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Govind Rao

CIHR spurns Aboriginal researchers' call for reconciliation - 0 views

www.cmaj.ca/E75

from heather aboriginal research

shared by Govind Rao on 15 Mar 16 - No Cached
  • CMAJ March 15, 2016 vol. 188 no. 5 First published February 8, 2016, doi: 10.1503/cmaj.109-5232
  • Laura Eggertson
  • Aboriginal health projects received less than 1% of the funding awarded by the Canadian Institutes of Health Research (CIHR) in its first major competition since restructuring — an outcome Aboriginal researchers say illustrates the need to reconcile the new system with the vast inequities in Indigenous health.
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  • CIHR’s decision-making style, which resulted in it going ahead with changes to funding despite objections from Indigenous and non-Indigenous researchers, “is not consistent with the recommendations of the Truth and Reconciliation Commission,” says Rod McCormick, a Mohawk researcher and co-chair of the Aboriginal Health Research Steering Committee.
  • There is no recognition or provision for the fact that systemic policies, when applied across the board, can have damaging impacts for groups that are different,” McCormick told an emotionally charged meeting at the Wabano Centre for Aboriginal Health in Ottawa on Jan. 25.
  • In 2014/15, funding for Aboriginal health research was $31 million, down from $34 million at its annual peak 2004–2008, the Aboriginal Health Research Steering Committee reported.
  • McCormick and co-chair Frederic Wien, the principal investigator for the Atlantic Aboriginal Health Research Program, urged CIHR to revisit its changes and rebuild what Wien called “a respectful relationship with First Nations, Métis and Inuit people.” Given the crisis in the health and well-being of many of these communities, the researchers want CIHR to prioritize Aboriginal health research.
  • We have gone through major changes at CIHR. I do not deny that,” Beaudet said. “But I would deny ... that these changes are affecting particularly the Aboriginal community.”
  • Marlene Brant Castellano, co-director of research for the Royal Commission on Aboriginal Peoples, believes CIHR is out of step with the Truth and Reconciliation Commission’s recommendations.
  • Beaudet made the remarks just three days after the shootings at La Loche, Saskatchewan. The murder of two teenagers, a teacher and a teacher’s aide in the largely Dene community underscored for some attendees the crises in suicide, lack of mental health support and poverty that affect many Aboriginal youth and families.
  • Beaudet said Aboriginal health research is “extremely important” for CIHR, and its strategic investments will reflect that. CIHR has been working with the Aboriginal Health Research Steering Committee for 14 months and, according to the institute’s media specialist David Coulombe, is committed to “co-building research initiatives” that “will improve the health of Canada’s First Nations, Inuit and Métis peoples.”
  • While Beaudet acknowledged both the magnitude of the recent changes and the fact that the Aboriginal health research budget has “flatlined,” he said it has done so parallel to CIHR’s overall budget. CIHR’s billion-dollar annual federal budget has not increased since 2009, meaning that its spending power has declined by roughly 25% since then.
  • CIHR’s president denied any need for the federal agency to engage in reconciliation. “I would like to bring my personal views, not only those of CIHR, about the stormy weather we have been experiencing lately,” Dr. Alain Beaudet told attendees at the January meeting. “But not in the spirit of reconciliation, because I don’t think anything has been broken.”
  • The Aboriginal Health Research Steering Committee contends that CIHR disadvantages researchers working in Aboriginal health through recent changes such as scrapping an Aboriginal-specific peer review process, requiring matching funds for several granting programs, and reallocating almost half the open competition funding for stellar emerging and establishing scholars.
  • But Beaudet said the changes promote more “out-of-the-box” research that will enable Canada to achieve more international success. He also suggested that those critical of the new system are afraid of change, and advised researchers that “looking back doesn’t work.” Learning from the past is a critical Indigenous value. CIHR is starting to analyze the
  • results of its initial investments, but it will take seven years for the new system to take full effect and before “meaningful” figures result, Beaudet said. “We’ll work as quickly as we can, but we need the data. I’m saying ‘Yes, trust us,’ because if you look at CIHR’s record, we’ve done a lot, and we’ve done it in good faith.”
  • Most of the researchers and representatives of Aboriginal political organizations at the meeting did not seem inclined to trust Beaudet’s reassurances.
  • You’re really saying to this group, ‘Trust us.’ And I just want to remind you that there’s very little basis for trust,” said Scott Serson, a former deputy minister of Indian Affairs and Northern Development, now with Canadians for a New Partnership, a group working for a new relationship between Indigenous and other Canadians.
  • The Aboriginal Health Research Steering Committee asked CIHR to set aside half a day at the June meeting of its governing council to address these issues. In an online statement, Beaudet acknowledged the request for an in-depth discussion at “a future meeting” of the governing council. He also urged Indigenous health researchers and community members to apply as members of the new Institutes Advisory Board on Indigenous People’s Health and a new College of Reviewers.
  • Marlene Brant Castellano, co-director of research for the Royal Commission on Aboriginal Peoples and the Mohawk elder who closed the meeting, described Beaudet and CIHR’s response to the committee’s requests as “disconnected” from the prevailing political environment.
  • Castellano, who is revered as the first Aboriginal full professor at a Canadian university, brought many in the audience to tears. Instead of recognizing the need for a new relationship between Canada and its Indigenous peoples, Beaudet’s remarks echoed a too-familiar demand that Aboriginal researchers “get with” CIHR’s program because, eventually, they would discover it was good for them, Castellano said.
  • “We have 400 years as Indigenous people trying to make things work in other people’s agendas, and that is where we’ve gotten to the place now, where we still are, of watching our children dying,” she said, tears streaming down her cheeks.
  • Beaudet had already left the meeting before Castellano went to the podium, and the two CIHR vice-presidents who had stayed for most of the discussion left as she began to speak, citing prior commitments. Only Malcolm King, scientific director of CIHR’s Institute of Aboriginal Peoples’ Health and a member of the Mississaugas of the New Credit First Nation, remained for the duration of the meeting.
  • According to Coulombe, Beaudet had a phone conversation with Castellano on Jan. 29, and “agreed to continue working collaboratively with community representatives and leaders in the future.”
Govind Rao

'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

Toronto researcher 'manipulated' findings; Resigns from Women's College after disputed ... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20151027|232281686

