Ontario Government Research Articles

The Impacts of Selling Alcohol in Grocery Stores in Ontario, Canada: A Before-After Study.

From 2015 to 2019, the Government of Ontario expanded privatized sales of alcohol, licensing 450 grocery stores to sell beer, cider, and wine. The impacts of a nearby grocery store gaining an alcohol license on adults' alcohol use in Ontario are examined, including whether impacts differed by gender. Data from 2015-2019 Canadian Community Health Survey participants in Ontario (age ≥ 20 years), living within 1,000 m and 1,500 m of grocery stores that gained a license to sell alcohol and propensity-matched controls were included (1,000 m n = 14,052, 1,500 m n = 30,486). Alcohol use outcomes included past-7-day number of standard drinks consumed, near-daily drinking (≥4 days/week), and heavy drinking (5+ drinks in men/4+ in women, at least once/month). Gender-specific difference-in-differences (DiD) analyses compared changes in alcohol use before and after intervention in intervention and control populations. Decreases in past-7-day drinks, near-daily drinking, and heavy drinking were observed after intervention in both intervention and control populations. At the 1,000 m level, adjusted DiD analyses showed past-7-day drinking in women (risk ratio = 1.21, 95% CI [0.88, 1.60]) and heavy drinking in men (odds ratio = 1.38, 95% CI [0.92, 2.08]) had effect sizes above 1, a relative increase over controls, although confidence intervals crossed 1. Findings did not indicate significant differences in alcohol use in intervention relative to controls for other alcohol use measures and at 1,500 m. Findings suggest no association between a partial alcohol deregulation initiative in Ontario and alcohol use from 2015 to 2019. It is important to monitor the impacts on alcohol use over time as further alcohol deregulation plans in Ontario and other jurisdictions are considered.

Mental Health Professionals' Views on the Regulation of Psychotherapy in Ontario

In Canada, statutory regulation for the mental health professions is a provincial or territorial matter. In 2007, the Ontario government introduced the Psychotherapy Act (PA), which details the scope of practice as well as the authorized act of psychotherapy. The PA established the College of Registered Psychotherapists of Ontario (CRPO) to regulate its members in the service of protecting the public. Given the long history of contestation and ambiguity surrounding the definition of psychotherapy, the PA represents an important historic moment for practitioners in Ontario. However, little research has been conducted on psychotherapy practitioners’ experiences and perspectives on professional regulation. This study qualitatively explored perspectives on, and experiences with, the PA among regulated mental health practitioners who have access to the act of psychotherapy in Ontario, including psychotherapists, nurses, physicians, occupational therapists, psychologists, and social workers. The study provides insights into the ways that these professional groups are impacted by the regulation of psychotherapy and has implications for the future implementation of statutory regulation.

Governing Professionals Through Discourses of Resilience and Value: A New Legitimation for Ontario Pharmacists

In a neoliberal turn, the government of Ontario cut more than $750 million in funds that were traditionally received by pharmacies through dispensing medication. These funds were replaced with a state-funded program that would reimburse pharmacists for professional services related to patient care. The problem facing professional elites from Ontario pharmacy’s advocacy body was how to govern members of a self-regulating profession to switch subjectivities (identities) from the traditional dispenser of medication to providing patient care for profit. We address a gap in the literature and pose the question, how are the rank and file of allied healthcare professions governed by professional elites to become responsibilized subjects who will adopt state/profession agendas? Using a Foucauldian governmentality framework, our findings reveal that the rank and file are governed by elites through two technologies: resilience and value making possible a new “legitimate” pharmacist subjectivity related to the market and health care sustainability.

Policymaker perspectives on self-management of disease and disabilities using information and communication technologies

