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CMA Patient Safety Policy Framework (Update 2010)

https://policybase.cma.ca/en/permalink/policy9747

Last Reviewed
2018-03-03
Date
2010-02-27
Topics
Health care and patient safety
  1 document  
Policy Type
Policy document
Last Reviewed
2018-03-03
Date
2010-02-27
Replaces
CMA Patient Safety Policy Framework (2001)
Topics
Health care and patient safety
Text
CMA PATIENT SAFETY POLICY FRAMEWORK (Update 2010) BACKGROUND The CMA’s mission is to promote the highest standard of health and health care for Canadians. This means, among other things, ensuring that the health care system is safe for patients and providers and effective in achieving good health outcomes for individuals and society. Unfortunately, studies published in recent years have raised concern that health care is not as safe as it could be; data collected by researchers in various countries has shown that there are unacceptably high levels of preventable adverse events, as high as 16% in one study of adverse events associated with hospital admissions. A study conducted by G. R. Baker, P.G. Norton et al, “The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada” showed an adverse event rate of 7.5 per 100 hospital admissions. (1) This suggests that of the nearly 2.5 million hospital admissions yearly in Canada, approximately 185,000 are associated with an adverse event and 70,000 of those possibly preventable. These studies have focused attention on health care error and adverse events, but patient safety requires that participants in the health care system are constantly aware of the risks present in the system, and that risks are addressed proactively - preferably before an adverse event occurs. If a preventable adverse event does occur, it provides an opportunity to learn about and correct sources of error. The CMA considers that a national patient safety strategy, aimed at building a culture of safety, is a priority. This Policy Framework has been developed to provide a clear statement of the CMA’s views on the principles that should underpin a patient safety strategy and to ensure clear support and direction for CMA members and staff involved in patient safety initiatives. PRINCIPLES The Health Care System Outcomes Errors and adverse events are inevitable in any complex system and more complex systems are more prone to errors. Nevertheless, studies have demonstrated an unacceptably high level of preventable adverse events associated with management of health care. 1. Patient safety initiatives should aim to improve health outcomes for patients by minimizing the rate of preventable adverse events and improving the management of events when they occur. Quality 2. Patient safety is one aspect of quality health care; activities relating to patient safety should result in a net increase in the quality of health care. Systemic factors 3. Patient safety initiatives should recognize that error and adverse events occur because of qualities of the system within which individuals operate. A primary concern of initiatives should be to prevent future errors by addressing the system rather than blaming and punishing individuals. Accountability The Canadian public has a reasonable expectation that health care will not result in avoidable injury. 4. Patient safety initiatives should support the accountability of the health sector, including providers, funders and regulators, to patients and the wider public for the safety of health care. Participants in Health Care Patients as partners 5. Patient safety initiatives should promote the role of patients as partners in the provision of safe care, including the prevention and management of adverse events. 6. Patient safety initiatives should encourage and anticipate the full and appropriate disclosure to patients of relevant information that is material to their health and healthcare, including information about adverse events or effects. Professional responsibility and support With a very few exceptions, health care is delivered by competent, caring professionals who are striving to achieve a good outcome for patients. 7. Patient safety initiatives should recognize the responsibility of professionals for achieving and maintaining the standard of their own practice. 8. Patient safety initiatives, while responding appropriately to adverse events, should be sensitive to the professional role and personal well being of individual physicians and other health care providers. Learning and Collaboration 9. Patient safety initiatives should promote and reflect teamwork, communication and collaboration at all levels. 10. Patient safety initiatives should support learning from one’s own experience and the sharing of knowledge so that it is possible to learn from the experience of others. Legal and Regulatory Environment 11. Patient Safety initiatives should promote a legal and regulatory environment that supports open communication and effective management of adverse events. 12. The protection afforded to the opinions expressed within quality assurance committees must be upheld Evidence Base and Evaluation Patient safety initiatives should be based on sound evidence. Patient safety initiatives should contain provision for appropriate evaluation. Patient safety initiatives should contain provision for broad dissemination of findings. PATIENT SAFETY INITIATIVE AREAS Building a culture of safety in Canadian health care will require the collaboration of many different groups and organizations. The CMA can play a leadership role within this larger group and within its own constituency of over 70,000 physicians. In some instances, it will be the CMA’s role to advocate for initiatives that can be delivered only by another provider or through a consortium; in other instances, CMA can assume sole responsibility for taking action. The CMA has identified that, as priorities, it will support: Advocacy for changes to legislation and regulation that would remove disincentives for health care providers to share information about adverse events. Raising awareness of patient safety and changing attitudes towards risk, error and adverse events within the health care community. Developing and providing resources such as clinical practice guidelines and information technology systems that have been shown to standardize practice and reduce adverse events. Reporting systems that collect and aggregate data on risks so that good practices can be developed and shared. Education and training for health care professionals and managers to provide them with the conceptual and practical tools to introduce change into their practice and organizations. Advocacy for, and development of, an agenda for patient safety research in Canada. The involvement of government at all levels in supporting and committing resources to initiatives for improved patient safety. GLOSSARY Adverse event – any unintended injury or complication that is caused by health care management rather than the patient’s disease and that leads to prolonged hospital stay, morbidity or mortality. Adverse events do not necessarily result from error, for example a toxic reaction to a drug in a patient without apparent risk factors for the reaction. Error – the failure of a planned action to be completed as intended (“error of execution”) or the use of a wrong plan to achieve an aim (“error of planning”). An error may not result in an adverse event if the error does not result in harm or is intercepted. Risk – the chance of injury or loss as defined as a measure of the probability and severity of an adverse effect to health, property, the environment or other things of value. (1) G. Ross Baker, Peter G. Norton, Virginia Flintoft, Régis Blais, Adalsteinn Brown, Jafna Cox, Ed Etchells, William A. Ghali, Philip Hébert, Sumit R. Majumdar, Maeve O'Beirne, Luz Palacios-Derflingher, Robert J. Reid, Sam Sheps, and Robyn Tamblyn. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada Can. Med. Assoc. J., May 2004; 170: 1678 - 1686.

