Background: People transitioning from incarceration into the community often experience adverse health outcomes driven by the social determinants of health. This study aimed to compare the prevalence of mental health and substance use disorders and their associations with poverty and housing instability among people incarcerated in British Columbia provincial correctional centres versus the general community population. Methods: We used linked administrative data on a random 20% sample of BC residents enrolled in public health insurance. Individuals with any provincial incarceration in 2015 or 2021 were identified and compared with nonincarcerated individuals in those years. Prevalence of mental illness, substance use disorders, and indicators of social disadvantage (income assistance, no fixed address) were calculated for both groups. In 2021, the sample included 1933 incarcerated people and 962 421 nonincarcerated people. Results: Incarcerated people had significantly higher rates of mental illness and substance use disorder (including opioid and stimulant use disorders) than the community population. In 2021, 51.1% of incarcerated people had a diagnosed mental illness, 58.9% had a substance use disorder, and 41.0% had both. Co-occurring mental illness and substance use disorder were frequently associated with extreme poverty and housing instability. Nearly one-third (32.5%) of incarcerated people in 2021 had co-occurring mental illness and substance use disorder and either received income assistance or had no fixed address. Mental illness, substance use disorder, and poverty were much less common in the community cohort. Conclusions: Incarcerated people in BC experiencea triple burden of mental illness, substance use disorders, and socioeconomic marginalization (poverty and homelessness). There is an urgent need for targeted interventions during incarceration (e.g., evidence-based mental health and substance use disorder treatment) and greater postrelease support (housing, social services, and employment opportunities) to reduce health inequities and break the cycle of recidivism.
Inappropriate use of diagnostic tests is common in medical practice. There is a tendency for clinicians to overinvestigate or order unnecessary tests that either do not impact medical care or potentially harm the patient. Excessive testing is common for several reasons, including fear of missing a diagnosis, limited time during patient visits, patient expectations, and institutional pressures. However, overtesting generates superfluous and misleading clinical data, leads us down the wrong path, causes unnecessary anxiety, and produces extra medical waste. I review my top five recommendations from Choosing Wisely relevant to both outpatient and inpatient management of infection.
Background: Inhaler medications are a corner-stone of treatment for respiratory diseases but are associated with substantial greenhouse gas emissions. Methods: In this quality improvement project, we implemented pharmacist-led screening of inhaler regimens at our outpatient respirology clinic to assess for more environmen-tally friendly modifications. Patients were first screened by a pharmacist, who flagged them for respirologist review if potential modifica-tions to their regimens were identified. The respirologist then intervened as appropriate. Results: In total, 106 patients were pre-screened by a pharmacist, 88 were flagged for respirologist review, and 68 had changes -made to their inhaler regimen. The average reduction in greenhouse gas emissions per patient screened was 200 gCO e per day. The total reduction in greenhouse gas emissions for all screened patients was 19 208 gCO,e per day, the equivalent of driving 79 km per day in a standard gasoline-powered passenger car. Conclusions: This project highlights the sub- stantial reductions in greenhouse gas emissions that can be achieved through pharmacist-led -screening of inhaler regimens.
Background: Physician burnout is increasingly recognized as a critical issue with serious consequences for physician well-being, patient care, and the health care system. Orthopaedic surgeons are particularly susceptible to burnout due to numerous stressors surrounding work and personal obligations. The objective of this study was to determine the prevalence of, and risk factors for, burnout in Canadian orthopaedic surgeons. Methods: Anonymous online surveys were administered to orthopaedic surgeons identified via the senior author's university and the Canadian Orthopaedic Association's mailing list. The survey included the Maslach Burnout Inventory, the Measure of Moral Distress for Health Care Professionals, and demographic questions. Risk factors for burnout were identified using a multivariate logistic regression model. Associations between risk factors and depersonalization and emotional exhaustion were assessed using a multivariate linear regression model. Results: In total, 215 participants responded to the survey (response rate of 19.6%). Of those, 62.8% (135/215) screened positive for burnout. When adjusting for other factors, moral distress was identified as a riskfactor for burnout (odds ratio = 1.03, 95% CI, 1.02-1.05, P < .001). Older age was negatively associated with burnout (odds ratio = 0.97, 95% CI, 0.94-0.99, P = .02). There was no association between burnout and work hours, administrative burden, sex, or level of training. Conclusions: This is the first national study to quantify burnout and moral distress among Canadian orthopaedic surgeons using fulllength validated instruments. The high prevalence of burnout, along with the strong association with moral distress, highlights the urgent need for systemic interventions targeting physician wellness.
