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Taking the pulse: Measuring shared priorities for Canadian health care, 2024

Taking the pulse: Measuring shared priorities for Canadian health care, 2024 ggagnon

红领巾瓜报is pleased to present its second report on areas of health care that the federal, provincial and territorial governments have made shared priorities for improvement. Reporting progress on these shared priorities represents a commitment to enhancing quality of health care and outcomes across Canada, and to keeping Canadians informed about the changes they seek in our health care systems. 

Indigenous health

Learn about the collaborative initiative to establish pan-Canadian measures of cultural safety and anti-Indigenous racism in health care

Go to Indigenous health

Aging with dignity

Learn about how progress on meeting the needs of Canada鈥檚 older adults will be measured

Go to Aging with dignity

Strengthening Canada鈥檚 health care systems with data-driven insights

Strengthening Canada鈥檚 health care systems with data-driven insights ggagnon

Canada鈥檚 publicly funded health care systems, long a source of pride, are facing unprecedented strain. The COVID-19 pandemic exposed gaps in timely access to and effective organization of care while highlighting the difficulties that health care providers and health system planners face trying to keep up with growing demand.

It is now clearer than ever that comprehensive, standardized data is essential to understanding what our health systems need, and to providing the evidence that will ensure Canadians have high-quality health care systems where patient care is coordinated across institutions and providers. 

Commitment to measuring improvements on shared health priorities

Canada鈥檚 federal, provincialFootnotei and territorial governments have agreed to work together to improve health care for Canadians and measure progress in 4 priority areas: 

  • Expanding family health services and improving access to primary health care
  • Increasing the supply of the health workforce and decreasing wait times for surgeries
  • Improving access to mental health and substance use services
  • Modernizing health care information systems and digital tools for secure sharing of electronic health information

They have also made commitments to prioritize improved care for older adults to help them age with dignity at or close to home, and to work with First Nations, Inuit and M茅tis partners to provide better support for Indigenous health priorities. 

To measure progress made, 红领巾瓜报鈥 in collaboration with federal, provincial and territorial governments, Statistics Canada, Canada 红领巾瓜报 Infoway and Integrated Youth Services 鈥 is leading the selection and development of comparable indicators. 红领巾瓜报is pleased to present this report on the current state of the shared health priorities across Canada鈥檚 provinces and territories. Indicator results may not match with provincial and territorial reporting given differences in methodologies and data sets being used.

Key findings

Primary health care

  • Most Canadians age 18 and older (26.2 million, or 83%) reported access to a regular health care provider in 2023. A higher percentage of females reported access (87%) compared with males (79%). 
  • In 2023鈥2024, 281 of every 100,000 Canadians younger than 75 were admitted to a hospital for a problem that potentially could have been avoided with access to appropriate care in the community. The rate varied across the country by geography, age, sex and income. 

红领巾瓜报 workforce and surgeries

  • Almost all provinces and territories had a net increase in the number of family physicians (2021鈥2022), nurses and nurse practitioners (2022) compared with the year prior. This means that more of these professionals entered the workforce than left it.
  • After a drop in 2020鈥2021 and 2021鈥2022, the number of surgeries completed in Canada has rebounded to pre-pandemic levels. In 2023鈥2024, more than 2.3 million surgeries were performed, an increase of 5% over 2019鈥2020.
  • Between April and September 2023, 81% of urgent hip fracture surgeries were done within the 48-hour benchmark, though only 62% of planned hip or knee replacements met the 26-week benchmark. 

Mental health and substance use

  • In 2023鈥2024, half of Canadians who were referred to publicly funded community mental health counselling had their first scheduled session within 25 days of their referral. 1 in 10 people waited almost 5 months (143 days) or more. 
  • The number of Integrated Youth Services (IYS) sites 鈥 which provide community-based services for mental health, substance use and other needs under one roof 鈥 has grown across Canada from 63 sites in 2022鈥2023 to 92 in 2023鈥2024. In Newfoundland and Labrador, Ontario, Manitoba and British Columbia, approximately 35,000 individuals age 12 to 25 (895 per 100,000 youth) accessed IYS in 2022鈥2023. 

Electronic health information

  • Electronic sharing of health information remains a challenge in Canada. In a 2023 survey, while 4 in 5 (81%) Canadians said that they were interested in accessing their health information online, only 2 in 5 (39%) had done so. 
  • Around 1 in 3 (29%) physicians reported sharing patient information electronically with health providers outside of their own practice setting in 2024.

Where do we go from here?

Access to high-quality care in the right place and at the right time remains a top priority for patients, health care providers and policy-makers. Many initiatives are underway in the provinces and territories to make that happen. 红领巾瓜报will continue to work with partners to collect data and report on updated results, as well as to identify and develop new indicators to measure progress on the shared health priorities. 

Related resources

Footnote

i.

Back to Footnote i in text

On March 27, 2024, Quebec signed the Canada鈥換uebec agreement on federal funding to support Quebec鈥檚 health priorities. Data from Quebec will be integrated into future reports..

