Toronto, February 23, 2009 - Three new nurse practitioner-led clinics in Belle River, Sault Ste. Marie and Thunder Bay are strengthening family health care for Ontario families.
The three clinics focus on comprehensive primary care services, including chronic disease management and health promotion. They are the first of 25 new clinics that will come into operation by 2011/12. The remaining 22 clinics will begin to move forward in the spring.
Nurse practitioner-led clinics are a team-based approach to front line health care. Nurse practitioners work with other health care professionals, such as family doctors, to provide quality care closer to home.
Ontarians will be connected to nurse practitioner clinics through:
* Health Care Connect, a new program to help people find a family healthcare provider
* Your Health Care Options,a new source that enables Ontarians to make informed decisions aboutwhere to go for minor illnesses or injury
"Nurse practitioners bring unique and valuable skills and expertise to patient care teams across Ontario. By moving forward on 25 new, nurse practitioner-led clinics, we are ensuring that more Ontarians have access to this innovative health care option," said Dalton McGuinty, Premier of Ontario.
"I am excited and proud that we are moving ahead on our next round of nurse practitioner-led clinics. These clinics are helping to provide quality health care closer to home for thousands of Ontarians and are part of our priority to improve access to care for all Ontarians," said David Caplan, Minister of Health and Long-Term Care.
"There is a tremendous need for better access to primary care in these communities and this announcement is the answer thousands of people have been waiting for. We look forward to the opening of these NP-led clinics as soon as possible and to the announcement of the next 22 sites in the spring," said Wendy Fucile, President of the Registered Nurses' Association of Ontario.
Monday, February 23, 2009
Thursday, February 5, 2009
The UK. Choose and Book: learning lessons from local experience. Taken Directly from Hansard UK - 4 Feb 2009
NHS Appointments
2.30 pm
(Pour yourself a virtual glass of port and enjoy this blow by blow description of one patient's experience with the UK's Choose and Book system)
Andrew Stunell (Hazel Grove) (LD): I am pleased to have the opportunity to bring this important issue to the House and look forward to the Minister’s response. It has affected the medical histories of many of my constituents.
The system has been a problem for me and my constituents ever since it started. In turn, I have been in touch with the local foundation trust, the primary care trust and NHS Direct, and I have asked parliamentary questions—in fact, because my December question was too long, Mr. Speaker kindly offered an Adjournment debate. I shall try to do the issue some justice.
After I was told last week of the time of the debate, entirely serendipitously, the British Medical Association produced a report entitled, “Choose and Book: learning lessons from local experience”. I am not so arrogant as to think that my probing put the BMA up to it, but the report is interesting, and I hope the Minister addresses it when he responds to the debate. It talks about learning lessons from local experience, and I want the Minister to learn from my constituents’ local experience.
I will start with a disclaimer: MPs hear of the worst cases. Nobody writes to me and says, “I had a brilliant experience of choose and book” or indeed of public transport or any other public service. The scheme provides a comparatively easy route to medical care and treatment, but there is a significant minority for whom it is a major problem. I want to bring the cases of a number of my constituents to the Minister’s attention, and to draw one or two national lessons from them.
My worst case illustrates many of the features of choose and book that drive patients to distraction. Mr. I was first sent to choose and book on 19 July 2007, and first contacted me on 9 August 2007. Nine and a half months later, after much correspondence in many directions, he wrote to me again on 12 May 2008 and said:
“Me, I’m giving up but if you wish to carry on the saga be my guest!!!”
I suppose that the debate is me being Mr. I’s guest. I spoke to him yesterday, and I can report that he received his treatment last month. For him, the saga that started with a doctor’s diagnosis in July 2007 has now been completed with treatment in January 2009.
As I said, Mr. I is my worst case. What happened? On 19 July 2007, his general practitioner referred him to choose and book, gave him the telephone number, the address of the website and the password, and told him what to do. When he phoned the number, he was told that he should phone again because of a high volume of calls. He repeated that experience many times. He was referred to the website, but it did not respond to him. He did what many patients do, much to the irritation of their doctors: in frustration, he went back to his GP, because he thought that he might have got the number or password wrong. Having established that they were correct—he had a letter of confirmation from the system in due course—he tried again. Once again he was told that he should try the website because of a high volume of calls.
He eventually got on to the website, but it told him that no bookings were available for the period he had chosen, and that he should try again and seek another date. He did not want to make it hard for choose and book, so he did not try to make an appointment for the week after; instead, he tried to make an appointment for three months after his first choice. Anyone who knows choose and book knows what that means. The system would not give him an appointment because the date he selected was beyond the 18-week period in which it will accept an appointment.
Mr. I is articulate and persistent. After that trouble, he went to his GP for a third time. His GP said, “I’ll tell you what. Why don’t you phone up NHS HealthSpace?” That sounded like something to do, so Mr. I did it. What did it tell him? It told him that no appointments were available.
