Canadian Health Care Research Articles

The impact of changing the reference countries on the list prices for patented medicines in Canada: A policy analysis

Background: Canada's Patented Medicine Prices Review Board (PMPRB) uses external and internal reference pricing (IRP) to regulate patented drug list prices. PMPRB has changed external reference countries from 7 to 11 to include countries with prices closer to the OECD median. We examined the impact on the list prices for patented medicines had the amendment been implemented from 2013.Methods: Using IQVIA MIDAS® quarterly sales data, we selected branded products that were launched in Canada in 2013–2018. The list price for each product in each country was calculated as its average annual price during the 3rd year post Canadian launch. The median international price (MIP) was the median of the list prices of PMPRB7 (MIP7) and PMPRB11 (MIP11). We assumed the same IRP would be (scenario 1) or would not be used (scenario 2).Results: Among the selected 400 products, 80.3 % (321) had MIP7 and MIP11 (launched in at least one reference country); 18.3 % did not have MIP11. The total current expenditures were $7,134.4 M. In scenario 1, MIP11 would not be binding for most products and expenditures would decline only by 0.7 %. If IRP were abolished, expenditures might decline by 14.1 % if the launching sequence would not change.Conclusions: MIP11 might not be binding for most medicines. The impact depends on whether to retain the IRP and approaches taken for medicines without MIP11.

“I Am the Last Priority”: Factors Influencing Diabetes Management Among South Asian Caregivers in Peel Region, Ontario

ObjectiveIn this study, we aimed to identify sociocultural and systemic factors influencing diabetes management among South Asian (SA) caregivers in Peel Region, Ontario. MethodsTwenty-one semistructured interviews were conducted with SA caregivers using a qualitative descriptive design. Data were analyzed using thematic analysis and intersectionality analysis. ResultsThemes identified included 1) prioritizing family caregiving over diabetes self-management; 2) labour market impacts on diabetes self-management; and 3) challenges navigating Canadian health and social service systems. SA caregivers described social, economic, and systemic challenges impacting type 2 diabetes management. Systemic factors influencing diabetes management included discrimination and inequities in labour policies and lack of social and health resources funding. Recommendations by caregivers included whole-family, community-based, culturally tailored approaches to diabetes prevention and management strategies. ConclusionsProviding support with system navigation, encouraging family-based approaches, and addressing the social determinants of health could be beneficial for supporting SA families with diabetes management and prevention.

Iron Deficiency, Anemia, and Iron Supplementation in Patients With Heart Failure: A Population-Level Study.

Studies have shown an association between iron deficiency (ID) and clinical outcomes in patients with heart failure (HF), irrespective of the presence of ID anemia (IDA). The current study used population-level data from a large, single-payer health care system in Canada to investigate the epidemiology of ID and IDA in patients with acute HF and those with chronic HF, and the iron supplementation practices in these settings. All adult patients with HF in Alberta between 2012 and 2019 were identified and categorized as acute or chronic HF. HF subtypes were determined through echocardiography data, and ID (serum ferritin concentration <100 μg/L, or ferritin concentration between 100 and 300 μg/L along with transferrin saturation <20%), and IDA through laboratory data. Broad eligibility for 3 clinical trials (AFFIRM-AHF [Study to Compare Ferric Carboxymaltose With Placebo in Patients With Acute HF and ID], IRONMAN [Intravenous Iron Treatment in Patients With Heart Failure and Iron Deficiency], and HEART-FID [Randomized Placebocontrolled Trial of Ferric Carboxymaltose as Treatment for HF With ID]) was determined. Among the 17 463 patients with acute HF, 38.5% had iron studies tested within 30 days post-index-HF episode (and 34.2% of the 11 320 patients with chronic HF). Among tested patients, 72.6% of the acute HF and 73.9% of the chronic HF were iron-deficient, and 51.4% and 49.0% had IDA, respectively. Iron therapy was provided to 41.8% and 40.5% of patients with IDA and acute or chronic HF, respectively. Of ID patients without anemia, 19.9% and 21.7% were prescribed iron therapy. The most common type of iron therapy was oral (28.1% of patients). Approximately half of the cohort was eligible for each of the AFFIRM-AHF, intravenous iron treatment in patients with HF and ID, and HEART-FID trials. Current practices for investigating and treating ID in patients with HF do not align with existing guideline recommendations. Considering the gap in care, innovative strategies to optimize iron therapy in patients with HF are required.

