GetCheckedOnline is a digital service in British Columbia that allows people to get tested for sexually transmitted infections (STIs) without visiting a clinic. It has been successful in reaching people who face challenges accessing traditional healthcare. As the program continues to grow, it is important to find ways to keep its benefits accessible to everyone while managing resources effectively. This project will examine evidence from similar programs elsewhere, analyze GetCheckedOnline’s existing data, and conduct interviews with those involved in running the program. Our goal is to develop a plan to ensure GetCheckedOnline remains sustainable and well-integrated within the broader health system, continuing to serve all residents of British Columbia effectively.
Program: Health System Impact Fellowship
Community engagement and HIV research in the age of big data: Building a framework and tools for best practices
Big data science is becoming more prominent in many fields, including HIV. Data science utilizes electronic data already collected from multiple health sources, including administrative health data, i.e. data produced at each encounter with the healthcare system for administrative or billing purposes. Historically, active participation by People Living with HIV (PLHIV) has been pivotal to HIV research. However, data science has largely excluded PLHIV participation. It is established that community engagement is a matter of ethics and improved science, and it is problematic that this practice is underdeveloped in data science. Knowledge creation through data science brings two important shifts from traditional community-engaged research: data are typically not collected for research purposes, and opportunity for research collaboration comes after data collection. There is a need to develop new ways to engage people with lived/living experience in this form of research. This project brings together a team of older adults living with HIV, data scientists, clinicians and social scientists. We will examine how to authentically engage community members in data science while piloting community-led administrative data research. Our research investigates rates of survival from, and recurrence of, cardiovascular events among PLHIV compared to people without HIV in BC. Research about recurrence of cardiovascular events for PLHIV, particularly in Canada, is lacking.
The goal is to build a framework for researchers to engage community in data science for improved health outcomes among PLHIV in BC and British Columbians generally. We also hope to help reframe big data science research from an extractive to a collaborative process for more impactful research elsewhere.
Enhancing reproductive health equity for Two-Spirit, Transgender, Non-binary, and Gender Diverse (2STNBGD) communities in British Columbia through community engagement and integrated Knowledge Translation
This Health System Impact Fellowship is co-funded by the Canadian Institutes of Health Research, Michael Smith Health Research BC, and the BC Ministry of Health (health system partner), to help build BC’s health policy research capacity for the integration of policy research into decision-making. Gender-affirming care is a fundamental right supported by the Canadian Charter of Rights and Freedoms. In this project, the BC Ministry of Health will collaborate with a research team at Simon Fraser University and Two-Spirit, Transgender, Non-binary, and Gender Diverse (2STNBGD) community members to explore what it means for 2STNBGD people to feel safe in reproductive health care spaces and use these insights to collaboratively create resources designed to promote safety.
Examining Implementation Strategies for Reducing Antipsychotic Medication Use in Long-term Care Homes at Vancouver Coastal Health: Closing the Learning Cycle Loop
Inappropriate use of antipsychotic medication has been recognized as a concern in long-term care (LTC) in Canada. VCH is committed to reducing inappropriate antipsychotic medication use in LTC through implementing a strategic plan developed by the BC Ministry of Health. VCH leadership identified understanding the barriers and facilitators of implementing the strategies as their priority to spread the learnings to LTC across VCH and other parts of BC. The research aims to examine the facilitators and barriers to implementing the strategies for reducing antipsychotic medication use in LTC. It will adopt a mixed-method design, including rapid review, semi-structured interviews, and pharmacy data analysis. The anticipated findings will help to identify facilitators and barriers to implementing the strategies for reducing antipsychotic medication use in LTC. The potential impacts will include: 1) support and enhance the implementation of the antipsychotic medication use strategy in LTC, 2) reduce the inappropriate antipsychotic use in LTC and enhance the safety and quality of care to residents, and 3) promote learning for sustainable and continuous quality improvement for LTC patient care, and 4) ensure the efficient and effective use of resources by investing in strategies that work.
Enhancing the Assessment and Monitoring of Water Distribution Systems in British Columbia
This research proposal aims to enhance the assessment and monitoring of water distribution systems in British Columbia (BC). Water distribution systems (WDS) are crucial for public health, delivering drinking water from treatment plants to consumers. However, these systems often face challenges such as microbial contamination, cross-connection, corrosion, disinfectant byproducts, and physical integrity issues that can degrade water quality.
BC faces unique challenges, including microbiological quality issues, infrastructure complexities, drought, and climate change effects on infrastructure. These challenges can lead to WDS breaches impacting potable water quality, pathogen regrowth, biofilm formation, and external contamination. Heavy metal and chemical contamination due to pipe corrosion or accumulation from source water also poses a risk.
Existing provincial drinking water guidelines do not provide consistent advice to BC health authorities for assessing and monitoring WDS, as highlighted in the 2024 Provincial Health Officer’s Drinking Water report. This project aims to fill this gap by developing evidence-based best practices for the BC Ministry of Health to develop adequate guidelines. The project is funded by the Canadian Institutes of Health Research Health System Impact program with the contribution from Health Research BC and Michael Smith Institute. In this research, the project benefits from the collaboration of the BC Ministry of Health and the University of British Columbia to develop evidence-based best practices for the management of BC WDS.
An Evaluation of Models of Care for Heart Failure with Reduced Ejection Fraction Through the Use of a Microsimulation Model
Heart failure is a complicated medical condition that decreases patients’ quality of life and life expectancy. It is recommended that patients with heart failure receive care, and have their medications managed, by specialized heart failure clinics. However, heart failure clinic teams are different across the province (for example, only some teams have a pharmacist) and not every patient with heart failure has access to one of these clinics. This research will determine if there is a better way to manage heart failure medications in British Columbia. This could mean creating a standard team of healthcare providers for these clinics or better promoting heart failure care outside of these clinics (such as by family doctors). The results of this research will be used by Cardiac Services BC to decide how to best improve heart failure medication management across British Columbia.