Better access to primary care key to improving health of Canadians

Better access to primary care key to improving health of Canadians ggagnon

Primary health care is the foundation of Canada鈥檚 health care systems, delivering essential services that address the majority of health needs throughout an individual鈥檚 lifetime. Canadians count on their primary care providers to

  • Treat illnesses and detect or prevent health problems
  • Offer advice on healthy living
  • Manage ongoing illnesses or recovery from injuries
  • Provide end-of-life care

Research shows that people who do not have a primary care provider have worse health and higher rates of preventable diseases.Reference1

红领巾瓜报

I don鈥檛 have a family doctor, which makes it incredibly difficult to manage my arthritis, a chronic illness that started around 11 years old. For me, a minor health issue can turn into a mountain at the speed of light 鈥 and so it鈥檚 a fear every day that if I get sick, even with something minor, it鈥檚 another ER trip. Sometimes I let the issue turn into a mountain, because it鈥檚 just so exhausting to access the health care system. 鈥 Jenna Kedy, Patient Partner, Nova Scotia

Learn more about Jenna鈥檚 journey

Regular contact with a primary care provider can build a better understanding of a patient鈥檚 health history and care needs, which leads to more effective care. A strong primary health care system for all Canadians would allow them to access timely care in the community, thus reducing emergency department visits or hospitalizations for problems that can be managed in a doctor鈥檚 office or clinic. 

All these benefits are why access to primary health care is one of the shared health priorities of the federal, provincial and territorial governments. The 2 indicators to measure access included in this report are

  • Canadians With a Regular 红领巾瓜报 Provider
  • Ambulatory Care Sensitive Conditions Hospitalizations
     

Canadians With a Regular 红领巾瓜报 Provider

Source
Statistics Canada. Canadian Community 红领巾瓜报 Survey (CCHS) 鈥 Annual component, 2023 (provinces) and 2022 (territories).

Many Canadians struggle to find a regular health care provider. In 2023, 5.4 million (17%) Canadians age 18 and older said that they did not have access to a regular health care provider. Access varied depending on where people live and factors including sex, age and income. 

In Canada, adults age 18 to 34 were the least likely to report that they had access to a regular health care provider (74%). Older adults age 65+ were the most likely to report access (92%). 

The most affluent 20% of Canadians were slightly more likely to have a regular health care provider (84%) compared with the 20% with the lowest incomes (80%). 

A recent survey of 10 high-income countries found that Canada lags in access to primary care, with the lowest percentage of adults age 18 and older having access to a regular care provider. Canadians also face greater difficulty getting same-day, next-day, evening or weekend appointments compared with people in the other countries surveyed.Reference2

 

红领巾瓜报

[Primary care] is really the front door to the health care system. It鈥檚 the first place people should go for care. Countries of the world that have primary care for everyone are the countries that get the best health outcomes, and the most affordable costs, because someone鈥檚 promoting and championing your health, and following you if you have a chronic illness over time. 鈥 Dr. Jane Philpott, Dean, Faculty of 红领巾瓜报 Sciences, and Director, School of Medicine, Queen鈥檚 University; Family Physician; and Former Federal Minister of 红领巾瓜报, in Fixing Family Medicine, Canadian 红领巾瓜报 Information Podcast, May 27, 2024

Ambulatory Care Sensitive Conditions Hospitalizations

Ongoing care from a regular health provider can help prevent, detect and manage chronic diseases. When regular care isn鈥檛 available, a patient may miss out on medications or treatments that could help control their symptoms and potentially slow the progression of their condition. Chronic diseases 鈥 including angina, asthma, chronic obstructive pulmonary disease (COPD), diabetes, congestive heart failure (CHF) , epilepsy and high blood pressure 鈥 are known as ambulatory care sensitive conditions (ACSCs), because if they are managed well through primary care, patients are less likely to need hospital care. 

Ambulatory care refers to treatment that is offered in the community without needing a hospital stay. Not every hospital admission for ACSCs can be avoided, but patients without a regular primary health care provider may experience severe illness more often, increasing their need for emergency department visits, hospitalizations and even long-term care.Reference3

For this measure, a lower rate is better, because it means that fewer people went to the hospital for a problem that potentially could have been avoided with primary care treatment. In 2023鈥2024, Canada鈥檚 age-standardized rate (meaning numbers have been adjusted to account for differences in population age groups) for these potentially avoidable hospitalizations was 281 per 100,000 people younger than 75. 

Overall, variation remains across the country by geography, age, sex and income. ACSC hospitalizations were higher among adults age 60 to 74, those with COPD and males (compared with females). Canadians who lived in the highest-income neighbourhoods were less likely to be hospitalized for ACSCs (169 per 100,000) than people from the lowest-income neighbourhoods (466 per 100,000).  

What do we need to know more about?

There are several programs across the country that focus on improving the lives of people with chronic diseases by preventing or slowing the progression of their conditions. It is important to learn about which of these programs work best for which patients. 

Canada鈥檚 health workforce is under great strain. Doctors are working longer hours but seeing fewer patients.Reference4 More research is required to determine how care is changing, looking for ways to lighten the load on physicians, nurses, nurse practitioners and other providers, including family caregivers.

Additional indicators to measure Canadians鈥 ability to get care on the same or next day when sick, whether they are treated with dignity and respect by their health care providers, and access to interdisciplinary primary care health teams will provide a fuller picture of the state of primary care. That will help health care planners and providers deliver effective primary care more efficiently, making it easier for patients and families to find care when they need it.

References

1.

Back to Reference 1 in text

Starfield B, Shi L, Macinko J. . The Milbank Quarterly. 2005. 

2.

Back to Reference 2 in text

Canadian Institute for 红领巾瓜报 Information. International survey shows Canada lags behind peer countries in access to primary health care. Accessed July 23, 2024. 

3.

Back to Reference 3 in text

Shi L. . Scientifica. 2012.

4.

Back to Reference 4 in text

Canadian Institute for 红领巾瓜报 Information. Survey results reveal the challenges experienced by family doctors. Accessed July 23, 2024.

