Enhancing the delivery of comprehensive care for people living with HIV in Canada: insights from citizen panels and a national stakeholder dialogue.

BACKGROUND: People living with human immunodeficiency virus (HIV) are living longer with health-related disability associated with ageing, including complex conditions. However, health systems in Canada have not adapted to meet these comprehensive care needs. METHODS: We convened three citizen panels and a national stakeholder dialogue. The panels were informed by a plain-language citizen brief that outlined data and evidence about the challenge/problem, elements of an approach for addressing it and implementation considerations. The national dialogue was informed by a more detailed version of the same brief that included a thematic analysis of the findings from the panels. RESULTS: The 31 citizen panel participants emphasized the need for more prevention, testing and social supports, increased public education to address stigma and access to more timely data to inform system changes. The 21 system leaders emphasized the need to enhance person-centred care and for implementing learning and improvement across provinces, territories and Indigenous communities. Citizens and system leaders highlighted that policy actions need to acknowledge that HIV remains unique among conditions faced by Canadians. CONCLUSIONS: Action will require a national learning collaborative to support spread and scale of successful prevention, care and support initiatives. Such a collaborative should be grounded in a rapid-learning and improvement approach that is anchored on the needs, perspectives and aspirations of people living with HIV; driven by timely data and evidence; supported by appropriate decision supports and aligned governance, financial and delivery arrangements; and enabled with a culture of and competencies for rapid learning and improvement.

Examining the role of coaching in health-system transformations

OHTs are being introduced to provide a new way of organizing and delivering care that is more integrated from the perspective of the patients in their local communities, and that achieves measurable improvements in key quadruple-aim metrics of improving care experiences and health outcomes at manageable per capita costs and with positive provider experiences. This change requires significant adjustments to the way in which care is organized and provided, as well as the ways in which organizations and providers across the system interact with one another.

Exploring models for health workforce planning

The health of British Columbians has continued to improve over the past decade, with gains in healthadjusted life expectancy and a gradual decrease in the gap between the life expectancy of women and men.(1) These gains in health status have come, in part, as a result of provincial efforts to strengthen health systems and ensure that programs, services and technologies get to those who need them. Essential to these efforts is ensuring that the right mix of health workers are equipped with the right skills to provide British Columbians with high-quality care when and where they need it.

Examining the effects of youth skills-development programs

Improving labour-market participation of youth is a common objective across most advanced economies. Achieving this goal is critical to developing a strong economy, as well as for ensuring the social cohesion and inclusion of youth in society.(1) However, countries around the world face the significant challenge of ensuring youth have the skills they need to enter the labour market and to get fulfilling jobs that make use of their education.

Examining the efficiency and effectiveness of ontario's health workforce regulatory system

The regulation and oversight of the health professionals responsible for providing care to patients in Ontario is an important mechanism to ensure patients receive the highest-quality care possible (e.g., by setting the standards that professionals need to meet in their practice) while mitigating, to the extent that is possible, the risks of harm that may be associated with the provision of healthcare services (e.g., by ensuring health professionals are fit to practice, and that those who are licensed to practice have the competencies to provide the services patients need safely). There are currently 261 regulatory colleges in Ontario that provide oversight for the 292 health professions that are regulated in the province, which collectively include over 300,000 healthcare professionals Additionally, there are several organizations providing oversight and guiding the practice of the many health workers who are not currently regulated, such as personal-support workers (PSWs) ­ of which there are many ­ as well as assistants of many kinds (e.g., dental, medical laboratory, physiotherapy and osteopath), athletic therapists, hearing-instrument practitioners, lactation consultants, marriage and family therapists, medical geneticists, paramedics, pedorthists, phlebotomists, and personalservice workers of many kinds (e.g., ear piercers, tattoo artists).

Using multi-source feedback and other practice assessments for quality assurance in nursing

Under the Regulated Health Professions Act, 1991 every regulatory college in Ontario is expected to establish a quality-assurance program to ensure the ongoing quality of each profession's practice.

