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Editorials


Contents:
  1. Editorial: Health Professional Education: Its Relationship to Collaborative and Interdisciplinary Practice

  2. Health system costs not incurable but preventable
    - Aging population only small part of the problem


  3. The Canadian doctor who prescribes income to treat poverty

  4. Takin' It Easy

  5. Did You Know....?













Editorial: Health Professional Education: Its Relationship to Collaborative and Interdisciplinary Practice


by Jennifer (Jay) Sherwood, BScN, MEd.
One of the major foci of the Canadian First Ministers' Health Accords (2000 and 2003) was a commitment to appropriate planning and management of health human resources. Apart from determining numbers and types of health human resource personnel the First Ministers, taking information from both the Kirby and Romanow reports (and others that went before them) focused on Primary Health Care and the need for innovative delivery strategies for patient care and collaborative, interdisciplinary practice. They saw that changing the way that health professionals are educated by promoting interprofessional education for collaborative patient centred practice is one key to primary health care renewal and to recruiting and retaining a stable and well prepared health workforce in Canada.

The idea of collaborative practice is certainly not a new one. Like many good ideas in health care and elsewhere it has taken a long time (and numerous pilot projects, unreported initiatives and the like) for the focus to become a driving force in resource planning for health care delivery.

Collaborative Patient Centred Practice is defined by Health Canada as being the type of practice where there is active participation by all health disciplines relevant to a patient's care. In some ways it is not unlike the team approach that most of us practiced formally and informally in years past. As a concept it has been fleshed out to include continuous communication, active participation in clinical decision making and true respect built in for the disciplinary contributions of all health professionals. Interprofessional education, the interdependent concept, is defined as “…occasions where two or more professionals learn from and about each other to improve collaboration and the quality of care.” (CAIPR, 1997) The Faculty of Health Sciences at McMaster University stresses the importance of collaboration in faculty mission state. In essence it is suggested that students who learn together gain an appreciation of other professional's roles in the delivery of health services as well as learning to respect and value other professional input in the team decision making process.

As one component of the Health Canada's health human resource strategy a 304 page research report of the interprofessional education initiative, Interprofessional Education for Collaborative Patient-Centred Practice, was prepared. In the overview of the report and the initiative itself, it is noted that the concepts of “collaborative patient centred practice” and “interprofessional education” are interdependent. While the interdependence is illustrated in the description of the conceptual framework underlying the report, they are treated both separately and together. My purpose in this short editorial is to focus on interprofessional education.

Interprofessional education needs to happen both before and after licensure to practice. At the undergraduate level, the timing of interprofessional education is important. It is thought that students in all disciplines need a thorough grounding in their own disciplines before engaging in interprofessional learning activities suggesting that it occur at the senior levels of professional programs. Continuing education, both for academic credit (e.g. at the graduate level) and non-credit is imperative for the practice of collaboration across the continuum of patient care. There are three broad goals for providing interprofessional education.

These are:
• Socializing health care providers in working together in shared problem solving and decision making…;
• Developing mutual understanding of, and respect for, the contributions of various disciplines; and
• Instilling requisite competencies for collaborative practice.

More specifically the objectives of interprofessional education and collaborative patient-centred practice initiative outlined in the Overview mentioned above are:
• Promoting and demonstrating the benefits of interprofessional education for collaborative patient-centred practice;
• Increasing the number of educators prepared to teach from an interprofessional perspective;
• Increasing the number of health professionals trained for collaborative patient-centred practice before, and after entry-to-practice;
• Stimulating networking and sharing of best educational approaches for collaborative patient-centred practice; and
• Facilitating interprofessional collaborative care in both education and practice settings.

A major part of interprofessional education is the fostering of practice settings where successful collaboration amongst professionals is part of the culture of care. In settings such as these, professionals will demonstrate a shift in attitudes from professional autonomy to interdependence, be able to clearly communicate their professional knowledge and skill to other professionals and will demonstrate a respect for the contributions of each discipline as it relates to particular aspects of patient care. These professionals, competent in collaborating, will act as role models and provide experiences for both pre and post licensure students help them learn to work collaboratively. Developing collaborative practice settings where none exist requires formal competency training for health professionals on how to collaborate meaningfully and organizational and system change to focus on collaborative practices.

In a vision of interprofessional education a focus on developing teaching processes to develop the competencies necessary for current and future health professionals to work together is required. It is thought that if students in health professional programs and health professionals in practice develop the competence through formalized training that the potential for change in workforce patterns will be enhanced. Competence development in health professionals is not enough. There is a need for change in organizational processes and those at the individual team level for collaboration to be sustained and grow. The elements of collaboration need to be understood, promoted and sustained throughout the continuum of health professional learning, within the workforce of health professionals and the organizational environment in which they practice. The traditional “silo-like” practices among health professionals will not change by mastering the competencies alone.

Another pan-Canadian body that studied the issues in health human resource planning is the Health Council of Canada. In the summer of 2005 it released a report on health human resources. Part of the report focused on the professional regulatory issues inherent in professionals' scopes of practice. The report was based on a closed door conference that the Council held to discuss the issues in health human resources as they relate to health care reform in Canada. *According to the July 22, 2005 newsletter Health Edition, published by Merck Frosst Canada Ltd., the report would contain a strong plea to address scope of practice and education issues so that the phrase “having the right provider at the right place” would take on real meaning. Michael Decter, Chair of the Council at the time said that the need to have health and education working together to support collaborative practice is a major component of resource planning. More specifically he was quoted as saying “If we hope that the incoming health care professionals will work collaboratively then we should be doing more to train them collaboratively.”

Since 2005 almost every University in Canada that offers health professional education has had some focus on interprofessional education at both the basic and continuing levels. According to the World Health Organization 2010, interprofessional collaboration has many benefits for both patients and professionals. Patient care and outcomes have improved and professional demonstrate lower stress and greater hob satisfaction. (p.10) It has also been noted by other writers that it takes effort to establish effective. Sargeant et al, 2008 noted that interprofesional learning opportunities must be created.

For those of you who are interested in learning more about interprofessional education and collaborative practice try putting the keywords “interprofessional education collaborative practice” into your favourite search engine. As well, background papers/presentations and final report from the conference held on health human resource planning by the Health Council of Canada is no longer available on its website. (World Health Organization, 2010) www.healthcouncilcanada.ca.

* Note: The Health Council of Canada is no longer operating. The archived Web page remains online for reference, research or recordkeeping purposes by Carleton University Library. This page will not be altered or updated.

Reference

Sargent, J. (2009). Theories to aid understanding and implemention of interprofessional education. Journal of Continuing Education in the Health Professions, 29,3, 178-184

Bibliography

Kim. J., M. V. (2010). Enhancing Capacity for Interprofessional Collaboration: A Resource to Support Program Planning. Toronto Ontario: Toronto Rehabilitation Institut.

Oandasan, D. &. (May 2005 ). Interprofessionality as a field of interprofessional practice and interprofessional education: An emerging concept. Journal of International Care, Supplement 1, 8-20.World Health Organization. (2010). Framework for Action on Interprofessional Education & Collaborative Practice. Geneva, Switzerland: World Health Organization.

 

Health system costs not incurable but preventable
- Aging population only small part of the problem


by Michel Grignon
License to Republish: Our commentaries, Infographics and videos are provided under the terms of a CreativeCommons Attribution No-Derivatives license. This license allows for free redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author and EvidenceNetwork.ca

The tsunami metaphor is more and more often used in commentaries about the effect of aging on health care spending in Canada. It musters up images of devastation and irresistible strength submersing any levees the system might try to mount to oppose it. It is a powerful but misleading metaphor.
There is a worrying rise in health care spending in Canada, but it doesn't have much to do with population aging. To stay with the oceanographic metaphor, aging might be, at most, a modest tidal wave. The real tsunami of health spending is the result of changes in the way all patients are treated in the system, resulting from both price inflation (drugs and doctors cost more than ever) and technical progress (new diagnostic tests, surgeries and drugs).

