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Dr. Eric Cadesky: B.C. doctors working to improve care for residential-care patients

July 9, 2018

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Updated: June 30, 2018

The Vancouver Sun’s series on seniors’ care in B.C. brings to light challenges in how we care for people who bear the greatest burden of chronic disease. The provincial government has offered solutions such as hiring more care aids, opening additional long-term care beds and increasing support for seniors living at home. Readers should also be aware that B.C.’s medical doctors are working with the provincial government on the Residential Care Initiative.

Through non-profit organizations called Divisions of Family Practice (also funded by Doctors of B.C. and the provincial government), family doctors are creating local, grassroots residential-care solutions that reduce unnecessary hospital transfers, improve care experiences for patients and providers and reduce costs to the system while improving quality of care. All divisions have RCI projects, meaning that 99 per cent of the eligible 30,000 residential-care beds in the province now benefit from RCI work in some way.

RCI projects around the province provide residential-care patients with access to comprehensive care from their family doctor through regular visits, after-hours on-call coverage and care team meetings. Strong doctor/patient relationships play an important role in improving patients’ overall health and quality of life, especially when a patient has complex needs such as dementia, diabetes and heart and lung disease.

Providing patients with regular physician visits in local facilities has reduced unnecessary hospital transfers significantly in many regions. For example, transfer rates have been reduced in Mission by 33 per cent, in Kootenay Boundary by 34 per cent and 31 per cent in Salmon Arm.

Meaningful medication reviews are another component of RCI projects. Care teams — which can include doctors, pharmacists, nurses, care aids, family members and the patients themselves — review the goals of care and the current plan in order to avoid negative medication interaction, eliminate unnecessary prescriptions and investigations and reduce the number of patients prescribed antipsychotic medications (an issue outlined in the Vancouver Sun series’ fourth instalment, entitled, The problems with residential care.)

Physician-organized medication reviews in the Kootenay Boundary region have reduced the number of patients on antipsychotics without a diagnosis of psychosis by 28 per cent and reduced the number of patients on nine or more medications by 15 per cent. Medication reviews in Mission have also helped reduce the number of patients on nine or more medications by 18 per cent. Reviews in Abbotsford facilities have reduced the number of patients on multiple medications by 6.7 per cent and the number of patients being prescribed antipsychotics by 8.7 per cent.

These early data represent a small fraction of the results, as meaningful medication reviews are underway in facilities in Vancouver, Victoria, the Fraser Northwest and Shuswap-North Okanagan regions and in other communities around B.C.

To ensure value, RCI projects undergo in-depth evaluation and the early results are encouraging. While the RCI will not fix all of the systemic challenges facing our aging population, we commit to continuing to improve our patients’ quality of life through this work. Further evaluation of local RCI projects will identify which initiatives can be scaled to residential-care patients in communities around the province. It also shows that when we all work together — doctors, government, health authorities, health providers and patients — we can truly make a difference in the health of our patients and communities.

Dr. Eric Cadesky is president of Doctors of B.C.

Coming to Princeton!!!

June 27, 2018
Okanagan Men's Shed

Okanagan Men’s Shed

June 21, 2018

Men living in rural communities are at higher risk for loneliness and social isolation, factors that directly influence their health and wellbeing.  In a one year study, IHLCDP Associate Dr. Nelly Oelke, and her team are teaming up with the Okanagan Men’s Shed Association to deliver and evaluate a mobile Men’s Shed to rural communities in the Southern Okanagan Similkameen.  This project, the first of its kind, will also help to better understand the mental wellbeing needs of men in these rural communities and build capacity for supporting the development of local Men’s Sheds. Men’s Sheds are designed to bring men together in a space where they can connect with other men and participate in a range of activities. Research has shown that Men’s Sheds enhance men’s mental and physical wellbeing and improve quality of life. Other team members include IHLCDP Associate Dr. Carolyn Szostak, Dennis Jasper, and Art Post, President of the Okanagan Men’s Shed Association.  This research is funded by the SSHRC. Funding from the New Horizons program has enabled the Okanagan Men’s Shed Association to build a mobile shed and take it out to rural communities.

Listen to webinar focusing on Men’s Sheds with Dr. Nelly Oelke, Dr. John Oliffe, and Art Post
June 19, 2018 – Men’s Shed presentation

For more information, please visit Okanagan Men’s Shed Association.

