How Do Canadians Rate the Health Care System?

Christine Pierroz, Director, Communications, Health Council of Canada

Today the Health Council of Canada presents you with a revealing bulletin, How Do Canadians Rate the Health Care System?, based on survey results from the 2010 Commonwealth Fund International Health Policy Survey. http://bit.ly/bvq5pl

Canadians feel strongly about their health care system, but they recognize the need for improvement. The bulletin shows that of all the countries surveyed, Canadians have the greatest difficulty when it comes to access to care in the evenings, weekends, and on holidays – anywhere other than the emergency room. Other areas where Canada did not fare well, compared to international counterparts, were around timely access to medical appointments and coordination of care. In contrast, Canadians are very satisfied with the quality of medical care that they receive and are confident that they could have access to the most effective treatment should they become seriously ill.

This bulletin follows yesterday’s release in New York of the Commonwealth Fund’s own analysis of this 11-country survey. The focus there was on the US, a survey participant whose performance yielded statements such as “US adults most likely to forego care due to cost, have trouble paying medical bills; US stands our for highest out-of-pocket costs and most complex health insurance.”

In Canada, we stand to learn from survey results in some of the highest performing countries around questions of interest to us – countries such as the Netherlands, the United Kingdom, and Switzerland. Perhaps you have had some experiences with these systems you would like to share. We look forward to your insights.

Drug Safety and Effectiveness in Canada - David U Responds

David U, President and CEO, Institute for Safe Medication Practices Canada

On behalf of the Institute for Safe Medication Practices Canada (ISMP Canada), I would like to thank and congratulate the Health Council of Canada for preparing and disseminating their findings on the important topic of drug safety in Canada. It is encouraging to learn that a number of new initiatives are being put in place to enhance post-marketing surveillance and monitoring such as the “progressive licensing” approach, working with industry to encourage Phase 4 studies on marketed drugs, supporting Canadian research centres to focus on selected drugs for studying their real world effectiveness and safety, as well as creating the Drug Safety and Effectiveness Network. The discussion paper facilitates learning from information available nationally as well as internationally and will help enhance Canada’s ability to ensure the drugs being marketed and used in Canada are safe and will not trigger undesirable and potentially harmful side effects.

I would also like to take this opportunity to emphasize that we must ensure drugs are being used appropriately to prevent harm. Medication incidents (medication errors) leading to harm and death can be prevented. For example, there have been a number of fatal incidents involving the fentanyl transdermal system (fentanyl patches) and important information about this has been published by Health Canada. One such publication is the July 2008 issue of the Canadian Adverse Reaction Newsletter which highlights 52 cases with fatal outcome involving fentanyl patches; examples include incidents (errors) which involve healthcare professionals and consumers. ISMP Canada has also received incident reports related to fentanyl patches, and has issued several alerts and safety bulletins to healthcare practitioners as well as sharing learnings with manufacturer(s) for the purpose of enhancing labelling and packaging.

As part of Canadian Medication Incident Reporting and Prevention System (CMIRPS), the incident reports received by ISMP Canada contribute to knowledge in medication safety. For example, contributing to some harmful medication incidents is the confusion that has occurred from look-alike/sound-alike drug names and from look-alike labelling and packaging of pharmaceutical products. In October 2008, Health Canada initiated the development of a conceptual framework for the assessment of health product names for look-alike/sound-alike name attributes. An Expert Advisory Panel was created to support this development process, with representation from Health Canada, the Food and Drug Administration in the United States, ISMP Canada along with experts in the area of psycholinguistics and human factors. The proposed conceptual framework will inform the basis for the revision of the current Health Canada Guidance for Industry - Drug Name Review: Look-alike Sound-alike (LA/SA) Health Product Names. The guidance document will strive to bring greater scientific validity, transparency, objectivity and predictability to the evaluation of health product names for look-alike/sound-alike attributes. It is proposed that the framework and guidance will apply to the following product types for human use: prescription and non-prescription drugs, biologics, and natural health products. Over the past year, efforts have been focused on putting a number of health product names through each step of the proposed name review process to establish "proof of concept". It is anticipated that data gathering and analysis will be complete by 2011 followed by stakeholder consultation. Development of a similar framework is planned for labelling and packaging of pharmaceutical drugs for human use.

