Author: Samira Prasad

From Unity Health Toronto

Patients experiencing homelessness are 14 to 18 times more likely to visit emergency departments (EDs) in Toronto for cold weather-related injuries compared to non-homeless patients, according to a new study from Unity Health Toronto and ICES. The findings highlight the need to increase the number and accessibility of winter services throughout the cold season to prevent future injuries and lessen the strain on city emergency departments, the researchers say.

The study, led by researchers at MAP Centre for Urban Health Solutions and published in The Canadian Journal of Emergency Medicine, also found that women experiencing homelessness had consistently higher burden of cold-related injuries compared to men experiencing homelessness, relative to their housed counterparts.

 “Injuries related to cold exposure are to some extent an unavoidable reality in Canada, but the sheer excess burden among those experiencing homelessness is largely preventable,” said Lucie Richard, senior research associate at MAP and study lead author. “Providing adequate, accessible emergency warming services is not only a compassionate imperative, it’s also necessary to prevent major health-related consequences of cold weather-related injury including nerve damage, amputation, or loss of life.”

Dr. Carolyn Snider, chief of emergency medicine at St. Michael’s Hospital, said the study highlights a significant health consequence associated with the lack of access to round-the-clock shelter, particularly in adverse weather conditions. “The distressing effects on patients observed in our emergency departments in Canada are deeply worrisome – especially as they are preventable,” she said.

From the Toronto Star

Across the country, calls are growing for targeted reforms to primary care, including the expansion of team-based care, which connects patients to interdisciplinary groups made up of pharmacists, social workers, dietitians and other health-care professionals, in addition to nurses and physicians. Evidence suggests such teams improve patient outcomes.

Health leaders also want to see primary care shift to a geographic model to ensure every resident has access to a family doctor within a 30-minute drive of where they live or work. As well, there is a push to allow patients in a team-based environment have a non-physician health professional co-ordinate their care.

Such reforms are necessary given the scale of primary-care needs in the province, says Dr. Rick Glazier, scientific director of the Canadian Institutes of Health Research’s Institute of Health Services and Policy Research.

Even as the need grows for more family doctors to fill the gaps, research shows about 17 per cent of Ontarians are attached to a physician over the age of 65 who is nearing retirement. Glazier says there aren’t enough MDs graduating medical school to replace the aging workforce.

“We don’t have the generation coming behind those people who are retiring,” says Glazier, a family doctor at St. Michael’s Hospital, a part of Unity Health Toronto.

“We will need these interprofessional teams for primary care. We will not be able to do this with doctors alone.”

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From The Globe and Mail

Opioid-related deaths surged among teens and young adults in Ontario from 2014 to 2021, according to a new report that also found a sharp increase in the number of young people visiting the province’s emergency rooms because of opioid use.

While the vast majority of opioid-related deaths occur in people over the age of 25, the fact that more people the ages of 15 to 24 are dying is a cause for alarm, said Tara Gomes, lead of the Ontario Drug Policy Research Network and a scientist at Unity Health Toronto.

The report, which will be released Tuesday, found that emergency-room visits for opioid overdoses among 15- to 24-year-olds quadrupled from 69 in the second quarter of 2014 to 297 visits in the second quarter of 2021.

Deaths tripled from21 per quarter in 2014 to 58 in the first quarter of 2021, but there was a drop in deaths to 29 in the second quarter of 2021, the final quarter being studied. It’s unclear to researchers if the decline is part of a meaningful trend. According to online data from Public Health Ontario, there were 224 opioid-related deaths in the 15-24 age category in 2021.

Les décès liés aux opioïdes font un bond chez les adolescents et les jeunes adultes de l’Ontario entre 2014 et 2021 : rapport

Extrait du Globe and Mail

Entre 2014 et 2021, les décès liés aux opioïdes ont bondi chez les adolescents et les jeunes adultes en Ontario selon un nouveau rapport qui révèle également une forte augmentation du nombre de jeunes se rendant dans les salles d’urgence de la province en raison de leur consommation d’opioïdes.

Bien que la grande majorité des décès liés aux opioïdes surviennent chez des personnes de plus de 25 ans, le fait que davantage de personnes âgées de 15 à 24 ans en meurent est une cause d’alarme, a déclaré Tara Gomes, responsable de l’Ontario Drug Policy Research Network et scientifique à Unity Health Toronto.

Le rapport, qui sera publié mardi, révèle que les visites aux urgences pour des surdoses d’opioïdes chez les 15 à 24 ans ont quadruplé, passant de 69 au deuxième trimestre 2014 à 297 au deuxième trimestre 2021.

