Implementation In Canada Research Articles

Characterizing early Canadian federal, provincial, territorial and municipal nonpharmaceutical interventions in response to COVID-19: a descriptive analysis.

Nonpharmaceutical interventions (NPIs) are the primary tools to mitigate early spread of the coronavirus disease 2019 (COVID-19) pandemic; however, such policies are implemented variably at the federal, provincial or territorial, and municipal levels without centralized documentation. We describe the development of the comprehensive open Canadian Non-Pharmaceutical Intervention (CAN-NPI) data set, which identifies and classifies all NPIs implemented in regions across Canada in response to COVID-19, and provides an accompanying description of geographic and temporal heterogeneity. We performed an environmental scan of government websites, news media and verified government social media accounts to identify NPIs implemented in Canada between Jan. 1 and Apr. 19, 2020. The CAN-NPI data set contains information about each intervention's timing, location, type, target population and alignment with a response stringency measure. We conducted descriptive analyses to characterize the temporal and geographic variation in early NPI implementation. We recorded 2517 NPIs grouped in 63 distinct categories during this period. The median date of NPI implementation in Canada was Mar. 24, 2020. Most jurisdictions heightened the stringency of their response following the World Health Organization's global pandemic declaration on Mar. 11, 2020. However, there was variation among provinces or territories in the timing and stringency of NPI implementation, with 8 out of 13 provinces or territories declaring a state of emergency by Mar. 18, and all by Mar. 22, 2020. There was substantial geographic and temporal heterogeneity in NPI implementation across Canada, highlighting the importance of a subnational lens in evaluating the COVID-19 pandemic response. Our comprehensive open-access data set will enable researchers to conduct robust interjurisdictional analyses of NPI impact in curtailing COVID-19 transmission.

Attitudes of healthcare providers towards cardiac donation after circulatory determination of death: a Canadian nation-wide survey.

The number of patients on cardiac transplant waitlists exceeds the number of available donor organs. Cardiac donation is currently limited to those declared dead by neurologic criteria in all but three countries. Cardiac donation after circulatory determination of death (cardiac DCDD) can be conducted using direct procurement and perfusion (DPP) or normothermic regional perfusion (NRP). Implementation of cardiac DCDD in many countries has been slowed by ethical debates within the donation and transplantation community. We conducted a national survey to determine the perceptions of healthcare providers regarding cardiac DCDD. We conducted an electronic survey of 398 healthcare providers who are involved in the management of heart donors and/or heart transplant recipients in Canada (226 nurses, 82 critical care physicians, 31 donation specialists, and 59 transplant specialists). Our primary outcomes were their attitudes towards and concerns regarding cardiac DCDD protocols and their implementation in Canada. We distributed the survey electronically through several Canadian donation and transplantation organizations. We identified that 361 of 391 respondents (92.3%; 95% confidence interval [CI], 89.6 to 95.1) believed that DPP is acceptable, and 329 of 377 respondents (87.3%; 95% CI, 83.9 to 90.7) supported its implementation in Canada. We found that 301 of 384 respondents (78.4%; 95% CI, 74.2 to 82.6) believed that NRP is acceptable and 266 of 377 respondents (70.6%; 95% CI, 66.0 to 75.2) supported its implementation in Canada. This is the first survey describing the attitudes of healthcare providers towards cardiac DCDD. We identified widespread support for cardiac DCDD and its implementation in Canada among Canadian healthcare providers within the organ donation and transplantation community in Canada.

Voices Raised: The NCLEX-RN Experience in Canada.

