Despite the recent increase in research activity to study multidisciplinary collaboration in primary healthcare teams, there has been a paucity of research focusing on building collaborative relationships between primary care (Family Health Teams, Family Health Networks, and Community Health Centres) and public health. Nurses, including public health nurses, family practice nurses and nurse practitioners, are in a strong position to act as leaders in building collaboration between primary care and public health to meet local community health needs.
Research Pillar: Health Services
Negotiating International Health Policy on a Local Level: HIV Positive Women and their Experiences with Infant Feeding in Vancouver, Canada
Medical research currently debates what infant feeding method should be recommended to HIV positive mothers. Studies indicate that antiretroviral treatment effectively reduces transmission of HIV through breast milk by approximately at least two-thirds by lowering the amount of HIV in the blood. However, Canadian health policy strongly discourages breastfeeding regardless of a womanâs HIV viral status after giving birth, and encourages formula feeding as the alternative. Avoiding breastfeeding may eliminate the risk of HIV transmission, but is âreplacement feedingâ with formula the safest most viable option? Francoise GuignĂ© is interviewing physicians, health care providers, and educators, and women living with HIV in Saskatoon, a city reknown for breastfeeding promotion, about their recommendations and experiences with formula feeding. Preparing formula can be expensive and complicated. GuignĂ© is assessing the social, cultural, economic and emotional challenges HIV-positive women face with replacement feeding, and, the international flows of health knowledge that doctors, health care providers and educators use to address these challenges. Compared to breastfed babies, formula fed infants suffer higher rates of diarrhea, respiratory, ear and other ailments. HIV-positive mothers must weigh these health risks against the risk of acquiring HIV through breastfeeding. GuignĂ©âs research aims to identify and address any gaps in support services for HIV-positive mothers by improving the support networks, medical resources and counselling services currently available to them.
Adjusting for missing information in multilevel models with a non-binary response: identifying socioeconomic, cultural, demographic and clinical predictors of end-of-life health care service âŠ
Many Canadians believe that equal access to health care is a fundamental right; however, evidence suggests that people experience unequal access to end-of-life care. For example, approximately 70 per cent of cancer patients die in hospital. Although little is known about Canadian preferences, international studies suggest people prefer to die at their home. Socioeconomic status is known to play a role in explaining health inequities. Michael Regier is examining whether the impact of the Canadian cultural mosaic (ethnic groups, languages and cultures that interact within Canadian society) on the use of health services is more complex than socioeconomic status alone. Each culture has its own expectations for health services, so the health system must be flexible enough to integrate various cultural understandings of health, but uniform enough to reach everyone. Regier is studying how additional âecosocialâ factors like ethnicity, language, family structure, religious beliefs and acculturation contribute to the way individuals and communities understand and use health care. He is investigating the place of death for cancer patients in BC from this perspective to determine differences in health determinants for end-of-life care. Health planners can use this information to improve access to end-of-life care across cultures, geographic areas and socioeconomic differences.
Optimal, evidence-based use of vaccines
Immunization is one of the most powerful tools available in medicine. The number of available vaccines expands each year, reducing infection and disease. Optimal use of these new products can be hampered by gaps in understanding the disease epidemiology, vaccine effectiveness or longevity of protection provided. These gaps also affect decision-making related to resource allocation and prioritization of immunization programs. Dr. Jan Ochnio is working to close these gaps by gathering missing evidence to facilitate vaccine use in several viral and bacterial infections. As a MSFHR Scholar, Ochnio investigated the risk of hepatitis A for children in specific areas of the province. Now, his research is focusing on two areas: investigations of hepatitis A virus infections using population-based assays and saliva/mail-based surveys, and optimizing prevention of meningococcal infections by measuring the levels and duration of protection offered by the various meningococcal immunization schedules in Canada. A better understanding of the most efficient strategies for using vaccines could lead to substantial savings in health care by omitting unnecessary doses and the related costs of providing these doses. Ochnioâs findings will be shared with public health policy experts to be used in finely-tuned vaccination programs and policies that will provide optimal protection for Canadians.
Bereaved family caregivers’ adjustment to loss: developing evidence to support healthy adjustment
Providing care for someone with a life threatening illness is a difficult job that taxes family members’ emotional and physical resources. Changes in the health care system have increased the amount of care family caregivers provide at home, with the result that many are caring for a loved one seven days a week for weeks and months. About half of these family caregivers report chronic illnesses of their own, and up to a third have symptoms of depression. Painful emotions experienced by family caregivers can worsen when the ill person dies. Bereaved family caregivers suffer from exhaustion and emotional distress, and are at risk for developing health problems, including illness, insomnia, anxiety and depression. Even the most resilient people experience significant distress in the early months of bereavement. Health care providers do their best to respond to bereaved family caregivers’ needs, but little is known about what helps to foster adjustment in bereavement or when particular interventions would be most useful. Moira Cairns is asking bereaved family caregivers what they find helpful and unhelpful, with the goal of determining what types of care and support health professionals can offer to reduce physical, mental and social health risks and promote healthy adjustment among bereaved family caregivers.
