Ontario Government Research Articles

Understanding Government Decisions to De-fund Medical Services Analyzing the Impact of Problem Frames on Resource Allocation Policies.

Many medical services lack robust evidence of effectiveness and may therefore be considered "unnecessary" care. Proactively withdrawing resources from, or de-funding, such services and redirecting the savings to services that have proven effectiveness would enhance overall health system performance. Despite this, governments have been reluctant to discontinue funding of services once funding is in place. The focus of this study is to understand how the framing of an issue or problem influences government decision-making related to de-funding of medical services. To achieve this, a framework describing how problem frames, or explanatory naratives, influence government policy decisions was developed and applied to actual cases. The two cases selected were the Ontario government's decisions to de-fund the drug Oxycontin and blood glucose test strips used by patients with diabetes. A qualitative content analysis of public discourse (political debate and media coverage) surrounding these two resource withdrawal examples was conducted and described using the framework. In the framework, government decision-making is a partial reflection of the visibility of the policy issue and complexity of the causal story told within a problem frame. By applying this framework and considering these two key characteristics of problem frames, we can better understand, and possibly predict, the shape and timing of government policy decisions to withdraw resources from medical services.

Exploring physiotherapy practice within hospital-based interprofessional chronic pain clinics in Ontario

ABSTRACT Background: Chronic pain affects one in five persons and is a leading contributor to years lived with disability and high health care costs. In 2016, the government of Ontario increased public funding for pediatric and adult hospital-based interprofessional chronic pain clinics (HICPCs) in Ontario, Canada, expanding the role of physiotherapy in chronic pain management in the province. This role has yet to be described in the literature. Aim: The aim of this study was to explore physiotherapy practice within HICPCs in Ontario. Methods: We conducted an interpretive description qualitative study based on semistructured interviews with physiotherapists employed in pediatric and adult HICPCs in Ontario. Interviews were audio recorded, transcribed verbatim, and reviewed for accuracy. We analyzed interview data using thematic analysis. Results: Ten physiotherapists who practiced in pediatric and adult HICPCs (n = 4 pediatric; n = 6 adult) in Ontario were interviewed between February and April 2020. We constructed five themes related to physiotherapy practice in this setting. Themes included (1) contributing a functional lens to care; (2) empowering through pain education; (3) facilitating participation in physical activity and exercise; (4) supporting engagement in self-management strategies; and (5) implementing a collaborative approach to whole-person care. Conclusions: Our results illuminate how physiotherapy practice within HICPCs in Ontario focuses on providing a collaborative and whole-person approach to care, with an emphasis on supporting patients to increase their functional capacity by promoting engagement in active chronic pain management strategies.

Access to Justice: Recommended Reforms to the Ontario Justice System Using the Green Energy Act as an Example

Methods: A document was prepared and sent by a lawyer, Alan Whiteley, to Ontario government officials that identified the main concerns with the Green Energy Act and its impact on the rights of citizens. The Act had been introduced in 2009 in efforts to make Ontario a world leader in “green” energy production. With the passing of the Green Energy Act, a number of statutes were also amended in order to achieve this goal; they reduced impediments to the approval of industrial wind turbine projects. The letter in its entirety is included in this paper. Mr. Whiteley had been involved in a legal case initiated by a not-for-profit organization that argued that the regulatory changes impacted the rights of citizens. Documents such as those submitted through that court filings, such as Factums and Affidavits provided by Ontario residents, and other documents are referenced. Objectives: The goal of the letter was to affect modernization of the justice system to improve access to justice, citizen rights and animal protection. Results: The letter identified and described changes to Acts and policies, gave examples of impacts, and offered possible reform proposals that would allow citizens fair access to justice and protect their rights. These proposals were solutions through changes to the legal system. No reply to the letter was received from any of the government officials, increasing concern regarding the value of the voice of the public.

