Alisa Kim

Drug diversion in health-care facilities, when prescription medications are obtained or used illegally, is on the rise in Canada – and most Canadian hospitals do not have sufficient safeguards in place to detect and deal with the problem.

That's why Patricia Trbovich and her team at the University of Toronto, in partnership with the Institute for Safe Medication Practices Canada, have developed a free, online tool that helps hospitals identify the risk of drugs being lost or stolen within their organization, and offers guidance on how to address those risks.

In developing the tool, the team pinpointed areas that make a hospital vulnerable to diversion as opposed to targeting individuals who lose or steal drugs.

“We saw this as an opportunity to look at it from a system perspective, seeing what is it in terms of the way we’ve configured our technologies, workflow processes and environments that is allowing for diversion to occur?” says Trbovich, an associate professor at the Institute of Health Policy, Management and Evaluation in the Dalla Lana School of Public Health.

The diversion risk assessment tool addresses a huge and complex problem. Nationally, reports of the loss of opioids and other controlled drugs have doubled annually since 2015. When drugs are lost or stolen within hospitals, everyone suffers. Drug diversion compromises the safety of patients and staff, increases health-care costs and contributes to substance abuse in the population.

The most commonly diverted drugs are opioids, which are prescribed to relieve pain. Trbovich and Mark Fan, manager of Trbovich’s research group HumanEra, published a study in CMAJ Open that looked at opioid losses from Canadian health-care facilities from 2012 through 2017. Using Health Canada data, they found there were about 65,000 reports of loss during this period, equating to about 112 kilograms of opioids with a street value of about $136 million.

“What makes this topic challenging is that we think losses and thefts are underdetected, and then potentially underreported. We don’t know the relative contributions of those two things,” says Fan, noting that any medication is at risk of going missing.

Moreover, hospitals don’t seem to know when or how medications are being lost or stolen.

“When we started talking to hospitals about it, they were saying, ‘We know it happens, but we don’t have a good way to track how often it happens,’” says Trbovich, who holds the Badeau Family Research Chair in Patient Safety and Quality Improvement at North York General Hospital. “Opioids might go missing for example, but they don’t necessarily know what led to it going missing. They are mandated to report to Health Canada when opioids go missing; often they report it back as ‘unexplained loss.’”

Organizations can use the tool at no cost, but they must first register. The risk assessment examines how controlled drugs are managed throughout a hospital. Users are asked, for example, how discrepancies in inventory records are detected, how staff access controlled areas and how processes around ordering, storage, transfer and disposal of medications are conducted.

The tool produces a risk score based on the information provided. Users can compare their score against other hospitals. There is also a reference guide that has recommendations to address areas of weakness, which was developed in collaboration with the Institute for Safe Medication Practices Canada and the Ontario Branch of the Canadian Society of Hospital Pharmacists.

Hospitals can re-do the assessment after implementing recommended safeguards, notes Trbovich. “Once they’ve addressed [vulnerabilities], they could then on a regular basis benchmark themselves against others or themselves if they want to see how they’re improving,” she says.

To date, dozens of hospitals have signed up to do the risk assessment. The research team will analyze the aggregated results to provide an overview of the diversion risks in Canadian hospitals. The analysis will highlight differences in risk based on region, hospital size and technologies used, so that organizations can learn from each other, says Fan.

“Having this national ‘snapshot’ is going to help policymakers assess where we need to raise the floor on our safety practices across Canada, and to transfer the learnings,” he says. “If we see some people are doing really well, it’s something to celebrate and bring to other hospitals.”

The project received support from the Canadian Institutes of Health Research.

'A team sport': Hayley Wickenheiser on why she pursued a career in emergency medicine

Christopher.Sorensen — Wed, 08 Mar 2023 17:24:07 +0000

'A team sport': Hayley Wickenheiser on why she pursued a career in emergency medicine

Christopher.Sorensen Wed, 03/08/2023 - 12:24

Cutline

Hockey legend Hayley Wickenheiser, a four-time Olympic gold medalist, is in her second year of residency in U of T's department of family and community medicine (photo courtesy of Hayley Wickenheiser)

Alisa Kim

Topic

Our Community

Temerty Faculty of Medicine

Hockey

International Women's Day

After a storied hockey career that included being inducted to the Hockey Hall of Fame, Hayley Wickenheiser is now pursuing another childhood dream: becoming a doctor.

She traces her interest in the medical field to her youth, when one of her friends was badly injured after being hit by a truck.

“There were 30 kids in our neighbourhood and we’d go as a pack to check on her,” says Wickenheiser, a four-time Olympic gold medallist who is in her second year of residency in the department of family and community medicine (DFCM) in the University of Toronto’s Temerty Faculty of Medicine.

“I remember the doctors and nurses being very kind. We were little and they made it less scary for us. It was at that point that I got a real interest in medicine.”

Wickenheiser was named to the Canadian women’s national ice hockey team at the age of 15, but despite being focused on the sport during her young adulthood, she felt a pull toward medicine.

“I always knew I needed a life after hockey and thought that would be a good one,” says Wickenheiser, who is training to become an emergency medicine physician.

Wickenheiser will begin her enhanced skill year in emergency medicine in the department of family and community medicine in July 2023.