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CMA's submission to Finance Canada's consultation on ensuring the ongoing strength of Canada's retirement income system

https://policybase.cma.ca/en/permalink/policy9807

Date
2010-05-07
Topics
Physician practice/ compensation/ forms
  1 document  
Policy Type
Response to consultation
Date
2010-05-07
Topics
Physician practice/ compensation/ forms
Text
The Canadian Medical Association (CMA) is pleased to participate in the Government of Canada's consultation on ensuring the ongoing strength of Canada's retirement income system. Ensuring sufficient income in retirement is a concern for CMA's more than 72,000 physician members and the patients they serve. With the aging of the Canadian population and the decline in the number of Canadians participating in employer-sponsored pension plans, now is the time to explore strengthening the third pillar of Canada's government-supported retirement income system: tax-assisted savings opportunities. Two areas in need of government attention are tax-assisted savings vehicles for high-earning and self-employed Canadians, and vehicles available to help Canadians save to meet future continuing care needs. Like the Canadian population at large, physicians represent an aging demographic - 38% of Canada's physicians are 55 or older - for whom retirement planning is an important concern. In addition, the vast majority of CMA members are self-employed physicians and, as such, they are unable to participate in workplace registered pension plans (RPPs). This makes physicians more reliant on Registered Retirement Savings Plans (RRSPs) relative to other retirement savings vehicles. As we saw during the recent economic downturn, the volatility of global financial markets can have an enormous impact on the value of RRSPs over the short- and medium-term. This variability is felt most acutely when RRSPs reach maturity during a time of declining market returns and RRSP holders are forced to 'sell low'. The possibility that higher-earning Canadians, such as physicians, may not be saving enough for retirement was raised by Jack Mintz, Research Director for the Research Working Group on Retirement Income Adequacy of Federal-Provincial-Territorial Ministers of Finance. In his Summary Report on Retirement Income Adequacy Research, Mr. Mintz reported that income replacement rates in retirement fall below 60% of after-tax income for about 35% of Canadians in the top income quintile. This is due to the effect of the maximum RPP/RRSP dollar limits, which is why the government should consider raising these limits. The CMA supports exploring ways to expand tax-assisted options available for retirement saving, particularly measures that would allow organizations to sponsor RPPs and Supplementary Employee Retirement Plans (SERPs) on behalf of the self-employed. Such changes could allow the growing ranks of self-employed Canadians to benefit from the security and peace of mind already available to Canadians with workplace pensions. CMA members favour a voluntary approach, both for employers/plan sponsors in deciding whether to sponsor such plans and for potential plan participants in choosing whether or not to participate. Just as the government should explore ways to modernize the rules governing registered pension plans to account for today's demographics and employment structures, so too should it explore ways to help Canadians save for their continuing care - including home care and long-term care - needs. When universal, first-dollar coverage of hospital and physician services-commonly known as 'medicare' - was implemented in Canada in the late-1950s and 1960s, health care within an institutional setting was the norm and life expectancy was almost a decade shorter than it is today. With Canadians living longer and continuing care falling outside the boundaries of Canada Health Act first-dollar coverage, there is a growing need to help Canadians save for their home care and long-term care needs. The attached backgrounder highlights the pressing need for greater support for home and long-term care in Canada, as well as some principles and options for governments to help Canadians pay for these services. It should be noted that the introduction of Tax-free Savings Accounts (TFSAs) in the 2008 federal budget created a new savings vehicle to support Canadians' continuing care needs. The CMA was pleased to see its introduction. Government action on these two related issues would benefit all Canadians. Expanding retirement-saving options for physicians would provide a strong incentive for physicians to stay in Canada. Similarly, by helping Canadians save for their own continuing care needs, governments could contribute to the health of elderly citizens and ease the demand on unpaid caregivers and government-funded continuing care. Ensuring that Canadians have the tools at their disposal to save for their continuing care needs and that Canada's physicians have the right tools to save for retirement are important issues for the CMA. Canada's physicians have long been active on these issues and government action on these files would benefit all Canadians. We are pleased to take part in Finance Canada's consultations and would welcome any further opportunities to participate. Sincerely, Anne Doig, MD, CCFP, FCFP President

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Climate Change and Human Health

