N
ilinical use:
A coast-to-coast consultation on health innovation
iased on a relationship observed in PLATO between naintenance ASA dose and relative efficacy of BRILINTA :ompared to clopidogrel, BRILINTA is recommended o be co-administered with low maintenance dose \SA (75-150 mg daily). The safety and efficacy of 1RILINTA in pediatric patients below the age of 18 rave not been established. Therefore, BRILINTA is rot recommended in this population.
he era when Canadians could be confident their health care system is among the best in the world is “drawing to a close,” says Dr. David Naylor, chair of the federal government’s new Advisory Panel on Healthcare Innovation. Naylor, former president of the Uni versity of Toronto, and his seven col leagues are charged with identifying five areas of innovation in Canada and inter nationally that can reduce the growth of health care spending while improving quality and accessibility. The panel is to deliver its final report by June 2015. Naylor spoke to CM AJ about the panel’s work so far and what he hopes it will achieve.
T
Contraindications;
> Patients with active pathological bleeding (e.g., peptic ulcer or intracranial hemorrhage) ■ Patients with a history of intracranial hemorrhage » Patients with moderate to severe hepatic impairment > Patients who are also taking strong CYP3A4 inhibitors
i/lost serious warnings and precautions: Bleeding risk: BRILINTA should be used with
caution in patients with a propensity to bleed e.g., due to recent trauma, recent surgery, active x recent gastrointestinal bleeding, or moderate pepatic impairment) and in patients requiring oral anticoagulants (e.g., warfarin) and/or fibrinolytics agents (within 24 hours of BRILINTA dosing). Caution should also be used in patientswith concomitant administration of medicinal products that may ncrease the risk of bleeding (e.g., non-steroidal anti-inflammatory drugs [NSAIDs]).
Maintenance dose ASA: Co-administration of
BRILINTA and high maintenance dose ASA (>150 mg daily) is not recommended.
CMAJ. What have you been hearing in your consultations? Naylor: More people are focused now on value for money than was the case in the past. ... There are many fab ulous ideas and initiatives germinating in the system, and a big part of our chal lenge is to figure out how to evaluate rigorously and then scale those innova tions across the country.
Other relevant warnings and precautions:
• • • • • • • • •
Cardiac events in discontinued patients Bradycardic events Hypersensitivity, including angioedema Dizziness and confusion Discontinuation prior to surgery Dyspnea Pregnant or nursing women Possible increase in creatinine levels Uric acid increase
For more information;
Consult the Product Monograph at azinfo.ca/ brilinta/pm274 for important information regarding adverse reactions, drug interactions and dosing information not discussed in this piece. The Product Monograph is also available by calling AstraZeneca Canada at 1-800-668-6000.11
CMAJ. Has anything surprised you so far? Naylor: One thing that has surprised me ... is that the system has not changed dramatically in the last 15 or 20 years. There have certainly been experiments ... but we have the chal lenge in Canada of an architecture that worked beautifully for the first 20-plus years of medicare ... and then over the last 20 or 30 years has been struggling.
References: 1. British Columbia M inistry of Health. Available from: http://www.healtli.gov.bc.ca/pharm acare/sa/criteria/ restricted/tieagrelor.html. Accessed September 24, 2012. 2. Alberta Health Interactive Drug Benefit List. Available from: https://www.ab.biuecross.ca/dbl/idbl_m ain1.htm l. Accessed October 1, 2 0 1 3 .3 . Government of Saskatchewan Drug Plan and Extended Benefits Branch. Available from: http://formularydrugplan.health.gov.sk.ca/. Accessed November 2 ,2 0 1 2 .4 . Manitoba Health. Available from: http://www.gov.m b.ca/health/m dbif/edsnotice.pdf.Accessed January 21, 2 0 1 3 .5 . Ontario Drug Benefit Formulary/ Comparative Drug Index. Available from: http://w w w .health. gov.on.ca/en/pro/program s/drugs/formulary/41_update_ at_20130419.xls. Accessed April 3 0 ,2 0 1 3 .6 . Regie de I'assurance maladie du Quebec. Available from: http://www.ram q.gouvgc.ca/SiteCoilectionDocurnents/ professionnels/medicaments/codes-medicaments-exception/ internet/codes„medicaments_exception.pdt. Accessed March 15, 20 1 3.7 . Government of New Brunswick Department of Health. Available from: http://www.gnb.ca/0212/pdf/NBPDP_ Builetin/2012/NB PDP Bulletin8430ct9,2012Flnal.pdf. Accessed October 3 0 ,20 1 2 . 8. Government of Nova Scotia Department of Health and Wellness. Available from: http://www.gov.ns.ca/ health/Pharm acare/pubs/Criteria_for_Exception_Status_ Coverage.pdf. Accessed January 1 1 ,2 0 1 3 .9 . Newfoundland and Labrador Department of Health and Community Services. Available from: http://www.health.gov.nl.ca/health/prescription/ covered_specialautbdrugs.html. Accessed: January 7,2014, 10. Canadian Cardiovascular Society. 2012 Focused Update on the Canadian Cardiovascular Society Guidelines for the use of Antiplateiet Therapy. October 2012 11. BRILINTA5, Product Monograph. AstraZeneca Canada Inc. September 9 ,2 0 1 3 .
A s tra Z e n e c a
(M D m
BRILINTA® and the AstraZeneca logo are registered trademarks of the AstraZeneca group of companies. © AstraZeneca 2014
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CMAJ. Where do you see interna tional practices coming into play? Naylor: Health care systems have both a genotype and a phenotype and one has to be wary of simply assuming you can import something from afar, but I will say that the Canadian propen sity to learn from international experi ence may have been stunted by a ten dency to look south with ambivalence, and perhaps some spurious self-con gratulation about our arrangements.
"Anything we can do to accelerate evalu ation, dialogue, dissemination and adop tion would be a good thing," says Dr. David Naylor, chair of the Advisory Panel on Healthcare Innovation.
CMAJ. What do you hope to get from public consultation that differs from the surveys and town halls and fact-finding that has already gone on? Naylor: I think we are going to get Canadians coast to coast in their own words talking about their health care experiences and how they see the sys tem. That qualitative input will have a salience that no survey can capture. CMAJ: Isn’t the issue here a lack of action and resources, or is it truly a lack of information about evidence-based innovation? Naylor: The question will be what can we do on a pan-Canadian basis to change that culture, if indeed that’s the issue.... Anything we can do to acceler ate evaluation, dialogue, dissemination and adoption would be a good thing. CMAJ: What do you hope the result of this entire panel process will be? Naylor: Our emphasis is going to be on both the levers that are primarily within the hands of the federal govern ment and those elements of governance and decision support that are in the hands of pan-Canadian agencies. ... I hope that we’re able to offer some val ued input ... so that they are more sup portive of a health care culture that will be not only innovative but responsive to innovation wherever it can be found. — Laura Eggertson, CMAJ C M AJ 2014. DOI: 10.1503/cmaj.109-4908
CMAJ, O c to b e r 21, 2014, 186(15)
1137
Copyright of CMAJ: Canadian Medical Association Journal is the property of Canadian Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
ilinical use:
A coast-to-coast consultation on health innovation
iased on a relationship observed in PLATO between naintenance ASA dose and relative efficacy of BRILINTA :ompared to clopidogrel, BRILINTA is recommended o be co-administered with low maintenance dose \SA (75-150 mg daily). The safety and efficacy of 1RILINTA in pediatric patients below the age of 18 rave not been established. Therefore, BRILINTA is rot recommended in this population.
he era when Canadians could be confident their health care system is among the best in the world is “drawing to a close,” says Dr. David Naylor, chair of the federal government’s new Advisory Panel on Healthcare Innovation. Naylor, former president of the Uni versity of Toronto, and his seven col leagues are charged with identifying five areas of innovation in Canada and inter nationally that can reduce the growth of health care spending while improving quality and accessibility. The panel is to deliver its final report by June 2015. Naylor spoke to CM AJ about the panel’s work so far and what he hopes it will achieve.
T
Contraindications;
> Patients with active pathological bleeding (e.g., peptic ulcer or intracranial hemorrhage) ■ Patients with a history of intracranial hemorrhage » Patients with moderate to severe hepatic impairment > Patients who are also taking strong CYP3A4 inhibitors
i/lost serious warnings and precautions: Bleeding risk: BRILINTA should be used with
caution in patients with a propensity to bleed e.g., due to recent trauma, recent surgery, active x recent gastrointestinal bleeding, or moderate pepatic impairment) and in patients requiring oral anticoagulants (e.g., warfarin) and/or fibrinolytics agents (within 24 hours of BRILINTA dosing). Caution should also be used in patientswith concomitant administration of medicinal products that may ncrease the risk of bleeding (e.g., non-steroidal anti-inflammatory drugs [NSAIDs]).
Maintenance dose ASA: Co-administration of
BRILINTA and high maintenance dose ASA (>150 mg daily) is not recommended.
CMAJ. What have you been hearing in your consultations? Naylor: More people are focused now on value for money than was the case in the past. ... There are many fab ulous ideas and initiatives germinating in the system, and a big part of our chal lenge is to figure out how to evaluate rigorously and then scale those innova tions across the country.
Other relevant warnings and precautions:
• • • • • • • • •
Cardiac events in discontinued patients Bradycardic events Hypersensitivity, including angioedema Dizziness and confusion Discontinuation prior to surgery Dyspnea Pregnant or nursing women Possible increase in creatinine levels Uric acid increase
For more information;
Consult the Product Monograph at azinfo.ca/ brilinta/pm274 for important information regarding adverse reactions, drug interactions and dosing information not discussed in this piece. The Product Monograph is also available by calling AstraZeneca Canada at 1-800-668-6000.11
CMAJ. Has anything surprised you so far? Naylor: One thing that has surprised me ... is that the system has not changed dramatically in the last 15 or 20 years. There have certainly been experiments ... but we have the chal lenge in Canada of an architecture that worked beautifully for the first 20-plus years of medicare ... and then over the last 20 or 30 years has been struggling.
References: 1. British Columbia M inistry of Health. Available from: http://www.healtli.gov.bc.ca/pharm acare/sa/criteria/ restricted/tieagrelor.html. Accessed September 24, 2012. 2. Alberta Health Interactive Drug Benefit List. Available from: https://www.ab.biuecross.ca/dbl/idbl_m ain1.htm l. Accessed October 1, 2 0 1 3 .3 . Government of Saskatchewan Drug Plan and Extended Benefits Branch. Available from: http://formularydrugplan.health.gov.sk.ca/. Accessed November 2 ,2 0 1 2 .4 . Manitoba Health. Available from: http://www.gov.m b.ca/health/m dbif/edsnotice.pdf.Accessed January 21, 2 0 1 3 .5 . Ontario Drug Benefit Formulary/ Comparative Drug Index. Available from: http://w w w .health. gov.on.ca/en/pro/program s/drugs/formulary/41_update_ at_20130419.xls. Accessed April 3 0 ,2 0 1 3 .6 . Regie de I'assurance maladie du Quebec. Available from: http://www.ram q.gouvgc.ca/SiteCoilectionDocurnents/ professionnels/medicaments/codes-medicaments-exception/ internet/codes„medicaments_exception.pdt. Accessed March 15, 20 1 3.7 . Government of New Brunswick Department of Health. Available from: http://www.gnb.ca/0212/pdf/NBPDP_ Builetin/2012/NB PDP Bulletin8430ct9,2012Flnal.pdf. Accessed October 3 0 ,20 1 2 . 8. Government of Nova Scotia Department of Health and Wellness. Available from: http://www.gov.ns.ca/ health/Pharm acare/pubs/Criteria_for_Exception_Status_ Coverage.pdf. Accessed January 1 1 ,2 0 1 3 .9 . Newfoundland and Labrador Department of Health and Community Services. Available from: http://www.health.gov.nl.ca/health/prescription/ covered_specialautbdrugs.html. Accessed: January 7,2014, 10. Canadian Cardiovascular Society. 2012 Focused Update on the Canadian Cardiovascular Society Guidelines for the use of Antiplateiet Therapy. October 2012 11. BRILINTA5, Product Monograph. AstraZeneca Canada Inc. September 9 ,2 0 1 3 .
A s tra Z e n e c a
(M D m
BRILINTA® and the AstraZeneca logo are registered trademarks of the AstraZeneca group of companies. © AstraZeneca 2014
BR236E
0 3 /1 5
ew s
t
CMAJ. Where do you see interna tional practices coming into play? Naylor: Health care systems have both a genotype and a phenotype and one has to be wary of simply assuming you can import something from afar, but I will say that the Canadian propen sity to learn from international experi ence may have been stunted by a ten dency to look south with ambivalence, and perhaps some spurious self-con gratulation about our arrangements.
"Anything we can do to accelerate evalu ation, dialogue, dissemination and adop tion would be a good thing," says Dr. David Naylor, chair of the Advisory Panel on Healthcare Innovation.
CMAJ. What do you hope to get from public consultation that differs from the surveys and town halls and fact-finding that has already gone on? Naylor: I think we are going to get Canadians coast to coast in their own words talking about their health care experiences and how they see the sys tem. That qualitative input will have a salience that no survey can capture. CMAJ: Isn’t the issue here a lack of action and resources, or is it truly a lack of information about evidence-based innovation? Naylor: The question will be what can we do on a pan-Canadian basis to change that culture, if indeed that’s the issue.... Anything we can do to acceler ate evaluation, dialogue, dissemination and adoption would be a good thing. CMAJ: What do you hope the result of this entire panel process will be? Naylor: Our emphasis is going to be on both the levers that are primarily within the hands of the federal govern ment and those elements of governance and decision support that are in the hands of pan-Canadian agencies. ... I hope that we’re able to offer some val ued input ... so that they are more sup portive of a health care culture that will be not only innovative but responsive to innovation wherever it can be found. — Laura Eggertson, CMAJ C M AJ 2014. DOI: 10.1503/cmaj.109-4908
CMAJ, O c to b e r 21, 2014, 186(15)
1137
Copyright of CMAJ: Canadian Medical Association Journal is the property of Canadian Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