122 Evaluating the impact of the Translational Research Program at the University of Toronto

OBJECTIVES/GOALS: There is a need to develop a workforce of translational research professionals with the skills to innovate, mobilize, and commercialize research for unmet needs in the Canadian health system. The objective of this study is to evaluate the impact and value of the master’s degree on the Translational Research Program (TRP) alumni. METHODS/STUDY POPULATION: This study will use a cross-sectional approach and an electronic survey will be administered to alumni. The TRP was established in 2015 and has graduated over 150 students since its inception. Participants will be recruited through convenience sampling via email, social media platforms, and personal communication. Eligible participants must have a conferred Master of Health Science in Translational Research from the University of Toronto. All collected data will remain anonymous and include demographic information about graduation year, race, ethnicity, gender, and employment status. Descriptive statistics will be used to analyze and report the findings. RESULTS/ANTICIPATED RESULTS: The results of this survey will be used to evaluate how the TRP graduate degree helps alumni contribute to healthcare, learn to think differently, and establish their professional networks. The findings will also be used to inform curriculum improvements, enhance competency-based assessments, and understand demographic differences in student cohorts to promote equity, diversity, and inclusion. Investigating the perspectives of alumni reflecting on their degree will support validating the program’s objectives and advance the integration of translational science principles in the healthcare workforce and community. DISCUSSION/SIGNIFICANCE: This research addresses the need to evaluate health sciences education to ensure the program’s novel pedagogical approaches are equipping the next generation of health professionals with the skills to accelerate the transformation of discoveries into interventions that benefit human health, improve clinical medicine, and enhance patient care.

A Primer on Artificial Intelligence for Healthcare Administrators.

Healthcare administrators steer their organizations' strategic direction with an emphasis on quality, value and efficiency, aiming to improve patient outcomes and ensure operational sustainability. Artificial intelligence (AI) has become a transformative force in healthcare in the past decade, with Canadian health systems and research institutions investing in AI solutions to address critical healthcare challenges. This primer delivers a fundamental guide to essential AI concepts in healthcare and provides practical guidance to prepare organizations for AI readiness.

The effect of music type in ketamine-assisted group therapy on treatment-resistant mental health conditions: a prospective observational study

Introduction Currently, Ketamine is the only safe, effective, and widely used psychedelic-like medicine in Canada. It has demonstrated notably efficacy in providing relief to those experiencing treatment resistant mental health conditions. Pairing Ketamine treatment with psychotherapy, known as Ketamine Assisted Therapy (KAT), has been shown to yield more enduring outcomes. Work by Greenway et al. has demonstrated that playing music following ketamine administration for patients with bipolar disorder can help the patient feel more in control and reduce discomfort (Greenway et al. International Clinical Psychopharmacology 2021; 36 218-220).ObjectivesThe primary objective is to evaluate and compare the subjective clinical efficacy of two different types of music during ketamine-assisted group therapy. This will be explored through various validated psychiatric questionnaires, including the PHQ-9, GAD-7, and PCL-5. The secondary objective is to compare the objective changes in brain activity between the two music types. This will be evaluated using EEG data collected from MUSE headband before and after each ketamine-assisted therapy session.Methods This study is a crossover trial of 32 participants undergoing ketamine-assisted therapy for treatment-resistant mental health conditions. Half of participants will undergo a KAT session with a “weightless” music playlist followed by a session with a “grounding” music playlist. The other half will do the same, in reverse order. All participants will complete several psychiatric questionnaires within 7 days of each session over email. Before and after each session, participants will play a simple game to test executive function while wearing a headband to measure EEG activity.ResultsThe absolute and relative changes to the scores of the questionnaires will be examined between participants and music conditions. The change in brain activity from pre-session to post-session will be compared between the different music conditions as well. As this is a crossover trial, any changes in outcomes due to order effects will be controlled for. Relevant demographic and medical factors will also be controlled for.ConclusionsTo date, no studies have explored the influence that different types of music have on patients experience with KAT in a group therapy setting. With the results of this study, we hope to fine tune and improve the use of music in future KAT administration.Disclosure of InterestNone Declared

Addressing the root causes of the sex-based pay gap in medicine in Canada.

