Canadian Territories Research Articles

Identifying Canadian patient-centred care measurement practices and quality indicators: a survey.

Patient-centred quality indicators allow health care systems to monitor and evaluate patient-centred care practices and identify gaps in health care quality. Our objective was to determine whether Canadian provinces and territories measure patient-centred care, identify patient-centred quality indicators currently being used and compare patient-centred care practices and measurement in Canada to those of health care systems in other countries. An online survey was developed to collect data on demographic characteristics, patient-centred care practices, and indicators used at quality improvement organizations and health care authorities. The survey was conducted with quality improvement leads in Canada and 4 other countries. Content analysis methods were used to analyze and report the data. Patient-centred quality indicators were identified and categorized according to the Donabedian framework (structure, process, outcome). The survey had a response rate of 47/67 (70%) and a completion rate of 58/60 (97%). We obtained completed surveys from 12 of the 13 provinces and territories in Canada. Respondents from most provinces indicated their organization used patient-centred care measures to inform practices. Respondents in only 4 provinces/territories reported using patient-centred quality indicators, for a total of 61 unique indicators. Most indicators used across Canada assessed aspects of care related to the Donabedian components of process and outcome. Findings for Canada were comparable to those for Sweden, England, Australia and New Zealand, where many measures are still in development. This study provided greater insight into patient-centred care measurement across Canada, Sweden, England, Australia and New Zealand and helped us to identify patient-centred quality indicators currently in use. These results will inform the development of a standard set of patient-centred quality indicators for implementation by health care organizations to improve the quality of health care.

Canadian regulations and legal ramifications for hepatic encephalopathy: a descriptive analysis.

Hepatic encephalopathy, a form of brain dysfunction seen in the setting of liver insufficiency, negatively affects driving performance and so is both a patient and public safety issue. We aimed to review the motor vehicle codes in each Canadian province and territory relating to the reporting of patients with hepatic encephalopathy and to search a Canadian legal database for cases of motor vehicle collisions involving patients with hepatic encephalopathy. In this descriptive analysis, the transportation agencies of each Canadian province and territory were contacted via telephone and/or email between April and August 2017. Requirements of physicians to report medical conditions (including liver disease and hepatic encephalopathy) affecting a patient's fitness to drive were assessed. WestlawNext Canada was searched for any Canadian cases on hepatic encephalopathy and driving-related lawsuits from inception to Dec. 31, 2017. Reporting of medically unfit drivers is a requirement in all Canadian provinces and territories except Alberta, Quebec and Nova Scotia. Hepatic encephalopathy, cirrhosis and advanced liver disease were not specifically identified as reportable medical conditions in any province or territory. Our search did not identify any lawsuits involving a motor vehicle collision in Canada that were made either against physicians caring for patients with hepatic encephalopathy or against such patients themselves. Although hepatic encephalopathy has a substantial impact on driving performance, it is not specifically identified as a reportable medical condition in Canada. Increasing awareness of the potential impact of hepatic encephalopathy on safe driving for health care providers and the public is critical.

A Pan-Canadian Data Resource for Monitoring Child Developmental Health: The Canadian Neighbourhoods and Early Child Development (CanNECD) Database.

The Canadian Neighbourhoods and Early Child Development (CanNECD) database is a unique resource for research on child developmental health and well-being within the socioeconomic and cultural context of Canadian neighbourhoods. This paper describes the CanNECD database and highlights its potential for advancing research at the intersection of child development, social determinants of health, and neighbourhood effects.The CanNECD database contains cross-sectional population-level child developmental health data from all across Canada collected through regional implementation of the Early Development Instrument (EDI), geo-coded information on residential neighbourhoods covering all of Canada, and socioeconomic and demographic variables from the Canada Census and Income Taxfiler database. Individuals are not identified in the database, as no identifying information, such as names and addresses, is attached to the EDI record. At data collection, each individual child is given a unique number which is a combination of site, school, and position on a class list. Each neighbourhood receives a unique identifier which then is linkable across datasets. The nearly 800,000 EDI records spanning 2003-2014 and representing all Canadian provinces and territories (with the exception of Nunavut) are compiled in a secure electronic collection system at the Offord Centre for Child Studies, McMaster University in Hamilton, Canada.Early studies using the EDI demonstrated its utility as a tool for assessing child developmental health at a population level, and its potential for both community-level and large-scale monitoring of child populations. Research using the CanNECD database is now examining to what extent social determinants and the steepness of the social gradients of developmental health differ between geographical jurisdictions and between different sub-populations. We are also working to identify outlier neighbourhoods in which EDI scores are substantially higher or lower than predicted by a neighbourhood’s demographic and socioeconomic characteristics, and exploring other potentially important determinants of children’s developmental health. Finally, we are examining the extent to which change-over-time in aggregate EDI scores varies geographically, and how well it coincides with changes in socioeconomic factors. Thus, the CanNECD database offers the opportunity for research that will inform national policies and strategies on child developmental health.

