Prescription medicines play a key role in the treatment and prevention of disease, as evidenced by the fact they are the second-largest and fastest-growing component of health care expenditures in British Columbia. Dr. Michael Law's research program includes studies on the broad themes of pharmaceutical policies, coverage, and costs. Pharmaceutical Policies. In January 2009, a policy change in British Columbia gave pharmacists the authority to independently modify and renew prescriptions. While this policy was intended to improve patient access to drugs and reduce the already heavy burden on primary care physicians, concerns have been raised about potential negative effects on patient safety due and reduced continuity of care. This policy has not been rigorously evaluated.
Dr. Law is currently studying the effects of this policy change on drug utilization and costs, patient adherence to medication, and the number of visits patients make to physicians and hospitals. Pharmaceutical Coverage. Canadians pay for prescription drugs through a patchwork of mechanisms, including public drug programs, private drug insurance, and out-of-pocket payments. In 2008, private insurers paid $9.3 billion in drug costs, representing 31% of overall expenditure. Despite this, we have little sense for how private health benefits plans are changing in light of tough economic times. He is currently leading an investigation into private drug insurance benefits in Canada. Pharmaceutical Costs.
Dr. Law is conducting a series of studies on pharmaceutical costs. This research includes a Health Canada-funded study investigating the factors related to cost-related non-adherence to prescription medicines, an investigation into generic drug prices in Canada compared to international peers, and a continuation of his past work studying the influence of direct-to-consumer advertising on prescribing of medicines. Dr. Law’s research promises to help inform the future design and refinement of important and controversial pharmaceutical policies, provide insights into the trends in private drug insurance benefits in Canada, and create greater understanding of the influence of drug pricing on compliance. This research has the potential to create important changes in the health care system.
In Canada, health system funding has reached a crisis point. Not only are health care costs continuing to rise, but there are increasing conflicts about how these funds are allocated. Provinces are exploring different policies to improve the safety, efficiency, and efficacy of care, including patient-based payment for hospitals to increase 'volume' of hospital care, targeted pay-for-performance programs to reduce wait times, and alternative payment plans for physicians. While these funding policies are designed to change the incentives of providers and health care organizations, there are few methods to measure whether these policies are actually leading to health system improvements.
Dr. Jason Sutherland's applied research program examines the system-level and patient-level effects of new and existing funding policies. This program of research will help measure how health system expenditures are improving the health of BC’s residents, improving co-ordination between settings, and improving the quality of care. His work will assist policy- and decision-makers to interpret the complex relationships between health funding policies, health expenditures, utilization, gain in health, and health outcomes. This program of health services research has the potential to improve the effectiveness, efficiency, and equity of British Columbia's, and Canada's, health care system. By understanding how policy-makers’ decisions are impacting the health care residents receive, Canada's health system decision-makers will be more empowered to make the best decisions.
The objective of this 12-month project is to use a research synthesis approach to develop the knowledge required to inform decision makers charged with the implementation of nurse practitioner and physician assistant roles.
Some areas to be addressed through this synthesis are:
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What are the varying scopes of practice and practice autonomy for both roles?
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What population health needs are best served by which role?
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Are there barriers to implementing both roles simultaneously?
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Can both roles effectively support the BC health care system and, if so, how?
Continue reading “The Utilization and Impact of Nurse Pracitioners and Physician Assistants: A Research Synthesis”
The purpose of this study is to devise a comprehensive strategy for continuous improvement of trauma care system that addresses substantial gaps in the availability of information regarding processes and outcomes of trauma care in British Columbia.
Continue reading “An Integrated Regional Trauma Care Data System Linking Clinical Care and Process Outcome Evaluation”
The accumulation of mutations in the DNA of human cells can lead to tumour formation. More than 80 percent of solid tumours exhibit chromosome instability (CIN) – the property that results in an unequal distribution of DNA to each daughter cell upon cell division. The genetic instability associated with these tumours may allow them to adapt quickly and remain in the body.
Dr. Peter Stirling's research is focused on generating a comprehensive database of genetic mutations that lead to CIN, using the Baker's yeast cell model. The results will then be translated to related human genes. Using yeast to identify candidate human CIN genes has already been successful for a handful of genes and Dr. Stirling's project will extend this effort. The candidate CIN genes identified will provide important insight into the biology underlying tumour formation. Further, the results will validate interesting CIN genes relevant to cancer in human cells and provide greater understanding regarding the mechanisms of CIN for those genes.
Additionally, Dr. Stirling is also working to identify secondary genes whose mutations cause cell death in combination with a CIN mutation. By validating these "synthetic lethal mutant gene combinations" in human cells, Dr. Stirling will have defined drug targets for tumours carrying mutations in a particular CIN gene. And, working in collaboration with researchers at the University of British Columbia, Dr. Stirling will identify small molecules (i.e. drugs,) that selectively kill tumour cells based on the identified second-site mutations. Overall, the results will reveal new aspects of tumour biology, identify new anti-cancer drug targets and contribute to the development of new anti-cancer drugs.
Studies show that many brain areas are affected by drugs of abuse. The prefrontal cortex (PFC), however, plays an especially pivotal role in how addiction is manifested. Studies of addicted individuals show they have a reduced capacity to perform PFC dependent tasks, such as working memory (a process using multiple memory systems to facilitate problem solving and choose appropriate behaviours). Human studies also show abnormal activity patterns of the PFC in addicted individuals. When tested during withdrawal, the PFC of addicts remains inactive in response to cues that signal the delivery of natural rewards, such as food. In contrast, when they are given a cue that signals the delivery of a drug reward, addicts show both increased activation of their frontal areas and a high level of self-reported drug craving. Taken together, these data suggest an important component of compulsive drug taking. Linking the behavioural changes that an addict goes through to the underlying physiological changes that neural networks undergo is important for understanding the neurobiology of addiction. Dr. Christopher Lapish is studying the behavioral and neurophysiological changes that characterize the addicted state. His experiments will help delineate the neurophysiological changes that occur in the PFC during the process of addiction. By identifying the specific brain patterns that are induced by addiction, he hopes his work will result in a powerful tool to assess specific pharmacological treatments that may abolish them.
Research indicates that sustained physical inactivity leads to chronic degenerative conditions and premature death. Currently, approximately 75% of Canadians aged 50-75 years and 84% of those over 75 are physically inactive. The associated health and economic burdens will continue to escalate as the proportion of elderly British Columbians increases to 20% of the population by 2026. Physical activity can slow the progression of certain diseases; however, questions regarding cause-and-effect remain unanswered and specific exercise prescriptions for middle-aged and older people with acute, complex, and/or chronic health conditions are not clearly defined. RAMP comprises researchers from physiotherapy, kinesiology, sports medicine, orthopedics, respiratory medicine, engineering, geriatrics, and computer science disciplines. Using basic science, clinical, and translational approaches, the team is studying muscle deficits (atrophy, injury, and failure to train) at the cell, tissue, and whole body level among middle-aged and elderly people. From these investigations, the researchers will develop rehabilitation protocols to improve muscle performance and mobility. This team received an MSFHR Team Planning Award in 2006.
Neuroethics is a relatively new field of study that focuses on the ethical, legal, social and policy implications emerging from different branches of clinical neuroscience (neurology, psychiatry, psychopharmacology) and basic neuroscience (cognitive neuroscience). This award supports the creation of a team focused on working with practicing neuroscientists, physicians and clinical researchers, ethicists, and health policy-makers in BC to ensure that advances in neuroscience are aligned with societal and individual human values. The team will work towards identifying educational, research and clinical needs in neuroethics in BC, and encouraging collaboration between additional teams involved in complementary research activities.
Lung cancer is the leading cause of cancer death in Canada. Patients who undergo radiation therapy (RT) for lung cancer face only a 14% chance of surviving for five years. In addition, they are likely to experience significant radiation-related health effects, such as impaired lung function. While current therapy attempts to reduce injury by limiting the amount of lung tissue treated, it is difficult to predict how much function will be lost. Researchers believe radiation therapy could be given at higher, more effective doses if accurate ways were identified to measure lung function within the affected area prior to treatment, and to predict how the region will be affected by radiation. Currently, as functional imaging methods such as perfusion SPECT and hyperpolarized 3He MRI (He-MRI) are being developed, predictors of radiation lung damage are emerging. FLIRT — a multidisciplinary team of radiation oncologists, and radiotherapy and imaging physicists — is researching the potential to combine these two diagnostic techniques to improve the planning, delivery and outcome of RT for lung cancer patients.
Under normal circumstances, the vagina is home to many different microorganisms. A shift in the balance of vaginal microbiota can result in infections such as bacterial vaginosis (BV), the most common cause of vaginal infection. BV and other infections are associated with early pregnancy loss, preterm labour, and an increased risk for HIV. Our primitive understanding of the complex microbial ecosystem of the genital tract greatly hampers our ability to identify and describe normal vaginal microbiota. This hinders the development and evaluation of appropriate, focused therapies for genital infections. The use of high throughput molecular methods promises to be very effective for characterizing vaginal microbiota. This award supports the development of a multidisciplinary, team of researchers, with links across Canada, to apply molecular methods for microbial species identification. Their comprehensive description and monitoring of vaginal microbiota will facilitate the development of new diagnostic technologies and therapies for infection-related problems in obstetrics and gynecology.
