Peer Health Navigator Certificate -Lesson 2: Canadian Health Care System

Please watch the following recorded lecture and video and respond to the discussion question below.

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ACS Patient Navigator Program 

Reflecting on your setting, what gaps in care do you identify?

Instructions: You must post your responses in the comments section below before the next live lesson. The instructor will review your comments and have a debrief discussion at the start of the next live session. The comments section will not be moderated otherwise.

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12 comments on “Peer Health Navigator Certificate -Lesson 2: Canadian Health Care System

  1. I am not in hospital yet, but some gasps I know for sure we have, are mental health and addictions services. Due to not having the resources, many people go to the Emergency Department because they just don't know where else to go. They are sent away without any real, concrete plans and they don't know where to go from there.
    I any situation, there is always a need to have assistance in any areas, stress makes it hard for anyone to focus and hear everything.

  2. Some gaps I've identified:
    *once released from hospital, you fall into the frightening gap of "what now?"
    *funds run out, but care needs continue. ie. physio can continue for years, but your coverage is minimal.
    *there are very few specialists in particular fields of mental health, specifically as it relates to children and trauma.
    *the notion that once the acute care needs are dealt with, medical hands are washed of the problem. But life needs to continue for patients, and they are often forgotten.

  3. A large portion of my clients have many obstacles in their way regarding social determinants of health before beginning their healthcare journey. Often, my clients have been shut out for years before addressing their health concerns due to stigma, self worth issues, and other factors of access. Often, our clients are intimidated not only by the healthcare service, but the abuse they have suffered from it either as PWUD or being from a marginalized -community (ex : indigenous or LBTQ+ clients). Due to these reasons, it would be highly effective and essential to have a Peer Navigator to help access healthcare and follow through the pathways without slipping through the cracks.

    Unfortunately, I work in Non- Profit and we are only an office of four people. We are constantly scratching for funds and as mentioned last class these funding cycles are very short. Passionate workers become disenfranchised or burnt out leaving both empathy and knowledge gaps. Funding the ability to foster relationships is a major factor in fostering wellbeing in people.

    1. Ps. Good news, I was invited into a sweat lodge today and given a great introduction to Maliseet and the recovery house here. ūüôā

  4. The gap with the medical system, is miscommunication, I noticed is when the doctors have found out what the name of the sickness you have they should be a follow up from the doctor before the surgery - like a checklist because when I had to go for day surgery, the night before this nurse had asked me when you got admitted to this unit, did the intake nurse gave u a booklet of what the surgery of what you will be doing. I answered no, she stated by the way do you still pee, she stated that she was not going to ask me that question because most dialysis patients do not pee. I then answered her and told I still pee. She commented the side effects of the dye that we put in your body will prevent you from peeing for the rest of your life, if this nurse did not ask me those questions, I would not have known that for each procedure there is a booklet. As a result of this incident, I phoned patient managment and I left a message with them to phone me back and they did not phone me.

    In 2020, while I was admitted on Wed afternoon to the hospital, the kidney doctor came by and stated to me that my liver is infected and I was in shocked because I have kidney issues too. So the next day when another kidney doctor showed up, she asked me if I have any questions, I stated to her yes, do I still have a liver infection. She stated that is very good question about your liver, however your kidney transplant and my liver was infected. My liver was infected because of high dosage of tylenol they were giving me for my fever. During this time my regular transplant doctor did not get back to me when I had left a message with them to phone me back. However, when I gave an update to the family doctor, his comment to me is to make sure that I request a copy of the discharge letter to the family doctor. I stated they should give you a copy of the discharge letter.

    On the third day, this person approached me and asked me my name, and I asked him who are you, he stated he is another kidney doctor, his name tag was turned around, he did not introducted himself. His comment that he was bad, that he should have introduced himself. Then his next comment how do you feel that you could leave now, I said I cannot leave now, I have to wait for husband to pick me up. He comes back with the discharge letter, I stated to the doctor I would like him to give a copy to my family doctor. He asked me to spell the name of the family doctor and where is he located. I followup with the family doctor and he stated when ever you are at the hospital that I have to request a copy to be sent to him, if I do not request it. He would not have gotten a copy of the letter, I feel that I have to advocate with my family doctor..

  5. Based on my 28 years of navigating health care systems for my daughter who has severe chronic health issues and now for myself, there are just too many gaps that I could detail. I will narrow it down to just a few.

    First, the health care system is very intimidating and extremely confusing to those who have not had to rely on it. People put their trust in the ‚Äúsystem‚ÄĚ and the doctors and quickly become very disillusioned and overwhelmed with it all. They get a diagnosis and they literally don‚Äôt know where to turn, often waiting weeks or months before they get to talk to anyone about it. Often their heads are spinning and they can‚Äôt make sense out of who is who and what their roles are until well into their journeys (and sometimes they still don‚Äôt understand at that point), especially those who might have cognitive decline. Moral support, connection and consistency definitely lack in our current system.

