This unit is focused on developing and translating research knowledge into policies and practices that improve health and quality of health care for children, women and their families. It brings together full-time researchers and clinician-researchers with the multidisciplinary skill sets, resources and linkages to identify and address a wide range of health care issues. Research teams, which will include decision-makers, will evaluate specific health issues, design and test interventions for these issues, and then implement and evaluate the effectiveness of ensuing policy and practice changes.
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Attention deficit hyperactive disorder (ADHD) is a persistent childhood disorder that affects about five per cent of children. Symptoms include inattention, hyperactivity or impulsivity at developmentally inappropriate levels. Numerous studies have shown that stimulant medication is the safest and most effective treatment for ADHD. Optimum treatment for ADHD usually requires two to three doses a day, generally administered by parents. But up to 80 per cent of parents frequently fail to give their child the medication as directed by a health professional. Douglas Scoular is examining parents’ beliefs, attitudes and intentions about giving their children stimulant medication for ADHD to determine why parents fail to administer the medication. This research will provide important information on parents’ concerns about administering stimulant medication, help predict which parents will be successful in following the treatment regimen, and ultimately help improve health care providers’ ability to successfully treat children with ADHD.
Women in developed societies around the world increasingly delay childbearing until the age of 35 or older. In BC, women who are 35 or older account for about 8,000 births a year. There has been little research into the effects of delayed childbearing, and studies that have been undertaken produced contrasting results. Some research suggested an increased risk of complications and other studies showed no greater risk. No research has compared differences in rural and urban settings. Sarka Lisonkova is investigating the impact of delayed childbearing on pregnancy outcomes and infants’ need for health care services in their first year. Using information on 200,000 births across the province from the BC Perinatal Database Registry, Sarka is comparing outcomes and health care utilization from births among 20 to 34-year-old mothers with those 35 and older. She is also reviewing the effect of risk factors for adverse pregnancy outcomes, such as smoking and fertility problems. The research could help improve prenatal counselling and risk assessment in prenatal care.
Genetic testing confirms the presence or absence of genes associated with the development of various diseases. Early detection of these genes sometimes enables physicians to recommend interventions that can help to delay onset of disease or prevent the most serious symptoms. The downside, however, is that many of the diseases that are detectable through genetic testing have no treatments or cures. This creates serious ethical and other considerations about when and how such tests should be administered. Dr. Susan Cox is studying the potential benefits and harms of using genetic information to diagnose, treat and prevent two common and devastating chronic diseases: autosomal dominant polycystic kidney disease (ADPKD) and rheumatoid arthritis (RA). Increased availability of genetic screening for ADPKD may have implications for routine screening of people at risk for the disease and for assessing potential kidney donors. The discovery of a gene influencing the severity of some forms of RA may prove to be clinically useful in tailoring drug therapies to persons diagnosed with the condition. Dr. Cox is documenting and comparing perspectives on these developments from patients, families, health care professionals and non-profit agencies. She will use this information to develop criteria for the appropriate use of genetic information in the diagnosis, treatment and prevention of ADPKD and RA. Results from the study will also be relevant to other genetic and hereditary diseases.
Almost one in five British Columbians will experience mental illness during their lifetime and nearly three per cent of the population suffers from severe and persistent mental illness. Research reveals that mothers with serious mental illness face stigma, isolation, poverty, the challenges of single parenthood, problems accessing affordable and safe housing as well as difficulty finding and keeping employment. The health care system has an important role to play in supporting mothers with serious mental illness. But little is known about the policies and services that are effective in supporting women with serious mental illness. Tasnim Nathoo is exploring the health care experiences of mothers with serious mental illness and the barriers they encounter when trying to access support. Tasnim will use this information to develop recommendations on how BC communities can better structure health services to meet the needs of mothers with mental health issues.
Research has shown that a positive relationship between patients and their health care providers has a significant impact on the success of medical, psychological and drug treatments. The therapeutic relationship has a positive impact on both psychological and physiological factors, such as increasing hope and strengthening the immune system. In addition, the therapeutic relationship may have healing power in and of itself. Although the connection between the success of treatments and a therapeutic relationship has been established, little research has been done to identify the factors that contribute to an effective or ineffective relationship between a patient and health care provider. Robinder Bedi’s doctoral research will identify the factors that create a strong alliance. Health care professionals will be able to use this knowledge to establish more effective therapeutic relationships with patients, and to intervene early in situations where concerns about the relationship may impair treatment. Ultimately, this research should help improve patient outcomes and satisfaction with their care.
About 37,000 people in BC suffer from panic disorder, a debilitating condition characterized by recurrent panic attacks, intense fear and anxiety. Common symptoms include heart palpitations, sweating, nausea, dizziness, numbness in the extremities, and hot or cold flashes. Panic disorder is also costly to our health care system: two-thirds of patients in Canada have sought psychiatric care, 21 per cent visited emergency departments (sometimes repeatedly), nine per cent saw a cardiologist, and 17 per cent saw a neurologist in an effort to understand their symptoms. Recent lab studies have shown cognitive behaviour therapy significantly decreased the frequency and severity of symptoms and achieved better outcomes than other treatments and medications for panic disorder. In her doctoral research, Kathleen Corcoran is comparing these results to outcomes among patients in two community settings-a community mental health clinic and the Anxiety Disorders Unit at UBC Hospital-to determine whether cognitive behaviour therapy is as effective in treating panic disorder in a less controlled, real-life setting.
Carolyn Green is studying the use of information by regional health authorities in public health policy decisions. Health authorities need high quality information to assess the health care needs of communities and appraise the performance of health care systems. But while health authorities make system-wide decisions that can affect whole populations, authority board members do not rate the information they receive as being adequate or timely. Carolyn is investigating what kinds of information are needed and which technologies can best deliver the information to authorities. Her research will help improve the quality of information available to health authorities for evaluating and making decisions about the health care system.
Judith Laposa has conducted the first study to demonstrate a higher prevalence of post-traumatic stress disorder (PTSD) among emergency department staff than in the general public. Her research also shows these symptoms sometimes interfere with job performance. Previous studies have focused on victims of trauma, and not those who routinely deal with horrifying events as part of their jobs. Following a life-threatening event, people with PTSD experience ongoing anxiety and intrusive images of the trauma. Judith is studying the onset and interpretation of trauma memories in emergency staff at several hospitals in Greater Vancouver. This study will examine risk factors for negatively interpreting trauma memories, such as other negative life experiences, a propensity toward negativity, and conflict at work. The results will help identify how to decrease the prevalence of post-traumatic stress among emergency staff, which will help improve the quality of emergency health care.
The cornerstone of treatment for rheumatoid arthritis is early intervention with drug therapies. There are, however, limitations to the long-term effectiveness and safety of the conventionally-used drugs. While the use of new drug therapies, called biologicals, have yielded positive results in clinical trials, these drugs are many times more expensive than the traditional therapies for rheumatoid arthritis. Already a Doctor of Pharmacy, Carlo Marra is focusing his PhD studies in Health Care and Epidemiology on the long term costs and consequences (such as health-related quality of life) of using biological agents instead of traditional drug therapies. The potential of these drugs to reduce other direct and indirect health care costs and improve quality of life for patients with severe rheumatoid arthritis may, in fact, make them more-cost-effective over the long term. The results of this study could help inform drug therapy funding decisions by provincial drug plans.
