January is the month for predictions. Thus far, there have been two major subjects for forecasts in the healthcare field. One is COVID and the other is the state of the Canadian healthcare system overall. Of course, the two are interlinked.
First, COVID. To be honest, this writer has lost track of which wave we are in, if we are in a wave at all. Perhaps epidemiologists and surfers are more familiar with the terminology of waves. Given that Canadians are currently dealing not just with COVID, but also with seasonal flu and other respiratory ailments, we are surely at least in a swell, if not a tidal wave.
Experts in virology and emergency medicine are not unanimous in predicting when another variant or variants might develop. They are of one mind, however, that one or more will come this year. The two unknowns are when and how serious the variants will be. Will they overtake Omicron, as is suggested with XBB.1.5? Will current vaccines and boosters and immunities from previous COVID infections fight off the new variants? There is no way to accurately predict answers.
The only thing that is certain at the start of 2023 is that COVID is not over. It is still everywhere and everyone is still susceptible, regardless of vaccine status. Yet again, the only thing that can protect Canadians is to be fully vaccinated, including boosters. Unfortunately, however, the rate of vaccine and booster uptake has decreased. Canadians remain at just over 80 per cent level of at least one shot. It’s not enough.
While it is true that even those fully vaccinated and boosted can catch COVID, this should not deter people from getting all the shots possible. Evidence shows that previously vaccinated people who contract COVID experience a milder version of the virus. Evidence also shows that they require fewer hospitalizations and that far fewer die of the disease.
Even if not familiar with the wave lexicon, this writer is exceedingly familiar with the line “get vaccinated.” Since vaccines first became available to Canadians in 2020, getting each vaccine as it becomes available has always been the single greatest protection against the virus. Nothing has changed in that regard and that’s my final answer.
Which brings us to the second subject of predictions. The overall state of healthcare in Canada and what can be done about it. We are currently at a stand-still, as the provinces and territories insist on more federal money to fix the system and the federal government insists that more money be tied to measurement of outcomes.
There has been a shift in the commentary on this debate. While everyone believes that more money will help, many voices now insist that the system itself must change. The consensus is that spending more money to fix the current system is not the way to go.
The provinces and territories still want funds for new fixes to the old system. Others, including professional groups and healthcare policymakers, now urge a revamp of the healthcare system as a whole. And that revamp has to include measurement of outcomes.
To be fair, some positive changes have been made. Individual hospitals and healthcare providers have made helpful strides.
For example, Women’s College Hospital (WCH) in Toronto has developed the capacity for many surgeries and procedures to be performed without requiring patients to stay overnight. The hospital, a pioneer in Canada as a hospital without beds, uses non-invasive procedures to send patients home without extended stays, even for procedures like hip and knee replacements.
WCH should be congratulated for such innovation. The challenge is for hospitals across the country to follow suit. How can such changes be scaled up? Canada does not have a mechanism to make doing so simpler.
Another example is the expansion of the role of pharmacists in Ontario. Beginning in 2023, they will be able to diagnose and prescribe medications for thirteen of the most common ailments. No longer will people with such problems as pink eye, UTIs, hemorrhoids, among others, require a doctor’s visit.
Ontario pharmacists will also be able to prescribe Paxlovid to high-risk patients who contract COVID.
Will this be the start of a welcome expanded scope of practice for pharmacists? Even if it is, it is not without its own issues. Not all pharmacies can accommodate this extra responsibility and not everyone can access pharmacies that do.
What about other healthcare professionals? Many professional groups continue to operate under mandates established in the previous century. Not all healthcare professionals currently practicing can take on expanded responsibilities without further training. Examining the scope of practice of all healthcare professionals cannot be done in silos, nor can it be done overnight. Coordination and timing are major factors.
What are the overriding concerns to address the problems in Canada’s healthcare system? Everyone seems to agree that there are problems, but no one seems to be able to find a starting point to fix the issues.
One organization out of the UK has been bold enough to predict the next big response to what ails us. And what ails them is very similar to what ails us. Pharmaphorum states that it “combines industry leading publications, strategic consulting and a content-driven stakeholder engagement agency.”
Their prediction for the new year is blunt. “As the full fallout from the pandemic hits health systems in the form of squeezed budgets, patient backlogs and serious resource shortages, we should expect to see concerted efforts aimed at a leap in digital maturity. In 2022, digital transformation may offer the only way for stressed health systems to move towards a sustainable, post-pandemic future.”
If only digital transformation were that simple. Certainly, the state of integrated digital records and of digital healthcare service delivery in Canada needs massive investments in development and implementation.
Ontario readers may recall an earlier plan to coordinate healthcare records. eHealth was engulfed in a spending scandal that the province’s former auditor general said cost taxpayers $1 billion. It was not Ontario’s finest hour. Improvements have been made, but province-wide integration is years away.
Is there a final answer to the crisis in healthcare that Canada is facing? No. Is that my final answer? Yes