Abstract: Engaging with Policy Makers: The Need for Accessible and Timely Health Services and Systems Research in 2020 PubDate: Fri, 29 May 2020 04:00:00 +000
Abstract: Canada's single-payer healthcare system is at a critical crossroads. A legal challenge underway in British Columbia alleges that legislative restrictions on privately financed care infringe the right to "life, liberty and security" guaranteed under Section 7 of the Canadian Charter of Rights and Freedoms. The greatest challenge for the court will be comparing healthcare systems across disparate jurisdictions, with the future of single-tier healthcare system hanging in the balance. If successful, the case may require a major overhaul of Canada's single-payer system – a perilous task politically, if history is any guide, and this may be the system's undoing. PubDate: Fri, 29 May 2020 04:00:00 +000
Abstract: The Cambie proposition is the American individualistic one: If I can afford to pay for quick access to care, then that should be my right. It denies any concept of universalism, of the common good or that your rights might adversely impact my rights and my healthcare experience. Some private care proponents offer the magical prospect that this quicker access for the wealthy few has no impact on access for the many. It is even sometimes perversely argued that if the wealthy pay for access outside the public health system, that reduces demand for public care, freeing up space for others and, hey presto, magically everyone benefits from the increase in inequality. The Australian experience is that this magic does not work. PubDate: Fri, 29 May 2020 04:00:00 +000
Abstract: Health Canada is proposing to update its accelerated review pathways to get important new drugs into the market more quickly. To date, the two pathways that Health Canada uses have not demonstrated that they can identify therapeutically valuable new drugs. Drugs approved under the two pathways also have a greater likelihood of acquiring a serious safety warning post-marketing compared with drugs approved through the standard review pathway. The new proposals from Health Canada will not go far in rectifying this situation, and major changes are needed. Health Canada needs to present evidence that the changes it is proposing will actually allow these pathways to fulfill the set objectives and support health benefits for Canadians. PubDate: Fri, 29 May 2020 04:00:00 +000
Abstract: Lexchin has criticized Health Canada's recently published draft guidance on accelerated drug review, expressing concern over agency conflicts of interest and observing that priority review and notice of compliance with conditions correlate poorly with therapeutic benefit. Although agency operations may be imperfect, perhaps the most important finding of Lexchin's research is that only 11% of newly approved drugs provide meaningful benefit over standard treatments. To improve the expedited review process in light of these findings, we suggest eliminating user fees and fully funding the review process with public monies, reserving the use of expedited approval pathways for when preliminary measures of benefit are so large that traditional approval thresholds can be met earlier in the clinical trial process, improving labelling to quantitatively communicate drug benefits and risks, and avoiding the use of titles such as "priority" review, which could imply a magnitude of clinical superiority that has not been established. PubDate: Fri, 29 May 2020 04:00:00 +000
Abstract: Policy makers face challenges with the number of drugs for rare indications and rapidly rising costs. In facing these challenges, decision-makers see real-world evidence (RWE) as an opportunity. Health Canada and the Canadian Agency for Drugs and Technologies in Health (CADTH) recently announced their intent to co-develop an action plan to optimize the process for the systematic use and integration of RWE into both regulatory and reimbursement decision-making in Canada. When implemented, this will have a significant impact on how drugs are approved and paid for in Canada. We highlight the key opportunities, barriers and future directions related to the use of RWE throughout the life cycle of drugs in Canada. PubDate: Fri, 29 May 2020 04:00:00 +000
Abstract: We surveyed Canadian healthcare experts to identify policies to address antimicrobial resistance (AMR) in Canada between 2008 and 2018. Respondents identified AMR policy interventions implemented in Canada during the previous 10 years. Additional policies were identified through systematic searches of seven electronic databases and a review of government documents. Fifty-two unique policies were identified, with at least one policy in most provinces and territories. This environmental scan suggests that Canadian AMR efforts are disjointed and inadequate, given the urgency of this public health threat. Governments have mostly refrained from using more powerful policy tools, including regulation, legislation and fiscal measures. PubDate: Fri, 29 May 2020 04:00:00 +000
Abstract: Objective: This study examines the association between community-level marginalization and emergency room (ER) wait time in Ontario.Methods: Data sources included ER wait time data and Ontario Marginalization Index scores. Linear regression models were used to quantify the association.Results: A positive association between total marginalization and overall, high-acuity and low-acuity ER wait time was found. Considering specific marginalization dimensions, we found positive associations between residential instability and ER wait time and negative associations between dependency and ER wait time.Conclusions: Reductions in community-level marginalization may impact ER wait time. Future studies using individual-level data are necessary. PubDate: Fri, 29 May 2020 04:00:00 +000
