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									June 10, 2011                                — Presented by IMS Brogan —                                               Vol. 15, No. 23

   Queue-jumping claims
   rock Alberta health care                          Mental health readmission
    A speech given by former Alberta
Health Services CEO Stephen                          rates reveal care challenge
Duckett May 5 is causing a stir for
claims he made that politically well-            About one in nine patients hospi-                   The 30-day readmission rate of
connected people in the province had         talized for mental illness were read-               11.4 per cent may point not only to
been able to jump wait-list queues           mitted within 30 days after discharge               sub-optimal discharge planning, but
before he put a stop to the practice.        in 2009-10, the Canadian Institute of               signal the need for better continuity of
    Mr. Duckett was appointed CEO            Health Information says in its 2011                 mental health services after dis-
of AHS in March 2009 as it took over         Health Indicators report released                   charge.
health care delivery from nine former        Wednesday. Mental health services                       Both of these possibilities are re-
health regions. In his speech to a To-       are the focus of this year’s report.                inforced by the fact that two of five
ronto audience he said he was told                                                               (41 per cent) mental health readmis-
                                                           In This Issue:                        sions occurred within a week of dis-
shortly after his arrival that his prede-
cessors in the regions had                   ♦   Quebec passes new health-care                   charge, and almost two-thirds (64 per
“designated go-to guys for discrete              governance law..............................4   cent) took place within just 14 days.
waiting list adjustments on requests                                                                 Among provinces, 30-day read-
from MLAs.”                                    Federal budget tabled, no                         mission rates were highest in British
    In June 2009 he sent a memo to              changes for health care                          Columbia (12.9 per cent) and lowest
AHS vice-presidents on the matter of                                                             in Manitoba (9.6 per cent).
                                                 The 2011-12 federal budget was
“Requests for Preferential or Expe-                                                                  Nearly a third of short-term read-
                                             presented Monday with few changes
dited Care” saying the practice is “not                                                          missions occurred with patients who
                                             from the one tabled in March and
uncommon.” In it, he said such prac-                                                             had been hospitalized multiple times
                                             which precipitated the May election.
tices are not condoned and requests                                                              for mental health issues within a 12-
                                                 The accounting for health-care
for preferential treatment should be                                                             month period. These patients also ac-
                                             promises contained in the former
forwarded to him.                                                                                counted for 28 per cent of all mental
                                             budget remains the same such as a
    The CBC broke the story of Mr.                                                               health hospitalizations and 27 per
                                             beefed-up caregiver allowance, a stu-
Duckett’s speech Monday and it be-                                                               cent of the total number of patient
                                             dent-loan forgiveness program for
came a front-page story in the Cal-                                                              days.
                                             medical students, and a number of
gary Herald and Edmonton Journal                                                                     Another topic explored in the CIHI
                                             investments in health research.
Tuesday.                                                                                         report is hospitalization due to self-
                                                 The election promise to keep the
    The same day, Alison Redford, a                                                              injury.
                                             six per cent escalator for the Canada
former Justice minister who is a can-                                                                In 2009–2010, approximately
                                             Health Transfer after the expiry of the
didate for the leadership of the gov-                                                            17,500 Canadians – 45 people a
                                             2004 health accord was included in
erning Progressive Conservative                                                                  day – were admitted to hospital after
                                             the last budget as a “planning as-
Party, called for a judicial inquiry into                                                        attempting suicide or deliberately
the matter to restore public confi-                                                              harming themselves.
                                                 The major changes in the budget
dence. Premier Ed Stelmach, the                                                                      Across the country, health regions
                                             concern the government’s plan to
person she hopes to replace when he                                                              had a self-injury hospitalization rate
                                             erase the $32 billion deficit a year
steps down October 1, has vetoed                                                                 of 65 per 100,000 population but it
                                             earlier than expected in 2014 which
the idea.                                                                                        was almost six times higher in Nuna-
                                             also happens to be when a renewed
    There have been repeated de-                                                                 vut and three times higher in the two
                                             health accord with the provinces and
mands from a number of quarters for                                                              other territories. Newfoundland and
                                             territories will take effect.
a judicial inquiry into widespread alle-                                                         Labrador and New Brunswick had the
                                                 To do this, the government is
                 (See "Alberta” on page 4)                                                                  (See "Mental health" on page 2)
                                                                   (See “Budget” on page 2)
HealthEdition                                            —2—                                                Vol. 15 No. 23

("Mental health" from page 1)
highest rates among provincial health                              Hansard                Highlights
regions at 81 per 100,000.                             Debates in provincial legislatures and House of Commons
    Young women age 15 to 19 were
the most likely to self-injure. Women         Last Friday, a Speech from the           the health care needs of their resi-
in this age group had a self-injury       Throne opened the First Session of           dents.”