On 1 August, he got the first of his letters from Appointments Line criticising him for failing to book a choose and book appointment—that was when he first wrote to me. He told me that he wanted to tell Appointments Line that he had been trying to book, but he could not do so because the standard letter from Appointments Line has no address on it—he showed me a copy of the letter to prove it. The only way in which a patient can contact Appointments Line was by phoning the number that tells them that they cannot get through. It is absolutely ridiculous.
Patients might not be able to write to Appointments Line, but MPs can. I now know that it is run by NHS Direct. The chief executive of NHS Direct, Mr. Matt Tee—that is not an abbreviation—sent me a letter. He invited me to comment on the application of NHS Direct for trust status. I told him in no uncertain terms that until he sorted out Appointments Line, it would not be sensible to give it such status. The letter he wrote back to me is interesting in many ways, but I like this bit:
“The Appointments Line takes over 280,000 calls a month and at present receives 0.56 complaints for every 10,000 calls.”
I thought that that was an interesting way of expressing things, but I marvel at how half a complaint managed to sneak through. How would Appointments Line know that people wanted to complain if they cannot write or phone? There is no address to write to. People have to know that it is run by NHS Direct before they can get anywhere.
I also marvelled at another part of the letter that delightfully passes the buck for the problem:
“I agree that services should be user friendly and less bureaucratic and will do all I can both to ensure that this is the case for the services I control (such as The Appointments Line) and to encourage others to do so with the services that I do not control (such as the national Choose and Book system).”
I thought that that was a pretty neat sidestep from my constituent’s concerns. Who runs the national choose and book system? Mr. Tee said:
“We are working closely with colleagues both in the Department of Health and (specifically) in Connecting for Health, to promote improvements to the systems and software associated with Choose and Book”.
So it is not his problem; in his view, it seems to be the problem of the Department of Health, NHS Connecting for Health and the software manufacturers. Evidently, choose and book has nothing to do with the Appointments Line and everything to do with everybody else.
I would not want the Minister to think that, because I started with a case from 2007, he can respond by saying, “Yes, there were some initial teething difficulties, but everything is fine nowadays.” It is no better now. Calls still go unanswered, appointments are still unavailable and infuriating reminder letters are still sent. Unanswered calls are a problem for my constituents.
Last November, my hon. Friend the Member for North Norfolk (Norman Lamb) asked a parliamentary question and received a briefing in the Minister’s reply saying that last October, 338,000 callers tried to access the Appointments Line. According to the figures in the reply, 27,000 were not answered. One must read the small print carefully to find out that 17,000 callers found the line engaged and 10,000 found it playing Vivaldi. One in 16 calls made to the Appointments Line is unsuccessful. That is from the Minister’s own figures for last October, which show 27,000 calls not answered last October. That works out at 324,000 missed calls a year. A third of a million calls, according to his own figures, fail to get through to the Appointments Line.
The astonishing thing is that the Appointments Line met all its key performance indicators. I do not know whether any other call centre in the country, commercial or public, would meet all its key performance indicators if it left out a third of a million callers a year. If so, I hope that the Minister will brief us on which one it is. I suggest to him that the key performance indicators for the Appointments Line are not sufficiently rigorous. He is not getting his money’s worth.
The second big problem is that appointments are not available when people do get through. There are two causes for that. Well, there may be more than two causes—the BMA report suggests quite a range of them—but I will focus on just two. The first, and perhaps the one that the Minister could most easily do something about, is the 18-week waiting period, which creates a black hole beyond 18 weeks when appointments are not taken. If appointments cannot be booked more than 18 weeks ahead, when a particular clinic or consultant is fully booked, they are taken off the list of appointments available. They do not even appear. Of course, at the call centre, they cannot say, “Well, that’s because they’re booked up for the first 18 weeks”; what they say is, “They’re not on the system.” They disappear into a black hole.
2.30 pm
(Pour yourself a virtual glass of port and enjoy this blow by blow description of one patient's experience with the UK's Choose and Book system)
Andrew Stunell (Hazel Grove) (LD): I am pleased to have the opportunity to bring this important issue to the House and look forward to the Minister’s response. It has affected the medical histories of many of my constituents.
The system has been a problem for me and my constituents ever since it started. In turn, I have been in touch with the local foundation trust, the primary care trust and NHS Direct, and I have asked parliamentary questions—in fact, because my December question was too long, Mr. Speaker kindly offered an Adjournment debate. I shall try to do the issue some justice.
After I was told last week of the time of the debate, entirely serendipitously, the British Medical Association produced a report entitled, “Choose and Book: learning lessons from local experience”. I am not so arrogant as to think that my probing put the BMA up to it, but the report is interesting, and I hope the Minister addresses it when he responds to the debate. It talks about learning lessons from local experience, and I want the Minister to learn from my constituents’ local experience.
