Health Systems Part 1

Care provider

Provide patient-centered pharmacy care

Communicator

Communicate effectively in lay and professional language

Collaborator

Work collaboratively w/ patients and intra-/interprofessionnal teams

Leader-manager

Engage w/ others to optimize safety, effectiveness, efficiency of healthcare

Health advocate

Demonstrate care for indv. patients, communities, populations

Scholar

Take responsibility for excellence

Equal or better performance to comparable countries

Health status (life expectancy, avoidable mortality)

Quality of care (safe hospital/cancer care)

Healthcare resources (nurse per capita, gov health spending)

Access to care (population coverage, financial protection)

Lacking performance

Effective primary care

Healthcare resources (diabetes rates, chronic disease morbidity)

Social determinants of health (SDOH)

Specific gp of social/economic factors within the broader determinants of health
Circumstances and system in place to deal w/ illness, shaped by:
- economics
- social policies
- politics

ex: income, access to care, housing, education

Illness causes in Canada

Personal life 50%
Healthcare 25%
Biology 15%
Environment 10%

Health Equity vs Health Equality

Allows people to reach full health potential by providing support based on their circumstances while equality refers to everyone receiving the same supports

Ministry of long-term care (MOHLTC)

Quality long-term care in safe, home-like environments

Minister: Paul Calandra (elected)

Ministry of Health structure

Minister: Sylvia Jones (elected)
Keep people healthy and deliver ^quality care (OHIP)
Protect health system
Deputy minister/staff: not elected
Divisions headed by assist. or associate deputy minister
Staff admin. all legislation governing health

Governance

Ontario can make decisions about the functioning of system
Delegated authority (hospitals, hc profes.)
Non-profit private organisations
- government plays stewardship role

Legislation

Health services directed by laws/budget
Ideas proposed by government or private member
Implemented as a "Bill"

Ontario - Bill 74 The people's health care act

2019
First reading (Feb.), received in April
Schedule 1 - Connecting Care Act (creates ON health)
Schedule 2 - Indigenous health council and french to advise minister

Ontario Health Mandate

Manage health service needs

Plan, coordinate, undertake and support activities (Trillium Gift of Life Network Act)

Support patient ombudsman (Excellent Care for All Act)

Support SPM to health service providers

Provide advice (minister, participants in hc system)

Promote health service integration

Decentralized government agencies now under ON Health

Health Quality ON

Cancer Care Ontario

Health Shared Services ON

Health Force ON (health professional distribution)

Trillium Gift of Life Network (organ donation)

eHealth ON

"Integrated Care Delivery Systems"

Under Connecting Care Act (CCA)
Person/gp that delivers 3+ prescribed hc services
Minister provides funds that can then be provided by ON Health
Ontario Health teams

Ontario Health Teams

Deliver coordinated services
Complete self-assessment, application
Hospital, home-care, community and primary care

Tax dollars used by healthcare

40%

Characteristics of a profession

Formal specialized body of knowledge

Autonomy/control of own work (statutory in ON)

Altruism

Socially sanctioned by legislation

Regulated Health Professions Act (RHPA)

1991
Sets framework for statutory self-regulation

Goals of RHPA

Fair
Access and choice
No exclusive rights to specialized practices

Themes of RHPA

Accountable public interest (oversight bodies)
Public access (expanded public register)
Patient choice (controlled act scheme)
No sexual abuse (mandatory reports/penalties)
Equity

Common Legislation of RHPA

Registration
Complaints/reports
Discipline
Incapacity
Quality Assurance
Patient relations

Each profession has:

Legislation/code of ethics

Standards of practice

Guidelines/policies

ON controlled Acts Model

No one except licensed hc profs can perform controlled acts:
- communicating a diagnosis
- administering a substance (injection, inhalation)
- prescribing, dispensing, selling or compounding a drug

Using the title "Doctor"

Physicians

Dentists

Chiros

Psychologists

Optometrists

Naturopaths

Regulatory bodies

Protect public

Public members are appointed for decision-making

OCP

Sets standards/policies/guidelines

Oversees legislation, complaints, discipline, quality assurance

Regulatory body for pharmacy

Professional Associations

Enhance, support, advocate for the profession

Pharmacy: OPA, CPA, etc.

