Management In Ontario Research Articles

Minor Ailments and Pharmacist Management in Ontario, Canada: Attachment and Primary Care

Minor ailments (MA) are health conditions that can be managed with minimal prescribed treatment and/or self-care strategies. In Ontario, Canada, pharmacists were given authority to deliver service for thirteen MAs on January 1, 2023, with an additional six MAs on October 1, 2023. This study aims to identify patterns of MA service provision and describe characteristics of recipients of MA services. A cross-sectional analysis of linked health administrative data, including pharmacist billing for MA services, patient demographics, and physician and hospital billing data, was conducted. Delivery of MA services prescribed in Ontario from January 1 to December 31, 2023 were analyzed with key demographics (age, sex, income, new arrival status, comorbidity), health care utilization (ED, hospitalization) and primary care attachment. In 2023, 547,673 (3.6%) Ontario residents received at least one MA service, with the top 5 services being urinary tract infections (199,282), conjunctivitis (153,021), herpes labialis (46,659), allergic rhinitis (41,521), and dermatitis (39,365). Compared to all Ontario residents, the MA service recipients were more likely to be people with a higher rate of ED visits (41.7% vs. 32.4%), comorbidities (17.5% vs. 9.7%), higher incomes (highest income quintile, 23.1% vs. 20.1%; lowest income quintile, 16.5% vs. 19.4%), and hospitalizations (23.6% vs. 17.6%), and less likely to be newcomers to Ontario (8.7% vs. 13.1%). They were more likely to be attached to a primary care provider (91.3% vs. 84.7%). This study provides insight into early users of this program, and sheds light on those with systemic vulnerabilities and equity deserving groups.

Developing a transdisciplinary tool for water risk management and decision-support in Ontario, Canada

Extant literature reveals limited examination of risk management strategies and tools to support decision-making for sustainable water management in the private sector in Ontario, Canada. Moreover, a gap persists in understanding how water risks are prioritized and managed in the private sector. Addressing these gaps, this transdisciplinary study applied a novel normative-analytical risk governance theoretical framework to water security risks, which combines analytical risk estimation with normative priorities and insights of practitioners, to examine contextually-attuned water risk management strategies and develop a decision-support tool. Using mixed methods, the study first employed a survey to elicit practitioner priorities for seven water risk indicators and investigated water risk management approaches. Then, interviews were conducted to obtain in-depth understanding about the priorities, strategies, opportunities, and role of trust in water risk management. The study found that a combination of regulatory, voluntary, and multi-stakeholder participatory approaches is needed, contingent on the severity of water risks, sector, location, and context. Moreover, the criteria of flexibility, efficiency, strategic incentives, and economic and regulatory signals, are essential. Finally, using secondary data analysis, the study integrated interdisciplinary risk data with practitioner priorities to develop a first-of-a-kind decision-support tool for water risk management in Ontario, ‘WATR-DST’. WATR-DST is an automated tool that applies the study’s findings and assists multi-sector water-related decisions, practices, and investments by providing contextually-attuned risk information in a user-friendly format. Based on the user inputs (location, sector, and source type), it displays the severity of seven water risks, qualitative themes under public and media attention, and recommends water risk management strategies. Thus, the study contributes to knowledge in sustainability management, risk analysis, and environmental management by demonstrating the novel application of the normative-analytical framework for water risk management in the private sector. WATR-DST is a key contribution envisioned to improve multi-sector water-related decisions in Ontario.

