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Alberta pharmacists can't offer publicly funded measles vaccine as outbreak worries grow – CBC.ca

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There are calls for Alberta to improve access to publicly funded measles vaccines, by allowing pharmacists to provide them, as some Albertans struggle to access the shots.

Canadian health officials recently began urging people to ensure they’re protected against measles, especially before travelling. Cases have surged in Europe and are popping up in parts of Canada as well.

Many adults are now scrambling to sort out if they need another dose.

According to the Public Health Agency of Canada, adults who were born before 1970 and plan to travel should have at least one dose of the vaccine. Those born after 1970 should have two.

“I didn’t want to take a chance with the measles,” said Red Deer resident Jean Kennedy-Roy, prior to leaving for France to visit her new grandbaby, who is too young to be vaccinated.

When she heard the vaccination recommendations for travellers, she immediately set out to secure an appointment for herself.

But, according to Kennedy-Roy, it wasn’t easy.

“This needs to be dealt with so people can get their injections in a more timely manner,” she said.

She wasn’t able to book an appointment in time at a public immunization clinic and tried a number of different pharmacies before driving to Lacombe, where she paid out of pocket to get the shot.

“The government is behind the 8-ball,” she said.

“They really need to get on to this. They need to work with public health and the pharmacies and move the vaccine into more accessible community spaces.”

Kennedy-Roy wrote Alberta’s health minister about her concerns but has yet to hear back.

Role of pharmacists

Randy Howden, president of the Alberta Pharmacists’ Association, said pharmacists would like to help but have not been given the green light by the provincial government.

Currently, pharmacists can only access private supplies and charge customers for measles shots.

“It’s pretty difficult to get it through the public health system right now, there’s a bit of a wait,” he said.

According to Howden, the association has asked that the measles vaccine be added to the list of publicly funded shots they’re already allowed to provide such as influenza and COVID-19 immunizations.

“It would be very, very easy for us to increase access to these vaccines … and take some of the load off other parts of the health system,” he said.

“We have the scope to provide these vaccinations and we’ve shown that we’re able to roll out effective vaccine systems and processes in the past.”

According to the group’s website, pharmacists have administered more than 4.5-million doses of the COVID vaccine since March 2021.

The government said it is not planning to launch a measles vaccination program with the pharmacies.

“Pharmacists are valued partners in our health system and we appreciate their support in administering publicly funded vaccines,” Sheri Clegg, an Alberta Health spokesperson, said in a statement emailed to CBC News.

“Alberta Health is not currently considering partnering with community pharmacies to administer measles-containing vaccine for various reasons, including vaccine logistics, dilution of supply, vaccine administration route and vaccine reporting requirements.”

Alberta’s immunization program, which is led by public health nurses, is working well, the statement went on to say.

“Increased access to influenza vaccine (for ages five-plus) and pneumococcal vaccine (for 65-plus) through pharmacies has not increased immunization rates,” Clegg said.

However, according to the Alberta Pharmacists’ Association, pharmacists are the largest provider of influenza vaccine in the province each year.

Randy Howden is a pharmacist and the owner of the Crowfoot and Sunridge Medicine Shoppe locations in Calgary. (CBC)

“It is a little bit surprising when we start to hear calls and recommendations to get vaccinated that at the same time there isn’t an avenue to provide easier access to those vaccines,” said Howden.

To make matters worse, manufacturers are reporting shortages of the measles vaccine, due to increased demand. 

“My pharmacies ran out [last] Saturday and we don’t have capacity to get more,” said Howden.

Health Canada said both manufacturers have indicated they’re able to fill orders for public immunization programs.

But the private supplies are affected by the shortage, and the pharmacists who offer them are fielding a lot more calls these days.

“Now we have so many inquiries from the general public,” said Kenneth Kwon, a pharmacist at Two Pharmacy in Cochrane.

Often, he said, people are confused about whether they qualify for a measles shot and he guides them through that process. 

As a travel pharmacist, Kwon usually keeps a good supply on hand. But he’s unsure how long it will last.

“We get inquiries on a daily basis.… If the trends keep going, we may use them up.”

Meanwhile, Alberta Health Services (AHS) said it’s working to improve access to adult immunization in the Calgary zone.

Adult immunization is offered one day a week at the Brentwood and Sunridge clinics as well as the South Calgary Health Centre.

Starting at the end of March, it will be centralized at Sheldon M. Chumir Health Centre in the Beltline, with appointments offered six days a week as well as evenings and weekends.

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Older patients, non-English speakers more likely to be harmed in hospital: report

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Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.

The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.

The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.

The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.

“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.

When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.

“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.

“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.

The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.

Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.

The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.

“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.

They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.

“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”

This report by The Canadian Press was first published Oct. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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Alberta to launch new primary care agency by next month in health overhaul

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CALGARY – Alberta’s health minister says a new agency responsible for primary health care should be up and running by next month.

