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ith a goalof ensuringCanadians willhave thebest health and the best

health care in theworld by 2025,

the Canadian Medical Association(CMA) andthe Canadian NursesAssociation (CNA) are spearhead-ing a drive to transform health careforthe better when the currenthealth accord expires in 2014.

Armed with the results of anew Canada-wide public opinionpoll that shows overwhelmingsupport for the key aspects of a setof jointly agreed principles as thebasis for a new health accord, thetwo organizations are calling fora high-quality health care systemthat is universal, equitable, sus-tainable and truly centred on theneeds of patients.

CMA president John Haggiesayswhile the2004 Health Accordresolved theissue of stable andpre-dictable funding;the system now

needs a major overhaul.Anything you do nowwithout

a systematic transformational ap-proach will just be tinkering, saysDr. Haggie. The systemevolvedfroma different era with a differentparadigmof health carefocusedmainly on acute care. But now 80percent of thediseaseburden inCanada is chronicdisease man-agement andthe system of acutecare management,does not fit anylonger.

CNA president Judith Shamianagrees.

The2004 health accord madesomeprogress on someof theissues,but we are nowherenearachieving the transformation ofhealth care in Canada that weneedto makesure that Canadians arehealthier tomorrow than theyaretoday, says Dr. Shamian.

Right now, shesays, Canada isheading in thewrong direction;

health careoutcomes areworse in2011 than they were 20 years agocomparedto someother coun-tries. For example, Dr. Shamian

points out that Canada ranked 10thamong OECD countries for infantmortality in 1982. In 2008, the coun-try wasranked27th out of 34 OECDmember states.

Former Quebec Minister ofHealth and Social ServicesPhilippeCouillardsays Canada needs tocreatean environment that bettersupportspeople and organizationsoperatingin the health care sectorto provide betterservice, safety,quality, accessand patient experi-ence.

Ibelievethere isa politicalwillto make these changes;they arenot revolutionary, they are patient-centredand aimed at bringingqualityback into the system, saysDr. Couillard.

Dr. Haggie believesthat howCan-

adas health caredollarsare spent ismoreimportant than the sizeof thebudget. He points out that Canadaspends close to $200 billion a yearon health care, which puts thecountryshealth care spendingfifthamongOECDcountriesas a per-centage of GDP. However, Canadaranks only27th in the OECD whenit comes to the efficient use of itshealth carebudget.

Thats a hugegap,so it maynotbe a question ofspending more,but just not letting costs rise bygaining efficiencies anddoingthings better, getting better valueby spendinghealth caremoneycloser to the patient and focusingon patient-centredcare, he says.

The CMA-CNAprinciples callforan equitable andaccountablepatient-centred health care systemfocused on quality and incorporat-ing health promotion and illnessprevention.

ForDr. Shamian, that means asystemthat measures outcomesrather than outputsand one thatbrings teams of practitioners

together to meet theneeds ofpatients. It also means lookingbeyond just the health care systemto ensure a healthypopulation.

We needto see health care aspart of a larger system, shesays.We can have thebest health care intheworld,but if wedont deal withthe challenges that lead to healthissues such as homelessnessandpoverty, wewill not achieve theoutcomes we arelookingfor.

Dr. Haggiesays thelatest poll re-sults underscore support for healthcare transformation.

For example,more thanthree-quartersof respondents saidimprovingthe health care systemshould be thefederalgovernmentstop priority. Nothing scored higher.And85 per cent saidour six prin-

ciples should be adoptedas partof the discussionson a newhealthaccord between the federal govern-ment andthe provinces,says Dr.Haggie.

The acidtest,he adds,is howpolicy-makers will respondto callsfor health care transformation.

Thebroadly endorsedprincipleson health care transformation arethe standards that Canadianscanuseto determine if ourelected of-ficials have developed a newhealthaccord that willcreatea patient-centredhealth care system, saysDr. Haggie. Canadians have toldus clearly that is what theywant.It isnow up to our politicians torespond.

Special2014 Health Accord

T H U R S D AY , D E C E M B E R 1 , 2 0 1 1 SECTION CMA

AN INFORMATION FEATURE FOR THE CANADIAN MEDICAL ASSOCIATION

ABOUTTHE CANADIANMEDICAL

ASSOCIATION(CMA)

The CMA is the national voice of

Canadian physicians. Founded in1867, the CMAs mission is to serveand unite the physicians of Canadaand be the national advocate, in

partnership with the people ofCanada, for the highest standardsof health and health care. On behalfof its more than 75,000 membersand the Canadian public, the CMA

performs a w ide variety of functions .Key functions include advocating forhealth promotion and disease/injury

prevention polici es and s trategies,advocating for access to qual-ity health care, facilitating changewithin the medical profession, and

providing leade rship and guidanceto physicians to help them influence,manage and adapt to changes inhealth care delivery.

KEY FINDINGS*

INSIDE

Smarter investments are

needed for better health, writes

Canadian Nurses Association

President Judith Shamian.

CMA 2

Wellness model emphasizes

illness prevention.

CMA 4

Overcoming social inequitiesamong keys to better health.

