Among 10 other countries, who take part in the Commonwealth Fund Survey, Canada falls exactly in the middle percentage range when it pertains to patient engagement. New Zealand, Australia and Switzerland have the most engaged patients at 68%, 63% and 59% respectively. These same countries in a past Commonwealth survey (2010) earned high ratings from citizens on access, affordability, timeliness and coordination of care.

The report takes a deeper look into patient engagement in Canada and reveals that overall, more engaged patients perceive themselves to be healthier and better use the health services and resources in the system.

However, the report finds that only 48% of Canadians feel involved and are actively participating in their own health care. That means less than half of Canadians are taking a more active role in maintaining their health and oftentimes leading to increased satisfaction with their care. Engaged patients are more likely to make active efforts to participate in disease prevention, screening and health promotion activities.

The biggest barrier to patient engagement is time. Increasing patient expectations are placing greater demands on doctors’ time. Not having enough time with their doctor keeps many Canadians from feeling engaged in their care. Feeling rushed during appointments is a key barrier to engagement. Patients want more time with their doctors. Physicians need more time.

Alternatively, the report found that Canadians are more likely to feel engaged if they believed it was easy for them to access care. In fact, of the 27% of Canadians who believed it was easy to get answers via telephone with their doctor’s offices, 71% were considered engaged patients. Furthermore, patients are almost twice as likely to be engaged if someone follows up to give them their test results.

“Patients are more likely to feel engaged if they believe that their time has not been wasted; if they have access to their primary care providers and understand the information being provided to them,” says John G. Abbott, CEO of the Health Council of Canada. “But the responsibility rests between both the patient and the physician to ensure both parties are involved and satisfied in the care.”

The report provides tips for physicians on how to re-design their service around patient needs and for patients on how to be more involved in their care. For example, physicians can talk more with their patients and find out if they feel involved, and ask someone in their office to follow-up with a patient on test results regardless of whether the news is negative or positive.
Patients, on the other hand, can come to their appointment prepared. They can bring a list of questions to their appointment, describe their symptoms accurately, and ask for clarity or more information from their physicians when required.

The report notes that governments and policy makers are working on a variety of structural changes to relieve the time pressures that create barriers to more involvement between physicians and their patients.  For example:

• Implementation of team-based care across some provinces have been able to free up physicians’ time to see patients who need their clinical skills.
• Through the execution of electronic health records, patients’ medical history is easily available for all providers involved in care, which makes patients feel their time was not wasted, and their care was organized well and test results or records were readily available at every visit.

About Patient Engagement             
For the purposes of this report a patient is defined as engaged by their physician if all of the following criteria have been satisfied. Patients must be involved in their decision making, provided adequate time during visits and provided the opportunity to ask questions about recommended treatment.

As the first point of contact with the health care system for many Canadians, family physicians make decisions that affect patients’ treatments, and also impact the health system as a whole. The report finds that physicians, today, are faced with many challenges, that they are prescribing more medications and ordering more diagnostic imaging tests than ever before, and that they need support to avoid inappropriate and over-use of these costly services.

“Family physicians act as ‘gatekeepers’ and play a key role in ensuring that our health care services such as drugs, diagnostics, and specialist services are being used appropriately,” says John G. Abbott, CEO, Health Council of Canada. “Given the host of factors that influence their decision-making, we can do more to assist family physicians in curbing the overuse of diagnostics and drugs, and make significant improvements in managing our health care system.”

Over the past 10 years, the number of prescriptions filled at community pharmacies has almost doubled – from 272 million in 1999 to 483 million in 2009. This suggests that some Canadians are getting drugs they do not need, while others are not getting medications from which they could benefit – putting into question the appropriate use of prescription drugs in Canada. Furthermore, the report indicates that between 1990 and 2009, the number of CT scanners more than doubled from 198 to 465 and within that same period MRI scanners increased from 19 to 266 – resulting from federal investments over the past decade. Compared to 2003, there has been a 58% increase in CT scans and 100% increase in the number of MRIs conducted.

