Midterm Flashcards
What are the key competencies for Physiotherapy?
Expert Communicator Collaborator Advocate Scholarly Practitioner Professional Manager
What are the criteria for professional status?
Grounded in theory and research Relevant to basic social values University level extensive training Autonomy Motivation, commitment Sense of community w/in practice Code of ethics National organization and culture. Sanction by the community
What are some OT/PT practice domains?
Home care Orthopaedics Medicine ER Neurology Health promotion and wellness Cardio-respiratory Oncology Sports Medicine Mental Health Vocational Rheumatology Burns/plastics Amputees Disability management Developmental Paediatrics Geriatrics Neonatology TBI Teaching Research
What is the starting salary for OT? PT?
Echelon 1
- 69
- 56
Echelon 3 (masters degree)
- 83
- 71
What is part of the Profile of Practice of OT in Canada (2012)
Professional Practice Manager Change Agent Collaborator Scholarly Practitioner Communicator
Core Competency of an OT is enabling occupation.
What is a change agent?
As a change agent, OT responsibly use their expertise and influence to advance occupation, occupational performance and occupational engagement.
- Advocate
- Work for population and community change
- Collaborate
What is important to being a successful change agent?
Believe that change is possible. Work collaboratively with institutional staff. Work collaboratively with management. Draw on evidence. Build team motivation.
What are the three types of change agents?
Change generators: Identify a need and for example develop a program.
Change resistors: Someone who goes against change. (Opposition is good such as resisting budget cuts).
Change recipients: Help adopt changes suggested by others.
What are characteristics of a change agent?
Reflective in practice. High self-efficacy Stronger internal locus of control Optimistic Adaptable Visionary
What is the definition of an advocate?
Its responsibly use their knowledge and expertise to promote the health and well-being of individual clients, communities, populations and the profession.
What are some examples of advocacy for CAOT and CPA?
CAOT: Elder abuse, seniors caring for seniors.
CPA: 15 position statements. Building national outcomes database. The value of PT. Health care for Aboriginal communities. Pain management and opioid crisis.
Both have strategic partnerships.
What is global health?
Global health is an area for study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide. Global health emphasizes transnational health issues, determinants and solutions… and is a synthesis of population based prevention with individual level clinical care.
- Broader level (population) trends in health care
- Equal access and equity to health care
Global health is “a collection of problems which turn on the quest for equity” or the quest for health equity.
Define Disability
A complex phenomenon, reflecting an interaction btwn features of a person’s body and features of the society in which he or she lives.
ICF
Impairments
Activity limitations
Participation Restriction
WHO:
An outcome of the interaction between a person with an impairment and the environmental and attitudinal barriers that he/she faces
Disability Statistics from WHO
1 billion people w/ disability (world’s largest minority)
785 million adults and 95 million children
15% of the global population
80% developing countries
Chronic diseases account for 2/3 of years lived w/ disability in low and middle income countries.
What is the link between disability and poverty?
50% of disability is preventable and linked to poverty.
There is a reciprocal relationship between disability and poverty. People are disabled because they are poor (lack of access to services…), but people are also poor because they are disabled (increase cost of living due to disability.
The lower the income of the country (by quintile) the higher the percentage of people w/ disabilities.
What does rehabilitation as a health strategy mean?
We think of rehabilitation professions and institutions. Rehabilitation as a health strategy aims to enable people with health conditions experiencing or likely to experience disability to achieve and maintain optimal functioning in interaction w/ the environment.
(i.e. there is palliative, supportive, preventative, so rehabilitation is another strategy)
What are some ways of providing access to rehab services in other countries?
Capacity building: training OT/PTs in other countries.
McGill SPOT: Handicap International training rehabilitation professionals in HAITI where there is a lot of need, but not a lot of resources i.e. 2 PTs and 1 OT or something like that.
What are some examples of providing access to assistive devices?
Only 10-15% of people with disabilities can access assistive devices in the developing world.
Mold for chairs for children with disabilities.
What is community-based rehabilitation?
Aims to promote rehabilitation, poverty reduction, equalization of opportunities and social inclusion of all people with disabilities through the combined effort of people with disabilities themselves, their families, organizations and communities and the relevant governmental and non-governmental health, education, vocational, social and other services.
Much more integrated approach
Actively involves people with disabilities.
What is a health care system?
