Chronic Disease in NS and Ontario
This is a comparison of the Prevalence, surveillance, management and funding of chronic disease between Nova Scotia and Ontario.
Preventing and Managing Chronic Disease: Ontario’s Framework. (2007). Retrieved from http://www.health.gov.on.ca/en/pro/programs/cdpm/pdf/framework_full.pdf
Prevalence
Chronic diseases are long-term diseases that develop slowly over time, often progressing in severity, and can often be controlled, but rarely cured. They include conditions such as cardiovascular diseases (heart disease and stroke), cancer, diabetes, arthritis, back problems, asthma, and chronic depression. Chronic diseases may significantly impair everyday physical and mental functions and reduce one’s ability to perform activities of daily living
Worldwide, chronic diseases have overtaken infectious diseases as the leading cause of death and disability. Non-communicable diseases now account for 59% of the world’s 57 million annual deaths, and 46% of the global burden of disease. The picture for Ontario is similar. In 2003, heart disease was the leading cause of death in the province – and myocardial infarction the largest single cause of death within heart disease – followed by cancers, stroke, and chronic obstructive pulmonary disease (COPD).
Chronic disease is most frequent among older Ontarians, since chronic diseases can take decades to develop. In 2003, almost 80% of those over the age of 45 or 3.7 million people were living with a chronic condition, including 34% with arthritis, 9% with diabetes, 30% with high blood pressure, and 12% with osteoporosis
Chronically ill Ontarians are also likely to have more than one chronic disease. In 2003, 70 percent of chronically ill Ontarians over the age of 45 had multiple conditions. The high levels of co-morbidity reflect the fact that, untreated, a serious chronic condition tends to lead to additional conditions and other health problems. Ontarians with diabetes account, for example, for 32% of heart attacks, 43% of heart failures, 30% of strokes, 51% of new dialysis, and 70% of amputations in the province.
In Ontario, chronic diseases account for 55% of direct and indirect health costs, which includes years of healthy life lost from premature death and lost productivity from disability as well as direct health care costs. Moreover, Ontarians with multiple serious chronic conditions consume disproportionately more health care than others with chronic conditions
Nova Scotia:
NOVA SCOTIA CHRONIC DISEASE PREVENTION STRATEGY (2003) Retrieved From: https://novascotia.ca/dhw/healthy-communities/documents/Nova-Scotia-Chronic-Disease-Prevention-Strategy.pdf
Nova Scotia in conjunction with Dalhousie University developed a Strategy that was initiated in the fall of 2001, funded by the Nova Scotia Department of Health and coordinated by the Unit for Population Health and Chronic Disease Prevention. The following is from the final report from 2003. This is the most recent strategy that was documented pertaining to Nova Scotia.
In Nova Scotia, chronic diseases account for almost three-quarters of all deaths in the province, and are the largest causes of premature death and hospitalization.
Four types of chronic disease (cardiovascular diseases, cancer, chronic obstructive pulmonary disease and diabetes) kill an estimated 5,800 Nova Scotians every year, account for nearly three-quarters of all deaths in the province, and are the major causes of premature death and hospitalization. Compared to other Canadians, Nova Scotians have particularly high rates of chronic illness.
Nova Scotia has the country’s highest rate of deaths from cancer and from respiratory disease and the second highest rate of circulatory deaths and of diabetes.
In Canada and the rest of the developed world, chronic diseases are a significant economic burden to society. Medical care costs for people with chronic diseases account for 60% of total medical care expenditures, or $1.2 billion a year in Nova Scotia
The chronic diseases targeted in this Strategy are linked by common preventable lifestyle risk factors and their underlying determinants. These factors include tobacco use, physical inactivity, and unhealthy diet. Substantial evidence exists that these diseases are preventable through interventions aimed at the major risk factors and the environmental, economic, social and behavioural determinants in the population.
Looking at the preventable risk factors, Nova Scotia is one of the unhealthiest provinces.
From the report, “Major Health Issues in Nova Scotia: An Environmental Scan” (2009), for self-reported conditions, the percentage of Nova Scotian’s reporting the following is higher than the national average:
current daily smokers age 12 and over (NS: 24.4%, Canada: 21.9%) ;
heavy drinkers (5 or more drinks on one occasion 12 or more times per year) (NS: 28.6%, Canada: 21.8%);
body mass index of 30 or higher (NS: 20.1%, Canada: 16.0%); and
high blood pressure ((NS: 19.0%, Canada: 15.9%)
Chronic Disease risk factors
Chronic Disease can be Prevented, Detected and Managed in Ontario
Changing health behaviors and biological factors have the potential to reduce chronic disease in Ontario significantly. For example:
A tobacco-free society would prevent more than 90% of lung cancer deaths and 30% of all other cancer deaths.