The journey to this issue on the National Council Licensure Examination (NCLEX) began when the CJNL editorial director received two unsolicited NCLEX-focused manuscripts for consideration to publish. Adding to the growing body of articles and news stories published about the NCLEX since its 2015 implementation in Canada, the two papers revealed that the NCLEX-RN remains a controversial and unresolved issue for our profession. CJNL has long published special issues to focus attention on specific topics. Such focused publication creates a convenient repository of knowledge and information about a given subject, facilitating deeper exploration of the issue and serving as a historical reference point for the topic going forward. This issue continues that tradition by presenting 10 papers that discuss the NCLEX from the perspectives of researchers, policy makers, educators, students and a coalition of nurses that is vigorously advocating for remedies to address the disproportionately adverse impact of the NCLEX on students and especially on francophone writers. As CJNL's editor for policy and innovation, I was asked to serve as guest editor for this issue, and it has been my privilege to do so.

Policies to Create Healthier Food Environments in Canada: Experts’ Evaluation and Prioritized Actions Using the Healthy Food Environment Policy Index (Food-EPI)

Food environment policies play a critical role in shaping food choices, diets, and health outcomes. This study endeavored to characterize and evaluate the current food environment policies in Canada using the Healthy Food Environment Policy Index (Food-EPI) to compare policies in place or under development in Canada as of 1 January 2017 to the most promising practices internationally. Evidence of policy implementation from the federal, provincial, and territorial governments was collated and verified by government stakeholders for 47 good practice indicators across 13 policy and infrastructure support domains. Canadian policies were rated by 71 experts from across Canada, and an aggregate score of national and subnational policies was created. Potential policy actions were identified and prioritized. Canadian governments scored ‘high’ compared to best practices for 3 indicators, ‘moderate’ for 14 indicators, ‘low’ for 25 indicators, and ‘very little or none’ for 4 indicators. Six policy and eight infrastructure support actions were prioritized as the most important and achievable. The Food-EPI identified some progress and considerable gaps in policy implementation in Canada, and highlights a particular need for greater attention to prioritized policies that can help to shift to a health-promoting food environment.

Wind Speed Retrieval from Simulated RADARSAT Constellation Mission Compact Polarimetry SAR Data for Marine Application

RADARSAT Constellation Mission (RCM) compact polarimetry (CP) data were simulated using 504 RADARSAT-2 quad-pol SAR images. These images were used to samples CP data in three RCM modes to build a data set with co-located ocean wind vector observations from in situ buoys on the West and East coasts of Canada. Wind speeds up to 18 m/s were included. CP and linear polarization parameters were related to the C-band model (CMOD) geophysical model functions CMOD-IFR2 and CMOD5n. These were evaluated for their wind retrieval potential in each RCM mode. The CP parameter Conformity was investigated to establish a data-quality threshold (>0.2), to ensure high-quality data for model validation. An accuracy analysis shows that the first Stokes vector (SV0) and the right-transmit vertical-receive backscatter (RV) parameters were as good as the VV backscatter with CMOD inversion. SV0 produced wind speed retrieval accuracies between 2.13 m/s and 2.22 m/s, depending on the RCM mode. The RCM Medium Resolution 50 m mode produced the best results. The Low Resolution 100 m and Low Noise modes provided similar results. The efficacy of SV0 and RV imparts confidence in the continuity of robust wind speed retrieval with RCM CP data. Three image-based case studies illustrate the potential for the application of CP parameters and RCM modes in operational wind retrieval systems. The results of this study provide guidance to direct research objectives once RCM is launched. The results also provide guidance for operational RCM data implementation in Canada’s National SAR winds system, which provides near-real-time wind speed estimates to operational marine forecasters and meteorologists within Environment and Climate Change Canada.

