Healthcare policy in Canada

HealthcarePapers, 12(2) 2012: 34-39

Commentary

Of Honey and Health Policy: The Limits of Sweet, Sticky Substances in Reforming Primary Care 

Danielle Martin
Abstract
It is a well-known axiom that one attracts more flies with honey than vinegar. Nowhere has this approach been taken more to heart than in the past decade of primary care policy in Canada. Governments, physician and nursing organizations and regional health authorities have invested in a lot of "honey" to draw healthcare providers onto a path from single-physician offices to team-based care with flexible hours and a population-based approach. In the lead essay for this edition of Healthcare Papers, Kates and colleagues have outlined a framework that embraces this paradigm. Their articulation of a framework is a place to start, but it can only be a start. To make that framework come alive, a wider variety of policy tools will be needed than have been used thus far, and by a wider variety of actors. Within the healthcare workforce itself, leadership, vision and the courage to hold ourselves to account for changes to primary care are needed.

FIRST MINISTERS MEETING and healthcare, diabetes

Our ministers from across the country are meeting and talking about healthcare.
Interesting, as there is much buzz in the news about the Americans being worried about healthcare insurance, which is not affordable by those without the means to buy it.
The Americans, those with the money to buy healthcare insurance, without pre-existing conditions, or chronic care needs, who earn 6-digit salaries, don't want universal care as they believe it is like Canadian Socialism.

Amputation is often a suggestion for those with
diabetes-related circulation issues.
Many of my clients in LTC have amputations.

I say, if you put all of your money into the pot, share what you have, stand up to the big-bucks pharmaceuticals, you stand a chance.

It is interesting that the Prime Minister refuses to meet with the Premiers:

Premiers invite Prime Minister Stephen Harper for meeting on Economy

HALIFAX - Canada's premiers are calling on Prime Minister Stephen ... "Why would a prime minister not want to meet with us on that kind of an issue?"

It's been three years since Harper last met with the premiers.


Perhaps, like many meetings, it is to dictate terms, not collaborate on what is good for the people of this country.
Many, living below the poverty line, suffer from issues like diabetes. Education means fewer health issues, for the most part. If you are struggling to make ends meet, you do not have the time, knowledge or energy to change bad habits. This is why in depressed rural areas, like Smiths Falls, we have many on welfare of disability. Simple prevention of work-related health issues, or cure, through physiotherapy rather than drugs, is beyond the means of many.

FIRST MINISTERS MEETING

Premiers forge own health-care path

JANE TABER

Canada’s premiers are taking the lead on health-care reform without direct leadership from Ottawa, a departure from the way the country’s cherished but increasingly expensive system has long been managed.

Needless amputations and diabetes

Premiers focus on best practices, health-care innovations at ...

... to close," he told a news conference Thursday. "We've got to fix that." The premiers ... Of those, there were 118 amputations - 80 per cent of which he said were unnecessary

Tackle foot care postcode lottery to end amputations, diabetes ...

Around 80% of the 6,000 diabetes-related amputations in England each year ... in the UK are enduring unnecessary foot amputations is ... the Diabetes UK ProfessionalConference 

Premiers approve report

Jul 27, 2012 · Saskatchewan Premier Brad Wall ... close," Wall told a news conference ... Of those, there were 118 amputations - 80 per cent of which he said were unnecessary

The premiers have agreed to bulk buying of pharmaceuticals before, but commitments have floundered in the face of politics and pressure from the highly competitive pharmaceutical industry, which argues bulk buying would drive down profit margins and lead to possible shortages.

Aging in a Changing World

I loved attending PD and conferences when working as a teacher. As a volunteer, I feel very much left out of such events. Many of us volunteer with Transfer Payment Agencies, and these individual agencies have small budgets, but rely upon meagre government financing as well as donation. We are the people who work so hard to advocate with clients. We see the big picture and we see where services are lacking. We know what our clients face on a daily basis, and the barriers to good care. We also know what works well.
We see the hoarding, the self-neglect, and the choices seniors make in choosing to die at home.

