Today the greatest barrier to optimal health among persons living with HIV (PLWH) is antiretroviral (ART) adherence. The WelTel program uses weekly text-messages to improve ART adherence and HIV viral suppression among PLWH, but does not work for everyone. The literature states that personality traits and sense of purpose (dispositional traits) play a role in HIV-related outcomes. Measuring disposition is simple and rapid, and could be used to personalize adherence supports for clients with relative ease.
We will enrol 300 PLWH from three Vancouver HIV clinics into the WelTel program. Participants will receive a basic cell phone and phone plan if they do not have one, and receive a weekly (two-way) text message for 12 months asking 'How are you?'. Problem responses will be triaged by a nurse.
We will use existing validated tools to measure disposition at baseline/over time to determine whether we can predict who is most likely to benefit from the WelTel program, and how WelTel works to enact behaviour change. In this way we hope to provide a means by which limited resources could be triaged in vulnerable populations struggling with adherence to provide well-suited programs to the greatest number of individuals possible.
Medications have transformed the lives of Canadians suffering from many debilitating conditions. However, medications may also cause harm. As medication use has increased, so has the incidence of adverse drug events (ADEs), harmful and unintended events related to medication use. Today, ADEs cause over 2 million emergency department visits across Canada each year, and are a leading cause of admissions.
Preventing ADEs is not easy. Health care providers often unknowingly expose patients to the same or similar medications as ones that previously caused harm. For example:
"I saw a diabetic who was discharged from hospital after being admitted for hypoglycemia [low blood sugar] due to glyburide [a blood sugar lowering drug]. The physician asked him to stop the glyburide and put him on gliclazide which has a lower risk of causing hypoglycemia. But he presented [a different hospital] with an even lower blood sugar. When I looked at his blister pack I discovered that both glyburide and gliclazide had been dispensed. The patient had been given a discharge prescription for gliclazide, but no note was made to discontinue glyburide, and neither his [family] doctor nor his pharmacist were aware of what had happened."
Hospital pharmacist, 2012
Using combined professional and research expertise we will pilot-test, refine, implement and evaluate ActionADE, a new health information technology developed by my team to prevent repeat ADEs.
Cerebral venous thrombosis (CVT) is a rare type of stroke that can cause headaches, vision loss, weakness, seizures and coma. It is most common in young women and causes 1/3 of strokes that occur around pregnancy. Among those affected, up to 15% are left dead or disabled, 25% cannot return to work, and over half have lasting issues with energy, thinking or mood.
As a rare disease, CVT is hard to study in large trials, and treatment decisions are based on clinician opinion. CVT is treated with strong blood thinners, but it is not clear which blood thinner is best or how long people should be treated. We are conducting a national study to determine the best way to treat CVT.
Collaborating with 18 other hospitals we will recruit patients from across the country. People living outside of major cities can participate in the study over video-conference and we will also hold forums to consult with patients and family members about lasting symptoms that affect their quality of life.
Our aim is to improve treatments for CVT, and better understand its long-term effects. We also want to continue to expand our video-conference network so that people with health issues will be able to access research treatments, regardless of where they live.
Health information technology (HIT) safety is an important issue internationally. Clinician organizations (e.g. American Medical Association, Institute of Medicine) and health informatics organizations (e.g. Digital Health Canada) have made statements about HIT safety concerns and their implications.
This research will encompass several interconnected studies to develop a comprehensive strategy to improve HIT safety in Canada and internationally, to be conducted in a series of phases.
- Phase 1 of the research will involve a systematic review of HIT safety issues and approaches to improving the safety of HIT as well as its safe use.
- In Phase 2, national incident reporting on HIT safety will be studied and analyzed from three countries (Canada, Finland and the United States).
- Phase 3 will involve clinical simulations to understand how technology-induced errors arise and to identify best practices that could be used to improve and educate health professionals on HIT safety.
Recent debates about palliative end-of-life (EOL) care and legalized assisted dying have stimulated new questions about EOL care for those living with dementia. However, when discussing preferences for EOL care, individuals with dementia are often excluded from the decision-making process, leaving decision making to family members and/or care providers.
With growing numbers of people living with dementia, it is imperative to understand what they envision for their EOL care. While some research suggests they are able to discuss their preferences for care, there is a significant gap in understanding what people with dementia envision for their own EOL care and how they and their family members share in the decision-making process.
Utilizing a critical narrative approach that employs in-depth interviews, visioning workshops, visual arts and storytelling, Dr. Puurveen will examine the EOL preferences and shared decision-making processes of people living with dementia and their family members. Her study will explore:
- How people with dementia and their family engage in shared EOL decision-making.
