Do provincial drug benefit initiatives create an effective policy lab? The evidence from Canada.

Although the costs of doctors' visits and hospital stays in Canada are covered by national public health insurance, the cost of outpatient prescription drugs is not. To solve problems of access, Canadian provinces have introduced provincial prescription drug benefit programs. This study analyzes the prescription drug policymaking process in five Canadian provinces between 1992 and 2004 with a view to (1) determining the federal government's role in the area of prescription drugs; (2) describing the policymaking process; (3) identifying factors in each province's choice of a policy; (4) identifying patterns in those factors across the five provinces; and (5) assessing the federal government's influence on the policies chosen. Analysis shows that despite significant differences in policy choices, the ideological motivations of the provinces were unexpectedly similar. The findings also highlight the importance of institutional factors, for example, in provinces' decision to compete rather than to collaborate. We conclude that, to date, Canada's federalism laboratory has only partly benefited the Canadian public. Cost pressures may, however, eventually overcome barriers to cooperation between the provincial and the federal governments, enabling them to capitalize on Canada's federal structure to improve the accessibility and affordability of drugs.

Prevalence of emotional distress in newly diagnosed lung cancer patients.

GOALS OF WORK: Distress is defined by the National Comprehensive Cancer Network as a multifactorial unpleasant emotional experience of a psychological, social, and/or spiritual nature that may interfere with the ability to cope effectively with cancer. We investigated the prevalence and associated symptoms of distress in newly diagnosed lung cancer patients. PATIENTS AND METHODS: Between November 2005 and July 2007, 98 newly diagnosed lung cancer patients completed an assessment. The Distress Thermometer (DT) and Edmonton Symptom Assessment Scale (ESAS) were used as screening tools. MAIN RESULTS: Fifty (51%) patients reported clinically significant distress (>or=4) on the DT. Of those, 26 (52%) patients reported high levels of depression, nervousness, or both on ESAS. The remaining 24 (48%) patients had elevated levels of distress but no significant depression or nervousness. A correlation between the DT and the total ESAS score was observed (Pearson correlation = 0.46). The ten items of the ESAS together explained 46% of the variability in DT scores. The depression and nervousness ESAS items were significant predictors of DT score (p < 0.01 for both items). However, once the two psychosocial items, depression and nervousness, were removed from the total ESAS score, leaving only physical symptoms and the sleeplessness item, the predictive power of the model decreased to R(2) = 0.12. CONCLUSIONS: The prevalence of distress in lung cancer patients is high. The DT appears to discriminate between physical and emotional distress. This easily measured score may determine which patients require further intervention for emotional distress.