A comparison between British Columbia and Quebec.
In 2000, Canada chronic diseases accounted for $99.1 billion with $31.6 billion being associated in direct costs (BC Ministry of Healthy Living and Sport, 2010). These numbers have only risen and it is estimated that chronic diseases account for $190 billion annually with $68 billion of it being in direct costs (Chronic Disease Prevention Alliance of Canada, 2018). Most of the direct costs are due to chronic diseases that can be prevented and mitigated. Currently in Canada, 44% of adults 20+ have at least one common chronic condition (Health Canada, n.d.). Additionally, 10% of these individuals are affected by Chronic Obstructive Pulmonary Disease (COPD) (Health Canada, n.d.).
Working as a Respiratory Therapist, COPD is a chronic disease that I encounter very frequently. In British Columbia (BC) alone, approximately 138,500 individuals aged ≥ 45 years in BC have been diagnosed with COPD (Government of BC, n.d.). This is roughly 6% of British Columbians aged ≥ 45 years (Government of BC, n.d.). In the Fraser health, the health authority I work in roughly 30, 000 people live with COPD (Fraser Health, n.d.).These numbers however may not represent the true number of people living with COPD as many individuals go undiagnosed.
Chronic Disease is an issue that is plaguing all of Canada. As our population ages, chronic disease management has become an increasingly more focused area in health care. Each province has implemented their own strategies to combat chronic disease through various preventive and management methods. Below I will highlight how BC and Quebec tackle chronic diseases. I will specifically elaborate how each province conducts chronic disease surveillance, management and obtain funding.
Chronic Disease surveillance:
For the surveillance of Chronic disease management, BC uses The Population & Public Health Program. This program collects, analyzes, and shares data about health status and chronic diseases in BC (BCCDC, n.d.). In Quebec, the Quebec Integrated Chronic Disease Surveillance System (QICDSS) was created for Chronic Disease surveillance. The database was created by linking five health administrative databases (Blais et al, 2014). The QICDSS allows the surveillance of the following chronic diseases: diabetes, cardiovascular diseases, respiratory diseases, osteoporosis, osteoarticular diseases, mental disorders and other related disorders (Blais et al, 2014.).
Chronic Disease management:
British Columbia Core Functions of Public Health Framework (CF Framework) identified the need for twenty-one core public health programs. The CF Framework highlighted the areas of health improvement; disease, disability and injury prevention; environmental health; and health emergency management (Kothari et al, 2013). It is the responsibility of the various health authorities for implementation and quality of their programs. Health authorities are expected to develop programs/services and conduct a performance improvement plan for each core program (Kothari et al, 2013). Although in BC, the provincial government has established a provincial wide program called The Chronic Disease Self-Management Program for individuals suffering from chronic diseases. It is a six-week program that focuses on patient education (Government of British Columbia, n.d.). The program is tailored to the individual’s specific chronic disease and is available in various languages (Government of British Columbia, n.d.).
Additionally, many of the various health authorities in BC provide their own chronic disease management programs. Fraser health, the health authority I work in for instance has; Asthma Education Program, Chronic Pain Clinic, Community Dialysis, Community pain program, COPD Self-Management Program, Diabetes Education, Home Hemodialysis, Inflammatory Arthritis Rehab Clinic, Kidney Care Centre, Lung Health, Multiple Sclerosis Clinic, Peritoneal Dialysis, Positive Health Services, Pulmonary Rehabilitation Program, Renal Vascular Access Clinic and Stroke Prevention Clinic (Fraser Health, n.d.). For example, the COPD Self-management program provides education and tips on how to better manage chronic obstructive pulmonary disease (COPD) condition at home. Patients are given education on medication review, breathing exercises, controlling shortness of breath and other COPD relevant information (Fraser Health, n.d.). Similarly, Providence Health has many chronic disease management programs. The COPD outpatient clinic in providence health aim to optimize care in COPD patients according to best clinical practice in a multidisciplinary setting (Providence Health, n.d.). The team is composed of a respirologist, a respiratory therapist, a dietitan, physiotherapist and patients are referred by physicians (Providence Health, n.d.). Additionally, the increasing number of individuals living with chronic diseases has led Providence Health to establish the Rapid Access to Consultative Expertise (RACE). The RACE program is a telephone advice line where family physicians can call and choose various specialty services and be routed directly to a specialist for real-time advice (Providence Health, n.d.).
The Ministère de la Santé et des Services sociaux (MSSS) of Quebec has made the prevention and management of chronic diseases a priority. The government has developed and disseminated their strategy for the prevention and management of chronic diseases to all health and social services agencies (ASSS) in Quebec (Ahmed et al, 2015). Quebec uses the Chronic Care Model (CCM) framework for the management of chronic diseases like the rest of Canada. It has been adopted by the MSSS’s strategy for the prevention and management of chronic diseases (Ahmed et al, 2015). As a result, Quebec has made Family Medicine Groups (FMGs) one of the cornerstones of its chronic disease management reforms (Health Canada, 2007). The FMG is composed of family physicians working in close collaboration with nurses to provide a wide range of services to clients who enroll voluntarily (Health Canada, 2007). The services offered are tailored to the individual health status of registered patients. The program offers disease prevention, health promotion, medical assessment, diagnosis and treatment of acute and chronic conditions (Health Canada, 2007).
Funding:
Both BC and Quebec utilized the Primary Health Care Transition Fund (PHCTF). The PHCTF provides funds to all the provinces and territories for the development and implementation of new models of public health care delivery (Health Canada, 2007). The fund was created with an increase emphasis on health promotion, disease and injury prevention, and chronic disease management (Health Canada, 2007). Currently, majority of funding for programs in both provinces comes from the provincial government. Quebec uses the Fonds de recherche du Québec—Santé (FRQS), the provincial funding agency (Ahmed et al, 2015).
