Health
Alberta doctors speak out against AHS review recommendations targeting surgery – CBC.ca
Some Alberta doctors are pushing back against recommendations in the recently released Alberta Health Services performance review that call for cutbacks and even the removal of government funding for dozens of surgeries.
One section of the $2-million report, conducted by Ernst and Young for the Alberta government, takes aim at a list of 44 surgeries (more than 50,000 cases) defined by the U.K.’s National Health Service as “of limited clinical value.”
The report recommends a targeted reduction could result in $47 million to $100 million in savings.
The review also recommends working to remove these procedures from Alberta’s list of insured services — something the province is now saying won’t happen.
Adult abdominal hernia repairs, which were performed 8,658 times in Alberta in 2018-19, top that list.
“This section of the report paints a picture that’s not accurate at all,” said Dr. Parveen Boora, a general surgeon at the Chinook Regional Hospital in Lethbridge.
According to Boora, the NHS recommendations cited in the report — and used to justify targeted cuts — contain the same criteria doctors here in Alberta already use.
Surgeons, he says, are fixing hernias only when it’s medically necessary.
“It doesn’t say not to fix them. It doesn’t say fixing them all is of limited clinical value. It basically says that if they are of a certain subtype or if they are symptomatic or if they have caused complications, they should fix them,” he said.
“And that’s already the criteria we use to decide on fixing hernias.”
The AHS review defines “limited clinical value” as “procedures where the evidence of clinical effectiveness is deemed to be weak or absent. Many times, alternative therapeutic approaches exist that reduce the risk of patient harm and promote more efficient use of OR capacity.”
It goes on to say that detailed clinical reviews “alongside AHS’s clinical experts” are required to adequately assess the appropriateness of the procedures.
Boora says its clear to him that the authors of the report are not doctors and don’t understand Alberta’s medical system.
“They did not go and audit 8,700 charts and determine whether or not it met the NHS’s criteria. They just word matched,” he said.
“People who work in the field of medicine would see something like that and right away they’d be like, ‘you’re not interpreting that right. There’s something wrong here.’ So when you see something like that in a report, it would suggest to me that there wasn’t somebody there who knew how to interpret the guideline.”
‘Life-saving’ surgery
Dr. Sean Gregg, a Red Deer surgeon, has similar concerns.
“I did two hernia surgeries last week. Both of those patients would have died within several days because their bowel was dead. It was stuck in their hernia, How could you ever say that’s not of clinical value?” said Gregg.
“Those lives were saved.”
According to Gregg, most, if not all, of the abdominal hernia surgeries performed in Alberta are medically necessary.
“I am extremely pessimistic about the ability to translate these recommendations into the kind of numbers that they’re predicting because the low value care that they’re talking about. It just doesn’t exist in real life,” he said, pointing to the report’s suggestion that a targeted reduction of this surgery list could net a savings of up to $100 million.
Gregg believes that while the AHS performance review may contain some important recommendations, it missed the mark when it comes to surgery.
Tubal ligation
The list also includes female sterilization (tubal ligation), a procedure that was conducted 1,095 times in Alberta last year
“My first response was disbelief. My second was anger,” said Dr. Fiona Mattatall, a Calgary-based gynecologist who was shocked when she read the report.
“‘Limited clinical value’ would be the opposite of how I would describe this surgery. It’s of significant clinical value both for a woman to be able to control her birth control but also … risk reduction for ovarian cancer.”
According to Mattatall, tubal ligation is done mostly for contraception in women for whom other forms of birth control have failed and also for women who can’t afford other birth control methods.
Tubal ligation is the only funded form of birth control for women in Alberta
“I think it’s important both for reproductive freedom for women but particularly for women of limited socio-economic status,” she said
Mattatall says the criteria recommended by the NHS and cited in the report as a reason for reducing these surgeries are already being used by physicians who perform tubal ligations.
She notes the Alberta health-care system is different.
“What’s different in the NHS is that under their program, all contraception is paid for by the NHS. So a woman can have an IUD, or birth control pill, condoms, tubal, her partner can have a vasectomy — all at no cost to the patient. Very different here in Alberta.”
No plans to delist
Alberta’s Health Minister, Tyler Shandro, insists the province has no plans to stop funding the surgeries listed in the report.
In a statement emailed to CBC News, Shandro’s press secretary, Steve Buick wrote: ” We’re not de-insuring hernia repairs, mastectomies or any of the procedures listed in the report.”
To be absolutely clear: this does not mean de-listing or de-insuring these procedures. In fact <a href=”https://twitter.com/AHS_media?ref_src=twsrc%5Etfw”>@AHS_media</a> has already been doing this work for a long time and this section of the report builds off of that work.
