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Irene Jansen

What if prevention doesn't save money? - The Washington Post - 0 views

www.washingtonpost.com/...gIQAM60OnO_blog.html

prevention us

shared by Irene Jansen on 23 Jan 12 - No Cached
  • idea that preventive health care saves money is among the most ubiquitous and bipartisan health policy ideas out there.
  • What if we’re all wrong? What if prevention doesn’t save money?
  • “Prevention vs. Treatment,” a new book edited by Halley Faust, president-elect of the American College of Preventive Medicine, and Pacific Lutheran University’s Paul Menzel
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  • A chapter by Louise Russell of Rutgers University stands out in challenging much of our political and policy discourse around preventive health.
  • she draws heavily on research of Tufts’ Joshua Cohen, who crunched the numbers on the cost-effectiveness of 279 interventions that range from colonoscopies to smoking cessation programs
  • Only 20 percent of those regularly used preventive measures are “cost saving,” reducing costs while improving the quality of health, the research found. The rest tend to buy improved health care but do so at a cost.
  • Slate’s Matt Yglesias pursued a similar argument this week, suggesting that the cost-saving argument isn’t always prevention’s best political defense.
  • Not all preventive interventions, it turns out, are created equal.
  • Prevention and treatment arguably both play a role in our health-care system.
Govind Rao

Liberals revive crucial coverage for needy; Government reverses course on proposal that... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|tost|20141209|209988181

from heather ontario dental health

shared by Govind Rao on 09 Dec 14 - No Cached
  • Toronto Star Tue Dec 9 2014
  • The Liberal government scrambled Monday to reverse a proposal that would have resulted in thousands of children of low-income families being denied preventative dental health services. "Our government will ensure that no child will lose access to preventive dental services that they are currently eligible to receive," an email from Health Minister Eric Hoskins' office stated.
  • NDP MPP France Gélinas earlier in the day warned that because the Liberal government is proposing to slash income-based eligibility in half, some 15,000 children in Toronto alone will not have access to dental services. This number was supported in an August report from the Toronto Board of Health. "It is a partial victory," said Gélinas. "These are shocking and appalling cuts that strike at the heart of vital public-health services in our province," she told a news conference at Queen's Park in the morning.
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  • Gélinas said a single mom with two children making $43,432 can now access dental-health services, but the proposed change would see that net-income eligibility reduced to $23,275 effective next summer. "We were aware of what the NDP highlighted this morning so we are committed to ensuring that children of low-income families will not lose coverage," Hoskins' spokesman Gabe De Roche told the Star. Public-health units across the province are mandated to provide preventative dental care to children of low-income families, but Gélinas cautions that in northwestern Ontario only 80 of 4,000 children seen under the program last year would qualify under the new rules.
  • Preventive oral health services delivered by public health units, as mandated in the Ontario Public Health Standards, includes scaling, fluoride varnish and fixing cavities. "We believe that investing in preventative dental care saves tens of millions of dollars in health-care costs down the road," Gélinas told reporters. Premier Kathleen Wynne fired back in the legislature that because of changes made earlier this year through the $30 million Healthy Smiles program, 70,000 more kids from low-income families are receiving dental care, but Dr. Melvin C. Hsu, the manager of Dental and Oral Health Services at Toronto Public Health, told the Star that increase was taken into consideration when the board calculated that 15,600 children will lose preventative dental services.
  • "From our point of view we want to prevent disease and when you let disease progress it will cost much more and the health of the child suffers ... and that means 15,000 children may be more vulnerable to oral disease," Hsu said. Opposition critics, the Canadian Union of Public Employees (CUPE), public-health officials and families that benefit from the plan all agree the proposed change must be scrapped. Tim Maguire, president of local 79, CUPE, said thousands of kids receive dental-health screenings annually. "If you leave someone without the ability to have dental work, all of a sudden you are into an emergency department. That's the most costly form of health care we can have," Tory MPP Bill Walker said.
Irene Jansen

Fewer Canadians dying from avoidable diseases and injury - thestar.com - 0 views

www.thestar.com/...-avoidable-diseases-and-injury

safety prevention success poverty gender

shared by Irene Jansen on 25 May 12 - No Cached
  • The number of Canadians who die before age 75 from avoidable causes has dropped dramatically in the last 30 years, according to a sweeping new report.
  • due to advances in disease prevention and treatment and to social policy changes, such as traffic safety laws, that have cut down on avertable injuries.
  • The report, released Thursday by the Canadian Institute for Health Information, found rates of premature deaths have declined in almost every jurisdiction in the country
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  • in 1979, 225 of every 100,000 Canadian deaths could have been avoided by preventing a disease or injury. By 2008, the rate had fallen to 119 per 100,000 deaths — a drop of 47 per cent
  • Improvements in getting people timely and effective healthcare also helped to reduce untimely deaths. The rate for this measure dropped by 56 per cent in three decades, from 149 per 100,000 Canadians in 1979 to 66 per 100,000 in 2008.
  • the drop in preventable deaths was largely due to fewer people dying from circulatory diseases, including heart disease
  • gains in cancer survival rates, which are improving all the time, and policy changes to boost public safety and reduce injury, such as seatbelt laws and other driving legislation, have been the other big factors
  • Canada ranked third lowest in preventable death rates, coming behind Japan and France
  • large differences between socioeconomic groups. Specifically, the rate of preventable deaths for people living in the least affluent neighbourhoods was double that of people living in the most affluent neighbourhoods
Irene Jansen