https://policybase.cma.ca/en/permalink/policy9809

Last Reviewed
2018-03-03
Date
2010-06-09
Topics
Population health/ health equity/ public health
  1 document  
Policy Type
Policy document
Last Reviewed
2018-03-03
Date
2010-06-09
Topics
Population health/ health equity/ public health
Text
Climate Change and Human Health Background Climate change is increasingly recognized as a significant threat facing society and has the potential to be one of the greatest threats to human health in the 21st Century1. While the damage is being done now, many of the health effects may arise only decades in the future2. Possible impacts could include some or all of the following: * Increased mortality, disease and injuries from heat waves and other extreme weather events; * Continued change in the range of some infectious disease vectors (i.e. 260-320 million more cases of malaria predicted by 2080, with six billion more at risk for dengue fever); * Effects on food yields- increased malnutrition; * Increased flooding in some areas and increased droughts in others, along with other impacts on freshwater supply; * Increases in foodborne and waterborne illnesses; * Warming and rising sea levels adding to displacement and also impacting water supply through salination; * Impaired functioning of ecosystems; * Negative effects on air quality associated with ground level ozone, including increases in cardio-respiratory morbidity and mortality, asthma, and allergens; * Displacement of vulnerable populations (especially in coastal areas)1; and * Loss of livelihoods3. Most of the impacts of climate change will result from amplifying the existing health hazards found in populations4. How susceptible a population is to the effects of climate change is dependent on their existing vulnerabilities (i.e. disease burden, resources etc.) as well as their adaptive capacity5. The World Health Organization has projected that countries that have, and will likely continue to suffer the greatest effects, are those who have contributed the smallest amount to the causes of climate change.6 While the vast majority of climate change deaths will occur in developing countries with systemic vulnerabilities, a recent Health Canada report has noted that Canada is likely to experience higher rates of warming in this century than most other countries in the world. Climate change scenarios predict an increased risk of extreme weather and other climate events for all regions of Canada, with the exception of extreme cold7. Canadians most vulnerable to climate change include seniors, children and infants, socially disadvantaged individuals, and those with pre-existing medical conditions such as cardiovascular disease8. Those living in cities could be especially vulnerable due to the impact of the heat island effect. However, given their greater access to emergency, health, social, and financial resources, they might also have the greatest adaptive capacity9. The health consequences of climate change have the potential to be more severe in far northern regions. Populations in Canada's north including aboriginals have already begun to see differences in their hunting practices as a result of changing ice patterns10, and the melting of permanent snowpacks11. Changes in ice patterns have also led to increased injuries12. In some places in the North, climate changes have led to greater risks from avalanches, landslides and other hazards13. Further problems are related to the infrastructure in Northern Canada, with some communities already noticing degradation of structures due to the thawing of the permafrost14. Given that much of the Northern infrastructure is already in disrepair, this represents a considerable problem. Geographic isolation, and a lack of resources may further exacerbate the situation15. What CMA has done? Physicians have a critical role to play in advancing public understanding of the potential impact of climate change on health and promoting health protecting responses. The CMA has been working on the issue of climate change and human health for a number of years. CMA was supportive of Canada's ratification of the Kyoto Protocol, and urged the Government of Canada to commit to choosing a climate change strategy that satisfied Canada's international commitments while also maximizing the clean air co-benefits and smog-reduction potential of any greenhouse gas reduction initiatives. In 2007, a number of resolutions were passed at General Council calling on government to properly plan for the health impacts of climate change and put in place measures to mitigate the impact of climate change on vulnerable populations in Canada's north. In that same year, CMA and the Canadian Nurses Association updated a joint position statement first entered into in 1994 calling for environmentally responsible activity in the health-care sector. Most recently, the CMA has been an integral part of the drafting of the World Medical Association (WMA) policies on health and climate change. The WMA Declaration of Delhi on Health and Climate Change was adopted at its annual General Assembly in New Delhi, India in October 2009, The declaration calls for action in five main areas; advocacy to combat global warming; leadership-help people be healthy enough to adapt to climate change; education and capacity building; surveillance and research; and collaboration to prepare for climate emergencies. This policy is written to complement the WMA declaration. What needs to be done? Climate change may lead to significant impacts on human health. While it is unlikely that these outcomes can be avoided, there are some strategies that can be employed to help limit the negative consequences. Education and Capacity Building There is a need for greater public and health professional awareness and education about climate change in order to gain understanding of the health consequences and support for strategies to reduce green house gases and mitigate climate change effects. CMA recommends: 1. A national public awareness program on the importance of the environment and global climate change to personal health; 2. Encouraging health sciences schools to enhance their provision of educational programs on environmental health; and fostering the development of continuing education modules on environmental health and environmental health practices. Surveillance and Research There are important gaps in our knowledge on the health impacts of climate change as well as the effectiveness of various mitigation and adaptation strategies. Surveillance and reporting functions need to be strengthened to allow for greater accuracy in modeling of future impacts. CMA recommends: 3. That the federal government must address the gaps in research regarding climate change and health by undertaking studies to - quantify and model the burden of disease that will be caused by global climate change - identify the most vulnerable populations, the particular health impacts of climate change on vulnerable populations, and possible new protections for such populations; - increase the collection and accuracy of health data, particularly for vulnerable and underserved populations; - report diseases that emerge in conjunction with global climate change, and participate in field investigations, as with outbreaks of infectious diseases; and - develop and expand surveillance systems to include diseases caused by global climate change. Reducing the Burden of Disease to Mitigate Climate Change Impacts How susceptible a population is to the effects of climate change is dependent on their existing vulnerabilities. Therefore, work needs to be done to reduce the burden of diseases and improve upon the social determinants of health for vulnerable populations in Canada and globally. CMA recommends: 4. That the federal and provincial/territorial governments work together to improve the ability of the public to adapt to climate change and catastrophic weather events by - Encouraging behaviours that improve overall health, - Creating targeted programs designed to address specific exposures, - Providing health promotion information and education on self-management of the symptoms of climate-associated illness, - Ensuring physical infrastructure that allows for adaptation; 5. That the