Impact of public dental care spending and insurance coverage on utilization disparities among Canadian jurisdictions.

To investigate the role of public dental care spending and insurance coverage on dental services utilization disparities among different Canadian jurisdictions. We utilized Canadian Institute for Health Information provincial/territorial per capita estimates for public dental care expenditure, public information on legislated dental care programs, and oral health data from the 2007-2008 Canadian Community Health Survey to make inferences regarding the relationship between dentist visits in the past 12 months and self-perceived oral health. We performed descriptive statistics and binary logistic regression analysis to determine the relationship between dentist visits and self-perceived oral health status at the provincial/territorial level and on stratified data based on three age groups - children (12-17 years), adults (18-64 years), and seniors (65 years and older). Overall, the presence of the "inverse care law" in dental care at the provincial/territorial level was evident. However, in the Canadian territories, which had the highest per capita public dental care expenditure, individuals with poor oral health had the highest odds of visiting a dentist compared with other jurisdictions. In jurisdictions with public dental care programs for children and/or seniors, children and seniors with poor oral health were more likely to visit dentists. Jurisdictions with more public spending and greater population coverage for dental care appear to better cater to those with the highest oral health care needs.

Cutaneous malignant melanoma incidence and mortality trends in Canada: A comprehensive population-based study

The incidence of cutaneous malignant melanoma (CMM) is on the rise in many parts of the world. However, there is limited knowledge on the epidemiology of CMM in Canada. To conduct a comprehensive population-based study of CMM in Canada. We examined patient clinical and pathologic characteristics as well as the incidence and mortality trends of CMM in Canada using 3 independent population-based registries. In total, 72,565 Canadian patients were given CMM diagnoses during 1992-2010; 47.5% were women. Average age at the time of diagnosis was 56.5years for women and 60.4years for men. We report a steady increase in CMM incidence and mortality rates in both sexes. The overall incidence rate of CMM in Canada was 12.29 cases/100,000 person-years. We also report important differences in the incidence and mortality rates between Canadian provinces and territories; the highest incidence of this cancer was documented in Nova Scotia and Prince Edward Island. Data on race, clinical disease stage, and Breslow depth of CMM was not available. This study, for the first time, defines the disease burden of CMM in Canada and highlights important longitudinal, geographic, and spatial differences in the distribution of CMM in this country.

Perceptions of sense of community and community engagement among rural nurses: Results of a national survey

BackgroundVariations in rural nurses' sense of community and engagement in rural communities are poorly understood, although there is evidence that these are linked to community cohesion and perceived community resilience. ObjectiveThe aim of our research was to develop descriptive profiles of rural nurses who exhibit a sense of community and community engagement at low, average, and high levels, based on occupational, personal, community, and regional characteristics. These results were linked to levels of cohesion and resilience. DesignA survey questionnaire, including established scales, demographic information, and information about rural nursing practice was administered to rural nurses. SettingsRural communities in all provinces and territories in Canada outside the commuting zone of urban areas with 10,000 or more inhabitants. ParticipantsMulti-level systematic stratified sampling was employed for the national survey. A subsample of 2116 Registered Nurses, Nurse Practitioners, and Licensed Practical Nurses comprised the participants for this analysis. MethodsThe analysis was conducted in two stages: (1) in the first subset, those (n = 2116) whose primary work community was rural, remote, or rurban with less than 10,000 inhabitants were grouped into a nine-group typology based on low, average, and high tertiles of Psychological Sense of Community and Community Engagement. The second subset (n = 993) represented those in three groups: low-low, average-average, and high-high scores on the two indices. Significant differences between the three groups were identified based on occupational, personal, community, and regional characteristics. Chi Square, ANOVA, and correlation tests were applied as required. ResultsNurses with low scores on both Psychological Sense of Community and Community Engagement were more likely to be from larger communities, single or divorced and living and working in the North. Those with average scores on both scales have been in their nursing positions for more than 20 years, are middle aged and are satisfied with their home community. Nurses in the third group have high scores on both indicators; they are more likely to be from a smaller childhood communities, married or living common-law, and are in the late middle age group. ConclusionsBy focusing on the key variables or traits of nurses, modifiable recruitment and retention practices can be implemented. For example, it is important to recruit nurses who are from smaller communities. Other initiatives for nurses include matching community activities with the age and stage of the family and developing a welcoming strategy for the workplace and community for newly arrived nurses.

