A Prescription for Canada: Achieving Pharmacare for All

MESSAGE FROM THE CHAIR

{Excerpts]Canadians have considered the idea of universal drug coverage, as a complement to universal health care, for over five decades. For such a long-standing debate there is a surprising level of consensus. After hearing from many thousands of Canadians, we found a strongly held, shared belief that everyone in Canada should have access to prescription drugs based on their need and not their ability to pay, and delivered in a manner that is fair and sustainable. That’s why our council has recommended that Canada implement universal, single-payer, public pharmacare.

There is no single, uniform method in Canada for a child with asthma to get her inhaler. It depends on her family’s coverage. There is no one consistent way that all cancer patients obtain take-home cancer drugs or medicines for coping with chemotherapy side effects. Some pay more. Some pay less. Some don’t have access to those medicines at all.

There is a cost to universal pharmacare and we understand that governments have fiscal limits. But universal, single-payer, public pharmacare can save billions by lowering the price we pay for prescription medicines and by avoiding the greater costs that accumulate when a manageable condition becomes a serious health crisis or when complications develop because someone could not afford to take medicine as prescribed. It might be the person recently laid off who stops taking medicines for preventing heart attack or stroke. They don’t feel an immediate, daily difference when they take those pills. So, they question the expense when money is tight. They mean to get back on the medicine when they get back on their feet. But time runs out. They end up in an emergency room in crisis. They may now need ongoing home care. Any return to work is delayed or maybe never happens. Barriers to accessing prescribed medication can and do result in additional visits to the doctor’s office, emergency departments and hospital inpatient wards, all costing our society much more than the cost of that preventive medicine. Improving access to prescription medicine improves health outcomes, reduces health care visits, and saves billions in downstream health care costs.

Our current fractured system also weakens Canada’s negotiating position with pharmaceutical companies. We pay some of the highest drug prices in the world. Other countries with universal pharmacare get better deals for the same drugs. 
Dr. Eric Hoskins

Final Report of the Advisory Council on the Implementation of National Pharmacare:
https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/implementation-national-pharmacare/final-report.html

INTERVIEWS

Rural citizen health councils empower communities: BC researchers

Fran Yanor / Local Journalism Initiative Reporter / The Rocky Mountain Goat
May 28, 2020

Several rural health groups are calling for the creation of citizen health councils as a way to correct decision-making imbalances and genuinely involve rural patients in healthcare policy-making.

“Citizen patients want a voice in their healthcare system,” said Dr. Jude Kornelsen, co-director of the BC Centre for Rural Health Research. “We don’t have a codified or systematic way of providing a mechanism for real citizen patient voices in healthcare planning.”

A recent review by Kornelsen’s group laid out the rationale and benefits of citizen health council models around the world and a second survey of rural residents garnered enthusiasm for rural health councils. According to the review, citizen health councils are formed “to improve decision-making and population health outcomes, to ensure public trust and accountability, and to promote inclusivity, community ownership and community empowerment.”

Dr. Ray Markham, executive director of the BC Rural Coordination Centre, a multi-pronged entity that funds research, educates practitioners, and facilitates rural healthcare stakeholder collaboration, likens the intention behind citizen health councils to the First Nations approach of ‘Nothing about us, without us.’

“Whenever you get into equity in conversations, often people will want to speak for somebody,” said Markham, who also practices family medicine in Valemount, BC. “But fundamentally, we really need to explore how the people who are affected, or where the inequity sits, have a meaningful voice in shaping what happens.”

Citizen patient health councils can help correct power imbalances, enabling those who are ‘excluded from political and economic processes… to be included moving forward,’ according to the review.

“You can have 10 people sitting around a table and one or two patients bringing a patient perspective,” Markham said. “But some of these groups will have a very strong infrastructure sitting behind them.”

Accountability is essential. Genuine citizen patient engagement goes beyond a board or council position, said Kornelsen.

“How well do they work in achieving the citizen patient voice? She asked. “There’s some things that we have to be thinking mindfully about, like ensuring that it’s not just a tick box exercise, that it is authentic voice, and that it represents all spectrums.”

The BC Rural Coordination Centre funds groups to pull together that collective perspective and has convened a citizen community group to bring the community perspective into provincial government-level conversations, said Markham.