from heather drugs pharmacare fraud research

shared by Govind Rao on 27 Oct 15 - No Cached
  • Toronto Star Tue Oct 27 2015 Page: A1
  • A senior physician at Women's College Hospital who has garnered international recognition for her research on osteoporosis "manipulated" data of a study published in a leading medical journal, according to an investigation by the facility.
  • Dr. Sophie Jamal, who until recently served as research director at the Centre for Osteoporosis and Bone Health, and the division head of endocrinology and metabolism at the hospital, misrepresented findings of a 2011 study published in the Journal of the American Medical Association, the hospital said after an investigation that wrapped up earlier this month.
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  • "There was unequivocal systematic manipulation of data on the part of this researcher," hospital president Marilyn Emery told the Star in an interview. The study in question found "significant" improvement in the bone density of post-menopausal women who applied nitroglycerine ointment to their arms every evening for two years.
  • "The findings were made to look more positive than they were," explained Dr. Paula Rochon, vice-president of research at Women's College. Jamal, an endocrinologist, resigned her clinical privileges at the hospital last month, prior to the conclusion of the probe. She stepped down from the senior positions she held at the facility last June.
  • She also recently resigned as an associate professor of medicine at the University of Toronto. JAMA, the most widely circulated medical journal in the world, is now considering whether to run a retraction. "JAMA is aware of the concern of Women's College and will make a decision about (a) retraction in the coming weeks," editor Dr. Howard Bauchner said in an email. Jamal declined an opportunity to comment through her lawyer, Jennifer McKendry. "We do not have instructions to make any comments on your story," McKendry said.
  • The investigation found there were no deficiencies in any institutional systems or processes at the hospital, which adheres to nationally accepted research standards. "Despite that, it is still very important that we look at how we can review everything that we are doing and how we can work to raise the bar to learn from this experience," Rochon said.
  • The hospital learned from the University of Toronto last March that something might be amiss with Jamal's research, and the two bodies together commenced an inquiry. A formal investigation was then launched in June. Some 243 post-menopausal women participated in the study, with some receiving the ointment and some receiving a placebo. They have been sent registered letters, informing them that they may have received inaccurate information about the research.
  • "There is no evidence of negative outcomes for any of these research participants," Emery said. Research papers published in JAMA are peer-reviewed. It's unclear how allegations of wrongdoing by Jamal first surfaced. U of T spokesperson Althea Blackburn-Evans said the university received an allegation of research misconduct, which it passed along to the hospital, where Jamal had her primary appointment. Asked if Dr. Jamal explained what happened with the research findings, Emery responded: "No, we haven't been in that kind of conversation with (her)."
  • However, Emery acknowledged there is pressure among researchers to get good results on studies and to get them published. "Having said that, there is pressure in many roles (and) we wouldn't be looking to that as a rationale necessarily," Emery said. Jamal has impressive credentials. She graduated from U of T's medical school in 1991 and specialized in general internal medicine. She then did a two-year post-doctoral fellowship in biostatistics and epidemiology at the University of California, San Francisco.
  • That was followed by the completion of a Ph.D. in clinical epidemiology at the University of Toronto. Jamal's research has also focused on the treatment of fractures among patients with impaired kidney function. She has been the first or senior author on about 50 published papers, some of which are editorials and the others systematic reviews. Most were done prior to her work at Women's College.
  • Asked if her previous work is now being called into question, Emery said that's a "natural question" and one the hospital is now reflecting upon with regard to any work done under the name of Women's College. Jamal's public profile on the website of the College of Physicians and Surgeons of Ontario shows her now working for the Appleby Medical Group on Lake Shore Blvd. W. in Toronto.
Irene Jansen

Research Canada / Recherche Canada » Health Research Caucus - 0 views

rc-rc.ca/...health-research-caucus

government federal

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Irene Jansen on 23 Jan 12
     
    The Health Research Caucus has been convened to provide the necessary forum to inform Members of Parliament about the importance of health research to the health and wealth of Canadians as well as the benefits of the health research industry's skilled and knowledgeable work force.
Govind Rao

Your smartphone will see you now; Apps that can track symptoms are among new ways of br... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20150728|225804364

from heather it

shared by Govind Rao on 28 Jul 15 - No Cached
  • Toronto Star Tue Jul 28 2015
  • Jody Kearns doesn't like to spend time obsessing about her Parkinson's disease. The 56-year-old dietitian from Syracuse, N.Y., had to give up bicycling because the disorder affected her balance. But she still works, drives and tries to live a normal life. Yet since she enrolled in a clinical study that uses her iPhone to gather information about her condition, Kearns has been diligently taking a series of tests three times a day. She taps the phone's screen in a certain pattern, records a spoken phrase and walks a short distance while the phone's motion sensors measure her gait. "The thing with Parkinson's disease is there's not much you can do about it," she said of the nervous-system disorder, which can be managed but has no cure. "So when I heard about this, I thought, 'I can do this.'"
  • Smartphone apps are the latest tools to emerge from the intersection of health care and Silicon Valley, where tech companies are also working on new ways of bringing patients and doctors together online, applying massive computing power to analyze DNA and even developing ingestible "smart" pills for detecting cancer. More than 75,000 people have enrolled in health studies that use specialized iPhone apps, built with software Apple Inc. developed to help turn the popular smartphone into a research tool. Once enrolled, iPhone owners use the apps to submit data on a daily basis, by answering a few survey questions or using the iPhone's built-in sensors to measure their symptoms.
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  • Scientists overseeing the studies say the apps could transform medical research by helping them collect information more frequently and from more people, across larger and more diverse regions, than they're able to reach with traditional health studies. A smartphone "is a great platform for research," said Dr. Michael McConnell, a Stanford University cardiologist, who's using an app to study heart disease. "It's one thing that people have with them every day." While the studies are in early stages, researchers also say a smartphone's microphone, motion sensors and touchscreen can take precise readings that, in some cases, may be more reliable than a doctor's observations. These can be correlated with other health or fitness data and even environmental conditions, such as smog levels, based on the phone's GPS locator.
  • "Participating in clinical studies is often a burden," he explained. "You have to live near where the study's being conducted. You have to be able to take time off work and go in for frequent assessments." Smartphones also offer the ability to collect precise readings, Dorsey added. One test in the Parkinson's study measures the speed at which participants tap their fingers in a particular sequence on the iPhone's touchscreen. Dorsey said that's more objective than a process still used in clinics, where doctors watch patients tap their fingers and assign them a numerical score.
  • The most important is safeguarding privacy and the data that's collected, according to ethics experts. In addition, researchers say apps must be designed to ask questions that produce useful information, without overloading participants or making them lose interest after a few weeks. Study organizers also acknowledge that iPhone owners tend to be more affluent and not necessarily an accurate mirror of the world's population. Apple had previously created software called HealthKit for apps that track iPhone owners' health statistics and exercise habits. Senior vice-president Jeff Williams said the company wants to help scientists by creating additional software for more specialized apps, using the iPhone's capabilities and vast user base - estimated at 70 million or more in North America alone. "This is advancing research and helping to democratize medicine," Williams said in an interview.
  • Apple launched its ResearchKit program in March with five apps to investigate Parkinson's, asthma, heart disease, diabetes and breast cancer. A sixth app was released last month to collect information for a long-term health study of gays and lesbians by the University of California, San Francisco. Williams said more are being developed. For scientists, a smartphone app is a relatively inexpensive way to reach thousands of people living in different settings and geographic areas. Traditional studies may only draw a few hundred participants, said Dr. Ray Dorsey, a University of Rochester neurologist who's leading the Parkinson's app study, called mPower.
  • Others have had similar ideas. Google Inc. says it's developing a health-tracking wristband specifically designed for medical studies. Researchers also have tried limited studies that gather data from apps on Android phones. But if smartphones hold great promise for medical research, experts say there are issues to consider when turning vast numbers of people into walking test subjects.
  • Some apps rely on participants to provide data. Elizabeth Ortiz, a 48-year-old New York nurse with asthma, measures her lung power each day by breathing into an inexpensive plastic device. She types the results into the Asthma Health app, which also asks if she's had difficulty breathing or sleeping, or taken medication that day. "I'm a Latina woman and there's a high rate of asthma in my community," said Ortiz, who said she already used her iPhone "constantly" for things such as banking and email. "I figured that participating would help my family and friends, and anyone else who suffers from asthma."
  • None of the apps test experimental drugs or surgeries. Instead, they're designed to explore such questions as how diseases develop or how sufferers respond to stress, exercise or standard treatment regimens. Stanford's McConnell said he also wants to study the effect of giving participants feedback on their progress, or reminders about exercise and medication. In the future, researchers might be able to incorporate data from participants' hospital records, said McConnell. But first, he added, they must build a track record of safeguarding data they collect. "We need to get to the stage where we've passed the privacy test and made sure that people feel comfortable with this."
  • Toward that end, the enrolment process for each app requires participants to read an explanation of how their information will be used, before giving formal consent. The studies all promise to meet federal health confidentiality rules and remove identifying information from other data that's collected. Apple says it won't have access to any data or use it for commercial purposes.
  • Elizabeth Ortiz uses the Asthma Health smartphone app to track her condition. • Richard Drew/the associated press
Irene Jansen