Avoidable deaths plummet - but not for those in low-income areas - The Globe and Mail - 1 views

www.theglobeandmail.com/...article2442696

poverty determinants

shared by Irene Jansen on 25 May 12 - No Cached
  • The number of Canadians dying early from potentially avoidable causes has plummeted over the past 30 years, but the gains made greatly depend on a person’s income and neighbourhood.
  • A significant portion of the decline is thanks to prevention and better treatment of heart disease.
  • Avoidable mortality from preventable causes dropped by 46 per cent, from 225 per 100,000 in 1979 to 119 per 100,000 in 2008. The shift reflects a societal move toward adopting healthier lifestyles, with fewer people smoking and more people paying attention to nutrition than 30 years ago, for instance. Other preventative measures could include vaccinations or seatbelt laws. Avoidable mortality from treatable causes declined by 56 per cent, explained by advances in screening, early detection and improved treatment of diseases.
    • Irene Jansen
      Irene Jansen on 25 May 12
       
      Do preventable causes include healthcare associated infections and medical errors?
  • ...1 more annotation...
  • those living in the poorest neighbourhoods in Canada are twice as likely to die from preventable causes than those living in the most affluent areas
Irene Jansen

MPs call for national palliative care strategy - 0 views

www.canada.com/...story.html

federal government palliative

shared by Irene Jansen on 23 Jan 12 - No Cached
  • On Thursday, a cross-party parliamentary committee agreed with Woelk, saying the patchwork system of end-of-life care must be replaced with a national palliative-care strategy.
  • The committee's nearly 200-page report recommends the federal government create a palliative-care secretariat that could ensure end-of-life care is available to anyone across the country.
  • Other nations, such as Georgia and Poland, have national strategies for end-of-life care, but not so in Canada, the report said.
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  • Currently, palliative care is only available for up to one-third of Canadians, the report found, and sometimes care isn't provided evenly in the same city.
  • Conservative Harold Albrecht, who co-chaired the committee along with Joe Comartin of the NDP
  • The report, titled Not to be Forgotten, provides a list of 14 recommendations that also address ways to prevent suicide and elder abuse.
  • also recommending the federal government create a national secretariat for suicide prevention and an office of elder abuse under the watchful eye of the minister for seniors
  • The recommendations include sections for First Nations, Inuit, Metis and rural communities
  • The committee's suicide prevention ideas mirrored guidelines recommended by a the Canadian Association for Suicide Prevention. Its blueprint for suicide prevention was first released in 2004 and updated in 2009
  • The report is the culmination of about a year of work from the ad hoc committee, which was formed by MPs with a personal interest in the issues and funded out of their office budgets.
Govind Rao

Secrecy, sloppy oversight and the hospital suicide rate; Details on deaths have been wi... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20150927|230149479

from heather hospital Ontario quality

shared by Govind Rao on 28 Sep 15 - No Cached
  • Toronto Star Sun Sep 27 2015
  • The noose was a 54-inch shoelace. Fresh white, it was pulled out of an unworn New Balance running shoe, size 14. The knot was tied in a hospital room in the cold midnight hours of Feb. 24, 2013. Ken Coyne, a 68-year-old semi-paralyzed stroke victim, was somehow able to unthread the lace with only his left hand, tie the noose to the mechanical hoist above his wheelchair and hit the raise button to be slowly lifted to death - all while under 15-minute suicide watch.
  • A Star investigation that sampled almost half of Ontario's hospitals found that at least 96 in-patients have died by their own hand while under care since 2007. A further 760 were seriously harmed while attempting suicide in hospitals. Coyne's death was born of a system characterized by secrecy, inconsistency and lack of oversight, the Star found in a probe that looked into 70 hospitals, including the largest teaching facilities and major mental health centres in the province.
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  • The Star's analysis shows that at least one patient is seriously injured attempting suicide every three days, and 13 patients take their own lives every year. The hospital suicide rate is too high for psychiatrist Dr. Ian Dawe. "We are committed to making in-hospital suicides a 'never event,'" he said, noting that many hospitals in the United States are in the process of adopting what is known as a "zero suicide" strategy. Last May, after the Star started investigating this story, the government created a task force to develop standards on suicide prevention in hospitals and appointed Dawe as chair.
  • Suicides and attempts occur in all hospital departments, from maternity to neuro-clinical, emergency, medical and psychiatry. Methods range from strangulation and suffocation to drowning, overdose and electrocution, according to the data. Records show that a 12-year-old patient attempted to hang herself with her nightgown in the Sault Area Hospital, a 71-year-old woman went missing from Homewood Health Centre and jumped to her death from a parking garage and a patient at Alexandra Marine and General Hospital used a broken vase to slit his or her wrists. The three hospitals declined to comment on these incidents. Secrecy is a big part of the problem, the Star found.
  • Following an in-patient suicide, hospitals hold reviews behind closed doors to identify what went wrong and what can be done to prevent further deaths. But hospitals are not required to share these results publicly, or even with other institutions, under Ontario's health secrecy legislation - the Quality of Care Information Protection Act.
  • Details about deaths have even been withheld from grieving families. The family of Prashant Tiwari, 20, had to fight Brampton Civic Hospital for basic details about how he died by suicide last year. Tiwari was taken to the hospital after stabbing himself and placed under 15-minute suicide watch. His family eventually learned he had hanged himself in a bathroom after he was not checked for three hours. (Earlier this month, the health minister introduced changes to the protection act to address the problem of families being left in the dark.) Brampton Civic Hospital has refused to comment publicly on the Tiwari case, other than expressing its condolences, but in a letter to the family it said three staff members have not worked at the hospital since the day of his death. The Star's investigation found significant inconsistencies in how hospitals approach suicides: Some hospitals use only clothing and shoes without drawstrings, ties and shoelaces. Others don't take such precautions. Some confiscate personal medication from patients to prevent overdoses. Others don't.
  • Some lock the windows of mental health units and remove the window handles. Others don't. It's not surprising then that there is confusion about the exact number of in-patient suicides province-wide. While the Star's investigation found more than 96 patients had taken their own lives in half of Ontario's hospitals since 2007, the coroner's office, to which all hospitals must report suicides by law, says there have been only 60. "(I) cannot account for the reasons why our data differs from that offered by the specific hospitals," Chief Coroner Dirk Huyer said. There hasn't been a single coroner's inquest into a hospital suicide in the past nine years because, Huyer said, it is not the coroner's role "to raise issues that are already known." In the previous decade, the coroner's office held six inquests into in-patient suicides resulting in numerous recommendations aimed at preventing these deaths, including the establishment of task forces targeted toward the most at-risk patients. But little has been done and the problem continues.
  • A few weeks before Ken Coyne committed suicide at Providence Healthcare in Scarborough, he told his sister, Jean Brewster, that he wanted to die because the stroke had left him with only "half a body." She says the doctors knew of his suicidal intent and that she will never understand how he managed to hang himself while he was bed-bound and under 15-minute suicide watch. She recalls exactly what she said to the police officer who delivered the news: "I remember saying to the officer: 'Hang on, how did he do that in a hospital?'" Providence Healthcare said staff members continued to be deeply affected by Coyne's "tragic" death.
  • Just last week, two major Canadian health organizations identified suicides in hospitals as "preventable" incidents. Health Quality Ontario and the Canadian Patient Safety Institute released a report, "Never Events for Hospital Care in Canada," which said suicides in hospitals "should never happen" when patients are under suicide watch.
Doug Allan