Probe Design for Simultaneous, Targeted Capture of Diverse Metagenomic Targets

The compounding challenges of low signal, high background, and uncertain targets plague many sequencing efforts, including monitoring potential zoonotic resevoirs. One solution has been targeted DNA capture, where probes are designed to hybridize with target sequences, enriching them relative to the background. We have developed the HUBDesign pipeline which makes use of sequence homology to design probes at multiple taxonomic levels. This creates an efficient probe set capable of simultaneously and specifically capturing known and potentially novel sequences. We validated HUBDesign by generating a probe set targeting the breadth of coronavirus diversity. We demonstrated significant enrichment of SARS-CoV-2 and HCoV-NL63 from a human background, without interference between the two viruses, nor background enrichment. This probe set will be of use in identifying coronavirus co-infections and surveillance of coronaviruses resevoirs. HUBDesign has broad applicability wherever there are multiple organisms of interest, such as ancient DNA, and host specific microbiomes.Funding Statement: This work was partially supported by CIHR COVID-19 Rapid Response funding to MSM. MSM was supported in part by a CIHR New Investigator Award and an Early Career Researcher Award from the Government of Ontario. This work was partially funded by a CIHR COVID grant to Principal applicant KM and co-applicant AB. AB, HP, GBG, and ZWD were funded through Natural Sciences and Engineering Research Council of Canada.HP was generously funded by the Boris Family Fund, the Micheal G. DeGroote Institute for Infectious Disease Research.Declaration of Interests: None to declareEthics Approval Statement: Work with SARS-CoV-2 was performed in a containment level 3 laboratory and all protocols were approved by the McMaster Presidential Biosafety Advisory Committee.

Successes and Challenges Implementing a "Fresh from the Farm" Fundraising Program in Schools.

In 2013, 4 partner organizations: Dietitians of Canada (DC); Ontario Fruit and Vegetable Growers Association; Ontario Ministry of Agriculture, Food and Rural Affairs; and Ontario Ministry of Education created "Fresh from the Farm" (FFF), a healthy fundraiser for Ontario Schools. FFF was designed to support the Ontario government's School Food and Beverage Policy and Local Food Act and to provide a feasible alternative for less healthy fundraising options. This paper outlines the program successes and challenges over the 6 years of DC's involvement. After 6 years, over 1700 schools successfully participated in FFF and over $2 million has been paid to Ontario farmers for product and distribution. The average participating school has generated $2040 in sales towards their fundraising efforts, equating to 770kg (1700 lbs) of fresh produce per school. Schools reported high satisfaction with FFF, with over 90% of participating schools enrolling in subsequent years. The main reasons for satisfaction included: easy to implement, profitable, offers a healthy alternative to "traditional" fundraising programs, and provides great value for cost. The main challenges were logistics of sourcing and delivery, higher than anticipated costs that made the financial model less feasible than predicted, and competition from other fundraisers.

A journey of wastewater to clean hydrogen: A perspective

A journey of wastewater to clean hydrogen: A perspective

Ontario's Debt and Deficit Reduction Strategy

The Government of Ontario shows a current debt load of $343 billion dollars . The Ontario Financing Authority, which manages the provincial debt, forecasts a medium-term debt outlook of $437.8 billion dollars for 2021-2022, and $472.9 billion for 2022-2023. Debt not being free, 2021-2022 estimates show the fourth largest line item in our province’s budget will continue to be interest on the debt at $13.2 billion dollars. Without action by those elected to office, this problem can only worsen as interest rates rise, and the debt continues to balloon. Presented here are three actionable ideas that will ameliorate, not solve the debt crisis in Ontario. It will take buy-in from Ontarians, sacrifice from Ontarians, and courage from politicians to solve it.

Differences in lipid treatment patterns in women versus men in a large cohort of patients with atherosclerotic cardiovascular disease in Ontario, Canada

Abstract Background/Introduction The prevalence of ischaemic heart disease is lower in women vs men in Canada. Studies have shown that women are more likely to be underdiagnosed and less likely to receive guideline-recommended treatments than men. Women receiving lipid-lowering therapies (LLTs) are also less likely to attain treatment goals vs men. Purpose We analysed use of LLTs and attainment of low-density lipoprotein cholesterol (LDL-C) treatment goals in a recent longitudinal cohort of patients with ASCVD with public drug coverage in Ontario to describe differences observed between female and male patients. Methods Patients ≥65 years with a primary ASCVD event/procedure between 1 Apr 2005 and 31 Mar 2016, treated with an LLT and with index and follow up LDL-C values were identified from claims data at the Institute for Clinical Evaluative Sciences data repository. Patients were assessed over a 1 year follow up period for LDL-C goal attainment (<2.0 mmol/L or 50% reduction from index LDL-C as per Canadian Cardiovascular Society Guidelines) and analysed by LLT category. Results 143,302 patients with ASCVD ≥65 years on LLTs were identified of which 41% were female. A higher proportion of female vs male patients were prescribed low (3% vs 2%) and medium intensity statins (51% vs 44%) compared with high intensity statins (43% vs 52%). A higher proportion of women failed to attain LDL-C goal compared to men (33% vs 24%) (Figure). When analysed by low, moderate or high intensity statin, 65%, 35%, and 27% of female patients and 49%, 25% and 19% of male patients failed to attain LDL-C goal at follow up. Conclusions In this retrospective study, women with a diagnosis of ASCVD were more frequently treated with low/moderate intensity statins whereas men were more frequently treated with high intensity statins. Approximately 2 of 3 women and 3 of 4 men receiving statin treatment attained LDL-C goal during the 1-year follow up period. Overall, there appear to be treatment differences between female and male patients with ASCVD, with males receiving higher intensity statin therapy and attaining LDL-C goal more frequently. Further research is needed to determine why these discrepancies exist. This study made use of de-identified data from the ICES Data Repository, which is managed by the Institute for Clinical Evaluative Sciences with support from its funders and partners: Canada's Strategy for Patient-Oriented Research (SPOR), the Ontario SPOR Support Unit, the Canadian Institutes of Health Research and the Government of Ontario. The opinions, results and conclusions reported are those of the authors. No endorsement by ICES or any of its funders or partners is intended or should be inferred. Parts of this material are based on data and/or information compiled and provided by CIHI. However, the analyses, conclusions, opinions and statements expressed in the material are those of the author(s), and not necessarily those of CIHI. Figure 1 Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Amgen Canada Inc

Low-density lipoprotein cholesterol goal attainment and treatment patterns in a cohort of >143,000 patients with atherosclerotic cardiovascular disease in Ontario, Canada

Abstract Background/Introduction Limited real-world data are available on attainment of low-density lipoprotein cholesterol (LDL-C) treatment goals in patients with atherosclerotic cardiovascular disease (ASCVD) in Canada. Purpose A retrospective observational study was conducted to describe types of ASCVD events/procedures, time between events and use of lipid lowering treatment (LLT) in patients who did not achieve LDL-C goal. Methods Patients in Ontario ≥65 years with a primary ASCVD event/procedure between 1 Apr 2005 and 31 Mar 2016, treated with an LLT and with index and follow up LDL-C values were identified from claims data at the Institute for Clinical Evaluative Sciences data repository. Patients were assessed over a 1-year follow up period for LDL-C goal attainment (<2.0 mmol/L or 50% reduction from index LDL-C) and analysed by LLT and by index event type. Results Overall, 28% of 143,302 patients ≥65 years on LLT failed to attain LDL-C goal at follow up (Figure). The proportion of patients failing to achieve LDL-C goal decreased from 35% to 22% over the 11-year study period. Mean time between index and follow up LDL-C (based on lowest score >2 weeks and up to 1 year after index LDL-C) was 203±97 days. When analysed by low-, moderate- or high-intensity statin, 57%, 30%, and 22% of patients failed to achieve LDL-C goal at follow up, respectively. Conclusions In this study, more than 1 in 4 patients with ASCVD in Ontario failed to achieve guideline recommended LDL-C goal despite treatment. In particular, ∼1 in 3 patients with cerebral and peripheral arterial disease were not at goal. An opportunity exists to better manage these high risk ASCVD patients with further statin intensification and additional LLTs This study made use of de-identified data from the ICES Data Repository, which is managed by the Institute for Clinical Evaluative Sciences with support from its funders and partners: Canada's Strategy for Patient-Oriented Research (SPOR), the Ontario SPOR Support Unit, the Canadian Institutes of Health Research and the Government of Ontario. The opinions, results and conclusions reported are those of the authors. No endorsement by ICES or any of its funders or partners is intended or should be inferred. Parts of this material are based on data and/or information compiled and provided by CIHI. However, the analyses, conclusions, opinions and statements expressed in the material are those of the author(s), and not necessarily those of CIHI Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Amgen Canada Inc.

