Beyond Pharmacare Flashcards
What are some examples of health system reforms that have preoccupied provinces?
- Chronic disease management (reduce hospitalizations, costs, and improve outcomes)
- Align system with provincial objectives (governance structure and incentive systems)
- Shift from hospital to community-based care (reduced hospitalizations and length-of-stay key objectives)
- Integrate physicians into the system (increase management of physicians to follow best practices)
- Develop capacities for improvement (ability to assess needs, define problems, and take action)
What were the three biggest problems facing healthcare in 2022?
- Not enough staff
- Access/waiting times
- Aging population
What are some healthcare priorities from the perspective of physicians?
- Not enough healthcare workers
- Long wait times for treatment (lack of staff, beds, and OR times)
- Poor access and quality in LTC (lack of funding)
- Poor access to mental health services (lack of funding)
- Underperforming primary care (lack of integration and collaboration)
- Racism and cultural safety
How can health human resources be enhanced?
Need to address staffing issues beyond hiring more people
- Create a national workplace plan (place skilled people where they’re needed)
- Pan-Canadian licensure (encourage mobility of professionals nationwide)
- Develop mental health supports
What are the consequences of excessive delays accessing health care?
- Disease progression
- Increased anxiety
- Depression
- Mental health flare-ups
- Worsening of patient outcomes
How are wait times assigned based on distributive justice?
- Type and severity of a patient’s condition
- Changes in health status
- Needs of other patients
- Patient volume
- Provider experience
- Availability of resources
- Patient readiness
What is long-term care?
A range of programs and services, including residential care, personal care homes, and other community-based LTC services
Are there federal standards for the level of LTC care provided by the provinces?
Referred to as extended services, meaning there are no federal services (almost an afterthought)
Each province sets its own standards and very different approaches
Most provincial governments see LTC supporting care provided by families and other informal caregivers
What is the issue with relying on family members and other informal caregivers for LTC?
Declining fertility rates
Smaller families
Families are dispersed across the country
What is the focus of healthcare in nursing homes?
Quality of life, quality of life at the end of life, and a good death
Are palliative services readily available?
No, in LTC facilities there are high rates of burdensome symptoms and inappropriate care at the end of life
Do patients in LTC tend to retain functional status?
No, they lose functional mobility rapidly with up to 70% of nursing home residents using wheelchairs
What percentage of LTC workers are regulated caregivers?
10% (registered and licensed practical nurses)
90% is carried out by unregulated care aides, personal support workers, nurse assistants, etc.
What are unregulated LTC workers at risk of experiencing?
Burnout and poorer physical and mental health status than other healthcare workers
How are LTC facilities funded?
Although only 3.5% of elderly are in LTC, 13% of provincial health budgets are spent on caring for this population
Private providers account for a substantial amount of spending in care homes, especially in Ontario, BC, and NS
Did patients in private provider care homes show better health outcomes among patients?
No, publicly funded or non-profit LTCs saw fewer sicker under this model
publicly funded LTCs are common in NFLD, Quebec, Manitoba, and SK
What are some characteristics of primary care?
Delivered by a variety of HCPs (physicians, nurses, pharmacists, and others)
Provided in a variety of settings (MD offices, outpatient clinics, community health centres, walk-in clinics, pharmacies, pts. home)
What are some issues with Canada’s primary care system?
Canada lags behind its peers based on:
- Timely access to care
- Patients’ ability to communicate electronically with primary care providers
- Development of interprofessional teams
- Communication across healthcare settings
What is the definition of high quality primary care?
Provision of holistic, integrated, accessible, and equitable health care by IPE teams accountable for addressing the majority of an individual’s health and wellness needs through sustained relationships that understand the patient’s full story
Review slide 23 for characteristics of a high performing primary care system
What are some examples of efforts to improve primary care in Canada?
Adoption of e-medical records, QI training, growth of IP teams
Limited progress in governance mechanisms, system coordination, and outcomes-based payment model
Least progress in patient engagement, HCP performance measurement, research capacity
Why is progress towards improving primary care in Canada so slow?
Each province/territory guards its authority
Relationship between MDs and governments and maintaining fee-for-service payment models (MDs have central role currently, and they have clinical and financial autonomy concerns about changes)
What are some factors that are contributing to the inability to access mental health care?
- Long wait times
- Shortage of accessible mental health professionals
- Cost of care
- Lack of service integration and oversight
- Cultural and language barriers
- Inequities due to geographic and demographic
- Concerns about stigma
- Not knowing where to go for help
Do older adults have better access to mental health care?
Yes, as a proportion of the population
Younger cohorts are having harder time finding mental health services, perhaps due to increased demand among younger age groups (cultural changes)