Wickenheiser says she chose to do her residency in the department because she would learn about a wide breadth of topics and undergo generalist training, allowing for maximum flexibility in her career.

While fewer graduating medical students rank family medicine as their first choice when applying to residency, Wickenheiser says she is very happy with her decision.

“Family medicine is touted as less 'sexy' than specialist training, but I think it's the best kept secret in medicine and one of the most underrated routes to choose,” she says. “I have zero regrets about choosing DFCM – it's been amazing. From awesome professional development to preceptor teaching, it's really a choose-your-own-adventure at times. I like that.”

Gold medalist Hayley Wickenheiser celebrates at the Sochi 2014 Winter Olympics (photo by Doug Pensinger/Getty Images)

After announcing her retirement from hockey in 2017, Wickenheiser began medical school at the University of Calgary. The transition was eased by years of preparation. For close to a decade before her retirement, Wickenheiser shadowed an emergency department doctor who helped her realize her affinity for the specialty. “I don’t do well sitting all day long,” she says.

She is quick to rattle off the things that drew her to emergency medicine: “Every patient encounter is different. You have to think quickly, work in a team and be very good under pressure. It feels very much like a team sport.”

Widely regarded as one of the greatest hockey players of all time, Wickenheiser thought she would be done with the sport when she began her studies. “Then the Toronto Maple Leafs called a few months into medical school,” she says.

Now an assistant general manager for the Leafs, Wickenheiser oversees 11 staff members and is responsible for the development of not only the franchise players, but of prospects and players from the Toronto Marlies and affiliate Newfoundland Growlers.

“My job is to make sure it’s a high-functioning department where we’re helping the players both on and off the ice to maximize their potential and get them prepared to be successful NHL players – if they already are a successful NHL player, then help them find that one per cent here and there that can elevate their game,” she says.

Her workday varies depending on her clinical responsibilities, but generally she wakes up early and heads to the rink for a workout because of her duties with the Leafs. If she is doing a family medicine rotation, then she will work an afternoon or evening clinic. If she is doing a hospital-based shift that runs from 8 a.m. until late afternoon, she says she adapts her schedule accordingly.

Wickenheiser says the parallels between sport and medicine are striking.

“Everything I learned in hockey, I use every day,” she says. “Medicine is a team game. You’ve got to think on your feet. You’ve got to handle stress. You’ve got to be physically at your best.”

She also says that using constructive criticism to enhance performance is another common theme.

“In medicine, you’re being told what you need to improve on all the time. Being able to handle that in a productive way is very important to your development as a physician.”

There is, she adds, a big difference between these two worlds when it comes to self-care and wellness. “As an athlete, you’re celebrated for taking care of your body. In medicine, sometimes it feels like that should be the last thing you should be doing as a physician taking care of everyone else. I think it’s counterintuitive. It’s something I think medicine has to get a lot better at.”

When asked what motivates her to stay on a difficult path, Wickenheiser, who grew up on a farm in rural Saskatchewan, says hard work is part of her identity.

“I don’t think of myself as overly smart or special in any way, but one thing I hang my hat on as an athlete and what I do in medicine is that I’m confident I can outwork just about anyone. It’s the one thing I know I can control in my life even when there are other things happening that I can’t. You can always control your effort.”

Researchers highlight the critical role of Ontario's primary care providers during the pandemic

Christopher.Sorensen — Tue, 04 Oct 2022 13:29:00 +0000

Researchers highlight the critical role of Ontario's primary care providers during the pandemic

Christopher.Sorensen Tue, 10/04/2022 - 09:29

Cutline

(Photo by Geber86 via Getty Images)

Alisa Kim

Topic

Our Community

COVID-19

Temerty Faculty of Medicine

Unity Health

Dalla Lana School of Public Health

Women's College Hospital

Primary care providers have a critical role to play in the pandemic – and improving access to that care is key, say researchers from the Ontario COVID-19 Science Advisory Table.

The researchers released a three-part brief (part 1, part 2 and part 3) this week detailing the work of primary care providers during the first two years of the pandemic.

The brief, which has been widely reported, outlines issues affecting primary care in Ontario and offers lessons learned to improve access to primary care.

“The pandemic is not over, and COVID-19 is increasingly an illness that will be managed in the community, supported by family doctors, nurse practitioners and primary care teams,” said Danielle Martin, a clinician and teacher at Women’s College Hospital who is chair of the department of family and community medicine in U of T’s Temerty Faculty of Medicine.

“The Science Table wanted to understand the evidence base around the contributions of primary care to the pandemic response so far, as well as current strengths and challenges that will affect response to future waves. At this time it is critical to understand the lessons learned from the last two and a half years.”

Core authors of the brief, which was concieved by Martin, include experts in primary care from across Ontario with a wide variety of backgrounds, including Imaan Bayoumi, Azza Eissa, Noah Ivers, Tara Kiran, Derelie Mangin, Sarah Newbery, Andrew Pinto and Kamila Premji. The team analyzed more than 200 articles for the research and consulted other experts broadly in its work.

The release of the briefs is the last official act of the Ontario COVID-19 Science Advisory Table. Composed of scientific experts and health system leaders, the advisory table evaluated and reported on evidence relevant to the pandemic to guide Ontario’s response.

