Research in Focus: Collaboration for Outcomes Research & Evaluation (CORE)

Issue TWO: NOVEMBER 2013

RESEARCH IN

FOCUS Collaboration for Outcomes Research & Evaluation (CORE) Dr. Carlo Marra and Dr. Larry Lynd

Introduction The mission of CORE (www.core.ubc.ca) is to improve health-related outcomes to drug therapy through the application of the best in research, education, and practice enhancement strategies.

This involves collaboration with other outcomes researchers, professional organizations, and policy makers. Our mandate has been to develop CORE in terms of both research and training in pharmaceutical outcomes.

In this regard, we have assembled an expert team of epidemiologists, health economists, and statisticians, recruited high-quality graduate students, and acquired state-of-the-art computer resources to undertake sophisticated modeling and analysis.

We have also established collaborative associations with other key stakeholders including the College of Pharmacists of BC, BC Pharmacy Association, BC Ministry of Health, as well as other groups on campus and in the teaching hospitals (for example, CORE’s staff are members of the Centre for Health Evaluation and Outcome Sciences at St. Paul’s Hospital – www.cheos.ubc.ca). In addition to training graduate students in outcomes research, we have developed the first undergraduate course in pharmacoeconomics and health technology assessment in Canada with the objective of training clinicians in critical thinking, understanding health care and policy decision making, and incorporating evidence into clinical practice.

Dr. Carlo Marra is a Professor at UBC’s Faculty of Pharmaceutical Sciences and the Director of CORE. Dr. Larry Lynd is an Associate Professor and the Associate Director of CORE. Both Drs. Marra and Lynd have an educational background in Pharmacy, Epidemiology and Health Economics, and are expert researchers in health outcomes.

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CORE MEMBERS Dr. Carlo Marra, Director Dr. Larry Lynd, Associate Director Dr. Mary De Vera, Faculty Dr. Peter Zed, Faculty Dr. Conor Douglas, Postdoctoral Fellow Dr. Nick Dragojlovic, Postdoctoral Fellow Dr. I fan Kuo, Postdoctoral Fellow Litsa Blanis, Project Manager Jessica Galo, Research Coordinator Louise Gastonguay, Research Manager Amir Khakban, Research Analyst Salma Lalji, Developer Kathy Li, Statistician Tima Mohammadi, Research Analyst Faye Pedersen, Research Administrator Nicole Tsao, Research Assistant 9 MSc Graduate Students 6 PhD Graduate Students

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Research Summary Dr. Marra’s research interests include outcomes research projects in arthritis, respiratory diseases and in evaluating genetic and biomarker tests. In addition, Dr. Marra is very interested in evaluating the role of the community pharmacist in health care provision and investigating models of care and policies of expanded scope in terms of economic and health outcomes. Dr. Lynd’s primary area of interest is in the conduct of state of the art outcomes research and epidemiologic studies. One of his research objectives is to be involved specifically in research that will ultimately translate into improved patient outcomes, or be integrated into the decision-making process. Dr. Mary De Vera, our newest faculty member and Chair in Medication Adherence, is interested in population-based studies evaluating the burden and determinants of non-adherence as well as developing and evaluating interventions to address this issue.

Core Research Themes •

How can community pharmacists participate in chronic disease management?

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Economic Evaluation of Genetically-Based Health Care Strategies

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Examination of Patient and Societal Preferences For Health States In Different Diseases

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Cost-Effectiveness Analyses of Public Health Interventions

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Funding and Reimbursement for Orphan Drugs (www.rare-diseases.ca)

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International Health – Rwanda and Cambodia

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Developing methods for quantitative risk benefit analysis

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Respiratory Medicine

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Medication Adherence

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Reproductive Health

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Selected Projects

Brain Tumour Preferences: The purpose of this study is to investigate, through focus groups and online surveys, clinicians, general population and parents’ preferences regarding treatment intensity, chance of survival, psychological as well as the economic costs associated with survival from the treatment of a childhood brain tumour. The information obtained in the focus groups was used to design an online questionnaire. The online survey was administrated to the general population across Canada, and analysis has been initiated. Recruitment inviting parents and clinicians to complete the online survey is in progress.

Interventions For Moderate/Severe Obstructive Sleep Apnea/ Hypopnea: We have conducted analyses that have investigated the cost-effectiveness of continuous positive airway pressure (CPAP) for this condition and are currently investigating the cost-effectiveness of dental appliances, which are cheaper than CPAP but potentially less effective.

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An evaluation of Canadian Societal Values and views on funding and coverage of expensive prescription medications: Through generating empirical evidence on what the values and priorities of the public as a stakeholder are, we aim to determine whether rare conditions are an area of drug reimbursement for which value-based funding should be made, and whether there is rationale for them to be exempt from traditional cost-effectiveness thresholds.

Respiratory Syncytial Virus (RSV): We are currently involved in a project in which we explore the methodology surrounding deriving health utilities from infants, in temporary health states, and ultimately the derivation of health utilities for infants. This in turn should contribute to the evaluation and reimbursement decisions relating to treatments for RSV. The BC Medication Management Project (BCMMP): The BCMMP was a demonstration project developed between the BC Pharmacy Association (BCPhA) and Pharmaceutical Services Division (PSD) of the BC Ministry of Health. It involves pharmacists working in community pharmacies implementing a standardized patient care service called medication management. The goal of our research is to determine the opinions and preferences of patients, pharmacists, pharmacist leaders, physicians and the BCMMP team members regarding the BCMMP. The findings from these focus groups, as well as interviews that will be conducted with pharmacists, pharmacy leaders, patients and GPs, will be used to help us evaluate the program and to develop a survey that will explore stakeholders’ preferences about the BCMMP. Pharmacists Working Conditions in BC - A Survey: Given the expanding role of pharmacists, there is concern regarding whether or not the current working environment can support these changes. In order to address these concerns, we have been asked as independent researchers to conduct this province-wide survey on behalf of the 6 ¡ RESEARCH IN FOCUS

College of Pharmacists of BC to seek direct feedback on pharmacy working conditions.

The Impact of Arthritis Medications During Pregnancy on Maternal and Neonatal Health Outcomes: Many types of arthritis strike in women during their childbearing years, yet there is little understanding on how taking arthritis drugs during pregnancy affect the health of the mother and her baby. In this study, we will use health records on doctor and hospital visits, drug prescriptions, and pregnancies in British Columbia to assess the impact of arthritis medications on perinatal outcomes including miscarriages, congenital malformations, prematurity, and stillbirths.

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Learn more about research at UBC Pharm Sci The University of British Columbia is one of the most respected research institutions in the world. To learn more about the ground-breaking health science research happening at the Faculty of Pharmaceutical Sciences, visit http://www.pharmacy.ubc.ca/research/overview

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