Lesson Two Canadian Health Care System - Provincial

Lesson Two Canadian Health Care System - Provincial Introduction At this point in the program it is important for you as a health care professional to become aware of what is available in your province in relation to health care. This begins by looking at the provincial health department in the province where you live. One aspect to find out about in your province includes what are the main outcomes hoped to be met by the provincial health department in the next few years. Other questions to explore are: How are the health authorities set up in your province? What provincial health programs are available and what do they offer? What community resources are there? What are the main health issues of the people who live in my province? Having read about primary health care, what does this look like in my province? Learning Outcomes Based on the province where you are located: 1. Describe the current outcomes/initiatives of the provincial health department. 2. Explore the structure of the health authorities. 3. Examine the provincial health programs. 4. Describe community health organizations/agencies and resources. 5. Identify health issues affecting the population. 6. Explore primary health care initiatives. September 2014 Registered Nurses Professional Development Centre & Nova Scotia DHW, Halifax, NS 1

Provincial Government Health Departments In beginning this unit, it is helpful to first look at the 2013 populations of each of the three provinces that will be discussed: 1 Nova Scotia - 940,000 New Brunswick - 756,100 Prince Edward Island - 145,200 Each province in Canada has its own health department. For the purpose of this orientation program the focus is on Nova Scotia, New Brunswick and Prince Edward Island. The specific names of the health departments are as follows: Nova Scotia - Department of Health and Wellness New Brunswick - Department of Health Prince Edward Island - Health PEI Valuable information is available on each of these sites and assists health care professionals working in their specific province to keep current on trends and issues occurring in the health care system. As new health care professionals coming to Canada it is useful to view, on an ongoing basis, the web site related to the province where you live. Nova Scotia 2 The Nova Scotia Department of Health and Wellness identified several outcomes for 2014-2015 in a recent report and are stated as follows: 1. Health of the Population - Improve the health and wellness of Nova Scotians through health promotion, disease and injury prevention, improved access to primary health care and enhanced chronic disease management. Examples of areas of focus: Tobacco Control Strategy Prescription Drug Abuse Responsible Alcohol Consumption Newborn Screening Sexual Violence Strategy 1 Statistics Canada. (2013). Population by year, by province and territory. Ottawa, ON: Author. Retrieved July 29, 2014. www.statcan.gc.ca/tables-tableaux/sum-som/101/cst01/demo02a-eng.htm 2 Nova Scotia Health and Wellness. (2014). Annual statement of mandate for the fiscal year 2014-2015. Halifax, NS: Author. Retrieved July 30, 2014. http://novascotia.ca/dhw/corporate-reports/documents/dhw-statement-of-mandate-for-2014-2015.pdf September 2014 Registered Nurses Professional Development Centre & Nova Scotia DHW, Halifax, NS 2

2. Experience of Care - Access to quality, evidence-informed and appropriate care through the continuum of care. Examples of areas of focus: Diagnosis Imaging, Pathology and Laboratory Medicine Initiative Continuing Care Strategy Senior Abuse Mental Health and Addictions Strategy Stroke Strategy 3. Health System Workforce - A workplace culture that fosters leadership, competence, interprofessional practice and engagement. Examples of areas of focus: Health Workforce Planning Provider Compensation Workplace Injury Prevention, Health and Safety 4. Resource Stewardship - A sustainable funding model that supports learning, research, leadership, innovation and effective use of resources. Examples of areas of focus: ehealth Technologies Planning for Restructuring System Efficiencies Initiatives New Brunswick 3 In New Brunswick, their Provincial Health Plan 2013-2018, is used to manage existing health services and resources; to design new programs and policies; and to make decisions regarding money. Their plan is based on seven principles: Access: The ability for clients to get the right care or service at the right time at the right place. It is based on the needs of clients in the language they choose. Appropriate Range of Services: The care or service is appropriate for clients and is based on standards. Effective: Desired outcomes are met by the care or service. 3 Province of New Brunswick. (2013). Rebuilding health care together: The provincial health plan 2013-2018. Fredericton, NB: Author. Retrieved July 20, 2014. http:www.gnb.ca/0212/values/pdf/9129%20english.pdf September 2014 Registered Nurses Professional Development Centre & Nova Scotia DHW, Halifax, NS 3

