pan-Canadian Approach Research Articles

Taking action towards climate-resilient, low-carbon, health systems: Perspectives from Canadian health leaders and healthcare professionals.

Climate change poses significant public health and health system challenges including increased demand for health services due to chronic and acute health impacts from vector-borne diseases, heat-related illness, and injury from severe weather. As climate change worsens, so do its effects on health systems such as increasing severity of weather extremes causing damage to healthcare infrastructure and interference with supply chains. Ironically, health sectors globally are significant contributors to climate change, generating an estimated 5% of global emissions. Achieving "net zero" health systems require large-scale change with shared decision-making to coordinate a pan-Canadian approach to creating climate-resilient and low-carbon healthcare. In this article, we discuss healthcare professionals' and health leaders' perceptions of responsibility for practicing and advocating for climate-resilient and low-carbon healthcare in Canada.

Report card on access to rural health care in Canada.

Canadians living in rural communities continue to experience challenges in accessing rural health care. The Rural Road Map for Action (RRM) was developed in February 2017 and provides a guiding framework for a coordinated, pan-Canadian approach to physician rural work force planning and improved access to rural health care. The Rural Road Map Implementation Committee (RRMIC) was formed in February 2018 to support the implementation of the RRM. The RRMIC was co-sponsored by the College of Family Physicians of Canada and the Society of Rural Physicians of Canada and had a broad membership that deliberately crossed sectors supporting the RRM's social accountability vision. In April 2021, the \"Rural Road Map: Report Card on Access to HealthCare in Rural Canada\" was discussed at a Society of Rural Physicians of Canada national forum. Next steps included: focusing on equitable access to rural health care service delivery; enhancing rural physician resource planning including national medical licensure and the adoption of more effective strategies for rural physician recruitment and retention; improving access to rural specialty care; supporting the work of the National Consortium on Indigenous Medical Education; and developing metrics as useful tools to facilitate change in rural health care, social accountability in medical education and provisions for supporting the delivery of virtual health care. Collaborative partnerships and commitments from all key stakeholders will be critical to addressing national and regional health work force needs. No one sector alone can fix the inequitable health care realities of people living in rural communities in Canada.

P.150 The Canadian Medical Student Interest Group in Neurosurgery (CaMSIGN) platform: a retrospective study on Canadian medical students

Background: The Canadian Medical Student Interest Group in Neurosurgery (CaMSIGN) is the first neurosurgery platform of its kind in Canada. Methods: In this retrospective study, data from CaMSIGN’s online platforms have been collated from February 2021 to the present and analyzed to show trends in user engagement. Results: CaMSIGN events generated 1,575 views on YouTube (384 from Canada). The total watch time was 170.3 hours, of which 43.9 hours were Canadian (28.5%). The total views normalized by the total number of students interested in neurosurgery was 17.12 hours. The normalized Canadian view was 4.17. 717 people follow the CaMSIGN Facebook account (normalized= 7.79). 152 people follow our Instagram (normalized= 1.65). 338 people follow our Twitter (normalized= 3.67). This number is comparable to that of estimated practicing neurosurgeons in Canada (333). A total of 32,974 people visited the Twitter page, with a monthly average of 2747.8. Lastly, the campaign website has had 5,811 visitors since its launch in June 2021 with a monthly average of 695.57 visitors. The number of website visitors has increased at a rate of 3.1327 visitors/month. Conclusions: Through this initiative, our aim has been to model a pan-Canadian approach to neurosurgery.

Striving to Fill in Gaps between Clinical Practice and Standards: The Evolution of a Pan-Canadian Approach to Patient-Reported Outcomes Use.

Despite the known importance and necessity of the standardized collection and use of patient-reported outcomes (PROs), there remain challenges to successful clinical implementation. Facilitated through a quality improvement initiative spearheaded by the Canadian Partnership for Quality Radiotherapy (CPQR), and now guided by the Canadian Association of Radiation Oncology (CARO)’s Quality and Standards Committee, patient representatives and early-adopter radiation treatment programs continue to champion the expansion of PROs initiatives across the country. The current review discusses the evolution of a pan-Canadian approach to PROs use, striving to fill in gaps between clinical practice and guideline recommendations through multi-centre and multidisciplinary collaboration.