BackgroundPolicies that support health self-management are malleable and highly dependent on various factors that influence governments. Within a world that is shifting toward digitalization due to pressures such as the COVID-19 pandemic and labor shortages, policymaking on older adults’ self-management of chronic diseases and disability using information and communication technologies (ICTs) needs to be better understood. Using the province of Ontario, in Canada, as a case study, the research question was What is the environment that policymakers must navigate through in development and implementation of policies related to older adults’ self-management of disease and disability using information and communication technologies (ICTs)?MethodsThis study used a qualitative approach where public servants from 4 ministries within the government of Ontario were invited to participate in a 1-h, one-on-one, semi-structured interview. The audio-recorded interviews were based on an adapted model of the policy triangle, where the researcher asked questions about the influences from the different sources identified in the model. The interviews were later transcribed and analyzed using a deductive-inductive coding approach.ResultsTen participants across 4 different Ministries participated in the interviews. Participants shared insights on various aspects of context, process and actors that help shape the current content of policies. The analysis revealed that policies, in the form of programs, services, legislation and regulations, are the result of collaborations and dialogue between different actors and get developed and implemented via a set of complex government processes. In addition, policy actions come from a plethora of sectors which all get influenced by several predictable and unpredictable external pressures.ConclusionsThe environment for policymaking in the government of Ontario regarding older adults’ self-management of disease and disability using ICTs is one that is mostly reactive to external pressures, while organized within a set of complex processes and multi-sectoral collaborations. The present research helped us to understand the complexity of policymaking on the topic and highlights the need for increased foresight and proactive policymaking, regardless of which governments are in-place.

"My Biggest Fear Is She'll Die Alone": Care Partner Perspectives of Institutional COVID-19 Visitor Restrictions in Ontario, Canada.

In March 2020, the Government of Ontario, Canada implemented public health measures, including visitor restrictions in institutional care settings, to protect vulnerable populations, including older adults (> 65 years), against COVID-19 infection. Prior research has shown that visitor restrictions can negatively influence older adults' physical and mental health and can cause increased stress and anxiety for care partners. This study explores the experiences of care partners separated from the person they care for because of institutional visitor restrictions during the COVID-19 pandemic. We interviewed 14 care partners between the ages of 50 and 89; 11 were female. The main themes that emerged were changing public health and infection prevention and control policies, shifting care partner roles as a result of visitor restrictions, resident isolation and deterioration from the care partner perspective, communication challenges, and reflections on the impacts of visitor restrictions. Findings may be used to inform future health policy and system reforms.

Applying an ethical lens to the provision of care in for-profit healthcare facilities.

In early 2023, after three years of pandemic and delayed care, Ontario faced an overwhelming backlog of elective surgical procedures and unacceptable wait times. With hospitals experiencing historic health human resources shortages and critical capacity limitations, disruptive change was required. The Ontario government proposed to address these mounting access-to-care issues by paying for-profit healthcare clinics and surgi-centres to provide insured services, resulting in considerable controversy, much opposition, some praise, and many public protests. Previous experiences with for-profit independent health facilities had generated both complaints and documented problems with their operations. This article examines these concerns against the ethical principles of autonomy, beneficence, non-malfeasance, and justice. While much of this unease can be effectively addressed through collaboration and oversight, the complexity and costs involved in ensuring equity and quality may make it difficult for such facilities to maintain profitability.

“Shared Language” Or “Straitjacket”? The Hidden Costs of Legitimising Participation Through Standardised Frameworks

In this paper, we examine how a framework developed by the International Association for Public Participation is used to frame and legitimise the participatory practices of local governments in Ontario, Canada and Victoria, Australia. We find the association of IAP2 materials with appeals to “best practice” raises questions about the potential consequences of the use of standardised frameworks for participation. While these frameworks encourage a minimum standard for public participation, they may also stifle creative and contextually sensitive participatory planning practice.

Impact of a Publicly-Funded Pharmacare Program on Prescription Stimulant use Among Children and Youth: A Population-Based Observational Natural Experiment.