Research shows health systems with strong primary care have better health outcomes and improved health equity at lower cost, which makes an examination of the lessons learned about primary care in the pandemic a fitting capstone activity for the Science Table.

The three-part brief involves dozens of researchers and primary care experts from across Ontario, Canada and internationally. It outlines the evidence on how primary care clinicians – family doctors, nurse practitioners, pharmacists, social workers and other allied health care providers – took on new roles and worked more days to support COVID-19 care in addition to their routine clinical work, which includes preventive, chronic and acute care.

Primary care clinicians in Ontario assumed new responsibilities such as: COVID testing, assessment and isolation; vaccine counselling and delivery; and treatment prescribing, referral and post-COVID-19 acute care. They also aided other areas of the health system such as in emergency departments, intensive care units and long-term care, and assisted people experiencing mental health issues as well as poverty and food insecurity.

“As misinformation rises around COVID-19, primary care clinicians are highly trusted members of their communities – they are an invaluable resource for conveying fast-changing scientific developments around prevention and treatment of COVID-19 to the public,” said Fahad Razak, scientific director of the Ontario COVID-19 Science Advisory Table, who is a clinician-scientist at St. Michael’s Hospital, Unity Health Toronto, and an assistant professor in the Temerty Faculty of Medicine and at the Dalla Lana School of Public Health.

Ontario faces a significant challenge in keeping up with demand for primary care, the researchers note. About 1.8 million Ontarians do not have a regular family doctor, with new immigrants and people living on low incomes least likely to have one.

Moreover, 1.7 million Ontarians have a family doctor who is of retirement age. Compounding this shortage is the decline in medical school graduates choosing to specialize in family medicine. These challenges, along with inequitable access to team-based care, shape the ability of primary care to respond to future pandemic waves and support health system recovery.

Based on their findings, the researchers outlined several lessons learned:

Care provided in formal attachment relationships and through team-based models provides superior support for COVID-19- and non-COVID-19-health issues in the community.
In the absence of additional resources, COVID-19 response results in tradeoffs and unmet needs in other areas.
Innovative models and new partnerships supported patients to get needed care, but infrastructure is needed for sustainability, spread, and scale.
The absence of an integrated data system compromised the pandemic response in primary care.
Primary care can leverage its longitudinal relationships to achieve public health aims.

Martin says the ultimate goal of the work is to provide evidence to help decision-makers, including governments, professional associations and front-line providers, to improve the ongoing pandemic response.

“We’re in a state where we’re facing significant health human resources shortages, inequitable access to teams and uncertainty about the future,” Martin said. “My hope is that the crisis we’re facing will motivate all leaders in the system to look to the evidence about how we can best improve access to high-quality primary care for all Ontarians.”

Beyond emergencies: Researchers rethink the role of paramedics in the health system

Christopher.Sorensen — Tue, 26 Apr 2022 18:48:24 +0000

Beyond emergencies: Researchers rethink the role of paramedics in the health system

Christopher.Sorensen Tue, 04/26/2022 - 14:48

Cutline

Health care could be improved if paramedics worked with community groups and were given the tools to assess risks associated with housing, income and food insecurity, says U of T grad and paramedic Amir Allana (photo by Cole Burston/AFP via Getty Images)

Alisa Kim

Topic

Our Community

Unity Health

Institute of Health Policy Management and Evaluation

Alumni

Dalla Lana School of Public Health

Research & Innovation

St. Michael's Hospital

As a paramedic, University of Toronto alumnus Amir Allana routinely responds to a wide range of calls – from people suffering a heart attack or stroke to those experiencing mental health issues and addiction.

“On a given day, I might go from acute trauma to someone who’s 70 and has just had a fall but is otherwise uninjured,” says Allana, who recently defended his master’s thesis in the health services research program offered by the Dalla Lana School of Public Health’s Institute of Health Policy, Management and Evaluation (IHPME).

“The next call might be for someone who’s in a shelter system who has a number of chronic conditions that have gotten worse, or who just needs somewhere to go. You’re trying to navigate to what extent is this a health issue versus a social issue? Is this an addictions issue? You’re switching gears all the time, and a lot of it is case-finding, triage and navigation of the health system,”

In fact, Allana says that traditional medical emergencies account for only a small fraction of the cases he sees.

“It’s difficult for newer paramedics who spend all their schooling thinking about trauma and cardiac arrest, only to realize, ‘Oh, that’s just 10 per cent of what I do,’” he says. “Not enough education or cultural pieces are in place to tell them, ‘Actually, your role for the most part is diagnostics and care navigation. Your role is an extension of health services because you’re mobile in the community.’”

Allana and his co-supervisor, Andrew Pinto, an associate professor at the Dalla Lana School of Public Health and a family physician at St. Michael’s Hospital, recently published a paper in Healthcare Policy, that explores how paramedics can address social determinants of health more effectively.

Care could be improved, they argue, by equipping paramedics with tools for better social and environmental assessments. For example, questionnaires could be used to help paramedics assess patients for risks associated with housing, income and food insecurity. Paramedics could also address social factors linked to health by working directly with community-based organizations such as legal aid, shelters, detox centres, food banks and employment agencies. Allana says such an approach would require a shift in paramedic education, culture and governance.

His research also looks at integrated care and how paramedics can extend primary and preventive care in home and community settings.

