Over the last several decades, Alberta has led Canadian provinces in waves of healthcare system reform: first to regionalize, first to replace regions with a province-wide health authority and, in 2024, first to blow up such an authority for a new combination of functionally based organizations. Yet behind the flux in organizational forms lies a consistent set of storylines. On the surface, reforms have continually tried to find ways to facilitate the transfer of resources from the acute care sector to other components of the health system. Less openly, changes from the Klein government onward appear to be intended to facilitate greater political control over health bureaucrats and professionals, and to pave the way for an expanded private sector role.

Disasters can disrupt normal healthcare processes, with serious effects on children who depend upon regular access to the health care system. Children with medical complexity (CMC) are especially at risk. These children have chronic medical conditions, and may depend on medical technology, like feeding tubes. Without clear, evidence-based processes to connect with healthcare teams, families may struggle to access the services and supports they need during disasters. There is limited research about this topic, which has been pushed forward in importance as a result of the COVID-19 pandemic. The authors therefore conducted a rapid scoping review on this topic, with the intention to inform policy processes. Both the peer-reviewed and gray literatures on disaster, CMC, and communication were searched in summer 2020 and spring 2021. Twenty six relevant articles were identified, from which four main themes were extracted: 1. Cooperative and collaborative planning. 2. Proactive outreach, engagement, and response. 3. Use of existing social networks to connect with families. 4. Return to usual routines. Based on this review, good practices appear to involve including families, professionals, other stakeholders, and children themselves in pre-disaster planning; service providers using proactive outreach at the outset of a crisis event; working with existing peer and neighborhood networks for support; employing multiple and two-way communication channels, including social media, to connect with families; re-establishing care processes as soon as possible, which may include virtual connections; addressing mental health issues as well as physical functioning; and prioritizing the resumption of daily routines. Above all, a well-established and ongoing relationship among children, their caregivers, and healthcare teams could reduce disruptions when disaster strikes.

Since the 1990s, Alberta has been a leader in attempting to reform its health care system. These reforms have largely focused on delivery of services and governance. Underpinning these policy changes has been a continuing effort to promote privatization in the health sector, an idea which can be defined as the results of a range of strategic choices: “increasing out-of-pocket payments for care, private ownership, for-profit methods, privatized care work, private responsibility, and private decision-making regarding the organization and delivery of health care” (Bryant and Raphael 2020, 137). While these efforts have been tempered over the years by political leadership and fluctuations in the provincial economy, the renewed push by the current United Conservative Party (UCP) government appears to be the most overt and aggressive effort since the Ralph Klein government of the 1990s. This article provides an update from a recently completed book about Alberta’s health care system (Church and Smith 2006; Church and Smith 2022). Much of the efforts of the current government have focused. [full text continues in PDF / HTML].

Background The global COVID-19 pandemic led to rapid changes in both medical care and medical education, particularly involving the rapid substitution of virtual solutions for traditional face-to-face appointments. There is a need for research into the effects and impacts of such changes. The objective of this article investigates the perspectives of Family Medicine Residents in one university program in order to understand the impact of this transition to virtual care and learning. Methods This is a qualitative focus group study. Four focus groups, stratified by site type (Rural = 1; Semi-Urban = 1; Urban = 2) were conducted, with a total of 25 participants. Participants were either first or second-year Residents in Family Medicine. Focus group recordings were analyzed thematically, based upon a five-level socio-ecological model (individual, family, organization, community, environment and policy context). Results Two main themes were identified: (1) Residents' experiences of Virtual Learning and Virtual Care, and (2) Living and Learning in Pandemic Times. In the first theme, Residents reported challenges both individually, in their family context, and in their training organizations. Of particular concern was the loss of hands-on experience with clinical skills such as conducting physical examinations. In the second theme, Residents reported disruption of self-care routines and family life. These Residents were unable to engage in the relationships outside of the workplace with their preceptors and peers which they had expected, and which play key roles in social support as well as in future decisions about practice location. Conclusions While many patients appreciated virtual care, in the eyes of these Residents it is not the ideal modality for learning the practice of Family Medicine, and they awaited a return to normal times. Despite this, the pandemic has pointed out important ways in which residency training needs to adapt to an evolving world.

under way to develop a comprehensive set of health system performance measures for PWOUD in British Columbia using best practices in validation and endorsement. Using a similarly defined cohort from provincial administrative data, 104 unique performance measures were developed to quantify: the cascade of care for OUD; compliance with clinical guidelines; 51 health care integration, both across the spectrum of available health care services and specifically for treatment of concurrent disorders; and health care use. Given the unique availability of linkable data on community-based services in VCH, the DTES-2GS cohort was leveraged to develop 26 of these measures, fo-cusing on health care integration between acute and community services.