Examining the effects of prenatal education

Prenatal education has expanded significantly over the past two decades, from its initial conception as an opportunity to teach pain management in labour and preparation for birth in the hospital environment to including broader public-health principles of preparing women and their families for pregnancy, labour and birth, care of the newborn and the adjustments to life as a family.(1) It also provides an opportunity to assist women in detecting warning signs in pregnancy, build confidence in self-care, and can act as an opportunity for early intervention in high-risk pregnancies.

Learning from the Experience of Accountable Care Organizations in the US

In February 2019, the Government of Ontario revealed its plans to reform the Ontario health system. The plans include the amalgamation of the province's six provincial agencies (i.e., Cancer Care Ontario, Health Quality Ontario, eHealth Ontario, Trillium Gift of Life Network, Health Shared Services Ontario and HealthForceOntario Marketing and Recruitment Agency) and its 14 Local Health Integration Networks into one central agency responsible for planning, delivering and improving the quality of care in Ontario.(1) In addition, the province announced its intention to support the development of a number of Ontario Health Teams (OHTs), which would have providers and organizations work together in networks to deliver the

Identifying effective approaches to support parents and caregivers of children with fetal alcohol spectrum disorder

Fetal Alcohol Spectrum Disorder (FASD) is used "to describe a broader spectrum of presentations and disabilities resulting from alcohol exposure in utero."(1) FASD affects fetal and brain development and may result in limitations to any of an individual's: memory; sensory integration; social communication; language processing; emotional regulation; adaptive functioning; and other executive functions that may make conforming to social, behavioural and cognitive expectations difficult.(2; 3) These effects may mean that individuals affected by FASD are unable to live independently, have difficulty securing employment, and experience behavioural challenges that increase their risk of being in conflict with the law.

Supporting parents in making informed decisions in relation to their children's health needs

Momentum for patient and caregiver engagement in health and social care is growing across Ontario.(1) This is evidenced by a number of recently released strategies and frameworks highlighting the importance of involving Ontarians in their own care as informed consumers of health and social services. One such notable example was the Patients First Act 2016, for which a key pillar was informing and educating patients to make informed decisions about their health in efforts to improve their experiences and health outcomes.

Examining compensation models for walk-in clinics

Positioning primary care as the cornerstone of the health system and establishing primary-care providers as the gatekeepers and coordinators of care has been a long-sought aim of health systems around the world. Further, a main aim of this goal in Canada has been to have a primary-care provider that is responsible for the health and well-being for each insured patient. However, ensuring that all citizens in a province are registered with a primary-care provider who is responsible for their care and can provide timely access to care when needed has proven difficult to achieve. This is not surprising given that primary-care providers in Canada are confronted with many challenges in their practices, including one or more of having to serve large geographical areas, providing care to uninsured populations, and managing high workloads as well as a mismatch between provider availability and the need for timely access to services (particularly after-hours and weekend care). When coupled with the policy legacies of how physicians in Canada have traditionally delivered care and been remunerated (e.g., as private business owners with public fee-for-service payment), the result is a patchwork of primary-care models.

Understanding the use of and compensation for virtual-care services in primary care

Provincial and territorial health systems across Canada continue to struggle with delivering timely access to primary-care services. In 2016, 74% of Canadians reported in the Commonwealth International Health Policy Survey that they received excellent or very good care from their regular doctor, which is above the 11-country average of 65%. However, Canadians also reported the longest wait times to see a primary-care provider across the 10 countries, with one in five reporting a wait of over seven days the last time they needed medical attention. To address this challenge, policymakers across the country have been increasingly exploring options to improve the delivery of patient-centred health services through the introduction and evolution of virtual care to enhance accessibility and efficiency.

