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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.
  • 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.
  • 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.
  • 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

Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Inc... - 1 views

www.plosmedicine.org/...10.1371%2Fjournal.pmed.1001244

privatization quality costs excellent

shared by Irene Jansen on 31 Mar 13 - No Cached
  • Studies evaluated in this systematic review do not support the claim that the private sector is usually more efficient, accountable, or medically effective than the public sector
  • Irene Jansen on 31 Mar 13
     
    Summary by Anna Marriott, Oxfam Access and responsiveness * Studies that measured utilization by income levels tended to find the private sector predominately serves the more affluent. In Colombo, Sri Lanka, where a universal public health service exists, the private sector provided 72% of childhood immunisations for the wealthiest, but only 3% for the poorest. * Waiting times are consistently reported to be shorter in private facilities and a number of studies found better hospitality, cleanliness and courtesy and availability of staff in the private sector. Quality * Available studies find diagnostic accuracy, adherence to medical management standards and prescription practices are worse in the private sector. * Prescribing subtherapeutic doses, failure to provide oral rehydration salts, and prescribing of unnecessary antibiotics were more likely in the private sector, although there were exceptions. * Higher rates of potentially unnecessary procedures, particularly C-sections, were reported at private facilities. In South Africa for example, 62% of women delivering in the private sector had C-sections, compared with 18% in the public sector. * Two country studies found a lack of drug availability and service provision at public facilities, while surveys of patients' perceptions on care quality in the public and private sector provided mixed results. Patient outcomes * Public sector provision was associated with higher rates of treatment success for tuberculosis and HIV as well as vaccination. In South Korea for example, TB treatment success rates were 52% in private and 80% in public clinics. Similar figures were found for HIV treatment in Botswana. Accountability, transparency and regulation * While national statistics collected from public sector clinics vary considerably in quality, private healthcare systems tended to lack published data on outcomes altogether. Public-private partnerships also lacked data. * Several reports ob
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

More spent on taxes than food, shelter and clothing - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|wifp|20150828|228050643

from heather taxes privatization medicare

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  • Winnipeg Free Press Fri Aug 28 2015
  • CANADIANS spend more on taxes than on food, clothing and shelter combined, according to a study released Thursday. The study by the Fraser Institute shows the average Canadian family spent 42.1 per cent of its income on taxes while 36.6 per cent went to the combined basic necessities of food, clothing and shelter. In its study, the non-partisan, public policy think-tank looked at an average family in Canada earning $79,010 in 2014. While 42.1 per cent of that income went to taxes, just 21 per cent was spent on shelter, 11 per cent on food and five per cent on clothing.
  • That translated to $33,272 in total taxes compared to $28,887 on food, clothing and shelter combined. "With growth in the total tax bill outpacing the cost of basic necessities, taxes now eat up more family income, so families have less money available to spend, save or pay down household debt," Charles Lammam, director of fiscal studies at the Fraser Institute and co-author of the study, said in a statement. However, a community advocate cautions people should remember taxes cover programs such as health care that would have to be paid by families as necessities if those programs didn't exist. "There's no question we're paying far more in taxes, but what tends to be really misleading is to state that we are paying more in taxes than we are paying in necessities in life when you take into account medicare because that's part of the reasons taxes went up after 1961," said Harold Dyck, a community social-assistance advocate with Winnipeg Harvest, referring to Canada establishing its universal health-care program. A key focus of the study was a comparison of taxes paid in 2014 by families with taxes paid by families in 1961. It found an average family's tax bill has risen 1,886 per cent in the past 53 years while average income increased by 1,480 per cent, a slower rate than taxes.
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  • In 1961, the scales tipped the other way as the average family spent 33.5 per cent on taxes and 56.5 per cent on food, clothing and shelter. "Over the past five decades, the tax bill for the average Canadian family has ballooned, and now the amount of money going to taxes is greater than what's spent on life's basic necessities," Lammam said in a statement. The study noted the total tax bill considered reflected "both visible and hidden taxes families pay to the federal, provincial and local governments, including income taxes, payroll taxes, sales taxes, property taxes, health taxes, fuel taxes, alcohol taxes and more." Dyck said it is necessary to consider the 1961 date as the baseline for the comparison to get a clearer picture.
  • "From 1961 back, we did not have a national medicare program. Since then we have, and that is definitely part of our tax dollars. We now have free access to this necessity of life, medical care," he said. "A portion of that tax burden needs clarification so people aren't left with the impression that this (tax dollars) goes into some netherworld where we never see anything coming back to us," Dyck said. "It (the study) is a subtle way to get people's ire up that we want taxes cut, cut, cut without asking what does that mean and how would that impact Canadians in the end? What services are we going to lose? There are many other things you can consider necessities. Taxes pay for our highways and roads, hospitals, education system, all these things that should also be considered necessities."
  • The study showed average families in 1961 earned an average of $5,000 and paid taxes worth $1,675. In the past 53 years, the average family's tax bill increase of 1,886 per cent outpaced price increases to food (561 per cent), clothing (819 per cent) and shelter (1,366 per cent). Dyck said the focus should be on where the waste takes place in use of tax dollars and ways to reduce that waste. The study also found the percentage of income used to pay taxes has risen steadily since 2008 when 40.9 per cent of income was spent on taxes. ashley.prest@freepress.mb.ca
Irene Jansen