CMA 5

A vision for high-quality health carePoll results show public support for principles to inform new health accord

1. ENHANCE THE HEALTH

CARE EXPERIENCE

2. IMPROVE POPULATION

HEALTH

3. IMPROVE VALUE FOR

MONEY

With Canadas current health careaccord set to expire in 2014, leadinghealth care professionals and otherexperts are bringing their ideas toOttawa in a bid to help shape a betterfuture for all Canadians.

ONLINE?

For more information, visithealthcaretransformation.ca.

CMA president John Haggie is among the chorus of experts calling for an overhaul of Canadian health care. In anticipation of the 2014 Health Accord, the CMA and the Canadian Nurses Associationhave tabled a set of principles to help inform a new health accord that will result in Canada having the best health and health care by 2025. PHOTO: MARK HOLLERAN/HOLLERONPHOTOGRAPHY.COM

*Statistics are drawn from a recent, nationally representative telephone survey commissioned by the Canadian Medical Association and Canadian Nurses Association that asked 1,001 Canadians, 18 years of age and older their

views on health and health care.

#1Health care is seen as the mostimportant priority for theGovernment of Canada.

85%of Canadians feel it is im-portant that the CMA/CNAprinciples be adopted as partof the 2014 Health Accorddiscussions.

77%support a national strategy toaddress the needs of our ag-ing population (e.g., throughincreased home care andlong-term care), even if this in-creases our taxes or increasesour debt/deficit levels.

46%of Canadians feel qualityof the health care servicesremains the most importantaspect of the system.

28%of Canadians feel the qualityof the health care system hasdeteriorated over the past two

years.

www.healthcaretransformation.ca

Will my aging parents getthe health care they need?

CANADAS DOCTORS ARE LISTENING.


2/6

Focus on patient-centred care highlights need for reforms

iven todays overtaxedhealth care system, it canbe difficult to see whats at

its centre: patients.Patient-centred care is increas-

ingly the focus of reforms andinitiatives across the health carespectrum, from improving patientaccess and delivering more timelycare to helping family physicianscope with exponential demand.

When you have an over-loaded,over-stressed system, constantlyrunning at 100 per cent capacity, itbecomes increasingly difficult to

maintain a patient focus, says Dr.Linda Slocombe, president of theAlberta Medical Association and afamily physician in Calgary special-izing in low-risk maternity cases.Its a different world for doctorsout there now, and patients needmore support.

Albertahas responded by creat-ingPrimaryCare Networks (PCNs),multidisciplinary teams,led by fam-ily physiciansand organized underformal arrangements with AlbertaHealthServices, that co-ordinateprimary care servicesfor patients.There arecurrently40 PCNs inAlberta,involving80 percent offamily physiciansand lookingaftermore than 2.5millionAlbertans.

PCNs are tailored to needs andare the connective tissue allowing

for better integration of care, whilefostering innovation and increas-ing capacity and access, says Dr.Slocombe, whos been practisingfor 28 years. She is a member ofthe Calgary Foothills Primary CareNetwork, which includes 350 practi-tioners, while some PCNs have justa handful of doctors, she says. Itsa co-ordinated approach to carefor that group of patients and thatgroup of doctors.

Barry Stein, a corporate lawyerand businessman in Quebec who ispresident of the Colorectal CancerAssociation of Canada, says thatpatient-focused initiatives need

to put the patient in the driversseat,while incorporating businessmodels to improve how servicesare delivered.

Weve become accustomed tobeing at the will of a very outdatedsystem, says Mr. Stein, a survivorof metastatic colorectal cancer

who sought health care outside of

Canada to fight his disease and wasreimbursed by the province follow-ing a judgement in the SuperiorCourt of Quebec. Today hes anadvocate for cancer awareness andeducational and support programsfor patients and their families.

Nurse-navigators, who helpcancer patients co-ordinate their

treatments, are a step in the rightdirection, but they are rare andonly come into the picture oncepatients are in specialist care,Mr. Stein says. Solutions such ascommunities of practice thatfocus on certain types of patientsand creative models and systemsfor delivering health care servicesare critical, he adds. This is a hugechallenge.

Dr. Slocombe says that as wellas focusing on patients and betterco-ordinating their care, its beenimportant to offer support to fam-ily physicians, who are dealing withmore significant cases, often inisolation

The solutions are complex, sheexplains. Weve got a ways to go,

but we are seeing real benefits.The development of the PCN

model in Alberta is a start, Dr.Slocombeadds.Its brought familydoctors together, and its giventhem extra support to providepatient-centred care.

CM A 2 AN INFORMATION FEATURE FOR THE CMA t h e g l o b e a n d m a i l t h ur s daY, d e c e m b e r 1 , 2 0 1 1

2014 HEALTH ACCORD

EVOLUTION

Colorectal Cancer Association of Canada president Barry Stein is among the health advocates who want to seeimprovements to services that would put patients in the drivers seat. PHOTO: CHRISTINNE MUSCHI

Patient-centred: The patient must be at the cen-tre of health care. Patient-centred care is seam-less access to the continuum of care in a timelymanner, based on need and not the ability to pay,

that takes into consideration the individual needsand preferences of the patient and his/her family,and treats the patient with respect and dignity.Improving the patient experience and the health

1PRINCIPLE

This report was produced by RandallAnthony Communications Inc. (www.randallanthony.com) in conjunction with the advertisingdepartment of The Globe and Mail. Richard Deacon, National Business Development Manager, [email protected].