Stimulants are first-line pharmacotherapy for individuals with attention-deficit hyperactivity disorder. However, disparities in drug coverage may contribute to inequitable treatment access. In January 2018, the government of Ontario, Canada, implemented a publicly-funded program (OHIP+) providing universal access to medications at no cost to children and youth between the ages of 0 and 24. In April 2019, the program was amended to cover only children and youth without private insurance. We studied whether these policy changes were associated with changes in prescription stimulant dispensing to Ontario children and youth. We conducted a population-based observational natural experiment study of stimulant dispensing to children and youth in Ontario between January 2013 and March 2020. We used interventional autoregressive integrated moving average models to estimate the association between OHIP+ and its subsequent modification with stimulant dispensing trends. The implementation of OHIP+ was associated with a significant immediate increase in the monthly rate of stimulant dispensing of 53.6 individuals per 100,000 population (95% confidence interval [CI], 36.8 to 70.5 per 100,000) and a 14.2% (95% CI, 12.8% to 15.6%) relative percent increase in stimulant dispensing rates between December 2017 and March 2019 (1198.6 vs. 1368.7 per 100,000 population). The April 2019 OHIP+ program amendment was associated with an increase in monthly stimulant dispensing trends of 10.2 individuals per 100,000 population (95% CI, 5.0 to 15.5), with rates increasing 7.5% (95% CI, 6.2% to 8.7%) between March 2019 and March 2020 (1368.7 vs. 1470.8 per 100,000 population). These associations were most pronounced among males, children and youth living in the highest income neighbourhoods and individuals aged 20 to 24. A publicly-funded pharmacare program was associated with more children and youth being dispensed stimulants.

Network Migration Problem: A Hybrid Logic-Based Benders Decomposition Approach

Telecommunication networks frequently face technological advancements and need to upgrade their infrastructure. Adapting legacy networks to the latest technology requires synchronized technicians responsible for migrating the equipment. The goal of the network migration problem is to find an optimal plan for this process. This is a defining step in the customer acquisition of telecommunications service suppliers, and its outcome directly impacts the network owners’ purchasing behavior. We propose the first exact method for the network migration problem, a logic-based Benders decomposition approach that benefits from a hybrid constraint programming–based column generation in its master problem and a constraint programming model in its subproblem. This integrated solution technique is applicable to any integer programming problem with similar structure, most notably the vehicle routing problem with node synchronization constraints. Comprehensive evaluation of our method over instances based on six real networks demonstrates the computational efficiency of the algorithm in obtaining quality solutions. We also show the merit of each incorporated optimization paradigm in achieving this performance. History: Accepted by David Alderson, Area Editor for Network Optimization: Algorithms & Applications. Funding: This work was supported by Mitacs. SciNet is funded by the Canada Foundation for Innovation, the Government of Ontario, Ontario Research Fund–Research Excellence, and the University of Toronto. Supplemental Material: The e-companion is available at https://doi.org/10.1287/ijoc.2023.1280 .

Evolution of public health policy on healthcare self-management: the case of Ontario, Canada

BackgroundAs people live longer, they are at increased risk for chronic diseases and disability. Self-management is a strategy to improve health outcomes and quality of life of those who engage in it. This study sought to gain a better understanding of the factors, including digital technology, that affect public health policy on self-management through an analysis of government policy in the most populous and multicultural province in Canada: Ontario. The overarching question guiding the study was: What factors have influenced the development of healthcare self-management policies over time?MethodsArchival research methods, combining document review and evaluation, were used to collect data from policy documents published in Ontario. The documents were analyzed using the READ approach, evaluated using a data extraction table, and synthesized into themes using the model for health policy analysis.ResultsBetween January 1, 1985, and May 5, 2022, 72 policy documents on self-management of health were retrieved from databases, archives, and grey literature. Their contents largely focussed on self-management of general chronic conditions, while 47% (n = 18/72) mention diabetes, and 3% (n = 2/72) focussed solely on older adults. Digital technologies were mentioned and were viewed as tools to support self-management in the context of healthcare delivery and enhancing healthcare infrastructure (i.e., telehealth or software in healthcare settings). The actors involved in the policy document creation included mostly Ontario government agencies and departments, and sometimes expert organizations, community groups and engaged stakeholders. The results suggest that several factors including pressures on the healthcare system, hybrid top-down and bottom-up policymaking, and political context have influenced the nature and implementation timing of self-management policy in Ontario.ConclusionsThe policy documents on self-management of health reveal a positive evolution of the content discussed over time. The changes were shaped by an evolving context, both from a health and political perspective, within a dynamic system of interactions between actors. This research helps understand the factors that have shaped changes and suggests that a critical evidence-based approach on public health policy is needed in understanding processes involved in the development of healthcare self-management policies from the perspective of a democratic governing system.

Abstract P3-07-14: A phase II study of CFI-400945 in patients with advanced/metastatic cancer: Canadian Cancer Trials Group (CCTG) IND.237

Abstract Background: CFI-400945 is a selective oral inhibitor of Polo-like Kinase 4 (PLK4), a controller of centriole duplication and mitotic progression identified by functional screening of genomically unstable breast cancer (BC). IND.237 (NCT01954316) is an open label, multicentre, phase 2 study in HER2 negative metastatic breast cancer (MBC) with 3 cohorts, 1 enriched for PTEN loss of function. Enrollment started in 2018 at 64mg based on a previously established recommended phase 2 dose (RP2D). The initial patients had higher than expected grade 3/4 neutropenia which led to a voluntary hold and dose de-escalation; the new RP2D was declared at 32mg as previously reported Here we report the results of the phase 2 study of CFI-400945 in advanced BC patients. Materials and Methods: 49 patients were enrolled across 3 cohorts: 1: triple negative; 2: ER+/HER2- PTEN low (by IHC); 3: ER+/HER2-, PTEN intact. The primary outcome is objective response rate (ORR); secondary outcomes included disease control rate (DCR) >16w, and safety. A Simon 2-stage design was used (9 – 25 pts planned for each cohort). CFI-400945 would be considered active if ≥3 responses were observed in any given cohort. Eligibility included ECOG 0-1, adequate organ function and receipt of at ≥1 prior line of cytotoxic chemotherapy in any setting including anthracycline taxane (unless contraindicated). Treatment was 32mg 7d on 7d off in cycle 1 (cycle length=28d), then continuously starting cycle 2. Safety assessments were performed each cycle and response (RECIST 1.1) every 2 cycles. Results: 60 patients have been screened, 49 enrolled: 10 were in initial dose ranging and were excluded from phase 2 response assessment. 10 patients were enrolled in cohort 1, 4 in cohort 2, and 25 in cohort 3. Table 1 presents patient characteristics and response results. 1 patient in cohort 3 has not had disease re-assessed at time of abstract submission. The most common adverse events have been cytopenias, nausea, fatigue, headache, constipation and vomiting. Less than 5% of patients experienced a non-hematologic AE > grade 3; 33% experienced ≥ grade 3 neutropenia. Conclusions: CFI-400945 32mg is well tolerated in this MBC population with moderate incidence of uncomplicated neutropenia. The TNBC cohort so this arm has been closed to further accrual for lack of responses. The PTEN loss group has been slow to accrue and remains open. Responses in the ER+/HER2- arm are encouraging – results from patients remaining on study are awaited and correlative studies to identify features associated with responses are underway. Acknowledgements: Sponsored by the Canadian Cancer Trials Group. Supported by Stand Up To Cancer Canada (scientific partner AACR) Canadian Cancer Society (CCS) Breast Cancer Dream Team Research Funding, Ontario Institute for Cancer Research (funding provided by the Government of Ontario) and grants from CCS to CCTG. Table 1. Table 1. Patient characteristics and response rates in each cohort treated with CFI-400945. Citation Format: David W. Cescon, John Hilton, Philippe Bedard, Phillip Blanchette, Rossanna C. Pezo, Ayesha Bashir, Vikaash Kumar, Terry L. Ng, Arif Awan, Anthony Lott, Jacques Antoun Raphael, Linda Hagerman, Mark Bray, Lindsay Muyot, Jesus Fuentes Antras, Lesley Seymour, Dongsheng Tu, Pierre-Olivier Gaudreau, Moira Rushton. A phase II study of CFI-400945 in patients with advanced/metastatic cancer: Canadian Cancer Trials Group (CCTG) IND.237 [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-07-14.

Open curriculum for teaching digital accessibility

In Ontario, Canada, universities are obligated under the Accessibility for Ontarians with Disabilities Act (AODA) to ensure that people with disabilities do not face barriers to education, and they are free from barriers in society more broadly. Those who produce online curriculum for postsecondary education in the province need at least a basic understanding of digital accessibility, and for some roles, like software or web developers, a level of expertise is required. However, finding people with the right knowledge, skills, and attitude can be difficult. This problem can be attributed to the fact that until recently digital accessibility skills have received little attention in post-secondary education. To address the issue, in 2015, with support from the Government of Ontario, we began several projects to develop digital accessibility curriculum. These efforts created a series of free Massive Open Online Courses (MOOCs) aimed at teaching digital accessibility skills to audiences ranging from office support workers, to managers, to developers, to digital accessibility specialists. The MOOCs ran between 2016 and 2019 and served more than 5000 participants, with more than 600 successfully completing the requirements for the digital badge(s) awarded. Following the MOOCs project, the content of the courses was converted into Open Educational Resources (OERs) that could be used as textbooks to support the introduction of digital accessibility topics over a range of subject areas, with encouragement for others to reuse the content to add accessibility related topics into their teaching. The OERs were downloaded more than 10,000 times between late 2020 and late 2022 and provided the base content for four open courses developed through OERU. In this article the pedagogy and curriculum for this digital accessibility training are described.

University Competency-based Courses for Internationally Educated Nurses (IENs) in Ontario: A Pilot Education Pathway to Registered Nurse (RN) Licensure

In 2014, a team of nurse educators and champions of internationally educated nurses (IENs) in Ontario, Canada, came together to address the issue of supporting IEN transition to practice as one route to help address nursing shortages. Courses were developed with funding from the Government of Ontario, and policy and coordination support from the Council of Ontario Universities, to pilot an educational bridging pathway for IENs. The faculty team across four Ontario universities used a consortium approach to coalesce province-wide expertise in IEN education. What began as a selection of targeted, competency-based courses has since evolved into a full Competency-Bridging Program of Study for Internationally Educated Nurses in Ontario, aligned with other IEN bridging program offerings across the province. This paper describes the initial process of the group, from 2015 to 2018, to create foundational learning and competency-based courses to meet targeted entry-to-practice (ETP) competencies for Registered Nurse (RN) registration with the College of Nurses of Ontario (CNO). The barriers to IENs in meeting ETP requirements and how the gap in the existing Ontario IEN bridging to a Bachelor of Science in Nursing (BScN) education to meet regulatory requirements are also addressed. This article explores how Ontario may respond to the increasing nursing shortages and the need to engage ethically and retain IENs in practice. Lessons learned from competency-course development add to the growing body of knowledge about IEN program experiences in Canada to enable more IENs to enter the Ontario nursing workforce.

On the lack of scientific evidence for the Ontario cormorant cull and other cormorant management actions: a response to Dorr et al. (2022)

Essay In their recent essay in Avian Conservation and Ecology, Dorr et al. (2022) were compelled to clear up apparent misunderstandings they felt were perpetrated by the separate editorials of Hobson (2021) and Cooke (2021) dealing specifically with the Ontario government’s decision to allow a province-wide public cull of Double-crested Cormorants (Nannopterum auritum) in response […]

Preserving Winescapes amid North America’s Urban Sprawl*

Ontario’s Niagara Peninsula and California’s Napa Valley, both smaller than most of the world’s famed wine regions, exist within two of the most densely populated regions in North America. Their fields, orchards, and vineyards faced pressure from expanding metropolises and became part of ongoing debates about the loss of prime agricultural lands in Canada and the United States. In 1968, Napa County created one of the world’s first agricultural preserves to stave off sprawl. In 2005, after decades of debate, the Ontario government included the Niagara Peninsula in a greenbelt for the larger Toronto metropolitan region; its agricultural provisions mimicked Napa’s preserve. Boosters in both regions have emphasized the multifunctionality of the countryside. In the end, however, wine production and the tourism it engendered offered financial benefits that few other crops provided. Winescapes proved essential to protecting rural spaces. Yet differences also emerge in these histories. The complexity of land use and of municipalities in Niagara complicated efforts to preserve agricultural lands.

Economic Recovery in Response to Worldwide Crises: Fiduciary Responsibility and the Legislative Consultative Process with Respect to Bill 150 (Green Energy and Green Economy Act, 2009) and Bill 197 (COVID-19 Economic Recovery Act, 2020) in Ontario, Canada

The Green Energy and Green Economy Act (2009) was an omnibus bill that affected a number of other acts. Due to the breadth of its effects, it should have seen a rigorous consultation and review process; this is especially true given how it would impact First Nations and its explicit mention in the Bill. However, it took less than three months for it to receive Royal Assent and become an act. This timeline is extremely short, even among similar bills within the same context. One of the core reasons for this swift transition is due to its labeling as green energy, which has benign connotations. This effectively allowed the bill to be expedited through the consultation process. The consultation process had many hurdles of its own that inhibited meaningful consultation including its timeframe, location of hearings, accessibility, and other factors. The term green energy was also never defined within the Act, meaning it only served as a form of signaling. This raises many questions with respect to the Government of Ontario’s conduct in the situation and how they handled their legal duty to consult with Indigenous people of Ontario, Canada. There are many voices that have raised issues with this process. If nothing else, this example serves the purpose of demonstrating the dangers of green-labelling, especially to Indigenous people of Canada and other Indigenous groups worldwide.