Provincial acts/regulations affecting pharmacy

RHPA (1991)
Pharmacy Act (1991)
Drug/Pharmacy Regulation Act (1990)
Drug Interchangeability and Dispensing Fee Act (1990)
Ontario Drug Benefit Act (1990)

Drug Legislation

Provincial - Drug and Pharmacies Regulation Act 1990

Federal:
- Food and Drug Act and Regulations
- Narcotic Act and Regulations
- Controlled Drugs and Substances Act and Regulations

Scope of Practice for pharmacists

1. Custody, dispensing, prescribing drugs

2. Provision of hc aids/devices

3. Provision of info for 1 and 2

4. Promotion of health, prevention, treatment and monitering

Code of Ethics OCP

Beneficence

Accountability

Respect for persons/justice

Non maleficence

Controlled acts for pharmacists

Dispensing

Admin

Prescribing drug in regulation or other in accordance w/ regulation

Performing procedure below dermis

Covid-19 exemptions

Pharmacists can:
- take verbal prescriptions (technicians too)
- Perform covid tests on asymptomatic patients
- admin covid vaccines (students, interns, technicians too)

Standard of practice

Medicine expertise

Collaboration

Safety/quality

Professionalism/equity

Health Quality ON

Provide advice/data in supporting hc professionals to be more efficient

Improving hc for Ontarians

Health Workforce in Canada (Covid-19)

Increased supply

Many services provided virtually

Long term care workers hit hardest

Long term effects of the hc workforce (mental health)

Factors of health system

Longevity of the population

Strained health resources

Chronic disease burden

Drug therapy burden
^Mental health/ addiction issues

COVID-19 strain on system

ON hc needs

Health human resources:
- Trying to predict need
- Tracking practice and migration patterns
- Planning educational enrolment for hc prof programs

Perspective is important

Benefits of collaboration

Quality of Care

Patient engagement

Patient safety

Staff and organization

Types of Quality

Quality improvements:
Find smt to improve
Develop measures to achieve this
Adapt, adopt, discard
- supporting sustainable improvements in care across ON

Quality indicators:
Measures health quality

Key domains of quality

Safe: avoiding harm

Effective: providing care that is beneficial and avoiding that which is not

Patient-centered: care that is respectful/responsive to indv patient values, needs, preferences

Timely: reducing wait times and harmful delays

Efficient: avoid waste of equipment, supplies, ideas, energy

Equitable: providing care that doesn't vary from person to person

Quality Improvement Plan (QIP)

Set of quality commitments that an organization makes
Narrative (Workplace Violence or Collaboration/intgn)
Progress report
Workplan
Quad Aim Framework

Selected indicators for pharmacy

Patient/caregiver experience/outcomes

Appropriateness of dispensed meds

Med-related hospital visits

Transition of care

Quad Aim Framework

Improving patient experience
Improving health of population
Reducing per capita cost of healthcare
Staff satisfaction

Systems approach vs Just Culture

Focus on improving work processes, systems, environment rather than to improve indv skills (Swiss Cheese model)

Changes focus from errors to system design, creating open and honest environment free of blame/shame but accountability still present

Medication safety programs

Canada:
- MedEffect Canada (Canada vigilance)
- Institute for safe medication practices
- Canadian Foundation for hc improvement and Canadian Patient Safety Institute (HC Excellence Canada)

Ontario:
- Assurance and Improvement in Medication Safety (AIMS) (OCP)

MedEffect Goals

Provide centrealized access to relevant/reliable health product safety information (Health Canada Advisories)

Make it easier for hc profs/consumers to complete adverse rxn reports

Build awareness of adverse rxn reporting to Health Canada

Adverse drug event (ADE)

Negative/harmful occurrence during treatment that may or may not be caused by meds

Adverse drug rxn (ADR)

Noxious/unintended response to a drug at doses for treating, preventing, diagnosing, or modification of organic function

Medication incident

Preventable event that may cause or lead to medication use error or harm to patient

Canada Vigilance Program

Mandatory reporting of Serious ADRs and medical device incidents (MDIs) by hospitals

Pharmacovigilence

Safety

Efficacy

Quality

Vanessa's law

Protecting Canadian's from unsafe drugs (and devices) (2019)

Increase reporting of ADRs and MDIs

ISMP Canada

Institute for Safe Medication Practices Canada

Creation of safe and reliable systems for managing medications in all healthcare environments (CMIRPS, CPhIR)

