Paul Masotti

Ontario’s 36 Public Health Units (PHUs) were responsible for implementing the H1N1 Pandemic Influenza Plans (PIPs) to address the first pandemic influenza virus in over 40 years. It was the first under conditions which permitted mass immunization. This is therefore the first opportunity to learn and document what worked well, and did not work well, in Ontario’s response to pH1N1, and to make recommendations based on experience.

Naturally occurring retirement communities (NORCs) exist on a “health promoting” continuum in the extent to which they facilitate healthy aging. Some NORCs are healthier than others for seniors because their physical and social environments encourage activity and promote feelings of well-being. Municipal governments and public health agencies have different potential roles in developing healthy-NORCs. Municipal government responsibilities affect housing, transportation, green space, and zoning policies, which in turn affect the physical and built environment, a key senior-sensitive determinant of health. Public health agency responsibilities include population-based approaches to health promotion and chronic disease and injuries prevention through the encouragement of behaviors such as healthy eating and physical activity. Public health recognizes the importance of supportive environments, to which the built environment contributes. The gap between the responsibilities of public health and those of municipal government hinders the development of healthy-NORCs. Public health, although responsible for health promotion, has limited ability to influence the built environment. The municipal government is responsible for policy affecting the built environment, but health promotion is rarely considered in this exercise. Public policy aimed at facilitating healthy aging would be supported by increased collaboration between public health and municipal government.

The paper summarizes the results of a scoping review that focused on the occurrence of adverse events experienced by homecare patients. The literature search covered published and grey literature between 1998 and 2007. Databases searched included: MEDLINE, EMBASE, CINAHL and EBM REVIEWS including the Cochrane Library, AGELINE, the National Patient Safety Foundation Bibliography, Agency for Healthcare Research and Quality and the Patient Safety Net bibliography. Papers included research studies, review articles, policy papers, opinion articles and legal briefs. Inclusion criteria were: (i) homecare directed services provided in the home by healthcare professionals or caregivers; (ii) addressed a characteristic relevant to patient experienced adverse events (e.g. occurrences, rates, definitions, prevention or outcomes); and (iii) were in English. A pool of 1007 articles was reduced to 168 after analysis. Data were charted according to six categories: definitions, rates, causes, consequences, interventions and policy. Eight categories emerged: adverse drug events, line-related, technology-related, infections and urinary catheters, wounds, falls, studies reporting multiple rates and other. Reported overall rates of adverse events ranged from 3.5 to 15.1% with higher rates for specific types. Few intervention studies were found. Adverse events were commonly associated with communication problems. Policy suggestions included the need to improve assessments, monitoring, education, coordination and communication. A standardized definition of adverse events in the homecare setting is needed. Prospective cohort studies are needed to improve estimates and intervention studies should be undertaken to reduce the risk that homecare patients will experience adverse events.

Best practices, policy and innovations in the administration of healthcare. For administrators, insurers, suppliers, and policy pundits. Edited by Dr. G. Ross Baker, University of Toronto, Toronto, ON