Governance in the transformational journey toward integrated healthcare: The case of Ontario

Ontario, the most populous province and the main driver of economic growth in Canada, has been plagued by rising healthcare costs and declining health quality. Firmly believing that care integration is integral to health quality and efficiency of the healthcare system, the Ontario government has embarked on its journey of healthcare system transformation. The case, by taking a snapshot of its transition from the Local Health Integration Network (LHIN) model to the Ontario Health Team model, offers insights into the governance of the LHIN model as well as the initiative of integrating a myriad of healthcare information systems to support care integration. After 12 years’ controversial operation of LHINs, the government dissolved the organization and announced its plan to switch to the Ontario Health Team model. Under the new model, Ontario Health Teams would be responsible for providing a full and coordinated spectrum of care for patients, especially those with complex care needs. Would this round of transformation and emphatic focus on digital health lead Ontario one step closer to integrated care that Ontarians have been chasing for so long?

Sistema de Educação Superior canadense: avaliação da Agência HEQCO para o desenvolvimento da Educação na província de Ontário

Abstract Canada is a country with a recognized Education system, and the province of Ontario has the largest number of students enrolled in Higher Education. Due to its management complexity, the Government of Ontario created the agency Higher Education Quality Council of Ontario (HEQCO). Because it is an unusual agency in most countries, this research aims to better understand HEQCO under the vision of the main stakeholders of the system. In order to reach the results, exploratory and qualitative research was developed, from the accomplishment of interviews with managers of the Canadian government and application of questionnaire for six professors specialists in Canadian Higher Education and two student leaderships. The results showed that HEQCO has a prominent role but needs greater autonomy. This study also realized that in highly centralized systems, having an agency acting on specific issues can be an efficient way to identify the greatest challenges and be more assertive in the actions and policies outlined for each locality, assisting in its development.

Do more, with less: The realities of local government in rural Ontario

AbstractOver the past 30 years, the responsibilities, mandates, and activities of local governments in Ontario have undergone substantial transformations. Influenced by New Public Management, policy changes are characterized by marketization and managerialism resulting in downloading of responsibilities to local governments. This research examines the ebbs and flows of policy changes among different provincial governments since 1990 and the impacts of these policies on rural local governments in Ontario. Interviews were conducted with elected officials and senior staff in eight local governments to understand their realities. The findings demonstrate the continual policy changes led to the “do more, with less” approach currently faced by rural local governments—increased regulatory requirements, limited human and financial capacities, and small tax bases to support their activities. This experience, combined with limited fiscal levers, hinders the ability of rural local governments to address both new demands for infrastructure and existing infrastructure deficits, housing stock and affordability, and economic and workforce development strategies. The reality has necessitated local governments to seek alternative strategies to deliver programs and services through partnerships and collaboration.

One hundred years of drainage development in the Holland Marsh, Canada, and implications for long‐term sustainability

AbstractThe low‐lying peatlands of the Holland Marsh are intensively cultivated with high‐value vegetable crops, worth some $450 million Canadian annually. This high productivity is due to the fact that there have been significant investments to empolder the marsh, through the construction of dykes, embankments, canals, ditches, tile drainage, and installation of pumping stations. However, attention must be paid to the long‐term environmental sustainability of the Holland Marsh, given the high phosphorus loads and eutrophication in Lake Simcoe, the principal drainage outlet for the agricultural run‐off from the marsh. It is important that non‐point source pollution be reduced and drainage water quality better managed. In addition to agro‐environmental best management practices, adoption of controlled drainage, and improved drainage water pumping strategies are recommended. These could help achieve the P reduction target established by the government of Ontario and the Lake Simcoe Region Conservation Authority.