Healthcare Policy, 7(1) 2011: 68-79 Population Aging and the Determinants of Healthcar... - 0 views

www.longwoods.com/...22525

demographics spending

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    • Irene Jansen
      Irene Jansen on 23 Jan 12
       
      Rising hospital expenses, use of specialists threaten system; Aging population accounts for one third of increase, says UBC study Vancouver Sun Tue Aug 30 2011 Page: A4 Section: Westcoast News Byline: Matthew Robinson 
  • We found that population aging contributed less than 1% per year to spending on medical, hospital and pharmaceutical care. Moreover, changes in age-specific mortality rates actually reduced hospital expenditure by –0.3% per year. Based on forecasts through 2036, we found that the future effects of population aging on healthcare spending will continue to be small. We therefore conclude that population aging has exerted, and will continue to exert, only modest pressures on medical, hospital and pharmaceutical costs in Canada. As indicated by the specific non-demographic cost drivers computed in our study, the critical determinants of expenditure on healthcare stem from non-demographic factors over which practitioners, policy makers and patients have discretion.
  • research dating back 30 years illustrates that population aging exerts modest pressure on health system costs in Canada (Denton and Spencer 1983; Barer et al. 1987, 1995; Roos et al. 1987; Marzouk 1991; Evans et al. 2001; McGrail et al. 2001; Denton et al. 2009)
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  • To shed new empirical light on this old debate, we quantified the impacts of demographic and non-demographic determinants of healthcare expenditure using data for British Columbia (BC) over the period 1996 to 2006. Using linked administrative healthcare data, we quantified the trends in and the determinants of expenditures on hospital care, physician services and pharmaceuticals. To our knowledge, this is the first time that all three of these major components of healthcare costs have been analyzed in a single Canadian study.
  • our study cohort included 3,159,900 residents in 1996 and 3,662,148 residents in 2006
  • We found that population aging in British Columbia contributed less than 1% per year to total growth of expenditures on hospital, medical and pharmaceutical care from 1996 to 2006. We also found that changes in age-specific mortality rates reduced (albeit modestly) per capita healthcare costs over time, confirming what other researchers have suggested (Fries 1980; Breyer and Felder 2006). With rigorous analysis of recent healthcare data, we can therefore confirm what studies spanning earlier decades for British Columbia, elsewhere in Canada and other comparable health systems have found: the net impact of demographic factors on major components of the healthcare system is moderate (Denton and Spencer 1983; Fuchs 1984; Barer et al. 1987, 1995; Gerdtham 1993; Evans et al. 2001; McGrail et al. 2001). Moreover, when we forecasted the effects of expected demographic changes in British Columbia through 2036, we found that the future effects of population aging on healthcare spending will continue to be modest (1% or less per year).
  • Our findings also indicated that average payment per unit of hospital care increased over the period. The increase in hospital unit costs may have been an appropriate policy response to increases in age-adjusted clinical complexity per patient remaining in care following reductions in the average length of stay
  • After taking into account population aging, the average number of days of prescription drug therapy received by British Columbia residents grew more than 5% per year during the first half of our study period and plateaued in the latter half of the period (data not shown)
  • Despite popular claims about population aging and the sustainability of healthcare in Canada, demographic changes exert steady, predictable and modest forces on the cost of major components of our healthcare system. This is likely to remain true for the foreseeable future.
  • Irene Jansen on 23 Jan 12
     
    Despite popular claims about population aging and the sustainability of healthcare in Canada, demographic changes exert steady, predictable and modest forces on the cost of major components of our healthcare system. This is likely to remain true for the foreseeable future. Changes in the age-specific profile of healthcare costs, by contrast, can exert and have exerted significant pressures on health system costs. Clinicians, policy makers and patients have some discretion over the non-demographic sources of healthcare cost increases - unlike population aging. Though these results are largely confirmations of studies from past decades, it is nevertheless important to update the scientific basis for policy debates. Moreover, close attention to recent trends and cost drivers - such as the price of prescription drugs that drove pharmaceutical expenditures in the past decade - also helps to illuminate the non-demographic forces that seem most amenable to policy intervention. Ultimately, then, research of this nature is a reminder that the healthcare system is as sustainable as we want it to be.
Govind Rao

