bill provincial governments $1-billion a year for "counselling and psychotherapy" - one third of which goes to family doctors - a service many of them acknowledge they are not best suited to provide, and that doesn't come close to covering patient need. Meanwhile, psychologists and social workers are largely left out of the publicly funded health-care system, their expertise available only to Canadians with the resources to pay for them.
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  • Imagine if a Canadian diagnosed with cancer were told she could receive chemotherapy paid for by the health-care system, but would have to cough up the cash herself if she needed radiation. Or that she could have a few weeks of treatment, and then be sent home even if she needed more. That would never fly. If doctors, say, find a tumour in a patient's colon, the government kicks in and offers the mainstream treatment that is most effective. But for many Canadians diagnosed with a mental illness, the prescription is very different. The treatment they receive, and how much of it they get, will largely be decided not on evidence-based best practices but on their employment benefits and income level: Those who can afford it pay for it privately. Those who cannot are stuck on long wait lists, or have to fall back on prescription medications. Or get no help at all. But according to a large and growing body of research, psychotherapy is not simply a nice-to-have option; it should be a front-line treatment, particularly for the two most costly mental illnesses in Canada: anxiety and depression - which also constitute more than 80 per cent of all psychiatric diagnoses.
  • Why aren't we providing evidence-based care?" .. The case for psychotherapy Research has found that psychotherapy is as effective as medication - and in some cases works better. It also often does a better job of preventing or forestalling relapse, reducing doctor's appointments and emergency-room visits, and making it more cost-effective in the long run.
  • Therapy works, researchers say, because it engages the mind of the patient, requires active participation in treatment, and specifically targets the social and stress-related factors that contribute to poor mental health. There are a variety of therapies, but the evidence is strongest for cognitive behavioural therapy - an approach that focuses on changing negative thinking - in large part because CBT, which is timelimited and very structured, lends itself to clinical trials. (Similar support exists for interpersonal therapy, and it is emerging for mindfulness, with researchers trying to find out what works best for which disorders.) Research into the efficacy of therapy is increasing, but there is less of it overall than for drugs - as therapy doesn't have the advantage of well-heeled Big Pharma benefactors. In 2013, a team of European researchers collated the results of 67 studies comparing drugs to therapy; after adjusting for dropouts, there was no significant difference between the most often-used drugs - selective serotonin reuptake inhibitors (SSRIs) - and psychotherapy.
  • The issue is not one against the other," says Montreal psychiatrist Alain Lesage, director of research at the Douglas Mental Health University Institute. "I am a physician; whatever works, I am good. We know that when patients prefer one to another, they do better if they have choice." Several studies have backed up that notion. Many patients are reluctant to take medication for fear of side effects and the possibility of difficult withdrawal; research shows that more than half of patients receiving medication stop taking it after six months. A small collection of recent studies has found that therapy can cause changes in the brain similar to those brought about by medication. In people with depression, for instance, the amygdala (located deep within the brain, it processes basic memories and controls our instinctive fight-or-flight reaction) works in overdrive, while the prefrontal cortex (which regulates rational thought) is sluggish. Research shows that antidepressants calm the amygdala; therapy does the same, though to a lesser extent.
  • But psychotherapy also appears to tune up the prefrontal cortex more than does medication. This is why, researchers believe, therapy works especially well in preventing relapse - an important benefit, since extending the time between acute episodes of illnesses prevents them from becoming chronic and more debilitating. The theory, then, is that psychotherapy does a better job of helping patients consciously cope with their unconscious responses to stress.
  • According to treatment guidelines by leading international professional and scientific organizations - including Canada's own expert panel, the Canadian Network for Mood and Anxiety Treatments - psychotherapy should be considered as a first option in treatment, alone or in combination with medication. And it is "highly recommended" in maintaining recovery in the long term. Britain's independent, research-guided scientific body, the National Institute for Health and Care Excellence, has concluded that therapy should be tried before drugs in mild to moderate cases of depression and anxiety - a finding that led to the creation of a $760million public system, which now handles therapy referrals for nearly one million people a year.