he Canadian Nurses As-sociation (CNA) believesour countrys health care

system is one that Canadianscan be proud of and grateful for.However, changes are criticalnow more than ever if Canadiansare to become healthier. Despitean ongoing increase in spend-ing, Canadas health care systemis lagging. In 1982, Canada wasranked 10th among Organisationfor Economic Co-operation andDevelopment (OECD) countries ininfant mortality rates, the overallbest indicator of a societyshealth. By 2008, Canada slippedto 27 out of 34 OECD nations.Considerable strides in improv-ing our populations healthcould be made if the federal andprovincial/territorial govern-ments worked together to upholdCanadas not-for-profit, publiclyfunded system, while shiftinginvestments from the current ill-ness treatment model to one thatis patient-centred and emphasizeshealth promotion and preven-tion and management of chronicdiseases.

Currently, millions of Canadi-ans are forced to turn to hospital

emergency departments oneof the most costly forms of care for health problems that couldbe managed more effectively inthe community. According to thePublic Health Agency of Canada,chronic diseases represent 67per cent of all direct health careexpenditures. Costly to budgets

and productivity, chronic diseasessuch as diabetes one of manyexamples could be managedbetter if the system provided

the appropriate structure andsupport. Targeting investmentsfor primary care options, such asnurse practitioners and commu-nity health centres, will make Ca-nadians healthier. Better primarycare will open access points to thesystem and enhance the team-

work of he alth care professiona lslike nurses, doctors and otherhealth professionals who educatepatients about their health andhow to prevent and managechronic illnesses.

We need to get a better returnon our health care investments.Refocusing our approach mustbe based on improving healthoutcomes and the performance ofthe system. Funding needs to betied with national health indica-tors linked to expected outcomes,such as reducing diabetes andimproving management of highblood pressure, rather than thenumber of patients seen or pre-scriptions written in a given day.To assure Canadians access to anequitable, patient-centred andhigh-performing health system,the federal government mustfulfill its leadership role by settingmeaningful and measurable goalsfor regions across the country.

Canada has outstanding healthcare professionals, world-classresearch and the investments tomatch. Only when we have goalsand collaboration between healthcare interest groups, governmentsand the public can we achieve

a healthy, productive Canada.Moreover, we want our leaders torecognize and appreciate that be-cause registered nurses and nursepractitioners are so connected tothe delivery of care from coastto coast, they are integral to thefuture of health care in Canadaand have solutions to offer.

By Judith Shamian,RN, PhD, LLD (hon), D.Sci. (hon) FAAN

President, Canadian NursesAssociation

A MESSAGE FROM CANADAS NURSES

Smarter investments needed forbetter health

Toward a strategy for

patient-centred care

The CMA has called forimplementation of a strat-egy for Patient-centred care

within a national f rameworkto ensure:

the rights and expectationsof patients as to the qualityand timeliness of health

care; the responsibilities of pa-tients for their health andhealth care;

a mechanism to registerpatient concerns and com-plaints about the qualityand timeliness of healthcare;

a mechanism to provide re-dress of patient complaints.

The Strategy for Patient-Centred Care is built on afoundation of reasonablenessand fairness. The essentialprinciple is that health careservices are provided in themanner that works best forpatients.

Health care providers

partner with patients andtheir families to identify andsatisfy their range of needsand preferences. Notwith-standing resource constraints,governments have the dutyto ensure availability of theresources required to providehigh-quality care.

To read more on the Patient-Centred Strategy, go tohealthcaretransformation.ca.

BRIEF

Enhance the healthcare experience

See this entire

2014 Health

Accord report

plus web-

exclusive stories

online.

ONLINE

View the principles in full at globeandmail.com/healthcaretransformation

globeandmail.com/healthcaretransforma

tion

cna-aiic.ca

invested in your health

committed to your care

whoever you are

wherever you live

THE VOICE OF 143,843 REGISTERED NURSES

we are registered nurses

and nurse practitioners


3/6

he promised benefits ofelectronic medical recordsare no longer a futuristic

vision. They are here, and healthexperts say the full potential ofEMRs and EHRs are just beginningto be explored.

With the PS Suite EMR systemdeveloped by MD Physician Ser-

vices, for example, many physi-cians now have ready access to

their patients health information,wherever they are.In Ontario, critical mass has

been achieved in the provincesprimary care system, reportsDr. Darren Larsen, Ontario MDssenior peer physician. In two tothree years, as physicians col-lect data, we will be able to makesome powerful improvements topopulation-based health deliveryand service.

EMR adoption has alreadyimproved efficiencies and qualityof care. When a medication isprescribed, for example, the EMRsystem flags potential interactions

with other medications, as well asside-effects and risks associated

with co-existing conditions.

Physicians also have mobileaccess to EMR, enabling them toconnect to patient records wher-ever they are. If Im on a housecall, at the hospital, or at homeand on-call, I have all the informa-tion I need at my fingertips, all thetime. That leads to better decision-making and more effective patientadvice, says Dr. Larsen, a PS SuiteEMR client.

PS Suite EMR has the potentialto improve patient education andcompliance. I use my computerto show my patients graphs of

where theyve been and wheretheyre likely going, he notes.For example, I can point out thatsomeone has had a high numberof urinary infections over a periodof time, to show that we need toinvestigate the cause.

