What are the impacts of being formally enrolled with a GP on continuity and integration of care? Evidence from a comparison of Quebec and British Columbia

MSFHR is providing matching funds to support Kimberlyn McGrail’s and Laurie Goldsmith’s BC-based research activity as part of the Canadian Institutes of Health Research (CIHR) Strategy for Patient-Oriented Research (SPOR) Network in Primary and Integrated Health Care Innovation (PIHCI) initiative. The BC/Quebec research team was funded through a SPOR PIHCI Provincial/Territorial Comparative Program and Policy Analysis Grant, with additional funding from the University of British Columbia and several Quebec-based institutions and organizations.

The idea behind patient enrolment with a general practitioner (GP) — also called rostering or registration — is that all patients have a family doctor responsible for their care. For some provinces, patient enrolment is a foundation of efforts to make primary health care more accessible, continuous, and of higher quality. Many jurisdictions either have or are considering implementing such programs, with the belief that this can ensure accessible, timely health care for Canadians. To date, little is known about the actual benefits of patient enrolment policies in Canada.

Researchers in two provinces with patient enrolment programs — British Columbia and Quebec — have teamed up to investigate and compare the impact of different approaches to enrollment with a GP on the continuity and integration of care for patients in each province.

Dr. Kimberlyn McGrail, associate professor at the University of British Columbia (UBC) in the School of Population and Public Health, and the Centre for Health Services and Policy Research, is leading the BC team of researchers. The Quebec-based research is led by the project’s overall principal investigator Dr. Erin Strumpf, associate professor in the Department of Economics and the Department of Epidemiology, Biostatistics and Occupational Health at Montreal’s McGill University.

The two-year project brings together patients, health care providers, decision makers and researchers. Researchers will interview patients and family doctors on their experiences and priorities regarding enrolment and will analyze health care data to assess the effects of enrolment policies on health care services use.

The research results will provide insights on the effects of enrolment, including whether it is more effective for some patients than others, with special attention paid to those Canadians who use and need the health care systems most. The resulting evidence will support decision makers in designing and tailoring policies to build patient-oriented, integrated health care and social services systems.

Preclinical development of a disease modifying small molecule therapy for Alzheimer disease

Dr. David Vocadlo is leading one of five BC researchers leading teams supported through the British Columbia Alzheimer’s Research Award. Established in 2013 by the Michael Smith Foundation for Health Research (MSFHR), Genome British Columbia (Genome BC), The Pacific Alzheimer Research Foundation (PARF) and Brain Canada, the goal of the $7.5 million fund is to discover the causes of and seek innovative treatments for Alzheimer’s disease and related dementias.

Alzheimer’s disease (AD) is a debilitating and progressive neurodegenerative disease, accounting for almost two-thirds of all dementias in Canada, and in BC affects up to 70,000 people. Symptoms include memory loss, behaviour and personality changes, and a decline in cognitive abilities.

Current AD medications treat symptoms of the disease, but none exist that can stop or even slow the progression of AD which starts in the brain many years before it manifests. The need for AD therapies that treat underlying progression of the disease is paramount for the aging population, in particular because of the projected increase in the number of AD patients.

Dr. David Vocadlo, a professor in Chemistry and Molecular Biology & Biochemistry and Canada Research Chair in Chemical Biology at Simon Fraser University (SFU), aims to address several key challenges that would clear the way for a promising new AD therapeutic target.

The two biological hallmarks of Alzheimer's disease in the brain, neurofibrillary tangles and amyloid plaques, are caused by the dysfunction and abnormal accumulation of specific proteins that can kill brain cells over time, progressively impairing brain function.

Vocadlo and a multidisciplinary group of research teams from SFU, the University of British Columbia (UBC) and the University of York in the UK, are pioneering their new approach that has been shown to block disease progression in animal models of AD by blocking the toxicity of the brain proteins that form the tangles within brains. Their approach centres on a specialized sugar unit called O-GlcNAc. Clumps of protein from AD brains have almost none of this sugar attached to them because the O-GlcNAcase enzyme continues to remove this sugar modification.