As illustrated above, both these Provinces have prioritized efforts to deal with the increasing prevalence of chronic disease. Each province uses their own methods to conduct chronic disease surveillance and management. BC and Quebec both use similar methods for obtaining funding. Although, both provinces use different methods, they share a similar commitment to helping individuals deal with and combat chronic diseases.
References:
Ahmed, S., Ware, P., Visca, R., Bareil, C., Chouinard, M. C., Desforges, J., Finlayson, R., Fortin, M., Gauthier, J., Grimard, D., Guay, M., Hudon, C., Lalonde, L., Lévesque, L., Michaud, C., Provost, S., Sutton, T., Tousignant, P., Travers, S., Ware, M., … Gogovor, A. (2015). The prevention and management of chronic disease in primary care: recommendations from a knowledge translation meeting. BMC research notes, 8, 571. https://doi.org/10.1186/s13104-015-1514-0
BC Centre for Disease Control. (n.d.). Population & Public Health Surveillance. BCCDC. Retrieved March 8, 2022 from http://www.bccdc.ca/our-services/programs/population-public-health-surveillance
BC Ministry of Healthy Living and Sport. (2010). Model Core Program Paper: Chronic Disease. BC Ministry of Healthy Living and Sport. Retrieved January 23, 2022 from https://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/public-health/healthy-living-and-healthy-communities/chronic_disease-model_core_program_paper.pdf
Blais, C., Jean, S., Sirois, C., Rochette, L., Plante, C., Larocque, I., Doucet, M., Ruel, G., Simard, M., Gamache, P., Hamel, D., St-Laurent, D., & Emond, V. (2014). Quebec Integrated Chronic Disease Surveillance System (QICDSS), an innovative approach. Chronic diseases and injuries in Canada, 34(4), 226–235. https://www.canada.ca/en/public-health/services/reports-publications/health-promotion-chronic-disease-prevention-canada-research-policy-practice/vol-34-no-4-2014/quebec-integrated-chronic-disease-surveillance-system-qicdss-innovative-approach.html
Centers for Disease Control and Prevention (CDC). (2019). Chronic Disease. Retrieved March 8, 2022 from https://www.youtube.com/watch?v=c91ggTlEGv8
Centers for Disease Control and Prevention (CDC). (2017). Self-Management Education: Managing Chronic Conditions Beyond Medications. Retrieved March 8, 2022 from https://www.youtube.com/watch?v=de2llrEajvU
Chronic Disease Prevention Alliance of Canada (2018). 2018 pre-budget submission to the House of Commons Standing Committee on Finance. Chronic Disease Prevention Alliance of Canada. Retrieved January 23, 2022 from https://www.ourcommons.ca/Content/Committee/421/FINA/Brief/BR9073636/br-external/ChronicDiseasePreventionAllianceOfCanada-e.pdf
Fraser Health Authority. (n.d.). Chronic Disease Management. Fraser Health. Retrieved March 8, 2022 from https://www.fraserhealth.ca/Service-Directory/Services/chronic-disease-management
Fraser Health Authority. (n.d.). COPD Self-Management Program. Fraser Health. Retrieved March 8, 2022 from https://www.fraserhealth.ca/Service-Directory/Services/chronic-disease-management/copd-self-management-program
Fraser Health. (n.d.). Chronic Obstructive Pulmonary Disease (COPD). Fraser Health. Retrieved March 8, 2022 from https://www.fraserhealth.ca/health-topics-a-to-z/copd#:~:text=COPD%20is%20a%20lung%20disease,last%20year%20in%20the%20province.
Government of British Columbia. (n.d.). Chronic Condition Care. Government of British Columbia. Retrieved March 8, 2022 from https://www2.gov.bc.ca/gov/content/family-social-supports/seniors/health-safety/disease-and-injury-care-and-prevention/chronic-condition-care
Government of British Columbia. (n.d.). Chronic Obstructive Pulmonary Disease (COPD): Diagnosis and Management. Government of BC. Retrieved from March 8, 2022 from https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/copd#:~:text=Approximately%20138%2C500%20individuals%20aged%20%E2%89%A5,Columbians%20aged%20%E2%89%A5%2045%20years).&text=Many%20individuals%20have%20unrecognized%20COPD%20and%20remain%20undiagnosed.
Health Canada. (2007). Chronic Disease Prevention and Management. Retrieved March 8, 2022 from https://www.canada.ca/en/health-canada/services/health-care-system/reports-publications/primary-health-care/chronic-disease-prevention-management.html#f2
Health Canada. (n.d.). Prevalence of Chronic Diseases Among Canadian Adults. Health Canada. Retrieved March 8, 2022 from https://www.canada.ca/en/public-health/services/chronic-diseases/prevalence-canadian-adults-infographic-2019.html
Kothari, A., Gore, D., MacDonald, M., Bursey, G., Allan, D., Scarr, J., & Renewal of Public Health Systems Research Team (2013). Chronic disease prevention policy in British Columbia and Ontario in light of public health renewal: a comparative policy analysis. BMC public health, 13, 934. https://doi.org/10.1186/1471-2458-13-934
Providence Health. (n.d.). Chronic Disease Management. Providence Health Retrieved March 8, 2022 from https://www.providencehealthcare.org/chronic-disease-management
Providence Health. (n.d.). COPD Clinic. Providence Health. Retrieved March 8, 2022 from https://www.providencehealthcare.org/copd-clinic
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