Nursing home ills tied to heavy antibiotic use - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150702|223996437

from heather ltc drugs hai

shared by Govind Rao on 06 Jul 15 - No Cached
  • The Globe and Mail Thu Jul 2 2015
  • It has been known for some time that long-term care facilities use a lot of antibiotics. Earlier studies have suggested there is a significant amount of overuse in this sector of the healthcare system, with potentially between one-third and half of all use being inappropriate or unnecessary. Residents of these facilities are typically frail, elderly people with a variety of health concerns. They are at the point in life where their immune systems cannot fight off invaders easily.
  • her risk," said Dr. Nick Daneman, first author of the study. "Unlike other medication classes, which can harm the individual recipient of that medication, antibiotics have the capacity to do harm even beyond the individual that gets the medication." Daneman is an adjunct scientist at the Institute for Clinical Evaluative Sciences and an internal medicine physician at Toronto's Sunnybrook Health Sciences Centre. The study appeared in the journal JAMA Internal Medicine, a publication of the American Medical Association.
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  • Antibiotics are likely being overused in some nursing homes in Ontario - and that misuse is putting all residents of these facilities at risk, a study suggests. With most drugs, inappropriate use only threatens the health of the person who takes the medication. But with misuse of antibiotics, the problems that arise - drug-resistant bacteria, C. difficile infections - are not restricted to the people who have been taking the drugs. "[Nursing] homes with higher use put patients at hig
  • These people often live in close quarters and are cared for by staff who move from resident to resident. It's a situation that makes for efficient spread of bacteria and other pathogens that cause infections. For this study, Daneman and his co-authors looked at antibiotic use in 110,656 residents of 607 nursing homes in Ontario in 2010 and 2011. The nursing homes studied were divided into low, medium and high antibiotic-use categories. The differences were stark: antibiotic prescribing in high-use facilities was 10 times that of low-use homes. If high-use homes had residents who were significantly sicker and more frail, that might explain their heavy reliance on antibiotics. But the authors also did a comparison of the residents of the various facilities and found there were not major health differences among them. That suggests the increased use of antibiotics in the high-use homes likely is a result of the doctors who are prescribing at those facilities, said infectious diseases expert Dr. Andrew Simor, who was not involved in this study. Simor is head of microbiology at Sunnybrook.
  • He suggested this information could help change prescribing behaviours; facilities where antibiotic use is higher than the norm could be targeted with programs aimed at minimizing misuse of these critical drugs. The article, which Simor praised, also drew a line between high antibiotic use and higher rates of negative consequences of antibiotic use. Those side-effects included allergic reactions to antibiotics, developing antibiotic-related diarrhea, contracting C. difficile infection, or becoming infected with a drug-resistant bacteria. Daneman said the adverse events were generally serious enough to send these people to hospital. "If you live in a high antibiotic-use home versus a low antibiotic-use home, you had 25 per cent increased risk of one of these serious antibiotic-related adverse events," he said. Because of the way the study was designed, the authors could not tell if the antibiotics used were needed in each setting. So they cannot say that the low-use homes had hit the sweet spot for antibiotic use - not too much, but enough.
  • Still, Simor observed that when hospitals started to develop programs to cut back on unneeded use of antibiotics - it's called antibiotic stewardship - concerns were raised that some people who needed the drugs might not get them. That hasn't proven to be the case, he said. "So if you feel comfortable translating those findings into a nursing home setting, I think you'll find the same situation is true - that stewardship will not place patients at increased risk for not getting an antibiotic when they need it."
Govind Rao

CMAJ: Pharma influence widespread at medical schools - 0 views

www.cmaj.ca/...at-medical-schools-study.xhtml

from heather drugs doctors

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  • Govind Rao on 09 Aug 13
     
    August 9, 2013 Recent research has revealed widespread pharmaceutical influence and weak institutional safeguards in Canadian medical schools. But lecturers, medical students and ethicists are far from united on the extent to which relations with industry are acceptable and what role universities should play in preparing students to withstand influence. A July 4 study in PLoS One ranked the rigour of Canadian medical schools' 2011 conflict-of-interest policies. A simple conflict of interest would be gifts, where drug companies provide pens, prescription pads or lunches, while a more complex conflict of interest would be ghostwriting, where faculty members sign on as authors of studies conducted and written by pharmaceutical companies. Only 4 of 17 schools scored higher than 50% in the study's parameters. The study by Adrienne Shnier, a doctoral candidate in health policy and equity at York University in Toronto, Ontario, and colleagues also found that one school, the Northern Ontario School of Medicine, had no policy as of 2011.
Irene Jansen

