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Contents contributed and discussions participated by Irene Jansen

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Irene Jansen

M. McGregor and D. Martin. 2012. Testing 1, 2, 3. Is overtesting undermining patient an... - 0 views

www.cfp.ca/...1191.full

overtreatment diagnostics

shared by Irene Jansen on 19 Nov 12 - No Cached
  • the guideline committees that make recommendations do not appear to consider cost-effectiveness, opportunity costs, and the potential harms of decisions to broaden screening guidelines
  • Not only are we screening with widespread laboratory testing at younger ages, but our definition of disease is also shifting.
  • In BC, there has been a 13.9% increase per year in treatment rates for 8 chronic diseases, beyond what would be expected for the changing demographic characteristics of the population
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  • Either British Columbians are rapidly becoming much sicker, or this increase in prevalence is a reflection of what Welch and colleagues describe as “looking harder” and “changing the rules.”
  • about one-third of the increasing cost of testing is related to physician adherence to guidelines
  • patients now often request particular tests
  • Earlier diagnoses and more aggressive treatments appeal to our self-definition as fighters of illness—and we all shudder at the successful lawsuit against the physician who did not screen
  • we use them as therapy of a sort, giving hope to the patient that we will find an explanation for the symptoms instead of admitting that we do not know and might never know the exact cause of the problem
  • At the highest level, there needs to be a broader evaluation of guidelines. Such evaluation needs to have representation from policy thinkers and health economists in addition to family doctors, other specialists, patients, and the public.
  • the opportunity costs of deciding to implement widespread laboratory testing for healthy people, compared with adopting population-based policies, such as 24-hours-a-day, 7-days-a-week access to community recreation facilities and social housing, or free access to smoking cessation supports, should be debated.
  • Tests and repeat tests that are deemed to be of less benefit or not worth the opportunity-cost trade-off should be delisted.
Irene Jansen

Medecins Québécois pour un Regime Public. Two-Tier Radiology: Quebec's Creep... - 2 views

www.mqrp.qc.ca

doctors quebec coalition ally private clinics

shared by Irene Jansen on 19 Nov 12 - No Cached
  • Irene Jansen on 19 Nov 12
     
    Our 2012 annual report is now available in English The report shows: "While it has more material and human resources, Quebec is less effective than Canada as a whole in providing accessible medical imaging services. The exclusion from public coverage of CAT scan, MRI and ultrasound tests performed outside a hospital leads to joint public-private practice that has the effect of draining resources from the public to the private sector. This damaging distortion leads to problems of access to medical imaging for most patients…"  The report documents the inequitable, inefficient, costly and potentially unsafe utilization of medical imaging technology in Quebec's unique and highly privatized system.  One aspect, the relatively effective use of technology in hospitals compared to private clinics (which would be better yet if the system were entirely public), is clearly not limited to Quebec: "According to a 2008 study by Bercovici and Bell of public hospitals and private clinics offering MRIs in several provinces, including Quebec, the rate of use of machines is about 50% higher in hospitals than in private clinics: an average of 14.7 hours of operation per day during the week and 11.8 hours per day on weekends for hospital machines, compared to 9.7 hours per day during the week and 8.2 hours per day on weekends for machines in clinics." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645224/ The recommendations are also valuable information. 
Irene Jansen

Editorial: Quebec's health care problems call for new thinking - 1 views

www.montrealgazette.com/...story.html

quebec waits neoliberal surgery

shared by Irene Jansen on 14 Nov 12 - No Cached
  • Surgery wait times for deadly ovarian, cervical and breast cancers are typically three times longer than government benchmarks for the procedures.
  • the problem is not confined to a particular institution or area
  • a lack of resources, notably nursing staff and budget compressions that result in operating rooms standing empty even as a backlog of surgeries accumulates.
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  • Another difficulty is ideological resistance to such innovations as increased private health service delivery and performance-based funding
  • Claude Castonguay, under whose direction Quebec’s medicare system was instituted four decades ago, has written a new book
  • In an open letter to the premier published this week, he says that what is needed is an overall plan
Irene Jansen

Home First program deprives some elderly patients of right to apply for long-term care,... - 0 views

www.ottawacitizen.com/...story.html

ontario home care substitution

shared by Irene Jansen on 14 Nov 12 - No Cached
  • Some seniors are being pushed out of hospital too soon under the province’s Home First policy, says a lawyer who advocates for older people.
  • Jane Meadus, a lawyer with the Toronto-based Advocacy Centre for the Elderly (ACE)
  • “While many patients will do well at home with extra home-care services, there are many who are too sick to be cared for at home.”
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  • ACE has received about 250 complaints from across Ontario in the past year, including from Ottawa, about hospital discharges. “Discharge from hospital is the No. 1 issue in our office,” said Meadus.
  • some elderly patients are being “forced” to go home to recuperate without being given the option to apply for long-term care and waiting for a bed while in hospital. And that might violate their legal rights.
  • In other cases, people are being pressured to enter private retirement homes, which can cost $5,000 a month and might not be able to provide the care needed
  • this policy runs contrary to the provincial Long Term Care Homes Act
  • Without being provided with the correct information, they cannot make an informed choice as is required by the law. Hospitals cannot require physicians to discharge before the person can be safely cared for in the appropriate destination.”
Irene Jansen