Home care nursing health human resources NHSRU Dec 2011 - 0 views

www.nhsru.com/...ng-a-quality-nursing-workforce

home care nursing utilization

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Determine how decisions, on the utilization and allocation of Registered Nurses (RNs) and Registered Practical Nurses (RPNs), are currently being made in Ontario home care provider agencies; investigate the feasibility of, and provide input into, the development of an RN/RPN Utilization Toolkit for the home care sector.
  • Compile a detailed demographic profile of nurses working in the home care sector and identify areas of concern/strength related to current trends in the home care nursing workforce.
  • Evaluate the unique challenges of attracting and retaining early, mid and late career nurses to the home care sector and describe factors or policy initiatives that may be instrumental in attracting new graduates to community nursing as an employment choice.
  • Irene Jansen on 23 Jan 12
     
    Research Team Diane Doran, RN, PhD, FCAHS Dan Laporte, Research Manager, NHSRU Sang Nahm, Data Analyst, NHSRU Laureen Hayes, Research Officer, NHSRU Roshan Khan, Research Officer, NHSRU
Govind Rao

Harper, the economic meddler. Who knew?; Record sums to provinces for health care, bail... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150917|229446679

from heather medicare federal election

shared by Govind Rao on 17 Sep 15 - No Cached
  • The Globe and Mail Thu Sep 17 2015
  • kyakabuski@globeandmail.com Canadians should have known when they elected a Conservative government, especially one led by such a notorious small-government crusader as Stephen Harper, that it would mean an implacable withdrawal of the state from the economy. Nine years on, the results are in.
  • The Harper government wasted no time after its 2006 election disembowelling the federal state, forcing the provinces and private sector to sink or swim. This wholesale retreat showed up in the 2007 budget, with its record cash transfers to the provinces for health care and a boost to the equalization program, which was such an unexpected bonus for then-Quebec premier Jean Charest that he turned around and awarded Quebec voters a $700million income-tax cut. Mr. Harper, the fiscal taskmaster, stuck to his ideological guns during the Great Recession with a $63-billion stimulus program, supplemented by the $9.1-billion that Ottawa contributed to the bailouts of General Motors and Chrysler. The cuts just kept coming as his government nearly tripled non-stimulus-related infrastructure spending to $5-billion from $1.7-billion annually, with an additional $1-billion a year promised for public transit in the April budget.
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  • And what can be said of Mr. Harper's contempt for Canadian scientists? Under his rule, federal expenditures on university research have put Canada near the top of the global rankings for publicly funded research and development. The Conservative Leader clearly believes the state has no place in basic research. Why else would his government give the Canadian Institutes of Health Research $1-billion a year, or provide the Canadian Foundation for Innovation with $1.3-billion to support research infrastructure at postsecondary institutions and hospitals?
  • Mr. Harper's war on state-funded science includes the $243-million he has promised to fund Canada's participation in the Thirty Meter Telescope project; the extra $45-million awarded this year to the TRIUMF cyclotron particle accelerator; the $105-million committed to enable scientists to collaborate on research through the CANARIE cloud-computing network; and the $15-million promised to the Council of Canadian Academies to conduct "science-based assessments." The GM and Chrysler bailouts set the tone for the Harper government's hard line on corporate welfare. It has been a dry well ever since. Most recently, this unyielding insensitivity toward the pleas of manufacturers has manifested itself in a $300-million loan to Pratt & Whitney Canada to develop jet engines and a $60-million loan to Toyota to upgrade two auto plants in Ontario.
  • The Harper Tories have shown their disdain toward the Liberal fetish for picking winners by boosting (after renaming) a smorgasbord of industrial policy slush funds, including the $1-billion Strategic Aerospace and Defence Initiative and the Automotive Innovation Fund. The latter's $250-million annual kitty was increased to $500-million a year for two years in the 2014 budget. The Harper government's clean-tech fund, Sustainable Development Technology Canada, has doled out $740-million so far, with hundreds of millions more still to go out the door. No wonder the Liberals and New Democrats have been calling for the state to re-engage with business to boost Canadian innovation. After all, the Tories abdicated their responsibility in this area by conducting the most comprehensive review of federal support for private-sector research in decades and implementing the main recommendations of a 2011 expert panel's report on the matter. The Scientific Research and Experimental Development Tax Credit, which cost $3.5-billion annually and had been subject to much abuse, was scaled back by about $500million - with most of the savings plowed into direct grants to businesses, just as the experts ordered.
  • It's debatable whether any of this largesse has made Canada's economy more competitive or innovative. No amount of state support can compensate for a lack of vision or guts among businesses. It's not for a lack of trying by Ottawa that innovation policies that seem to work elsewhere aren't replicable here. The state can go only so far to substitute for the private sector's listlessness. To wit, firms in the oil patch are reacting to tough times by cutting R&D, which is exactly the opposite of what they should be doing right now. They should know only innovation can save them.
  • Now, Liberal Leader Justin Trudeau is vowing to "invest in Canada" by doubling infrastructure spending, while NDP Leader Thomas Mulcair promises to be a "champion" of manufacturing (subsidies). They have big shoes to fill. Both would be hard-pressed to outdo Mr. Harper, who, if you haven't gleaned by now, has turned out to be as much of a meddler as any Liberal who preceded him.
Heather Farrow

Indigenous health: Time for top-down change? - 0 views

www.cmaj.ca/E247

aboriginal cma

shared by Heather Farrow on 08 Aug 16 - No Cached
  • CMAJ August 9, 2016 vol. 188 no. 11 First published July 4, 2016, doi: 10.1503/cmaj.109-5295
  • Lauren Vogel
  • A year after the Truth and Reconciliation Commission’s call to action, public health experts say indigenous health won’t improve without major system change. Last June, the commission issued a comprehensive treatment plan for healing the trauma inflicted on indigenous communities under Canada’s residential schools system — but not much has happened. Eight of the commission’s 94 recommendations directly addressed health care. So what’s the hold up on high-level change?
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  • That question dominated the recent Public Health 2016 conference in Toronto. Speakers described persistent inequity and inaction across the health system, from research to medical training to hospital care. “The common response is to deny that the problem lies in the structures,” said Charlotte Loppie, director of the Centre for Indigenous Research and Community-led Engagement at the University of Victoria in British Columbia.
  • She argued that it’s a mistake to see “colonization” as something that happened in the past. “It’s about the control that some people have over other people, which obviously continues today in the health policies and programs that are developed and expanded on indigenous communities, rather than with those communities.”
  • Research Loppie spoke at a panel hosted by the Canadian Institutes of Health Research (CIHR), which faced criticism in February for awarding less than 1% of funding to Aboriginal health projects in its first major competition since restructuring. “We know we have to work to get this right and get this better and I think we’re learning as we go,” said Nancy Edwards, scientific director of the Institute of Population and Public Health at CIHR.
  • According to Edwards, Aboriginal health is now a “standing item” at science council meetings, which bring together CIHR top brass every four to six weeks. There has also been “a lot of consultation” with indigenous researchers and communities. There isn’t a single barrier standing in the way. “It’s not that simple,” she said.
  • Speakers at the Canadian Public Health Association’s annual conference urged structural change to improve indigenous health.
  • Loppie said she considers Edwards an ally, but noted that CIHR has “a long way to go” to correct the disadvantage to Aboriginal health research under the new funding structure. “Change is a difficult point,” particularly at the most senior levels of administration, she said.
  • Medical education Australia’s experience integrating indi genous health education into medical training shows how change at that level can help transform a system. Australia’s version of a Truth and Reconciliation Commission recommended compulsory courses for all health professionals in 1989. But this didn’t become reality for doctors until 2006, when the Australian Medical Council set standards that the indigenous health training schools must provide.
  • With accreditation on the line, change was rapid and meaningful, said Janie Smith, a professor of innovations in medical education at Bond University in Australia. “If you don’t meet the standards, you can’t run your program, so it’s very powerful.” Bond’s medical program overhauled its case-based curriculum to include indigenous examples to teach core concepts. Students also complete a two-day cultural immersion workshop in first year and a remote clinical placement in fifth year.
  • “It’s a really important principle that this is the normal program and it’s funded out of the normal budget,” Smith said. Integration in core curriculum teaches students that cultural sensitivity is fundamental to being a good doctor, like understanding anatomy. It also protects indigenous health education from “toe cutters” when budgets are tight. Although Canadian medical schools are expanding their indigenous health content, some educators noted that it’s still peripheral to core training.
  • Lloy Wylie teaches medical students as an assistant professor of public health at Western University in London, Ontario. She recalled one indigenous health session that only a third of students attended. “When it’s voluntary, only the people who don’t need the training show up.”
  • Hospital care Wylie said she encountered the same indifference among some medical colleagues at Victoria Hospital in London, Ont., where she is appointed to the psychiatry department. “There are still some very unsettling things that I see going on in our hospital system.” She shared stories of “huge jurisdictional gaps” between the hospital and reserve, of patients with cancer denied adequate pain medication because of assumptions about addiction, and of health workers “woefully unaware” of indigenous culture and services.
  • People in the hospital weren’t even aware of the Aboriginal patient liaison that was in the hospital,” Wylie said. There are some recent bright spots; for example, British Columbia and Ontario are boosting cultural sensitivity training for health workers. But Wylie noted that the same workers “go back to institutions that are very culturally unsafe, so we need to look at changing those institutions as a whole.”
  • Brock Pitawanakwat, an assistant professor of indigenous studies at the University of Sudbury in Ontario, cited the importance of creating space for traditional healing alongside clinical care. In some cases, it’s a physical space: Health Sciences North in Sudbury has an on-site medicine lodge that provides traditional ceremonies and medicines.
  • These services are as much about healing mistrust as any physical remedy, Pitawanakwat said. “Going into a hospital after attending a residential school, there’s still that negative emotion,” he explained. “If you look at these buildings in archival photos, they’re almost identical.”
  • Wylie suggested that the fee-for-service model could also be changed to support physicians building better relationships with patients. “Anything we do to make our hospitals more welcoming places for Aboriginal people will be good for everybody,” she said. “Right now, they’re really alienating for everybody.”
Irene Jansen

Universal Drug Coverage lecture Hamilton Oct 5 2011 - 0 views

chepa.org/...ubject_of_Labelle_lecture.aspx

pharma conference

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  • Irene Jansen on 23 Jan 12
     
    22 Sep 2011 A researcher with expertise in pharmaceutical policy will describe how the changing market for generic drugs presents a unique opportunity for Canadian governments to introduce universal coverage, at the 20th Annual Labelle Lectureship. Michael Law, a faculty member with the Centre for Health Services and Policy Research at UBC, will be the guest lecturer at the event on Oct. 5, from 3 p.m. to 4:30 p.m. While Canadian medicare has historically provided universal first-dollar coverage for physician and hospital services, public coverage for prescription drugs is limited. This mix of public and private insurance left Canadians paying $4.6 billion out of their own pockets for prescription drugs last year. Law will share his recent research that estimates this expense resulted in more than two million Canadians not taking their medications as prescribed.
Irene Jansen

Senate Social Affairs Committee review of the health accord, Evidence, September 29, 2011 - 0 views

www.parl.gc.ca/...49055-e.htm

accord waits senate

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Christine Power, Chair, Board of Directors, Association of Canadian Academic Healthcare Organizations
  • eight policy challenges that can be grouped across the headers of community-based and primary health care, health system capacity building and research and applied health system innovation
  • Given that we are seven plus years into the 2004 health accord, we believe it is time to open a dialogue on what a 2014 health accord might look like. Noting the recent comments by the Prime Minister and Minister of Health, how can we improve accountability in overall system performance in terms of value for money?
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  • While the access agenda has been the central focal point of the 2004 health accord, it is time to have the 2014 health accord focus on quality, of which access is one important dimension, with the others being effectiveness, safety, efficiency, appropriateness, provider competence and acceptability.
  • we also propose three specific funds that are strategically focused in areas that can contribute to improved access and wait time
  • Can the 2014 health accord act as a catalyst to ensure appropriate post-hospital supportive and preventive care strategies, facilitate integration of primary health care with the rest of the health care system and enable innovative approaches to health care delivery? Is there an opportunity to move forward with new models of primary health care that focus on personal accountability for health, encouraging citizens to work in partnership with their primary care providers and thereby alleviating some of the stress on emergency departments?
  • one in five hospital beds are being occupied by those who do not require hospital care — these are known as alternative level of care patients, or ALC patients
  • the creation of an issue-specific strategically targeted fund designed to move beyond pilot projects and accelerate the creation of primary health care teams — for example, team-based primary health care funds could be established — and the creation of an infrastructure fund, which we call a community-based health infrastructure fund to assist in the development of post-hospital care capacity, coupled with tax policies designed to defray expenses associated with home care
  • consider establishing a national health innovation fund, of which one of its stated objectives would be to promote the sharing of applied health system innovations across the country with the goal of improving the delivery of quality health services. This concept would be closely aligned with the work of the Canadian Institutes of Health Research in developing a strategy on patient oriented research.
  • focus the discussion on what is needed to ensure that Canada is a high performing system with an unshakable focus on quality
  • of the Wait Time Alliance
  • Dr. Simpson
  • the commitment of governments to improve timely access to care is far from being fulfilled. Canadians are still waiting too long to access necessary medical care.
  • Table 1 of our 2011 report card shows how provinces have performed in addressing wait times in the 10-year plan's five priority areas. Of note is the fact that we found no overall change in letter grades this year over last.
  • We believe that addressing the gap in long-term care is the single more important action that could be taken to improve timely access to specialty care for Canadians.
  • The WTA has developed benchmarks and targets for an additional seven specialties and uses them to grade progress.
  • the lack of attention given to timely access to care beyond the initial five priority areas
  • all indications are that wait times for most specialty areas beyond the five priority areas are well beyond the WTA benchmarks
  • we are somewhat encouraged by the progress towards standardized measuring and public reporting on wait times
  • how the wait times agenda could be supported by a new health accord
  • governments must improve timely access to care beyond the initial five priority areas, as a start, by adopting benchmarks for all areas of specialty care
  • look at the total wait time experience
  • The measurements we use now do not include the time it takes to see a family physician
  • a patient charter with access commitments
  • Efficiency strategies, such as the use of referral guidelines and computerized clinical support systems, can contribute significantly to improving access
  • In Ontario, for example, ALC patients occupy one in six hospital beds
  • Our biggest fear is government complacency in the mistaken belief that wait times in Canada largely have been addressed. It is time for our country to catch up to the other OECD countries with universal, publicly funded health care systems that have much timelier access to medical care than we do.
  • The progress that has been made varies by province and by region within provinces.
  • Dr. Michael Schull, Senior Scientist, Institute for Clinical Evaluative Sciences
  • Many provinces in Canada, and Ontario in particular, have made progress since the 2004 health accord following large investments in health system performance that targeted the following: linking more people with family doctors; organizational changes in primary care, such as the creation of inter-professional teams and important changes to remuneration models for physicians, for example, having a roster of patients; access to select key procedures like total hip replacement and better access to diagnostic tests like computer tomography. As well, we have seen progress in reducing waiting times in emergency departments in some jurisdictions in Canada and improving access to community-based alternatives like home care for seniors in place of long-term care. These have been achieved through new investments such as pay for performance incentives and policy change. They have had some important successes, but the work is incomplete.
  • Examples of the ongoing challenges that we face include substantial proportions of the population who do not have easy access to a family doctor when needed, even if they have a family doctor; little progress on improving rates of eligible patients receiving important preventive care measures such as pap smears and mammograms; continued high utilization of emergency departments and walk-in clinics compared to other countries; long waits, which remain a problem for many types of care. For example, in emergency departments, long waits have been shown to result in poor patient experience and increased risk of adverse outcomes, including deaths.
  • Another example is unclear accountability and antiquated mechanisms to ensure smooth transitions in care between providers and provider organizations. An example of a care transition problem is the frequent lack of adequate follow-up with a family doctor or a specialist after an emergency department visit because of exacerbation of a chronic disease.
  • A similar problem exists following discharge from hospital.
  • Poorly integrated and coordinated care leads to readmission to hospital
  • This happens despite having tools to predict which patients are at higher risk and could benefit from more intensive follow-up.
  • Perverse incentives and disincentives exist, such as no adjustment in primary care remuneration to care for the sickest patients, thereby disincenting doctors to roster patients with chronic illnesses.
  • Critical reforms needed to achieve health system integration include governance, information enablers and incentives.
  • we need an engaged federal government investing in the development and implementation of a national health system integration agenda
  • complete absence of any mention of Canada as a place where innovative health system reform was happening
  • Dr. Brian Postl, Dean of Medicine, University of Manitoba, as an individual
  • the five key areas of interest were hips and knees, radiology, cancer care, cataracts and cardiac
  • no one is quite sure where those five areas came from
  • There was no scientific base or evidence to support any of the benchmarks that were put in place.
  • I think there is much less than meets the eye when we talk about what appropriate benchmarks are.
  • The one issue that was added was hip fractures in the process, not just hip and knee replacement.
  • in some areas, when wait-lists were centralized and grasped systematically, the list was reduced by 30 per cent by the act of going through it with any rigour
  • When we started, wait-lists were used by most physicians as evidence that they were best of breed
  • That continues, not in all areas, but in many areas, to be a key issue.
  • The capacity of physicians to give up waiting lists into more of a pool was difficult because they saw it very much, understandably, as their future income.
  • There were almost no efforts in the country at the time to use basic queuing theory
  • We made a series of recommendations, including much more work on the research about benchmarks. Can we actually define a legitimate benchmark where, if missed, the evidence would be that morbidity or mortality is increasing? There remains very little work done in that area, and that becomes a major problem in moving forward into other benchmarks.
  • the whole process needed to be much more multidisciplinary in its focus and nature, much more team-based
  • the issue of appropriateness
  • Some research suggests the number of cataracts being performed in some jurisdictions is way beyond what would be expected to be needed
  • the accord did a very good job with what we do, but a much poorer job around how we do it
  • Most importantly, the use of single lists is needed. This is still not in place in most jurisdictions.
  • the accord has bought a large amount of volume and a little bit of change. I think any future accords need to lever any purchase of volume or anything else with some capacity to purchase change.
  • We have seen volumes increase substantially across all provinces, without major detriment to other surgical or health care areas. I think it is a mediocre performance. Volume has increased, but we have not changed how we do business very much. I think that has to be the focus of any future change.
  • with the last accord. Monies have gone into provinces and there has not really been accountability. Has it made a difference? We have not always been able to tell that.
  • There is no doubt that the 2004-14 health accord has had a positive influence on health care delivery across the country. It has not been an unqualified success, but nonetheless a positive force.
  • It is at these transition points, between the emergency room and being admitted to hospital or back to the family physician, where the efficiencies are lost and where the expectations are not met. That is where medical errors are generated. The target for improvement is at these transitions of care.
  • I am not saying to turn off the tap.
  • the government has announced, for example, a 6 per cent increase over the next two or three years. Is that a sufficient financial framework to deal with?
  • Canada currently spends about the same amount as OECD countries
  • All of those countries are increasing their spending annually above inflation, and Canada will have to continue to do that.
  • Many of our physicians are saying these five are not the most important anymore.
  • they are not our top five priority areas anymore and frankly never were
  • this group of surgeons became wealthy in a short period of time because of the $5.5 billion being spent, and the envy that caused in every other surgical group escalated the costs of paying physicians because they all went back to the market saying, "You have left us out," and that became the focus of negotiation and the next fee settlements across the country. It was an unintended consequence but a very real one.
  • if the focus were to shift more towards system integration and accountability, I believe we are not going to lose the focus on wait times. We have seen in some jurisdictions, like Ontario, that the attention to wait times has gone beyond those top five.
  • people in hospital beds who do not need to be there, because a hospital bed is so expensive compared to the alternatives
  • There has been a huge infusion of funds and nursing home beds in Ontario, Nova Scotia and many places.
  • Ontario is leading the way here with their home first program
  • There is a need for some nursing home beds, but I think our attention needs to switch to the community resources
  • they wind up coming to the emergency room for lack of anywhere else to go. We then admit them to hospital to get the test faster. The weekend goes by, and they are in bed. No one is getting them up because the physiotherapists are not working on the weekend. Before you know it, this person who is just functioning on the edge is now institutionalized. We have done this to them. Then they get C. difficile and, before you know, it is a one-way trip and they become ALC.
  • I was on the Kirby committee when we studied the health care system, and Canadians were not nearly as open to changes at that time as I think they are in 2011.
  • there is no accountability in terms of the long-term care home to take those patients in with any sort of performance metric
  • We are not all working on the same team
  • One thing I heard on the Aging Committee was that we should really have in place something like the Veterans Independence Program
  • some people just need someone to make a meal or, as someone mentioned earlier, shovel the driveway or mow the lawn, housekeeping types of things
  • I think the risks of trying to tie every change into innovation, if we know the change needs to happen — and there is lots of evidence to support it — it stops being an innovation at that point and it really is a change. The more we pretend everything is an innovation, the more we start pilot projects we test in one or two places and they stay as pilot projects.
  • the PATH program. It is meant to be palliative and therapeutic harmonization
  • has been wildly successful and has cut down incredibly on lengths of stay and inappropriate care
  • Where you see patient safety issues come to bear is often in transition points
  • When you are not patient focused, you are moving patients as entities, not as patients, between units, between activities or between functions. If we focus on the patient in that movement, in that journey they have through the health system, patient safety starts improving very dramatically.
  • If you require a lot of home care that is where the gap is
  • in terms of emergency room wait times, Quebec is certainly among the worst
  • Ontario has been quite successful over the past few years in terms of emergency wait times. Ontario’s target is that, on average, 90 per cent of patients with serious problems spend a maximum of eight hours in the emergency room.
  • One of the real opportunities, building up to the accord, are for governments to define the six or ten or twelve questions they want answered, and then ensure that research is done so that when we head into an accord, there is evidence to support potential change, that we actually have some ideas of what will work in moving forward future changes.
  • We are all trained in silos and then expected to work together after we are done training. We are now starting to train them together too.
  • The physician does not work for you. The physician does not work for the health system. The physician is a private practitioner who bills directly to the health care system. He does not work for the CEO of the hospital or for the local health region. Therefore, your control and the levers you have with that individual are limited.
  • the customer is always right, the person who is getting the health care
  • It is refreshing to hear something other than the usual "we need more money, we absolutely need more money for that". Without denying the fact that, since the population and the demographics are going to require it, we have to continue making significant investments in health, I think we have to be realistic and come up with new ways of doing things.
  • The cuts in the 1990s certainly had something to do with the decision to cut support staff because they were not a priority and cuts had to be made. I think we now know it was a mistake and we are starting to reinvest in those basic services.
  • How do you help patients navigate a system that is so complex? How do you coordinate appointments, ensure the appointments are necessary and make sure that the consultants are communicating with each other so one is not taking care of the renal problem and the other the cardiac problem, but they are not communicating about the patient? That is frankly a frequent issue in the health system.
  • There may be a patient who requires Test Y, X, and Z, and most patients require that package. It is possible to create a one-stop shop kind of model for patient convenience and to shorten overall wait times for a lot of patients that we do not see. There are some who are very complicated and who have to be navigated through the system. This is where patient navigators can perhaps assist.
  • There have been some good studies that have looked at CT and MRI utilization in Ontario and have found there are substantial portions where at least the decision to initiate the test was questionable, if not inappropriate, by virtue of the fact that the results are normal, it was a repeat of prior tests that have already been done or the clinical indication was not there.
  • Designing a system to implement gates, so to speak, so that you only perform tests when appropriate, is a challenge. We know that in some instances those sorts of systems, where you are dealing with limited access to, say, CT, and so someone has to review the requisition and decide on its appropriateness, actually acts as a further obstacle and can delay what are important tests.
  • The simple answer is that we do not have a good approach to determining the appropriateness of the tests that are done. This is a critical issue with respect to not just diagnostic tests but even operative procedures.
  • the federal government has very little information about how the provinces spend money, other than what the provinces report
  • should the money be conditional? I would say absolutely yes.
Irene Jansen

York U research program to shed light on gender influences in senior care work | York M... - 1 views

news.yorku.ca/...influences-in-senior-care-work

ltc ally

shared by Irene Jansen on 04 Mar 13 - No Cached
  • will be supported by eight partner organizations
    • Irene Jansen
      Irene Jansen on 04 Mar 13
       
      CUPE is one of the partner organizations.
  • “LTC work is increasingly precarious, fast-paced and low paid and that leads to health implications.
  • Comparative studies exploring LTC working conditions among various provinces, as well as Canadian conditions in comparison with those in Germany, Sweden, Norway, the United Kingdom and the United States, are proposed as part of the five-year plan.
  • ...4 more annotations...
  • York University Professor Tamara Daly will lead a research program studying the gendered health impacts of performing paid and unpaid care work for seniors in long-term care (LTC) settings.
  • The professor has been awarded one of nine Canadian Institutes of Health Research (CIHR) research chairs in Gender Work and Health. The program, Working well: understanding how gender influences working conditions and health in long term care settings across Canada and internationally, will receive $800,000 in CIHR funding over five years
  • “Health care work is unhealthy and at times dangerous work, with the most challenging conditions prevailing in LTC settings. We don’t often talk about gender in LTC settings even though care work is primarily performed by women,” says Daly, a professor at the School of Health Policy and Management in York U’s Faculty of Health.
  • (Watch the video)
Irene Jansen

Healthy Workplaces for Health Workers in Canada: Knowledge Transfer and Uptake in Polic... - 0 views

www.longwoods.com/18668

safety health and safety hhr

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Abstract The World Health Report launched the Health Workforce Decade (2006-2015), with high priority given for countries to develop effective workforce strategies including healthy workplaces for health workers. Evidence shows that healthy workplaces improve recruitment and retention, workers' health and well-being, quality of care and patient safety, organizational performance and societal outcomes. Over the past few years, healthy workplace issues in Canada have been on the agenda of many governments and employers. The purpose of this paper is to provide a progress update, using different data-collection approaches, on knowledge transfer and uptake of research evidence in policy and practice, including the next steps for the healthy workplace agenda in Canada. The objectives of this paper are (1) to summarize the current healthy workplace initiatives that are currently under way in Canada; (2) to synthesize what has been done in reality to determine how far the healthy workplace agenda has progressed from the perspectives of research, policy and practice; and (3) to outline the next steps for moving forward with the healthy workplace agenda to achieve its ultimate objectives. Some of the key questions discussed in this paper are as follows: Has the existing evidence on the benefits of healthy workplaces resulted in policy change? If so, how and to what extent? Have the existing policy initiatives resulted in healthier workplaces for healthcare workers? Are there indications that healthcare workers, particularly at the front line, are experiencing better working conditions? While there has been significant progress in bringing policy changes as a result of research evidence, our synthesis suggests that more work is needed to ensure that existing policy initiatives bring effective changes to the workplace. In this paper, we outline the next steps for research, policy and practice that are required to help the healthy workplace agenda achieve its ultimate objectives. The early decades of the 21st century belong to health human resources (HHR). The World Health Report (World Health Organization [WHO] 2006) launched the Health Workforce Decade (2006-2015), with high priority given for countries to develop effective workforce strategies that include three core elements: improving recruitment, helping the existing workforce to perform better and slowing the rate at which workers leave the health workforce. In this recent report, retaining high-quality healthcare workers is discussed as a major strategic issue for healthcare systems and employers, and improving workplaces as a key strategy for achieving this goal. The workplace can act as either a push or pull factor for HHR. Heavy workloads, excessive overtime, inflexible scheduling, safety hazards, poor management and few opportunities for leadership and professional development are among the push factors that result in poor recruitment and retention of HHR. Evidence shows that healthy workplaces improve recruitment and retention, workers' health and well-being, quality of care and patient safety, organizational performance and societal outcomes. What are healthy workplaces? Based on existing definitions, there is not yet a standardized and comprehensive definition of healthy workplaces. In this paper, we define healthy workplaces as mechanisms, programs, policies, initiatives, actions and practices that are in place to provide the health workforce with physical, mental, psychosocial and organizational conditions that, in return, contribute to improved workers' health and well-being, quality of care and patient safety, organizational performance and societal outcomes (Griffin et al. 2006). Over the past few years, healthy workplace issues in Canada have been on the agenda of many governments and stakeholder organizations. Nationally and internationally, robust evidence has been accumulated on the impact of healthy workplaces on workers' health and well-being, quality of care, patient safety, organizational performance and societal outcomes. This evidence has provided guidance for governments and employers in terms of what should be done to make the workplace healthier for healthcare workers. Across Canada, many initiatives to improve the working conditions for HHR are currently under way, but the continuing concerns suggest that barriers remain. An assessment of the progress to date is necessary in order to inform the next steps for research, policy and practice.
  • Irene Jansen on 23 Jan 12
     
    Healthcare Papers 7(Sp) 2007: 6-25 Judith Shamian and Fadi El-Jardali
Irene Jansen

The Oprah effect and why not all scientific evidence is valuable - Science-ish - Maclea... - 0 views

www2.macleans.ca/...cientific-evidence-is-valuable

research methods

shared by Irene Jansen on 23 Jan 12 - No Cached
  • On the question of type, it’s important to differentiate between primary research (such as control studies and clinical trials) and secondary research (meta-analyses and systematic reviews). In the media, you often read about primary research, like this jewel from earlier this week: “Study touts new way to spot babies at risk for obesity.” Greenhalgh points to a useful “evidence hierarchy” that ranks the relative weight of research from highest to lowest: 1. Systematic reviews and meta-analyses 2. Randomised controlled trials with definitive results (confidence intervals that do not overlap the threshold clinically significant effect) 3. Randomised controlled trials with non-definitive results (a point estimate that suggests a clinically significant effect but with confidence intervals overlapping the threshold for this effect) 4. Cohort studies 5. Case-control studies 6. Cross sectional surveys 7. Case reports
Irene Jansen

Evidence Network - the latest evidence on controversial health policy issues - CIHR / MHRC - 0 views

EvidenceNetwork.ca

research fromdelicious

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Irene Jansen on 23 Jan 12
     
    a non-partisan web-based project funded by the Canadian Institutes of Health Research and the Manitoba Health Research Council to make the latest evidence on controversial health policy issues available to the media. This site links journalists with heal
Irene Jansen

The worst of both worlds: high drug prices, low R&D - The Globe and Mail - 0 views

www.theglobeandmail.com/...article2324591

drugs research patents spending sustainability

shared by Irene Jansen on 04 Feb 12 - No Cached
  • Canadians are among the biggest consumers of pharmaceuticals in the world, the costs for which are also among the highest in the world.
  • And yet, despite these consumption and cost patterns, coupled with patent protection for brand-name pharmaceuticals, Canada lags way behind in the volume of research and development.
  • In exchange for expanded patent protection in 1987 (bringing Canada into conformity with international norms), Canada’s Research-Based Pharmaceutical Companies pledged to increase their ratio of R&D to sales to 10 per cent by 1996. These brand-name companies did that, and more. By 1996, the ratio had jumped to 12.3 per cent. The next year, it hit a record 12.7 per cent. The ratio has been declining ever since; it dipped below 10 per cent in 2004 and slumped to 8.2 per cent in 2010.
  • ...13 more annotations...
  • But their specific commitment ran out in 1996. Worse for them, some of the patents on big blockbuster drugs have begun to expire.
  • So the companies try to rearrange the chemical formulas in products and seek patents for drugs very similar to the ones losing patent protection.
  • prices fall
  • In addition, the PMPRB regulates prices such that patented drug prices can’t grow by more than the consumer price index over a three-year period.
  • When drugs lose their patents, generics replace them – sometimes produced directly by the brand-name companies or under contract, more often by a generic drug company.
  • With prices held down by the PMPRB and patented drugs losing market share, it’s hard to explain why drugs cost so much. Part of it relates to the absurd Canadian system whereby each province negotiates prices; part of it is because drug use overall has skyrocketed; and part of it is tied to these new patents for drugs being not very different from the previously patented ones. Drug expenditures in Canada from 2000 to 2008 grew at twice the growth in the economy (6.4 per cent), faster than anywhere else.
  • While sales rise, R&D declines. The ratio of R&D to sales rose from 2000 to 2008 in France, Germany, Italy, Switzerland, the United States and Britain, but fell in Canada.
  • Countries with pharmaceutical head offices definitely get more R&D than branch plant countries such as Canada.
  • In some of these countries with much greater R&D, patented drug prices are below those in Canada, meaning that no link exists between research intensity and domestic prices.
  • Canada has the worst of both worlds: high prices, internationally speaking, with a low R&D intensity
  • Brand-name drug companies have been extensive users of the research tax credits on offer from federal governments (augmented sometimes by provincial ones). These have come under assault from two federal studies into Canada’s lagging innovation. It would appear the Harper government is prepared to shake up this credit
  • country is being short-changed relative to what it pays for drugs, how it protects them under patent, and compared with what happens in comparable countries
  • And in case anyone rushes to the defence of generic (off-patent) drug companies, Canadians pay among the highest prices for generic drugs in the world
Govind Rao

Make universal dental care an election priority - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|vitc|20150719|225173880

from heather dental health medicare research

shared by Govind Rao on 21 Jul 15 - No Cached
  • Times Colonist (Victoria) Sun Jul 19 2015
  • As Canadians, we are justifiably proud of our universal publicly funded medicalcare system where nobody has to lose their home to get an operation. But is it truly universal? The Canada Health Act that enshrines our accessible health-care system states: "It is hereby declared that the primary objective of Canadian health-care policy is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers."
  • But dental care is not covered under the Canada Health Act. Surely proper medical care of our teeth and gums is an essential health service. It is time for us to resurrect the fighting spirit of Tommy Douglas and demand that our leaders bring in universal dental care. The need for universal dental care pivots around one important fact: Everything that happens in our mouths affects every other area of our bodies. When it comes to human health and care, they cannot be separated. The oral cavity, teeth and the rest of the body are all fed by the same blood and oxygen and controlled by the same nervous system. Any infection or harmful bacteria in our teeth and gums gets distributed to many corners of our bodies. Since what happens in our teeth and gums is intimately involved in all aspects of our overall health, it makes no logical or scientific sense to have national health care that provides universal access to medical treatment for every tissue and organ in our bodies - but just not for the teeth or gums.
  • ...4 more annotations...
  • New research points to a close relationship between our oral and overall health. In Oral Health in America: A Report of the Surgeon General published by the U.S. National Institute of Dental and Craniofacial Research, the authors conclude that "the oral cavity is a portal of entry as well as the site of disease for microbial infections that affect general health status." And: "Animal and population-based studies have demonstrated an association between periodontal diseases and diabetes, cardiovascular disease, stroke and adverse pregnancy outcomes." My own experience getting total knee-replacement surgery offers indisputable proof of that all-important connection between mouth and body. And the inherent risk to my overall health from the lack of dental medicare proved undeniable. An abscess under my crown went untreated because I could not afford to properly replace the tooth once it was extracted.
  • Due to the infection, my kneereplacement surgery was postponed because the bacteria from the gum and tooth infection could have wreaked havoc on the surgery site, destroying any chance of a new knee now or in the future. So I had the tooth and infection removed and my surgery was rescheduled. I chose a better life and being able to walk again over worrying about an unsightly hole in my mouth. But why should I have to choose?
  • I am immensely grateful that the medical costs of replacing both my knees are covered. But when an infection in my tooth and gums adversely impacts this lifechanging surgery, it seems unbelievably obtuse and ludicrous that there is no universal medical coverage for my mouth. That is like trying to purify and clean a jug of water while ignoring a small patch of toxic material floating on the top. Brushed Aside: Poverty and Dental Care in Victoria, A Report
  • from the Vancouver Island Public Interest Research Group by University of Victoria researcher Bruce B. Wallace raises important questions: Are Canadians - regardless of income - entitled to basic health care, including basic oral health care? Why do we disconnect the jaw from the body? A person's dental health affects their whole health status, and yet we refuse to treat it. In Canada, while we pride ourselves on our provision of universal health care, we exclude oral health. As a society we are agreeing to not provide basic health care to a significant part of our population." Let's show the world that we know how to take care of each other. Universal dental care should get top billing in the fall federal election campaign. Doreen Marion Gee is a Victoria writer and activist.
Govind Rao

Fired B.C. health researchers pen letter demanding inquiry - British Columbia - CBC News - 0 views

www.cbc.ca/...er-demanding-inquiry-1.3125804

from heather bc pharmacare drugs fraud

shared by Govind Rao on 29 Jun 15 - No Cached
  • We believe that the strength of democracy depends on unbiased evidence,' say researchers
  • Jun 24, 2015
  • University of Victoria PhD candidate Roderick MacIsaac, committed suicide three months after he was fired by the B.C. government.
  • ...1 more annotation...
  • Seven health researchers fired by the B.C. government, and the sister of an eighth who killed himself after he was fired, have banded together to demand a public inquiry into the case. The group has written an open letter to Health Minister Terry Lake demanding an inquiry into what happened. It's believed to be the first joint statement by the researchers since their termination in 2012.
Govind Rao

Fired health workers call for inquiry; Group representing eight former ministry employe... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150624|223421268

from heather bc pharmacare drugs drug

shared by Govind Rao on 24 Jun 15 - No Cached
  • The Globe and Mail Wed Jun 24 2015
  • B.C. Health Minister Terry Lake needs to call an independent inquiry into the firing of eight ministry workers because the ongoing scandal has undermined the public's confidence in the safety of prescription medications, the fired workers say.
  • Speaking in a collective voice for the first time since they were fired in 2012, seven of the employees - along with the sister of a fired researcher who killed himself - said the mass dismissal interrupted their independent research to ensure quality in prescription drugs, a program they say has saved taxpayers millions of dollars annually.
  • ...11 more annotations...
  • The inquiry should seek to understand, and to remedy, how a painstakingly built program to bring evidence to prescribing could be undone so quickly and, based on the government's own public statements, mistakenly," they say in an open letter to Mr. Lake. "It should recommend how to restore public confidence that the government is fully engaged in ensuring the safety and effectiveness of prescription medicines."
  • The provincial government has apologized for the firings and acknowledged it overreacted to a data breach involving patient information. An independent review could not determine who was responsible for the firings or why they occurred.
  • The health ministry staff and contractors were helping an independent agency called the Therapeutics Initiative develop evaluations of the effectiveness and safety of prescription drugs
  • The information was used to determine if those pharmaceuticals should be eligible for coverage under the publicly funded PharmaCare program. Last week, Mr. Lake said he is still trying to find a way to release more information about what happened, but is constrained by privacy laws and a wrongful dismissal lawsuit.
  • On Tuesday, Finance Minister Mike de Jong said a public inquiry would be too expensive, costing "millions upon millions of dollars." "The desire to ensure that employees are being treated fairly and that there are proper processes in place to guarantee that fact is not, in my view, dependent upon a public inquiry," Mr. de Jong told reporters.
  • In their letter, the workers dismissed the argument that B.C.'s privacy laws are a barrier to an independent inquiry, noting that the B.C. Freedom of Information and Protection of Privacy Act excludes public servants from privacy protection in matters concerning accountability for official actions.
  • They also argue that the cost would be recouped if the inquiry led to a complete renewal of the government's commitment to scrutinizing prescription drugs. Although they are not calling specifically for a full public inquiry, they said the review should be independent, with the authority to call witnesses under oath, and provide funding to cover the legal costs of participants.
  • "We share the concern about additional costs," they wrote, but said the province would benefit from better health care and lower costs if it can fully restore its drug research efforts.
  • "Our work ... enabled BC PharmaCare to improve prescribing safety and save over $100-million in the past 20 years by not covering drugs that were later confirmed in other jurisdictions to have caused harm to patients and massive wastage of expenditures."
  • The workers were suspended and then fired, and left under a cloud for three years after the government said the data breach was so serious that it warranted an RCMP investigation. However, internal e-mails show the RCMP probe, although still not formally closed, never went far.
  • One of the researchers, Roderick MacIsaac, killed himself after being interrogated by government officials and fired just two days before the end of his student co-op term. His sister Linda Kayfish signed the letter on his behalf. The other workers are Ramsay Hamdi, Robert Hart, Malcolm Maclure, Rob Mattson, David Scott, and Rebecca and William Warburton.
Govind Rao

Health care under attack in Quebec; Why the Trudeau government must act now to save hea... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|shrc|20151116|233774979

from heather quebec privatization private clinics

shared by Govind Rao on 16 Nov 15 - No Cached
  • The Record (Sherbrooke) Mon Nov 16 2015
  • The people of Quebec will only benefit from a universal, free and comprehensive health-care system if there is strong and swift intervention by the federal government. Otherwise, Quebec will likely be the first province to slip out of the Canadian health care scheme. In fact, Quebec's current health care laws and practices do not respect the principles set out in the Canada Health Act. During the past decade, the core principle of health care - that medically necessary care should be universally covered and paid through public funds - has gradually eroded in Quebec. The process has been a slow but steady sum of small legislative changes that have benefited practitioners over patients. The result has been governmental tolerance for grey-zone billing practices and impressive fee-charging creativity from medical entrepreneurs.
  • The turning point was probably the Supreme Court of Canada Chaoulli ruling in 2005. The decision said that prohibiting private medical insurance was a violation of the Quebec Charter of Human Rights and Freedoms, particularly in light of long wait times for some health services. The ruling has fed steady development and acceptance of a two-tier health care system in Quebec. The expectation that medically necessary care will be free in Quebec is less and less warranted. Some specialists in public hospitals propose faster access to their patients - for a fee - or less invasive interventions through their for-profit clinics. In such clinics, doctors are still paid by Quebec's public health insurance, but patients are often billed for the rental of the surgery room, for local anesthetics or for access to more advanced technologies. hile officially illegal, such practices are widespread. Stories abound about W eye drops or anesthetics that cost the clinics cents being billed to patients for hundreds of dollars.
  • ...3 more annotations...
  • This clearly puts the doctors involved in a conflict of interest. In a health system experiencing a significant shortage of practitioners, medical resources are drained from public hospital-based "free" care and into private purses. It also ties health care quality and accessibility to a patient's wealth - precisely what the Canada Health Act tries to prevent. For example, Montreal Children's Hospital - one of Montreal's two pediatric university hospitals - has decided to stop offering many medically necessary services. Instead, it will direct some patients to a new outpatient clinic. There, parents may be billed for such services as dermatology, endocrinology, general pediatrics and other important specialized care.
  • This steady disintegration of the principles of health care could soon be irreversible. Premier Philippe Couillard's new Bill 20 will legalize direct patient billing for medically necessary services provided outside of hospitals. The provincial government is confident that Ottawa won't intervene to enforce the Canada Health Act in Quebec (the federal government hasn't intervened in the past decade). Bill 20 makes legal practices that were grey-zone breaches in the universal public health system. This is creates a parallel, legal private health-care system subsidized by public health insurance. This could be the final blow to health care in Quebec. An unhealthy coalition - the Couillard government, private clinic owners, medical federations, private insurers and even some hospital administrators - is irresistibly pushing to decrease the care offered in public institutions and to increase the market share of direct payment and privately insured services. The only chance to save health care in Quebec is direct intervention by the federal government. Prime Minister Justin Trudeau and federal Health Minister Jane Philpott must enforce the Canadian Health Act in Quebec, even cutting federal health transfers until the province conforms.
  • Doing anything less will mean access to care according to a Quebec patient's wealth, rather than their needs. Astrid Brousselle is a professor in the Community Health Department, and researcher at the Centre de recherche de l'Hopital Charles-LeMoyne, Universite de Sherbrooke and Canada Research Chair in Evaluation and Health System Improvement. Damien Contandriopoulos is a professor in Nursing and a researcher at the Public Health Research Institute at University of Montreal (IRSPUM). CIHR Research Chair in Applied Public Health.
Govind Rao

College denies being lax on accessory fees - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=ar|7482594|mtgz|20151216|235953740

from heather user fees quebec private clinics privatization

shared by Govind Rao on 16 Dec 15 - No Cached
  • Montreal Gazette Wed Dec 16 2015
  • The Quebec College of Physicians is defending itself against charges by two researchers that the professional order has been lax on the growing use of accessory fees in private clinics. The researchers, Guillaume Hébert and Jennie-Laure Sully, accused the College of failing to crack down on abusive fees that some physicians in private practice are billing patients.
  • "Over the years, doctors have gradually inflated the amounts they charge to the point of demanding significant sums from their patients for unjustified reasons," they wrote in a research paper published by the Institut de recherche et d'informations socio-économiques (IRIS). "After years of procrastination, the College of Physicians clarified its code of ethics by reminding Quebec physicians that they cannot place themselves above the law. Despite this directive, doctors have continued to impose accessory fees and the College did not choose to enforce its own code of ethics, preferring instead to negotiate reimbursements for patients who have made complaints."
  • ...6 more annotations...
  • The Quebec government has negotiated with the medical federations a list of fees that are permitted, such as the use of liquid nitrogen to remove moles ($10) or the use of a topical anesthetic for a minor eye wound (also $10). Over the years, many physicians in private practice have started billing for many more items and services, occasionally prompting investigations by the Régie de l'assurance maladie du Québec (RAMQ).
  • In a statement made public Tuesday, College president Charles Bernard countered that the researchers based their conclusions on "impressions and partial data ... without taking the time to analyze in depth an issue so complex." Bernard noted that the College produced a report on accessory fees in 2011, and in January, it modified its code of ethics warning doctors that they cannot bill patients "disproportionately high" fees and that they must produce detailed invoices.
  • In April, the College called on the provincial government to modernize its system of accessory fees. In November, the National Assembly adopted Law 20, which gave the health minister the power to expand the range of fees now charged in private practice and to limit certain amounts. "We need to calibrate the expectations of pressure groups that would wish that the College - through its code of ethics - defend the public coverage of fees for medical services," Bernard added.
  • The number of Quebecers filing complaints about excessive fees soared by 374 per cent during the past five years, according to a report by the College in April. The complaints jumped from 31 in 2010-11 to 147 in 2014-15. To date, two cases over abusive fees have gone before the College's disciplinary board. In one of those cases, a Westmount physician was fined $10,000 in 2013 for charging patients "excessive and unjustified fees."
  • An Oct. 1 report by Quebec's Ombudsman found that some private clinics have billed patients $300 for eye drops; $100 to freeze offa wart; $40 to apply a four-centimetre bandage; and $200 to insert an intrauterine device. aderfel@montrealgazette.com Twitter.com/Aaron_Derfel
  • Dr. Charles Bernard, left, president of the Quebec College of Physicians, seen at a February news conference with college secretary Dr. Yves Robert, says researchers based their conclusions about accessory fees on "impressions and partial data."
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