hospitalization rate of more than 140     the Forty-First Parliament of Canada.            Health care has been a daily topic
per 100,000 – more than double the        On health care, it said the Conserva-        in question period over the past week.
rate of men in the same age cate-         tive government “is committed to re-         On Monday, NDP Health Critic Libby
gory.                                     specting provincial jurisdiction and         Davies called on the government to
    CIHI says self-injury rates are an-   working with the provinces and territo-      hold “open consultations with Canadi-
other indicator of access to commu-       ries to ensure that the health care          ans so that the next accord reflects
nity care.                                system is sustainable and that there is      their values and priorities for health
    “While suicide and self-harming       accountability for results.” It reiterated   care in this country.” In her response,
behaviours are very complex, they         the government’s election promise to         Health Minister Leona Aglukkaq did
are considered largely preventable        maintain the six percent escalator for       not address the matter of public con-
when accessible and effective com-        the Canada Health Transfer and to            sultations, but said the discussions
munity-based intervention strategies      work collaboratively with the prov-          with the provinces on a renewed ac-
are in place,” Kira Leeb, CIHI’s direc-   inces on renewing the 2004 health            cord “will emphasize the importance
tor of health system performance,         accord “and to continue reducing wait        of accountability and results for Cana-
said in a news release.                   times.” It said a renewed health ac-         dians, including better reporting from
    CIHI’s Health Indicators report is    cord would contain a separate agree-         the provinces and territories to meas-
produced in partnership with Statis-      ment with Quebec as was in the previ-        ure progress and guarantees covering
tics Canada, and presents more than       ous accord.                                  additional medically necessary proce-
40 comparable measures of health              In the House of Commons                  dures.”
and health system performance by          Wednesday, Bob Rae, the interim                  In the New Brunswick legislature
health region, province and territory.    leader of the Liberal Party, called on       last Friday, Bernard Leblanc, the op-
It can be found at HE        the government to start negotiations         position critic for Social Development
                                          with the provinces on the renewal of         and Seniors, asked when the govern-
(“Budget” from page 1)                    the health accord, noting that “All the      ment will make up its mind about
looking for $4 billion in savings in      provinces want to see a different atti-      nursing home construction and reno-
program spending. According to Fi-        tude from the federal government             vation projects which are on hold
nance officials, every department         when it comes to health and consult-         while cost estimates are being exam-
has been asked to plan for two sce-       ing with the provinces in particular.”       ined. He said lack of nursing home
narios: spending cuts of five and ten     Prime Minister Stephen Harper                beds is being blamed for backlogs in
per cent.                                 pointed out that the current accord is       emergency departments. Premier
    Last Friday, Treasury Board           not about to expire any time soon and        David Alward replied that the govern-
President Tony Clement (a former          he said health transfers have gone up        ment needs to do its homework on the
health minister) tabled the govern-       over 30 per cent since his government        issue, pointing out that “the cost of
ment’s spending estimates for 2011-       has been in power. Liberal Health            construction of nursing homes and the
12. Health Canada will have planned       Critic Hedy Fry then asked about the         standard increases over the last four
expenditures of $3.3 billion which is     status of the National Pharmaceuti-          years are unsustainable. It has gone
a $75.6 million, or 2.2 per cent re-      cals Strategy, saying the recent report      from building a bed in a nursing home
duction from the Main Estimates of        from the Health Council of Canada            for approximately $180 000, which is
last year.                                had said this initiative in the accord       a lot of money, to over $300 000.” He
    Most of this is coming from the       had stalled. She said there was no           said the former government’s plan
sunsetting of stabilization funding for   mention of the pharmaceuticals strat-        was to replace old nursing homes with
the Non-Insured Health Benefits pro-      egy in Monday’s budget. Colin Carrie,        new ones which would not signifi-
gram for First Nations and Inuit cli-     parliamentary sector to the health           cantly increase the number of beds.
ents, primary care nursing and capi-      minister, again noted the increase in        “We will ensure that the seniors of
tal contribution funding for First Na-    transfer payments so that provinces          New Brunswick have the care they
tion communities. HE                      and territories “can continue to meet        need.”