Newsroom : More Physiotherapy, Exercise and Falls Prevention for Seniors - 0 views

news.ontario.ca/...ls-prevention-for-seniors.html

physiotherapy homecare

shared by Doug Allan on 19 Apr 13 - No Cached
  • Starting on August 1, 2013, community-based physiotherapy, exercise classes and falls prevention services will be offered in more locations across Ontario. In total, 218,000 more people, mostly seniors, will benefit from the additional services.
  • Each Local Health Integration Network (LHIN) will receive funding to provide falls prevention and exercise classes for 68,000 more seniors across the province, benefitting 130,000 seniors in total.
  • Long-term care homes will receive $68.5 million in funding for physiotherapy and exercise directly.  All residents who have an assessed need for physiotherapy in their care plan will receive appropriate one-on-one physiotherapy to help them restore their mobility.
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  • Community Care Access Centres will receive $33 million in additional funding to reduce the waitlist for in-home physiotherapy services, which will help to keep more seniors and eligible patients healthy and at home longer. Up to 60,000 more people, mostly seniors, will receive physiotherapy in the comfort of their own homes, benefitting 150,000 people in total.
  • Over the coming months, the Ministry of Health and Long-term Care and the LHINs will engage physiotherapy providers and community partners interested in delivering these services in communities across Ontario.
  • Until now, a small number of for-profit companies have had almost exclusive control over the delivery of publicly-funded physiotherapy.
  • Doug Allan on 19 Apr 13
     
    Physiotherapy restructuring  -- more home care?
Irene Jansen

Impact of remuneration and organizational factors on completing preventive manoeuvres i... - 0 views

www.cmaj.ca/...E135.full

primary care publication payment methods prevention it

shared by Irene Jansen on 14 Feb 12 - No Cached
  • Simone Dahrouge, PhD⇓, William E. Hogg, MD MClSc, Grant Russell, MBBS PhD, Meltem Tuna, PhD, Robert Geneau, PhD, Laura K. Muldoon, MD, Elizabeth Kristjansson, PhD, John Fletcher, MD
  • No funding model was clearly associated with superior preventive care. Factors related to physician characteristics and practice structure were stronger predictors of performance. Practices with one or more female physicians, a smaller patient load and an electronic reminder system had superior prevention scores. Our findings raise questions about reform initiatives aimed at increasing patient numbers, but they support the adoption of information technology.
Govind Rao

The evidence and politics of mandatory health care worker vaccination - Healthy Debate - 0 views

healthydebate.ca/...health-care-worker-vaccination

from heather infectious disease

shared by Govind Rao on 06 Feb 14 - No Cached
  • by Sophia Ikura, Christopher Doig & Andreas Laupacis (Show all posts by Sophia Ikura, Christopher Doig & Andreas Laupacis) February 6, 2014
  • Unions oppose mandatory vaccination policies
  • ONA representative Vicki McKenna
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  • However, the BC government and New York State have instituted policies that require workers to either be vaccinated or wear a mask.
  • Michael Gardam, Medical Director of Infection Prevention and Control at University Health Network says that the debate has galvanized a growing group of experts, including the authors of the Cochrane review, who believe the limited efficacy of the flu shot generally does not warrant a policy of mandatory vaccination for workers.
Doug Allan

Scientists say UK wasted £560m on flu drugs that are not proven | World news ... - 0 views

www.theguardian.com/...ted-560m-stockpiling-flu-drugs

flu

shared by Doug Allan on 10 Apr 14 - No Cached
  • The government has wasted half a billion pounds stockpiling two anti-flu drugs that have not been proved to stop the spread of infection or to prevent people becoming seriously ill, according to a team of scientists who have analysed the full clinical trials data, obtained after a four-year fight.
  • But the Cochrane Collaboration, a group of independent scientists who investigate the effectiveness of medicines, says that the best Tamiflu can do is shorten a bout of flu by approximately half a day – from around seven to 6.3 days.
  • They also found worrying side-effects in people taking it to prevent flu, which had not been fully disclosed, including psychiatric and kidney problems. "There is no credible way these drugs could prevent a pandemic," said Carl Heneghan, professor of evidence-based medicine at Oxford University and one of the team. They are now calling for the WHO to review its advice to countries and for the UK government not to renew its stockpile when the drugs go out of date.
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  • "When one thinks of what half a billion pounds could have been spent on in the NHS, let alone around the world, one has to be pretty scathing about that decision."
  • The findings come at the end of a gruelling battle with the drug companies to see the actual data produced during all the trials, rather than the often ghostwritten and always company-funded scientific papers selectively published in medical journals. In a watershed development, they have put all the company data online, to allow anybody to interrogate the source material.
  • The Department of Health said it looked forward to receiving the report, but insisted that the stockpile was important.
  • Roche said it fundamentally disagreed with the review and maintained that the drugs were a vital treatment option for flu patients. Cochrane had got it wrong, the company said. "The report's methodology is often unclear and inappropriate, and their conclusions could potentially have serious public-health implications," said UK medical director Dr Daniel Thurley. "We'd absolutely defend [Tamiflu] for treatment and prevention." A recent study of 30,000 patients given Tamiflu in the swine-flu pandemic, published in the Lancet, found it saved lives.
Govind Rao