federal government develop concrete actions to reduce the health impact of climate-related emissions, in particular those initiatives which will also improve the general health of the population; 6. That the federal government support the Millennium Development Goals and support the principles outlined in the WHO Commission on the Social Determinants of Health report; and Preparing for Climate Emergencies To deal with the future burden of climate change related health issues there is a need to ensure adequate health capacity and infrastructure. Rebuilding of public health capacity globally is seen as the most important, cost-effective, and urgently needed response to climate change16. Domestically, there is a need to ensure adequate surge capacity within the health care system to be prepared for an increase in illness related to climate change effects. There is also a need to strengthen not only the health systems, but the infrastructure (i.e. housing) for vulnerable populations including Aboriginals and those in the North. CMA recommends that the federal and provincial /territorial governments work together to: 7. Strengthen the public health system both domestically and internationally in order to improve the capacity of communities to adapt to climate change; 8. Ensure adequate surge capacity within Canada's health system to handle the increase in climate change related illness; 9. Ensure the health of vulnerable populations is adequate to handle climate change related situations; 10. Develop knowledge about the best ways to adapt to and mitigate the health effects of climate change; 11. Integrate health professionals into the emergency preparedness plans of government and public health authorities so that front-line providers are adequately informed and prepared to properly manage any health emergencies. Advocacy to Combat Climate Change Finally, there is a need to take action to reduce the damaging effects of climate change. The global community needs to come together to reduce the levels of green house gases being released in the atmosphere, and focus on safer more environmentally friendly energy sources. Investments in cuts to greenhouse gas emissions would greatly outweigh their costs, and could help to reduce the future burden of climate change related illness17. CMA recommends: 12. That the government of Canada become a global leader in promoting equitable, carbon neutral economic, industrial, and social policies, and practices that fight global warming and adopt specific green house gas reduction targets as determined by the evolving science of climate change. 13. That health care professionals act within their professional settings to reduce the environmental impact of medical activities and to develop environmentally sustainable professional settings; 14. That all Canadians act to minimize individual impacts on the environment, and encourage others to do so, as well. Conclusions The CMA believes that Canada must prepare now for the potential health threat that climate change poses to its population. While many of these effects will take decades to materialize, certain populations, such as those in Canada's north, or those in low lying coastal areas, are already starting to experience the impact of climate change. A focus on education and health promotion, as well as advocacy for improved public policy and primary health care resources will be a good start in dealing with this issue. Additionally, further research and data collection is necessary to improve our understanding of climate change and the effectiveness of adaptation and mitigation strategies. Finally, the global community needs to act together to address the health and environmental impacts of climate change. By working together, in an international response, strategies can be implemented to mitigate any negative health effects of climate change. Canada's physicians believe that: What is good for the environment is also good for human health. It is past time for those of us in the health sector in Canada to engage fully in the debate and discussions within our own house, as well as in the broader body politic to ensure that protecting human health is the bottom line of environmental and climate change strategies. Bibliography 1 Currently a third of the world's population lives within 60 miles of the shoreline and 13 of 20 biggest world cities located on the coast- more than a billion people could be displaced (Costello et.al., 2009) 1 Costello, Anthony et.al. "Managing the health effects of climate change.' The Lancet Volume 373 May 16, 2009. pp.1693-1733. 2 World Health Organization, World Meteorological Organization & United Nations Environment Programme (2003) Climate Change and Human Health- Risks and Responses, Summary. Available at: http://www.who.int/globalchange/climate/en/ccSCREEN.pdf 3 Confalonieri et.al., (2007) Human Health. Climate Change 2007: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change. Available at: http://www1.ipcc.ch/pdf/assessment-report/ar4/wg2/ar4-wg2-chapter8.pdf ; Epstein, Paul R. "Climate Change and Human Health." The New England Journal of Medicine 353 (14) October 6, 2005.; Friel, Sharon; Marmot, Michael; McMichael, Anthony J.; Kjellstrom, Tord & Denny Vagero. "Global health equity and climate stabilization: a common agenda." The Lancet Volume 372 November 8, 2008. pp.1677-1683. 4Confalonieri et.al., (2007) Human Health. Climate Change 2007: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change. Available at: http://www1.ipcc.ch/pdf/assessment-report/ar4/wg2/ar4-wg2-chapter8.pdf; World Health Organization (2009) Protecting Health From Climate Change: Global research priorities. Available at: http://whqlibdoc.who.int/publications/2009/9789241598187_eng.pdf 5 Health Canada (2001) Climate Change and Health & Well-being: A Policy Primer Available at: http://www.hc-sc.gc.ca/ewh-semt/pubs/climat/policy_primer-abecedaire_en_matiere/index-eng.php 6 Campbell-Lendrum, Diarmid; Corvalan, Carlos & Maria Neira "Global climate change: implications for international public health policy." Bulletin of the World Health Organization. March 2007, 85 (3) pp.235-237 7 Seguin, Jacinthe & Peter Berry (2008) "Human Health in a Changing Climate: A Canadian Assessment of Vulnerabilities and Adaptive Capacity, Synthesis Report." Health Canada Available at: http://www.nbhub.org/hubfiles/pdf/HealthinChangingClimate_Synthesis_english_low.pdf 8 Health Canada (2002) Climate Change And Health & Well-Being: A Policy Primer for Canada's North. Available at: http://dsp-psd.pwgsc.gc.ca/Collection/H46-2-02-290E.pdf 9 Seguin, Jacinthe & Peter Berry (2008) "Human Health in a Changing Climate: A Canadian Assessment of Vulnerabilities and Adaptive Capacity, Synthesis Report." Health Canada Available at: http://www.nbhub.org/hubfiles/pdf/HealthinChangingClimate_Synthesis_english_low.pdf 10 Ibid 11 Health Canada (2002) Climate Change And Health & Well-Being: A Policy Primer for Canada's North. Available at: http://dsp-psd.pwgsc.gc.ca/Collection/H46-2-02-290E.pdf 12 Epstein, Paul R. "Climate Change and Human Health." The New England Journal of Medicine 353 (14) October 6, 2005. 13 Seguin, Jacinthe & Peter Berry (2008) "Human Health in a Changing Climate: A Canadian Assessment of Vulnerabilities and Adaptive Capacity, Synthesis Report." Health Canada Available at: http://www.nbhub.org/hubfiles/pdf/HealthinChangingClimate_Synthesis_english_low.pdf 14 Field, Christopher B. et.al. (2007) North America. Climate Change 2007: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change. Available at: http://www1.ipcc.ch/pdf/assessment-report/ar4/wg2/ar4-wg2-chapter14.pdf 15 Health Canada (2002) Climate Change And Health & Well-Being: A Policy Primer for Canada's North. Available at: http://dsp-psd.pwgsc.gc.ca/Collection/H46-2-02-290E.pdf 16 World Health Organization, World Meteorological Organization & United Nations Environment Programme (2003) Climate Change and Human Health- Risks and Responses, Summary. Available at: http://www.who.int/globalchange/climate/en/ccSCREEN.pdf 17 Campbell-Lendrum, Diarmid; Corvalan, Carlos & Maria Neira "Global climate change: implications for international public health policy." Bulletin of the World Health Organization. March 2007, 85 (3) pp.235-237