AimThe purpose of this research was to provide haemophilia treatment centres (HTCs) with guidance for the potential development of appropriate and timely interventions related to employment and vocational counselling and supports.MethodsA multi‐method approach was employed, where initial focus groups (n = 13) and review of the literature were used to construct a structured survey instrument (n = 75).ResultsFocus group participants made choices about employment with keen awareness of how their bleeding disorder might limit them physically; they described the role of social networks in career choices; and they wrestled with issues of disclosure. Among survey respondents, 47% per cent of respondents reported that haemophilia had a small negative impact, 27% felt that it had a moderate negative impact and 13% indicated that it had a very large negative impact. One‐third of respondents had at some point received employment‐related advice from a member of their haemophilia treatment centre team. Roughly two‐thirds of respondents suggested that vocational advice would be “somewhat” or “very” useful at present.ConclusionCanadian men with haemophilia continue to experience challenges related to employment and career development. There appears to be an opportunity for HTCs to incorporate additional supports on these topics into the range of services which they currently provide.

Purpose Despite growing attention to physician engagement there is a lack of literature to guide the development of physician-led interventions. A scoping review was conducted to describe physician-led strategies that have been implemented to promote increased physician engagement in acute care settings. Strategies are viewed through the theoretical lens of institutional work to advance the understanding about how the theory can be applied. The paper aims to discuss this issue. Design/methodology/approach Searches were conducted in English-language publications (2012–2017). Of 35 retained articles, 15 were from the gray literature; and 20 were peer reviewed. The review was guided by Arskey and O’Malley’s (2005) five-stage process. Findings Five themes reflecting different foci of physician-led activity were examined from the perspective of institutional work: systematically analyze context using participatory methods; work collaboratively toward locally defined, shared targets and build in processes to monitor progress; expand physicians’ role and capacity to include leadership toward shared organizational goals; promote appropriate rewards and incentives for work that builds engagement; and invest in opportunities for formal and informal communication and interaction. Practical implications Physicians considering action to increase their engagement in system improvement may benefit from analysis of local opportunities and barriers in selecting context-relevant activities that will motivate participation and build engagement through a balance of institutional work. Originality/value The paper considers the potential for physicians to initiate and support activity that will increase their engagement. It provides pragmatic strategies for designing intervention and research using the theoretical lens of institutional work.

We argue that public health matters more today than ever because it is uniquely positioned as a meeting point or fulcrum between health care and social welfare policy perspectives on the social determinants of health. It combines a grounding in the sciences of biomedicine and epidemiology with the moral imperatives of social advocacy. Health cannot be delivered through health care policy alone and neither can social welfare policy ensure the well-being of all citizens on its own. Social policy is at a disadvantage because it does not engender universal consent the way health policy can. While the way that illness should be addressed is debated, it should be addressed to be not contested, as is social welfare for vulnerable populations. The convergence of health and social policy to address the social determinants of health means public health advocacy must explicitly leverage biomedicine to provide materialist and substantive arguments and social welfare to provide the normative and moral arguments. We conclude that a new model of public health advocacy or social lobbying is necessary to effectively raise concerns that health care-focused thinking will not, but with potential heft that social welfare, historically, has not been able to command.

Metabolic syndrome (MetS) has been associated with a procoagulant and hypofibrinolytic state. Current data exploring the role of MetS in venous thromboembolism (VTE) are limited. The objective was to measure the prevalence of MetS in patients with acute PE receiving catheter-directed thrombolysis (CDT) and to investigate its effect on mean pulmonary arterial pressure and overall treatment success.We used a 3-year prospective registry of ED patients with acute PE with severity qualifying for activation of a PE response team (PERT). All patients had CDT with catheter-measured mPAP and angiography. The presence or absence of MetS components were extracted from chart review based on the following criteria: 1. body mass index (BMI) > 30 kg/m2; 2. diagnosed hypertension; 3. diabetes mellitus (including HbA1c > 6.5%) and; 4. dyslipidemia (including triglycerides > 150 mg/dL or high-density lipoprotein < 40 mg/dL).Of the 134 patients, 85% met the criteria for at least one of four MetS components, with obesity being most common, present in 71%. Results demonstrated a positive concordance between the number of criteria for MetS and MPAP, both pre- and post-fibrinolysis, as pressures tended to increase with each additional MetS criterion. Multivariate regression analysis determined age (-), BMI (+) and hypertension (+) to be significant independent predictor variables for mPAP.MetS was common in patients with more severe manifestations of PE and was associated with higher mPAP values both at diagnosis and following treatment with CDT.

