Author: Samira Prasad

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From The Globe and Mail

…Schools are organized in a way that guarantees every child a spot in a classroom. When families move or teachers retire, parents aren’t forced to call multiple schools looking for a teacher who is accepting new students. They’re never told that every local school is full, or that an education is only available to their children on an emergency basis.

Why shouldn’t primary care work the same way?

The idea of reorganizing primary care so that it works more like public schools isn’t a new one, but it is enjoying a renaissance as Canada struggles with a shortage of family doctors that is about to get worse.

…primary-care researcher Dr. Tara Kiran is leading a series of national surveys and provincial focus groups called Our Care. The effort has found broad support for reorganizing primary care along the lines of public schools, so long as patients can retain some choice in providers.

As Dr. Kiran pointed out, other countries with high-performing medical systems already do this.

Une réorganisation des soins primaires pourrait atténuer la pénurie de médecins de famille

Extrait du Globe and Mail

… Les écoles sont structurées de manière à garantir à chaque enfant une place dans une classe. Lorsque des familles déménagent ou que des enseignants prennent leur retraite, les parents ne sont pas obligés d’appeler plusieurs écoles pour trouver un enseignant qui accepte de nouveaux élèves. On ne leur dit jamais que toutes les écoles locales sont pleines ou que leurs enfants ne pourront être scolarisés qu’en cas d’urgence.

Pourquoi les soins primaires ne fonctionneraient-ils pas de la même manière?

La réorganisation des soins primaires de manière qu’ils fonctionnent davantage comme des écoles publiques n’est pas une idée nouvelle, mais elle connaît un regain d’intérêt alors que le Canada est confronté à une pénurie de médecins de famille qui est sur le point de s’aggraver.

… la D^re Tara Kiran, chercheuse en soins primaires, dirige une série d’enquêtes nationales et de groupes de discussion provinciaux intitulée NosSoins. Cette initiative a permis de recueillir un large soutien en faveur d’une réorganisation des soins primaires sur le modèle des écoles publiques, à condition que les patients puissent conserver un certain choix quant aux prestataires de soins.

Comme l’a souligné la D^re Kiran, d’autres pays dont les systèmes médicaux sont très performants procèdent déjà de la sorte.

From CTV News

All Canadian jurisdictions should routinely collect data on racial and Indigenous identity to help address inequities in health care, and the best way to do that is during the health card application or renewal process, a group of experts says.

Dr. Andrew Pinto, the lead author of the commentary published Monday in the Canadian Medical Association Journal, said Black and Indigenous patients have less access to care and worse outcomes but allowing them to voluntarily provide identity data could help track racism in the health-care system. He said it would also help monitor any progress toward addressing stereotypes that lead to poorer care for some people.

“It creates a foundation to say, ‘We need to narrow these gaps and develop tailored programs and services,’ ” said Pinto, founder of the non-profit Upstream Lab based at the MAP Centre for Urban Health Solutions at St. Michael’s Hospital in Toronto.

“In Canada, we just lack that data in many, many ways.”

Many racialized communities, which have higher rates of some chronic diseases, including diabetes, heart disease and certain types of cancer, have called for race-based data to gain insights into contributing factors such as poverty.

Op-ed in The Free Press by Tara Kiran, Alan Katz, Amanda Condon

Hardly a day goes by in Manitoba without health care being in the news — and much of the coverage is negative. While there are reports of good, even excellent, individual patient experiences, it is clear that urgent change is needed.

Our health-care system in this province is indisputably struggling. And there is one problem at the heart of our myriad health system challenges: too many Manitobans are struggling to access primary care.

Primary care is the front door to the health-care system. It’s typically delivered by family doctors and nurse practitioners, sometimes with other health professionals.

Family doctors should be the first point of contact when you have a new health issue. Family doctors also manage chronic conditions like diabetes and high blood pressure, help keep you well with immunizations and cancer screening tests, and co-ordinate care from other parts of the health system.

