BACKGROUND AND AIMS:In 2019, British Columbia (BC) became the first jurisdiction in North America to introduce a mandatory non-medical switching (NMS) policy requiring patients with Crohn's disease (CD) and ulcerative colitis (UC) to be switched from originator biologics to biosimilar equivalents. This study examines the influence of the BC Biosimilars Initiative NMS policy on the longer-term infliximab and adalimumab biosimilar utilization and patterns of continuation/discontinuation of biosimilars. METHODS:We used health administrative data from BC to study drug utilization trends between 2015 and 2022. We used an interrupted time series design with segmented regression analysis to evaluate the impact of the Biosimilars Initiative on the utilization of biosimilars for infliximab and adalimumab and marginal Cox regression models to explore predictors of discontinuation of biosimilars post NMS. RESULTS:The Biosimilars Initiative was associated with an increase in the proportion of biosimilars within the anti-TNF market of 29.3% (95% CI: 28.6%, 29.9%) in Phase 1 (infliximab) and 49.5% (95% CI: 48.4%, 50.7%) in the adalimumab phase; thereafter, biosimilar use increased by 1.5% per year (95% CI: 0.3%, 2.7%). After the NMS, by the end of 2022, 13.5% (n = 4648) had switched from a biosimilar to an originator or a biologic in a different class. Female patients and biologic-naive patients starting on a biosimilar were more likely to switch from a biosimilar to another drug. CONCLUSIONS:Our results suggest that the Biosimilars Initiative NMS in BC was successful in switching patients to biosimilars and that most patients remained on biosimilar versions.

BACKGROUND:In Canada, 11 % of people in prison have been exposed to hepatitis C virus (HCV). Systematic screening and universal access to direct-acting antivirals (DAAs) for people in prison is needed for HCV elimination. This study aims to project the long-term impact of HCV screening and treatment intervention strategies, tailored to incarcerated populations, on the incidence and prevalence of HCV-related health outcomes of both the incarcerated and entire population of Alberta, Canada, up to 2050. METHODS:An agent-based model was developed to characterize the HCV epidemic before and after the COVID-19 pandemic and the introduction of DAAs in Alberta, Canada. HCV transmission was simulated through contact networks, specifically designed for provincial prisons and the broader community. Model parameters were estimated from existing literature and calibrated against historical data. Sensitivity analyses were performed to assess uncertainty. RESULTS:By maintaining 90 % HCV screening and DAA coverage among people in provincial prison starting in 2024, the incidence of chronic hepatitis C (CHC), CHC prevalence, and the incidence of CHC-induced liver-related deaths in incarcerated and non-incarcerated populations would decrease by 21.3 %, 54.0 %, and 89.1 %, and by 17.7 %, 53.5 %, and 62.3 %, respectively, between 2015 and 2050. Results were sensitive to the probability of initiating injection drug use and annual number of individuals initiating HCV treatment. CONCLUSIONS:Offering HCV screening and treatment to people in Alberta provincial prison would accelerate population-level HCV elimination efforts in the province. Improved linkage to HCV care before and after release is essential to meet the desired goals.

Emerging adults who are students (EAS) face challenges balancing academic demands with early career development in a competitive labour market. Career and vocational interventions (CVIs) aim to support this transition by improving employability, academic outcomes, career self-efficacy, and mental health protective factors. This systematic review assesses the effectiveness of CVIs compared with standard approaches in improving employment-related outcomes for EAS, following Cochrane and PRISMA guidelines. Multiple databases were searched for studies published between 2018 and May 2025. Three independent reviewers screened abstracts and full texts in duplicate. Eligible studies were primary research evaluating CVIs for students aged 12–25 yrs and reporting employment-related outcomes. Thirty-one moderate- to low-quality studies examining middle school, high school, and university students were included from an initial 5765 records. CVIs were typically multi-component, combining training, school- or work-based learning, and additional supports. Overall, CVIs were associated with improved career readiness, academic outcomes, employment, resilience, and career adaptability. However, some studies reported lower employment rates and income for women and students with disabilities compared with men and peers without disabilities. These findings suggest that CVIs can support school-to-work transitions but underscore the need for tailored, integrated approaches, and higher-quality longitudinal research to guide policy and practice.