This research has been generously funded by Health Research BC, Canadian Institutes of Health Research, and Cardiac Services BC through a Health System Impact Fellowship. Dr. Ricky Turgeon (Assistant Professor at the University of British Columbia’s Faculty of Pharmaceutical Sciences), Kelly Mackay (Senior Director Provincial Quality with Cardiac Services BC), and Dr. Nathaniel Hawkins (clinician-scientist cardiologist and Associate Professor at the Unive
Economic evaluation of the administrative burden of family physicians in British Columbia
Family physicians (FPs) are the first point of contact in the community, providing comprehensive care as an integral part of the healthcare system. However, twenty percent of Canadians cannot access a regular FP, which does not meet the population’s needs and is an unfair service distribution. FPs are being challenged by the growing demand on their time for administrative tasks, which impacts their well-being. Third-party forms such as sick notes and disability forms place an unnecessary burden on the health care system, particularly with staff shortages, and they take away from the time FPs spend with patients. This research project will evaluate strategies to reduce FPs’ administrative burden, potentially increasing patient appointments and improving FPs’ workflow and work-life balance. The economic evidence generated from this research will strengthen policy arguments and guide decisions on reducing administrative burden.
This project was funded by the Health System Impact Fellowship from CIHR and is being conducted in partnership with Health Research BC. The doctoral student leading this project is Hayley Lawrence from the School of Population and Public Health at UBC. She will work with Dr. Craig Mitton, whose research focuses on applying health economics to impact health policy, and Christina Krause from Health Quality BC.
The real-world impact of ETI on prescribing patterns, clinical outcomes, and healthcare utilization for PwCF living in British Columbia
Cystic fibrosis (CF) is a leading genetic disease in Canada, particularly prevalent in British Columbia. The treatment of CF is complex, requiring multiple medications and therapies. The recent introduction of Elexacaftor/Tezacaftor/Ivacaftor (ETI), marketed as Trikafta®, has shown significant potential in improving lung function and quality of life for People with CF (PwCF). However, as PwCF experience symptom relief from ETI, many reduce or discontinue traditional inhaled therapies. The potential risks associated with stopping these established treatments are not well understood.
This study will evaluate the impact of ETI therapy on medication use, lung function, and healthcare costs among PwCF in British Columbia. By analyzing connected health data, the study will compare outcomes for PwCF before and after starting ETI, as well as against non-eligible CF patients and healthy individuals. This research addresses a critical knowledge gap regarding the safety and implications of reducing or discontinuing older therapies in favor of ETI, with a focus on the long-term effects on health outcomes and healthcare costs.
Advancing Equitable Cancer Care for Incarcerated Populations
An estimated 40,000 individuals are imprisoned in Canadian correctional facilities at any time. Incarcerated people, often individuals from marginalized populations, bear an unequal burden of cancer because they experience chronic disabilities, mental health concerns and substance use disorders. Increased risk factors also include family violence, childhood abuse, housing insecurity, lack of education, low-income status, high rates of suicide, high-risk sexual behaviors, and physical injuries. Despite international recognition of the importance of palliative and cancer care as a shared universal right, a health equity gap exists between the general and carceral populations in Canada. Incarcerated people face significant health inequities before, during and post incarceration.
This project aims to address BC Cancer’s goal of promoting high-quality cancer services that are equitable, accessible, and respectful for all British Columbians.
The specific objective is to provide evidence-based recommendations for advancing equitable cancer care for incarcerated populations in BC by examining barriers in access to cancer treatment and care.
End of Award Update – September 2024
Results
During the Fellowship, I conducted an environmental scan of Canadian literature and 11 interviews with oncology leaders and healthcare providers to understand how justice-involved people in the province access and receive cancer care.
Impact
Not applicable, as the analysis is still underway.
Potential Influence
The results of this project can inform policy and practices related to access and quality of health care for justice-involved people who live with life-limiting illnesses. Driven by my findings, the health care provided behind and beyond bars can become increasingly proactive, preventative, and encapsulating various stages of one’s health trajectory.
Next Steps
The research conducted within the Fellowship will inform my doctoral dissertation. Further research will focus on understanding how justice-involved individuals access and receive palliative care when faced with life-limiting illnesses. The findings from both studies will be submitted for publication. In addition, I will disseminate the study’s results using the BC Center for Palliative Care ECHO model.
Modelling the Future of Home Health for Seniors – A Markov based Cost Effectiveness Analysis
The task of providing high quality care has become increasingly difficult as pressure mounts on both the funding and demand side of the provision equation. This challenge is particularly acute for health leaders caring for a growing elderly population in an already strained system. While our senior patient populations consume more expensive acute healthcare resources with higher frequency, they are also more likely to experience negative outcomes in these venues of care and often prefer to remain in their homes for as long as possible.
The Economic Learning Health System (eLHS) is a framework designed to guide continuous improvement and optimization of limited health care resources to achieve the highest possible quality of care for patients. This research project is aimed at applying this framework to the challenge of caring for seniors in British Columbia. Anticipated outcomes include an analytic infrastructure that will quantify care needs, simulate potential innovations to address these needs, and determine the most sustainable path to caring for our seniors now and in the future.
This project was funded by the Health System Impact Fellowship from CIHR, and is being conducted in partnership with the BC Ministry of Health. The fellow leading this project is Dr. William Hall – a health economist trained at UBC and creator of the eLHS framework. He will be working with Dr. Michael Law from the Centre for Health Services and Policy Research, and Christine Voggenreiter from the BC Ministry of Health.