Health Committee on Oct. 31st, 2011

[Dr. Dorothy Pringle]

Yes, absolutely.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Could you answer a quick question about e-prescribing and drug shortages?

[Dr. Jeff Poston]

E-prescribing has a lot of potential to actually improve the safety of drug use if it's done properly. However, as you're perhaps aware, there are some studies of e-prescribing where in fact it has created more errors than it has solved. It has to be done carefully. It has to be done by paying attention and making sure—and I think most provinces have done this—the privacy issues are addressed.

We still are in a situation where physicians prescribing for patients may not know all of the medications that a patient is receiving, and we've seen provinces try to do that as a first step, to make sure there's a complete medication record for all patient. I think that's important.

Drug shortages are a major issue currently in Canada. It's a global issue at the moment--

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Poston. I'm sorry, but we're way over time.

We'll now go to Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madam Chair.

As well, I would like to thank the witnesses today for excellent presentations.

I would like to follow up a bit on what my Liberal colleague was mentioning about the best profession for delivery of services, because we did do the human health resource study.

Mr. Poston, I think you were here then, and we got the same recommendation from you to recognize scope of practice. You mentioned that Ontario—I come from Oshawa, Ontario—would save $72.4 million a year if we would just coordinate the service delivery with pharmacists.

I was wondering about this. Basically, delivery of services is a provincial jurisdiction, but I'm curious about this. What is the obstacle? There seems to be a hodge-podge across the country. Pharmacists can work within their scope of practice, but other provinces don't recognize that. What would be the obstacle there?

Is there anything the federal government could do to help jurisdictions start working to recognize scopes of practice? Because we're having a demographic shift, and that's why this study is so important. What can we do to help out those jurisdictions?

[Dr. Jeff Poston]

Thank you for the question.

Certainly we see variations, but it's just a reflection of provincial governments passing legislation. The nature of legislation and the stage the province is at in terms of developing primary health care vary from province to province. I think that's part of the reason why we have this patchwork quilt at the moment. Probably Alberta has been the most progressive province, closely followed by the Maritimes. B.C. and Ontario, in some ways, have been less progressive than some other provinces.

One thing in the 2004 accord was that we created the primary health care transition fund federally. That helped to fund a lot of the studies that have supported these developments, so the federal government's role is leadership, and that is absolutely crucial on a range of issues. We've heard about continuing care. I think pharmacare is probably another one. I think making best use of health human resources is another.

So leadership, pan-Canadian standards, funding the development of demonstration projects and pilot projects.... I know it's not sexy and there's a lot of criticism around pilot and demonstration projects, but these are critical areas--and I think we've heard of some today--where investment in research is really important to help move the agenda forward.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you. I know there is a lot of frustration because, as I've said, the provincial jurisdiction is the lead in delivering the different services and to get all the provinces to agree to something is always a challenge.

I wanted to ask you about adverse drug reactions. I've had family members who were on over a dozen drugs per day. Many seniors are on multiple medications. What does your organization do to help seniors manage adverse drug reactions?

[Dr. Jeff Poston]

One of the critical things is that, as I mentioned, we provide this digital service e-Therapeutics+, and we post every Health Canada advisory that becomes available, alerting physicians, pharmacists, nurses, and other prescribers to any new adverse drug reaction that's out there. We play a role in the dissemination of information.

We're also very interested in some of the proposals to look at new approaches to drug regulation that would allow a combination of strategies, where you could perhaps get drugs to the market earlier but at the same time be more effective at collecting data relating to adverse drug reactions. I think it's something that we still need to work on. I still think we have under-reporting of adverse drug reactions, but as an association we do what we can through our digital information service to make sure that prescribers have up-to-date information around adverse drug reactions, to guide their decisions.

[Colin Carrie, Conservative, Oshawa, ON]

Our health care system now seems to be based on acute care. Some of the presenters brought that up. It's very expensive.

As we're starting to manage these chronic diseases, what are your organizations doing to promote more chronic care self-care and education for seniors? I'd like the panel, if I have the time, to give their comments.

[The Chair, Conservative, Joy Smith]

Who would like to take that one on first?

Dr. Hirst.

[Dr. Sandra Hirst]

From our perspective, our primary role is the education and support of health care professionals, because if we can educate health care professionals on how to work with and for older adults and their families, we can reduce acute care waiting lists. We can reduce acute care admissions. We can teach about fall prevention and dealing with falls. If we can work with the health care professionals first--and I'm saying that deliberately because that builds capacity to respond--so working with the collector group....

But at the same time, we have our curriculum design for professionals across the country that we're moving on implementing in various ways to ensure the content in reference to older adults: the management of chronic conditions, acute care admissions, and polypharmacy issues are addressed in every health care curriculum. That's a huge issue in itself, but that education is key.

From my perspective, those are probably our key thrusts right now.

[Colin Carrie, Conservative, Oshawa, ON]

Perhaps I could get a response from the pharmacists too. I know that Britain has a self-care program. Have you embraced that?

[Phil Emberley, Director, Pharmacy Innovation, Canadian Pharmacists Association]

First I'd like to echo that: we are promoting the education of our pharmacist members as well. We see that as a key role in enhancing the service they provide in pharmacies.

As changes of scope occur, the tools and the knowledge required to provide those services are critical, so we have a number of courses--on chronic disease states, on diabetes, and on smoking-cessation programs as well--to help our members to deliver in those areas. We're also looking at promoting self-care to seniors so they can manage their own disease, because that is critical in helping them manage their diseases effectively.

[Dr. Sandra Hirst]

I'll just add that there are a number of self-management programs in this country, one at the University of Victoria. I've totally forgotten the name, but it's just one of a number. They're not massive in scope, but they are certainly demonstrating that they are cost-effective and that they promote quality of life for older adults.

[The Chair, Conservative, Joy Smith]

Thank you. We're over time now, so we'll have to go into our second round, which is five minutes for Q and As. I'll just remind the committee that at 5:20 today we will be suspending to go into 10 minutes' worth of business.

We'll now begin with five minutes for Ms. Davies.

[Libby Davies, NDP, Vancouver East, BC]

Thank you very much, Madam Chairperson.

First of all, thank you to the witnesses for coming today. I thought your presentations were all really well researched and had excellent information.

I think the thing that leaps out is that while there are some very good things going on, you actually only have to look at the map of age-friendly cities Madame Garon presented to see how much disparity there is across the country, whether it's the 40 nursing homes you're looking at or.... I think this is a glaring issue.

I also thought it was quite alarming to hear--I think it was from you, Ms. Estabrooks--that 80% of caregivers are unregulated. This is very alarming and I think it speaks to the need to have something like a continuing care act.

I have two questions.

Home care was in the Romanow report. It was meant to be the next big thing. It was in the 2004 accord. How do we move forward on this idea of a continuing care act? Do you see it as being under the umbrella of the Canada Health Act principles or is it something completely different?

In terms of drug safety, Mr. Poston, I agree very much with what you said. You touched on some very key points.

I wonder if you're familiar with the Therapeutics Initiative at UBC, which I think the pharmacology department is very involved with. It's happening in one province. I know that you're doing some stuff with your e-Therapeutics+, but it seems to me, again, that there's nothing across the country dealing with this issue of drug safety and drug affordability. Again, it was in the accord, but no progress has been made.

If you're familiar with the Therapeutics Initiative, is it something like that we should be rolling out? That, at least, would be giving us some progress.

[The Chair, Conservative, Joy Smith]

Dr. Estabrooks, would you begin, please?

[Dr. Carole Estabrooks]

With respect to long-term care and a continuing care act, we think it should parallel the Canada Health Act. There are some important principles there, such as the principle that enables us to receive services regardless of which province we go to. The inability to move an aging parent is a major issue right now for many families.

We think, however, that one of the areas we need to address in the part of the act that would look at residential long-term care in particular, but also at home care, is the issue of health human resources. Not only do 80% of care providers constitute an unregulated group, but we don't know how many there are in the country. We can't count them. Registries are not mandatory, and voluntary registries are pretty spotty across the country. That means tremendous variation. Many of these health care workers can't speak English well enough to answer a survey. It's unclear how that affects their provision of care. In English-speaking facilities, this is an issue.

We really need to have the guidelines and the umbrella principles under which to grapple provincially with issues of health human resources in terms of both qualifications and numbers. We need the ability to count them and the ability to address the needs of that workforce. Many of these women, primarily immigrant women in urban areas, work two full-time jobs. They work 16 hours a day and are themselves a vulnerable group that is caring for this complex group. We would see this as one of the major areas for which we need guiding principles that parallel some of the principles we have in the Canada Health Act.

[The Chair, Conservative, Joy Smith]

Go ahead, Mr. Poston.

[Dr. Jeff Poston]

If I can address the Therapeutics Initiative, I think that for some of the work this initiative has traditionally done, the common drug review is sort of doing some of that work now. However, I think it is important that we look at aspects of the work of the Therapeutics Initiative at a provincial level.

One of the things we've called for in successive submissions to the finance committee is funding for what we've called a national medication management centre. We have quite a lot of information relating to drugs. We have CADTH. We have CIHI. We have PMPRB doing their stuff. There's a lot of work and a lot of data that gets gathered. I think we need to look at better ways of actually getting it utilized at the provincial level.

I think you could imagine a network of centres at a provincial level, similar to the Therapeutics Initiative, but perhaps doing less on drug evaluation and more on playing their role in the academic detailing of physicians to improve prescribing outcomes. I think there would really be merit in looking at some sort of national network of such centres.

[Libby Davies, NDP, Vancouver East, BC]

If you've presented on that before, could you forward to us that information on the idea of a national...what did you call it?

[Dr. Jeff Poston]

National medication management centre.

[Libby Davies, NDP, Vancouver East, BC]

A national medication management centre. Could you forward that information?

[The Chair, Conservative, Joy Smith]

Yes, perhaps, Mr. Poston, you could forward it to the clerk, and she'll distribute to all members of the committee. Thank you so much.

Thank you, Ms. Davies. Now we'll go on to Mrs. Block.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Thank you very much, Madam Chair.

I'd like to thank each of our witnesses for being here today.

My first question will be directed to Ms. Garon. Among other measures to improve the quality of life for aging Canadians, our government provides funding to non-profit organizations through the new horizons for seniors program. With an annual budget of $28.1 million, this program helps improve the quality of life for seniors and their communities through what I believe you would call social participation.

My question for you is this: how do community organizations encourage or address social participation for aging Canadians living with reduced mobility? For homebound seniors who don't get out into the community, what does your organization do to encourage that participation?