Safe Injection Sites and Drug Injection Overdose: A Literature Review

Background: Canada is struggling with the escalating rate of drug injection overdose deaths. Harm reduction interventions can be implemented to address this epidemic. Safe injection sites are one of those harm reduction interventions but implementation in Canada has been politically hampered. The purpose of this paper is to show how safe injection sites are an effective harm reduction intervention for fatal drug injection overdose. Methods: A literature review was conducted to determine the impact of safe injection sites on fatal drug injection overdose. Inclusionary criteria were: peer-reviewed journal articles, published between 2003 and 2016, in English, and were primary research that discussed the impact of safe injection sites on fatal drug injection overdose in Canada. Exclusionary criteria were: journal articles that were secondary research, grey literature, and journal articles that researched the benefits of safe injection sites other than drug injection overdose prevention. Four databases produced 22 journal articles pertinent to this study. They were analyzed to identify themes. Results: Three themes were identified: (1) overdose from injection drug use was better managed in safe injection sites, (2) safe injection sites reduced mortality rates from drug injection overdose, and (3) safe injection sites are utilized by injection drug users. Conclusion: Safe injection sites are an effective harm reduction intervention for fatal drug injection overdose.

Valuing Citizen Access to Digital Health Services: Applied Value-Based Outcomes in the Canadian Context and Tools for Modernizing Health Systems.

BackgroundIn publicly funded health systems, digital health technologies are strategies that aim to improve the quality and safety of health care service delivery and enhance patient experiences and outcomes. In Canada, governments and health organizations have invested in digital health technologies such as personal health records (PHRs) and other electronic service functionalities and innovation across provincial and territorial health systems.ObjectivePatients’ access to their own information via secure, Web-based PHRs and integrated virtual care services are promising mechanisms for supporting patient engagement in health care. We draw on current evidence to develop an economic model that estimates the demonstrated and potential value of these digital health initiatives.MethodsWe first synthesized results from a variety of Canadian and international studies on the outcomes for patients and service providers associated with PHRs across a continuum of services, ranging from viewing information (eg, laboratory results) on the Web to electronic prescription renewal to email or video conferencing with care teams and providers. We then developed a quantitative model of estimated value, grounded in these demonstrated benefits and citizen use (2016-2017). In addition to estimating the costs saved from patient and system perspectives, we used a novel application of a compensating differential approach to assess the value (independent of costs) to society of improved health and well-being resulting from PHR use.ResultsPatients’ access to a range of digital PHR functions generated value for Canadians and health systems by increasing health system productivity, and improving access to and quality of health care provided. As opportunities increased to interact and engage with health care providers via PHR functions, the marginal value generated by utilization of PHR functionalities also increased. Web-based prescription renewal generated the largest share of the total current value from the patient perspective. From the health systems perspective, Canadians’ ability to view their information on the Web was the largest value share. If PHRs were to be implemented with more integrated virtual care services, the value generated from populations with chronic illnesses such as severe and persistent mental illness and diabetes could amount to between Can $800 million and Can $1 billion per year across Canadian health systems.ConclusionsPHRs with higher interactivity could yield substantial potential value from wider implementation in Canada and increased adoption rates in certain target groups—namely, high-frequency health system users and their caregivers. Further research is needed to tie PHR use to health outcomes across PHR functions, care settings, and patient populations.

Integrated (Enterprise) Risk Management in Canadian Healthcare Organizations: Common Barriers and a Shared Solution for Effective and Efficient Implementation in Canada.

Healthcare is a complex, high-risk industry as evidenced by frequent accounts of unintended patient and staff harm as well as other disruptions leading to financial, reputational and facility losses. Canadian healthcare organizations have struggled to adopt effective organization-wide risk management programs to reduce the likelihood and impact of these losses. This paper outlines an evidence-based initiative to spread, at scale, an effective and efficient program for integrated risk management. National results and benchmarks from the first three years of implementation are provided.

Laparoscopic colectomy: trends in implementation in Canada and globally

<h3>Summary</h3> Comparisons with other high-income countries suggest that Canada has been slower to adopt laparoscopic colectomy (LC). The Canadian Association of General Surgeons sought to evaluate the barriers to adoption of laparoscopic colon surgery and to propose potential intervention strategies to enhance the use of the procedure. Given the clinical benefits of laparoscopic surgery for patients, the increasing needs for surgical care and the desire of Canadian general surgeons to advance their specialty and enhance the care of their patients, it is an important priority to improve the utilization of LC.