Background In order to meet the challenges presented by increasing demand and scarcity of resources, healthcare organizations are faced with difficult decisions related to resource allocation. Tools to facilitate evaluation and improvement of these processes could enable greater transparency and more optimal distribution of resources. Methods The Resource Allocation Performance Assessment Tool (RAPAT) was implemented in a healthcare organization in British Columbia, Canada. Recommendations for improvement were delivered, and a follow up evaluation exercise was conducted to assess the trajectory of the organization’s priority setting and resource allocation (PSRA) process 2 years post the original evaluation. Results Implementation of RAPAT in the pilot organization identified strengths and weaknesses of the organization’s PSRA process at the time of the original evaluation. Strengths included the use of criteria and evidence, an ability to re-allocate resources, and the involvement of frontline staff in the process. Weaknesses included training, communication, and lack of program budgeting. Although the follow up revealed a regression from a more formal PSRA process, a legacy of explicit resource allocation was reported to be providing ongoing benefit for the organization. Conclusion While past studies have taken a cross-sectional approach, this paper introduces the first longitudinal evaluation of PSRA in a healthcare organization. By including the strengths, weaknesses, and evolution of one organization’s journey, the authors’ intend that this paper will assist other healthcare leaders in meeting the challenges of allocating scarce resources.

I would like to thank the authors of Physician and parent barriers to the use of oral corticosteroids for the prevention of paediatric URTI-induced acute asthma exacerbations at home, published in the July 2017 issue for their contribution in our efforts to understand and improve translational medicine; their opinions are valuable and welcome. Unfortunately, they have directed their talents to study barriers preventing physicians and parents from adopting a treatment strategy that is controversial at best and widely rejected at worst. The authors studied 27 children (52% of which were preschoolers) and report on barriers to the use of parent-initiated oral corticosteroids (OCS) at the onset of a upper respiratory tract infection (URTI) to prevent acute asthma exacerbations—a strategy which they describe as ‘effective in the management of acute asthma’ and its use as a ‘key message to paediatricians’ (1). To support this contention, they cite a 10-year-old American Guideline (2) from the National Heart Lung and Blood Institute; a recommendation that has remained unchanged from an even earlier 1997 version of this Guidleine (3)—despite 20 years of published research to inform a more contemporary view. In addition, the authors further cite two Cochrane reviews (4,5) as evidence that administering oral steroids at the onset of URTI symptoms can improve asthma-related outcomes. These Cochrane Reports, however, examined the rapid benefits of the addition of OCS to reduce asthma-related symptoms in patients receiving standard asthma therapy in an Emergency Department (ED). Although it may be tempting to extrapolate these findings to support the strategy of parent-initiated OCS at the onset of all URTIs at home, that was not the objective of those reviews and should not be generalized to support that approach when other, more direct evidence is available. Beigelman et al. (6) recently summarized the available clinical trials on this topic and highlight the paucity of evidence to support the widespread use of OCS in this age group in general, and the lack of evidence supporting parent-initiated OCS use at the onset of a URTI in particular. In addition, the short-term treatment with OCS in young children is not without risk and should not be considered lightly (7). The use of OCS to treat severe, acute viral-triggered wheezing remains an important option in current Canadian Asthma Guidelines (8,9) but the routine prophylactic use of parent-initiated OCS at the onset of a URTI does not. In our hands, standard asthma care using these Canadian Guidelines reduces asthma-related paediatric ED visits and admissions by approximately 60% and 80%, respectively (10). In this scenario, we view the need for OCS during viral-triggered asthma exacerbations as a management failure, not a component of routine care. Research in translational medicine is a crucial component of evidence-based medicine. We welcome future publications from the authors to help reduce the barriers preventing greater adoption of our national guidelines.

Purpose Current conditions have intensified the need for health systems to engage in the difficult task of priority setting. As the search for a "magic bullet" is replaced by an appreciation for the interplay between evidence, interests, culture, and outcomes, progress in relation to these dimensions requires assessment of achievements to date and identification of areas where knowledge and practice require attention most urgently. The paper aims to discuss these issues. Design/methodology/approach An international survey was administered to experts in the area of priority setting. The survey consisted of open-ended questions focusing on notable achievements, policy and practice challenges, and areas for future research in the discipline of priority setting. It was administered online between February and March of 2015. Findings "Decision-making frameworks" and "Engagement" were the two most frequently mentioned notable achievements. "Priority setting in practice" and "Awareness and education" were the two most frequently mentioned policy and practical challenges. "Priority setting in practice" and "Engagement" were the two most frequently mentioned areas in need of future research. Research limitations/implications Sampling bias toward more developed countries. Future study could use findings to create a more concise version to distribute more broadly. Practical implications Globally, these findings could be used as a platform for discussion and decision making related to policy, practice, and research in this area. Originality/value Whilst this study reaffirmed the continued importance of many longstanding themes in the priority setting literature, it is possible to also discern clear shifts in emphasis as the discipline progresses in response to new challenges.

