Health and Community Leaders Talk: Sheila MacDonald

By Sheila MacDonald, Clinical Manager of the Women’s College Hospital Sexual Assault and Domestic Violence Care Centre (SA/DVCC) and Provincial Coordinator of the Ontario Network of Sexual Assault/Domestic Violence Care and Treatment Centres (SADVTC)

How does research inform the work you do across Ontario and at the Women’s College Hospital (WCH) Sexual Assault and Domestic Violence Care Centre (SA/DVCC)?

In my role as provincial coordinator, I collaborate with the 35 hospital-based sexual assault treatment centres across the province. We partnered with the Women’s College Research Institute (WCRI) many years ago because we wanted to make sure that the work we were doing was evidence-based.

Dr. Janice Du Mont, a senior scientist at Women’s College Research Institute has provided the leadership in our research initiatives, which has ensured data quality and integrity. In 2003, we carried out a HIV Post-exposure Prophylaxis (PEP) project because patients had started to ask about access to HIV PEP medications after an assault. A research team led by Dr. Mona Loutfy, an HIV expert here at WCH, and Dr. Du Mont, developed, implemented and evaluated an HIV PEP program of care in collaboration with 24 SADVTC programs in Ontario. That resulted in the development of a program of care for HIV PEP with funding from the Ontario Ministry of Health and Long-Term Care for the medication.

As a Network, we also worked with Dr. Du Mont to carry out a client evaluation study from 2009 to 2011 to evaluate our services and identify any gaps in our care. Although the clients that do see us express a high degree of satisfaction with services, we wanted to identify any improvements that could be made to services.

Currently, the Network and Dr. Du Mont have several initiatives underway to strengthen the training/education for SADVTC clinicians across the province. One initiative is the first step toward enhancing training for service provision for victims/survivors who identify as transgender. We have an Advisory Committee of experts that is providing leadership and guidance on this project. A second initiative is a collaborative project led by the Ontario Federation of Indigenous Friendship Centres to strengthen service delivery for Indigenous persons.

On a population level, why is it important for us to be studying sexual assault and domestic violence?

Violence against women occurs at alarming rates with significant negative impacts on the victims/survivors, their families and the community. We need a better understanding of the impact of violence, and the supports needed to aid in recovery. We also need to work on prevention strategies to reduce violence from happening in the first place. Finally, we need to identify the strengths and weaknesses of the current system in place that respond to issues of violence including criminal justice system processes, and work collaboratively to improve these systems.

What research are you collaborating on now that could help address these issues?

The ongoing development of evidence-based training for health professionals is really important. Robin Mason, PhD, a scientist at WCRI, and Dr. Du Mont and myself have collaborated on educational initiatives to strengthen clinical expertise by developing curricula at DVEducation.ca. One of the curricula we are working on right now is focused on service provider understanding of the less well-understood responses to sexual assault; for example, why a victim/survivor would contact the perpetrator subsequent to a sexual assault.  In addition to gaining an understanding of such issues, the curriculum will aid service providers in providing appropriate responses to women who have been sexually assaulted.

 

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Read more Health and Community Leaders Talk blog posts on our Healthier, Wealthier, Smarter site and share your insights on Twitter with the hashtag, #onHWS. To learn more about how health research makes Ontario healthier, wealthier, and smarter, check out our website and our other blog posts and videos.

 

Patients + Research: Nicole Brady

Meet Nicole

Nicole Brady, a pediatric nurse at The Hospital for Sick Children, had her first baby in 2009. About six weeks after her son was born, she began to develop anxiety, insomnia and intrusive negative thoughts about herself and the baby — symptoms of postpartum depression.

Women’s College Hospital’s (WCH) family practice team referred her to the Reproductive Life Stages Program, led by Dr. Simone Vigod, a psychiatrist and scientist at WCH.

Nicole is not alone. Depression is one of the most common complications postpartum, with rates estimated from 6.5 to 12.9 per cent. Untreated postpartum depression affects the health of mothers and their families. But studies suggest the condition is underdiagnosed and undertreated.

