Social pediatrics is a model of practice that places specific emphasis on the importance of the relationship between the practitioner and the child as well as focuses on family and community engagement as vital to the ways in which care is provided. Moreover, it is located in the child’s community and seeks to ensure care is accessible and responsive to the child and family’s health needs. To date, little is known about the processes needed to implement a social pediatrics model of practice within the current structure of the health system.
Research Pillar: Health Services
Partnership for Ongoing Impact Assessment of Academic Detailing
The Canadian Academic Detailing collaboration (CADC) includes academic detailing (AD) programs that routinely reach over 1,000 physicians in six provinces. They deliver evidence-based, independent information on optimal prescribing practices to physicians through one-on-one or small group visits. As the health system continues to face drug safety controversies and escalating costs of chronic disease, AD holds promise for providing physicians timely access to information and tools for better prescribing and case management. While there is evidence of AD effectiveness in special research projects, rigorous evidence is lacking of real-world impacts of ongoing AD programs.
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Pharmacy Immunization Community Strategy
Influenza is a major cause of morbidity and mortality in Canada. Community attack rates range from 10 to 20 percent, but can be more than 50 percent in closed settings such as residential care facilities or schools. In BC, influenza vaccine is provided free to hose at increased risk of severe disease and/or death from influenza infection, including the elderly and people with chronic health conditions. Despite access to free vaccine, adult immunization rates in the eligible population remain too low.
Assessing the impacts of social, sexual and drug-use networks on HIV-positive Aboriginals receiving highly active anti-retroviral therapy (HAART) in British Columbia
58,000 people live with HIV/AIDS in Canada. British Columbia houses 20% of national infections. The BC Centre for Excellence in HIV/AIDS (BCCfE) estimates that there are 2,000 HIV+ people in BC who are eligible for HIV treatment and not accessing it, either because they are unaware of their infection or not appropriately linked to care. It is believed that a large percentage of these individuals may be Aboriginal, given their disproportionate risk of acquiring HIV, and limited access to treatment. As HAART access is expanded to HIV-positive communities throughout BC, additional research is necessary to understand Aboriginal risk factors for acquiring HIV, to explain their limited access to HIV treatment and care, and to understand their elevated mortality while receiving HAART. Overall, my PhD research seeks to answer the question: How do social, sexual and drug-using networks influence Aboriginal risk for HIV acquisition, HIV treatment access and HAART outcomes. I will explore three hypotheses: 1) Socio-demographic and economic status, injection drug use and risky sexual behavior, are primary risk factors for HIV infection among Aboriginals in BC; 2) Socio-cultural beliefs and drug addiction perpetuate limited treatment access among Aboriginals in BC; 3) Lifestyle issues influence poor treatment outcomes among Aboriginals on HAART in BC. I intend to employ social, sexual and drug-use networking techniques that have been pre-validated for HIV/AIDS epidemiological study. An initial pool of consenting HIV-positive Aboriginal adults on HAART (n=30) will be asked to recruit up to 10 people from their sexual and/or drug use network, defined as someone with whom they have had sex and/or done injection drugs with, within the preceding 2 months. A maximum of 300 participants will be recruited through this technique (n=300). Mathematical modelling techniques will be used to analyze the impacts of sexual and drug use networks on Aboriginals’ HIV risk behavior, treatmenta access and treatment outcomes. This research will be coordinated from the British Columbia Centre for Excellence in HIV/AIDS, and carried out at the Vancouver Native Health Society.
Pharmaceutical sales representatives, patient safety and cost-effectiveness of care: comparative cross-sectional survey
Prescription medicines are a common and important form of treatment offered by family doctors. The information that doctors receive about the effectiveness and safety of medicines helps to determine their prescribing choices. Most doctors in Canada see pharmaceutical sales representatives regularly. Previous research has demonstrated that sales representatives influence prescribing choices and that doctors often underestimate the extent to which they are influenced. A recent example of this influence emerged in the US with the arthritis drug Vioxx. Despite a 2001 Food and Drug Administration advisory committee recommendation that doctors be warned of heart attack risks associated with the drug, sales staff were advised not to inform doctors of. By the time Vioxx was withdrawn from the market in 2004, it had been linked to between 88,000 and 140,000 heart attacks. Dr. Barbara Mintzes is investigating whether information critical to safe prescribing is provided to doctors by sales representatives. She is gathering data from three countries: Canada (British Columbia and Quebec), the US, and France. She aims to identify best practices in regulation of drug promotion, and to understand how the messages doctors receive from sales representatives can be incorporated into education to improve prescribing. Ultimately, her goal is to improve prescribing safety and appropriateness. A key component of the research will be discussions of the implications of the results with policy-makers, physicians, medical educators and industry.