Like other Canadian provinces and territories, Alberta has been attempting to reform primary care since the mid-1990s. Although initially these efforts were focused almost exclusively on the method of payment for physicians, since 2003, the focus of government policy has broadened to include other aspects of practice, including governance and accountability, improved continuity, the use of a team-based approach and the use of electronic information systems. Although significant progress has been made, Alberta continues to face challenges.

International comparative studies constitute a highly valuable contribution to public policy research. Analysing different policy designs offers not only a mean of knowing the phenomenon itself but also gives us insightful clues on how to improve existing practices. Although much of the work carried out in this realm relies on quantitative appraisal of the data contained in international databases or collected from institutional websites, countless topics may simply not be studied using this type of methodological design due to, for instance, the lack of reliable databases, sparse or diffuse sources of information, etc. Here then we discuss the use of the qualitative descriptive approach as a methodological tool to obtain data on how policies are structured. We propose the use of online qualitative surveys with key stakeholders from each relevant national context in order to retrieve the fundamental pieces of information on how a certain public policy is addressed there. Starting from Sandelowski's seminal paper on qualitative descriptive studies, we conduct a theoretical reflection on the current methodological proposition. We argue that a researcher engaged in this endeavour acts like a composite-sketch artist collecting pieces of information from witnesses in order to draw a valid depiction of reality. Furthermore, we discuss the most relevant aspects involving sampling, data collection and data analysis in this context. Overall, this methodological design has a great potential for allowing researchers to expand the international analysis of public policies to topics hitherto little appraised from this perspective.

ObjectivesAdministration of oral corticosteroids at the onset of an upper respiratory tract infection (URTI) can be effective in the management of acute asthma exacerbations in children. This study was designed to identify barriers to parent-initiated implementation of clinical practice guideline-recommended use of oral corticosteroids for prophylaxis against severe asthma exacerbations in children.MethodsTwenty-seven children who presented to BC Children's Hospital with URTI-induced asthma exacerbations were recruited. Parents received a filled prescription for a course of oral corticosteroids to be used at the earliest onset of their child's next URTI. Each family was contacted monthly over a 1-year period to inquire about URTI events, asthma symptoms, medication use and health care utilization. Focus groups were held with family physicians, paediatricians and parents; transcripts were analyzed qualitatively to identify key themes.ResultsIncidence of URTI events among participants was high (85%). Uptake of study medication was low; 44% used the medication as directed at their first URTI event. Eleven per cent of the patients who used the study medication also visited the emergency department for an exacerbation. Focus groups identified four main barriers to the effective use of parent-initiated oral corticosteroids: physician resistance and conflicting messages from providers; parent uncertainty about oral corticosteroids; multiple caregivers and relative ease of access to an emergency department.ConclusionWe have identified key barriers to the effective use of parent-administered oral corticosteroids as an asthma management strategy and gained important insights regarding the research that is required to enhance the applicability of the strategy.

BACKGROUND:Hospitals in Canada are being asked by governments to improve efficiency and do more with fewer resources. Healthcare decision makers are thus driven to find better ways to manage budgets and deliver on their mission. Formal processes of priority setting and resource allocation (PSRA) are one means to this end.OBJECTIVE:This paper reports an evaluation of one such approach, Program Budgeting and Marginal Analysis (PBMA), as applied at a children and women's tertiary care facility in Nova Scotia, Canada. A brief evaluation conducted immediately after the conclusion of the PBMA process was supplemented with a larger retrospective evaluation.METHODS:The retrospective evaluation included 26 face-to-face individual interviews with senior and middle managers who took part in PBMA. Interview transcripts were analyzed against a template consisting of 19 elements of structure, process, attitudes, and outcomes associated with high performance in PSRA.RESULTS:Respondents had a good experience with the implementation of PBMA, and considered it an improvement over past practice. Success was attributed to effective leadership, and substantial efforts to engage staff members. Understanding of economic and ethical principles of decision making was reportedly increased. Areas for improvement included ensuring that everyone participated in good faith, better communication of final results, and stronger follow-through to determine if anticipated changes and benefits in fact occurred.CONCLUSION:The evaluation framework employed here proved useful in assessing the quality of this resource allocation exercise. The results are directly useful to local decision makers, and the identified strengths and weaknesses are broadly consistent with those reported in studies of other organizations.