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CMA's Presentation to the Senate Standing Committee on National Finance: Bill C-9, An Act to implement certain provisions of the budget tabled in Parliament on March 4, 2010 and other measures

https://policybase.cma.ca/en/permalink/policy9833

Date
2010-06-22
Topics
Health systems, system funding and performance
  1 document  
Policy Type
Parliamentary submission
Date
2010-06-22
Topics
Health systems, system funding and performance
Text
Thank you Madame Chair and Committee members for the opportunity to speak to you today. As mentioned, I am Briane Scharfstein, Associate Secretary General at the Canadian Medical Association (CMA). I am a family physician by training and a member of the Ad Hoc Working Group on Medical Isotopes. The working group was created to advise the Minister of Health in 2008 when the first major sustained shutdown of the Chalk River occurred. When I agreed to join the group, I certainly didn't expect it to still be going over two years later. And, while I am a member of the working group, I want to be clear, that today I am speaking on behalf of the CMA and our more than 72,000 physician members across the country. My comments are a reflection of the Working Group's June 2008 Lessons Learned report and I regret to say that a good portion of our observations are still true today. I congratulate the Senate for looking specifically at the AECL proposals and for looking at implications for patients. While the CMA is not taking a specific position on the proposal in Bill C-9 for Atomic Energy Canada Ltd (AECL), in whole or in part, to be sold off to the private sector, we do believe that it is in the best interests of our patients that Canada remains a leader in the sector. As well, Canada's doctors strongly believe that the impact on individual patient care must be considered and factored into any decisions that might result in disruptions of the supply of medical isotopes. The CMA acknowledges that the federal budget did include $48 million over two years for research, development and application of medical isotopes and alternatives. Further, there was another allocation of $300 million on a cash basis for AECL's operations in 2010/11 to cover anticipated commercial losses and support the corporation's operations to ensuring a secure supply of medical isotopes and maintaining safe and reliable operations at the Chalk River Laboratory. However, the CMA remains preoccupied with Canada's ability to ensure a long-term, stable and predictable supply of medically necessary isotopes. That is why we are uneasy about the federal government's exit strategy from the isotope production sector. The report of the federal government's Expert Panel on the Production of Medical Isotopes, (December 2009) and the federal government's response to that report, (March 2010) appears to focus on the viability of this specific sector of the nuclear industry and has not alleviated our concerns. The government's response to the Panel Report was disappointing to the medical community. The government's decision to abandon Canada's long-standing international leadership in this sector is disheartening. Of particular concern is the absence of both immediate and medium-term solutions to address the current and impending challenges facing nuclear medicine. This is simply unacceptable. The CMA, along with our colleagues in the medical community, continues to assert that ensuring access to safe and reliable medical procedures and the provision of high-quality patient care must be the fundamental consideration of government decisions. While the production cost of isotopes cannot be ignored, particularly in times of global fiscal challenges, the medical application and benefits received are of paramount importance and must be neither discounted nor dismissed. Early diagnosis and treatment are key factors in successful outcomes in cardiac and cancer cases. Without early diagnosis and treatment, patients have an increased risk of needing greater medical intervention later on. With more intensive treatment comes a corresponding increase in costs to the health care system and, most importantly, poorer outcomes for patients. Specific concerns identified by the CMA and the medical community include, but are not limited to the following: * Canada's current dependence on international reactors, without a practical back-up plan should these reactors experience difficulties, or shutdown for routine maintenance. This is especially worrisome as the international agency, the Association of Imaging Producers & Equipment Suppliers (AIPES) warns of the unprecedented level of shortages, in a large part due to the Canada's Chalk River nuclear reactor remaining off line until August 2010 or beyond. In a recent Supply Crisis Update, AIPES points out that with a number of international reactors off-line for scheduled maintenance, the remaining reactors -the OPAL (Australia), Maria (Poland) and REZ (Czech Republic) reactors-are producing Mo99, but their combined output is limited to 15 - 20 % of the world requirements. * The abandonment of Canada's international responsibilities and world leadership in this sector is counter to the government's own innovation and productivity agenda. * A growing reliance on emerging technology, cyclotrons and liner accelerators that have yet to be proven as a suitable secure alternative source of radiopharmaceutical. * A projected future supply chain that is reliant on external sources, rather than domestic production, in times of domestic supply shortages. As well, we are concerned that the federal government is leaving it to the marketplace, solely relying on current distributors to identify external sources supply, rather than searching to identify alternative safe sources of supply. * Basing Canada's supply strategy on relicensing of the Chalk River reactor five years past its current license with no current guarantees that the plant will return and remain in production, let alone meet relicensing standards. * The apparent lack of a federal contingency plan if, in 2016, alternative sources of supply and alternative emerging technology does not meet clinical needs. * An analysis of the overall costs to the health care system as a result of the increased costs incurred during the prolonged period of shortages of isotopes supply and the rising costs as the demand for the alternative diagnostic and treatment models is not apparent. * Initiatives to help mitigate increased costs for governments and particularly for nuclear medicine facilities do not exist. The just released survey by the Canadian Institute for Health Information found that two-thirds of nuclear medicine facilities reported that they experienced an increase in the cost of isotopes and that they were managing but exceeding their budget due to vendor surcharges. Only 2% reported that the isotope supply disruptions had no economic impact. Canada's medical community therefore strongly urges that consideration be given to: * investing in a mixed-use reactor for research and isotope production, as per the recommendation of the Expert Panel on Isotopes Production report of December, 2009; * putting in place appropriate strategies and contingency plans to meet the health needs of Canadians; in particular consider a national deployment of PET technology for cancer detection and follow up. * enhancing transparency by the government that provides more information on the short and medium-tern detailed plans to address isotope shortages; * increasing the direct consultation with the official representatives of the nuclear medicine and medical community; * making a public commitment to keep the Chalk River NRU reactor operational beyond the arbitrary date of 2016, as long as necessary and until secure alternative supplies of isotopes or alternative radiopharmaceuticals are proven and are in place; and, * ensuring that the CNSC resurrects the external medical advisory council to facilitate communication between the medical community and the commission. Prior to 2001, members of the council provided CNSC staff with insight into how operational and policy decisions would affect patient care across the country. Canada's doctors believe that the federal government must maintain a leadership role in this sector and must not compromise the medical needs of Canadians.

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Lessons from the frontlines: A collaborative report on Pandemic H1N1