Do no harm: There's an infection hospitals can nearly always prevent. Why don't they? -... - 0 views

www.vox.com/...ical-harm-infection-prevention

from heather hai

shared by Govind Rao on 22 Jul 15 - No Cached
  • There’s an infection hospitals can nearly always prevent. Why don’t they?
  • by Sarah Kliff on July 9, 2015
  • Nora Boström died in a hospital room, her arms clenched around her mother’s neck, on November 22, 2013. It was 22 days before her fourth birthday.
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  • That's wrong: Federal data shows that what happened to Nora happened at least 9,997 times in 2013. Central line infections remain a leading cause of death in the American health-care system — despite research showing that they are nearly all preventable.
  • This helped create a simple five-item checklist that centered on obsessive, meticulous cleanliness when inserting the central line and changing the dressing: washing hands, covering yourself and the patient in sterile clothing and drapes, using the antiseptic chlorhexidine on the site, avoiding groin-area catheters (which get infected more often), and removing catheters when not needed.
  • Welsh’s results were typical for Michigan: A landmark 2006 study of 103 intensive care units there showed that within three months of implementing Pronovost's checklist, central line infections fell 70 percent.
  • This article is the second in Vox's year-long series on fatal medical harm. Reporting for this series is sponsored by the Association of Health Care Journalists' Reporting Fellowship on Health Care Performance and supported by the Commonwealth Fund.
Govind Rao

New workplace violence and harassment prevention kit ready | Canadian Union of Public E... - 0 views

cupe.ca/arassment-prevention-kit-ready

from heather cupe health and safety violence

shared by Govind Rao on 15 Jan 16 - No Cached
  • Dec 21, 2015
  • Workplace violence is a serious hazard that many CUPE members face every day. In response to this hazard, the CUPE health and safety branch is pleased to announce our most recent resource, the updated Workplace Violence and Harassment Prevention Kit. 
Govind Rao

Address huge public health coverage gaps - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|gumr|20151015|231429264

from heather Ontario determinants pharmacare medicare

shared by Govind Rao on 15 Oct 15 - No Cached
  • Guelph Mercury Thu Oct 15 2015
  • It's time to tackle root causes of health inequities As Canadians, we are justifiably proud of our publicly funded health-care system. It is, arguably, the single-most powerful expression of our collective will as a nation to support each other. It recognizes that meeting shared needs and aspirations is the foundation on which prosperity and human development rests. We can all agree that failing to treat a broken leg can result in serious health problems and threats to a person's ability to function. Yet, we accept huge inequities in access to dental care and prescription drugs based on insurance coverage and income. Although the impacts can be just as significant, dental care isn't accessible like other types of health care, and many Canadians don't receive regular or even emergency dental care. Many others have no insurance coverage for urgently needed prescription medications and may delay or dilute required doses due to financial hardship.
  • Demand for dental care among adults and seniors will only increase as the population continues to grow in Ontario. From 2013 to 2036, Ontario's population aged 65 and over is projected to increase to more than four million people from 2.1 million. It is time all Canadians had access to dental care. This necessitates federal and provincial leadership in putting a framework together to make this possible. Dental health problems are largely preventable and require a comprehensive approach for all ages that includes treatment, prevention, and oral health promotion.
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  • Low-income adults who do not have employer-sponsored dental coverage through a publicly funded program - and most don't - must pay for their own dental care. Because the cost is often prohibitive, too many adults avoid seeking treatment at dental offices. Instead, they turn to family doctors and emergency departments for antibiotics and painkillers, which cannot address the true cause of the problem. In 2012, in Ontario alone, there were almost 58,000 visits to Ontario hospital emergency rooms due to oral health problems. Why is access to dental care essential now?
  • A person's oral health will affect their overall health. Dental disease can cause pain and infection. Gum disease has been linked to respiratory infections, cardiovascular disease, diabetes, poor nutrition, and low birth weight babies. Poor oral health can also impact learning abilities, employability, school and work attendance and performance, self-esteem, and social relationships. It is estimated that 4.15 million working days are lost annually in Canada due to dental visits or dental sick days. Persons with visible dental problems may be less likely to find employment in jobs that require face-to-face contact with the public.
  • Why is there such a difference in coverage? In short, dental care and pharmacare were not included within the original scope of Canada's national system of health insurance (medicare), and despite repeated evidence of the need to correct this oversight, is still not covered today. Instead, we are left with a patchwork of private employer-based benefits coverage, limited publicly funded programs, and significant out-of-pocket payments for many. Publicly funded dental programs for children and youth do exist for low-income families, including the dependents of those on social assistance. Most provinces and territories have some access to drug coverage, mostly for seniors and social assistance recipients, and there is some support for situations where drug costs are extremely high.
  • Pharmaceutical coverage in Canada remains an unco-ordinated and incomplete patchwork of private and public plans - one that leaves many Canadians with no prescription drug coverage at all. This has many negative consequences including: Three million Canadians cannot afford to take their prescriptions as written. This leads to worse health outcomes and increased costs elsewhere in the health-care system.
  • One in six hospitalizations in Canada could be prevented through improved regulation and better guidelines. Medicines are commonly underused, overused, and misused in Canada. Two million Canadians incur more than $1,000 a year in out-of-pocket expenses for prescription drugs. The uncontrolled cost of medicines is also a growing burden on businesses and unions that finance private drug plans for approximately 60 per cent of Canadian workers. Canada pays more than any comparable health-care system for prescription drugs. We spend an estimated $1 billion on duplicate administration of multiple private drug plans. Depending on estimates, we also spend between $4 billion and $10 billion more on prescription drugs than comparable countries with national prescription drug coverage plans.
  • Affordable access to safe and appropriate prescription medicines is so critical to health that the World Health Organization has declared governments should be obligated to ensure such access for all. Unfortunately, Canada is the only developed country with a universal health care system that does not include universal coverage of prescription drugs. From its very outset, Canada's universal, public health insurance system - medicare - was supposed to include universal public coverage of prescription drugs. The reasoning was simple. It is essential to deliver on the core principles of "access," "appropriateness," "equity" and "efficiency." Building universal prescription drug coverage into Canada's universal health-care system, based on the above principles, is both achievable and financially sustainable.
  • A public body - with federal, provincial and territorial representation - would establish the national formulary for medicines to be covered. This body would negotiate drug pricing and supply contracts for brand-name and generic drugs. Importantly, it would use the combined purchasing power of the program to ensure all Canadians receive the best possible drug prices and thereby coverage of the widest possible range of treatments. To patients, the program would be a natural extension of medicare: when a provider prescribes a covered drug, the patient would have access without financial barriers.
  • To society, universal access to safe and appropriately prescribed drugs and access to dental care will improve population health and reduce demands elsewhere in the health system. The single-payer system will also result in substantially lower medicine costs for Canada. In short, Canada can no longer afford not to have a national pharmacare program and a national dental care program. Disclaimer: The Guelph and Wellington Task Force for Poverty Elimination is a non-partisan organization. However, the poverty task force does have ties with two Guelph federal party candidates. Andrew Seagram, the NDP candidate, is a current member of the task force and Lloyd Longfield, the Liberal candidate, is a past member.
Govind Rao