With healthy eating, regular exercise, and not smoking, up to 90% of type 2 diabetes, 80% of coronary heart disease, and one-third of cancers can be avoided.9
Detecting chronic disease early, and intervening quickly to prevent its progress, also has significant potential to reduce deaths from chronic disease. For example:
If 70% of women between the ages of 50 and 69 underwent mammography screening, there would be about one-third fewer breast cancer deaths over a ten-year period.
If Ontarians 50-75 received regular colorectal screening by fecal occult blood testing, more would receive early treatment and deaths from colorectal cancer could drop by 15-33%.11
With the right treatment and support, people diagnosed with a chronic disease can improve their health and quality of life. Management typically involves multi faceted interventions providing integrated social and medical support for people with chronic conditions
Ontario’s health care system was designed to address acute illness rather than chronic illnesses. Care tends to be reactive – responding to acute health problems when they present (Health Quality Ontario,2013 , Retrieved from http://www.hqontario.ca/Portals/0/documents/qi/health-links/bp-improve-package-cdm-en.pdf
Therefore, the Chronic Disease Prevention and Management Framework supports health care system changes from one that is designed for episodic, acute illness to one that will support the prevention and management of chronic disease
For the health care system, the Framework’s approach to prevention means: expanded prevention and health promotion in health care settings, more pro-activity in preventing disease and promoting the health of clients, and outreach beyond client rosters to catchment area populations and the population as a whole
Ministry of Health and Long-Term Care Public Health: Chronic Disease Prevention. Retrieved from http://www.auditor.on.ca/en/content/annualreports/arreports/en17/v1_310en17.pdf
Public health works to prevent and protect individuals from becoming sick by promoting healthy lifestyle behaviours and preventing the spread of diseases. One of public health’s functions is to prevent chronic diseases.
In Ontario, the number of people living with these chronic diseases has been on the rise. For example, the prevalence, that is, the number of cases of a disease in a population at a given time, increased from 2003 to 2013 in the following four health conditions:
• diabetes increased by 65%;
• cancer by 44%;
• high blood pressure by 42%; and
• chronic obstructive pulmonary disease (a type of respiratory disease) by 17%.
https://archive.cancercare.on.ca/common/pages/UserFile.aspx?fileId=382671
Chronic diseases, including cancers, cardiovascular disease, chronic respiratory diseases, diabetes, and chronic kidney disease, place a large burden on the Ontario population. Evidence suggests that implementing health-promoting policies and programs that modify the economic, physical, and social environments that influence health-related behaviours and exposure to other chronic disease risk factors (e.g., occupations), are more effective than are individual interventions in creating change at the population level.6. Reductions in Ontarians exposure to modifiable risk factors and exposures can also reduce health care costs.
Cancer Care Ontario’s Chronic Disease Prevention Strategy strives to strengthen CCO’s contribution to chronic disease prevention through a variety of measures. These measures aim to ensure that healthy people stay healthy, disease can be detected and treated early, and when people develop a chronic disease, the progression, recurrence or the development of other chronic conditions are prevented.
Tele homecare Supports Chronic Disease Management (2016). Retrieved from http://ocfp.on.ca/communications/telehomecare-supports-chronic-disease-management
Program helps keep patients with COPD and heart failure out of the ER. A remote home monitoring and self-management coaching initiative for patients with COPD and congestive heart failure (CHF) Widely available across Ontario, Tele homecare is a program of the Ontario Telemedicine Network (OTN) and funded by the Government of Ontario and Canada Health Infoway. The COPD/CHF self-management model is delivered in 10 Local Health Integration Networks via Community Care Access Centres and hospitals, with plans to expand throughout the entire province. To date, more than 9,000 patients have participated in the program. New models are being tested in diabetes, mental health and chronic kidney disease and a post-acute pilot is underway to improve care transitions for patients requiring monitoring and just-in-time support post hospital discharge.
Participating patients are provided with easy-to-use touchscreen technology and a blood pressure cuff, pulse oximeter and weight scale, as well as lots of training. They send their vitals daily during the weekdays for monitoring by specially trained RNs who reviews the patient’s results daily and contacts the patient if there is a change in their health that needs further investigation
Management and Funding In Nova Scotia
According to the Department of Health and Wellness:
Nova Scotia has one of the highest rates of chronic disease and disability in Canada. Chronic disease has a significant impact on both quality of life and economic growth.