Ontario Family GP on the Benefits of Adding a PA to his practice

June 20, 2018

Published on May 9, 2018

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Anne Dang, CCPA
Vice President at Canadian Association of Physician Assistant


What benefit have you noticed since adding PA to your practice?

Dr. Dhalla:  A great benefit of having our PA, Deniece, join us is increased access. We see more patients, perhaps more importantly, the quality of service for each encounter is also enhanced . Patients often present with multiple complaints, we must triage the more important ones, while maintaining a patient centered approach.   With Denice, both access to care and quality have improved. In addition, she adds preventative care aspects to the patients care.

In my 15 years in practice, I realize that good communication is the foundation of great care. We follow guidelines and interpret tests, and implement recommendations. Sometimes, in the routine, we lose focus of the patient’s viewpoint. When we both see or review patients, we can better reframe our (clinician and patient) goals..

With our PA Deniece, we have better access for same day appointments. This reduces unnecessary ER visits, or walk in clinic use and allows early intervention in the course of an illness. More often, patients benefit from reassurance and counselling, along with health education.

As other physicians are retiring in our community, we have been able to take on new patients and provide care for those who would otherwise not have a family physician. In addition, having Deniece in my practice allows some patients to open up a little bit more than they would to a physician directly. Patients have a connection with Deniece and they feel they can confide their health concerns and worries, trusting that she will listen and help them.

Benefits of adding a Physician Assistant to a Family Practice – Deniece O’Leary, PA-C in Canada

How is it determined whether the patient gets to see a PA or MD? Read more »

Family-and-friend caregivers to receive much-needed relief with expanded supports

June 18, 2018

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News Release
Vancouver
Monday, June 18, 2018 11:45 AM

The Ministry of Health is investing $75 million to expand respite care and adult day programs, helping both seniors and their loved ones, announced Adrian Dix, Minister of Health.

“Many B.C. seniors count on their spouses, children and close friends to help them stay at home, and cope and manage chronic conditions,” said Dix. “Caregiving without adequate supports can impact the whole family, particularly a person’s ability to live at home, which is what most seniors and their loved ones want. Giving seniors better options and supporting unpaid caregivers to take time for themselves is a necessity.”
Over the next three years, the Province will improve and strengthen respite services and adult day programs to support seniors and their family-and-friend caregivers. The number of respite beds will be increased, and overnight care at home will be made more accessible. In addition, the number of adult day program spaces will be increased, and the hours of operation will be expanded to provide services on evenings and weekends. As part of the work, health authorities are developing plans to meet localized needs of family-and-friend caregivers and seniors in their regions.

“The August 2017 report from the Office of the Seniors Advocate estimates that 31% of seniors had a primary caregiver in distress,” Dix said. “According to the report, the number of clients accessing adult day programs and the number of hours per client decreased in recent years. Over the past five years, there were also a significant cut in the number of respite beds. Under the direction of Premier Horgan, we are changing direction by expanding respite care and adult day programs. This plan will provide more direct care for seniors and afford family-and-friend caregivers time for themselves to reduce stress and exhaustion.” Read more »

B.C. should allow physician assistants

June 7, 2018

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Times Colonist

MAY 27, 2018 12:05 AM

The B.C. government should be applauded for launching a renewed approach to primary care. Patients in B.C. deserve faster and improved access to primary care, which is a key pillar in any successful health system. A focus on team-based care will be critical to this success.

There simply aren’t enough providers to care for everyone in B.C., especially those in remote communities. Recruiting more family doctors and hiring more nurse practitioners will most certainly help.

What was not included in this important announcement was the introduction of physician assistants into B.C. PAs work independently under the supervision of a physician and are able to diagnose, develop treatment plans and work closely with patients throughout their care.

PAs practice in Alberta, Manitoba, Ontario, New Brunswick and in our Canadian Armed Forces. They are also critical members of the health-care team in the U.K., the Netherlands, the U.S. and elsewhere.

They’re used in all of these jurisdictions because evidence proves that PAs reduce wait times, improve care and save money. It’s time for B.C. to introduce PAs so that patients and families can benefit from their skills as part of the health care team.

Trevor Stone

President

Canadian Association of Physician Assistants

How Ontario’s next government could relieve overcrowded hospitals

June 3, 2018

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By THERESA BOYLE Health Reporter

Sun., June 3, 2018

The number of patients who occupied hospital beds even though they no longer required hospital care hit a record level in Ontario this past winter, the Star has learned.

As a result, emergency room wait times also hit an all-time high.

