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Shen N, Sequeira L, Silver MP, Carter-Langford A, Strauss J, Wiljer D. Patient Privacy Perspectives on Health Information Exchange in a Mental Health Context: Qualitative Study. JMIR Ment Health 2019; 6:e13306. [PMID: 31719029 PMCID: PMC6881785 DOI: 10.2196/13306] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/14/2019] [Accepted: 08/31/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The privacy of patients with mental health conditions is prominent in health information exchange (HIE) discussions, given that their potentially sensitive personal health information (PHI) may be electronically shared for various health care purposes. Currently, the patient privacy perspective in the mental health context is not well understood because of the paucity of in-depth patient privacy research; however, the evidence suggests that patient privacy perspectives are more nuanced than what has been assumed in the academic and health care community. OBJECTIVE This study aimed to generate an understanding on how patients with mental health conditions feel about privacy in the context of HIE in Canada. This study also sought to identify the factors underpinning their privacy perspectives and explored how their perspectives influenced their attitudes toward HIE. METHODS Semistructured interviews were conducted with patients at a Canadian academic hospital for addictions and mental health. Guided by the Antecedent-Privacy Concern-Outcome macro-model, interview transcripts underwent deductive and inductive thematic analyses. RESULTS We interviewed 14 participants. Their privacy concerns varied, depending on the participant's privacy experiences and health care perceptions. Media reports of privacy breaches and hackers had little impact on participants' privacy concerns because of a fatalistic belief that privacy breaches are a reality in the digital age. Rather, direct observations and experiences with the mistreatment of PHI in health care settings caused concern. Decisions to trust others with PHI depended on past experiences with the individual (or institution) and health care needs. Participants had little knowledge of patient privacy rights and legislation but were willing to participate in HIE because of perceived individual and societal benefits. CONCLUSIONS This study introduces evidence that patients with mental health conditions would support HIE. Participants were pragmatic, supporting HIE because they wanted the best care possible. They also understood that their PHI was critical in supporting the single-payer Canadian health care system. Participant health care experiences informed their privacy perspectives, trust, and PHI sharing attitudes-all accentuating the importance of the patient experience in building trust in HIE. Their lack of knowledge about patient rights and PHI uses highlights the degree of trust they have in the health care system to protect their privacy. These findings suggest that the patient privacy discourse should extend beyond the oft-cited barrier of patient privacy concerns to include discussions about building trust, communicating the benefits of HIE, and improving patient experiences. Although our findings are in the Canadian context, this study highlights the importance of engaging patients in privacy policy discussions, regardless of jurisdiction, to ensure their nuanced perspectives are reflected in policy decisions on their PHI.
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Affiliation(s)
- Nelson Shen
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Lydia Sequeira
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Michelle Pannor Silver
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Interdisciplinary Centre for Health and Society, University of Toronto Scarborough, Scarborough, ON, Canada
| | | | - John Strauss
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - David Wiljer
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
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202
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Bassim CW, MacEntee MI, Nazmul S, Bedard C, Liu S, Ma J, Griffith LE, Raina P. Self‐reported oral health at baseline of the Canadian Longitudinal Study on Aging. Community Dent Oral Epidemiol 2019; 48:72-80. [DOI: 10.1111/cdoe.12506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 10/09/2019] [Accepted: 10/09/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Carol W. Bassim
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton ON Canada
| | | | - Sohel Nazmul
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton ON Canada
| | - Chloe Bedard
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton ON Canada
| | - Siying Liu
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton ON Canada
| | - Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton ON Canada
| | - Lauren E. Griffith
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton ON Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton ON Canada
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203
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Perceived Barriers to Mental Health Services Among Canadian Sexual and Gender Minorities with Depression and at Risk of Suicide. Community Ment Health J 2019; 55:1313-1321. [PMID: 31327106 DOI: 10.1007/s10597-019-00445-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 07/14/2019] [Indexed: 10/26/2022]
Abstract
This study examines barriers to mental health services among sexual and gender minorities (SGM) who screened positive for depression and risk of suicide. Data from an online survey of SGM (N = 2778) are analyzed. 37.5% met criteria for depression and 73.6% screened for being at risk of suicide. The most frequently cited barriers to mental health services access were inability to pay (62.3%), insufficient insurance (52.2%), a preference for 'waiting' for the problems to go away (51.5%), discomfort discussing emotions (45.7%), and feeling embarrassed and ashamed about mental health challenges (42.5%). Policy and practices implications of these findings are discussed.
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204
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Bremner KE, Yabroff KR, Coughlan D, Liu N, Zeruto C, Warren JL, de Oliveira C, Mariotto AB, Lam C, Barrett MJ, Chan KKW, Hoch JS, Krahn MD. Patterns of Care and Costs for Older Patients With Colorectal Cancer at the End of Life: Descriptive Study of the United States and Canada. JCO Oncol Pract 2019; 16:e1-e18. [PMID: 31647697 DOI: 10.1200/jop.19.00061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE End-of-life (EOL) cancer care is costly, with challenges regarding intensity and place of care. We described EOL care and costs for patients with colorectal cancer (CRC) in the United States and the province of Ontario, Canada, to inform better care delivery. METHODS Patients diagnosed with CRC from 2007 to 2013, who died of any cancer from 2007 to 2013 at age ≥ 66 years, were selected from the US SEER cancer registries linked to Medicare claims (n = 16,565) and the Ontario Cancer Registry linked to administrative health data (n = 6,587). We estimated total and resource-specific costs (2015 US dollars) from public payer perspectives over the last 360 days of life by 30-day periods, by stage at diagnosis (0-II, III, IV). RESULTS In all months, especially 30 days before death, higher percentages of SEER-Medicare than Ontario patients received chemotherapy (15.7% v 8.0%), and imaging tests (39.4% v 31.1%). A higher percentage of Ontario patients were hospitalized (62.5% v 51.0%), but 43.2% of hospitalized SEER-Medicare patients had intensive care unit (ICU) admissions versus 17.9% of hospitalized Ontario patients. Cost differences between cohorts were greater for patients with stage IV disease. In the last 30 days, mean total costs for patients with stage IV disease were $15,881 (SEER-Medicare) and $12,034 (Ontario) versus $19,354 and $17,312 for stage 0-II. Hospitalization costs were higher for SEER-Medicare patients ($11,180 v $9,434), with lower daily hospital costs in Ontario ($1,067 v $2,004). CONCLUSION These findings suggest opportunities for reducing chemotherapy and ICU use in the United States and hospitalizations in Ontario.
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Affiliation(s)
- Karen E Bremner
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada
| | - K Robin Yabroff
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Diarmuid Coughlan
- National Cancer Institute, Rockville, MD.,Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ning Liu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | | | - Claire de Oliveira
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | | | - Clara Lam
- National Cancer Institute, Rockville, MD
| | | | - Kelvin K-W Chan
- University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada and Toronto, Ontario, Canada
| | - Jeffrey S Hoch
- University of Toronto, Toronto, Ontario, Canada.,University of California, Davis, Davis, CA
| | - Murray D Krahn
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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205
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Bello AK, Zaidi D, Braam B, Chou S, Courtney M, Deved V, Glassford J, Jindal K, Klarenbach S, Osman M, Scott-Douglas N, Shurraw S, Thompson S, Manns B, Hemmelgarn B, Tonelli M. Electronic Advice Request System for Nephrology in Alberta: Pilot Results and Implementation. Can J Kidney Health Dis 2019; 6:2054358119879778. [PMID: 31632683 PMCID: PMC6778992 DOI: 10.1177/2054358119879778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 07/23/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Residents of rural areas of Alberta face significant barriers regarding access to specialist care, resulting in delays in provision of optimal care. Electronic referral and consultation systems are promising tools for facilitating timely access to specialist care, especially for people living in rural locations. Objective: To report our initial experience with the launch of an electronic advice request system for ambulatory kidney care in Alberta, Canada. Methods: We analyzed electronic advice requests for nephrology services in Alberta after the system’s pilot launch, from October 2016 to December 2017. Data for province-wide advice request utility by primary care providers (PCPs) were extracted from Alberta Netcare for analysis. Results: The total number of electronic advice requests directed to nephrology was 118 (mean number of requests: 2 per week). Only 31 (26.3%) of the cases required a face-to-face clinic visit with a nephrologist. Most (87; 73.7%) cases were managed by PCPs with ongoing nephrologist support via the advice request tool. Typical nephrologist response time was 5.7 ± 0.6 (mean ± SEM) days. Conclusion: These preliminary data suggest that the electronic advice request program has potential to enhance timely access to specialist kidney care and minimize unnecessary nephrologist visits while reducing response time. Broad implementation of this system may have a substantial positive impact on health outcomes and improve cost-effectiveness for nephrology care in the long term, particularly in rural communities of Alberta.