    Another barrier that exists is the ability for patients on similar journeys to connect with each other for moral support. Understandably, there are privacy laws for a reason but navigators, with consent from the parties, could help make this happen. Certainly, the internet and social media now afford us the ability to find connections that we would have never made before, but it still remains a barrier for some.

    A huge gap exists in the transition from pediatric to adult health care. In the pediatric world, the pediatrician plays an integral role of liaising with other health care professionals and acting as the central consistent professional on the team. They most often also have hospital privileges. In the adult world, especially in the chronic health care services in the area I live in, that central liaison does not exist professionally and holistic care is non-existent. The role of liaison and holistic care falls squarely on the caregiver‚Äôs shoulders or the shoulders of the patients themselves. They hold an immense amount of healthy history information in their brains and in their binders. Some professionals value this, some don‚Äôt. Another gap is where some parental caregivers do not have ‚Äúlegal‚ÄĚ legal guardianship to make decisions. We do have the ability to be deemed as ‚Äúsubstitute decision makers‚ÄĚ for those who are unable to communicate themselves but it can be a grey area at times for those who do not possess the capacity to assign power of attorney. Obtaining legal guardianship is a time and energy consuming process that costs a lot of money.

    In the case of a parental caregiver for an cognitively delayed adult child, caregivers are often not included in any discussions at the bedside (often too early in the morning) or they have difficulty accessing consultants on service in teaching hospitals where residents are highly relied upon to make decisions and report back to a consultant. Decisions are made with respect to medications and other treatments that are not discussed with the parental care provider, creating an inconsistency in care between the home and hospital environments. Parental caregivers in the adult world are sometimes seen as the most valuable member of the team and are relied upon heavily for their knowledge and expertise but in other instances or with other physicians, they are disregarded and that leads to a great amount of distrust. Additionally, family physicians do not carry hospital privileges where I live and therefore cannot order some necessary tests for their patients that are only available in hospital settings. Whereas in other Cities and areas of the country, family physicians have no difficulty accessing necessary tests at their local hospitals.

    Another gap in the system I have identified over the years is the inability to access some physicians outside of appointment times. My daughter has one specialist who is impossible to get to through his secretary. She is stern like a security guard, sometimes quite rude, and insists the doctor does not take calls, nor return calls from patients. It can be very intimidating for some so they will delay receiving attention for their issues until their appointments. For those who are expert at navigating the system, such as patient navigators, we are able to figure ways around that like accessing through another physician or allied health professional.

    Education for the patient and the caregivers is another very key aspect in the holistic care of the patient. I find this doesn‚Äôt happen enough. Fortunately for myself and my daughter, some of her specialists have been very good in educating me. For example, I‚Äôve learned what a ‚Äúgood‚ÄĚ baseline lung x-ray looks like for her and because of that, I was able to stop a resident from treating her for pneumonia in emergency when I had presented her to emergency for another reason. When he reviewed her chest x-rays, he saw what he thought was pneumonia whereas I knew what he was looking at was her intestines. Radiology confirmed what I saw and therefore I was able to avert the inappropriate treatment. I also know the majority of her lab level "normals" and have been told that one of her kidney levels is considered low but for her it is her 'normal'. I've been instructed that if that level ever goes up into the ‚Äúnormal‚ÄĚ range, it would be high for her and to not let anyone dismiss that. I‚Äôm not saying that all patients and caregivers have to be educated to the extent I have been but the more they are involved with understanding their condition and knowing their normal baselines and armed with information about themselves in order to allow them to trust their gut instincts and know their bodies, the better they and others are at advocating for them. Sadly, not all professionals value that. I see patient navigators playing an integral part with helping patients and caregivers in this aspect.

  6. Some gaps that I've observed or experienced:

    Hospice care - There is a huge demand for more residential hospice beds which requires more government funding. While more money is required upfront it would save money in the long run, and also improve the experience for the patient and family. It would keep some palliative patients out of the hospital therefore ultimately saving the government money. Governments need to do more cost/benefit analysis when looking at health investments such as hospice care. Too much of the responsibility is now landing on private fundraising efforts and this is not sustainable.

    Mental health - While there has been a shift in society in terms of talking about mental health and trying to remove the stigma, there is still a huge gap in terms of people experiencing mental health issues getting the help they need. There is lots of lip service in this area (eg. Bell Let's Talk Day) but not enough resources. Once again, the cost/benefit analysis would show that investing in this area would ultimately reduce health costs (eg. unnecessary visits to the ER, health costs of addictions).

    Seniors - There is a huge gap between the haves and have nots in terms of senior care. If one can afford it, there are lots of private services available to help those who can pay, thus allowing them to stay in their home longer. But those who can't afford help often end up in health care settings like hospitals just to have their basic needs met.

  7. Filling in the gaps and priorities in Dementia care and delivering appropriate Dementia care is a challenge in many countries or care settings that leads to contributing to unmet needs of people living with dementia.

    Organizations driven by considerations of cost-efficiency mostly provide the care for people with dementia within contexts marked by limited resources. Emphasis in these contexts is usually on completing physical care tasks without allocating adequate time to get to know the person with dementia. The focus is also on individual and organizational philosophies of safety, deprioritizing equity, dignity, and respect. This is evident in the labels used in frontline healthcare practice for people with dementia such as “difficult patient and the methods used to deescalate challenging behaviors.

    People living with dementia find social and healthcare systems fragmented, confusing, and difficult to navigate. Ineffective care pathways trigger transfers of people with dementia to inappropriate care settings, which leads to unnecessary medical interventions, extended lengths of stay in acute care settings, and poor experiences of care. People living with dementia frequently use emergency care services such as ambulances and emergency departments to overcome difficulties encountered in navigating care pathways, including end-of-life care. However, emergency care services lack the expertise and validated tools to undertake robust assessments of dementia care needs. The care required to meet complex medical and social needs at different stages of dementia is often poorly coordinated with limited access to specialist care and support from relevant services, especially at the end of life.

    Raising awareness about mental capacity empowers the workforce to support the people living with dementia with issues relating to consent, best interest decision-making, lasting power of attorney, and advance decision-making. The views of people living with dementia should inform learning and development frameworks for both senior and junior staff, including management teams to support continued improvements in care environments, staff confidence, and perceptions about dementia care; functional dementia care pathways to enhance the access to specialized care and to minimize the disruptions to care plans.

    Navigating priorities in Person centeredness in dementia care aims to sustain the person’s identity that is vulnerable to progressive cognitive decline. Person-centered dementia care encompasses recognizing individuality of the person as a whole and getting to know them and their diagnosis. Health and social care professionals achieve this through building relationships, involving families and maximizing communication with people living with dementia to draw on their expertise, as well as provide relevant information about stages of the dementia trajectory and supportive services available.

  8. Some gaps in care I've experienced:
    ‚ÄĘ Communication between care groups and systems (e.g. between walk-in clinics/emerg, family med, and specialists) - often they don't know what actually happens and rely on the patients for a complete history. Because a health card can't track visits/lab results from different sources like a bank card can for transactions, there is pressure on the patient that they need to have a binder and know everything about their care. Hopefully EMR help a bit with this.
    ‚ÄĘ Communication/education: Care path. Useful for specialists to know what happens to their patients after they leave their care. Might be able to help them if a patient in the future comes in with a similar case. Hopefully new Ontario Health Teams help a bit with this. Also would be helpful for specialists across regions to be able to communicate and learn from each other, especially as cancers are becoming more common but have specific mutations.
    ‚ÄĘ Communication/education: Hospital rounds (mentioned in Class 1) - I would show up for the 6:30am rounds to take notes. No one else in the ward did this, and the other patients were older. Although the meetings were between the doctors/students and patient, I was there as another set of ears + step in to ask questions that the patient forgot to ask.
    ‚ÄĘ Rural family med resources - often limited technology and talent available (therefore wait times + repeated scans and healthcare spending), so the window of time to go from "you might have a lump" to being referred to a specialist is lengthy and negative impact on patient outcomes for aggressive cancers. Rural and urban centres should communicate earlier. As well, due to limited resources/talent, the quality of care is decreased resulting to poor/negative/traumatic experiences for the patient and their family.
    ‚ÄĘ 0 support for patients who have cancer but have not started any treatment yet due to wait times. Can have patients feeling helpless and worthless. Being able to learn about holistic options and support groups just to "try anything" in the meantime could offer hope and let the patient "take charge" of their care. Cancer is very mindset-based as well so if a patient has the option to try anything in times of need, they might!

  9. The gaps that are currently present in the health care system in my opinion begin with a lack of communication and resources. Health teams, particularly in hospitals, do not seem to share patient information on a routine basis and therefore are not able to operate collectively. Having a liaison or navigator who could help link the gap would be advantageous. As well, initial contact with patients being admitted in hospital has gaps in terms of having an initial and consistent contact person who is able to build a relationship with the patient.

  10. Gaps based on my observation and more important from patient feedback:
    ‚ÄĘ A steady, consistent presence which helps them build trust.
    ‚ÄĘ Empathy, someone taking the time to listen to their concerns, opposed to being sent to another team.
    ‚ÄĘ Quality care delivered promptly and safely, respectfully, and affordably.
    Gaps across Canada regardless of province is access and only covers part of a patients needs. The popular buzzword is patient-centric (even pharmaceutical companies have jumped onto the buzzword), but the gap it truly human-centricity.
    We cannot solve all of Canada’s health care gaps, this would be an overwhelming complexity of a change in legislation and above all a major cultural shift.
    A first step, then, might be taking the time to understand the true scale and significance of the issue. ‚ÄúThe better we can frame the problem, the closer we are to a solution to the small wins for patients, caregivers and health care providers. Identifying and addressing biases and obstacles to care require a focus on on-the-groundwork. ‚ÄúWe have to look at the way teams are built‚ÄĚ and do a better job of incorporating community members or patient navigators throughout the healthcare continuum.
    Correcting the disparities of healthcare equity is imperative, and better engagement with neglected audiences is crucial to close this divide, and the neglected audiences being patients and what they want is a voice, how can we be patient centred if no one asks what the patient wants or needs.

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