Abstract: Background: The Quebec Government published Canada's first breastfeeding policy in 2001 with the goal to increase breastfeeding rates in the province.Objective: To ultimately contribute to more informed policy decision-making, this investigation aimed to identify key stakeholders and understand events and processes that contributed to the establishment of this policy.Methods: Building from the neo-institutional theory, this was a retrospective case study. Interviews with key informants were conducted, and several texts were compiled. Hybrid thematic analysis was used to analyze text transcribed verbatim from interviews. Resulting themes, summary of archival material and temporal bracketing were adopted to elaborate a historical narrative of the development of the policy.Results: The emergence, development and initial implementation of the Quebec breastfeeding policy phases were traced from 1977 to 2009. The policy was triggered by a grassroots health professional movement that advocated for years for a cultural change toward breastfeeding in Quebec. Once Quebec's Ministry of Health finally accepted dialogue, institutional actors cooperated to formulate the policy. However, conflicts arose because of the Ministry's increasingly centralized mechanisms of governance. By 2009, discontent was so pervasive that several health professionals and other breastfeeding actors created an independent organization to further support breastfeeding, out of the Ministry's scope of control.Conclusion: Collaboration in this domain was possible when shared decision-making was accepted, but conflict emerged when the institutional actor with formal authority re-adopted traditional top-down modes of action. PubDate: Fri, 29 May 2020 04:00:00 +000
Abstract: Individuals face multiple health risks and therefore can undertake many preventive activities simultaneously, thus creating a portfolio of preventive activities. In this article, we first investigate the determinants likely to influence the composition of portfolios of preventive activities. Second, we look at the interactions between preventive activities. We use the US Behavioral Risk Factor Surveillance System survey data set conducted in 2016, comprising 22,510 observations from 50 states and US territories. Our results show that information-related variables, in particular, being aware of illness, having access to information and having a personal doctor, increase the portfolio size of preventive activities. We also show that vaccinations tend to be performed together with screening activities and to a lower extent with exercising. PubDate: Fri, 29 May 2020 04:00:00 +000
Abstract: Although biosimilars offer cost savings in Canadian healthcare, uptake is low. We discuss the literature on international experiences with biosimilar adoption in the context of the Diffusion of Innovations model. We highlight potential challenges with biosimilar implementation and gaps in research needed to inform implementation efforts. We observe a lack of systematic description of implementation design and evaluation and a paucity of in-depth and engaged research to understand stakeholders' pragmatic considerations and the knowledge, messages and meanings that shape clinician and patient decisions to choose biosimilars. PubDate: Fri, 28 Feb 2020 05:00:00 +000
Abstract: Background: First Nations peoples in Ontario are facing increasing rates of cancer and have been found to have poorer survival. Cancer screening is an important strategy to improve cancer outcomes; yet, Indigenous people in Canada are less likely to participate in screening. Ontario has established organized breast, cervical and colorectal cancer screening programs; this paper examines the health policy context that informs these programs for First Nations peoples in the province.Method: This paper follows an embedded multiple-case study design, drawing upon a document review to outline the existing policy context and on key informant interviews to explore the aforementioned context from the perspective of stakeholders.Results: Policies created by agencies operating across federal, regional and provincial levels impact First Nations peoples' access to screening. Interviews identified issues of jurisdictional ambiguity, appropriateness of program design for First Nations persons and lack of cultural competency as barriers to participation in screening.Conclusion: Federal, provincial and regional policy makers must work in collaboration with First Nations peoples to overcome barriers to cancer screening created and sustained by existing policies. PubDate: Fri, 28 Feb 2020 05:00:00 +000
Abstract: Objective: The objective of this study is to examine if women are less likely than men to receive surgery following work-related musculoskeletal injury in the Canadian province of British Columbia.Methods: The study included 2,403 workers with work-related knee meniscal tear, thoracic/lumbar disc displacement or rotator cuff tear. Probability of surgery was compared by gender using Kaplan–Meier methods and Cox proportional hazards models.Results: For each injury type, a smaller proportion of women received surgery compared to men (knee: 76% vs. 80%; shoulder: 13% vs. 36%; back: 13% vs. 19%). In adjusted models, compared to men, women were 0.87 (95% confidence interval [CI] [0.69, 1.09]), 0.35 (95% CI [0.25, 0.48]) and 0.54 (95% CI [0.31, 0.95]) times less likely to receive knee, shoulder or back surgery, respectively.Conclusions: Probability of surgery following work-related musculoskeletal injury was lower for women than for men. Strategies to ensure gender equitable delivery of surgical services by workers' compensation systems may be warranted, although further research is necessary to investigate determinants of the gender difference and the impact of elective orthopaedic surgery on occupational outcomes. PubDate: Fri, 28 Feb 2020 05:00:00 +000