  • In 2012, Canada's Mental Health Commission estimated that only about one in three adults and one in four children are receiving support and treatment when they need it. Ironically, anti-stigma campaigns designed to help people understand mental illness may only make those statistics worse. In Toronto, for instance, putting up posters in subway stations in 2010 had the unexpected effect of spiking the volume of walk-ins at nearby emergency rooms by as much as 45 per cent in 12 months. Dr. Kurdyak treated many of them at CAMH. The system, he says, "has been conveniently ignoring this unmet need. It functions as if two-thirds of the people suffering won't get help." What would happen if the healthcare system outright "ignored" two-third of tumour diagnoses?
  • Essentially, argues Dr. Lesage, adding therapy into the health-care system is like putting a new, highly effective drug on the table for doctors. "Think about it," he says. "We have a new antidepressant. It works as well as many others, and it may even have some advantages - it works better for remission - with fewer side effects. The patients may prefer it. And [in the long run] it doesn't cost more than what we have. How can it not be covered?" ..
  • A heavy price This isn't just a medical issue; it's an economic one. Mental illness accounts for roughly 50 per cent of family doctors' time, and more hospital-bed days than cancer. Nearly four million Canadians have a mood disorder: more than all cases of diabetes (2.2 million) and heart disease (1.4 million) combined.
  • Mental illness - and depression, in particular - is the leading cause of disability, accounting for 30 per cent of workplace-insurance claims, and 70 per cent of total compensation costs. In 2012, an Ontario study calculated that the burden of mental illness and addiction was 1.5 times that of all cancers, and more than seven times the cost of all infectious diseases. Mental illness is so debilitating because, unlike physical ailments, it often takes root in adolescence and peaks among Canadians in their 20s and 30s, just as they are heading into higher education, or building careers and families. Untreated, symptoms reverberate through all aspects of life, routinely trapping people in poverty and homelessness. More than one-third of Ontario residents receiving social assistance have a mental illness. The cost to society is clearly immense.
  • Yet, when family doctors were asked why they didn't refer more patients to therapy in a 2008 Canadian survey, the main reason they gave was cost. For many Canadians, private therapy is a luxury, especially if families are already wrestling with the economic fallout from mental illness. Costs vary across provinces, but psychologists in private practice may charge more than $200 an hour in major centres. And it's not just the uninsured who are affected.
  • Although about 60 per cent of Canadians have some form of private insurance, the amount available for therapy may cover only a handful of sessions. Those with the best benefits are more likely to be higherincome workers with stable employment. Federal public servants, notably, have one of the best plans in the country - their benefits were doubled in 2014 to $2,000 annually for psychotherapy. Many of those who can pay for therapy are doing so: A 2013 consultant's study commissioned by the Canadian Psychological Association found that $950-million is spent annually on private-practice psychologists by Canadians, insurance companies and workers compensation boards. The CPA estimates t
  • These are the patients that family doctors juggle, the ones who eat up appointment time, and never seem to get better, the ones caught on waiting lists. Sometimes, they have already been bounced in and out of the system, received little help, and have become wary of trying again. A 40-something mother recovering from breast cancer, suffering from chronic depression post-treatment, debilitated by fear her cancer will return. A university student, struggling with anxiety, who hasn't been to class for three weeks and may soon be kicked out of school. A teenager with bulimia removed from an eatingdisorder program because she couldn't follow the rules. They are the ones dangling on waiting lists in the public system for what often amounts to a handful of talk-therapy sessions, who don't have the money to pay for private therapy, or have too little coverage to get the full course of appointments they need.
  • Canada's investment does not match that burden. Only about 7 per cent of health-care spending goes to mental health. Even recent increases pale when compared to other countries: According to a study by the Canadian Mental Health Association, Canada increased per-capita funding by $5.22 in 2011. The British government, meanwhile, kicked in an extra 12 times that amount per citizen, and Australia added nearly 20 times as much as we did. Falling off a cliff, again and again
  • In Winnipeg, Dr. Stanley Szajkowski watched for months as his patient, a woman in her 80s, slowly declined. Her husband had died and she was spiralling into a severe depression. At every appointment, she looked thinner, more dishevelled. She wasn't sleeping, she admitted, often through tears. Sometimes she thought of suicide. She lived alone, with no family nearby, and no resources of her own to pay for therapy. "You do what you can," says Dr. Szajkowksi. "You provide some support and encouragement." He did his best, but he always had other patients waiting.
