Health Committee on June 1st, 2006

[Dr. Cyril Frank]

Yes. I believe this method is transferable, but I want to emphasize that we haven't even transferred it to all the surgeons in the province of Alberta yet. It was a pilot that started with 13 surgeons that achieved those results, and there are a number more who we're engaging now. We would like to meet that standard for all of them over the next 12 to 18 months.

And we are talking about this with our colleagues across the country. At the Canadian Orthopaedic Association meeting starting on Friday, there is a working group talking about best practices in hip and knee replacement access, so we are discussing this with all of our colleagues.

[Nicole Demers, Bloc, Laval, QC]

Thank you very much, Dr. Frank.

Dr. Reed, I have one specific concern. There are many women who received silicon gel breast implants and who have to have them removed. However, they must undergo an MRI scan in order to detect the problem. I know that there is not much equipment in Canada and in Quebec for detecting leaks, breaks, and other problems with breast implants. I also know that very few radiologists have been trained in this kind of diagnosis.

Could you tell me how many there are? Could you tell me how many pieces of specialized apparatus and equipment have been designed specifically for this kind of diagnosis? I think that in English they call this core MRI equipment.

[Dr. Martin Reed]

I'm sorry. I'm a pediatric radiologist, and you're going out of my area of expertise, so I'm afraid I can't answer that question. I'm sure that we could answer it through the CAR, but I can't answer it personally at this time.

[Nicole Demers, Bloc, Laval, QC]

Could you get the information and send it to the health committee through the Canadian Association of Radiologists?

[Dr. Martin Reed]

Yes, I can try.

[Nicole Demers, Bloc, Laval, QC]

Thank you very much, Dr. Reed.

[The Chair, Conservative, Rob Merrifield]

Thank you, Madame Demers.

Madame Demers is quite passionate about this issue. We have another session--I think it's next week--on this, so that will be valuable information for us.

Mr. Epp, go ahead, please.

[Ken Epp, Conservative, Edmonton—Sherwood Park, AB]

Thank you very much.

Thank you so much for coming here and telling us of your successes. If we could just spread that across the country, the problem would be solved, right? Everybody smiles.

I would like to ask a question of Ms. Estey. She's the director of the regional diabetes program in Edmonton. She's come all the way to Ottawa from there, and I'd like to give her the opportunity to tell us briefly what her group is doing in order to give timely and rapid access to people who are suffering from diabetes.

Go ahead.

[Angela Estey, Director, Regional Diabetes Program, Capital Health]

Thank you for the opportunity, and thank you to the larger committee for the opportunity to be here.

Dr. Lewanczuk has highlighted a number of different types of initiatives that we've put in place that deal with, first of all, understanding what the problems and the needs of people are, and then with trying to make sure there is timely access to care, whether that be a simple call from a nurse or a dietician to ask people how they're making out, or whether it be attending a formal group education program.

There are a number of things. One is a central access system. There's a phone line that patients can call. It's widely advertised. People know how to access our team at any time. We have leveraged off some of the successes of Health Link Alberta, which is a provincial nurse call centre where our diabetes educators have spent some time training some of the nurses who are available 24/7 to help patients.

We know that people get into trouble at all times of the day and night. Quite often diabetes centres work eight to four, typically, Monday to Friday. So having this available 24/7, 365 days of the year, as somewhere people can get that kind of personal contact, is great. We have information available on websites that people can go into. We're actually now exploring some e-health technology as a way to customize information and have more virtual contacts and connections with people. Giving people lots of different options as opposed to the old traditional approach of, “Here's your brochure, and here's your program to take”, certainly, I think, has helped with access.

As Dr. Lewanczuk mentioned, we monitor all the time. As soon as we see pressure starting to build, we learn about the population, what works with them, and what's been successful, not just for diabetes but for other jurisdictions, and we see how they've dealt with the needs of these patients. One of the examples is the Northeast Community Health Centre, into which we've gone and provided free lunch. What a great way to get to know not only the people who attend but their friends who might have diabetes. We link with running rooms. We link with community agencies to deliver lots of lifestyle education programs. Partnerships have also been really important and have helped us to identify other people in need.

There are lots of different innovations. We're trying to not be static. We want to be responsive, so our people are out in the communities trying to learn how best to meet the needs of our patients.

