When Audrey Steenbeek worked as a community health nurse in Baffin Island, Nunavut, she was concerned by the high prevalence of sexually transmitted diseases (STDs). That experience inspired her to pursue doctoral studies in health care and epidemiology. She is currently researching transmission patterns of chlamydia and gonorrhea among Inuit living in remote and isolated communities in Baffin Island. Audreyâs aims are to measure the prevalence of chlamydia and gonorrhea in these communities, characterize core groups and individuals who are most vulnerable to STD infections, describe STD-related, high-risk behaviours and risk perception and, analyze the role of social networks and use of health services. These results could help decrease incidence and prevalence of STDs among remote Aboriginal populations through improved access to STD screening and treatment, improved contact tracing and partner notification procedures, and more culturally appropriate health promotion and disease prevention strategies.
Research Pillar: Health Services
The public health impact of obstructive sleep apnea hypopnea – a focus on work productivity, occupational injuries and motor vehicle crashes
Sleep is an integral part of our lives. Inadequate or poor quality nightly sleep has many adverse health and safety consequences. The most important medical disorder that disrupts sleep is obstructive sleep apnea hypopnea (OSAH), a common, under-diagnosed condition characterized by recurrent collapse of the upper airway during sleep (up to 100 times per hour). Symptoms of the disease include loud snoring, nocturnal choking, poor quality sleep, recurrent awakenings, daytime sleepiness, impaired alertness, reduced quality of life, hypertension and strokes. Therapy to prevent the upper airway from collapsing can reverse many of these symptoms. Dr. Najib Ayasâs work is focused on investigating the pathogenesis, diagnosis, therapy, economic impact, occupational impact, public health, and safety consequences of sleep disorders, with a particular focus on OSAH. For instance, by developing a comprehensive registry of patients with OSAH, he hopes to determine whether patients with OSAH suffer from reduced work productivity and higher rates of occupational injuries and motor vehicle crashes; and whether therapy reduces these risks. Findings could then be used to develop screening and treatment guidelines for OSAH, and occupational and transportation policy recommendations. In the future, this unique registry will help identify biochemical cardiovascular risk, genetic and biochemical factors associated with OSAH.
Costs, access and equity under income-based Pharmacare
Following the February 2003 First Ministers Health Accord, the Canadian Government created a five-year $16 billion Health Reform Fund targeted to primary health care, home care and catastrophic drug coverage. The drug coverage is intended to ensure that Canadians with serious health conditions have reasonable access to necessary drug therapy. Standards for catastrophic coverage will be determined in the coming years, yet there is little evidence to guide the choice of standards. Dr. Steven Morgan is evaluating two possible options for basing standards: mixed pharmacare and income-based pharmacare. Dr. Morgan is studying the change in BC from a mixed program, which covered drug costs for low income seniors and social assistance recipients and charged a $1,000 deductible to all other residents, to an income-based system that enables people to pay a sliding scale based on income levels. Dr. Morgan is comparing data from both systems to results in Manitoba, which also has an income-based program. He is assessing the impact of both systems on cost, access and equity for people across the spectrum of socio-economic status, age and health status. The results could help guide the development of provincial and national policies for drug coverage programs.
Delayed recovery and chronic disability associated with whiplash associated disorders
Whiplash is the most common injury from motor vehicle collisions, and a major cause of chronic disability and pain. The progression and outcome of whiplash treatments vary, as does recovery time. Dr. John Dufton, an experienced chiropractor, is studying factors that lead to delayed recovery in patients with whiplash. Using the nationwide database of CBI Health, Dr. Dufton is comparing patients from BC, Alberta, Saskatchewan, Ontario and Quebec to determine how different types of insurance compensation and litigation systems influence patient recovery. He is also identifying physical factors and patient characteristics that place people at higher risk of developing chronic disability. The findings will provide new data on the factors that affect recovery after a whiplash injury.