Vocadlo’s therapeutic goal is to use small molecules to block the activity of the O-GlcNAcase enzyme, and in this way increase the levels of O-GlcNAc in the brain to prevent this protein from clumping together and becoming toxic. Vocadlo’s team is currently advancing this therapeutic target in order to advance it into the clinic.

Implementation and evaluation of an enhanced PharmaNet-based adverse drug event reporting platform to improve patient safety and meet adverse drug reaction reporting requirements

MSFHR is contributing match-funding towards Dr. Ellen Balka’s research (co-led with Dr. Corinne Hohl, recent awardee of Clinician Scientist Award), one of 22 projects as part of the Canadian Institutes for Health Research (CIHR) eHealth Innovation Partnership Program (eHIPP). eHIPP was designed to address gaps in health care — including supporting seniors with complex care needs in their home — by stimulating collaborations between health researchers and Canadian innovative technology companies. Collaborators include Connected Displays, Vancouver Coastal Health, Provincial Health Services Authority and the BC Ministry of Health. Funding support is provided by the College of Pharmacists of BC and Lower Mainland Pharmacy Services. MSFHR is also funding the eHIPP research projects of Drs. Scott Lear and Kendall Ho.

Each year in British Columbia, adverse drug events (ADEs), the unintended harmful reactions to medication use, result in 240,000 emergency department visits and 480,000 hospital days, with their treatment adding $90 million to health care costs. Seniors, the highest users of medications, experience the greatest proportion of adverse drug events.

Up to 70 percent of ADEs have been identified as preventable, with 30 percent occurring when health care providers unknowingly re-prescribe and re-dispense drugs that had previously harmed patients. Current electronic systems are not effective in preventing the unintentional prescribing of culprit or contraindicated drugs as ADEs are often not documented in medical records, and not communicated between care providers and across health care sectors.

Dr. Ellen Balka, a communication and technology expert and professor at Simon Fraser University (SFU) and Dr. Corinne Hohl from the University of British Columbia’s (UBC) Department of Emergency Medicine and Vancouver General Hospital are leading the ActionADE project to reduce ADEs. The team will implement and evaluate an ADE reporting platform through PharmaNet — BC’s provincial drug billing system — and integrate into existing health care practices. The goal of the platform is to bridge current information gaps and address the need for improved communication of ADEs across health care settings and providers by generating real-time patient- and medication-specific alerts about previous ADEs for clinicians when prescribing or dispensing medications.

The project team, based at the Vancouver Coastal Health Research Institute’s Centre for Epidemiology and Evaluation, worked with industry partner PHEMI of Vancouver to develop the ActionADE software that will be used by hospital-based and family physicians, in-hospital and community-based pharmacists and other health care providers. Decision-making authorities, including government and researchers, will have access to the data generated. It is estimated the ActionADE platform will help avoid as many as one-third of the preventable ADEs, translating into more than 40,000 fewer ED visits, saving the provincial health care system as much as $18 million annually. 

In 2018, Hohl received a MSFHR Health Professional Investigator Award related to this project.

Brain channelopathies – Target validation and novel therapeutic strategies

MSFHR supported Dr. Terry Snutch’s award as one of five interprovincial teams from across Canada funded through Brain Canada’s Multi-Investigator Research Initiative (MIRI). The MIRI supports the research of multidisciplinary teams and aims to accelerate novel and transformative research that will fundamentally change the understanding of nervous system function and dysfunction and its impact on health. MSFHR committed funding over three years to support the work of Snutch’s BC-based research activities and research led by fellow MIRI recipient Dr. Neil Cashman on the role of protein misfolding in Amyotrophic Lateral Sclerosis (ALS).

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Deliberative public engagement to inform cancer control decision-making in Canada

MSFHR is providing matching funds for Dr. Stuart Peacock’s research through the Canadian Institutes of Health Research Institute of Cancer Control (CIHR-ICR) Partnerships for Health Systems Improvement (PHSI) program. PHSI projects focus on health system improvements through applied and policy-relevant health systems services research that is useful to health system managers or policy-makers and strengthen the Canadian health system. The Canadian Centre for Applied Research in Cancer Control and Canadian Association of Provincial Cancer Agencies also contributed support.