For the millions of Canadiansliving with chronic health condi-tions, EMRs enable more proactivehealth management. If a patient

with diabetes has not had an eyeexamination in the past year, thesystem will alert the physician, sothe patient can be notified. Muchof chronic care for diabetes, asth-

ma, cancer, thyroid disease, COPDand scores of other disorders requires looking forward, usingthe data from the past. EMR allowsthat. Once you build a system ofreminders, a lot of the processbecomes almost automatic, Dr.Larsen says.

In Peterborough, Ontario, Dr.Nick Vanderkamp has used PSSuite EMR in his practice for about

four years. Its helpful in measur-ing the benefit of lifestyle inter-ventions and medication.

On a macro level, he says, searchcapability makes it possible tomeasure quality of care. As a com-munity, were working to improveoverall health outcomes, particu-larly for chronic disease manage-ment. With EMR, we can searchrecords to see how many people inour practice are meeting the out-come measures were looking for.Its an exciting new direction.

In multi-physician clinics, leg-ibility of records, lost records andrecord retrieval were formerlychallenging issues, says Dr. NeerajSanjeev Bector of Edmonton.With PS Suite EMR, nothing fallsthrough the cracks. Whether its

our staff or a physician dealingwith an issue or patient request,everything is dealt with in thesystem electronically and can bereviewed after, if necessary, in theaudit log.

Visual representation of labresults are much more powerful inmotivating patients than havinga bunch of numbers thrown atthem, he says. They can actuallysee the effect that medications orother interventions are making ontheir care in a simplified graphic.

In Alberta, NetCare is a provin-cial repository for lab information,diagnostic imaging, hospital dis-

charge summaries and emergencyrecords. It provides timely access,and I can retrieve data that otherphysicians have generated, saysDr. Bector. Were not duplicatinglab tests or imaging, potentiallyre-exposing patients to radiationor generating extra cost.

For patients, EMR can mean bet-ter care and greater peace of mind.Mary Jane McQueen, who is the

primary caregiver for her 86-year-old mother, says, When my momhas serious health issues, Im ableto stay in contact with Dr. Larsenby e-mail. As he has access to herelectronic health records whereverhe is at the time, weve been ableto get ahead of the game in termsof treatment, rather than get tothe point where wed have to go toemergency.

While Ms. McQueens motherhas had a number of long stintsin the hospital, thanks in part toEMRs and her daughters ongoingcommunication with Dr. Larsen,she is still able to live at homemost of the time with her daugh-ter and son-in-law.

Being in regular contact withthe family practitioner also made

a big difference when her motherwas in the hospital receiving acutecare, says Ms. McQueen. It mademe feel like we had a supportteam.

All physicians quoted in this articleuse PS Suite EMR and are clients ofMD Physician Services Software. PSSuite EMR is a leading EMR solution,which also offers a fully integratedmydoctor.ca Health Portal, developedexclusively for Canadian physicians.For more information, please callthe Hotline at 1-800-361-9151, e-mail

[email protected], or visitmd.cma.ca/EMR.

Electronic Medical Records provide a new platformfor efficient, quality care

AN INFORMATION FEATURE FOR THE CMA C MA 3t h e g l o b e a n d m a i l t h ur s daY, d e c e m b e r 1 , 2 0 1 1

2014 HEALTH ACCORD

TECHNOLOGY

of Canadians must be at the heart of any reforms.

Quality: Canadians deserve quality services thatare appropriate for patient needs, respect indi-

vidual choice and are delivered in a manner thatis timely, safe, effective and according to the mostcurrently available scientific knowledge. Servicesshould also be provided in a manner that ensures

continuity of care. Quality must encompass boththeprocessesand theoutcomes of care. More at-tentionneeds tobe given to ensuringa system-wideapproach to quality.

n an age of health carecutbacks and harriedpractitioners, a sign in Dr.

Davidicus Wongs medical officein Burnaby, B.C., sends an unusualmessage. The sign asks patientsto reveal their complete lists ofmedical problems at the start ofeach visit, so that each can be ad-dressed thoroughly by the familyphysician and his staff.

Its a philosophy of quality

that Dr. Wong both practices andteaches as the Family PracticeChampion of the provinces Prac-tice Support Program.

Set up by the British ColumbiaMedical Association (BCMA) andthe B.C. Ministry of Health underthe General Practice Services Com-mittee (GPSC), the program helpsfamily doctors and their officesenhance both their efficiency andthe level of care they provide.It includes financial incentives,strategies and training modules inareas ranging from chronic diseasemanagement to better scheduling,sessions that Dr. Wong helps todeliver.

I tell my colleagues to embracethe list, he says, explaining thatsome doctors limit patients to onemedical problem per visit, to keepappointments short. But it canactually be more efficient for thedoctor to know all aspects of theirconditions, because it can helpuncover related issues and planoverall care, says Dr. Wong, whohas been practising for 20 years.Its a new way of listening.

Such quality initiatives areintended to improve the health

of the population, enhance thepatient experience and reduce orat least control the cost of healthcare.

We are on the right track, saysDr. Nasir Jetha, the president ofthe BCMA, adding that the GPSCis having a beneficial effect onprocesses and outcomes in theprovince. The patient is gettingthe best care possible, the physi-cians have the right tools, and its

a benefit to the health care systemin terms of savings.