Allana says the pandemic has exposed the vulnerability of the health system and provides an opportunity to think about how to restructure it in a way that leverages local agencies and services to improve outcomes.

“There are approaches to care that can be provided in the community, but require a rethink of the role of primary care, community-based nursing and mobile care teams – including paramedics and mental health services – to address people’s needs in a way that doesn’t rely just on doctors and nurses in a hospital,” he says.

In a study published in the International Journal of Integrated Care, Allana looked at 108 programs around the world that use paramedics in various care pathways in the community. He found paramedics bridged gaps in care by working across silos that exist between hospitals, social services, primary care and public health. For instance, paramedics in some jurisdictions work with primary care teams to address flare-ups of chronic diseases such as heart failure (when the heart is too weak to meet the body’s pumping needs) and chronic obstructive pulmonary disorder (a lung disease that causes breathing problems) by going into the community to address needs both reactively and proactively.

“Even something simple like weight monitoring for people with congestive heart failure can catch deterioration early,” says Allana. “Systems can be put in place by family health teams and paramedics to follow care plans and adjust medications. There’s something in the middle of purely scheduled primary care and highly acute unscheduled emergency care – there’s a big gap in the middle that no one fills, and a lot of new [paramedicine] programs are filling that.”

Allana says that, ultimately, a more expansive view of the profession is needed and that investing in the capacity of paramedics to provide urgent and preventive care will strengthen the health system for everyone.

“The use of emergency departments and hospital services has outstripped population growth for several decades and that’s going to continue to happen. The reason for that is you’re not providing appropriate care options in the community. We don’t have capacity in the acute care system to appropriately care for people. If you invest in prevention and care co-ordination, it’ll pay off in the long term and curb the need for additional emergency coverage over time.”

Researchers to study burnout among female health-care workers

Christopher.Sorensen — Tue, 29 Mar 2022 15:54:37 +0000

Researchers to study burnout among female health-care workers

Christopher.Sorensen Tue, 03/29/2022 - 11:54

Cutline

(Photo by COLE BURSTON/AFP via Getty Images)

Alisa Kim

Topic

Our Community

Institute of Health Policy Management and Evaluation

Dalla Lana School of Public Health

Research & Innovation

The COVID-19 pandemic has exacerbated the long-standing issue of burnout among health-care workers – a problem that will be studied in depth by a University of Toronto research team.

Prior to 2020, severe burnout – characterized by intense emotional exhaustion and decreased professional achievement – was found in 20 to 40 per cent of health-care workers in Canada, according to a brief prepared for Ontario’s COVID-19 Science Advisory Table. By spring 2021, rates of severe burnout surged to more than 60 per cent of Canadian doctors, nurses and other health-care professionals.

Moreover, data from Statistics Canada show in the fourth quarter of 2020, job vacancies in health occupations rose by 28,000, which accounts for more than one-half of the overall increase in job vacancies compared with the year before.

“Seventy-five per cent of health-care workers are women, and there is a huge supply-and-demand issue right now in the health-care workforce,” says Abi Sriharan, an expert in health human resources and director of the System Leadership and Innovation program at the Institute for Health Policy, Management and Evaluation (IHPME) at the Dalla Lana School of Public Health.

Sriharan, an assistant professor at IHPME, adds many female health-care workers are leaving their occupation or moving away from front-line care. The exodus of female health professionals could lead to poorer quality of care, longer wait times and more medical errors, she says.

Sriharan was awarded a $100,000 grant from the Canadian Institutes of Health Research to lead a team of researchers to study the experiences of female health care workers with the goal of supporting them so that they stay in the field. The team includes IHPME faculty Whitney Berta, Audrey Laporte, Tyrone Perreira and Gillian Strudwick.

The researchers will first studythe literature to understand the reasons why some women decide to leave the health-care field. “We want to understand the underlying factors of workforce retention,” says Sriharan, who notes organizations like the Ontario Hospital Association are particularly interested in knowing what hospitals need to put in place to support women in the workforce.

Next, they will conduct in-depth interviews with female doctors, nurses, pharmacists and other allied health professionals to understand their experiences and gain insight to support their retention.

Sriharan notes that in nursing, for example, recent graduates work in clinical settings for an average of five years before moving into administrative roles, while personal support workers deliver front-line care for about four years before leaving the field altogether.

Sriharan says health-care professionals are going to choose occupations that support work-life balance.

“We’ve seen the power of flexible work arrangements and taking out unnecessary, low-value care,” she says. “Now it’s time to document those things to say, ‘Here is some evidence about process issues and how the system is set up.’ In a sense, we have a [health-care] system based on 1970s health care needs, but we are living in the 2020s. There are technologies that we have not utilized effectively.”

The ultimate aim of the research is to provide decision-makers with the evidence they need to address the current health-care worker crisis.

“To give high-quality, efficient health care, we need a high-functioning workforce,” says Sriharan. “Given that 75 per cent of our health workforce is women, if we don’t address their needs, we’re going to have issues.”

