Projects 1998

  1. Development of Ontario Drug Therapy Guidelines for Chronic Heart Failure in Primary Care. Levine M. (download article at www.opot.org)
  2. Development of Ontario Drug Therapy Guidelines for Ischemic Heart Disease in Primary Care. Levine M. (download article at www.opot.org)
  3. Development of Ontario Guidelines for the Prevention and Treatment of Osteoporosis. Levine M. (download article at www.opot.org)
  4. Development of Ontario Guidelines for the Pharmacotherapy Management of Diabetes Mellitus. Levine M. (download article at www.opot.org)
  5. A Randomized, Blinded Controlled Trial of Group Meetings vs Stretching and Strengthening vs Strengthening and Aerobic Exercise in the Treatment of Osteoarthritis of the Hip. Peloso PM, Schachter C, Busch A, Goldsmith CH, Riley L: The Arthritis Society. September 1998
  6. Asthma-Community Pharmacists Training Trial. Dolovich L, Agro K, Lee A, September 1998
  7. Canada Drug Guide – Information Needs of Patients. Levine M. (PI), Dolovich L, Gray J, McCormack J. November 1998
  8. COMPETE: Computerization of Medical Practices for the Enhancement of Therapeutic Effectiveness . A trial of drug utilization review and educational intervention via electronic medial records. GD Searle Canada. Holbrook A. (PI), Goldsmith C, Levine M, Macleod S, Sebaldt R

The COMPETE study is the first of its kind in Canada and seeks to evaluate the benefits, risks and feasibility of state-of-the-art electronic medical record application in community primary care. The main objectives of the study are:

  1. To compare the quality and completeness of prescribing information obtained from the electronic medical record versus paper charts and large prescription database using an innovative, electronic appropriateness of prescribing rating tool (APEQ).
  2. To study work efficiency, satisfaction and concerns about privacy in community-based family medicine before and after computerization.
  3. To conduct a randomized trial examining the effectiveness of additional computerized patient-specific decisions support (computer detailing) as an educational intervention to improve prescribing.

In preparation for this major project a number of development projects were undertaken. These included:

  1. Selection of software. A rigorous multi-staged reduction methods involving clinicians, technical and research expert.
  2. Qualitative Research regarding i) barriers to computerization, willingness to pay and privacy concerns with physicians, ii) privacy concerns with patients.
  3. APEQ Development - early work on an explicit, evidence-based prescribing evaluation questionnaire.
  4. EMR implementation, practice management and case management pilot studies,
  5. Reviews of barriers and predictors of success for electronic decision support.
  1. Cost-effectiveness Sub-study in Canada and Germany of Implantable Defibrillator Therapy in High Risk Post-MI Patients (DINAMIT Trial) Investigators: O'Brien B. (PI), Schulenberg M, Goeree R, Connolly S. Sponsor: St. Jude Medical. 1998
  2. Development of Practice Guidelines for the Treatment of Dyspepsia in Primary Care in Ontario . Drug Programs Branch, Ministry of Health of Ontario Grant 05181. Holbrook A. (PI)
  3. Development of Practice Guidelines for the Treatment of Musculoskeletal Disorders . Drug Programs Branch, Ministry of Health of Ontario Grant 05230. Holbrook A. (PI)

These guidelines are directed at the medical management of patients presenting to family physicians with musculoskeletal (MSK) disorders. These disorders are the most frequently reported cause of impairment affecting the adult population in Canada and the United States. The 1990 Ontario Health Survey reported that disease affecting the MSK system were the most commonly reported conditions at 29%. Recent guidelines also suggest that 1 in 7 patient visits to a family physician is prompted by MSK pain or dysfunction. As the prevalence of these conditions increases with age, the number of cases will likely increase over the next decade. Establishing clear evidence-based treatment guidelines is therefore important to optimize the management of these patients.

Our guideline methodology is an explicit evidence-based process with sequential consensus panels and stakeholder review. The methods include formal literature searching, meta-analyses where needed, appraisal and formulation.

  1. Economic Evaluation Comparing Low-Molecular Weight Heparin (LMWH) with Unfractionated Heparin for Unstable Coronary Artery Disease in Canada (ESSENCE Trial) Investigators: O'Brien B. (PI), Goeree R, Willan A. Sponsor, Rhone Poulenc Rorer 1998
  2. Levels of Evidence for Drug Interactions Among Antidepressant Drugs . Organon Canada Ltd. Holbrook A. (PI), Labiris R, Choi N.
  3. Ontario Prehospital Advanced Life Support (OPALS) Study - Phase III Investigators: Stiell I. (PI), Nichol G, O'Brien B, Wells G. Sponsor: Canadian Health Services Research Foundation, Ontario Ministry of Health. 1998
  4. Pharmacotherapy Specialist Team Consultation Integrated into Primary Care Practice Settings versus Specialty Service Provided in a Hospital Outpatient Clinic. Dolovich L (PI), Levine M, Marshman J, Sellors J. October 1998
  5. Pilot Project to Develop a Model of an Enhanced Pharmacist Role and Enhanced Collaboration Among Pharmacists and Family Physicians to Improve Drug Utilization Using Information Technology. Levine M, Sellors J, Sellors C, Dolovich L. June 1998
  6. Randomised Controlled Trial of Enoxaparin versus Standard Heparin in the Treatment of Proximal DVT Investigators: O'Brien B. (PI), Levine M, Goeree R, Willan A, Blackhouse G. Sponsor: Rhone-Poulenc Rorer 1998
  7. Specialized Medication and Revascularization Therapy (SMART) Investigators: Teo KK. (PI), Knudtson ML, Yusuf S, O'Brien B. Sponsor: MRC/PMAC, Merck Frosst, DuPont, HMR, Fujisawa. 1998
  8. The Effects of Changes of Co-Payment & Premium Policies on Use of Prescription Drugs in Nova Scotia Seniors' Pharmacare Program. Kephart G, Reudy J, Grootendorst PV, Somers E, Hoar J. Canadian Health Services Research Foundation [grant 97-047], matching support from the NS Health Services Research Fund and Nova Scotia's Senior's Pharmacare Program, Nova Scotia Department of Health. 1998

We assess the impact of a series of user fees applied to prescription drugs taken by beneficiaries of the Nova Scotia Department of Health Senior's Pharmacare Program between 1990-1996 on the overall volume of drugs reimbursed, program costs, and the differential effects of the user fees on drugs used by individuals with specific diseases, and with various levels of income.

  1. The Impact of Reference-Based Pricing on the Use of Prescription Drugs, Hospitals and Physicians' Services in B.C. Investigators: P. Grootendorst (PI), L. Dolovich, A. Holbrook, B. O'Brien Sponsor: Canadian Health Services Research Foundation and BC Ministry of Health. 1998
  2. The Impact of Reference-Based Pricing of Calcium Channel Blockers and ACE Inhibitors on the Use of Prescription Drugs, Hospital and Physicians' Services in British Columbia. Grootendorst PV, Dolovich L, Holbrook AM, Levy A, O'Brien BJ. Health Transitions Fund [grant NA222], Drug Information Association 1998

The Reference Pricing program introduced by the British Columbia Ministry of Health Pharmacare program limits reimbursement of drugs in a cluster of therapeutically similar drugs to the lowest price drug in the cluster. We assess whether the reference pricing of calcium channel blockers and ACE inhibitors has lowered overall health care costs without adversely affecting program beneficiaries.

  1. Views of Concerned Patients Regarding the EMR and Use of Their Health Information for Research Purposes . Searle Canada. Willison D, Holbrook A, Keshavjee K.
 
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