This week in my MHST 601 course, I took a closer look at how British Columbia manages chronic disease so that I could participate in an inter-provincial comparison with a classmate. I decided to summarize what I learned about BC into a blog post.
CHRONIC DISEASE SURVEILLANCE:
British Columbia (BC) has its own method of surveillance for chronic diseases. The BC Centre for Disease Control (BCCDC) is responsible for this surveillance via its Population and Public Health (PHH) Surveillance program. This program is responsible for the collection and analysis of data for health status and chronic diseases. On the BCCDC website you can find an interactive dashboard entitled Chronic Disease Dashboard that tracks the prevalence and incidence of chronic disease (Basham, 2020). You can sort by age, gender, health region and time periods from 2000 to 2018.
As stated on the BCCDC website (2021) the PPH surveillance team works “closely with the Ministry of Health, PHSA agencies, the BC Observatory for Population and Public Health, regional health authorities, and universities, aiming to enhance provincial surveillance capacity through collaboration and partnership.” The BC Observatory for Population and Public Health (the Observatory) was established as part of the Surveillance Plan for BC and represents these partnerships. The surveillance information provided by The Observatory guides policy and program creation (BCCDC. 2021). Data is gathered from a variety of sources including a Chronic Disease Registry, Statistics Canada, and hospital discharge data.
BC has a Healthy Families BC program that hosts a range of programs in communities and schools aimed at health promotion and the prevention of chronic disease. The surveillance team co-leads the evaluation of the program alongside the Ministry of Health (BCCDC, 2021).
CHRONIC DISEASE MANAGEMENT:
BC has addressed chronic disease management at a variety of levels across the community, health care system and individual. BC has adopted an Expanded Chronic Care Model and emerged as a provincial leader in the management of chronic disease in Canada (Health Canada, 2007). Two reasons for this success are the provinces focus on all 6 areas of the model and leadership by the Ministry of Health (Health Canada, 2007). The expanded model not only addresses the management of chronic disease but also supports health promotion at the community level by addressing the determinants of health and the delivery of healthcare services (Barr et al, 2003). The management of chronic disease in BC is multi faceted. BC hosts a variety of programs aimed at injury and disease prevention and to the management of chronic disease.
Healthy Families BC: this is a provincial strategy that began in 2011 aimed at improving the health of those living in BC. Aimed at the reduction of chronic disease by health promotion in four areas: healthy eating, healthy lifestyles, resources for parents and fostering healthy communities (Healthy Families BC, 2012).
BC Guidelines: a website created by the Guidelines and Protocols and Advisory Committee (GPAC) with clinical practice guidelines to ensure standardized and quality care of chronic illness. An app can be downloaded to allow clinicians immediate access to the guidelines (BCGuidelines.ca). GPAC is a partnership between the Ministry of Health and the Doctors of BC. (Government of BC, n.d.)
A variety of self management programs that involve education classes aimed at teaching patients how to manage and live with chronic disease. In my health authority examples of these are Diabetes Self Management classes and Pulmonary Rehab classes. (Fraser Health Authority, n.d.)
Incentive payments to physicians were trialled to encourage patient visits over time vs. episodic care although this had limited success (Lavergne et al., 2017).
Primary Care Networks: the establishment of primary care networks (PCN) across BC is underway. This is a provincial government strategy where family practice divisions, health authorities, primary care services providers and community and indigenous partners are coming together to provide team-based care at hubs located in the same geographical areas where patients live (Government of BC, 2018). Although this is largely directed at connecting people to primary health care, it is projected to have significant impact on chronic disease prevention and management.
FUNDING FOR CHRONIC DISEASE MANAGEMENT:
I did not find a whole lot of interesting information on funding for chronic disease management in BC despite a heartfelt search. In general, funding for health care delivery is provided federally and provincially (Government of Canada, n.d.). The funding is managed locally by one of the six health authorities (5 regional health authorities and 1 First Nations Health Authority). For example, in 2019/20 the Fraser Health Authority (which stretches from Burnaby to Boston Bar) had an operating budget of $3.95 billion (Government of BC, n.d.).
Physicians can collect Chronic Disease Management fees after following a patient with diabetes, hypertension, chronic obstructive pulmonary disease, and congestive heart failure after the period of one year (BC Family Docs, 2020). The General Practice Services Committee (2020) outlines that this is to compensate physicians for the extra work to provide guideline informed care beyond the care provided in the office, over time. Changes to the fee policy were made due to COVID-19 to allow provision of these services virtually (BC Family Docs, 2020). This care can also include a visit by an Allied Health professional.
INCIDENCE OF LEADING CONDITIONS IN BC:
I had a look at the incidence of leading conditions in BC and then specifically for diabetes. In BC, the BCCDC has a Chronic Disease Dashboard as mentioned in my earlier posts. Figure 1(Chronic Disease Dashboard, 2021) below shows the crude incidence of chronic disease in BC for the year 2017/18.
FIGURE 1
Note: Figure 1 shows crude incidence for leading conditions in BC for the fiscal year 2017/18. The data was pulled from the Chronic Disease Dashboard for all ages, sexes and health regions.
I was surprised to see mood and anxiety disorders at the top of this list. It may be that I have a skewed perspective because in my role, I usually only know the admitting diagnosis of the patients as I work to direct them to the best inpatient unit for their care (given their primary reason for coming into hospital).
Let’s look specifically at the incidence of diabetes in BC. According to Diabetes Canada (2019) there are 1,527,000 people with diabetes or prediabetes in BC with Ontario being the only other province to report higher numbers. Diabetes Canada goes on to state that the rates of both Type 1 and Type 2 diabetes have increased in BC by 58.6% since 2009. In 2019 costs were estimated at just under $30 billion nationwide (Diabetes Canada, 2019) and $509 million provincially (King, 2019).