The report acknowledges the difficultly in tracking how physicians’ decisions affect the use of health care services. For example, available data do not show conclusively whether the use of family physician services has increased or decreased over the past decade, despite an increase in the number of family physicians in practice.

The report further finds that use and adherence to clinical practice guidelines is too low. Clinical practice guidelines inform providers – family physicians – about appropriate care while helping to reduce the variation in care.

Similarly, improvements are needed in terms of use and access to electronic medical and health records across the country. Canada continues to lag behind many other countries in the use of health information technology. Few family physicians use electronic medical records. The use of computers is often confined to administrative duties such as electronic billing and scheduling appointments, but not clinical work. The increased adoption of better usage of electronic health systems will lead to more comprehensive data on how drugs are prescribed and used, linking them back to effects on health outcomes, while encouraging adherence to clinical practical guidelines.

“We can make up for this lack of information through additional research and the wider adoption of electronic health records by family physicians,” stated Abbott. “It is a critical foundation for safe and appropriate prescribing and medication management. It is essential that an electronic system is in place to efficiently assist physicians in following clinical practice guidelines, making the best decisions for their patients and for the sustainability of our health-care system.”

**Note to broadcast journalists: B-roll is available for download by request.

A year ago, the Health Council of Canada published a report on the progress of a National Pharmaceutical Strategy (NPS.) At the time, we asked governments to rededicate themselves to this important element of health policy nationwide.  Drug pricing was a challenge identified in the 2003 First Ministers’ Accord on Health Care Renewal. In the follow-up 2004 10-year Plan to Strengthen Health Care, First Ministers said that they wanted to “accelerate access to non-patented [generic] drugs and achieve international parity on prices.”  The Health Council of Canada is encouraged by some recent provincial initiatives to tackle generic prices, which some estimate could save taxpayers, consumers and businesses as much as $800 million a year.

“Canadians pay some of the highest prices in the world for generic drugs,” said John G. Abbott, CEO, Health Council of Canada. “The paper we are releasing today should help policy makers and people across the country move forward to curtail the cost of generic drugs for both public and private plans while maintaining access and quality of service.”

Governments, through their own health plans, have traditionally set the price for generic drugs - the safe, effective and cheaper “copies” of brand name drugs that come to market after the patent exclusivity of the brand name drug has expired.  This discussion paper explains how government pricing policies consciously and otherwise have produced a system that does not get the best price for the taxpayer or for private sector employers. The current way governments and others set generic prices leaves “too much money” with manufacturers, distributors and retailers that otherwise could create savings for the taxpayer or be used in other areas of healthcare.

“Our goal in publishing this discussion paper is to shed light on generic drug pricing issues in order to help Canadians understand what is at stake and to encourage broad public discussion,” said Dr. Jeanne Besner, Chair, Health Council of Canada.  “Knowing we have options for real reform should be helpful to governments in the current fiscal environment.”

“This discussion paper highlights the complex reasons as to why generic drug prices are so high and the longstanding lack of transparency about how prices are set. It suggests options available to governments in order to institute reforms, reduce costs, and increase the transparency of generic drug transactions,” stated Abbott.

The paper offers six basic suggestions:

• Drug insurance plans could revisit their maximum reimbursement prices since a body of evidence suggests that Canadian prices are too high;
• Reimbursement prices could be set at the pharmacy level;
• The use of alternative and competing distribution channels could be encouraged;
• Using the pharmacist to provide additional paid services would moderate the impact of reducing generic-drug prices and benefit the healthcare system;
• Drug plans, including employer-sponsored plans, could use tiered formularies to encourage their beneficiaries to use low-cost drugs; and
• Provincial and territorial drug plans could ensure that newly approved drugs are listed on their formularies in a timely manner. 

Since generic drug prescriptions represent more than half of all prescriptions written in our health systems, it is important that Canadians have better information about generic drug pricing.  The Health Council of Canada encourages Canadians to join in a broader public discussion on this critical health care issue and become better informed.