In conclusion: A summary of Health Systems in Canada

Over the past three months, the ‘Foundations of Health Systems in Canada’ course has covered a great deal of content. As a CT technologist in a busy urban city, professionalism is an incredibly important trait to possess. One must have the ability to communicate thoroughly and openly with all members of the healthcare team including – but not limited to – physicians, nurses, technologists, respiratory therapists, cleaning staff, and others. An education on the operations of provincial and federal healthcare is important to understand the role of a technologist, or any health professional. Since the World Health Organization’s definition of health was publicized in 1948, no updates have been made, yet the world has evolved. The past seventy years have brought forth many determinants of health that vary for each individual. It is important to remember that there are multiple levels of health. Health and disease affect each individual different based on many factors such as age, region of residence, gender, culture, and others. Some populations such as elderly, youth, homeless, indigenous, or ‘language limited’ are much more at risk than others. Chronic diseases are a major factor for the Canadian healthcare system and its society. In fact, 67% of all deaths in Canada yearly are caused by four major chronic diseases – cancer, diabetes, cardiovascular and chronic respiratory diseases (Public Health Agency of Canada, 2017). Current trends in the management of these chronic diseases is at the forefront of Canadian healthcare. There are many levels of health and wellness – every patient is unique, and the Canadian healthcare system needs to reflect that.

A multilevel approach to health should be used for each individual patient. For example, the social ecological model considers the complex links between individual, relationship, community, and societal factors for each individual. This model focuses on the whole of any particular patient including their demographics, home and school lifestyle, culture/religion, socioeconomic status, disability, etc. It is also important to consider what the patient believes makes him/her healthy – their personal determinants of health. When determining how to treat a patient aside from the necessary medications or interventions, a specific approach catered to the patient should be taken. This is incredibly important in any cases involving mental health, children, or any other vulnerable population. An example of this is the obesity trend in youth. Each patient has different home lives and environments, and may need to be treated differently based on their personal needs and limitations. "The home environment is a critical factor in the development of childhood obesity" (Strauss & Knight, 1999). Health care professionals must focus on enhancing support from media sources, strengthening community context, and bolstering personal and parental self-management to combat childhood obesity. Future chronic diseases are more common in obese youth: “Canadians aged 18 and older who were either overweight or obese were more likely than those who were classified as having a normal weight to report that they had been diagnosed with diabetes” (Brule, McDiarmid & McDonald, 2018). It is a large responsibility of the Canadian government as well as healthcare professionals to educate and help the population stay healthy.

Chronic disease is a part of a healthcare professionals’ daily life. In the CT technologist world, patients present with all different symptoms and are monitored with scans for diagnosis, progression, remission and recurrence of disease. Diabetes is one of the main chronic diseases in Canada, and is a large part of a typical CT technologist’s day. Diabetes mellitus is a chronic metabolic group of disorders that are characterized by prolonged high blood sugars. One of the largest causes of type-2 diabetes is obesity – another large issue in Canada. Approximately 30% of all patients with type 1 diabetes, and 10-40% of all those with type 2 will eventually suffer from kidney failure (Diabetes - A Major Risk Factor for Kidney Disease, 2017). In contrast enhanced CT scans, an iodine-based agent (contrast) is used to highlight blood vessels and tissue structure throughout the body. This contrast is injected intravenously, and filtered out of the body through the kidneys. Anyone with chronic kidney disease or diabetes may have lowered kidney function and therefore diminished filtration capabilities, which can result in contrast-induced nephropathy. This adverse effect makes screening a very important tool for all technologists.