Dr.Jetha,who has beenpractis-ing as a pediatricianin Vancouverfor27 years, saysthat managingchange can be challengingfor doc-tors. But we cant throw ourhandsupin the air whenwe see there are

ways by which we can deliverbettercare and betterquality.

There are more to come in B.C.,Dr. Wong says, such as additionaltraining modules focused on areassuch as palliative care and youthmental health.

Theres many, many layers toimproving quality, he explains.For example, he is the MedicalLead and Chair of the BurnabyDivision of Family Practice, set upunder the GPSC, sort of a newdoctors lounge where a com-munitys family physicians havea voice to improve the health oftheir patients, he says. Were nolonger working in isolation.

The divisions, as well as thetraining modules and otherstrategies, spell the renaissanceof family practice, he says. Wereclosing the care gap between whatpatients need and what they get.

IMPROVEMENTS

Initiatives aim to improvecare and better managehealth care costs

B.C. Medical Association president Dr. Nasir Jetha says while managingchange can be difficult, we cant throw our hands up in the air when wesee there are ways by which we can deliver better care and better quality.PHOTO: RAYMOND LUM

With PS Suite EMR,nothing falls throughthe cracks. Whetherits our staff or aphysician dealing withan issue or patientrequest, everythingis dealt with in thesystem electronicallyand can be reviewedafter, if necessary, inthe audit log.

Dr. Neeraj Sanjeev Bector,Edmonton

By thenumbers

Canadas

evolving

healthneeds

Lifespan

1961:71 years

2011:81.4 years

2025: ?


4/6

C MA 4 AN INFORMATION FEATURE FOR THE CMA t h e g l o b e a n d m a i l t h ur s daY, d e c e m b e r 1 , 2 0 1 1

r. John Haggie is a strongproponent of the adagean ounce of prevention is

worth a pound of cure.As a surgeon practising in

Gander, Nfld., he has first-handexperience with serious medicalconditions that could be prevent-ed with early intervention.

Among his examples, Dr. Haggiepoints to a patient who is about to

lose her leg due to complicationsof type 2 diabetes. This outcomecould have been avoided at anynumber of points, he says. Betterchildhood nutrition and fitnesscould have prevented the obesitythat led to the development ofthis womans diabetes. Better drugcoverage could have improvedher blood glucose management.Even something as simple as hav-ing her feet checked by a nurse,

which costs about $20, could havesaved this womans leg and tens ofthousands of dollars to the healthcare system.

As president of the CanadianMedical Association, Dr. Haggie ispromoting a transformation of thehealth care system that will focuson illness prevention and health

promotion. The current acutedisease model of health care is 20

years out of date. Today, the big-gest burden on the system comesfrom largely preventable chronicdiseases and their complications,he says, noting part of the chal-lenge in promoting health is thatmany highly effective interven-tions are based in the community,not in hospital or doctors offices(for example, programs to encour-age youth fitness and smokingcessation initiatives). As a result,they are not funded by medicare.

We have to convince thegovernment to invest in primary

and secondary prevention initia-

tives. The evidence shows that anupfront investment more thanpays for itself down the road,says Michael Cloutier, presidentand chief executive officer of theCanadian Diabetes Association.He notes that just a two per centreduction in diabetes prevalencerates would result in a nine percent reduction in direct healthcare costs.

Unfortunately, the tools andmedications that promote healthare not accessible to all Canadi-ans. Almost two-thirds of people

with diabetes report that th eycannot afford to comply with

their prescribed therapy to effec-

tively manage their disease. Alot of people have to choose be-tween paying for their rent or fortheir medications. Many more especially those in remote andlower income communities cannot afford healthy food. Theresult is more diabetes-relatedcomplications, poorer quality oflife for these individuals and anincreasing strain on our healthcare system, says Mr. Cloutier.We need to create a standard ofcare for chronic disease manage-ment across Canada.

The Canadian Medical As-sociation is advocating for co-ordinated investments in health

promotion and disease pre-vention that wi ll elimi nate thesegaps. Our goal is to ensure that

by the end of the end of the nextHealth Care Accord, Canadians

will have the best health in theworld, says Dr. Ha ggie. There isno reason why we cant do that.By emphasizing health promo-tion now, we will see results by2020.

CHRONIC DISEASE

Our goal is to ensurethat by the end of theend of the next HealthCare Accord, Canadianswill have the best healthin the world.

John Haggie,President,Canadian Medical Association

Canadian Diabetes Association president and CEO Michael Cloutier says public investments in primary and secondaryprevention initiatives are money well spent. The evidence shows that an upfront investment more than pays foritself down the road. PHOTO: SUPPLIED

esearch focused on pa-tients is the cornerstoneof world-class health care.

Canadas Strategy for Patient-Ori-ented Research is a new nationalhealth research strategy that putspatients first.

It is focused on providingpatients, health professionals andpolicy-makers with the best avail-able information to make treat-ment and policy decisions that areappropriate, timely and effective.It aims to strengthen supportfor clinical trials and interven-tion studies as well as researchthat compares the effectiveness,benefits and harms of existingtreatment options. The strategyalso endeavours to improve thetranslation of innovative preventa-tive, diagnostic and therapeuticapproaches into the health caresetting.

