Shared Health unable to handle even the small things

Hey there, time traveller!
This article was published 30/08/2023 (823 days ago), so information in it may no longer be current.

“If you can’t do the little things right, you will never do the big things right.” ― William H. McRaven, retired United States Navy four-star Admiral

Shared Health, Manitoba’s provincial health authority, is consumed with reacting to “crises-du-jour” and appears incapable of implementing small changes that would not only benefit patients but also save money. It is failing to live up to its “patients first” mantra.

Here is one example, among many, of an obvious little change on which Shared Health has dragged its heels.

People with chronic stomach aches (gastritis) may be suffering from a treatable infection, caused by a bug called Helicobacter pylori, or H. pylori. Left untreated, H. pylori gastritis can cause stomach and duodenal ulcers and is linked to an increased risk of stomach cancer.

Those with H. pylori infections are easily treated with common antibiotics that can be taken at home.

Despite this fact, Manitoba continues to use a more costly and less convenient test, the urea breath test (UBT), to detect H. pylori infections. The UBT involves patients drinking a small amount of a special fluid and then providing a breath sample. The presence, or absence, of H. pylori can be detected by laboratory analysis of the breath sample.

UBTs have historically been done in hospital nuclear medicine departments because the test used to use trace amounts of radioactive material. Although UBTs no longer use radioactive materials, they are still done in nuclear medicine departments in Manitoba.

This means that Manitobans who need a UBT have to travel to a hospital with a nuclear medicine department. There are only five in the province —four in Winnipeg and one in Brandon.

For patients living in remote Northern communities, this means flying in for the test.

However, there are more convenient, just-as-accurate and cheaper alternative tests for H. pylori that could be available everywhere in the province, including in rural and remote settings.

In 2019, Shared Health published a report recommending switching from UBTs to a sequence of blood-and-poop (stool antigen) tests.

The conclusion of Shared Health’s Provincial Co-ordinated Helicobacter pylori Testing Strategy report was that this sequence of blood-and-stool antigen tests was cheaper — at just over half the cost of a UBT; just as accurate — if not more accurate; and was more convenient, as the tests could be done in any medical lab collection site in Manitoba. After collection, the blood-and-poop specimens would be sent to larger centres for analysis.

In addition to the H. pylori blood-and-stool antigen tests costing about 60 per cent of what UBTs cost, further savings would be garnered by reduced travel costs for patients. In 2019, Shared Health estimated that $23,000 a year was being spent to fly people from Northern locations to Winnipeg for UBTs. This cost is now probably closer to $35,000, as the average cost for a return ticket from Northern locations, such as Flin Flon, The Pas and Thompson, has risen by about 50 per cent since 2019, according to information provided by Manitoba’s Northern Health Region in response to a freedom of information request.

Four years after Shared Health recommended moving away from UBTs, it has still not followed its own advice and transitioned to the cheaper, just-as-accurate and more convenient blood-and-stool antigen tests.

Since 2019, 7,360 UBTs have been provided in Manitoba, with the bulk — 89 per cent — being done in Winnipeg and the remainder in Brandon, according to information provided by Shared Heath in reply to a freedom of information request.

Based on Shared Health’s 2019 analysis and recommendations, a change from UBTs to the blood-and-stool antigen tests should be a no-brainer — cheaper, just as accurate and more convenient for patients.

Such changes would also free up nuclear medicine technologists to image more patients with cancer and heart disease.

Four years later, Shared Health is still using UBTs.

Why? According to a Shared Health statement the authority’s review of H. pylori testing was stalled, in large part due to pressures on the health-care system caused by COVID. Efforts to set a standardized approach for H. pylori testing in Manitoba have been renewed, it said.

But Shared Health made its original H. pylori testing recommendations one year before COVID and COVID lock-down measures were lifted more than a year ago. Health leaders can’t keep blaming COVID for not doing the right thing. The lack of specific timelines for “having a standardized approach for H. pylori testing in Manitoba” is a prime example of avoiding accountability.

Not being able to manage a change for the better as small as this erodes my confidence that our health-care leaders can tackle the bigger problems.

Dr. Sandor Demeter is a Winnipeg physician, an associate professor in the department of community health sciences at the University of Manitoba and a graduate of the Dalla Lana School of Public Health Global Journalism program at the University of Toronto.