Fraser Institute study: How much can a survey of 253 doctors really tell us? | OpenFile - 0 views

montreal.openfile.ca/...n-survey-253-doctors-really-te

waits think tank

shared by Irene Jansen on 23 Jan 12 - No Cached
  • explaining the methodology of the study – something I noticed La Presse and some of the other media reporting on the study didn’t do
  • only 253 Quebec specialists (PDF) responded to the two-page survey sent to them by the Fraser Institute, a 9 per cent response rate out of 2,979 surveys distributed in Quebec – 6 percentage points fewer than the next lowest province, Ontario (see p. 38 of the report).
  • the Globe only published a short Canadian Press story about the study – nothing more
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  • La Presse published a follow-up story the next day with a response from the Government of Quebec’s health ministry, saying the minister does not agree with the numbers in the study. The health ministry pointed to their own statistics, which showed a much shorter average wait time for surgery – 8.5 weeks instead of 19.9.
  • “At the very least I think media reports should have explained the limitations,” Picard said.
  • “I don’t think the report has much value because it’s a survey with a small sample size and questionable methodology,” Picard wrote in an email.
  • The La Presse story didn’t mention that Quebec’s health ministry starts calculating wait times from the moment the doctor decides the patient needs surgery. The Fraser Institute’s 19.9 weeks of waiting is calculated from the time the patient gets a referral to a specialist from their GP – a vital piece of information that would have explained some of the discrepancy.
  • “When wait times are measured in a scientific fashion using a common definition – such as in the Health Council of Canada annual report – the data are valuable,” Picard said.
Govind Rao

Why keep so quiet on pharmacare? - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|tost|20150924|229940122

from heather pharmacare federal election

shared by Govind Rao on 24 Sep 15 - No Cached
  • Toronto Star Thu Sep 24 2015
  • When NDP Leader Thomas Mulcair announced his plans for a national pharmacare plan last week, he was uncharacteristically low-key. He didn't promise a medicare-style plan that would allow the sick to receive necessary prescriptions free of charge. He didn't give a target date for implementing his plan. He didn't explain how his proposed universal scheme would fit in with existing private drug plans that are offered by many employers.
  • He didn't even use the word pharmacare. His pledge was sandwiched in after a televised leaders debate, on a day when reporters were more concerned with Conservative Leader Stephen Harper's use of the term "old stock" to describe some Canadians. All of which is a shame. Because if the New Democrats are serious about this, their pharmacare scheme could be one of the most important health-care initiatives in decades.
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  • Pharmacare is the great idea that never quite gets off the ground. Jean Chrétien's Liberals talked about it but never acted. In 1975, Saskatchewan's NDP government sent up a provincial pharmacare scheme. In 1993, another Saskatchewan NDP government cancelled it in order to pay down the province's deficit. Yet study after study shows that a national universal pharmacare scheme would save money.
  • A recent study in the Canadian Medical Association Journal calculates that universal pharmacare would cost governments an extra $1 billion a year but would save Canadians, as a whole, $7.3 billion. The savings come from the ability of a national plan to bargain for better prices with the drug giants and pool risk over a large population, as well as the cheaper administration costs that come from replacing multiple private insurers with one single-pay system. To the NDP's credit, the party seems to understand this. Indeed, background material provided to journalists cites the CMAJ study. Still, the proposal announced last Friday seems unusually woolly. Mulcair does talk of bulk-buying as a way to reduce drug prices. And he does pledge to have Ottawa spend $2.6 billion over four years.
  • But would the NDP plan cover all Canadians or just those who currently don't have private drug insurance? I put those questions to the New Democrats. On the one hand they said their scheme would be universal (that is, it would cover everyone). On the other they said they wouldn't meddle with existing private plans. All of this matters according to Danielle Martin, a Toronto family physician and one of the authors of the CMAJ pharmacare study. She points out that if the plan doesn't cover all Canadians - that is, if it doesn't replace existing private plans - it won't achieve the savings associated with a single-pay system.
  • Marc-André Gagnon, a Carleton University public policy professor and another co-author of the CMAJ study, says the NDP's language around its proposal seems deliberately fuzzy - perhaps to aid in any future negotiations with the provinces. Certainly, the new fiscally conservative NDP is moving cautiously. It doesn't say whether its plan would require those buying drugs to pay part of the cost out-of-pocket. That, it says, will be decided in negotiations with the province. It suggests that the plan might operate differently in different provinces. That, too, is up for negotiation. Quebec, for instance, requires employers who offer any kind of benefits to their workers to also provide drug coverage. Any Quebecers not covered by these private schemes can get prescription drugs through the province's public drug plan.
  • The $2.6 billion spent over four years would come from the extra funds the NDP plans to deliver to the provinces by reversing Harper's proposed health-care cuts. That money would be used to get the scheme going and start phasing in better coverage. Annual costs to the federal treasury once the scheme is up and running are estimated at $1.5 billion.
  • It's not clear what the provinces would have to pony up. But they would not be expected to spend more on drugs than they already do. In short, the devilish details remain vague. Still, it's worth noting that neither Justin Trudeau's Liberals nor Harper's Conservatives had come up with anything at all on this front. "It's the most comprehensive kick at the can we've seen," says Martin. "I'm thrilled they're bringing it to the table." Thomas Walkom's column appears Wednesday, Thursday and Saturday.
Govind Rao