I will start with a disclaimer: MPs hear of the worst cases. Nobody writes to me and says, “I had a brilliant experience of choose and book” or indeed of public transport or any other public service. The scheme provides a comparatively easy route to medical care and treatment, but there is a significant minority for whom it is a major problem. I want to bring the cases of a number of my constituents to the Minister’s attention, and to draw one or two national lessons from them.
My worst case illustrates many of the features of choose and book that drive patients to distraction. Mr. I was first sent to choose and book on 19 July 2007, and first contacted me on 9 August 2007. Nine and a half months later, after much correspondence in many directions, he wrote to me again on 12 May 2008 and said:
“Me, I’m giving up but if you wish to carry on the saga be my guest!!!”
I suppose that the debate is me being Mr. I’s guest. I spoke to him yesterday, and I can report that he received his treatment last month. For him, the saga that started with a doctor’s diagnosis in July 2007 has now been completed with treatment in January 2009.
As I said, Mr. I is my worst case. What happened? On 19 July 2007, his general practitioner referred him to choose and book, gave him the telephone number, the address of the website and the password, and told him what to do. When he phoned the number, he was told that he should phone again because of a high volume of calls. He repeated that experience many times. He was referred to the website, but it did not respond to him. He did what many patients do, much to the irritation of their doctors: in frustration, he went back to his GP, because he thought that he might have got the number or password wrong. Having established that they were correct—he had a letter of confirmation from the system in due course—he tried again. Once again he was told that he should try the website because of a high volume of calls.
He eventually got on to the website, but it told him that no bookings were available for the period he had chosen, and that he should try again and seek another date. He did not want to make it hard for choose and book, so he did not try to make an appointment for the week after; instead, he tried to make an appointment for three months after his first choice. Anyone who knows choose and book knows what that means. The system would not give him an appointment because the date he selected was beyond the 18-week period in which it will accept an appointment.
Mr. I is articulate and persistent. After that trouble, he went to his GP for a third time. His GP said, “I’ll tell you what. Why don’t you phone up NHS HealthSpace?” That sounded like something to do, so Mr. I did it. What did it tell him? It told him that no appointments were available.
On 1 August, he got the first of his letters from Appointments Line criticising him for failing to book a choose and book appointment—that was when he first wrote to me. He told me that he wanted to tell Appointments Line that he had been trying to book, but he could not do so because the standard letter from Appointments Line has no address on it—he showed me a copy of the letter to prove it. The only way in which a patient can contact Appointments Line was by phoning the number that tells them that they cannot get through. It is absolutely ridiculous.
Patients might not be able to write to Appointments Line, but MPs can. I now know that it is run by NHS Direct. The chief executive of NHS Direct, Mr. Matt Tee—that is not an abbreviation—sent me a letter. He invited me to comment on the application of NHS Direct for trust status. I told him in no uncertain terms that until he sorted out Appointments Line, it would not be sensible to give it such status. The letter he wrote back to me is interesting in many ways, but I like this bit:
“The Appointments Line takes over 280,000 calls a month and at present receives 0.56 complaints for every 10,000 calls.”
I thought that that was an interesting way of expressing things, but I marvel at how half a complaint managed to sneak through. How would Appointments Line know that people wanted to complain if they cannot write or phone? There is no address to write to. People have to know that it is run by NHS Direct before they can get anywhere.
I also marvelled at another part of the letter that delightfully passes the buck for the problem:
“I agree that services should be user friendly and less bureaucratic and will do all I can both to ensure that this is the case for the services I control (such as The Appointments Line) and to encourage others to do so with the services that I do not control (such as the national Choose and Book system).”
I thought that that was a pretty neat sidestep from my constituent’s concerns. Who runs the national choose and book system? Mr. Tee said:
“We are working closely with colleagues both in the Department of Health and (specifically) in Connecting for Health, to promote improvements to the systems and software associated with Choose and Book”.
So it is not his problem; in his view, it seems to be the problem of the Department of Health, NHS Connecting for Health and the software manufacturers. Evidently, choose and book has nothing to do with the Appointments Line and everything to do with everybody else.
I would not want the Minister to think that, because I started with a case from 2007, he can respond by saying, “Yes, there were some initial teething difficulties, but everything is fine nowadays.” It is no better now. Calls still go unanswered, appointments are still unavailable and infuriating reminder letters are still sent. Unanswered calls are a problem for my constituents.
Last November, my hon. Friend the Member for North Norfolk (Norman Lamb) asked a parliamentary question and received a briefing in the Minister’s reply saying that last October, 338,000 callers tried to access the Appointments Line. According to the figures in the reply, 27,000 were not answered. One must read the small print carefully to find out that 17,000 callers found the line engaged and 10,000 found it playing Vivaldi. One in 16 calls made to the Appointments Line is unsuccessful. That is from the Minister’s own figures for last October, which show 27,000 calls not answered last October. That works out at 324,000 missed calls a year. A third of a million calls, according to his own figures, fail to get through to the Appointments Line.
