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Legislation and regulations Legislation and regulations have been proven to be effective tools cheap atorvastatin 40mg with amex cholesterol diet chart india. For example buy atorvastatin 5 mg overnight delivery grams of cholesterol in eggs, legislation to reduce smoking rates was found to be more effective than 45 individual-level interventions such as physician counseling purchase generic atorvastatin online cholesterol medication starting with v. Legislation and regulations, including by-laws that prohibit smoking in public places, that provide good facilities, such as bike lanes and green spaces, and provide affordable 30 housing and transportation have helped reduce threats to health, improve living 46 conditions, and encourage healthier behaviours. Fiscal policies Fiscal policies are an effective tool to reduce social inequities and remove economic barriers to healthier choices. Findings indicate that policies that led to changing the economics of food choices in schools and other environments can 47 have positive effects on healthy eating. Financial incentives can be used to encourage the use of public transit, to encourage the private sector to reduce pollution, to increase participation in sports and recreational activities and to persuade tobacco farmers to switch to other crops. Economic interventions such as reducing the price of whole wheat flour and lowering duty on imported fruits can make healthy eating more accessible. Financial disincentives can be created to make it more costly to partake in unhealthy behaviours, such as raising taxes on cigarettes, junk food or driving fuel-inefficient automobiles. Guidelines Guidelines that encourage healthier choices help to set the standards for healthy living. Examples of these guidelines include the Canada Food Guide, Canada’s Physical Activity Guide and low-risk drinking guidelines. Easy to use tools and programs, such as the ‘5 to 10 a day’ vegetables and fruits campaign and ‘activ8’ to promote physical activity in schools that are based on guidelines, support individuals and families to make consistently healthier choices. The translation of the Canada Food Guide into several languages, as well as ensuring that it is culturally appropriate, is an example of how guidelines can also reduce inequities in access to new immigrants. Organizational policies and programs Organizations can develop policies and programs to support individuals and families in their efforts to maintain their health. Examples of this include workplaces that offer fitness programs, car pooling, flexible hours, elder care leaves and Employee Assistance Programs. Private sector policies that lead to supermarkets and other services being available in lower income neighborhoods, as well as community policies and programs such as day care, at-risk youth outreach, employment retraining, immigration and re-settlement initiatives, all promote health and the reduction of inequalities. The creation of healthy public policy requires cooperation and support among a diversity of stakeholders. Individuals, communities, institutions and organizations can be expected to lead or to be full participants in the development of most healthy public policies. For example, a coalition of over 25 agencies serving homeless young parents in downtown Toronto were effective in securing funding for the development of social housing for their clients.

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I understand that there are budgetary problems confronting the health care system discount 40mg atorvastatin with mastercard cholesterol medication makes me tired. I respectfully say it is something to be considered by those who are responsible for the provision of medical care and those who are responsible for fnancing it discount 10mg atorvastatin mastercard cholesterol chart tracker. I also say that if it comes to a choice between a physician’s responsibility to his or her individual patient and his or her responsibility to the medicare system overall purchase online atorvastatin cholesterol in eggs mg, the former must take precedence in a case such as this. While the courts do not appear willing to apply a lower standard of care for physicians based on cost considerations alone, some relief has been aforded physicians in circumstances where, for economic or other reasons, clinical resources are simply not available. Thus, in a recent case involving the alleged breach of the standard of care for failing to conduct further investigations 180. This consideration will afect the standard of care in that a doctor cannot reasonably be expected to provide care which is unavailable or impracticable due to scarcity of resources. As in other matters, the standard of care expected of a physician is determined by reference to the reasonable conduct of peers in similar circumstances. Physicians should therefore seek a consensus among colleagues and, where appropriate, seek advice from specialty organizations as to what might constitute appropriate guidelines or criteria for prioritizing patients. Physicians might also discuss with the patient, as part of the consent process, limitations in availability of healthcare resources and the reasonable alternatives available to the patient, including seeking treatment elsewhere. Finally, if physicians have concerns about lack of resources or protocols in their hospital that might adversely afect patient care, they should make every efort to draw those concerns to the attention of the appropriate authorities and to work toward resolution of the problem. Perhaps the most comprehensive is the 1990 Federal, Provincial, Therritorial Review on Liability and Compensation Issues in Healthcare chaired by J. Responsibility of healthcare institutions for the quality of care provided in and by them should be increased. An alternative to the no-fault compensation system might be considered for avoidable healthcare incidents that cause serious personal injuries. There is an increasing need for tort reforms, either by legislation or through the courts, to stabilize the issues of liability and, in particular, quantum in professional liability cases. At the moment, there is very little enthusiasm to introduce even a limited no-fault compensation plan given concerns that the costs of implementing such a plan in Canada would represent a signifcant increase over those of the current system. There are, however, several initiatives being pursued to amend the present judicial system to improve case management, explore alternative means of resolving legal actions, and ensure proportionality in the adjudication of disputes. The changing nature of medical practice challenges the law in many ways, particularly related to the use of technology. Early forays into telemedicine were primarily designed as pilot projects to address the extraordinary needs of very remote communities. Thelemedicine or telehealth initiatives are now much broader in scope and may change the way medicine is practised. Thechnology has also raised concerns about security and privacy, electronic medical records, healthcare information networks, and even the nature of the physician-patient relationship. The use of information in communication technologies, particularly related to the Internet, has raised questions about risk and possible new areas of liability for physicians.

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Underlying these problems is the use of a one-size-fits-all standard to wait times and scheduling cheap atorvastatin 20mg with amex definition de colesterol total, the lack of data-driven practices atorvastatin 20 mg fast delivery cholesterol medication names uk, and the reliance on behavior change to accommodate changes in patient flow order atorvastatin 40 mg mastercard calories cholesterol in eggs. The result is typically a set of scheduling practices that are idiosyncratic down to the provider level and unworkable for the staff charged with following them. The capacity to provide care is often driven by the supply of physicians and health professions at a particular institution and is unevenly distributed across the country. Because facilities in urban centers tend to house more specialty and subspecialty physicians than those in rural settings, patient influx and wait times can often be exacerbated at larger hospital centers. In a survey of 4,000 emergency rooms, the wait at public hospitals or major teaching hospitals tended to be longer than those at other care centers (Hsia et al. These challenges have led to the exploration of systems engineering strategies and processes for optimizing resource use. While these concepts have been introduced as strategic solutions, the spread and depth of their implementation is still lagging. Scheduling and Wait Time Metrics A noted opportunity lies in the metrics used to assess wait times that measure the key components of access, scheduling, and outcomes. This standard was designed for primary care yet has also been adopted by many subspecialty practices. Although no specific numeric standard exists in the public or private sector, third next available appointment represents a nationally reported measure against which organizations can monitor their performance with a goal of seeing patients when clinically indicated and when they desire (Murray and Berwick, 2003). This standard was designed for use in outpatient primary care yet has also been adopted by many subspecialty practices. Other measures of access are less common, with few systems reliably tracking the travel distance to an appointment or actively managing schedules to coordinate appointments for those coming from afar. In the acute care setting, within emergency rooms and hospitals, metrics are increasingly reflecting aspects of access that are relevant to patients and families such as parking availability, the registration experience, and the discharge process, while other measurement activities reflect system function such as availability of a test result, time to obtain a procedure, and operating room turnover. In the postacute care environment of a rehabilitation facility, a full census is a priority with few incentives to speed discharge processes. While financial incentives are commonly used at the leadership level, some organizations are now using direct incentives for frontline staff, which offers the opportunity to have additional data and work on process challenges that get in the way of day-to-day high-quality, patient-centered care. For example, the incentives of emergency rooms to shorten wait times have resulted in an increase in unnecessary admissions (Hsia et al. The recent use of bonuses tied to appointment wait times while potentially successful in other settings, resulted in falsifying data when combined with an intolerant management style (Kizer and Jha, 2014). Exploring New Models of Scheduling The challenges noted have led some health care leaders to explore new methods to improve scheduling and patient access, including methods of systems engineering and operations management, used successfully in other industries including aerospace, power distribution, and manufacturing. These techniques include Lean, six sigma, and the use of modeling and prediction tools to analyze, improve, and optimize the performance of complex systems, including health care (Litvak and Bisognano, 2011; Toussaint and Berry, 2013; Pocha, 2010; DelliFrane et al. The methods developed by operations research and systems engineering to match supply and demand has led to substantial improvements in cost, efficiency, and patient satisfaction in select hospitals, patient populations, and clinics (Litvak and Fineberg, 2014; Rohleder et al. Yet, these efforts are nascent, localized, and not necessarily scalable (Watts et al.

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