The strategywas createdafterextensive consultations led bytheCanadian Institutesof HealthResearch (CIHR)with health chari-ties, academichealthcare organiza-tions, industries, universities andgovernments. Thestrategy, a firstforCanada,will bring together acoalition of researchersand stake-holders to work with the provincesandterritories to meetthe chal-lenge of delivering high-quality andsustainable health care.

Patients are at the centre ofhealth care. Canadas Strategy forPatient-Oriented Research is aboutrecognizing the patients perspec-tive and ensuring that the carethey receive meets their needs andis based on the best available infor-mation. If done right, the strategycan transform clinical practice inthis country for the benefit of Ca-nadians. This will improve healthoutcomes as well as the patientssatisfaction with their care, saidDr. Alain Beaudet, president ofCIHR.

n January1911,when thepostoffice began deliver-ingthe first issueof theCa-

nadian Medical Association Journal(CMAJ) to about 1,500 physiciansspread across thecountry, CMAJ

was the only form of continuingeducation availableto mostofthose readers.

Fast forward100 years.Today, 71,000 doctors receivethe

paperversionof CMAJ,but they arealsojoinedonline by thousandsmorereaders spread around the

world. But thats just the start other changesin physiciansongo-ing education have beeneven morestaggering.

At theCanadian Medical Associa-tion, thiseducation explosion is

called K4P Knowledge forPractice anditsripple effectsare beingfeltacross medicine.

Physiciansof 100 yearsago even25 yearsago usually hadaccessto a handfulof journalsandtextbooks to helpthem provideup-to-date care. The CMAs K4Ppro-gram takes the same concept up-to-date information and deliversit instantly to the patients bedsideor physiciansexamining room.

Today, CMA members caninstantly consultmore than100 on-linetextbooksand marvellous diag-nostic resources such as DynaMedandMD Consult justby clickingafewcomputer keys or touching aniPad. When patients visits areover,the doctorcan providethem withtake-away information by pressinga fewmore keys. Later, that samephysician canupdatehis or herskills by taking an accredited onlinecourse or webinar.

That,in a nutshell, isthe goal ofthe CMAs K4P project: to providedoctors with easyaccessto thebestinformation so thatpatients canreceivethe bestcare. Theresnodoubtthatthe editorsof that firstedition of CMAJwouldbe pleased.

EXPERT OPINIONS

Ideas for improved chronicdisease management

CIHR: Better health carethrough patient-oriented

research

Knowledge for practice:Managing medical

knowledge

RISK MANAGEMENT

Poll shows Canadians need

to wake up to chronic disease

truths

By thenumbers

Canadas

evolving

health needs

Birthrate

1932:22.4births/1,000popula-

tion

2011:10.28births/1,000popula-tion

2025: ?

Health promotion/illness prevention: Thehealth system must support Canadians in theprevention of illness and the enhancement oftheir well-being. The broader social determinantsof health (e.g., income, education level, housing,employment status) affect the ability of individu-als to assume personal responsibility for adopting

and maintaining healthy lifestyles and minimiz-ing exposure to avoidable health risks. Co-ordinat-ed investments in health promotion and diseaseprevention, including attention to the role of thesocial determinants of health, are critical to thefuture health and wellness of Canadians and tothe viability of the health care system.

2PRINCIPLE

Improve populationhealth

Wellness model emphasizes illness prevention

2014 HEALTH ACCORD

According to poll resultsreported in the 2011 Heart &Stroke Foundation Report onCanadians Health, nine out of

10 Canadians are jeopardizingthe quality and length of theirlives. The foundation foundthat many Canadians are indenial about their risk factorsfor heart disease such as beingoverweight and being physical-ly inactive risk factors theycan manage and control.

While the poll results indicates90% of Canadians rate them-selves as healthy, the reality is:

9/10Canadians have at least onerisk factor for heart diseaseand stroke.

Approx. 50%of Canadians dont meet thephysical activity and healthyeating recommendations.

25%of Canadian adults are obese.

The foundations prescriptionfor a healthy lifestyle and morequality years of life includesmanaging controllable riskfactors by following a healthydiet, being physically active,knowing and controlling ones

blood pressure and cholesterollevels, maintaining a healthy

weight, being smoke-free,reducing stress, managingdiabetes and limiting alcoholconsumption.


Governments across Canada will soon

decide the future of our healthcare.

Together we can make the health ofCanadians the centre of the debate.

Lets Put

People First!

cancer.ca


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n apple a day may keepthe doctor away, but whatif you cant afford to buy

apples or other fresh fruits andvegetables? What if your home isovercrowded or has mould? Whatif you dont even have a home?

Studies show that factors suchas the availability of affordablehealthy food, housing and employ-ment have a direct impact on an

individuals health. The UnitedNations recently declared that theright to health extends beyondhealth care to include the underly-ing social determinants of health,such as potable water, adequatesanitation and access to health-related information.

The health care system is re-ally just a small portion of healthcare, says Canadian Medical Asso-ciation president Dr. John Haggie.We need to look beyond doctorsand hospitals, and address thesocial inequities that are contrib-uting to poor health.

These inequities are particularlyevident in remote and poorercommunities. Consider the chal-lenge of providing nutritiousmeals to a family when Coke is

far cheaper than milk and thesingle local grocery stores shelvesare bare of fresh produce, meatand fish. That is the reality YMCA

Canada president Scott Haldanewitnessed recently when he visitedseveral First Nation communitiesas chair of a national panel on na-tive education. If you are living inan isolated community and are ona low income, the apple-a-day ap-proach to health is not relevant,he says.