“Jude’s work is really helping looking at a citizen or community voice to help shape research and evidence development,” said Markham. “And we’re doing the same thing, but looking at how (to make) system change.”

It’s important to honor the community perception, said Edward Staples, president of the BC Rural Health Network, a collective of community organizations and individuals working to improve health service delivery in rural BC. “Their perceptions and understandings can be used to help develop informed policy, strategies for improvement, and ways to make sure that the needs of the community are being served properly.”

A survey of 180 rural B.C. communities in 2019 by the BC Centre for RuralHealth Research revealed significant interest in citizen health councils.

“They know what’s happening on the ground,” said Kornelsen. “And from the most important perspective, which is those receiving health care.”

More than 1,900 rural residents identified concerns which might all be constructively addressed by meaningful citizen engagement in policy-making and service delivery decision-making.

A pressing concern identified by some was the need for greater or more consistent access to primary and specialist health care.

People understand a community under 10,000 won’t have specialist and sub-specialist care, said Kornelsen. “They get that, but why is the first recourse leaving the community to access care?”

Some participants suggested specialists could operate rotating clinics with reduced hours in different communities. Others wondered if some specialist consultations could be done in the community from the family physician’s office, linked with the specialist via telephone or video chat. 

Other top issues were cost and transportation. For instance, a surgical patient may have to travel to a regional centre or even Vancouver for a pre-operative consultation, return again for the actual operation, then go back a third time for a post-operative follow-up. 

“People spend more than $2,000 per person, on average to leave their community,” said Kornelsen. “It might be okay for people who can afford it, but there’s a lot of people who can’t.”

Citizen health councils might not be the magic bullet, but that voice needs to be heard alongside other stakeholders.

“It’s really a matter of bringing together the health care providers, the elected officials and the community members,” Staples said. “To find ways to work together to improve the services in a particular community.”

“You can’t fix everything,” he said. “But that community patient perspective, as well as the operational health authority perspective, are really important to actually get to that sweet spot where things are going to shift.” 

The ‘Whole-of-Person Retention Improvement Framework’

Int J Environ Res Public Health. 2020 Apr; 17(8): 2698.Published online 2020 Apr 14. doi: 10.3390/ijerph17082698PMCID: PMC7216161PMID: 32295246

The Whole-of-Person Retention Improvement Framework: A Guide for Addressing Health Workforce Challenges in the Rural Context

Catherine Cosgrave

April 14, 2020
[Excerpts]
Health professionals’ decisions to stay or leave a rural position are multifaceted involving personal, organisational, social and spatial aspects. While current rural health workforce frameworks/models recognise the multidimensional and interrelated influences on retention, they are often highly complex and do not easily support the development of strategic actions.

The ‘Whole-of-Person Retention Improvement Framework’ (WoP-RIF) has three domains: Workplace/Organisational, Role/Career and Community/Place. The necessary pre-conditions for improving retention through strengthening job and personal satisfaction levels are set out under each domain. The WoP-RIF offers a person-centred, holistic structure that encourages whole-of-community responses that address individual and workforce level needs. It is a significant response to, and resource for, addressing avoidable rural health workforce turnover that rural health services and communities can harness in-place.

In the literature, job satisfaction is strongly correlated with increased retention. Retention has also been found to be contingent on the extrinsic rewards provided by the employer (e.g. salary and work conditions) and the intrinsic rewards that come from within the individual, which are derived from the role and the work being performed (e.g., degree of autonomy and/or challenge).

For rural and remote allied health professionals, the most cited extrinsic factors with a negative influence on retention are lack of professional development opportunities, professional isolation and insufficient supervision, while the most cited intrinsic factors with a positive influence on retention are autonomy and community connectedness [9]. However, recent analyses posit that health professionals’ decisions to stay or leave a rural health position (retention/turnover) are complex and influenced by ‘a myriad of highly interactive dimensions within personal, organisational, social and spatial domains’.

