Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
377 Cards in this Set
- Front
- Back
|
Health Canada definition of the health care system
|
universal coverage of medically necessary health care services provided on the basis of need rather than on the ability to pay
|
|
|
which province was the first to introduce a province-wide, universal hospital care plan
|
Saskatchewan
|
|
|
in what year did Saskatchewan introduce its universal hospital care
|
1947
|
|
|
which province was second to introduce universal hospital care
|
BC
|
|
|
what specifically was the first type of universal health care introduced in Canada
|
hospital care
|
|
|
which was the first province to introduce universal coverage for doctor's services
|
Saskatchewan
|
|
|
role of the 5 principles of the Canada Health Act
|
provinces don't get federal health money if they don't adhere to the principles
|
|
|
what happened in 1984
|
Canada Health Act
|
|
|
When was the Canada Health Act enacted
|
1984
|
|
|
what does the Canada Health Act say
|
5 principles - provinces get no money unless they adhere to the principles
prohibit extra billing or user fees for insured services (ie. doctors cannot charge for something covered under the Canada Health Act) |
|
|
why doctors initially opposed (3)
|
feared loss of autonomy (ie. the government taking over and micromanaging them)
feared decrease in pay fear of socialism after WW2 |
|
|
principles of the Canada Health Act (5)
|
public administration
comprehensiveness universality accessibility portability |
|
|
define the principle of public administration
|
administering organization is:
non-profit accountable to government |
|
|
define the principle of comprehensiveness
|
must insure all medically necessary services provided by medical practitioners working within a hospital setting
|
|
|
define the principle of universality
|
must entitle all insured persons to health coverage on uniform terms and conditions
|
|
|
which principle is this
must entitle all insured persons to health coverage on uniform terms and conditions |
universality
|
|
|
which principle is this
must insure all medically necessary services provided by medical practitioners working within a hospital setting |
comprehensiveness
|
|
|
which principle is this
administering organization is: non-profit accountable to government |
public administration
|
|
|
which principle is this
Must provide all insured persons reasonable access to medically necessary hospital and physician services |
accessibility
|
|
|
definition of principle of portability
|
must cover Canadians travelling abroad
|
|
|
problem with portability
|
only reimburses the amount that it would cost if you were treated in Canada - it costs more in the US
|
|
|
who decides on medically necessary services
|
provinces and territories in consultation with physician groups
|
|
|
who did not decide on medically necessary services
|
the Canada Health Act
|
|
|
things that are not covered
|
depends:
home care chiropractic naturopath massage cosmetic eye care dental *note: some of these depend on your diagnosis and/or whether your primary care provider deems it medically necessary |
|
|
roles of provincial/territorial governments (5)
|
administration of health insurance plans
planning and funding of care in hospitals and other faciities regulation of all health care services health promotion and public health initiatives negotiation of fee schedules with health professionals |
|
|
most provincial and territorial governments offer supplementary benefits for special groups for 4 things not required by the Canada Health Act
|
drugs prescribed outside hospitals
ambulance costs hearing/vision care dental care |
|
|
where does Health Care money come from (% break down_
|
65% provincial (but supported by federal)
30% private sector 4% federal direct 1% municipal 1% social security funds |
|
|
when we say funded by the private sector what does that mean
|
out of pocket
3rd party insurance |
|
|
trends in health care spending since 1975
|
less on hospitals
less on physicians more on drugs more on other health care professionals |
|
|
what do we spend the most health care money on
|
hospital
|
|
|
primary care
|
first point of contact with the health care system
services provided directly coordinates specialized services (ex, specialists) usually family physician |
|
|
secondary services (care)
|
hospital or other institution
ex. long term/chronic care |
|
|
tertiary care
|
specialized/advanced care
usually in regional hospitals |
|
|
examples of secondary care
|
intensive care
physiotherapy childbirth psychiatry |
|
|
examples of tertiary care
|
cancer management
neurosurgery palliative care |
|
|
% and # of Canadians who work in health occupations
|
1 000 000 people
6% of the workforce |
|
|
definition of profession (4)
|
formal, specialized body of knowledge
autonomy/control over their own work altruism often socially sanctioned by legislation |
|
|
how professionals ensure they have autonomy/control over their own work
|
restrict members of their group
this demonstrates to the public that they can have high expectations of this group because everyone else is not good enough the organization has to be trusted to make their own standards because other people don't know enough about the profession to make standards for them |
|
|
define altruism
|
putting others before yourself
|
|
|
what is NOT a required to be a profession
|
regulation
|
|
|
2 ways health professions are regulated
|
voluntary (self)
statutory (government) |
|
|
trend with self-regulation
|
disappearing (globally)
|
|
|
what type of regulation in Ontario for health care providers
|
self
|
|
|
what type of regulation is there for health care providers in most countries
|
government regulation
|
|
|
how health care professionals are regulated in Ontario
|