41st Annual Scientific and Educational Meeting
Canadian Association on Gerontology

October 18 - 20, 2012
Vancouver, BC

The Canadian Association on Gerontology is pleased to announce that registration is now open for CAG2012: Aging in a Changing World, the 41st Annual Scientific and Educational Meeting of the CAG, October 18 - 20, 2012, Vancouver, BC. To register and view the preliminary program.

Highlights include...

Preconference Workshops

• Addressing Abuse of Older Adults: Connecting the Dots - Front Line Practice, Coordination, Policy, and Research
  • Sponsored by the Ministry of Health, Province of British Columbia in cooperation with Re:Act Program, Vancouver Coastal Health

• Transitions Across the Points of Care: Minimizing Risk in Seniors in the Emergency Department
  • Sponsored by Providence Health Care Research Institute

• An Identity Crisis? Enhancing Skills to Market Yourself in Gerontology
  
  • Sponsored by the Canadian Association on Gerontology Student Connection-Connexion Étudiante and the Canadian Institutes of Health Research Institute of Aging

Keynote Addresses
All keynote addresses will have simultaneous translation.

• Neena Chappell, PhD, FRSC, University of Victoria
• Geoff Fernie, PhD, MIMechE, CEng, PEng, CCE, University of Toronto
• Réjean Hébert, MD, MSc, MPhil, University of Sherbrooke
• Phyllis Moen, PhD, University of Minnesota (Supported by CIHR Institute of Aging)
• Thomas Perls, MD, MPH, Boston University (Supported by CIHR Institute of Aging)

Symposia 

• Sponsored Symposia
  • Canada Mortgage and Housing Corporation: The State of Seniors' Housing in Canada
  • Health Council of Canada & Institute for Research on Public Policy:Health System Transformation in Light of Population Aging
  • Ministry of Health, Province of British Columbia: Innovations in Aging: Engaging British Columbians in Solutions for Health Care and Healthy Aging
  • Public Health Agency of Canada: The Changing Environment and Changing Population Demographics: Exploring Health, Social Impacts, and Population Needs

• CAG Divisional Symposia

Paper, Poster, Symposium and Workshop Sessions

• Hear about the latest research in your fields of interest
• CIHR Institute of Aging Student Poster Competition

10th Annual Ellen Gee Memorial Lecture (Sponsored by Simon Fraser University Department of Gerontology)

• Victor Marshall, PhD, University of North Carolina at Chapel Hill

CAG2012 is hosted by Simon Fraser University Department of Gerontology and Gerontology Research Centre.

What is osteoporosis? What puts me at risk for osteoporosis?

What is osteoporosis? 

Hip Fracture

Osteoporosis is a common condition among older people, particularly postmenopausal women. Osteoporosis affects the strength of your bones and can make them fragile and more likely to break. In Canada, osteoporosis affects approximately 1 in 4 women and 1 in 8 men over the age of 50.

Learning about osteoporosis can help you better understand your risk for osteoporosis. It can be overwhelming, even a little scary, when you're first diagnosed with osteoporosis. However, a few simple steps can go a long way to help you live a full life.

The 2010 Canadian Osteoporosis Guidelines recommend that all postmenopausal women and men over 50 be assessed for osteoporosis and clinical risk factors for fragility fractures. Post-menopausal women are especially at risk of osteoporosis because at menopause estrogen levels drop. Estrogen plays an important role in keeping women’s bones healthy. There are several factors that can increase your risk of developing osteoporosis.

Take this self-assessment to help understand if you are at risk: Osteoporosis Risk Factors Test.

What puts me at risk for osteoporosis? 
Risk factors are additive, meaning that the more risk factors you have, the greater your risk of developing osteoporosis. If you are over 50, Osteoporosis Canada recommends that you talk to your physician about being assessed for osteoporosis. You can print your results and take them to your next doctor’s appointment.

If you are diagnosed with osteoporosis, your doctor may prescribe medication to help slow bone loss, increase bone density and therefore help reduce the risk of fractures. No two people are alike, so your doctor will help you evaluate which treatment is right for you based on your needs, other health conditions you may have, and medications you may already be taking. Your doctor may also recommend that you take calcium and/or vitamin D to supplement your medication

Facts found from Fight Osteoporosis.ca
Payment for this AdverPost donated to CHSLC.ca

Palliative Care for Mesothelioma Patients

I was asked to place a guest post on this topic. I am in favour of helping people deal with the realities of death and dying. 

Asbestos.com

Mesothelioma treatments can fall into two groups: potentially curative therapies, which aim to kill the cancer cells, or palliative therapies, which aim to improve the patient’s quality of life.

Mesothelioma patients can receive both palliative and curative therapies at the same time. The

Alternative Therapies

palliative care improves their overall quality of life while the curative care works to improve their
survival rate. If patients are not candidates for curative therapies because of old age or advanced
cancer, they may rely solely on palliative care to bring their symptoms down to a manageable level.

Palliative mesothelioma care helps control pain, reduce coughing and promote easier breathing. Seniors can obtain these palliative benefits through several different therapies.

Traditional treatments such as surgery and radiation therapy can be part of a palliative care regimen, along with additional options such as oxygen therapy and respiratory therapy. Alternative treatments such as acupuncture and massage therapy may also have a palliative effect.

Common Palliative Care Options

Although surgery may seem like a big step, several surgical procedures are primarily palliative in

Complimentary Therapies: chair massage

nature and some are hardly invasive. They can reduce coughing, chest or abdominal pain and difficulty breathing. Palliative operations include:

• Pleurodesis (surgical draining of fluid around the lungs)
• Paracentesis (surgical draining of fluid in the abdomen)
• Cytoreductive surgery

Debulking surgeries have a high risk of side effects – especially in elderly patients – so surgeons rarely perform them with a solely palliative intent. However, some patients do benefit from the reduction in pressure on their lungs.

Radiation therapy can also help shrink mesothelioma tumors and reduce the number of side effects that patients experience. Palliative radiation can provide temporary pain relief and does not require as high of a dose as curative radiation therapy.

Reiki

Less aggressive treatments can also palliate symptoms. Many seniors explore these treatments because they do not want to put themselves at risk for the side effects associated with more invasive surgery or radiation therapy. Oxygen therapy administers highly concentrated oxygen to patients who are struggling to breathe, while respiratory therapy helps unblock air passageways and encourage smoother breathing.

Patients may also turn to medications to palliate their pain. If they wish to avoid pharmaceuticals, they may consider acupuncture, therapeutic massage, Reiki or other natural forms of pain palliation instead.

Author bio: 
Faith Franz researches and writes about health-related issues for The Mesothelioma Center.
One of her focuses is living with cancer.

Montessori Methods With Dementia Patients

Here are some great ideas...

Montessori project meaningful for residents and student nurse  
Monday July 9, 2012 -- Lisa BaileyTORONTO - Aafreen Hassan’s passion for nursing deepened with every smile and activity by residents at Leisureworld Caregiving Centre Altamont.

The third-year nursing student from Ryerson led a Montessori project at the long-term care home, working one on one every week with about 10 residents who have varying levels of cognitive challenges.

Using the Montessori principles she researched with program manager Annie MacDonald’s support, Hassan developed hands-on activities for residents to try based on their current needs and past experiences and interests. She aimed to enhance their sensory stimulation, gross motor and other skills, self-expression and social interaction.


Having a sharp brain:

The Ten Habits of Highly Effective Brains

By: Alvaro Fernandez

Let’s review some good lifestyle options we can fol­low to main­tain, and improve, our vibrant brains.

Clinical Trials and The Montessori method focuses on an individual's personal strengths, preferences, and abilities to increase a person's participation in facility activities and/or personal self-care, improving their independence and self-esteem. The programming has increased the
residents' participation in activities and gets high marks in staff satisfaction.

Useful resources on Montessori Approach to Caring for the Elderly with Alzheimer's/Dementia
1.  A Different Visit: Activities for Caregivers and their Loved Ones with Memory
Impairments  by Adena Joltin, Cameron J. Camp, Beverly H. Noble, Vincent M.
Antenucci - Montessori-Based Activities for Persons with Dementia, Vol. 1
by Cameron Camp Ph.D., Cameron J. Camp Ph.D.  Dr. Cameron’s radio shows
2. Lost and Found - By Barbara Basler, September 2005 
3. One can download free exercises (PDF Format) to be used with the elderly, from the
AARP web site:
     • Treasure Hunt
     • Face Puzzle
     • Food Drive
     • Tool Match 
4. Articles and Activity Ideas from www.caregiving.com Caregiving 101 
a. Can Art Help Alzheimer's? by Denise M. Brown
b. A Montessori Intervention by Tom and Karen Brenner
c. Fitness Training for the Mind by Tom and Karen Brenner Montessori Work Helps Elderly with Dementia  
 d. Spiritual Engagement - Montessori Activities by Tom and Karen Brenner

Technology and seniors in the news

What I love to see are people of my generation using technology. The young people mock us, but we've managed to get ourselves out of our rocking chairs, and getting out in the world.
We also have learned to use the Internet to find information on healthcare, as well as for play.

Here is a timely news item:

 Revera, UofT collaborating on technology for seniors
Aim is to identify issues that technology can solve
Monday, July 9, 2012 -- Deron Hamel
Ninety-year-old Adrienne Dawson says she can’t imagine how she managed living so long without the Internet.


Dawson isn’t alone. Today, she is among the 27 per cent of Canadians aged 75 and older who are online. And it’s residents like Dawson that Revera will be connecting with through a partnership with the University of Toronto’s Technologies for Aging Gradually Lab (TAGlab) to discover new innovations in technology for senior citizens.

Ontario Trillium Benefit

Diabetes-induced neuropathic pain.
Lack of circulation causes swelling.

This is an item of interest to those receiving benefits from the Ontario Government.
I am proud to be living in a province where we look after those who cannot look after themselves. The Ontario Trillium Benefit helps those without the means to help themselves.

I have many clients, some on disability, who depend upon our tax dollars for support. For those who cannot support themselves, it is important that we help look after them.
For those Americans who have mocked the Canadian healthcare system, or choose to misunderstand it, you can assure yourselves that poverty is a good indicator of poor health, especially in older women.

For those who are uneducated, without money to pay for particular drugs, or therapies, they will suffer longer and more deeply than the rest of us. FOr those with unmanaged, chronic pain, for example, life is difficult.

Pain Evaluation Form p.1

Pain Evaluation Form p.2

For those unable to determine how to eat well, choosing nutritious meals; to exercise sleep deeply and well; practice good hygiene; self-advocate with healthcare professionals; they will continue to suffer. For those who lack hope, something to do, someone to love, lack dignity and self-respect, we must give them a helping hand.

In this part of the world, we must be careful to look out for one another. My tax dollars go into the Ontario Healthcare pot. I am happy to share with those who are sick, unemployable, and unable to support themselves.

Medication dosset

On July 10, 2012, the first payment of the monthly Ontario Trillium Benefit will be mailed to homes and deposited into bank accounts. This benefit rolls the payment of Property, Energy and Sales Tax credits into one monthly benefit. Your money. Every month. 

If you qualify for this benefit, based on your 2011 income tax return, you will receive your 2012 tax benefits earlier and more frequently than before. You won’t have to wait until after you file your tax return next year and you can count on regular and predictable access to your tax benefits.

Visit our website for more information about the Ontario Trillium Benefit – www.ontario.ca/trilliumbenefit, including:

-          A list of payment dates

-          Videos

-          A tax credit calculator

-          Frequently asked questions

-          A phone number to call if your payment is late

If you need any additional information, please do not hesitate to contact me.

Thank you,

Sharyn

Sharyn.MOF@ontario.ca

www.twitter.com/OntMinFinance

CHPCA Policy Alert on Assisted Suicide

CHPCA Policy Alert Recent Physician Assisted Suicide or Euthanasia Developments July 9, 2012

Cliquez ici pour la version français CHPCA has a Euthanasia and Assisted Suicide Task Group that is actively monitoring this issue.  Lately, there has been much debate over physician assisted suicide or euthanasia. In June 2012, the B.C. Supreme Court stated that suicide is not illegal. But, people living with physical disabilities who are unable to commit suicide without assistance are denied this option. This dichotomy was deemed unconstitutional by Justice Lynn Smith, who ruled in favour of the right to assisted suicide. Justice Smith granted Gloria Taylor a year long exception to the existing ban, enabling her to make her own decisions about her life and death. The judge also suspended the ruling for a year, allowing time to change current legislation. There is still the potential for an appeal of Gloria Taylor’s case. Moreover, a change in these laws must be approved by parliament. An appeal is expected in this case that may go right to the Supreme Court of Canada so no changes should be seen quickly. In March 2012, the Special Commission on Dying with Dignity (Commission spéciale sur la question de mourir dans la dignité) released the report, Dying with Dignity. The Committee made 24 recommendations to the Minister of Health and Social Services as to how end-of-life care should be improved in Quebec. Please click here to read the full report (currently available in French only). In light of these developments, the Canadian Hospice Palliative Care Association and the Euthanasia and Assisted Suicide Task Group will be re-launching a larger campaign around the need for hospice palliative care in Canada. In 2010, we launched the “Let’s Talk about Hospice Palliative Care Instead” campaign, which encouraged hospice palliative care professionals to re-direct the discussion around euthanasia and assisted suicide to the need for hospices palliative care.  The hope is to differentiate between the two issues that seem to be getting confused in Canadians minds. In fall 2012, we will resume a similar campaign, in an effort to shift the recent public dialogue from euthanasia and the more negative views of death, to high quality hospice palliative care and living until the end. Stay tuned for more, this promises to be a great initiative! Have a wonderful summer, Sharon Baxter Executive Director Canadian Hospice Palliative Care Association

What to Look For When Choosing LTC or a Retirement Home

Carole Bursack, a US-based author, published an excellent piece:

What to Look For When Visiting an Elder in Senior Housing

Eye contact, genuine respect for residents, meals, activities, and atmosphere, are only a few of the considerations. Read more...

I have found, volunteering in various LTC, e.g., PCCC, that there is a feeling of fun, respect, and a delight in things like history, music, games, pet therapy, art and crafts.
I laud those who visit and volunteer, sharing their hobbies like Heritage Fashion Show, or quilting. 

This is a stressful time in a family's life, as it signifies a different stage. Some cannot cope with it, others fight it. Adults making good decisions about their life situation, their ability to take care of their activities of daily living (ADL - preparing meals, cleaning, toileting) or independent activities of daily living (IADL - e.g., banking, shopping), must make mature decisions about how they will ensure that their needs are met.
Dementia is another glitch that can make home life unsafe.

Photos by Jennifer Jilks

Lyme Disease in Ontario

Sadie, after I removed a tick

Lyme disease testing in Canada questioned

Advocates with Lyme disease are calling on all levels of government in Canada to improve testing and treatment for the illness. The disease is spread by a bite from an infected black-legged tick that introduces bacteria into the bloodstream. Without antibiotic treatment, it can cause a complicated, serious illness.

How to protect yourself from bugs that bite!

How to treat bug bites!

Lyme Disease, while rare, is highly preventable with the right precautions. The bacterium is carried by black-legged ticks, which bite you and suck blood over a period of hours.

I've been getting requests from an American to publicize his articles. They are not research-based, and outline his issues with treatment, or lack thereof, in the US of A. Canada's healthcare is a different situation than in the US, where for-profit Lyme Disease specialists prey on victims of Lyme Disease.

The following is from the Public Health Agency of Canada. Here are a few snippets of good information.

Check for ticks. If you find one:

Carefully remove attached ticks using tweezers. Grasp the tick's head and mouth parts as close to the skin as possible and pull slowly until the tick is removed. Do not twist or rotate the tick and try not to squash or crush the tick during removal.

Lyme disease has been a nationally notifiable disease in Canada since 2009. Please click here for more information on diagnosis and reporting. For more information about the diagnosis of Lyme disease, please see: Ogden N et al. The emergence of lyme disease in Canada. CMAJ 2009;180(12):1221-1224 

Feeding ticks found on a patient’s skin can be submitted to the National Microbiology Laboratory for identification and testing for B burgdorferi infection. For additional information, contact the National Microbiology Laboratory: Phone: (204) 789-2000 Email: ticks@phac-aspc.gc.ca

Lyme Disease Fact Sheet

• What is Lyme disease?

Creepy little thing that hangs on.
They have eight legs.

Lyme disease is an illness caused by the bacterium, Borrelia burgdorferi, which can be spread through the bite of certain types of ticks.

• How do people get Lyme disease?

Small rodents are the most common reservoirs of B. burgdorferi, while larger animals serve as hosts for ticks. Ticks that transmit Lyme disease thrive in wooded areas and can lurk on the tips of grasses or shrubs where they can easily transfer to people or animals as they brush past.

Ticks live in and around wooded areas and they get infected when they feed on mice, squirrels, birds and other small animals that can carry the bacterium. Ticks then spread the bacterium to humans.

• What are the symptoms of Lyme disease?

Symptoms include flu-like reactions: The first sign of infection is usually a circular rash called erythema migrans or EM. It looks like a bull's eye. Next, fatigue, chills, fever; headache; muscle and joint pain; and swollen lymph nodes.

The second stage of the disease, known as disseminated Lyme disease, can last up to several months and include: central and peripheral nervous system disorders, multiple skin rashes, arthritis and arthritic symptoms, heart palpitations and extreme fatigue and general weakness.

If the disease remains untreated, the third stage can last months to years with symptoms that can include recurring arthritis and neurological problems.

For more information on the clinical symptoms of Lyme disease, please see - Lyme disease, A zoonotic disease of increasing importance to Canadians. Canadian Family Physician 2008 

• How is Lyme disease diagnosed?

The diagnosis of Lyme disease should be made after evaluating a patient's symptoms and the risk of exposure to infected ticks. Blood tests may also be used to detect the presence of antibodies to the bacteria.

• What is the treatment for Lyme disease?

Several antibiotics can treat the illness. The sooner treatments starts, the better. Most cases of Lyme disease can be cured with a 2-4 week treatment of doxycycline, amoxicillin, or ceftriaxone.

• What is the Government of Canada doing to address Lyme disease?

The Canadian Institutes of Health Research is currently funding a health research project on Lyme disease. Funding of $820,000 over five years has been provided to study the properties of the bacteria. This health research project will lead to further understanding of the pathogen causing Lyme disease. 

The emergence of Lyme disease in Canada

1. Nicholas H. Ogden, DPhil, 
   
2. L. Robbin Lindsay, PhD,
   
3. Muhammad Morshed, PhD, 
4. Paul N. Sockett, PhD, 
   
5. Harvey Artsob, PhD

GSK Will Pay $3-billion for Avandia, Paxil, Wellbutrin Violations

GlaxoSmithKline agreed to plead guilty and pay a record $3 billion in a deal with federal prosecutors over its marketing of Paxil and Wellburtrin, and for failing to report safety problems with Avandia.

• Drug giant pleads guilty, fined $3B for drug marketing

  WASHINGTON--Prescription drug giant GlaxoSmithKline will plead guilty and pay $3 billion to resolve federal criminal and civil inquiries arising from the… 

• GSK Will Pay $3-billion for Avandia, Paxil, Wellbutrin Violations

    

• GlaxoSmithKline settles healthcare fraud case for $3 billion

Sad day for the chronically ill in California

Medical marijuana

It has its uses. For some of my clients, who have had chronic pain, it is the only solution.

For those who can tolerate it, Cesamet can be a solution, the THC pill.

CANNABINOIDS

Cities Balk as Federal Law on Marijuana Is Enforced

By NORIMITSU ONISHI

Over eight months, more than 500 dispensaries have closed in California. Local officials say the crackdown has brought new chaos to the medical marijuana industry.