—@shandro
Buick said the list reflects the NHS’s concerns about inappropriate use or overuse of some procedures in the U.K. and “the AHS review recommends that AHS continue its own work to ensure appropriate care in Alberta, in consultation with clinicians.”
He pointed to work that’s been done for years by AHS and doctors to reduce the use of MRIs, CT scans and anti-psychotic drugs in continuing care as examples.
“Decisions on the appropriateness of surgery for a patient will continue to be made by medical professionals at AHS, not by politicians,” he said.
Opposition not convinced
Despite the minister’s commitment to maintain coverage for the surgeries, NDP Leader Rachel Notley continues to raise questions about the aim of the report.
“I’m very concerned that we’re actually looking at delisting or reducing coverage for any kind of health-care procedure that makes a difference in the lives of Albertans,” she said.
“They’re identifying them as procedures that they need to look at whether they’ll continue to offer,” Notley said. “If they’re not offering them, then presumably people will have to buy them.… I’m not at all comforted by the assurances of the minister.”
The review is now in the hands of AHS officials, who have been given until May 13 to develop an implementation plan.
For his part, Boora says the problems he sees with the report’s recommendations on surgery are making him question the work behind dozens of other recommendations found in the review.
“It does make me then wonder: So what else in this report is being put forward without an understanding of how to interpret recommendations, for example, or how to actually provide health care. That’s … what stood out to me.”
US’ health emergency declaration may come too late to halt spread, experts say
The administration of US President Joe Biden on Thursday declared the country’s monkeypox outbreak a public health emergency, but many health experts fear that it may be too late to contain the spread of infections.
Criticism of the White House’s response to the disease outbreak has been building, with experts saying the authorities have been slow off the mark in distributing treatments and vaccines.
The White House’s declaration signals that the monkeypox virus now represents a significant risk to citizens. The Secretary of Health and Human Services, Xavier Becerra, is considering a second declaration that would empower federal officials to expedite medical countermeasures, such as other potential treatments and vaccines, without going through comprehensive federal reviews.
That also would allow for greater flexibility in how the current supply of vaccines is administered, Becerra said.
Some 6,600 monkeypox infections have been reported in the United States, a number that has risen sharply over the past weeks.
Lawrence Gostin, a public health law expert at Georgetown University, said the declaration of the health emergency “signals the US government’s seriousness and purpose, and sounds a global alarm”. But he told The Associated Press that the action was overdue.
Gostin said the government has been too cautious and should have declared a nationwide emergency earlier.
On July 23, the World Health Organization declared a global health emergency over the outbreak, with cases in more than 70 countries.
California, Illinois and New York have all made declarations recently, as have New York City, San Francisco and San Diego County.
Since doctors diagnosed the first US case on May 27, the virus has been spreading rapidly in the country, with the highest rates per capita reported in Washington, New York and Georgia.
More than 99 percent of the infections are among men who have sex with men.
The virus is transmitted mostly during close physical contact. So far, no deaths from the disease have been reported in the US.
The country now has the highest case count among nonendemic countries, and the number is expected to rise as surveillance and testing improve.
Monkeypox is endemic in parts of Africa, where people have been infected through bites from rodents or small animals. Classification as endemic means a disease has a constant presence in a population but is not affecting an alarmingly large number of people, as typically seen in a pandemic.
‘Rarely fatal’
On its website, the Centers for Disease Control and Prevention says of the virus: “Monkeypox virus is part of the same family of viruses as variola virus, the virus that causes smallpox. Monkeypox symptoms are similar to smallpox symptoms, but milder, and monkeypox is rarely fatal. Monkeypox is not related to chickenpox.”
There is increasing concern that the US may have lost its chance to contain the monkeypox virus. Some public health experts have pointed fingers at the administration for its slowness in rolling out vaccines and treatments.
“The window for containing monkeypox is rapidly closing,” Gostin warned in an interview with CNN late last month. He had called for the US to declare a national public health emergency and make more vaccine doses available.
“I do think it’s still possible to contain, but it’s also equally possible that this may become endemic in the United States,” he said.
Supplies of a monkeypox vaccine called Jynneos have been limited even as demand surges. The administration has been criticized for moving too slowly to expand the number of doses.
Federal officials have identified about 1.6 million people as being at the highest risk for monkeypox, but the US has received enough Jynneos doses to fully cover only about 550,000 people.
The shortage of vaccines was caused in part because the Department of Health and Human Services failed early on to ask that bulk stocks of the vaccine it already owned be bottled for distribution, reported The New York Times, citing multiple unnamed administration officials familiar with the matter.
The government is now distributing about 1.1 million vaccine doses, less than a third of the 3.5 million that health officials now estimate are needed to fight the outbreak. It does not expect the next delivery, of 500,000 doses, until October.
US’ health emergency declaration may come too late to halt spread, experts say
The administration of US President Joe Biden on Thursday declared the country’s monkeypox outbreak a public health emergency, but many health experts fear that it may be too late to contain the spread of infections.