Women’s College Hospital is performing knee replacement surgery as an ambulatory procedure, in which patients are sent home the same day. (LUCAS OLENIUK / TORONTO STAR)

Women’s College Hospital is performing knee replacement surgery as an ambulatory procedure, in which patients are sent home the same day. (LUCAS OLENIUK / TORONTO STAR)

Almost 5,000 patients, most of them frail and elderly, were stuck in hospital beds because long-term-care homes were full or because it was unsafe for them to return home without more support, according to newly audited data from the Ontario Hospital Association (OHA) and the province’s Health Ministry.

This caused a bottleneck for patients admitted to hospitals through emergency departments. The 90th-percentile wait time for transfer to an in-patient bed was 40.9 hours, meaning 90 per cent of patients waited less than that time before being admitted.

It’s not surprising then that “hallway medicine” has become a major theme in the June 7 provincial election. There has been a lot of talk on the campaign trail about hospitals housing patients in “unconventional spaces” such as bathrooms and storage rooms. Health care always ranks as a top concern among voters, but rarely gets this kind of attention. Read more »

Cities & States Sue Big Pharma, Targeting the Firms Who Profited from Peddling Addictive Opioids

June 3, 2018

opioids

New York Mayor Bill de Blasio announced earlier this year that the city would sue manufacturers and distributors of prescription opioids to account for their part in the city’s ongoing deadly opioid epidemic. Firms named in the suit include Purdue Pharma, Johnson & Johnson and McKesson Corporation. The Guardian reports that more than 60 cities are suing Big Pharma over opioids. An explosive New York Times report has revealed that manufacturers of the drug OxyContin knew it was highly addictive as early as 1996, the first year after the drug hit the market. 

MAYOR BILL DE BLASIO: This is a man-made crisis if ever there was one, fueled by corporate greed, fueled by the actions of big pharmaceutical companies that hooked millions of Americans on opioids to begin with. And some of them still are addicted to prescription drugs, and others have migrated to heroin. But we know where it began for so many people. And, bluntly, it was so a very few people could profit, and, obviously, the horrible actions of criminals who sell drugs and profit in death, as well. That combination has led to where we are today. We need to remember that those origins at the root of this problem means it’s a problem that can be defeated. We can fight back against the big pharmaceutical companies. We can fight back against the criminals who peddle drugs. We can change in so many ways, including changing the entire culture around this issue, so we can help people.

To read the full article, click on 

https://www.democracynow.org/2018/6/1/cities_states_sue_big_pharma_targeting?utm_source=Democracy+Now%21&utm_campaign=2d4c38c3e2-Daily_Digest_COPY_01&utm_medium=email&utm_term=0_fa2346a853-2d4c38c3e2-191686713

BC Health Coalition applauds the new team-based primary health care strategy

May 28, 2018

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May 24, 2018

Team-based strategy will ensure faster and more appropriate care

For immediate release

Vancouver, BC – Unceded Coast Salish Territories 

The BC government announced today a major investment in the new primary health care strategy to improve access for British Columbians. Team-based care is central to the new primary health care strategy. This announcement indicates a change of approach and a system-wide transformation of primary care.

Primary health care is a major priority for BCHC members. Over the past few months, the BC Health Coalition has been actively working with Ministry of Health on primary health care. The BCHC has been a strong advocate for community and patient participation in health care development.

“Primary health care is not one size fits all. People need to be able to access the type of health care worker that can best address their needs–this might be a physiotherapist, a social worker, a pharmacist, or a doctor,” says Edith MacHattie, BC Health Coalition co-chair. “Providing team-based care will better meet the needs of British Columbians.”

As part of the new strategy, the BC government is implementing primary care networks, urgent care centres and community health centres. Read more »

China caring for our seniors

May 26, 2018

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Colin Dacre – May 26, 2018 / 5:00 am | Story: 227232

Photo: Retirement Concepts

Local politicians are sounding the alarm about the level of care being provided to seniors at a care home in Summerland now owned by the Chinese government.

The Summerland Seniors Village is one of 21 B.C. facilities owned by Retirement Concepts, a company purchased by China’s Anbang Insurance for $1B last year. In February, the Chinese government seized control of the company and jailed its CEO for fraud.

Central Okanagan MP Dan Albas says he’s heard from family members of residents at the Summerland Seniors Village that care has degraded since the takeover.

He said he’s been told of instances where the facility has been staffed so short, a single nurse is supervising 20 residents overnight.

“That’s alarming. If there was an emergency of any sort, a fire or whatnot, lives are at risk,” he said.

