The Medical Futurist

When Will COVID-19 Be Over

[Excerpt] 2020 has brought previously unseen challenges upon humankind. A virus that, due to globalisation, spread at an unprecedented speed, stormed the entire planet and there is only one thing that can stop it as it is now: a vaccine. And as I wrote in The Medical Futurist vaccine pledge, if you worry about the long-term consequences (which no data indicate for now after having tested the vaccine on tens of thousands of people and vaccinating already millions), you might want to wait out. But then we’ll be in lockdown for years.

Over the past year several lockdowns have taken place. We adopted new habits, learned and worked through videoconferences, made social distancing an everyday habit and masks a fashion item. But we all hate these, don’t we? So once we have a chance to end the pandemic, I’d say we should go for it; and with several trustworthy and reviewed vaccines available worldwide, the race for vaccination has begun. 

In April 2020, we collected what will be the most specific changes we would need to bear even after the pandemic has gone. Almost a year on and the virus still upon us, we are revisiting those statements and having a look at all those things we expected and forecast: what will surely change, what has the chance to change and what shouldchange in the future. Our 2021 updates are clearly marked within the topics.

What will surely change

We’ve seen it all during this global public health crisis; overwhelmed hospitals forcing patients to sleep on the floor; mounting fear of being in proximity to others; but also the importance of a robust healthcare system. As a consequence of our collective and individual experiences throughout the pandemic, things will change in the healthcare landscape. Below we discuss three of the most significant changes we’ll experience.

1. An unprecedented toll on healthcare workers

2. Diminishing trust in the globalized world

3. Focus on the healthcare system

To read more, click on: https://medicalfuturist.com/life-after-covid-19-what-will-change/

Government of Canada COVID-19 Resources

Taking care of your mental and physical health during the COVID-19 pandemic

If you’re in crisis

If you’re in immediate danger or need urgent medical support, call 911.

If you’re experiencing gender-based violence, you can access a crisis line in your province or territory.

You may also access support workers, social workers, psychologists and other professionals for confidential chat sessions or phone calls by texting WELLNESS to:

  • 686868 for youth
  • 741741 for adults

For a wide range of resources and support for Canadians:

Wellness Together Canada portal for mental wellness and substance use issues

COVID-19: Digital tools and apps for staying healthy 

To help Canadians in this unprecedented time, we have put in place a suite of digital tools to provide you with information and resources. Help limit the spread of COVID-19 and protect yourself and your community.

COVID Alert app

Get notified if someone you were near in the past 14 days tells the app they tested positive.

Canada COVID-19 app

Track your symptoms, receive the latest updates, and access trusted resources.

ArriveCAN

Help reduce wait times at Canadian ports of entry and limit points of contact.

Wellness Together Canada

Resources to empower you to take care of both your physical and mental health and help you manage substance use.

Identifying the Features and Impacts of Community Health Centres – McMaster University

[EXCERPTS]

KEY MESSAGES

Questions
• What are the key features of community health centres?
• What impacts have community health centres had on enhancing client experiences and improving health outcomes with manageable per capita costs and positive provider experiences?

Why the issue is important

  • Community Health Centres (CHCs) deliver integrated primary care and social services and programs within communities who experience systemic barriers to care.
  • CHCs can also address and provide support to underserved populations by coordinating efforts related to social determinants of health (e.g., housing, employment and nutrition).
  • However, there is a need to better understand how CHCs can be effectively integrated into a coordinated delivery system.
  • There is a need to identify features of CHCs, and the impact of CHCs on enhancing client experiences and improving health outcomes with manageable per capita costs and positive provider experiences.

