Access and quality of health care in Canada: Insights from 1998 to the present.

This article reviews perceptions of Canada's public and health professionals regarding access and quality of healthcare. Principal data sources were 13 sequential Health Care in Canada (HCIC) surveys, from 1998 to 2018. Over time, the data series reveals that an increasing majority of the public report receiving quality care, rising from a national average of 53% in 2002 to 61% in 2018.

Canada's Evolving Medicare: End-of-Life Care.

A challenging issue in contemporary Canadian Medicare is the evolution of end-of-life care. Utilizing data from the 2016 and 2018 Health Care in Canada (HCIC) surveys, this paper compares the support and priorities of the adult public (n = 1500), health professionals (n = 400), and administrators (n = 100) regarding key components for end-of-life care just prior to and post legalization of medical assistance in dying (MAiD) in Canada. In 2016 and 2018, the public, health professionals and administrators strongly supported enhanced availability of all proposed end-of-life care options: pain management, hospice and palliative care, home care supports, and medically assisted death.

Canada's Evolving Medicare: Patient-Centred Care.

Canada's universal healthcare program, medicare, continues to evolve. An area of care that has gained increasing attention over the past several years is the general concept and specific components of patient centricity in healthcare delivery. This paper compares key measures of patient-centred care practices recorded in the 2013 and 2016 Health Care in Canada (HCIC) surveys, with the most recent preferences of the public and health professionals obtained in the 2018 HCIC survey, including priorities for improved future care.

Non-Adherence to Prescribed Therapies: Pharmacare's Existential Challenge.

Pharmacare, a recently proposed addition to Canada's universal medicare program, has become a prominent topic in the public discourse, but funding and leadership have not been established. Repeated Health Care in Canada (HCIC) surveys of the adult public and a broad spectrum of health professionals reveal very strong support for a national system that is easy to access and covers all prescribed pharmaceuticals. Although the practical details of universal pharmacare remain to be established, there is strong support among the public and professionals as well as increasing federal government interest in moving forward and ultimately implementing pharmacare.

Medicare's Evolution: National Pharmacare and Shared Leadership.

Repeated Health Care in Canada (HCIC) surveys over the past two decades have consistently reported that the adult public and clinical and administrative health professionals consider medicare to be successful in terms of quality of care, despite a growing concern that timely access to care remains challenging. These key stakeholders have also recently signalled that major change strategies are likely necessary for continuing success. In the 2018 survey, both the public and professionals ranked highest the creation of a national comprehensive pharmacare plan, entirely funded by the federal government, or with federal funding for those not currently covered by existing pharmaceutical plans.

Healthcare in Canada: Choices Going Forward.

The overarching purpose of serial Health Care in Canada (HCIC) surveys of the adult Canadian public and a broad spectrum of healthcare professionals over the past two decades has been the development of an evidence-based map to inform strategic and clinical decisions to improve care and outcomes for Canadians. Recent surveys reveal a growing concern that medicare may require complete rebuilding or major strategic repairs. On the other hand, a majority of stakeholders perceive continuing underlying quality in our clinical care and look forward to both system- and patient-centred initiatives to improve future care.

Public and Professional Insights on End-of-Life Care: Results of the 2016 Health Care in Canada Survey.

A new dimension has been added to Canadian Medicare ߝ exemption from prosecution for physicians, nurse practitioners and assistants providing medical assistance in dying for competent and informed adult patients with a grievous and irremediable medical condition causing intolerable physical or psychological suffering, irreversible decline in capabilities and reasonably foreseeable natural death. To define stakeholders' perceptions on all contemporary end-of-life care options, we analyzed data from the 2016 Health Care in Canada Survey comprising representative samples of the adult public (n = 1,500), physicians (n = 102), nurses (n = 102), pharmacists (n = 100), administrators (n = 100) and allied health professionals (n = 100). Among the public, enhanced pain management, hospice/palliative care and home/family care were all supported at, or above, the 80th percentile; medically assisted death was supported by 70%.

Patient-Centred Care in Canada: Key Components and the Path Forward.