Assessing the Cumulative Impacts of Forest Management on Forest Age Structure Development and Woodland Caribou Habitat in Boreal Landscapes: A Case Study from Two Canadian Provinces

The Canadian boreal forest biome has been subjected to a long history of management for wood production. Here, we examined the cumulative impacts of logging on older forests in terms of area, distribution and patch configuration in the managed forest zones of the Eastern Canadian provinces of Ontario and Quebec. We also examined the consequences of these cumulative impacts on a once widely distributed and now threatened species, the woodland caribou (Rangifer tarandus caribou). The cumulative area of recently logged forest (since ~1976) was 14,024,619 ha, with 8,210,617 ha in Quebec and 5,814,002 ha in Ontario. The total area of older forests was 21,249,341 ha, with 11,840,474 ha in Quebec and 9,408,867 ha in Ontario. Patch statistics revealed that there were 1,085,822 older forests with core patches < 0.25 ha and an additional 603,052 < 1.0 ha. There were 52 > 10,00–50,000 ha and 8 < 50,000 ha. Older forest patches (critical caribou habitat) in the 21 local population ranges totalled 6,103,534 ha, distributed among ~387,102 patches with 362,933 < 10 ha and 14 > 50,000 ha. The median percentage of local population ranges that was disturbed was 53.5%, with Charlevoix having the maximum (90.3%) and Basse Côte-Nord the least (34.9%). Woodland caribou local population ranges with disturbed suitable habitats >35% are considered unable to support self-sustaining populations. We found that for the 21 caribou local population ranges examined, 3 were at very high risk (>75% area disturbed), 16 at high risk (>45 ≤ 75% area disturbed), and 2 at low risk (≤35% area disturbed). Major changes are needed in boreal forest management in Ontario and Quebec for it to be ecologically sustainable, including a greater emphasis on protection and restoration for older forests, and to lower the risks for caribou populations.

Climate change and human footprint increase insect defoliation across central boreal forests of Canada

Anthropogenic climate change is contributing to increased insect infestation globally, leading to pest population growth, expansion of niche and geographic ranges as well as increased outbreak frequencies, resulting in economic losses and reduction in food security. In recent years, spongy moth (Lymantria dispar dispar), jack pine budworm (Choristoneura pinus pinus), large aspen tortrix (Choristoneura conflictana) and spruce budworm (Choristoneura fumiferana) caused widespread defoliation across one of Canada’s most forested provinces, Ontario. Observations of such outbreaks have been limited to field sightings around Ontario, with few studies focused on mapping of outbreak occurrence across the province or exploring potential anthropogenic and climatic drivers of infestation. Using random forest probability estimates and satellite data resampled to 1 km spatial resolution from the Moderate Resolution Imaging Spectroradiometer (MODIS), we reveal greater expansion of insect defoliation across Ontario between 2018 and 2020 than previously recorded. Much of the geographic expansion of outbreaks was driven by increasing temperature, and the proximity of roads. With ongoing global warming and growing economic development, infestations will not only continue to increase across Ontario but also expand northward due to their responses to accelerated warming at higher latitudes. This expansion presents an important and alarming new challenge for forest conservation and management in Ontario, in particular, and Canada in general.

Designing systems for the care we need: A transformation journey in Southwestern Ontario.

Primary care is considered the foundation of any health system. In Ontario, Canada Bills 41 and 74 introduced in 2016 and 2019, respectively, aimed to move towards a primary care-focused and sustainable integrated care approach designed around the needs of local populations. These bills collectively set the stage for integrated care and population health management in Ontario, with Ontario Health Teams (OHTs) introduced as a model of integrated care delivery systems. OHTs aim to streamline patient connectivity through the healthcare system and improve outcomes aligned with the Quadruple Aim. When Ontario released a call for health system partners to apply to become an OHT, providers, administrators, and patient/caregiver partners from the Middlesex-London area were quick to respond. We highlight the critical elements and journey of the Middlesex-London Ontario Health Team since its start.

A focus group study exploring dairy farmers' perspectives of cull cow management in Ontario, Canada.

