Health Policy paper provides review of changes in pharmaceuticals policy

In 2009, the Health Council of Canada released a report on the National Pharmaceuticals Strategy, which commented on the patchwork of drug coverage policies across Canada.

A recent paper in Health Policy by Jamie Daw and Steve Morgan reviews the changes in pharmaceuticals policies over a decade (2000-2010).  The paper gives a good overview of the trends and changes in policy with regard to drug coverage in Canada, and presents a follow-up to our own findings in 2009. 

Although many provinces are moving toward income-based catastrophic[1] drug coverage, there continue to be differences in the types and amounts of drugs covered, depending on where in Canada you live.

Federal leadership is needed to protect all Canadians from the high costs of drugs. 

To read the abstract: Stitching the gaps in the Canadian public drug coverage patchwork? A review of provincial pharmacare policy changes from 2000-2010.

Shilpi Majumder, Policy Lead, Health Council of Canada

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[1] Catastrophic refers to the impact of the cost of drugs on one’s finances.

Key Words: Catastrophic drug coverage, Health Policy, National Pharmaceuticals Strategy

Health Innovation Challenge deadline fast approaching

In September, we challenged students to identify innovative policies or practices in Canadian health care, and let us know why the innovations are working and how they could benefit the whole country.

The third annual Health Innovation Challenge requires students to prepare a written submission of up to 2,500 words for the chance to win $1,000 and a paid internship at the Health Council of Canada office in Toronto. Several professors incorporated the Challenge into their curriculum, and as a result we’ve received many high-quality entries already.

The deadline is January 16, 2012 – so students get your entries in, professors remind your students to submit, and let’s all look forward to the shortlist announcement in February!

Key Words: Health Innovation Challenge, Student Contest

Happy holidays from the Health Council team!

Not enough specialists, not enough time

Frank Austin is a stroke survivor who is active in the Kitchener-Waterloo area with his own stroke website and works as a peer counsellor for other stroke victims. His big frustration with the health care system is the lack of specialists with enough time to provide adequate service. He suffers from aphasia, but cannot access sufficient speech therapy.

Affordability: Since a stroke is a sudden illness, the loss of one income in a home with a small child is very significant.   In my situation, I was about to start a new job on the Monday after my stroke, so I did not have any long term/short term disability coverage through an employer. I had to wait for therapy and was not able to afford private speech therapy while waiting for speech therapy at the hospital.

Timeliness of Care: I was in the hospital for a week after my stroke.  I was discharged from the hospital with a prescription for cholesterol medication and was told to make an appointment with my family doctor.  The neurologist in the hospital was an on-call doctor and he said he was not going to be my neurologist.   It would have been a lot easier and far less stressful if we had been given a referral to a neurologist after staying in the hospital for a week, or at least an appointment with the stroke clinic upon leaving the hospital.  While my doctor kept monitoring my blood pressure and ordering blood tests, my wife worked to get a referral to a neurologist ASAP.  It was not until I had finally started my speech therapy at the hospital that I found the name of a neurologist for my wife to call at the stroke clinic.    Once I was at home, I was left alone with knowledge of very few resources.  My wife contacted one organization that we were referred to, and they did not have my file or information.  My wife had a very difficult time trying to find assistance or answers to my many questions, as our life was suddenly turned upside down.  She contacted several private speech therapists who were very helpful at explaining what happened to my speech etc.,  but  charged  more than we could afford.   One therapist told her to call the organization back and tell them that “your husband needs and is entitled to speech therapy now.” She said “Don’t take no for an answer. The longer he goes without speech therapy the worse it can be.” 

 

Coordination of Care – When my wife called the stroke clinic, they had been in contact with my family doctor’s office. However, the receptionist at the stroke clinic mentioned they had to request copies of the test results from the hospital several times and she was getting frustrated, almost to the point of giving up since they took so long.  The neurologist was informed, he did have the test results once we finally had an appointment with him, i.e., approximately six months after my stroke.  

Patient Engagement:  The neurologist was exceptional. He completed a full examination, he asked a lot of questions regarding what happened the night the stroke occurred and my previous health history.  He took as much time as we needed to ask questions, and since I have aphasia, he was very patient with me.  He took time to explain the results of all the tests.  He also reviewed all the medications I was taking and increased the dose of the cholesterol pill.   He was concerned since I am young and he wanted to prevent another stroke if at all possible.   He also ordered another test right away.  