    What we found
  • We identified three systematic reviews (which were assessed as being of low, medium, and high methodological quality) and 37 primary studies, which we supplemented with information from websites of relevant stakeholder organizations such as the Canadian Association of Community Health Centres.
  • The Canadian Association of Community Health Centres indicates that “CHCs are multi-sector, not-for- profit organizations” that share five core attributes:
    1) providing team-based interprofessional primary care (involving clients, providers, allied healthprofessionals, patient navigators, and others who connect health and social services in the community);
    2)  integrating the provision of a diverse array of health and social services (including health-promotionprograms, disease prevention and management, and services to address social determinants of health);
    3)  being community centred (integrating community partnerships and community-elected governancewithin CHCs);
    4)  addressing the social determinants of health (supporting clients to help address different needs such asaccess to housing, food security, education, and/or language barriers); and
    5)  committing to health equity and social justice (advocating for systemic changes to reduce healthdisparities and providing culturally appropriate services).
  • We found that CHCs enhanced patient experiences and increased satisfaction in the delivery of care, especially when there was a positive relationship between patients/clients and providers.
  • CHCs helped address health-equity issues among underserved populations (e.g., LGBTQ+, Indigenouspeoples, new immigrants, youth, and individuals with severe mental illness or physical conditions), and increased engagement with screening programs, cardiovascular-disease prevention, and management of chronic conditions such as diabetes.
  • The literature indicated that CHCs are found to have lower costs of care and provide cost savings to health systems.
  • A supportive work environment with shared values of advocacy and equity were described when discussing the perceptions of staff at CHCs, but there were mixed findings related to fairness in decision-making processes in CHCs, specifically for nurse practitioners and family physicians (e.g., in relation to decisions from administration about services and programs in CHCs).

Key features of community health centres [Excerpts] 
Providing team-based interprofessional primary care
Integrating the provision of a diverse array of health and social services
Being community centred
Addressing the social determinants of health
Committing to health equity and social justice
Barriers associated with CHCs
Enhanced patient experience
Improved health outcomes
Manageable costs
Positive provider experience

To access the full report, click on: Identifying the Features and Impacts of Community Health Centres – McMaster University

Mandatory vaccination: legal, justified, effective?

Anne McMillan Friday 19 March 2021

[Excerpt]

Vaccine programmes being rolled out around the world have provided hope for many, but are causing concern and opposition among others. Global Insight assesses how governments and medical authorities should respond and whether compulsory vaccination is the answer.

Vaccination against Covid-19 is seen as a route back to normality, an escape from the current restrictions which mean we can’t shake hands, hug loved ones or travel freely. For some people, vaccination promises release from the fear the virus may strike them, a relative or a friend, hope of reinvigorating a moribund livelihood or resuming a child’s disrupted education.

But, while millions wait anxiously, counting the weeks or months (probably years in some low-income countries) until they reach the priority vaccine group, others fear that their refusal to accept a vaccine against Covid-19, regardless of the reason, will isolate them by labelling them unsafe to be around, and may even affect their ability to earn a living.

The controversy over vaccines is nothing new. When Edward Jenner created the first vaccination against smallpox in 1796, it was initially seen as miraculous solution to a disease which was killing millions worldwide. But it wasn’t long before his vaccination began to attract opponents and when smallpox vaccination was made compulsory in the UK by the Vaccination Act of 1853, the legislation only served to increase resistance.

By the late 19th century there was strong anti-vaccination sentiment in parts of Britain. Anti-vaccination leagues were formed and thousands took to the streets to demonstrate against what they saw as an invasive practice. Objections included religious or health concerns, along with the recurring theme of the trampling of individual rights, which resonate in the cries of present-day vaccine objectors. The scale of anger led to the legislation being amended in 1898 to allow for ‘conscientious objection’ to receiving a vaccine.

Now, with the Covid-19 pandemic, the issue has come to a head again and not just in Britain. Around the world the controversy over vaccines seems as fresh today as it was when Jenner first discovered his answer to smallpox. Two centuries later, similar objections are being raised by vaccine sceptics and opponents, some of which merit a hearing. ‘There is a need to recognise that beyond general vaccine sceptics and/or those simply buying into the latest conspiracy theory expounded on social media, many people may hold genuine fears and anxieties about vaccination in general (or relating to specific vaccines),’ says Barbara Connolly QC, member of the IBA’s Family Law Committee Advisory Board.