National group criticizes cuts to health care in Nova Scotia | Globalnews.ca - 0 views

globalnews.ca/...oup-criticizes-n-s-health-cuts

from heather NS infectious disease cuts ally

shared by Govind Rao on 23 Mar 16 - No Cached
  • March 21, 2016
  • By Marieke Walsh
  • A national group says Nova Scotia’s ability to prevent and control infections is being put at risk with cuts to the province’s health department.Infection Prevention and Control Canada (IPAC) is an organization that promotes best practice in infection prevention and control.
Irene Jansen

Canadian Health Coalition. Harper's Cuts to Refugee Health Care: A violation of medical... - 0 views

healthcoalition.ca/...stnl_iframe.php

chc immigration federal budget cuts

shared by Irene Jansen on 07 May 12 - No Cached
  • As of June 30th refugees in Canada will be cut off access to treatment for chronic diseases including hypertension, angina, diabetes, high cholesterol, and lung disease.
  • “The changes are being justified using three flawed arguments. First, we are told that refugees are abusing our health care system. The reality is the exact opposite. Our challenge as physicians is to engage vulnerable people with the health care system, especially prevention and primary care, not turn them away. I have never met a refugee who came to Canada because they wanted better health care. In comparison to starvation, torture, and rape, getting vision care is never the motivation. Second, they say they are doing this for public safety. Actually, they are endangering public safety by denying basic health care services. People only pose a risk to the public if they are not properly engaged in health care. For example, if a person with tuberculosis is only offered care after they are spitting blood, they will have already infected others. Third, the Minister claims this is about saving taxpayers money. When you stop providing preventive care you wind up with repeated emergency room visits and preventable hospitalizations that cost a lot more money,” said Dr. Mark Tyndall, Head of Infectious Diseases at the Ottawa Hospital and Professor of Medicine at the University of Ottawa.
  • The Canadian Heath Coalition sees the cuts to refugee health care services as part of a broader pattern emerging from the recent federal budget. Other cuts that affect the health of vulnerable Canadians include: mental health services for soldiers at Petawawa; systematic spending cuts to aboriginal health programs; the elimination of Health Canada’s Bureau of Food Safety Assessment and food safety inspection at the CFIA.
Irene Jansen

Should You Run from that Medical Test? Interview with Alan Cassels. The Tyee - 0 views

thetyee.ca/...Alan-Cassels-Interview

diagnostics overtreatment

shared by Irene Jansen on 28 May 12 - No Cached
  • In his latest book, Seeking Sickness (Greystone Books
  • Cassels looks at tests that are commonly given to healthy people, including screens for prostate cancer, breast cancer, osteoporosis and high cholesterol.
  • there is often little evidence they actually extend lives and in some cases they are likely to lead to more harm than good
  • ...10 more annotations...
  • the consumer is naked in the screening market place. There's no one really protecting people from being exposed to screening that is neither recommended, didn't have scientific support, that had evidence of harm in terms of exposure to radiation and good evidence that kind of screening causes huge amounts of follow up in the average person
  • They're marketed as providing peace of mind, when they are statistically more likely to do the opposite, which is to give you a bunch of things you now have to worry about that you never knew you had to worry about before.
  • they may say prostate cancer screening improves survival time, as opposed to improving survival, meaning the time you survive after they've diagnosed you with the disease. If you're tied to the railway track, and the train's coming down the track and it's going to hit you at a particular time, you can see it maybe without binoculars at five miles, say a five year survival rate. Or, if you use the screening test, binoculars, you can see it at seven miles. Your survival time has improved. The date at which the train hits you does not change, but the statistics look like the survival time has improved by two years.
  • what have the independent experts said about the value of the screening. The United States Preventive Services Task Force is one of them. The Canadian Task Force on Preventive Health Care, that's the Canadian equivalent. Most of the stuff you see about prevention is biased. For every one site like this funded by the taxpayer with largely no conflicts of interest, there's a hundred sites that will tell you other things.
  • the business model depends on overdiagnosis and over treatment
  • There's a huge gap in the pharmaceutical world between what the marketers or advertisers say and what the evidence says. In screening it's the same niche
  • It's a bigger tent. There's the patient advocates, the radiologists, the urologists, the specialists and the others who are pushing various types of screening. And the drug industry is there too.
  • You don't need to prove the benefits of a screening test before you launch it on the public.
  • many doctors feel they have lawyers looking over their shoulders as they consider whether or not to recommend a screen
  • I think that's a largely US thing, but I think it motivates physicians here as well.
Irene Jansen