  • hat 30 per cent of private patients pay out-ofpocket themselves. When the afflicted don't seek help, the cost isn't restricted to their own pocketbook. People with mental-health problems are significantly more likely to abuse drugs and alcohol, and to become physically sick, further increasing health-care costs. A 2014 study by Oxford University researchers found that having a mental illness reduced life expectancy by 10 to 20 years, roughly the same as did smoking and obesity. A 2008 Statistics Canada study linked depression to new-onset heart disease in the general population. A 2014 U.S. study found that women under the age of 55 are twice as likely to suffer or die from a heart attack, or require heart surgery, if they have moderate to severe depression. The result: clogged-up doctors' offices, ERs, and operating rooms. And an inexorable burden for the patients' families forced to fill the gaps in caregiving - or carry on when they lose a loved one.
  • Patients refer to it as falling repeatedly off a cliff. And they can only manage the climb back up so many times. Family doctors interviewed for this story admitted that they are often "handholding" patients with nowhere else to go. "I am making them feel cared for, I am providing a supportive ear that they may not get anywhere else," says Dr. Batya Grundland, a physician who has been in family practice at Toronto's Women's College Hospital for almost a decade. "But do I think I am moving them forward with regard to their illness, and helping them cope better? I am going to say rarely." More senior doctors have told her that once in a while "a light bulb goes off" for the patients, but often only after many years. That's not an efficient use of health dollars, she points out - not when there are trained therapists who could do the job better. However, she says, "in some cases, I may be the only person they have."
  • Family doctors aren't the only ones struggling to find therapy for their patients. "I do a hundred consultations a year," says clinical psychiatrist Joel Paris, a professor at McGill University and research associate at the Montreal Jewish General, "and one of the most common situations is that the patient has tried a few anti-depressants, they have not responded very well, and from their story it is obvious they would benefit from psychotherapy. But where do they go? We have community clinics here in Montreal with six-to-12-month waiting lists even for brief therapy." A fractured, inefficient system
  • "You fall into the role that is handed to you," says Antoine Gagnon, a family doctor in Osgoode, on the outskirts of Ottawa. He tries to set aside 20-minute appointments before lunch or at the end of the day to provide "active listening" to his patients with anxiety and depression. Many of them are farmers or self-employed, without any private coverage for therapy. "Five of those minutes are spent talking about the weather," he says, "and then maybe you get into the meat of the problem, but the reality is we don't have the appropriate amount of time to give to therapy, even to listen, really." Often, he watches his patients' symptoms worsen over several months, until they meet the threshold of a clinical diagnosis. "The whole system could save on productivity and money if people were actually able to get the treatment they needed."
  • But these issues aren't insurmountable, as other countries have demonstrated. Britain, for instance, has trained thousands of university graduates to become therapists in its new public program, following research showing that, as long they have the proper skills, people don't need PhDs to be effective therapists. Australia, which has created a pay-for-service system, also makes wide use of online support to cost-effectively reach remote communities.
  • Except for a small fraction of GPs who specialize in psychotherapy, few family doctors have the training - or the time - to provide structured therapy. Saadia Hameed, a GP in a family-health team in London, Ont., has been researching access to psychotherapy for an advanced degree. Many of the doctors she has interviewed had trouble even producing a clear definition of therapy. One told her, "If a patient cries, than it's psychotherapy." Another described it as "listening to their woes." A 2007 survey of 163 family doctors in Ontario found that almost four out of five had not received training in cognitive behavioural therapy, and knew little about it. "Do family doctors really need to do that much psychotherapy," Dr. Hameed asks, "when there are other people trained - and better trained - to do it?"