Influence and impact: interacting factors in asylum policy-making and implementation in Canada and Turkey (1988–92)

ABSTRACTWith rates of asylum seekers increasing across decades worldwide, why do high- and middle-income countries persistently adopt more restrictive asylum policies? By analyzing data from the cases of Canada and Turkey (1988–92), this study shows that domestic policy preferences of decision-makers and refugee determination systems constitute the factors with the highest impact on restrictive asylum policy-making. Through the use of latent content analysis of primary historical documents and elite and expert interviews and an innovative application of the ADVIAN classification method of impact analysis, this study claims that interactions among institutions are critical for the changes a country's asylum policy. Conclusions of this study challenge existing research to move beyond monocausal explanatory schemes for understanding restrictive asylum policy trends and engage with complex frameworks accounting for interacting factors.

Outcomes During Early Implementation of Mifepristone-Buccal Misoprostol Abortions up to 63 Days of Gestation in a Canadian Clinical Setting.

In January 2017, mifepristone became available in Canada. The goal of this study was to determine the effectiveness and safety of mifepristone-misoprostol abortion during its early implementation in a Canadian setting. This retrospective chart review included the first 477 patients who had a mifepristone-misoprostol abortion from March 13 to October 31, 2017, in an urban sexual health clinic. Women with pregnancies up to 63days of gestation had an initial dating ultrasound and β-human chorionic gonadotropin determination. They were provided mifepristone 200 mg orally in clinic, followed 24-48hours later with misoprostol 800 µg buccally at home. Follow-up, 7-14days later, in clinic or by telephone, used symptom review and follow-up β-human chorionic gonadotropin or ultrasound. The primary outcome was successful abortion, defined as expulsion of pregnancy without uterine aspiration. Of 477 consecutive mifepristone abortions, 422 women (88.5%) had documented follow-up, with 408 (96.7%) successful abortions, including eight in women who had a repeat dose of misoprostol. Fourteen (3.3%) unsuccessful abortions required uterine aspiration, two (0.5%) for ongoing pregnancy and 12 (2.8%) for incomplete abortion or persistent bleeding. Seventeen women (4.0%) had emergency department visits, one (0.2%) of whom was hospitalized and three (0.7%) of whom received blood transfusion. Four women (1.0%) were treated for infection. Mifepristone-misoprostol medical abortion was safe and effective during early implementation in Canada, comparable to previously published outcomes.

Moderating the impact of patent linkage on access to medicines: lessons from variations in South Korea, Australia, Canada, and the United States

BackgroundThe inclusion of patent linkage mechanisms in bilateral and plurilateral trade and investment agreements has emerged as a key element in the United States’ TRIPS-Plus intellectual property (IP) negotiating agenda. However, the provisions establishing patent linkage mechanisms in several agreements appear to reflect a degree of ambiguity, potentially enabling some flexibility in their implementation. In this study, we reviewed the features of the prototypic patent linkage mechanism established by the Hatch-Waxman Act in the United States, and compared these with the implementation of systems in three countries whose agreements with the US include patent linkage obligations. From these analyses, we draw lessons for moderating the impact of these mechanisms on access to generic medicines.MethodsWe reviewed the features of the patent linkage mechanism in the US, and undertook a detailed analysis of relevant treaty provisions and the manner of implementation in Canada, Australia, and South Korea.ResultsA key difference between the US implementation of patent linkage and that of its trading partners is the disparate treatment afforded to biologics. Because of the significant differences in the regulatory frameworks applying to small molecule and biologic medicines in the US, the Hatch- Waxman provisions do not apply to biologics and they are not subject to patent linkage. By contrast, the regulatory frameworks in Canada, Australia and South Korea do not reflect similar distinctions and thus patent linkage mechanisms also capture biologics. Additional variations in implementation, mainly the result of constructive ambiguities in the respective treaty texts, offer potential opportunity for mitigating the adverse impact of patent linkage provisions on market entry of generic medicines. Practical measures include ensuring the availability of an accessible, transparent and easily searchable database of patent information; avoiding automatic stays of generic marketing approval where possible; and requiring certification by rights holders to prevent abuse of the system.ConclusionsWhere countries accept treaty obligations to establish patent linkage mechanisms, the impact on access to generic medicines may be moderated to a degree by retaining and exploiting constructive ambiguities in the treaty text and addressing practical aspects of implementation.

