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PubMed2006

Considerations for adolescent integrative health care in Canada.

The increased use of complementary/alternative medicine (CAM) has stimulated practitioners, policy makers, and researchers to examine its integration into mainstream medicine. For adolescents, there is evidence that they are using CAM as an option for health care. However, there is limited information on how adolescent integrative care should be developed in Canada. Practice, practice environments, and education are the three areas identified in which modifications should be made to current adolescent-focused practice in Canada to make it more of an integrative system.

Adolescent↗
PubMed1995

A comparison of personal response services in Canada and the UK.

Personal response services operating over public telephone networks are now widespread in Western Europe and North America. They serve the needs of a million people in the UK and a further two to three million elsewhere. While most clients are elderly, the scope of such services is extending to people with support needs of all ages, especially where there are medical risks or a likelihood of falls. Such services are, therefore, on a convergent course with those concerned with telemedicine. A study of two personal response services was carried out, one based in Ottawa (Canada) and the other in Oldham (UK). The parallels and contrasts were examined through a survey involving personal interviews with samples of clients. Thirty-eight valid personal interviews were completed, 20 in Ottawa and 18 in Oldham, representing 14% and 53% respectively of all service clients in the survey areas. It is concluded that services established within the health sector (such as many in Canada) are better placed to accommodate change. Convergence with telemedicine will, as a result, be facilitated. In the UK, health authorities and trusts are likely to develop their own telemedicine services in competition with current providers of personal response services, thus delaying convergence.

Adult↗
PubMed2004

Does a perception of increased blood safety mean increased blood transfusion? An assessment of the risk compensation theory in Canada.

BACKGROUND: The risk compensation theory is a widely used concept in transport economics to analyze driver risk behaviour. This article explores the feasibility of applying the theory in blood transfusion to raise important questions regarding the increased blood safety measures and their possible effects on blood usage (e.g., the appropriateness in transfusion). Further, it presents the findings of a pilot survey of physicians in Canada. DISCUSSION: While studies have attempted to define transfusion appropriateness, this article argues that if the risk compensation theory holds true for transfusion practice, physicians may actually be transfusing more. This may increase the possibility of contracting other unknown risks, such as the variant Creutzfeldt-Jakob Disease (vCJD), as well as increasing the risk of non-infectious transfusion risks, such as transfusion reactions. SUMMARY: A much larger study involving psychosocial assessment of physician decision making process to fully assess physician behaviour within the context of risk compensation theory and transfusion practice in Canada is needed to further explore this area.

Attitude of Health Personnel↗
PubMed2004

The osteoporosis care gap in Canada.

BACKGROUND: The presence of a fragility fracture is a major risk factor for osteoporosis, and should be an indicator for osteoporosis diagnosis and therapy. However, the extent to which patients who fracture are assessed and treated for osteoporosis is not clear. METHODS: We performed a review of the literature to identify the practice patterns in the diagnosis and treatment of osteoporosis in adults over the age of 40 who experience a fragility fracture in Canada. Searches were performed in MEDLINE (1966 to January 2, 2003) and CINAHL (1982 to February 1, 2003) databases. RESULTS: There is evidence of a care gap between the occurrence of a fragility fracture and the diagnosis and treatment of osteoporosis in Canada. The proportion of individuals with a fragility fracture who received an osteoporosis diagnostic test or physician diagnosis ranged from 1.7% to 50%. Therapies such as hormone replacement therapy, bisphosphonates or calcitonin were being prescribed to 5.2% to 37.5% of patients. Calcium and vitamin D supplement intake was variable, and ranged between 2.8% to 61.6% of patients. CONCLUSION: Many Canadians who experience fragility fracture are not receiving osteoporosis management for the prevention of future fractures.

Absorptiometry, Photon↗
PubMed2005

Regional variation of multiple sclerosis prevalence in Canada.