Self Management – I attended “Living with a Stroke” through the Grand River Hospital. This was very helpful and allowed me to meet other survivors.   I also attended “Stroke Recovery Canada” meetings to meet other survivors and as part of my post-stroke therapy. 

I was discharged from speech therapy after approximately nine months, but was in no way in a place to be finished.   I was sent home with no other resources, other than private speech therapy and, unfortunately, we were not able to afford it.   That was why I was determined to find help for myself and others sitting at home without the continued therapy we require to be self-sufficient.   That was why I created a website – www.kwstrokesurvivor.com – and worked hard to start an aphasia conversation therapy group for survivors – Expressive Café.

Key Words: Home and Community Care, Patient Engagement

  

Pumping up the volume on patient voices

   

Zal Press is Executive Director of Patient Commando Productions, an internet initiative dedicated to promoting the patient voice as a guide to practice change. www.patientcommando.com has more than 1400 patient experience stories that will be loaded onto the site, considered the world’s largest collection.

I’m taking a biologic for Crohn’s disease. And I’m a lucky guy – my $30,000 annual tab is picked up by my wife’s benefit plan. But in five years, when I hit 65, we’ll be off her plan and I’ll be transferred to the Ontario Drug Benefit Plan.

I’m already fretting over what that future will bring. Will the continued financial strain on the health system foreclose on my access to this medication, and instead force a body-altering operation because it will cost the system less in the short run?

And will this decision be made by a cost-benefit analyst rather than by a collaborative agreement between me and my doctors?

US insurance companies have required multiple step therapies before approving many biologics, resulting in multi-year delays. In Ontario, the Exceptional Access Program has fallen behind in processing applications. The population percentage with chronic illness is growing and treatment of choice for managing many conditions is increasingly these pricey biologics.

After living with a chronic illness for over 30 years, I understand it’s important for patients to be active participants in our health care. But I also know that outside of the examination room, the patient’s voice is still faint and needs amplification as the discourse necessary over preserving access to treatment starts to gain momentum.

Our southern neighbour offers insights into the problem of access. Is the US experience just the tip of the iceberg of a dangerous Canadian trend? We can learn from that as we debate the broader issue of sustainability. In the meantime, I’ll take comfort from the security of my marriage - and my wife’s plan.

Key Words: Patient Engagement, Ontario Drug Benefit Plan

CMA’s Globe and Mail special section on health care

 A few weeks ago the Canadian Medical Association published a special information section in the Globe and Mail featuring articles on a range of health care issues, from various Canadian health groups. The section focuses on the upcoming 2014 accord negotiations, and which issues need to be at the centre of discussions.

You can find all the articles at: www.theglobeandmail.com/healthcaretransformation, but here are a few we found interesting, with links to what we ourselves have said about the issues:  

Principles to guide health care transformation in Canada

This article is an overview of topics covered in the others, focusing on four areas of transformation:
·         Enhance the health care experience
·         Improve population health
·         Improve value for money
·         Accountability (see John G. Abbott, Health Council CEO, discuss accountability in this video clip at 1:51:24.)

Overcoming social inequities key to improved wellness.

An apple a day may keep the doctor away, but what if you can’t afford to buy apples or other fresh fruits and vegetables? What if your home is overcrowded or has mould? What if you don’t even have a home?
This article discusses how social inequities affect health and wellness, with comments from Scott Haldane, President, YMCA Canada.

For our perspective on this issue, see our report, Stepping it Up: Moving the Focus from Health Care in Canada to a Healthier Canada.

 

Focus on patient-centred care highlights needs for reforms

What is patient-centered care and why is it important? This article explores the challenges in maintaining a focus on the patient and discusses suggested solutions.

Read about our symposium on patient engagement, or our recent report, How Engaged are Canadians in their Primary Care?.

Electronic Medical Records provide a new platform for efficient, quality care

This article highlights the importance of EMR adoption across the country, and what it can mean for patients and the health system as a whole. We discussed the fulfillment of governments’ commitments to electronic medical records in our Progress Report 2011.