HealthEdition                                              —3—                                                Vol. 15 No. 23

 .. Briefly .. News Shorts .. Briefly .. News Shorts .. Briefly
    Manitoba is placing pharmacists         2012. The government has also              sician office visits, 750 hospitaliza-
in the province’s busiest emer-             agreed to fund more hours of physi-        tions, 57 deaths and saved millions in
gency departments. Ten pharmacy             cian coverage. (Halifax Chronicle-         annual health-care costs. The funding
positions, including seven in Winnipeg      Herald, June 7)                            will allow OPIS to be expanded from
hospitals, are being created as part of         Ontario nurses have an arbi-           33 to 48 treatment sites. (News re-
a $1.75 million investment announced        trated contract settlement covering        lease at
this week. The pharmacists will review      a three-year period retroactive to April   aspx?portalId=1377&pageId=98704)
a patient’s medication to ensure they       1, 2011. In each of the first two years,        British Columbia is opening five
are receiving the correct dosage, ad-       the award provides a lump sum pay-         new integrated cancer care centres
verse drug interactions are prevented,      ment for the more than 50,000 RNs          in Victoria, Kelowna, Abbotsford and
and their physician is informed of any      that is worth from $565 to $1,306 de-      Prince George as well as a virtual one
potential problems with their drug re-      pending on their number of years of        in Vancouver. The InspireHealth cen-
gime. (News release at         experience. There are also improve-        tres, which combine nutrition, exer-
ca/news/index.html?archive=2011-06-         ments to health benefits, shift premi-     cise, emotional and spiritual support
01&item=11677)                              ums and vacation entitlements offset       with standard cancer treatments, will
    New Brunswick has released a            by amendments to short-term disabil-       be launched in a phased approach be-
new four-year diabetes strategy to          ity and early retirement allowance pay-    ginning September 2011. Full imple-
tackle rising diabetes rates in the prov-   ments. The award also includes a 2.75      mentation is expected by September
ince. It is estimated that almost 10 per    per cent salary increase in the last       2012. More information at www.
cent of the population will be affected     year. The government has been trying
by 2012-13. The plan includes: im-          to impose a public sector wage freeze           All Quebec hospitals will have to
proved detection and better patient         but Premier Dalton McGuinty admitted       eliminate 24-hour shifts for medical
education with access to affordable         Friday that it is impossible to impose     residents within six months, an arbi-
medications, supplies and devices,          this across the board. He made it clear    trator ruled this week in a case
and ongoing monitoring for the man-         that hospitals will have to cover the      launched against the McGill University
agement of diabetes; increased forms        lump sum payments within their budg-       Health Centre by one such resident.
of self-care support will be available,     ets. (News releases; Toronto Star,         The maximum length of shift will be 16
accessible, affordable and appropriate      June 4)                                    hours and this is being hailed by the
for a variety of learning levels and            Allied health professionals in         Fédération des médecins résidents du
preferences; providing health care          Saskatchewan have a new contract           Québec (FMRQ) which has been fight-
teams with access to technology-            offer to mull over. The Saskatche-         ing for the change over the last four
enabled reminders for appropriate           wan Association of Health Organiza-        years. (Montreal Gazette, June 8;
monitoring, and decision-support tools      tions (SAHO) has offered a wage in-        News release)
to support clinical practice based on       crease averaging 11 per cent over               Quebec hospitals are gearing up
evidence and best practices; and, pro-      four years. The union representing the     to provide free in vitro fertilization
viding citizens, health-care providers      workers has called off rotating strikes    treatments, a program announced
and health-system planners with ac-         for now, and is planning to present a      last summer by Health Minister Yves
cess to the appropriate information to      counterproposal. (Regina Leader-           Bolduc. Five sites are involved, only
support personal, patient and popula-       Post, June 9)                              one of which (McGill) has a program
tion health. The strategy can be found          Cancer Care Ontario has re-            already in place. The startup costs are
at          ceived $9.7 million from eHealth           not inconsiderable, including new fa-
asp.                                        Ontario to expand its Oncology Pa-         cilities and equipment as well as the
    Emergency physicians in Halifax         tient Information System (OPIS). It        recruitment and training of personnel.