The province is moving toward a proactive, patient driven approach to chronic disease management through investments in self-management and self-management support programs and initiatives, collaborative primary health teams, uptake and support of electronic medical records as well as guidelines based care.
This is has not been updated since 2013 on the website but continues to be the focus for management of Chronic diseases within the province. Chronic diseases are preventable and looking back at the prevention strategy from 2003 they recommended that, “chronic disease prevention efforts need to target whole populations by employing comprehensive strategies that include intersectoral action.” Looking at the programs available and what strategies are being funded it appears that within Nova Scotia this strategy was never truly adopted and self-Management is the focus. On the DOH website chronic disease management is a sub category under the Primary Care Category. The lack of primary care resources in Nova Scotia is at the crisis stage. Without Nova Scotian’s having a primary Care Physician/NNP to refer them to these programs the impact on the management of these chronic diseases is minimal.
As part of the NS government and DOH commitment to improve the health care system in NS and the health of the population there are nine provincially funded programs. The provincial programs are part of the delivery of safe, high quality care to Nova Scotian’s. Four specifically address chronic diseases.
They are:
Cancer Care Nova Scotia
Cardiovascular Health Nova Scotia
Diabetes Care Program of Nova Scotia
Nova Scotia Renal Program
Some of the programs aimed at self-care and management are:
For Youth living with Chronic Disease there is the, “You’re in Charge!” Program. This is a pediatric self-management program. You’re in Charge! Was designed to prepare youth (13 to 15 years old) to initiate self-management of their chronic condition.
Your Way to Wellness is a provincially sponsored, community based, free program for people living with chronic (ongoing) health conditions. Participants learn how to manage their conditions better, develop new skills, and use proven tools to help them maintain an active, fulfilling life.
Implementing a Novel and Supportive Program of Individualized Care for Patients and Families Living with Respiratory Disease (INSPIRE) in Nova Scotia is a national program that recently finished its pilot implementation and evaluation phase in Nova Scotia targeting COPD
The province has an Innovation Fund . This is awarded annually to address the root causes of chronic disease. Community groups, working in partnership with community health boards, will propose projects that will help Nova Scotian’s live longer and healthier lives. These will include helping people stop smoking and reduce their alcohol consumption; improve exercise levels; helping people eat more fruit and vegetables; and combatting obesity.< >! A plan for a healthier Nova Scotia (2013). Thrive! Is designed to help build a province where healthy eating and physical activity become part of our daily environment.
References
Atlantic Canada Backgrounder: Supporting COPD Patients at home saves hospital resources and health care dollars. (2015). Canadian Foundation of Health Care Improvement. Retrieved from: http://www.cfhi-fcass.ca/sf-docs/default-source/documents/inspired/inspired-backgrounder-atlantic-e.pdf?sfvrsn=3ed3d244_2
Cancer Care Ontario (CCO). Retrieved from
https://archive.cancercare.on.ca/common/pages/UserFile.aspx?fileId=382671
Department of Health and Wellness. Chronic Disease Prevention and Management. Retrieved from: https://novascotia.ca/dhw/primaryhealthcare/chronic-disease-management.asp
Department of Health and Wellness. Provincial Programs. Retrieved From: https://novascotia.ca/dhw/provincial_programs.asp
Health Quality Ontario, 2013, Retrieved from http://www.hqontario.ca/Portals/0/documents/qi/health-links/bp-improve-package-cdm-en.pdf
Major Health Issues in Nova Scotia: An Environmental Scan (2009).Retrieved from: https://www.nshrf.ca/sites/default/files/environmental_scan_-current_major_health_issues.pdf
Ministry of Health and Long-Term Care Public Health: Chronic Disease Prevention. Retrieved from http://www.auditor.on.ca/en/content/annualreports/arreports/en17/v1_310en17.pdf
NOVA SCOTIA CHRONIC DISEASE PREVENTION STRATEGY (2003) Retrieved From: https://novascotia.ca/dhw/healthy-communities/documents/Nova-Scotia-Chronic-Disease-Prevention-Strategy.pdf
Preventing and Managing Chronic Disease: Ontario’s Framework. (2007). Retrieved from http://www.health.gov.on.ca/en/pro/programs/cdpm/pdf/framework_full.pdf
Tele homecare Supports Chronic Disease Management (2016). Retrieved from http://ocfp.on.ca/communications/telehomecare-supports-chronic-disease-management