The yearly increases in total health care spending in Canada - approximately 10 billion dollars per year nowadays - does not result from aging per se, but the costs of treatment, including diagnostic tests, drugs and doctors, for all patients, young and old. It's not that we have too many seniors that will break the bank, but how those seniors, and others, are treated in the health system that affects the bottom line.
Put another way, aging on its own adds around two billion dollars to the annual health care bill while changes in the cost of treatment per average patient adds eight billion dollars.

How is it possible? To answer, let's take a closer look at the age profile of health care spending: if age is on the horizontal axis and average spending per individual of a given age on the vertical axis, the profile resembles a valley. In other words, it costs a lot to be born, because it happens most often in a hospital; then, each year of age between one and 50 does not cost the health system much on average (the profile is flat and low) - but costs start picking up again at age 50 and the slope becomes steeper with age until plateauing around 80.

Contemplating such an age profile (drawn to illustrate a single year, say 2013), one might conclude that aging will increase spending dramatically. However, looking at two such annual profiles (one for 1993 and one for 2013), it is easy to see that the really striking change has been at the ground level: we spend much more today on anyone at any age than twenty years ago, and this is what really drives our health care costs.
This increase in costs for patient care has not been sudden, but has taken place over several decades and will likely continue apace. Costs have been driven by current investments in research and development (in industry and academia alike), insurance coverage for expensive, cutting edge treatments - whether truly beneficial or not - and our demand for longer and better quality lives.

We can't really do anything about costs resulting from our aging population, but we can make choices about what services we provide patients of all ages. These choices might mean rationing care (and, as a result, longevity and quality of life) but also, and preferably, making sure all patients receive essential care, but not unnecessary care. The latter is about reducing “waste” in our health system, interventions that have not been proven to enhance length or quality of life.

So, how do we distinguish necessary from unnecessary care?

We need to build our health system on evidence; we need to know how many years of life and how much quality of life we buy through the increased volume of services and the flow of new technologies in the health care system. We also need to pay for services and innovation on the basis of what they add to quality and quantity of life (outcome-based payments). Instead we continue paying for technology on the basis
of how much it costs to develop, not how much it delivers.

It's time we stop throwing ever more money after the latest and greatest technologies in health services without knowing if we are getting a return on our investment. Our health care system suffers in the process.

Michel Grignon is an expert advisor with EvidenceNetwork.ca, an associate professor with the departments of Economics and Health, Aging & Society at McMaster University and Director of the Centre for Health Economics and Policy Analysis (CHEPA).

The Canadian doctor who prescribes income to treat poverty


by Trudy Lieberman
A version of this commentary appeared in Ottawa Life, the Windsor Star and the Medical Post
License to Republish: Our commentaries, Infographics and videos are provided under the terms of a CreativeCommons Attribution No-Derivatives license. This license allows for free redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author and EvidenceNetwork.ca

Last fall when I visited Canada, I met a Toronto doctor named Gary Bloch who has developed a poverty tool for medical practitioners. The tool assesses what patients might need other than prescriptions for the newest drugs. Bloch's idea was to zoom in on the social determinants of health - food, housing, transportation - all poverty markers linked to bad health and poor health outcomes.

The tool, a four-page brochure, notes that poverty accounts for 24 percent of a person's years of life lost in Canada and offers three steps for doctors to address poverty. The first step is to screen every patient by asking them, “Do you ever have difficulty making ends meet at the end of the month?” The next two steps urge clinicians to factor poverty into clinical decisions like other risk factors and to ask questions about income support by age/family status, such as whether seniors have applied for supplemental income benefits they may be entitled to.

“We've created an advocacy or interventional initiative aimed at changing the conversation about poverty and how doctors think about poverty as a health issue,” Bloch explained. “It's one of those cultural shift things.”

