Psychologists and Medications in the Era of Interprofessional Care: Collaboration is Less Problematic and Costly Than Prescribing

Increasing emphasis on interprofessionalism and teamwork in healthcare renders psychologists’ collaborations critical and invites reexamination of psychologists’ roles related to medications. The Collaboration Level outlined by the APA’s Ad Hoc Task Force is more achievable and in synch with health reform than prescription privileges (RxP). RxP remains controversial due to training and safety concerns, lacking support from health professionals, psychologists, and consumers. Differences in educational preparation of psychologists relative to prescribing professionals are discussed. Enactment of only three of 170 RxP initiatives reveals RxP to be a costly, ineffectual agenda. Alternatives (e.g., integrated care, collaboration, telehealth) increase access without risks associated with lesser medical knowledge. Concerns about RxP and the movement toward team-based care warrant reconsideration of the profession’s objectives regarding psychopharmacology

Current Developments in Services for People with Intellectual Disabilities

[Taken from Executive Summary] This literature review is the culmination of the Saskatchewan Community Living Division jurisdictional study which began in the autumn of 2003. Following a brief survey of developments in providing services to people with intellectual disabilities (hitherto the People) for creating the questionnaire for this study, information was gleaned from the provinces and territories on their services. The CLD Jurisdictional Project was completed in the spring of 2005. Subsequently, a thorough search and examination of pertinent resources for serving this People and for policy development was conducted. From over 800 documents about 350 were selected for this literature review. The material is recorded in the following chapters: Public Consultation and Policy Development; Social Philosophy: the philosophical influence on contemporary social issues; Definition of disabilities; Needs assessment systems; Human Rights; Advocacy; Community services & Deinstitutionalization; Issues and Influences; Citizenship; Inclusion; Self-determination; Person-centered planning; Supports; Respite; Individualized funding; Canadian governmental initiatives; Provincial Services

Pan-Canadian Pharmaceutical Alliance (pCPA): Timelines Analysis and Policy Implications

© 2019 Salek, Lussier Hoskyn, Johns, Allen and Sehgal. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY).This analysis follows our recent study showing that Canadian public reimbursement delays have lengthened from regulatory approval to listing decisions by public drug plans and delayed public access to innovative medicines, mainly due to processes following the Common Drug Review (CDR) and the pan-Canadian Oncology Drug Review (pCODR). Public drug plans participate in a pan-Canadian Pharmaceutical Alliance (pCPA) joint negotiation process before making decisions about whether or not to reimburse a product reviewed through CDR and pCODR. This research aims to report the findings from a comprehensive analysis of pCPA process times, times to reimbursement by public payers in Canada, and to explore the opportunities to reduce total delays in public reimbursement with a specific focus on the pCPA process. An analysis was conducted of pCPA timelines with respect to making decisions about products and indications reviewed through CDR/pCODR, and focusses on three separate time components: time to begin negotiating, time spent negotiating, and time to implement the negotiation (i.e., time to list) in each of nine jurisdictions (i.e., 10 provinces of Canada, excluding Quebec). This study demonstrates the role of post-CDR/pCODR processes in large and lengthening delays to listing new medicines. Notably, oncology products have experienced the longest increases in time to begin negotiating and to complete negotiations. Trends in listing times post-pCPA across provinces are less clear, however, it appears that consistency in terms of timelines across provinces is not happening quite so smoothly for oncology products compared to non-oncology products. Listing rates also appear to be declining for non-oncology products, although this trend is less conclusive for oncology products. Challenges need to be addressed to improve efficiency, transparency, and ultimately reduce pCPA timelines and total timelines to public reimbursement. Suggested ways to improve and streamline the listing process are: (1) transparent target timelines and associated performance incentives for the pCPA and public plan decisions, (2) parallel HTA-pCPA processes to enable pCPA negotiations to start part-way through the HTA review and allow pCPA negotiation information to be fed back into the HTA review, and (3) innovative agreements that consider patient input and earlier coverage with real-world evidence development.Peer reviewedFinal Published versio

Evidence-based Decision-making in Canada’s Protected Areas Organizations: Implications for Management Effectiveness

Aichi Biodiversity Target 19 calls on Parties to the United Nations Convention on Biological Diversity (CBD) to improve, share, transfer, and apply knowledge. In this study, we provide an initial assessment of the state of evidence-based decision-making in Canada’s protected areas organizations by examining (1) the value and use of various forms of evidence by managers and (2) the extent to which institutional conditions enable or inhibit the use of evidence in decision-making. Results revealed that although managers value and use many forms of evidence in their decision-making, information produced by staff and their organizations are given priority. Other forms of evidence, such as Indigenous knowledge and peer-reviewed information, are valued and used less. The most significant barriers to evidence-based decision-making were limited financial resources, lack of staff, inadequate timeframes for decision-making, a lack of monitoring programs, and a disconnect between researchers and decision-makers. Overall, our results suggest that the potential benefits of evidence-based approaches are not being maximized in Canada’s protected areas organizations. We propose several recommendations to introduce or improve the use of diverse forms of evidence to enhance management effectiveness of Canada’s protected areas and by extension conservation outcomes

Environmental performance outcomes and indicators for indigenous peoples: Review of literature

The literature review in this report was the starting point for developing a Māori research strand (2003-2009) within the Planning Under Co-operative Mandates (PUCM) research programme (1995-2009). An early task of the PUCM Māori team was to review the international literature on environmental outcomes and indicators for indigenous peoples. This was in order to gain an understanding of what had been written on the subject and to become familiar with approaches taken by others that might provide lessons for the development of our proposed kaupapa Māori outcomes and indicators framework and methodology, which was aimed at local government performance in Aotearoa/New Zealand. This current report is not intended to provide an exhaustive catalogue of writings on environmental performance outcomes and indicators for indigenous peoples, including Māori. Rather, some of the more obvious and important writings are noted as a ready reference for others interested in this topic. Before detailing the approach we took in carrying out the review, the key terms, outcomes and indicators, are defined

Marine Protected Areas in Canada with a Particular Emphasis on Newfoundland: Science, Policy and Implementation at Multiple Institutional Levels

The primary goal of Marine Protected Areas is to conserve and protect part or all of a marine environment through legal or other effective means. MPAs are a global phenomenon that has become part of national level ocean policy and practice in such nations as Australia, Canada, and the US. Marine protected areas depend, for their success, on the development of an informal network of local policy and practice, which varies among communities. They succeed in circumstances where national policy or legal precedent does not dissolve local policy and practice, and where national policy facilitates and can accommodate local arrangements. The collapse of fisheries in the late 20th century in Canada provided the political impetus and policy framework that increased the capacity of the federal government to accommodate local arrangements in marine waters through Canada’s Oceans Act 1996. Two Marine Protected Areas, at Eastport and Gilbert Bay, were designated in Newfoundland and Labrador in 2005 under the Oceans Act, and a third, at Leading Tickles, is in the development stage. Eastport has a research program on lobsters in place, Gilbert Bay has a program on ‘golden cod’, but no research program existed at Leading Tickles. DFO Oceans began to collect data and worked closely with community members to develop research priorities, carry out research projects and develop management programs for each MPA. The provincial government was involved as members of the MPA steering committees, and local representatives provided input. Based on the political momentum for Marine Protected Areas, the second objective of this project was to identify internationally significant science questions for research within Newfoundland and Labrador. Recent research conducted by Memorial University at the Gilbert Bay and Eastport MPAs and the Leading Tickles Area of Interest (AOI) has been a mixture of descriptive and causal science directed at local issues arising within each of the three locations (two MPAs and one AOI). Past research helped to define the scope of some of the science problems in an informal way. This report takes the next step, which is to identify questions significant to both local issues and the understanding of coastal ecosystems by the national and international science community. Sound scientific evidence is needed to identify whether the intended effects are being achieved and to document accompanying effects. The emerging practice is initial science input followed by devolution of monitoring activities to local communities, with guidance from academic scientists. The effectiveness of these scientists would be increased by national initiatives to develop the capacity to guide locally based monitoring efforts. One potential model for science guidance is that used for environmental impact assessment, where monitoring activities are designed as tests of hypotheses concerning effects stated in an impact assessment

Who needs what from a national health research system: Lessons from reforms to the English Department of Health's R&D system

This article has been made available through the Brunel Open Access Publishing Fund.Health research systems consist of diverse groups who have some role in health research, but the boundaries around such a system are not clear-cut. To explore what various stakeholders need we reviewed the literature including that on the history of English health R&D reforms, and we also applied some relevant conceptual frameworks. We first describe the needs and capabilities of the main groups of stakeholders in health research systems, and explain key features of policymaking systems within which these stakeholders operate in the UK. The five groups are policymakers (and health care managers), health professionals, patients and the general public, industry, and researchers. As individuals and as organisations they have a range of needs from the health research system, but should also develop specific capabilities in order to contribute effectively to the system and benefit from it. Second, we discuss key phases of reform in the development of the English health research system over four decades - especially that of the English Department of Health's R&D system - and identify how far legitimate demands of key stakeholder interests were addressed. Third, in drawing lessons we highlight points emerging from contemporary reports, but also attempt to identify issues through application of relevant conceptual frameworks. The main lessons are: the importance of comprehensively addressing the diverse needs of various interacting institutions and stakeholders; the desirability of developing facilitating mechanisms at interfaces between the health research system and its various stakeholders; and the importance of additional money in being able to expand the scope of the health research system whilst maintaining support for basic science. We conclude that the latest health R&D strategy in England builds on recent progress and tackles acknowledged weaknesses. The strategy goes a considerable way to identifying and more effectively meeting the needs of key groups such as medical academics, patients and industry, and has been remarkably successful in increasing the funding for health research. There are still areas that might benefit from further recognition and resourcing, but the lessons identified, and progress made by the reforms are relevant for the design and coordination of national health research systems beyond England.This article is available through the Brunel Open Access Publishing Fund

The North American Free Trade Agreement (NAFTA) and U.S. Agriculture

[Excerpt] The North American Free Trade Agreement (NAFTA) entered into force on January 1, 1994 (P.L. 103-182), establishing a free trade area as part of a comprehensive economic and free trade agreement among the United States, Canada, and Mexico. Although some industries may have reduced their U.S. operations, in general, NAFTA is considered to have benefitted the United States economically as well as strategically in terms of North American relations. The U.S. food and agricultural sectors, which is the focus of this report, has benefitting especially from NAFTA. The U.S. Department of Agriculture (USDA) and many agricultural industry groups claim that NAFTA has positively affected U.S. agricultural markets. NAFTA continues to be of interest to Congress given continued strong trilateral trade and investment ties and the agreement’s significance for U.S. trade policy