“Evidence-based treatment can improve the lives of those living with an opioid use disorder”
…so begins a report prepared by the Canadian Centre on Substance Use and Addiction (CCSA) last year documenting the many best practices in use across the country to manage a condition inexorably linked to the explosion of opioid-related deaths.
The Public Health Agency of Canada estimated 10,300 Canadians died from opioid-related causes between January 2016 and September 2018. More than 100 Ontarians are dying of an opioid overdose each month, and the crisis is not yet slowing. It is clear that we have an evidence-based consensus that more can and should be done to support those working on the front-lines of our health care system—family physician offices, nurse practitioner led clinics, and emergency departments, for example.
Over the last five years, several organizations in Ontario have developed and shared reports to support primary care clinicians in their efforts to improve patient care. Until now, these reports were produced independently and in a largely uncoordinated fashion.
Each of these initiatives were intended to fill an important gap in access to information. It wasn’t too long ago that there was no mechanism for family physicians practicing in Ontario to see comparative data on their own practice. As recently as 2015, less than a third of family physicians in Ontario reported routinely receiving information on how the clinical performance of their practice compared with that of peers. In contrast, 70% of family physicians practicing in the UK reported receiving this type of information.
Though well-intended, the number of reports in Ontario then became overwhelming. Many family physicians indicated they did not access or read the reports they were receiving due to time pressures, little relevance or concerns about validity. This was expressed by physician leaders at a roundtable called to address the issue. Not suprisingly, there was clear and shared understanding across providers of the reports that these multiple uncoordinated reporting efforts could lead to disengagement and accelerate burnout.
A quality health care system seamlessly delivers care across a broad spectrum of care settings and patient populations. Unfortunately, even a good health care system can have fault lines into which patients can fall and where quality care is deficient.
Measuring Up, Health Quality Ontario’s newly released 11th annual report on the performance of the province’s health system and on the health of Ontarians, documents those fault lines as well as other areas where the provincial system can improve. It takes the pulse of the system through measurement and through narratives from people like Gordon, Lilac and Elgin who share their experiences as patients and that of Shawn Dookie, a nurse practitioner.
According to a recent report from Health Quality Ontario, 9 Million Prescriptions, one in seven Ontarians fills a prescription for opioids every year. More than 9 million prescriptions for opioids were filled in the province in 2015/16. Canada remains the second-largest consumer of prescription opioids in the world, after the US.
Unfortunately, many patients are receiving these highly addictive drugs, from both legitimate and illicit sources, with only questionable benefit. This is a complex problem involving many health care providers and many interwoven factors compounding the situation.
While physicians are faced with the challenges of treating patients with often complex disorders and few resources, more appropriate prescribing by all physicians is part of the solution.
Ten years ago, I gave birth in hospital to my first child – a healthy, beautiful baby girl.
I still remember looking into her eyes for the first time and I still remember what it was like to be a patient. I remember wanting to provide feedback to someone about my experiences – both the good (great breastfeeding support) and the bad (being woken before dawn for a blood pressure check). But there was never any opportunity.