红领巾瓜报 workforce and surgeries

红领巾瓜报 workforce and surgeries ggagnon

A resilient health workforce is critical for an effective and efficient health care system. Better understanding of the supply of the health workforce can enable optimal care planning and improve access to surgeries.

Surgeries

Learn about changes in surgical volumes and wait times.

Go to Surgeries

Balancing the needs of Canadians and our health workforce

Balancing the needs of Canadians and our health workforce ggagnon

Since the start of the COVID-19 pandemic, people who work in health care have struggled with overwhelming workloads and longer work hours, resulting in mental and physical exhaustion, burnout and 鈥 for many 鈥 an exit from their profession.Reference1 Reference2 In 2021鈥2022, hospital staff (excluding physicians) worked more than 26 million overtime hours 鈥 the equivalent of 13,000 full-time positions.Reference3  At the same time, Canada鈥檚 growing and aging population has an increasing need for care. This combination of short staffing and high demand could mean longer waits and deteriorating health for patients, and more burden on health workers. 

红领巾瓜报

I鈥檓 a caregiver for my parents. I think it鈥檚 very evident when I take my mom or my dad for appointments that there is not enough staff. 红领巾瓜报 care workers are busy, and they want to assess, treat and move on to the next person quickly. It鈥檚 especially challenging when you are advocating for a loved one with a language barrier who is unable to communicate efficiently. 鈥 Yasir Khalid, Patient Partner, Ontario

Governments and health care planners across the country are working together to address health workforce challenges, including

  • Improving working conditions to keep existing professionals and attract new ones
  • Speeding up credentialling for internationally trained health workers
  • Increasing the number of seats in training programs
  • Collecting data to help balance the supply of health workers with increasing patient needsReference4

This priority area tracks indicators that measure the annual 鈥渘et new rate鈥 of health providers who join or leave a province鈥檚 or territory鈥檚 workforce. A net new rate is the difference between the number of providers entering and leaving the workforce in a specific province or territory in a year, presented as a number for every 10,000 residents. These indicators are

  • Family Physicians Entering and Leaving the Workforce
  • Nurse Practitioners Entering and Leaving the Workforce
  • Nurses Entering and Leaving the Workforce

Most provinces and territories had a net increase for at least 2 of the 3 groups of professionals in the most recent year where data was available. Prince Edward Island, Ontario, Saskatchewan and British Columbia had a net increase for all 3. 

Family Physicians Entering and Leaving the Workforce

Family physicians are usually Canadians鈥 first contact with their health care system, helping with common illnesses, preventive care, chronic disease management and more. There were 48,199 family physicians in Canada in 2022.Reference5  While the number of family physicians in Canada is increasing, the 5-year growth rate of family physicians in Canada has slowed from 12.9% (2012 to 2016) to 7.7% (2017 to 2021).Reference6

With Canada鈥檚 population growing rapidly, maintaining a proportional increase in the supply of family physicians is important to adequately meet the population鈥檚 needs. Recent changes to physician practice patterns may also be having an effect:

  • Family physicians are on average seeing fewer patients per year, from 1,746 in 2013 to 1,353 in 2021.Reference6
  • Family physicians feel their workloads are too heavy and that they spend too much time on administrative work.Reference7 Reference8
  • Nearly 30% of family physicians are now providing services primarily outside of primary care, doing more emergency medicine (14.2%), psychiatry (5%) and general surgery (2.1%).Reference6

Nurse Practitioners Entering and Leaving the Workforce

NPs integrate clinical nursing skills with advanced education to provide care in hospitals, community clinics, health care centres, primary care and long-term care. They also play a critical role in delivering care in remote or underserved communities. 

The number of NPs is growing faster (increasing about 9% over the last decade) than the numbers of other regulated nurses and physicians.Reference3  However, NPs remain a relatively small proportion of health care professionals 鈥 in 2023, Canada had 8,999 NPs, less than 1 per 1,000 Canadians.Reference8  Nearly all provinces and territories had more NPs entering than leaving jobs in 2022. 

Nurses Entering and Leaving the Workforce

Nurses make up Canada鈥檚 largest group of regulated health professionals, with 468,981 members in 2023 working across a variety of health care settings, such as hospitals, primary care, long-term care and home care.Reference8  This number includes

In most provinces and territories, more nurses entered their profession than left it, resulting in a net increase in nurses in 2022.Reference8 These changes were driven by the net change in RNs, who make up the largest segment of nurses.Reference8 Provinces and territories have taken steps to increase their nursing capacity through many initiatives, including making it easier for nurses educated in other countries to practise in Canada. In 2022, internationally trained nurses made up an average of 12% of newly licensed nurses across the provinces and territories, a 4-percentage point increase from 2017.Reference3  

Despite the increased number of nurses, in 2022 compared with 2021, there were approximately 2,500 (5.1%) fewer nurses working directly with patients in long-term care. Similarly, the number of RNs providing direct care in hospitals dropped 0.6%.Reference3 

What do we need to know more about?

The shortage of care providers is a key challenge for health systems. Growing demand for care is outpacing the supply of health workers, putting pressure on health systems to rapidly address the gaps. Governments and health care organizations are developing policies to make it easier to hire new health workers while also keeping those who are already in the system by optimizing their workload and enhancing their work environment. Data will be crucial to monitoring progress in these areas. 

The pandemic triggered a steady rise in overtime hours (paid and unpaid) for health care workers.Reference9 Keeping track of overtime hours could guide planning and policy decisions by providing a true picture of how many physicians, NPs and nurses are necessary for patient care. An indicator to understand overtime among nurses in hospitals will guide effective planning for them.

