Should acute cardiac care be regionalized? A Multi-method study of access to reperfusion therapy for acute myocardial infarction in 5 Canadian Provinces.
Debate continues about how the Canadian health system can best treat patients who have suffered an acute ST segment-elevation myocardial infarction (STEMI) and how to ensure timely access to preferred therapies.
The debate hinges on a) whether to use primary percutaneous intervention (PCI, an invasive procedure to unblock clogged arteries) versus fibrinolytic therapy (a medicinal approach to unblock clogged arteries) to address the acute event, and b) how to ensure timely access to the selected treatment. This project aims to inform this debate, through the following objectives:
- Determine current policies regarding access to primary PCI vs. fibrinolytic therapy in 5 Canadian Provinces
- Compare ‘time-to-reperfusion’ and patient outcomes among patients treated with primary PCI vs. fibrinolytic therapy
- To survey Emergency Medical Services in 5 Canadian provinces regarding their patient management and transport policies and protocols
- To determine barriers to and facilitators of regional primary PCI programs for treatment of STEMI patients
The overall goal is to determine the most appropriate delivery and type of care to be used to reduce STEMI mortality rates in Canada.
Effect on Variations in Drug Policies on Access, Utilization and Clinical Outcomes
In Canada, variations in provincial drug policies on access, utilization and clinical outcomes of cardiac patients is a growing issue. Depending on provincial access to certain medications such as angiotensin receptor blockers (ARB’s ), angiotensin-converting enzyme inhibitors (ACE), clopidogrel, and Beta blockers, cardiac patients may be experiencing variations in their care and clinical outcome.
Through collaboration with Québec, Ontario, Nova Scotia and British Columbia, the purpose of this project is to determine the clinical implications of variations in provincial drug policies on the Canadian population by studying the following:
- Effects of variations in provincial drug policies on access, utilization and clinical outcomes
- How variations in provincial drug policies affect the types of patients receiving medication, adherence with the medication, expenditures on the medications and patient outcomes
Optimizing Access to the use of Invasive Cardiac Procedures
Based on previous work conducted by CCORT in Phase I of the initiative, it was discovered that cardiac procedure rates in Canada have steadily increased. While increasing, the rates tended to vary across provinces, and within provinces. The rise and variation in rates have not been fully explored, and it has not yet been determined whether the cardiac procedures are used appropriately and are clinically effective.
It is important to understand cardiac procedure utilization and outcomes in order to create concrete recommendations for health policy related to cardiac procedure funding, utilization and outcomes.
This project will explore the issues discovered during Phase I in further detail by researching the following:
- Appropriateness and necessity of coronary angiography by evaluating the relationship between inappropriateness, unmet needs and procedural capacity in Canada
- Exploring inter-regional variations in outcomes following coronary revascularization procedures across Canada
- The economic implications of increasing population rates of cardiac catheterization
Access to primary and secondary prevention of heart disease in the community
Interest in the quality of healthcare Canadians receive is an issue at the forefront of the Canadian healthcare system, due to a greater need to account for increasingly scarce healthcare resources.
This project will specifically examine the accessibility to primary care, treatment and outcomes of patients with coronary heart disease in Ontario by examining the following:
- Cardiac risk factors and physician and patient characteristics associated with uncontrolled hypertension and lipid elevation in community based primary care using a novel electronic medical record (EMR)
- The quality of primary and secondary heart disease prevention in primary care using the EMR
- Development of enhanced micro simulation models that will enable population based projection of cardiovascular disease outcomes and associated health care resource requirements
The research will also assess risk factors associated with coronary heart disease in order to create improved control measures that will lead to better function and improved health for Canadians.