Pharmacare article Aug 27 2014 - 0 views

www.fpinfomart.ca/...arrow_20140903_1416_ir7i_6.pdf

from heather pharmacare

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  • Govind Rao on 03 Sep 14
     
    Waterloo Region Record  Wed Aug 27 2014  Page: A7  Section: Editorial  Byline: Marc-André Gagnon  Canadians pay among the highest costs per capita among Organization for Economic Co-operation and Development countries for prescription drugs, with one Canadian out of 10 unable to fill their prescriptions because of financial reasons. According to the recently released study, A Roadmap to a Rational Pharmacare Policy in Canada, commissioned by the Canadian Federation of Nurses Unions, there are two main reasons why prescription drug costs are so expensive in Canada. First, we have a fragmented system with multiple public and private drug plans. In a fragmented system, attempts to reduce costs normally result in shifting the cost somewhere else in the system. Although provincial public plans have managed to significantly reduce drug costs since 2010 by reducing the price of generics and by negotiating confidential agreements with drug companies, there have been significant cost increases in private plans as drug companies and pharmacists seek compensation for their losses from public plans. Second, according to the study, Canadians pay artificially inflated prices for both brand-name drugs and generics in order to support the national pharmaceutical sector. But this strategy has not delivered what was promised, namely, investment and employment in Canada. Studies show that paying higher prices for drugs does not result in a thriving pharmaceutical sector in the country. Numbers alone tell the story; employment in the Canadian brand-name pharmaceutical sector went from 22,332 employees in 2003 to 14,990 in 2012. Instead of 
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.
Govind Rao

Little change in wait times, reports find; New studies highlight Saskatchewan as an exa... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20151208|235370951

from heather waits Saskatchewan privatization lean accord

shared by Govind Rao on 08 Dec 15 - No Cached
  • The Globe and Mail Tue Dec 8 2015
  • Canadians continue to queue up for medical care with efforts to reduce wait times bringing limited improvements, say two new studies that come one month before federal and provincial ministers meet to begin negotiating a new health accord.
  • The pair of annual reports - one from the Wait Time Alliance, the other from the Fraser Institute - find little year-over-year change in the wait for medically necessary procedures. Where there is improvement, the report from the Wait Time Alliance finds the progress is "spotty" with access to care, dependent on where in the country you live and, at times, your age.
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  • The Alliance, a coalition of medical specialists, is calling on provincial and federal leaders to help fashion a "new national vision for health care," one that sets national benchmarks that go beyond the 2004 initiative that targeted five procedures: hip and knee replacements, cataract surgery, heart operations, diagnostic imaging and cancer radiotherapy.
  • We still don't measure nearly enough," said Dr. Chris Simpson, chair of the alliance and a former president of the Canadian Medical Association. "You can't fix what you can't measure."
  • At a time when more care is moving out of the hospital, Dr. Simpson said wait times for home care and long-term care beds should be monitored by all provinces, as should the number of patients in hospital because they cannot access these services.
  • When health ministers meet in January in Vancouver, Dr. Simpson said he hopes a partnership to establish such standards will be part of the discussion, rather than just the level of federal funding. "If we have made a collective mistake in the past, it is to say to the federal government, 'It's all up to you,' " he said.
  • The annual report card provides a snapshot of wait times across a range of measures gathered from provincially available information this summer. In doing so, it highlights the variation in the information available among provinces, and this year also notes that the federal government - responsible for delivering health care to First Nations, refugees, veterans, Canadian Forces and inmates in federal prisons - provides only limited data on its own performance.
  • The study, which gives a grade to provinces across a range of procedures, finds those provinces that got high marks last year - Saskatchewan, Ontario and Newfoundland and Labrador - continue to do well.
  • Both studies point to the success of Saskatchewan in cutting wait times as evidence of what can be done with a focused effort and both note that the improvement came from more than increased funding.
  • In five years, the number of patients in Saskatchewan waiting more than six months for surgery dropped by 96 per cent, the Alliance report card finds, thanks to a $176-million investment over four years and also because of innovative practices. Bacchus Barua, a senior economist at the Fraser Institute and author of its wait-time study, said measures such as a pooled referral system helped give Saskatchewan the shortest wait times in the survey.
  • The report from the Fraser Institute is based on a survey of specialists and tracks the time between the initial referral and the appointment with a specialist as well as the time between seeing a specialist and treatment. At the national level, it found the median wait time from referral to treatment was 18.3 weeks, almost the same as the 18.2 weeks recorded in 2014, but almost double the 9.3 weeks recorded in 1993 when the survey began.
  • Across Canada, wait times have stabilized, but they have stabilized at a very high level," Mr. Barua said
  • Saskatchewan had the shortest total wait at 13.6 weeks and Prince Edward Island had the longest at 43.1 weeks, although the small sample size in PEI makes that result less reliable. Among specialties, the longest waits were for orthopedic surgery at 35.7 weeks and the shortest were for patients in line for radiation oncology at 4.1 weeks, the study said.
Irene Jansen

Hospital privacy curtains laden with germs: study - The Globe and Mail - 0 views

www.theglobeandmail.com/...article2178437

cleaning hai

shared by Irene Jansen on 23 Jan 12 - No Cached
  • The privacy curtains that separate care spaces in hospitals and clinics are frequently contaminated with potentially dangerous bacteria, according to a U.S. study.
  • There is growing recognition that the hospital environment plays an important role in the transmission of infections in the health care setting
  • In their study, Dr. Ohl and his team took 180 swab cultures from 43 privacy curtains twice a week for three weeks.
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  • The curtains were located in the medical and surgical intensive care units and on a medical ward of the University of Iowa Hospitals.
  • Of the 13 privacy curtains placed during the study, 12 showed contamination with in a week. Virtually all privacy curtains tested – 41 out of 43 – were contaminated on at least one occasion.
  • “The vast majority of curtains showed contamination with potentially significant bacteria within a week for first being hung, and many were hanging for longer than three or four weeks,” Dr. Ohl said.
Govind Rao

CUPE Ontario | New study on C. difficile suggests benefits of rapid testing - Union cal... - 0 views

www.cupe.on.ca/...new-study-difficile-suggests

from heather Ontario cupe hai

shared by Govind Rao on 06 Sep 13 - No Cached
  • New study on C. difficile suggests benefits of rapid testing - Union calls on Ontario to lead in development
  • A major study of 12,000 samples from patients with C. difficile in four  hospitals in the United Kingdom (UK), published in respected medical journal The Lancet Infectious Diseases this week, suggests there are  benefits of rapid testing for the disease.  The study also points to the lack of accuracy of some of the existing testing procedures.
Govind Rao

CFHI - News Release > Release of The Safety at Home: A Pan- Canadian Home Care Study - 0 views

www.cfhi-fcass.ca/...98-475a-8bca-e3c591ddee65.aspx

from heather home care safety

shared by Govind Rao on 04 Sep 13 - No Cached
  • Release of The Safety at Home: A Pan- Canadian Home Care Study 26/06/2013
  • One out of every six seniors receives home care services in Canada. As the aging population continues to grow there is a greater need to ensure the delivery of Home Care in Canada is safe.  The release today of The Safety at Home: A Pan- Canadian Home Care Study is the first of its kind that examines adverse events in the home and includes recommendations on how to make care safer. The Canadian Patient Safety Institute (CPSI) partnered with other sponsoring organizations for the study including, the Canadian Institutes of Health Research (CIHR), Institutes of Health Services and Policy Research (IHSPR), The Change Foundation, and the Canadian Foundation for Healthcare Improvement (CFHI). The study examined the reasons for harmful incidents, determined the impact on families and clients and made suggestions on how to make home care safer.
Govind Rao

1 in 3 prescriptions not filled, Canadian study finds | Metro - 0 views

metronews.ca/...ot-filled-canadian-study-finds

from heather drugs pharmacare research

shared by Govind Rao on 09 Apr 14 - No Cached
  • March 31, 2014
  • TORONTO – A new Canadian study suggests nearly one in three new prescriptions goes unfilled, with expensive drugs and medications used to control some chronic conditions more likely not to be taken as directed. The lead author of the work admitted the magnitude of the gap between prescriptions written and drugs purchased was greater than she and her co-authors expected, even though the figure was in line with a previous American study looking at the issue. “We were startled,” said Robyn Tamblyn, an epidemiologist who teaches in McGill University’s school of medicine.
  • The study was published Monday in the journal Annals of Internal Medicine. It was funded by the Canadian Institutes of Health Research (CIHR).
Govind Rao

Typhoid 'superbug' may break out in Africa; Journal says illness has been quietly shape... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20150513|220380514

