Healthcare Policy最新文献

Introduction: Public engagement in long-term care policy making in Canada has primarily focused on "intermediary agents" who speak on behalf of long-term care (LTC) residents and their family caregivers. Yet the legitimacy of these intermediaries, as perceived by those they represent, has gone largely unexplored. This study examines LTC resident and family perspectives on who can legitimately represent them in LTC policy making.

Methodology: We used an interpretive description design, drawing on semi-structured interviews with LTC residents and family caregivers in Ontario, Canada. Data were analyzed using inductive thematic analysis.

Results: Eighteen interviews were conducted with 19 participants. Three key characteristics of legitimate representatives were identified: (1) willingness to act in the best interests of residents and families, (2) having the necessary skills and capacity to participate in LTC policy making and (3) engaging directly with residents and families.

Conclusion: Governments and civil society organizations seeking to establish and maintain legitimacy in the eyes of LTC residents and family members can pursue this goal by supporting intermediaries who mirror the identities or experiences of those they represent, who are dedicated to serving their interests and who routinely and directly engage with them to understand the realities of LTC.

People with serious mental illness experience poorer physical health and higher mortality rates than the general population. One option for responding to this disparity is reverse integration, which promotes physical health monitoring in secondary and tertiary mental health settings. Health leaders in Canada can learn from reverse integration approaches that have been adopted or proposed in other jurisdictions. We conducted a jurisdictional scan and applied the 3I framework for policy analysis to suggest that Canadian adaptations of existing approaches should foreground equity, build on existing infrastructure and human resources and prioritize leadership of people with lived experience.

In speeches this year, a bank of canada official announced that our country experienced no growth in productivity over the past two years (Rogers 2024a, 2024b). To improve this predicament, the bank says businesses should focus on adding value and being more efficient. These recommendations should be heeded by healthcare - the industry exceeds 12% of Canada's gross domestic product and is growing (CIHI 2024b).

Aims: This study examined the reasons for high emergency department (ED) use among patients with common mental disorders (MDs), substance-related disorders (SRDs) or co-occurring MDs-SRDs.

Method: Following content analysis, 42 high ED users (three-plus visits/year) recruited in two Quebec EDs were interviewed.

Results: The reasons included barriers to outpatient care, patient disabilities and professional practices. Patients with SRDs trust outpatient services less, those with MDs had important unmet needs and those with MDs-SRDs faced care coordination issues.

Conclusion: Improvements such as ED use monitoring, consolidating MD-SRD practices and continuous training are needed in EDs and outpatient services to enhance access and continuity of care.

Lexchin and Sirrs (2024) proposed five relevant principles to guide the use of federal funding for expensive drugs for rare diseases, including funding of outcomes-based risk-sharing agreements (OBRSAs) and proactive commitment and participation in the generation of high-quality evidence in a transparent way. This rejoinder, however, questions whether the federal funding should be used only to buy new drugs or whether it could be used to develop new drugs as well. It also examines what OBRSAs would require in terms of institutional capacities to allow the collection of real-world evidence.

This study assesses the quality of work life for Nova Scotian continuing care assistants (CCAs) (n = 266), nurses (n = 144) and managers (n = 45) from 10 long-term care (LTC) homes in late 2021. CCAs scored significantly worse than nurses and managers on measures of mental health and anxiety. All groups reported high levels of cynicism and emotional exhaustion; CCAs' scores were higher than nurses or managers. CCAs scored significantly higher on professional efficacy than other groups. CCAs can derive a strong sense of accomplishment from their work, but results raise concerns of a potential breaking point. This suggests the need for continued action to support LTC staff.

The COVID-19 pandemic significantly impacted primary care, but its effect on quality of care is not well understood. We used health administrative data to understand the changes in quality-of-care measures for primary care between October 2018 and April 2022. We examined the following domains: cancer screening, chronic disease (diabetes) management, high-risk prescribing, continuity of care and capacity of primary care services. Colorectal and breast cancer screenings declined after the pandemic and had not returned to baseline by study end. In patients living with diabetes, in-person visits and up-to-date retinopathy screening rates declined after the pandemic declaration and did not return to baseline by study end, while statin prescribing remained stable. High-risk opioid prescribing decreased over time and was not affected by the pandemic. Physician continuity remained stable, though new patient enrollments decreased over the pandemic but returned to baseline by study end. Existing disparities in colorectal cancer screening by income and recent registration widened during the pandemic. In summary, COVID-19 had a variable impact on primary care, with the strongest influence on preventive and chronic disease care that was dependent on in-person visits.

The mortality gap faced by Canadians living with a severe and persistent mental illness is a national scandal. If we are to change this and take advantage of the possibilities that reverse integration presents, we need to rethink the ways our systems of care function and remove barriers to accessing care while tapping the full potential of collaborative partnerships, moving to earlier interventions with this population and integrating poverty reduction into all our work. Above all, we need to be much more effective in bringing these issues into the public discourse.

When ill, many Albertans' first interaction with their healthcare system is Alberta's centralized emergency medical services (EMS) system operated by Alberta Health Services (AHS). The media has become saturated with articles articulating concerns about lagging response time, limited ambulance availability and poor work conditions. As Alberta undergoes restructuring of the EMS system by Alberta Health and AHS, there are lessons to be learned from prior EMS restructuring. It is crucial that front-line paramedics are heard and their concerns addressed regarding implemented policies. Several policy recommendations focus on optimizing operations and improving the working environment for paramedics in the long term.

In response to quality issues within the long-term care (LTC) sector, the Government of Ontario implemented the Fixing Long-Term Care Act, 2021, and updated accountability and compliance measures, including doubling fines for non-compliance and investing in 193 new inspectors. However, enforcement tactics and inspection regimes may contribute to harm and neglect the root issues within the sector. Fines for non-compliance may create catch-22 situations in which homes lack the funds to fix the root issues. Governments also dictate and determine much of the resource allocation within the LTC sector. Accountability and quality improvement should involve addressing performance problems as a system.