Title: Low concentrations of glyphosate in water and sediment after direct over-water application to control an invasive aquatic plant

When an invasive wetland grass degrades a Ramsar wetland and Important Bird Area, decisive management action is called for. To limit the extent and spread of European Phragmites australis, the Ontario government began the first, large-scale application of glyphosate (Roundup CustomⓇ) over standing water to control an invasive species in Canadian history. Between 2016 and 2018, over 1000 ha of marsh were treated. To assess the concentration, movement and longevity of this herbicide in treated marshes, we measured the concentration of glyphosate, its primary breakdown product aminomethylphosphonic acid (AMPA), and the alcohol ethoxylate-based adjuvant AquasurfⓇ in water and sediments in areas of the highest exposure and up to 150 m into adjacent bays. The maximum observed concentration of glyphosate in water was 0.320 mg/L, occurring within 24 hr of application. The maximum glyphosate concentration in sediment was 0.250 mg/kg, occurring within about 30 days of application. AMPA was detectable in water and sediment, indicating microbial breakdown of glyphosate in the marsh, but at low concentrations (maxwater = 0.025 mg/L, maxsed = 0.012 mg/kg). The maximum distance from the point of application that glyphosate was detected in the water was 100 m, while AMPA was detectable only at the edge of where glyphosate was applied (0 m). Concentrations in water returned to pre-treatment levels (<DL) within 20–30 days of application. In sediment, glyphosate residue persisted above detection limits (>0.005 mg/kg) for over one year but less than two years. Concentrations of alcohol ethoxylates were variable in space and time, following a pattern that could not be attributed to AquasurfⓇ use. The direct, over-water application of Roundup CustomⓇ with AquasurfⓇ to control invasive P. australis did not reach concentrations deemed to pose toxicological concern to aquatic biota by the Canadian Council of Ministers of the Environment.

Social service responses to human trafficking: the making of a public health problem

Human trafficking has received considerable attention from policymakers, researchers and service providers globally, with resulting interventions often positioning trafficking as something that simply exists. Drawing on Bacchi’s ‘What’s the Problem Represented to be?’ approach, this article proposes that trafficking is continually made through efforts designed to eradicate it. We conducted 22 interviews with representatives from social service organisations funded by the government of Ontario, Canada, for anti-trafficking programming. These interviews provide insight into how trafficking is being represented and with what effects. Our findings suggest that organisational initiatives often rely on individualised health-related interventions, such as trauma-informed counselling and other mental health support, to address trafficking. In the process, various sex work activities are deemed ‘symptoms’ of trafficking, and perceived pathways to engaging in sex work (such as drug use/dependence, a history of trauma and low self-esteem) are produced as ‘causes’ or ‘risk factors’. We contend that by pathologising sex work and sex workers, organisations are employing a contradictory neoliberal paternalism to advance a public health representation of human trafficking that simultaneously responsibilises and disenfranchises purported victims.

Effects of quality-based procedure hospital funding reform in Ontario, Canada: An interrupted time series study

The Government of Ontario, Canada, announced hospital funding reforms in 2011, including Quality-based Procedures (QBPs) involving pre-set funds for managing patients with specific diagnoses/procedures. A key goal was to improve quality of care across the jurisdiction. Interrupted time series evaluated the policy change, focusing on four QBPs (congestive heart failure, hip fracture surgery, pneumonia, prostate cancer surgery), on patients hospitalized 2010-2017. Outcomes included return to hospital or death within 30 days, acute length of stay (LOS), volume of admissions, and patient characteristics. At 2 years post-QBPs, the percentage of hip fracture patients who returned to hospital or died was 3.13% higher in absolute terms (95% CI: 0.37% to 5.89%) than if QBPs had not been introduced. There were no other statistically significant changes for return to hospital or death. For LOS, the only statistically significant change was an increase for prostate cancer surgery of 0.33 days (95% CI: 0.07 to 0.59). Volume increased for congestive heart failure admissions by 80 patients (95% CI: 2 to 159) and decreased for hip fracture surgery by 138 patients (95% CI: -183 to -93) but did not change for pneumonia or prostate cancer surgery. The percentage of patients who lived in the lowest neighborhood income quintile increased slightly for those diagnosed with congestive heart failure (1.89%; 95% CI: 0.51% to 3.27%) and decreased for those who underwent prostate cancer surgery (-2.08%; 95% CI: -3.74% to -0.43%). This policy initiative involving a change to hospital funding for certain conditions was not associated with substantial, jurisdictional-level changes in access or quality.

The role of co 2 in improving sonic hydrogen production

The role of co ₂ in improving sonic hydrogen production

A Canadian Perspective: French Language Learning

In Canada, language learning is viewed as an international, national and local need. Herein an international perspective is provided that guides the reader into a National language perspective which is uniquely Canadian. For instance, within Ontario there are concerns about French language education and the multiple entry points for students and inequities in most school boards in Ontario. The fact that School Boards across the province have identified the supply and demand for Ontario elementary and secondary teachers as variable especially in certain subjects such as French Language is unsettling. Future recruitment needs to cast a wide net and move deep into Faculties of Education in a proactive manner. Having the necessary French teachers and support staff is very important yet the need to retain students and educators in French programs is equally essential since retention and attrition rates impact program viability. Recent history in Ontario Core French (CF) programs demonstrate reduced enrollments over time therefore the government of Ontario has acknowledged a need to increase FSL student retention via improved access, training, relationships and special programs, to ensure students are enrolled and retained as long as possible.

Dealing with disruption, rethinking recovery: Policy responses to the COVID-19 pandemic in higher education

This paper examines policy responses in higher education in the months of March and April 2020 during the rapid unfolding of the COVID-19 pandemic. The purpose is to map responses and compare levels of coordination between three actors—the Canadian federal government, the Ontario provincial government, and Ontario’s publicly funded colleges and universities—and to consider the policy implications of these initial responses for higher education’s future recovery from the pandemic. Conceptualizing COVID-19 as both a wicked problem and, in the Canadian context, a complex intergovernmental problem, the paper draws on over 200 data points from public announcements made by these three actors. It uses an emergency management framework to present a chronological comparison of actors’ actions during the response and mitigation phases focusing on four areas: academic mobility, teaching and learning, research initiatives, and student support. Actions to support higher education were largely dispersed and uncoordinated in the two key months of March and April 2020. Colleges and universities were proactive in restricting academic mobility, adapting teaching and learning, and providing student support. There was some alignment with the federal government’s responses, although federal announcements focused more on research initiatives and, latterly, student support. The Ontario government did not appear to play a significant role in shaping the initial higher education responses to the pandemic. Despite the disconnect between responses, we argue that all three actors will play an equally critical role in the future recovery and necessary rethinking of the functions and purpose of higher education.

No free rides: Winners and losers of the proposed Toronto Transit Commission U-Pass program

This paper explores the financial gains and losses for university students in Toronto, Ontario as a result of the U-Pass proposed by the Toronto Transit Commission (TTC). The proposed program was subsequently not implemented in concert with a broader initiative by the Ontario government to reduce mandatory student fees in universities. Based on the proposal, should a student body adopt the U-Pass through majority vote, the program would have offered students unlimited travel on the TTC for $70 per month to be funded through fees paid by all students enrolled in a participating university. Toronto already has high student transit ridership and fares are not integrated across municipal boundaries, setting a context in which a U-Pass would be expected to impact different students in different ways. This study uses data from the 2015 StudentMoveTO survey to estimate the redistribution of resources among students across different campuses, commute modes, and geographies. Generally, students that benefit live within the City of Toronto and use TTC to get to school, while those expected to experience welfare losses either live outside of Toronto or live close enough to their campus to walk or bike to school. The U-Pass program design implies a goal of shifting from market-based equity (each student paying for his or her own transit fares) towards equity of opportunity (each student having equal opportunity to use TTC). This contemplated shift away from market-based understandings of equity also appears to underscore why the program was nor implemented as part of a broader initiative by the provincial government to reduce mandatory university fees.

Coronavirus Disease 2019 (COVID-19) in Children: Vulnerable or Spared? A Systematic Review.

The ongoing pandemic of coronavirus disease 2019 (COVID-19) has affected people from all cultures, religions, gender, and age groups around the world. In the last few months, several studies have been conducted on various aspects of COVID-19. Our goal was to see if the pediatric population is vulnerable to this infection.In this review, we conducted extensive research mainly by using the PubMed database. We used Medical Subject Headings (MeSH) and associated keywords to engage in an extensive search focussing on COVID-19 in the pediatric population. We discovered that most of the studies were from China, and some of them were in the Chinese language. However, English translations of many of the studies were available. For accessing the relevant statistical data, we relied on the World Health Organization (WHO) resources and the official website of the Ontario Government (ontario.ca).Most of the studies showed that the virus has affected the pediatric population. However, we found some differences among these studies regarding the severity of symptoms in children affected by COVID-19. While a few studies stated that the virus has presented with milder symptoms in the pediatric population, some studies have presented data of children who have suffered life-threatening complications due to COVID-19.Although the data is limited, we have been able to conclude from the studies we reviewed that COVID-19 does indeed affect children the same way as any other age group. Moreover, children can act as carriers of the virus and can endanger the lives of other individuals. Besides, neonates and infants can easily acquire the infection from family members without having any exposure to the outside world. Hence, utmost care should be taken while handling this population. More trials and studies should be conducted to analyze the impact of early diagnosis of infection in children and its management.

For the people? Regulating employment standards in an era of Right-wing populism

Set in the context of the June 2018 election of Doug Ford’s Progressive Conservative provincial government in Ontario, this paper examines the implications of Right-wing populism for the regulation of legislated employment standards. Focusing on the Making Ontario Open for Business Act, 2018, the paper argues that the Ford Government’s Right-wing populism served to legitimate legislative changes that undermine workplace protections and workers’ rights, and contribute to growing precariousness in the labour market.

Assessment of fish consumption beneficial use impairment at the Great Lakes Thunder Bay and St. Marys River Areas of Concern, Canada

The North American Great Lakes were designated with 43 locally degraded Areas of Concern (AOCs) in the 1980s. Remediation activities geared towards restoring beneficial use impairments (BUIs) at the AOCs have been conducted by both the American and Canadian governments. Here we examine if the fish consumption BUI has been restored at the Thunder Bay Harbour and St. Marys River AOCs within the Canadian waters by applying a three-tier assessment framework using the fish contaminant data collected by the Government of Ontario, Canada. Fish consumption advisories published by the government as well as simulated advisories based on the post-2005 data were examined in Tiers 1 and 2. The results highlighted that the restrictions advised on eating fish from the AOCs are mild and are typically similar to other non-AOC areas of lakes Superior and Huron. Temporal trend analyses of three contaminants of concern, mercury, PCB and dioxins/furans, generally showed substantial improvements over the last 30+ years and mostly continued declining trends in the recent years. These findings support a re-designation of the fish consumption BUI to “not impaired” at the two AOCs. As a follow up, it is recommended to confirm improvements in the dioxin/furan/dioxin-like PCB levels in fish at the Thunder Bay AOC. It is also advisable to conduct a survey to properly define “beneficial use” of fish consumption for the AOCs (i.e., which fish and in what quantity do people eat), and thereby validate the critical assumption of 8+ meals/month as a non-restrictive advice used in this assessment.

Prison Health as Public Health in Ontario Corrections

The majority of incarcerated individuals in Canada, and especially in Ontario provincial correctional institutions, are released into the community after a short duration in custody. Adult correctional populations have generally poor health, including a heightened prevalence of mental health and substance use disorders. There are legal and ethical obligations to address health care needs of incarcerated individuals, and also public health benefits from ensuring adequate, appropriate, and accessible health services to individuals in custody. The Independent Review of Ontario Corrections recommended the transformation of health care in Ontario provincial corrections in 2017, including transferring health service responsibilities to the Ministry of Health and Long-Term Care. The Correctional Services and Reintegration Act, 2018, would affirm the provincial government’s obligation to provide patient-centred, equitable health care services for individuals in custody. We encourage the Government of Ontario to proclaim the Act and continue the momentum of recent reform efforts in Ontario.