In addition to independent and assisted living, the facility provides complex care to residents with severe dementia.

Albas is calling on the federal government to open a dialogue with the Chinese government about the issue, “it’s not up to the province of B.C. to negotiate with China’s state government.”

Penticton MLA Dan Ashton said he’s heard the same complaints about the Summerland Seniors Village being understaffed recently. However, he said other factors are also at play.

He pointed to a large wage disparity for staff between privately run care homes and the union-staffed facilities managed by Interior Health. With an existing shortage of care aides in the province, most new graduates are opting to work for IH for more money and benefits.

“The government requires 3.34 hours per individual in these homes, and it is my understanding the residents are not getting that because of the inability to find staff to provide that,” Ashton said.

“It’s not being contained to just this one centre, but this centre is feeling a substantial pinch on it, that in my opinion and other people’s opinions, residents are being put at risk due to the amount of help that is available at certain times during the day,” he continued.

Ashton is calling on Interior Health to enforce staffing regulations in care homes and stop sending patients to facilities that are documented to be understaffed.

He raised the issue with Health Minister Adrian Dix in the Legislature earlier this month, who called the Chinese takeover of Retirement Concepts a “very significant situation.”

“They have a responsibility to provide adequate care. We’ve been very clear with them. We’re meeting with the representatives of the new owners, who are effectively the government of China, in the coming weeks,” Dix said.

“Our message is that care standards have to be maintained, that we don’t expect any deviation from the commitments made to us and that we’re reviewing every aspect of this to make sure that the seniors who live in those care homes are protected,” he continued.

The federal government’s approval of the sale of Retirement Concepts to Anbang in Feb. 2017 raised eyebrows in both B.C. and Ottawa, but the Trudeau government said at the time the company assured service levels in care homes would be maintained.

Noting that he also gets complaints about understaffing at non-Chinese owned care homes, Ashton said he wants to see all privately run centres, “bring their standards up to where they are supposed to be, at a minimum.”

“That’s going to involve Interior Health, the Province of B.C. and the Government of Canada.”

Medical school graduates face growing problems obtaining required residency positions

May 26, 2018

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PAUL ATTFIELD

PUBLISHED 3 HOURS AGO

UPDATED MAY 25, 2018

Around 115 medical-school graduates across the country will be without residency positions this year – up from 99 in 2017 and 77 the year prior.

Around 115 medical-school graduates across the country will be without residency positions this year – up from 99 in 2017 and 77 the year prior.

 

More than many Canadian medical schools, the Rady Faculty of Health Sciences at the University of Manitoba seems to understand the current plight of the country’s medical students.

With around 115 medical-school graduates across the country without residency positions this year – up from 99 in 2017, and 77 the year prior – the school acknowledges the state of limbo that these students face.

Quite simply, without those two-to-seven years of required training in their fields following graduation from faculties of medicine, they are unable to practise.

“It’s not a degree that you can move into the work force without residency training, so it really does strand you,” says Dr. Brian Postl, dean of the Max Rady College of Medicine and the university’s Rady Faculty of Health Sciences.

Residency positions are allocated through a process known as matching, in which students rank their preferred specialties and residency locations and the medical schools do the same, with a system of algorithms determining a match. If students are passed over in the first round of selection, they can try again in the second round of matching. However, if they are unable to find a match at that point, they have to wait a year.

The number of unmatched students is increasing on a yearly basis; this year, there were 101 positions available for every 100 graduates, compared with a ratio of 110:100 in 2009. But many of those left over are francophone positions in Quebec, and/or in locations or specialties which students didn’t rank among their preferences.

To help address the problem, the University of Manitoba has devised something of a solution, offering positions for any of its unmatched students.

“We, for a very long time, have felt that there was an inherent crap-shoot effect to the match [process] that we were uncomfortable with ,” Dr. Postl says of the policy, which was approved by the faculty council six or seven years ago.

According to the Association of Faculties of Medicine of Canada (AFMC), which represents the country’s medical faculties, the University of Manitoba’s ability to find matches for unmatched graduates is unparalleled at other schools. “It is the ideal [solution] of course,” Marie-Hélène Urro, the communications co-ordinator at AFMC, said in an e-mail. Read more »

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SOHC Discussion Paper

Developing an Improved and Sustainable Health Care Model for Princeton, B.C
Support Our Health Care has released a discussion paper in order to get feedback from the community, politicians and professionals about the state of local healthcare and what the long term solutions should be.
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