  • What further frustrates treatment for physicians and patients is lack of access to specialists within the system. Across the country, family doctors describe the difficulty of reaching a psychiatrist to consult on a diagnosis or followup with their patients. In a telling 2011 study, published in the Canadian Journal of Psychiatry, researchers conducted a real-world experiment to see how easily a GP could locate a psychiatrist willing to see a patient with depression. Researchers called 297 psychiatrists in Vancouver, and reached 230. Of the 70 who said they would consider taking referrals, 64 required extensive written documentation, and could not give a wait-time estimate. Only six were willing to take the patient "immediately," but even then, their wait times ranged from four to 55 days. Psychiatrists are in increasingly short supply in Canada, and there's strong evidence that we're not making the best use of these highly trained specialists. They can - and often do - provide fee-for-service psychotherapy in a private setting, which limits their ability to meet the huge demand to consult with family doctors and treat the most severe cases.
  • A recent Ontario study by a team at CAMH found that while waiting lists exist in both urban and rural centres, the practices of psychiatrists in those locations tend to look very different. Among full-time psychiatrists in Toronto, 10 per cent saw fewer than 40 patients, and 40 per cent saw fewer than 100 - on average, their practices were half the size of psychiatrists in smaller centres. The patients for those urban psychiatrists with the smallest practices were also more likely to fall in the highest income bracket, and less likely to have been previously hospitalized for a mental illness than those in the smaller centres.
  • And those therapy sessions are being billed with no monitoring from a health-care system already scrimping on dollars, yet spending a lot on this care: On average, psychiatrists earn $216,000 a year. There is nothing to stop psychiatrists from seeing the same patients for years, and no system to ensure the patients with the greatest need get priority. In Australia, Britain and the United States, by contrast, billing for psychiatrists has been adjusted to encourage them to reduce psychotherapy sessions and serve more as consultants, particularly for the most severe cases, as other specialists do.
  • As the Canadian system exists now, says Benoit Mulsant, the physician-in-chief at CAMH and also a psychiatrist, the doctors in his specialty "can do whatever they please. If I wanted, I could have a roster of actor patients who tell me entertaining stories, and I would be paid the same as someone who is treating homeless people. ... By treating the rich and famous, there is zero risk of being punched in the face by a patient." Left out in all this, by and large, are other professionals who can provide therapy. It doesn't help that the rules are often murky around who can call themselves psychotherapists. While psychologists and social workers are licensed under their professional associations, in some provinces a person can call himself a marriage counsellor or music therapist with no one demanding they be certified. In 2007, Ontario passed a law to regulate psychotherapists, requiring them to register with a provincial college that would set standards and handle complaints. Currently, however, the law is in limbo, although the government has said it will finally bring it into force by December. The brain keeps many secrets
  • Science, however, has yet to find depression's equivalent of insulin. Despite being scanned, poked and stimulated over and over and over again, the brain keeps its secrets. The "chemical imbalance" theory is now viewed as simplistic at best. It may not do much for patients, either: A 2014 study published in the journal Behaviour Research and Therapy suggested that, rather than reassuring them, focusing on the biological explanation for depression actually made patients feel more pessimistic and lacking in control. SSRIs work by increasing the amount of serotonin, a chemical that helps deliver messages within the brain and is known to influence mood. But researchers aren't sure why the drugs help some patients and fail with others. "Basically, it's like we have a bucket of water and we pour it over the patient's head," says Dr. Georg Northoff, the University of Ottawa's Michael Smith chair of Neurosciences and Mental Health. "But you want a drug that injects the water in a very specific brain regions or brain system, which we don't have."
  • Critics of therapy have argued that it's basically "good listening" - comparable to having a sympathetic friend across the kitchen table - and that in the real world of mercurial patients and practitioners of varying abilities, a pill just works better. That's true in many cases, especially when the symptoms are severe and the patients is suicidal: a fast-acting medication is safer, and may even be necessary before starting talk therapy. The staunchest advocates of therapy do not suggest it should be the first course of treatment for psychosis, or debilitating chronic depression, or mania - although, in those cases, there is evidence that psychotherapy and medication work well in tandem. (A 2011 meta-analysis found that patients with severe depression who received a combination approach had higher recovery rates and were less likely to drop out of treatment.) But drugs also don't work as well as the manufacturers would like us to think. Roughly one-third of patients given a drug will see no benefit (although they often respond to a second or third medication). In randomly controlled trials, drugs often perform only marginally better than sugar pills.