https://policybase.cma.ca/en/permalink/policy9840

Last Reviewed
2018-03-03
Date
2010-08-26
Topics
Population health/ health equity/ public health
  1 document  
Policy Type
Policy document
Last Reviewed
2018-03-03
Date
2010-08-26
Topics
Population health/ health equity/ public health
Text
Lessons from the frontlines: A report on Pandemic H1N1 from Canadian Medical Association, The College of Family Physicians of Canada, National Specialty Society for Community Medicine One year ago, a novel influenza virus claimed its first victim in Mexico, and soon the world was plunged into its first influenza pandemic in 40 years. Although pandemic H1N1 (pH1N1) swept across the globe, we were fortunate this time as the virus was far less virulent than first feared. Now that pH1N1 has peaked and faded, it is time to look at what we learned and how it will help us plan for the next national public health emergency. The College of Family Physicians of Canada, the National Specialty Society for Community Medicine and the Canadian Medical Association have joined together to present a picture of lessons learned from the front lines of the pandemic. Together we represent over 80,000 physicians, of whom almost 50,000 are family physicians, engaged in all aspects of Canada's health care and public health systems. Canada's experience with SARS in 2003 was a "wake-up call"; much changed in its aftermath. The creation of the Public Health Agency of Canada led by a chief public health officer and the Pan-Canadian Public Health Network increased Canada's ability to respond to a public health emergency like pH1N1. The Canadian Pandemic Influenza Plan for the Health Sector, as well as complementary provincial and territorial plans, provides a framework and approach to responding to a pandemic. In many ways, this planning paid off. Canada mobilized quickly in response to the pH1N1 threat. Morbidity and mortality were lower than feared, and 45% of the population was vaccinated. But this response can also be seen as a "dress rehearsal" for a more severe influenza pandemic or some other national public health emergency: a test of our plans and an opportunity to learn from experience, with the time to incorporate these lessons into our strategic planning. Those on the front lines of response understand how health emergencies test our entire system - public health, acute and primary care and the community-based family physician. The success of our response depends on planning and practice, the effectiveness of public health and clinical countermeasures, our health human resources, the surge capacity within our health care and public health systems and our ability to reach the public. One of our greatest challenges in Canada is also to establish a coherent national and provincial/territorial strategy that can be implemented at a local level. Although we believe that Canada's overall response to pH1N1 produced many success stories, there were circumstances that challenged us as health professionals. Both health care and public health need further strengthening, and their separate infrastructures and the interdependence between these structures need attention and bolstering. The following comments focus on two overarching areas that influenced our ability to respond to the pandemic: communications and health system integration. Communications Communication was a consistent source of concern. Channels of communication among the various levels of public health providers were stronger than those for primary care providers, especially family physicians. On 9 Aug. 2009, following the first wave of pH1N1, our leaders wrote to chief public health officer of Canada Dr. David Butler-Jones on behalf of our members to share their thoughts and recommendations on how to improve communications with physicians. Family physicians in particular, but also other front-line health care providers, needed communication that was tailored to the practice setting, resources that were easy to access, and clear messages written in a manner that allowed rapid implementation into clinical practice during health emergencies because the timing of clinical response was critical. We recommended that front-line clinical practitioners be involved in the development of guidelines and the strategies for their dissemination, so that the content could be linked directly to the clinical setting. Family physicians are part of our first line of defence during infectious disease outbreaks. To ensure optimum patient care, they need clinical guidance quickly. Many physicians felt that the urgent need to provide consistent, clinically relevant information was not well recognized by the Public Health Agency of Canada (PHAC), the Public Health Network and, in some cases, provincial, territorial, regional or local levels. It took three months after recognition of the emerging pandemic to publish Interim Guidance for Ambulatory Care of Influenza-like Illness in the Context of H1N1. The current Public Health Network process of federal/provincial/territorial (FPT) consultation and consensus building seemed ill-suited to the acute national need for clinical information on issues such as the use and prescription of anti-viral medications. As provincial authorities and professional medical organizations moved to fill the void, different approaches and recommendations arose independent from one another. Better integration of primary care response by a national organization such as PHAC and the provincial/territorial health ministries could address the needs of clinical practitioners in concert with public health responses. This would also ensure that care directives are translated into user-friendly formats appropriate to clinical settings. We were pleased to be able to work with PHAC in fall 2009 to produce Pandemic H1N1: Fast Facts for Front-line Clinicians. This resource was highly valued by many of our members, and the collaboration demonstrated how health organizations can work effectively with government to contribute their expertise to the development and distribution of appropriate, clinically relevant information. Nevertheless, our critics declared that it was too little, too late. In situations where scientific evidence is rapidly changing, the processes used to distribute information to both front-line public health and clinical professionals must be designed to avoid confusion. Coordinated, unified communication strategies are needed at the national, provincial/territorial and local levels. Regardless of the official source, the information must be consistent. During the pandemic, many physicians and public health workers complained that multiple levels of government provided similar, but not the same advice. The differences led to skepticism, and the inundation of messages led to overload. The bottom line is that clinically relevant and trustworthy information should be provided on a timely basis, even if levels of certainty are fluctuating. Jurisdictions with effective communication to the primary care sector were characterized by cooperation and consultation between the medical community and the provincial, territorial and regional health authorities, both before and during the crisis. We recommend: 1. That the Public Health Agency of Canada, with the provinces and territories, evaluate the effectiveness of pH1N1 communications between public health and physicians and other front-line primary health care providers, and use the finding of this evaluation to research options for future response to a public health crisis. 2. That federal, provincial/territorial public health authorities and health care professionals and their associations work together in the inter-pandemic period to develop a pan-Canadian communication strategy to be used during health emergencies. 3. The establishment of a pan-Canadian centre within the Public Health Agency of Canada - similar to the Centre for Effective Practice - to undertake timely knowledge translation of clinical management guidelines for clinicians during public health crises. Surveillance and electronic communications The national response to infectious disease would have been greatly facilitated if system-wide communicable disease surveillance had been in place to support the sharing of data between public health and the rest of the health care system, particularly at the regional and local levels of pandemic response. Clinicians' practices are highly influenced by illness patterns that develop regionally and locally within their practice populations; thus, surveillance data are useful in determining appropriate treatment. Real-time data were not available to most physicians and when data did become available, they were already several weeks old. Delayed clinical guidelines were not a suitable substitute for timely surveillance information. Expansion of the use of electronic medical records (EMRs) in primary care, with bi-directional links to public health electronic health records (EHRs), could have facilitated surveillance and communications. Family practice clinics with EMRs were able to quickly identify high-risk patients, communicate with them to schedule vaccination appointments and collect the required data for public health. The varied levels of success of public pH1N1 vaccination clinics were further proof of the need to move to standard use of EMRs and EHRs in the health system. Communications can be enhanced through the sharing of data between the public health and primary care systems. EMRs may help resolve the challenge of collecting data from primary care sites. Collaboration among the PHAC, the Canadian Medical Association and the Information Technology Association of Canada's Health Division led to development of a pilot project to demonstrate the use of primary care EMRs as real-time sentinel surveillance tools for public health action to supplement existing surveillance mechanisms. In addition, after a successful two-year pilot project, the College of Family Physicians of Canada is working with the PHAC, in association with the Canadian Institute for Health Information, to conduct surveillance for five chronic diseases using EMRs, local networks across Canada and a national central repository for standardized data. These studies represent the increasingly important role of electronic information in surveillance and the value of collaboration between public health and primary care. We recommend: 4. That the federal and provincial/territorial governments provide EMR funding to enable clinical care and public health authorities to build interconnectedness and allow real-time information collection and analysis. System issues FPT responsibilities The division of responsibility between federal and provincial/territorial authorities for health care and emergency response influences how we respond to public health emergencies. Provincial/territorial governments have a primary role to play in regulating health matters within their boundaries. At the same time, the federal government has responsibilities related to national public safety and health protection. There can be no disputing the legitimacy of federal involvement in public health matters of an interprovincial/territorial nature. Under International Health Regulations, the federal government also has a responsibility to report and monitor public health emergencies of potential harm to other countries. Since Canada's SARS experience, there has been much progress in building FPT cooperation and increasing consultation on public health matters. However, the division of responsibility has led us to a situation where public health and clinical guidance in each province and territory was similar, yet different. Although the Pandemic Influenza Committee and the Special FPT Advisory Committee on H1N1 Influenza strove for consensus at the national level, individual provinces and territories were under no obligation to implement the guidance agreed to at the FPT level. Consultative and collaborative processes at the FPT level created delays in decision-making and directly interfered with the capacity of front-line professionals to respond to the urgent health needs of their patients. This led to a sense of confusion in the media and a loss of trust among the public and health professionals regarding Canada's capacity to respond to pH1N1. System capacity Canada's health system lacks surge capacity and can be sorely tested during a public health emergency, such as the recent experience with pH1N1. The underdeveloped public health infrastructure also means that it is a challenge to handle more than one national crisis at a time. To mount a response to pH1N1, public health units pulled human resources from other programs and many critical ones were delayed, suspended or cancelled altogether. During the first wave of pH1N1, Manitoba experienced a severe outbreak that stretched the resources of its critical care infrastructure to its limits. Front-line health care providers were inundated with telephone calls from the worried well and an increase in visits from those with flu symptoms. If pH1N1 had been the severe pandemic that was expected and for which Canada had been preparing, our health system would have been brought to its knees. In 2008, the Canadian Coalition for Public Health in the 21st Century noted that Canada remains vulnerable to the risks presented by epidemics and pandemics. This vulnerability remains today, and a long-range plan to build our public health capacity and workforce and to address the lack of surge capacity in our health system must become a priority if we are to be prepared for the next emergency. We recommend: 5. That the federal government increase infrastructure funding to provinces/territories to assist local health emergency preparedness planning and response, to reduce variation across the country and to integrate clinical care structures into public health structures at the local level. 