In Canada, chronic disease is monitored using the Canadian Chronic Disease Surveillance System which measures incidence and prevalence of chronic disease, hospitalisations, and health outcomes (Government of Canada, n.d.). Data is collected, aggregated, and compared from all provinces and territories in support of chronic disease program and policy planning and evaluation, and funding administration (Government of Canada, n.d.).
Provincially, methods of surveillance may vary. In Ontario, administrative chronic disease data (submitted both to the provincial Ministry of Health and Long-term Care and to the national system) is collected through coordinated efforts between regional public health units, hospitals, (former) Local Health Integration Networks (though this function has since transferred to the new provincial body of oversight Ontario Health) and other health organizations (now also under the integrated umbrella of Ontario Health) including Cancer Care Ontario, e-Health Ontario, and Health Quality Ontario. In many instances, population self-reporting is also utilized, though it is recognized that this may present limitations to data accuracy given a likely underreporting of chronic disease prevalence and multimorbidity (Region of Waterloo, 2017).
Similarly, in Alberta, surveillance of chronic disease is supported by the provincial Ministry of Health. An online database of administrative health data, research, standards, and statistics is used, and provides interactive dashboards, demographics, and information sources related to physical and environmental health (Government of Alberta, n.d-a). Akin to Ontario, this data is submitted for use in the national system (Government of Canada, n.d.). Population self-report data is also commonly utilized (Ye et al., 2016).
An example of Alberta’s chronic disease surveillance can be seen in the large cohort data study Alberta’s Tomorrow Project which measured incidence and prevalence of chronic disease in residents aged 35-69 between 2000-2015 (Ye et al., 2016). The study made use of administrative health data sources to complement participant self-report on lifestyle behaviours and disease risk factors in an effort to improve chronic disease measurement and understanding in the province (Ye et al., 2016). The study concluded an overall increase across the study period in prevalence of most chronic conditions among the 52 000+ participants, including a noted increase in multimorbidity, and confirmed the feasibility of using provincial administrative health data to improve chronic disease research and health system planning and capacity (Ye et al., 2016).
As in Alberta, Ontario chronic disease data is used to inform health system planning and improvement but is also uniquely tied to the receipt of provincial health funding (to be described later) in effort to improve funding equity, hospital and community capacity, and health system sustainability (Ministry of Health and Long-Term Care [MOHLTC], n.d.; MOHLTC, 2007).
In Alberta, the prevention and management of chronic disease is most evident in the implementation of two major initiatives: Health Link Alberta and the Capacity Building Fund. These initiatives, funded through the Primary Health Care Transition Fund (PHCTF) enhanced Alberta’s already existent strategies in chronic disease management through improved access, accountability and service integration throughout the province (Government of Canada, 2007). Through both Health Link Alberta (a province-wide, 24/7 health information advice service) and the Capacity Building fund, Alberta strived to improve chronic disease management through the achievement of defined objectives, including developing and integrating innovative health promotion, disease prevention and chronic disease management programs; developing and supporting integrated care and service delivery models; developing and implementing effective change management strategies (regionally and provincially); establishing education and training services to support new models of service delivery; and identifying and developing infrastructure to support the delivery of primary care (Government of Canada, 2007)
Like Alberta, Ontario made use of the PHCTF in its improvement of primary care and the provincial capacity to better manage chronic disease. Not having well-established models of chronic disease management (as in Alberta) the province undertook 9 key initiatives with goals of improved access, quality and continuity of care, patient and provider satisfaction, and cost-effectiveness (Government of Canada, 2007). Similar objectives to Alberta were identified, including the development and integration of new care models, the establishment of education and training, and the development of infrastructure to better support research and care delivery (Government of Canada, 2007).
In Ontario, similar to Alberta, prevention and management of chronic disease is recognized as involving “interconnected and mutually dependent practice and system changes” (MOHLTC, 2007). This recognizes that, while undoubtedly important, efforts must extend beyond primary care in condition management, to include also, systematic efforts by community, health care organizations, and government to improve chronic disease education, care delivery and prevention efforts (Government of Alberta, n.d-b; MOHLTC, 2007).
At the community level, this includes the creation of supportive environments that foster healthy behaviours and reduce social isolation, as well as community action and advocacy that supports accessible and equitable care and services for those experiencing or at risk of chronic disease (MOHLTC, 2007; Roberts et al., 2015). At the organizational level, this includes (but is not limited to) the establishment of a framework for health promotion and prevention activities, integration of evidence-based guidelines into daily practice, use of a collaborative and coordinated approach, and improved use of physician-accessible chronic disease information and reporting systems that integrate consumer, decision support, and community information, to improve quality of care (Government of Alberta, n.d-b; MOHLTC, 2007).