When people don’t have access to primary care, when they don’t have a family doctor and when the front door is closed, nothing works as it should; emergency departments become crowded, unnecessary medications may be prescribed, there are more missed or delayed diagnoses, and patients suffer the consequences.

We need to do better. But how?

For too long, our health-care system reforms have been mainly informed by “experts” — health professionals, people in government, researchers and administrators. We need bold reform to address the crisis at hand, and that reform needs to be driven by the public’s voice.

With this in mind, a team of researchers and clinicians launched OurCare, a national initiative to engage the public about the future of primary care.

From the Toronto Star

We must have law and order, they say. There are more unhoused Canadians, more tent cities, more drug overdoses, more deaths, and you may have to see a homeless person on the subway, so we must get tough. Yes, this may be a complex blend of a global pandemic, a housing crisis, the underfunding and erosion of existing institutions, a toxifying drug supply, and maybe some crypto mixed in, to help move drugs around.

But we are told we must get tough, and that will solve everything. That will bring it home.

“Worst of all, crime and chaos, drugs and disorder rage in our streets,” said Pierre Poilievre, leader of Canada’s federal Conservatives, in the House of Commons last month. “Nowhere is this worse than in the opioid overdose crisis, which has expanded so dramatically in the last several years.”

Such concern, deep concern. Poilievre introduced a motion to ban safe supply of drugs, or safer supply, as some people call it, as if there can be safe supply of a narcotic in our society. That’s the kind of thing a person might say after several alcoholic drinks or maybe some cannabis, purchased at either a government-run store or a private establishment.

The bill was soundly defeated, but Poilievre keeps blaming safer supply — which is often hydromorphone, pharmaceutical-grade heroin — for increases in overdoses and crime. The actual evidence seems to indicate that is just about the opposite of what is actually happening, but who trusts actual evidence these days?

We must have law and order, they say. There are more unhoused Canadians, more tent cities, more drug overdoses, more deaths, and you may have to see a homeless person on the subway, so we must get tough. Yes, this may be a complex blend of a global pandemic, a housing crisis, the underfunding and erosion of existing institutions, a toxifying drug supply, and maybe some crypto mixed in, to help move drugs around.

But we are told we must get tough, and that will solve everything. That will bring it home.

“Worst of all, crime and chaos, drugs and disorder rage in our streets,” said Pierre Poilievre, leader of Canada’s federal Conservatives, in the House of Commons last month. “Nowhere is this worse than in the opioid overdose crisis, which has expanded so dramatically in the last several years.”

Such concern, deep concern. Poilievre introduced a motion to ban safe supply of drugs, or safer supply, as some people call it, as if there can be safe supply of a narcotic in our society. That’s the kind of thing a person might say after several alcoholic drinks or maybe some cannabis, purchased at either a government-run store or a private establishment.

The bill was soundly defeated, but Poilievre keeps blaming safer supply — which is often hydromorphone, pharmaceutical-grade heroin — for increases in overdoses and crime. The actual evidence seems to indicate that is just about the opposite of what is actually happening, but who trusts actual evidence these days?

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Put the money from safe supply into rehabilitation only, Poilievre and others say. The idea of involuntary confinement has been floated. No more safe supply.

“No, safe supply isn’t killing people,” says Zoe Dodd, a community scholar at the MAP Centre for Urban Health Solutions, at Unity Health. “People are dying from the unregulated drug market. They’re dying of fentanyl and fentanyl laced with benzodiazepines and other drugs. That’s been the case for many years now.”

“It’s not about addiction and mental illness. It’s about trying to invisibilize people who are on the street, and not actually address the problem that we have in this country, which is about the unaffordability of housing, which affects everybody.

“They’re telling people to go to organized crime for your drugs instead.”

There are those who actually deal with the problem and support safer supply: frontline doctors, the Centre for Addiction and Mental Health, the BC Centre For Disease Control, Toronto police, the Canadian Association of Chiefs of Police, Toronto Public Health, almost every Toronto mayoral candidate, Quebec’s Health Ministry, Health Canada. This is a very partial list.