Here in BC, Health Families BC (n.d.) is focusing on 4 main areas:
1. Healthy Eating
2. Healthy Lifestyles
3. Resources for Parents
4. Fostering Healthy Communities
One associated program I found was the Prescription for Heath program that is available for patient that have 1 or more of the following risk factors:
1. Smoking
2. Unhealthy Eating
3. Physical Inactivity
4. Medical Obesity
The Healthy Families BC initiative hosts several programs and online resources aimed at health and prevention (n.d).
While reading up on BC, I learned that BC is one of the most physically active provinces in Canada (Government of BC, n.d.) with 64% of people over age 12 reporting being physically active (Ministry of Health, 2015). Other interesting facts I pulled from this activity strategy were:
physical activity levels were greater in men than women
physical activity levels varied across the province
I found this figure that showcases the framework that BC is using to increase physical activity. It stood out to me as a multi leveled approach like what we have been discussing in this course.
FIGURE 2
Note: BC Physical Activity Framework for Action 2.0. Included in the BC Physical Activity Strategy, Status Update Report 2020.
In comparing this framework to the one BC introduced in 2015, I noted the bottom bar has been added to include Physical Literacy and Opportunities for Physical Activity.
Out of curiosity I looked at the self reported date for the Township of Langley (where I live) and found that only 49% of those surveyed reported that they participated in 150 minutes of physical activity per week (My Health, My Community, n.d.). These numbers are self reported so that actual number is likely less.
REFERENCES:
Basham, C. A. (2020). Regional variation in multimorbidity prevalence in British Columbia,
Canada: a cross- sectional analysis of Canadian Community Health Survey data, 2015/16. Health Promotion and Chronic Disease Prevention in Canada, 40(7/8), 225–234. https://doi.org/10.24095/hpcdp.40.7/8.02
Barr, V. J., Robinson, S., Marin-Link, B., Underhill, L., Dotts, A., Ravensdale, D., & Salivaras, S. (2003). The expanded Chronic Care Model: an integration of concepts and strategies from population health promotion and the Chronic Care Model. Hospital Quarterly, 7(1), 73–82. https://doi.org/10.12927/hcq.2003.16763
BC Centre for Disease Control (2021). BC Observatory for Population and Public Health. http://www.bccdc.ca/our-services/programs/bc-observatory-for-pop-public-health
Child Health Indicators BC (n.d.) Data Sources | CHBC. Retrieved March 7, 2021, from https://www.childhealthindicatorsbc.ca/appendices/data-sources#h2-7
BC Family Docs. (June, 2020). Billing in the Time of COVID-19. Retrieved from https://bcfamilydocs.ca/covid19/
British Columbia Ministry of Health (2021). BC Observatory for Population and Public Health. Chronic Disease Dashboard. http://www.bccdc.ca/health-info/disease-system-statistics/chronic-disease-dashboard
Diabetes Canada (2019). New Data Shows Diabetes Rates And Economic Burden On Families Continue To Rise In B.C. Retrieved from https://www.diabetes.ca/media-room/press-releases/new-data-shows-diabetes-rates-and-economic-burden-on-families-continue-to-rise-in-b.c.--
Fraser Health Authority, (n.d.). COPD self-management - Langley Memorial Hospital. Retrieved March 7, 2021, from https://www.fraserhealth.ca/Service-Directory/Service-At-Location/5/1/copd-self-management---langley-memorial-hospital#.YEU26GhKhPY
Fraser Health Authority, (n.d). Diabetes Education - Langley. Retrieved March 7, 2021, from https://www.fraserhealth.ca/Service-Directory/Service-At-Location/1/E/diabetes-education---langley#.YEU3bmhKhPY
General Practice Services Committee (n.d). Fees. Retrieved from https://gpscbc.ca/what-we-do/incentives/fees
Government of BC. (2018). B.C. government’s primary health-care strategy focuses on faster, team-based care. Retrieved March 7, 2021, from https://news.gov.bc.ca/releases/2018PREM0034-001010
Government of BC. (n.d). Health & Drug Coverage. Retrieved from https://www2.gov.bc.ca/gov/content/health/health-drug-coverage
Government of Canada. (n.d). Canada’s Health Care System - Canada.ca. (n.d.). Retrieved from https://www.canada.ca/en/health-canada/services/health-care-system/reports-publications/health-care-system/canada.html
Health Canada (2007). Chronic disease prevention and management. Retrieved from https://www.canada.ca/en/health-canada/services/health-care-system/reports-publications/primary-health-care/chronic-disease-prevention-management.html
Healthy Families BC. (2012). Healthy Families BC is the provinces health promotion plan for British Columbians. Retrieved March 7, 2021, from https://www.healthyfamiliesbc.ca/home/about-us
King, J. (2019). Diabetes Canada. Diabetes Canada 2020 Pre-Budget Consultation Submission Standing Committee on Finance and Government Services Government of British Columbia.
https://www.diabetes.ca/DiabetesCanadaWebsite/media/Advocacy-and-Policy/Submissions%20to%20Government/Provincial/2020-BC-Pre-Budget-Submission_Final.pdf
Lavergne, M. R., Law, M. R., Peterson, S., Garrison, S., Hurley, J., Cheng, L., & McGrail, K. (2018). Effect of incentive payments on chronic disease management and health services use in British Columbia, Canada: Interrupted time series analysis. Health Policy, 122(2), 157–164. https://doi.org/10.1016/j.healthpol.2017.11.001
Commentaires