Nicole received treatment and support through two more pregnancies at WCH. She has participated in research, including a study led by Dr. Vigod to develop a patient-decision aid to help women decide if they should take anti-depressants during pregnancy. Nicole shared her experience of treatment and recovery.

nicole-brady

Can you tell us about your health story?

I started seeing Dr. Danielle Martin with my first pregnancy. After he was born, I ended up starting to develop some symptoms of post-partum depression around the six-week mark, and Dr. Martin helped me through that. Eventually, she ended up referring me to the Reproductive Life Stages Program at WCH and I started seeing Dr. Vigod, who was really fantastic. The first year my depression was quite severe. I also attended a group program.

When things were better, I pulled back a little bit. Then I got pregnant again with my second baby, and I ended up seeing Dr. Vigod again. She followed me throughout that pregnancy and then afterward too. I did have some postpartum depression symptoms that time but it was much better. I ended up seeing Dr. Vigod for a shorter period of time, and then I had my third baby.  She followed me a little, but I was great with that pregnancy and postpartum.

Did your experience as a nurse make it easier for you to recognize symptoms and seek care?

I always wonder that. Partially, but I think it also made me a bit more resistant in a way, that I felt like I should be able to handle it on my own. That I have this knowledge base, and I am a pediatric nurse, so I know how to take care of children. But when I realized things were really going downhill, I knew we needed to take care of this right now. I also know how to access things within the healthcare system.

What made you decide to participate in research?

For one I’m a nurse myself, so I value research very much. I wanted to take a medication that was compatible with breast-feeding, and Dr. Vigod helped me decide what would work best for me. She really brought the newest research to my attention and was very respectful, knowing my background and knowing the information that I needed to feel comfortable with it. Research is constantly evolving. We have new information and that can help us make the best-informed decision possible.

Why is the patient voice important to health research?

I think the patient voice is important because every patient has different needs. Every patient is coming from their experience — from a different perspective. There isn’t a one size fits all solution to everything. For me, my patient experience was very much dictated by my healthcare background and having that knowledge. The great part of my experience with Dr. Vigod was that she could tailor what I needed based on my knowledge and my experience.

 

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Add your voice to the Patients + Research blog series. Email or call Elise Bradt at ebradt@caho-hospitals.com, 416-205-1469, or direct message or tweet at us on Twitter at @CAHOhospitals.

Read more Patients + Research posts and share your own insights on Twitter with the hashtag #onHWS. To learn more about how health research makes Ontario healthier, wealthier and smarter, visit our impact page, and check out our other blog posts and videos.

RESEARCH SPOTLIGHT: Women’s College Hospital

Bringing virtual mental healthcare to Ontario

Researchers at the Women’s College Hospital (WCH) Institute for Health System Solutions and Virtual Care are testing virtual mental health care that helps patients learn how to monitor and manage their symptoms and support others with similar problems – all while remaining anonymous. This is the largest comprehensive study of an online mental health service taking place now in Canada.

A new collaboration between the Ontario Telemedicine Network and Ontario hospitals is bringing an online service called the Big White Wall to the province and evaluating its potential as a strategy in mental healthcare. The Big White Wall is a website and app developed in the United Kingdom that allows those experiencing mental health concerns to share their feelings with peers in an anonymous community monitored by trained counsellors. The service also provides articles and courses with tips about improving your mental health.

One in five Canadians experience mental illness each year. Dr. Jennifer Hensel, a psychiatrist and lead scientist on the project says that virtual mental healthcare presents us with an exceptional opportunity to help more people access support, gain knowledge and remove barriers from stigma through greater anonymity. “There are so many people with mental health problems that our system’s capacity to provide enough care to everybody just isn’t there,” says Dr. Hensel.

In fact, the researchers are primarily focusing on recruiting patients who are on wait lists to receive mental health services. The pilot will recruit 1,000 patients aged 16 and up from WCH, Ontario Shores Centre for Mental Health Sciences and Lakeridge Health. Participants will be able to use the Big White Wall service to complement existing care.