from heather infectious disease international

shared by Govind Rao on 13 May 15 - No Cached
  • Toronto Star Wed May 13 2015
  • A "superbug" strain of the bacterium that causes typhoid fever has spread globally in just three decades and is currently seeding a silent epidemic in Africa, according to a study in the journal Nature Genetics. An international team of researchers on Monday reported that typhoid fever - a centuries-old disease that still afflicts millions of people in the developing world - has been quietly shape-shifting into a deadlier threat, thanks to the rapid emergence of a drug-resistant strain called H58.
  • The strain refers to a family of Salmonella enterica Typhi (the bacterium that causes typhoid fever) that has developed resistance to antibiotics commonly used to treat the disease. In recent years, public health officials have seen H58 popping up in countries such as Vietnam and Malawi, but this latest study is the first to provide a snapshot of the superbug's global spread. In a major international collaboration, more than 70 researchers analyzed 1,832 samples of S. Typhi collected from 63 countries. Twenty-one of those countries had H58, which has "expanded dramatically" across Asia and Africa since first emerging three decades ago, the study found. The superbug is also now moving across Africa, where it is causing an "ongoing, unrecognized multi-drug resistant epidemic."
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  • "One of the surprising findings was that when we sequenced all these ... almost half of them fell into the H58 lineage," said first author Dr. Vanessa Wong, an infectious disease specialist with the Wellcome Trust Sanger Institute and University of Cambridge. "That (covered) 21 countries. So we were like, oh no. This is actually kind of everywhere." Typhoid fever is a disease that can be spread by only humans who carry the S. Typhi bacterium in their bloodstreams and intestinal tracts.
  • The disease is now rare in industrialized countries like Canada - which had 144 reported cases in 2012, probably mostly in travellers - but it is still relatively common in the developing world, especially where hygiene and sanitation are poor. While a typhoid vaccine is available, its efficacy wears off after a few years and many people also can't afford the vaccine in the developing world, where the disease is estimated to cause 21 million cases every year and about 200,000 deaths. Typhoid fever can be treated with antibiotics but the overuse of these drugs has fuelled resistance, as bacteria capable of defeating these drugs survive and proliferate. In a 2013 report, the Public Health Agency of Canada found that S. Typhi infections resistant to the antibiotic ciprofloxacin had increased to 18 per cent from 10 per cent the previous year. When asked if H58 has ever been reported in Canada, the agency said it doesn't routinely analyze the strains of S. Typhi cases since typhoid fever is not endemic here.
  • In countries where H58 has emerged, the superbug is now crowding out weaker strains, thus dramatically "changing the architecture of the disease," Wong said. She said treating multidrug-resistant strains like H58 also requires intravenous antibiotics - an expensive luxury that many people in the developing world cannot access or afford. Resistance against last-line antibiotics will probably also eventually emerge, she added. "If we carry on and the bug continues to evolve, we'll run out of options pretty quickly." She noted that her study also found H58 in Nepal, where devastating earthquakes have now left the country highly vulnerable to outbreaks of diseases like typhoid fever.
  • For Virginia Pitzer, a professor of epidemiology with the Yale School of Public Health who was not involved with this study, this "important and interesting" new paper underscores the need to tackle typhoid fever.
Doug Allan

Scarborough's two hospital systems to study merger - Infomart - 0 views

www.fpinfomart.ca/...171390451

restructuring scarborough

shared by Doug Allan on 21 Jun 13 - No Cached
  • Scarborough's two hospitals have agreed to start studying a full merger.
  • The Central East Local Health Integration Network, a regional overseer expected to approve the study on Monday, ordered the hospitals in March to create an "integration plan" between TSH General and Birchmount campuses and RVHS Centenary.
  • "Right away it was like silos fell down between the two hospitals," said Lyn McDonell, a TSH board member on the committee.
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  • "Everything's on the table," said TSH CEO Robert Biron, who argued Scarborough's hospitals have suffered a lack of operating and capital funds because they are split, an arrangement he called "to some degree dysfunctional."
  • The TSH board expected to hear the report of an expert panel on two proposals the LHIN said required more study, the elimination of the birthing centre at the General and a division of programs turning the Birchmount into a centre for day surgery and the General into the facility for operations requiring overnight stays.
  • "We felt strongly that merger seemed to be the (option) that had the most potential."
  • As the province forces hospitals into "a more competitive model," those in Scarborough need a way to "obtain our fair share," he said.
  • We're much better positioned if we do that together."
  • "The days of hospitals doing everything for everybody" are changing, said Dr. Robert Ting, the group's president. "We have to decide what our community needs and focus on certain areas."
  • So much enthusiasm for a merger was expressed, Warren Law, a TSH board member who is not on the ILC, cautioned colleagues the appropriate time to make the case was "down the road."
  • Biron insisted the ILC is "starting from a blank slate" and no decision to merge had been made.
  • In 2011, Dr. John Wright, the former TSH CEO, initiated study of a merger between TSH and Toronto East General Hospital in East York, but the work was shelved last year after objections from medical staffs of both hospitals, residents and the LHIN, which noted the East General was outside its jurisdiction.
  • Doug Allan on 21 Jun 13
     
    As the province forces hospitals into "a more competitive model," those in Scarborough need a way to "obtain our fair share," he said. "We're much better positioned if we do that together."
Govind Rao