Canadian wildlife health surveillance—patterns, challenges and opportunities identified by a scoping review

The protection and promotion of healthy wildlife populations is emerging as a shared goal among stakeholders in the face of unprecedented environmental threats. Accordingly, there are growing demands for the generation of actionable wildlife health information. Wildlife health surveillance is a connected system of knowledge that generates data on a range of factors that influence health. Canada recently approved the Pan-Canadian Approach to Wildlife Health that describes challenges facing wildlife health programs and provides a path forward for modernizing our approach. This scoping review was undertaken to describe the range of peer-reviewed Canadian wildlife health surveillance literature within the context of the challenges facing wildlife health programs and to provide a quantitative synthesis of evidence to establish baselines, identify gaps, and inform areas for growth. This review describes patterns related to species, location, authorship/funding, objectives, and methodology. Five areas are identified that have the potential to propel the field of wildlife health: representativeness, expanded/diversified collaboration, community engagement, harmonization, and a shift to a solutions-focused and One Health mindset. This scoping review provides a synopsis of 10 years of Canadian wildlife health surveillance, challenges us to envision the future of successful wildlife health surveillance, and provides a benchmark from which we can measure change.

The Tension Between Regulation and the Pursuit of Quality in Canadian Nurse Practitioner Education Programs.

Nurses in advanced practice roles have existed in Canada for over 100 years, yet only in the last two decades, have nurse practitioners (NPs) been recognized as advanced practice nurses (APNs). During this time, NP educational programs have increased and transitioned from post-baccalaureate level to graduate level. Legislation and national NP regulatory approval processes have contributed to existing barriers to NP role implementation and full scope of practice. While regulation is mandatory and focused on public safety, an emphasis towards quality has led to the introduction of a national voluntary NP program accreditation process. The purpose of this paper is to initiate a discussion between Canadian NP regulators and educators related to proposed regulatory approaches and accreditation processes that balance public safety while promoting quality and excellence in NP education. Having two separate and costly processes has led to tension during a time of provincial fiscal restraint on university budgets coupled with the COVID-19 pandemic and its impact on nursing education. An integrated pan-Canadian approach of regulation and accreditation may ensure public safety, continuity, and consistency in quality NP education, enhance mobility of the NP workforce, and systematic planning to guide successful future NP role development and practice.

Nordicity and its relevance for northern Canadian infrastructure development

ABSTRACT Infrastructure development in Canada’s northern regions remains a challenge. Although scholars and policy-makers recognize the significant socio-economic potential of northern infrastructure, the prevailing piecemeal approach does not respond to many of the challenges faced by Indigenous communities. A pan-Canadian approach, such as a Northern Corridor, can circumvent some of the disadvantages stemming from fractured and uncoordinated initiatives but it still underlies the diverse environmental and socio-economic conditions across the Canadian North. The Nordicity index, originally developed by Hamelin, reflects northern Canada’s diversity and has been applied as a public policy tool, e.g. for determining northern living allowances or adapted for transportation development. However, these indices are spatio-temporally fixed which means they do not recognize changing spatial patterns of northern mobility. Thus, this paper argues that northern infrastructure development should be informed by Indigenous spatial practices of mobility. To this aim, the paper investigates the role of Nordicity in Canadian policy-making and analyses how northern Indigenous spatial practices of mobility have transformed throughout the last century. The Nordicity index recognizes the environmental and socio-economic conditions across Canada’s diverse northern regions but it should be complemented with an analysis of the spatial practices of northern Indigenous Peoples to inform future infrastructure development.

Integrative Governance for Ecological Public Health: An Analysis of ‘Food Policy for Canada’ (2015-2019)

Normatively grounded in the ecological public health paradigm, this paper speaks to the role of public policy in addressing food and nutrition-related health challenges through a critical analysis of the 2019 Food Policy for Canada (FPC). We draw on primary data gathered through a SSHRC-funded Partnership Grant, Food: Locally Embedded, Globally Engaged (FLEdGE). Qualitative research methods include interviews with key stakeholders and policy makers, critical review of national food policy consultation documents, participant observation in government-, industry- and civil society-led conversations about the food policy, as well as an investigation of stakeholder responses to the FPC announcements of 2019. Our analysis focuses on how Canada’s new food policy: adopts an integrative, pan-Canadian approach; explicitly connects health and environmental dimensions of food; augments food security in a systematic way; addresses unique food security and health issues facing Indigenous Peoples; improves the health of food environments, such as those in Canada’s schools; and, meaningfully includes relevant stakeholders in food system governance. Against these expectations, we assert that the Food Policy for Canada does not yet provide an integrative, systems-based approach to addressing food and nutrition-related health issues consistent with the ecological public health approach, despite significant progress made. We conclude by proposing a research agenda for tracking Canada’s food policy implementation and development going forward.