self regulation that is approved by the government
|
|
|
regulations for health care professionals are set in whose interest
|
public
|
|
|
why self-regulation is declining
|
scandal occurs
lose relationship with public government takes over |
|
|
other possible models for regulating a health profession
|
1. government makes rules. organization enforces rules
2. shared responsibility |
|
|
what was enacted in 1991
|
The Regulated Health Professions Act
|
|
|
when was the Regulated Health Professions Act enacted
|
1991
|
|
|
what does The Regulated Health Professions Act do
|
sets framework for statutory self-regulation of all regulatory health care professions in Ontario
|
|
|
goals of The Regulated Health Professions Act 1991
|
eliminates expectation of exclusive rights to specific practices (ex. if nurses couldn't give shots)
fair and even playing field gives public access and choice |
|
|
why The Regulated Health Professions Act was controversial
|
fear that different professions would have different standards (but this is stupid because they different colleges can talk to each other
money - one group hogged all the patients because nobody else could give a certain surface |
|
|
why it doesnt make sense to allow a single profession to monopolize asservice
|
we have enough patients to share
|
|
|
major themes of the Regulated Health Professions Act
|
accountable public interest
public access patient choice eradication of sexual abuse equity |
|
|
what does "accountable public interest" mean (a theme of the regulated health professions act)
|
the regulatory bodies act in public interest
they are accountable to the public, the government, their own college and other colleges members of public are on the board |
|
|
are there more pharmacists or members of the public on the board
|
pharmacists
|
|
|
what does "public access" refer to (a major theme of RHPA)
|
the public can access a register on the college website where they can see that you are registered with the college and your disciplinary occurrences
|
|
|
what does "patient choice" mean (a major theme of the regulated health professions act)
|
multiple practitioners can perform some of the acts - the patient can choose between them
|
|
|
what is the list of things that certain professions can perform called
|
controlled acts
|
|
|
how did the Regulation Health Professions Act attempt to eradicate sexual abuse
|
mandatory reports and penalties
|
|
|
what does "equity" refer to (a major theme of the regulation health professions act)
|
people who wish to join the profession can do so as long as they meet certain requirements - the colleges cannot discriminate based on ethnicity, gender, etc.
|
|
|
how many regulated health professions are there
|
28
|
|
|
number 1 criteria to determine whether a health profession will be regulated
|
degree of risk to patient - what would happen if people did what your group does but they were unregulated
|
|
|
role of regulatory colleges vs. professional associations
|
regulatory college = public interest, members of the profession are required to be members
professional association = enhance, support, and advocate for the profession |
|
|
specific examples of the regulatory environment for health occupations varies
|
medical lab techs and medical radiation techs are not regulated in every province
pharmacists are regulated in every province |
|
|
Controlled Acts Model
|
no one except licensed health care providers can perform any controlled acts
|
|
|
where does the controlled acts model exist
|
Ontario
|
|
|
3 examples of the Controlled Acts Model
|
1. communicating a diagnosis
2. administering a substance by injection or inhalation 3. prescribing, dispensing, selling or compounding a drug (Defined as requiring a prescription) |
|
|
what the controlled acts have in common
|
could seriously harm someone if a non-licensed person did them
|
|
|
can any profession perform all of the acts?
|
no
|
|
|
how many of the controlled acts can physicians do
|
all but one
|
|
|
how it is determined which profession can perform which act
|
they applied to the government for permission
they had to come up with standards for each one |
|
|
who can use the title "Doctor"
|
physicians
dentists chiropractors psychologists optometrists naturopaths - pending |
|
|
who can not use the title "Doctor" in a health care setting
|
PhDs
|
|
|
who can prescribe drugs in Ontario (8)
|
physicians
dentists (chiropractors) (midwives) (NPs) (optometrists) (pharmacists) veterinarians most groups can only prescribe within their scope of practice. Brackets indicate restrictions (ex. restricted list of medications and/or special additional training) |
|
|
fun fact about who can prescribe drugs in Ontario
|
psychiatrists can prescribe antihypertensives
|
|
|
how much education physicians have
|
3-4 years undergrad
4 years medical school 2-7 years residency |
|
|
how many controlled acts are there
|
14
|
|
|
how many controlled acts dentists may perform
|
9
|
|
|
how much education dentists have
|
3-4 years undergrad
4 years dental school |
|
|
how many MDs in Ontario
|
26 000
|
|
|
# of dentists in Ontario
|
8600
|
|
|
# of midwives in Ontario
|
500
|
|
|
dentist scope of practice
|
the assessment of the physical condition of the oralfacial complex and the diagnosis, treatment and
prevention of any disease, disorder or dysfunction of the oral-facial complex |
|
|
education of chiropodists
|
3 years college
|
|
|
scope of practice of chiropodists
|
the assessment of the foot and the treatment
and prevention of diseases, disorders or dysfunctions of the foot by therapeutic, orthotic or palliative mean |
|
|
where chiropodists go to school
|
Michener Institute
|
|
|
education of midwives
|
Ontario Midwifery Education Programme (MEP)
4 years university |
|
|
which schools offer midwifery
|
Ryerson
Laurentian McMaster |
|
|