Improving the translation of novel biomarkers to clinical practice: The story of cystatin C implementation in Canada: A professional practice column

Improving the translation of novel biomarkers to clinical practice: The story of cystatin C implementation in Canada: A professional practice column

Minimum alcohol pricing policies in practice: A critical examination of implementation in Canada.

There is an interest globally in using Minimum Unit Pricing (MUP) of alcohol to promote public health. Canada is the only country to have both implemented and evaluated some forms of minimum alcohol prices, albeit in ways that fall short of MUP. To inform these international debates, we describe the degree to which minimum alcohol prices in Canada meet recommended criteria for being an effective public health policy. We collected data on the implementation of minimum pricing with respect to (1) breadth of application, (2) indexation to inflation and (3) adjustments for alcohol content. Some jurisdictions have implemented recommended practices with respect to minimum prices; however, the full harm reduction potential of minimum pricing is not fully realised due to incomplete implementation. Key concerns include the following: (1) the exclusion of minimum prices for several beverage categories, (2) minimum prices below the recommended minima and (3) prices are not regularly adjusted for inflation or alcohol content. We providerecommendations for best practices when implementing minimum pricing policy.

Policy Governance in Multi-level Systems: Economic Development and Policy Implementation in Canada Charles Conteh Montreal: McGill-Queen's University Press, 2013, pp. xii, 280.

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People are failing! Something needs to be done: Canadian students' experience with the NCLEX-RN

BackgroundCanada's nurse regulators adopted the NCLEX as the entry-to-practice licensing exam for Canada's registered nurses effective January 2015. It is important to determine whether any issues from this change emerged for nursing students in preparing for and taking this new exam. ObjectivesTo explore the experiences of Canadian graduate student nurses who were the first to write the NCLEX examination for entry to practice in Canada, determine whether any issues with implementation were identified and how these could be addressed. DesignA qualitative study. MethodsThematic analysis of semi-structured interview data obtained through interviews with 202 graduate Canadian nursing students was the methodology employed in this study. ResultsThe predominant theme that emerged from the interview data was policy related issues that students identified with preparing for and taking the NCLEX. Sub-themes included: a) temporary test centre concerns, b) perceptions of American context and content on the exam, c) lack of French language resources and translation issues, d) the limited number of opportunities to write the exam, e) communication and engagement with regulators, f) financial costs incurred and g) reputational costs for the Canadian nursing profession. ConclusionsThe experiences of study participants with NCLEX implementation in Canada were less than positive. This is of critical importance given the pass rates for first-time NCLEX writers in Canada were reported as 69.7%, substantially lower than pass rates on the previous Canadian entry-to-practice exam.

Second language education and micro-policy implementation in Canada: The meaning of pedagogical change

Using data from a study investigating the implementation of a popular French as a second language (FSL) teaching method in Canada (i.e. the Accelerative Integrated Method), this article presents a second language (L2) perspective on micro-policy implementation and pedagogical change. According to Fullan (2007), successful change implementation requires the establishment of ‘shared meaning’: a balanced vision of what the change represents and coordinated management of its implementation. This inquiry compared stakeholder perspectives ( n = 36) on the method and its implementation in contexts where it was mandated and optional for FSL instruction. Data from interviews and focus groups were triangulated to provide a descriptive synthesis of the shared realities and practices of these local players. Findings showed that the bias for action and utility of the method, teacher agency and lack of collaborative monitoring emerged as factors affecting the short-term implementation of this change and its potential long-term sustainability. The findings present important implications for FSL education, micro-level L2 policy implementation and ongoing research focusing on L2 pedagogical change in the Canadian context.