Canadians' health and its care continue to evolve. Chronic diseases affect more than 50% of our aging population, but the majority of public and professional stakeholders retain a sense of care quality. An emergent issue, however, is generating an increasingly wide debate.

Searching for Best Direction in Healthcare: Distilling Opportunities, Priorities and Responsibilities.

Canada's health and its care are evolving. Evidence from serial Health Care in Canada surveys of the public and health professionals over the last two decades reveal a persistent sense of care quality, despite an aging population, decreasing levels of good and excellent health, increasing prevalence of chronic illnesses; and sub-optimal access to timely and patient-centred care. Stakeholders are, however, somewhat pessimistic and many sense complete rebuilding, or major changes, may be necessary.

Contributions and Challenges of Non-Professional Patient Care: A Key Component of Contemporary Canadian Healthcare.

The Canadian public is aging. Population levels of excellent, or very good, health are decreasing, and the prevalence of chronic diseases is increasing. Timely access to caring and respectful care from health professionals, with supporting information transfer, are key qualities in patients' sense of centricity and hope for best outcomes.

Stakeholder surveys of Canadian healthcare performance: what are they telling us? Who should be listening? Who should be acting, and how?

Eleven Health Care in Canada (HCIC) surveys, spanning 1998-2014, offer a comprehensive overview of the changing perceptions of physician, nurse, pharmacist, administrator and public stakeholders of the nation's health status, its burden of illness and its quality and cost of care. Overall, there persists a universal sense of quality in our health system--despite evidence that national health status is declining, chronic illnesses are increasing, patients' timely access to care and ability to afford care are diminishing and all these indicators are predicted to worsen over time. Among the public and health professionals, key priorities for improving future patient care are increasing professional schools' output and team-based care, along with enhanced use of national supply systems to reduce costs of care.

Partnership and measurement: the promise, practice and theory of a successful health social networking strategy.

Patient health management (PHM) was launched as a promising paradigm to close care gaps, the inequities between usual and best care, for whole patient populations. PHM's core premise was that interventions of multidisciplinary, community-oriented partnerships that used repeated measurement and feedback of provider practices, clinical and economic outcomes and general communication of relevant health knowledge to all stakeholders would continuously make things better. This article reviews the evolution of PHM from its genesis in a series of casual hospital-based networks to its maturation in a province-wide, community-focused, clustered-lattice social network that facilitated the improved clinical and cost-efficient care and outcomes of whole patient populations.

Canada's future healthcare: can it be better? Will it be better?

Thought leaders envisage high-performing partnerships of engaged community practitioners, informed patients and non-professional caregivers collaborating continuously, and efficiently, to improve care and outcomes for whole patient populations. These primary care health social networks would be facilitated by needs-based training, meaningful measurements, sustained funding, effective leadership and integration with available resources and processes. Broadly voiced opinion supports such integrated, community-focused partnership and data-driven healthcare models, and a province-wide implementation of the model for acute and chronic cardiac diseases in Nova Scotia has conclusively demonstrated sustained improvements in clinical and economic outcomes.

Advancing the chronic care road map: a contemporary overview.

In an effort to assess and advance the community-based model of chronic care, we reviewed a contemporary spectrum of Canadian chronic disease management and prevention (CDMP) programs with a participatory audience of administrators, academics, professional and non-professional providers and patients. While many questions remain unanswered, several common characteristics of CDMP success were apparent. These included community-based partnerships with aligned goals; inter-professional and non-professional care, including patient self-management; measured and shared information on practices and outcomes; and visible leadership.

ICONS: Managing Care and Costs: The Sustained Cost Impact of Reduced Hospitalizations in a Partnership-Measurement Model of Disease Management.

Improving Cardiovascular Outcomes in Nova Scotia (ICONS) was a multidisciplinary-partnership, measurement-driven disease management project designed to improve the care and outcomes of patients with acute and chronic heart diseases in Nova Scotia. Previous analyses demonstrated beneficial clinical and macroeconomic end points at the population and system levels, including heightened awareness of the value of team care, increased use of proven therapies, decreased re-hospitalizations and a positive dollar return on investment for the economies of Nova Scotia and Canada. This article analyzes the additional cost-reduction benefits resulting from the reduced re-hospitalizations that occurred among patient populations with heart attacks and heart failure.