Diagnosing infectious diseases is often not straightforward. Clinicians may be misled by nonspecific or irrelevant symptoms and signs, and they may misinterpret test results. The appropriateness of the prescribed treatment hinges entirely on the accuracy of the working diagnosis. Even when the diagnosis is correct, pitfalls are frequently encountered during the management stage of the infection. This review of the literature shows how clinicians mayfall victim to cognitive traps when working through the diagnostic and therapeutic process and provides guidance on how to avoid these pitfalls when managing adult patients with suspected infections.
Background: Health care disparities in rural and remote British Columbia have persisted overtime despite efforts to improve access to care. While strategies have typically focused on improving access to primary care, discrepancies in access to specialist care remain uncertain. The aim of this study was to better understand the temporospatial distribution of general specialists in BC. Methods: Clinician data were acquired from BC Ministry of Health Medical Services Plan reports for 2010-11 to 2022-23.The number of internal medicine specialists, pediatricians, and psychiatrists registered in each health service delivery area was analyzed over time. Results: In 2022-23, 1480 internal medicine specialists, 364 pediatricians, and 864 psychiatrists were registered in BC. Only 6% to 7% of specialists were registered in rural and remote areas, a pattern that has persisted despite increases in clinician numbers since 2010-11. Conclusions: Rural-urban discrepancies in specialist distribution in BC have persisted over the past decade. We call upon clinicians and policymakers to address this long-standing issue.
Background: Child and youth mental health concerns are increasing in Canada, resulting in an increase in visits to community providers. Methods: We distributed a 14-question survey to members of the British Columbia Pediatric Society (N = 309) in February 2025 to explore the role community-based consultant pediatricians (CBCPs) play in delivering pediatric mental health services in British Columbia. Results: The response rate was 26% (n = 81). Mental health care now comprises most of the care that CBCPs provide, and this has increased significantly over the last decade. Due in part to self-directed learning, CBCPs appear comfortable caring for straightforward concerns. Yet, as they shoulder the burden of complex mental health care with insufficient support, they are grappling with burnout and professional sustainability. Conclusions: The current delivery of BC's pediatric mental health care system has placed CBCPs in an untenable situation. Because this issue threatens the long-term viability of the community pediatric workforce, we need to consider strategies that more effectively meet changing pediatric mental health care needs.
Gastric ischemia secondary to infection by Sarcina ventriculi is rare and has been reported in a limited number of case studies. We describe the case ofa patient who presented after a low-velocity motor vehicle accident with no symptoms. During his workup, a CT scan incidentally found the patient had portal venous gas and a focus of gastric wall ischemia, despite being asymptomatic. He underwent an esophagogastroduodenoscopy, which showed patchy necrosis but no perforation. He was managed conservatively with antibiotics and bowel rest. Biopsy showed the presence of S. ventriculi. A repeat CT scan with oral contrast and an esophagogastroduodenoscopy did not show any leak, and the patient was progressed to a full diet and discharged with oral antibiotics. This case showed that initial conservative management of S. ventriculi in hemodynamically stable patients, even in patients with gastric ischemia and necrosis, can be considered in the absence of perforation.
Background: Vancouver General Hospital, the sole provider of adult liver transplants in British Columbia, faces increasing numbers of referrals. We examined potential areas for efficiency gain in its preclinic evaluation process. Methods: This single-centre study included interviews with internal and external health providers and a retrospective analysis of all 112 liver transplants performed in 2023. Wait times were compared between outpatients and inpatients and between Vancouver Coastal Health and the other regional health authorities in BC: Fraser Health, Interior Health, Northern Health, and Island Health. Results: In 2023, median wait times from referral to first consult were 87 days for outpatients (highest in the Interior Health Authority: 156 days) and 1 day for inpatients. Median evaluation times were 143 days for outpatients and 8 days for inpatients. Median referral to transplant times were 320 days for outpatients and 32 days for inpatients. Median referral to transplant times for outpatients were shortest in Vancouver Coastal Health and Fraser Health and longest in Interior Health, followed by Northern Health and Island Health. Challenges to activation in the preclinic were attributed to the referral process, staffing, and resource allocation. Conclusions: To meet increasing demand for adult livertransplants and improve efficiency, the preclinic requires additional clinic space, an online referral system, and better communication among health authorities.