Dr. Hensel is an Innovation Fellow at the WCH Institute for Health System Solutions and Virtual Care (WIHV), which investigates new ideas to improve health outcomes, both at the individual and population level, while reducing costs across the entire healthcare system. WIHV will evaluate the results of the pilot when it concludes in June of 2017.

The evaluation will assess whether access to the Big White Wall improves mental health recovery, lowers participants’ anxiety and depression levels, reduces calls to mental health crisis lines and decreases the number of emergency department visits for issues related to mental health.

The researchers hypothesize that the service will help participants to manage their own symptoms through these online resources. Dr. Hensel, who is also a research fellow of Women’s College Research Institute, says that self-management is a promising aspect of virtual care, particularly for the majority of people who seek mental health services for mild to moderate symptoms. “Helping people learn how to self-manage their problems, build their own goals and implement strategies is really important,” she said. She added that self-management is beneficial for maintaining mental health over the long-term, for example, preventing future episodes of depression.

Dr. Hensel says that Big White Wall is just one example of the virtual services that WIHV is testing to see whether it is worthy of being scaled up across the entire healthcare system. The aim of the pilot evaluation is to understand more about the people for whom apps like Big White Wall work and why. This can inform future approaches to online mental health treatment in Ontario.

 

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Women’s College Hospital is one of Ontario’s 24 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.

Health & Community Leaders Talk: Dr. Paula Rochon

How research closes health gaps

By Dr. Paula Rochon, Senior Scientist, Women’s College Research Institute; Vice-President, Research, Women’s College Hospital; Professor, Department of Medicine and Institute of Health Policy, Management & Evaluation, University of Toronto; Senior Scientist, Institute for Clinical Evaluative Sciences

Dr. Paula Rochon: How health research closes health gaps

Health research is an opportunity to fill gaps in knowledge, helping us deliver efficient health care that meets patients’ needs. Women’s College Research Institute scientists are focused on closing the health gap between men and women.

Women often have different risk factors for disease, symptoms and treatment responses. But scientific studies do not always collect the information needed to reveal these differences. This data gap in health research has not gone unnoticed. The Bill & Melinda Gates Foundation recently pledged $80 million to close gender data gaps and help women and girls.

As a geriatrician, health services researcher and the Retired Teachers of Ontario Chair in Geriatric Medicine at the University of Toronto, I am particularly concerned about the data gap for older adults. Older people, particularly those of advanced age, are poorly represented in research — and women make up the bulk of the older population. More importantly, when they are included, information is not reported separately on women and men. As a result, we lack important data to help us tailor therapies to benefit women and men. As our population ages, it becomes even more important to understand how women and men differ, through gender-sensitive and equity-oriented analyses of older adults along various trajectories of healthy aging.

It is important to view aging beyond just the presence or absence of disease, but in terms of how we can optimize quality of life for older adults and maintain their health. For example, older adults are more likely to be taking multiple, sometimes conflicting drugs that could cause adverse reactions. In a recent study, we found than many Ontarians are prescribed both cholinesterase inhibitors for dementia and anticholinergic drugs, which have side-effects that cause confusion and undo the cognitive benefits of the dementia treatment. Increasingly, researchers are exploring ways to prevent problematic polypharmacy and de-prescribe potentially unnecessary drugs. This includes reducing the number of unnecessarily prescribed anti-psychotic drugs, which increase the risk of falls and hospitalizations that are costly to the health system and most important to older people.

Research that finds solutions to these challenging problems prevent problems from developing and can help Ontarians live long, healthy lives with independence. They can also make our health system more efficient and cost-effective.

 

Read more Health and Community Leaders Talk posts here, and share your own insights about the value of health research on Twitter with our hashtag, #onHWS.

To learn more about how health research makes Ontario healthier, wealthier, and smarter, check out our website and our other blog posts and videos.