In addition to struggling with alagging food security, First Nation

families also contend with highunemployment, substandardhousing and high dropout rates.The latter is particularly concern-ing, says Mr. Haldane, as youth

who dont graduate high schoolare more likely to fall into sub-stance abuse, be unemployed andlive in poverty all factors thatcontribute to poor health.

Lack of education also affectsthe ability to access, understandand act on health information.How can you educate yourselfabout wellness and develop theskills you need to care for yourselfif you cant read? asks Dr. Haggie.

The disparities in health statusbetween First Nation populationsand the rest of Canada are strikingand disturbing. Compared to the

national average, First Nationscommunities have double theinfant mortality rate, three tofive times the prevalence of type2 diabetes, 30 times the rate oftuberculosis infection and a lifeexpectancy that is five to seven

years lower.Closing these gaps in health

outcomes will require the develop-ment of innovative, culturally rel-evant community-based programsthat address a wide range of socialissues. We cannot talk abouthealth in isolation, says ShawnAtleo, Assembly of First Nations(AFN) National Chief.

Towards that end, AFN recentlyheld a national health forum thathighlighted the need for First Na-tion control of First Nation healthto achieve fair and sustainablehealth service delivery to theircommunities. Experts discussedthe need for programs thattackle inequities in education,overcome barriers to economicdevelopment and improve infra-structure so that communitieshave access to clean water andsafe housing.

Funding is critical to imple-menting these plans. In 2010, First

Nation communities receivedless than half the funding givento non-First Nation communi-ties to provide basic services fortheir citizens ($8,754 compared to$18,724). If services and programsdo not receive sustained, equitablefunding, health care and judicialcosts in First Nation communities

will reach close to $1 billion overthe next 10 years.

Collective action at thisjuncture in history is critical. Ifwe dont act now, we risk the lossof an entire generation, saysNational Chief Atleo.

AN INFORMATION FEATURE FOR THE CMA CMA 5t h e g l o b e a n d m a i l t h ur s daY, d e c e m b e r 1 , 2 0 1 1

Overcoming social inequities key to improved wellnessACCESS

If you are living inan isolated com-munity and are ona low income, theapple-a-day approachto health is not rel-evant.

Scott Haldane,

President,YMCA Canada

ow Canadians age and diehas changed dramaticallyin recent decades, with

the resulting shift emphasizinggrowing needs to rethink the waysand places care is delivered.

Just a generation or two ago,death usually came suddenly, theresult of an acute cardiac event or

illness. Today, more people are liv-ing longer than ever with chronicdiseases (80 per cent of seniorsover the age of 65 have at least onechronic disease), yet our healthcare system still works on the oldacute care model.

We need to shift our philoso-phy about setting of care to thinkbeyond acute care hospitals, saysSharon Baxter, executive directorof Canadian Hospice and PalliativeCare Association (CHPCA).

Home care offers an alternativethat not only benefits patients,but is also more cost-effectivethan hospital-based care. Well-supported home care enablespeople to be discharged fromhospitals earlier, delays admis-sion to long-term care facilitiesand allows individuals to live withdignity and independence, saysNadine Henningsen, executivedirector of Canadian Home CareAssociation (CHCA).

For those with terminal ill-nesses, hospice palliative carehelps patients die the way the ma-

jority of Canadia ns say they wouldprefer: at home. We believe thateveryone has the right to die withdignity, free of pain, surroundedby their loved ones, in the settingof their choice, says Ms. Baxter.

Funding for and availability ofthese services varies widely across

the country, however. If youwant to die at home, you needhome care. But you may or not beable to get home care, and it mayor may not be funded, depend-ing on where you live, says Ms.Baxter. Even where services areavailable, terminally ill patientssometimes remain in hospital

because they do not receive timelyreferral to palliative program. Weneed to train health care workershow to talk to patients about end-of-life issues, she says.

Availability of home care andhospice palliative care services arealso being strained by increasingdemand and limited resources.CHCA estimates that more than800,000 seniors with chronicconditions will require home careservices in 2017.

The lack of qualified humanresources is a significant challengeall home care providers face. Itis difficult to recruit and retainhealth professionals, and ourcurrent workforce is aging. Thedemand for home care services

will soon outstrip our humanresources, says Ms. Henning-sen. The results are waitlists forservices, an increasing burden onfamily caregivers and continuingreliance on hospitals.

Both CHCA and CHPCA want tosee the federal government com-mit increased financial, humanand technology resources to homeand palliative care services. We

want to guarantee a minimumstandard of resources across thecountry so that you can spendthe last years of your life at homeif thats what you want, says Ms.Baxter.

SERVICE DELIVERY

Home can be where the health is

While they have proved to be cost efficient, demand for home care servicesis expected to soon outstrip the sectors human resources capacity.PHOTO: ISTOCKPHOTO.COM

By thenumbers

Canadas

evolving

health needs

Infantmor-tality

1911:120deaths/1,000 live

births

2011:4.92deaths/1,000 livebirths

2025: ?