Addressing the root causes of the sex-based pay gap in medicine in Canada.

Access to Oncology Medicines in Canada: Consensus Forum for Recommendations for Improvement.

Patient access to new oncology drugs in Canada is only possible after navigating multiple sequential systemic checkpoints for national regulatory approval, health technology assessment (HTA) and collective government price negotiation. These steps delay access and prevent health care providers from being able to prescribe optimal therapy. Eighteen Canadian oncology clinicians from the medicine, nursing and pharmacy professions met to develop consensus recommendations for defining reasonable government performance standards around process and timeliness to improve Canadian cancer patients' access to best care. A modified Delphi methodology was used to identify consensus on 30 questions involving five themes: accountability, disparities, endpoints, timeliness, and cost-effectiveness. It was agreed that greater transparency is required across regulatory and HTA processes. Health professionals in oncology are frustrated for their patients because they are unable to deliver the modern guideline-supported therapies they want to provide due to delays in approval or funding. Canadian health care providers request improvements in timely access to life-saving therapeutics in line with other comparator countries. Clinicians expect urgent improvements in Canadian health systems to give our patients their best chance of survival.

Recovery from the Pandemic: The Study of Fluctuations and Short-Term Forecasting in The Canadian Health System Workforce

Recovery from the Pandemic: The Study of Fluctuations and Short-Term Forecasting in The Canadian Health System Workforce

Integration trends of internationally educated nurses in Canada and Australia: A scoping review

Background: Canada is less successful in integrating internationally educated nurses (IENs) into the nursing workforce than other developed countries like Australia. Objective &amp; Design: This scoping review compares the integration trends of internationally educated nurses in Canada with those in Australia. Data Sources &amp; Methods: Nine online databases were searched for English-language studies on the integration pathways of IENs in Canada or Australia. Results: Twenty-seven articles included in the review were completed in Canada (62.96%, n=17) and Australia (37%, n=10). The articles reported on internationally educated nurse integration in the workforce (18.5%, n=5) and workplace (66.7%, n=18), and four studies (14.8%) examined both workforce and workplace integration. This review highlighted the difficulties IENs encounter during their integration in Canada and Australia. Collaboration among stakeholders in Australia resulted in better integration of IENs. Conclusion: This review suggests Canadian ministries collaborate and align their policies to support better integration of internationally educated nurses into the Canadian health system.

Cost and value of cancer medicines in a single-payer public health system in Ontario, Canada: a cross-sectional study

The financial impact of cancer medicines on health systems is not well known. We describe temporal trends in expenditure on cancer medicines within the single-payer health system of Ontario, Canada, and the extent of clinical benefit these treatments offer. In this cross-sectional study, we identified cancer medicines and expenditures from formularies and costing databases (the New Drug Funding Program, Ontario Drug Benefit Program, and The High-Cost Therapy Funding Program) during 10 consecutive years (April 1, 2012, to March 31, 2022) in Ontario, Canada. For intravenous medicines, we applied the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS) to identify expenditures associated with substantial clinical benefit. We also identified treatments associated with improved overall survival or quality of life. 69 intravenous and 98 oral or injectable medicines were funded during 2012-22. Annual expenditure on cancer medicines increased by approximately 15% per year during 2012-22; the increase was more rapid in the most recent 4 years. Total expenditure on cancer medicines in the 2021-22 financial year was CA$1·7 billion. Immune checkpoint inhibitors were the single biggest expense by class ($284 million), representing 17% of the entire cancer medicine annual budget. Drugs with the highest individual costs were lenalidomide ($178 million) and pembrolizumab ($163 million), each accounting for around 10% of the entire budget. 29 (76%) of 38 indications eligible for ESMO-MCBS scoring met the threshold for substantial clinical benefit. Eight (21%) indications had no randomised trial evidence of improved overall survival, and only four (11%) were associated with improved QOL. $346 million (67% of the expenditure on intravenous cancer medicines) was spent on drugs that improved median overall survival by more than 6 months, $82 million (16%) was spent on medicines with overall survival gains of 3-6 months, and $32 million (6%) was spent on medicines with overall survival gains of less than 3 months. $53 million (10%) was spent on medicines with no established improvement in overall survival. Costs of cancer medicines to the Canadian health system are increasing rapidly. Most funded indications met thresholds for substantial clinical benefit and two-thirds of the expenditure were for medicines that improve survival by more than 6 months. Whether this cost trajectory can be maintained in a sustainable, equitable, high-quality health system is unclear. Efforts are needed to ensure the price of medicines with substantial benefit is affordable and funding of treatments with very modest benefit might need to be re-assessed, particularly when alternative supportive and palliative therapies are available. None.

Perspectives of Canadian Healthcare and Harm Reduction Workers on Mobile Overdose Response Services: A Qualitative Study.

Supervised consumption sites (SCS) are an evidence-based intervention proven effective for preventing drug overdose deaths. Obstacles to accessing SCS include stigma, limited hours of operation, concerns about policing, and limited geographic availability. Mobile overdose response services (MORS) are novel technologies that provide virtual supervised consumption to help reduce the risk of fatal overdoses, especially for those who use alone. MORS can take various forms, such as phone-based hotlines and mobile apps. The aim of this article is to assess the perceptions of MORS among healthcare and harm reduction staff to determine if they would be comfortable educating clients about these services. Twenty-two healthcare and harm reduction staff were recruited from Canada using convenience, snowball, and purposive sampling techniques to complete semistructured interviews. Inductive thematic analysis informed by grounded theory was used to identify main themes and subthemes. Four themes were identified: (1) increasing MORS awareness among healthcare providers was seen as useful; (2) MORS might lessen the burden of drug overdoses on the healthcare system but could also increase ambulance callouts; (3) MORS would benefit from certain improvements such as providing harm reduction resources and other supports; and (4) MORS are viewed as supplements for harm reduction, but SCS were preferred. This research provides valuable perspectives from healthcare and harm reduction workers to understand their perception of MORS and identifies key areas of potential improvement. Practical initiatives to improve MORS implementation outcomes exist.

Health status and missed care among youth in care in British Columbia, Canada: A population study

PurposeYouth in care (YIC) are a marginalized population with high health care needs and barriers to access, resulting in lifelong health disparities. This study examines the health of Canadian YIC and their engagement with the Canadian health care system on a population level. MethodsData were retrieved from the 2018 British Columbia Adolescent Health Survey, a cross-sectional population survey of Grade 7–12 students (ages 12–19 years) in British Columbia, Canada (n = 38,015). Primary outcomes were self-rated general health and mental health, missed medical care, and missed mental health care among YIC. Secondary outcomes included health care access and gender differences. Multivariate analyses adjusted for age, gender, and food insecurity. ResultsYIC represented 1.9 % of the weighted sample population. Compared to non-YIC, YIC accessed health care more frequently from mental health professionals and youth-focused clinics and less frequently from family physicians. YIC reported worse general health (AOR 1.81 [99 % CI 1.40–2.34]) and mental health (AOR 1.81 [99 % CI 1.42–2.32]) than non-YIC. Adjusted for health status, YIC experienced more missed medical care (AOR 1.96 [99 % CI 1.46–2.62]) but comparable missed mental health care to non-YIC. Significant barriers for YIC included negative health care experiences and transportation. Among YIC, female and non-binary genders also had increased risk for worse health and missed care compared to males. ConclusionsYIC in Canada have inequitably unmet health care needs. Many complex factors contribute to this disparity and its correlation with out-of-home care. Further action is needed to reduce health care barriers for YIC.

Disparities in public awareness, practitioner availability, and institutional support contribute to differential rates of MAiD utilization: a natural experiment comparing California and Canada

ABSTRACT Even though California and Canada both legalised medical aid in dying (MAiD) in 2016 and have similarly sized populations, only 853 medically assisted deaths occurred in California versus 13,241 in Canada in 2022, the most recently reported year. Ten testable hypotheses were proposed to explain this 15-fold differential in MAiD utilisation. A demographically representative online survey of adults 60 and older in both jurisdictions (N = 556) revealed no differences in moral acceptance of MAiD or willingness to use it. However, only 25% of Californian participants were aware that MAiD was legally available versus 67% of Canadian participants. Evidence in the public domain revealed that there were 6.0 times more MAiD practitioners per capita in Canada than in California, and there was far greater support for MAiD by Canadian healthcare institutions. The evidence did not support hypotheses presuming more restrictive laws in California or greater access to palliative care/hospice. While other reasons may contribute to the difference in MAiD utilisation, limited public awareness, fewer MAiD practitioners per capita, and sparse support by healthcare institutions may significantly reduce California residents’ ability to exercise their autonomy when making end of life choices.

Implementing Activity-Based Therapy for Spinal Cord Injury Rehabilitation in Canada: Challenges and Proposed Solutions.

Activity-based therapy (ABT) is a therapeutic approach with multiple benefits including promoting neurorecovery and reducing the likelihood of secondary complications in people living with spinal cord injury (SCI). Barriers and facilitators to ABT implementation for SCI rehabilitation have been studied from various perspectives through qualitative research. However, these viewpoints have not been synthesized to identify challenges of and strategies for implementing ABT across the Canadian healthcare system. Thus, the purpose of our study was to examine the current state of ABT in Canadian healthcare settings according to users' perspectives. Our main objectives were to compare barriers and facilitators to ABT implementation across Canadian healthcare settings according to users' perspectives and to identify optimal intervention strategies for ABT delivery across the Canadian healthcare system from acute to community care. We searched Scopus, CINAHL, OvidMedline, and other sources. Eligible articles were qualitative or mixed methods studies exploring ABT for adults with SCI in a Canadian healthcare setting. We analyzed qualitative findings through a thematic synthesis followed by a deductive content analysis. The Mixed Methods Appraisal Tool was used for critical appraisal. Nine articles were included. The thematic synthesis revealed two main themes: (1) factors influencing acceptance and adaptation of ABT across healthcare settings in Canada and (2) proposed solutions. The deductive analysis applied the Behaviour Change Wheel (BCW) to identify limited components of behaviour and appropriate interventions. To address ABT implementation challenges across the Canadian healthcare system, evidence-based interventions should target BCW subcategories of reflective motivation, social opportunity, and physical opportunity.

Barriers to Mental Health care in Canada Identified by Healthcare Providers: A Scoping Review.

The mental health treatment gap remains wide across the world despite mental illness being a significant cause of disability globally. Both end-user and healthcare provider perspectives are critical to understanding barriers to mental healthcare and developing interventions. However, the views of providers are relatively understudied. In this review, we synthesized findings from current literature regarding providers' perspectives on barriers to mental healthcare in Canada. We searched Medline, PsycINFO, Embase, and CINAHL for eligible Canadian studies published since 2000. Analysis and quality assessment were conducted on the included studies. Of 4,773 reports screened, 29 moderate-high quality studies were reviewed. Five themes of barriers emerged: health systems availability and complexity (reported in 72% of the studies), work conditions (55%), training/education (52%), patient accessibility (41%), and identity-based sensitivity (17%). Common barriers included lack of resources, fragmented services, and gaps in continuing education. Interestingly, clinicians often cited confusion in determining the ideal service for patients due to an overwhelming number of potential services without clear descriptions. These five domains of barriers present a synthesized review of areas of improvement for mental healthcare spanning both patients and clinicians. Canadian mental health systems face a need to improve capacity, clinician training, and in particular service navigability and collaboration.

Ageism Healthcare: Implications for the Psychological Well-Being of Atlantic Canadian Healthcare Professionals.

Ageism in healthcare is related to poor outcomes for older patients. The objective of this study was to evaluate the relationships between ageism and various aspects of the psychological well-being of healthcare professionals in Atlantic Canada. In 2023, an online survey of 294 healthcare professionals from various disciplines was conducted. This survey included items to measure expectations of aging, stress, burnout, emotional dissonance, and well-being. Results indicated that aging expectations were significantly related to burnout, perceived stress, well-being, and emotional dissonance. With the use of a path analysis, emotional dissonance partially mediated relationships between burnout and well-being with stress. However, aging expectations did not significantly predict emotional dissonance. Differences were found across professional groups on ageism. Conclusions support the need for increased awareness to the relationship between ageist attitudes and professionals' well-being, as well as the need for education and interventions to reduce false expectations about the aging process.

The influence of health service interactions and local policies on vaccination decision-making in immigrant women: A multi-site Canadian qualitative study

ObjectivesResearch on immigrant and refugee vaccination uptake in Canada shows that immunization decisions vary by vaccine type, location, age and migration status. Despite their diversity, these studies often treat immigrant and refugee populations as a single group relative to other Canadians. In this comparative study, we explored how previous risk communication and immunization experiences influence immunization decisions by immigrant and refugee women from three communities across Canada. MethodsParticipants included women from the Punjabi immigrant community located in Surrey and Abbotsford, British Columbia (n = 36), the Nigerian immigrant community located in Winnipeg, Manitoba (n = 43), and the Congolese refugee community in Edmonton, Alberta (n = 18). Using focus groups guided by focused ethnography methodology, we sought to understand immunization experiences in Canada and before arrival, and what information sources influenced the immunization decision-making process by the women in the three communities. ResultsParticipants had differing past experiences in Canada and before their arrival that influenced how they used information in their vaccination decisions. Clear vaccination communications and dialogue with Canadian health care providers increased trust in Canadian health care and the likelihood of vaccine uptake. By contrast, weak vaccine recommendations and antivaccination information in the community prompted participants to decline future vaccines. ConclusionGiven our participants' different communication preferences and needs, we argue that a one-size-fits-all communication approach is inappropriate for immigrant and refugee populations. Instead, multi-pronged communication strategies are required to reach participants and respond to previous experiences and information that may lead to vaccination hesitancy.

Trends in socioeconomic inequalities in breast cancer mortality in Canada: 1992-2019.

Breast cancer is the second leading cause of death from cancer among Canadian females. This study aimed to quantify and assess trends in education and income inequalities in the mortality rate of breast cancer in Canada from 1992 to 2019. We constructed a census division-level dataset pooled from the Canadian Vital Death Statistics Database (CVSD), the Canadian Census of the Population (CCP), and the National Household Survey (NHS) to examine trends in education and income inequalities in the mortality rate of breast cancer in Canada over the study period. The age-standardized Concentration index (C) was used to quantify income and education inequalities in breast cancer mortality over time. The national crude mortality rate of breast cancer has decreased in Canada from 1992 to 2019, with Alberta, British Columbia, Manitoba, Ontario, Prince Edward Island, and Quebec having the greatest decreases in mortality rate. The age-standardized C for education and income inequalities were always negative for all the study years, meaning that the mortality rate of breast cancer was higher among less-educated and poorer females. Moreover, the results indicate a growing trend in the concentration of breast cancer mortality among females with lower income and education from 1992 to 2019. The increasing concentration of breast cancer mortality among low socioeconomic status females remains a challenge in Canada. Continuous efforts are needed within Canadian healthcare systemto improve the prevention and treatment of breast cancer for this population.

Harmonizing Artificial Intelligence Governance; A Model for Regulating a High-risk Categories and Applications in Clinical Pathology: The Evidence and some Concerns

The Canadian healthcare system, grappling with issues like systemic and intelligently established structural anti-black racism, including indigenous nations; even within Pathology and Laboratory Medicine Communities: and deteriorating outcomes, sees potential in AI to address challenges, though concerns exist regarding exacerbating discriminatory practices. In clinical pathology, AI demonstrates superior diagnostic accuracy compared to pathologists in a study, emphasizing its potential to improve healthcare. However, AI governance is crucial to navigating ethical, legal, and societal concerns. The Royal College of Physicians of Canada acknowledges the transformative impact of AI in healthcare but stresses the need for responsible AI tools co-developed by diverse teams. Despite positive attitudes towards AI in healthcare, concerns about patient safety, privacy, and autonomy highlight the necessity for comprehensive education, engagement, and collaboration. Legal concerns, including liability and regulation, pose challenges, emphasizing the need for a robust regulatory framework. AI application in healthcare is categorized as high-risk, demanding stringent regulation to ensure safety, efficacy, and fairness. A parallel is drawn to drug regulation processes, suggesting a similar approach for AI. The lack of transparency in AI-based decision-making raises ethical questions, necessitating measures to address biases and ensure patient privacy. Social accountability is crucial to prevent AI from exacerbating health disparities and harming marginalized communities. In conclusion, while AI offers potential benefits in clinical pathology, a cautious approach with comprehensive governance measures is essential to mitigate risks and ensure ethical AI integration into healthcare.