The first blog post I wrote about Bloch and his “diagnosing poverty” tool received more than 3,000 hits on the Prepared Patient blog. Clearly, his message resonated in the U.S. and Canada. I wanted to circle back to Bloch and see whether a cultural shift in Canada was really taking place. Indeed it is. I was wowed by the acceptance of an intervention that seems so simple and could maybe lead to better health. “It's been a wildfire effect,” Bloch told me.

Bloch ticked off a laundry list of provinces and organizations that were using or about to use the tool. He described a “pretty amazing” and broad coalition that came together to promote the tool, including public health leaders, pediatric and family doctors, community health centers and regional health authorities. A doctor in British Columbia has developed a version for his region. Manitoba is about to roll out its own adaptation. A public health officer in Nova Scotia is pushing for the tool in that province. The tool is getting attention is Saskatchewan, too.

Physician groups have signed on, like the College of Family Physicians Canada and the Registered Nurses' Association of Ontario. The Canadian Medical Association (CMA) has developed a continuing education module based on these poverty interventions. On his website, CMA president Dr. Chris Simpson says, “Dr. Gary Bloch is one of those guys who walks the talk and speaks about 'prescribing money' as a way to help patients who are economically disadvantaged.”

Simpson told me that Bloch's approach is the first clinically relevant tool to address social determinants of health. To support Bloch's work, the CMA's conversations and advocacy about the tool are heightening awareness among Canadian physicians that they need to address these risk factors. Simpson added that Bloch and his team also conduct trainings to help doctors learn how to use the tool.

In a phone interview last week, Bloch observed that adding the steps in the tool to clinical practice is just a beginning. “It was never an end unto itself. It was a stepping stone to other interventions.” Bloch described what his family health group in central Toronto is doing. They hired an income security health promoter who meets with patients about their financial situations and works with them on becoming more financially literate. She works with the rest of medical team to acquaint doctors with patients' needs. For example, a person with diabetes without adequate housing will have trouble storing healthy food and insulin supplies.
Bloch and his team are beginning to study the tool's impact with a randomized trial and collecting data on the social determinants of health for people in central Toronto. “This will allow doctors, health planners and epidemiologists to draw out data and learn about who they are serving,” he said.

The American Academy of Pediatrics and the Academic Pediatric Association are considering adopting some aspects of Bloch's tool and are studying the development of a poverty curriculum for physicians. There are also a few programs like “Health Begins,” which is a group of doctors working on treating social and economic causes of poor health. But the U.S. has a long way to go to match the progress of Canada.
Differences in our two health insurance and payment systems may account for lack of interest or movement in the U.S. “We feel rooted in the communities we serve,” says Bloch. “We're not worried about insurance for the patients we provide care to.”

In the U.S., even with the Affordable Care Act offering access to care to more people, doctors should pause to consider how high deductibles and other out-of-pocket costs affect low income patients. “Will patients be able to afford the care they need?” is still very much an open question.

In the U.S., we don't like to talk about any aspect of the Canadian health system unless it's waiting lists. It would be great if next year I could report there was real progress in the U.S. towards embracing the poverty tool that Gary Bloch has moved his profession to adopt across Canada.

Trudy Lieberman, a journalist for more than 40 years, is an adjunct associate professor of public health at Hunter College in New York City. She is an advisor at EvidenceNetwork.ca, and a longtime contributor to the Columbia Journalism Review where she blogs for its website, CJR.org, about media coverage of health care, Social Security and retirement.

Takin' It Easy


by Dougy Wilson, The Healthy Livin' Team
Stress comes in many forms, it's one of those things that's tough to avoid in this day in age. Most would agree it's unavoidable so forget trying to eliminate it; face it head on and go right through it.
How should someone beat stress?
Tackle it in small steps; one by one. Try to avoid looking at the big picture which can seem overwhelming at times. It would be nice to rid ourselves of stress altogether, unfortunately it's not going away and we need to find ways to deal with it.

Lets focus on stress management

Solid methods to manage stress:

1. Take time each day for complete silence. It doesn't have to be a long time, but make the effort to sit, breathe, and relax. (TV turned off, cellphone on silent, leave the laptop in the other room and just relax.) Try it. Our days are busy and so are our thoughts, so try taking some time to slow the mind down and watch the stressful thoughts float away.