Learning from medication incidents occurs from reports received by both consumers and healthcare professionals as it provides useful information in detecting problems in the medication use system. In the spring of 2010, ISMP Canada launched a consumer medication incident reporting and learning web site: SafeMedicationUse.ca. Consumer reporting in Canada has resulted in important contributions to medication safety —10 newsletters and alerts have been published to provide incident learning and prevention strategies for all Canadians.

Another key project towards drug safety is the collaborative Canadian Pharmaceutical Bar Coding Project which aims to implement standardized bar codes on all aspects of pharmaceutical labelling. Headed jointly by the Institute for Safe Medication Practices Canada (ISMP Canada) and the Canadian Patient Safety Institute (CPSI), the initiative is guided by a national Implementation Committee and being developed with assistance from a 34-member Technical Task Force (TTF), representing six identified healthcare sectors. Adoption of the GS1 global standard for automated identification (e.g., bar coding) of pharmaceutical products in Canada has been endorsed. The multiphase project has developed draft technical requirements for Canadian pharmaceuticals in the following areas: bar code components and symbologies, product database elements, medications to be included in the categories to be bar coded, and packaging levels and bar code placement.
The report prepared by the Health Council of Canada will no doubt help to further raise the profile of drug safety. It provides the opportunity for the collective challenge in Canada for all of us to move collaboratively towards the common goal of drug safety.

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David U is the President and CEO at the Institute for Safe Medication Practices Canada (www.ismp-canada.org)

Drug Safety and Effectiveness in Canada - Hugh McLeod Responds

Hugh B. MacLeod , CEO, Canadian Patient Coalition

From the patient’s perspective, medication can be a tricky proposition. On one hand, we put our faith in pharmaceuticals in order to cure disease and improve our quality of life. On the other, we know the disastrous effect they can have if prescribed or taken incorrectly.

In a recent discussion paper commissioned by the Health Council of Canada, designed in part to inform Canadians and stakeholders about drug safety and effectiveness issues in Canada and abroad, it is suggested that Health Canada adopt a protocol for developing drug safety messages and disseminating them to the various stakeholders following harmful incidents.

As it happens, the Canadian Patient Safety Institute (CPSI) is involved in the creation of a series of initiatives to equip healthcare providers with the information and supports necessary to minimize, and hopefully eliminate, the occurrence and severity of harmful medication incidents in Canadian healthcare organizations. This work could not have been accomplished without the support and dedication of Health Canada, the Canadian Institute for Healthcare Information (CIHI), the Institute for Safe Medication Practices Canada (ISMP Canada) and stakeholders from throughout the healthcare sector.

For example, earlier this year, CPSI launched a project resulting in national consensus with respect to the use of GS1 global bar coding standards for labeling medication packaging in Canada. This system is far and away the safest way to track pharmaceutical products from manufacture to administration.

Another initiative is the Canadian Medication Incident Reporting and Prevention System (CMIRPS). The aim of the CMIRPS Program is to strengthen Canada’s capacity to reduce and prevent harmful medication incidents and to manage and share information about voluntarily reported medication incidents. For instance, in the aftermath of a death in hospital due to the inadvertent injection of the drug epinephrine, which is intended for topical use, ISMP Canada issued a nationwide alert giving healthcare providers the information they need to ensure the error is never repeated.

While this type of information sharing on a national scale is commendable, we need to start thinking about patient safety on a global scale – after all, why make our own mistakes causing undue harm to patients when we can learn from those who have already gone down that path?

In the words of Dr. Dale E. Turner, “the error of the past is the wisdom and success of the future.”

We encourage you to become a patient safety champion in your organization by kick-starting the discussion around medication safety and how you can leverage the wealth of information that exists to minimize, and hopefully eliminate, the occurrence and severity of harmful medication events.

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Hugh B. MacLeod is CEO of the Canadian Patient Safety Institute (CPSI) 

To learn more about CMIRPS and bar coding visit www.patientsafetyinstitute.ca and to learn more about our medication reconciliation intervention visit www.saferhealthcarenow.ca.