CAHO hospitals are driving safer prescribing practices for Ontarians

As the population ages, older Canadians are living with multiple chronic conditions and research shows that they are taking many medications.

About a quarter of Canadians over 65 take ten or more prescription drugs, according to a report by the Canadian Institute of Health Information. Some medications can become unnecessary – or even harmful – over time, with age and sometimes because of drug interactions. This can lead to unnecessary hospitalizations and health system costs. One study estimated that Canadians spend $1.4 billion each year in health care costs to treat harmful effects from medications, including fainting, falls, fractures and hospitalizations.

Patients don’t want to be overmedicated either. Another study found that Canadian seniors are prepared to reduce their medications or stop them entirely if their doctors advise it is safe.

Ontario research hospitals are helping physicians and health care professionals change prescribing practices to help patients take only the medications they need, reducing the medication burden in Ontario while improving the quality of life for seniors.

Dr. Paula Rochon at Women’s College Hospital identifies the problem of prescribing cascades

Dr. Paula RochonA prescribing cascade occurs when a doctor misinterprets a patient’s adverse drug reaction as a new medical condition and responds by prescribing another medication.

This issue was first described in 1995 by Dr. Paula Rochon, now the Vice President of Research at Women’s College Hospital, and co-author Dr. Jerry Gurwitz. Since then, there has been increasing focus on smarter prescribing practices and Drs. Rochon and Gurwitz recently revisited their two-decades-old article to see how far we’ve come.

“Since we first described prescribing cascades, they have made an important impact on medication safety in Canada and abroad,” Dr. Rochon says. “I am greatly encouraged by the work happening today across CAHO hospitals and by organizations including the Canadian Deprescribing Network.”

Dr. Barb Farrell at Bruyère Research Institute is developing guidelines to help doctors deprescribe

Dr. Barb FarrellDr. Barb Farrell is a lead researcher with the Bruyère Research Institute and a founding member of the Canadian Deprescribing Network. Together with her research team, she is developing evidence-based guidelines to help guide Canadian healthcare practitioners on when and how to deprescribe medications to improve patient care. The goal is to help clinicians evaluate, reduce and stop medications that may no longer benefit a patient or may cause them harm.

“Our hope is that these guidelines will provide the framework necessary for clinicians around the world to make the best decisions possible for their patients,” said Farrell.

Evidence-Based Deprescribing Guideline Symposium at Bruyere Hospital

The Evidence-Based Deprescribing Guideline Symposium, hosted by the Bruyère Deprescribing Research team, brought together 130 participants from ten countries to share best practices and develop tools.

Dr. Michelle Greiver at North York General Hospital is using data to improve prescribing patterns

Dr. Michelle GreiverDr. Michelle Greiver is a practicing Family Physician and Research Scientist at North York General Hospital (NYGH). She is working to decrease the number of drugs prescribed to seniors and optimize care for patients with complex needs through a new research project called SPIDER (Structured Process Informed by Data, Evidence and Research).  

SPIDER leverages electronic medical record data to identify seniors taking multiple medications and improves prescribing patterns by bringing together a broad range of health care players, each with a specific role. Hospital health planners and quality improvement coaches work closely with family physicians and patient advisors to implement practice changes and improve care for complex seniors taking multiple medications. Meanwhile, researchers use the electronic medical record data to measure overall changes in the types and number of drugs prescribed. The researchers also interview patients and physicians to find out what worked and what didn’t. This is all being done while preserving the privacy and confidentiality of patient information.

“Reducing medications that are not benefiting seniors could help reduce side effects like dizziness and confusion,” says Dr. Greiver. “This could lead to a decrease in falls and an improvement in patients’ ability to manage at home. Consequently, this could impact some areas of NYGH such as the emergency department (fewer visits due to falls and fractures) and the geriatric inpatient unit (fewer admissions).”

Led by Dr. Greiver, a team of more than 50 investigators will roll out SPIDER in five provinces across Canada.

 

North York General Hospital, Bruyere Continuing Care and Women’s College Hospital are three of Ontario’s 23 research hospitals that contribute to a healthier, wealthier, smarter province. Look for other RESEARCH SPOTLIGHT posts on our Healthier, Wealthier, Smarter blog or join the conversation about why health research matters for Ontario on Twitter, using the hashtag #onHWS.