are in line to receive a 21 per cent        automates the former paper-based           This is added to the estimated $63
pay increase under a new contract           chemotherapy drug ordering process         million in annual operating costs once
that boosts their hourly salary from        and improves patient safety. In the        the program is fully in place in 2014-
$156 to $190. The new rate, which is        past five years, it is estimated that      15. In vitro fertilization is currently of-
the same as in neighbouring New             OPIS has prevented approximately           fered by a number of private clinics in
Brunswick, will take effect April 1,        8,500 adverse drug events, 5,000 phy-      the province. (Le Devoir, June 9)
HealthEdition                                              —4—                                                 Vol. 15 No. 23

(“Alberta” from page 1)
gations of compromised care of pa-
tients requiring emergency care and                         E ditorials                   &   C ommentary
cancer surgery, as well as charges of
physicians being prevented from ad-         Answers on the health accord                  where we are now” with government
vocating for patients. The govern-              The Globe and Mail (June 3) is            revenues being overtaken by the de-
ment has responded by asking the            frustrated that the Health Council of         mands of an aging population. The
Health Quality Council of Alberta to        Canada, in its recent progress report         Globe suggests that the Harper gov-
investigate, and Mr. Stelmach says          on health reform, “can’t seem to make         ernment “should insist on spending
the Council can add Mr. Duckett’s           up its mind whether it’s happy or un-         less, and buying more” when it sits
claim to the list if substantive proof of   happy with the results” obtained from         down to negotiate a new accord with
MLA-influenced queue-jumping can            the 2004 health accord and the one            the provinces and territories.
be found.                                   preceding it in 2003. “Is it too much to
    But he doubts this will materialize.    ask that $41 billion buy a straight an-
Both he and Health Minister Gene            swer?” the Globe asks, referring to the        Health Edition is published by
Zwozdesky say they have never en-           price tag of the 2004 agreement. “The          Krysgar Communications Inc. Re-
countered the practice in their politi-     muddied picture — one step forward,            production without permission is
                                                                                           prohibited. This special version
cal careers. AHS officials have also        two steps sideways — should tell us            of Health Edition is an integral
dismissed Mr. Duckett’s claims as           why Ottawa needs to do more than               component of the PharmaFocus
“vague allegations about what may or        hand the provinces the keys to the             2015 suite of products provided
may not have occurred in the past.”                                                        by the Strategic Information Ser-
                                            vault when the current 10-year accord          vices group at IMS Brogan. You
    Nevertheless, on Wednesday,             lapses in 2013-14.” The Globe be-              can contact Health Edition at
NDP Leader Brian Mason asked the            lieves that the accord has not done  
RCMP to launch a criminal investiga-        enough to “prepare the system for              ISSN 1492-627X
tion into political influence-peddling to
aid queue-jumping. The NDP has                     Quebec passes new health-care governance law
also created a hotline for people to
report cases they are aware of. HE               Bill 127 was passed by Quebec’s              But the fact that there are three
                                            National Assembly Wednesday. The              levels of health-care management in
       Chaoulli decision,                   bill is designed to improve the man-          Quebec — the ministry, 18 health re-
          six years later                   agement of the health and social ser-         gions and the 95 CSSS — has fos-
    Thursday marked the sixth anni-         vice network but it has gone through a        tered criticisms about overlapping au-
versary of the famous Supreme               lot of changes since it was introduced        thority. Some believe the regions
Court of Canada decision on the so-         by Health Minister Yves Bolduc last           should be abolished altogether.
called Chaoulli case which chal-            December.                                         In his remarks to the legislature
lenged Quebec’s health insurance                 There was immediate concern that         Wednesday, Dr. Bolduc said he would
laws and forced the government to           it was a blatant power grab by the            continue to look at administrative
allow private delivery of some medi-        minister to give him the tools to inter-      processes, and this could lead to “a
cally necessary services — namely           vene in the operations of the 95              more substantial adjustment of shared
joint replacements and cataract re-         health and social services centres or         responsibilities.”
movals.                                     CSSS whose boards manage the de-                  Bill 127 also changes the composi-
    The anniversary was observed by         livery of hospital and community-             tion (and size) of the CSSS boards to
the Coalition Solidarité Santé, a           based care at the local level.                add independent members who bring
medicare advocacy group. It said pri-            One contentious clause in the final      particular expertise to the decision-
vatization of care has accelerated in       bill still gives the minister the final say   making process. Public elections of
the province since the Court deci-          on the selection of CSSS executive            some board members will also be re-
sion, and the government has failed         directors.                                    instated, and the CSSS have been
to make the necessary investments                The bill does tighten up board op-       directed to improve the use of public
to protect a public health system           erations by introducing new account-          forums to collect input.