Criticism of the White House’s response to the disease outbreak has been building, with experts saying the authorities have been slow off the mark in distributing treatments and vaccines.
The White House’s declaration signals that the monkeypox virus now represents a significant risk to citizens. The Secretary of Health and Human Services, Xavier Becerra, is considering a second declaration that would empower federal officials to expedite medical countermeasures, such as other potential treatments and vaccines, without going through comprehensive federal reviews.
That also would allow for greater flexibility in how the current supply of vaccines is administered, Becerra said.
Some 6,600 monkeypox infections have been reported in the United States, a number that has risen sharply over the past weeks.
Lawrence Gostin, a public health law expert at Georgetown University, said the declaration of the health emergency “signals the US government’s seriousness and purpose, and sounds a global alarm”. But he told The Associated Press that the action was overdue.
Gostin said the government has been too cautious and should have declared a nationwide emergency earlier.
On July 23, the World Health Organization declared a global health emergency over the outbreak, with cases in more than 70 countries.
California, Illinois and New York have all made declarations recently, as have New York City, San Francisco and San Diego County.
Since doctors diagnosed the first US case on May 27, the virus has been spreading rapidly in the country, with the highest rates per capita reported in Washington, New York and Georgia.
More than 99 percent of the infections are among men who have sex with men.
The virus is transmitted mostly during close physical contact. So far, no deaths from the disease have been reported in the US.
The country now has the highest case count among nonendemic countries, and the number is expected to rise as surveillance and testing improve.
Monkeypox is endemic in parts of Africa, where people have been infected through bites from rodents or small animals. Classification as endemic means a disease has a constant presence in a population but is not affecting an alarmingly large number of people, as typically seen in a pandemic.
‘Rarely fatal’
On its website, the Centers for Disease Control and Prevention says of the virus: “Monkeypox virus is part of the same family of viruses as variola virus, the virus that causes smallpox. Monkeypox symptoms are similar to smallpox symptoms, but milder, and monkeypox is rarely fatal. Monkeypox is not related to chickenpox.”
There is increasing concern that the US may have lost its chance to contain the monkeypox virus. Some public health experts have pointed fingers at the administration for its slowness in rolling out vaccines and treatments.
“The window for containing monkeypox is rapidly closing,” Gostin warned in an interview with CNN late last month. He had called for the US to declare a national public health emergency and make more vaccine doses available.
“I do think it’s still possible to contain, but it’s also equally possible that this may become endemic in the United States,” he said.
Supplies of a monkeypox vaccine called Jynneos have been limited even as demand surges. The administration has been criticized for moving too slowly to expand the number of doses.
Federal officials have identified about 1.6 million people as being at the highest risk for monkeypox, but the US has received enough Jynneos doses to fully cover only about 550,000 people.
The shortage of vaccines was caused in part because the Department of Health and Human Services failed early on to ask that bulk stocks of the vaccine it already owned be bottled for distribution, reported The New York Times, citing multiple unnamed administration officials familiar with the matter.
The government is now distributing about 1.1 million vaccine doses, less than a third of the 3.5 million that health officials now estimate are needed to fight the outbreak. It does not expect the next delivery, of 500,000 doses, until October.
Health unit to host monkeypox clinic Sunday
File photo courtesy of © Can Stock Photo / jbruiz
August 6, 2022 6:00am
The Windsor-Essex County Health Unit is making a limited supply of the monkeypox vaccine available.
The health unit will set up a monkeypox vaccine clinic on Sunday from 11 a.m. to 4 p.m. at Windsor-Essex PrideFest, centred at Lanspeary Park. Acting Medical Officer of Health Doctor Shanker Nesathurai said the clinic will be geared toward high-risk individuals.
“The term is sometimes described as ‘pre-exposure prophylaxis’, and that will be offered at the Pride event this coming weekend,” Nesathurai said during a media briefing Friday morning.
Chief Nursing Officer Felicia Lawal said the health unit will work with PrideFest and Pozitive Pathways to operate the mobile clinic.
“Public health nurses will be available to provide health information and resources on monkeypox, as well as pre-exposure vaccination for those who meet criteria and qualify,” said Lawal.
Nesathurai said the health unit will have about a hundred doses available at the clinic, and that the unit had distributed monkeypox vaccines in the past.
The health unit also emphasized that even though the biggest risk group continues to be men who have sex with men, anyone can get the virus, which can be transmitted through close contact. Nesathurai added that the PrideFest clinic will be the best way to raise as much awareness of the virus as possible, but the health unit is working not to stigmatize any segment of the population.
So far, there has been just one confirmed case of monkeypox in Windsor-Essex.
Complete information about monkeypox and vaccines can be found on the health unit’s official website.
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