The astonishing thing is that the Appointments Line met all its key performance indicators. I do not know whether any other call centre in the country, commercial or public, would meet all its key performance indicators if it left out a third of a million callers a year. If so, I hope that the Minister will brief us on which one it is. I suggest to him that the key performance indicators for the Appointments Line are not sufficiently rigorous. He is not getting his money’s worth.
The second big problem is that appointments are not available when people do get through. There are two causes for that. Well, there may be more than two causes—the BMA report suggests quite a range of them—but I will focus on just two. The first, and perhaps the one that the Minister could most easily do something about, is the 18-week waiting period, which creates a black hole beyond 18 weeks when appointments are not taken. If appointments cannot be booked more than 18 weeks ahead, when a particular clinic or consultant is fully booked, they are taken off the list of appointments available. They do not even appear. Of course, at the call centre, they cannot say, “Well, that’s because they’re booked up for the first 18 weeks”; what they say is, “They’re not on the system.” They disappear into a black hole.
SIIM Announces 2009 Resident Scholarship Program
SIIM Announces 2009 Resident Scholarship Program
Deadline: March 2, 2009
Recipients to Attend SIIM Annual Meeting in Charlotte, NC, June 4-7
February 4, 2009 - Leesburg, VA - The Society for Imaging Informatics in Medicine (formerly SCAR) has announced the fourth year of its scholarship program for radiology residents interested in imaging informatics. The scholarship is open to all trainees in North America who intend to pursue a career in radiology or imaging sciences.
"The SIIM resident scholarship program enjoyed another successful year in 2008. Our two winners had a variety of useful educational experiences at the meeting. The essays in 2008 addressed the educational impact of imaging informatics of trainees. This year, we are broadening the essays to see what software trainees find valuable outside the PACS. We are looking forward to some exceptional essays, just like those we have had the pleasure of reading in past years," said Barton F. Branstetter IV, MD, chair of the SIIM Resident & Fellow Education & Training Subcommittee.
Travel expenses and meeting registration for the SIIM 2009 Annual Meeting, as well as a one-year SIIM membership, are included for the recipients. The SIIM Annual Meeting takes place in Charlotte, NC, June 4-7.
Applicants are asked to submit a 500-750 word essay on the following topic: "Besides PACS, what one piece of software most improves workflow efficiency for radiologists?" The winning essays will be published in the Journal of Digital Imaging or SIIM News.
Topics of interest to SIIM members include PACS (monitors, networking, and storage), digital teaching files, speech recognition, computer-aided interpretation, reading room workflow and ergonomics, and communication technologies. "Residents who already have an interest in computers will find SIIM to be a welcoming group of like-minded radiologists," said Branstetter.
For more information and to see the online application: www.siim2009.org/Resident_Scholarship.html.
The application deadline is March 2, 2009.
About SIIM
The Society for Imaging Informatics in Medicine (SIIM) is proud to be the leading health care professional organization representing interests and goals of those who work with and whose work is affected by the rapidly changing world of information and imaging technologies. SIIM seeks to spearhead research, education, and discovery of innovative solutions, and to explore new technologies and applications to improve the delivery of medical imaging services and the quality and safety of patient care. For more information, visit www.siimweb.org.
For more information about the SIIM 2009 Annual Meeting and to view and download the preliminary program, visit www.siimweb.org/siim2009.
CONTACT:
Caroline Wilson
Director, Publications & Media
Society for Imaging Informatics in Medicine (SIIM)
703-723-0432 ext. 315
cwilson@siimweb.org
Deadline: March 2, 2009
Recipients to Attend SIIM Annual Meeting in Charlotte, NC, June 4-7
February 4, 2009 - Leesburg, VA - The Society for Imaging Informatics in Medicine (formerly SCAR) has announced the fourth year of its scholarship program for radiology residents interested in imaging informatics. The scholarship is open to all trainees in North America who intend to pursue a career in radiology or imaging sciences.
"The SIIM resident scholarship program enjoyed another successful year in 2008. Our two winners had a variety of useful educational experiences at the meeting. The essays in 2008 addressed the educational impact of imaging informatics of trainees. This year, we are broadening the essays to see what software trainees find valuable outside the PACS. We are looking forward to some exceptional essays, just like those we have had the pleasure of reading in past years," said Barton F. Branstetter IV, MD, chair of the SIIM Resident & Fellow Education & Training Subcommittee.
Travel expenses and meeting registration for the SIIM 2009 Annual Meeting, as well as a one-year SIIM membership, are included for the recipients. The SIIM Annual Meeting takes place in Charlotte, NC, June 4-7.