WHO:
A good health system delivers quality services to all people, when and where they need them. The exact configuration of services varies from country to country, but in all cases requires a robust financing mechanism, well-trained and adequately paid work force, reliable information on which to base decisions and policies; well maintained facilities and logistics to deliver quality medicine and technologies.
What are some controversies surrounding health care systems?
Who should pay
Who should be paid (in the public system)
How much should they be paid
Who should do what? Reserved acts
How should they be regulated
Where should resources be allocated (prevention/promotion vs treatment debate).
History of Healthcare in Canada: 1900-1945
Prior to 1940 there was limited health care legislation in Can
Health care concerns were considered private and local matters
Families and communities were responsible
History of Healthcare in Canada: 1945-1960
The development of hospital insurance in CAN:
1946: Saskatchewan Hospital Service Plan
Introduced by a social democratic government (Tommy douglas)
Only hospital services at first, but for everyone
History of Healthcare in Canada: 1957
Hospital Insurance for All
Canadian House of Commons unanimously passed the Hospital Insurance and Diagnostic Services Act
Federal-provincial cost-sharing program for hospital care (50% fed/50% province)
By the end of 1961 every province in CAN had adopted a public hospital insurance plan.
History of Healthcare in Canada: 1960-1970
The Struggle for Medical Insurance:
The social-democratize government in Sas lead the way again in medical care insurance.
1962 NA first public medical insurance went into effect in Sas
A doctor strike was launched to protest the plan
-Bc the public system set regulations on what a professional could charge.
Medical Insurance for All
1964
1966
1972
64: Royal Commission on Health Services (hall commission) recommends government-sponsored, comprehensive and universal health services across CAN
66: Medical Care Insurance Act passed in house of commons and comes into effect July 1968
72: All the provinces had implemented a medical insurance in accordance with the cost-sharing programme.
History of Healthcare in Canada: 1970-1990
Federal-Provincial Conflict: The federal government tried to establish more clarity over their role in health care:
1977: Establishes Programs Financing: Money to provinces in a per capita “block grant”
1984: Liberal Health Minister Monique Begin puts into place the Canada Health Act with more controls by the federal government to extra-billing and user fees.
Canada Health Act- 4 principles that Tommy Douglas proposed
What are the components of the Canada Health Act (1984?
Public Administration: All administration of provincial health insurance must be carried out by a public authority on a non-profit basis.
Universality: All insured residents are entitled to the same level of health care.
Accessibility: All insured persons have reasonable access to health care facilities.
Portability: A resident that moves to a different province or territory is still entitled to coverage from their home province.
Comprehensiveness: All necessary health services, include hospitals, physician and surgical dentists must be insured.
History of Healthcare in Canada: 1990-2004
Years of Challenge and Change:
Financial “game-changer”: 1995 Canada Health and Social Transfer which substantially reduced the cash portion of federal transfers to provinces.
Provinces begin serious cost-cutting measured and reexamine they health care systems.
Prohibits extra-billing
What is the main aim of Health Public Policy?
What is Health in All Policies
The main aim of healthy public policy is to create a supportive environment to enable people to lead healthy lives.
Health in all policies is an approach to public policies across sectors that systematically takes into account the health implications of decisions, seek synergies and avoids harmful health impacts, in order to improve population health and health equity. (i.e. sectors such as trade, industry and agriculture need to be accountable for health consequences)
Compare the governance of health care in QC before and after Bill 10.
Before: Minister of Health->Ministry of Health and Social services/ 14 advisory boards-> 18 Health and Social Service Agencies-> 95 Health and Social Service Centre (CSSS), not part of CSSS: rehab centres, some hospital centres, child and youth protection centres, some residential and LTC centres.
After: Minister of Health and Social Services-> Ministry-> 13 CISSS, 9 CIUSS-> 7 non-merged institutions, 5 non-targeted institutions.
What is Bill 10?
An act to modify the organization and governance of the health and social services network, in particular by abolishing the regional agencies.
Introduced by Health Minister Gaetan Barrette Sep 2014.
Came into for April 1, 2015
Provides territorial integration of health and social services, through set up of territorial health and social services, creation of institutions with a broader mission and two-tier management structure.
Integrated centres receive a single budget for all their activities and file unified financial statement for all institutions.