Examining health care interactions for their influence on effective and equitable perinatal health care services for women and families
Research has shown that quality of health care services influences the health and well-being of women and their families during pregnancy, birth and the first two to three months after birth. Studies also show that access to effective health services is important in helping women follow healthy practices. Less is known about the ways in which relationships between women and their health care providers influence the effectiveness and fair distribution of health services. Helen Brown is investigating this question, with a focus on understanding how these relationships affect healthy practices among women from marginalized or less powerful groups. Helen hopes the research will help improve health care relationships, enhance quality of care, strengthen health promotion and education for childbearing women, and help policy-makers create more effective and equitable services.
Evaluation of common drug review dissemination and use of evidence by drug plans
The cost of publicly funded prescription drug programs in Canada is growing an estimated 15 per cent a year. Studies show drug plan staff have little time to reassess drugs already on the market and are overwhelmed with submissions from pharmaceutical companies seeking approval of new drugs. In September 2001, federal, provincial and territorial Health Ministers launched the Common Drug Review (CDR) to develop a national process for reviewing evidence on new drugs and reducing duplication among provinces. How CDR will integrate with current communication systems to share information between drug plan staff and researchers is not yet clear. Mowafa Househ is assessing how drug plans use and produce evidence within the CDR system, and how virtual networking can improve the exchange of this knowledge. Using web-based conferencing, Mowafa is developing a three-step protocol to improve links between drug plan manager and researchers. He is applying the protocol to three major drug plan issues: assessing new drugs, re-assessing existing drugs, and evaluating the impact of drug policies.
An Evaluation of an Asthma Education Program in a Pediatric Emergency Department
The increasing prevalence in asthma diagnoses in North America over the 1980s and early 1990s has led to increased asthma-related admissions and emergency visits at pediatric institutions. In many cases however early intervention at home may have been a superior method of treatment for milder cases. In an effort to increase parental and patient knowledge about early interventions many asthma education initiatives have been launched. Studies to date on the effectiveness of these initiatives have been mixed. Jay Joseph is assessing retention of knowledge about asthma by specifically studying asthma exacerbation cases presented at the emergency department of BCâs Childrenâs and Womenâs Health Centre. From these cases Jay is analyzing general parental knowledge of asthma and their knowledge of how to cope with specific exacerbation scenarios. Ultimately, Jay hopes results from his study will contribute to reducing GP/pediatrician consultation rates and repeat emergency visit and readmission rates.
Enhancing access to health care for marginalized groups through a study of relationships between street nurses and the people they serve
In previous research, people experiencing marginalization such as those living with mental illness, HIV/AIDS, illicit drug use and homelessness have reported very negative experiences with the health care system. These experiences can result in delays seeking treatment and greater future costs to the health care system. At the same time, these groups have reported positive experiences with street nurses (registered nurses who work on the street). Bernadette Pauly is assessing the nature and quality of health care relationships between street nurses and their clients, and how health and social policies and organizational structures affect these relationships. Increasing understanding of these relationships, along with factors in the environment where street nurses provide care, could ultimately reveal ways to improve health care delivery for marginalized groups and, ultimately, their health.
A postdoctoral program to enhance planning and quality improvement initiatives in mental health through the validation of administrative mental disorder diagnoses
While a number of significant improvements in treatment of mental disorders have been made in recent years, gaps remain. For example, major depression is identified in only 50 per cent of people with the disorder when they visit their family doctor, and only half of those people receive appropriate treatment. Initiatives to address these gaps include programs that provide public and physician education and increase connections between care providers. However, itâs unclear how successful these initiatives will be due to a lack of data on the prevalence of mental disorders and whether people improve as a result of these programs. Dr. Paul Waraich is evaluating whether data routinely collected from hospital and physician visits, as well as medication prescriptions, are of sufficient quality to be used to evaluate changes in the care of major depression and other mental disorders. The research could greatly improve understanding of whether new mental health care programs are effective.
Centre for Health Services and Policy Research
This centre aims to expand research efforts focused on understanding the growing role of pharmaceutical agents within the health care system. In particular, unit researchers will focus on studying population-wide aspects of the financing, delivery and use of pharmaceuticals for the purpose of informing health policy, strengthening the health system and improving health. This will include developing a comprehensive pharmaceutical data infrastructure to support the research.
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