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Affiliation(s)
- Aminu K Bello
- Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Deenaz Zaidi
- Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Branko Braam
- Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Sophia Chou
- Division of Nephrology, University of Calgary, AB, Canada
| | - Mark Courtney
- Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Vinay Deved
- Division of Nephrology, University of Alberta, Edmonton, Canada
| | | | - Kailash Jindal
- Division of Nephrology, University of Alberta, Edmonton, Canada
| | | | - Mohammed Osman
- Division of Nephrology, University of Alberta, Edmonton, Canada
| | | | - Sabin Shurraw
- Division of Nephrology, University of Alberta, Edmonton, Canada
| | | | - Braden Manns
- Division of Nephrology, University of Calgary, AB, Canada
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206
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Jarvis JD, Murphy A, Perel P, Persaud N. Acceptability and feasibility of a national essential medicines list in Canada: a qualitative study of perceptions of decision-makers and policy stakeholders. CMAJ 2019; 191:E1093-E1099. [PMID: 31591095 PMCID: PMC6779536 DOI: 10.1503/cmaj.190567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND: Policy approaches have been considered to address inconsistent and inequitable prescription drug coverage in Canada, including a national essential medicines list. We sought to explore key factors influencing the acceptability and feasibility of an essential medicines list in Canada. METHODS: We conducted semi-structured interviews with decision-makers and other key stakeholders from government or pan-Canadian institutions, civil society and the private sector across Canada. We analyzed data using inductive thematic analysis and by applying Kingdon’s Multiple Streams Framework to analyze the emergent themes deductively. RESULTS: We conducted 21 interviews before thematic saturation was achieved. We categorized emergent themes to describe the problem, the essential medicines list policy (including content and process), and politics. There was consensus among participants that prescription drug coverage was an important problem to address. Participants differed in their views on how to define essential medicines and concerns about what would be excluded from an essential medicines list. There was consensus on important features for a process to develop an essential medicines list: an independent decision-making body, use of defined selection criteria based on quality evidence, and clear communication of the purpose of the essential medicines list. Federal government financing and the broader pharmacare model, engagement of various interest groups and changing political agendas emerged as core political factors to consider if developing a Canadian essential medicines list. INTERPRETATION: Although stakeholders’ views on the content of a Canadian essential medicines list varied, there was consensus on the process to formulate and implement an essential medicines list or common national formulary, including choosing medicines based on best evidence. Greater understanding is now needed on how patients, clinicians and the public perceive the concept of an essential medicines list.
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Affiliation(s)
- Jordan D Jarvis
- London School of Hygiene & Tropical Medicine (Jarvis), London, UK; Centre for Urban Health Solution (Jarvis), St. Michael's Hospital, Toronto, Ont.; Department of Health Services Research and Policy (Murphy); Epidemiology and Population Health Faculty (Perel), London School of Hygiene & Tropical Medicine, London, UK; Department of Family and Community Medicine (Persaud), University of Toronto, Toronto, Ont.
| | - Adrianna Murphy
- London School of Hygiene & Tropical Medicine (Jarvis), London, UK; Centre for Urban Health Solution (Jarvis), St. Michael's Hospital, Toronto, Ont.; Department of Health Services Research and Policy (Murphy); Epidemiology and Population Health Faculty (Perel), London School of Hygiene & Tropical Medicine, London, UK; Department of Family and Community Medicine (Persaud), University of Toronto, Toronto, Ont
| | - Pablo Perel
- London School of Hygiene & Tropical Medicine (Jarvis), London, UK; Centre for Urban Health Solution (Jarvis), St. Michael's Hospital, Toronto, Ont.; Department of Health Services Research and Policy (Murphy); Epidemiology and Population Health Faculty (Perel), London School of Hygiene & Tropical Medicine, London, UK; Department of Family and Community Medicine (Persaud), University of Toronto, Toronto, Ont
| | - Nav Persaud
- London School of Hygiene & Tropical Medicine (Jarvis), London, UK; Centre for Urban Health Solution (Jarvis), St. Michael's Hospital, Toronto, Ont.; Department of Health Services Research and Policy (Murphy); Epidemiology and Population Health Faculty (Perel), London School of Hygiene & Tropical Medicine, London, UK; Department of Family and Community Medicine (Persaud), University of Toronto, Toronto, Ont
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207
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Denham AMJ, Wynne O, Baker AL, Spratt NJ, Turner A, Magin P, Palazzi K, Bonevski B. An online cross-sectional survey of the health risk behaviours among informal caregivers. Health Promot J Austr 2019; 31:423-435. [PMID: 31529552 DOI: 10.1002/hpja.296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/30/2019] [Accepted: 09/08/2019] [Indexed: 12/13/2022] Open
Abstract
ISSUE ADDRESSED Informal caregivers may experience unique barriers to engaging in healthy lifestyles, consequently increasing their risk of chronic disease. Among a convenience sample of informal caregivers, this study aimed to: (a) assess the self-reported health risk behaviours of low fruit and vegetable consumption, low physical activity, current smoking and hazardous alcohol consumption; (b) examine the demographic, caree condition and country of residence variables associated with each health risk behaviour; and (c) report the engagement in multiple health risk behaviours. METHODS An online cross-sectional survey among caregivers in Australia, Canada, New Zealand, the United Kingdom and the United States was conducted. Self-reported health risk behaviours were assessed and compared to key Australian healthy living guidelines. Logistic regression modelling identified participant factors associated with each health risk behaviour. RESULTS Overall, 384 caregivers were included in the analysis. Hazardous alcohol consumption was the only self-reported health risk behaviour which was much higher than in the general population (60.0%). Caregiver age (P = .018) and country of residence (P = .015) were associated with hazardous alcohol consumption. A majority of caregivers reported engaging in three health risk behaviours (55.0%). CONCLUSIONS Caregivers are engaging in a range of health risk behaviours; however, rates of hazardous alcohol consumption among the sample were high. Health promotion interventions targeted to address alcohol consumption should consider caregiver age and country of residence. SO WHAT?: This study highlights the health risk behaviours caregivers engage in across a number of countries, and suggests that caregivers require further support to manage alcohol consumption in particular.
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Affiliation(s)
- Alexandra M J Denham
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle & Hunter Medical Research Institute, Callaghan, NSW, Australia.,Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Olivia Wynne
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle & Hunter Medical Research Institute, Callaghan, NSW, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle & Hunter Medical Research Institute, Callaghan, NSW, Australia
| | - Neil J Spratt
- Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Biomedical Sciences and Pharmacy, University of Newcastle, University Drive, Callaghan, NSW, Australia.,Department of Neurology, Hunter New England Local Health District, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Alyna Turner
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle & Hunter Medical Research Institute, Callaghan, NSW, Australia.,IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Parker Magin
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle & Hunter Medical Research Institute, Callaghan, NSW, Australia
| | - Kerrin Palazzi
- HMRI Clinical Research Design and Statistics (CReDITSS), Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle & Hunter Medical Research Institute, Callaghan, NSW, Australia
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208
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Sorin M, Franco EL, Quesnel-Vallée A. Inter- and intraprovincial inequities in public coverage of cancer drug programs across Canada: a plea for the establishment of a pan-Canadian pharmacare program. Curr Oncol 2019; 26:266-269. [PMID: 31548806 DOI: 10.3747/co.26.4867] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Prescription drug coverage is a significant problem in Canada.[...]
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Affiliation(s)
- M Sorin
- Department of Pharmacology, McGill University, Montreal, QC
| | - E L Franco
- Department of Oncology, McGill University, Montreal, QC.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC
| | - A Quesnel-Vallée
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC.,Department of Sociology, McGill University, Montreal, QC
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209
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Kerr R, Hendrie DV. Is capital investment in Australian hospitals effectively funding patient access to efficient public hospital care? AUST HEALTH REV 2019; 42:501-513. [PMID: 30135003 DOI: 10.1071/ah17231] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 05/07/2018] [Indexed: 11/23/2022]
Abstract
Objective
This study asks ‘Is capital investment in Australian public hospitals effectively funding patient access to efficient hospital care?’
Methods
The study drew information from semistructured interviews with senior health infrastructure officials, literature reviews and World Health Organization (WHO) reports. To identify which systems most effectively fund patient access to efficient hospitals, capital allocation systems for 17 Organisation for Economic Cooperation and Development (OECD) countries were assessed.