Applicants are asked to submit a 500-750 word essay on the following topic: "Besides PACS, what one piece of software most improves workflow efficiency for radiologists?" The winning essays will be published in the Journal of Digital Imaging or SIIM News.
Topics of interest to SIIM members include PACS (monitors, networking, and storage), digital teaching files, speech recognition, computer-aided interpretation, reading room workflow and ergonomics, and communication technologies. "Residents who already have an interest in computers will find SIIM to be a welcoming group of like-minded radiologists," said Branstetter.
For more information and to see the online application: www.siim2009.org/Resident_Scholarship.html.
The application deadline is March 2, 2009.
About SIIM
The Society for Imaging Informatics in Medicine (SIIM) is proud to be the leading health care professional organization representing interests and goals of those who work with and whose work is affected by the rapidly changing world of information and imaging technologies. SIIM seeks to spearhead research, education, and discovery of innovative solutions, and to explore new technologies and applications to improve the delivery of medical imaging services and the quality and safety of patient care. For more information, visit www.siimweb.org.
For more information about the SIIM 2009 Annual Meeting and to view and download the preliminary program, visit www.siimweb.org/siim2009.
CONTACT:
Caroline Wilson
Director, Publications & Media
Society for Imaging Informatics in Medicine (SIIM)
703-723-0432 ext. 315
cwilson@siimweb.org
Monday, February 2, 2009
PUBLIC HEALTH ASSOCIATION OF AUSTRALIA CALLS FOR OVERHAUL OF FOOD POLICY
The Public Health Association of Australia (PHAA) has today released a new report – A Future for Food – which calls for a complete overhaul of food policy in Australia in order to more effectively address the national priorities of chronic disease prevention, climate change and social inequality.
According to Michael Moore, CEO of the PHAA “Food is a critical issue across public health, the environment, social policy and the economy – and yet we have a fragmented approach. It is imperative we act now to establish a national, integrated whole-of-government food policy.” “We have a food supply skewed to inappropriate and overly processed foods that are high in sugar, fat and salt; there is inadequate understanding of the environmental impacts of food choices; and we have people struggling to afford healthy food to feed their families.” “We cannot afford to continue to do business as usual. And with the National Health and Medical Research Council (NHMRC) currently reviewing dietary recommendations in this country, it is imperative we act now,” said Michael Moore.
A Future for Food: Addressing public health, sustainability and equity from paddock to plate, states that the selection of foods for Australian guidelines has been largely based on nutrition science, which emphasises the adequacy of specific nutrients rather than whole foods. “But we eat food not nutrients,” said Mr Moore.
The PHAA is concerned that current guidelines offer inadequate consideration of: the chronic disease risk of certain foods despite their capacity to provide adequate nutrients; the environmental impact of those food choices; and cultural and equity issues – including at the very minimum affordability for all Australians.
“In reviewing the research on chronic disease, environmental sustainability and social equity, we believe it is imperative that food recommendations have a stronger emphasis on whole, or minimally processed, and plant-based foods,” said Michael Moore. In addition to calling on the government to establish a national integrated food policy, the PHAA is calling on the NHMRC to address these issues in its current review. “We want public health and food professionals, food industry and consumers to join our call for action at phaa.net.au. We must work together and act now,” said Mr Moore.
Contact: Michael Moore CEO PHAA 0417 249 731
For more information and a .pdf copy of A Future for Food visit www.phaa.net.au
The Public Health Association of Australia (PHAA) is a non-party-political organisation with a membership drawn from more than 40 health-related professions. The Association makes a major contribution to health policy in Australia and has branches in every State and Territory. www.phaa.net.au.
A Future for Food is an initiative of the PHAA, developed with specific input and guidance from the PHAA Food and Nutrition Special Interest Group, presentations at the Population Health Congress held in July 2008 and the PHAA Nutrition Round Table held in June 2008. It was made possible by an unencumbered educational grant from the Sanitarium Health Food Company.
www.phaa.net.au
According to Michael Moore, CEO of the PHAA “Food is a critical issue across public health, the environment, social policy and the economy – and yet we have a fragmented approach. It is imperative we act now to establish a national, integrated whole-of-government food policy.” “We have a food supply skewed to inappropriate and overly processed foods that are high in sugar, fat and salt; there is inadequate understanding of the environmental impacts of food choices; and we have people struggling to afford healthy food to feed their families.” “We cannot afford to continue to do business as usual. And with the National Health and Medical Research Council (NHMRC) currently reviewing dietary recommendations in this country, it is imperative we act now,” said Michael Moore.
A Future for Food: Addressing public health, sustainability and equity from paddock to plate, states that the selection of foods for Australian guidelines has been largely based on nutrition science, which emphasises the adequacy of specific nutrients rather than whole foods. “But we eat food not nutrients,” said Mr Moore.
The PHAA is concerned that current guidelines offer inadequate consideration of: the chronic disease risk of certain foods despite their capacity to provide adequate nutrients; the environmental impact of those food choices; and cultural and equity issues – including at the very minimum affordability for all Australians.
“In reviewing the research on chronic disease, environmental sustainability and social equity, we believe it is imperative that food recommendations have a stronger emphasis on whole, or minimally processed, and plant-based foods,” said Michael Moore. In addition to calling on the government to establish a national integrated food policy, the PHAA is calling on the NHMRC to address these issues in its current review. “We want public health and food professionals, food industry and consumers to join our call for action at phaa.net.au. We must work together and act now,” said Mr Moore.
Contact: Michael Moore CEO PHAA 0417 249 731
For more information and a .pdf copy of A Future for Food visit www.phaa.net.au
The Public Health Association of Australia (PHAA) is a non-party-political organisation with a membership drawn from more than 40 health-related professions. The Association makes a major contribution to health policy in Australia and has branches in every State and Territory. www.phaa.net.au.
A Future for Food is an initiative of the PHAA, developed with specific input and guidance from the PHAA Food and Nutrition Special Interest Group, presentations at the Population Health Congress held in July 2008 and the PHAA Nutrition Round Table held in June 2008. It was made possible by an unencumbered educational grant from the Sanitarium Health Food Company.
www.phaa.net.au
Thursday, January 22, 2009
Provincial Spending will only follow Federal Spending. Will Healthcare be on the Agenda?!
A major factor causing long emergency room (ER) wait times is the high number of alternate level of care (ALC) patients occupying acute care hospital beds, making it difficult to admit patients from the ER to hospital. ALC patients are unable to be discharged because the appropriate level of care they require is not always available.
Not a short term problem
This was released by the Canadian Institute for Health Information's (CIHI) in 2006: There were almost 73,000 patients designated as ALC patients among 2.4 million patients admitted to acute care hospitals outside of Quebec between April 1, 2004 and March 31, 2005.1 This is up by 13.6% from 2003-2004 and 19.6% from 2002-2003.
This was released by CIHI last week (January 14, 2009):
In 2007–2008, there were more than 74,000 hospital stays for alternate level of care (ALC) patients in Canada (outside of Quebec and Manitoba), representing more than 1.7 million hospital days, according to a new analysis by the Canadian Institute for Health Information (CIHI). The analysis, Alternate Level of Care in Canada, provides a first look at patients in acute care hospitals across Canada who no longer need acute services, many of whom are waiting to be discharged to a setting more appropriate to their needs.
Some highlights of the analysis include:
-- The equivalent of almost 5,200 beds was occupied by ALC patients in acute care hospitals.
-- Overall, dementia accounted for almost one-quarter of ALC hospitalizations and more than one‑third of ALC days in 2007–2008.
-- 83% of adult ALC patients were admitted to an acute care hospital through the emergency department, compared to 63% of non-ALC patients.
-- Most ALC patients were discharged to a long-term care facility (43%), while 27% were discharged home and 12% died during their hospitalization.
This is a national crisis in healthcare. Provinces are taking the lead to come up with answers. In Ontario Dr. Alan Hudson and Dr. Kevin Smith are dedicated to the task. The hospitals, community organizations, the associations, the integration networks and the governments are all collaborating.
And the media is even suggesting solutions.
Judy Steed's column is one example
Special to the Star
PROBLEM: In Canada, "bed blockers" – older people stuck in hospital, ready for discharge, lacking the home support they require – occupy 5,000 hospital beds and consume $200 million annually. They clog emergency departments and expand wait times for others.
SOLUTION: Hospitals in Denmark eliminated bed blockers by creating a stiff incentive to get elders moving. Municipalities are required to pay for those who stay in hospital past discharge dates. That got communities working to move seniors on – to rehab or home care.
. . . hospitals agree that community care is the answer. "I'm CEO of the Ontario Hospital Association and we think the solution is in the community," Tom Closson told me when he was CEO of the University Health Network. An effective long-term home care system is the answer, he says – only then will seniors discharged from hospitals and nursing homes be diverted from emergency departments.
Closson and his colleagues in community care and home care know that solutions will require spending and they know that provincial spending will be dependent on federal spending. They are counting on Mr. Flaherty taking note. Not only can investments bolster the economy, they can improve healthcare. Without it, they say, access, quality and human resources to care for the sick will be dramatically affected.
Not a short term problem
This was released by the Canadian Institute for Health Information's (CIHI) in 2006: There were almost 73,000 patients designated as ALC patients among 2.4 million patients admitted to acute care hospitals outside of Quebec between April 1, 2004 and March 31, 2005.1 This is up by 13.6% from 2003-2004 and 19.6% from 2002-2003.
