Patient Navigation Certificate - Lesson 2: Canadian Health Care System

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

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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 starting at 10 AM ET on Day 2. 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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17 comments on “Patient Navigation Certificate - Lesson 2: Canadian Health Care System

  1. RE: Gaps in our system?

    I believe at this time, if an individual develops an acute onset condition that requires emergency surgical intervention, our healthcare system often works very well as the patient quickly flows through the system that is designed to get them well and to a discharge.

    However, some of the more glaring gaps can be observed once the client is discharged from acute care. On many occasions, clients have expressed regret at disregarding hospital discharge instructions while an inpatient Many clients despite having had instruction on their health condition and goals struggle to explain what medications they are prescribed and why?

    Other gaps can be seen in the pediatric transition to adult health. In this regard children and parents are tasked with making their way in a busy adult world with very little in the way of hands on support. Navigation support for families who have a child with a disability is limited at this time.

  2. Reflecting on your setting, what gaps in care do you identify?
    Ontario health care system

    Cultural and Socioeconomic Barriers – Difficult for healthy, well educated, English speaking and financially secure patients to access information about the different care/treatment options and even more challenging for others.

    Financial Disparities - Patients often unaware of differences between OHIP and other provincial health care available in hospitals compared to what is available when the patient is at home, e.g. medications, chemotherapy. Some patients might discontinue or limit medications or treatment due to cost.

    Many patients have no private insurance coverage or limited coverage to cover care and treatments that OHIP and other provincial health insurance plans don’t cover or inadequately cover such as dental care, optometrist visits (adults between 20 and 64 years of age) and eye glasses.

    Inadequate Communication, Eligibility about provincial Drug Plans and difficulty with Application Process - Many patients are not aware of and do not qualify for Trillium Drug Program. Some patients who do qualify might experience difficulty completing application forms e.g. patients with cognitive deficits, or language barriers.

    Inadequate Communication - Many Ontario residents are not aware of the Assistive Devices Program which causes them to pay the full price for devices they might otherwise be able to acquire at a substantial savings. This is especially concerning for patients with limited financial resources who might forgo other necessities to purchase an assistive device.

    Inadequate Communication – Many residents are unaware that some patients may be eligible for provincially covered in-home care such as PSWs, OTs, etc.

    Limited In-Home Care Entitlement – Patients who are entitled to in-home care (e.g. PSWs etc.) are offered limited hours of care per week. This can make it difficult and stressful for some people to get the care they need and remain living at home safely.

    Financial Disparities - Patients often experience long wait lists for provincially covered physiotherapists, psychiatrists, etc.

    Relationship and Communication Problems with Gatekeepers – Rushed appointments with family physicians, NPs, contribute to poor communication. Patients might not understand the care instructions they are given, might not be able to adequately communicate to health care professionals and this might affect their ability to gain access to specialists and other care.

    Shortage of Family Physicians – Many patients experience long wait lists to acquire a family physician and will visit walk-in clinics where it is more difficult to develop a relationships with a physician.

    Inadequate Communication – Poor communication between the various health care professionals (family physician, optometrist, etc.). Poor communication between health care professionals and patient and family members may result in missing or misunderstood information. Appropriate treatment may not be provided.

    Inadequate Communication - Although Canadians are entitled to a basic level of health care across Canada, some might not expect that differences exist in coverage between the provinces and territories. This might catch some out of province visitors and long distant family caregivers by surprise.

    Difficult for out of province family caregivers to monitor their family members, to access specialists, to set up and monitor in-home care, to ensure patients follow treatment regime and to determine when family members might need health care modifications.

  3. Hi everyone. Thanks for sharing in such detail, with such passion for seeing improvement in these areas you all have identified. There is perhaps no gap raised so far by all those who posted before me that is not experienced to a large extent here in Trinidad & Tobago (where I am from - a small twin-island Caribbean nation). My background is in Biomedical Engineering so I am not immersed in the care environment like most of you to speak from firsthand experience. However, what I and every citizen knows is that the worst possible thing that can happen to you is to be in need of healthcare in our resource-limited settings. Even if someone accesses the public hospital emergency units, you will be in shock of how long they have to wait to be seen by a healthcare provider, a lot of of the times waiting over 48hrs in a chair. NCD patients also suffer extensively long-waits for clinic appointments, treatment services (radiation, chemotherapy) etc. Space limits me to speak of all the gaps in detail so I will just list some other major ones: lack (no) available funding for public health research, inadequate, overcrowded healthcare facilities, recent influx of of neighboring Venezuelan refugees that has contributed a significant additional overload on the system, no patient navigation program - strong reliance on family members for support.