OBJECTIVE: To describe the regional distribution of multiple sclerosis (MS) prevalence in Canada, controlling for age and sex. METHODS: This study used data from the Canadian Community Health Survey, a large general health survey (n = 131,535) conducted in 2000/2001. Subjects aged 18 and over were included in the current analysis (n = 116,109). The presence of MS was determined by self-report. Prevalence was computed in five regions (Atlantic, Quebec, Ontario, Prairies and British Columbia). Logistic regression was used to compare regions and examine for confounding/interaction by age and sex. RESULTS: The overall Canadian MS prevalence was 240 per 100000 (95%CI: 210 280). Prevalence ranged from 180 (95%CI: 90-260) in Quebec to 350 (95%CI: 230-470) in Atlantic Canada. Logistic regression revealed no statistical difference between the odds of MS in Quebec, Ontario and British Columbia adjusted for age and sex. The adjusted odds of MS in the Prairies and Atlantic regions were significantly higher than in the other regions combined, with odds ratios of 1.7 (95%CI: 1.1-2.4, P <0.01) and 1.6 (95%CI: 1.1-2.4, P <0.05) respectively. Sensitivity analysis demonstrated similar prevalence in the nonaboriginal/nonimmigrant group (n = 96219). CONCLUSION: Results suggest that Canadian MS prevalence differs by region. If validated, these regional differences may facilitate investigation of environmental influences.

Adolescent↗
PubMed1991

Suicide among immigrant psychiatric patients in Canada.

Ninety-four Canadian-born psychiatric patients who committed suicide were compared with 23 foreign-born patients committing suicide in Canada. East Europeans were over-represented, and significant differences were found in the age distribution, stress, level of education, social isolation, and methods of suicide. Most foreign-born patients had come to Canada for family or economic reasons but were unemployed, with poor social integration. Employment, housing, education, social integration and a support network seem to be important in preventing these deaths. Cultural evaluation of the patient and early intervention is recommended.

Acculturation↗
PubMed2001

Impact of the media and the internet on oncology: survey of cancer patients and oncologists in Canada.

PURPOSE: To evaluate the use of the news media and the Internet as sources of medical information by patients and oncologists in Canada and to investigate the impact on patients' treatment decisions and the patient-doctor relationship. PATIENTS AND METHODS: During a 2-week period, 191 ambulatory patients participated in the survey. Questionnaires were also mailed to Canadian oncologists: 410 of 686 questionnaires were returned (response rate = 60%). RESULTS: Of the 191 patients, 86% wanted as much information as possible about their illness, 54% reported receiving insufficient information, 83% cited physicians as their primary information source, and 7% cited the Internet. Seventy-one percent of patients actively searched for information, and 50% used the Internet. Patients' opinions about the balance, accuracy, and relevance of news media reports were evenly split. English as the first language, access to the Internet, and use of alternative treatments predicted a higher rate of information seeking. Most oncologists routinely pay some attention to medical news and believe that it is difficult for patients to interpret medical information in the media and on the Internet accurately. Both patients and oncologists agree that information seeking does not affect the patient-physician relationship. CONCLUSION: Information searching is common among cancer patients in Canada. It does not affect the patient-doctor relationship. The media and the Internet are powerful means of medical information dissemination. Strategic efforts are needed to improve the quality of medical news reporting by the media, and to provide guidance for patients to understand their disease and interpret such information better.

Adolescent↗
PubMed2001

Assessment of health economics in Alzheimer's disease (AHEAD): galantamine treatment in Canada.

BACKGROUND: Given the high costs of caring for patients with AD in Canada, it is important to evaluate the costs of new therapies that halt or delay the advancement of AD, relative to the savings associated with delaying disease progression. METHODS: The Assessment of Health Economics in Alzheimer's Disease (AHEAD) model, which uses algorithms to predict the time until patients with AD require full-time care (FTC), was adapted to Canada to compare treatment with galantamine versus no pharmacologic treatment. Data from two clinical trials provided inputs into the algorithms, and forecasts were made for up to 10 years. Drug and health care costs were evaluated according to the stage of disease based on Quebec unit costs along with follow-up data from the Canadian Study of Health and Aging. RESULTS: Galantamine is predicted to reduce the duration of FTC by almost 10%. Approximately 5.6 patients with mild to moderate disease must be placed on treatment to avoid one year of FTC, resulting in savings averaging $788 CAD ($528 USD) per patient. For patients with moderate disease, 3.9 patients must be placed on treatment to avoid one year of FTC, with savings predicted at $3718 CAD ($2533 USD) per patient. CONCLUSION: Galantamine cannot only potentially increase the time before patients require FTC, but may also lead to overall savings because treatment costs are offset by reductions in other health care expenditures.

Aged↗
PubMed1990

The development of national medical care programs in the United Kingdom and Canada: applicability to current conditions in the United States.

After a hiatus in the early to mid-1980s, a growing number of policy leaders, policy organizations, and citizen groups are advocating programs that ensure basic medical care for all. Although a large literature examines the applicability to the U.S. of national medical care programs that have been established in other countries from the perspective of operations and effectiveness, little attention has been given to the applicability of the experience of other nations in securing these programs. This paper examines the development of national programs in the U.K. and Canada and addresses two questions. First, what factors were critical to the establishment of the British National Health Service and the Canadian hospital and physician insurance programs? Second, how applicable are those factors to current conditions in the U.S.? The paper reviews the roles played by dislocations in society, by established models of state-sponsored medical care programs, by political institutions and leaders, and by the major medical sectors. It shows that the U.S., while differing in many particulars, presents several parallels to the U.K. and Canada. The paper argues that the current environment in the U.S. offers the nation the opportunity to develop at state or local levels government-sponsored programs that guarantee basic medical benefits to all. A new and powerful coalition, moreover, may in the coming years advance the cause of broader, more substantive change at the national level.

Canada↗
PubMed1995

Nothing succeeds like the right kind of failure: postwar national health insurance initiatives in Canada and the United States.

Health insurance was one of the most influential social reforms on the immediate postwar agenda in Canada and the United States. In both cases, proposals for national health insurance were not implemented. This article traces the evolution of these legislative proposals of the 1940s and shows how the events of this pivotal decade set the stage for future health reform in the two countries. The analysis focuses on how political institutions condition the role of state actors and the articulation of societal groups, and particularly on the crucial differences in party systems and the role of parties in shaping health reform in the two countries. In the United States, a divided Democratic party and the imperatives of political compromise made forging a consensus around health insurance more difficult. In Canada, meanwhile, the presence of a social-democratic third party led to a very different type of debate about health reform and opened the door for national health insurance.

Canada↗
PubMed1998

Access to medical care under strain: new pressures in Canada and Australia.

Health policy changes intended to achieve cost control in OECD countries run the risk of reintroducing financial barriers to health care. However, although the problems faced are similar, different countries are dealing with the situation in different ways. For example, Canada and Australia, which share many similarities, have taken quite different policy paths in the last decade: Canada has preserved universal access, whereas Australian policy is promoting a two-tier system through the provision of public subsidies for private insurance. The evidence is that country-specific factors such as institutional arrangements, attitudes, and values intersect with economic and financial factors to shape policy outcomes. Moreover, the Canadian and Australian experiences suggest that in relation to access issues, attitudes and values are the key policy determinants.

Australia↗
PubMed2003

Gonorrhoea resurgence in Canada.

After several years of decline, reported gonorrhoea rates in Canada have recently increased substantially. National goals for gonorrhoea control were developed in 1997, but it appears that reliance on secular trends is insufficient to attain the goal of eliminating locally transmitted infection by Neisseria gonorrhoeae by 2010. We have examined disease surveillance reports from 1994 to 2001 inclusive to assess demographic and epidemiologic trends in reported cases of gonococcal infection. Since 1997, reported cases have increased by 53% among men and 33% among women. The largest proportion of cases in women is in those aged 15-24; the most dramatic increase in males has been among those aged 30-39. Reasons for the resurgence remain unclear, but disease reports indicate that renewed attention to enhanced surveillance and targeted prevention are essential for gonorrhoea control in Canada.

Adolescent↗
PubMed2000

Legal issues relating to telemedicine in Canada's publicly funded health-care system.

The advent of telemedicine poses new legal challenges for Canada's health-care system. Although telemedicine increases access, it does not fit easily into Canada's traditional one-tier approach to health-care. Cross-border telemedicine services may inadvertently contribute to a two-tier system. The current legal system will have to be adapted to accommodate changes instigated by cross-border telemedicine.

Canada↗
PubMed2002

A case of chronic wasting disease in an elk imported to Korea from Canada.

A seven-year-old male elk (Cervus elaphus nelsoni) was euthanized and necropsied after having a 3-week history of body weight loss, emaciation, excessive salivation, teeth grinding, fever, anorexia, and respiratory distress. The elk was imported into Korea from Canada on March 9, 1997. Gross pathologic findings were restricted to a diffuse fibrinous pneumonia. Microscopic lesions included mild neuronal vacuolation and spongiform change in the neuropil of selected brain stem nuclei and generalized astrocytosis. Immunohistochemistry for protease-resistant prion protein (PrP(res)) was positive in all brain sections but more pronounced in the section of the obex of the medulla. And the PrP(res) was also detected by western immunoblotting in the brain and spinal cord. All the remaining elk and deer that had been in contact with this elk were destroyed and negative for chronic wasting disease (CWD). To our knowledge, this is the first case of CWD occurring outside of the U.S.A. and Canada.

Animals↗
PubMed2004

Patient safety culture and leadership within Canada's Academic Health Science Centres: towards the development of a collaborative position paper.

Currently, the Academy of Canadian Executive Nurses (ACEN) is working with the Association of Canadian Academic Healthcare Organizations (ACAHO) to develop a joint position paper on patient safety cultures and leadership within Academic Health Science Centres (AHSCs). Pressures to improve patient safety within our healthcare system are gaining momentum daily. Because AHSCs in Canada are the key organizations that are positioned regionally and nationally, where service delivery is the platform for the education of future healthcare providers, and where the development of new knowledge and innovation through research occurs, leadership for patient safety logically must emanate from them. As a primer, ACEN provides an overview of current patient safety initiatives in AHSCs to date. In addition, the following six key areas for action are identified to ensure that AHSCs continue to be leaders in delivering quality, safe healthcare in Canada. These include: (1) strategic orientation to safety culture and quality improvement, (2) open and transparent disclosure policies, (3) health human resources integral to ensuring patient safety practices, (4) effective linkages between AHSCs and academic institutions, (5) national patient safety accountability initiatives and (6) collaborative team practice.

Academic Medical Centers↗
PubMed2003

Maturation of complementary and alternative healthcare in Canada.

Complementary and alternative medicine (CAM) use is increasing rapidly in Canada. This use is mostly driven by consumer demand. While this field of research is relatively new, it is maturing rapidly. This commentary highlights three areas of increasing maturation: the emergence of integrative healthcare; the development and application of new approaches to investigating CAM and integrative healthcare; and the development of a research infrastructure to support these developments. It is encouraging, the authors note, that organizations, networks and federal agencies such as the Canadian Institutes of Health Research and Health Canada are collectively and collaboratively identifying barriers to these developments and are developing strategies to overcome them.

Canada↗
PubMed2005

The transformation experience of the Veterans Health Administration and its relevance to Canada.

Over the past few years, there has been a steady stream of visitors to Canada from the US Veterans Health Administration (VA). Led by the former Under Secretary for Health in the Department of Veterans Affairs, Dr. Ken Kizer, they come to tell the remarkable story of how the VA transformed itself from a hospital-based bureaucracy described as "dangerous, dirty and scandal-ridden" to a healthcare system for veterans recognized for its high-quality, patient-centred care. It is a fascinating story of how a publicly funded healthcare service changed its entire approach to patient care with a quality improvement lens at its core. Fifteen years ago, critics of the VA called for its complete privatization as the only solution to fixing its problems. A team of quality champions set out to prove otherwise. Canada has some lessons to learn. The VA is a compelling role model for Canadian reformers, in large measure, due to its public sector character.

Canada↗
PubMed2006

Pay-for-performance--can it work in Canada?

Physician reimbursement in Canada has been dominated by pay-for-volume which leads to high utilization. The concern is that this does not promote attention to quality issues that are known to affect health services. However, the evidence that pay-for-quality works is weak, despite the logic of the approach. Also, pay-for-quality methods that seem to work in primary care may not be appropriate in specialties such as surgery. Canada offers opportunities to assess the effect of pay-for-performance in several areas. Developing primary care networks are attractive locations to study the effect of pay-for-quality, perhaps even in a randomized trial. Specialized high-volume surgical programs, such as the Alberta arthroplasty pilot project, might be study of pay-for-participation, in a partnership of providers and sponsors.

Canada↗