Results
Australian government objectives (equitable access to clinically appropriate, efficient, sustainable, innovative, patient-based) for acute health services are not directly addressed within Australian capital allocation systems for hospitals. Instead, Australia retains a prioritised hospital investment system for institutionally based asset replacement and capital planning, aligned with budgetary and political priorities. Australian systems of capital allocation for public hospitals were found not to match health system objectives for allocative, productive and dynamic efficiency. Australia scored below average in funding patient access to efficient hospitals. The OECD countries most effectively funding patient access to efficient hospital care have transitioned to diagnosis-related group (DRG) aligned capital funding. Measures of effective capital allocation for hospitals, patient access and efficiency found mixed government–private–public partnerships performed poorly with inferior access to capital than DRG-aligned systems, with the worst performing systems based on private finance.
Conclusion
Australian capital allocation systems for hospitals do not meet Australian government standards for the health system. Transition to a diagnosis-based system of capital allocation would align capital allocation with government standards and has been found to improve patient access to efficient hospital care.
What is known about the topic?
Very little is known about the effectiveness of Australian capital allocation for public hospitals. In Australia, capital is rarely discussed in the context of efficiency, although poor built capital and inappropriate technologies are acknowledged as limitations to improving efficiency. Capital allocated for public hospitals by state and territory is no longer reported by Australian Institute of Health and Welfare due to problems with data reliability. International comparative reviews of capital funding for hospitals have not included Australia. Most comparative efficiency reviews for health avoid considering capital allocation. The national review of hospitals found capital allocation information makes it difficult to determine ’if we have it right’ in terms of investment for health services. Problems with capital allocation systems for public hospitals have been identified within state-based reviews of health service delivery. The Productivity Commission was unable to identify the cost of capital used in treating patients in Australian public hospitals. Instead, building and equipment depreciation plus the user cost of capital (or the cost of using the money invested in the asset) are used to estimate the cost of capital required for patient care, despite concerns about accuracy and comparability.
What does this paper add?
This is the first study to review capital allocation systems for Australian public hospitals, to evaluate those systems against the contemporary objectives of the health systems and to assess whether prevailing Australian allocation systems deliver funds to facilitate patient access to efficient hospital care. This is the first study to evaluate Australian hospital capital allocation and efficiency. It compares the objectives of the Australian public hospitals system (for universal access to patient-centred, efficient and effective health care) against a range of capital funding mechanisms used in comparable health systems. It is also the first comparative review of international capital funding systems to include Australia.
What are the implications for practitioners?
Clinical quality and operational efficiency in hospitals require access for all patients to technologically appropriate hospitals. Funding for appropriate public hospital facilities, medical equipment and information and communications technology is not connected to activity-based funding in Australia. This study examines how capital can most effectively be allocated to provide patient access to efficient hospital care for Australian public hospitals. Capital investment for hospitals that is patient based, rather than institutionally focused, aligns with higher efficiency.
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Affiliation(s)
- Rhonda Kerr
- Centre for Population Health Research, Faculty of Health Science, Curtin University, GPO Box U1987, Perth, WA 6845, Australia. Email
| | - Delia V Hendrie
- Centre for Population Health Research, Faculty of Health Science, Curtin University, GPO Box U1987, Perth, WA 6845, Australia. Email
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210
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Osman MA, Schick-Makaroff K, Thompson S, Bialy L, Featherstone R, Kurzawa J, Zaidi D, Okpechi I, Habib S, Shojai S, Jindal K, Braam B, Keely E, Liddy C, Manns B, Tonelli M, Hemmelgarn B, Klarenbach S, Bello AK. Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review. BMJ Glob Health 2019; 4:e001629. [PMID: 31565409 PMCID: PMC6747903 DOI: 10.1136/bmjgh-2019-001629] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/04/2019] [Accepted: 08/10/2019] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Electronic consultation (eConsult)-provider-to-provider electronic asynchronous exchanges of patient health information at a distance-is emerging as a potential tool to improve the interface between primary care providers and specialists. Despite growing evidence that eConsult has clinical benefits, it is not widely adopted. We investigated factors influencing the adoption and implementation of eConsult services. METHODS We applied established methods to guide the review, and the recently published Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews to report our findings. We searched five electronic databases and the grey literature for relevant studies. Two reviewers independently screened titles and full texts to identify studies that reported barriers to and/or facilitators of eConsult (asynchronous (store-and-forward) use of telemedicine to exchange patient health information between two providers (primary and secondary) at a distance using secure infrastructure). We extracted data on study characteristics and key barriers and facilitators were analysed thematically and classified using the Quadruple Aim framework taxonomy. No date or language restrictions were applied. RESULTS Among the 2579 publications retrieved, 130 studies met eligibility for the review. We identified and summarised key barriers to and facilitators of eConsult adoption and implementation across four domains: provider, patient, healthcare system and cost. Key barriers were increased workload for providers, privacy concerns and insufficient reimbursement for providers. Main facilitators were remote residence location, timely responses from specialists, utilisation of referral coordinators, addressing medicolegal concerns and incentives for providers to use eConsult. CONCLUSION There are multiple barriers to and facilitators of eConsult adoption across the domains of Quadruple Aim framework. Our findings will inform the development of practice tools to support the wider adoption and scalability of eConsult implementation.
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Affiliation(s)
- Mohamed A Osman
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Stephanie Thompson
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Liza Bialy
- Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
- Alberta SPOR SUPPORT Unit, Knowledge Translation platform, Edmonton, Alberta, Canada
| | - Robin Featherstone
- Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
- Alberta SPOR SUPPORT Unit, Knowledge Translation platform, Edmonton, Alberta, Canada
| | - Julia Kurzawa
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Deenaz Zaidi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ikechi Okpechi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Syed Habib
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Soroush Shojai
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kailash Jindal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Branko Braam
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Erin Keely
- Departments of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Research Institute, Ottawa, Ontario, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- CT Lamont Primary Healthcare Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Braden Manns
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brenda Hemmelgarn
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Scott Klarenbach
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Aggarwal M, Williams AP. Tinkering at the margins: evaluating the pace and direction of primary care reform in Ontario, Canada. BMC FAMILY PRACTICE 2019; 20:128. [PMID: 31510942 PMCID: PMC6739997 DOI: 10.1186/s12875-019-1014-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/26/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Primary care reform has been on the political agenda in Canada and many industrialized countries for several decades; it is widely seen as the foundation for broader health system transformation. Federal investments in primary care, including major cash transfers to provinces and territories as part of a 10-year health care funding agreement in 2004, triggered waves of primary care reform across Canada. Nevertheless, Commonwealth Fund surveys show, Canada continues to lag behind other industrialized nations with respect to timely access to care, electronic medical record use and audit and feedback for quality improvement in primary care. This paper evaluates the pace and direction of primary care reform as well as the extent of resulting change in the organization and delivery of primary care in Ontario, Canada's most populous province. METHODS Qualitative and quantitative methods were used for this study. A literature review was conducted to analyze the core dimensions of primary care reform, the history of reform in Ontario, and the extent to which different dimensions are integrated into Ontario's models. Quantitative data on the number of family physicians/general practitioners and patients enrolled in these models was examined over a 10-year period to determine the degree of change that has taken place in the organization and delivery of primary care in Ontario. RESULTS There are 11 core reform dimensions that individually and collectively shift from conventional primary care toward the more expansive vision of primary health care. Assessment of Ontario's models against these core dimensions demonstrate that there has been little substantive change in the organization and delivery of primary care over 10 years in Ontario. CONCLUSIONS Primary care reform is a multi-dimensional construct with different reform models bundling core dimensions in different ways. This understanding is important to move beyond the rhetoric of "reform" and to critically assess the pace and direction of change in primary care in Ontario and in other jurisdictions. The conceptual framework developed in this paper can assist decision-makers, academics and health care providers in all jurisdictions in evaluating the pace of change in the primary care sector, as well as other sectors.