Provincial and territorial governments face considerable challenges in making fair and sustainable health care funding decisions. These challenges are particularly evident in cancer control and care where expenditure has risen significantly in recent years compared to other areas of health care. Priority setting is the focus of health economics—a branch of economics concerned with issues related to the scarcity of healthcare resources. With cancer expected to continue to be the primary cause of death in Canada and anticipated to increase due to population growth and an aging population, priority setting is imperative.

Public input can assist policy-makers in developing policies that are fair, reflect citizens’ values, and are socially acceptable. Dr. Stuart Peacock, who holds the Leslie Diamond Chair in Cancer Survivorship, Faculty of Health Sciences at Simon Fraser University (SFU), is co-leading a four-year study on the use of deliberative public engagement to inform cancer control priority setting and decision-making in Canada.

The study is based at the Canadian Centre for Applied Research in Cancer Control (ARCC) where Peacock is a co-director and hosted by the BC Cancer Agency (BCCA). Peacock is joined by co-principal investigators Dr. Michael Burgess, from the W. Maurice Young Centre for Applied Ethics, School of Population and Public Health at the University of British Columbia (UBC) and Michael Sherar, CEO of Cancer Control Ontario.

The research team will develop, refine and expand methods of deliberative public engagement, with outputs from the study including: an “atlas” of priority setting processes in cancer control, a framework for deliberative public engagement, recommendations from deliberative public engagement at events relating to interventions and programs from across the cancer control continuum, development of tools and strategies, and recommendations for the most appropriate models of participatory governance.

Peacock’s study will result in values-based evidence that decision-makers at the national, provincial and territorial level can use to inform priority setting decisions for identifying effective and cost-efficient ways to improve cancer patient outcomes.

Delivery of self-management through a peer-support telehealth intervention in patients with cardiovascular disease: The Healing Circles Project

MSFHR is contributing matched funding for Dr. Scott Lear’s research, one of 22 projects as part of the Canadian Institutes for Health Research (CIHR) eHealth Innovation Partnership Program (eHIPP). eHIPP was designed to address gaps in health care—including supporting seniors with complex care needs in their home—by stimulating collaborations between health researchers and Canadian innovative technology companies. MSFHR is also contributing funds towards the eHIPP research projects of Drs. Ellen Balka and Kendall Ho.

Cardiovascular disease (CVD) is a leading cause of death and disability in Canada, resulting in an estimated $22.2 billion in health care costs and lost productivity annually. Older adults are afflicted more than any other population, with many dealing with complex chronic conditions in isolation.

Patient self-management has been found to play a key role in improving patient health and reducing hospital admissions. Correspondingly, social and peer support, and timely access to credible information on managing CVD, are essential for patient self-management and quality of life. Over a four-year period, Dr. Scott Lear, a professor in the Faculty of Health Sciences and the Department of Biomedical Physiology and Kinesiology at Simon Fraser University, and his team based at St. Paul’s Hospital, will study the use of a new application, Healing Circles, that offers support to seniors with CVD while staying in their homes and communities.

Healing Circles is a private and secure peer support and self-management platform created through a partnership between university-based researchers, industry, decision-makers, clinicians and patients. The Healing Circles application, accessible on smartphones, tablets, and desktop or laptop computers, was developed by Curatio, a digital mobile health company, headquartered in Vancouver. Expansion of the use of Healing Circles by seniors with CVD builds on Lear’s pilot study of the application involving women with heart disease from across Canada. After ten weeks, the women reported being better able to manage their health through the peer support and knowledge gained.

Healing Circles Project participants form virtual 'Circles' with 8 to 10 other patients to connect with and support one another as they learn to live day-to-day with their CVD. Additionally, the 250 study participants can interact with all members of the wider Healing Circles community to share experiences. Investigators anticipate that CVD patients using the Healing Circles platform in their homes will have improved self-management skills compared to patients receiving usual care, and improved quality of life, preventing secondary complications and reducing the need for health care and hospital use.