scope of practice of midwives
|
the assessment and monitoring of women during
pregnancy, labour and the post-partum period and of their newborn babies, the provision of care during normal pregnancy, labour and post-partum period and the conducting of spontaneous normal vaginal deliveries. |
|
|
type of deliveries that midwives are responsible for
|
normal
spontaneous vaginal |
|
|
education for RPN
|
2 years college
|
|
|
education for RN
|
4 years university
|
|
|
education of NP
|
MSc degree with Ontario Primary Health Care Nurse Practitioner certificate/diploma
|
|
|
4 specialties of NPs
|
primary health care
adult care pediatric care anaesthesia |
|
|
scope of practice of NPs
|
independent authority to perform additional controlled acts i.e., : diagnosis; prescribing &
administration of certain medications, and ordering basic diagnostic tests |
|
|
how many NPs in Ontario
|
1700
|
|
|
where are many NPs found
|
in areas too small to have a doctor
|
|
|
education of optometrists
|
3 years undergrad
4-5 years optometry program |
|
|
scope of practice of optometrists
|
the assessment of the eye and vision system and the diagnosis, treatment and prevention of disorders of refraction; sensory and oculomotor disorders and dysfunctions of the eye and vision system; and prescribed diseases
|
|
|
# of optometrists in Ontario
|
2000
|
|
|
health human resource planning involves 3 tasks
|
1. trying to predict need
2. tracking practice patterns and migration patterns 3. planning educational enrollment for healthcare professional programs |
|
|
general trend in number of practitioners for most health professions
|
increasing
|
|
|
which 4 health occupations are increasing the most
|
midwives
health info management professionals dental hygienists medical physicists |
|
|
variability in # of pharmacists per 100 000 population across Canada
|
relatively consistent
|
|
|
what type of health care provider shows large variation in # per 100 000 population across Canada (and why)
|
nurses - because there are fewer physicians in some provinces
|
|
|
which provinces have more nurses (than the average for all of Canada)
|
Newfoundland
PEI NS NB Man Sas Yuk |
|
|
trend in average age of health care providers over the last 15(ish) years
|
increasing
|
|
|
average age of pharmacists in 2006 vs. 1996
|
2006: 42
1996: 40 |
|
|
how many schools of pharmacy in Canada
|
10
|
|
|
does every province have a pharmacy school
|
no
|
|
|
accreditation
|
a process to ensure that an education program meets certain standards and is effective in preparing students for entry into a profession
|
|
|
what is the accreditation organization for pharmacists
|
Canadian Council for Accreditation of Pharmacy Programs (CCAP)
|
|
|
one way that pharmacists are better (for patients) than other Health care pros
|
most accessible
|
|
|
approximate % of pharmacists that work in the community
|
67
|
|
|
disadvantage to high accessibility of pharmacists
|
when the pharmacy is busy, patients still feel that they should be able to walk in and talk to the pharmacist right away. Cannot always meet these expectations
|
|
|
how do busy pharmacies deal with their patients having trouble getting to talk to the pharmacist in a timely manner
|
make appts
|
|
|
advantage of high accessibility of pharmacists
|
develop good rapport with community
have contact with lots of members of the public |
|
|
why does it matter how many practitioners choose to work full time in patient care
|
determines how many spots will be made for students (future health care pros)
|
|
|
% change in % of pharmacists living in rural areas from 1991 to 2001
|
-1.6%
|
|
|
comparison of % of health care providers living in rural areas compared to % of the general population
|
20% general population
10-15% health care providers Except RPNs (about 25%) |
|
|
how the regulatory body provides quality assurance (3)
|
continuing education
routine site visits complaint and resolution process |
|
|
2 entities that must be registered with the Ontario College of Pharmacies
|
pharmacies
pharmacists |
|
|
number of pharmacies in Ontario
|
3567
|
|
|
number of pharmacies that open each year in Ontario
|
100
|
|
|
% of pharmacies that are
independently owned franchise or banner large chain small chain |
independently owned: 47%
franchise or banner: 27% large chain: 24% small chain: 3% |
|
|
# of stores under single ownership that constitutes a chain
|
5
|
|
|
definition of independent
|
not affiliated with any corporate banner or franchise or chain
name of the store is unique to that store owner has complete control |
|
|
definition of banner
|
pay fees for the right to use a recognized name
pay for the right to participate in centralized buying, marketing, professional programs usually assume a required "look and feel" owners retain a high level of autonomy if the owner owns 5 or more, these stores comprise a chain |
|
|
example of banners (3)
|
IDA
Guardian Pharmasave |
|
|
definition of franchise
|
franchisees may not own the physical store or the fixtures
pharmacist owns the product there is some autonomy wrt local marketing, buying and services get access to programs developed by the head office |
|
|
example of franchise
|
SDM
|
|
|
definition of chain
|
chain pharmacies employ managers - salaried employees
|
|
|
example of chain
|
PharmaPlus/Rexall
|
|
|
% Ontario pharmacists who are female
|
58
|
|
|
% pharmacy technicians who are female
|
95
|
|
|
trend in number of pharm techs in Ontario
|
more than doubled from 2011 to 2012
|
|
|
% of new pharmacists in Ontario in 2012 who are Ontario graduates
|
50
|
|
|
number of (net) new Ontario pharmacists in 2012
|
503
|
|
|
comparison of Ontario to other provinces wrt to % of pharmacists internationally educated
|
40% in Ontario
much higher than other provinces (around 15%) |
|
|
% Ontario pharmacists working in community vs. hospital vs. other
|
com: 67
hosp: 17 other (family health teams, long term care facilities) : 17 |
|
|
why our current health care system is unsustainable
|
finite resources
aging population chronic conditions |
|
|
how changing scope of practice affects sustainability of health care system
|
increases sustainability - by having professions who are paid less perform a certain procedure instead of physicians you save money
|
|
|
Ontario compared to other provinces wrt scope of practice
|
middle of the pack
|
|
|
provinces where scope of practice is least for pharmacists (2)
|
NFL
PEI |
|
|
province where scope of practice of pharmacists is average (4)
|
BC
ON MB SK |
|
|
provinces where scope of practice is expanded (4)
|
AB
QC NB NS |
|
|
expanded pharmacy scope of practice in Canada consists of 8 new roles
|
emergency refills
renew prescriptions change dosage/formulation therapeutic substitution minor ailments prescribing initiate prescription drug therapy order and interpret lab tests administer a drug by injection |
|
|
what kind of therapy we can currently initiate
|
smoking cessation
|
|
|
what is therapeutic substitution
|
give someone a different drug within the same therapeutic class
|
|
|
the pharmacist workforce has been growing faster than 2 other workforces
|
physicians
nurses % growth is higher than that of the general population |
|
|
age of pharmacists in Ontario compared to other provinces
|
higher
|
|
|
there are more female than male pharmacists, but there are more male
|
pharmacists in manager/owner positions
|
|
|
Ontario compared to other provinces wrt # pharmacists per 100 000 population
|
lower
|
|
|
average number of pharmacists per 100 000 population in Canada
|
100
|
|
|
Ontario compared to other provinces wrt # patients per pharmacist
|
higher
|
|
|
# average number of patients per pharmacist in Canada
|
1000
|
|
|
# patients per health care professional
nurse OT physician PT pharmacist |
OT: 3000
PT: 2000 pharmacist: 1000 physician: 500 nurse: 100 |
|
|
% of Ontario pharmacists that practice outside of urban areas compared to other provinces
|
lower
|
|
|
people's perception of pharmacists
|
patients do not understand what a pharmacist can do for this as well as they understand the role of other HCPs
|
|
|
how the way pharmacists make money is changing from quantity to quality based
|
quantity - used to be paid for filling more prescriptions
quality: now paid for how valuable their tasks are |
|
|
why valuing pharmacists as medication experts and decision makers is important wrt the future of health care
|
can pick up prescription in the mail, remote kiosk
can get info from the internet, other professions but pharmacists are the medication experts |
|
|
define game changer
|
innovation or event that forever changes the way something is done
|
|
|
pharmacy and "game changers"
|
have to innovate to keep profession alive
we can't just distribute we need to be better entrepreneurs, managers, business people more than just drug knowledge |
|
|
which country spends more than other countries on health care (per capita and as % of GDP)
|
US
|
|
|
Canada compared to the world wrt # of acute care hospital beds per capita
|
very low
|
|
|
country that has the most acute care hospital beds per capita
|
Japan
|
|
|
Canada compared to rest of world wrt pharmaceutical spending
|
very high
|
|
|
country that spends the most on pharmaceuticals
|
US
|
|
|
implication of the fact that Canada has less hospital beds than the rest of the world but spends more on pharmaceutcials
|
Canada prefers to take care of outpatients in their own homes
|
|
|
Percent of physicians who say the amount of time they and other staff spend getting patients needed medications or treatment because of coverage restrictions is a major problem:
lowest highest where does Canada fit in |
lowest = UK
highest = US Canada = mid-high |
|
|
population per pharmacy - highest, lowest, Canada
|
highest = Denmark
lowest = Ireland Canada = mid |
|
|
prescriptions/pharmacy/year - highest, lowest, Canada
|
highest = Denmark
lowest = Switzerland Canada = middle |
|
|
# community pharmacies in Canada
|
9000
|
|
|
# community pharmacies in Ontario
|
3500
|
|
|
number of hospital pharmacies in Canada and Ontario
|
Canada: 300 (but not all are accounted for in this number because not all provinces require hospital pharmacies to be licensed)
Ontario: 30 |
|
|
how much does it cost for the initial and renewal certificate of accreditation for your pharmacy
|
$750
|
|
|
key points from the Drug and Pharmacies Regulation (6)
|
can't have a pharmacy without a certificate of accreditation
a corporation cant own or operate a pharmacy unless the majority of the directors of the corporation are pharmacists no one other than a pharmacist or a corporation complying with the above can own or operate a pharmacy no one can operate a pharmacy without the supervision of a pharmacist who is physically present, and it must be managed by a pharmacist who is the designated manager (designated by the owner of the pharmacy) this requirement does not apply to remote dispensing locations as long as a) certificate of accreditation has been issued b) it is operated in accordance with the regulations no one can compound, dispense, or sell drugs except: pharmacist others supervised by pharmacist (intern, student, technician) |
|
|
who can own and operate pharmacies
|
pharmacists
corporations in which most of the directors are pharmacists |
|
|
requirements for remote dispensing units (2)
|
a) certificate of accreditation has been issued
b) it is operated in accordance with the regulations |
|
|
who can compound, dispense and sell
|
pharmacist
others supervised by pharmacist (intern, student, technician) |
|
|
role of pharmacist vs. tech
|
pharmacist: ensures therapeutic appropriate for patient
tech: correct drug? correct label? correct patient? |
|
|
responsibility of owner and designated manager according to Drug and Pharmacies Regulation Act of 1990
|
the owner or designated manager or director of a corporation is responsible if the pharmacy is left unattended
|
|
|
6 types of pharmacies
|
1. grocery store
2. banner 3. franchise 4. chain 5. mass merchandiser (ex. Walmart) 6. independent |
|
|
which schedule are prescription drugs
|
Schedule I
|
|
|
which schedule are non-prescription drugs
|
Schedule II and III
|
|
|
what causes drug shortages
|
lack of raw ingredients
plant closures that did not anticipate demand of their drug |
|
|
unscheduled drugs do not have
|
DIN numbers
|
|
|
where are Schedule II and III available
|
pharmacies
|
|
|
where are unscheduled drugs available
|
any store (ex. variety store)
|
|
|
where are manufacturers found
|
US
Asia |
|
|
medication flow chain
|
manufacturer
warehouse (ex. SDM has a series of warehouses) shipping contracting and purchasing institutional or retail storage pharmacy compounding dispensing patient care area storage drug/dose selection dose administration |
|
|
community pharmacy workflow model
|
1. reception
2. data entry 3. dispensing 4. verification 5. release to patient |
|
|
sources of revenue for pharmacists
|
1. dispensing (cost of drugs + dispensing fee)
2. consumer goods a. health and beauty b. Schedule II and III c. grocery items d. random stuff 3. additional cognitive services (medication regimen review) |
|
|
mark up on health and beauty
|
30-50%
|
|
|
mark up on schedule 2 and 3
|
10-50%
|
|
|
markup on grocery items
|
4-8%
|
|
|
markup on random stuff
|
200-300%
|
|
|
countries in which pharmacy has single owners and single payers (2)
|
Australia
New Zealand |
|
|
countries in which pharmacy has multiple owners and multiple payers (2)
|
USA
Canada |
|
|
countries in which pharmacy has multiple owners and a single payer (2)
|
Ireland
UK |
|
|
countries in which pharmacy a single owner and multiple payers (2)
|
Germany
France |
|
|
single payer =
|
government
|
|
|
multiple payers =
|
private drug plan
government individuals |
|
|
fee + mark up in Ontario
|
$8.62
markup = 8% |
|
|
top 10 generic drugs are priced at __% of brand name drugs
|
18
|
|
|
look at slide 28 and 29 again
|
ok
|
|
|
where is capitation used (2)
|
Scotland
New Zealand |
|
|
general idea of capitation
|
paid per patient
|
|
|
which country has weighted fee system
|
Switzerland
|
|
|
how the weighted fee system works
|
$1.14 per point
basic med review = 3pts dispensing fee = 4pts supervised ingestion = 10pts polypharmacy (>4meds>3months) = 45pts |
|
|
Weighted Fee model of Switzerland
how many points for basic med review |
3
|
|
|
Weighted Fee model of Switzerland
how many points for dispensing fee |
4
|
|
|
Weighted Fee model of Switzerland
how many points for supervised ingestion |
10
|
|
|
Weighted Fee model of Switzerland
how many points for polypharmacy |
45
|
|
|
Weighted Fee model of Switzerland
how is polypharmacy defined |
> 4 meds
> 3months |
|
|
Resource Based Relative Value Scale
|
fee pro-rated to reflect number of:
drugs number of conditions drug therapy problems get more for new vs. follow up |
|
|
what is included in the dispensing fee
|
establishment of patient medication profiles
consultation health care services information (ex. phone calls) after hours emergency prescription service delivery service |
|
|
fixed costs of dispensing (9)
|
maintaining an inventory of common drugs
operating a billing system wages and benefits equipment required for accreditation marketing insurance rent fixtures utilities |
|
|
variable costs of dispensing (3)
|
personnel costs (managing, scheduling, training)
cost of drugs dispensed dispensing supplies |
|
|
role of Ontario gvt in the cost of prescription drugs
|
public drug plan
subsidize private insurance plans regulate drug prices |
|
|
what are rebates and when did they exist
|
60s and 70s
got extra money for stuff like being a certified diabetes educator to receive this allowance, you had to tell the government what you used the money for |
|
|
collaborative drug therapy management
|
extends the duties of the pharmacist from safeguarding the distribution of drugs to include a more significant role in securing the success of drug therapy
collaborative involves therapeutic drug monitoring through lab tests initiating and modifying regimens based on assessments |
|
|
disease states amenable to CDTM (Collaborative drug therapy management) (9)
|
asthma
CV risk reduction chronic pain management diabetes mellitus mental health disorders epilepsy women's health concerns infectious diseases anticoag therapy |
|
|
barriers to pharmacist involvement in their changing role
|
competence of pharmacist
willingness of the pharmacist to participate |
|
|
non technical aspects of core dispensing services (5)
|
check if medication is appropriate
assess for ADEs assess for accessibility patient dialogue patient call-back |
|
|
enhanced medication-related services
|
additional intervention if required
adapting Rx therapeutic substitution pharmaceutical opinion refusal to fill emergency prescribing adherence monitoring and compliance programs injection |
|
|
pharmaceutical opinion
|
pharmacist identifies a particular problem with drug therapy and discusses it with the prescriber
|
|
|
3 levels of service
|
core dispensing
enhanced medication-related expanded |
|
|
list of expanded patient care services (3)
|
comprehensive medication management (CMM)
management of minor ailments heath promotion (disease prevention) |
|
|
what does health promotion consist of
|
immunization
disease screening smoking cessation wellness-lifestyle |
|
|
2 ways pharmacists can manage their time
|
workflow
adjustment of workflow or appointments |
|
|
3 countries that are better at using generics than Canada (based on ratio of generic: total)
|
USA
Germany UK |
|
|
New services (6)
|
increases generic utilization
medication reviews prescribing authority and minor ailments chronic disease management screening and prevention new medicines services |
|
|
chronic diseases that are often involved in chronic disease management
|
diabetes
asthma CVS anticoagulant |
|
|
countries with New Services
|
Australia
England, Wales, Scotland Switzerland Germany Netherlands France US Ireland |
|
|
health living pharmacy (4 requirements)
|
health and well being services and targets met
trained health champion suitable premises local engagement |
|
|
purposes of New Medicines Service
|
increases compliance
|
|
|
New Medicines Service
|
Addresses non-adherence for chronic disease asthma and COPD type 2 diabetes
Hypertension |
|
|
Current issues in pharmacy
|
Lack of IT support
Slow uptake (there is overregulation = excessive documentation and reporting) Lack of education and training Lack of process |
|
|
2 fun facts about the changing scope of practice
|
1. Integration into primary health care is the goal
2. Measurement and evaluation will increase in importance (probably to see if the new scope of practice is going well) 3. Systems of funding will need to change 4. e-Health will be essential |
|
|
definition of primary care
|
first level of contact with the health system
first element of a continuing care process accessible addresses majority of health care needs sustained partnership with patients |
|
|
who is usually the primary care provider (8)
|
family physician
general practitioner nurses physician assistants pharmacists dietitians chiropodists nutritionists social workers |
|
|
3 ways in which primary care is continuous
|
relational - develop relationship with your provider
information - all practitioners who see you get information from the preceding ones management |
|
|
why primary care is a big part of our health care system
|
for every 137 000 family physician visits, there are much less occurrences at other levels of care (ex. 54 000 specialist visits, 3000 hospital visits
|
|
|
why primary care is important
|
higher primary physician supply is associated with better health outcomes and lower costs
|
|
|
why higher primary health care physician supply reduces health care spending
|
lower hospital utilization
|
|
|
how many primary care physicians in Ontario
|
11 500
|
|
|
where is primary health care provided
|
doctor's office
community clinics mobile clinic home visit hospital/ER pharmacies |
|
|
how does Canada compare in terms of primary care visits per capita per year
|
average
5 |
|
|
how does Canada compare wrt waiting for primary care
|
poor compared to other countries
51% can get same or next day appt 23% wait 6 days or more |
|
|
compared to the rest of the developed world, do more or less Canadians have difficult getting after hours care without going to the emergency room
|
more
|
|
|
compared to the rest of the developed world, have more or less Canadians used the emergency room in the past 2 years
|
more
|
|
|
what money is availabl reforming primary care
|
primary health care transition fund (PHCTF)
|
|
|
what is PFCTH
|
primary health care transition fund
|
|
|
5 objectives of PFCTH
|
PHCTF = primary health care transition fund
increase access increase health promotion and disease prevention increase chronic disease management expand 24/7 access establish multi-disciplinary teams facilitate coordination with other health services = reforming primary care to make it primary health care |
|
|
why primary health care models have been modified
|
to help physicians move from solo practice to group based care
|
|
|
3 main categories of models of payment for physicians
|
fee for service
capitated salary |
|
|
4 interdisciplinary practice models
|
family health teams
community health centres aboriginal health access centre nurse practitioner led clinics |
|
|
FFS stands for
|
Fee-for-service
|
|
|
how fee-for-service works
|
physicians directly OHIP
physicians are self employed mostly solo practices |
|
|
MOHLTC
|
Ministry of Health and Long Term Care
|
|
|
CHCs
|
Community Health Centres
|
|
|
how CHCs work
|
physicians are paid with salary
governed by a board of community members interprofessional teams not-for-profit funded by LHINs |
|
|
LHIN
|
local health integration network
|
|
|
who funds CHCs
|
LHINs
|
|
|
AHAC
|
aboriginal Health Access Centre
|
|
|
how AHACs differ from CHCs
|
include traditional healing and cultural programs
|
|
|
HSO
|
Health Services Organization
|
|
|
PCN
|
primary care network
|
|
|
HSO and PCN programs
|
capitation
monthly per registered patient adjusted for age and sex not adjusted for patients health status independent of patient having visits |
|
|
when was HSO phased out
|
90s
|
|
|
physician payment prior to new models
|
FFS
Capitation salary |
|
|
why FFS is bad
|
incentives for over-provision of services and barrier to interprofessional collaboration (the physician doesn't want anyone to take his money)
many people left their practices uncovered many unavailable after hours or weekends |
|
|
why capitation is bad
|
incentives for under-provision of care (physicians are paid anyway) and "Cream skimming" (selecting healthy patients and dumping unhealthy ones)
|
|
|
why salary is bad
|
incentives for low productivity
|
|
|
what kind of practice were doctors working in before reforms
|
solo FFS
|
|
|
why reforms
|
most doctors working in solo FFS
need to make family practice more attractive for new physicians |
|
|
features of Ontario Primary Care Reform
|
Practices made into group or network
Telephone Health Advisory Service (THAS): 24/7 extended hours incentives focus on prevention and comprehensive care expansion of NPs |
|
|
the Current Models of payment for primary care
|
Community Health Centres
Family Health Teams (FHTs) NP-led clinic family health organizations Family Health groups Family Health Networks comprehensive care model (CCM) Rural-Northern Physician Group Agreement |
|
|
blended capitation
|
capitation reimbursement + limited FFS and incentives
|
|
|
family health networks
|
blended capitation (capitation reimbursement + limited FFS and incentives)
on call 24/7 teletriage nurse physicians work in groups |
|
|
CCM
|
enhanced FFS
solo physicians block of after hours services to enrolled patients |
|
|
family health groups
|
FFS
gorups of at least 3 doctors eligible for EMR funding increased access for enrolled patients with after hours enrolment optional THAS (telephone health advisory service |
|
|
nurse practitioner led clinic
|
no formal enrolment
like other CCACs |
|
|
where are nurse practitioner led clinics commonly found
|
rural areas
|
|
|
family health organizations
|
predominantly capitation
some FFS bonus payments very popular eligible for EMR funding have lead physicians increased access to enrolled patients with after hours and THAS |
|
|
difference between FHN and FHO
|
scope of included codes and capitation rate
|
|
|
Rural NOrthern Physician Group Agreement
|
serves rural and northern communities with underservice designation
Blended complement model: base remuneration (based on number of physicians + incentives + premiums) incentive payment for rurality + 5% of shadow billing 24/7 coverage responsible for providing inpatient services to hospitals and LTC homes in the community THAS |
|
|
what do the physicians belong to in Family health teams
|
FHNs or FHOs or blnded complement models (RNGPGA)
|
|
|
who is there funding for within a family health team
|
executive director
allied health professionals electronic medical records |
|
|
who is on the board of directors for family health teams
|
physician led majority, mixed, or community
|
|
|
which models have pharmacists (4)
|
CHC
RNPGA FHT NP led |
|
|
which models do not have pharmacists (5)
|
FFS
CCM FHN FHG FHO |
|
|
which models are solo
|
FFS
CCM |
|
|
which models are 3+ (Practice size) (3)
|
FHN
FHG FHO |
|
|
which model is 1-7 (practice size)
|
RNPGA
|
|
|
which models are team practice (size)
|
CHC
FHT NP led |
|
|
which models involve no enrolment
|
NP led
CHC - registered to the centre not to the physician CCM |
|
|
see slide 30 and memorize the provider payments
|
ok
|
|
|
what are the requirements of all models except FFS and NP led
|
on call, after hours
|
|
|
incentives for all programs except NP led clinics
|
CCM
after hours Diabetes management heart failure management cumulative preventive care colorectal screening smoking cessation enrolling unattached patients premiums for new graduates |
|
|
how the use of the models has changed over the past decade
|
number of physicians practicing primary care has increased
|
|
|
notes about payment in FHTs
|
not a payment odel
physicians are already part of a payment model but they get paid more if they join FHTs |
|
|
why we are attempting to increase enrolment to physicians
|
provides continuity of care
|
|
|
main points of reform (5)
|
enrolment of patients to a physician
introduction of blended payment model focus on preventative on call and after hours shift from solo to group and team |
|
|
theoretical benefits of primary care reform
|
continuity of patient-provider relationship
increased accoutnability of physcians for their patients - because they are rostered increased access = decreased emergency admission group practices = increased quality |
|
|
why increased access is good
|
reduced emergency admission
|
|
|
what CHCs were better at than other models
|
chronic disease management
health promotion |
|
|
what HSOs were better at
|
accesibility
|
|
|
what has been gained from the reform
|
more family doctors in Ontario
increased satisfaction of family doctors not huge difference in accessibility not huge difference in percentage of adults without a family doctors |
|
|
gaps in primary care
|
wait times and access
chronic disease management - lots of people get hospitalized due to their chronic diseases for situations that could be avoided by more attentive family physicians use of electronic medical records |
|
|
% of physcians who use EMRs
|
50
|
|
|
% adult population that is seniors
|
17
|
|
|
relationship between spots in beds in long term care, hospital, long term care, etc
|
if you can't get into long term care you stay in the hospital
if you stay in the hospital , other people cant be admitted from emergency then people in ER waiting room can't be seen in ER |
|
|
ALC patients
|
hospital patients who no longer require acute care but for whom there is no long term care bed
they can't just be discharged they tie up hospital beds |
|
|
% ALC patients who are seniors
|
85
|
|
|
how to reduce the number of ALC patients
|
enhance access to home care and community support services
|
|
|
what is respite care
|
temporary relief for a family member providing home care
|
|
|
goals of home care
|
keep hospital beds and long term care beds open
coordinate admission to facility care when home care is insufficient |
|
|
why home care
|
people like independence
cheaper keep beds (hospital and long term care) for those who really need it) |
|
|
home care in the Canada Health Act
|
extended not essential
provinces do not have to cover it but they all do wide variability across the provinces in what is covered |
|
|
who pays for home care
|
government
insurance out of pocket |
|
|
% of care provided by family caregivers
|
80
|
|
|
home care as a national health care issue
|
it has been frequently cited as an issue but not much has been done
ministers committed to short term coverage (ex. post-surgery care) - this has been succesful but it has taken resources from chronic care patients |
|
|
2 types of home care services
|
home health (2/3 of patients)
home support (1/3 of patients) |
|
|
home health s. home support
|
health = nurse, PT, OT respiratory services
support = PSWs - homemaking and personal care |
|
|
home care services in all provinces and territories (3)
|
case management (assessment and coordination)
nursing PSW |
|
|
home care may include (depending on province) (8)
|
PT
OT pharmacist NP dietitian physician medical supplies Rx drugs necessary for provision of home care services - (ie. drugs ar eprovided if they are related to the reason for your home care) |
|
|
how some provinces cap th services provided by home care
|
keep home care spending below the cost of a bed in a long term care facility
|
|
|
how many hours per week most clients can get in Ontario
|
14
|
|
|
are PSWs regulated
|
no
|
|
|
who administers Ontario's home care program
|
CCACs
|
|
|
how many LHINs are there
|
14
|
|
|
how many CCACs per LHIN
|
14
|
|
|
does Ontario have copay for home care
|
no
|
|
|
how does CCAC administer home care
|
contracts with providers
competitive bidding system for the contracts |
|
|
do profit or non profit companies compete for home care contracts
|
both
|
|
|
how is home care integrated with primary care
|
each family health team is assigned a CCAC care coordinator
|
|
|
where do most home care referrals come from
|
hospitals
|
|
|
how home care is integrated with hopsitals
|
CCAC managers are based in hospitals
|
|
|
Home Frist Initiative
|
special funding provided toenhance access to community care for ALC patients
|
|
|
average length of stay in home care
|
mean = 164
median = 51 |
|
|
% long term care clients taking antidepressants
|
40
|
|
|
pharmacy participation in Ontario's home care program
|
may compete for CCAC parenteral drug therapy contracts
sometimes patients need 6 weeks of IV antibiotics and that is all they need |
|
|
pharmacist participation in home care
|
some CCACs provide a medication management support service
|
|
|
what happens in a pharmacist home visit
|
medication history
asks about and observes client medication taking behaviour inspects medication storage areas assess the situation develop plan implement plan follow up as necessary |
|
|
what is special about the Toronto CCAC
|
3 full time employee pharmacists
|
|
|
how pharmacy involvement in home care has changed
|
used to be limited to providing parenteral drug therapy
now involves MMSS |
|
|
business model for providing MMSS
|
pharmacist employees of the CCAC
pharmacists paid on a fee per visit basis CCAC contracts with one or more community pharmacies |
|
|
is community support services healt hcare
|
yes according to the WHO definition
|
|
|
Community support services
|
various services by a variety of agencies that help people live independently in their own home
often charitable or nonprofit organizations - ex. funded by the United Way |
|
|
who makes arrangemements for community support services
|
client or caregiver
|
|
|
3 forms of residential care for the elderly
|
retirement homes
supportive housing long term care facilities |
|
|
which categoriey does nursing home fit into
|
long term care facility
|
|
|
which form of residential care provides the most and least support
|
most = long term care
least = retirement home |
|
|
2 types of long term care homes
|
nursing homes (privately owned)
Homes for the Aged (municipal or charitable ownership) |
|
|
payment for LTC homes
|
resident pays for accomodation
MOHLTC funds care (Ministry of Health and Long term care) |
|
|
who assesses applicants for long term care homes
|
CCACs
|
|
|
features of LTC homes
|
24h availability of nurses
daily assistance nurses administer medications must have a contracted pharmacy provider |
|
|
required pharmacy provider role for LTCH
|
review and approve policies and procedures for the homes medication management system
participates in quarterly evaluations of the effectiveness of the medication management system alongwith the nursing and the medical director evaluate drug therapy outcomes provide drug education to staff |
|
|
MedsCheck in long term care
|
community pharmacies are reimbursed for reviewing the medication therapy of residents of licensed LTC homes
unlikely that a pharmacy other the contracted one woild be allowed to provide this service |
|
|
annual comprehensive interprofessinnal analysis required in long term care
|
evaluate and monitor effectiveness and safety of medications that may aggravate common geriatric problem areas - includes identifying drugs that should not be prescribed to the eldderly
|
|
|
where assisted living services are provided
|
retirement homes
or supportive housing |
|
|
CCACs and assisted living
|
CCACs can provide a list of organizations that provide assisted living
|
|
|
drugs in retirement homes
|
can make own arrangements or opt for assistance
many retirement homes contract with LTC pharmacies to provide Prescription medications |
|
|
how supportive housing works
|
governmnt funded services provided to people renting apartments in designated buildings
|
|
|
what is different in LTCH vs. supportive housing
|
PSWs rather than nurses
personal care homemaking 24hr emergency response |
|
|
extra stuff in suportive housing
|
completeing forms
access to interpreters referral and advocacy transportation to medical appts |
|
|
medication in supportive housing
|
may make own arragements
assistance may be available |
|
|
why retirement home costs more than supportive housing
|
no government subsidyre
|
|
|
who owns retirement home
|
private ownershios
|
|
|
in which type of living does the resident pay for accomodation and the gov't funds the care
|
LTCH
|
|
|
what Sakatch did first
|
province-wide, universal hospital care plan
|
|
|
which organization is in the interest of the professionals
|
professional association
|
|
|
which association is in the interest of the public
|
regulatory college
|