Beyond general vaccine sceptics and those simply buying into the latest conspiracy theory… many people may hold genuine fears and anxieties about vaccination

Barbara Connolly QC
IBA Family Law Committee Advisory Board

So, what have we learnt since the 19th century? Do arguments for and against vaccination still hold? And if so, how can, and should, governments and medical authorities respond? Perhaps most important, is mandatory vaccination legal and justified from a human rights perspective, or effective given this new threat to public health?

Vaccination fears

What is it about vaccines, one of the most simple and successful medical interventions ever, that attracts so much controversy? One characteristic of vaccination is that it is preventative rather than curative and so is generally rolled out on a widespread scale, thus magnifying any potential risk. As the President of the European Commission, Ursula von der Leyen (a qualified physician), said when justifying the comparatively longer time it took for the European Union to declare early Covid vaccines safe: ‘A vaccine is the injection of an active biological substance into a healthy body. We are talking about mass vaccination here, it is a gigantic responsibility.’

To access the entire article, click on: Mandatory vaccination: legal, justified, effective?


RUDi – Rural Urgent Doctors in-aid

Support for Rural Physicians

RUDi-Emergency is one of the Real-Time Virtual Support (RTVS) pathways for patient care and healthcare collaboration in rural and remote communities in BC.

RUDi physicians with emergency medicine and rural experience are available 24/7 by Zoom and phone to support rural healthcare providers looking for support with a patient or preparatory simulation, including:

  • providing a second opinion about a patient
  • reviewing a case
  • running through simulation scenarios
  • helping to navigate the healthcare system
  • providing collaborative support in critical times
  • other situations as needed by rural providers

Support through RUDi is available anytime, 24/7 through Zoom at rudi1@rccbc.ca.

If you’re a physician or nurse practitioner in rural BC and don’t have a Zoom for Healthcare account yet, fill out our online form to request a Zoom account, or visit our Zoom page for more information.

If you signed up for a Zoom license through RCCbc, all Real-Time Virtual Support (RTVS) pathways(RUDi, ROSe, CHARLiE, MaBAL, Dermatology, etc.) will be added to your Zoom contacts automatically.

HEiDi Virtual Physician COVID-19 Deployment

June 22, 2020 | Drs. Tamara Munzner and Kendall Ho were award DSI funding for their project, “Visual Analytics Support for the HEiDi Virtual Physician COVID-19 Deployment.”

This project will leverage advances in data visualization and analytics to optimize the delivery of telehealth care to patients stricken with COVID-19. The outcomes will help health system experts to gain a holistic snapshot of the current care system and expedite analysis and decision-making. Ultimately, this will allow the health care system to respond rapidly and deftly to current and future health-related scenarios such as a pandemic outbreak.

From https://dsi.ubc.ca/news/visual-analytics-support-heidi-virtual-physician-covid-19-deployment:

In the current extreme situation of the COVID-19 pandemic, health systems face unprecedented medical and social challenges that data science can help address. Dr. Kendall Ho’s group in Emergency Medicine has spearheaded the HealthLink BC Emergency iDoctor-in-assistance (HEiDi) project to augment the 811 service delivering health care guidance to the public through telephone access to nursing advice by integrating virtual physicians (VPs) into the triage process, to help balance the enormous increase in load due to this crisis. This project is being deployed in extreme haste, rolling out within only three weeks what would normally take many months or even years, with operational and strategic concerns being addressed simultaneously. The new data being gathered through this project needs to be analyzed in the context of existing health system data including a) service utilization and call data including follow-up call-backs, b) patient metadata and health system usage outcome data, c) VP and nurse shift scheduling data, d) other system and administrative data, and e) health economics data. Even as the project is being deployed, Ho’s group is developing assessment criteria to establish its efficacy considering the dual goals of high-quality patient outcomes and satisfaction, and sustainable cost to the health care system of delivering care.