    On that last point - from personal experience I have witnessed family members of patients experience extreme burn-out to the point of depression and life-disruption. I would like to better understand how certified navigators can provide support (even educational) to help them cope with the stress of caring for a loved-one. I may even be interested in starting this sort of program in my country since to my understanding there is none - unless you can afford to pay for private care.

    Finally, my project will focus on Breast Cancer Survivorship, and like we learned today wrt to Patient Navigation, it is firstly important to define what survivorship is or rather looks like among this patient population. Since there is currently no available data on cancer survivorship for our country, I hope to be able to identify the gaps and narrow in where the greatest needs are to be able to target those and incorporate them into a survivorship program that will help survivors to be able to better manage and cope with their condition. I hope to encourage a patient empowered approach to care and survival.

  4. Gaps I have identified in our area:

    Communication - not having access to a universal system to chart and communicate with other professionals in a persons care team. It is very challenging, with complex clients who potentially have large care teams, to stay up to date on a clients care and the status of their care goals..

    Silos - People and organizations that are made to work in very specific silos or what they can provide to a person, or for how long. In a perfect world, a client would be able to obtain the support they need until stable or goals are completely met (instead of offloading follow-ups or continuation of care to the client, family, or other person on the care team)

    Preventative Care - There seems to be little support for once a person is considered "stable". Once a crisis has stabilized many supports are quick to discharge, which often times leads to a relapse or exacerbation as no one was involved to identify these signs. There needs to be more continuation of care.

    Transportation - as many of us have identified this is a HUGE issue. Being in a rural setting where the closest specialists are a minimum of an hour away causes unnecessary hardship for anyone but especially those of low or fixed income.

    Safe/Affordable/Accessible Housing - very few rental opportunities available.

  5. Patients are often discharged from hospital without a clear understanding of how to get the care that they will need to stay out of the hospital. If they do not have someone to advocate for them and to ask questions, they may fall through the cracks. They will wait to see who comes to help them instead of being proactive and asking for what they need. I have seen this many times with some of our clients with early dementia. They can't get to medical appts or groceries and supplies and can't communicate that. I also see individuals who need help, beyond what the government offers but will not pay for it. Instead, they expect their spouse, who have their own health concerns to provide the care. The spouse can become worn out and more ill themselves.
    Patients need someone to guide themselves and their families, so they know how to ask for help. For example, if a palliative client comes home but equipment has not been arranged, or personal support doesn't start for a week, he/she will be at risk for ending up back in the hospital. Communication between all members of the patient's care team is very important. Sometimes its just a simple thing that needs to be shared among all, but it makes a huge difference in how the patient does.
    Families who can't afford to pay for extra care are at a definite disadvantage. Untrained family caregivers can also put a patient's health in jeopardy.

    1. I agree, there is a big gap when it comes to continuation of care from the acute setting into the community. We have a good working relationship with our local hospital staff but there are still kinks to work out.

      That goes with my point of everyone working in silos.. The main goal in hospital is stabilizing and getting them home, but without the follow up and support many end up back at hospital.

  6. Our community also requires more home care hours than what are given. Our home care department needs more case managers and personal support aides than what they are currently funded for. Palliative clients pose an even bigger struggle, as they often require increased personal care, as well as specialized care related to medication infusions/wound vacs/home suction etc. If this can't all be done within the allotted hours, the responsibility falls back on the client's caregiver. This leads to caregiver burnout, and admission to hospital (which often does not align with the client's end-of-life wishes). Definitely a frustrating situation.

  7. I currently work for the Primary Care Network in Whitecourt Alberta. We are a clinic organization, who work with Alberta Health, to support clients in the community. My focus is on cancer and palliative support.

