CAHO hospitals are driving safer prescribing practices for Ontarians

Research hospitals are driving safer prescribing practices for Ontarians

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

 

Patients + Research: Pamela Parker

Patients + Research is a platform for patients to discuss their relationship and experience with the research that leads to new cures, cares and treatments.

Patients + Research: Pamela Parker

Research and care at Canada’s first cardio-rheumatology clinic

Meet Pamela

Two years ago, Pamela Parker’s hands became cracked and sore, and she learned she had developed severe psoriasis and eczema.

Pamela Parker Women's College Hospital

After seeing a specialist, she learned the psoriasis was also in her joints, a condition known as psoriatic arthritis. She was referred to Dr. Lihi Eder, a rheumatologist and a scientist at Women’s College Hospital (WCH) who runs the psoriatic arthritis program at WCH. After sharing her family’s history of heart disease, Dr. Eder referred Pamela to the WCH cardio-rheumatology clinic, the first of its kind in Canada.

Research has shown that patients with rheumatic conditions, such as psoriatic arthritis and rheumatoid arthritis, are at a higher risk for heart disease and other cardiovascular complications. The new clinic is helping patients like Pamela manage their heart health, and ideally, prevent a serious cardiac event. Dr. Eder and Dr. Paula Harvey, the head of cardiology at WCH, jointly run the clinic and collaborate on research studies about the connections between joint health and heart health.

Pamela shared why she is grateful for her care and why she gives back by participating in research.

Could you tell us about your health story?

All of a sudden, it was May 2015, when my skin just went berserk and my joints just went berserk. I was getting married as well, and you are focused on your nails and hands. I thought — why would my hands go from normal to this, and my joints? That’s when I was referred to Dr. Eder. She is very thorough and very caring. She actually takes her time out of her day to call me personally, which does not usually happen with specialists. I found out I do have psoriatic arthritis on top of psoriasis and eczema. She said we need to treat this aggressively or I could end up being crippled.

How were you referred to the cardio-rheumatology clinic?

Dr. Eder said there was a correlation between psoriatic arthritis and heart disease. She asked if I had a family history. I do, my father passed away of a massive coronary and my sister has had a triple bypass. I was referred to the cardio-rheumatology clinic and they did tests, and I have elevated cholesterol, nothing major at this point. For me, it was so amazing to have access to a cardiologist at a stage where if there is an issue they will be on top of it, knowing my family history. Dr. Eder then asked if I wanted to join a combined study and I was happy to participate in their research.

Why did you decide to participate in research?

It is so important. Participating is minor compared to having a crippling disease that no one knows anything about. My kids, my grandkids, my great grandkids could end up with these conditions, and if studies could figure out the ins and outs and shortcuts to detect issues early, I am all for it!

 

Approximately 30% of the people with psoriasis will develop an inflammatory arthritis known as psoriatic arthritis. Learn more about the psoriatic arthritis rapid access clinic at Women’s College Hospital and discover patient resources.

 

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Add Your Voice

Want to add your voice to the Patients + Research blog series? Email or call Elise Johnson at ejohnson@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.

HIV care that’s made for women

HIV care that’s made for women

Women are one of the fastest growing populations at risk for HIV infection and they have worse clinical outcomes than men do.

Dr. Mona Loutfy, a senior scientist at Women’s College Research Institute, is developing HIV care designed especially for women’s needs to close the health gaps they experience.

Dr. Loutfy leads the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS), a national study funded by the Canadian Institutes of Health Research. The study’s goal is to help women with HIV be as healthy as they can be in every way.

Study findings have shown that women in Canada receive good treatment for their HIV but their overall women’s health needs — including pregnancy planning, Pap testing, mammograms and mental health care — are often overlooked. To find and address these gaps, Dr. Loutfy engages women with HIV and their communities to ensure their concerns drive her research questions.

“When we set out to look at what we thought as researchers, were the most important topics, we thought it was going to be all about delivery of HIV care. What came out was actually a bit different.”

The study found that 64 per cent of the women had experienced violence in childhood and 80 per cent had experienced violence in adulthood. Half of the women had depressive symptoms. Isolation and poverty were also significant issues in the community.

“I feel that the care needs to be a little bit different,” Dr. Loutfy says.

She is working to create a new model of care that is women-centred, meaning focused on optimizing the overall health of women with HIV in Canada, particularly those at a higher risk, such as Indigenous women and trans women.

For women like Evana Ortigoza, a Community Advocate with Dr. Loutfy’s Trans Women HIV Research Initiative, the effort is very important. Evana is a trans woman who has lived with HIV for 17 years.

“The research they’re doing here is for trans and women, women with kids and women in all their diversity; it’s amazing. We are not alone,” she says. “Everywhere I go, Women’s College is there to make sure that women are protected.”

Watch the video above to learn more about Evana and Dr. Loutfy’s research, and visit report2017.womensresearch.ca to learn more about research at Women’s College Research Institute at Women’s College Hospital.

 

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Women’s College Hospital is one 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.

Health and Community Leaders Talk: Sheila MacDonald

Ontario's health research hospitals make our province healthier, wealthier, and smarter

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

Patients + Research is a platform for patients to discuss their relationship and experience with the research that leads to new cures, cares and treatments.

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

Big White Wall website at Women's College Hospitals

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

Ontario's health research hospitals make our province healthier, wealthier, and smarter

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.