6. That the Public Health Agency of Canada review the recommendations of the 2003 report of the National Advisory Committee on SARS and Public Health (Naylor report) in light of the pH1N1 experience and develop a national action plan to address the persistent gaps. Public health/primary care partnership Family physicians, in particular, understand that primary health care happens at the local level. In fact, so does all public health. During times of public health crisis, it is crucial for public health and primary care to work together, each respecting, supporting and bolstering the efforts of the other. Strengthening local public health and primary care structures and the interface between them would have resulted in improved, shared understanding of each sector's roles and responsibilities during the pH1N1 epidemic, better communications, improved data sharing and, most important, better served populations. Public health measures are directed toward the mitigation of disease through surveillance, research and outbreak management activities, while physicians provide information, education and clinical treatment to their patients. A commitment from both sectors at the local and provincial levels - and the professionals within each sector - to work together in the inter-pandemic period to build on processes that allow sharing of perspectives and information is essential. It is crucial that local public health authorities receive financial resources to increase their ability to collaborate effectively with family physicians, specialist physicians and other front-line providers. A number of the challenges faced by front-line public health workers and front-line physicians during the pH1N1 outbreak could have been lessened if there had been stronger links within the health system. We recommend: 7. That the Public Health Agency of Canada develop a focus on improving the interrelationship between primary care and public health to support collaboration during public health crises. Vaccination A key measure to combat pandemic influenza is mass vaccination. On the whole, Canada mounted an effective campaign: 45% of Canadians were vaccinated, and the proportion was even higher in First Nations communities - a first in Canadian history. Canada was one of the first countries with sufficient vaccine for the population and, with one domestic vaccine supplier, Canada avoided the confusion of multiple formulations as seen in the United States. The outcome was positive, but many public health units were stretched as expectations exceeded the pre-existing constrained resources. Although we recognize that the provinces and territories have quite different approaches to the delivery of their routine immunization programs, there is agreement that the pandemic immunization process did not adequately engage physicians in planning and delivery. A number of difficulties, such as the impact of bulk packaging, manufacturing delays that affected the agreed "sequencing" of patients and the logistics of inventory management, led to friction between front-line public health practitioners and family physicians. These could have been avoided with strengthened interdependence and mutual understanding before this crisis. The great variation in mass vaccination programs between provinces/territories, and even between local public health units, led to public confusion. Recognition of the diversity of primary care settings in which physicians work and bilateral planning in advance of the event is essential, because it is simply not feasible to tailor responses to myriad settings in the heat of the moment. Television broadcasts of long lines of people waiting to be vaccinated contributed to a loss of confidence in the system at a time when public confidence was sorely needed to encourage vaccination. Nationally promulgated clinical practice guidelines had great potential to create consistent clinical responses across the country. Instead, the variation and lack of coordination in providing important clinical information during this crisis eroded the public's confidence in the federal, provincial and territorial response. Ensuring future consistency in clinical approaches will require examination of ethical principles for the allocation of resources, such as anti-virals, vaccines and hospital treatment. Public engagement in the discussion of ethical principles is essential and, as much as possible, the consultative process should be transparent and undertaken in advance. We recommend: 8. That the Public Health Network seek advanced pan-Canadian commitment to a harmonized and singular national response to clinical practice guidelines, including mass vaccination programs, during times of potential public health crisis. Conclusion In 2003, in its submission to the National Advisory Committee on SARS, the Canadian Medical Association noted that the uptake of new information is influenced by many qualitative factors, and that research is needed to determine how best to communicate with individual physicians and other health care providers in emergency situations. Communication processes should be based on sound research and build on existing communication networks and relationships. The College of Family Physicians of Canada has recommended that information networks be strengthened to promote the sharing of the most relevant information among family physicians, other primary care providers and public health at the local level. We believe that PHAC is well positioned to undertake research on how health professionals can best receive information and to catalogue existing communication networks to build them into a well-coordinated national emergency response communication system. We must work together to translate pandemic information into practical messages relevant to front-line providers and employ trusted channels to deliver key messages to our patients and the public. Broad consensus is developing that our experience with the pH1N1 outbreak has shown that one of our greatest needs in preparing for the next public health emergency is for a national communications strategy that involves all levels of government, targets all sectors of our health system and uses the channels with which these targets are most familiar. An effective response to infectious disease outbreaks depends on effective surveillance, data collection and sharing and tracking of clinical interventions. The absence of a national communicable disease/immunization monitoring system is an ongoing problem. In 2003, the report of the National Advisory Committee on SARS and Public Health recommended that "the [Public Health] Agency [of Canada] should facilitate the long term development of a comprehensive and national public health surveillance system that will collect, analyze, and disseminate laboratory and health care facility data on infectious diseases... to relevant stakeholders." In 2010, Canada still does not have a comprehensive national surveillance and epidemiological system. A pan-Canadian electronic health information system is urgently needed and must become a priority during the inter-pandemic phase, with adequate federal funding and provincial/territorial collaboration. Greater adoption of the EMR in primary care and better public health EHRs with the ability to link systems will augment existing surveillance capacity and should be considered essential to a pan-Canadian system. Many of the challenges front-line health practitioners faced during the pH1N1 were also challenges during the SARS outbreak in 2003. The Naylor report proposed a number of measures to improve Canada's readiness and strengthen public health. Although a great deal of work and effort has gone into building links with and between provinces/territories and the federal government within the public health and the health emergency management system, little has trickled down to the front lines. This is not to devalue the much-improved spirit of FPT cooperation and the important achievements that have been made. Rather it is to suggest that, as the roof is no longer leaking, it is time to focus attention on the foundation - the response at the local level. Embedding primary care expertise in public health planning within the PHAC and at provincial/territorial and local levels will help circumvent problems and improve the effectiveness of our health system to respond to public health emergencies. A dialogue between primary care and the emergency management structures will help the response team understand and value the capabilities within primary care and build them into their planning and response systems. At the end of the day, we need to nurture collaborative relations between public health and primary care. Our shared objective is protecting the health of Canadians, recognizing that, in reality, neither system can be successful in isolation. It is essential that we trust each other's professionalism and expertise and work together to ensure that a strong foundation is in place to protect Canadians from future health threats. We have the will and expertise. We need the resources and a firm commitment to move forward. We have had two "wake-up calls" - SARS and pH1N1. Let's not wait for a third to find that we are not yet prepared. Recommendations 1. That the Public Health Agency of Canada, with the provinces and territories, evaluate the effectiveness of pH1N1 communications between public health and physicians and other front-line primary health care providers, and use the finding of this evaluation to research options for future response to a public health crisis. 2. That federal, provincial/territorial public health authorities and health care professionals and their associations work together in the inter-pandemic period to develop a pan-Canadian communication strategy to be used during health emergencies. 3. The establishment of a pan-Canadian centre within the Public Health Agency of Canada - similar to the Centre for Effective Practice - to undertake timely knowledge translation of clinical management guidelines for clinicians during public health crises. 4. That the federal and provincial/territorial governments provide EMR funding to enable clinical care and public health authorities to build interconnectedness and allow real-time information collection and analysis. 5. That the federal government increase infrastructure funding to provinces/territories to assist local health emergency preparedness planning and response, to reduce variation across the country and to integrate clinical care structures into public health structures at the local level. 6. That the Public Health Agency of Canada review the recommendations of the 2003 report of the National Advisory Committee on SARS and Public Health (Naylor report) in light of the pH1N1 experience and develop a national action plan to address the persistent gaps. 7. That the Public Health Agency of Canada develop a focus on improving the interrelationship between primary care and public health to support collaboration during public health crises. 8. That the Public Health Network seek advanced pan-Canadian commitment to a harmonized and singular national response to clinical practice guidelines, including mass vaccination programs, during times of potential public health crisis.