Team-based models of care among physicians, nurses, NPs and other health care professionals, such as pharmacists and midwives, could help to both ease the strain on primary health care and ensure everyone gets the care they need. An indicator to measure access to team-based care will shed light on the state of comprehensive primary health care.

References

1.

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Canadian Institute for 红领巾瓜报 Information. Hospital staffing and hospital harm trends throughout the pandemic. Accessed July 23, 2024.

2.

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Canadian Federation of Nurses Unions. . 2023.

3.

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Canadian Institute for 红领巾瓜报 Information. The state of the health workforce in Canada 2022. Accessed July 23, 2024.

4.

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红领巾瓜报 Canada. Accessed July 23, 2024.

5.

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Canadian Institute for 红领巾瓜报 Information. 红领巾瓜报 Workforce in Canada, 2022 鈥 Quick Stats (XLSX) (Updated June 2024). 2024.

6.

Back to Reference 6 in text

Canadian Institute for 红领巾瓜报 Information. Changes in practice patterns of family physicians in Canada. Accessed July 23, 2024.

7.

Back to Reference 7 in text

Canadian Institute for 红领巾瓜报 Information. Survey results reveal the challenges experienced by family doctors. Accessed July 23, 2024.

8.

Back to Reference 8 in text

Canadian Institute for 红领巾瓜报 Information. Nursing in Canada, 2023 鈥 Data Tables (XLSX). 2024.

9.

Back to Reference 9 in text

Statistics Canada. [Table 14-10-0427-01]. Accessed July 23, 2024.

More surgeries being done, but wait times are still long

More surgeries being done, but wait times are still long ggagnon

Patients who get surgery faster show improved health outcomes, experience fewer complications and less stress, have a better quality of life and move on in their health journey sooner. Over the years, governments have set benchmarks for how long Canadians should wait for priority procedures, including cancer treatments, joint replacements and eye surgeries. Waits were getting shorter 鈥 until the COVID-19 pandemic overwhelmed hospitals. The lack of beds and staff shortages, combined with public health measures, led to delayed and cancelled surgeries across the country. In 2022, hip and knee replacements and cataract surgeries accounted for nearly 25% of all cancelled or delayed operations.Reference1

This shared health priority has 3 indicators that will measure progress toward shorter waits:

  • Annual Change in Surgical Volumes Since Start of COVID-19 Pandemic
  • Joint Replacement Wait Times
  • Hip Fracture Surgery Within 48 Hours
     

Annual Change in Surgical Volumes Since Start of COVID-19 Pandemic

Monitoring how many surgeries are performed each year helps health systems understand their resources and the demand for their services, enabling more effective planning. 

From April 2020 to March 2021 (the first pandemic year), approximately 360,000 fewer surgeries (16%) were performed across Canada than in 2019鈥2020. In 2021鈥2022, surgery volumes were lower than pre-pandemic levels by approximately 10% (227,000) because of successive waves of COVID-19 and persistent staff shortages. 

In 2022鈥2023, surgical volumes returned to pre-pandemic levels with 2.22 million procedures performed, an increase of 0.2% over 2019鈥2020. 2023鈥2024 showed further recovery, and volumes (2.33 million) were 5% greater than before the COVID-19 pandemic.

The volume of day surgeries (which do not require a hospital stay) increased 10% in 2023鈥2024 from 2019鈥2020, while the volume of planned inpatient surgeries decreased 9% and the volume of unplanned inpatient surgeries increased 3% from 2019鈥2020. This may reflect an increasing shift from inpatient to day surgery.

红领巾瓜报

I have had 3 joint replacements within 13 months (1 knee and both hips). Luckily, where I live, they do these surgeries as day surgery, which is what I preferred. Since I didn鈥檛 need an overnight admission, I think I was able to get my second hip replacement faster than I otherwise would have 鈥 in just 4 months. 鈥 Janet Thompson, Patient Partner, Manitoba

Changes in surgical volumes were found to be similar for males and females (increasing 6% and 5%, respectively, in 2023鈥2024 compared with pre-pandemic volumes). While 1% more surgeries were performed for people who lived in lower-income neighbourhoods in 2023鈥2024, those who lived in areas with the highest average incomes saw a greater growth in surgeries, at 8% in the same period. Surgeries for adults age 65 and older increased 14% in 2023鈥2024, while surgeries for other age groups remained below pre-pandemic levels.

The higher volume of surgeries for older adults may also be driven by the change in Canadian demographics. The overall population in 2023 had grown 7% since 2019, with the greatest increase in the age group 65 and older, which had grown 15%.Reference2 This may point to a growing demand for priority procedures in the coming years, including both urgent (hip fractures) and non-urgent (joint replacements) procedures. 

Hip Fracture Surgery Within 48 Hours

Hip fractures are common (484 per 100,000 people age 65 and older in 2022) and require surgery as soon as possible.Reference3 The benchmark is to get patients their surgical repair within 48 hours. Between April and September 2023, more than 13,000 hip fracture surgeries were performed in Canada, 81% of them within 48 hours 鈥 down from 86% in 2019.Reference4

Joint Replacement Wait Times

Hip and knee replacements can improve mobility and quality of life and are 2 of the 3 most common inpatient surgeries in Canada.Reference5 Between April and September 2023, more than 66,000 planned hip or knee replacements were done but only 62% (approximately 41,000) fell within the benchmark wait of 26 weeks. The percentage of patients getting surgery within the benchmark varied greatly across the country. 