Next-generation healthcare: a strategic appraisal.

Successful next-generation healthcare must deliver timely access and quality for an aging population, while simultaneously promoting disease prevention and managing costs. The key factors for sustained success are a culture with aligned goals and values; coordinated team care that especially engages with physicians and patients; practical information that is collected and communicated reliably; and education in the theory and methods of collaboration, measurement and leadership. Currently, optimal population health is challenged by a high prevalence of chronic disease, with large gaps between best and usual care, a scarcity of health human resources - particularly with the skills, attitudes and training for coordinated team care - and the absence of flexible, reliable clinical measurement systems.

Optimizing healthcare at the population level: results of the improving cardiovascular outcomes in Nova Scotia partnership.

Disease management is increasingly considered a valid strategy in the chronic care of our aging patient populations with multiple diseases. The Improving Cardiovascular Outcomes in Nova Scotia (ICONS) project examined whether a community-oriented health management partnership would lead to enhanced care and improved outcomes across an entire healthcare system. ICONS was a prospective cohort study, with baseline and repeated measurements of care and outcomes fed back to all project partners, along with other interventions aimed at optimizing care; preceding interval cohorts served as controls to post-intervention cohorts.

Contemporary disease management in Quebec.

Health or disease management (DM) has emerged as a promising solution to improve the quality of healthcare and patient outcomes in a cost-efficient way. This solution is particularly relevant in the care of our increasing, and aging, patient populations with multiple chronic diseases. This article reviews the recent history and current status of DM in the province of Quebec and summarizes its evolving perspectives and future prospects.

Changing healthcare: stakeholder perceptions of the burden of chronic disease and the value of teams, measurements and communication.

Canadian healthcare is changing. Over the course of the past decade, the Health Care in Canada Survey (HCIC) has annually measured the reactions of the public and professional stakeholders to many of these change forces. In HCIC 2008, for the first time, the public's perception of their health status and all stakeholders' views of the burden and effective management of chronic diseases were sought.

Time for chronic disease care and management.

To manage the future costs and quality of care, a health strategy must move beyond the individual, acute care model and address the care of older people with chronic, and often multiple, diseases. This strategy must address the issue of care gaps, ie, the differences between best care and usual care. It should also embrace broad partnerships in which providers may be a cross-disciplinary team of nurses, physicians and pharmacists; the patient partners may include all patients in the community with a disease or group of diseases; and the system managers should work with all to seek improved long-term care and share the governance of interventions and resources.

The economic impact of a partnership-measurement model of disease management: Improving Cardiovascular Outcomes in Nova Scotia (ICONS).

Improving Cardiovascular Outcomes in Nova Scotia (ICONS) was a five-year, community partnership-based disease-management project that sought, as a primary goal, to improve the care and outcomes of patients with heart disease in Nova Scotia. This program, based on a broad stakeholder partnership, provided repeated measurement and feedback on practices and outcomes as well as widespread communication and education among all partners. From a clinical viewpoint, ICONS was successful.

Patient-provider partnerships in healthcare: enhancing knowledge translation and improving outcomes.

In the complex health arena, a key proposition is that no person acting alone is as effective as a team to drive best practices and outcomes. Another key factor supporting best outcomes is access to the best information to support best choices. Currently, stakeholders suffer from a paucity of real-world knowledge of actual practices and outcomes that allows care gaps to go undiscovered.

Concordance, compliance and adherence in healthcare: closing gaps and improving outcomes.

The gap between best care and usual care is large for many important diseases. In particular, poor adherence remains a significant, inadequately addressed, cause of the care gap. About half of all patients with chronic diseases stop refilling prescriptions by one year.

Seeking value in pharmaceutical care: balancing quality, access and efficiency.

Healthcare remains a dominant issue for Canadians. Central to the debate is the dynamic tension among the value, accessibility and affordability of drugs. Simply put, innovative drugs improve health and economic outcomes for individuals and populations.