Key Words: Electronic health records, value for money, health care transformation, Health Accord

My experience with the mental health field

Paolo Scotti is currently the Peer Support Worker for the West Metro ACT Team at Canadian Mental Health Association Toronto and happily thriving in his transformation from his "illness phase" into his "recovery journey”.

I had always considered myself as being very healthy. Maybe I was so confident of my mental and physical strength that I arrogantly dismissed the fragility of life. So, at the age of 31, when I was admitted into a general hospital’s psychiatric ward with a psychotic break, it was totally devastating and completely debilitating. I had no idea at the time, but it was the beginning of my chronic schizophrenia. I am not sure that the physical symptoms of schizophrenia were my worst enemy.

Possibly more damaging was the human reaction and judgment from others, including some mental health professionals when I was first hospitalized in 1992. For example, my hospital psychiatrist was extremely unsupportive. He would get annoyed and inpatient with me, treating me with disrespect rather than a whole human being. I don’t have problems with self-esteem or self-worth. I was just a human being in a vulnerable situation, turning to “professionals” for support and guidance when I didn’t know what was happening to me. I was hoping for compassion, empathy and especially understanding and an explanation. Instead, I was made to feel like it was my fault for what was happening.

For example, when I couldn’t express myself because of thought disorder (a symptom of schizophrenia which no-one told me about even after being in hospital for over a year), I was told I was always repeating myself and that it was “so boring”.  Or, when I would talk about the strength of my religious faith, I was treated with complete contempt, ripped to pieces and treated as a fool and ridiculed. I don’t expect anyone to share my faith, but why not respect my worldview, especially since it may have made the difference between life and death? Just because someone is very ill does not mean that they are any less human and void of feelings.

When I was out of hospital, my community worker was also unbelievably disrespectful. She totally dismissed my goals, desires and my expressed employment wishes. Instead, she literally imposed her ideology on me (based on social goals). She did not listen to me and had no respect for my support systems. She criticized the fact that I lived with my mother, a source of huge support for me. That seemed an issue for her.

Happily, things appear to have changed dramatically in the past 20 years. Now, I work as a Peer Support Worker at a community mental health organization. Every day, I see amazing work done by many outstanding individuals. The mental health system still needs to transform, but now it’s focusing more on a recovery-oriented, strength-based, patient-centered, wellness-focused approach and treating people more holistically.

But looking back, with honesty and without dramatizing, if it were not for proper treatment, for my mom (who was an incredible source of hope and non-judgmental love) and my faith, I might not be here today. Back then, I think I would have seriously considered committing suicide. In my opinion, everyone else, including some mental health professionals in the hospital and in the community, failed terribly. Maybe I was just unlucky. Now, my only professional mental health support is an amazing psychiatrist. All of my family are very supportive now that they understand. However, it is important to say that some professionals, supposedly trained to help you when you’re most vulnerable, may actually harm you more and push you over the edge if you are not aware.

Key Words: Menral Health, Patient Engagement

Why didn't they listen?

Nicoleta Woinarosky is a volunteer in the Ottawa area.

I’ve had several experiences where I had excruciating pain which limited my physical activity and life quality. I asked doctors for tests and was refused, but then they prescribed antidepressants (which I strongly refused), only to find later - after suffering for years -  that tests would have allowed diagnosis and physical, not mental, treatment. The Arthritis Society's physiotherapist helps me.

I struggle with doctors for my right to be actively involved in managing my health and not be unnecessarily drugged. From 2003-2005, I asked my family doctor to x-ray my neck. Instead, she prescribed antidepressants. Finally, after getting x-rays she said, “Your neck x-ray is not good.”

In 2004, a neurologist said, “People who come to see me are quiet. You talk, you’re fine. Here, take these antidepressants.” In 2008, a different neurologist diagnosed serious neck-hands-shoulders problems using MRI/EMG/nerve conductivity. 

In 2008, 2009 and 2011, in pain, I requested tests. My family doctor refused, but prescribed antidepressants. I wrote her a letter asking how she would feel being unable to walk, sit, stand, bend, refused tests, and drugged. Two days later, she suggested a CT Scan which revealed serious low-back problems.