Background: Climate change is a health emergency, yet many medical schools provide minimal planetary health content in their undergraduate medical curriculum. This pilot project answered the global call to recognize the impacts of climate change on human health by creating a way to address the gap in the curriculum at the University of British Columbia. Methods: A multidisciplinary team of students, academic leadership, medical educators, and planetary health experts integrated climate change concepts into case-based learning scenarios and created patient perspective videos to supplement the cases. Results: Planetary health concepts were integrated into four cases on topics relevant to the British Columbia context.The cases focused on identifying vulnerable patients, addressing risk factors, and managing climate-related illness. A unique feature of this pilot project was the involvement of near peers to edit the cases to target the appropriate level of complexity for the learners. Conclusions: This pilot project demonstrates practical, strategic integration of climate change education into existing curricula. This collaborative approach, using multidisciplinary teams and patient perspectives, offers a model to prepare future clinicians for the impacts of climate change.
Background: Assessing patient satisfaction, particularly among patients with complex disability, is vital to patient-centred care and access to care. We evaluated patient satisfaction at the BC Children's Hospital Spinal Cord Clinic using the Patient Satisfaction Questionnaire Short Form (PSQ-18), modified to suit our pediatric population. Methods: The modified PSQ-18 was distributed to families who visited the Spinal Cord Clinic from June to October 2019. Seven domains of patient satisfaction were assessed: general satisfaction, technical quality, interpersonal manner, communication, financial aspects, time spent with doctor, and accessibility and convenience. Likert scale data were analyzed using descriptive statistics. Two independent evaluators analyzed additional qualitative feedback. Results: During the study period, 231 families visited the Spinal Cord Clinic; 80 participated in the study. Patients and families reported the highest degree of satisfaction with interpersonal manner and communication and the lowest satisfaction with financial aspects and accessibility and convenience. Participants also provided comments about their clinic experiences. Conclusions: Families were generally satisfied with their clinical care and aspects under the control of health care providers. The clinic has conducted follow-up visits virtually when possible to reduce the financial burden of inperson appointments.
Point-of-care ultrasound (POCUS) can improve patient care by reducing diagnosis, treatment, and transport times; reducing transfers; and providing medical care closer to home. However, barriers to acquiring and maintaining proficiency with POCUS result in widespread underuse of this technology. The medical community on Haida Gwaii, a remote archipelago off the coast of British Columbia, is using POCUS in innovative and sustainable ways. Employing an interpretive description methodology and the theoretical framework of the Eco-Normalization Model, we conducted semi-structured interviews with a community physician, a local hospital administrator, and a patient to discover the factors that led to the successful implementation of POCUS. Drivers included local physician "POCUS champions"and the desire to provide better and more compassionate medical care. Enablers included specific medical education, excellent administrative support, a culture of learning and collaboration, and patient satisfaction.
Background: Canada has substantially longer surgical wait times than several other Organisation for Economic Co-operation and Development member countries with universal health care. In British Columbia, lengthy surgical wait times are an ongoing problem. Methods: We used the BC Surgical Wait Times database to examine trends in wait times and surgical demand across hospitals (n = 59), cities, surgical specialties, and health authorities in BC from 2009 to 2022. Results: In general, small hospitals had the shortest wait times. Before 2013 and after 2018, medium-sized hospitals generally had longer wait times than large hospitals. Small and medium-sized cities generally had the longest wait times, and rural communities had the shortest. There were no trends in wait times by health authority. Demand was highest in small hospitals, rural communities, and the Interior Health Authority; it was lowest in large hospitals, large cities,and the Provincial Health Services Authority. Across all specialties, otolaryngology, orthopaedic surgery, and plastic surgery had the longest wait times, while neurosurgery and thoracic surgery had the shortest. Demand for ophthalmology was almost eightfold that of any other specialty. Spikes in wait times and decreases in demand occurred during the COVID-19 pandemic across almost all analyses. Conclusions: Overall, our analysis suggests that demand does not predict wait times for scheduled surgery in BC. Further investigation should be conducted to better understand predictors of wait times in BC.