Dr Catherine Cosgrave PhD

Cosgrave C. The Whole-of-Person Retention Improvement Framework: A Guide for Addressing Health Workforce Challenges in the Rural Context. Int J Environ Res Public Health. 2020;17(8):2698. Published 2020 Apr 14. doi:10.3390/ijerph17082698

 PubReader | PDF (659K) | Cite

To read the full report, click on:
The Whole-of-Person Retention Improvement Framework: A Guide for Addressing Health Workforce Challenges in the Rural Context

Petitions

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Free online presentation on medication safety for older adults and their caregivers

Do you work or volunteer with an organization that represents, serves, or advocates for older adults? a39100
Are you planning next year’s programming? 
While we still don’t know when we’ll be able to hold in-person events again, consider an online presentation on medication safety as part of your offerings for 2020-2021!

More than ever, medication safety is a priority. Unfortunately, harmful medication side effects such as falls, fractures and hospitalizations do not stop happening during pandemics. Nor does the need to educate the public about this issue. 

Key presentation details
Title: Do I still need this medication? How to make sure your medications are helping not harming

Presentation goals
• Explain why aging makes us more sensitive to the effects of medications;

• Identify situations in which the risks of harmful effects of medications outweigh the potential benefits; and

• Describe the steps patients, caregivers and healthcare professionals can take together to prevent harmful medication effects.

The webinar is free
• Average length: 1 hour (40-45 minutes + 15-20 minutes for questions) – can be adapted based on your needs.

• Can be offered via several different webinar platforms (eg. Zoom, Webex, etc.) – our team also has a Zoom account which we can use if needed.



Website | Site web:deprescribingnetwork.ca | reseaudeprescription.ca
Email: info@deprescribingnetwork.ca
Facebook:@deprescribingnetwork
Twitter: @DeprescribeNet

Free online presentation on medication safety for older adults and their caregivers

Nakusp

CAO Cheryl Martens – cao@nakusp.com

website: http://nakusp.com

From Wikipedia: The Village of Nakusp /nəˈkʌsp/ (Sinixt neqo’sp,[3]) is a village located on the shores of Upper Arrow Lake, a portion of the Columbia River, in the West Kootenay region of British Columbia. It has a population of around 1,574, and it is known primarily for its nearby hot springs, which are a popular destination for tourists, as well as its picturesque mountain lakeside setting.

Privatization the pre-existing condition killing seniors in long-term care

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A blind 94-year-old Chilliwack, B.C., woman is left confined for two weeks while bed bugs multiply on her mattress.
A 79-year-old woman in Viking, Alberta, dies of dehydration and a urinary tract infection caused by remaining too long in unchanged wet diapers.
A 63-year-old Brampton, Ontario, man is provided so little food and water that he has to be hospitalized for dehydration.
A 94-year-old woman in Dorval, Quebec, who has both Alzheimer’s and dysphagia dies from choking on her food. No written incident report is filed by the home where she resides.

If you presumed that these incidents relate to long-term care homes being overwhelmed by the current coronavirus crisis, you can be forgiven. The absolute horror stories emerging from Canada’s long-term care facilities have focused our attention as never before on the vulnerability of the residents that rely on these institutions.
But every one of these incidents came from media reports that predate the pandemic. They reflect Canada’s system of care for the elderly and people with disabilities in “normal” times, not times of crisis. In worsening this system’s failures, the coronavirus crisis is opening our eyes to realities that far too many Canadian families have long known all too well.

In his response to the gut-wrenching revelations that recently emerged at a Dorval nursing home (the same one where the woman choked on her food), Quebec premier François Legault stated that the situation “looks a lot like major negligence.”

The negligence Legault referred to was that of the privately owned company that ran this home. 

While our politicians can claim to be saddened over the tragedy that is now unfolding in long-term care homes around the country, none should claim to be surprised at this situation. Unions and organizations that advocate for the various people that depend on long-term care have for years decried the worsening conditions of these facilities. Many have also been extremely clear about the central reason for these worsening conditions — privatization.

Indeed, every one of the examples mentioned at the beginning of this article occurred at one of Canada’s privately owned for-profit facilities. While the number of for-profit care homes varies from province to province, such facilities house 37 per cent of Canada’s long-term beds.

The connection between private ownership and diminished standards of care has been documented in numerous studies and reports. One recent study from the peer-reviewed journal PLOS Medicine found that for-profit facilities not only provided “inferior” care but also were more likely to have been cited for serious deficiencies than facilities making less profit.

To read more, click on: Privatization the pre-existing condition killing seniors in long-term care