Far more could be done to stop the deadly bacteria C. diff - USATODAY.com - 0 views

www.usatoday.com/...1

us hai reporting

shared by Irene Jansen on 22 Aug 12 - No Cached
  • The bacteria is linked in hospital records to more than 30,000 deaths a year in the United States
  • William Jarvis, who spent 17 years heading the health care infection division at the U.S. Centers for Disease Control and Prevention. "We know what to do (to lower rates). It's not rocket science. And we know the barrier is cost."
  • more than 9% of C. diff-related hospitalizations end in death — nearly five times the rate for other hospital stays
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  • In England, the government requires hospitals to report all C. diff cases, underpinning a regulatory campaign that has slashed infections more than 50% since 2008. A new C. diff reporting rule for U.S. hospitals isn't scheduled to take effect until 2013.
  • England and other European countries also require health care institutions to have antibiotic control programs and meet targets for reducing C. diff. There are no such rules for U.S. facilities: The federal government doesn't track antibiotic use in hospitals, nursing homes and other care settings, and there is no penalty under Medicare and Medicaid for facilities that have high C. diff rates.
  • Thirty-four states now require hospitals to publicly report their rates of infections, but fewer than a quarter of those include C. diff
  • Reporting requirements for nursing homes are even less common.
  • Hospitals have cut housekeeping budgets up to 25% in recent years, according to the Association for the Healthcare Environment, an arm of the American Hospital Association. And the group's surveys show that many hospitals spend as little as 18 minutes cleaning a patient's room. That's well below the 25-30 minutes the group's studies have identified as optimal.
  • Other health care infections have been stemmed
  • Strategies to combat C. diff are more complicated and costly. Successful initiatives often require interdisciplinary teams.
  • Though infection control programs are shown to save facilities money in the long run, Jarvis, the former CDC infection control chief, says administrators often balk at the upfront investments because they worry about operating margins."Saving money is not the same as making money," he adds.
  • In a 2009 survey of 2,000 infection prevention specialists from U.S. hospitals, 41% said their facility had cut spending on infection control.
  • The U.S. Centers for Medicare and Medicaid Services has begun reducing reimbursement to hospitals for care tied to certain health care infections it deems preventable, such as those related to catheter use. But C. diff is not on that list.
  • It's difficult to hold facilities accountable for C. diff because it can be impossible to know where a patient was infected
  • That hasn't been a roadblock in England, where hospitals must meet strict targets for reducing infection rates or face sanctions. In fiscal 2011-12 through March, the country had just 18,000 C. diff cases — 17% below the prior year.
Irene Jansen

Senate Committee Social Affairs review of the health accord. Evidence, October 6, 2011 - 0 views