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Affiliation(s)
- Monica Aggarwal
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.
| | - A Paul Williams
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
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212
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Edmonds S, Hajizadeh M. Assessing progressivity and catastrophic effect of out-of-pocket payments for healthcare in Canada: 2010-2015. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:1001-1011. [PMID: 31140059 DOI: 10.1007/s10198-019-01074-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/15/2019] [Indexed: 06/09/2023]
Abstract
Equity in healthcare is an important policy objective of the Canadian healthcare system. Out-of-pocket payments for healthcare (OPPH) by Canadian households account for a substantial share of total healthcare expenditures. Using data from Statistics Canada's Survey of Household Spending (SHS, n = 33,367), this study examined the progressivity and catastrophic effect of OPPH in Canada over the period 2010 to 2015 inclusive. The Kakwani Progressivity Index (KPI) was used to measure the progressivity of OPPH for each year of the study period. The catastrophic effect of OPPH was calculated using a threshold of 10% of total household consumption. The computed KPI indicated that OPPH are a regressive source of healthcare funding in Canada and the regressivity of OPPH has increased over the study period. This indicates that the distribution of OPPH in Canada is not equitable and the percentage contribution of households from their total consumption to healthcare as OPPH decreases as their consumption increase. The results also suggested that 7% of Canadian households face catastrophic out-of-pocket payments for healthcare (COPPH) over the study period. The proportion of households with COPPH was higher in rural areas compared with urban areas over the study period. Policies to enhance financial risk protection among low-income and rural households are required to improve equity in healthcare financing in Canada.
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Affiliation(s)
- Sterling Edmonds
- School of Health Administration, Faculty of Health, Dalhousie University, Sir Charles Tupper Medical Building, 5850 College Street, 2nd Floor, Halifax, NS, B3H 4R2, Canada
| | - Mohammad Hajizadeh
- School of Health Administration, Faculty of Health, Dalhousie University, Sir Charles Tupper Medical Building, 5850 College Street, 2nd Floor, Halifax, NS, B3H 4R2, Canada.
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213
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Zarshenas S, Horn SD, Colantonio A, Jaglal S, Cullen N. Content of inpatient rehabilitation for patients with traumatic brain injury: A comparison of Canadian and American facilities. Brain Inj 2019; 33:1503-1512. [PMID: 31446781 DOI: 10.1080/02699052.2019.1658224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To compare components of inpatient rehabilitation (IR) for patients with traumatic brain injury (TBI) between Canada and the US facilities. Design: Secondary analysis of the TBI-practice-based evidence dataset. Participants: Patients with TBI who had a higher Functional Independence Measure (FIMTM) cognitive function score (≥21) that were admitted to 1 IR facility in Canada (n = 103) and 9 IR facilities in the US (n = 401). Main measures: demographic and clinical characteristics, type and intensity of activities by discipline, discharge location, FIM-Rasch score, social participation and quality of life. Results: Time from injury to rehabilitation admission was significantly longer in the Canadian cohort and they experienced a longer rehabilitation length of stay (p < .001, Cohen's d > .8). Patients in Canada received a greater total time of individual therapy and lower intensity of interventions per week from all disciplines. They also showed a higher score at discharge in FIM components, while US patients had better cognitive recovery and community participation long-term post-discharge. Conclusions: This study informs stakeholders of the large variation in service provision for patients who were treated in these two countries. These findings suggest the need for robust analyzes to investigate predictors of short and long-term outcomes considering the variation in health-care delivery. List of abbreviations: TBI: traumatic brain injury, CSI: comprehensive severity index, LoS: length of stay, OT: occupational therapy, PT: physical therapy, SLP: speech language pathology, IR: inpatient rehabilitation.
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Affiliation(s)
- Sareh Zarshenas
- Rehabilitation Sciences Institute, University of Toronto , Toronto , Ontario , Canada.,University Centre, University Health Network, Toronto Rehabilitation Institute , Toronto , Ontario , Canada
| | - Susan D Horn
- Department of Population Health Sciences, University of Utah School of Medicine , Salt Lake City , UT , USA
| | - Angela Colantonio
- Rehabilitation Sciences Institute, University of Toronto , Toronto , Ontario , Canada.,University Centre, University Health Network, Toronto Rehabilitation Institute , Toronto , Ontario , Canada.,Occupational Science and Occupational Therapy, University of Toronto , Toronto , Ontario , Canada.,Dalla Lana School of Public Health, University of Toronto , Toronto , Ontario , Canada
| | - Susan Jaglal
- Rehabilitation Sciences Institute, University of Toronto , Toronto , Ontario , Canada.,University Centre, University Health Network, Toronto Rehabilitation Institute , Toronto , Ontario , Canada.,Department of Physical Therapy, University of Toronto , Toronto , Ontario , Canada
| | - Nora Cullen
- Rehabilitation Sciences Institute, University of Toronto , Toronto , Ontario , Canada.,University Centre, University Health Network, Toronto Rehabilitation Institute , Toronto , Ontario , Canada
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214
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Designing Interactional Pattern of Health Financing Between Ministry of Health and Social Health Insurances in Iran. HEALTH SCOPE 2019. [DOI: 10.5812/jhealthscope.84928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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215
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Marchildon G. The integration challenge in Canadian regionalization. CAD SAUDE PUBLICA 2019; 35Suppl 2:e00084418. [PMID: 31411305 DOI: 10.1590/0102-311x00084418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/03/2018] [Indexed: 11/22/2022] Open
Abstract
In the 1990s, regionalization was introduced in Canada through administrative delegation in order to achieve a number of reform objectives, but among the most important was to improve the integration of services across diverse health sectors. Despite the failure of regionalization in fulfilling its promise of integration, regionalization still provides a foundation for achieving system-wide integration. For this to occur, however, regional and provincial health authorities need to be given the effective accountability for primary care. Given that primary healthcare physicians provide the majority of primary care in Canada, the funding for primary care physicians should be returned from provincial ministries of health to regional (or provincial) authorities in order to allow them the opportunity to become responsible for coordinating health services for their patient populations across the continuum of care, and to contract providers with the necessary incentives and penalties.
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Affiliation(s)
- Gregory Marchildon
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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216
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Impact of the 2016 Policy Change on the Delivery of MedsCheck Services in Ontario: An Interrupted Time-Series Analysis. PHARMACY 2019; 7:pharmacy7030115. [PMID: 31409033 PMCID: PMC6789745 DOI: 10.3390/pharmacy7030115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/01/2019] [Accepted: 08/06/2019] [Indexed: 12/02/2022] Open
Abstract
MedsCheck (MC) is an annual medication review service delivered by community pharmacists and funded by the government of Ontario since 2007 for residents taking three or more medications for chronic conditions. In 2010, MC was expanded to include patients with diabetes (MCD), home-bound patients (MCH), and residents of long-term care homes (MCLTC). The Ontario government introduced an abrupt policy change effective 1 October 2016 that added several components to all MC services, especially those completed in the community. We used an interrupted time series design to examine the impact of the policy change (24 months pre- and post-intervention) on the monthly number of MedsCheck services delivered. Immediate declines in all services were identified, especially in the community (47%–64% drop MC, 71%–83% drop MCD, 55% drop MCH, and 9%–14% drop MCLTC). Gradual increases were seen over 24 months post-policy change, yet remained 21%–76% lower than predicted for MedsCheck services delivered in the community, especially for MCD. In contrast, MCLTC services were similar or exceeded predicted values by September 2018 (from 5.1% decrease to 3.5% increase). A more effective implementation of health policy changes is needed to ensure the feasibility and sustainability of professional community pharmacy services.
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217
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Menear M, Blanchette MA, Demers-Payette O, Roy D. A framework for value-creating learning health systems. Health Res Policy Syst 2019; 17:79. [PMID: 31399114 PMCID: PMC6688264 DOI: 10.1186/s12961-019-0477-3] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 07/15/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Interest in value-based healthcare, generally defined as providing better care at lower cost, has grown worldwide, and learning health systems (LHSs) have been proposed as a key strategy for improving value in healthcare. LHSs are emerging around the world and aim to leverage advancements in science, technology and practice to improve health system performance at lower cost. However, there remains much uncertainty around the implementation of LHSs and the distinctive features of these systems. This paper presents a conceptual framework that has been developed in Canada to support the implementation of value-creating LHSs. METHODS The framework was developed by an interdisciplinary team at the Institut national d'excellence en santé et en services sociaux (INESSS). It was informed by a scoping review of the scientific and grey literature on LHSs, regular team discussions over a 14-month period, and consultations with Canadian and international experts. RESULTS The framework describes four elements that characterise LHSs, namely (1) core values, (2) pillars and accelerators, (3) processes and (4) outcomes. LHSs embody certain core values, including an emphasis on participatory leadership, inclusiveness, scientific rigour and person-centredness. In addition, values such as equity and solidarity should also guide LHSs and are particularly relevant in countries like Canada. LHS pillars are the infrastructure and resources supporting the LHS, whereas accelerators are those specific structures that enable more rapid learning and improvement. For LHSs to create value, such infrastructures must not only exist within the ecosystem but also be connected and aligned with the LHSs' strategic goals. These pillars support the execution, routinisation and acceleration of learning cycles, which are the fundamental processes of LHSs. The main outcome sought by executing learning cycles is the creation of value, which we define as the striking of a more optimal balance of impacts on patient and provider experience, population health and health system costs. CONCLUSIONS Our framework illustrates how the distinctive structures, processes and outcomes of LHSs tie together with the aim of optimising health system performance and delivering greater value in health systems.