Efficient: Desired outcomes are met by using cost-effective resources. Equitable: The intent is to provide equal care for everyone. Safe: Potential risks are avoided or decreased in regard to any interventions or to the environment. Clinically Sustainable: Expertise in programs is maintained by having a minimum of four to five providers. Examples of priority initiatives set by the New Brunswick Department of Health and their Regional Health Authorities are as follows: 4 Introduce a drug plan for New Brunswickers who are not insured. Improve services related to oncology, rheumatology and child psychiatry. Implement a plan to allow more seniors to stay in their homes and communities. Renew and revise diabetes education programs for clients. Begin the first phase of a provincial program for screening colon cancer. Plan and implement a congestive heart failure management strategy. Support smoking cessation. Standardize wait times for Magnetic Resonance Imaging (MRI) and diagnostic processes. Establish electronic medical records in team-based practices. Improve the management of human resources such as staff scheduling, sick time and wellness programs for employees. Continue with the development of the Drug Information System/Prescription Monitoring Program. Improve partnerships with First Nations communities and increase cultural sensitivity among staff in the health authorities. Standardize volunteer training programs to assist in providing spiritual care to clients in a consistent manner. 4 Province of New Brunswick. (2013). Rebuilding health care together: The provincial health plan 2013-2018. Fredericton, NB: Author. Retrieved July 20, 2014. http:www.gnb.ca/0212/values/pdf/9129%20english.pdf September 2014 Registered Nurses Professional Development Centre & Nova Scotia DHW, Halifax, NS 4

Prince Edward Island: 5 According to their Strategic Plan 2013 to 2016, the focus for Health PEI is on quality, access and efficiency. The purpose of the plan is to guide decisions and activities during this time frame. Quality: meeting patient safety standards applying the concept of patient-centered care improving health outcomes promoting a healthy work environment Access: decreasing wait times in priority areas assisting vulnerable populations to have better access to care Efficiency: using technology to improve quality, safety and continuity of care managing the use of beds in a better manner improving how care is coordinated using any resources more effectively ******************************************************** Activity 1: Provincial Government Health Departments 1. Based on the data provided so far in relation to each of the provincial health departments, identify any differences and similarities in their planned outcomes. 5 Health PEI. (2013). Strategic Plan 2013-2016: One Island health system supporting improved health for Islanders. Charlottetown, PEI: Author. Retrieved July 30, 2014. www.gov.pe.ca/photos/original/hpei-stratpl-16.pdf September 2014 Registered Nurses Professional Development Centre & Nova Scotia DHW, Halifax, NS 5

2. Spend some time searching the provincial health department of your province. Briefly identify aspects of this department in relation to its role in health care and the services it provides. 3. Each of the provincial health departments offers news releases on current health issues on an ongoing basis on the first page of their web site. Locate the health department web page in the province where you live. Describe a news release that is of interest to you. September 2014 Registered Nurses Professional Development Centre & Nova Scotia DHW, Halifax, NS 6

