• Access to Appropriate Care across the Continuum
• Drug Policy
• Health Information

Access to Appropriate Care across the Continuum

CIHR-IHSPR has identified Access to Appropriate Care across the Continuum as a priority research area, recognizing that Canadians expect access to quality healthcare services when and where they need them, and that they are increasingly receiving care outside the hospital walls in a range of community and other settings and from various healthcare providers who may or may not fall under the Medicare umbrella. This priority research area builds on CIHR-IHSPR's previous initiatives over past years in such areas as wait times, timely access to care, health human resources, and improved access for at-risk, vulnerable populations.

Canadians want a sustainable healthcare system that provides timely access to appropriate healthcare services and treatments. They expect health services and treatments that are based on the best and latest evidence and improve their health and quality of life. Ensuring their constituents have access to timely, appropriate and effective health care is a challenge for federal, provincial and territorial governments alike. For the most part, policy makers are aware of the problems that exist and where the gaps in the system lie. Now, they need evidence-informed approaches and implementation strategies to improve access to, and the quality of, appropriate care across the continuum. This includes effective approaches to the health service planning and management, training of health human resources, improving healthcare safety, and strategic management of wait times, including the appropriateness, prioritization, length and management of the waiting experience.

Although the site of care is increasingly shifting outside the hospital walls into a range of community and other settings (e.g., home care and long-term care), the healthcare system has not kept up in terms of ensuring that patients receive timely, comprehensive and coordinated care as they move through a fragmented and complex "system." As well, care provided outside of hospitals may fall into a mixed world of public and private financing, but the two sectors are not coordinated. Policy makers, managers and providers need strong evidence on effective interventions and practical solutions to improving health care across the continuum, as well as the means for overcoming the barriers to achieving these goals. Increased information is also required on how governance, financial and delivery arrangements impact on the delivery of timely, effective care, especially in the area of chronic disease prevention and management. Decision-makers need information and implementation strategies on how to shift from a world of acute care solutions for chronic care needs to a world of chronic care solutions for chronic care needs.

Realignment of existing capacity is needed to meet the health care needs of Canadians across the continuum of care; in some areas more capacity is desperately needed; in other existing capacity should be redeployed. As such, effective health human resource planning, management and training are vital for a responsive healthcare system. Change in scope of practice and practice models, as well as improved collaboration and information sharing, is required to ensure quality care and the most efficient use of the healthcare workforce. Change management (providing a bridge from evidence and into policy) and leadership development skills are critical to support to this change.

Within the strategic priority research area of Access to Appropriate Care across the Continuum, CIHR IHSPR has identified the following key areas for research:

• Health human resources
• Primary health care reform
• Community-based care (e.g., long-term care, home care, mental health, rehabilitation)
• Chronic disease prevention and management
• Strategic management for timely treatment
• Citizen engagement

Drug Policy

CIHR-IHSPR has identified Drug Policy as a priority research area. Prescription medicines are a vital part of the Canadian healthcare system. They can save lives, treat diseases and improve the quality of life for many. Drugs have also helped ease the burden on the healthcare system by shortening and preventing hospital stays. However, prescription drug use presents several challenges to the healthcare system. For example: they are the fastest growing and second largest category of total health care expenditure in Canada;¹ access to medicines varies across Canada due, in part, to the lack of harmonized drug coverage; and adverse drug-related events raise serious safety concerns. Governments across Canada are striving to address the challenges and ensure both good health outcomes and system sustainability.

First Ministers have agreed that no Canadians should suffer undue financial hardship in accessing needed drug therapies, and that affordable access to drugs is fundamental to equitable health outcomes for Canadians.² In September 2004, First Ministers directed Health Ministers to establish a Ministerial Task Force to develop and implement a National Pharmaceuticals Strategy (NPS) to address the challenges and opportunities across the drug lifecycle related to three themes: access; safety, effectiveness and appropriate use; and sustainability. The NPS strategy includes actions to assess cost drivers and cost-effectiveness, including best practices in resource allocation and drug plan policies; to develop options for catastrophic pharmaceutical coverage and a National Drug Formulary; to improve access to breakthrough drugs for unmet health needs and non-patented drugs; and to enhance action to influence prescribing behaviour of healthcare professionals. Further research in these areas is required to provide the best evidence to support drug policy development and initiatives.

In addition research that centres on the three main themes identified in the NPS, there is also increasing interest in factors that influence patient care-seeking related to prescription drugs, where patients get their information, and the extent of their involvement in clinical decision making. The time is also ripe for research and evaluation of models for improving public engagement and input into drug policy formulation and resource allocation decision making. An assessment of the levels of familiarity among the public with well-understood evidence-based facts about the safety, effectiveness and cost-effectiveness of health care alternatives could inform providers and decision makers alike. As well, decision-makers need an improved understanding of the impact of the media and the influence that direct marketing efforts such as direct-to-consumer advertising, toll-free lines, patient forums and patient support groups have on care-seeking.

Within the priority research area of Drug Policy, CIHR-IHSPR has identified the following key areas for research:

• Effectiveness, safety and adverse events
• Policies for equitable access to medicines (e.g., provincial formularies, regulation, financing and sustainability)
• Citizen-centeredness and public expectations (e.g., direct-to consumer advertising, role of the media, role of the public in resource allocation decision-making)

Health Information

Healthcare decision makers need data and information systems that support them in addressing access, quality and safety issues. The Romanow Report,³ federal health accords, Health Council of Canada reports and many other national and provincial organizations have emphasized the urgent need to establish an information infrastructure to support reform efforts of Canada's healthcare system. Subsequent initiatives to build a health information infrastructure have included Canada Health Infoway's efforts, together with those of the provinces, to create and implement electronic health records (EHRs) to increase the complement of electronic databases and improve the compatibility and intra-operability of data across jurisdictions.

Despite these initiatives, significant gaps remain in our understanding of the challenges related to developing, implementing and maintaining health information systems. Understanding these challenges is critical to driving and shaping future investments, encouraging clinicians to adopt e-Health solutions, ensuring public confidence in the systems and using the information to inform policy and planning. National frameworks are needed to allow for stakeholder input into the development of effective health information systems and the secondary use of data by decision makers and researchers. This would facilitate improved data systems, their effective use to develop policy and monitor the system, and researcher access to data in order to conduct timely, cross-jurisdictional health services and policy research.

This strategic priority focuses on four thematic areas, including:

• Electronic health records (e.g., evaluation, implementation, secondary use of data, ethical & privacy issues)
• Improving the quality, access to, linkage of, and use of data by decision makers and health services researchers
• Linkability of datasets across jurisdictions
• Harmonizing data privacy laws and consent for use of data for health services research

1. Canadian Institute for Health Information. 2007. "Drug Expenditure in Canada, 1985 to 2006." Retrieved from Drug Expenditure in Canada, 1985 to 2006
2. Health Canada. 2004. First Minister's Meeting on the Future of Health Care 2004: 10-Year Plan to Strengthen Health Care. Retrieved from First Minister's Meeting on the Future of Health Care 2004
3. Romanow RJ. 2002. "Building on Values: the Future of Health Care in Canada", Final Report, November 2002. Commission on the Future of Health Care in Canada.