Identifying performance measures, indicators and targets to monitor and evaluate dementia strategies

Dementia is a complex condition and refers to "progressive brain syndromes which affect memory, thinking, behavior and emotion."(1) While the experience of dementia is different for each person, it eventually progresses to an individual not being able to care for themselves and requiring assistance with all aspects of their daily life.(1) Accounting for approximately 50% to 60% of all cases of dementia, Alzheimer's disease is the most common of the more than 100 known forms of dementia. Common symptoms of all forms of dementia include memory loss (e.g., inability to recall details of recent events or conversations, not recognizing or knowing family members' names), frequent difficulty in finding words (e.g., with pauses or substitutions when finding words) or understanding what others are saying, not being to perform routine tasks, and changes in personality or mood

Fostering K-12 students' global competencies

The environment in which children are growing up today is very different than that of previous generations. There has been tremendous innovation in how society operates, with the rapid expansion of technology, globalization of businesses, new careers and opportunities, and increasingly diverse communities. Students graduating from high school have tremendous opportunities to be personally successful, economically productive, and actively engaged. To capitalize on these opportunities however, it is critical that our education systems support students in acquiring the right competencies to navigate increasingly complex societies.

Supporting professional learning approaches to foster global competencies in K-12 education

Education is key to equipping individuals with the necessary skills to meaningfully contribute to society.(1) Rapid developments in technology, workforce changes and the effects of globalization mean that societies are evolving at a faster than ever pace. Responsive education systems are needed to properly prepare students with the required skill sets to meet these changing demands

Determining the features of person-centred models of care that patients value

Providing care that is person-centred is a key goal for provincial and territorial health systems in Canada.(1) This is demonstrated by a number of provinces having recently put forward legislation or key strategies working towards this aim. For example, in 2014, the Ministry of Health of British Columbia (where this rapid synthesis was requested from) released their strategic plan, Setting Priorities for the B.C. Health System, which posited that the province's health system needed improvement with respect to meeting the needs of key patient populations.(2) The plan listed providing patient-centred care as one of the eight priorities for the healthcare system and reiterated its importance in the 2015 report - B.C. Health System Strategy Implementation.(

Identifying indicators and rates of poverty among older adults

At any age living in poverty and economic insecurity affects all aspects of an individual`s well-being, but there is a unique burden for seniors given that it is often combined with challenges associated with aging, such as multimorbidity, reduced mobility and independence, and loss of community and social supports.

Examining the costs and cost-effectiveness of policies for reducing alcohol consumption

Alcohol consumption is currently the world's third largest risk factor for disease, attributable for 5.1% of the global burden of disease, with clear links to conditions such as neuropsychiatric disorders, gastrointestinal diseases, cancer, intentional injuries, unintentional injuries, cardiovascular diseases and diabetes.(1; 2) As of 2014 alcohol was responsible for 3.3 million global deaths (or 5.9% of all deaths) annually.(2) In 2014, approximately 22 million Canadians, almost 80% of the population, reported that they drank alcohol in the previous year. In 2015, the Chief Public Health Officer of Canada reported that at least 3.1 million Canadians drank enough to be at risk for immediate injury and harm, and at least 4.4 million drank enough to be at risk for chronic health effects such as liver cirrhosis and forms of cancer.(3) Canadians are also among the largest consumers of alcohol in the world, with 2013 sales data indicating that Canada consumes 50% more alcohol than the global average, and has a higher prevalence of binge-drinking than most countries in the European Union.

Identifying effective and cost-effective population-level approaches to promote healthy eating

There is a well-documented global trend toward increased consumption of energy-dense and high-fat foods, combined with increases in sedentary lifestyles.(1) These changes have contributed to a global epidemic of overweight and obesity, as well as significantly increased risks for many diseases, including cardiovascular disease, diabetes, musculoskeletal disorders, and a number of different types of cancer.

Enhancing health promotion and disease prevention in networked primary care

Health systems are moving away from traditional primary care (e.g., by increasingly shifting to group practice and interprofessional teams rather than solo practice primary-care providers), which is often siloed and results in barriers to timely access to care.(1) The Ministry of Health of British Columbia, which requested this rapid synthesis, is undergoing system transformation to better coordinate and potentially integrate primary care with some and community care and public-health services.(2) The transformation presents an important opportunity to improve primary care and preventive care services through improved management of clinical conditions coupled with health promotion and diseaseprevention services.