2. Find your passion. Find a hobby or activity that allows you to fully absorb yourself and get you into the “zone”. If you've experienced this before you know how time flies without even knowing and what a great feeling it is.

3. Exercise. Physical activity can increase your mental state of mind, lower blood pressure, curb food cravings, and opens up your lungs.

4. Give the news a break. For some, watching or reading the news is a daily ritual. Don't go “cold turkey”, but try going a few days at a time news free. A lot of the news is quite negative and removing this may help reduce stress.

5. Treat yourself. If you work hard, play hard. For example, go in for a massage. This is only one of many ways to thank your body for the hard work you put it through.

6. Let your feelings flow, and then let them go. Don't hold things inside, they'll just linger there and leave you thinking about them. Write them down or talk to someone close to you.

7. Laugh as much as possible. They say a child smiles 400 times per day while adults crack a smile on average around 17 times per day. Let's all smile more!

While you're thinking of the above suggestions, here's another list you should be able to do during your day; quick and easy stress busters:
• Eating great = Feeling great. Simple enough. “Eat junk = feel like junk”
• Put it into words. Get a journal and write down your thoughts, this can change the way you view things.
• Sleep. This does the body and mind good.
• Get organized. Get a to do list and stick to it, feel great checking off anything completed.
• Set goals. Keep on the right track by moving forward to an accomplishment.
• Talk about it. Use your friends and family, that's what they are there for.
• Ask for help. We can't know everything in the world, be open to assistance.
• Laugh. There's no such thing as laughing too much.
• Chill out. Put on some music that you love or watch a funny movie.

It's so easy to get caught up in whatever situation we're going through. Our minds are one powerfully tool. They have the power to turn an early morning walk to the shower stubbed toe seem like the end of the world and ruin what could and should be a great day.

What it comes down to is YOU, how are YOU going to handle paying your bills, gas prices, relationships, etc. Do you want it to be stressed or not. The later sounds much more appealing. You decide.
In the mean time check out some lyrics from a song titled “Take It Easy” by The Eagles.

Take it easy
Take it easy
Don't let the sounds of your own wheels
Drive you crazy
Lighten up while you still can
Don't even try to understand
Just find a place to make your stand
and take it easy
oh oh oh
oh we got it easy
we ought to take it easy

You might have your own way of dealing with life's stresses, big or small let us know. The more help the better.
Dougy Wilson BSC, CSCS
Healthy Livin' Practitioner, dougy@thehealthylivin.com

Did You Know....?


by Jennifer (Jay) Sherwood, BScN, MEd.
This column highlights a sample of the information that has arrived since the last issue of HEALTHbeat. All of this comes from press releases, lists and other such things that are available on the Internet. Apart from editing, I am passing it along to you as it comes to me.
Be advised, HEALTHbeat does not endorse or otherwise support any of the products, new ideas etc.

Did you know that…?

EDMONTON, AB - After high-profile figures in the political and medical establishment criticized Alberta's electronic medical record (EMR) systems as fragmented and ineffective, the Health Minister launched a task force earlier this month to investigate how a more unified system could be created.

OSHAWA, ON - Lakeridge Health notified 578 people last month that their hospital records were inappropriately accessed. Hospital officials say 14 staff members who provide mental health services have been disciplined over the privacy breach, which occurred during a 10-year period between December 2004 and summer 2014.

VICTORIA, BC - Vancouver Island's health authority says it has fired two employees who looked at more than 100 patients' private healthcare records to satisfy their curiosity. Island Health says the employees looked at 112 electronic health records of patients with whom they had no care relationship.

MONTREAL, PQ - Healthcare professionals from the Montreal University Health Centre devised innovative solutions at the Design Challenge Montreal event, which was held in the city last month. Their prototypes included systems to keep depressed patients on track; an app to prepare children for MRI exams; and a predictive software tool for spotting breast cancer in mammograms.


Healthstaff

Bay of Plenty District Health Board



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