Amanda Carpellucci (Health Researcher from Alberta) and Caylee Pynn (Respiratory Therapist from Ontario) discuss the status of Chronic Disease (CD) management in Canada, comparing the performances of Ontario and Alberta.
Surprisingly, Alberta has no centralized reporting system to measure CD surveillance and there is no standardized CD management resource available for health providers. An Auditor General report from 2014 describes the cost of CD in Alberta - $4.5 billion in 2012-2013 and explains that CD burden spans the health system as it is the most common cause of hospitalization, emergency department visits, and family physician visits (Auditor General of Alberta, 2014). The report found that there was an overall lacking in defined expectations for care providers, coordination, consistency, integration, electronic medical records, and poor implementation of initiatives – listing several recommendations that remain outstanding and unfulfilled in 2020.
In comparison to Alberta, Ontario collects far more data via Health Quality Ontario (HQO) – a provincial health watchdog that reports various quality indicators. Despite having more data, and standardized management resources for providers, Ontario does not mandate or incentivize adherence or performance and has seen zero progress in 30-day hospital readmission for selected CDs since 2015 (HQO 2021):
30-day hospital readmission as a quality indicator is key because readmissions reflect hospital care as well as post-discharge follow-up (HQO 2018). An unplanned readmission reveals poor control over chronic illness, patients' inability to self-manage, and poor transitions from hospital to community care – similarly to Alberta’s Auditor General report, this exposes the poor coordination and integration of Ontario’s health care system. Amanda was also able to find hospital readmission data for Alberta, but none that were specific to CD.
We both found that CD is a significant financial burden on our provincial health systems and that despite big spending, we see minimal improvement in CD management. We both learned that Health Canada had published a CD initiative in 2007 incorporating a Primary Health Care Transition Fund (PHCTF) for the provinces to invest in team-based, specialist primary care models that would effectively respond to the growing demand of CD. The intent of the initiative was to improve patient outcomes, increase access, better utilize health care resources as well as fund multidisciplinary, collaborative practices and centralized electronic health records (EMRs) (Health Canada 2007).
At one time, Ontario seemed on point with necessary action and implemented primary health care reform strategies that modified physician renumeration from fee-for-service to blended capitation with bonuses for providers to meet needs-based targets like vaccinations, smoking cessation programs, diabetes education, mental health services, and other evidence-based interventions (Levesque et al. 2015). These changes were meant to incentivize health providers to spend more time with patients with complex needs, focusing on performance and outcomes over completing high numbers of billable procedures. These changes were unfortunately short-lived as the province then cancelled incentives and funding for building new family health teams and blocked new physicians from entering existing family health teams (Grant 2015). In 2016, HQO retired 2 key indicators: Emergency department visits for conditions best managed elsewhere and Emergency department visits for conditions that could be treated in an alternative primary care setting so the effects of the reversal on primary care reform were impossible to determine. Further to this, the demise of the Health Council of Canada in 2014 made it impossible to establish federal health standards and eroded federal-provincial health care strategies and accords (Cross 2014).
We concluded that without meaningful data we do not know where we need to improve because we do not fully understand where we are. What we are left with are provincial and regional disparities in health care and inconsistent CD management as cases and costs soar.
References
Auditor General of Alberta. (2014, September). Health—Report on Chronic Disease Management. https://www.oag.ab.ca/reports/oag-health-report-chronic-disease-management-sept-2014/
Cross, C. (2013). Advocates decry health council’s demise. In CMAJ : Canadian Medical Association journal (Vol. 185, Issue 9, p. 756). Canadian Medical Association. https://doi.org/10.1503/cmaj.109-4472
Grant, K. (2015). Ontario’s curious shift away from family health teams - The Globe and Mail. https://www.theglobeandmail.com/life/health-and-fitness/health/ontarios-curious-shift-away-from-family-health-teams/article22989363/
Health Canada. (2007). Chronic Disease Prevention and Management - Canada.ca. https://www.canada.ca/en/health-canada/services/health-care-system/reports-publications/primary-health-care/chronic-disease-prevention-management.html
(HQO) Health Quality Ontario. (2021). Patients Readmitted to Hospital in Ontario - Health Quality Ontario (HQO). https://www.hqontario.ca/System-Performance/Primary-Care-Performance/Hospital-Readmission
Levesque, J.-F., Haggerty, J. L., Hogg, W., Burge, F., Wong, S. T., Katz, A., Grimard, D., Weenink, J.-W., & Pineault, R. (2015). Barriers and Facilitators for Primary Care Reform in Canada : Results from a Deliberative Synthesis across Five Provinces Obstacles et appuis à la réforme des soins de santé primaires au Canada : résultats d ’ une synthèse délibérative réunissant cinq pro. Healthcare Policy = Politiques de Sante, 11(2), 44–57.
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