Health Authorities in Provinces Nova Scotia: District Health Authorities Currently, Nova Scotia is divided into nine district health authorities, plus the IWK Health Centre (provides tertiary care for children, mothers and newborns) which are governed by a volunteer board of directors. Within the district health authorities are community health boards consisting of volunteers who seek input from people in the community regarding all of the factors that affect health. They advise the district health authority about the initiatives needed to meet the needs of their community. People in communities now have the ability to participate in decisions regarding issues that affect their health. There is greater accountability for decisions given to individual communities, instead of from major city governments. The District Health Authorities: South Shore Health South West Health Annapolis Valley Health Colchester East Hants Health Authority Cumberland Health Authority Pictou County Health Authority Guysborough Antigonish-Strait Health Authority Cape Breton Health Authority Capital Health IWK Health Centre By April 1, 2015, the district health authorities in Nova Scotia will be reduced to two: one for the province and one for the IWK. It is described that this new structure will focus on provincewide solutions to the health system and will include: enhanced patient care and safety timely access to consistent care effective and efficient care 6 A few reasons identified for the decrease in the number of district health authorities in Nova Scotia are as follows: 7 Nova Scotians are not becoming more healthy even though there is increased spending in health care. Nova Scotia has a high population of seniors and there is a struggle to meet their needs. One thousand Nova Scotians turn 60 years old each month. In the next 5 to 10 years, almost half of the health professionals will be eligible to retire. 6 Nova Scotia Department of Health and Wellness. (2014). People centred health care: DHA reorganization update. Halifax, NS: Author. Retrieved July 29, 2014 http://novascotia.ca/dhw/peoplecentredhealthcare/ 7 Nova Scotia Department of Health and Wellness. (July 15, 2014). People centred health care: Transition news. Halifax, NS: Author. Retrieved July 29, 2014. http.novascotia.ca/dhw/peoplecentredhealthcare/documents/dha-consolidation-update-issue- 01.pdf September 2014 Registered Nurses Professional Development Centre & Nova Scotia DHW, Halifax, NS 7

In 2014, about 45 per cent of the provincial budget will go towards the cost of health care. New Brunswick: Regional Health Authorities 8 Since 2008, New Brunswick s health care system has been organized into two regional health authorities from the previous eight: Vitalité Health Network: Beauséjour {Moncton}, Edmundston, Campbellton and Bathurst Horizon Health Network: South East {Moncton}, Saint John, Fredericton and Miramichi Each regional health authority is responsible to deliver health services in New Brunswick. Each regional health authority is governed by a Board of Directors appointed by the Minister of Health. Services include Hospital, Community Health, Extra Mural, Addictions and Mental Health, and Public Health. A public company provides non-clinical services, such as information systems and materials management. The New Brunswick Health Council 9 was established by the government as a means to ensure that New Brunswick people are made aware of decisions; take part in making decisions; and know about health system outcomes and cost. These aspects are met by: including New Brunswick citizens in discussions measuring and evaluating population health and health service quality telling citizens about the performance of the health system making recommendations to the NB Minister of Health Prince Edward Island In 2005, the five regional health authorities in PEI were dissolved and responsibility for the entire health system was transferred to the PEI Department of Health. In 2010, power was moved from the PEI Department of Health and Wellness to Health PEI. As a result, Health PEI is accountable to the PEI Department of Health and Wellness. The change in 2010 occurred because of a need to address high demands for service, shortages in human resources and increasing costs. 10 8 Government of New Brunswick. (2014). Regional health authorities. Fredericton, NB: Author. Retrieved July 30, 2014. www2.gnb.ca/content/gnb/en/services/services-renderer.9435.regional-health-authorities-html#servicedescription 9 New Brunswick Health Council. (2014). Mandate. Fredericton, NB: Author. Retrieved July 30, 2014. www.nbhc.ca/aboutnbhc/mandate 10 Institute of Public Administration of Canada. (2013). Healthcare governance models in Canada: A provincial perspective. Retrieved July 31, 2014. www.ipac.ca/documents/all-combined.pdf September 2014 Registered Nurses Professional Development Centre & Nova Scotia DHW, Halifax, NS 8

Activity 2: Provincial Health Authorities and Provincial Hospitals 1. Complete an internet search to locate a health authority of interest to you in your province. Briefly describe the health authority chosen. 2. Complete an internet search to locate a list of hospitals in your province. How many are located in the health authority where you live? 3. Identify specific health services that are available at the hospital closest to where you live. September 2014 Registered Nurses Professional Development Centre & Nova Scotia DHW, Halifax, NS 9

Provincial Programs Nova Scotia 11 The Nova Scotia Department of Health and Wellness funds nine provincial programs with each having a focus on key health needs of Nova Scotians. Staff in these programs develop and track standards of care, offer education programs and take part in health-related research. The following programs have a role as advisors to the Nova Scotia Department of Health and Wellness. Cancer Care Nova Scotia Created to reduce the effects of cancer on individuals, families and the health care system through research, prevention and screening, and to decrease the fear of cancer through education. Cardiovascular Health Nova Scotia Developed to improve the cardiovascular health and care of Nova Scotians, with a focus on cardiac disease and stroke. Diabetes Care Program of Nova Scotia Developed to improve the health of Nova Scotians living with, affected by, or at risk of developing diabetes. Prevention, management and reduction of complications are addressed. Legacy of Life: Nova Scotia Organ and Tissue Donation Program Works to ensure Nova Scotians are aware of organ and tissue donation. Promotes donation and care for donors and families. Nova Scotia Breast Screening Program Provides access to mammography. Ensures that women who have abnormal mammograms receive appropriate follow-up care. Nova Scotia Hearing and Speech Centres Provides hearing services to Nova Scotians of all ages. Provides speech and language services to preschool children and to adults. Nova Scotia Provincial Blood Coordinating Program Leads collaboration with other health care workers in Nova Scotia and Canadian Blood Services to ensure safe management of blood services. 11 Nova Scotia Department of Health and Wellness. (2014). Provincial programs. Halifax, NS: Author. Retrieved July 29, 2014. http://nova scotia.ca/dhw/provincial_programs.asp September 2014 Registered Nurses Professional Development Centre & Nova Scotia DHW, Halifax, NS 10

Nova Scotia Renal Program Develops linkages and collaborative initiatives with partners to improve renal health and care for all Nova Scotians. Reproductive Care Program/Rh Program of Nova Scotia Works directly with hospital and community-based health professionals to promote excellence in the provision of reproductive care. Additional Provincial Initiatives, Programs and Services in Nova Scotia 12 The following are examples: 811 A registered nurse is accessed by dialing 811 for non-emergency health information and services. Addictions Care and service is provided in relation to health promotion, addiction prevention, interventions and treatment. Continuing Care Service is provided to individuals in the home and community on a long or short-term basis. Services can include, for example home care, home oxygen services and respite care. e-health Information technology established to help in delivering care. Emergency Health Services This service is responsible for emergency, out of hospital and urgent care through ambulances and helicopters. Family Physicians There is an on-line list of physicians in Nova Scotia who are willing to take on new patients. Health Card (MSI) The health insurance program in Nova Scotia for eligible residents which provides coverage for hospital, medical, dental and optometric services. 12 Nova Scotia Department of Health and Wellness. (2014). Health and wellness initiatives, programs and services. Halifax, NS: Author. Retrieved July 29, 2014. http://nova scotia.ca/dhw/programs-and-services.asp September 2014 Registered Nurses Professional Development Centre & Nova Scotia DHW, Halifax, NS 11

Other examples of services/initiatives in Nova Scotia: Infection Prevention and Control Mental Health Services Personal Health Information Act Pharmacare Primary Health Care Public Health Quality and Patient Safety Thrive New Brunswick The government of New Brunswick offers many health services. The following list is an overview of some of these services. For further information on other health services in New Brunswick, please refer to the applicable web site identified in your program overview. 13 Anonymous HIV Testing Services Free testing is provided by Public Health. A code is used instead of the client's name in their file and on the lab form. Early Childhood Initiatives Prenatal services that include healthy pregnancy and postnatal services to promote the healthy development of children from birth to five years old. Services included are screening, home visiting, referral and provision of nutrition supplements. Extra-Mural Program A home health service provided to New Brunswickers of all ages in their homes and communities. These services are publicly funded. Health care provided by an interdisciplinary team can range from health education and chronic disease self-care to more complex care such as, post surgery, dementia and end-of-life. Healthy Learners in School Program A public health program provided across the province to elementary and some middle and high school students. The purpose is to develop and support health promotion efforts. Organ and Tissue Donation Program Responsible to coordinate the retrieval of organs from all New Brunswick donors and to place these organs with Canadian transplant programs. 13 Government of New Brunswick. (2014). Government of New Brunswick: Services. Fredericton, NB: Author. Retrieved July 30, 2014. http://www2.gnb.ca/content/gnb/en/departments/ocmoh/services.html?_charest_=utf-8 September 2014 Registered Nurses Professional Development Centre & Nova Scotia DHW, Halifax, NS 12

Patient Connect NB A resource to match patients with primary health care providers who are able to take them into their practice. Poison Information Line Provides high priority response to NB residents and health care providers. Routine Immunization Services Publicly funded vaccines provided at no cost to eligible infants, adolescents and adults. Sexual Health Program Aimed to reduce unintended teen pregnancies and also the incidence of sexually transmitted and blood-borne infections. The two services offered are: Sexual health promotion activities; and Counselling and clinical services. Tele-Care A free, bilingual and confidential telephone service. Registered Nurses provide telephone triage and information for non-urgent health concerns. Callers can then make informed decisions. The service is available 24 hours a day, 7 days a week. The New Brunswick government recently introduced the New Brunswick Drug Plan 14 which is designed to help individuals avoid high drug costs and to ensure that drug insurance is available to all New Brunswickers. Prince Edward Island Health PEI offers many health services and programs. The following list is an overview of some of these. For further information on other health services and programs in Prince Edward Island, please refer to the applicable web site identified in your program overview. 15 Provincial Addictions Treatment Facility The main objective of this unit is to provide safe, medically supervised withdrawal management from mood altering chemicals, education related to addiction and motivation to further treatment. Provincial Breast Screening Program For PEI women to enable early detection of breast cancer. Provincial Geriatric Program Provides geriatric assessment to older adults who have complex care and support needs. Referrals are received from physicians requesting assessments. 14 Health - Government of New Brunswick. (2014). The New Brunswick drug plan. Retrieved August 4, 2014. www2.gnb.ca/content/gnb/en/departments/health/medicareprescriptiondrugplan/nbdrugplan.html 15 Health PEI. (2014). Index of programs and services. Charlottetown, PEI: Author. Retrieved July 30, 2014. http://www.healthpei.ca/ps_healthpei.php September 2014 Registered Nurses Professional Development Centre & Nova Scotia DHW, Halifax, NS 13

Provincial Diabetes Program Provides diabetes education and advice to clients and their families participating in the program. Plays a role in educating health professionals and the public about practices and standards for diabetes care. Provincial Integrated Palliative Care Program The goal of this program is provide quality of life for clients and their families. Care is given by health care teams in the home, long-term care, community care, palliative care units, and palliative care beds in acute settings. Care may include aspects, such as spiritual support; pain and symptom management; and emotional support. Provincial Renal Program Dialysis services are coordinated throughout the province. Home Care A range of services are offered, for example assessment, nursing, respite, social work and adult day programs. Mental Health Crisis Response Prompt responses are provided to people who present with a mental health emergency. Experienced mental health staff work closely with emergency room doctors and link clients to the appropriate level of care without any delays. Public Health Programs Includes public health nursing, community nutrition, speech language pathology/audiology, and dental public health. September 2014 Registered Nurses Professional Development Centre & Nova Scotia DHW, Halifax, NS 14

Activity 3: Provincial Health Programs and Services 1. Describe a health program/service from your home country. 2. Identify any programs/services available in your Canadian home province that were not available in your home country? 3. Select and describe a program/service available in your province. September 2014 Registered Nurses Professional Development Centre & Nova Scotia DHW, Halifax, NS 15

4. Discuss the value of this program/service to clients in your province. 5. Identify how services available in your province can benefit you in your practice as a health care professional. September 2014 Registered Nurses Professional Development Centre & Nova Scotia DHW, Halifax, NS 16

Community Health Organizations/Agencies/Resources Within Nova Scotia, New Brunswick and Prince Edward Island, there are a number of community health organizations, agencies and resources designed to assist individuals in need of a particular service. Some of these are managed provincially, while others are managed by local community groups. As a health care professional working with various individuals, groups and communities, it is very important to have an awareness of the resources available in your province and in your local community. Even one community referral made by you to an individual or family may make a significant difference in their day-to-day life in terms of maintaining health. This is a list of examples of community health organizations, agencies and resources common to the three provinces: Heart and Stroke Foundation Cancer Society Legal Aid Alzheimer's Society Grief Support Groups Alcoholics Anonymous Narcotics Anonymous Emergency Shelters for Women, Men and Youth Food Banks Clothing Banks Furniture Banks Walk-in-Medical Clinics Youth and Afterschool Programs Family Resource Centres Counselling Services Crisis Help Lines Employment and Career Supports Sexuality Support Groups Seniors Housing Services Boys and Girls Clubs Meals on Wheels Life Line Red Cross Services September 2014 Registered Nurses Professional Development Centre & Nova Scotia DHW, Halifax, NS 17

Activity 4: Community Health Organizations, Agencies and Resources 1. Complete an internet search of community health organizations, agencies and resources common to your province and local community. List some below. 2. Describe how the services you selected may be of benefit to clients you will be in contact with as a health care professional in your province. September 2014 Registered Nurses Professional Development Centre & Nova Scotia DHW, Halifax, NS 18

Health Issues Affecting Maritimers As health care professionals working in a Maritime Provinces: Nova Scotia, New Brunswick or Prince Edward Island, it is important for you to be aware of common health problems that affect the people who live there. The following section reviews some information specific to the health issues of residents of each province. Please review the section that applies to you. Nova Scotia A report stated that getting Nova Scotians healthy, helping Nova Scotians stay healthy and protecting their health are shared goals of the Nova Scotia Department of Health and Nova Scotia Health Promotion and Protection. This same report also identified various public health threats from chronic illness to pandemic influenza, as well as challenges including long wait times, an aging population and a shortage of trained health professionals. One in seven individuals in Nova Scotia is over the age of 65 years and it is estimated that one in five Nova Scotians will be a senior by 2016. Another report from the Nova Scotia Department of Health identified that: Nova Scotia, in comparison to other provinces in Canada, has higher rates of deaths from cancer and respiratory diseases, and the second highest rate of circulatory deaths and diabetes. Nova Scotians have the second highest obesity rate in Canada. The recommended daily intake of fruits and vegetables is not being met by about 70% of Nova Scotians. One in four Nova Scotians smoke. This is higher than the national average. An estimated 5800 Nova Scotians are killed by chronic diseases each year. Arthritis affects 173,000 Nova Scotians each year. Stroke affects 1300 Nova Scotians each year. These facts help to inspire health care professionals to strive to improve the health of our communities. Primary health care, with an emphasis on health promotion, disease prevention, improving the health care system and striving to address the determinants of health in our communities is a key part of building a better future for Nova Scotians. Please note that the government agencies referred to in these reports have changed. The Department of Health and Wellness of Nova Scotia was formed in 2011 when the Department of Health Promotion and Protection; and the Department of Health merged. The merger recognized health care as a continuum that requires a focus on both prevention and treatment. September 2014 Registered Nurses Professional Development Centre & Nova Scotia DHW, Halifax, NS 19

New Brunswick Data outlined in the New Brunswick Provincial Health Plan 2013-2018 16 included the following: New Brunswickers are satisfied with the quality of care received. Rates for smoking, adult obesity, diabetes, heart disease, respiratory disease and alcohol use is higher in New Brunswick compared to Canadian average rates. 20 per cent of hospital beds are occupied by seniors who require placement in longterm care facilities. At least one chronic condition is experienced by 70% of seniors in New Brunswick. Prince Edward Island 17 Cancer, heart disease and stroke are the leading causes of death in PEI. Fewer low birth weight babies are born in PEI compared to Canada. The unemployment rate in PEI remains higher than the Canadian rate. Over 50% of PEI residents identify their health as being very good or excellent. More individuals living in PEI are likely to be obese, compared to other Canadians. Physical inactivity is more likely among PEI residents. Rates of smoking have decreased, but heavy drinking is higher, in comparison to Canadian rates. Compared to Canadians overall, Islanders are more likely to experience arthritis, asthma, heart disease, stroke, diabetes or cancer. The most common cancers are prostate, breast in females, lung and colorectal. Aged 50 to 74 year old islanders are less likely to be screened for colorectal cancer, in comparison to other Canadians. Rates of diabetes Type II are similar to other Canadians. 16 Province of New Brunswick. (2013). Rebuilding health care together: The provincial health plan 2013-2018. Fredericton, NB: Author. Retrieved July 20, 2014. http:www.gnb.ca/0212/values/pdf/9129%20english.pdf 17 PEI Department of Health and Wellness. (2010). Prince Edward Island health trends 2010. Charlottetown, PE: Author. Retrieved July 20, 2014. www.gov.pe.ca/photos/original/dohw-epi-trnd10.pdf September 2014 Registered Nurses Professional Development Centre & Nova Scotia DHW, Halifax, NS 20

Activity 5: Local Health Issues Describe a topic related to a specific health issue in your province as identified in the local newspaper, radio or TV program. September 2014 Registered Nurses Professional Development Centre & Nova Scotia DHW, Halifax, NS 21

Primary Health Care Initiatives To become more familiar with specific primary health care programs in the three individual provinces, it is worthwhile to take time to explore some examples of what is currently happening in this area. In Nova Scotia, one such example is directed toward chronic disease prevention and management. 18 As Nova Scotia has one of the highest rates of chronic disease and disability in Canada, the province has focused on initiatives such as self-management support programs and collaborative primary health teams. Primary health care works with partners to promote healthy behaviours, such as eating well and being active. Other examples of primary health care programs are (1) Nova Scotia Chronic Pain and (2) You're in Charge - a program to help teenagers living with a chronic illness. The New Brunswick Health Council 19 and Health PEI 20 each conducted surveys in 2011 to obtain an overview of their populations' experiences with primary health care. To look at the results of these surveys, please refer to your program overview for web site addresses. ************************************************* Activity 6: Primary Health Care Initiatives Search the health department in your province to identify any primary health care programs/initiatives. Briefly describe what you found. 18 Nova Scotia Health and Wellness. (2014). Primary health care: Chronic disease prevention and management. Halifax, NS: Author. Retrieved July 29, 2014. http://novascotia.ca/dhw/primaryhealthcare/chronic-disease/management.asp 19 New Brunswick Health Council. (2011). New Brunswickers' experiences with primary health care. New Brunswick Health Council: Moncton, NB: Author. Retrieved July 31, 2014. www.nbhc.ca/sites/default/files/pdf/acute/executive%20summary%20- %20NBHC%20Primary%20Health%202011%20Survey%20Results.pdf 20 Health PEI. (2013). Primary health care survey results. Charlottetown, PEI: Author. Retrieved August 4, 2014. www.gov.pe.ca/photos/original/hpei-pcsurveyre.pdf September 2014 Registered Nurses Professional Development Centre & Nova Scotia DHW, Halifax, NS 22