CCNA Team 13: Frontotemporal dementia

Dr. Robin Hsiung’s research is part of the Canadian Consortium for Neurodegeneration in Aging (CCNA) initiative funded by a national partnership between the Canadian Institutes of Health Research (CIHR) and 14 organizations from the public and private sectors across Canada, including MSFHR. The CCNA was created in 2014, bringing together more than 350 clinicians and researchers from across Canada. Organized into 20 teams based on their area of specialized expertise, researchers will focus on preventing and delaying the onset of dementia, as well as improving the quality of life for the estimated 560,000 Canadians affected. MSFHR is also supporting the research of two other BC-based researchers leading CCNA teams: Dr. Neil. Cashman (protein misfolding) and Dr. Cheryl Wellington (lipid and lipoprotein metabolism).

Frontotemporal dementia (FTD) is a progressive neurodegenerative syndrome, and the second most common cause of young-onset dementia after Alzheimer’s disease. FTD is an umbrella term for a diverse group of disorders characterized by the gradual wasting away of the brain’s frontal and anterior temporal lobes, progressively affecting mental function, personality and behaviour, while leaving memory largely intact.

Dr. Ging-Yuek Robin Hsiung, an associate professor in the Department of Medicine (Division of Neurology) at the University of British Columbia (UBC), and staff neurologist at the UBC Hospital Clinic for Alzheimer and Related Disorders, is leading the CCNA Frontotemporal Dementia (FTD) Team.

The team of more than 15 researchers from 8 institutions across Canada will examine the factors that cause FTD and explore new laboratory and imaging techniques to help identify and distinguish the various types of dementia. The goal of the FTD team includes establishing a registry of FTD subjects from across Canada that will contribute genetic and epidemiological information and organized into a national repository of samples. The data will provide important insights into related neurodegenerative disorders such as Alzheimer’s disease and amyotrophic lateral sclerosis (ALS), as well as other more uncommon brain disorders including ancorticobasal degeneration (CBD) and progressive supranuclear palsy (PSP).

Silent genomes: Reducing health care disparities and improving diagnostic success for children with genetic diseases from Indigenous populations

MSFHR is providing matching funds for the research of Dr. Laura Arbour under the Genome Canada/ Canadian Institutes for Health Research Large-Scale Applied Research Project (LSARP): Genomics and Precision Health. Additional support is provided by Genome BC, the BC Children's Hospital Foundation, BC Provincial Services Health Authority and the University of British Columbia (UBC).

Indigenous populations in Canada and around the world face unique health challenges, inequities, and barriers to healthcare. As a result, they typically have poorer health outcomes than non-Indigenous groups.

The health disparity gap widens when it comes to Indigenous populations’ access to the technology and research involved in genomics – the study of the complete set of human genes – which have advanced health care by allowing medical treatments to be tailored to the specific needs of individual patients through precision medicine, routinely available to other Canadians.

Dr. Laura Arbour, a clinical geneticist at BC Children’s Hospital and Island Health, and a professor in UBC’s Department of Medical Genetics, is working to address the growing genomic divide – particularly the lack of background genetic variation data for Indigenous populations – through the Silent Genomes project. The four-year project aims to improve health outcomes by reducing health disparities, enhancing equitable access to diagnosis, treatment, and care for Indigenous children with genetic diseases. Arbour is joined on the project by the University of Northern British Columbia’s Dr. Nadine Caron, and Dr. Wyeth Wasserman from UBC and the BC Children’s Hospital Research Institute, where the research will be conducted, along with BC Women’s Hospital + Health Centre.

The Silent Genomes research team will work with First Nations, Inuit and Métis partners across Canada to establish processes for Indigenous-led governance of biological samples and genome data, leading to policy guidelines and best practice models for genomic research and clinical care.