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Affiliation(s)
- Matthew Menear
- Institut national d’excellence en santé et en services sociaux (INESSS), Quebec, Canada
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Landry-Poulin Pavilion, 2525 chemin de la Canardière, Quebec, QC G1J 0A4 Canada
| | | | | | - Denis Roy
- Institut national d’excellence en santé et en services sociaux (INESSS), Quebec, Canada
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218
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Fox AM, Choi Y. Political Economy of Reform under US Federalism: Adopting Single-Payer Health Coverage in New York State. Health Syst Reform 2019; 5:209-223. [DOI: 10.1080/23288604.2019.1635414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Ashley M. Fox
- Rockefeller College of Public Affairs and Policy, University at Albany, SUNY, Albany, NY, USA
| | - Yongjin Choi
- Rockefeller College of Public Affairs and Policy, University at Albany, SUNY, Albany, NY, USA
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219
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Cognitive and Motor Recovery and Predictors of Long-Term Outcome in Patients With Traumatic Brain Injury. Arch Phys Med Rehabil 2019; 100:1274-1282. [DOI: 10.1016/j.apmr.2018.11.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 01/08/2023]
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220
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Kreindler SA, Metge C, Struthers A, Harlos K, Charette C, Bapuji S, Beaudin P, Botting I, Katz A, Zinnick S. Primary care reform in Manitoba, Canada, 2011–15: Balancing accountability and acceptability. Health Policy 2019; 123:532-537. [DOI: 10.1016/j.healthpol.2019.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 02/22/2019] [Accepted: 03/20/2019] [Indexed: 11/30/2022]
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221
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Granados Moreno P, Ali-Khan SE, Capps B, Caulfield T, Chalaud D, Edwards A, Gold ER, Rahimzadeh V, Thorogood A, Auld D, Bertier G, Breden F, Caron R, César PM, Cook-Deegan R, Doerr M, Duncan R, Issa AM, Reichman J, Simard J, So D, Vanamala S, Joly Y. Open science precision medicine in Canada: Points to consider. Facets (Ott) 2019. [DOI: 10.1139/facets-2018-0034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Open science can significantly influence the development and translational process of precision medicine in Canada. Precision medicine presents a unique opportunity to improve disease prevention and healthcare, as well as to reduce health-related expenditures. However, the development of precision medicine also brings about economic challenges, such as costly development, high failure rates, and reduced market size in comparison with the traditional blockbuster drug development model. Open science, characterized by principles of open data sharing, fast dissemination of knowledge, cumulative research, and cooperation, presents a unique opportunity to address these economic challenges while also promoting the public good. The Centre of Genomics and Policy at McGill University organized a stakeholders’ workshop in Montreal in March 2018. The workshop entitled “Could Open be the Yellow Brick Road to Precision Medicine?” provided a forum for stakeholders to share experiences and identify common objectives, challenges, and needs to be addressed to promote open science initiatives in precision medicine. The rich presentations and exchanges that took place during the meeting resulted in this consensus paper containing key considerations for open science precision medicine in Canada. Stakeholders would benefit from addressing these considerations as to promote a more coherent and dynamic open science ecosystem for precision medicine.
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Affiliation(s)
- Palmira Granados Moreno
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montréal, QC H3A 0G1, Canada
| | - Sarah E. Ali-Khan
- Centre for Intellectual Property and Policy, Faculty of Law, McGill University, Montreal, QC H3A 1W9, Canada
| | - Benjamin Capps
- Department of Bioethics, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Timothy Caulfield
- Health Law Institute, Faculty of Law and School of Public Health, University of Alberta, Edmonton, AB T6G 2H5, Canada
| | - Damien Chalaud
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Aled Edwards
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
- Structural Genomics Consortium, University of Toronto, Toronto, ON M5G 1L6, Canada
| | - E. Richard Gold
- Centre for Intellectual Property and Policy, Faculty of Law, McGill University, Montreal, QC H3A 1W9, Canada
| | - Vasiliki Rahimzadeh
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montréal, QC H3A 0G1, Canada
| | - Adrian Thorogood
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montréal, QC H3A 0G1, Canada
| | - Daniel Auld
- McGill University and Genome Quebec Innovation Centre, Montreal, QC H3A 0G1, Canada
| | - Gabrielle Bertier
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montréal, QC H3A 0G1, Canada
| | - Felix Breden
- Department of Biological Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Roxanne Caron
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montréal, QC H3A 0G1, Canada
| | - Priscilla M.D.G. César
- Centre for Intellectual Property and Policy, Faculty of Law, McGill University, Montreal, QC H3A 1W9, Canada
| | - Robert Cook-Deegan
- School for the Future of Innovation in Society, Barrett & O’Connor Washington Center, Arizona State University, Washington, DC 20006, USA
| | | | - Ross Duncan
- Public Health Agency of Canada, Ottawa, ON K1A 0K9, Canada
| | - Amalia M. Issa
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montréal, QC H3A 0G1, Canada
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada
- Personalized Medicine & Targeted Therapeutics, Philadelphia, PA 19803, USA
- Health Policy & Pharmaceutical Sciences, University of the Sciences in Philadelphia, Philadelphia, PA 19104, USA
| | | | - Jacques Simard
- Genomics Center, Centre Hospitalier Universitaire de Quebec-Laval University, Quebec City, QC G1V 4G2, Canada
| | - Derek So
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montréal, QC H3A 0G1, Canada
| | - Sandeep Vanamala
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Yann Joly
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montréal, QC H3A 0G1, Canada
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222
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Shaw D, Norman WV. When there are no abortion laws: A case study of Canada. Best Pract Res Clin Obstet Gynaecol 2019; 62:49-62. [PMID: 31281015 DOI: 10.1016/j.bpobgyn.2019.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/19/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
Canada decriminalized abortion, uniquely in the world, 30 years ago. We present the timeline of relevant Canadian legal, political, and policy events before and since decriminalization. We assess implications for clinical care, health service and systems decisions, health policy, and the epidemiology of abortion in the absence of criminal legislation. As the criminal abortion law was struck down, dozens of similar private member's bills, and one government bill, have been proposed, but none were passed. Key findings include that initially Canadian provinces attempted to provide restrictive regulations and legislation, all of which have been revoked and largely replaced with supportive policies that improve equitable, accessible, state-provided abortion service. Abortion rates have been stable over 30 years since decriminalization, and a falling proportion of abortions occur late in the second trimester. Canada demonstrates that abortion care can safely and effectively be regulated as a normal component of usual medical care.
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Affiliation(s)
- Dorothy Shaw
- University of British Columbia, Vancouver, Canada
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223
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Seto Nielsen L, Goldstein Z, Leung D, Lee C, Buick C. A Scoping Review of Undocumented Immigrants and Palliative Care: Implications for the Canadian Context. J Immigr Minor Health 2019; 21:1394-1405. [DOI: 10.1007/s10903-019-00882-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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224
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Bello AK, Ronksley PE, Tangri N, Kurzawa J, Osman MA, Singer A, Grill A, Nitsch D, Queenan JA, Wick J, Lindeman C, Soos B, Tuot DS, Shojai S, Brimble S, Mangin D, Drummond N. Prevalence and Demographics of CKD in Canadian Primary Care Practices: A Cross-sectional Study. Kidney Int Rep 2019; 4:561-570. [PMID: 30993231 PMCID: PMC6451150 DOI: 10.1016/j.ekir.2019.01.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/16/2018] [Accepted: 01/07/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction Surveillance systems enable optimal care delivery and appropriate resource allocation, yet Canada lacks a dedicated surveillance system for chronic kidney disease (CKD). Using data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), a national chronic disease surveillance system, this study describes the geographic, sociodemographic, and clinical variations in CKD prevalence in the Canadian primary care context. Methods This cross-sectional study included 559,745 adults in primary care in 5 provinces across Canada from 2010 through 2015. Data were analyzed by geographic (urban or rural residence), sociodemographic (age, sex, deprivation index), and clinical (medications prescribed, comorbid conditions) factors, using data from CPCSSN and the Canadian Deprivation Index. CKD stage 3 or higher was defined as 2 estimated glomerular filtration rate (eGFR) values of <60 ml/min per 1.73 m2 more than 90 days apart as of January 1, 2015. Results Prevalence of CKD was 71.9 per 1000 individuals and varied by geography, with the highest prevalence in rural settings compared with urban settings (86.2 vs. 68.4 per 1000). CKD was highly prevalent among individuals with 3 or more other chronic diseases (281.7 per 1000). Period prevalence of CKD indicated a slight decline over the study duration, from 53.4 per 1000 in 2010 to 46.5 per 1000 in 2014. Conclusion This is the first study to estimate the prevalence of CKD in primary care in Canada at a national level. Results may facilitate further research, prioritization of care, and quality improvement activities to identify gaps and improvement in CKD care.