Abolish boards of individual health institutions, mainly hospital boards and merge them into 28 regional boards. The intent is to increase continuity of care, it will be easier to keep track of patients throughout treatment.
How many professional orders and regulated professions are there in QC?
46 and 54
What is the Conseil Interprofessionnel du Quebec (CIQ)
Mandate is to group together all of Qc professional orders.
W/ ‘Office des professions du Qc’ serves as an advisory body to the government.
Receives no government funding.
Both OEQ and OPPQ falls under this council.
Minister of Justice is responsible for professional legislation.
The Minister of Justice Reports to the Quebec National Assembly.
The Minister makes decision on policy, appoints certain officials and members of the Office des professions du Qc and is responsible for budget planning.
What is the Office Des Professions du Quebec?
Government agency mandated to ensure every professional order fulfils its function of protecting the public.
- Advises government (professional legislation)
- Functional control and supervision
- Ensures each order adopts regulations required under the Professional Code
- May pass regulations establishing rules and standards to be obeyed by al professional orders.
What is The Professional Code?
Aspects used to determine if a profession should be regulated and supervised by a professional order:
- knowledge required to engage in activities
- Degree of independence
- Personal nature
- Gravity of prejudice
- Confidential nature
Profession is regulated it had Reserved Title and Reserved Acts
What are Reserved Acts for OT and PT?
OT: Decide on use of restraints, assess neuromuscular function in a person w/ an impairment of physical function, evaluate an individual w/ mental health difficulty, assessment of student to determine plan of action.
PT: Treating a wound, pelvic floor dysfunction, tracheal suctioning, introduce an instrument past the pharynx or nasal passages.
How do Professional Orders Operate?
Mandated by the government to ensure the protection of the public, vested w/ power to regulate the practice of the profession and exercise oversight.
They respect the Professional Code
Control admission to the profession and regulates its practice, issuing of permits, professional inspection and disciplinary procedures.
OPPQ and OEQ
How many CISSS are there and what is the criteria for a CISSS?
13
Emerge from the merger of public institutions in the same region and where appropriate the health and social services agency in that region
Evolve within a management structure reduced from 3 to 2 hierarchal levels
Be at the core of their Reseau Territorial de Services (RTS)
What is the criteria for a CIUSS and how many are there?
9
Same model as CISSS
Be in a health a social service region with a university that offers a full undergraduate medicine program or operates a designated university institute centre for social services and
Exclude university hospitals, with the exception of CIUSS Estrie, which has integrated the Centre Hospitalier Universitaire de Sherbrooke (CHU de Sherbrooke).
What is a non-merged institution? How many are there?
What are they?
7
Non-merged institutions include university hospitals (except CHU Sherbrooke) and academic institutions.
CHU de Quebec- UdeLaval
Institut universitaire de cardiologie et de pneumologie de Quebec-UdeLaval
Centre Hospitalier de L’Universite de Montreal (CHUM)
Centre Universitaire de Sante McGill (CUSM)
Centre Hospitalier Universitaire Sainte-Justine
Institut de Cardiologie de Montreal
Institute Philippe-Pinel de Montreal
What are Non-Target institutions? How many are there? What are they?
5
Non-target institutions maintain their current status.
CLSC Naskapi
Centre regional de santé et de services sociaux de la Baie-James
Centre de santé Inuulitsvik
Centre de santé Tulattavik (baie Ungava)
Conseil Crie de la Sante et des services sociaux de la Baie James.
With the act what was the change in the number of institutions?
182 to 34 Institutions
What must each CISSS and CIUSS do to properly integrate public services?
Be at the core of a RTS
Be responsible for the delivery of care and services to the population of its territory (including public health component)
Assume population responsibility
Organize the core and complementary services in its territory as part of its multiple missions based on the needs of its population and territorial realities
.
Enter into agreements with other institutions and parter organization of the RTS (i.e. family med groups).
What are the factors influencing the health and social services basket of services in QC?
Evolution of the population according to group age
Growth rate
National and International Migration
Prevalent Health and Social Issues
What are some common health and social issues affecting Canadians in QC?
Diabetes, stroke, obesity, cancer…
Gambling, alcoholism and drugs, domestic violence, sexual assault, teenage pregnancy, troubled youth, discrimination, homelessness.
What partners are involved in health and social services?