    In regards to cancer navigation, I find accessing the cancer clinics one of the major gaps in our rural community. The closest Oncology and radiology centre is Edmonton. Many clients have difficulty accessing these programs due to the high costs related to travel and accommodations. Some clients have little to no support, or deal with cognitive impairments that further limit their access to transportation. There are programs available to provide assistance to cancer client's, but it is often based on client income and only provides funds rather than the actual transportation needed. These programs require referrals, and some only pertain to specific demographics. It can become confusing as to what programs certain clients do or don't qualify for. Many driver programs have been temporarily suspended due to COVID-19, creating more gaps for clients. I find a lot of time is spent on trying to find the programs needed to bridge these gaps, which often leads to delays in care. It would be nice if there were standard programs in place, that navigators could utilize to help provide consistent transportation and accommodations for cancer related appointments.

    As for palliative care, we are fortunate to have access to community care services which can provide in home palliative care support. However, government funded home care services are not 24/7. Unfortunately, clients often need more home care hours than what is available. It is then the responsibility of the client's family member to fill in these gaps and provide care. The only other option is to hire private home care services and pay out of pocket, or utilize the Palliative In-Home Rural Funding Program. This requires referral to the AHS Palliative Care team, once approved it then falls on the client/family to hire the care (which is often overwhelming for the family and a deterrent when applying for funds). there are also gaps in the provincial palliative ambulance program (Assess Treat & Refer). Whitecourt only has 2 ambulances, which greatly impacts their ability to respond and spend time with palliative 911 calls as other urgent clients need more rapid attention.

    Ultimately, I find our rural location is the culprit of many gaps in the system and decreased accessibility to necessary programs.

    1. I agree Aimee, this is a frustrating situation. In our community, like you, we have limited resources/staffing. There are folks in our local hospital that are waiting for their allotted PSW hours for up to 7 months, while still in hospital- no longer requiring any acute care.

      We have programs to support above and beyond care needs in the community; but the application process is long and arduous. We have had clients go as far as hiring temporary foreign workers as they require above and beyond what our community can provide. To manage staff, training, scheduling, accounting, etc on top of a complex medical condition puts many at risk of not having a caregiver at times, burn out and financial risk.

  8. Working in an acute care setting, one of the gaps that exist in this environment is a discontinuity of care from acute to home care. Although discharge planning is often performed before patients are sent home, patients usually end up not getting the appropriate care. At the end of the day, this usually translates to high readmission rates into hospitals. Similarly, when patients are back to the acute care facilities, there is often a lack of understanding of what was happening in the community. As much as the acute care setting is focused on the acuity of care, the transition in the community should also be at the forefront. In order to meet the needs of the individuals, we need to have better coordination and communication between different services. Hence, the focus should be on having healthcare professionals that oversee the clients along the continuum of care.

  9. In my own setting, the most seen gaps in health care is accessibility.
    The lack of HCP- Our area has seen a revolving door of Health Care Providers. Long waits- for LTC beds, Emerge visits, obtaining health care providers, obtaining equipment/supplies needed.
    Geography- Most of my clients are situated on First Nations that can be 3+ hours away from the nearest hospital/medical centre. Having an appointment in the morning may not be easily attended by some, it may mean staying in a hotel the night before. Paying drivers to bring people into town. Out of town appointments take time to organize and can depend on others.
    Some clients feel discriminated against, and uncomfortable going to appointments alone due to language barriers, disabilities and education levels. Client feel unheard and "shuffled" through.

  10. My team provides short-term consultation services geriatric clients in the community across the East part of Toronto. The clients we see are frail, often home bound with limited social/family supports. One of the most significant gaps in services is availability of long-term support services for client’s with geriatric syndromes (dementia, frailty etc) and complex health needs. Our team attempts to provide recommendations to the family physicians or family but there is often no one in the community to implement these recommendations, which results in the clients continuing to cycle back through our program/ED or continue to rely heavily on their primary care physician. Unfortunately, the long-term support services that do exist varies depending on where a client lives and are often difficult to access due to long waiting lists.

    In addition to this, there is also a great deal of inequity in home care (PSW) resources across our catchment area, with some clients being able to access more hours than others even with similar needs.

    Funding/subsidies available to low income clients are limited and difficult to access and clients often don’t have the ability (due to language, cognitive impairment, education level, physical function) or support to apply.

    There are so many more gaps, as someone said above, I could continue to go on but those are some of the big ones…

  11. Due to the population and geographic limitations my client setting has, there are many identified gaps. Often in our area, we do not have specialists (dental surgeons, speciality surgeons, etc); this almost always ensures a barrier or gap of care for our clients.

    Transportation is one of the gaps in care; often times you have to book transportation at least 1-2 weeks prior to a medical appointment for those that use a government subsidized program. There is still a cost and fee for this service. If a client has no family or supports, can not get a booking with a government funded program, transportation to get to a simple medical appointment can cost upwards of $100-200/way via taxi. This creates a large gap in ensuring a client is able to get to follow up appointments, or routine access to medical care.

    Secondly, due to our aging population and demographic, we typically see seniors who have "aged out of the system". Meaning, they have turned 65 years old and no longer qualify for social services, Ontario Works, ODSP, etc. Often times, those that are facing this transition struggle as they no longer qualify for the benefits that they once were able to use on social services (dental, transportation, etc). This also keeps their income bracket at or below the poverty line. When our aging population can no longer safely stay at home (lack of community resources/supports/medical services)- they are often faced with looking at alternative level or assisted living facilities.

    When a senior on a minimal income can no longer stay in their home, which they often do not own, but do not qualify or have met the criteria for long term care (LTC) are on a wait list (in our area, up to 7 years). This leaves the client having to at retirement homes. The financial ability to go to a assisted living facility is not at our clients fingertips. They often need to apply for subsidy (our local municipality has a program to financially support seniors in hospital transition into an assisted facility)-this can only be done when the client is in hospital; not avoiding a hospital admission where this could be placed in community to support acute care bed flow and occupancy rates, and most importantly client safety and wellbeing.

    I could go on, and on about gaps in our health care system, these are simply two that have jumped to the forefront of my mind. We are blessed to have the care that we do, but we still have a long way to go.

    1. Transportation is a huge gap in our area as well.
      One example is (my mothers case.) - For Radiation Treatment in our area, you will have to travel 4+ hours away and stay there 5days/week for 3.5 weeks. Because she's an Elder, and does not drive, she will need an escort to stay with her for the duration. She has a great support system, but not everyone has that.
      I am thankful that OTN has been very instrumental in our area with being able to connect with different specialists but we need a better access without having to leave home.

    2. Transportation is a major gap in my area as well! Being in a rural northern community greatly impacts our ability to even qualify for transportation services, as many are unwilling to drive to our location. There also isn't standardized programs available to clients, and each driver program varies from community to community. Any volunteer drive programs have been suspended due to COVID-19, and all other programs here also require a fee for transport (that not all clients can afford). I really wish there was one or two specific programs that I could rely on for consistent, affordable and timely transportation. I empathize with you and the gaps you experience!

  12. GAPS : clients need more homecare hours then they are given. Hours of service are often not when clients need the help. We need to ask clients when they want their hours of homecare and not tell them when your coming. Many need help overnight is one example. Overnight help is limited .
    utilizing nurses to do both nursing tasks and PSW tasks at the same visit could be better use of funds. I've seen Nurse come in every morning to do a blood sugar and give insulin but not prepare breakfast for client. Psw comes in same time and makes breakfast for client and assist with am care. Wholistic approach. If PSW is late the nurse sits and waits for her to arrive before doing BLS sugar. The nurse wont get the client out of bed.

    Clients need to have more say and choice with their providers and not feel if they complain they will get their services cut. We need to look at health services a s a customer service industry and work with clients satisfaction levels.

    1. I worked as a HCC Practical Nurse/Case Manager before taking on the Transitions Coordinator role, we did PSW care as well as nursing. This may be because we did have limited staff and time.

      I can imagine this must be very frustrating for the clients, the nurse and the PSW.

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