Equitable: The health care system has a dutyto Canadians to provide and advocate for equi-table access to quality care and multi-sectoralpolicies to address the social determinants ofhealth. In all societies, good health is directlyrelated to the socio-economic gradient thelower a persons social position, the worse his or

her health. The relationship is so strong that itis measurable within any single socio-economicgroup, even the most privileged. It is due to thesum of all parts of inequity in society materialcircumstances, the social environment, behav-iour, biology and psychosocial factors, all of

which are shaped by the soci al determ inants of

health. Some health inequities are preventable;failure to address them will result in poorerhealth and higher health care costs than neces-sary. Improved health literacy (defined as theability to access, understand and act on infor-mation for health) would help to mitigate theseinequalities.

YMCA Canada president and C EO Scott Haldane says yout h who dontgraduate high school are more likely to fall into substance abuse, be unem-ployed and live in poverty all factors that contribute to poor health.PHOTO: SUPPLIED

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CM A 6 AN INFORMATION FEATURE FOR THE CMA t h e g l o b e a n d m a i l t h ur s daY, d e c e m b e r 1 , 2 0 1 1

ECONOMICS

Sustainable health care: This requires uni-versal access to quality health services that areadequately resourced and delivered along the fullcontinuum in a timely and cost-effective manner.Canadas health care system must be sustainablein the following areas: resourcing, research, mea-suring and reporting, and public support.

Accountable: The public, patients, families,providers and funders all have a responsibility toensure the system is effective and accountable.This includes: good governance, responsible use,strong public reporting, enforceability and redress,leadership/stewardship and a responsive/innova-tive approach to care.

3PRINCIPLE

Improve valuefor money

Enhanced quality and safety among keys tosustainable health care

2014 HEALTH ACCORD

or DonDrummond, thequestion of whetherCan-adas health care system is

sustainable is best answered withanother question: whywould one

want to sustain the statusquo?For theamount of moneyspent,

the system should surely be deliver-

ing better results,says Mr. Drum-mond,the former chief economistfor TDBank and now chair oftheCommission onthe Reform of On-tarioPublic Services and MatthewsFellow inGlobal PublicPolicy atQueens University in Toronto.

Hesays thehealth care systemis oftendescribed as unsustain-able because health carecosts areincreasing faster thangovernmentrevenue growth. But he cautionsthatthis approachignoreschangesthat could make thesystem moresustainable.

For the health care system tobecome more sustainable, Mr.Drummond argues, it needs toshift from an acute-care modelto a chronic-care model and alsobroaden its scope tohealthin

general including prevention andsocio-economic factors that lead tohealthissues.

Butthat does notnecessarilymeanincreased spending.In fact,says Mr.Drummond, economicrealities meanthat provincialgov-ernmentswill soonbe compelledtoreinin health care cost increasesas part of their drive toreturn tobalanced budgets, which meansreform of thesystem is themostobvious solution to the growingchallenge.

The process for reform, inwhich stakeholders must take aleading role, will be as important

as the diagnosis, prognosis andperhaps even the medicine, saysMr. Drummond.

Improving the efficiency andsustainability of the system, headds, will require a range of ac-tions from organizational andinformational improvements, toreforming service delivery incen-tives and sharpening the focus ofhealth care.

Mr. Drummondbelieves thenecessary reforms can be accom-modated under the current public

administrationor financing modelwithout modifying the general pa-rameters of the Canada Health Act.Specifically, he would like to seebetter integration of the systemaround the patient.

For instance, better value formoney could be achieved whenhigh-needs patients, such ashigh-needs diabetes patients, areclosely attached to a primary carepractice. Cost reductions, in thisinstance, might be had from a sub-stantial reductionin hospital costs

the greater the attachment toone primary care group, the lowerthe overall costs on the healthsystem, he says.

Peter Barrett, a past president ofthe Canadian Medical Association,believes the healthcare system canmove towards sustainability byfocusing on quality and safety andreducing waste.

There are still huge variationsinwhat we do and how we doit.Variation is the breeding groundfor error; most other organizations

knowthat and try to standardizetheir activity. We need to do thattoo, says Dr. Barrett.

He adds that a focus onevidence-based best practices im-proves outcomes and quality andsaves money.

Ultimately we will need policychanges to bring about some ofthese reforms, but a lot can bedone without policy changes.If it is good for patients andthesystem, it seems to me to be a nobrainer, says Dr. Barrett.

Don Drummond, a former senior federal finance official and TD Bank chief economist, says to become more sustainable, Canadas health care system

needs to shift from an acute-care model to a chronic-care model and also broaden its scope to health in general including prevention andsocio-economic factors that lead to health issues. PHOTO: MARK HOLLERAN/HOLLERONPHOTOGRAPHY.COM


CANADAS DOCTORS ARE LISTENING.

What kind of healthcare system will mygrandchildren have?

www.healthcaretransformation.ca

www.capa-acam.ca

OptimizingPhysician Assistants

Adjoints au mdecin

patient careBy fostering the Physician/Physician Assistant Model,we can ensure superior care for Canadians andimprove access to quality medical care.

Optimiser lessoins aux patients

En favorisant le modle mdecin/ adjoint au mdecin, nous pouvons

assurer des soins de qualit suprieure pour les Canadiens et lesCanadiennes et damliorer laccs aux soins mdicaux de qualit.

2014healthaccord.dec.1.11

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