Wednesday, September 30, 2009

Ontario's doctors support collaboration among health care professionals -- sort of

TORONTO, Sept. 29 /CNW/ - At an appearance today before the Ontario Legislative Standing Committee on Social Policy, Ontario's doctors will stress the importance of health care professionals working together to enhance and strengthen the delivery of safe and quality care to patients. The Standing Committee is listening to oral submissions from stakeholders as the government moves ahead with proposed legislation that would expand the scope of practice of some health care providers.

"Ontario's doctors firmly believe that collaboration between health care professionals is the best way to strengthen and enhance the delivery of safe, high quality care to patients," said Dr. Suzanne Strasberg, President of the Ontario Medical Association (OMA). "We know that when physicians, nurse practitioners, pharmacists, dieticians and other health professionals work together we can and often do, deliver a more comprehensive level of care to our patients."

The OMA applauded several aspects of the proposed legislation including:

- Requiring all regulated health professionals to have professional
liability protection;
- Creating an independent expert drug committee that will streamline
regulatory processes, support colleges in developing their drug
lists while keeping pace with the changing health care landscape;
- Setting parameters for HPRAC to make recommendations regarding
changes to health professions statutes.

However, Dr. Mark MacLeod, President-Elect of the OMA will raise some concerns at the hearing about several proposals within the legislation. Specifically, with respect to pharmacists being granted the ability to 'adjust, adapt or extend' a prescription, Dr. MacLeod pointed out that this may create separate practice silos between a prescribing physician and a pharmacist and this type of fragmented treatment may diminish the quality of patient care.

Dr. MacLeod reiterated the OMAs long standing position that collaboration among health professionals results in a more comprehensive level of care being delivered to patients. The OMA strongly believes that if nurse practitioners are able to prescribe, dispense, sell, or compound drugs, then their prescribing power must be carefully regulated. More importantly, all drugs should be vetted and approved by the proposed independent expert drug committee rather than the College of Nurses of Ontario.

"The number one priority for Ontario's doctors throughout this entire process has been and remains patient safety because the level and quality of care that a doctor can provide should not be substituted for expediency," said Dr. MacLeod. "Ontario's doctors have offered constructive recommendations that we believe will protect patient safety by ensuring that all health care professionals maintain collaborative relationships with physicians."

Ontario government's lawsuit against the tobacco industry

TORONTO, Sept. 29 /CNW/ - The Canadian Cancer Society is pleased the Ontario government is suing tobacco companies to recover tobacco-related health care costs.

"The lawsuit filed today will begin the process of holding the industry accountable for the harm they have done to the health of Ontarians," says Rowena Pinto, Senior Director, Public Affairs, Ontario Division, Canadian Cancer Society. "The tobacco industry's addictive products are responsible for 30% of cancer deaths."

Cost-recovery litigation could significantly benefit public health. In other jurisdictions, litigation has resulted in restrictions on the marketing practices of the tobacco industry.

Benefits of litigation:
- Justice: lawsuit against the tobacco industry will hold them accountable for their destructive behaviour.
- Truth: through the court process, tobacco industry documents will become public. Documents released through the court process, will shed light on the many deceptive and destructive practices pursued by the industry for decades. The public will finally understand that this is an industry that operates outside the rules of normal
- Compensation: potentially billions of dollars could be recovered as compensation for health care and other costs.
- Health: the process of litigation could result in greater restrictions on tobacco industry marketing and sales practices. For example, more restrictions on tobacco advertising.

- 13,000 people die of tobacco related illness every year in Ontario.
- Tobacco use is responsible for 30% of cancer deaths.
- Tobacco-related health care costs currently total more than $1.6 billion per year in Ontario.
- British Columbia, Saskatchewan, Manitoba, New Brunswick, Newfoundland, and Nova Scotia have already passed similar legislation.
- British Columbia and New Brunswick have begun the process of suing the tobacco industry.

The Canadian Cancer Society is a national community-based organization of volunteers whose mission is the eradication of cancer and the improvement of the quality of life of people living with cancer. When you want to know more about cancer, visit our website or call our toll-free, bilingual Cancer Information Service at 1 888 939-3333.

For further information: Christine Koserski, Ontario Provincial Office, Canadian Cancer Society: (416) 323-7030,

Monday, September 28, 2009

In a pandemic more than twice as many hospital patients will require intensive care, with less than half the staff

When the Hamilton Health Sciences (HHS) Pandemic Influenza Planning Committee contemplated how the triage process would be enacted at its hospitals, numerous gaps were identified:

  • How is critical care triage operationalized in different care settings within the hospital (e.g., emergency department, hospital wards, ICU)?
  • Who can function as a "triage officer"? What skills are required? If there is a single triage officer in each institution, what happens when these officers are needed in two places at once?
  • Should these life and death decisions, made under extremely stressful circumstances, rest on the shoulders of single individuals? What are the risks of this model for triage officers and healthcare organizations? What supports do triage officers require?
  • What procedural and institutional structures ensure triage decisions are of high quality, consistent (across time, triage officers and different hospitals), efficient, ethical and evidence-based? How should decisions be documented?
  • What happens if the demand for critical care is so great that it cannot be managed using the Ontario Health Plan for an Influenza Pandemic process? How should choices be made between patients with the same clinical priority for critical care (i.e., SOFA score)?

Hamilton Health Sciences is the first hospital in Canada to develop a detailed critical care triage protocol for bedside application. In this article, we present (1) the rationale and process HHS undertook to create this protocol, (2) highlights and key innovations of the protocol and (3) issues arising from preliminary testing of the protocol.

Copies of the paper can be downloaded at