From Unity Health Toronto

Rates of opioid-related deaths among Ontario teens and young adults tripled from 2014-2021 and hospital emergency department visits related to opioid use quadrupled over the same period, a new report shows. At the same time, treatment rates for opioid use disorder decreased for Ontarians ages 15-24, the research found. 

The report, led by  the Ontario Drug Policy Research Network at St. Michael’s Hospital, ICES, the Office of the Chief Coroner for Ontario and Public Health Ontario, analyzed provincial healthcare and demographic data from 2014-2021, and identified trends, characteristics and patterns of healthcare use among teens and young adults aged 15-24.

The report found that medications used to treat opioid use disorder (including methadone and buprenorphine) among teens/young adults fell 50 per cent between 2014 and 2021. Residential treatment admissions fell 73 per cent during this same time period.

“The contrasting patterns of declining rates of treatment for opioid use disorder against rising opioid-related harms among younger Ontarians is troubling,” said Dr. Tara Gomes, principal investigator of the ODPRN and scientist at the Li Ka Shing Knowledge Institute at St. Michael’s Hospital and ICES.

“This report shows that both teens and young adults who have an opioid use disorder and those who use drugs only occasionally are experiencing harm, which is primarily driven by fentanyl in the illicit drug supply. We, therefore, need to adapt our available treatment, harm reduction, and mental health supports to ensure that they are designed to meet the unique needs and goals of our younger population.”

From Unity Health Toronto

Physicians, researchers and experts – many from Unity Health Toronto — are calling for the collection of data on race and Indigenous identity during the health card application and renewal process as a way to identify and address health inequities.

The group outlined their proposal in a commentary published in The Canadian Medical Association Journal.

In Canada, research shows that Indigenous and racialized patients have worse access to healthcare, receive poorer care and have worse outcomes than White people. Racism in healthcare faced by Indigenous and Black patients has been well-documented in reports and investigations.

“Having data on race available for analysis can facilitate the measurement of racial inequities and help to hold organizations and governments accountable for addressing these and monitor progress,” wrote the authors, who include Dr. Andrew Pinto, Dr. Azza Eissa, Dr. Tara Kiran, Dr. Angela Mashford-Pringle, Unity Health Director of Anti-Racism, Equity and Social Accountability Allison Needham and Dr. Irfan Dhalla.  

The group wrote that collecting self-reported race data will allow for the measurement of health inequities, and help hold organizations and governments accountable for addressing these inequities. Having data on race will also help analysts track and measure progress, they wrote.

Dr. Tim Rutledge, President and CEO of Unity Health Toronto network, which includes St. Joseph’s Healthcare, St. Michael’s Hospital and Providence Healthcare, said the recommendations will help ensure the best care for all patients.

“At Unity Health our aim is to provide excellent, compassionate and equitable care to all in need. Having appropriately trained individuals analyze data on race and Indigenous identity is a critical step in helping hospitals like ours achieve this goal,” Rutledge said. “We need to ensure we are centering the voice and expertise of Indigenous and racialized communities as we make plans about how to address health care needs.”

There are several examples of how data on race and Indigenous identity helped pave the way for change. For example, in 2021 the Centre for Addiction and Mental health in Toronto found that Black patients were restrained 44 per cent more often than White patients, and used this data to justify the development of an antiracism plan. Public health programs in Ontario and Manitoba used data on race and Indigenous identity to inform the rollouts of the COVID-19 vaccines.

Last year, Nova Scotia began giving people the option of providing race information when they renewed their health cards, as part of an effort to provide more equitable care and improve healthcare services to all communities in that province.

Anna Greenberg, Chief Regional Officer for Toronto and East Regions and Executive Lead, Equity, Inclusion, Diversity and Anti-Racism at Ontario Health, said the recommendations are consistent with the Black Health Plan for Ontario, which were recently released by Ontario Health and its partners.

“Tracking how outcomes are different for some communities compared to others is critical to developing data-informed strategies to improve care and eliminate disparities,” Greenberg said.

The group suggests a framework for collecting this information, with appropriate safeguards in place to prevent potential harms. They suggest:

1. Asking about race and Indigenous identity in a safe and transparent manner, with an explanation that disclosing this information is voluntary.
2. Data on race and Indigenous identity should not be visible on health cards and individuals who have access to the data should receive antiracism training.
3. Ensuring data are not interpreted or presented in a manner that reinforces racism and discrimination.
4. Create legislation that protects communities, so that health data are not used to draw broad conclusions about communities.
5. Support Indigenous, Black and racialized communities to lead and direct the process of data collection, analysis and dissemination, with data sovereignty and governance frameworks.

Learn more: https://www.cmaj.ca/content/195/25/E880

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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.