Vision realized: Pilot project to deliver eye care to Indigenous children

Christopher.Sorensen — Tue, 18 Jan 2022 16:31:25 +0000

Vision realized: Pilot project to deliver eye care to Indigenous children

Christopher.Sorensen Tue, 01/18/2022 - 11:31

Cutline

(Photo by Gravity Images/Getty Images)

Alisa Kim

Topic

Our Community

Temerty Faculty of Medicine

Unity Health

Institute of Health Policy Management and Evaluation

Dalla Lana School of Public Health

Hospital for Sick Children

Indigenous

St. Michael's Hospital

One in three Indigenous Canadians haven't had an eye exam within the last two years, according to a 2015 study commissioned by the Canadian National Institute for the Blind. Research has also shown Indigenous kids experience a high rate of astigmatism. Poor sight can have a knock-on effect of making it harder for children to learn in the classroom.

Justin Kritzinger, a student in the system and leadership innovation program at the University of Toronto's Institute of Health Policy, Management and Evaluation (IHPME) at the Dalla School of Public Health, is seeking to address barriers that Indigenous children face in accessing eye care as part of a capstone project.

He and his supervisors – Helen Dimaras, a scientist in the Child Health Evaluative Sciences Program at the SickKids Research Institute and an associate professor in the Dalla Lana School of Public Health; ophthalmologist Myrna Lichter of St. Michael's Hospital and Unity Health Toronto; and Abi Sriharan of IHPME – have developed a pilot program with two urban Indigenous community organizations to assess the eye health needs of local children.

“It is extremely important to work with these community organizations as partners to deliver the best possible care and to make sure we’re doing it in a culturally sensitive way that works for the individuals we’re trying to serve,” says Kritzinger, who is also a third-year medical student in U of T's Temerty Faculty of Medicine.

Eye clinics will be run through Native Child and Family Services of Toronto and the Native Women’s Resource Centre of Toronto, who will publicize the clinic's services. Dr. Lichter, along with eye health specialists from The Hospital for Sick Children, will check for eye problems, assess visual acuity and prescribe glasses as needed.

The idea for the project arose from Kritzinger’s prior work with the Native Women's Resource Centre to deliver eye care to adults. Many of the patients would say they would love to have their kids eyes examined as well, Kritzinger recalled. “We thought: Why couldn’t we do the same thing we’re doing with the adults with the children? The moms there could bring in their kids and both could have their eyes examined at the same time. It would be a convenient experience and the kids could receive eyeglasses as well,” he said.

The clinics will be made possible thanks to volunteering ophthalmologists as well as a $25,000 grant from the Centre for Global Child Health at The Hospital for Sick Children, which will pay for the children’s glasses.

In addition to providing care, the team will study the prevalence of vision and eye disorders among school-aged Indigenous children, identify barriers Indigenous children face in accessing care and find ways to provide culturally safe and comprehensive eye exams and follow-up care.

The team's ultimate goal is to develop a long-term program that can be integrated into the existing infrastructure of community centres. “My hope is that we’ll be able to impact the quality of life for many children by correcting vision problems early on, which can have immense downstream consequences if left uncorrected,” Kritzinger said. “We also want to develop a sustainable program that’s able to serve the community in a meaningful way for a long time. This can only be done by working with the community and organizations under their direction.”

Student-built dashboard aims to more accurately track global COVID-19 infections

Christopher.Sorensen — Fri, 24 Sep 2021 20:15:59 +0000

Student-built dashboard aims to more accurately track global COVID-19 infections

Christopher.Sorensen Fri, 09/24/2021 - 16:15

Cutline

SeroTracker, co-created by U of T graduate student Tingting Yan, is an online tool that aims to more accurately depict global COVID-19 infections by relying on data from antibody tests (image courtesy of Serotracker)

Alisa Kim

Topic

Our Community

Coronavirus

Institute of Health Policy Management and Evaluation

Dalla Lana School of Public Health

David Naylor

Confirmed cases of COVID-19 have been tracked closely throughout the pandemic – but they represent only a fraction of the total number of people who have been infected by SARS-CoV-2.

That’s why Tingting Yan, a master’s student at the University of Toronto’s Institute of Health Policy, Management and Evaluation (IHPME) at the Dalla Lana School of Public Health, decided to create SeroTracker with Rahul Arora, a Rhodes Scholar and PhD candidate in biomedical engineering at the University of Oxford.

The online tool aims to more accurately depicts global COVID-19 infections by tracking serology tests that look for COVID-19 antibodies in a person’s blood, which indicates a prior infection or vaccination.

“Diagnostic testing is like the tip of the iceberg,” says Yan, who is in IHPME’s system leadership and innovation program. “Serosurveys show what is underneath the surface – COVID infections that weren’t severe enough for testing, people with COVID-19 who didn’t have access to testing and asymptomatic infections where people didn’t even know they had an immune response to COVID.”

The dashboard monitors and synthesizes studies from governments and research organizations to track seroprevalence data – the percentage of people in a population who have SARS-CoV-2 antibodies. The platform visualizes antibody estimates on a map and allows users to compare differences in past exposure between countries, demographic groups and occupations.

The idea for SeroTracker was born out of Yan and Arora’s desire to contribute to Canada’s long-term pandemic response. The pair reached out to U of T Professor and President Emeritus David Naylor, who in turn connected them with Tim Evans, executive director of Canada’s COVID-19 Immunity Task Force. They were advised what was needed was a repository of global antibody testing information that was accessible and searchable to monitor the evolution of the pandemic.