X-rays, CT Scan, MRI, EMG, and nerve conductivity found various bulging disks, spurs, nerve and muscle damage in different areas. How would all those previous prescribed antidepressants mend my discs, spurs, nerves, muscles?

Doctors know I have an MA in Health Science. My thesis was, “The Effects of Exercise on Chronic Pain and Pain Related Mental Health Issues.” I have knowledge on pain anatomy and all pain treatment modalities. Why didn’t they listen? Due to health, I resigned March 2011 and now volunteer using my MA, teaching weekly physical activity in a seniors’ residence and monthly pain self-management at the Arthritis Society.

The cost of trial and error

   

New Westminster, B.C. resident Jason Bosher is crafting a career as a writer/editor. Since 2001, he has been dealing with rheumatoid arthritis, osteoarthritis in his hips, minor carpel tunnel disease, and a chronic spine issue.

I love this country and I am grateful for Canada’s health care system. If I had to find one fault with our system, it would be the medication hierarchy. I have rheumatoid arthritis. I am also considered low income. I spend about $400/month on medications.

After six years, my initial medications were no longer keeping my RA in remission. I had two basic options: if I wished to receive partial coverage from the government, I had to show the next two medications in the hierarchy were ineffective. Then, the drug my specialist believed would be the most effective would partially be covered.

Or, I could go straight to the recommended medication and pay the full price myself, which was quite expensive.

Wait a minute; let’s go back to option A. I would have to ingest medications with all sorts of potential side effects for a prolonged period of time. Then if my RA began to flare up and reduce my quality of life, I could move on to the next medication. If this medication failed I could then receive the recommended medication with some cost savings. The big danger with a disease like RA is that due to its unpredictable nature, once out of remission it may never go back into remission. If I chose to play the health care game, I could potentially become severely disabled for life.

To me the gamble wasn’t worth it. I chose option B. This raises a couple of questions: If I went with option A and became severely disabled, wouldn’t that place a far greater strain on our health care system? If I could no longer work, wouldn’t that be worse than receiving help with medication costs now?

A sound recommendation from a specialist should allow for partial coverage.

The cost of chronic illness

Lene Andersen is a writer and photographer living in Toronto. She has had severe rheumatoid arthritis since childhood and uses a power wheelchair. Lene is the author of the award-winning blog, The Seated View.

 

When we talk about the cost of living with a chronic illness, it usually refers to the impact on quality of life - the ability to participate in your family, community and work.

Living with a chronic illness is also expensive.

I am lucky there's a financial assistance program that covers the very expensive medication which has given me back so much of my life. Because of this I can work part-time, give back to my community and be there for my family.

Even so, other medical conditions pop up, as do side effects from the drug that gave me back my life. More medications are needed, some only covered in generic form and others not at all. Sometimes, the generics don't work as well as the brand name. I have two choices: endanger my health by not taking the meds or pay for the brand name myself. Every month, they cost me $400 I don't have.

Treating a chronic illness isn’t just about drugs. Physiotherapy can help maintain my level of function but costs $80 for one treatment. Without it, I have high pain levels that can reduce life to just getting through the day. With it, I go deeper into debt.

I have used a power wheelchair since I was a teenager. It is my legs, my mobility -  without it, I would be confined to bed. Because I do not receive social assistance, I pay for maintenance and repair myself. This past summer, it cost me $2000.

I am a lucky woman. I have good medical care and medication, treatment and equipment that give me the opportunity to live a wonderful life even with a severe chronic illness and disability. Without them, I risk my health and lose the ability to live my life. With them, I sink forever deeper into debt because I am also caught in a vicious circle of necessary expenses that I cannot afford.

Worrying about my future

Sharon Noseworthy had to leave her career as a Human Resource Counsellor due to retinal disease. Currently, she advocates for support and rehabilitation services for Canadians with vision loss, hoping to stop unnecessary hardships. Sharon has also written a compelling piece, Fear, about dealing with Polypoidal Choroidal Vasculopathy on the MD Support website.

I have an incurable, untreatable chronic illness, a retinal disease. Despite long wait times for appointments, hours spent in the waiting room and too little time with the doctor resulting in no time for questions, I believe my eyes receive excellent care. I did worry about the cost of the expensive drugs used to treat the eye. I was already spending thousands of dollars on tools to assist with daily living. 