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Affiliation(s)
- Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Navdeep Tangri
- Department of Medicine, Max Rady College of Medicine, Winnipeg, MB, Canada
| | - Julia Kurzawa
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Mohamed A Osman
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Alexander Singer
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Allan Grill
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - John A Queenan
- Canadian Primary Care Sentinel Surveillance Network, Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - James Wick
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cliff Lindeman
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Boglarka Soos
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | - Delphine S Tuot
- Division of Nephrology, University of California, San Francisco, California, USA.,Kidney Health Research Institute, University of California, San Francisco, California, USA
| | - Soroush Shojai
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Scott Brimble
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Neil Drummond
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,Department of Family Medicine, University of Alberta, Edmonton, AB, Canada.,Department of Family Medicine, University of Calgary, Calgary, AB, Canada
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225
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Sells JR, Taylor DA, Sbrocco T. Engaging in Policy During Graduate Training. ANNUAL REVIEW OF NURSING RESEARCH 2018; 36:205-218. [PMID: 30568019 DOI: 10.1891/0739-6686.36.1.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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226
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Meltzer CJ, Irish J, Angelos P, Busaidy NL, Davies L, Dwojak S, Ferris RL, Haugen BR, Harrell RM, Haymart MR, McIver B, Mechanick JI, Monteiro E, Morris JC, Morris LGT, Odell M, Scharpf J, Shaha A, Shin JJ, Shonka DC, Thompson GB, Tuttle RM, Urken ML, Wiseman SM, Wong RJ, Randolph G. American Head and Neck Society Endocrine Section clinical consensus statement: North American quality statements and evidence-based multidisciplinary workflow algorithms for the evaluation and management of thyroid nodules. Head Neck 2018; 41:843-856. [PMID: 30561068 DOI: 10.1002/hed.25526] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/28/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Care for patients with thyroid nodules is complex and multidisciplinary, and research demonstrates variation in care. The objective was to develop clinical guidelines and quality metrics to reduce unwarranted variation and improve quality. METHODS Multidisciplinary expert consensus and modified Delphi approach. Source documents were workflow algorithms from Kaiser Permanente Northern California and Cancer Care of Ontario based on the 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. RESULTS A consensus-based, unified preoperative, perioperative, and postoperative workflow was developed for North American use. Twenty-one panelists achieved consensus on 16 statements about workflow-embedded process and outcomes metrics addressing safety, access, appropriateness, efficiency, effectiveness, and patient centeredness of care. CONCLUSION A panel of Canadian and United States experts achieved consensus on workflows and quality metric statements to help reduce unwarranted variation in care, improving overall quality of care for patients diagnosed with thyroid nodules.
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Affiliation(s)
- Charles J Meltzer
- The Permanente Medical Group, Kaiser Permanente, Santa Rosa, California
| | - Jonathan Irish
- Department of Otolaryngology, Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network/University of Toronto, Toronto, Ontario, Canada
| | - Peter Angelos
- Department of Surgery, MacLean Center for Clinical Ethics, The University of Chicago Medicine, Chicago, Illinois
| | - Naifa L Busaidy
- Department of Endocrine Neoplasia & Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Louise Davies
- The VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont.,Section of Otolaryngology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
| | - Sunshine Dwojak
- Northwest Permanente Medicine, Kaiser Permanente, Portland, Oregon
| | - Robert L Ferris
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Bryan R Haugen
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado
| | - Richard M Harrell
- Departments of Integrative Endocrine Surgery and Pathology, Memorial Healthcare System, Hollywood, Florida
| | - Megan R Haymart
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Bryan McIver
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jeffrey I Mechanick
- Divisions of Cardiology and Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, Mount Sinai School of Medicine, New York, New York
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John C Morris
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Luc G T Morris
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Odell
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Joseph Scharpf
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ashok Shaha
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jennifer J Shin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - David C Shonka
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia
| | | | - R Michael Tuttle
- Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark L Urken
- Department of Otolaryngology Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York.,Icahn School of Medicine, Mount Sinai, New York, New York.,Thyroid, Head and Neck Cancer Foundation, New York, New York
| | - Sam M Wiseman
- Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard J Wong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gregory Randolph
- Department of Otolaryngology, Massachusetts General Hospital, Boston, Massachusetts
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227
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Raphael MJ, Booth CM. Neoadjuvant chemotherapy for muscle-invasive bladder cancer: Underused across the 49 th parallel. Can Urol Assoc J 2018; 13:29-31. [PMID: 30721125 DOI: 10.5489/cuaj.5827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Michael J Raphael
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada.,Departments of Oncology, Queen's University, Kingston, ON, Canada
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada.,Departments of Oncology, Queen's University, Kingston, ON, Canada.,Departments of Public Health Sciences, Queen's University, Kingston, ON, Canada
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228
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Martin D, Adams E, Caron NR. Canada's global leadership and Indigenous people - Authors' reply. Lancet 2018; 392:2349. [PMID: 30527610 DOI: 10.1016/s0140-6736(18)32747-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Danielle Martin
- Women's College Hospital and Department of Family and Community Medicine, University of Toronto, Toronto, ON M5S 1B2, Canada.
| | - Evan Adams
- First Nations Health Authority of British Columbia, Vancouver, BC, Canada
| | - Nadine R Caron
- Department of Surgery, Northern Medical Program and Centre for Excellence in Indigenous Health, University of British Columbia, Prince George, BC, Canada
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229
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Stime B, Laliberte N, Mackie J, Waters S. Canada's global leadership and Indigenous people. Lancet 2018; 392:2348-2349. [PMID: 30527608 DOI: 10.1016/s0140-6736(18)32757-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 10/19/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Bjorn Stime
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
| | - Nancy Laliberte
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Jennifer Mackie
- Peter A Allard School of Law, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Shannon Waters
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; Vancouver Island Health Authority, Victoria, BC, Canada
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230
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Brandt J, Shearer B, Morgan SG. Prescription drug coverage in Canada: a review of the economic, policy and political considerations for universal pharmacare. J Pharm Policy Pract 2018; 11:28. [PMID: 30443371 PMCID: PMC6220568 DOI: 10.1186/s40545-018-0154-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Canadians have long been proud of their universal health insurance system, which publicly funds the cost of physician visits and hospitalizations at the point of care. Prescription drugs however, have been subject to a patchwork of public and private coverage which is frequently inefficient and creates access barriers to necessary medicine for many Canadians. METHODS A narrative review was undertaken to understand the important economic, policy and political considerations regarding implementation of universal prescription drug access in Canada (pan-Canadian pharmacare). PubMed, SCOPUS and google scholar were searched for relevant citations. Citation trails were followed for additional information sources. Published books, public reports, press releases, policy papers, government webpages and other forms of gray literature were collected from iterative internet searches to provide a complete view of the current state on this topic. MAIN FINDINGS Regarding health economics, all five of the reviewed pharmacare simulation models have shown reductions in annual prescription drug expenditure. However, differing policy and cost assumptions have resulted in a wide range of cost-saving estimates between models. In terms of policy, a single-payer, 'first-dollar' coverage model, using a minimum national formulary, is the model most frequently advocated by the academic community, healthcare professions and many public and patient groups. In contrast, a multi-payer, catastrophic 'last-dollar' coverage model, more similar to the current "patchwork" state of public and private coverage, is preferred by industry drug manufacturers and private health insurance companies. Primary concerns from the detractors of universal, single-payer, 'first-dollar' coverage are the financing required for its implementation and the access barriers that may be created for certain patient populations that are not majorly present in the current public-private payer mix. CONCLUSION Canada patiently awaits to see how the issue of prescription drug coverage will be resolved through the work of the Advisory Council on the Implementation of National Pharmacare. The overarching and ongoing discourse on policy and program implementation may be construed as a political debate informed by divergent public and private interests.
