ARCHIVED - Research About – Health Systems

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The Canadian Institutes of Health Research (CIHR) is the Government of Canada's agency for health research. CIHR's mission is to create new scientific knowledge and to catalyze its translation into improved health, more effective health services and products, and a strengthened Canadian health-care system. Composed of 13 Institutes, CIHR provides leadership and support to more than 13,000 health researchers and trainees across Canada. Through CIHR, the Government of Canada invested approximately $ 70.3 million in 2008-09 in health systems research.

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The Facts

• Canada's health-care spending was an estimated $171.9 billion in 2008 – $5,170 per person. That total represents an increase of more than $10 billion – about $270 per person – over 2007.*

• In 2007, about 4.1 million Canadians aged 12 or older did not have a regular medical doctor. Of that number, 3.3 million people sought treatment from walk-in/appointment clinics, hospital emergency rooms and outpatient clinics, doctors' offices and telephone health lines.**

• Total drug spending in Canada is estimated to have reached $29.8 billion – or $897 per Canadian – in 2008. Prescription drugs accounted for 84% of that total.***

• For more than two decades, the public-sector and private-sector shares of Canada's total health expenditure have remained relatively stable at around 70% and 30% respectively.*

Sources:
* Canadian Institute for Health Information, National Health Expenditure Trends, 1975 to 2008
** Statistics Canada, The Daily, June 18, 2008, Canadian Community Health Survey
*** Canadian Institute for Health Information, Drug spending estimated at $30 billion in 2008

Finding Solutions

Study calls for coordinated response to nurses' turnover

With CIHR funding, the Nursing Health Services Research Unit, a collaboration between the University of Toronto Faculty of Nursing and McMaster University School of Nursing, has completed a comprehensive study of nurse turnover in Canada. Health-care organizations at 18 sites, representing more than 41 hospitals and 181 nursing units, participated in the study, led by Drs. Linda O'Brien-Pallas, Gail Tomblin Murphy and Judith Shamian. It pegs the average turnover rate at almost 20% per year. According to the report, nurses' reasons for leaving include: decreased job satisfaction, non-supportive working environments, poor relationships with nurse managers and other team members, and role ambiguity. It recommends coordinated intervention strategies from ministries of health, funders, regulatory bodies, institutional decision makers, nurse managers and clinical educators, and frontline health-care providers to address the costs and causes of turnover.

Hospitals not yet ready to provide patients with electronic records

Giving patients access to their electronic health records (EHRs) has been hailed as an innovative way to help people be more active in their own care. Canadian hospitals, however, have obstacles to overcome before they can provide the consumer-based service. In a national survey, funded in part by CIHR, just over half (54.2%) of the hospitals had some sort of EHR system in place, but for almost all (97.6%) it was not the only method for recording patient information. Survey respondents identified financial resources as the most important barrier to providing patients with access to their EHRs. The study, published online by BMC Medical Informatics and Decision Making, was conducted by researchers at the Princess Margaret Hospital, the University Health Network, the University of Toronto, Grand River Hospital in Kitchener-Waterloo, Sunnybrook Health Sciences Centre, the University of British Columbia, the University of Victoria and the BC Cancer Agency.

The very old are less likely to receive palliative care

Age is a factor in terminally ill cancer patients' registration in palliative care programs, a CIHR-funded study shows. Examining inequalities in access to end-of-life care, Dalhousie University's Dr. Frederick Burge studied the records of more than 7,500 Nova Scotians who died of cancer and found that people aged 85 and older were significantly less likely to have been registered in community-based palliative care than those under 65. Distance to the closest cancer centre had a major impact on registration, the study found. The results, published in Medical Care in December of 2008, provide important information for developing policy and programming based on the needs and wishes of patients approaching death.

Stroke units could save $240 million

Treating all stroke patients in organized stroke units could save the health-care system almost a quarter of a billion dollars a year in hospital costs, according to a study led by Dr. Michael Hill of the University of Calgary. The study, published in Stroke, shows that the length of hospital stay for stroke patients is reduced from an average of 19 days in a general hospital ward to 15 days in a stroke unit, where they are cared for by an experienced and specially trained team. Given the current national rate of 50,000 strokes a year, the reduced hospital stays could translate into annual savings of $240 million. Dr. Hill's research is funded by CIHR and the Heart and Stroke Foundation.

The Researchers

Dr. Martin Fortin – Seeing the Whole Person, Not a Single Illness

Based in Chicoutimi, Quebec, Dr. Martin Fortin uses the latest communications technologies to talk with his colleagues and graduate students around the world. But, while teleconferencing can get the job done, the family physician, researcher and medical educator says he much prefers meeting by videoconference.

"Videoconferencing lets you see peoples' body language and that can often tell you a lot more than their words," says Dr. Fortin, director of research in the faculty of family medicine at the University of Sherbrooke.

It's an approach that's characteristic of how Dr. Fortin interacts with patients: rather than focus on a single medical complaint, he's thinking about the whole person. And when family physicians across Canada do this, he says, what they see isn't a patient with a single health problem, but one with many.

"The vast majority of patients who arrive at their family physician don't just have one health problem - they actually have two, three or even four chronic conditions at the same time," he says.

However, notes Dr. Fortin, at present the evidence on which medical science develops is obtained mostly from studying single diseases in isolation, rather than multimorbidity, a combination of several concurrent medical conditions. Through his CIHR-funded research he's at the forefront of international efforts to change this practice.

Dr. Fortin's research has found that the levels of multimorbidity among patients seen in primary care are in fact double that previously reported for the general population. Among patients older than 65-years, 98% arrive at their physicians' office with multiple issues.

He's now leading a three-pronged, five-year research program to establish further baseline information that will aid primary care physicians in assessing and treating patients using a multimorbidity approach.

"One of the first things we're doing is finding ways to harmonize the multimorbidity language that physicians use," says Dr. Fortin, noting that as a new field there's confusion about terminology.

He's also involved in two large, longitudinal studies in Quebec in part to determine how patients with multiple chronic conditions experience the health-care system.

"Right now we only have snapshots of these patients' experience. We need to monitor patients over time to see which approaches are truly successful," he says.

Finally, Dr. Fortin's research group is creating the first program devoted to patients with multimorbidity, one that uses collaborative practices among primary care physicians and nurses. The program was begun with an investigator-initiated research grant from the pharmaceutical company Pfizer.

"Primary care reform across Canada has built on nurses and family doctors working together under a single roof. But this alone doesn't make for 'collaborative practice'," says Dr. Fortin. "Now we have to learn how to work together for the best care of patients with multiple chronic conditions. This requires taking into account the whole person instead of just a single disease. "

For More Information

CIHR's Institute of Health Services and Policy Research (CIHR-IHSPR) has identified Access to Appropriate Care across the Continuum as a health research priority for Canada. To learn more about this priority and other CIHR-IHSPR activities, please visit the Institute's website.

For more information, go to ARCHIVED - Your Health Research Dollars at Work.