To date, no treatment, no drug has helped. I recall the day the retinal specialist said, “We are sorry but there is nothing further we can do for you.” I understand that there is nothing that can be done to treat the eyes, but what about me! 

There was, and is, no offer of rehabilitation, no offer of counselling, no evaluation of my needs and arrangement for required services. I left the clinic feeling helpless and hopeless. I went home not knowing how to deal with living with low vision. With no continuum of care, my health has deteriorated. I became acutely ill.

My family doctor monitors my health, including side effects from vision loss. With, or without reports, she provides excellent care. The retinal disease is still active so specialists continue to monitor my eyes. However, what I truly need are comprehensive vision loss rehab services. These services do not exist. As a result, I am not able to live independently. I worry about my future. Will I, like so many others, have to prematurely enter a retirement or nursing home?

In search of support: the importance of communication in the heath care system

 

Daniel Stolfi is an actor, writer and producer and currently resides in Toronto, Ontario.  Daniel took his two-year battle with cancer and turned it into the heartwarming and hilarious one person comedy show, "Cancer Can't Dance Like This."  Daniel has shared his story all over Canada and has helped raise over $75,000 for cancer-related charities across the country.  "Cancer Can't Dance Like This" recently won the 2011 Canadian Comedy Award for best one-person show. 

 In March of 2008, I was diagnosed with Acute Non-Hodgkin’s T-Lymphoblastic Lymphoma.   An aggressive tumour was growing rapidly over my heart and if treatment wasn’t started immediately, this grapefruit-sized mass would end my life in a matter of weeks.  I was just 25 years old and had my whole life to live.   
During my two-year chemotherapy protocol, I was challenged to navigate my way through a complex world that was the Canadian health care system.   I struggled to find support from my peers in the young adult stages of life.   I became very vocal about my need for support and was eventually able to convince my doctors to introduce me to another patient around my age who was going through the same thing as me.  After eight months of treatment, I was finally introduced to a 22-year old young adult named Ari.  He was in the midst of completing the exact same protocol as I was, and through this commonality of experiences we provided each other with support to get ourselves through the remaining 60-plus weeks of chemotherapy.   Through patient interaction, engagement and overall communication with my health team, I was able to get what I truly needed to help make my journey a success.   

Unfortunately, this process of finding support took much longer than it should have.  Some patients never get that support because it isn’t made clear to them where they can find it.  Communication between patients and health care providers is a simple solution to creating a more empowering journey for any patient.

Time is of the essence (or, don’t put off today what you can’t do tomorrow)

A recent CBC article discusses the meeting of Health Minister Leona Aglukkaq and provincial health ministers on November 24 - 25, and the potential for preliminary discourse on a new health accord for 2014. More than once the article mentions that there is still time for these discussions in advance of the 2004 accord expiry in 2014.  However, given that the article further mentions the need to review the Canadian Health Transfer funding model, fundamental reforms to current health care delivery, and the “crisis-fuelled negotiation…conducted earlier this decade” to devise the 2003 and 2004 health accords, “more than two years” doesn’t seem like nearly enough time.

Added to this are the arguments presented by André Picard in his article on the upcoming meeting of health ministers, wherein he discusses the need for revamped health financing.

These arguments are all valid in the context of a new or renewed health accord for 2014.  But time is of the essence.  Although simple enough to suggest how to reform health care in Canada, it is much more difficult to come up with reforms that are evidence-based and have buy-in from all stakeholders (that is, provinces, territories, the federal government, health care providers and the public). 

The National Healthcare Service (NHS) in England began consultations in 2007 for national reforms that culminated in the NHS Outcomes Framework that was first implemented in 2011.

In Australia, the Council of Australian Governments agreed to a reform agenda in 2007 that included reforms to health care.  The National Healthcare Agreement established in 2008 (revised in 2011) outlines specific goals for healthcare, and requires yearly performance reports on progress towards achieving these goals.

Given these two examples and the timelines for developing health care reform agendas, is two years enough time to fully hash out health care reform in Canada?  Serious discussions need to start now at all levels of government with expert and public consultation in order to develop well-planned strategies for health care reform in 2014.