Maintaining the welfare of cull dairy cows from the farm to slaughter is an ongoing challenge for the dairy industry. Recent research suggests that some cull dairy cows within the marketing system are in physical states that are below regulatory standards, and further research is required to determine why these unfit cows are found throughout the journey to abattoirs. Since dairy farms are the origin of these cows, decision making by dairy farmers has been identified as key to preventing cull cows that are considered unfit for transport from entering the marketing system. The objectives of this study were to understand dairy farmers' perspectives on their cull dairy cow management practices, recommendations and requirements of regulations, management tools, and welfare issues. Four focus groups with a total of 21 participants were each conducted virtually, video recorded, and transcribed verbatim, with dairy farmers from Ontario, Canada. A thematic analysis of focus group discussions was conducted utilizing deductive reasoning. There were three themes identified including deciding to cull or not, management of cows being culled, and knowledge and perceptions of cull cow regulations. When making culling decisions, farmers utilize multiple sources of information including personal experiences and values and external referents like veterinarians, family members and other farmers. The welfare of their cows was a high priority but one that was often weighed against the financial outcomes of culling decisions. Finally, most participants considered recent regulatory changes for the management of cows before shipment to be of little importance on their farms. In conclusion, the farmers from this study showed the diversity of considerations they make in culling decisions and the large contribution of animal productivity and economic factors. There was a general lack of knowledge of recent regulatory changes for the shipment of cull cows, and there is room for improving the uptake of new recommendations for culling only cows fit for transportation.

Lessons learned from implementing a surge capacity support program for COVID-19 contact management in Ontario

SettingIn Ontario, local public health units (PHUs) are responsible for leading case investigations, contact tracing, and follow-up. The workforce capacity and operational requirements needed to maintain this public health strategy during the COVID-19 pandemic were unprecedented.InterventionPublic Health Ontario’s Contact Tracing Initiative (CTI) was established to provide a centralized workforce. This program was unique in leveraging existing human resources from federal and provincial government agencies and its targeted focus on initial and follow-up phone calls to high-risk close contacts of COVID-19 cases. By setting criteria for submissions to the program, standardizing scripts, and simplifying the data management process, the CTI was able to support a high volume of calls.OutcomesDuring its 23 months of operation, the CTI was used by 33 of the 34 PHUs and supported over a million calls to high-risk close contacts. This initiative was able to meet its objectives while adapting to the changing dynamics of the pandemic and the implementation of a new COVID-19 provincial information system. Core strengths of the CTI were timeliness, volume, and efficient use of resources. The CTI was found to be useful for school exposures, providing support when public health measures were lifted, and in supporting PHU’s reallocation of resources during the vaccine roll-out.ImplicationsWhen considering future use of this model, it is important to take note of the program strengths and limitations to ensure alignment with future needs for surge capacity support. Lessons learned from this initiative could provide practice-relevant knowledge for surge capacity planning.

An Interdisciplinary Water Risk Assessment Framework for Sustainable Water Management in Ontario, Canada

AbstractThe Province of Ontario in Canada illustrates contemporary water security issues, where despite perception of water abundance, water challenges arise locally. Water risks stem from biophysical dimensions of groundwater depletion, low surface water flows, and degraded quality, and, contextual dimensions of regulatory uncertainty, public concerns and perception. While academic, policy, and practitioner interest is growing, literature reveals major gaps in comprehensive assessment of multidimensional water risks at the subwatershed scale. Addressing these gaps, the study developed a locally attuned and interdisciplinary water risk assessment framework. Using secondary mixed data analysis, the study integrated quantitative and qualitative data for water quantity and quality risks, regulatory trends, water user conflicts for 38 subwatersheds in Ontario. The framework identifies subwatersheds and sectors at high, moderate, and low risk along with media and public concern themes. The study finds high and moderate risk potential in at least 50% of studied subwatersheds for all water risk indicators and challenges the myth of water abundance in Great Lakes watershed of Ontario. The study advances knowledge in water risk assessment by applying social‐ecological perspectives, interdisciplinary approaches of Risk Theory, and mixed methods to provide a comprehensive evaluation of water security and demonstrates integration of social science perspectives in the field of sociohydrology. Our framework assesses interdisciplinary water risks to inform multisector sustainable water management decisions. While spatially scoped to populous subwatersheds of Ontario, this framework can be methodologically generalized to other geographical regions by using local data.