This was released by CIHI last week (January 14, 2009):
In 2007–2008, there were more than 74,000 hospital stays for alternate level of care (ALC) patients in Canada (outside of Quebec and Manitoba), representing more than 1.7 million hospital days, according to a new analysis by the Canadian Institute for Health Information (CIHI). The analysis, Alternate Level of Care in Canada, provides a first look at patients in acute care hospitals across Canada who no longer need acute services, many of whom are waiting to be discharged to a setting more appropriate to their needs.
Some highlights of the analysis include:
-- The equivalent of almost 5,200 beds was occupied by ALC patients in acute care hospitals.
-- Overall, dementia accounted for almost one-quarter of ALC hospitalizations and more than one‑third of ALC days in 2007–2008.
-- 83% of adult ALC patients were admitted to an acute care hospital through the emergency department, compared to 63% of non-ALC patients.
-- Most ALC patients were discharged to a long-term care facility (43%), while 27% were discharged home and 12% died during their hospitalization.
This is a national crisis in healthcare. Provinces are taking the lead to come up with answers. In Ontario Dr. Alan Hudson and Dr. Kevin Smith are dedicated to the task. The hospitals, community organizations, the associations, the integration networks and the governments are all collaborating.
And the media is even suggesting solutions.
Judy Steed's column is one example
Special to the Star
PROBLEM: In Canada, "bed blockers" – older people stuck in hospital, ready for discharge, lacking the home support they require – occupy 5,000 hospital beds and consume $200 million annually. They clog emergency departments and expand wait times for others.
SOLUTION: Hospitals in Denmark eliminated bed blockers by creating a stiff incentive to get elders moving. Municipalities are required to pay for those who stay in hospital past discharge dates. That got communities working to move seniors on – to rehab or home care.
. . . hospitals agree that community care is the answer. "I'm CEO of the Ontario Hospital Association and we think the solution is in the community," Tom Closson told me when he was CEO of the University Health Network. An effective long-term home care system is the answer, he says – only then will seniors discharged from hospitals and nursing homes be diverted from emergency departments.
Closson and his colleagues in community care and home care know that solutions will require spending and they know that provincial spending will be dependent on federal spending. They are counting on Mr. Flaherty taking note. Not only can investments bolster the economy, they can improve healthcare. Without it, they say, access, quality and human resources to care for the sick will be dramatically affected.
Sunday, January 11, 2009
Help two Ontario farm girls complete medical school. An Investment Opportunity with Two-Fold Return.
Two rural Ontario sisters and their family are looking for finances to complete their training as medical doctors at the Royal College of Surgeons in Ireland. Well-placed in their classes, they will graduate in 2011 and 2013. Offering an 8% return on investment, interest payments would be made until June 2011 when principal and interest payments would begin. Beyond personal guarantees, the girls offer their family business and farm, which has been in the family for 30 years, as additional security. For added security, third party management of the funds would be welcomed. Interested? Call toll-free 888.301.3477 or emailto: medical-investment@live.ca
Friday, January 9, 2009
Can Shoppers Drug Mart Do Anything Right?
Shopping for specialty items is a pain at the best of times. Try finding a seasonal affective disorder light. Sure there are some specialty stores that carry them. But few. Shoppers Drug Mart carries them and has cornered the market. Not a good time to restrict access -- especially if you have stores just about everywhere. And, by all appearances (looking through the window), they do offer a good array of lights to choose from. But I arrive at one of the few stores that actually carries these lights and I can't get in. Its 8 pm. I can get into the main store using the same entrance (Danforth and Main area in Toronto) and buy groceries, chocolate, cheap pop, cosmetics and yes a good array of over the counter pills and products. But try a specialty item. Humbug. If it’s a little-out-of-the-ordinary healthcare item the doors are closed. Once again Shoppers Drug Mart demonstrates that their mission is shareholder value. Consumers be damned.
So now it’s 9 a.m. and I will drive to a store. It's not nearby. I can go by car and make my purchase. I still lose half a day in the process + the time last night.
And call them to get this message. "We close at 7 pm." But get there and find that its really 6 pm.
p.s. I dropped by four stores. Three of their pharmacists had no idea what I was talking about. One wondered if I bought these lights there regularly. The other had no idea what I was asking for. A third realized what it was but had never seen or heard about one at Shoppers. Oyez, oyez oyez.
But some faint praise. The excessive space dedicated to chocolate, cheap pop, cheap butter tarts and Danish pastries has been taken down at the Queen and Carlaw store. Stocking clerks tell me that head office insisted. If they remove all of it maybe they can earn their partnership with the Diabetes Association.