[Ken Epp, Conservative, Edmonton—Sherwood Park, AB]

It's my understanding, from what little I know of diabetes, that down the road diabetes will put great pressure on our health care system. In other words, the consequences of having an untreated situation will escalate the demand on our health care system.

Is it your experience and your view that one of the things you are doing to reduce the pressure on our health care system and thereby, in general, reduce wait times is to give earlier diagnosis and better care?

[Angela Estey]

Yes. We really believe that the healthier people are and the more that's done upfront for them, the less strain there will be on our system. We need to find the people, connect with them, and then monitor them on an ongoing basis. We don't just provide one-time intervention. We want to hang on to them. We want to see how they're doing. We send the reminder letters. We look at their labs, virtually; and if we start to see trends of blood sugars creeping up, we don't wait until they show up in crisis. We're on the phone with them, and again we are providing the support to the primary care teams that are seeing them on an ongoing basis.

So yes, we're doing a lot more upstream.

[Ken Epp, Conservative, Edmonton—Sherwood Park, AB]

Obviously you are on the cutting edge here of a new approach, which is very encouraging, and I'm glad it comes from Alberta and from the city that I represent.

What I would like to know now is whether you are working together with other provinces, with other areas, in order to help get this system out there, so that there are more people involved and so that we get a national result from the work you're doing.

[Angela Estey]

Yes, definitely.

I'm not sure you are familiar with the chronic care model, and we could certainly provide some background on it, but most jurisdictions in Canada are now using this model. There are some common themes through this model around community partnerships, decision support tools--IT, things like that--so when we start attending conferences we're all talking the same language. There are great opportunities to share when we're all seeing things the same way. So yes, that is happening.

We are working very closely with the other health regions in our provinces, and as Richard mentioned, we have been doing a lot of touring around to try to share our learning and to learn from other experts.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Before we start into the second round, perhaps the committee will allow me to get a little bit of clarification from Dr. Frank's presentation.

There was $20 million in a pilot project. Can you tell us where that money was spent? I understand there were no new doctors and no new nurses, so can you tell the committee where that money actually went?

[Dr. Cyril Frank]

Sure.

The money was divided between the three health regions that participated in the project: Edmonton, Calgary, and Red Deer. Each received a proportionate amount to deliver 1,200 new joint replacements. They were to be delivered in the way that the region and its physicians thought was best for the resources and infrastructure they had.

Calgary contracted out with a private facility to provide the care in a private facility, with people who were hired by that facility to provide the care. Edmonton and Red Deer seconded staff who were dedicated to this purpose and seconded operating rooms for the purpose of delivering their portion of the 1,200, which was 500 in Edmonton, 500 in Calgary and 200 in Red Deer. The funding went to the case costs through the local cooperative between the region and the physicians in that region, to provide the care across the continuum. The funding went into a case cost per patient that the region managed and gave to the collective.

[The Chair, Conservative, Rob Merrifield]

Is it accurate to say that the case costs would have been there anyway and this was just accelerated? The case costs would have been there at any rate. I'm just trying to get a handle on it. Was it an extra $20 million provided or would the system have been tabbed with the $20 million, even if the time had been extended?

That is the nuts and bolts of my question.

[Dr. Cyril Frank]

This was $20 million new money that the province dedicated for this purpose, over and above the existing health region budget.

[The Chair, Conservative, Rob Merrifield]

You said it went into each specific case, probably for the knees and the hips and so on. Would that money have been spent, regardless of whether the project had been in place or not?

[Dr. Cyril Frank]

It could have been done without the incremental funding, but to be honest, receiving the incremental funding provided an incentive to the regions to commit time and resources to make this happen.

[The Chair, Conservative, Rob Merrifield]

There were no new doctors.

[Dr. Cyril Frank]

No, these were the same doctors and the same nurses.

[The Chair, Conservative, Rob Merrifield]

Fair enough. I think that clears it up.

We will have one quick question from Ken, then we'll go to Mr. Batters for the second round.

[Ken Epp, Conservative, Edmonton—Sherwood Park, AB]

This is just a short intervention.

The major part of that cost was the cost of the prosthesis itself, wasn't it?

[Dr. Cyril Frank]

Well, we're collecting accurate case costs, actually, and the prosthesis cost is about one-quarter of the case cost.

[The Chair, Conservative, Rob Merrifield]

That will come in your report that we'll be waiting for.

Mr. Batters, you have a few minutes.