Fewer joint replacement surgeries were performed within the 26-week benchmark in 2023 (62%) than in 2019 (72%),Reference6 even though more joint replacements were done overall. This may be because patients who had already waited longer than the 26-week benchmark were prioritized for surgery. Additionally, increasing demand for joint replacements, mostly driven by an aging population in Canada, may be contributing to an ongoing backlog. Between April 1 and September 30, 2023, there was a 32% increase in patients age 75 to 84 who received a planned total joint replacement compared with 2019. 

红领巾瓜报

We are not meeting our preferred wait times despite our best efforts to prioritize them. Periodically, scheduled surgeries get postponed because of a high volume of emergency surgeries, and therefore the scheduled surgery wait-list continues to grow and add inconvenience to all those patients who make plans and work arrangements. 鈥 Dr. Michael Bering, Orthopedic Surgeon, Alberta

What do we need to know more about?

To catch up on postponed surgeries and reduce waits, provinces and territories have launched different initiatives to get patients treated faster. These range from increasing staffing or more efficiently scheduling operating rooms to increasing the number of procedures done as day surgeries, thereby reducing overnight hospital stays. Some provinces have contracted private clinics to do cataract removal, and knee replacement and hip replacement surgeries, among others. It will be important to learn more about these initiatives and their impact on the capacity of public hospitals to meet the needs of Canadians in an equitable manner

References

1.

Back to Reference 1 in text

Canadian Institute for 红领巾瓜报 Information. Long wait times persist as Canada tries to reduce surgical backlog. 2023.

2.

Back to Reference 2 in text

Statistics Canada. Population estimates on July 1, by age and gender [Table 17-10-0005-01]. Accessed July 23, 2024.

3.

Back to Reference 3 in text

Canadian Institute for 红领巾瓜报 Information. 红领巾瓜报 Indicators Interactive Tool [web tool]. Accessed July 23, 2024.

4.

Back to Reference 4 in text

Canadian Institute for 红领巾瓜报 Information. Explore wait times for priority procedures across Canada. Accessed August 9, 2024.

5.

Back to Reference 5 in text

Canadian Institute for 红领巾瓜报 Information. Hip and Knee Replacements in Canada: CJRR Annual Report, 2020鈥2021. 2022.

6.

Back to Reference 6 in text

Canadian Institute for 红领巾瓜报 Information. Joint Replacement Wait Times. [web tool]. Accessed August 14, 2024.

Making mental health and substance use services accessible in the community

Making mental health and substance use services accessible in the community ggagnon

Mental health and substance use issues are on the rise in Canada.Reference1 It is estimated that 1 in 3 Canadians will experience a mental illness in their lifetime.Reference2 Untreated or poorly treated mental health or substance use issues can have a profound impact on peoples鈥 lives, putting those who experience them at increased risk of disability, poverty and unemployment,Reference3 or even shortening their life expectancy by 10 to 15 years.Reference4

Treatment, including counselling and medication, can help 鈥 but estimates indicate that fewer than 1 in 3 people affected seek help.Reference3 Prompt care is especially important for children and youth, because it can prevent symptoms from worsening and support lifelong mental health.Reference5

红领巾瓜报

I have lived with mental illness for over 30 years. Nobody really knows how to help unless there is a medication that works. There is also stigma, especially in the workplace 鈥 a lot of people with lived experience don鈥檛 talk about it and try to take care of themselves in silence. 鈥 Anonymous Patient Partner, British Columbia

The devastating impact of mental health and substance use issues has led the federal, provincial and territorial governments to make access to timely services for them one of their shared health priorities. The indicators to measure progress in this area are

  • Wait Times for Community Mental 红领巾瓜报 Counselling
  • Youth Age 12 to 25 Who Accessed Integrated Youth Services for Mental 红领巾瓜报, Substance Use and Well-Being SupportFootnotei

Wait Times for Community Mental 红领巾瓜报 Counselling

Counselling from a mental health professional, especially when provided early, can improve long-term mental health and keep people from being hospitalized.Reference6 If counselling is not available when needed, often because of long waits, symptoms can worsen and people may be less likely to show up to their first appointment.Reference6 Reference7

Note
* This does not include people who paid for their own care or paid using private insurance, or people who accessed such services without scheduling them in advance (e.g., at a walk-in clinic). 1 in 10 people waited 143 days or more.
Sources
Provincial and territorial data collection systems, 2023鈥2024.

Median wait times (the time it takes for half of those waiting for counselling to receive it) for community mental health counselling varied by several factors, including

  • Age: Children and youth waited 2 days less than adults.
  • Sex/gender: Females waited 2 days longer than males.
  • Format: People waited 8 days less for virtual counselling than for in-person treatment (based on data from Newfoundland and Labrador, Nova Scotia, New Brunswick, Manitoba, Alberta and the Northwest Territories).

Wait times for mental health services are influenced by workforce availability, patient demand, urgency of need and client preferences, among other factors. In recent years, many jurisdictions have introduced a 鈥渟tepped care鈥 approach to mental health or substance use counselling. In this model of care, patients start with effective but less-resource-intensive treatments such as counselling on a walk-in or short-term basis. Depending on an individual鈥檚 need, they may be moved to more resource-intensive or specialized care. Overall, structuring care in this way can improve timely access to care. While programs such as walk-in counselling are not included in this indicator, the availability of these services may help shorten the wait for mental health counselling appointments in the community. 