The need for greater government intervention, as suggested by Ontario’s Chronic Disease Prevention and Management Framework, and Alberta’s Public Health Amendment Act can/should take the form of improved policy, the creation of legislation/regulations/guidelines (an Ontario example here), and increased fiscal and human resources (MOHLTC, 2007). The role of interprovincial and interjurisdictional knowledge transfer and sharing can also not be understated, as it provides key learnings and best practice for use in future provincial government chronic disease intervention and prevention activities (Government of Canada, 2007).
A unique example of provincial government intervention into chronic disease can be seen in the Ontario development and use of Health System Funding Reform.
In Ontario, funding for chronic disease (and health care more broadly) is distributed by the provincial government under the Health System Funding Reform (HSFR) model. HSFR was established in 2012 under the Excellent Care for All Act, 2010. In this model, hospitals as well as long-term care homes, and (former) Local Health Integration Networks, receive provincial compensation that relates directly to number of patients, service provision (including volume and type), evidence-based quality of services provided, and defined needs of the population (MOHLTC, n.d.). This change (from a global [read: guaranteed] model of health care funding) was made in response to factors including the increased incidence of chronic disease in the province, which saw an unsustainable increase in provincial budget spending on health (MOHLTC, n.d.). Using a HSFR model, the government endeavours to improve health care in the province by incentivizing quality improvements, tying funding amounts directly to the quality of care received and needs of the population (Pollard, 2015; MOHLTC, n.d.).
The HSFR model allows the provincial government to estimate and monitor future health spending needs using data related to past service levels, efficiency, and population health information (Pollard, 2015). This supports the provision of funding that is both more equitable, and more responsive to the increasing incidence of chronic disease, and multimorbidity in Ontario (Pollard, 2015; Roberts et al., 2015).
In Alberta, chronic disease and other health funding appears to be administered by the provincial government to Alberta Health Services (AHS), the provincial health authority, using a global model, with defined amounts identified for operating costs, emergency services, surgeries and related care, and improved health care capacity (Junker, 2022). Provincial health system funding is projected to increase year-over-year for the next several years, in anticipation of continued population growth and aging, and anticipated health system pressures (Junker, 2022). Such increases are informed by annual AHS performance reviews (Junker, 2022).
References
Government of Alberta (n.d-a). Health analytics interactive data. https://healthanalytics.alberta.ca/health-analytics.html
Government of Alberta (n.d-b). Modernizing public health laws. https://www.alberta.ca/modernizing-public-health-laws.aspx
Government of Canada (2007, March). Chronic disease prevention and management. https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/hcs-sss/alt_formats/hpb-dgps/pdf/prim/2006-chronic-chroniques-eng.pdf
Government of Canada (n.d.). Heart diseases and conditions. https://www.canada.ca/en/public-health/services/diseases/heart-health/heart-diseases-conditions.html
Junker, A (2022, February 24). Alberta budget: Health care gets $515-million boost, focuses on capacity issues, expanding continuing care. Edmonton Journal. https://edmontonjournal.com/news/politics/alberta-budget-health-care-gets-515-million-boost-focuses-on-capacity-issues-expanding-continuing-care
Ministry of Health and Long-Term Care (2018, January). Chronic disease prevention guideline, 2018. https://health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/protocols_guidelines/Chronic_Disease_Prevention_Guideline_2018.pdf
Ministry of Health and Long-Term Care (n.d.). Health system funding reform. https://www.health.gov.on.ca/en/pro/programs/ecfa/funding/hs_funding.aspx#1
Ministry of Health and Long-Term Care (2007, May). Logic model for Ontario’s chronic disease prevention and management framework [PDF]. https://www.health.gov.on.ca/en/pro/programs/cdpm/pdf/logic_model.pdf
Pollard, Brian (2015, July 6). Health system funding reform [PowerPoint slides]. Ministry of Health and Long-Term Care. http://www.tcu.gov.on.ca/pepg/audiences/universities/uff/Health%20Funding%20Deck%20EN.pdf
Region of Waterloo Public Health (2017, March 28). Quick stats: Chronic disease prevalence, Waterloo and Ontario, 2009-2010, 2011-2012, 2013-2014. https://www.regionofwaterloo.ca/en/regional-government/resources/Reports-Plans--Data/Public-Health-and-Emergency-Services/QSChronicDiseasePrevalence.pdf
Roberts, K. C., Rao, D. P., Bennett, T. L., Loukine, L., & Jayaraman, G. C. (2015). Prevalence and patterns of chronic disease multimorbidity and associated determinants in Canada. Health Promotion and Chronic Disease Prevention in Canada, 35(6), 87–94. https://doi.org/10.24095/hpcdp.35.6.01
Ye, M., Vena, J., Johnson, J., Shen-Tu, G., & Eurich, D. (2021). Chronic disease surveillance in Alberta’s tomorrow project using administrative health data. International Journal of Population Data Science, 6(1). https://doi.org/10.23889/ijpds.v6i1.1672
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