Importance:While most individuals in Canada have some form of drug coverage, many public and private plans leave a substantial role for direct payment by individuals. For contraceptives, cost-sharing (deductibles and copayments) and the exclusion of some contraceptives from formularies often leads to access gaps and inequity. How universal, first-dollar contraceptive coverage policies change patient and public costs compared with a mixed public-private system is unclear. Objective:To evaluate whether patient out-of-pocket (OOP) costs and payer type changed after the implementation of a universal coverage policy for contraceptives, compared with a mixed public-private insurance system. Design, Setting, and Participants:This controlled interrupted time-series analysis examined aggregate monthly contraceptive prescription data, with British Columbia (BC) as the intervention province and a synthetic control modeled using other provinces. The analysis included all contraceptives dispensed to reproductive-aged females (15-49 years) in 10 Canadian provinces who had contraceptives dispensed between April 1, 2021, and March 31, 2025, using a national prescription database. This period covered 2 years before and 2 years after the policy's implementation on April 1, 2023. Exposures:Policy change in BC implementing free coverage for contraception by the public payer. Main Outcomes and Measures:The main outcome was the monthly proportion of contraception dispensed and estimated costs, stratified by age, majority payer type, and contraception type. Costs are given in Canadian dollars (currency exchange rate of CAD $1 = US $0.73 as of April 30, 2026). Results:During the 48-month study period, 2 791 157 contraceptive prescriptions were dispensed in BC (1 341 289 before policy implementation and 1 449 869 after). In the prepolicy period, 38.7% (95% CI, 38.0%-39.1%) of these prescriptions were paid OOP, 49.2% (95% CI, 48.6%-49.8%) by private insurance, and 12.0% (95% CI, 11.3%-12.7%) by public insurance. When the policy was introduced, the OOP share immediately decreased by 24.9 (95% CI, -26.3 to -23.5) percentage points. The highest prepolicy OOP share (44.6%) was in individuals aged 20 to 29 years, who also had the highest prepolicy costs. Compared with controls, by 2 years postpolicy, the OOP share was 29.5 (95% CI, 38.2-26.1) percentage points lower (33.4 [95% CI, 37.1-29.6] percentage points lower for ages 20-29 years), reaching 9.6% (95% CI, 8.7% to 10.4%) of contraceptives being paid OOP. At 2 years, OOP per-capita costs decreased by $8 per capita (ages 15-19 years: -$7 per year; 20-29 years: -$11 per year; 30-39 years: -$7 per year; 40-49 years: -$6 per year), or a mean of -$43 per year per contraceptive user. Conclusions and Relevance:In this controlled interrupted time-series analysis, a public drug plan providing universal, first-dollar contraception coverage was consistent with substantially reduced OOP payments, with the largest reductions among individuals aged 20 to 29 years. Contraception may be uniquely sensitive to gaps in mixed public-private insurance systems; these findings suggest that universal, first-dollar contraceptive coverage mandates are a highly effective policy measure to improve access to contraceptives, especially for young adults who often lack comprehensive drug insurance coverage.

PURPOSE:Rural communities face significant challenges in recruiting and retaining health care professionals (HCP) due to high workloads, lack of financial incentives, and demanding occupational requirements. Recent research shows that telehealth has the potential to enhance holistic care quality and reduce barriers to patient care; however, its potential to impact rural HCP retention remains unexplored. The purpose of this review was to assess the relationship between telehealth and rural HCP professional satisfaction and retention. METHODS:A systematic review was conducted following the Cochrane guidelines. MEDLINE ALL and Embase were searched from January 2014 to February 2025. Studies assessing the use of telehealth in rural health care settings and reporting on retention rates or professional satisfaction were included. Due to significant expected heterogeneity, studies were analyzed narratively. FINDINGS:The search identified 1,678 unique citations, with 38 studies proceeding to full-text review. Four studies were included in the final analysis: two mixed-methods studies and two qualitative studies. Each study assessed a different telehealth intervention, including tele-emergency, wound care, and general practice. Job satisfaction was reported in three studies, with personal fulfillment and professional development commonly reported. Retention was reported in two studies, with minimal actual impacts on retention but with HCPs perceiving considerable potential. Importantly, there were no quantitative measures of job satisfaction or retention reported. CONCLUSIONS:Despite telehealth being lauded as a way to improve retention and professional satisfaction in rural health care settings, there are very few studies assessing these outcomes. Though telehealth qualitatively improved professional satisfaction, there were minimal impacts on retention.

