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Productivity Decline or Administrative Avalanche? Examining Factors That Shape Changing Workloads in Primary Care. 生产力下降还是行政雪崩？检查改变初级保健工作量的因素。
Healthcare Policy Pub Date : 2023-08-01 DOI: 10.12927/hcpol.2023.27152
Ruth Lavergne, Sandra Peterson, David Rudoler, Ian Scott, Rita Mccracken, Goldis Mitra, Alan Katz
{"title":"Productivity Decline or Administrative Avalanche? Examining Factors That Shape Changing Workloads in Primary Care.","authors":"Ruth Lavergne, Sandra Peterson, David Rudoler, Ian Scott, Rita Mccracken, Goldis Mitra, Alan Katz","doi":"10.12927/hcpol.2023.27152","DOIUrl":"10.12927/hcpol.2023.27152","url":null,"abstract":"<p><strong>Background: </strong>In Canada, family physicians (FPs) per capita have increased but so have access challenges. We explored changes in population characteristics, service delivery and FP practice that may help understand these trends.</p><p><strong>Methods: </strong>We used linked administrative data in British Columbia to describe changes in patient ages and comorbidities, hospitalizations and receipt of services that may require FP coordination, review and/or follow-up: prescriptions dispensed, laboratory tests, diagnostic imaging (radiology and ultrasound), specialist visits and emergency department visits. We estimate the number of FPs delivering community-based comprehensive care and report changes in service volume per community-based FP visit.</p><p><strong>Results: </strong>Between 1999/2000 and 2017/2018, people experienced fewer days in hospital, but the number of treated comorbidities, day surgeries and other services requiring FP coordination increased over and above the expected levels attributed to population aging. While the total number of FPs per capita have increased, numbers in community-based care have not and visits per physician have fallen. Increases in services that may involve FP coordination per community-based FP visit ranged from 32.2% for diagnostic radiology to 122.1% for lab tests.</p><p><strong>Conclusion: </strong>Findings suggest substantially increased coordination workload per FP visit. Ongoing impacts of population aging and changing service delivery on primary care workload require further examination.</p>","PeriodicalId":39389,"journal":{"name":"Healthcare Policy","volume":"19 1","pages":"114-129"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10596325","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
Reforming Paediatric Drug Regulations in Canada: A Clinical and an Access Imperative. 加拿大儿科药物法规改革：临床和准入的当务之急。
Healthcare Policy Pub Date : 2023-08-01 DOI: 10.12927/hcpol.2023.27157
Charlotte Moore Hepburn, Allison A Chang, Deborah M Levy
{"title":"Reforming Paediatric Drug Regulations in Canada: A Clinical and an Access Imperative.","authors":"Charlotte Moore Hepburn, Allison A Chang, Deborah M Levy","doi":"10.12927/hcpol.2023.27157","DOIUrl":"10.12927/hcpol.2023.27157","url":null,"abstract":"<p><p>Children deserve the same high standards for drug safety, efficacy and access as adults. Unfortunately, Canada lags behind leading international regulators in implementing reforms to ensure access to paediatric medications. Paediatric regulations, also known as paediatric rules in the US, include a mandate to submit paediatric data in all new drug applications when paediatric use can be anticipated. Absent paediatric regulations, many medications with paediatric-specific indications in other countries remain \"off-label\" for Canadian children. In addition to concerns related to off-label drug safety, the absence of paediatric indications prohibits appropriate paediatric-specific health technology assessments and limits the evidence-based listing of paediatric medications on public and private formularies.</p>","PeriodicalId":39389,"journal":{"name":"Healthcare Policy","volume":"19 1","pages":"54-64"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10229835","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
Reversing the Stigma around Canada's Poor-Performing Healthcare Systems. 扭转围绕加拿大糟糕的医疗保健系统的污名。
Healthcare Policy Pub Date : 2023-08-01 DOI: 10.12927/hcpol.2023.27162
Jason M Sutherland
{"title":"Reversing the Stigma around Canada's Poor-Performing Healthcare Systems.","authors":"Jason M Sutherland","doi":"10.12927/hcpol.2023.27162","DOIUrl":"10.12927/hcpol.2023.27162","url":null,"abstract":"<p><p>Recent statistics report that healthcare spending growth is persistently high; in recent years, spending growth exceeded 5% (CIHI 2022). Some portion of the outsized growth can be attributed to the COVID-19 pandemic, though the cause is irrelevant. High spending growth in the healthcare sector is not a good prospect for taxpayers or for education and social programs competing for the same pot of money. Spending is important, but it is not the only attribute for measuring the success of our provinces' and territories' efforts to fund healthcare services that maintain or improve their populations' health.</p>","PeriodicalId":39389,"journal":{"name":"Healthcare Policy","volume":"19 1","pages":"8-22"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10229833","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 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
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