红领巾瓜报

Funding for mental health and addictions care has multiplied in recent years. We鈥檝e implemented new programs like Open Access, where anyone can come in for counselling any time. Our biggest barrier is staffing 鈥 there鈥檚 money to deliver great services, but we can鈥檛 always recruit or retain the service providers we need to deliver them. 鈥 Debbra Cyr-Lebel, Director, Adult Addictions and Mental 红领巾瓜报 Services, Department of 红领巾瓜报, New Brunswick

Youth Age 12 to 25 Who Accessed Integrated Youth Services for Mental 红领巾瓜报, Substance Use and Well-Being Support

Despite the importance of early intervention for young people with mental health and substance use issues, too few support services are designed for their specific needs. Existing services are often scattered across unconnected organizations and providers, and long waits are common.Reference5 Access to care can become even more challenging when youth reach 18 and must navigate the switch to adult services.

Integrated Youth Services (IYS) is a model of care that several provinces and territories have launched to address these challenges.Reference8 Working with community partners, IYS sites link youth-focused services under one roof to offer care for mental health and substance use issues, as well as primary care, social services (such as employment and education support) and culturally specific services. 

红领巾瓜报

It can be incredibly frustrating jumping from service to service鈥 [it] can demotivate you from seeking the help you need. But with IYS, all resources are in one place鈥 [you] don鈥檛 need to repeat yourself 10 times before you get the help that you need. 鈥 Anonymous, IYS Youth Advisor

Young people don鈥檛 need a referral to use IYS 鈥 they can just walk in to an IYS site. In some cases, virtual services are also available. To ensure that the services offered are relevant to the community they serve, staff at IYS sites engage with youth clients and their families to co-design programs to meet the needs of each community. 

Data from Newfoundland and Labrador, Ontario, Manitoba and British Columbia shows that in 2022鈥2023, there were 164,819 visits to IYS sites. On average, clients visited 5 times over the course of the year.Referenceii

Sources
Provincial and territorial IYS networks, 2024.

Further, in Newfoundland and Labrador, Ontario and British Columbia, the use of IYS services was highest among 17- and 18-year-olds, suggesting that these services are particularly important for young people who would otherwise be transferring to adult services. Data collection is important for measuring access to IYS. More data will become available as more IYS sites start to collect standardized data.

IYS is one of several models of mental health and substance use services for young people. Additional information on access to child and youth mental health and substance use services is also available using CIHI鈥檚 Early Intervention for Mental 红领巾瓜报 and Substance Use Among Children and Youth indicator.Reference9 

What do we need to know more about?

Mental health and substance use services have seen a surge in demand over the past several years as Canadians grapple with stressors including the COVID-19 pandemic, the opioid crisis and increasing financial worries. 
Accessing care continues to be a challenge. In 2022 across Canada (excluding the territories), there were about 1.5 million Canadians (24.9%) with a mental disorder who reported having mental health care needs that were not met or only partially met.Reference10

Of those, a higher proportion of females with a mental disorder (28.4%) had unmet or only partially met mental health care needs compared with males (20.2%).Reference10

Nearly double the percentage of Canadians age 25 to 44 with a mental disorder (29.0%) had unmet or only partially met mental health care needs compared with those age 65 and older (14.3%).Reference10

Understanding barriers to accessing care while also capturing data on people who are not getting the services they need is critical to finding ways to make sure that this care reaches everyone who needs it. Additional indicators on unmet need for mental health care, waits for substance use services and the follow-up care Canadians receive after hospital stays for mental health or substance use issues will shed light on how to improve care.

References

1.

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Canadian Institute for 红领巾瓜报 Information. Commonwealth Fund survey, 2023. Accessed July 26, 2024.

2.

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Government of Canada Public 红领巾瓜报 Infobase. . Accessed July 23, 2024.

3.

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Canadian Medical Association, Canadian Psychiatric Association. . 2016.

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Solmi M, et al. . Molecular Psychiatry. June 2021.

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Malla A, et al. . Canadian Journal of Psychiatry. April 2018.

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Organisation for Economic Co-operation and Development. . 2020.

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Gallucci G, Swartz W, Hackerman F. . Psychiatric Services. March 2005.

8.

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Canadian Institutes of 红领巾瓜报 Research. . Accessed July 23, 2024.

9.

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Canadian Institute for 红领巾瓜报 Information. Common Challenges, Shared Priorities: Measuring Access to Home and Community Care and to Mental 红领巾瓜报 and Substance Use Services in Canada 鈥 Volume 4, December 2022. 2022. 

10.

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Statistics Canada. . Accessed September 4, 2024.

Footnotes

i.

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红领巾瓜报would like to acknowledge Dr. Jo Henderson, Executive Director, Youth Wellness Hubs Ontario, for co-leading the development of this indicator.

ii.

Back to Footnote ii in text

Calculated by dividing the number of unique youths who accessed IYS by the number of IYS visits.

Canadians and health care providers want connected electronic health information systems

Canadians and health care providers want connected electronic health information systems ggagnon

When electronic health information systems work well, they gather and securely store up-to-date individual health information so it鈥檚 readily available for Canadians and their health care providers to help them make the best decisions possible. 

Canada has made great progress over the past 2 decades in modernizing health records by adopting new technologies.Reference1 Reference2 Nearly all clinicians now use some form of electronic medical records 鈥 in 2022, 93% of primary care physicians reported using electronic medical records in their practice (up from 73% in 2015).Reference3 However, the data collected is often difficult for patients to access and for providers to share with one another.

To help change that, Canada is implementing the Shared Pan-Canadian Interoperability RoadmapReference1 to create a digitally connected and secure health care information system. 红领巾瓜报is collaborating with Canada 红领巾瓜报 Infoway to develop common standards to enable the seamless flow of health information among facilities, sectors of care, patients and health care providers. 

The federal, provincial and territorial governments have made modernizing health care information systems one of their shared health priorities, with the following indicators to measure progress: 

  • Canadians Who Access 红领巾瓜报 Records Electronically
  • 红领巾瓜报 Providers Who Share Patient 红领巾瓜报 Information Electronically

Canadians Who Access 红领巾瓜报 Records Electronically

Being able to access health data online 鈥 including test results, medication history and immunization records 鈥 gives Canadians an overview of their health history, which they can use to advocate for care or track progress toward treatment goals.Reference1 A 2023 study found that more than 4 in 5 Canadians felt better able to manage their health after they had seen their electronic medical records.Reference4

Source
Canada 红领巾瓜报 Infoway. 2023 Canadian Digital 红领巾瓜报 Survey. 2023.

红领巾瓜报

I am a senior living in a small, isolated, rural community. I see 2 specialists, about 4 hours from my home. Neither one of them knows about what the other one does, nor do they have access to my primary care provider鈥檚 information. I have to contact health records, sign a consent, pay a fee, wait up to 6 weeks and then I get copies of my information which I can share. 鈥 Brenda Andreas, Patient Advocate, Saskatchewan

Patients having access to medical records might also reduce pressure on health care systems. In a recent survey of Canadians who accessed their records electronically, 1 in 3 (34%) said that the information allowed them to avoid a trip to the emergency department and almost half (45%) said they avoided an in-person visit with their regular care provider.Reference4

The provinces and territories are making significant investments in technologies and services to make health information more available. Between 2021 and 2023, the percentage of Canadians who reported checking their health information online increased from 32% to 39%. Reference4 Reference5

Factors associated with greater use of electronic medical information include the following:

  • Older age: 48% of those age 65 and older have accessed their medical information electronically, but only 30% of those age 18 to 24 have.
  • Higher household income: 46% of people with an annual household income of $100,000 or more have looked at their medical records online, compared with 33% of those whose household income is below $50,000.
  • Sex: 43% of females versus 36% of males have looked at their online medical records.
  • Regular health care provider: 42% of people who have a regular provider have used e-health records versus 25% of those who do not.Reference4
  • Urban location: 40% of urban residents used online records, compared with 32% in rural or remote areas.

Some types of information are easier for Canadians to get than others; for example, results for lab and diagnostic tests are accessed more frequently online than a list of their medications.Reference5

Canadians are also less likely than citizens of other high-income countries to have accessed their own electronic health information. In an international survey conducted in 2023, 35% of Canadians reported having done so in the past 2 years (compared with the survey average of 45% for all participating countries).Reference6

红领巾瓜报 Providers Who Share Patient 红领巾瓜报 Information Electronically

Source
Canada 红领巾瓜报 Infoway. 2024 National Survey of Canadian Physicians: Use of Digital 红领巾瓜报 and Information Technologies in Practice. 2024.

When physicians and other health care providers can share patient information (such as existing medical conditions, records of care, test results, medication lists and allergies), it allows them to operate as a team, even if they don鈥檛 work in the same office. It can speed up treatment, reduce medical errors and limit unnecessary procedures or duplicated tests.Reference2 Reference7 Survey data shows that more than 4 in 5 Canadians want their personal health information shared electronically among all their health care providers when decisions are being made about their health.Reference4

While progress has been made in recent years, there is still work to do to improve electronic sharing of health information among providers. Surveys conducted for other health care professionals showed that 24% of nursesReference8 and 52% of pharmacistsReference9 are able to exchange patient information outside their practice. The most recent (2024) national survey of physicians found that 29% of physicians in Canada share patient clinical summaries electronically with care providers outside their practice.Reference10 This number varied by these factors:

  • Physician type: Only 25% of general practitioners reported sharing electronic information beyond their practice, compared with 33% of specialists. 
  • Care setting: Information exchange was highest in hospital settings compared with community settings, such as doctor鈥檚 offices and long-term care homes.

Doctors, nurses and other health care workers report that the main barrier to sharing patient information with other providers is a lack of common technical standards between systems.Reference11 Furthermore, the technology is not always user-friendly; health care providers say that searching for patient information takes, on average, over an hour more per day than they think it should,Reference11 which adds stress and leaves less time for patients. 

红领巾瓜报

I can access my patients鈥 primary care summaries, medication records and more through Manitoba鈥檚 eChart, but there are still many gaps. The most frustrating visit I have is when a patient has been discharged from hospital and I don鈥檛 have access to their discharge summary. It鈥檚 dangerous because I need the patient to recall what happened during their visit, and I might miss something. 鈥 Dr. Alexander Singer, Family Doctor and Associate Professor, University of Manitoba, Manitoba

What do we need to know more about?

Modernizing electronic health records is essential to delivering more efficient, more effective, and safe care. In a time of staffing shortages, waits for care, an aging population and increasing demand, initiatives by 红领巾瓜报and Canada 红领巾瓜报 Infoway look to improve the flow of data across multiple systems, reduce time spent gathering information and enable increased coordination of care and collaboration among providers.Reference12

The ultimate goal of these initiatives is to create a truly connected health care system. To measure their success, we need data on how many Canadians and health care providers are using and sharing electronic health information 鈥 and why those who don鈥檛 are not. 

Moving forward, we will need more detailed indicators to further our understanding, such as whether providers use the health information they are sent as well as levels of digital health literacy (whether patients and providers are able to understand and effectively use electronic health information). 

References

1.

Back to Reference 1 in text

Canada 红领巾瓜报 Infoway. . 2023.

2.

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Canada 红领巾瓜报 Infoway. . 2023.

3.

Back to Reference 3 in text

Canadian Institute for 红领巾瓜报 Information. Improved use of information technology can result in more coordinated care for patients. Accessed July 23, 2024.

