Wellness model emphasizes illness prevention

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Dr. John Haggie is a strong proponent of the adage "an ounce of prevention is worth a pound of cure."

As a surgeon practising in Gander, Nfld., he has first-hand experience with serious medical conditions that could be prevented with early intervention.

Among his examples, Dr. Haggie points to a patient who is about to lose her leg due to complications of type 2 diabetes. "This outcome could have been avoided at any number of points," he says. "Better childhood nutrition and fitness could have prevented the obesity that led to the development of this woman's diabetes. Better drug coverage could have improved her blood glucose management. Even something as simple as having her feet checked by a nurse, which costs about $20, could have saved this woman's leg and tens of thousands of dollars to the health care system."

As president of the Canadian Medical Association, Dr. Haggie is promoting a transformation of the health care system that will focus on illness prevention and health promotion. "The current acute disease model of health care is 20 years out of date. Today, the biggest burden on the system comes from largely preventable chronic diseases and their complications," he says, noting part of the challenge in promoting health is that many highly effective interventions are based in the community, not in hospital or doctors' offices (for example, programs to encourage youth fitness and smoking cessation initiatives). As a result, they are not funded by medicare.

"We have to convince the government to invest in primary and secondary prevention initiatives. The evidence shows that an upfront investment more than pays for itself down the road," says Michael Cloutier, president and chief executive officer of the Canadian Diabetes Association. He notes that just a two per cent reduction in diabetes prevalence rates would result in a nine per cent reduction in direct health care costs.

Unfortunately, the tools and medications that promote health are not accessible to all Canadians. Almost two-thirds of people with diabetes report that they cannot afford to comply with their prescribed therapy to effectively manage their disease. "A lot of people have to choose between paying for their rent or for their medications. Many more – especially those in remote and lower income communities – cannot afford healthy food. The result is more diabetes-related complications, poorer quality of life for these individuals and an increasing strain on our health care system," says Mr. Cloutier. "We need to create a standard of care for chronic disease management across Canada."

The Canadian Medical Association is advocating for co-ordinated investments in health promotion and disease prevention that will eliminate these gaps.

"There is no reason why we can't do that. By emphasizing health promotion now, we will see results by 2020."

RISK MANAGEMENT

Poll shows Canadians need to wake up to chronic disease truths

According to poll results reported in the 2011 Heart & Stroke Foundation Report on Canadians' Health, nine out of 10 Canadians are jeopardizing the quality and length of their lives. The foundation found that many Canadians are in denial about their risk factors for heart disease such as being overweight and being physically inactive − risk factors they can manage and control.

While the poll results indicate 90% of Canadians rate themselves as healthy, the reality is:

9/10 Canadians have at least one risk factor for heart disease and stroke.

Approx. 50% of Canadians don't meet the physical activity and healthy eating recommendations.

25% of Canadian adults are obese.

The foundation's prescription for a healthy lifestyle and more quality years of life includes managing controllable risk factors by following a healthy diet, being physically active, knowing and controlling one's blood pressure and cholesterol levels, maintaining a healthy weight, being smoke-free, reducing stress, managing diabetes and limiting alcohol consumption.

IDEAS FOR IMPROVED CHRONIC DISEASE MANAGEMENT

CIHR: Better health care through patient-oriented research

Research focused on patients is the cornerstone of world-class health care. Canada's Strategy for Patient-Oriented Research is a new national health research strategy that puts patients first.

It is focused on providing patients, health professionals and policy-makers with the best available information to make treatment and policy decisions that are appropriate, timely and effective. It aims to strengthen support for clinical trials and intervention studies as well as research that compares the effectiveness, benefits and harms of existing treatment options. The strategy also endeavours to improve the translation of innovative preventative, diagnostic and therapeutic approaches into the health care setting.

The strategy was created after extensive consultations led by the Canadian Institutes of Health Research (CIHR) with health charities, academic health care organizations, industries, universities and governments. The strategy, a first for Canada, will bring together a coalition of researchers and stakeholders to work with the provinces and territories to meet the challenge of delivering high-quality and sustainable health care.

"Patients are at the centre of health care. Canada's Strategy for Patient-Oriented Research is about recognizing the patients' perspective and ensuring that the care they receive meets their needs and is based on the best available information. If done right, the strategy can transform clinical practice in this country for the benefit of Canadians. This will improve health outcomes as well as the patients' satisfaction with their care," said Dr. Alain Beaudet, president of CIHR.

Knowledge for practice: Managing medical knowledge

In January 1911, when the post office began delivering the first issue of the Canadian Medical Association Journal (CMAJ) to about 1,500 physicians spread across the country, CMAJ was the only form of continuing education available to most of those readers.

Fast forward 100 years.

Today, 71,000 doctors receive the paper version of CMAJ, but they are also joined online by thousands more readers spread around the world. But that's just the start – other changes in physicians' ongoing education have been even more staggering.

At the Canadian Medical Association, this "education explosion" is called K4P – Knowledge for Practice – and its ripple effects are being felt across medicine.

Physicians of 100 years ago – even 25 years ago – usually had access to a handful of journals and textbooks to help them provide up-to-date care. The CMA's K4P program takes the same concept – up-to-date information – and delivers it instantly to the patient's bedside or physician's examining room.

Today, CMA members can instantly consult more than 100 online textbooks and marvellous diagnostic resources such as DynaMed and MD Consult just by clicking a few computer keys or touching an iPad. When patients' visits are over, the doctor can provide them with take-away information by pressing a few more keys. Later, that same physician can update his or her skills by taking an accredited online course or webinar.

That, in a nutshell, is the goal of the CMA's K4P project: to provide doctors with easy access to the best information so that patients can receive the best care. There's no doubt that the editors of that first edition of CMAJ would be pleased.