which is the only model for guaran-         ability measures, and boards will have            The changes to the new boards
teeing the provision of equitable and       to produce five-year strategic plans in       are to be fully in place by February 1,
efficient care. HE                          line with ministry direction.                 2012. HE
HealthEdition                                            —5—                                             Vol. 15 No. 23

 Ontario to audit pharmacy
  compliance with reforms
    Ontario marked the one-year an-
                                                          Company News
niversary this week of sweeping drug
reforms which the government says              Amgen Canada has received            (paroxysmal nocturnal hemoglobinu-
have met the commitment to save            Health Canada approval for Xgeva         ria) says it is disappointed with last
$500 million per year by reducing ge-      for reducing the risk of developing      week’s recommendation by the Insti-
neric drug prices 50 per cent.             skeletal-related events (SREs) in        tut national d'excellence en santé et
    It is also taking new steps to audit   adults with bone metastases from         services sociaux (INESSS) to not in-
more pharmacies, wholesalers and           solid tumours. It is not indicated for   clude Alexion’s Soliris on Quebec's
generic drug manufacturers. This will      reducing the risk of developing SREs     public drug insurance plan drugs list.
help to ensure they are complying          in patients with multiple myeloma.           Medicago Inc. of Quebec is re-
with the reforms, including eliminating    (News release) … Health Canada           porting positive results from a U.S.
professional allowances.                   has granted Shire’s Mezavant an          Phase I human clinical trial of its
    Canadian Press reported that           expanded indication to include main-     H1N1 vaccine candidate. (News re-
Health Minister Deb Matthews has           tenance of clinical and endoscopic       lease) … Cipher Pharmaceuticals
received anecdotal evidence that           remission (mucosal healing) in pa-       of Mississauga is also reporting en-
some pharmacies may not be playing         tients with ulcerative colitis. (News    couraging top-line safety and efficacy
by the rules. She told CP that it was      release)                                 results from a Phase III safety study
important to let the auditors go in and        Quebec is reimbursing Takeda         of Cip-Isotretinoin, its formulation of
do their job because a lot of money is     Canada’s Uloric for people suffering     isotretinoin for the treatment of se-
involved.                                  from gout. Quebec is also covering       vere, nodular acne. (News release)
    CP also reported that between          Takeda’s Dexilant, a delayed-release         Somaxon Pharmaceuticals of
June 2010 and March 31, 2011, 27           proton pump inhibitor for the once-      San Diego and Paladin Labs have
independent pharmacies closed in           daily treatment of heartburn associ-     entered into an exclusive collabora-
Ontario but 77 opened, and just as         ated with symptomatic non-erosive        tion under which Paladin will com-
many chain drug stores opened as           gastroesophageal reflux disease          mercialize Silenor for the treatment of
closed (15) in the period. Still, the      (GERD). (News releases) …The As-         insomnia in Canada, South America
Ontario Pharmacists Association            sociation québécoise de l'HPN            and Africa. (News release)
says it is too early to say how the re-
forms will affect the pharmacy busi-
                                                    CETA seen as opportunity, threat for Canada
    Opposition Leader Tim Hudak                A Comprehensive Economic and         thing more than it already has in
says he is concerned about the im-         Trade Agreement (CETA) between           place for its own 27-member coun-
pact of the drug reforms on small,         Canada and the EU was promoted           tries.” He said it is widely acknowl-
independent pharmacies. However,           as “The opportunity of a lifetime” by    edged that Canada’s intellectual
he told CP he would not reverse the        Canada’s Research-Based                  property regime “is less than world
ban on professional allowances if he       Pharmaceutical Companies Tuesday,        class.” HE
becomes premier in October’s elec-         the same day the Canadian Generic
                                           Pharmaceutical Association issued a       QC pharmacist prescribing
                                           release claiming it would potentially         bill promised in fall
    A news release announcing the
drug-reform anniversary said the gov-      wipe out the savings from Ontario           In the Quebec legislature
ernment has reinvested savings in 15       government’s drug reforms .              Wednesday, Parti Quebecois Leader
new brand-name and cancer drugs,               The CGPA repeated its claim that     Pauline Marois asked when the gov-
expanding the MedsCheck program            EU proposals for CETA would add          ernment would finally table a bill giv-
and providing seniors with more ac-        approximately $1.2 billion annually to   ing pharmacists expanded scope of
cess to free services at their local       the province’s prescription drug bill.   practice. Health Minister Yves
pharmacy. HE                                   However, Rx&D President Russell      Bolduc admitted that the bill would
                                           Williams accused the CGPA of using       not be ready before the legislature
 Pharma News in This Issue:                “misinformation and exaggeration” in     adjourns Friday for the summer re-
♦   Harper government questioned           its attempts to derail the agreement.    cess, but it would be tabled “very,
    about NPS (Hansard)……........2         He said the EU “is not proposing any-    very early in the fall.” HE

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