Abstract: Background and objective: Nurses provide essential primary care (PC) in rural and remote Canada. We examined the practice context and responsibilities of this little-known understudied workforce.Method: Data from Nursing Practice in Rural and Remote Canada II, a 2014 to 2015 pan-Canadian survey, were analyzed.Results: Of 3,822 respondents, 192 identified that PC was their only practice focus (PC-Only), and for 111, it was one focus among others (PC-Plus). Proportionally more PC-Only than PC-Plus nurses had graduate education, were employed in larger communities and had experienced higher job resources and lower job demands. Proportionally fewer PC-Only than PC-Plus nurses followed protocols/decision support tools, dispensed medications and provided emergency services. Proportionally more PC-Only than PC-Plus nurses ordered advanced diagnostic tests/imaging, and fewer PC-Only than PC-Plus nurses performed and interpreted laboratory tests and diagnostic imaging on site.Conclusion: Contributions of the rural and remote nursing workforce to PC are rendered invisible by contemporary characterizations of the PC workplace, limiting evaluation and improvement efforts. PubDate: Fri, 28 Feb 2020 05:00:00 +000
Abstract: Background: Cancer in children presents unique issues for diagnosis, treatment and survivorship care. Phase-specific comparative cost estimates are important for informing healthcare planning.Objectives: The aim of this paper is to compare direct medical costs of childhood cancer by phase of care in British Columbia (BC) and Ontario (ON).Methods: For cancer patients diagnosed at <15 years of age and propensity-score-matched non-cancer controls, we applied standard costing methodology using population-based healthcare administrative data to estimate and compare phase-based costs by province.Results: Phase-specific cancer-attributable costs were 2%–39% higher for ON than for BC. Leukemia pre-diagnosis costs and annual lymphoma continuing care costs were >50% higher in ON. Phase-specific in-patient hospital costs (the major cost category) represented 63%–82% of ON costs, versus 43%–73% of BC costs. Phase-specific diagnostic tests and procedures accounted for 1.0%–3.4% of ON costs and 2.8%–13.0% of BC costs.Conclusions: There are substantial cost differences between these two Canadian provinces, BC and ON, possibly identifying opportunities for healthcare planning improvement. PubDate: Fri, 28 Feb 2020 05:00:00 +000
Abstract: Background: Concordance between Common Drug Review (CDR) recommendations and provincial plans has been studied previously. However, no study has, to the best of the authors' knowledge, examined the characteristics of CDR recommendations that may be associated with concordance.Methods: Recommendation–decision pairs were collected from the CDR and the provincial plans of Ontario, British Columbia and Alberta. Concordance was evaluated by province. Characteristics of each CDR recommendation were collected, and associations with concordance were evaluated by logistic regression.Results: Recommendation–listing concordance was high. Positive references to cost and clinical outcomes compared to placebo were statistically associated with concordance. Negative references to cost and to the consistency and certainty of economic evidence were statistically associated with discordance. However, these findings were inconsistent across the jurisdictions studied.Conclusions: Although concordance was high, the ability of recommendation characteristics to explain the relationship between province and CDR listing decisions was limited. This exploratory study highlights the complexity of the reimbursement process and possible reasons for drug listing differences across jurisdictions. PubDate: Fri, 28 Feb 2020 05:00:00 +000
Abstract: Medical advancements have now made it possible to provide allogeneic stem cell transplantation (allo-SCTs) to older patients and use stem cells from less well-matched donors. This has resulted in access to a life-saving modality for a greater number of patients with imminent life-threatening illnesses. However, resources have not always kept pace with innovation and expanded volumes. During the summer of 2015 in the province of Ontario, Canada, inadequate resources contributed to a capacity crisis, resulting in extended wait-lists for allo-SCT across the province. This situation presented unique ethical challenges, including the need for ongoing negotiations with health system partners and nimble process management to ensure timely delivery of care. This article reports on the process one organization used to determine how to equitably allocate scarce allo-SCT resources. With the ever-expanding landscape of new and emerging medical technologies, our experience has implications for the ethics of translating other increasingly expensive health technologies to clinical care. PubDate: Fri, 28 Feb 2020 05:00:00 +000
Abstract: The development of refugee health policies is significant, given the increased volume of displaced persons seeking refuge in Canada and around the world. Changes to the Canadian refugee health policy, known as the Interim Federal Health Program (IFHP), limited healthcare access for refugees and refugee claimants from 2012 to 2016. In this article, we present a policy analysis using the case of the IFHP retrenchments to examine how political actors on opposing sides of the issue defined the problem using different causal story mechanisms. This analysis reveals that organized interests dramatically changed the problem definition of the IFHP reforms. Following their use of causal stories in redefining the problem, the courts declared that the reforms to refugee healthcare were a form of cruel and unusual treatment. Understanding policy strategies used by proponents of refugee healthcare coverage expansion is important for countries responding to the current, enduring refugee crisis. PubDate: Fri, 28 Feb 2020 05:00:00 +000
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