Background: Self-administered vaginal swabs became available at the Island Health outpatient lab in Campbell River and at labs throughout northern Vancouver Island in February 2021. This project aimed to increase the use of the swabs to improve access to testing for sexually transmitted infections. Methods: Clinicians and lab staff at Island Health lab collection sites on northern Vancouver Island were surveyed to gauge their understanding of self-administered vaginal swabs. Information sessions were provided to enhance their knowledge. Patient satisfaction surveys were also conducted. Results: At baseline, a median of 117 swabs perquarter were returned to Island Health lab collection sites on northern Vancouver Island. After the swabs became available, the median increased to a peak of 294 per quarter. Knowl-edge about the swabs among lab staff and clinicians increased from 33% preintervention to 100% postintervention. Patients preferred the swabs over other testing methods. Conclusions: Improving access to and provid-ing education about self-administered vaginal swabs led to increased sexually transmitted infection testing at Island Health labs on north-ern Vancouver Island.
Addressing barriers to cervical cancer screening as a public health priority in British Columbia requires innovative approaches. Community-based health promotion initiatives like Papapalooza connect the public with low-barrier cervical cancer screening and accessible health education, offering inclusive, celebratory, and trauma-informed Pap test experiences through pop-up events. To determine whether patients support Papapalooza as a strategy to reduce screening barriers, we administered 354 pre-Pap surveys and 309 post-Pap surveys to 533 Papapalooza attendees at five events held between March and June 2023. Identified barriers included inaccessible primarycare, provider-related factors, and personal factors. Surveys showed increased knowledge and comfort accessing and understanding the importance of screening, with 93.8% of post-Pap survey participants "very likely" to attend another Papapalooza. Community-based health promotion is an acceptable means of connecting patients with important screening, while creating meaningful opportunities to enhance health literacy.
Background: The opioid epidemic has been linked to liberal opioid prescribing practices of physicians. We re-examined trends in opioid prescription practices in British Columbia that have led to new long-term use. Methods: A data set of community-dispensed opioids from January 2013 to December 2017 was used to identify opioid-naive individuals. Opioid prescriptions were analyzed to describe new long-term and non-long-term users. Initial prescription factors associated with longer use were estimated. Results: In total, 19 785 practitioners issued 15 693 867 opioid prescriptions to 1 692 035 patients; 7.2% of opioid-naive individuals became new long-term users. Compared with non-long-term users, new long-term users were first prescribed a total opioid dose 1.7 times higher, and most received their prescription from a family physician. By the end of the study, 59.8% of new long-term users had stopped opioid use, 37.9% continued use, and 2.3% transitioned to methadone/buprenorphine. Longer duration of opioid use was associated with older age, a first prescription of fentanyl or butorphanol, and a first prescriber specialty type of psychiatry. Conclusions: Limitations included the fact that first prescriptions may have been renewals of hospital prescriptions and indications were unknown. This study may inform prescribers how opioid prescriptions impact long-term use.
Background: Advanced age and chronic comorbidities were established as important risk factors of severe illness early in the COVID-19 pandemic. We examined COVID case fatality rates among long-term care residents in the Vancouver Coastal Health region to reveal the scale and temporal patterns offatalities during the initial waves of local disease transmission during the pandemic. Methods: Data were obtained from Vancouver Coastal Health surveillance records and the British Columbia Vital Statistics Agency, spanning 12 January 2020 to 25 June 2022. The fatality rate of long-term care residents within the Vancouver Coastal Health region who were COVID-positive was measured across six phases of the pandemic. "COVID-19-related" and "30-day all-cause" case fatality variables were used, and data were stratified by time period and age group. Results: In total, 3418 COVID cases were included. The COVID-related fatality rate among long-term care residents declined from wave 1 (34.3%) to wave 6 (1.9%); the overall fatality rate was 9.9%. The overall 30-day all-cause case fatality rate also declined from wave 1 (32.9%) to wave 6 (6.0%), with an overall 30-day all-cause case fatality rate of 13.6%. Conclusions: The significant reduction in COVID-related fatality rates among long-term care residents in the Vancouver Coastal Health region in association with vaccination uptake and effectiveness, hybrid immunity, and changing viral strains emphasizes the critical role of timely vaccinations in safeguarding vulnerable populations.