  • Yet it's talk therapy that the public often views most skeptically. "Until you go to a therapist, or a member of your family has a serious psychological problem, people are unsympathetic [about therapy]," says Dr. Paris, the Montreal psychiatrist. "They are very skeptical, and they don't believe the research. It's amazing, because pharmaceutical trials will get approval for a drug on the basis of two clinical trials that they paid for. And we have 100 clinical trials and no one believes us."
  • Dr. Ajantha Jayabarathan, an assistant professor at Dalhousie University's medical school, spent her early years as a family doctor in Spryfield, N.S., trying to manage an overload of mental-health cases. Most of her patients had little insurance; there was one reduced-cost counselling service in town, but the waiting lists were long. In 2000, her group practice became a test site for a shared-care project, which gave the doctors access to a mental-health team, including weekly in-person consultations with a psychiatrist. "It was transformative," she says. "We looked after everything in-house.
  • Over time, Dr. Jayabarathan says, she learned how to properly assess mental illness in patients, and how to use medication more effectively. "I just made it my business to teach myself what to do." It's the kind of workaround GPs are increasingly experimenting with, waiting for the system to catch up. Who would pay - and how?
  • The case for expanding publicly funded access to therapy is gaining traction in Canada. In 2012, the health commissioner of Quebec recommended therapy be covered by the province; it is now being studied by Quebec's science-based health body (INESSS), which is expected to report back next year. A new Quebec-based organization of doctors, researchers and mental-health advocates called the Coalition for Access to Psychotherapy (CAP) is lobbying the government.
  • In Manitoba, the Liberal Party - albeit well behind in the polls - has made the public funding of psychologists one of its campaign platforms for the province's spring 2016 election. In Saskatchewan, the government commissioned, and has since endorsed, a mental-health action plan that includes providing online therapy - though politicians have given themselves 10 years to accomplish it. Michael Kirby, the former head of the Canadian Mental Health Commission, has been advocating for eight annual sessions of therapy to be covered for children and youth in need.
  • There are significant hurdles: Which practitioners would provide therapy, and how would they be paid? What therapies would be covered, and for how long? Complicating every aspect of major mentalhealth change in Canada is the question of who should shoulder the cost: the provinces or Ottawa. In a written statement in response to questions from The Globe and Mail, federal Health Minister Rona Ambrose lobbed the issue back at her provincial counterparts, pointing out that the Canada Health Act does not "preclude provinces and territories from extending public coverage to other services or providers such as psychologists."
  • One result can be overloaded family doctors minimizing mental-health problems. "If you have nothing to offer someone," asks Dr. Anderson, "how much are you going to dig around to find out what is going on?" Some doctors also admit that the lack of resources can lead to physicians cherry-picking patients who don't have mental illness. And yet family physicians alone bill about $361million a year for counselling or psychotherapy in Canada - 5.6 million visits of roughly 30 minutes each. This is a broad category, and not always specifically related to mental health (some of it includes drug counselling, and a certain amount of coaching is a necessary part of the patient-doctor relationship). When it is psychotherapy, however, doctors admit it's often more supportive listening than actual therapy.
  • So how would Canada pay for access to such therapy? It wouldn't be cheap, in the short term. The savings would come from what Canadians would not have to spend in the long term: in additional medical and drug costs, emergency-room visits and hospital stays, and in unnecessary disability payments, to say nothing of better long-term health outcomes for patients given good care earlier. Some of the figures being tossed around sound staggering. Rolling out a version of Britain's centre-based program across Canada would cost $950-million. Michael Kirby's plan would amount to $1,000 annually per patient. A 2013 report commissioned by the Canadian Psychological Association calculated that, based on predicted need, and assuming no coverage from private health-care plans, providing an average of six sessions of therapy a year would cost an estimated $2.8-billion annually.
