Improving management of HDP

A new integrated, evidence-based approach to the hypertensive disorders of pregnancy (HDP) is expected to keep approximately 2400 women annually in BC safer and closer to home.

Dr Peter von Dadelszen, Sherry Hamilton, and an international team of expert clinicians and decision-makers have integrated three lines of enquiry into a new guideline for management of the HDP. This guideline reflects both the variable presentation and the systemic nature of gestational hypertension. The three lines of enquiry are:

• A model of standardized assessment and surveillance of HDP.

• A regional model for the management of severe pre-eclampsia.

• A validated set of clinical indicators for benchmarking in the HDP.

The project’s name, Translating Evidence-based Surveillance and Treatment Strategies (TESS), reflects the broad scope of the project that is designed to influence all women with an HDP admitted to a BC health care facility. It is anticipated that the integrated knowledge translation model will improve outcomes at lower costs and with less social disruption.

The research team engaged in active consultation with the BC Reproductive Care Program to align the integrated model with their needs, requirements, and standards. Telehealth Rounds to introduce the guideline were hosted by the UBC/BCWHHC Department of Obstetrics and Gynaecology and broadcasted to every maternity centre in BC in late February 2006. A dialogue was held in March 2006 with 40 provincially representative maternity service providers and managers, allowing for review and critique of the guideline, assessment of its feasibility and responsiveness to local needs and limitations, and to encourage the support of those who will be given the task of implementing and using the guideline.

Education and implementation of the guideline, from April to August 2006, will develop local ownership of the process and make the guideline easily accessible to every maternity service provider in BC. Members of the research group will travel through BC to meet with groups, identify local champions, and give in-service sessions prior to local implementation of the integrated model. The delivery of this model will be supported by guideline distribution with the BCMJ in May and web-based documents and training modules on the BCRCP web site (www.rcp.gov.bc.ca), the TESS project web site (www.obstgyn.ca/mfmresearch/guidelines), the BC midwifery web site (www.bcmidwives.com), and the Maternity Care Discussion Group of the College of Family Physicians.
Maternal and perinatal outcomes, collected by the BC Perinatal Database Registry and the Ministry of Health, will be compared prior and subsequent to implementation of the new guideline to evaluate its effectiveness. For more information about the TESS project please visit www.obstgyn.ca/mfmresearch/guidelines.

—Sarah Gilgoff, BSc
Peter von Dadelszen, MD

 New mental health beds improve patient care at St. Paul’s

In February 2006, St. Paul’s Hospital began admitting patients to its new Treatment and Evaluation Unit. Funded by Vancouver Coastal Health, the 15 beds that form the unit will work to improve the care, treatment, and safety of psychiatric patients, while reducing wait times and congestion in the hospital’s busy emergency department.
Since 2001, the number of psychiatric patients admitted through the St. Paul’s ER has increased by approximately 20%. The new facility was specifically designed to meet the needs of mental health patients, with private and semi-private rooms, more seclusion rooms, natural lighting, more space and open areas, and video monitoring.

Increase your disposable income

A new option is being added to the Medical Office Benefit Plan (MOBP) effective 1 July 2006. The new Core-Plus Plan is designed for physicians who wish to provide extended health and dental benefits for themselves, their families, and their employees in a flexible, comprehensive, and tax-effective manner.

The new option will consist of the following:

• A core insurance component, providing basic, competitively priced extended health and dental protection.

• A self-insured Cost-Plus component to cover eligible health and dental expenses not included under the Core insurance.

The plan is structured so that eligible expenses will be tax deductible to the member and are not taxable benefits to plan participants.

To give members an opportunity to get first-hand information about the new Core-Plus MOBP option, and any other insurance-related questions you may have, BCMA Benefits staff will be touring the province during May and June. Information sessions are being planned in the following communities. Dates and venues that have been confirmed at the date of writing are also shown below. With the exceptions of Penticton and Vancouver, all sessions will be held in the local hospital. All sessions are from 6 p.m. to 8 p.m. and a light meal will be provided.
Notice of the meeting in your area will be posted on the hospital notice board. In addition, you will receive a personalized invitation to attend the session nearest you. Information about the sessions will also be posted on the BCMA web site, at www.bcma.org.

Don’t miss this opportunity to meet with the staff of the BCMA and find out about the newest innovation in the lineup of BCMA insurance programs. We look forward to seeing you!