Background: There is interest in reducing out-of-pocket payments for prescription medicines, but the effects of such interventions remain unclear. Objective: To study the impact of changes to the public prescription drug insurance program in British Columbia (BC), Canada that eliminated copayments for low-income households. Methods: We used administrative data from 2017 to 2021 from Population Data BC and a controlled interrupted time-series design to examine a 2019 policy that eliminated copayments for households with incomes below $13,750. Households with incomes over $45,000-who experienced no changes in public coverage-served as a control. Our primary outcomes were prescription drug expenditures and the number of prescriptions dispensed. We also conducted a pre-post analysis to study impacts on dispensing and expenditures across therapeutic classes. Results: The intervention cohort included 9,095 patients representing 8,011 households with an average age of 48.4. The control cohort included 820,395 patients representing 471,778 households with an average age of 51.1. Copayment elimination led to a level increase of $3.85 (95 % CI: $1.13 - $7.03) in monthly drug expenditures and had no impact on the trend. The mean number of prescriptions dispensed had a level increase of 0.07 (95 % CI: 0.04 - 0.09) and the rate of dispensing increased by 0.006 prescriptions monthly (95 % CI: 0.002 - 0.010). Copayment elimination was associated with increased expenditures and dispensing across most therapeutic classes. Interpretation: Copayment elimination for low-income households in BC led to significant increases in prescription drug expenditures and dispensing across drug classes. Eliminating copayments appears to be effective at improving access to medicines for lower-income families.

Background:Understanding the impact of wider access to treatment on chronic hepatitis C (CHC) prevalence and the undiagnosed CHC proportion is important to achieving the World Health Organization's 2030 elimination targets. This research aimed to: (1) estimate the CHC prevalence and undiagnosed rates in Alberta, Canada; and (2) explore the impact of new direct-acting antiviral therapy on these rates since its introduction in 2014. Methods:This study adopted a two-step approach to estimate CHC prevalence and undiagnosed rates. This involved a population-based retrospective analysis of health administrative data for Alberta from 2002 to 2018 to generate CHC-related events for three birth cohorts: individuals born before 1945, individuals born between 1945 and 1965, and individuals born after 1965. A back-calculation method was employed to obtain historical prevalence and incidence estimates. Results:After the introduction of direct-acting antiviral treatment in 2014, the mean prevalence of CHC over all the birth cohorts fell by approximately 6.5% from 1.23% (95% CI: 0.97%-1.5%) to 1.15% (95% CI: 0.91%-1.45%) between 2015 and 2018. Similar trends were estimated for the 1945-1965 and the >1965 birth cohorts over the same period. Likewise, the mean proportion of undiagnosed CHC infections over all the birth cohorts fell by approximately 8.25% from 39.36% (95% CI: 30.08%-48.48%) to 36.36% (95% CI: 27.49%-45.31%) over the same period. A similar trend was experienced in all three birth cohorts. Conclusions:This is the first study to estimate CHC prevalence and undiagnosed proportions in Alberta using provincial health administrative data. These results could provide vital evidence to guide decisions about current and future hepatitis C virus strategies and help achieve the World Health Organization goal of eliminating hepatitis C in Canada by 2030.