Susan Brien, Policy Lead, Health Council of Canada

Key Words: Health Accord

What health care can learn from sports

A new blog by Steven Lewis, Mark Wahba and Mary Smillie was launched in October, 2011, with the purpose of creating “a community of thinkers, writers and readers interested in exploring how health and medicine can learn from the development, use and application of statistical analyses in sports.”

The authors of “Meaningful Analogies in Sports and Health” (M.A.S.H.) were inspired by the Michael Lewis book, Moneyball (now a major motion picture starring Brad Pitt) – a chronicle of the Oakland A’s manager’s success in building his baseball team on a budget by using data. The blog operates on the premise that health care could be better if data as well as concepts from baseball and other sports were used to improve decision making and overall quality.

Interesting concepts are discussed, and new ways of thinking about evidence-based decision making are presented. Not only are the discussions relevant to those of us in health and health care policy, but are also often of interest to the public. For example, one post discusses performance measurement in figure skating, and shows how a former scoring system overvalued certain metrics, similar to the way certain health care performance measurements are undervalued.  

The best part is that the discussions make meaningful analogies to issues in sports, a topic more widely accessible to the public than the usual health care policy forums.

Susan Brien, Policy Lead, Health Council of Canada

Photos from the Health Council of Canada’s National Symposium on Patient Engagement

On October 25, 2011, the Health Council of Canada hosted an invitational symposium on patient engagement in Toronto, Ontario.

This event brought together patients, health care providers, health system planners, government representatives and researchers from across Canada to explore the challenges and opportunities in patient engagement and the benefits to be gained from involving patients in the design of the Canadian health care system.

Participants gained a better understanding of what is needed to shift system-level design of health care services from ‘provider-focused’ to ‘patient-centred’.

Here are some photos from the event:

Lessons learned from the UK on the quality of patient engagement

2010, The King’s Fund commissioned an inquiry paper by Picker Institute Europe to review the quality of patient engagement and involvement in primary health care. The paper focuses on patients’ engagement in primary consultations about their own health care, namely the interaction between the general practitioner and patient. Similar to our findings in a recent report, the importance of patient engagement is underscored.

In the UK, efforts have been made to bring patient engagement to the forefront. In the last four years, the NHS has reviewed professional codes, legislation and regulation to propose patient engagement as a requirement for all doctors.  Over the past decade, professional education and training for doctors has been revised to highlight communication skills.

Although these changes have resulted in some improvements, the report cites remaining challenges in patient engagement. There are certainly parallels to challenges identified in our previous work, as well as others for future consideration.

                     

Some key challenges highlighted in the report are:

·        Workforce skills: There is a need to train professionals in advanced communication skills that aid in understanding patient values, preferences and desire for involvement in decision making. Although developing patient-partnership skills has become a focus for professionals trained during the last decade, these individuals are less likely to be in senior roles in the health care system and are less likely to be influencing a practice model that encourages patient partnerships. 

·        Practice orientation: There is little awareness of the value for practices to adopt a patient-partnership approach, particularly since there are no specific financial incentives or outcome measures tied to engaging patients.  

·        Health Literacy: The ability of patients to read, understand and make use of health information available to them in their decision-making can be a barrier to engagement. The strong relationship between health literacy and health inequalities suggest that to improve patient knowledge information must be designed to adjust to patients’ health literacy levels.

·        Time factor: The length of consultation time available is a key barrier to engagement for both physicians and patients.

The complete report is available here.

Commonwealth Fund findings on "sicker" adults released

The annual Commonwealth Fund International Health Policy surveys track trends in health care access, affordability, quality and general policy and practices issues internationally.

This week,  the Commonwealth Fund released its findings from the 2011 survey with a focus on the United States’ health care system. The 2011 survey looked at health care experiences of adults who are likely to have greater health care needs (so-called “sicker” adults).

The Health Council of Canada, a co-founder of this survey, has used the same data to understand Canadian health care system performance from the views of ‘sicker’ adults in the 11 participating countries. In our analysis, sicker Canadians are those with chronic conditions who describe their health as poor or fair. Our analysis highlights the gaps in our health care system for this population of sicker Canadians who have greater health care needs in access, affordability, timeliness, coordination and patient engagement.