Study reveals increasing life-expectancy gap between First Nations an nd non-aboriginal... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150820|227465846

from heather aboriginal

shared by Govind Rao on 20 Aug 15 - No Cached
  • The Globe and Mail Thu Aug 20 2015
  • Members of First Nations communities are more than twice as likely to face an early and avoidable death than other Canadians, with the greatest risk faced by native women and young adults, according to a new benchmark study by Statistics Canada. The sweeping study, using data from the 1991 long-form census, racks mortality rates of 61,220 ative adults and 2.5-million on-aboriginal Canadians over a 5-year period.
  • The results show a trend that idened over the course of the tudy, with the First Nations roup significantly more likely to ie before they reached their 5th birthday and from prevenable conditions. Diabetes, disorers linked to alcohol and drug se, and injuries were the leadng causes. "Closing the gap in the quality of life between First Nations and Canada has to be our national priority," Assembly of First Nations National Chief Perry Bellegarde said in a statement to The Globe and Mail. "This report provides further evidence of what we know: The gap has not changed over time and it is killing our people."
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  • She called the numbers "shocking," but suspects they actually underreport the disparity because the census undercounts aboriginal people, who represent a disproportionate percentage of the country's homeless population and those that are "highly mobile." "To me, this is compelling evidence that we need to take serious the recommendations of the [Truth and Reconciliation Commission]," said Dr. Smylie, director of Well Living House, an indigenous action research centre at Toronto's St. Michael's Hospital. It is also important, Dr. Smylie said, to remember the link between alcohol and drug use and unresolved complex trauma when looking at the causes of death. The Statistics Canada study covers the period between June, 1991, and the end of 2006, and includes individuals 25 and older. It divides "avoidable mortality" into two groups: preventable deaths caused by factors such as injuries; and treatable mortalit
  • Native men were twice as likely to die prematurely from avoidable causes and native women were 21/2 times as likely, the study found. The highest risk was found among First Nations members between 25 and 34 years of age. The risks for both men and women fell substantially when education and income were taken into account, suggesting, the researchers conclude, that socioeconomic factors "explain a substantial share" of the disparity. The new numbers follow the report from the Truth and Reconciliation Commission earlier this year, which identified lingering health effects as a legacy of residential schools, and called on the federal government to take action to close the health gap and to provide sustainable funding for aboriginal healing centres and the integration of indigenous medicine in health care. For Josee Lavoie, the director of the Manitoba First Nations Centre for Aboriginal Health Research at the University of Manitoba, the results are sadly familiar.
  • which is a death that potentially could have been averted by screening, early detection and successful treatment, such as tuberculosis and female breast cancer.
Doug Allan

A prescription for new hospitals; Many hospitals were built in the 1960s or earlier and... - 0 views

www.fpinfomart.ca/...223003639

p3

shared by Doug Allan on 19 Jun 15 - No Cached
  • The two Edmonton hospitals are among many across the country depleted by deferred maintenance costs. To balance tight budgets, hospital administrators choose to pay for more nurses or new equipment over investing in repairs, explained Dr. Johnston, president of the Alberta Medical Association.
  • A recent study has found Canadian hospitals have accumulated $15.4-billion in deferred maintenance costs - but this is a conservative estimate; the same study indicates it could be as high as $28-billion.
  • The preliminary findings from the study commissioned by HealthCareCan, a national body representing academic and industry health care associations, were presented Tuesday at the National Health Leadership Conference in Charlottetown.
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  • Many of the country's hospitals were built in the 1960s or earlier through a federal funding program. With these hospitals now reaching their "best before" date, it's time for the federal government to invest again, Tholl said.
  • The design of new hospitals is not only aesthetic. These facilities have natural lighting, better noise control and more private rooms that are comfortable for patients and prevent disease spread, said Dr. Michael Gardam, director of infection prevention and control at the University Health Network in Toronto.
  • Investing in hospital maintenance was one solution on the agenda at Tuesday's health care conference. But current maintenance costs need between $2.8-billion and $3.21-billion every year, according to the HealthCareCan study - and the funding wouldn't address the years of work that was put off.
  • Apart from structural problems such as leaky roofs, older hospitals are also at higher risk of outbreaks because of the facilities' poor ventilation, shortage of private rooms and overall design.
  • "We're not advocating for renovating this old house, we're saying we need new facilities for the future."
  • "Any new hospital built in Ontario over the last five years is a dramatic improvement over the old ones," Dr. Gardam said.
  • The new McGill University Health Centre replaced four facilities, yet has fewer beds with the intention to be more efficient than the aging buildings it supplanted, Tholl said. Not only is the design better, but the building includes more medical services (such as equipment and testing) so that patients can access what they need faster. The Montreal example is one that could be replicated in other communities, he said.
  • "If we build a new hospital and 20 per cent of patients should be cared for elsewhere, you're not going to get the benefit from that hospital," Dr. Gardam said.
  • The complete findings of the HealthCareCan study on hospital's deferred maintenance costs will be released this fall.
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