The Determination of Accessibility to and Utilization of Fair PharmaCare by Various Ethnic Minority Groups
Since the mid-1990s, North American prescription drug expenditures have been escalating at double-digit rates. Canadians spent $18 billion on prescription medicines in 2004. The rising cost of prescription drugs has raised concerns about the affordability of health care for Canadians. Provincial drug coverage programs within Canada employ diverse strategies for reimbursement. In British Columbia, an income-based drug benefit plan is utilized. This program, dubbed Fair PharmaCare, requires residents to register with the government to be eligible for public subsidy. Vivian Leong is evaluating levels of participation in the Fair PharmaCare program in different socioeconomic and socio-cultural communities to determine the factors that influence access among ethnic minorities. Vivian will identify whether some groups have unequal access to pharmacare subsidies, and if so, why the inequity exists. She is also assessing whether provincial government efforts to promote awareness among minority groups have been effective. This research will help policy makers address inequities and target health promotion to reach and better serve various ethnic communities in British Columbia.
An Internet-based self monitoring intervention for patients with chronic heart failure
In 1997, congestive or chronic heart failure (CHF) was the primary cause of death in British Columbia and in 2000, it was the most common cause of hospitalization for Canadians over the age of 65. Multidisciplinary interventions, including education, follow up and self-management strategies have been shown to improve quality of life and decrease subsequent hospital admissions among people with CHF. However, up to 50 per cent of hospital readmissions for CHF occur because patients have not learned to manage and monitor their condition effectively. Biljana Maricâs research is investigating the feasibility of Internet-based self-monitoring for CHF patients. Participants will log on to the study website each morning, enter their current body weight and answer five questions about their health status and any symptoms they are experiencing. A nurse will log on to a secure database to monitor responses and follow up with participants when responses trigger an alert. Biljanaâs study will examine patient and staff uptake, and assess the impact of the program on patient quality of life and self care. If adopted, Internet monitoring of heart patients could decrease the health care costs associated with heart failure readmissions, alleviating some of the financial burden on the health care system while improving patient health outcomes.
Evaluating Patientsâ Preferences for Asthma Therapy Using a Discrete Choice Experiment
Approximately one in 12 Canadians has asthma, a chronic respiratory disease characterized by airway inflammation and variable airflow obstruction. Previous research into how asthma patients manage their disease has found an over-reliance on short-acting beta-agonists (used as needed to quickly relieve symptoms) and an under-use of inhaled corticosteroids (used regularly to prevent asthma attacks). This treatment pattern has been associated with a higher risk of death related to asthma. The overuse of short-acting beta-agonists appears to be linked to socioeconomic status. Despite receiving all drugs at no cost, asthma patients receiving social assistance are more likely to use greater amounts of short-acting beta-agonists than individuals not needing assistance. Helen McTaggart-Cowan is conducting research aimed at identifying the extent to which patients are willing to trade off the immediate symptom relief of short-acting beta-agonists against the ongoing management achieved with inhaled corticosteroids. She is investigating the relative importance of symptom control, cost, side effect minimization and convenience of treatment in an effort to determine the associations between drug preferences and both socioeconomic status and asthma control status. By identifying the factors that result in inappropriate asthma management, Helenâs research will contribute to improved asthma care and provide a foundation for future work aimed at improving treatment efficacy and compliance.
An Empirical Test of Rational Polydrug Addiction
The economic model of rational addiction was a breakthrough in the economic theory of consumption of addictive substances. This modelâs aim is to reliably estimate an addictâs change in consumption of an addictive substance due to a change in the drugâs price or the price of another drug to which the individual is addicted. Polydrug abuse within populations of heroin addicts has been observed within health services research literature for some time. Suggestions have been made to target treatment interventions and outcome assessment to multiple drugs, rather than a single drug in clinical trials involving substance abusers. Despite this, relatively little epidemiological research has been carried out to evaluate the effectiveness of different modes of treatment for drug abuse in polydrug addicts. Bohdan Nosyk is researching whether individuals addicted to more than one substance (e.g. heroin and cocaine) display some association in their consumption patterns of these substances. If there is a significant association in consumption, focusing treatment on one addiction may be ineffective given the increase in consumption within the other (untreated) drug addiction. This study will survey individuals addicted to multiple drugs residing in Vancouverâs Downtown Eastside to determine the relationship between illicit drug prices and consumption. Research into the addicted illicit drug consumerâs behaviour â in particular, how the consumer substitutes between substances and which drugs tend to complement one another â will provide policy-makers with evidence on which to base future directions in the treatment for addictive substance abuse.
Perceptions of Health Care Providers about Integrative Breast Cancer Care: A Pilot Study
Complementary therapies are a diverse set of treatment approaches that fall outside of mainstream medicine. The majority of cancer patients â especially those with breast cancer â use a form of complementary therapies. While there is growing evidence that some of these therapies can contribute to effective cancer care, their use has not become part of standard cancer care. Patients often research complementary care options and investigate ways of integrating them in their treatment plan, without discussing these approaches with conventional health care providers. This can lead to poorly integrated care, which raises concerns about potential toxicities, adverse reactions and patients engaging in therapies with little therapeutic value. Alison Brazier is researching health care providersâ perceptions of the factors that either serve as barriers or facilitate an integrative approach to breast cancer care. Alison is conducting a series of in-depth qualitative interviews with health care providers and women living with breast cancer in four Canadian cities. She is also developing a survey instrument, to be used in a large national survey, which examines the attitudes and knowledge of complementary and conventional health care providers about integrative cancer care. The results of this study are aimed to enable a more integrative approach to cancer care in Canada that provides safer, more effective and more comprehensive cancer care.