www.parl.gc.ca/...49076-e.htm

accord home care senate

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Pamela Fralick, President and Chief Executive Officer, Canadian Healthcare Association
  • I will therefore be speaking of home care as just one pillar of continuing care, which is interconnected with long-term care, palliative care and respite care.
  • The short-term acute community mental health home care services for individuals with mental health diagnoses are not currently included in the mandate of most home care programs. What ended up happening is that most jurisdictions flowed the funding to ministries or other government departments that provided services through established mental health organizations. There were few provinces — as a matter of fact, Saskatchewan being one of the unique ones — that actually flowed the services through home care.
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  • thanks to predictable and escalating funding over the first seven years of the plan
  • however, there are, unfortunately, pockets of inattention and/or mediocrity as well
  • Six areas, in fact, were identified by CHA
  • funding matters; health human resources; pharmacare; wellness, identified as health promotion and illness and disease prevention; continuing care; and leadership at the political, governance and executive levels
  • The focus of this 10-year plan has been on access. CHA would posit that it is at this juncture, the focus must be on quality and accountability.
  • safety, effectiveness, efficiency, appropriateness
  • Canada does an excellent job in providing world-class acute care services, and we should; hospitals and physicians have been the core of our systems for decades. Now is the time to ensure sufficient resources are allocated to other elements of the continuum, including wellness and continuing care.
  • Home care is one readily available yet underused avenue for delivering health promotion and illness prevention initiatives and programs.
  • four critically important themes: dignity and respect, support for caregivers, funding and health human resources, and quality of care
  • Nadine Henningsen, Executive Director, Canadian Home Care Association
  • Today, an estimated 1.8 million Canadians receive publicly funded home care services annually, at an estimated cost of $5.8 billion. This actually only equates to about 4.3 per cent of our total public health care funding.
  • There are a number of initiatives within the home care sector that need to be addressed. Establishing a set of harmonized principles across Canada, accelerating the adoption of technology, optimizing health human resources, and integrated service delivery models all merit comment.
  • great good has come from the 10-year plan
  • Unfortunately, there were two unintended negative consequences
  • One was a reduction in chronic care services for the elderly and
  • a shift in the burden of costs for drugs and medical supplies to individual and families. This was due to early discharge and the fact that often a number of provinces do not cover the drugs and supplies under their publicly funded program.
  • Stakeholders across Canada generally agreed that the end-of-life expectations within the plan were largely met
  • How do we go from having a terrific acute care system to having maybe a slightly smaller acute care system but obviously look toward a chronic care system?
  • Across Canada, an estimated 30 to 50 per cent of ALC patients could and should benefit from home care services and be discharged from the hospital.
  • Second, adopt a Canadian caregiver strategy.
  • Third, support accountability and evidence-informed decision making.
  • The return on investment for every dollar for home care is exponentially enhanced by the in-kind contribution of family caregivers.
  • Sharon Baxter, Executive Director, Canadian Hospice Palliative Care Association
  • June 2004
  • a status report on hospice, palliative and end-of-life care in Canada
  • Dying for Care
  • inconsistent access to hospice palliative care services generally and also to respite care services; access to non-prescribed therapies, as well as prescription drug coverage
  • terminated by the federal government in March of 2008
  • the Canadian Strategy on Palliative and End-of-Life Care
  • Canadian Hospice Palliative Care Association and the Canadian Home Care Association embarked on what we called the Gold Standards Project
  • In 2008, the Quality End-of-Life Care Coalition released a progress report
  • progress was made in 2008, from the 2004 accord
  • palliative pharmaceutical plan
  • Canadians should have the right to choose the settings of their choice. We need to look for a more seamless transition between settings.
  • In 2010, the Quality End-of-Life Care Coalition of Canada released its 10-year plan.
  • Seventy per cent of Canadians at this point in time do not have access to hospice palliative care
  • For short-term, acute home care services, there was a marked increase in the volume of services and the individuals served. There was also another benefit, namely, improved integration between home care and the acute care sector.
  • last summer, The Economist released a document that looked at palliative services across 40 countries
  • The second area in the blueprint for action is the support for family caregivers.
  • The increasing need for home-based care requires us to step up and strive for a comprehensive, coordinated and integrated approach to hospice palliative care and health care.
  • Canadian Caregiver Coalition
  • in Manitoba they have made great strides
  • In New Brunswick they have done some great things in support of family caregivers. Ontario is looking at it now.
  • we keep on treating, keep on treating, and we need to balance our systems between a curative system and a system that will actually give comfort to someone moving toward the end of their life
  • Both the Canadian Institute for Health Information and the Canadian Health Services Research Foundation have produced reports this year saying it is chronic disease management that needs our attention
  • When we look at the renewal of health care, we have to accept that the days of institutional care being the focus of our health care system have passed, and that there is now a third leg of the stool. That is community and home care.
  • Over 70 per cent of caregivers in Canada are women. They willingly take on this burden because they are good people; it is what they want to do. The patient wants to be in that setting, and it is better for them.
  • The Romanow report in 2002 suggested that $89.3 million be committed annually to palliative home care.
  • that never happened
  • What happened was a federal strategy on palliative and end-of-life care was announced in 2004, ran for five years and was terminated. At best it was never funded for more than $1.7 million.
  • Because our publicly funded focus has been on hospitals and one provider — physicians, for the most part — we have not considered how to bring the other pieces into the equation.
  • Just as one example, in the recent recession where there was special infrastructure funding available to stimulate the economy, the health system was not allowed to avail itself of that.
  • As part of the 10-year plan, first ministers agreed to provide first dollar coverage for certain home-care services, based on assessed need, by 2006. The specific services included short-term acute home care, short-term community mental health care and end-of-life care. It appears that health ministers were to report to first ministers on the implementation of that by 2006, but they never did.
  • One of the challenges we find with the integration of mental health services is
  • A lot of eligibility rules are built on physical assessment.
  • Very often a mental health diagnosis is overlooked, or when it is identified the home care providers do not have the skills and expertise to be able to manage it, hence it moves then over to the community mental health program.
  • in Saskatchewan it is a little more integrated
  • Senator Martin
  • I think ideally we would love to have the national strategies and programs, but just like with anything in Canada we are limited by the sheer geography, the rural-urban vast differences in need, and the specialized areas which have, in and of themselves, such intricate systems as well. The national picture is the ideal vision, but not always the most practical.
  • In the last federal budget we got a small amount of money that we have not started working with yet, it is just going to Treasury Board, it is $3 million. It is to actually look at how we integrate hospice palliative care into the health care system across all these domains.
  • The next 10-year plan is about integration, integration, integration.
  • the Canadian Patient Safety Institute, the Health Council of Canada, the Canadian Health Leadership Network, the health sciences centres, the Association of Canadian Academic Healthcare Organizations, the Canadian College of Health Leaders, the Canadian Medical Association, the Canadian Nurses Association, the Canadian Public Health Association, the Canadian Agency for Drugs and Technologies in Health and Accreditation Canada
  • We are all meeting on a regular basis to try to come up with our take on what the system needs to do next.
  • most people want to be cared for at home
  • Family Caregiver Tax Credit
  • compassionate care benefit that goes with Employment Insurance
  • Have you done any costing or savings? Obviously, more home care means more savings to the system. Have you done anything on that?
  • In the last federal election, every political party had something for caregivers.
  • tax credits
  • the people we are talking about do not have the ability to take advantage of tax credits
  • We have a pan-Canadian health/human resource strategy in this country, and there is a federal-provincial-territorial committee that oversees this. However, it is insufficient
  • Until we can better collaborate on a pan-Canadian level on our human resources to efficiently look at the right mix and scope and make sure that we contain costs plus give the best possible provider services and health outcomes right across the country, we will have problems.
    • Irene Jansen
      Irene Jansen on 23 Jan 12
       
      get cite from document
  • We have not as a country invested in hospital infrastructure, since we are talking about acute care settings, since the late 1960s. Admittedly, we are moving away from acute care centres into community and home care, but we still need our hospitals.
  • One of the challenges is with the early discharge of patients from the hospital. They are more complex. The care is more complex. We need to train our home support workers and our nurses to a higher level. There are many initiatives happening now to try to get some national training standards, particularly in the area of home support workers.
  • We have one hospital association left in this country in Ontario, OHA. Their CEO will constantly talk about how the best thing hospitals can do for themselves is keep people out of hospitals through prevention promotion or getting them appropriately to the next place they should be. Jack Kitts, who runs the Ottawa Hospital, and any of the CEOs who run hospitals understand one hundred per cent that the best thing they can do for Canadians and for their institutions is keep people out of them. That is a lot of the language.
  • We have an in-depth brief that details a lot of what is happening in Australia
  • I would suggest that it is a potentially slippery slope to compare to international models, because often the context is very different.
  • Irene Jansen on 23 Jan 12
     