- The kinds of decisions that they make regarding future care.
- How the age, gender, race, and relationships of individuals with dementia and their families, as well as larger socio-political factors such as legalized assisted dying, influence EOL decision-making.
- What people with dementia identify as an important message about EOL care that can be shared with the public.
To provide an opportunity for conversation beyond those immediately involved in the research, a public art exhibition will be held at a local gallery that invites members of the public, care providers and policy makers to view the art created at the visioning workshops and reflect upon living well with dementia to the end of life.
Dr. Puurveen’s findings will generate practice and policy recommendations for improving EOL decision-making (e.g., advance care planning), that will in turn help improve the quality of care of individuals with dementia and their quality of life at the EOL.
Early intervention therapy (EIT) programs for children with developmental challenges and disabilities have been shown to be highly beneficial for young children (0-5 years) in the wider Canadian population. However, EIT programs are consistently significantly under-utilized by Indigenous communities and families. Indigenous parents and community stakeholder perspectives on EIT are largely absent in current literature, and Indigenous communities are often not consulted on how these programs are delivered.
Dr. Gerlach’s research will generate new knowledge aimed at improving the health, development, and quality of life of Indigenous children with developmental challenges and disabilities. The research will take place in northern BC, where there are a large number of rural/remote First Nations and urban Indigenous communities. This study builds on Dr. Gerlach’s extensive experience working with Indigenous communities, organizations, and families as an early intervention occupational therapist and community researcher. The methodology has been developed in close collaboration with research impact partners, including community stakeholders, the First Nations Health Authority, the Ministry of Children & Family Development, and child development centers in the northern region.
A local Indigenous advisory circle will be formed to guide the research process, and sources such as policy documents and interviews with key policy stakeholders will provide insight into how funding, policy, and organizational factors influence Indigenous parents and children’s access to and use of EIT services. The results of Dr. Gerlach’s research will inform the creation of EIT practices and policies that are responsive to the realities, strengths, and needs of Indigenous families and children living in rural and remote communities in northern BC. The findings will also be shared with a wide audience through community forums, policy briefs, and publications.
This research has national and international relevance at practice and policy levels. BC has an opportunity to take a leadership role in this emerging field of research and in the implementation of Jordan’s Principle, which is focused on achieving health equity for all Indigenous children regardless of where they live.
Residential care aides (RCAs) provide the majority of hands-on care for individuals in long-term residential care (LTRC). Yet, as they are situated at the bottom of the workplace hierarchy, they receive little respect or recognition for their work. In BC, LTRC workers (mainly RCAs) have the highest rates of on-the-job injury; four times higher than the provincial average and twice as high as acute care workers, due primarily to overexertion and violent or aggressive acts from residents.
Little is known about RCAs’ experiences of peer workplace incivility and bullying, also known as horizontal violence. This is a significant gap, as staff turnover and absenteeism (factors which negatively impact residents’ quality of care and quality of life) are more correlated to exposure to workplace incivility and bullying than to patient threats and violence.
Quality person-centred care depends on respectful and collaborative relationships among RCAs; however, workplace incivility and bullying have the potential to significantly disrupt such relationships. For example, faced with workplace incivility and bullying, RCAs may lift or ambulate immobile residents alone rather than asking for help, putting themselves and residents at risk.
Using a critical ethnographic approach, this novel study will examine workplace incivility and bullying among RCAs in LTRC and its effect on care provision. Dr. Cooke’s findings will generate practice and policy recommendations for improving staff relationships that will, in turn, help improve residents’ quality of care and quality of life.
A Community Advisory Committee will provide input throughout the research process. Forums will be held periodically at each study site to share emergent findings, and a publicly-accessible, study-specific website will be created. Findings will also be shared with a variety of knowledge user groups (e.g., health authority residential care quality committees, UBC Centre for Research on Personhood in Dementia’s colloquium series, and the Patient Voices Network) to encourage dialogue and exchange. This will provide an opportunity to stimulate transformation in LTRC beyond the scope of the study sites and influence policy and practice across BC and potentially beyond.
In British Columbia (BC), it is estimated that 78,000 people are living with hepatitis C virus (HCV), most of whom do not even know they have the disease. If left untreated, HCV can cause serious harm, including liver cancer and death. People who inject drugs (PWID) are at elevated risk of HCV infection given their exposure to various individual and environmental circumstances, such as their ongoing addiction and barriers to accessing health care. A growing body of research suggests that harm reduction and addiction treatment programs may present important opportunities to engage PWID in the HCV treatment and care. Efforts are now underway in BC to dramatically expand access to low-threshold addiction treatment that extends beyond traditional methods. Research in this area is particularly timely, as these new policies offer an opportunity to evaluate the impacts of the expansion and optimization of addiction treatment on HCV-related outcomes among PWID.
Dr. Ti's research is an extension of past work that focused on the relationships between infectious diseases, addiction, and the delivery of harm reduction and health services. Utilizing her expertise in this area, Ti will evaluate novel interventions to reduce the health burden caused by HCV and addiction by:
- Characterizing HCV re-infection rates among PWID and examining harm reduction-based and addiction treatment interventions that may protect against reinfection.
- Evaluating evolving addiction treatment guidelines and their impact on HCV incidence among PWID.
- Evaluating the impact of innovative HCV and addiction treatment interventions on treatment uptake and completion.
This research is designed to provide evidence for health system leaders and policy makers to develop policies that are in line with evolving trends in HCV and addiction, and to support health system improvement.
Among women who give birth in industrialized countries maternal age, obesity, twin or triplet pregnancy, and presence of chronic diseases such as diabetes and hypertension continue to increase. For example, 34% of mothers in Canada today are overweight or obese, and approximately 20% of births are to women over 34 years. These demographic trends highlight the need for increasingly complex obstetric care with careful prenatal monitoring and timely obstetric intervention if necessary.
Dr. Lisonkova's research will quantify the risk of severe maternal morbidity by developing a score system that will accurately distinguish between high, moderate, and low risk women. This score calculator will help, for example, women in rural areas to decide about transport to higher-level obstetric care, as these women may face geographical barriers to timely transfer. Determinants of these elevated risks will be examined, as well as whether these risks increase with distance to maternity care, seasonally (for example in winter), or occur only among women in selected geographically specific areas.
The results of this research will provide information to women who are contemplating delaying childbirth, who are overweight or obese, or have chronic health problems. This information will also help health care providers in pre-pregnancy and pregnancy counselling, and health care administrators to identify maternal care needs with respect to maternal-fetal medicine specialists and intensive care units. The maternal morbidity risk score calculator can also be used to adjust for baseline risks (maternal comorbidity, etc.) when comparing hospital performance and evaluating new safety measures in maternal care.
This project will be conducted in collaboration with the Society of Obstetricians and Gynaecologists of Canada, Public Health Agency of Canada, and the Department of Family Medicine & Midwifery, University of British Columbia. The collaboration between midwifery, family physicians and obstetricians will be beneficial especially for women in rural areas, for whom accurate risk identification is crucial.
British Columbia (BC) faces a mental health and addiction crisis with an estimated cost of $100 million annually. In April 2016, a public health emergency was declared due to an alarming increase in opioid-related overdose deaths in recent years.
People who use illicit drugs (PWUD) bear a great burden of preventable morbidity and mortality from drug overdoses as well as other comorbidities including mental disorders and infectious diseases. While opioid agonist therapies (OAT) have proven effective in reducing heroin use, concomitant use of opioids and stimulant drugs (e.g., heroin and cocaine) is common among PWUD. Furthermore, recent research has suggested that many PWUD also suffer from untreated chronic pain, which may be driving prescription opioid (PO) misuse among this population. However, little is known about patterns of concomitant use of illicit opioids, POs and stimulants, and how OAT and other health services may serve to mitigate potential harms associated with such polydrug use. Currently, no approved pharmacotherapies exist for stimulant use disorder, necessitating urgent research effort in this area.
Dr. Hayashi's research will inform policies, programs and clinical practice to reduce harms associated with polydrug use. The primary research objectives are:
- To investigate and address the impact of PO misuse, untreated chronic pain and concomitant opioid and stimulant use on patterns of drug-related harm.
- Evaluate "naturally occurring" interventions and policy changes (i.e., new opioid addiction-related services and Vancouver Coastal Health's Downtown Eastside Second Generation Strategy) that are relevant to polydrug users.
- Evaluate the efficacy of a novel pharmacotherapy to treat polydrug users.
The research will employ vast longitudinal behavioural and biological data collected since 1996 via three ongoing prospective cohort studies of over 3000 PWUD in Vancouver. The findings are expected to inform care development and overdose prevention efforts for a high needs population in BC. One objective will involve implementing a clinical trial to evaluate whether an amphetamine-based medication reduces powder/crack cocaine use among 130 patients on OAT, who have both opioid and cocaine use disorders. If the study medication proves effective, Dr. Hayashi's research will potentially contribute to the identification of the first proven medication for cocaine addiction.