Background: Cost is a key driver of inadequate, unequal contraception access. Without a national public pharmacare plan, Canadians use a mix of private or public prescription insurance plans to pay for drugs or devices. High deductibles, copayments, and/or exclusion of contraception from insurance formularies can result in access gaps. In April 2023, the western-most Canadian province (British Columbia (BC)) introduced universal, first-dollar coverage for prescription contraception. We estimated the effect of this free contraception policy on prescription contraception payer type and costs. Methods: Using a national prescription database, we measured the monthly proportion of all dispensed contraception to reproductive-aged females (15-49y) in BC according to majority payer (out-of-pocket (patients), private, and public) and estimated costs per capita by payer type. We used a controlled interrupted time series analysis to compare outcomes in BC to expected trends if the policy had not been introduced and compared with synthetic controls derived from other Canadian provinces. Findings: Pre-policy in BC, 39% of prescription contraception was paid out-of-pocket, 49% by private insurance, and 12% by public insurance. When BC's policy was introduced, out-of-pocket payments immediately decreased (-24.3% 95%CI -24.8 to -23.7). At 2-years post-policy, 5.4% (95% CI 4.5% to 6.4%) of on-formulary contraceptives were paid out-of-pocket and 8.4% (7.5% to 9.3%) was paid by private insurance. Total monthly per capita out-of-pocket costs in BC were 86% lower than expected if the policy had not been implemented. Time trends pre-and post- policy were similar in BC and controls. Interpretation: Up to 40% of contraceptives were previously paid out-of-pocket in BC compared to prior studies showing 20% of all drugs in Canada were paid out-of-pocket. Contraception may be uniquely sensitive to inadequate insurance coverage as with a mix of public and private drug plans. The implementation of a public drug plan providing universal, first-dollar coverage policy for contraception substantially reduced out-of-pocket payments for dispensed contraception. ### Competing Interest Statement WVN has consulted for the governments of BC, Ontario and Canada and provided expert testimony on contraception cost in relation to health equity and cost-effectiveness. MRL has consulted for Health Canada and Canada's Drug Agency and has provided expert witness testimony regarding drug benefits for several labour unions. FC has also consulted for Health Canada, the World Health Organization and Canada's Drug Agency. SB has consulted for the government of BC and Canada's Drug Agency. LS has consulted for Canada's Drug Agency. ### Funding Statement This project was supported by a Canadian Institutes of Health Research (CIHR) Catalyst Grant: Policy Research for Health System Transformation (#PR5-187076); Project Grant-Priority Announcement: Sex and Gender in Health Research; CIHR Institute of Gender and Health (PJX-196054). Laura Schummers holds a Canadian Institutes of Health Research Patient-Oriented Research Award-Transition to Leadership Stream Phase 2 Award (#TLS-185093). Elizabeth Nethery holds a Michael Smith Health Research BC Postdoctoral Trainee Award. Wendy V Norman holds a Tier 1 Canada Research Chair in Family Planning Innovation (100597, CRC-2023-00135). Michael R Law holds a Tier 2 Canada Research Chair in Access to Medicines. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Research Ethics Board of the University of British Columbia gave ethical approval for this work (H23-04138). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data used in this study was obtained under license from IQVIA Solutions Canada Inc and cannot be shared by the authors. The statements, findings, conclusions, views, and opinions expressed in this report are based in part on data obtained under license from IQVIA Solutions Canada Inc. concerning the following information service(s): GPM, from: September 1st, 2016 to March 31st, 2025. All Rights Reserved. The statements, findings, conclusions, views, and opinions expressed herein are not necessarily those of IQVIA Inc. or any of its affiliated or subsidiary entities.

Background Randomized clinical trials have shown that semaglutide is associated with a clinically relevant reduction in body weight and a lower risk of adverse cardiovascular events in those who are overweight or obese with a history of cardiovascular disease but no diabetes. The objective of this study was to assess the cost-effectiveness of semaglutide for this indication. Methods A decision analytic Markov model was used to compare the lifetime benefits and costs of semaglutide 2.4-mg subcutaneous weekly vs standard care in a hypothetical cohort of patients who were overweight or obese with preexisting cardiovascular disease (and no diabetes) from the health care payer perspective. Our model included ischemic stroke, heart failure hospitalization and/or urgent visit or myocardial infarction, and death over monthly transition cycles. Model outcomes included costs (2023 CAD$), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios. Results Base case analysis showed that the incremental cost-effectiveness ratio for semaglutide compared with standard care was $72,962 per QALY gained with a 14% likelihood of cost-effectiveness adopting a $50,000 per QALY gained willingness to pay threshold. Factors with the greatest influence on cost-effectiveness were medication efficacy on mortality and medication cost. When the price of semaglutide was reduced by 50%, it was economically attractive at $37,190 per QALY gained with an 80% likelihood of cost-effectiveness at a $50,000 per QALY threshold. Conclusions Semaglutide might be a cost-effective option for the publicly funded health care system contingent on initial pricing. Considering the candidate population—patients who are overweight or obese with preexisting cardiovascular disease—policymakers should consider the budget effect of funding semaglutide and weigh it against other ways scarce health care dollars might be used.