  • But any of those figures would still be a fraction of the roughly $210-billion that Canada spends annually on health care. Figuring out how to make the system most costeffective is, according to sources, currently delaying the INESSS report to the Quebec government. "You need to facilitate the government," says Helen- Maria Vasiliadis, a professor of community health at the University of Sherbrooke. "You can't be going to policymakers and showing them billions and billions of dollars. People start having heart attacks. With evidence in hand, we have to present possible solutions."
  • An insurance-based plan is the proposal that has emerged from the Quebec-based CAP group, which sent its proposal to Quebec's health minister last month. In its design, the system would work much like Quebec's public drug plan - Quebeckers not covered through work plans would contribute to a provincial insurance program for therapy. That would be similar to the system that Germany has used for decades. One step forward, one step back
  • Last year, the Sherbrooke clinic where Marie Hayes works received provincial funding for a part-time psychologist and a full-time social worker. With a roster of 25,000 patients, the clinic team laid out clear guidelines for the psychologist, who would consult on cases and screen patients, and be limited to a mere four sessions of actual counselling with any one patient. "We wanted to be careful she didn't become a waiting list - like everything in the system," says Dr. Hayes. The social worker helps guide patients into services such as housing and addiction counselling. They have also offered group sessions for depression management at the clinic. As stretched as those new professionals are in such a large practice, Dr. Hayes says the addition of that mental-health team is improving the care she can provide patients. Recently, for instance, the 32- year-old mother with anxiety attended sessions with the psychologist. "She is making progress," says Dr. Hayes, "slowly."
  • At Women's College Hospital in Toronto, Dr. Grundland is not so lucky. Asked to describe a difficult case, the family-practice physician mentions a patient suffering from depression after a lifechanging accident. Every month, doctor and patient would repeat the same conversation they'd already had more than a dozen times - and make little real headway. Her patient, says Dr. Grundland, needs a trained therapist: someone she can see regularly, to help her move past her frustration, counsel her about addiction, and ease the burden on her family.
  • But there's no extra money in the patient's budget for a psychologist. "I do my best," Dr. Grundland says, "but it's not my area of expertise." Meanwhile, the patient isn't getting better, and in the time that it takes to make it through one appointment with her, Dr. Grundland could see three other people with problems she was actually trained to treat. "But," says Dr. Grundland, "she has nowhere else to go." Erin Anderssen is a feature writer at The Globe and Mail. OPEN MINDS How to build a better mental health care system
  • The Centre for Addiction and Mental Health has purchased advertisements to accompany this series. While CAMH professionals are quoted in this story, the organization had no involvement in the creation or production of this, or any other story in the series. $20.7-billion The cost, according to a 2012 Conference Board of Canada report, of lost productivity each year due to mental illness. What else does $20-billion represent?
  • $20B: Canadian spending on national defence, 2012-13 $20B: Market valuation of Airbnb, 2015 $21B: Kitchener-CambridgeWaterloo region's GDP, 2009 $21B: Amount food manufacturing contributed to the economy, 2012
Govind Rao

BlackburnNews.com - C. Difficile in Stratford General Hospital - 0 views

blackburnnews.com/...-in-stratford-general-hospital

from heather hai hospital Ontario

shared by Govind Rao on 21 May 15 - No Cached
  • May 21, 2015
  • The Stratford General Hospital has raised the level of it’s sterilization procedures and visitor instructions. An outbreak of C. difficile has been confirmed on the Medicine and Integrated Stroke Unit. C. difficile is a bacteria that usually does not cause any problems or symptoms in healthy people. However, in some hospitalized patients, C. difficile can damage the lining of the bowel, causing diarrhea. People at risk include those who have a history of antibiotic use, recent bowel surgery, chemotherapy, prolonged hospitalization, advanced age or a serious underlying illness. Visitors to the Stratford General Hospital are required to follow posted instructions and are asked to limit their interaction to one patient per visit.
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