Adriana LaGrange says Primary Care Alberta will work to improve Albertans’ access to primary care providers like family doctors or nurse practitioners, create new models of primary care and increase access to after-hours care through virtual means.

Her announcement comes as the provincial government continues to divide Alberta Health Services into four new agencies.

LaGrange says Alberta Health Services hasn’t been able to focus on primary health care, and has been missing system oversight.

The Alberta government’s dismantling of the health agency is expected to include two more organizations responsible for hospital care and continuing care.

Another new agency, Recovery Alberta, recently took over the mental health and addictions portfolio of Alberta Health Services.

This report by The Canadian Press was first published Oct. 15, 2024.

The Canadian Press. All rights reserved.

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Experts urge streamlined, more compassionate miscarriage care in Canada

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Rana Van Tuyl was about 12 weeks pregnant when she got devastating news at her ultrasound appointment in December 2020.

Her fetus’s heartbeat had stopped.

“We were both shattered,” says Van Tuyl, who lives in Nanaimo, B.C., with her partner. Her doctor said she could surgically or medically pass the pregnancy and she chose the medical option, a combination of two drugs taken at home.

“That was the last I heard from our maternity physician, with no further followup,” she says.

But complications followed. She bled for a month and required a surgical procedure to remove pregnancy tissue her body had retained.

Looking back, Van Tuyl says she wishes she had followup care and mental health support as the couple grieved.

Her story is not an anomaly. Miscarriages affect one in five pregnancies in Canada, yet there is often a disconnect between the medical view of early pregnancy loss as something that is easily managed and the reality of the patients’ own traumatizing experiences, according to a paper published Tuesday in the Canadian Medical Association Journal.

An accompanying editorial says it’s time to invest in early pregnancy assessment clinics that can provide proper care during and after a miscarriage, which can have devastating effects.

The editorial and a review of medical literature on early pregnancy loss say patients seeking help in emergency departments often receive “suboptimal” care. Non-critical miscarriage cases drop to the bottom of the triage list, resulting in longer wait times that make patients feel like they are “wasting” health-care providers’ time. Many of those patients are discharged without a followup plan, the editorial says.

But not all miscarriages need to be treated in the emergency room, says Dr. Modupe Tunde-Byass, one of the authors of the literature review and an obstetrician/gynecologist at Toronto’s North York General Hospital.

She says patients should be referred to early pregnancy assessment clinics, which provide compassionate care that accounts for the psychological impact of pregnancy loss – including grief, guilt, anxiety and post-traumatic stress.

But while North York General Hospital and a patchwork of other health-care providers in the country have clinics dedicated to miscarriage care, Tunde-Byass says that’s not widely adopted – and it should be.

She’s been thinking about this gap in the Canadian health-care system for a long time, ever since her medical training almost four decades ago in the United Kingdom, where she says early pregnancy assessment centres are common.

“One of the things that we did at North York was to have a clinic to provide care for our patients, and also to try to bridge that gap,” says Tunde-Byass.

Provincial agency Health Quality Ontario acknowledged in 2019 the need for these services in a list of ways to better manage early pregnancy complications and loss.

“Five years on, little if any progress has been made toward achieving this goal,” Dr. Catherine Varner, an emergency physician, wrote in the CMAJ editorial. “Early pregnancy assessment services remain a pipe dream for many, especially in rural Canada.”

The quality standard released in Ontario did, however, prompt a registered nurse to apply for funding to open an early pregnancy assessment clinic at St. Joseph’s Healthcare Hamilton in 2021.

Jessica Desjardins says that after taking patient referrals from the hospital’s emergency room, the team quickly realized that they would need a bigger space and more people to provide care. The clinic now operates five days a week.

“We’ve been often hearing from our patients that early pregnancy loss and experiencing early pregnancy complications is a really confusing, overwhelming, isolating time for them, and (it) often felt really difficult to know where to go for care and where to get comprehensive, well-rounded care,” she says.

At the Hamilton clinic, Desjardins says patients are brought into a quiet area to talk and make decisions with providers – “not only (from) a physical perspective, but also keeping in mind the psychosocial piece that comes along with loss and the grief that’s a piece of that.”

Ashley Hilliard says attending an early pregnancy assessment clinic at The Ottawa Hospital was the “best case scenario” after the worst case scenario.

In 2020, she was about eight weeks pregnant when her fetus died and she hemorrhaged after taking medication to pass the pregnancy at home.

Shortly after Hilliard was rushed to the emergency room, she was assigned an OB-GYN at an early pregnancy assessment clinic who directed and monitored her care, calling her with blood test results and sending her for ultrasounds when bleeding and cramping persisted.

“That was super helpful to have somebody to go through just that, somebody who does this all the time,” says Hilliard.

“It was really validating.”

This report by The Canadian Press was first published Oct. 15, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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