Documents

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Patient-focused funding

https://policybase.cma.ca/en/permalink/policy9843

Last Reviewed
2017-03-04
Date
2010-08-25
Topics
Health systems, system funding and performance
Resolution
GC10-11
The Canadian Medical Association will work with provincial/territorial medical associations and governments to ensure that patient-focused funding initiatives are based on data that are scientifically valid, accurate and publicly available.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2010-08-25
Topics
Health systems, system funding and performance
Resolution
GC10-11
The Canadian Medical Association will work with provincial/territorial medical associations and governments to ensure that patient-focused funding initiatives are based on data that are scientifically valid, accurate and publicly available.
Text
The Canadian Medical Association will work with provincial/territorial medical associations and governments to ensure that patient-focused funding initiatives are based on data that are scientifically valid, accurate and publicly available.
Less detail

Collaborative development of patient-focused funding initiatives

https://policybase.cma.ca/en/permalink/policy9844

Last Reviewed
2017-03-04
Date
2010-08-25
Topics
Ethics and medical professionalism
Health systems, system funding and performance
Resolution
GC10-12
The Canadian Medical Association will work with provincial/territorial medical associations to ensure meaningful consultations by governments with physicians who are accountable to the medical profession in the collaborative development of patient-focused funding initiatives.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2010-08-25
Topics
Ethics and medical professionalism
Health systems, system funding and performance
Resolution
GC10-12
The Canadian Medical Association will work with provincial/territorial medical associations to ensure meaningful consultations by governments with physicians who are accountable to the medical profession in the collaborative development of patient-focused funding initiatives.
Text
The Canadian Medical Association will work with provincial/territorial medical associations to ensure meaningful consultations by governments with physicians who are accountable to the medical profession in the collaborative development of patient-focused funding initiatives.
Less detail

Patient-focused funding

https://policybase.cma.ca/en/permalink/policy9845

Last Reviewed
2017-03-04
Date
2010-08-25
Topics
Population health/ health equity/ public health
Health systems, system funding and performance
Resolution
GC10-13
The Canadian Medical Association will work with provincial/territorial medical associations and governments to ensure that patient-focused funding supports the timeliness, safety and quality of patient care.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2010-08-25
Topics
Population health/ health equity/ public health
Health systems, system funding and performance
Resolution
GC10-13
The Canadian Medical Association will work with provincial/territorial medical associations and governments to ensure that patient-focused funding supports the timeliness, safety and quality of patient care.
Text
The Canadian Medical Association will work with provincial/territorial medical associations and governments to ensure that patient-focused funding supports the timeliness, safety and quality of patient care.
Less detail

Charter for Patient-centred Care

https://policybase.cma.ca/en/permalink/policy9847

Last Reviewed
2017-03-04
Date
2010-08-25
Topics
Ethics and medical professionalism
Population health/ health equity/ public health
Resolution
GC10-15
The Canadian Medical Association will work with provincial/territorial medical associations, patient advocacy groups and other medical and health organizations to further develop the elements of the Charter for Patient-centred Care.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2010-08-25
Topics
Ethics and medical professionalism
Population health/ health equity/ public health
Resolution
GC10-15
The Canadian Medical Association will work with provincial/territorial medical associations, patient advocacy groups and other medical and health organizations to further develop the elements of the Charter for Patient-centred Care.
Text
The Canadian Medical Association will work with provincial/territorial medical associations, patient advocacy groups and other medical and health organizations to further develop the elements of the Charter for Patient-centred Care.
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Family physicians

https://policybase.cma.ca/en/permalink/policy9849

Last Reviewed
2017-03-04
Date
2010-08-25
Topics
Ethics and medical professionalism
Health human resources
Resolution
GC10-17
The Canadian Medical Association will promote the significant role that family physicians play in securing the sustainability of the health care system through patient attachment.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2010-08-25
Topics
Ethics and medical professionalism
Health human resources
Resolution
GC10-17
The Canadian Medical Association will promote the significant role that family physicians play in securing the sustainability of the health care system through patient attachment.
Text
The Canadian Medical Association will promote the significant role that family physicians play in securing the sustainability of the health care system through patient attachment.
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