Access

• Of the countries surveyed, Canadians (36%) rank high in finding it very difficult to access care in the evenings, weekends and holidays, without going to an emergency department.
• Canadians (60%) are the most likely to use the emergency department when compared internationally (47%). As a result Canadians are also among the highest users of emergency departments for conditions that could be treated at their regular place of care if it had been available.

Affordability

• Canadians rank second highest (following the US) in reporting concerns about prescription costs. Nearly one-quarter of sicker Canadians report not filling a prescription for medicine, or skipping doses because of cost.

Timeliness

• Overall, Canadians have the longest waits to get an appointment. Only half of Canadians (50%) say can get an appointment on the same or next day when they’re sick or need medical attention. Canadians also have long waits to see a specialist compared to international respondents. Half of Canadians (50%) say they have had to wait four or more weeks to see a specialist after being advised to do so.

Coordination

·         Canadians have the most difficulty in having their test results or medical records available at appointments. Nearly one-quarter say their test results or medical records were not available at the time of their appointment.  However, Canadians rank above international average in receiving help from their regular doctor to coordinate other care.

Patient engagement

·         Sicker Canadians (55%) are among the those least likely to report they have enough time with their doctor, a key barrier to patient engagement. However, these same Canadians have similar ratings to the international average in understanding information from their regular doctor and feeling encouraged to ask questions. 

For more detailed findings on these key areas of health system performance, please download our findings chart pack with a comparison of sicker Canadians internationally.

In December, we will release a report that focuses on the health care experiences of sicker Canadians’ compared to that of the general public. The report highlights what is working and isn’t working in Canada as it pertains to Canadians with greater health care needs.

Sukirtha Tharmalingam, Senior Policy Analyst, Health Council of Canada

Key Words: Access and Wait Times, Primary Health Care

Congratulations to B.C. on landmark agreement improving on health services for First Nations

We want to commend the B.C. First Nations Health Society, B.C. First Nations Health Council, and the federal and provincial ministries of health on the landmark agreement transferring responsibility for First Nations health care in British Columbia to a new agency.

The agreement indicates the new agency will be responsible for on-reserve programs like primary care, mental health, maternal and child health services and addiction services. The agency will work with established health authorities in B.C. to ensure First Nations’ cultural knowledge and practices are incorporated into their care.

We’re happy to see that the agreement echoes some findings and recommendations from our recent report on Aboriginal health. The report talked about how funding policies for Aboriginal health lack focus on prevention and community health, and that Western medicine tends to look at health issues in isolation rather than as a balance of physical, spiritual and emotional health. As a result, it is important for Aboriginal communities, who know what they need and what programs are working, to be able to take responsibility for their own health.

Check out this video from the signing of the agreement in Squamish territory, West Vancouver, B.C.:

Congratulations again to all parties involved, we look forward to seeing the results of this agreement.

Patient Engagement in Primary Care: What Are the Next Steps?

Kathryn Nicholson is completing her Masters of Science in Epidemiology and Biostatistics at the University of Western Ontario, in particular, looking at primary care encounters among fatigue patients. Next, she plans to complete a PhD focusing on patient-centered care, electronic medical records, and how these factors will combine to influence the long-term sustainability of the Canadian health care system. After that, she hopes to combine this research with medical practice. Kathryn won first place in the Council’s Health Innovation Awards in the individual category in 2010 and last year was a student ambassador for the awards.

Achieving a patient-centred health care system is a dynamic interplay of expectations, enablers, and desirable outcomes, many of which have been identified in the Health Council’s recent report, “How Engaged are Canadians in their Primary Care?" The changes or components required for patient-centred health care delivery (from both the patient and provider perspective, as listed within the Health Council report) seem to be fairly reasonable, especially given the dividends these actions promise.  Successfully integrating a patient-centred approach into our current system will not only be beneficial for the professionals and the consumers of health care, but ultimately its long-term sustainability.  However, as a current consumer of health care and as a hopeful future family physician, ensuring that patient engagement becomes entirely enshrined in the culture of primary care practice does not seem to be straightforward. 

