The Ontario Drug Policy Research Network: Generating Evidence to Inform Policy

Transcription

1 The Ontario Drug Policy Research Network: Generating Evidence to Inform Policy Presented by Tara Gomes The Ontario Drug Policy Research Network April 20,

2 Overview Integrating Research into Drug Policy Overview of the Ontario Drug Policy Research Network (ODPRN) Examples of research undertaken by ODPRN Accomplishments and conclusions The Ontario Drug Policy Research Network is funded by the Ontario Drug Innovation Fund, Ontario Public Drug Programs, Ontario Ministry of Health and Long-Term Care 2

3 Integrating Research into Drug Policy: Drivers of Change Social Factors Financial Factors Evidence Competing Interests Other Considerations Beliefs Behaviours 3

4 Integrating Research into Drug Policy: Defining Drug Policy Research Drug Policy Research Any research that affects beliefs and behaviours of policy-makers Key Characteristics: Scientifically Valid Timely Accessible, easily interpretable 4

5 Conflicting Perspectives of Researchers and Policy-makers Researchers Policy Makers End-Goal(s) Publication Promotion Policy Decisions Enhance Public Image Research Question Well-Defined Broad Timeliness Months to years Now : days / weeks Level of precision As precise as possible Ballpark Metrics of Value Academic : relative risks Pragmatic : absolute risks, temporal trends 5

6 ODPRN Core Principles Scientific Rigor / Quality Interdisciplinary approach Leading clinical researchers from five medical schools across Ontario Timeliness Standardized data extraction and analysis algorithms Ready access to administrative data at ICES, with expedited project and ethics review Typical turn-around times of days / weeks Policy Relevance Regular communication and feedback with policy-makers 6

7 ODPRN Structure ODPRN Ontario MOHLTC Rapid Response Unit (RRU) Ontario Public Drug Programs (OPDP) Core Academic Unit (CAU) 7

8 ODPRN Structure Drug Utilization, Costs Policy-driven Projects Adherence Drug Interactions Drug Safety Rapid Response Unit (RRU) Academic Projects Ontario Public Drug Programs (OPDP) Drug Safety Cost Effectiveness Core Academic Unit (CAU) 8

9 RRU Structure Rapid Response Unit (RRU) Investigators Program Leader Analyst(s) Project Manager Develop new project ideas Policy contact Independent Investigator Policy contact Methodologist/Epidemiologist Support external researchers Core staff supervisor General project oversight Analyst Extract data and perform analyses Track projects and key metrics Privacy/ethics submission General Organization/Meetings 9

10 Examples of ODPRN Projects Policy Driven Projects: Patterns of Blood Glucose Test Strip Use Potentially Inappropriate Opioid Analgesic Utilization Utilization, adherence, and adverse events associated with urinary incontinence drugs Academic Projects: Macrolide-Induced Digoxin Toxicity Thiazolidinediones and Adverse Cardiovascular Events 10

11 Blood Glucose Test Strip Use: Patterns, Costs, and Potential Savings Associated with Reduced Testing The CDA and the ADA recommend the use of SMBG test strips up to 3 or more times daily for patients treated with insulin, however no clear guidelines exist regarding the optimal frequency of use of SMBG test strips in other patients with diabetes. Published evidence suggests a lack of clinically relevant improvement in diabetes-related outcomes associated with SMBG in non-insulin treated patients with diabetes. A study on health care professionals attitudes found that there is little perceived benefit of SMBG in patients with type 2 diabetes managed by diet and/or OHAs, whose blood glucose levels are within target range and are stable. A CADTH Expert Review Committee recently recommended against routine use of blood glucose test strips for most adults with type 2 diabetes using oral hypoglycemic agents. Gomes, Juurlink, Shah et al CMAJ; 182(1) Gomes, Juurlink, Shah et al ICES Investigative Report 11

12 Study Objectives The purpose of this study was to: Summarize SMBG test strip utilization patterns among elderly Ontarians according to the nature of their diabetes therapy Calculate the costs associated with payment for these strips Project costs for SMBG test strips from 2009 to 2013, and cost-savings associated with 5 hypothetical scenarios of reduced test strip utilization in subgroups of patients with diabetes 12

13 Annual number and cost of blood glucose test strips dispensed to patients aged 65 years and older with diabetes, in Ontario to 2008 Gomes, Juurlink, Shah et al CMAJ; 182(1) Gomes, Juurlink, Shah et al ICES Investigative Report 13

14 Description of the five scenarios related to testing frequency, based on diabetes therapy group Gomes, Juurlink, Shah et al CMAJ; 182(1) Gomes, Juurlink, Shah et al ICES Investigative Report 14

15 Projected costs of blood glucose test strips associated with five scenarios related to testing frequency, in patients with diabetes aged 65 years and older, in Ontario, 2009 to

16 Policy Implications Modest changes in the frequency of self-monitoring of blood glucose among selected patients with type 2 diabetes through focused policy decisions could lead to substantial reductions in test strip use. Any associated cost reductions could be used to improve diabetes care in ways that are better supported by evidence Results presented to the Committee to Evaluate Drugs (CED) and the OPDP which have driven several discussions within the MOH-LTC and have led to a reevaluation of current SMBG funding. 16

17 Rapid Response Policy-related Research Accomplishments in past 18 months: Academic: 8 publications 12 manuscripts in preparation for submission or submitted Policy-relevant: 12 ministry reports 12 presentations to MOH-LTC and international conferences Increased ministry engagement SAS code algorithms and templates for analytical plans developed for various study methodologies 17

18 Conclusions Collaboration between academic researchers and policy-makers can be beneficial to both groups by: Generating timely research that can be used in policy development More tailored research questions through direct communication Resources available to allow rapid development and publication of highly impactful and relevant projects of interest to academics and clinicians 18