Relationship of Neighbourhood Social Deprivation and Ethnicity on Access to Transcatheter and Surgical Aortic Valve Replacement: A Population-Level Study.

Wide geographic variation in access to transcatheter (TAVR) and surgical (SAVR) aortic valve replacement exists, but the impact of socioethnic factors on the geographic variation of AS management in Ontario, Canada, is unknown. Neighbourhood rates of AS admissions, as a proxy for AS burden, and downstream TAVR and SAVR referrals and procedures were estimated for the 76 subregions in Ontario. To determine if the socioethnic geographic variations in referrals and procedures were concordant or discordant with AS burden, we calculated Pearson correlation coefficients to determine the relationship between AS burden and each of TAVR referrals, TAVR procedures, SAVR referrals, or SAVR procedures. We developed generalised linear models to determine the association between social deprivation indices captured in the Ontario Marginalization index and the rates of AS burden as well as TAVR/SAVR referral and procedures. There was wide geographic variation that was concordant between AS burden and the referral and procedure rates for TAVR and SAVR (correlation coefficients 0.86-0.96). Increased dependency was associated with higher rates of both TAVR/SAVR referrals and procedures (rate ratios 1.63-2.22). Neighbourhoods with a higher concentration of ethnic minorities were associated with lower AS burden as well as lower rates of both SAVR and TAVR referrals and procedures (rate ratios 0.57-0.85). An important ethnic gradient exists in AS burden and in both referral and completion of TAVR and SAVR in Ontario. Further research is necessary to understand if this gradient is appropriate or requires mitigation.

Changing patterns of opioid initiation for pain management in Ontario, Canada: A population-based cross-sectional study.

The recent publication of a national guideline and quality standards in Canada have provided clinicians with new, evidence-based recommendations on safe, appropriate opioid use. We sought to characterize how well opioid initiation practices aligned with these recommendations before and following their release. We conducted a population-based study among people initiating opioids prior to the release of national guidelines (April 2015-March 2016; fiscal year [FY] 2015) and in the most recent year available (January-December 2019) in Ontario, Canada. We used linked administrative claims data to ascertain the apparent indication for opioid therapy, and characterized the initial daily dose (milligrams morphine or equivalent; MME) and prescription duration for each indication. In FY2015, 653,885 individuals commenced opioids, compared to 571,652 in 2019. Over time, there were small overall reductions in the prevalence of initial daily doses exceeding 50MME (23.9% vs. 20.1%) and durations exceeding 7 days (17.4% vs. 14.8%); but the magnitude of the reductions varied widely by indication. The prevalence of high dose (>50MME) initial prescriptions reduced significantly across all indications, with the exception of dentist-prescribed opioids (13.6% vs. 12.1% above 50MME). In contrast, there was little change in initial durations exceeding 7 days across most indications, with the exception of some surgical indications (e.g. common excision; 9.3% vs. 6.2%) and among those in palliative care (35.2% vs. 29.2%). Despite some modest reductions in initiation of high dose and long duration prescription opioids between 2015 and 2019, clinical practice is highly variable, with opioid prescribing practices influenced by clinical indication. These findings may help identify medical specialties well-suited to targeted interventions to promote safer opioid prescribing.

Applying the British Columbia Health System Matrix (BCHSM) population segmentation framework to support integrated care in Ontario, Canada.

ObjectiveTo adapt the BCHSM population segmentation methodology to Ontario’s health administrative data to identify mutually exclusive segments with similar health care needs to support integrated care efforts and population health management in Ontario, Canada. To compare health system related costs across derived segments to identify opportunities for better integrated care. ApproachWe identified Ontarians alive with valid health card numbers as of April 1, 2020 (n =14,358,565) and created a matrix of prior utilization, cost and diagnoses using linked health administrative databases. Using a hierarchical technique, we assigned individuals into one of 14 BCHSM segments based on the greatest health care needs. Segments of need range from non-users (low need) to end-of-life patients (greatest need). We report the distribution of individual characteristics, average monthly costs across segments and further stratified health care costs by quintile of material deprivation within segments. ResultsThe largest segment was the healthy (low) users (43%) followed by low chronic conditions (28%) and non-users (10%). Five segments comprised <1% of the total population: end-of-life, frail in care, cancer, frail in the community and child and youth major. Average costs per month alive increased from $28 for the non-user segment to $5,100 for the end-of-life segment (0.5% of the population). Costs in the Frail with high chronic conditions segment ($2,740/mo) were 3-times higher than costs in the high chronic conditions segment ($930/mo), 6-times higher than costs in the medium chronic conditions segment ($450/mo), and 14-times higher than costs in the low chronic conditions segment ($193/mo). Results were generally more favourable in areas of low (vs high) material deprivation overall and within population segments. ConclusionUsing Ontario’s linkable health administrative data we have created an Ontario adaptation of the BCHSM needs-based population segmentation approach. Segmentation supports population health management as well as helping identify opportunities for improvement to strengthen integrated care and potential cost savings.

A0778 - Secular trends in pediatric urolithiasis surgical incidence and management in Ontario, Canada: A population based retrospective cohort study

A0778 - Secular trends in pediatric urolithiasis surgical incidence and management in Ontario, Canada: A population based retrospective cohort study

Impacts of harvested species declines on Indigenous Peoples’ food sovereignty, well-being and ways of life: a case study of Anishinaabe perspectives and moose

Global declines in wildlife are increasing the vulnerability of Indigenous communities to food insecurity. Meanwhile, many colonial policies continue to ignore social-ecological relationships that have traditionally maintained a balance between wildlife and Indigenous Peoples’ subsistence needs. We provide a case study on perspectives and insights from three Anishinaabe Nations in Ontario, Canada on the importance of a traditional food, moose (<em>mooz</em> [Nishnaabemowin]; <em>Alces alces</em>), and how changes in the moose population are affecting food security, well-being, and ways of life. In partnership with each Nation, we conducted interviews with community members and related observations on change in the moose population to estimates of moose abundance and non-Indigenous harvest collected by the Ontario provincial government over a 16-year time frame (2001–2016). Moose was described as important for subsistence needs as well as for maintaining Anishinabek culture, traditions, and identity within each community. A decline in the moose population was observed by most participants, which corresponded with provincial data on moose abundance. Additionally, the number of non-Indigenous hunters per moose harvested on traditional territories increased linearly over time, and community members expressed concern over how the province was managing moose. The effects of moose decline in the communities included reduced food security and health, increased financial costs due to both relying more on store-bought foods and having to travel further to harvest moose, as well as a decline in the practice of traditions and ceremonies surrounding moose harvest and passing this knowledge on to younger generations. Despite the potential impacts on Indigenous subsistence harvest, there is a lack of collaborative decision-making with Indigenous communities on moose population and harvest management in Ontario. Using community perspectives and insights, we discuss how autonomous moose monitoring can support and facilitate co-management and collaborative decision-making to reinstate Indigenous food sovereignty.

Does the Profit Motive Matter? COVID-19 Prevention and Management in Ontario Long-Term-Care Homes.

We introduce evidence that for-profit long-term-care providers are associated with less successful outcomes in coronavirus disease 2019 outbreak management. We introduce two sets of theoretical arguments that predict variation in service quality by provider type: those that deal with the institution of contracting (innovative competition vs. erosive competition) and those that address organizational features of for-profit, non-profit, and government actors (profit seeking, cross-subsidization, and future investment). We contextualize these arguments through a discussion of how contracting operates in Ontario long-term care. That discussion leads us to exclude the institutional arguments while retaining the arguments about organizational features as our three hypotheses. Using outbreak data as of February 2021, we find that government-run long-term-care homes surpassed for-profit and non-profit homes in outbreak management, consistent with an earlier finding from Stall et al. (2020). Non-profit homes outperform for-profit homes but are outperformed by government-run homes. These results are consistent with the expectations derived from two theoretical arguments—profit seeking and cross-subsidization—and inconsistent with a third—capacity for future investment.

A Retrospective Cohort Study of Healthcare Utilization Associated with Paravertebral Blocks for Chronic Pain Management in Ontario

ABSTRACT Background: Injections, particularly paravertebral blocks (PVBs), are frequently performed procedures in Ontario, Canada, for the management of chronic pain, despite limited evidence and risk of complications. Aim: This study examines usage patterns of PVBs to evaluate their effects on healthcare utilization and opioid prescribing. Methods: A retrospective cohort study in Ontario using administrative data. Ontario residents receiving their initial PVBs between July 1, 2013 and March 31, 2018 were included. Changes in use of other interventions, physician visits, and opioids were compared to the 12-month periods before and after index PVBs. Data use was authorized under section 45 of Ontario’s Personal Health Information Protection Act. Results: 47,723 patients received their initial PVBs in the study period. The rate of index PVBs increased from 1.61 per 10,000 population (2013) to 2.26 per 10,000 (2018). Initial PVBs were performed most commonly by family physicians (N = 25,042), followed by anesthesiologists (N = 14,195). 23,386 patients (49%) received 1 to 9 repeat PVBs in the 12 months after index PVB; 12,474 patients (26.15%) received 10 or more. Use of other nonimage guided interventional pain procedures per patient (mean±SD) increased from 2.19 ± 9.35 to 31.68 ± 52.26 in the year before and after index PVB. Relevant physician visits per patient (mean±SD) also increased from 2.92 ± 3.61 to 9.64 ± 11.77. Mean opioid dosing did not change significantly between the year before and the year after index PVB. Conclusion: PVBs are associated with increases in healthcare utilization and no change in opioid use patterns.

Bulk water extraction charge calculator: a tool for sustainable water management in Ontario

Given growing anthropogenic pressures on water resources and uncertain climatic conditions, sustainable water management using effective demand management strategies will be crucial to tread the path towards sustainable development. This paper makes a contribution to the interdisciplinary realm of water management by designing a flexible tool that overcomes the weaknesses of current extraction charges and reliance on general taxes to finance water management initiatives. These dynamic water extraction charges are envisioned to be important policy instruments to increase water security in Ontario. To ensure sustainable use of provincial water resources, the province of Ontario not only extended the moratorium imposed in 2016 on new groundwater extraction permits for water bottling until 1 January 2020, but is also reviewing its water taking policies. While the moratorium and the extraction charge hike of $500/Million liters is focused on water bottlers, the need for more long-term comprehensive policy approaches to sustainable management is apparent. Economic theory suggests that pricing a resource by reflecting its economic value and scarcity can incentivize optimal consumption. While economic instruments like extraction charges exist in Ontario, a methodological calculation linking the level of these charges to the actual costs and hydrological water risks is largely lacking. Addressing this gap, this paper designs a calculator that operationalizes the conceptual pricing framework for Ontario to transparently arrive at water extraction charges. The public cost data for water resource management initiatives are considered along with extreme water contamination events as contingency environmental costs. Using data from Statistics Canada for annual volume of water withdrawn, the base provincial water extraction charge for all permit liable sectors is calculated to be $23.08/Million liters. Moreover, price multipliers reflecting the sub-watershed scale water quantity risks (identified in sub-watershed source protection assessment reports) along with sector and source specific risks were embedded in the calculator.

Melanoma Nodal Management in Ontario the Year after the 2012 American Society of Clinical Oncology and Society of Surgical Oncology Guideline

In 2012 in the United States, the American Society of Clinical Oncology and the Society of Surgical Oncology (asco/sso) published a joint guideline about indications for sentinel lymph node biopsy (slnb) in cutaneous melanoma. The guideline supported completion lymph node dissection (clnd) for all patients with positive sentinel nodes. We examined the rates and predictors of slnb and clnd for melanoma patients in Ontario (population 13.6 million) after publication of that guideline. We used the Ontario Cancer Registry to identify patients diagnosed with cutaneous melanoma in 2013. Patient records were linked to prospectively maintained health administrative databases to obtain details for each patient, including surgical procedures. Of the 3298 patients with melanoma identified in Ontario in 2013, 1973 (59.8%) could be analyzed. Most of that group (n = 1227, 62.2%) underwent local excision alone; 746 (37.8%) had a slnb. The slnb was performed in 13.9%, 67.8%, 62.6%, and 47.2% of patients with T1, T2, T3, and T4 primary melanomas respectively. In multivariate analysis, receipt of slnb was positively associated with younger age (<80 years), higher T stage, and a non-head-and-neck primary. Of the patients who had a slnb, 136 (18.2%) were found to be node-positive. A clnd was performed in 82 of those patients (60.3%). In Ontario, only two thirds of patients with intermediate-thickness melanomas (T2, T3) underwent slnb as recommended by the asco/sso guideline. Use of slnb was less frequent for patients with a head-and-neck primary and higher for younger patients (<80 years). The rate of clnd after a positive slnb was also low relative to the guideline recommendation.

Developing a standardized approach to cancer medication-related infusion reaction prevention and management in Ontario.

255 Background: Cancer medication-related infusion reactions (CMIRs) can lead to treatment delays, switching to less optimal therapy, or discontinuation. Variation in the prevention, management and reporting of CMIRs was identified as a quality and safety gap by Ontario clinicians. This initiative aimed to facilitate a standardized approach to CMIRs in Ontario through the development of user-friendly health-care provider and patient resources. Methods: A multidisciplinary working group of 15 oncology clinicians (oncologists, pharmacists, nurses, administrators) with experience in the management of CMIRs reviewed available literature on CMIR assessment, prevention and management. Recommendations were based on best available evidence and group consensus when only low-level evidence was available. Final guideline content was reviewed and validated by external experts. Complementary patient information was created based on best practices in health literacy and input from patient education experts, patients and caregivers. A mechanism for system-wide reporting to track CMIRs was explored. Results: A CMIR clinical practice guideline was created. Definitions, risk factors, prophylaxis strategies, an acute management algorithm and desensitization protocols are described. A CMIR severity grading system was proposed. A toolkit was developed and contains a table outlining risk factors, mechanism, incidence, symptoms, onset, prophylaxis, acute management and re-challenge by specific drug and a tool for calculating a three-bag 12-step desensitization. Patient-friendly information was also created. A new data element for collection of CMIR incidence and severity was added to the provincial Activity Level Reporting (ALR) data set to track CMIR trends. Conclusions: A review of current evidence and expertise from oncology clinicians resulted in an evidence-informed, consensus-based guideline. This guideline and the accompanying resources can help to facilitate safe and standardized prevention and management of CMIRs across Ontario. The collection of system-wide CMIR data based on the proposed grading system will inform future quality and safety improvement initiatives.

Supporting older adults with health and social care needs in the community—a case study of case management in Ontario’s home and community care system

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

An Evaluation of Crown Forest Management in Ontario from a Free Market Environmentalist Approach

This paper analyzes the forestry and logging industry in Crown forests in Ontario. We present historical trends on harvested areas, employment, revenue collected by the province, biophysical impacts, and revenue from the industry. We discuss the institutional context of Crown forest management in Ontario which includes a description of the Ministry of Natural Resources and Forestry (MNRF) and NGOs such as the Sustainable Forestry Initiative and the Forest Stewardship Council. We conclude that the current management of Crown forests in Ontario is not achieving maximum potential, as we found that there is a decline in employment and revenue from the industry. We recommend a Free Market Environmentalist (FME) approach to Crown forest management in Ontario. This approach involves common property management and the establishment of Forest Trusts. Current management does not take into account externalities that FME would, which could enhance potential in order to achieve maximum employment and revenue. There is a lack of biophysical data being collected to document the impact on key wildlife species and there is a lack of transparency regarding the management of crown forests by the MNRF. The Haliburton forest was used as case study which emulates an example of a FME approach.