The project will also create an Indigenous Background Variant Library (IBVL) of genetic variation from a pool of 1,500 First Nations Canadians that will improve the accuracy of genomic diagnosis by providing necessary reference data for Indigenous populations living in Canada and globally. Researchers will also assess the effectiveness of the IBVL to lower health care costs, and plan for long-term use of the IBVL for Canadian Indigenous children and adults needing genetic/genomic health care.

Seniors Adding Life to Years (SALTY)

MSFHR is providing matching funds to support the work of a BC team lead by Dr. Kelli Stajduhar as part of the Canadian Institutes of Health Research (CIHR) Team Operating Grant: Late Life Issues initiative. Other funding partners include Nova Scotia Health Research Foundation, Alberta Innovates Health Solutions and Alzheimer Society of Canada.

Late life is a time when older adults and their caregivers face health and social issues that can impact their well-being. Everyone wants to live well in their final years, but this may be a challenge, particularly for people living in residential long-term care (LTC) settings.

A multi-disciplinary, multi-sectoral team of researchers, care providers, administrators, policy makers and older adults and their families from across Canada have come together to better understand how to add quality to years in the last phase of life for people in residential care and their caregivers. Seniors-Adding Life To Years (SALTY) is a four-year research project that will evaluate promising programs, practices and policies currently employed in four provinces – British Columbia, Alberta, Ontario and Nova Scotia – to support change in how decision makers and practitioners provide care and support in long-term care across the country.

Led by professor Janice Keefe at Mount Saint Vincent University and director of the Nova Scotia Centre on Aging, the study team will develop innovative strategies to understand and assess the impact of existing programs on quality of care and quality of life, with the goal of rolling out effective approaches in jurisdictions across Canada.

SALTY’s research program is organized in four interrelated research streams or problem areas, each applying a different perspective to the late-life trajectory in LTC. Dr. Kelli Stajduhar, of the University of Victoria’s (UVIC) School of Nursing and Institute on Aging and Lifelong Health is co-leading one of the streams. Stajduhar is joined by Drs. Denise Cloutier, also with the Centre of aging and UVIC’s department of geography, and Leah MacDonald, medical director of Island Health’s End-of-Life program. The BC research team is evaluating an implementation project entitled “Improving End-of-Life Outcomes in Residential Care” taking place in four Vancouver Island LTC homes. The goal of the implementation project is to facilitate a promising palliative approach in the context of care provided in LTC facilities for people with life-limiting conditions. Additionally, the team’s evaluation will provide evidence to support application of the project in other provinces.

End of Award Update – June 2022

Most exciting outputs

Each stream of research addressed issues of significant importance, such as quality of life and care for staff, residents, and family in long-term care (LTC); quality improvement in end-of-life care; policy and procedural landscape in LTC; and measurement issues in LTC. The most exciting research output was the establishment of relationships with key stakeholders, decision makers, family members, and research trainees.

Impact so far

In BC, Island Health was able to implement a quality improvement project with an in-depth evaluative component. Improvements to the project were made in real time because of the evaluation. As a result, the impact of the project was immediately understood (and improved). As such, palliative approaches to care in long-term care have been implemented across the health authority.

Potential influence

A new generation of scholars was engaged across the country resulting in networking opportunities that otherwise would not have happened. There are now established partnerships and mentorships between early-, mid-, and late-career scholars and decision makers in long-term care planning and practice. This will ensure that institutional knowledge and lessons learned are carried forward, while the next generation of research is widely shared between scholars and decision makers at all stages of their careers.

Next steps

Dissemination and KT activities continue.

Useful links

Locally produced brain insulin in memory and Alzheimer’s disease: A multi-disciplinary approach to a key question

Dr. James Johnson is one of five BC researchers leading teams supported through the British Columbia Alzheimer’s Research Award. Established in 2013 by the Michael Smith Foundation for Health Research (MSFHR), Genome British Columbia (Genome BC), The Pacific Alzheimer Research Foundation (PARF) and Brain Canada, the goal of the $7.5 million fund is to discover the causes of and seek innovative treatments for Alzheimer’s disease and related dementias.

Continue reading “Locally produced brain insulin in memory and Alzheimer’s disease: A multi-disciplinary approach to a key question”