ARCHIVED - Research About - Health Systems

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For the past 10 years, the Canadian Institutes of Health Research (CIHR) has supported better health and health care for Canadians. As the Government of Canada's health research investment agency, CIHR enables the creation of evidence-based knowledge and its transformation into improved treatments, prevention and diagnoses, new products and services, and a stronger, patient-oriented health-care system. Composed of 13 internationally recognized Institutes, CIHR supports more than 13,600 health researchers and trainees across Canada. Through CIHR, the Government of Canada invested approximately $110.6 million in 2009–10 in health services- and policy-related research.

The Facts

• More than 35% of rural doctors surveyed by the Canadian Institutes of Health Information said they were accepting new patients, compared to less than 18% – or fewer than one in five – of practitioners in urban areas.¹
• In a recent survey of more than 7,000 registered nurses, more than half reported almost always feeling fatigued at work. Nurses blamed the fatigue, which can impair their ability to make sound judgments, on workloads, staffing and sicker patients.²
• In 2009, there were 266 magnetic resonance imaging (MRI) scanners operating in Canada – an increase of 44 machines in two years. Rates of MRI exams performed in Alberta or New Brunswick were more than twice as high as those in Prince Edward Island or Newfoundland and Labrador.³
• More than 46,000 registered nurses and 7,000 licensed practical nurses work in community health in Canada, about 16% of the nursing workforce.⁴

Sources:

1. Canadian Institute for Health Information: Rural family physicians twice as likely to accept new patients as those in larger cities
2. Canadian Nurses Association: Media Room, Growing levels of nurse fatigue threaten patient safety
3. Canadian Institute for Health Information: Use of MRI and CT exams varies greatly among provinces
4. Canadian Health Services Research Foundation: Maximizing Community Health Nursing Capacity in Canada: A Research Summary for Decision Makers

Finding Solutions

Angioplasty rates soar while bypass surgeries stall

Technical advances in angioplasty – inserting a balloon-tipped catheter to unblock a blood vessel – have led to a remarkable uptake in the procedure to treat coronary patients, while rates of bypass surgery have slipped. Angioplasty is less invasive and gets heart patients out of hospital and back to work quicker, says Dr. Jack Tu, a senior scientist with the Institute for Clinical Evaluative Services. Research from his lab indicates rates of angioplasty in Canada increased to 187 from 86 per 100,000 people between 1994 and 2005 while bypass surgery fell to 71 from 76 per 100,000. Improvements to the metal mesh stents used to keep the vessels unblocked after angioplasty are a big reason for the increase, says Dr. Tu.

How many patients is too many?

How many patients can a family physician take on while continuing to provide high quality care? Dr. William Hogg of the University of Ottawa and his colleagues intend to answer that question with a comprehensive review of how people in Ontario are being served by their family doctors. Using anonymized data gathered from the Ontario Health Insurance Plan, Dr. Hogg will measure the quality of care patients are receiving based on criteria such as their ability to see their own provider and the degree to which they receive recommended care to prevent illness. "For example, we can tell whether a patient is diabetic and whether they've received a particular blood test that is indicated for patients with that disease," says Dr. Hogg. The goal, he says, is to find the tipping point at which quality of care begins to suffer. "People need to know this in order to craft the health-care system so that the incentives are in the right place," says Dr. Hogg.

Desire to die at home often gets overtaken by need for care

Dr. Frederick Burge of Dalhousie University and his team have interviewed about 300 spouses or close relatives of people who recently died from chronic illnesses. Half the respondents reported their loved one had a preference for where they wanted to die, with the vast majority of them (70%) wanting to die at home, but only 37% actually did so. "We have the sense that it has to do with the sudden onset of a variety of symptoms and issues that seem unmanageable," says Dr. Burge. "This leads to caregiver stress at home from the challenge of finding enough support to look after someone who is so ill, so close to death." Dr. Burge expects the study will eventually include responses from 1,200 participants and will provide valuable insights into the services required for high-quality end-of-life care.

Project integrates medical/surgical therapies for obesity

Rates of bariatric surgery are rising, as the health-care system copes with growing rates of obesity. Now researchers at the Centre hospitalier universitaire de Sherbrooke are investigating whether the integration of medical and surgical care can help patients and improve hospital services. "In a lot of centres bariatric surgery is becoming more common, but many places don't have medical treatment such as lifestyle modification for obesity available," says Dr. Marie-France Langlois, who leads the three-year project. "When there are, a lot of the times those involved in lifestyle modification work separately from the bariatric surgery staff." The Sherbrooke researchers are collaborating with colleagues at Institut universitaire de cardiologie et pneumologie de Québec and the Royal Alexandra Hospital in Edmonton to help establish a model for medical/surgical care for obese patients. The project will evaluate the benefits of lifestyle modification treatment before bariatric surgery and co-ordinated follow-up care afterwards.

For More Information

The CIHR Institute of Health Services and Policy Research (CIHR-IHSPR) is helping the country meet the challenge of making high-quality health care available to all those who need it, when and where they need it, while also ensuring that Canada's health-care system is responsive, efficient and sustainable. It does so by supporting the brightest minds in health services and policy research, championing the development of the methods and tools that generate excellent research, and supporting evidence-informed health policy decision making. To learn more about these priorities and other CIHR-IHSPR activities, please visit the Institute's website.

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