AIMS program goal - OCP

Reduce the risk of patient harm caused by medication incidents in Ontario pharmacies

Requirements: report, document, analysis, share learnings

Factors affecting patient outcomes

Adherence/compliance

SDOH

Screening

Follow up/monitering

Dimensions of adherence

Social/economic

Hc team and health system

Condition/therapy/patient characteristics

Improving med adherence

Educate patients

Nurture relationships

Collaborate/engage w/ pharmacy team

Benefits and challenges of shared decision making

- Improved patient knowledge
- Patients feel better about what matters most to them
- Time constraints
- Variations in involvement

SHARE - Shared decision making

Seek

Help

Assess

Reach

Evaluate

Medication reconciliation

hc providers work w/ each other, family, patient to ensure accurate, comprehensive med info is communicated

How do we know if safe and effective care is provided

Follow up

Royal Commission

1964

Saskatchewan/BC create medical insurance plans

1968

Medical Care Act

1966
Reimburse/cost-share half of prov/terr costs for medical services

Ontario creates medical insurance plans

1969

All provinces create medical insurance plans

1971-2

Canada Health Act

1984

Federal, prov/terr responsibilities

Municipal Hospital Plans

1920

Saskatchewan provincial hospital insurance plan

1947

Hospital Insurance and Diagnostic Services Act

1957

Saskatchewan medical insurance for physician services

1962

Federal Cost Sharing

1958-9

Medically necessary services

Are not defined by the Canada Health Act

Prov/terr determine what is medically necessary

Home and community care not medically necessary

Tommy Douglas

Proposed universal hc (1959)

IPE Competencies

Patient/client/family/community-centered care
Role clarification
Interprofessional communication
Interprofessional conflict resolution
Team functioning
Collaborative leadership

Principles of the Canada Health Act

Public Administration

Comprehensiveness

Universality

Portability

Accessibility

Canada Health Act use

Discourage parallel private hc system

Replaced federal/hospital medical insurance acts

Public Administration

Non-profit admin by public authority accountable to prov/terr government

Comprehensiveness

Ensure all medically necessary services provided by hospitals, medical practitioners and dentists within hospital setting

Universality

Entitle all insured persons to health insurance coverage on uniform terms/conditions

Accessibility

Provide all insured persons reasonable access to medically necessary hospital/physician services

Federal government

Funds/delivers hc services to:
- First nation/inuit
- Canadian Forces
- eligible veterans
- Inmates in federal penitentiaries
- Refugee claimants

Canada health transfer (cash/tax transfers to prov/terr)

Roles of federal government

Health protection/regulation and consumer safety (eg. regulation/standards of pharmaceuticals)

Disease surveillance/prevention (eg. Public Health Agency of Canada)

Health research and data (CIHI)

Health-related tax measures, disability, caregivers

Role of prov/terr government

Admin health insurance plans (eg. OHIP)

Plan/fund care in hospitals/facilities

Regulate services provided by hc profs

Plan/implement health promotion and public health initiatives

Negotiate fee schedules w/ hc profs

Primary care

First point of contact w/ hc system

Direct provision of services

Referral to specialists

Secondary care

Hospitals (general/community)

Residential care (long term or chronic care)

Specialists

Tertiary care

Specialized or advanced care (regional hospitals)

Quaternary care

Advanced, highly specialized care not widely accessible

Experimental medicine

Treatment of rare conditions

Uncommon surgical procedures

Canada ranking better than OECD countries

Safe primary care

Effective secondary care

Health spending

Nurses

Smoking

Alcohol

Canada ranking worse than OECD countries

Obese

Effective primary care

Effective preventative care (even)

Hospital beds

Doctors

Countries ranking better than Canada

Norway

Germany

Community pharmacy

OTC recommendations

MedsCheck

Chronic disease management (wellness programs)

Safe meds disposal

OTC recommendations

Most accessible hc provider

85% patients seek advice from pharmacists

18% of these avoided ER visits

MedsCheck

Voluntary
Paid by government

Qualify if:
- Resident of ON
- Holder of valid ON health card
- Currently taking min. 3 meds

Obtain:
- Comprehensive and accurate medical history
- Helps identify drug therapy problems
- Provide patient with accurate personal medication review