Infectious diseases remain a serious and constant threat despite the high standards of sanitation and health care enjoyed by the British Columbians. Moreover, British Columbians, living in a major port of entry to Canada, face an increased risk of contact with emerging infectious diseases as exemplified by SARS. An effective disease surveillance system requires multiple health organizations to work together and share information with each other. Advances in genomic technology have improved the detection and characterization of disease-causing microbes and provide public health practitioners a better surveillance tool. Yet, genomic data is voluminous and complex, creating a challenge for our health care system and practitioners. Moreover, contextual data needed to interpret genomic data often contain sensitive and private information making sharing of contextual data across jurisdictions a challenge.
Dr. Hsiao's research program builds innovative technology solutions to improve organizational efficiency, trust, and capacity of BC's public health surveillance network. Our work will stop the spread of diseases, reduce the overall disease burden and health care cost, and ultimately improve the health and well-being of British Columbians.
This program of research will seek to understand how youth and young adults (YYA) with mental health (MH) disorders make decisions about seeking MH services at YYA centres such as Foundry BC. Foundry BC provides health and wellness services to YYAs through integrated service care in communities across BC. Nearly 75% of MH disorders develop before the age of 25, yet less than 20 percent of Canadian YYAs receive appropriate treatment. This can cause serious problems such as relapse, rehospitalisation, increased suicide risk, and can interrupt critical identity development. Currently, there is little to no research that understands how Canadian YYAs making decision about accessing and staying engaged MH services.
This program of research will work closely with Foundry BC to:
- To develop a theoretical framework of service use decision-making and engagement among Canadian YYAs living with MH disorders using mixed-method approaches; and
- Explore barriers that marginalized YYAs with MH disorders face when accessing digital information using mixed method approaches. Ultimately, this research will lead to the development of a YYA MH service use lab in BC that uses mixed-method approaches and an innovative decision-making framework to develop interventions to increase service use among this vulnerable group in BC. This research will work closely with YYAs and parent knowledge users as part of the research team, and mentor highly qualified students to become MH leaders.
Substance dependence and mental illness frequently co-occur, presenting challenges to treatment providers and increasing the likelihood of suicide, drug overdose, and criminal justice involvement. Assessment and treatment of concurrent disorders (CD) have been identified by police, health professionals, and the Auditor General as urgent priorities in BC, and leadership in the treatment of CD is integral to the mandate of the Provincial Health Services Authority.
Despite well-documented personal and public risks associated with schizophrenia and opioid dependence, little research has examined the combination of these disorders. Medications, including methadone and antipsychotic drugs, are the first line treatments for patients with these diagnoses. Recent studies, including research conducted in BC, have revealed low levels of adherence to these prescribed medications, leading to increased risks of violence, property crime, and mortality.
Researchers investigating HIV/AIDS have shown that when opiate dependent patients are adherent to methadone they are also more likely to follow their HIV/AIDS treatment. This research will investigate whether methadone adherence similarly increases adherence to antipsychotic treatment and leads to superior outcomes for patients diagnosed with both disorders.
In Canada, poor mental health among Indigenous youth is an ongoing issue. This leads to high rates of suicide, addiction, violence, chronic diseases and chronic pain. A potential reason for these challenges is historical trauma linked to government policies intended to eliminate Indigenous cultures, including residential schools, the 'sixties scoop' and the child welfare system.
With Indigenous families in the Fraser Valley and Lower Mainland, British Columbia, Dr. Cooper will explore how people understand historical trauma, mental health and abuse. With participants, she will also explore experiences with current mental health programs and interventions. The focus will be on strengths and challenges experienced by First Nations parents and youth aged 11-14.
Indigenous and qualitative arts-based approaches will be used to unpack key themes related to mental health and community wellbeing, and participants will help guide the creation of resources that will aim to improve health within Indigenous families and communities.
Abortion is a common reproductive health procedure, with nearly one-third of women in Canada having had at least one abortion. However, abortion access is not equitable. Most abortions are surgical, and are provided in a small number of facilities located in BC’s largest cities. Some women, particularly those in rural or remote regions, experience significant wait times and must travel long distances to reach abortion services.
The medical abortion drug mifepristone became available in BC in 2017. Mifepristone can be provided in primary care and is a safe and effective alternative to travelling to large centres for surgical abortion, enabling abortion to occur at earlier (and therefore safer) gestations. Mifepristone medical abortion delivered in primary care has the potential to improve equity for abortion access and outcomes in BC, while reducing pressure on surgical services.
Dr. Schummers’ research will centre on a population-based cohort study using BC linked health administrative data to understand abortion access, outcomes, and costs before and after mifepristone became available.
The results of this study will inform knowledge users and health policy-makers about the effect of mifepristone medical abortion delivered in primary care on abortion service access, outcomes, distribution, and costs.
Human papillomaviruses (HPV) can lead to cervical cancer and other anogenital, head, and neck cancers in both women and men. A safe and effective vaccine against the most common types of HPV associated with cancer was introduced in 2008 into BC’s exemplary school immunization program. However, rates of HPV vaccine uptake have remained low, with less than 70% of eligible students receiving the vaccine each year.
Evidence suggests parents are more likely to consent to an HPV vaccine for their child if they engage in a conversation with a trusted health care provider. Suggesting that simply leveraging existing public health infrastructure could improve HPV vaccine uptake to reduce the future burden of HPV related diseases.
Dr. Racey’s research will evaluate the implementation and impact of a tailored messaging intervention, delivered by public health nurses , to improve HPV vaccine uptake for grade 6 girls and boys in a rural community in BC. BC’s robust immunization registry and monitoring will allow the measurement of HPV vaccine uptake across comparable communities to assess the impact of the intervention.
The results of this research will be directly relevant to school-based immunization programs across BC and Canada, and could lead to or help inform future expansion of the intervention.
British Columbia is facing an unprecedented and escalating opioid crisis, underscoring the urgent need for innovative science-driven solutions. There is critical implementation gap of evidence-based care for opioid use disorder (OUD), this research will seek to narrow this gap.
First, Dr. Socias will seek to advance the implementation of evidence-base treatments for OUD, by leading a series of ongoing and planned clinical trials evaluating innovative and promising models of care (e.g. take-home strategies) and alternate treatment options (e.g. slow-release oral morphine).
Second, leveraging vast data from two long-standing cohort studies of over 3,000 people who use drugs, she will apply innovative quality metrics (i.e., cascade of care framework) to evaluate the impacts of addiction health system implementation efforts in BC over time. Identifying individual-, social- and structural-level facilitators and barriers to uptake and effectiveness of novel interventions, as well as to how these new addiction programs may impact health care access and outcomes of OUD care and related comorbidities (e.g. HIV, hepatitis C) will be key to informing efforts to improve the delivery of addiction care in BC.
End of Award Update – April 2024
Results
Findings from the OPTIMA trial showed that more flexible approaches to opioid use disorder care are similarly effective than more traditional approaches requiring people to go to the pharmacy every day. This has important clinical and policy implications as there is substantial evidence, including from my own research, that rigid models of care are one of the main barriers to retention in treatment, and that discontinuation from treatment increase the risk of overdose and death. We are now evaluating the effectiveness of novel pharmacotherapies in real-world settings.
Impact
Findings from my research have informed clinical guidelines, and policy decisions (re-introduction of methadone formulation in the OAT program in BC).
Potential Influence
I expect that findings from my research evaluating slow-release morphine will have implications to better understand its benefits and risks in the continuum of care of opioid use disorder.
Next Steps
I will continue with research to close the implementation gap in substance use care, including opioid use disorder, but also using some of the learnings to address alcohol use, which has a substantial burden of disease.
Stroke is a leading cause of death and disability in Canada, costing our economy $3.6 billion per year. More than 405,000 people are currently living with the effects of stroke. This number is expected to rise to 720,000 by 2038.
We all know that a stroke is an emergency health issue requiring immediate medical attention. Fewer people, however, know that strokes also have long-term health effects that patients live with on a daily basis, including muscle weakness and balance and coordination issues. Unlike other diseases with long-term health effects, such as heart failure and diabetes, there has been little research to improve the health services provided to stroke patients after they return home from the hospital. As a result, it is common for these people to have another stroke, have many hospital visits, and report other health issues. More research is needed to improve the access to and delivery of health services to stroke patients to better manage their health over time.
The purpose of this five-year research project is to improve long-term care for stroke patients. Dr. Sakakibara will work with stroke patients to ensure the research focuses on what is important to them, and then evaluate new programs (delivered using mobile technologies and the internet) to help patients plan their return home from hospital; improve lifestyle behaviours to prevent other health issues; and better manage their health and well-being for long-term health benefits.
Dr. Hanley's research in women's reproductive health uses the large population-based datasets that already exist in British Columbia, and is driven by diverse training in population and public health, health services research, and economics.
Specifically, Hanley will study whether removing a woman's fallopian tubes at the time of other routine gynecologic surgeries is a safe, effective and cost-effective ovarian cancer prevention strategy. This will provide much needed and timely evidence on the effectiveness of removing the fallopian tubes as an ovarian cancer prevention strategy. Known as the British Columbia protocol, this practice has been adopted in many countries around the world.
Hanley will also examine the safety of using psychotropic medicines during pregnancy, specifically whether using antidepressants during pregnancy may increase a child's risk for autism spectrum disorder and social and emotional and motor development in early childhood. This will generate evidence that can be used to minimize or avoid adverse outcomes from maternal mental illness and use of prescription drugs to treat that illness in pregnancy.
This focus on women's reproductive health and the use of the large linkable population-based datasets in BC will generate evidence on improving population health, improving patient care, and reducing health system costs. This research has already, and will continue to, guide patient care in British Columbia.
Mental health and substance use (MHSU) disorders affect 1 in 4 Canadian youth. Of all age groups, young Canadians (ages 15 to 24) have the poorest access to health services. In response, British Columbia (BC) established a primary health initiative called 'Foundry' to promote and support early treatment for young people with MHSU disorders. Foundry is comprised of seven centres that provide integrated, coordinated health services for young people. The aim of my five-year research program is to improve health outcomes for youth accessing Foundry services through enhanced patient-centred assessment and evidence-based care tailored to the specific needs of young people experiencing MHSU challenges.
The key elements of this research program include:
- Enhancing the role of youth in MHSU research.
- Measuring and understanding the health needs of young people with MHSU disorders.
- Developing tailored and accessible treatments for youth with MHSU, including employment support.
Over the next five years, Dr. Barbic will work collaboratively with Foundry and other community organizations across BC to identify the health priorities of youth with MHSU disorders, and use new methods to measure these priorities and demonstrate how patient-centred assessment can drive meaningful care. By engaging youth, families, clinicians and trainees, this research program will address a national priority to improve the health outcomes of young people with MHSU disorders.