    Home Care
Irene Jansen

Senate Committee Social Affairs review of the health accord. Evidence, October 5, 2011 - 0 views

www.parl.gc.ca/...49078-e.htm

accord hhr senate

shared by Irene Jansen on 23 Jan 12 - No Cached
  • our theme today is health and human resources
  • Dr. Andrew Padmos, Chief Executive Officer, Royal College of Physicians and Surgeons of Canada
  • The first is to continue and augment investments in patient-centred medical education and training programs that support lifelong learning.
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  • we have three recommendations
  • Patient-centred care, inter-professional care and comprehensive care are all things that deserve and require additional investment and attention.
  • We need a pan-Canadian human resources for health observatory function to provide evidence and data on which to plan. Our workforce science in Canada is at a very primitive stage, and we are lurching from one crisis in one locality or one specialty to another.
  • The second recommendation
  • Our third recommendation
  • Canada needs an injury prevention strategy to elevate in the public's attention and bring resources to bear to reduce needless injuries in our life. The reason for this is that injuries cause a lot of loss of life, disability, long-lasting disability and painful disability, and they cost a lot of money.
  • Jean-François LaRue, Director General, Labour Market Integration, Human Resources and Skills Development Canada
  • foreign credential recognition
  • Marc LeBrun, Director General, Canada Student Loans, Human Resources and Skills Development Canada
  • Canada student loan forgiveness for family physicians, nurses and nurse practitioners, as introduced in Budget 2011
  • Robert Shearer, Acting Director General, Health Care Programs and Policy Directorate, Strategic Policy Branch, Health Canada
  • in 2004 the federal government committed to the following: accelerating and expanding the assessment and integration of internationally trained health care graduates across the country; targeting efforts in support of Aboriginal communities and official language minority communities to increase the supply of health care professionals in these communities; implementing measures to reduce the financial burden on students in specific health education programs, in collaboration with our colleagues in other federal departments; and participating in HHR planning with interested jurisdictions
  • Canada does not have a single national health human resources plan
  • Health Canada plays a leadership role in HHR by supporting a range of targeted projects and initiatives of national significance.
  • Pan-Canadian Health Human Resource Strategy
  • Internationally Educated Health Professionals Initiative
  • Health Canada supports collaborative efforts as co-chairs of the federal-provincial-territorial Advisory Committee on Health Delivery and Human Resources known as ACHDHR. This committee was created by the conference of deputy ministers of health back in 2002, to link issues of primary health care, service delivery and HHR.
  • ACHDHR will be providing a written brief
  • The federal government also participates on ACHDHR as a jurisdiction that directly employs health care providers and has responsibility for the funding and delivery of certain health care services for populations under federal responsibility, such as First Nations and Inuit, eligible veterans, refugee protection claimants, inmates of federal penitentiaries, and serving members of the Canadian Forces and the Royal Canadian Mounted Police.
  • Shelagh Jane Woods, Director General, Primary Health Care and Public Health Directorate, First Nations and Inuit Health Branch, Health Canada
  • Dr. Brian Conway, President, Société Santé en français
  • account for over a million Canadians who need access to quality health services in their own language.
  • Acadian and francophone communities outside Quebec
  • Senator Eggleton
  • I am interested in the injury prevention idea. We hear of it from time to time. Do you have some specific thoughts on what an injury prevention program or strategy might look like and how it might fit in with the health accord? One of the things the Health Accord brought about in 2004 was the federal government saying to the provinces, “If you do this and you do that we will give you money here and there.” Maybe we should be doing that here. Maybe we should ask the federal government to provide an incentive for the provinces to be able to do something. It would be interesting if you could come up with a vision of what that strategy might look like.
  • Irene Jansen on 23 Jan 12
     
    Health Human Resources
Doug Allan

Deaths from adverse events are halved in Dutch hospitals | BMJ - 0 views

www.bmj.com/bmj.f7147

adverse events

shared by Doug Allan on 05 Dec 13 - No Cached
  • The number of deaths from adverse events in hospitals in the Netherlands has halved during a national five year programme to improve safety, show figures from the country’s latest survey of harm related to care.
  • The study found that the number of deaths related to failures in organisational or professional standards fell by just over half from 1960 in 2008 to 970 in 2011-12
  • The proportion of potentially preventable adverse events also fell over the same period, from 2.9% of all admissions in 2008 to 1.6% in 2011-12. Meanwhile, rates of adverse events in general caused by unforeseeable or unexpected complications remained static at about one in 14 patients.
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  • he national safety improvement programme, launched in 2008, included a focus on infection prevention, targeted screening of vulnerable elderly patients, and extra checks on administration of high risk drugs.2Although the study was not a randomised controlled trial and so proved no causal relation, the researchers argued that the reductions found in numbers of preventable adverse events in elderly and surgical patients fitted well with progress made in the use of checklists for these groups as part of the national patient safety programme. Though the figures are encouraging, concerns remain that nearly 1000 patients still die every year.
  • Doug Allan on 05 Dec 13
     
    The number of deaths from adverse events in hospitals in the Netherlands has halved during a national five year programme to improve safety, show figures from the country's latest survey of harm related to care.
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