The doctrine of a patient-centred family physician must be complete and encompassing of all practitioners to fully shift from administering health care “to” a submissive, agreeable patient, to delivering this care with the active partnership of an engaged consumer.  Shared decision-making has been shown to be an essential component of what patients view as effective “patient-centred care,” but this process is a significantly delicate balance between the clinical expertise of the family physician and the personal views and desires of the individual patient.  Moreover, each patient must be “practiced” or literate in being engaged at each visit, and ensuring that each primary care visit is productive in meeting their needs, is tailored to their current goals, and results in a meaningful next step to improving or caring for their health.  Undoubtedly, this culture change must occur at both the physician level and patient level, in order to achieve the most sustained effects and the most positive outcomes. 

Young future family physicians are trying to establish how we can translate what we have learned from the research into innovative action.  I, for one, would be inspired by the “rolling out” of best practices currently being undertaken and applying the most appropriate approaches to each primary care practice throughout the country.  However, until this action is possible or plausible, perhaps the most practical and effective approach is to be found in some of the actions listed by the report, such as simply giving patients the opportunity to ask questions or helping coordinate patients’ care with specialist services.  There seems to be some question as to what the next steps will be in “rolling out” patient-centredness in a unified way throughout Canadian primary care centres, but whether it is that many small steps are required or one gigantic leap, a whole-hearted culture shift toward successful patient engagement is what excites me about the future of primary care practice in Canada.

Key Words: Health Innovation Challenge, Patient Engagement, Primary Care

The Canadian Academy of Health Sciences discusses the direction of health system reform in Canada

We were at the Canadian Academy of Health Sciences annual forum in Ottawa on September 15, called “Smarter Caring for a Healthier Canada: Embracing System Innovation.”  The keynote address was delivered by Brian Golden (Rotman School of Management), who presented his thoughts on the direction of health system reform in Canada. This was followed by four panel sessions covering the topics of Equity, Efficiency, Sustainability and Community. 

The Equity panel discussed how current inequities in health, health care access and outcomes can be overcome with system reforms.

Presenters: Nancy Edwards (University of Ottawa), Margo Greenwood (National Collaborating Centre for Aboriginal Health), Louise Nasmith (University of British Columbia)

The Efficiency panel presented their thoughts on how the health care system can become more efficient through strategic planning and the use of health information technologies, and how personal privacy can be protected in light of these new information technologies. 

Presenters: Dr. Jack Kitts (CEO, Ottawa Hospital and Chair if the Health Council of Canada), Patricia Kosseim (Office of the Privacy Commissioner of Canada), Bartha Knoppers (McGill University), Robyn Tamblyn (McGill University)

The Sustainability panel conveyed the collective message that sustainability goes beyond financial dimensions and that smarter policies are needed to contain costs.

Presenters: Don Drummond (formerly Chief Economist, TD Financial Group), Jeremiah Hurley (McMaster University), Kevin McNamara (Deputy Minister of Health and Wellness, Nova Scotia), Pierre-Gerlier Forest (formerly Chief Scientist, Health Canada)

Finally, the Community panel presented their thoughts on the day’s discussion and highlighted aspects of health system reform that may have been missed by the other panels. 

Presenters: Cindy Blackstock (First Nations Child and Family Caring Society of Canada), Sharon Soholzberg-Gray (former president of the Canadian Healthcare Association), Anne Snowdon (Ivey Centre for Health Innovation) and Andre Picard (Globe and Mail)

Dr. Jeff Turnbull (Past President, Canadian Medical Association) presented his thoughts on a new health system that gives universal access to quality and patient-centred care that is adequately resourced and delivered to all Canadians. He wrapped up by calling for meaningful accountability and a national framework for reporting on health system performance. 

Slides of the presentations are available on the CAHS website: http://www.cahs-acss.ca/

Susan Brien, Policy Lead, Health Council of Canada

Key Words: Sustainability, Health Innovation

Photos from our celebratory event in Eskasoni, NS

On September 7, 2011, the Health Council of Canada held a celebratory event in Eskasoni to show how one program, the Unama’ki Maternal Child Health Program, is making a real difference in the lives of Aboriginal mothers and children, and to release our video on the program called Culture is Good Medicine (http://youtu.be/QC4f07snDMg). Here are some photos from the event: