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"A Band-Aid Solution": Policy Maker and Primary Care Provider Perspectives on the Value of Attachment Incentives. “创可贴解决方案”:政策制定者和初级保健提供者对依恋激励价值的看法。
Healthcare Policy Pub Date : 2023-05-01 DOI: 10.12927/hcpol.2023.27090
Emily Gard Marshall, Mackenzie Cook, Lauren Moritz, Richard Buote, Maria Mathews, Mylaine Breton
{"title":"\"A Band-Aid Solution\": Policy Maker and Primary Care Provider Perspectives on the Value of Attachment Incentives.","authors":"Emily Gard Marshall,&nbsp;Mackenzie Cook,&nbsp;Lauren Moritz,&nbsp;Richard Buote,&nbsp;Maria Mathews,&nbsp;Mylaine Breton","doi":"10.12927/hcpol.2023.27090","DOIUrl":"https://doi.org/10.12927/hcpol.2023.27090","url":null,"abstract":"<p><p>Approximately 15% of Canadians are without a primary care provider (\"unattached\"). To address \"unattachment,\" several provinces introduced a financial incentive for family physicians who attach new patients. A descriptive qualitative approach was used to explore perspectives of patient access and attachment to primary care. Semi-structured qualitative interviews were conducted with family physicians, nurse practitioners and policy makers in Nova Scotia. Thematic analysis was performed to identify participant perspectives on the value and efficacy of financial incentives to promote patient attachment. Three themes were identified: (1) positive impacts of the incentive, (2) shortcomings of the incentive and (3) alternative strategies to strengthen primary healthcare. Participants felt that attachment incentives may offer short-term solutions to patient unattachment; however, financial incentives cannot overcome systemic challenges. Participants recommended alternative policy levers to strengthen primary healthcare, including addressing the shortage of primary care providers and developing remuneration and practice models that support sustainable patient attachment.</p>","PeriodicalId":39389,"journal":{"name":"Healthcare Policy","volume":"18 4","pages":"106-119"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/55/2f/policy-18-106.PMC10370396.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9890405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Commentary: Access to Psychedelics for Psychological Suffering at the End of Life - Prioritizing Our Priorities. 评论：为临终前的心理痛苦获取迷幻剂--优先考虑我们的优先事项。
Healthcare Policy Pub Date : 2023-05-01 DOI: 10.12927/hcpol.2023.27047
Daniel Rosenbaum, Sarah Hales, Daniel Z Buchman
{"title":"Commentary: Access to Psychedelics for Psychological Suffering at the End of Life - Prioritizing Our Priorities.","authors":"Daniel Rosenbaum, Sarah Hales, Daniel Z Buchman","doi":"10.12927/hcpol.2023.27047","DOIUrl":"10.12927/hcpol.2023.27047","url":null,"abstract":"<p><p>We agree with Kratina et al. (2023) that the problem of psychological suffering at the end of life deserves attention from a policy standpoint and that psychedelic therapies show promise in this clinical context. However, we argue the following in this rejoinder: (1) disproportionate attention to psychedelics may overstate the current evidence base, potentially diverting resources away from existing evidence-based programs; (2) a more pressing policy priority related to this public health problem is to address population-level inequities in accessing high-quality, early and holistic palliative care, including psychosocial care; and (3) discussions about expanded access to psychedelics must also foreground equity issues.</p>","PeriodicalId":39389,"journal":{"name":"Healthcare Policy","volume":"18 4","pages":"143-148"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10370398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9883891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Bilateral Federalism, Value-Based Healthcare and the Future of Canadian Intergovernmental Diplomacy on Health. 双边联邦制、基于价值的医疗保健和加拿大政府间卫生外交的未来。
Healthcare Policy Pub Date : 2023-05-01 DOI: 10.12927/hcpol.2023.27095
Tom Mcintosh
{"title":"Bilateral Federalism, Value-Based Healthcare and the Future of Canadian Intergovernmental Diplomacy on Health.","authors":"Tom Mcintosh","doi":"10.12927/hcpol.2023.27095","DOIUrl":"https://doi.org/10.12927/hcpol.2023.27095","url":null,"abstract":"<p><p>The COVID-19 pandemic has laid bare some profound challenges facing the preservation of Canada's single-payer, publicly administered healthcare system. At the same time, it may have presented an opportunity to take bold action on system reform. Part of that opportunity may lie in linking recent developments in intergovernmental diplomacy (termed bilateral federalism) with the growing emphasis on value-based healthcare initiatives coming out of some of the provinces. Bilateralism may be a means to steer reform efforts toward a value-based healthcare system that can articulate pan-Canadian values while accommodating provincial asymmetry in a highly decentralized federation like Canada.</p>","PeriodicalId":39389,"journal":{"name":"Healthcare Policy","volume":"18 4","pages":"26-42"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b9/8d/policy-18-026.PMC10370399.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9895628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Innovating for Value-Based Surgical Care in Canada: A Post-Pandemic Necessity. 加拿大基于价值的外科护理创新：大流行后的必然选择。
Healthcare Policy Pub Date : 2023-05-01 DOI: 10.12927/hcpol.2023.27094
Alana M Flexman, Janny Ke, Julie Hallet
{"title":"Innovating for Value-Based Surgical Care in Canada: A Post-Pandemic Necessity.","authors":"Alana M Flexman, Janny Ke, Julie Hallet","doi":"10.12927/hcpol.2023.27094","DOIUrl":"10.12927/hcpol.2023.27094","url":null,"abstract":"<p><p>Providing high-quality, efficient and cost-effective surgical care to Canadians has become increasingly challenging since the pandemic, resulting in long waitlists due to limited staff and resources. The pandemic has facilitated some areas of innovation in surgical care, notably in virtual care and expedited discharge, although many challenges remain. Key policy recommendations for reform include investing in infrastructure to collect and report on value-based metrics beyond volume, devising strategies to improve health equity, enhancing out-of-hospital support for surgical patients by using remote monitoring and digital technology, increasing patient segmentation into low- and high-complexity pathways, centralizing surgical triage and initiating careful financial incentivization of integrated groups of clinicians.</p>","PeriodicalId":39389,"journal":{"name":"Healthcare Policy","volume":"18 4","pages":"43-56"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10370401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9890398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Patients Living with Social Vulnerabilities Experience Reduced Access at Team-Based Primary Healthcare Clinics. 生活在社会弱势地位的患者在团队式初级保健诊所就医的机会较少。
Healthcare Policy Pub Date : 2023-05-01 DOI: 10.12927/hcpol.2023.27091
Nadia Deville-Stoetzel, Isabelle Gaboury, Jeannie Haggerty, Mylaine Breton
{"title":"Patients Living with Social Vulnerabilities Experience Reduced Access at Team-Based Primary Healthcare Clinics.","authors":"Nadia Deville-Stoetzel, Isabelle Gaboury, Jeannie Haggerty, Mylaine Breton","doi":"10.12927/hcpol.2023.27091","DOIUrl":"10.12927/hcpol.2023.27091","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to explore differences in access to care as experienced by patients registered in team-based primary healthcare clinics according to their social vulnerability profile.</p><p><strong>Method: </strong>A total of 1,562 patients from four team-based primary healthcare clinics completed an e-survey conducted between June and November 2021. The social vulnerability index was used to compare the experiences.</p><p><strong>Results: </strong>Patients with low vulnerability consulted at emergency rooms three times more often because their family physician was not available (<i>p</i> = 0.006) than patients with no vulnerability. Lack of continuity was reported two times more often by patients with low vulnerability related to team members not knowing their recent medical history (<i>p</i> = 0.006) and by patients with high vulnerability related to no one being in charge of their file (<i>p</i> = 0.023). Both vulnerable groups reported receiving contradictory information more often than patients with no vulnerability.</p><p><strong>Conclusion: </strong>Patients with high vulnerability experienced more access difficulties related to continuity, interprofessional collaboration and communication with providers.</p>","PeriodicalId":39389,"journal":{"name":"Healthcare Policy","volume":"18 4","pages":"89-105"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/01/2e/policy-18-089.PMC10370394.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9890404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A North Star Vision: Results from a Deliberative Dialogue to Identify Policy Strategies to Improve Value in Healthcare. 北极星愿景：旨在确定提高医疗保健价值的政策战略的慎重对话的结果。
Healthcare Policy Pub Date : 2023-05-01 DOI: 10.12927/hcpol.2023.27089
Amity E Quinn, Rachelle Drummond, Fiona Clement, Melanie Columbus, Stephana J Moss, Emily Fitzgerald, Rukhsaar Daya, Liza Mastikhina, Jeanna Parsons Leigh, Henry T Stelfox
{"title":"A North Star Vision: Results from a Deliberative Dialogue to Identify Policy Strategies to Improve Value in Healthcare.","authors":"Amity E Quinn, Rachelle Drummond, Fiona Clement, Melanie Columbus, Stephana J Moss, Emily Fitzgerald, Rukhsaar Daya, Liza Mastikhina, Jeanna Parsons Leigh, Henry T Stelfox","doi":"10.12927/hcpol.2023.27089","DOIUrl":"10.12927/hcpol.2023.27089","url":null,"abstract":"<p><p>We hosted a deliberative dialogue with citizens (<i>n</i> = 3), policy researchers (<i>n</i> = 3), government decision makers (<i>n</i> = 3) and health system leaders (<i>n</i> = 3) to identify evidence-informed policy options to improve the value of Canadian healthcare. The analysis resulted in three themes: (1) the need for a vision to guide reforms, (2) community-based care and (3) community-engaged care. Results suggest the need for a new paradigm: community-focused health systems. Such a paradigm could serve as a North Star guiding healthcare transformation, improving value by aligning citizen and healthcare system goals, prioritizing spending on services that address the social determinants of health and improving quality and equity.</p>","PeriodicalId":39389,"journal":{"name":"Healthcare Policy","volume":"18 4","pages":"120-133"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10370391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9890403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Psychedelics to Relieve Psychological Suffering Associated with a Life-Threatening Diagnosis: Time for a Canadian Policy Discussion. 用迷幻药缓解与危及生命的诊断相关的心理痛苦：加拿大政策讨论的时机已到。
Healthcare Policy Pub Date : 2023-05-01 DOI: 10.12927/hcpol.2023.27048
Sarah Kratina, Christopher Lo, Carol Strike, Robert Schwartz, Brian Rush
{"title":"Psychedelics to Relieve Psychological Suffering Associated with a Life-Threatening Diagnosis: Time for a Canadian Policy Discussion.","authors":"Sarah Kratina, Christopher Lo, Carol Strike, Robert Schwartz, Brian Rush","doi":"10.12927/hcpol.2023.27048","DOIUrl":"10.12927/hcpol.2023.27048","url":null,"abstract":"<p><p>In Canada, the conversation to enable access to therapeutic psychedelics is under way. With recent federal initiatives, Canadians can request access to psychedelic-assisted therapies (PATs) to alleviate enduring and intolerable psychological suffering (EIPS) associated with life-threatening conditions on a case-by-case basis. The resurgence of past research concerning the therapeutic potential of PATs, promising preliminary results from contemporary clinical trials, public and media interest and the recognition of traditional Indigenous use of psychedelics have facilitated a change in the popular narrative around these stigmatized substances. A lack of access to PATs for treating EIPS, especially at end of life, is a public policy problem worth addressing.</p>","PeriodicalId":39389,"journal":{"name":"Healthcare Policy","volume":"18 4","pages":"134-142"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10370393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9895630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Use of Electronic Medical Record Data to Create a Dashboard on Access to Primary Care. 使用电子病历数据创建获得初级保健的指示板。
Healthcare Policy Pub Date : 2023-05-01 DOI: 10.12927/hcpol.2023.27092
Mylaine Breton, Isabelle Gaboury, François Bordeleau, Catherine Lamoureux-Lamarche, Élisabeth Martin, Véronique Deslauriers, Jean-Benoît Deville-Stoetzel
{"title":"Use of Electronic Medical Record Data to Create a Dashboard on Access to Primary Care.","authors":"Mylaine Breton,&nbsp;Isabelle Gaboury,&nbsp;François Bordeleau,&nbsp;Catherine Lamoureux-Lamarche,&nbsp;Élisabeth Martin,&nbsp;Véronique Deslauriers,&nbsp;Jean-Benoît Deville-Stoetzel","doi":"10.12927/hcpol.2023.27092","DOIUrl":"https://doi.org/10.12927/hcpol.2023.27092","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to present a proof of concept of a dashboard on a set of indicators of access to primary healthcare (PHC) based on electronic medical records (EMRs).</p><p><strong>Methods: </strong>This research builds on a multi-method design study including (1) a systematic review, (2) a pilot phase and (3) the development of a dashboard.</p><p><strong>Results: </strong>Eight indicators were carefully selected and successfully extracted from EMRs obtained from 151 PHC providers. Indicators of access over time, as well as among providers and among clinics, have been enabled in the dashboard.</p><p><strong>Conclusion: </strong>EMR data enabled the development of a real-time dashboard on access, giving PHC providers a reliable portrait of their own practice, its evolution over time and how it compares with those of their peers.</p>","PeriodicalId":39389,"journal":{"name":"Healthcare Policy","volume":"18 4","pages":"72-88"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/64/92/policy-18-072.PMC10370395.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9890402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Value in Primary Care: Evidence from the Canadian Primary Care Sentinel Surveillance Network. 初级保健的价值:来自加拿大初级保健哨点监测网络的证据。
Healthcare Policy Pub Date : 2023-05-01 DOI: 10.12927/hcpol.2023.27093
Sabrina T Wong, Rachael Morkem, Ayat Salman, David Barber, Jerome A Leis
{"title":"Value in Primary Care: Evidence from the Canadian Primary Care Sentinel Surveillance Network.","authors":"Sabrina T Wong,&nbsp;Rachael Morkem,&nbsp;Ayat Salman,&nbsp;David Barber,&nbsp;Jerome A Leis","doi":"10.12927/hcpol.2023.27093","DOIUrl":"https://doi.org/10.12927/hcpol.2023.27093","url":null,"abstract":"<p><p>Primary care antimicrobial stewardship programs are virtually non-existent. Using electronic medical record (EMR) data for an interrupted time series study, the authors examined the relationship between antibiotic prescriptions for acute respiratory tract infections (RTIs) and the COVID-19 pandemic. The main outcome of the study was to gauge the proportion of RTI encounters with an antibiotic prescription. The pre-pandemic RTI antibiotic prescribing rate was 27.8%. During the COVID-19 pandemic, prescribing dropped significantly by 9.4% (<i>p</i> < 0.001). Almost 750,000 fewer patients could potentially avoid receiving an antibiotic prescription for RTI. The authors also discuss the value of EMR data; their use can help develop insights for health system improvement.</p>","PeriodicalId":39389,"journal":{"name":"Healthcare Policy","volume":"18 4","pages":"57-71"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/dd/89/policy-18-057.PMC10370397.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9890399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Value-Based Healthcare: Is It Just Another Buzzword? 基于价值的医疗保健:这只是另一个流行语吗?
Healthcare Policy Pub Date : 2023-05-01 DOI: 10.12927/hcpol.2023.27096
Fiona Clement
{"title":"Value-Based Healthcare: Is It Just Another Buzzword?","authors":"Fiona Clement","doi":"10.12927/hcpol.2023.27096","DOIUrl":"https://doi.org/10.12927/hcpol.2023.27096","url":null,"abstract":"<p><p>The concept of value-based healthcare has been gaining traction, with several issues of <i>Healthcare Policy</i> discussing the agenda and highlighting pockets of excellence. However, we currently have no shared common goal that would define value-based healthcare. Furthermore, we have major limitations in measuring both the cost and benefit components of the concept of value, irrespective of the definition. It is time to make progress, which will include a recognition of the need to engage the public in a discussion around the values of the Canadian healthcare system and the federal government taking a hands-on role for the accountability of value as an outcome.</p>","PeriodicalId":39389,"journal":{"name":"Healthcare Policy","volume":"18 4","pages":"18-25"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/28/15/policy-18-018.PMC10370400.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9890400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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