Yan and Arora mobilized a team with diverse backgrounds including data science, engineering, medicine, epidemiology and management consulting.

“SeroTracker is mostly driven by graduate and professional students, and keen and talented undergrad students. We are coast-to-coast very proudly Canadian-founded and Canadian-led,” says Yan, noting the contributions of Niklas Bobrovitz, a U of T medical student whose expertise in epidemiology – he has a PhD in clinical epidemiology from Oxford –has advanced the team’s research.

To date, the tool has reviewed nearly 3,000 serosurveys from 116 countries and territories. The SeroTracker team has published the largest global systematic review of serosurveys to shed light on global patterns of infection and communities that are disproportionately affected by COVID-19.

Yan says it has been gratifying to provide a tool that has been useful to policy-makers and public health officials in making evidence-informed decisions.

“We make this data available to different people for their purposes and that makes it more of a collaborative project,” she says.

The Public Health Agency of Canada and the World Health Organization used the platform to develop global models of disease spread. The Bill and Melinda Gates Foundation looked at SeroTracker data to guide investment in serosurveys in low- and middle-income countries. Publications such as The Economist referenced the website to estimate excess deaths from COVID-19, while the New York Times examined the site’s seroprevalence data to look at the true toll of the pandemic in India.

Yan and her team are now looking beyond COVID-19 to determine how the platform could be used in other scenarios involving different diseases. They recently received a grant from the Canadian Medical Association Joule Innovation Fund to work on machine learning algorithms that can predict whether an abstract will be included in a search to make the process more efficient.

Yan says developing the platform has been a rewarding experience, allowing her to contribute to the global pandemic response.

“[Working on SeroTracker] gave a really cool community and a real purpose to work towards.”

SeroTracker is funded by Canada’s COVID-19 Immunity Task Force through the Public Health Agency of Canada, the World Health Organization, Canadian Medical Association Joule Innovation Fund and Robert Koch Institute.

U of T researchers to build virtual tool to enhance genetic testing services, empower patients

Christopher.Sorensen — Tue, 14 Sep 2021 20:58:43 +0000

U of T researchers to build virtual tool to enhance genetic testing services, empower patients

Christopher.Sorensen Tue, 09/14/2021 - 16:58

Cutline

Researchers Robin Hayeems and Yvonne Bombard are building a digital tool that aims to reduce distress for patients while waiting for genetic test results and empower people to act on medical information (photos supplied)

Alisa Kim

Topic

Our Community

Temerty Faculty of Medicine

Institute of Health Policy Management and Evaluation

Dalla Lana School of Public Health

Hospital for Sick Children

Mount Sinai Hospital

St. Michael's Hospital

University Health Network

Genomic sequencing can illuminate the causes of health problems, indicate family members who may also be at risk and guide personalized treatment programs. Yet, there remains a dearth of trained genetic counsellors who can advise patients on inherited diseases and clinical decisions.

In fact, one 2018 study estimated there are only about 350 genetic counsellors in all of Canada.

“It’s a new technology that’s becoming increasingly affordable to do as routine,” says Yvonne Bombard, an associate professor at the Institute of Health Policy, Management and Evaluation (IHPME) at the University of Toronto’s Dalla Lana School of Public Health and a scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital. “It’s definitely part of cancer care, and it’s increasingly become a part of pediatrics, cardiology and neurology.

“But we don’t have the kind of workforce we need to support more routine or high-frequency ordering and management of this type of test. We don’t have the service that is robust enough to accommodate test volumes that are being requested now.”

It’s an issue Bombard plans to address head-on by leading the development of a novel digital health platform for delivering personalized genetic services.

With IHPME Associate Professor Robin Hayeems, Bombard secured a $2-million Team Grant from the Canadian Institutes of Health Research to build a tool to improve genetic service delivery, accessibility and outcomes that aims to reduce distress for patients while waiting for test results and empowering people to act on medical information.

The research team is made up of experts in artificial intelligence, machine learning, genomics, health technology assessment and user-centred design. It includes fellow researchers June Carroll (IHPME, Temerty Faculty of Medicine, Sinai Health System), Muhammad Mamdani (IHPME, Temerty Faculty of Medicine, Unity Health), Emily Seto (IHPME, University Health Network), Quynh Pham (IHPME, University Health Network), Wendy Ungar (IHPME, SickKids), Kevin Thorpe (IHPME), Lauren Chad (Temerty Faculty of Medicine, SickKids) and patient partner Maureen Smith.

“We are really excited to bring our expertise together, particularly as the pandemic has highlighted the need for innovative models of care,” says Hayeems, who is also a scientist at SickKids Research Institute.

The tool will virtualize care for genetic services from patient intake, which involves obtaining someone’s personal and family history and understanding their symptoms, providing education and counselling, and the return of results to help with management of care with the support of a provider. It will also incorporate a chatbot to triage patients and determine which people need follow-up with a counsellor or specialist.

The team will work with patients and health-care providers across Canada to ensure the platform meets patients’ and providers’ specific needs and works well in a range of contexts. Once the platform is developed, the researchers will conduct a randomized controlled trial to test whether it is better than usual care, provides value for money and is responsive to user needs.

The ultimate goal of the platform is to improve patients’ access and outcomes, and to enhance a person’s agency in their own care.

“The idea is to empower patients. They are partners in their care,” says Bombard. “The virtualization and tailoring of a person’s management is fundamentally a human interface, but there are a lot of elements that can be made more user-friendly for patients. If it’s more user-friendly, then people feel empowered and follow through on the recommendations from their care providers.”

U of T researcher leads project focused on transitioning health-care system to 'net-zero' emissions

Christopher.Sorensen — Mon, 07 Jun 2021 16:35:51 +0000

U of T researcher leads project focused on transitioning health-care system to 'net-zero' emissions

Christopher.Sorensen Mon, 06/07/2021 - 12:35

Cutline

Fiona Miller, a professor at the Institute of Health Policy, Management and Evaluation, is leading an effort supported by Environment and Climate Change Canada to make the country's health-care system greener (photo courtesy of IHPME)

Alisa Kim

Topic

Our Community

Institute of Health Policy Management and Evaluation

Dalla Lana School of Public Health

Sustainability

Fiona Miller, a professor at the Institute of Health Policy, Management and Evaluation (IHPME) at the University of Toronto’s Dalla Lana School of Public Health, will lead a collaborative project that aims to engage Canada’s health-care community in climate action and awareness through a nationally co-ordinated network.

The Cascades: Creating a Sustainable Canadian Health System in a Climate Crisis project, supported by $6 million in funding from Environment and Climate Change Canada, has two overarching goals. The first is to build the capacity of Canada’s health care community to achieve resilient, net-zero health care by increasing awareness and motivation, and by developing the skills, tools and networks to enable action.

The second goal is to cultivate and support sustainable health-care innovations.

“Although there have been pockets of extraordinary excellence and effort, there’s just not the co-ordinated and consistent movement forward that will drive the health system toward the direction it needs to go, which is net-zero [emissions] at minimum,” says Miller who is the founding director of U of T’s Centre for Sustainable Health Systems.

Miller is partnering with Sean Christie and Gillian Ritcey of the Healthy Populations Institute at Dalhousie University; Andrea MacNeill, who leads the Planetary Health Care Lab at the University of British Columbia; and Neil Ritchie and Linda Varangu of the Canadian Coalition for Green Health Care. The team members are, in turn, connected to diverse regional and national health associations, health-care leaders, clinicians, administrators and sustainability researchers.

Getting to “net-zero” means reducing the greenhouse gas emissions from health care to as close to zero as possible, and offsetting the small subset of remaining emissions in socially and environmentally sustainable ways.

MacNeill, who is also a cancer surgeon at Vancouver Coastal Health Authority and one of the founding partners in the network says “the bar has been set” by England’s National Health Service, which has committed to a net-zero health system for both direct and indirect emissions by 2045. For Canada to follow suit, all stakeholders in the health-care system must be engaged, she says.

“This project is bottom-up change,” says MacNeill. “We need a mandate from the health system – we need patients, communities, frontline providers, administrators and senior leaders to say that this is their business. That’s our job – to elevate that.”

The Cascades project’s efforts to develop the capacity for sustainability in the health-care system will be achieved through professional development training, providing clinicians and administrators with the knowledge and skills to understand and support sustainable change. There will also be outreach and communications to foster awareness and attract new audiences.

Efforts to support innovation include testing novel ideas and approaches to assess whether they can usher in an era of high-quality, low-greenhouse gas health care. The most promising innovations will then be disseminated across Canada via “playbooks” so that they become best practice in sustainable health care. Examples of service delivery innovations include using alternative anesthetic gases and substituting standard asthma inhalers with dry powder inhalers or smaller volume inhalers.

Christie, who is also a neurosurgeon in the Nova Scotia Health Authority and one of the founding partners in the Cascades network, argues that the health-care community should play a major role in Canada’s pledge to achieve net-zero emissions by 2050 because of the sector’s greenhouse gas footprint and its social reach. Greenhouse gas emissions from health care account for five per cent of Canada’s total carbon footprint, notes Christie. Moreover, health care is the second largest employer nationally and represents the largest single provincial budget expense.

“Climate action across Canada’s health-care community, however, remains limited in scope and piecemeal owing to partial implementation of solutions, inconsistent measurement across settings and regions, and insufficient communication,” he says.

“Our team is ideally placed to overcome these limitations,” says Ritchie, executive director of the Canadian Coalition for Green Health Care and one of the founding partners of the Cascades network. “We possess sustainability expertise and health care expertise, with deep connections with both sectors. We understand how to engage diverse members of the health care community on their own terms, and pursue national co-ordination while respecting local priorities, provincial and territorial jurisdiction, and differences across professions, practice settings and context.”

The federal government’s investment in the team’s proposal to harness efforts toward a sustainable health system is both encouraging and empowering, according to Miller.

“It puts an enormous amount of wind in your sails that the vision we’re articulating is appreciated and understood,” she says. “There’s tremendous opportunity to move forward. You really do need to create a framework where people can pull together in a common direction. That is what this is about: leveraging the efforts of many towards a shared goal.”