From CBC News

A quick brush of the gums and you’ll know your HIV status. No blood required. 

That’s the kind of painless, fast and accurate HIV testing researchers at St. Michael’s Hospital in Toronto are hoping will become the norm for Canadians as the researchers test OraQuick, a rapid oral self-test that will deliver results in 20 minutes. 

The federal government estimates about 62,000 people in Canada have the disease, based on surveillance data. But only about 87 per cent of those with HIV have been diagnosed, leaving about 13 per cent who may not know they are positive, it says.

While the test is new to Canada, OraQuick was approved by the U.S. Food and Drug Administration in 2012. 

St. Michael’s is now testing OraQuick at two Toronto sexual health clinics, Hassle Free Clinic and Maple Leaf Medical Clinic, along with several others across Canada. Trials at the Toronto clinics started last week. 

The study will look at the test’s accuracy and ease of use. OraSure Technologies, which created OraQuick, estimates the test has a 92 per cent accuracy rate. 

“The test is easier than the COVID test,” said Sean Rourke, a clinical neuropsychologist and one of the leaders of the study. 

Advances in HIV treatment mean that ideally, once diagnosed, a person can access medications that allow them to live a long life and not transmit the disease, even through unprotected intercourse or by giving birth, he said.

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Story by Alyssa Ranieri, Outreach Counsellor with the Navigator Project

I met Mike (not his real name) this past April. He’s in his 30s and lives with schizophrenia, anxiety, fetal alcohol syndrome and PTSD. It’s a lot to carry. I first met him at St. Michael’s Hospital, where he was admitted with an acute illness. He was homeless at the time.

I work in the hospital’s Navigator Program. I am a Homeless Outreach Counsellor, which means I work with patients who are homeless and who have a serious health condition requiring care in the hospital. My job is to make the healthcare experience easier and more comfortable while patients are in hospital, and afterward to help them access healthcare and other services in the community so they can avoid another hospitalization.

I arranged to meet Mike at a shelter shortly after he was discharged. We try to work with people where they are, whether on the street or in shelters. I wish more programs did this. It can be so difficult just to manage basic survival needs when you’re homeless – so we make this part easier. The people we work with don’t do well if they have to show up in an office at exactly the right time. They also often feel stigmatized in traditional healthcare settings and may have experienced discrimination in the past.

When I got to the shelter, Mike wasn’t there. I went to the pharmacy that he had told me he used regularly. He was surprised to see me. I think it convinced him that I really was on his side.

Over the next few months, Mike and I did a lot of work together. When we first met, he was in a bad cycle. People with fetal alcohol syndrome can be an easy target for bullies and thieves. He was using drugs to cope with the stress of being on the street. Then the drugs would make him paranoid and he’d end up in hospital.

Our goal was to break the cycle.

We found him somewhere to live – first in a shelter, then in a rooming house. His drug use was putting him at high risk of an overdose, so we helped him get into a new harm reduction program called Safer Opioid Supply. It’s a mobile team that includes physicians, nurses, nurse practitioners and case workers who visit people who use street drugs; the team administers a weekly supply of safe opioids. And we talked, a lot, as I tried to help him build the confidence he would need to try to overcome the hurdles standing between him and a healthier, safer future. Through all this, I was always impressed by Mike’s courage and resiliency.

I completed my time working with Mike in October, as the Navigator Program is intended to make a difference in people’s lives over a time-limited period. Over the course of several months, Mike made a lot of changes. He got settled in housing. He has supports. He’s safer and, I think, less anxious. He knows there are people who care about him.

The last time I saw Mike, he told me how grateful he was. He said he was really going to miss me. Thousands of people in Canada, just like Mike, need this kind of helping hand to improve their health. I’m doing my best to reach as many as I can.

Mike et moi : surmonter les obstacles à l’accès aux soins de santé

Récit d’Alyssa Ranieri, conseillère communautaire du Projet Navigateur

J’ai fait la connaissance de Mike (nom fictif) en avril dernier. Il a une trentaine d’années et souffre de schizophrénie, d’anxiété, du syndrome d’alcoolisation fœtale et du syndrome de stress post-traumatique. C’est beaucoup de choses à supporter. Je l’ai rencontré pour la première fois à l’Hôpital St. Michael, où il avait été admis pour une courte maladie. Il était alors sans domicile fixe.

Je travaille au sein du programme Navigateur de l’hôpital. Je suis conseillère auprès des sans-abri, ce qui signifie que je travaille avec des patients qui sont sans domicile fixe et qui ont un problème de santé grave nécessitant des soins hospitaliers. Mon travail consiste à rendre l’expérience des soins de santé plus facile et plus confortable pendant que les patients sont hospitalisés et, par la suite, à les aider à accéder aux soins de santé et à d’autres services au sein de la collectivité afin qu’ils puissent éviter une nouvelle hospitalisation.

J’ai organisé une rencontre avec Mike dans un refuge peu après sa sortie de l’hôpital. Nous essayons de travailler avec les gens là où ils se trouvent, que ce soit dans la rue ou dans les centres d’hébergement. J’aimerais que davantage de programmes fonctionnent de la sorte. Il peut être très difficile de répondre aux besoins de base des personnes sans abri; c’est pourquoi nous rendons cette tâche plus facile. Les personnes avec lesquelles nous travaillons ne sont pas très à l’aise lorsqu’elles doivent se présenter dans un bureau à un moment précis. Elles se sentent également souvent stigmatisées dans les environnements de soins traditionnels et elles peuvent avoir été victimes de discrimination dans le passé.

From Healthy Debate

There is no doubt primary care plays a vital role in reducing health inequities. Health systems with strong primary care have been shown in multiple studies to lower both the absolute numbers and the gap between people with low and high incomes when it comes to neonatal mortality, babies with low birth weight and deaths from cancer, stroke, heart and lung disease, while increasing life expectancy at the population level.

Even though health care in Canada is publicly funded, individuals with low incomes too often face barriers when it comes to accessing health-care services, which can adversely impact their overall health. For instance, the life expectancy in Montreal’s poorest neighbourhoods is 10 years shorter than in the richest ones, due to an interplay of unfavourable health determinants, including access barriers to primary-care services that are influenced by cultural, economic and educational factors. For example, recent data from Ontario found that people living in the poorest neighborhoods were the least likely to have a regular family doctor. The COVID-19 pandemic illustrated how low income – and other social determinants of health – coalesced with poor access to services; together these were associated with communities having higher numbers of COVID-19 cases, hospitalizations and deaths.

At the same time, the COVID-19 pandemic has significantly accelerated the adoption of virtual care in Canada, leading to major investments by the federal government and the emergence of multiple privately operated virtual-only services, some of which are not part of the publicly funded system.

But income plays a significant role in virtual care adoption and interest.

According to the OurCare survey, 69 per cent of individuals with an income of $150,000 or more say that they are not at all or not very willing to use virtual services that charge fees for services they could obtain for free through regular doctor or nurse practitioner visits. In comparison, 88 per cent of those with an income less than $20,000 say the same. If improperly regulated, the development of new private-pay virtual care services could potentially exacerbate existing disparities in access to care.

From CTV News

Overall health-care costs could be reduced in Canada by providing free prescription drugs to patients, according to a new study.

Led by a researcher from the University of Toronto’s medical school, the three-year study aimed to see how eliminating out-of-pocket medication fees would impact health-care system spending, particularly for patients who reported delaying or not taking prescription drugs due to costs.

“There are millions of Canadians who report not taking medications because of the costs,” lead author and University of Toronto associate professor Dr. Nav Persaud told CTVNews.ca. “We were trying to measure the effects of providing people with free access to medicines, as would happen in a national pharmacare program.”