Dr. Tamara Munzner’s group has extensive experience in visual analytics (VA), building tools for human-in-the-loop decision-making in complex and heterogeneous data environments. Visual analytics approaches allow human analysts to comprehend the rich and nuanced nature of the full data landscape beyond the bare-bones descriptive statistics that summarize only the largest-scale trends. Her group has extensive experience in the methodology of conducting design studies, a user-centered and problem-driven design methodology in visual analytics, and in collaboration with experts in the genomics, biology, and medical domains.

This collaborative effort between Munzner and Ho will help the HEiDi project answer their driving data-centric questions including which information is needed for daily reports, how many doctors are needed in what optimal daily shift coverage for upcoming service days and follow-ups, which system usage outcomes change when virtual physicians interact with patients and with advising nurses, and which overload and triage issues remain severe. They will develop visual analytics workflows to represent as much information as possible visually in a way that expedites analysis and decision-making by health system experts, and their communication with many other stakeholders including clinicians, patients, and policymakers. The overall goal of this new collaboration is to provide visual analytics support for the HEiDi system, to help health system experts observe and improve the system even as it is built, in terms of virtual physician impact on patient experience, while adapting to the specific requirements of the current COVID-19 crisis.

In summary, this project will help health system experts to observe and improve the clinical pathway of 811 service on a strategic and operational level, to foster the effectiveness and efficiency of VPs, and to improve patient experience. It will also gain an initial understanding of stakeholders and this very interesting ecosystem, as a basis for a systematic and methodology-driven data science research multi-year project. Data science support for the 811 ecosystem will both address today’s urgent problems and serve to develop methods and tools that can be used in future extreme situations.

Learn more about Real-Time Virtual Support Services in BC

New data-driven dashboard highlights how patients benefit from virtual health visits

May 20, 2021The dashboard tells many stories, but at its core shows the benefits that virtual health visits can bring to patients when used appropriately.

What if we could get a snapshot of the tangible benefits that virtual health visits provide to patients? What if, instead of going through rows of data collected, we could see it collected and contextualized in one clear image? 

Thanks to assistance from PHSA’s Information Management/Information Technology Services (IMITS) and Data Analytics, Reporting and Evaluation (DARE), PHSA’s Office of Virtual health (OVH) has created an interactive dashboard by leveraging the data from one of its pilot projects prior to the pandemic.

“The virtual health visit pilot project was launched back in 2019 with the goal to bring specialized care into patients’ homes. We used project data to inform the analysis and make a patient benefit realization dashboard to bring the story to life.” says Ying Jiang, senior leader with the OVH who led the patient benefit realization dashboard from conception to completion. 

The dashboard analyzed 977 visits completed by 421 patients. It is estimated that virtual health visits saved the participating patients a total of 816 travel hours and $33,585 travel costs over 5,514 km. On average, it saved each patient 1 hour and 39 minutes, although generally patients in more remote communities receive the greatest benefit given the increased distance they must travel to see a specialist in person. 

The dataset covers close to 1000 visits conducted by over 400 patients from 15 clinical programs for a variety of clinical needs; it can be considered a random sample of the diverse population seeking specialized care in B.C. The largest part of the dashboard is the interactive map, which is covered in multi-coloured dots all over the province and as far afield as the Yukon and Alberta. The dots, located based on the prefix of the patients’ postal code, range in size which corresponds to the number of virtual health visits held in each general location, demonstrating the reach of virtual health visits in a visual way.

The data contains the first three-character postal code to estimate the patient’s location for map visualization. This is also used as the base to calculate distance. Time and cost savings were estimated by the distance between patient locations in relation to clinical facilities. The estimated benefits on the dashboard are also a very conservative calculation given that it’s not possible at this time to estimate exact travel cost and time based on factors like precise road conditions while preserving patient confidentiality. 