Provincial governments Health Canada Public Health Agency Health Professional Associations (CPA) Voluntary Organizations Justice/Revenue Canada Educational Institutions Research Agencies Third Party Insurers Accreditation Bodies Regulatory Bodies Population
Who do you go to for the approval of a new device like a CPM? What is the role of this organization?
Health Canada -Prevent -Promote -Efficient and accessible -Reduce health inequalities -Health information (Leader, funder, guardian, service and information provider).
What populations fall under the federal rather than provincial government for health care?
Veterans (this is about portability)
Aboriginals
Inmates
What is the role of the Ministry of Health and Social Services (MSSS)
Province-wide health objectives
Budget allocation (takes funding from fed government, taxes and government corporations)
Equitable distribution of resources in the regions
What insurance plans do residents of Quebec have?
Health Insurance Plan:
- Established in 1970, covers all QC residents.
- Individual registered with the Regie de l’assurance malady du Quebec (RAMQ) take advantage of an array of insured services such as optometry, medical devices, dentistry, visual and hearing aids, prostheses.
Drug Plan:
- 1997
- Basic protection to all Quebecers, membership in a drug insurance plan is compulsory
What is the CSST?
Commission de la Santé et de La Sécurité De Travail:
-Occupational Health and Safety Plan on behalf of government
-Responsible for administering two key Acts: 1) Industrial accidents and occupational diseases 2) Occupational health and safety
The CSST oversees: Protection of income Right to return to work Temporary assignment Danger-free maternity program Right to refuse work Compensation for dependents Importance for OT/PT
Triad of CSST, employer and therapist.
Plan provides QC businesses with essential insurance service and workers are protected.
Pays for rehab services in the public and private sector to help get people back to work.
What is the SAAQ?
Societe de l’assurance automobile.
1978 Automobile insurance plan where all Quebecers are compensated when physically injured in a car accident.
Objective: provide fair compensation to all accident victims who have been injured, regardless of responsibility and reduce administrative cost of automobile insurance.
Importance for OT/PT- third party payer for public and private rehab.
What are the levels of care?
Primary: More generalized care. Often points of access to health care system (family docs)
Secondary: More specialized care, referral often from primary care (ex: orthopaedic surgeon or hand specialist).
Tertiary: Center for highly specialized care (neurosurgery, burn unit)
Quaternary Care: Extension of tertiary care, even more specialized
What are the points of service in the QC health care system? What are their roles?
Hospital Centers (CH): Diagnostic services, medical care, nursing care, psychosocial, preventative and rehabilitation services.
Residential and extended long term care centres (CHSLD):
Adults experiencing a loss of functional or psychosocial autonomy. Substitute living environment with various services such as rehabilitation.
Local Community Service Centers (CLSC/CSSS):
Offer day-to-day preventative, curative, rehabilitation and reintegration health and social services (home care).
Rehabilitation Centers (CRDP or CRDI): Rehab on the premises of health care establishment (in or out patient) or in the home Adaptation, rehabilitation, social integration and community participation; supervisory and family support services.
Child and Youth Protection Services (CPEJ):
Offer young ppl and families psychosocial services, child placement and family mediation services, custody counselling, adoption services.
Private or Public Clinics
- Group practices or sole practice
- Primary health care, rehab or chronic disease management
Community agencies: Wide array of services (ex: home care for elderly, meals on wheels, soup kitchen, shelters for abused women)
Elements of Private Rehabilitation Services to Consider
Payment: Fee for service, CSST, SAAQ, private insurance, sub-contract
Format: Franchise, several points of service or a single clinic
Team: Multidisciplinary or one profession only
Owner or Employee: Who owns the clinic (conflict of interest)
What was the layout of health care in QC before Law 10?
MSSS controlled 18 Agencies by Region which was responsible for 95 CSSS with 5 types of establishments (CH, CLSC, CPEJ, CRDP/CRDI, CHSLD) plus community organizations and private clinics.
What are the changes that happened with Law 10?
There are no longer regional agencies. The 13 CISSS and 9 CIUSS should each have the 5 services as before. There is no layer of middle management. The non-merged institutes are the large university centres (MUCH)
The CIUSS/CISSS met make links in the community to the resources.
Within each region a patient should get all the services they need at one spot.
What are the anticipated changes from Law 10?
Wider range of resources available
Better coordination of services for clients (continuum of care)
Better communication flow of client info
Strengthen decision making power of MSSS
Save $220 million/year.