From Efficacy to Community Effectiveness. The proposed program of research, mentoring and knowledge translation will addresses the more effective, scalable, population-based, chronic disease and that …
The unprecedented investment in biomedical research during the past 50 years has resulted in many important advances in health care knowledge. However, the successful and timely integration of these advances into clinical practice remains a major challenge, especially in primary care and community settings. There is growing recognition that one of the obstacles to translating knowledge into clinical practice may be the knowledge itself, and how, where and by whom it was generated. Often, research knowledge is created in academic settings with little opportunity for involvement or input from primary care providers, community partners or patients. Dr. Janusz Kaczorowski aims to generate more high quality research evidence by end-users themselves, and under clinical conditions that closely resemble real life primary care and community settings. He believes that such an approach will help develop evidence that is more relevant to healthcare professionals working in these setting, which will speed up the knowledge transfer process. Building on his previous work across North America, Kaczorowski’s research focuses on the development of innovative primary care and community-based strategies for chronic disease prevention and management that will have a positive impact on the lives of British Columbians and Canadians. Strategies include collaborative ways to involve, in addition to family physicians, community caregivers (such as pharmacists), volunteer peer health educators, community-based organizations and patients in the research process.
Measuring equity in access to pharmaceuticals
Canadians spend about $27 billion each year on pharmaceuticals, which represents the largest component of private health care costs. For some, this means significant financial hardship. For others, the costs are too high, prohibiting access to necessary care. To date, very little attention has been paid to equity in access to prescription drugs, even though a central goal of Canadian health care policy is to promote access to necessary health care. British Columbia’s Pharmacare program of income-based drug coverage has been proposed as a national standard. Gillian Hanley is examining the degree of income-related inequity in accessing prescription drugs, before and after the program was introduced in 2003, to assess the potential impact of national implementation. She is looking at how a change in coverage affects equity of access to medicines at a population level as well as within and across population subgroups. Previous research by Hanley and her colleagues has shown that the major impact of BC’s Pharmacare program is one of redistributing costs from public to private sources and across various income levels. Part of this research suggested that individuals of higher income generally have higher total drug expenditures. As previous research has shown that higher income individuals are often healthier than those of lower income, their higher drug spending is unexpected and warrants further examination. . Her goals are to offer policy makers insight into how to improve current Pharmacare models and to provide researchers with new methods to examine equity in access to medicines and health services.
Who works in rural areas?: Experiences and characteristics shared by long term health care professionals working in rural areas of Northern British Columbia
The recruitment and retention of health care professionals is one of the most pressing challenges facing the Canadian health care system today. BC is competing with the rest of the world to recruit and retain physiotherapists, pharmacists, X-ray technicians, socials workers and other health care professionals. This challenge is even more prevalent for rural and northern BC communities seeking talented professionals. Candice Roberge is researching the experiences and personal characteristics shared by health care professionals who successfully make a career of working in rural, northern BC communities. Her study will provide insight into the kind of people that need to be trained to meet the health care needs of rural BC. With her findings she hopes to assist health authorities target their recruitment strategies towards health professionals who will thrive on the lifestyle and the unique rewards of providing health services in small-town BC. In addition, her research strives to improve health care services and accessibility to services for individuals living in rural BC.
A Preliminary Study to Assess and Develop a Métis Community Readiness Model and Indicators of Success
Métis in BC and Canada have significantly lower health status than the general population. Arthritis, high blood pressure, diabetes and stomach problems are common chronic conditions among the Métis population. Currently, the BC health care system addresses Métis health issues within the mainstream system of care — a system that lacks the resources and guidelines to address culturally and regionally specific health issues. Consequently, there have been calls for Métis-specific health services. The provincial organization, Métis Nation BC (MNBC), has recently begun working with Métis communities to plan and deliver Métis-specific health programs and services. The Community Readiness Model (CRM) is a method for assessing and planning culturally valid strategies in communities that takes community resources, attitudes, and experiences into consideration. Dr. Peter Hutchinson is collaborating with MNBC and Okanagan Métis Child and Family Services to assess the CRM and identify indicators of success for social services. Dr. Hutchinson will present the model to community members and Métis social service providers to gather suggestions for adapting it for Métis communities. In addition, Dr. Hutchinson will work with his Métis partners to identify indicators for gauging the success of Métis-specific health services, determining the Okanagan Métis community’s priorities for specific health issues, and developing a proposal to pilot test the CRM. Ultimately, this research will improve health in Métis communities by enhancing health delivery and increasing access to services.
The structure and process level determinants of improved clinical outcomes in prehospital cardiac arrest and major trauma
Emergency Medical Services (EMS) systems provide care to complex patients under less than ideal circumstances. Paramedics treat patients without knowing much about the patient’s medical history or the cause of the emergency. This makes it very difficult to know how to evaluate the care provided to them. Generally, quality of care in medicine is evaluated by measuring the effect of various components of the system and the interaction between the clinician and the patient, to see the effect on the patient’s health. EMS managers evaluate factors such as the number of ambulances per population, the level of training of paramedics and 911 call response times. Recent research has called into question the theoretical relationship between improved quality of care and the level of training for paramedics, leaving EMS system managers with the difficult task of re-evaluating their assumptions about how to improve the quality of their systems. Douglas Andrusiek’s research will help managers by exploring the relationships between each component of the Emergency Medical System. He will conduct a statistical analysis to determine which structural and care components contribute to better patient care. While most research evaluates only cardiac arrest performance, this project is also examining EMS care of major trauma patients. Andrusiek’s research will lead to the development of strategies that will improve patient care for all British Columbians who suffer acute injury and illness.