 

 

Feature photo: Simone van der Koelen on Unsplash

 

Inaugural Research Day Focuses on Smart Health in Northern Ontario

Thunder Bay Regional Health Sciences Centre (the Hospital) and its research arm, the Thunder Bay Regional Health Research Institute, are teaming up to host their first ‘Research Day’ on September 6, 2018.

Focused on “smart health” and technology as a driver of health care, the fullday event is open to the public and designed to showcase how health research is improving care for people in Northern Ontario.

“Technology can assist in overcoming several of Northwestern Ontario’s geographical and cultural barriers to care,” said Jean Bartkowiak, President and CEO of the Hospital and CEO of the Health Research Institute. “It can help us streamline and improve access to care so that we are able to provide the right care to the right person at the right time, no matter where they live in the region.”

That’s where “smart health” comes in. Smart health is an umbrella term for connected and interconnected health solutions for diagnosing, monitoring, treating and advising patients. It uses technologies such as smart phone apps, internet and even video technology in innovative ways to overcome those barriers and improve patient care.

The Health Research Institute is currently exploring how technology can bring smart health solutions to the region and to achieve the objectives of the Hospital’s Strategic Plan 2020 to contribute to a healthier, wealthier and smarter Ontario.

Healthier

Indigenous health has been identified as one of the Hospital’s five key directions and is one of the directions in the Health Research Institute’s 2020 Strategic Plan. The Health Research Institute will be working with Hospital staff and others to engage Indigenous leaders and communities to learn more about the communities that the Hospital serves and their health needs. The goal is to research and develop programs and services that can be adapted to each community need and capacity. Smart health can help achieve that goal, providing opportunities to overcome the specific geographical, cultural, language and other barriers to care.

Wealthier

The Health Research Institute was founded on the understanding that homegrown solutions work best for a unique region such as Northwestern Ontario, where health care delivery faces a unique set of challenges. The Research Institute’s scientists and researchers attract research funding that supports homegrown projects. For example, Dr. Naana Jumah and Dr. Chris Mushquash are developing prenatal services for Indigenous mothers and increased health education for Indigenous high school students in Thunder Bay.

Smarter

One of the Institute’s first steps in 2018 is to hire a smart health technology scientist with a joint appointment at Lakehead University. Many digital tools can enhance distance health and indeed most areas of health care – perhaps an overwhelming number of tools. The Institute plans to bring in an expert who can determine the best tools for the Hospital and its partners in health, and investigate how smart health technologies such as apps, sensors and other software-based solutions can be used to improve care.

Driving innovation through collaboration

While it’s still early days for smart health technology, the Research Institute plans to implement new technology over the next several years that will significantly improve patient care in the region, keeping patients closer to home.

The new venture into smart health relies on other research programs as well as academic, clinical, and community affiliates. The Institute is looking to partner with Mohawk College in Hamilton and their mHealth & eHealth Development and Innovation Centre (MEDIC) – which is itself a partnership with McMaster University – to assist in finding the right digital health solutions. By sharing resources and expertise, researchers in Thunder Bay can focus on how technology can improve health care delivery in Northwestern Ontario rather than learning to use the technology from scratch.

The Health Research Institute is also expanding its partnerships with innovators. As a member of the Council of Academic Hospitals of Ontario (CAHO), the Institute participates in CAHO’s role as an Innovation Broker, appointed by the Ministry of Health and Long-Term Care in 2017. Through this role, CAHO connects innovators with its member hospitals to remove barriers and bring innovations into hospitals faster, benefiting the Ontario economy and improving patient care.

These partnerships will support the Hospital’s Strategic Plan 2020 and will assist the Health Research Institute to meet its 2020 Strategic Plan Directions to fuel a Healthier, Wealthier, and Smarter future.

 

Thunder Bay Regional Health Science Centres is one of Ontario’s 23 academic research hospitals that contribute to a healthier, wealthier, smarter province. Look for other RESEARCH SPOTLIGHT posts on our Healthier, Wealthier, Smarter blog or join the conversation about why health research matters for Ontario on Twitter, using the hashtag #onHWS.