Incentivizing stewardship in a biodiversity hot spot: land managers in the grasslands

Federal and provincial governments of Canada recently signed onto a Pan-Canadian Approach to Transforming Species at Risk Conservation. The approach is based on collaboration among jurisdictions and stakeholders to enhance multiple species and ecosystem-based conservation in selected biodiversity hot spots. In this review paper, we focus on one of the biodiversity hot spots—the South of the Divide area in the province of Saskatchewan—to propose appropriate mechanisms to incentivize stewardship on agricultural Crown lands. Through a focused review and synthesis of empirical studies, we propose a range of policy instruments and incentives that can help deliver multi-species at risk conservation on Crown agricultural lands in Saskatchewan. We outline a range of policy instruments and incentives that are relevant to conservation on Crown agricultural lands and argue that a portfolio of options will have the greatest social acceptability. More germane is the need to foster collaboration between the government of Saskatchewan, other provincial/territorial governments, and the federal government, nongovernmental organizations, and land managers. Such collaboration is critical for enhanced decision-making and institutional change that reflects the urgent call for creating awareness of species at risk policies, building trust, and leveraging the local knowledge of land managers for conservation.

144: A Pan-Canadian Approach to Supporting The Collection and Utilization of Patient Reported Outcomes in Radiation Oncology: An Initiative of the Canadian Partnership for Quality Radiotherapy

144: A Pan-Canadian Approach to Supporting The Collection and Utilization of Patient Reported Outcomes in Radiation Oncology: An Initiative of the Canadian Partnership for Quality Radiotherapy

186: A Pan-Canadian Approach to Patient-Centered Quality Improvement Initiatives: Development and Promotion of Patient Education, Engagement and Patient Reported Outcome Guidance Documents

186: A Pan-Canadian Approach to Patient-Centered Quality Improvement Initiatives: Development and Promotion of Patient Education, Engagement and Patient Reported Outcome Guidance Documents

A Pan-Canadian Approach to Patient-Centered Quality Improvement Initiatives: The Canadian Partnership for Quality in Radiotherapy (CPQR)’s Development of Patient Education, Engagement and Patient Reported Outcome Guidance Document

In 2011 the Canadian Partnership for Quality in Radiotherapy (CPQR) released its seminal document Quality Assurance Guidelines for Canadian Radiation Treatment Programs outlining the overarching elements of quality that are important in all radiation treatment (RT) programs. Since that time, there has been an interest expressed by the radiotherapy community to expand upon these guidelines with an increased emphasis on the patient focus which would promote alignment with accreditation standards and patient-centred practice. To this end, the CPQR initiated the development of a new suite of complementary documents to provide guidance for RT programs in the development and implementation of patient-centred quality improvement initatives.

Preventing transmission of bloodborne viruses from infected healthcare workers to patients: Summary of a new Canadian Guideline.

Although it is well documented that bloodborne viruses (BBVs), including human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV) have been transmitted from patients to healthcare workers (HCWs), there has also been reported transmission from HCWs to patients during the provision of health care. With remarkable progress in infection prevention, diagnosis tools, treatment regimens and major improvements in guideline development methodology, there was a need to develop an evidence-based guideline to replace the 1998 Canadian consensus document for managing HCWs infected with BBVs. This article summarizes the Canadian Guideline on the Prevention of Transmission of Bloodborne Viruses from Infected Healthcare Workers in Healthcare Settings. A Guideline Development Task Group was established and key questions developed to inform the guideline content. Systematic reviews were conducted to evaluate the risk of HCW-to-patient transmission of HIV, HCV and HBV. Environmental scans were used to provide information on Expert Review Panels, disclosure of a HCW's serologic status and lookback investigations. Federal, provincial and territorial partners and key stakeholder organizations were consulted on the Guideline. The risk of HCW-to-patient BBV transmission was found to be negligible, except during exposure-prone procedures, where there is a risk that injury to the HCW may result in exposure of a patient's open tissues to the HCW's blood. Risk of ensuing transmission and the rate of transmission varied by BBV, and were lowest with HIV and highest with HBV. The Guideline provides key content, including recommendations regarding criteria to determine if a procedure is an exposure-prone procedure, management of HCWs infected with a BBV, including considerations for the HCW's fitness for practice, Expert Review Panels, HCW disclosure obligations and right to privacy and lookback investigations. This new Guideline provides a pan-Canadian approach for managing HCWs infected with a BBV, with recommendations related to preventing HCW-to-patient transmission of BBVs during the provision of care.

1208. Preventing Transmission of Bloodborne Viruses from-Infected Healthcare Workers to Patients in Canadian Healthcare Settings: A National Guideline

BackgroundInfectious agents, such as bloodborne viruses (BBVs), can potentially be transmitted from healthcare workers (HCWs) to patients. In an effort to reduce this risk to patients, this guideline, which provides a framework for policies on the management of HCWs infected with BBVs in Canada, was developed.MethodsA total of six systematic reviews (1995–2016) were conducted to inform the risk of transmission of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) from infected HCWs to patients and the infectivity of each virus related to source serum viral load. Three environmental scans were conducted to inform sections on disclosure of HCW’s serologic status, Expert Review Panels, and lookback investigations. Government partners and key stakeholder organizations were consulted and a Task Group provided technical expertise.ResultsThe risk of HCW-to-patient BBV transmission is negligible, except during exposure-prone procedures where there is a risk of HCW injury and possible exposure of a patient’s open tissues to the HCW’s blood. Transmission rates were lowest with HIV and highest with HBV (Table 1). Rates varied with several factors including source viral load, nature of potential exposure, infection prevention and control breaches, susceptibility of exposed patient, and use of post-exposure prophylaxis where relevant. The extent of reporting bias for exposure incidents where transmission did not occur is unknown. Current antiviral therapy informed guideline recommendations, with viral load thresholds provided to assist treating physician, Expert Review Panels and regulatory authorities in determining a HCW’s fitness for practice.ConclusionRoutine Practices (or Standard Precautions) are critical to prevent HCW-to-patient transmission of infections; including BBVs. Recommendations provided in this guideline aim to further reduce the already minimal risk of HCW-to-patient transmission. The guideline provides a pan-Canadian approach for managing HCWs infected with a BBV, with recommendations directly impacting clinical practice related to preventing and controlling healthcare-associated infections. Disclosures All authors: No reported disclosures.

66 High Cost Drug Policies in Canadian Children’s Hospitals

Over the past decade a number of highly promising new therapeutic entities have become available. Many of these new treatments are biologicals or antibodies rather than conventional small molecules. These drugs offer great promise but come with the potential for potent adverse effects as well as creating challenges for access. Many of these new treatments are very expensive and are frequently not on hospital formularies. There is no comprehensive pan-Canadian strategy on how to best provide access to these drugs for the children at most need and how to address the rapidly evolving world of novel therapeutics for children. To evaluate how this issue is being addressed nationally we conducted a survey among the 17 Departments of Paediatrics across Canada. In Paediatrics high cost drugs are most commonly used in academic child health care centres. Our objectives were to; I) Determine what the policies as to provision of high cost drugs in Canada’s academic child health care centres, ii) Determine what the challenges facing Canada’s academic health care centres were in providing access to novel therapies to children at most need and iii) Explore possible solutions to these challenges. To explore these questions we conducted a survey of the 17 Departments of Paediatrics across Canada through the Paediatric Chairs of Canada and faciliated through Childrens Healthcare Canada. A questionnaire was sent to all Department Chairs asking the following four questions; 1) Does your hospital have a policy for how to deal with high cost drugs that are not covered by provincial health insurance or are not on the hospital formulary? 2) If so, how does this policy work? 3) If not, how are these therapies addressed? 4) What do you think is the best approach to provide access to high cost drugs for children? Department Chairs agreed to voluntarily participate in the survey. After completion of the survey areas of uncertainty were followed up by interviews with the respective Department Chairs. The issue of high cost drugs for children was noted to be a growing issue by all Departments of Paediatrics across Canada. There was a wide variability in how requests for high cost drugs were dealt with, ranging from a somewhat ad hoc case-specific response to a formal process involving decision making groups representing physicians, hospital administration and hospital pharmacy. No single best practice was identified. There was a concensus that this has emerged as a major problem in terms of access having a significant impact on hospital budgets with no end in sight as the therapeutic revolution in biological, factor and molecular therapy continued. It was acknowledged that traditional payment measures have failed to address this and some changes in provincial policy towards drugs for children may have negatively impacted access to these therapies. There was also a wide concensus that a pan-Canadian approach was needed, with suggestions including a national formulary for drugs for children that could provide evidence and recommendations to provincial funders as well as the suggestion of a pan-Canadian pharmacare plan for children. An urgent need for national leadership on this issue was also identified. Historically the per capita expenditure for pharmaceuticals for a Canadian child was in the range of $450. With the advent of new therapies that cost in the tens of thousands of dollars new approaches to drug evaluation and drug access for Canada’s children are urgently needed. This is a concern for all Departments of Paediatrics across Canada and pan-Canadian solutions are needed to address how to best treat Canada’s children at highest need.

Improving patient outcomes and radiotherapy systems: A pan-Canadian approach to patient-reported outcome use.

Standardized collection and use of clinical patient-reported outcomes (PRO) have potential to benefit the care of individual patients and improve radiotherapy system performance. Its centralized health-care system makes Canada a prime candidate to take a leader and collaborator role in international endeavors to promote expansion of patient-reported outcome collection and use in radiotherapy. The current review discusses the development of a pan-Canadian approach to PRO use, through a quality improvement initiative led by the Canadian Partnership for Quality Radiotherapy (CPQR), a unique partnership of Canadian radiotherapy professional organizations (Canadian Association of Radiation Oncology-CARO, Canadian Organization of Medical Physicists-COMP, and the Canadian Association of Medical Radiation Technologists-CAMRT).

Results of a pan-Canadian approach to systems change for smoking cessation support in Canadian cancer centers.

e18538Background: Smoking cessation even after a cancer diagnosis can improve survival, but access to smoking cessation support is limited. The purpose of this abstract is to describe results from ...

Striving for equivalency across the Alberta, British Columbia, Ontario and Québec carbon pricing systems: the Pan-Canadian carbon pricing benchmark

ABSTRACTThe Pan-Canadian Framework on Clean Growth and Climate Change is designed to put Canada on track to meet its Paris commitments. A key pillar of the plan is the introduction of a pan-Canadian carbon price by the end of 2018. However, four Canadian provinces, nearly 85% of the Canadian economy and population, have already implemented carbon pricing systems. British Columbia (BC) has a carbon tax. Alberta is transitioning from an output-based allocation system for industrial emitters to a hybrid system combining a carbon levy and refined output-based system. Québec and Ontario have implemented cap-and-trade systems, linked to California. Recognizing these existing systems, rather than impose a single carbon pricing mechanism, the Pan-Canadian Approach to Carbon Pricing gives provinces and territories the flexibility to adopt a carbon tax, a hybrid system, or a cap-and-trade system. To address concerns relating to ‘fairness’ and equivalency of carbon price, a federal carbon pricing benchmark establishes criteria relating to minimum ‘common scope’ and ‘increases in stringency’ that provincial and territorial carbon pricing systems must meet. This article explores the design features of the existing Alberta, BC, Ontario and Québec carbon pricing systems, and considers how the benchmark affects stringency and addresses equivalency of carbon price across these different systems.Key policy insightsCanada is taking advantage of its federal structure of government to introduce a minimum pan-Canadian carbon price of $10/tCO2e in 2018, rising by $10/year to $50/tCO2e in 2022.Rather than imposing a uniform pricing mechanism, the Canadian federal government is recognizing existing subnational carbon pricing mechanisms with very different design features – BC’s carbon tax, Québec and Ontario’s cap-and-trade systems, and Alberta’s hybrid system – to deliver the pan-Canadian carbon price.In order to deliver a minimum level of increasing stringency and to address issues of equivalency of carbon price across sub-national jurisdictions, the federal government is in the early stages of implementing a federal carbon-pricing benchmark.The lessons learned from the Canadian experience will be relevant to harmonizing carbon pricing systems across both other federal jurisdictions and countries.

Call for a pan-Canadian approach to ethics review in Canada.

KEY POINTS Obtaining research ethics approval is an important component of research conducted in humans. Increasingly, researchers undertake multicentre studies, which can require them to seek approvals from a number of research ethics boards (REBs). Many researchers have complained about

Canada's Carbon Price Floor

The pan-Canadian approach to carbon pricing, announced in October 2016, ensures that carbon pricing applies throughout Canada in 2018, with increasing stringency over time to reduce emissions. Canadian provinces and territories have the flexibility to either implement an explicit price-based system—with a minimum price of CAN $10 per tonne of carbon dioxide equivalent in 2018, increasing to CAN $50 per tonne by 2022—or an equivalently scaled emissions trading system. This paper discusses the rationale for, and design of, the price floor requirement; its (provincial-level) environmental, fiscal, and economic welfare impacts; monitoring issues; and (national-level) incidence. The general conclusion is that the welfare costs and implementation issues are manageable, and pricing provides significant new revenues. A challenge is that the floor price by itself appears well short of what will be needed by 2030 for Canada’s Paris Agreement pledge.