Interprofessional connectedness is a crucial component of patient care. Communication between departments allows for safer, more efficient care of each patient. “Quality, safe patient care requires high functioning interdisciplinary teams” (Engum & Jeffries, 2012). For a CT technologist, this involves having an open line of communication between coworkers directly in the radiology department (other technologists, nurses, clerical and especially radiologists), as well as throughout the hospital, and into outpatient clinics and physician offices. All behaviour must be ethical and professional to protect not only the patient, but also one’s self. As Bergeson and Dean (2006) discussed, “providing care centered on patients' needs and expectations is a key attribute of quality care” and in turn, professionalism of the health care provider. Communication is key for all radiology-based patient care but also through the healthcare system. Donnelly and Strife (2006) also discussed this, stating: “effective health care delivery systems rely heavily on high degrees of skill in professionalism and communication. These skills are essential to all of the missions of a successful radiology department”. When a patient comes in for a CT scan with IV contrast, technologists will go through screening questions with each patient. These include questions about allergies, diabetes, dialysis, kidney disease, myasthenia gravis, and at some hospitals - heart disease, hypertension and thyroid problems. There are many times when these questions cannot be answered directly by the patient, whether that is due to language barriers, changes to their level of consciousness, mental incapability or any other reason. These vulnerable patients still need the best quality of care with the least amount of risk associated. Communication between departments becomes vital in these cases. One of the vulnerable populations of Canadians is those that do not speak English. This can cause many issues: "When clinicians lack the linguistic and cultural skills needed and interpreters are not available, patients may have to rely on medically inexperienced, bilingual relatives or non-medical staff, compromising quality of care and worsening health outcomes for migrant communities" (Meuter, Gallois, Segalowitz, Ryder & Hocking, 2015). A family member may be trying to answer questions about a patient but not truly know the answer and adversely compromise that patient’s care. This can occur in CT, when an allergy is undocumented or underlying diabetes/ chronic kidney disease are not known by the patient’s decision maker. This can even occur when the person simply cannot translate the medical jargon. The future of electronic health records could eliminate a lot of grey area with regards to patient’s medical history and any barriers for health care providers to learn this information.

The future of healthcare in Canada could be very bright. This would involve having the correct people involved to induce change. Technology advancements such as provincial or even Canada-wide electronic health records could change the way patient’s receive healthcare. Advancements have finally been made to the Canada food guide which show that Canada is on its way to conquering obesity and hopefully lowering type 2 diabetic rates. Compared to the 2003-2004 data, Canadians living with diabetes do have a greater life expectancy - meaning that the management of diabetes has gotten better (Public Health Agency of Canada, 2017).

This course in its entirety highlights and links many healthcare issues in Canada. Updates to the healthcare system need to be made for inclusion – all people in Canada should feel they are being treated with dignity and respect in healthcare situations. They should feel that they are always welcome and never a burden. Chronic disease prevention and management should be continuously updated and reviewed to ensure the current processes are helping. Vulnerable populations need to be evaluated to ensure that healthcare systems are meeting their needs without compromising their care. Each individual patient needs to be treated with patient centered care. Communication techniques and education for the public should always be evolving. Canada needs to be open to change and allow technology to broaden the horizons of the healthcare system.

Resources

Bergeson, S. C., & Dean, J. D. (2006). A Systems Approach to Patient-Centered Care. Jama,296(23), 2848. doi:10.1001/jama.296.23.2848

Brule, S., McDiarmid, C., & McDonald, H. (2018, November 14). This is a Health Fact Sheet about diabetes among Canadians aged 12 and older. The results shown are based on data from the Canadian Community Health Survey. Retrieved from https://www150.statcan.gc.ca/n1/pub/82-625- x/2018001/article/54982-eng.htm

Diabetes - A Major Risk Factor for Kidney Disease. (2017, February 03). Retrieved from https://www.kidney.org/atoz/content/diabetes

Donnelly, L. F., & Strife, J. L. (2006). Establishing a Program to Promote Professionalism and Effective Communication in Radiology. Radiology,238(3), 773-779. doi:10.1148/radiol.2383041849

Engum, S. A., & Jeffries, P. R. (2012). Interdisciplinary collisions: Bringing healthcare professionals together. Collegian,19(3), 145-151. doi:10.1016/j.colegn.2012.05.005

Meuter, R. F., Gallois, C., Segalowitz, N. S., Ryder, A. G., & Hocking, J. (2015). Overcoming language barriers in healthcare: A protocol for investigating safe and effective communication when patients or clinicians use a second language. BMC Health Services Research,15(1). doi:10.1186/s12913-015-1024-8

Public Health Agency of Canada. (2017, November 14). Government of Canada. Retrieved from https://www.canada.ca/en/public-health/services/publications/diseases-conditions/diabetes-canada-highlights-chronic-disease-surveillance-system.html