With a health equity lens, U of T researcher leads study focused on diabetes-related vision loss

Christopher.Sorensen — Tue, 13 Apr 2021 20:49:08 +0000

With a health equity lens, U of T researcher leads study focused on diabetes-related vision loss

Christopher.Sorensen Tue, 04/13/2021 - 16:49

Cutline

A woman receives an eye exam, which can help detect a complication of diabetes that can lead to blindness (photo by choja via Getty Images)

Alisa Kim

Topic

Our Community

Insulin 100

Institute of Health Policy Management and Evaluation

Dalla Lana School of Public Health

The University of Toronto’s Aleksandra Stanimirovic is currently leading a study that, she says, underscores the reason she chose to become a health researcher as opposed to a physician.

The project focuses on a screening program for diabetic retinopathy – a complication of diabetes that can lead to blindness – among women from lower socio-economic groups.

She hopes her work will help affected women detect changes in their vision early so they can receive appropriate care.

“I thought as a clinician, my impact is somewhat limited to my patients, whereas with the research I’m doing now, for example, which is focused on policy change, my impact can be further reaching,” says Stanimirovic, now a post-doctoral researcher at the University of Toronto’s Institute of Health Policy, Management and Evaluation (IHPME) at the Dalla Lana School of Public Health.

“I can influence the outcomes not just of patients, but their caregivers and researchers.”

Stanimirovic, who is also a post-doctoral researcher in the Health System and Technology Evaluation Program at Toronto General Hospital Research Institute and a trainee in the Diabetes Action Canada CIHR SPOR Network, says early detection and treatment of diabetic retinopathy can prevent most vision loss. However, she notes there is an inverse relationship between screening, income and gender. Research shows, for instance, that women from lower socioeconomic groups are less likely to be screened for breast cancer and colon cancer.

Stanimirovic will study those who participated in a teleretina program, which provided diabetic retinopathy screening via a mobile clinic to users of the South Riverdale Community Health Centre in downtown Toronto between 2014 to 2019. The Toronto teleretina screening program was developed to address difficulties in getting vision checkups by Canadians with diabetes. It is geared toward low-income communities with a high prevalence of diabetes and low diabetic retinopathy screening rates.

A prior study led by Stanimirovic and her supervisor, Valeria Rac, showed the program was a more cost-effective way of screening than standard of care provided in disadvantaged communities. It cited prior research that found 37 per cent of those who participated in the program had never had an eye exam and 27 per cent of the screened cohort were diagnosed with diabetic retinopathy.

“When looking at women in lower socioeconomic groups, usually those with diabetes have multiple health conditions and very limited resources,” says Stanimirovic. “This impedes their opportunity to achieve health equity, which is access to health resources.

“There’s more than one factor that intersects to create this challenge of health inequity. These could be age, gender, ethnic background, etc. They all come together and create a condition of health inequity. The oppression doesn’t come from one factor; it comes from the intersectionality of all these factors that we call social determinants of health.”

Looking at the design, implementation and evaluation of health interventions with the intersectionality framework is important, says Rac, an assistant professor at IHPME. “I want to bring that lens for people to think through when they plan to implement a new program. What is the effect of that program with respect to equity and access to care on women, people from lower socioeconomic groups or people from certain cultures or racial backgrounds?

“We need to think comprehensively about this when we are bringing something new to the [health] system.”

Stanimirovic will examine how many people from the South Riverdale Community Health Centre – some of whom lack Ontario health insurance – were referred for screening, the number of people who had it done, and outcomes of screening. She will identify differences in referral and screening rates among men and women.

There is also a qualitative aspect to the study that involves speaking with patients, care providers and administrators of the teleretina program to gather feedback on what is working and how it can be improved.

By understanding the barriers and facilitators to screening, Stanimirovic hopes to develop engagement strategies that are more culturally appropriate for specific groups.

“We want to understand from those who identify as women: What are the barriers for getting screening? Is it because they’re taking care of kids? Maybe they’re not aware [the program] exists? Maybe they have competing priorities? We hope the thematic analysis will guide us in culturally reshaping this initiative,” says Stanimirovic. “Research has shown cultural components are critical in the success of community implementation.”

The aim, Stanimirovic says, is to increase rates of screening for diabetic retinopathy within the study population to detect changes in vision early so people can get the appropriate care. In Canada, more than three million people have diabetes; by 2025, that number will swell to five million.

“I don’t want to be [naïve] and think everybody’s going to get screened, but even small steps may improve their quality of life significantly,” Stanimirovic says. “I would like this to be an intervention that’s tailored to their needs and context, with the hope that it will improve their quality of care and quality of life.”

The research is supported by a trainee internship award from Diabetes Action Canada.

Alisa Kim

Researchers develop tool to help hospitals reduce loss and theft of medications

'A team sport': Hayley Wickenheiser on why she pursued a career in emergency medicine

Researchers highlight the critical role of Ontario's primary care providers during the pandemic

Read more about the brief at CBC

Read more about the brief in the Globe and Mail

Beyond emergencies: Researchers rethink the role of paramedics in the health system

Researchers to study burnout among female health-care workers

Vision realized: Pilot project to deliver eye care to Indigenous children

Student-built dashboard aims to more accurately track global COVID-19 infections

U of T researchers to build virtual tool to enhance genetic testing services, empower patients

U of T researcher leads project focused on transitioning health-care system to 'net-zero' emissions

With a health equity lens, U of T researcher leads study focused on diabetes-related vision loss