The study tracked 786 adult patients at nine primary care sites in Ontario who were taking 128 different essential medicines that covered everything from diabetes to depression. In addition to prescriptions, total health-care cost calculations included emergency room trips, hospitalizations, home care, and visits with doctors and specialists.

From CBC News

Manitoba researchers looking for people to take part in a national HIV Stigma Index project are only about halfway to their goal of hearing from at least 75 people living with a positive diagnosis.

The international peer-driven research project helps understand the stigma associated with HIV and supports those living with a diagnosis.

“I wouldn’t say that anybody ran out and said ‘I’m gonna go get HIV today and see how that happens.’ Things happen to people and it’s our duty as human beings to support people no matter what they’re going through,” research co-ordinator Arthur Miller told CBC Information Radio Wednesday.

The Canadian HIV Stigma Index is a community-led and community-based research study, part of the international implementation of the People Living with HIV Stigma Index project

Participants are interviewed by another person living with a positive diagnosis. Interviews are about an hour-and-a-half long and can be done in person, by phone or through a video conferencing platform, said Miller, a Mi’kmaw HIV activist based out of Nova Scotia and research co-ordinator of the project with REACH Nexus, under the MAP Centre for Urban Health Solutions at Unity Health Toronto.

The national project has been done in Ontario, Quebec, Atlantic Canada and British Columbia, and this is the second time it’s being done in Manitoba, with an updated survey.

Researchers collect information related to stigma, discrimination and human rights, with the aim of better understanding the social determinants and stigma across systems like health care, schools and legal fields. The research aims to help people develop supports and policies at both local and national levels.

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From CBC News

Results from an experimental program that provides free prescription drugs to hundreds of people in Ontario suggest covering the cost of medication produces overall savings for the health-care system, according to a new study.

The research, published Friday in the journal JAMA Health Forum, tracked a total of 747 patients who reported that the high cost of drugs has forced them to leave prescriptions unfilled or stretch out the time between doses. About half were randomly selected to have their drugs fully covered.

After three years, the researchers found that providing prescriptions free of charge to these patients saved the public health-care system an average of $1,488 per patient per year, by helping to prevent such things as unexpected trips to the hospital.

“I was surprised by the magnitude of the savings,” said Dr. Nav Persaud, one of the study’s authors, a Canada Research Chair in Health Justice and a staff physician at St. Michael’s Hospital in Toronto.

“It seems like eliminating medication costs both saves money in avoided hospitalizations, avoided emergency room visits, makes people healthier and addresses health inequities — it makes access to health more fair.”

The study comes as Canadians wait to see if legislation enabling a universal pharmacare plan will be tabled by the end of 2023, as promised under the confidence-and-supply agreement between the federal Liberals and New Democrats. 

Une nouvelle étude suggère que la gratuité des médicaments permet de réaliser des économies globales en matière de soins de santé dans le cadre d’un essai mené en Ontario

Tiré de CBC News

Les conclusions d’un programme expérimental qui fournit gratuitement des médicaments sur ordonnance à des centaines de personnes en Ontario suggèrent que la prise en charge du coût des médicaments permet de réaliser des économies globales pour le système de santé, selon une nouvelle étude.

La recherche, publiée vendredi dans la revue JAMA Health Forum, portait sur 747 patients qui ont déclaré que le coût élevé des médicaments les avait contraints à ne pas renouveler leurs ordonnances ou à espacer les prises. Environ la moitié d’entre eux ont été sélectionnés au hasard et ils ont vu leurs médicaments entièrement pris en charge.

Après trois ans, les chercheurs ont constaté que le fait de fournir gratuitement des ordonnances à ces patients permettait au système de santé public d’économiser en moyenne 1 488 $ par patient et par an, notamment en évitant des déplacements imprévus à l’hôpital.

« J’ai été surpris par l’ampleur des économies réalisées », a déclaré le D^r Nav Persaud, l’un des auteurs de l’étude, titulaire d’une chaire de recherche du Canada sur la justice en santé et médecin à l’Hôpital St. Michael de Toronto.