Anton Hart
Thursday, January 8, 2009
by Neil Seeman
Canada's most widely read major newspapers are outperforming health blogs on reporting important clinical content. However, both newspapers and health blogs are performing poorly in this regard. Major Canadian newspapers (on average) covered just 37% of what clinical experts considered critically important medical news in 2007. By comparison, the most popular 50 health blogs, on average, covered just 23% of these stories. However, these averages obscure important findings. When isolating general interest health blogs - a minority of the top 50 health blogs, most of which cater to a particular illness, such as diabetes or autism - one finds that, in all instances, these general interest blogs fare at least as well as and usually significantly better than general interest newspapers in reporting critical medical stories. The most popular such general interest health blogs include The Wall Street Journal's health blog (http://blogs.wsj.com/health/), The Health Care Blog (www.thehealthcareblog.com/) and Kevin M.D. Medical Weblog (www.kevinmd.com/blog/).
Also revealing is the overall performance of the 50 leading health blogs, as compared with popular newspapers, on the governance criteria measured in this analysis. The vast majority ( > 90%) of these popular health blogs lack drug industry sponsorship or overt partisanship that is readily detectable by the user. By comparison, drug industry sponsorship of events (other than direct-to-consumer advertisements) is not uncommonly seen in Canadian newspapers; and all major newspapers in Canada offer overt partisan commentary on health and medical issues on the editorial page - the "official voice" of the newspaper - and these editorials are usually written by anonymous editorial writers who rarely possess any clinical credentials.
As Figure 1 illustrates, health blogs can stand to do a better job of avoiding general industry sponsorship and offering users clear confidence regarding the privacy of user-submitted content. By comparison, newspapers fall down entirely on these scores, with no major newspapers in Canada prohibiting industry sponsorship or providing prominent assurances to letter writers (online or in print) that their submitted health content will be kept private in a manner that observes the Health on the Net Foundation code of conduct (HONcode) or equivalent privacy practices. Finally, 60% of the most popular health blogs are moderated partially or fully by SMEs, usually practising clinicians. The same cannot be said of major Canadian newspapers, whose health reporters and editors seldom have any clinical or graduate-level credentials in any health-related field. In many cases, newspapers do not have dedicated health editors.
More on this topic here.
Tuesday, January 6, 2009
Investing in future doctors. Here is an offer to consider.
An idea whose time has come
An Investment Opportunity with Two-Fold Return. Help two Ontario farm girls complete medical school.
Two rural Ontario sisters and their family are looking for finances to complete their training as medical doctors at the Royal College of Surgeons in Ireland. Well-placed in their classes, they will graduate in 2011 and 2013. Offering an 8% return on investment, interest payments would be made until June 2011 when principal and interest payments would begin. Beyond personal guarantees, the girls offer their family business and farm, which has been in the family for 30 years, as additional security. For added security, third party management of the funds would be welcomed. Interested? Call toll-free 888.301.3477 or email: medical-investment@live.ca.
Friday, January 2, 2009
How can local, provincial and federal politicians make a constructive difference to healthcare in Canada?
How can local, provincial and federal politicians make a constructive difference to healthcare in Canada? Here are three comments from three levels of government representing Sault Ste. Marie in Ontario’s near north. To respond use this blog or send a note to the publisher@longwoods.com
From the middle of Canada: Elaine Della-Mattia comments in the Sault Star (click on the title)
. . . all area politicians agree that health care will be a major issue locally in the coming year.
(Mayor John) Rowswell called health care the No. 1 priority for council in 2009. In fact, he believes the issue will be a priority across the province.
(Sault Member of Provincial Parliament, David) Orazietti said he's predicting some relief to the doctor shortage with the first class of the Northern Ontario Medical School graduating.
"A good portion of these students were born and raised in Northern Ontario and I have huge expectations that many will remain in the North and practice here," he said.
(Sault Member of Parliament, Tony) Martin said he continues to be concerned for the Sault's aging population and their health care needs. Martin said he will encourage and work with government to support front-line workers dealing with the added demand. He said he's been personally energized by the political activity that has taken place the last month, along with many other Canadians.
What are your suggestions? How should they leverage their political position. What would be a constructive strategy for your mayors, your provincial or state representatives , your representatives in congress?
From the middle of Canada: Elaine Della-Mattia comments in the Sault Star (click on the title)
. . . all area politicians agree that health care will be a major issue locally in the coming year.
(Mayor John) Rowswell called health care the No. 1 priority for council in 2009. In fact, he believes the issue will be a priority across the province.
(Sault Member of Provincial Parliament, David) Orazietti said he's predicting some relief to the doctor shortage with the first class of the Northern Ontario Medical School graduating.
"A good portion of these students were born and raised in Northern Ontario and I have huge expectations that many will remain in the North and practice here," he said.
(Sault Member of Parliament, Tony) Martin said he continues to be concerned for the Sault's aging population and their health care needs. Martin said he will encourage and work with government to support front-line workers dealing with the added demand. He said he's been personally energized by the political activity that has taken place the last month, along with many other Canadians.
What are your suggestions? How should they leverage their political position. What would be a constructive strategy for your mayors, your provincial or state representatives , your representatives in congress?
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