OA134] Secondary analysis of canada’s national computed tomography (CT) survey data: digging deeper on DRLS

Purpose Following publication of Canada’s first national survey of Computed Tomography (CT) in 2016 [1] , Diagnostic Reference Levels (DRLs) are now available for select head and trunk examinations of both pediatric (0–3, 3–7 and 7–13 yrs.) and adult ( ≥ 19 yrs.) patients. The analysis performed also included additional investigation into the effect of scanning mode (axial or helical), contrast use (C+ or C−) and inclusion of dose reduction methods (Fixed or Dose Reduction (DR)). The intent was to investigate, at least semi-quantitatively whether this can help identify key protocols that could benefit from further optimization. Methods The Canadian CT survey was adapted from the 2003 CT survey performed in the United Kingdom [2] . In close collaboration with all Canadian provinces and territories, data was collected from approximately 75% of all CT scanners in Canada and ultimately provided machine, dose index, age, mass and cross-sectional dimension information from 24 280 individual patient sequences. For each patient sequence, an algorithm also scored and confirmed the scan mode, use of contrast and use of DR. CTDIvol data for each examination type (group) could then be sub-divided and compared with 8 sub-group DRLs or CTDIvol percentiles. E.g. Adult Head DRL versus Adult Head, Helical, C+ and Fixed current DRL, and so on. A custom graphic plot was created in order to clearly compare group (or examination) with sub-group dose index distributions. Results In almost all cases, the use of a fixed (non-modulated) current (mAs) showed higher CTDIvol values, across sub-group DRLs (75th percentile of CTDIvol sub-group data). Indicating that those protocols may potentially benefit most from dose reduction activities. Conclusions DRLs are an important part of dose reduction initiatives, and with some additional analysis, clear indicators can be produced that provide guidance on where to initiate any protocol review for potential dose reduction.

Kelvin and Faraday kimberlite emplacement geometries and implications for subterranean magmatic processes

The Kennady North Project kimberlites (Northwest Territories of Canada) comprises multiple shallow dipping dykes and several volcaniclastic bodies that have an unusual shallow plunging geometry and complex “pipe” shapes that are termed chonoliths. The detailed exploration of the entire system provides exceptional evidence for subterranean volcanic conduit growth processes. The possible processes leading to the development of the kimberlite bodies are discussed, with emphasis on the importance of the subsurface intrusive system geometry and the local stress tensor. Emplacement into a locally compressive stress regime (i.e. σ1 and σ2 inclined at a low angle to surface) could change the kimberlite emplacement geometries to that observed at Kennady North. Models are proposed for the development of the chonoliths, to emphasize aspects of the growth of kimberlite systems that are not well understood. The conclusions challenge or evolve current emplacement models and should influence kimberlite exploration and resource definition assumptions.

The principle of good faith in the performance of contractual obligations under the common law of Canada and the law of Quebec

Introduction. In the paper, the author analyzes the principle of good faith in contractual performance under the common law of Canada and carry out a legal analysis of one of the key judicial precedents that is in relation to the designated area and that was adopted by the Supreme Court of Canada in 2014, i.e. Bhasin v. Hrynew case. The study is focused on the principle of good faith contractual performance under the law of the Canadian province of Quebec as well.Materials and methods. The material for the study consists of the judicial precedents of Canadian courts as well as the papers of foreign and Russian researchers in the field of civil law. The methodological basis of research comprises general scientific methods of cognition (analysis, synthesis, analogy) as well as specific ones, i.e. the comparative legal method, the formal logical method, the systematic method, methods of structure and function and the method of interpretation.Results. The author conducts a detailed analysis of Bhasin v. Hrynew case and determines the role of this precedent in the common law of Canada as well as the criteria for identifying the principle and a duty of good faith contractual performance. The author also analyzes the principle of good faith under the law of Quebec, i.e. the relevant jurisprudence and the codification of this principle in the legislation of Quebec.Discussion and conclusion. The distinction of the principle of good faith in the performance of contractual obligations as a freestanding principle of Canada’s common law is justified. The Bhasin v. Hrynew case is a vivid illustration of the growing role of the principle of good faith in the countries of the common law tradition. Furthermore, the convergence of Canada’s common law and the law of the province of Quebec, the only one among ten provinces and three territories of Canada that clearly adheres to civil law tradition, is an impact on this precedent.

Readability of advance directive documentation in Canada: a cross-sectional study.

In the Canadian context, health literacy has been shown to depend on place of birth, education level, socioeconomic status, language spoken and geographic location. This study seeks to determine whether currently available advance directive documentation in Canada is written in accordance with the average reading level of the population and to assess whether recommendations for health literacy are currently being met. A cross-sectional study design was used. Patient-oriented English-language advance directive documents (brochures and/or forms) were obtained from the health agency websites of all Canadian provinces and territories and analyzed for readability using the Flesch-Kincaid Grade Level and Flesch Readability Ease scales. Advance directives in Canada are distinct from one another and surpass the recommended reading level by 4.5 ± 1.4 grade levels on average (95% confidence interval 8.7-10.3) with the hardest-to-read documents existing in Ontario, Quebec and Alberta. These results demonstrate that the provincial and territorial governments issuing advance directive documentation have fallen short of their fiduciary responsibility to provide documents that facilitate health literacy. Addressing this shortcoming can result in increased patient engagement in advance directive completion while promoting patient autonomy.

Patterns of bronchial challenge testing in Canada.

BackgroundBronchial challenge testing (BCT) measures airway hyperresponsiveness; asthma guidelines recommend using BCT when symptoms manifest despite normal spirometry. Improper application of these guidelines commonly results in the misdiagnosis of asthma. Yet, statistics concerning BCT remain largely obscure. The current paper addresses this gap and explores how various health variables may elucidate adherence to asthma guidelines and patterns of BCT across Canadian provinces.MethodsUsing the Access to Information Act, medical financial claims for BCT (or equivalent procedures) were requested from each of the Canadian provinces and territories. Based on the available information (from provinces only), correlations between frequency of BCT claims and medical demographics (e.g., prevalence of respirologists, health expenditures) are reported.ResultsControlling for population or for people with asthma, physicians from Québec claim four times more BCT per year than those in other provinces; physicians from Alberta close to eight-fold fewer. The number of respirologists per capita and BCT per capita correlated moderately, r(132) = 0.582, p < 0.001, [95% CI 0.421, 0.716]. Excluding “outliers” (i.e., British Columbia, Alberta, and Saskatchewan) greatly strengthened this correlation, r(87) = 0.930, p < 0.001, [95% CI 0.883, 0.958].DiscussionThese findings demonstrate that provinces vary in their use of BCT. This result seems to stem, at least in part, from differences in the prevalence of respirologists. Interestingly, geographic region appears to wield a strong influence; in the correlation between number of tests and number of respirologists, physicians from Western provinces (i.e., Alberta, Saskatchewan, and British Columbia) administered fewer tests than their Eastern colleagues. Given the association between inadequate application of BCT and misdiagnosis of asthma, physicians should pay special attention to the Canadian guidelines when considering an asthma diagnosis.

Use of Hospitals by Older versus Younger Canadians: Myths and Misconceptions

ABSTRACTThis study investigated concerns regarding the extensive use of hospitals by older people and subsequent long wait lists. We analysed complete individual-anonymous, 2014-2015 inpatient hospital data for all Canadian provinces and territories (except Quebec). People aged 65 and older accounted for 37.0 per cent of all hospital episodes and 41.5 per cent of all admissions to intensive or coronary care units. Similarly, of all admitted individuals, 32.8 per cent were older. The data also revealed only 14.3 per cent of older Canadians living outside of Quebec were admitted to hospital one or more times that year. This study indicates that issues other than hospital use by older people should be addressed in Canada for improved hospital accessibility. Improved care of older persons is also indicated, as their higher risk of hospital admission, longer hospital stays, and dying in hospital could be from a lack of age-informed hospital and community services.

Description des initiatives pour prévenir et traiter l'intimidation scolaire dans Jes provinces canadiennes

This paper is based on a research project in progress (Roberge &amp; Beaudoin, submitted), and maintains the objective of studying the content of bullying prevention and intervention policies in Canadian provinces and territories. A content analysis of these policies has been conducted in order to determine to which extent they adhere to promising anti-bullying practices identified in extant research. An instrument created and validated by Smith, Smith, Osborne &amp; Samara (2008) and Roberge &amp; Beaudoin (submitted) was utilized for the analysis of these policies. The results presented discuss the strengths and limitations of proficient bullying prevention and intervention practices that have been established in Canadian provinces and territories.

Not Just for Kids: How to Improve Adult Vaccination Uptake in Canada

Vaccinations and booster shots aren’t just for kids. Adult vaccination rates urgently need a booster shot in Canada. Better and more regular uptake of vaccines during adulthood and retirement could improve the well-being of older Canadians and offset some of the challenges associated with an aging society. Despite clinical evidence showing the value of immunization against infectious diseases in the adult population, insufficient attention to lifetime immunization policies persists. This Commentary suggests creating formal approaches, based on applied behavioural design concepts, for improved adult immunization uptake. Influenza should be a pivot point. Even though the seasonal influenza vaccine suffers from relatively lower clinical efficacy than other vaccines, the related lack of confidence in its usefulness is exacerbated by doubts among healthcare workers. Still, the routine nature of the seasonal influenza shot does make it a pivotal part of adult immunization schedules. It should be used to prompt healthcare providers to review a patient’s overall immunization status, helping to develop databases to monitor and encourage other adult vaccines. This Commentary utilizes behavioural economic policy design issues and suggests major changes to the way Canadian provinces and territories monitor and ensure uptake of vaccines among adults. Alongside a digital strategy to create databases to monitor coverage of all adult vaccines, policies should build upon many patients’ preference to get their annual influenza shot at their local pharmacy by expanding pharmacists access to immunization databases, building greater links to primary care, and expanding pharmacists’ ability to set up immunization reminders for patients upon pharmacy visits, plus encouraging the use of digital apps. Going forward, the focus should shift to overcoming complacency with more use of automatic scheduling and reminders. Pharmacies, often a very convenient location for most urban-dwelling Canadians, could act as important parts of multidisciplinary primary care efforts to gather data on publicly funded adult vaccines – likely through digital platforms – and create reminders and prompts to overcome complacency as well.

Improving Physician Accountability through Primary Care Reform in Alberta.

Like other Canadian provinces and territories, Alberta has been attempting to reform primary care since the mid-1990s. Although initially these efforts were focused almost exclusively on the method of payment for physicians, since 2003, the focus of government policy has broadened to include other aspects of practice, including governance and accountability, improved continuity, the use of a team-based approach and the use of electronic information systems. Although significant progress has been made, Alberta continues to face challenges.

Unscientific hunt management plans

Applied Ecology Governments often claim, and society often believes, that science guides policy for natural resource management, including hunting policies across the United States and Canada. But no standard exists for what science-based management entails. Artelle et al. identified four fundamental hallmarks of science for natural resource management. Fewer than half were present in most hunt management plans surveyed across U.S. states and Canadian provinces and territories. Broader application of a science-based framework could improve policies and mitigate risks. Sci. Adv. 10.1126/sciadv.aao0167 (2018).

COSSACKS PHENOMENON AS THE NATION PRESERVING FACTOR OF CULTURE OF THE UKRAINIAN DIASPORA OF CANADA (MIDDLE OF XX - BEGINNING OF ХХІ CENTURY)

The purpose of this scientific article consists of definition of ways of maintaining national memory by representatives of the Ukrainian diaspora of Canada on the basis of the glorious Cossack past. The necessary quantity of sources and historiographic literature which concerned various aspects of the touched issue has been attracted to achievement of the specified purpose. The author has used such following scientific methods of a research as the analysis, historical genetic and historical comparative. Chronologically article is connected with the period of the middle of XX – the beginnings of the XXIst century. Within this scientific article activity of the cultural and scientific organizations connected with the Cossack direction has been considered. The author investigates influence of the Cossack culture on development of the Ukrainian society of Canada. The special attention is devoted to the Ukrainian festivals of the Cossacks in the territory of Canada. For the first time the attempt to give generalizing view on the different aspects of problem was made.

10 Canadian Provinces And 3 Canadian Territories: Map And List

10 Canadian Provinces And 3 Canadian Territories: Map And List

Trends in incidence of neonatal abstinence syndrome in Canada and associated healthcare resource utilization

BackgroundNeonatal abstinence syndrome (NAS) is a collection of symptoms that occurs primarily due to antenatal opioid exposure. National data on incidence, hospital resource utilization, and demographic features of NAS have not been previously described for Canada. MethodsSecondary analysis was performed with data from hospitals in all Canadian provinces and territories, excluding Quebec. Infants with NAS were identified by searching for ICD-10-CA code P96.1 in the Canadian Institute for Health Information’s discharge abstract database. We examined incidence, hospital beds occupied per day, length of stay (fiscal 2003–2014), hospital costs, and demographic features (due to data availability, limited to fiscal 2010–2014). ResultsThe incidence of NAS in Canada tripled between 2003 and 2014 (1.8–5.4 per 1000 live births), with an average annual increase of 0.33 cases per 1000 live births (95% CI 0.31, 0.34). Provincial incidence in 2014 ranged from 2.7 (Alberta) to 9.7 (New Brunswick) per 1000 live births. Between 2010 and 2014 total and mean per-patient costs rose from $15.7 to $26.9 million CAD and $14,629 to $17,367 CAD, respectively, with substantial inter-provincial variation in expenditure. Mean length of stay was 14.4 days in 2003 and 14.8 days in 2014, and beds occupied per day rose from 19.7 in 2003 to 69.4 in 2014. ConclusionsThe incidence of NAS is increasing in Canada with associated rise in healthcare resource utilization. Inter-provincial variability in incidence and resource utilization underscores the need to further explore best practices for cost-effective prevention and management of NAS.

Infectious and congenital syphilis in Canada, 2010-2015.

Syphilis is the third most commonly reported notifiable sexually transmitted infection (STI) in Canada, following chlamydia and gonorrhea, respectively. Rates of this STI have been rising rapidly in Canada since 2001. To summarize trends observed in syphilis rates for 2010 to 2015 in Canada. Laboratory-confirmed cases of infectious syphilis and early congenital syphilis were reported to the Public Health Agency of Canada by all of the Canadian provinces and territories. National infectious syphilis rates were computed, as were rates per sex, age group and province/territory. Rates of congenital syphilis were also calculated. From 2010 to 2015, the rate of infectious syphilis in Canada increased by 85.6%, from 5.0 to 9.3 cases per 100,000 population. In 2015, a total of 3,321 cases of infectious syphilis were reported, mainly in males (93.7%), among whom the rate was 17.5 cases per 100,000 males versus 1.2 per 100,000 females. The rate also rose faster among males in 2010-2015, a 90.2% increase versus 27.8% among females. Individuals aged 20-39 years had the highest rates. Across the provinces and territories, the highest rates of infectious syphilis were in Nunavut, British Columbia and Manitoba.​: The rate of congenital syphilis decreased from 2010 to 2014 (1.6 to 0.3 cases per 100,000 live births) before increasing to 1.5 cases per 100,000 live births in 2015, which corresponds to six reported cases. Rates of syphilis continue to rise in Canada, especially among young men, and this is consistent with trends in the United States of America and European Union. Based on data from Canada and from these regions, the sexual behaviour of men who have sex with men (MSM) is thought to be a major risk factor for syphilis.