EIHR evidence in the making
Giving the public a voice
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Engaging the public in health technology assessment
The challenge: The importance of involving patients and the public in the decision making process about their health care is widely acknowledged. This is a challenging task for governments and health organizations responsible for evaluating health technologies where patient and public values must be considered alongside evidence about what works and at what cost. What is the best way to incorporate patient and public perspectives into the assessment of health technologies? Who should be involved, how and to what end?
Research: Dr. Julia Abelson of McMaster University is examining how governments and health technology assessment (HTA) bodies, specifically Health Quality Ontario and the Ontario Health Technology Advisory Committee, can engage patients and the public in the HTA process. The study's reviews of published and grey literature and organizational websites, as well as key informant interviews, highlight varied approaches to engaging patients and publics, motivated by different – and sometimes conflicting – goals and rationales. Evidence about what works is limited and difficult to generalize. The HTA landscape is changing rapidly – there is increased pressure for rapid HTAs, greater emphasis on health care for complex diseases, and limited capacity of HTA organizations to engage patients and publics. As a result, strengthening patient and public engagement requires a carefully designed and flexible approach. The results of the research are directly informing Ontario's strategy for involving patients and publics in HTA and may be applicable to other jurisdictions as well.
Sources: Gauvin, F.P., Abelson, J., Lavis, J.N., Evidence Brief: Strengthening Public and Patient Engagement in Health Technology Assessment in Ontario (Hamilton: McMaster Health Forum, May 8, 2014).
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Think global, act local
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Putting design into action: Child and youth mental health in the Yukon
The challenge: One in five Canadians will experience a mental disorder in their lifetime. Most mental disorders can be diagnosed before age 25, yet mental health services for children and youth are hard to access. In 2010, the Mental Health Commission of Canada developed Evergreen, a resource for those affected by and responsible for child and youth mental health policy, plans, programs and services. This national framework was designed to be adapted to local circumstances. In the Yukon, this means taking into account remoteness, a small and dispersed population, and a high proportion of First Nations children and youth.
Research: McMaster University's Dr. Gillian Mulvale and Dalhousie's Dr. Stan Kutcher are leading a collaborative effort to apply the values and strategic directions of Evergreen to the Yukon's specific circumstances. Working with a 13-member Working Group representing Yukon policy makers and two First Nations groups, the team has consulted widely and reviewed experience in nine comparator jurisdictions. It gathered input on policy options for an Evergreen-modelled child and youth mental health framework at a policy roundtable discussion. The research aims to improve Yukon child and youth mental health services. It will also provide answers to the larger question of whether and how national health policies can be relevant to local contexts. The research demonstrates that national frameworks can assist in identifying necessary care components and context-relevant evidence-based practices for local application. It also underscores the importance of developing and delivering systems of effective mental health care based on the identified needs of young people and their families.
Sources: Mental Health Commission of Canada. Child and Youth Advisory Committee. Evergreen: A Child and Youth Mental Health Framework for Canada (2010).
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Caring for the caregivers
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Developing a caregivers' strategy for Ontario
The challenge: Every day, an army of unpaid, informal caregivers deploys to care for their loved ones. More than 96% of home and community care clients are supported by an unpaid caregiver. For people with dementia alone, that caregiving is valued at $25–31 billion a year. Fully 60% of all caregivers juggle their caregiving with a job, most often full-time, costing Canadian businesses $1.3 billion a year in lost days, missed hours or staff turnover, while taking a toll on the well-being of caregivers. There is no consensus among provinces or nationally on how best to support caregivers.
Research: To inform a caregivers' strategy for Ontario, Drs. Samir Sinha, provincial lead for Ontario's Seniors Care Strategy, and Geoff Anderson, of the University of Toronto, engaged researchers, policy makers, care providers and caregivers in evidence-based consultations focusing on how governments can best support caregivers. Their work led to three policy options for government, presented directly to Ontario's Minister of Health: working with businesses to ensure a workplace culture that better addresses the needs of employed caregivers; providing caregivers with the opportunity to have their voices heard and needs assessed; and implementing a caregiver benefit in Ontario for low- and moderate-income caregivers who meet specified needs tests. Drs. Sinha and Anderson believe that involving researchers and care providers in this research and "learning to speak the language of policy makers" increased the likelihood that their recommendations will guide policy makers in their efforts to support caregivers.
Sources: Sinha, S.K., Living Longer, Living Well: Report Submitted to the Minister of Health and Long-Term Care and the Minister Responsible for Seniors on recommendations to Inform a Seniors Strategy for Ontario, Chapter 9 (2012).
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Supporting teams and collaborative practice in primary health care
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What are the policy options?
The challenge: Team-based primary care has been a hot topic in jurisdictions across Canada. It is thought to deliver better health outcomes for patients in a more cost-effective manner. But no two provinces or territories share a vision of what team-based care should look like. Often, they differ in a number of areas, such as structures to support team-based care, including compensation models. There are also different interpretations about who should be on a team – physicians, nurse practitioners, allied health professionals – the team structure, and the roles of various team members.
Research: A research team operating within Alberta Health Services, led by Dr. Esther Suter, examined three provinces in Western Canada to explore the evolution of team-based primary health care in each jurisdiction. The team's goal was to examine the similarities and differences in the provinces' policy frameworks and to identify feasible and realistic policy options for moving team-based primary health care forward. Based on the team's preliminary work, these potential policy options will likely focus on themes such as scope of practice, liability and regulatory issues, system alignment, concepts of team-based care, and compensation models. The team has identified four policy options with the greatest potential to advance team-based care and had the opportunity to present and discuss them with policy makers from the provincial health ministries, senior health authority representatives, physicians and academics. The involvement of policy makers from all three provinces increases the likelihood of this research having an impact, says team member Dr. Renée Misfeldt.
Sources: Misfeldt, R., et al. An exploratory study of interprofessional teams in primary care networks in Alberta (Calgary: Workforce Research and Evaluation, Alberta Health Services, 2013). Mickelson, G., et al., "Inter-professional collaboration as a health human resources strategy: moving forward with a Western provinces research agenda," Health Care Quarterly 15, 4 (2012): 41–6.
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Motivating and building an effective team
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Interdisciplinary primary health care – Financing, remuneration and governance
The challenge: Many aspects of primary health care rely on effective collaboration, coordination, continuity and quality (3C&Q). Previous research has produced some evidence that interdisciplinary teams provide the best means for supporting these key attributes. What is less clear, however, is how different approaches for funding teams, compensating team members and creating governance structures contribute to 3C&Q. In part, this is due to a lack of clarity around the models.
Research: Dalhousie University's Dr. Dominika Wranik is leading the 3C&Q research program. The goal is to assess which models of remuneration and governance best support the goals of primary health care in interdisciplinary team settings. The first step, currently under way, is to classify the different types of models in use across Canada. Examples include the traditional model, where a physician receives fee-for-service payments and uses these to hire other team members. An example of a non-traditional model is one in which each team member receives a salary from the provincial Ministry of Health, either directly or via a health authority. In several Canadian regions, physicians or teams are eligible for additional bonus payments that may be awarded for reaching specific targets. Examples of targets include quantity targets (e.g. number of well-child visits, number of home visits), where the idea is for physicians to shift the focus of care delivery to specific types of services. The results of this research project will be directly relevant to decision makers across Canada and internationally who are seeking guidance on how best to finance, remunerate and govern interdisciplinary primary health care teams. The results will contribute to creating incentives that best support primary health care goals.
Resources: Visit the Interdisciplinary Primary Health Care Teams web page for more information on this project and about team-based approaches to primary care in general.
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