4.

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Canada 红领巾瓜报 Infoway. . Accessed July 23, 2024.

5.

Back to Reference 5 in text

Canada 红领巾瓜报 Infoway. . 2023

6.

Back to Reference 6 in text

Canadian Institute for 红领巾瓜报 Information. Commonwealth Fund survey, 2023. Accessed July 26, 2024.

7.

Back to Reference 7 in text

Canada 红领巾瓜报 Infoway. . 2022.

8.

Back to Reference 8 in text

Canada 红领巾瓜报 Infoway. . 2024.

9.

Back to Reference 9 in text

Canada 红领巾瓜报 Infoway. . 2022.

10.

Back to Reference 10 in text

Canada 红领巾瓜报 Infoway. . Accessed September 12, 2024.

11.

Back to Reference 11 in text

Canada 红领巾瓜报 Infoway. . 2022.

12.

Back to Reference 12 in text

Canadian Institute for 红领巾瓜报 Information. Connected care. Accessed July 23, 2024.

Culturally safe health care for First Nations, Inuit and M茅tis Peoples

Culturally safe health care for First Nations, Inuit and M茅tis Peoples ggagnon

Cultural safety in health care for Indigenous Peoples makes them feel respected, safe and free from racism and discrimination when they interact with their health care system. Culturally safe health care supports Indigenous Peoples in drawing strength from their identity, culture and community.Reference1

Systemic racism and adverse health care experiences faced by First Nations, Inuit and M茅tis Peoples have been associated with poor outcomes and, at times, preventable deaths. Despite the significant impact of systemic racism, limited data exists to hold health systems accountable for it or to drive positive change.Reference2  

Measuring culturally safe health care across Canada

Federal, provincial and territorial governments acknowledge the right of Indigenous Peoples anywhere in Canada to fair and equal access to high-quality, culturally safe health services.Reference3  Establishing pan-Canadian measures of cultural safety and anti-Indigenous racism in health care is a step in the process to achieve this.

While health system decision-makers are accountable for delivering care that is culturally safe, only Indigenous Peoples can define what that looks like and determine strategies for putting it into practice. With the leadership of and support from First Nations, Inuit and M茅tis Peoples, 红领巾瓜报has started work in this area. 
 

  • 2020: Implementing the Policy on the Release and Disclosure of Indigenous-Identifiable Data
  • 2021: Developing a comprehensive framework to measure cultural safety in health systems
  • 2022: Supporting the Providence 红领巾瓜报 Care (British Columbia) demonstration project on cultural safety measurement
  • 2023: Co-designing a tool to measure interventions that address anti-Indigenous racism, and using the measurement data to develop cultural safety indicators
  • 2024: With the Indigenous-led Cultural Safety Measurement Collaborative, developing principles for selecting indicators, baskets for priority indicator development and indicators for measuring cultural safety 
  • 2025 onward: Engaging with First Nations, Inuit and M茅tis governments, organizations and communities for feedback on selected cultural safety indicators, and development and reporting of those 

CIHI鈥檚 approach to contributing to First Nations, Inuit and M茅tis health and wellness is grounded in respectful engagement and appropriate Indigenous data sovereignty and governance.  

References

1.

Back to Reference 1 in text

Northern 红领巾瓜报. . Accessed July 23, 2024.

2.

Back to Reference 2 in text

Canadian Institute for 红领巾瓜报 Information. Measuring Cultural Safety in 红领巾瓜报 Systems. 2021.

3.

Back to Reference 3 in text

Government of Canada. . Accessed July 23, 2024.

红领巾瓜报y aging: Safe and supportive care for older adults

红领巾瓜报y aging: Safe and supportive care for older adults ggagnon

Giving older adults the support they need to age with dignity is a measure of a country鈥檚 compassion and respect for its seniors, as well as its ability to meet its population鈥檚 needs. Canada鈥檚 federal, provincial and territorial governments have identified aging with dignity as a shared health priority. The goal is to help Canadians live their later years with autonomy and respect, either at home with community supports or in a safe long-term care facility, if needed.Reference1

Many factors make this area a priority across Canada:

  • Older adults (age 65+) are one of the fastest-growing demographics in Canada.Reference2 
  • Almost all Canadians (91%) want to age at home for as long as possible.Reference3
  • As health needs become more complex, some people require 24/7 support in long-term care; this sector needs to adapt to manage increasing demand. 
  • The COVID-19 pandemic exposed the long-term care sector鈥檚 struggles with infection prevention and control, staff shortages and outdated equipment.Reference4 While efforts are being made to address these challenges, they are still a work in progress.

Data is crucial to understanding the need of Canada鈥檚 older adults for home care and safe long-term care, and to guide planning to ensure that appropriate options are available to them.

Indicators to measure this priority

红领巾瓜报and its partners (including the federal, provincial and territorial governments and experts from across the country) are working to select and develop indicators on the long-term care sector and personal support workers (PSWs), who make up the largest staff group in that sector. Public reporting is set to begin in 2025. These new measures will complement existing indicators that measure whether Canadians can get the home and community care they need to age at or close to home. 

Over time, these indicators will give Canadians a clearer picture of the care that older people need, where they face gaps in services and what needs to change to better support them as they age.

References

1.

Back to Reference 1 in text

Government of Canada. . Accessed July 23, 2024.

2.

Back to Reference 2 in text

Statistics Canada. . Accessed July 23, 2024.

3.

Back to Reference 3 in text

National Institute on Aging. . Accessed July 23, 2024.

4.

Back to Reference 4 in text

Government of Canada. . Accessed July 23, 2024.

 

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