INTRODUCTION:The simultaneous existence of low-value health care and underutilization of high-value care are global problems. Health technology reassessment (HTR) aims to optimize the value for money of technologies already in use within health care. Identifying candidate interventions for HTR remains challenging. Therefore, we tested a novel method to identify candidate outpatient prescription drugs for HTR through practice variation. METHODS:We used administrative data for all publicly funded outpatient prescriptions dispensed to persons aged 65 or older in Alberta in 2023. Through quantitative comparison of funnel plots for Anatomic Therapeutic Chemical (ATC) classes at the fourth level stratified by prescriber specialty, variation in prescription dispensation rates between prescribers was used to estimate three outcomes: the number of prescribers affected, the number of patients affected, and the potential budgetary impact. We ranked combinations of ATC class and prescriber specialty in descending order for each outcome, with use above and below the mean considered separately. RESULTS:We analyzed data on 17.5 million dispensations, encompassing more than 8,000 prescribers and approximately 600,000 patients. The top ATC class-prescriber specialty combinations for each outcome showed high similarity above and below control limits while exhibiting minimal overlap between outcomes. CONCLUSIONS:Our method successfully identified ATC class-prescriber specialty combinations with marked variation in use, for potential advancement through the HTR process. Depending on the perspective of those undertaking HTR of prescription drugs, different outcomes may be useful in technology prioritization. To make the ATC class-prescriber specialty combinations actionable, future efforts should focus on exploring the patients affected.

Since the passage of the Canada Health Act (1985), there have been many advisory bodies established by successive federal governments, each tasked with providing advice and making recommendations about where and how to improve the health system. Our analysis of interviews with advisory board members and implementers (e.g., ministry of health leaders, staff and consultants) addresses why participants perceived their advice and recommendations were generally not implemented and informal strategy groups used to facilitate implementation. We recommend that future health system advisory bodies focus on coalition building during policy development, integrate implementation plans into policy recommendations and evaluate the impact of policy recommendations.

OBJECTIVE:To estimate effects of a policy introducing universal, no-cost public coverage for prescription contraception on use in British Columbia, Canada. DESIGN:Population based, controlled, interrupted time series analysis. SETTING:10 Canadian provinces. PARTICIPANTS:Prescription medications dispensed to reproductive aged (15-49 years) female residents of British Columbia, Canada, compared with a synthetic control derived from the nine other Canadian provinces and a population based cohort of 859 845 female individuals in British Columbia (age 15-49 years) between 1 April 2021 and 30 June 2024. INTERVENTION:Introduction of a universal contraception coverage policy in April 2023, where the public insurer pays 100% of prescription costs. OUTCOME MEASURES:Number of monthly dispensations for long-acting reversible contraception (LARC) and number of monthly dispensations for all forms of prescription contraception (including LARC), percentage of reproductive aged female residents using LARC and using all forms of prescription contraception, and the proportion of people using prescription contraception who use LARC (LARC market share). Segmented regression models were used to estimate policy effects by comparing the expected outcome values after 15 months of the policy (ie, the counterfactual, derived from trends before the policy and changes in the control) with the observed values, with 95% confidence intervals (CIs) estimated using bootstrapping. RESULTS:In April 2021, 3249 (95% CI 3066 to 3391) LARC prescriptions were dispensed in British Columbia, with a declining slope trend of -17 (-30 to -7) fewer dispensed per month before the policy. Monthly LARC dispensations increased by 1050 (942 to 1487) immediately after British Columbia's policy change and saw a steady increasing trend after the policy introduction. An additional 1273 (963 to 1698) monthly LARC prescriptions were dispensed 15 months after policy implementation compared with the expected volume, representing an estimated 1.49-fold (1.34 to 1.77) increase. Dispensations for all prescription contraception (including LARC) increased by 1981 (356 to 3324) per month, representing a 1.04-fold (1.01 to 1.07) increase. Among the 859 845 female residents aged 15-49 years in the population, 9.1% were using LARC in April 2021. 15 months after the policy, 11 375 (10 273 to 13 013) more individuals were using LARC than expected without the policy, representing an additional 1.3% (1.2% to 1.5%) of the population. The policy led to an additional 1.7% (1.5% to 2.3%) of the population using any prescription contraception. 15 months after the policy, the LARC market share was 1.9% (1.2% to 2.3%) higher than expected. CONCLUSIONS:Universal, no-cost public coverage in British Columbia increased prescription contraception use overall, driven by increased LARC use. As such, cost seems to be an important contributor to contraception use and method selection at the population level.

Objective Our study aimed to summarise and reflect on current evidence around patient and surgeon perspectives regarding the use of a central intake system (CIS) as a strategy for managing surgical waitlists.Search strategy A systematic review was conducted. Searches were performed on 9 October 2023. The strategies used key words such as ‘central intake’, ‘surgery’ and ‘experience’. Medical and the Web of Science core databases were searched.Inclusion criteria Titles and abstracts were assessed by two independent reviewers. Studies were included if: the study population was adult (age >18), and patients were referred for non-emergency surgery assessment.Data extraction Data were independently extracted by two reviewers using a standardised form. The Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative Research was used to assess study quality. Of 2805 studies identified, nine were included with a moderate to high confidence of evidence. Through thematic analysis, four patient and five surgeon themes were identified, with a further two common themes (although conceptualised differently).Results Patients value CISs for their potential to create an equitable referral process and clearer timelines, yet they emphasise the importance of preserving autonomy and personalised care by maintaining the option to choose their surgeon. Surgeons recognise the operational benefits of CISs in streamlining referrals and reducing wait times, but also caution that adequate resources, strong leadership and careful case selection are critical to sustain quality and engagement.Conclusions These findings highlight the complex balance required to successfully implement CISs. The system-level gains in access and coordination must be carefully aligned with patient-centred values such as choice and trust and supported by organisational culture shifts and leadership commitment. Importantly, the study identifies gaps in end-user involvement and decision-making power that should be addressed to enhance acceptability and effectiveness.Future actions should consider a framework that incorporates clear governance with continued pilot programmes that include evaluation of patient satisfaction, quantitative and qualitative clinical outcomes, and impact on equity. Additionally, targeted strategies are needed to accommodate complex or specialised cases that may not fit the central intake model. Through careful implementation and continuous stakeholder engagement, central intake models have the potential to meaningfully improve surgical waitlist management while respecting the needs and preferences of both patients and surgeons.

There is no doubt that healthcare systems in Canada's provinces and territories are under duress - staffing problems, costly technology adoptions and barriers to accessing care are endemic. Among those who are already ill, the systems' problems create frustration, anxiety and even unchecked disease progression for some people. The worst instances are seen in the media almost daily; the result is an erosion of trust among the Canadian public who had been assured that high-quality medically necessary services would be accessible when needed.

Background: Health advocacy remains inconsistently integrated in Canadian medical education despite being a core CanMEDS competency. This review examined barriers to medical student advocacy participation and identified practical opportunities for self-directed engagement. Methods: We conducted a systematic literature search of MEDLINE and grey literature (from 2010 to 2025) focusing on medical student advocacy participation, educational frameworks, and barriers. Two independent reviewers screened 1,253 citations using predefined criteria. Forty studies were narratively synthesized. Eligibility criteria: Population: Medical students Intervention or exposure: Participation in advocacy efforts (e.g., health policy, health equity, political engagement). Educational frameworks, curricula, or structured programs supporting advocacy in medical education. Comparator: Not required. Primary outcome: Barriers to medical student advocacy (e.g., time constraints, institutional resistance, lack of training). Opportunities for enhancing advocacy skills within medical education (e.g., mentorship, policy involvement). Effectiveness of structured frameworks in integrating advocacy into medical training. Study designs: Any study design that produced primary data. Other criteria: Published in English or French language. Results: Three primary barriers emerged: inconsistent advocacy training across institutions, lack of recognition of physician influence on health policy, and insufficient health policy skills development. Four evidence-based opportunities for student engagement were identified: seeking mentorship from faculty advocates and external advocates, participating in legislative lobby days, developing communication skills through writing and public speaking and collaborating with medical societies and nonprofit organizations. Conclusions: Medical students can proactively develop advocacy competencies through structured self-directed activities. Future work should focus on implementing standardized advocacy curricula across Canadian medical schools with ongoing evaluation of effectiveness.

Abstract Background Despite longstanding efforts and calls for reform, Canada’s incremental approach to healthcare changes has left the country lagging behind other OECD nations. Reform to the Canadian healthcare system is essential to develop a higher performing system. This study sought to gain a deeper understanding of the views of Canadian stakeholders on structural and process deficiencies and strategies to improve the Canadian healthcare system substantially and meaningfully. Methods We conducted individual, ~ 45-minute, semi-structured virtual interviews from May 2022 to August 2022. Using existing contacts and snowball sampling, we targeted one man and one woman from five regions in Canada across four stakeholder groups: (1) public citizens; (2) healthcare leaders; (3) academics; and (4) political decision makers. Interviews centered on participants’ perceptions of the state of the current healthcare system, including areas where major improvements are required, and strategies to achieve suggested enhancements; Donabedian’s Model (i.e., structure, process, outcomes) was the guiding conceptual framework. Interviews were audio-recorded, transcribed verbatim, and de-identified, and inductive thematic analysis was performed independently and in duplicate according to published methods. Results The data from 31 interviews with 13 (41.9%) public citizens, 10 (32.3%) healthcare leaders, 4 (12.9%) academics, and 4 (12.9%) political decision makers resulted in three themes related to the structure of the healthcare system (1. system reactivity; 2. linkage with the Canadian identity; and 3. political and funding structures), three themes related to healthcare processes (1. staffing shortages; 2. inefficient care; and 3. inconsistent care), and three strategies to improve short- and long-term population health outcomes (1. delineating roles and revising incentives; 2. enhanced health literacy; 3. interdisciplinary and patient-centred care). Conclusion Canadians in our sample identified important structural and process limitations to the Canadian healthcare system. Meaningful reforms are needed and will require addressing the link between the Canadian identity and our healthcare system to facilitate effective development and implementation of strategies to improve population health outcomes.

Abstract Background The impact of the COVID-19 pandemic on young people with eating disorders (EDs) and their families was profound, with surging rates of hospitalizations and referrals reported internationally. This paper provides an account of the additional health and social costs of ED care for young people living in Canada incurred during the COVID-19 pandemic, drawing attention to the available data to inform these estimates while noting gaps in data capacities to account for a full view of the ED system of care. Methods Three methodologies were used to capture costs: (1) provincial administrative data holdings available at the Canadian Institute of Health Information (CIHI) were used by Deloitte Access Economics to conduct analyses on costs related to hospitalizations, emergency room visits, outpatient visits with physicians and loss of well-being from being on a waitlist. These were examined across three fiscal years (April 1 to March 31, 2019–2022) to compare costs from one year before to two years after the onset of the pandemic, (2) data collected on support-based community ED organizations and, (3) costs identified by young people, caregivers and health care professionals. Results Estimates of additional health care costs and social costs arising from ED care waitlists were estimated to have increased by 21% across the two years after the onset of the pandemic and is likely to represent an underestimate of costs. Costs related to some standard ED care services (e.g. day treatment programs) and support-based community ED organizations that saw a 118% increase in services during this time, are some examples of costs not captured in the current cost estimate. Conclusions This paper provides a first account of the additional health and social ED care costs associated with the pandemic, which indicate at minimum, a 21% increase. The results invite discussion for more investments in ED services for young people in Canada, as it is unclear if needs are expected to remain elevated. We suggest a call for a national surveillance strategy to improve data holdings to aid in managing services and informing policy. A robust strategy could open the door for much-needed, data-informed, system transformation efforts that can improve ED care for youth, families and clinicians.

Objective To summarise the uses, outcomes and implementation of interactive voice response (IVR) as a tobacco cessation intervention.Data sources A systematic review was conducted. Searches were performed on 3 May 2023. The strategies used keywords such as “tobacco cessation”, “smoking reduction” and “interactive voice recording”. Ovid MEDLINE ALL, Embase, APA PsycINFO, CINAHL, Cochrane Library and Web of Science were searched. Grey literature searches were also conducted.Study selection Titles and abstracts were assessed by two independent reviewers. Studies were included if IVR was an intervention for tobacco cessation for adults; any outcomes were reported and study design was comparative. Any abstract included by either reviewer proceeded to full-text review. Full texts were reviewed by two independent reviewers.Data extraction Data were independently extracted by two reviewers using a standardised form. The Risk of Bias Tool for Randomised Trials and the Risk of Bias in Non-Randomised Studies of Interventions tools were used to assess study quality.Data synthesis Of 308 identified abstracts, 20 moderate-quality to low-quality studies were included. IVR was used standalone or adjunctly as a treatment, follow-up or risk-assessment tool across populations including general smokers, hospitalised patients, quitline users, perinatal women, patients with cancer and veteran smokers. Effective studies found that IVR was delivered more frequently with shorter follow-up times. Significant gaps in the literature include a lack of population diversity, limited implementation settings and delivery schedules, and limited patient and provider perspectives.Conclusions While the evidence is weak, IVR appears to be a promising intervention for tobacco cessation. However, pilot programmes and research addressing literature gaps are necessary.

[Voir la version anglaise de l’article ici: www.cmaj.ca/lookup/doi/10.1503/cmaj.231441][1]; [voir l’article connexe (en anglais) ici: www.cmaj.ca/lookup/doi/10.1503/cmaj.221785][2] Points clés Le trouble dépressif majeur (TDM) est l’une des principales causes d’incapacité au Canada, et