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Affiliation(s)
- Jaden Brandt
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
| | - Brenna Shearer
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
- Pharmacists Manitoba, Winnipeg, MB Canada
| | - Steven G. Morgan
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
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231
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Damji AN, Martin D, Lermen N, Pinto LF, Trindade TGD, Prado JC. Trust as the foundation: thoughts on the Starfield principles in Canada and Brazil: The Besrour Papers: a series on the state of family medicine in Canada and Brazil. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:811-815. [PMID: 30429175 PMCID: PMC6234947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To compare primary care in Canada and Brazil and how both countries have embraced the Starfield principles in the design of their health care systems. COMPOSITION OF THE COMMITTEE A subgroup of the Besrour Centre of the College of Family Physicians of Canada developed connections with colleagues in Brazil and collaborated to undertake a between-country comparison, comparing and contrasting various elements of both countries' efforts to strengthen primary care over the past few decades. METHODS Following a literature review, the authors collectively reflected on their experiences in an attempt to explore the past and current state of family medicine in Canada and Brazil. REPORT The Brazilian and Canadian primary care systems have both adopted and advanced the Starfield principles in various ways, with both countries showing an increasing trend toward adopting interprofessional team-based care. Access to primary care remains a challenge in rural areas in both countries, and longitudinal relationships between providers and patients appear to be more common in Canada. With the advent of technology, increasing patient engagement and expectations, the decline of paternalistic medicine, and the sheer mass of readily available information (and misinformation), to be successful, primary care systems must also be constructed to engender trust at both the local and the system levels. Both countries face challenges to maintaining trust in the context of the increasing prevalence of team-based care, and a lack of trust at the system level can be seen in patients' perceptions about the difficulty of finding a family doctor and in high rates of emergency department and urgent care centre use in both countries. Primary care reform must be implemented with the public's trust in mind. CONCLUSION Trust is a crucial ingredient to the success of primary care and must be protected at both local and system levels. If designed with trust in mind, primary care in Canada and Brazil has the potential to meet the challenges set out by the Starfield principles.
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Affiliation(s)
- Ali N Damji
- Chief Family Medicine Resident at Credit Valley Hospital in Mississauga, Ont, and a member of the College of Family Physicians of Canada's Section of Residents Council and the Resident Doctors of Canada Board of Directors
| | - Danielle Martin
- Dr Martin is a family physician and Vice President for Medical Affairs and Health System Solutions at Women's College Hospital in Toronto, Ont, and Associate Professor in the Department of Family and Community Medicine and the Institute of Health Policy, Management and Evaluation at the University of Toronto.
| | - Nulvio Lermen
- Director of Ambulatory Services in the United Health Group in Brazil
| | - Luiz Felipe Pinto
- Adjunct Professor in the Department of Family Medicine and Community at the Federal University of Rio de Janeiro in Brazil
| | - Thiago Gomes da Trindade
- Adjunct Professor in the Department of Clinical Medicine at the Federal University of Rio Grande do Norte in Natal, Brazil
| | - José Carlos Prado
- Family physician in the municipality of Florianópolis in Santa Catarina, Brazil
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232
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Orser BA. Anesthesiology in the 21st century: our science is our destiny. Can J Anaesth 2018; 66:1-13. [DOI: 10.1007/s12630-018-1241-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 07/13/2018] [Indexed: 01/09/2023] Open
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233
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MacDonald NE, Harmon S, Dube E, Taylor B, Steenbeek A, Crowcroft N, Graham J. Is physician dismissal of vaccine refusers an acceptable practice in Canada? A 2018 overview. Paediatr Child Health 2018; 24:92-97. [PMID: 30996599 DOI: 10.1093/pch/pxy116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/28/2018] [Indexed: 12/25/2022] Open
Abstract
Despite robust evidence that routine immunization is effective and safe, some parents refuse some or all vaccines for their children. In 2007, concern that Canadian paediatricians and family physicians might be considering dismissal of vaccine refusers from their practices prompted an ethical, legal, and public health analysis which concluded that dismissal was professionally problematic. We now reassess this important issue in the Canadian context updating ethical, legal, and public health considerations highlighting changes since 2007. In light of the recent strengthening of Ontario's school immunization requirements that include stiffer steps to qualify for a medical, conscience, or religious belief exemption, physicians and health care workers may be under more pressure from vaccine refusers in their practice leading some to contemplate dismissal or even consider no longer offering immunizations at all in their practice. Given the challenges that vaccine refusers may present, we offer an overview for managing vaccine refusal by parents/patients in a medical practice.
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Affiliation(s)
- Noni E MacDonald
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia
| | - Shawn Harmon
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia.,JK Mason Institute for Medicine, Life Sciences and Law, University of Edinburgh, Edinburgh, UK
| | - Eve Dube
- Institut National de Santé Publique du Québec and Université Laval, Québec, Québec
| | - Beth Taylor
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia
| | - Audrey Steenbeek
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia
| | - Natasha Crowcroft
- Public Health Ontario, Laboratory Medicine and Pathobiology and Dalla Lana School of Public Health University of Toronto, Toronto Ontario
| | - Janice Graham
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia.,Technoscience and Regulation Research Unit, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia
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234
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Philippon DJ, Marchildon GP, Ludlow K, Boyling C, Braithwaite J. The comparative performance of the Canadian and Australian health systems. Healthc Manage Forum 2018; 31:239-244. [PMID: 30249145 DOI: 10.1177/0840470418788378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Using three data sets, each providing an overview of health service delivery in high-income countries, this article provides a high-level comparative analysis of health system performance against specified key performance indicators in two jurisdictions: Canada and Australia. Several variations, nuances, and points of comparison between delivery and organization of care are discussed. The article examines three policy and structural differences that may help explain the comparatively superior performance of the Australian system on most indicators, and two key areas of improvement for the Canadian system were illuminated: a stronger central government role and a national pharmaceutical plan. It is hoped that this article will empower health leaders to take action in these areas.
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Affiliation(s)
- Donald J Philippon
- 1 School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Gregory P Marchildon
- 2 Dalla Lana School of Public Health and North American Observatory on Health Systems and Policies, University of Toronto, Toronto, Ontario, Canada
| | - Kristiana Ludlow
- 3 Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Claire Boyling
- 3 Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- 3 Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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235
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Abstract
The Commonwealth Fund 2017 report ranked Canada's healthcare system low in access to care and last among all 11 counties studied in terms of timeliness of care. While long wait times for certain elective surgical procedures appear to be emblematic of Canadian Medicare, they are not inevitable. Wait times could be improved by focusing on public awareness and measurement of wait times and improving the appropriateness, efficiency (eg, with implementation of single-entry models for surgical referrals and greater use of ambulatory surgery), and productivity of surgical care (eg, by activity-based funding for surgical procedures and by reducing the cost of perioperative care). Ideas on how physician leaders can build on recent accomplishments are provided.
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Affiliation(s)
- David R Urbach
- 1 Department of Surgery, Women's College Hospital, Toronto, Ontario, Canada
- 2 Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
- 3 Women's College Hospital Research Institute, Toronto, Ontario, Canada
- 4 Toronto General Hospital Research Institute, Toronto, Ontario, Canada
- 5 Department of Surgery and Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Ivers N, Brown AD, Detsky AS. Lessons From the Canadian Experience With Single-Payer Health Insurance: Just Comfortable Enough With the Status Quo. JAMA Intern Med 2018; 178:1250-1255. [PMID: 30083756 DOI: 10.1001/jamainternmed.2018.3568] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
With single-payer public health insurance again on the political radar in the United States at both the state (California) and federal (Democrat party) levels, the performance of the Canadian health care system during the last 50 years and the lessons it may offer should be considered. Canadians are proud of their universal approach to health insurance based on need rather than income. The system has many strengths, such as the ease of obtaining care, relatively low costs, and low administrative costs, with effectiveness and safety roughly on par with other countries, including those, such as the United States, that spend considerably more per capita. There are increasing frustrations, however, with system performance, especially with issues related to access and coordination of care. Medicine has changed dramatically since the introduction of Canadian Medicare in the late 1960s, which primarily covered acute care physician and hospital services-the needs of the time. Meaningful reforms that match coverage and services to changing needs, especially those of community-based patients with multiple chronic conditions, have been difficult to implement. The status quo represents a compromise struck decades ago between payers and physicians and organizations that provide health care, and the current system works just well enough for those who both need it and vote. Enacting substantial change simply carries too much risk. Perhaps the most important lesson that the United States can learn from Canada's experience during the last 50 years is that a single-payer health care system solves a lot of problems, but it does not equate to an integrated, well-managed system that can readily meet the changing health care needs of a population.
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Affiliation(s)
- Noah Ivers
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario.,Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario.,Department of Family and Community Medicine, Women's College Hospital, Toronto, Ontario.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario
| | - Adalsteinn D Brown
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.,Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario.,Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario
| | - Allan S Detsky
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.,Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario.,Department of Medicine, University of Toronto, Toronto, Ontario
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237
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Kouyoumdjian FG, Cheng SY, Fung K, Orkin AM, McIsaac KE, Kendall C, Kiefer L, Matheson FI, Green SE, Hwang SW. The health care utilization of people in prison and after prison release: A population-based cohort study in Ontario, Canada. PLoS One 2018; 13:e0201592. [PMID: 30075019 PMCID: PMC6075755 DOI: 10.1371/journal.pone.0201592] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/18/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Many people experience imprisonment each year, and this population bears a disproportionate burden of morbidity and mortality. States have an obligation to provide equitable health care in prison and to attend to care on release. Our objective was to describe health care utilization in prison and post-release for persons released from provincial prison in Ontario, Canada in 2010, and to compare health care utilization with the general population. METHODS We conducted a population-based retrospective cohort study. We included all persons released from provincial prison to the community in 2010, and age- and sex-matched general population controls. We linked identities for persons released from prison to administrative health data. We matched each person by age and sex with four general population controls. We examined ambulatory care and emergency department utilization and medical-surgical and psychiatric hospitalization, both in prison and in the three months after release to the community. We compared rates with those of the general population. RESULTS The rates of all types of health care utilization were significantly higher in prison and on release for people released from prison (N = 48,861) compared to general population controls (N = 195,444). Comparing those released from prison to general population controls in prison and in the 3 months after release, respectively, utilization rates were 5.3 (95% CI 5.2, 5.4) and 2.4 (95% CI 2.4, 2.5) for ambulatory care, 3.5 (95% CI 3.3, 3.7) and 5.0 (95% CI 4.9, 5.3) for emergency department utilization, 2.3 (95% CI 2.0, 2.7) and 3.2 (95% CI 2.9, 3.5) for medical-surgical hospitalization, and 21.5 (95% CI 16.7, 27.7) and 17.5 (14.4, 21.2) for psychiatric hospitalization. Comparing the time in prison to the week after release, ambulatory care use decreased from 16.0 (95% CI 15.9,16.1) to 10.7 (95% CI 10.5, 10.9) visits/person-year, emergency department use increased from 0.7 (95% CI 0.6, 0.7) to 2.6 (95% CI 2.5, 2.7) visits/person-year, and hospitalization increased from 5.4 (95% CI 4.8, 5.9) to 12.3 (95% CI 10.1, 14.6) admissions/100 person-years for medical-surgical reasons and from 8.6 (95% CI 7.9, 9.3) to 17.3 (95% CI 14.6, 20.0) admissions/100 person-years for psychiatric reasons. CONCLUSIONS Across care types, health care utilization in prison and on release is elevated for people who experience imprisonment in Ontario, Canada. This may reflect high morbidity and suboptimal access to quality health care. Future research should identify reasons for increased use and interventions to improve care.
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Affiliation(s)
- Fiona G. Kouyoumdjian
- Department of Family Medicine, McMaster University, Hamilton, Canada
- St. Michael’s Hospital, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- * E-mail:
| | | | - Kinwah Fung
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Aaron M. Orkin
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Claire Kendall
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- C.T. Lamont Primary Health Care Research Group, Bruyère Research Institute, Ottawa, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Lori Kiefer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Ontario Ministry of Community Safety and Correctional Services, Toronto, Canada
| | - Flora I. Matheson
- St. Michael’s Hospital, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Centre for Criminology and Sociolegal Studies, University of Toronto, Toronto, Canada
| | - Samantha E. Green
- St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Stephen W. Hwang
- St. Michael’s Hospital, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
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238
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Thorogood A. Canada: will privacy rules continue to favour open science? Hum Genet 2018; 137:595-602. [PMID: 30014188 PMCID: PMC6132649 DOI: 10.1007/s00439-018-1905-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 07/05/2018] [Indexed: 12/03/2022]
Abstract
Canada’s regulatory frameworks governing privacy and research are generally permissive of genomic data sharing, though they may soon be tightened in response to public concerns over commercial data handling practices and the strengthening of influential European privacy laws. Regulation can seem complex and uncertain, in part because of the constitutional division of power between federal and provincial governments over both privacy and health care. Broad consent is commonly practiced in genomic research, but without explicit regulatory recognition, it is often scrutinized by research or privacy oversight bodies. Secondary use of health-care data is legally permissible under limited circumstances. A new federal law prohibits genetic discrimination, but is subject to a constitutional challenge. Privacy laws require security safeguards proportionate to the data sensitivity, including breach notification. Special categories of data are not defined a priori. With some exceptions, Canadian researchers are permitted to share personal information internationally but are held accountable for safeguarding the privacy and security of these data. Cloud computing to store and share large scale data sets is permitted, if shared responsibilities for access, responsible use, and security are carefully articulated. For the moment, Canada’s commercial sector is recognized as “adequate” by Europe, facilitating import of European data. Maintaining adequacy status under the new European General Data Protection Regulation (GDPR) is a concern because of Canada’s weaker individual rights, privacy protections, and regulatory enforcement. Researchers must stay attuned to shifting international and national regulations to ensure a sustainable future for responsible genomic data sharing.
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Affiliation(s)
- Adrian Thorogood
- BCL/LLB, Centre of Genomics and Policy, McGill University, Montreal, Canada.
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240
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Greenwood M, de Leeuw S, Lindsay N. Challenges in health equity for Indigenous peoples in Canada. Lancet 2018; 391:1645-1648. [PMID: 29483024 DOI: 10.1016/s0140-6736(18)30177-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Margo Greenwood
- National Collaborating Centre for Aboriginal Health, University of Northern British Columbia, Prince George, BC V2N 4Z9, Canada.
| | - Sarah de Leeuw
- National Collaborating Centre for Aboriginal Health, University of Northern British Columbia, Prince George, BC V2N 4Z9, Canada; Northern Medical Program, University of Northern British Columbia, Prince George, BC, Canada
| | - Nicole Lindsay
- National Collaborating Centre for Aboriginal Health, University of Northern British Columbia, Prince George, BC V2N 4Z9, Canada
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241
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242
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Nixon SA, Lee K, Bhutta ZA, Blanchard J, Haddad S, Hoffman SJ, Tugwell P. Canada's global health role: supporting equity and global citizenship as a middle power. Lancet 2018; 391:1736-1748. [PMID: 29483026 PMCID: PMC7138077 DOI: 10.1016/s0140-6736(18)30322-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/11/2017] [Accepted: 10/12/2017] [Indexed: 12/27/2022]
Abstract
Canada's history of nation building, combined with its status as a so-called middle power in international affairs, has been translated into an approach to global health that is focused on equity and global citizenship. Canada has often aspired to be a socially progressive force abroad, using alliance building and collective action to exert influence beyond that expected from a country with moderate financial and military resources. Conversely, when Canada has primarily used economic self-interest to define its global role, the country's perceived leadership in global health has diminished. Current Prime Minister Justin Trudeau's Liberal federal government has signalled a return to progressive values, driven by appreciation for diversity, equality, and Canada's responsibility to be a good global citizen. However, poor coordination of efforts, limited funding, and the unaddressed legacy of Canada's colonisation of Indigenous peoples weaken the potential for Canadians to make meaningful contributions to improvement of global health equity. Amid increased nationalism and uncertainty towards multilateral commitments by some major powers in the world, the Canadian federal government has a clear opportunity to convert its commitments to equity and global citizenship into stronger leadership on the global stage. Such leadership will require the translation of aspirational messages about health equity and inclusion into concrete action at home and internationally.
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Affiliation(s)
- Stephanie A Nixon
- Department of Physical Therapy, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; International Centre for Disability and Rehabilitation, and Rehabilitation Sciences Institute, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Kelley Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Zulfiqar A Bhutta
- Department of Nutrition, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - James Blanchard
- Centre for Global Public Health, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Slim Haddad
- Centre de Recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, QC, Canada; Département de Médecine Sociale et Préventive, Université Laval, Québec City, QC, Canada
| | - Steven J Hoffman
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, School of Health Policy and Management, and Osgoode Hall Law School, York University, Toronto, ON, Canada
| | - Peter Tugwell
- Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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