Lower Mainland
Vancouver—BCMA Boardroom 

New Westminster—Royal Columbian 
Abbotsford—MSA General 
Burnaby—Burnaby General 
Surrey—Surrey Memorial 
Richmond—The Richmond Hospital 
North Vancouver—Lions Gate 
Langley—Langley Memorial 
Chilliwack—Chilliwack General

Wed., 3 May
Tues., 9 May 
Tues., 2 May
Thurs., 4 May
Wed., 10 May
Thurs., 11 May
Mon., 15 May
Tues., 16 May
Wed., 17 May
Thurs., 18 May
Vancouver Island/Sunshine Coast
Royal Jubilee 
Victoria General 
Nanaimo—Nanaimo Regional 
General Hospital 
Comox—St Joseph’s General Hospital 
Powell River—Powell River 
General Hospital

Mon., 12 June
Tues., 13 June

Wed., 14 June
Thurs., 15 June

Tues., 20 June

Penticton—Penticton Health Centre 
Kelowna—Kelowna General 
Vernon—Vernon Jubilee
Tues., 23 May
Wed., 24 May
Thurs., 25 May
Cranbrook—East Kootenay 
Regional Hospital 
Castlegar & District Community 
Health Centre 

Mon., 19 June

Thurs., 22 June
To be confirmed
To be confirmed

Kamloops—Royal Inland 
Prince George—Prince George Regional
Tues., 6 June
Wed., 7 June

—Sandie Braid, CEBS
BCMA Benefits Department

Your 2006–2007 mat leave benefit

Are you a physician practising medicine in British Columbia and having a baby or planning a pregnancy in the period of 1 April 2006 to 31 March 2007? If you are, then it is important to take advantage of the Maternity Leave Benefit Program (MLBP) that was negotiated for you in the 2001 Working Agreement between the BCMA and the government of British Columbia. The MLBP ensures that a new mother can recover from pregnancy and delivery. 
For more information, contact Ms Lorie Arlitt, MLBP Administrator: Toll free in BC: 1 800 665-2262, ext 2882
Direct line: 604 638-2882, E-mail: larlitt@bcma.bc.ca

—Sandie Braid, CEBS
BCMA Benefits Department

New BCMA Partners scholarship

The BCMA Partners have good news for mature students this year. The Partners scholarship panel has been receiving a rising number of applications from students returning to school to complete a degree or earn a second degree, and following a successful year of fundraising, the Partners are now offering a third $500 scholarship to honor applicants in this category.

Ms Louise Oyler, past president of the Partners, says, “It’s hard to compare the extracurricular accomplishments of high school students being supported in the home to mature students who are supporting themselves and perhaps a family. These students should be recognized in a category of their own.”

The quality of applications for the scholarship program continues to be impressive, and the judging process is challenging. Applications are assigned a number and forwarded to the panel with names and contact information removed to assure anonymity. They are graded in categories such as marks, athletics, arts, and volunteer and community work. Evaluation of these accomplishments is the easy part of the judging process. Once the applications are narrowed down based on those scores, the panel must look for extraordinary qualities in each student in order to make their difficult final decision. Students who have overcome some sort of adversity or personal challenge, or who have shown an extraordinary level of community service, tend to make the final cut. Cover letters also play an important role. Ms Lori Garg, treasurer of the Partners, says, “All applicants are high achievers, all are involved in things besides academics. We need to see something beyond that. Some cover letters are written so well that by the time you finish the letter you feel like you know them.”

The Partners fundraising efforts are greatly valued by scholarship recipients. Mr Ryan Wilson, one of the successful applicants from 2005, is in his first year at the University of Calgary, studying biosciences. Mr Wilson contends that winning his scholarship helped to increase his confidence so that he now has the grades and determination to get into medical school, and he says that the money helped toward paying his tuition. He has greatly enjoyed his first year at university and welcomes the challenges of pursuing his career in medicine.

Applications for Partners scholarships will be accepted until 1 May 2006, and successful applicants will be notified by 30 May. Information and applications can be found online at www.bcma.org, in the members’ section.

—Tara Lyon
BCMA Communications

BCMA Annual Convention

Your annual opportunity to mingle with fellow members!

Join us at this year’s BCMA Annual Convention, 10 June 2006, at the Sheraton Wall Centre Hotel in downtown Vancouver, BC.

Save time by registering in advance, either online or by calling Ms Lorie Janzen at 604 638-2877 in Vancouver, or toll free at 1 800 665-2262, local 2877.

Tentative agreement between BCMA and provincial government now in the hands of BC physicians

The BCMA’s Board of Directors approved a new 6-year draft agreement between the BCMA and the provincial government. Covering the period of 1 April 2006 to 31 March 2012, the agreement offers a combination of general compensation increases and targeted funding to address critical patient care and to support modernizing the health care system.

The agreement provides for a general compensation increase of 10.4% over 4 years (3%, 2%, 2%, 3%), and targeted compensation increases of 8.7% over 4 years. These combined increases result in an average increase of 19.1% over 4 years, or an average annual increase of 4.5%. In years five and six of the agreement, binding arbitration will determine the compensation increases.

General practice compensation and targeted increases total $382 million of new money cumulatively over 4 years. The first year of funding of $60 million increases to $80 million in the second year, $105.5 million in the third year, and to $136.5 million in the fourth year of the agreement. Also available are two one-time payments totalling $10 000 for those physicians who participate in the chronic disease management program. New money will be available to family physicians who provide complex and longitudinal care, and a new Complex Care fee will be implemented.

Specialist compensation and targeted increases total $168.3 million cumulatively over 4 years. The first year of funding of $29 million increases to $42.1 million in the second year, to $46.1 million in the third year, and to $51.1 million in the fourth year of the agreement. Ongoing payments will be put toward correcting disparities between lower and higher paid specialty sections, to support surgeons participating in the surgical registry project, and to create a new provincial MRI fee.

Service contracts and salaries compensation and targeted increases total $59.5 million cumulatively over 4 years. Ongoing payments include a new payment structure and workload model for emergency medicine service contracts, and addressing changes to the salary and service contract grids to compensate for market comparisons and disparity corrections.

For physicians paid by sessions, in addition to the general increase taking place 1 April 2006, sessional rates will increase by a further 5.5%.

In addition to the specific funding for compensation, other targeted funding will also be implemented. Government will contribute $3.6 million over the life of the agreement to the Physician Health Program, doubling the current level of support. The Maternity Leave Plan will continue until 2010 when it will change into the Parental Leave Plan (to cover both parents and to include all births and adoptions). An additional $3 million is added to the plan for this change. The Rural Recruitment and Retention Program “cap” is removed, thereby protecting the level of current payments. Other rural programs such as Rural CME, the Rural Locum Program, and the REAP will receive additional funding.

The current MOCAP (medical on-call availability program) budget of $126 million per year is protected for the life of the agreement. For the first time, funding for the expansion of information technology will be implemented. One-time funding of $20 million has been earmarked for the purchase of computers/software and initial connectivity costs. Funding of $87.8 million (cumulative over 6 years) will be available for ongoing reimbursement of costs such as maintenance of high speed Internet access and ongoing costs of using an electronic health record.

In terms of non-monetary improvements within the agreement, key protections of the second Master Agreement will be maintained. These include:

• No prorationing of fees.

• Physician control over the Fee Guide.

• The requirement that physicians be consulted through the BCMA on changes that affect physicians’ services.

• Physicians’ right to be represented by the BCMA in their local negotiations.

• The requirement that government and the BCMA negotiate compensation and benefits on a regular basis. Protections against doctors being forced to change their practice form or method of compensation.

• Provision of a binding arbitration process to resolve disputes between government and the BCMA.

• Maintenance of a Single Available Amount.

The agreement lays the foundation for a new Master Agreement that supports a trilateral relationship between doctors, the provincial government, and health authorities that will be negotiated over the next year. It includes trilateral joint committees for specialist services; GP services; salary, service and sessional physicians; rural physicians; shared care; and information technology.

The ratification package was sent out to members at the end of March, with the final voting deadline set for 3 May 2006.

The entire agreement and numerous related documents can be found at www.bcma.org.

—Sharon Shore
BCMA Media Relations Manager

Negreiff new SCPHC director

The Society for Clinical Preventive Health Care (SCPHC) is pleased to introduce their new Executive Director, Theresa Negreiff.

Ms Negreiff has broad experience with not-for-profit organizations, primarily in the environmental field. She comes to the SCPHC after working most recently with Sierra Legal Defence Fund.

SCPHC is a registered charitable organization with a mandate to implement proven clinical preventive health care measures as defined by the Canadian Task Force on Preventive Health Care. They oversee several preventive health programs including the BC Doctors’ Stop Smoking Program. Their Medical Director is Dr Frederic Bass. For more information on the SCPHC, visit their web site at www.bcdssp.com.

Sarah Gilgoff, BSc,, Peter von Dadelszen, MD,, Sandie Braid, CEBS, Tara Lyon, Sharon Shore. Pulsimeter. BCMJ, Vol. 48, No. 3, April, 2006, Page(s) 132-133, 135, 139, 145 - News.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

BCMJ Guidelines for Authors

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