Physician-assisted death: A Canada-wide survey of ALS health care providers.

To survey amyotrophic lateral sclerosis (ALS) health care providers to determine attitudes regarding physician-assisted death (PAD) after the Supreme Court of Canada (SCC) invalidated the Criminal Code provisions that prohibit PAD in February 2015. We conducted a Canada-wide survey of physicians and allied health professionals (AHP) involved in the care of patients with ALS on their opinions regarding (1) the SCC ruling, (2) their willingness to participate in PAD, and (3) the PAD implementation process for patients with ALS. We received 231 responses from ALS health care providers representing all 15 academic ALS centers in Canada, with an overall response rate for invited participants of 74%. The majority of physicians and AHP agreed with the SCC ruling and believed that patients with moderate and severe stage ALS should have access to PAD; however, most physicians would not provide a lethal prescription or injection to an eligible patient. They preferred the patient obtain a second opinion to confirm eligibility, have a psychiatric assessment, and then be referred to a third party to administer PAD. The majority of respondents felt unprepared for the initiation of this program and favored the development of PAD training modules and guidelines. ALS health care providers support the SCC decision and the majority believe PAD should be available to patients with moderate to severe ALS with physical or emotional suffering. However, few clinicians are willing to directly provide PAD and additional training and guidelines are required before implementation in Canada.

Interventions to prevent or reduce the level of frailty in community-dwelling older adults: a protocol for a scoping review of the literature and international policies

IntroductionWith ageing comes increased vulnerability such that older adults’ ability to recover from acute illnesses, fall-related injuries and other stresses related to the physical ageing processes declines. This increased vulnerability,...

Financial risk-sharing agreements: Using options to make marginal benefits cost effective.

41 Background: New cancer treatments have become increasingly costly. Although new drugs may be sufficiently cost-efficiency for a primary indication (i1) to receive funding, subsequent indications (ia) may not prove cost-effective. A financial risk-sharing agreement to increase access is proposed. A potential 2012 real-world implementation in Canada for pazopanib use in metastatic renal cell carcinoma (mRCC) as i1, and soft-tissue sarcoma (STS) as ia is presented. Methods: The market value of an indication can be approximated by its net-present-value (NPV) of expected cash flows. If the incremental cost-effectiveness ratio (ICER) for ia is expected to be greater than willingness-to-pay (WTP), the payer then has an incentive to enter into a risk-sharing agreement. A binomial option pricing model is employed to compute the price of the call option to contract such an agreement. The probability of being eligible for ia is extracted from the pan-Canadian Oncology Drug Review (pCODR), a national drug funding advisory body. Correspondence with industry was performed to identify additional ia. Cost, effectiveness, the ICER, discount rates, and drug revenues are calculated using inputs from pCODR, the Bank of Canada, Statistics Canada, and pazopanib’s relevant clinical data at the time of its submission for i1. Results: Of the 47 drugs eligible for i1, 46% are eligible for an ia(Wilson interval 33%-60%). For pazopanib in mRCC, at a mean price of $164/day and an ICER of $0-$57,309, the expected NPV was computed to be $338M. In STS, based on its clinical data at the time, at the same price, the ICER was expected to be &gt; $100,000, with an NPV of $37M. The price of the call option is $17M. Alternatively, the price of pazopanib could be adjusted to $172/day in mRCC, keeping its ICER below WTP, with an agreement that if efficacious, the drug would be provided by the company gratis for STS patients. Conclusions: In a reality where high drug costs are limiting access for vulnerable patients, risk sharing agreements using financial instruments offer an opportunity to re-deploy health technology assessment to expand drug access. For a price increase of $8 per day in i1, Canadian STS patients could have had access to an effective treatment instead of nothing.