Hotel room tests uncover high levels of contamination - CBC Marketplace - 0 views

www.cbc.ca/...marketplace-dirty-hotels.html

cleaning

shared by Irene Jansen on 09 Nov 12 - No Cached
  • A CBC Marketplace investigation has uncovered potentially dangerous levels of filth and contamination in hotel rooms across the country.
  • tested thousands of individual spots inside hotel rooms at a wide spectrum of chains in Montreal, Vancouver and Toronto
  • A scan of any surface gauges the level of contamination with a simple numerical value, employing a scale used in similar tests in schools and offices. An ATP level under 300 is considered a "pass," while anything between 300 and 999 is in considered to be in the "caution zone." An ATP level over 1,000 is deemed a fail.
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  • Guelph University microbiologist Keith Warriner conducted the tests for Marketplace and found alarming results. “I wasn’t expecting [bacteria] to be so prolific,”
  • Over 70 per cent of remote controls tested were rated a caution or fail.
  • faucets in hotel rooms were quite dirty themselves, with 16 fails out of 54
  • Comforters were the most consistently contaminated spot, rating a "fail" in 23 out of 51 tests
  • Other major hot spots included bed throws, bathroom sinks, toilet bases and telephones.
  • a pillow with so much bacteria it has “its own life story.”
  • Overburdened hotel staff is the main reason that many rooms are so filthy
  • Canada’s hotel union tries to enforce a cap 15 to 16 rooms cleaned per shift, giving staff approximately 30 minutes per room. Ruiz says that isn’t enough.
  • many housekeepers work unpaid overtime to reach their daily targets, but many still use time-saving “shortcuts” like not dusting or vacuuming.
Irene Jansen

Province to investigate scalding of disabled man - 0 views

www.edmontonjournal.com/...story.html

alberta social services privatization safety

shared by Irene Jansen on 09 Nov 12 - No Cached
  • Alberta’s associate minister responsible for persons with disabilities has ordered an investigation into another severe scalding of a vulnerable Albertan in provincial care, but the father of a Calgary man scalded to death last year says more has to be done to make sure it doesn’t happen again.
  • a man with developmental disabilities was scalded in a bath in a care home in southern Alberta a week ago
  • A protection for persons in care unit is investigating the incident and the victim has been transferred to another care facility where he is recovering
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  • Oberle said he has also ordered a review of all of the facilities operated by the contract care provider
  • the incident came in the wake of a fatal scalding of a 35-year-old Calgary man in October 2011
  • the government has spent $2 million installing more than 2,000 temperature control devices in care homes
  • It’s the eighth known case of a serious scalding in a care facility in the province since 1980
  • Following Holmes’ Nov. 26, 2011, death, the province said it was looking at more tightly regulating contracted facilities and providing more funding to pay workers better.
  • opposition critics suggested chronic staffing shortages in Alberta care facilities may turn out to be a factor in the tragedy
Irene Jansen

Dix staying the course on labour policy, focusing on 'one practical step at a time' - T... - 0 views

m.theglobeandmail.com/...article4957519

bc ndp election contracting out

shared by Irene Jansen on 09 Nov 12 - No Cached
  • Mr. Dix said he was distressed that 90 members of the HEU at the George Derby Centre have been told they will be laid off, effective next April 30. They are to be replaced by contract employees
  • “I don’t know about you, but I don’t think we should let that stand,” he said, to loud applause.
  • Mr. Dix also made a strong committment to wipe out the sections of Bill 29 that have not already been overturned by the Surpeme Court of Canada.
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  • a section that eliminates union successorship rights when operations change hands is still on the books. One of the NDP’s first acts in its first session, should the party be elected, will be to get rid “of what’s left of Bill 29,” Mr. Dix declared.
Irene Jansen

Ça urge, car les besoins vont en croissant! | IREC | Institut de recherche en... - 2 views

www.irec.net/index.jsp

quebec home care

shared by Irene Jansen on 01 Nov 12 - No Cached
  • mette en place un ensemble cohérent de services basé sur les valeurs d’accessibilité et de justice sociale
  • La politique des services à domicile doit continuer à relever du secteur public, c’est-à-dire des infirmières et des auxiliaires familiales et sociales des centres de santé et services sociaux (CSSS), tout en se préoccupant d’améliorer les arrangements institutionnels concernant le personnel du tiers secteur ».
  • le développement des services à domicile souffre de lacunes générées par un problème chronique de sous-financement : tendance à la privatisation, insuffisance de l’aide apportée aux proches aidants, partage de responsabilités mal défini concernant le rôle de certains fournisseurs de services, mauvaises conditions de travail des employés du secteur privé et du tiers secteur, listes d’attente décourageantes de plusieurs personnes en besoin urgent de services
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  • la politique libérale sur la vieillesse présentée en mai 2012 ne répond pas aux enjeux réels. Avec seulement quelques centaines de nouvelles places en CHSLD, des investissements minimes dans les services à domicile et la poursuite en douce de la politique de privatisation des services qui, par définition, conduit à une dégradation de la qualité des services pour les moins nantis, nous sommes loin du compte ».  
  • Bien que l’ancien gouvernement libéral ait annoncé des investissements additionnels de 71,6 millions de dollars dans les services à domicile, l’analyse permet aux chercheurs de constater que « le budget additionnel pour les entreprises d’économie sociale en aide domestique (EESAD) au terme de ce plan de cinq ans n’aurait été, dans la réalité, que de 20 millions $ », ont conclu les chercheurs.
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