“One of the biggest challenges in evaluating virtual health initiatives is the ability to demonstrate an improvement on health outcomes,” notes Julie Wei, senior leader at the Office of Virtual Health. “Sometimes it is nearly impossible to attribute the impact of virtual health on outcomes in such a short period of time. To be able to demonstrate the immediate impact from the patient perspective using time and dollars saved is an effective way to show decision-makers the value of virtual health.”

​With support, age not a barrier to adoption

 A common misconception is that seniors will find virtual health visit technology hard to understand or use. 

“The first analysis we did with the dashboard was to look at the average number of virtual appointments per patient by age group,” says Jiang. “In this dataset, utilization is very similar across all age groups. We don’t see any patterns or correlation between age and number of visits. We were really glad to see that seniors are not left behind when it comes to virtual health visits.” 

Health equity more important than ever

Challenges in using virtual health visit technologies do exist, such as device access, connectivity, and technological literacy. Jiang emphasizes that we have to take every possible action to make virtual health visits accessible to all, and notes many health care providers do their part to support their patients in having virtual health visits.

 “One clerk offered practice calls to patients in need,” said Jiang. “She had laminated a printed screenshot of the interface of the software so when the patient appears on the screen and can see her but, for example, they don’t know how to adjust the audio, she holds up the image and points to the right icons to access to fix the problem. They are the unsung heroes in health care.” 

Practice calls are not necessarily a sustainable solution when we scale virtual health visits upward.  Now, the citizen support desk has been launched to support patients in a more coordinated and sustainable manner. The Office of Virtual Health has also developed multiple patient resources, such as help guides and videos. These are important actions to promote access as we continue to enable and embrace virtual health visits. 

Making the impact through collaboration

The virtual health visit demonstration project providing data for the dashboard was a collaborative effort between PHSA and various clinical programs. The dashboard was built in partnership with IMITS and the DARE office, who provided ​guidance on formulating the cost calculation into the dashboard.

“With support from our partners at IMITS, we were able to bring data to an analytics environment that is interactive,” says Wei. “We just need to feed new data collected on a regular basis to display automatically the travel distances avoided and estimated cost-savings.”

Currently, the dashboard is based on data from this project, but the possibility to feed in different datasets is available. As it is, fresh data is added to this dashboard each quarter.

Virtual health visits are aimed to help improve access, patient experience and make health care more cost efficient. There are always challenges in demonstrating cost savings. The benefit realization dashboard can help health care planners understand the benefits of using virtual health in order to continue to promote and integrate virtual health into care delivery models and modernize the way we access and deliver care. ​

http://www.phsa.ca/about/news-stories/stories/virtual-health-visit-dashboard

Canadian Virtual Hospice


Canadian Virtual Hospice
 is proud to announce our new Two-Spirit and LGBTQ+ resources, Proud, Prepared, and Protected has officially launched. 

  • 10 Myths about Palliative Care
  • What Is Palliative Care?

    https://www.virtualhospice.ca/2SLGBTQ

    Proud, Prepared, and Protected is a collection of online resources to assist people who identify as 2SLGBTQ+ to access and receive inclusive, respectful care. Created in partnership with Health Canada, these resources represent a collaboration with over 60 2SLGBTQ+ and ally agencies from across Canada and 100+ people who identify as 2SLGBTQ+ with lived experience. The series includes a dedicated webpage with various articles, over 150 videos, webinars, and innovative tools: 

    Canadian Virtual Hospice


    Canadian Virtual Hospice
     is proud to announce our new Two-Spirit and LGBTQ+ resources, Proud, Prepared, and Protected has officially launched. 

    Proud, Prepared, and Protected is a collection of online resources to assist people who identify as 2SLGBTQ+ to access and receive inclusive, respectful care. Created in partnership with Health Canada, these resources represent a collaboration with over 60 2SLGBTQ+ and ally agencies from across Canada and 100+ people who identify as 2SLGBTQ+ with lived experience. The series includes a dedicated webpage with various articles, over 150 videos, webinars, and innovative tools: