universal coverage for medically necessary health care service, provided based on need, rather than ability to pay
First province wide universal health care plan? Second?
Saskatchewan 1947-covered hospital visits
BC was second (1948)
When did medicare take effect
July 1st, 1962; medicare election in 1960
In what year did all provinces have medicare?
Canada health act enacted in?
What are its 5 principles
What is the role of provincial/territorial governments in administering health care? (APRPN)
Administer health insurance plans
Planning and funding of care in hospitals and other health facilities
Regulation of services provided by HCPs
Planning and implementing health promotion+public health intiatives
Negotiation of fee schedules with HCP
What is the breakdown of total healthcare expenditures?
65% provincial/territorial (but actually federal tax money due to fiscal transfer)
30% private sector
4% direct fiscal
What is the trend in health expenditure over time, until now?
Hospital spending decreasing as a total %
Drug spending increasing as a total %
Number of pharmacies in ontario? number of pharmacists in ontario?
Gender ratio of ontario pharmacists?
58 female- 42 male
Approximately how many pharmacies open every year?
Total additions to pharmacy register? How many from ontario? Total deletions from pharmacy register? Net gain?
250 from ontario
500 net additions
% of ontario pharmacists that are internationall educated? most are educated where?
40% of ontario pharmacists are internationally educated, of these, 20% are educated in egypt.
Percentage of community to hospital pharmacy?
Next steps with pharmacy scope in Ontario
prescribe for minor ailments
order and interpret lab tests
administer a drug by injection beyond flu/immunization
initiate drug therapy beyond smoking cessation
Value proposition for pharmacists:
medication expert, who uses knowledge/sklls to make decisions that positively impact patient health
% increase in pharmacist workforce from 2006-2011? How does this rank with physicians/nurses
Workforce increased by 21%, higher than physicians/nurses
Average age of pharmacists in Ontario? How does this compare to Canada?
45 y.o.,highest in Canada
Density of pharmacists in ontario? comparison to rest of country
81/100,000; significantly less than other provinces
1228 patients/pharmacist; significantly higher than other provinces
Which province has highest percent of pharmacists working in urban areas? What is the percentage?
Where will pharmacists add value?
Place to pick up prescriptions
place to get advice
WHO definition of primary care
First level of contact with the health care system, bringing healthcare as close as possible to people, and constitutes first element of continuing care process. Addresses the main health problems in the community
Institute of medicine definition of primary health care
Integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health needs, developing a sustained partnership with patients, and practicing in the context of family and community
Only difference between FHO and FHN is scope of include codes and capitation rate
most popular primary care model
Family Health Teams
not actually a payment model (groups already in FHO/FHN/RNPGA)
funding for a director, allied health professionals, and implementation of EMR
about 200 FHTs in Ontario
similar to CHC but CHC focus on reducing barriers and FHT focus on interprofessional expertise.
How many physicians (%) are in reformed primary care models? How many patients (%)
What are some benefits of primary care reform?
Continuity of patient-provider relationship
Increased accountability of physicians for their patients
increased access associated with les emergency admissions
group practices associated with increased productivity
interdisciplinary care associated with quality of care
CHC (salary model) had higher scores for what compared to FFS and capitation models?
chronic disease management
addressing lifestyle modifications
What is Alternate level of care
Patients who no longer require an acute care bed but for whom no long-term care bed is available
What is home care?
An array of services in the home and community setting that encompass health promotion and teaching, curative intervention, end-of-life care, rehabilitation, support and maintenance, social adaptation and integration, and support for the informal (family) caregiver
Often integrate delivery of
very broad definition
What is the difference between formal and informal home care? What percentage of home care is delivered by family members?
Formal: care that is paid for, either publically or privately
Informal: family, friends, volunteers providing care
80% of all home care delivered by family members
15% of Canadians provided care to a family/friend with a chronic condition
How many Canadians use home care? How much spending does home care recieve compared to LTC and hospitals?
Almost 1,000,000 at any given time (50% increase from 1998-> 2008)
Home care funding is lower than LTC and wayyy lower than Hospitals
Two types of services provided by home care, and what percentage of people use each?
Home Health (68% of clients)-nursing/PT/OT
Home Support (38% of clients)- home making and personal care (provided by PSW)
How are home care services capped?
some provinces cap number of hours/spending to the equivalent cost of a LTC facility
in Ontario, the average is around 14 hours of home care / week
What is a Community Care Access Centre? How many are there in Ontario?
Single point of entry for all gov't funded LTC services
Receive referrals for home care from anyone
Assess eligibility, authorize, case manage
provide info for other community support agencies
CCACs do not provide care but contract and manage third parties to provide care
Acute Care and CCACs. What is the "home first" initiative?
some CCAC case managers present in every hospital in their LIHN
majority of home care referrals are from hospitals
Home first initiative: investment in home care to reduce alc until LTCF beds are available
How many people use home care in Ontario?
Avg. age, impairments, medications?
What is the mean and median of home care use in Ontario? What does this tell you?
500,000 clients, avg age is 78, 68% have cognitive impairments, 25% on antidepressents
Thus minority of people people using home care for an extended period of time
What is a pharmacists role with CCAC, and when did it start?
Provide Medication Management Support Service (MMSS).
Began as a pilot project in Scarborough in 2004
How are pharmacists reimbursed when working with CCACs?
pharmacists salaried employees of CCAC
pharmacists paid on fee/visit basis
CCACs contracts community pharmacy
What are community supportservices
Various services that assist people to live independently, delivered in homes or in community centres
-usually requires a copay
-up to client to make arrangements (CCAC will only provide info)
What are three types of residential care options available to the elderly?
Long term care facilities/Nursing homes
nursing homes(privately owned) but the care is provided for by the MoHLTC
for people who need high assistance (nursing support available 24 hours a day)
nurses administer medication
nursing home must have a contracted pharmacy provider (24/7), usually given in multidose packaging
pharmacists reimbursed for medchecks in nursing homes
Funded by the government
For clients in Supportive housing or retirement homes who need more care than home care.
privately owned; on site support
dont need a pharmacy contract
not gov't subsidized/funded
privately owned buildings, but assisted living services (thus paid for by MoHLTC)