Indigenous peoples in Canada suffer from significantly higher rates of diabetes and obesity, resulting in reduced quality of life. There is often a lack of Traditional knowledge and community leadership within health, government, and community organizations. The impact of Western care services on improving health are often limited, whereas inclusion of Indigenous community-led care services has shown to improve health. Our current study will co-develop, co-implement, and co-evaluate locally-informed, culturally relevant diabetes and obesity programs in six urban/rural Indigenous Centres. The aim of the study is to blend Traditional and Western knowledge to improve diabetes and obesity services in urban/rural Indigenous communities.
Throughout the project, Community members and Advisory teams will identify needs and solutions for community specific interventions. The proposed will explore the effects of community programs on participant clinical diabetes and obesity measures. Knowledge translation activities will include community gatherings, presentations, publications, and adaptable program platforms. Knowledge gained from this will inform health policy, research, and practice for urban Indigenous communities.
The emergence of novel technologies in health care is associated with promising opportunities to improve patient health outcomes. Advances in health technologies also come at a substantial cost. New gene therapies have been estimated to cost between $300,000-$4,000,000 per patient. These new therapies offer promise, but do not offer certainty; decision-makers have to choose whether to reimburse the therapy with little evidence for how it might work in the real-world.
Health economics can be used to assess the value of a new therapy compared to current therapies. While the use of health economics seems to be supported, the extent to which it impacts decisions seems to be limited. The proposed research will improve health economics analyses to support decision-makers at BC Cancer. The approach will incorporate real-world evidence, expert and patient opinion, and effective communication with decision-makers. Chimeric antigen receptor T-cell (CAR-T) therapy will serve as a case study as it is promising, but is associated with high costs and uncertainty about long-term effectiveness.
This project will bridge the gap between the type of evidence that is provided by standard health economics analyses and that required by decision-makers.
In scientific research, many decisions are needed. Some take scientific expertise, but others take knowing what people find important. Such 'value judgments' include: choosing a topic and how to study it, setting goals, and deciding how to share results.
Patients and the public can inform value judgments in research by being partners and sharing what is most important to them, including
- what is most important to know;
- what errors are most important to avoid.
This is necessary in health economics, the type of research that looks at health and costs as part of healthcare planning. This project will build on a study that asked health economists about value judgments, including whether and how value judgments in their studies could affect healthcare. In a new project, researchers will start a conversation with patients and the public about the same issue. First, they will create short videos about value judgments in research, including how health economists think about and manage them in their studies. Then, patients and the public who viewed the videos will be asked what they think. Could health economists do a better job of managing value judgments?
The study will help make sure health economics research in BC is clear, understandable, and done in partnership with patients and the public. It will help ensure that British Columbians' values are front and centre in research, including where to focus and how to manage possible errors in studies about healthcare.
The drug overdose crisis has been hardest felt in BC. Research has shown that gender plays a key role in shaping contexts of drug use (e.g., within sex work, intimate partnerships) and access to treatment and harm reduction services. Women access treatment with more severe drug-related profiles relative to men (e.g. violence/trauma), yet few services are women-centred. New Vancouver Coastal Health guidelines highlight grave gaps in supports and prevention for marginalized women, and several new models of care are being rolled out (e.g., women-only consumption rooms). Several randomized clinical trials (RCTs) are underway in BC to increase access to evidence-based treatments.
However, the gendered impacts of these interventions remain poorly understood and under-investigated. The proposed research will evaluate the impacts of 'naturally occurring' and clinical interventions (i.e., through prospective methods and RCTs) using a gender lens to identify gender differences in treatment outcomes and barriers to accessing services. Research findings will be widely disseminated with the aim of informing gender-specific policies and programs for people who use drugs in BC and beyond.
This study will examine how organizations are able to roll-out and improve GetCheckedOnline (GCO), an internet-based testing service for sexually and blood transmitted infections currently available in British Columbia.
Using the research approach of institutional ethnography, this study aims:
- to learn what it takes to implement and expand GCO in fair and sustainable ways, and
- to speak to healthcare and community stakeholders in British Columbia to understand the contextual obstacles and opportunities that have shaped the implementation of GCO.
This study's findings will help to inform how GCO can be improved to expand the service to new locations in British Columbia and potentially to the healthcare system in Toronto, Ontario. More generally, this project will offer insights into how sexual health services are implemented and how to promote the equitable growth of digital health interventions.
Decision makers need to decide how to best allocate limited societal and healthcare resources to fund different healthcare services. Health economic evaluation is a tool commonly used to inform these types of funding decisions; however, which costs to consider in economic evaluation can have a significant impact on the resulting funding decision. A societal perspective considers costs within the formal healthcare sector (e.g., physician, hospital and drug costs) as well as costs outside the healthcare sector (e.g., work productivity costs of patients and their family caregivers). Existing health economic evaluations have largely ignored patient and caregiver work productivity costs mainly due to the limitations in current measurement methods.
My program of research will focus on the development of methods that will provide accurate estimates of patient and caregiver work productivity costs. These methods will then be applied and tested in an economic evaluation of new treatments for recurrent Clostridium difficile infection. Ultimately, my research findings will help improve health economic evaluations for other diseases, leading to better healthcare decision making in BC, Canada and beyond.
End of Award Update – March 2024
Results
My research program has provided practical recommendations on how to measure, analyze and present work productivity loss among patients and their caregivers in clinical trials.
Impact
There are increasing research interests in measuring the impact of health care interventions on work productivity loss by following the practical recommendations developed during my award period.
Potential Influence
There will be consensus methods for measuring, analyzing, and presenting work productivity loss results across studies. This will improve the comparability between studies.
Next Steps
More related articles will be published in journals and presented at conferences. Workshops will be organized to teach on the methods of measuring, analyzing, and presenting work productivity loss.
Useful Links
www.thevolp.com
Endometrial cancer (EC), or cancer of the uterus, is the most common gynecological cancer in Canada, with new cases and deaths increasing annually, due to an increase in the rate of common risk factors, like obesity. In British Columbia, the number of new EC cases is projected to increase by 50% and mortality to double by 2031. We must investigate economically feasible prevention strategies to control the rate of this cancer.
For women diagnosed with EC, it is difficult for clinicians to reliably distinguish between cancers that can be cured and those likely to progress, because parameters currently used to make this judgement are not reliably measured. Consequently, we give toxic treatment (chemotherapy and radiation) to many patients who may only require surgery, and fail to treat others as aggressively as we should.
My research program adopts a precision medicine approach, defined by the individualized care to EC patients, to predict:
- which patients are at high risk of developing EC, and
- and of those, which patients are likely to progress. Precision medicine can also improve early screening efforts to reduce EC incidence by detecting and treating pre-cancers, promoting early improved diagnosis, and targeting treatment recommendations for EC patients. This will benefit both patients and the healthcare system, as fewer EC patients will be given expensive toxic cancer treatments that are not needed, or to which they are unlikely to respond.
Depression has recently become the leading cause of disability, worldwide. It affects one out of every 20 Canadians, causing significant suffering to patients and their families and costing the economy CAD$32.3 billion each year. Previous efforts to address the burden of disease caused by depression have mostly been focused on expanding access to mental health services.
Recent analyses, however, suggest that the prevalence and burden of depression has remained the same in the last two decades, in spite of the intensified efforts to improve access to mental health services. This is mainly because not enough efforts have been spent on providing treatments that are adequate, appropriate, and equitable, and also because of the lack of investments on prevention.
In my research program, I propose to:
- study treatment patterns that are adequate and that work for specific group of people at specific times
- examine complex combinations of social factors that influence access to mental health services, and
- identify community-based activities that promote mental wellness and resilience. The program of research has the potential to generate recommendations at the individual, health system, and community level that can be implemented to reduce the prevalence and burden of depression over time.
The healthcare system is undergoing a paradigm shift toward person- and family-centred care. While this is a critical priority, it will be challenging to put into practice. One strategy to implement this change is shared decision-making (SDM), a process that supports patients and providers to discuss the risks and benefits of options, clarify preferences, and make choices based on their informed values. Knowledge translation and implementation science (KT/IS) are key approaches for accelerating this system change.
To advance the science of implementing evidence into policy and practice, I will implement and assess evidence-based SDM tools in routine primary care, focusing on maternal health.
Key objectives include to:
- Investigate factors contributing to successful implementation of SDM tools in routine care,
- Adapt, implement, and assess health care professional training to support uptake of SDM,
- Investigate how documentary film can work as a method of knowledge translation to support patients’ informed choices, and
- Evaluate partnerships between researchers and policy makers to catalyze the implementation of SDM.
This research will be used to advance person- and family-centred care in maternal health and in primary care more broadly.
Primary care includes the day-to-day services provided by family doctors, nurse practitioners, and other health care providers. High quality primary care that follows patients over time and coordinates specialist and hospital care is key to an effective and efficient health care system. Unfortunately, many Canadians struggle to get primary care where and when they need it, despite there being more family doctors per person than ever before.
My research program seeks to answer the following questions:
- How can we make sure we have the right number of health care providers to meet the needs of Canadians now and in the future?
- How can we efficiently organize delivery of primary care to meet the needs of patients? How do we improve access to effective care for underserved groups, including people managing both mental and physical health conditions and recent immigrants and refugees?
I analyse routinely collected data from health care delivery and look at the impact of policy changes using statistical models. I work in partnership with researchers who have complementary skills collecting information through interviews and focus groups. My research teams include patients, care providers, and people who plan health services. This helps make sure we ask questions that matter and that research results will help change our health care system.
