From the Lab to the Real World

The Case for Evidence-Based Policy: Looking at the Impact of the Ontario Drug Policy Research Network

In 2008, researchers Tara Gomes and Dr. Muhammad Mamdani from St. Michael’s Hospital and Dr. David Juurlink from Sunnybrook Health Sciences Centre collaborated with researchers from across Ontario, establishing a research network that could rapidly respond to the policy needs of the Ontario Public Drug Programs. With support from the Health System Research Fund, the Ontario Drug Policy Research Network (ODPRN) has since delivered significant impact on the daily lives of patients—and significant savings for Ontario’s health system.

Research supported by the Health System Research Fund has transformed care in the past, and has the promise to do so again in the future. This is just one example.

prescriptions Mature pharmacist giving a medicine to a senior woman in pharmacy.

 

To demonstrate the value of evidence-based policy, we don’t need to look much further than the Ontario Drug Policy Research Network (ODPRN), whose proven track record of delivering research evidence to the Ministry of Health and Long-Term Care has had significant impact on improving quality of care in priority areas including opioids, diabetes, and pulmonary artery hypertension.

Co-led by Tara Gomes and Dr. Muhammad Mamdani from St. Michael’s Hospital, along with Dr. David Juurlink from Sunnybrook Health Sciences Centre, the ODPRN is Ontario’s drug policy research hub that provides timely, relevant scientific evidence to directly support the policy needs of the provincial government. Their work brings significant value to improving patient care and the health system:

“After researchers suggested that frequent monitoring of blood glucose levels has little to no impact on diabetes management for certain populations, the ODPRN provided the Ontario government with estimates of potential cost savings if a policy was introduced to reduce unnecessary test strip use,” explains Dr. Mamdani, co-principal investigator of ODPRN and director of the Li Ka Shing Centre for Healthcare Analytics Research and Training (LKS-CHART) of St. Michael’s. “The government implemented an evidence-informed policy in 2013, which has not only saved patients the inconvenience of frequent testing throughout the day, but we also estimate has saved the system more than $20 million each year since implementation.”

UPDATE – New study published in the Journal of the American Medicine Association (JAMA) finds that new blood glucose test strip policy has saved Ontario $24 million in one year without increasing patient risk.

 

Diabetes Indicator Strips For Blood Glucose Testing

 

Each year, support from the Health System Research Fund (HSRF) enables the ODPRN to conduct dozens of studies and evaluations. The test strip research is one example of these studies, and the resulting policy change is expected to save Ontario more than $100 million within five years of its implementation in 2013. “These findings represent substantial savings for the government and do not adversely affect health care or inconvenience patients,” said Dr. Arthur Slutsky, vice-president of Research at St. Michael’s. “This is a great example of the return on investment that health system research can provide.”

Committed to driving system improvements based on proven evidence, the Ministry of Health and Long-Term Care awarded the ODPRN a HSRF Program Award in 2013.

 

Building strong foundations for Ontario drug policies

The need for evidence-based drug policy has never been greater in Ontario. During the fiscal year ending in 2015, the Ontario Public Drug Programs spent nearly $5 billion providing drug coverage for nearly 4 million Ontarians—nearly one-third of all residents in the province. With an aging population, Ontario has an increasing burden of providing care for patients with chronic diseases and multiple illnesses. Combined with a growing interest in personalized medicine, it’s clear that Ontario’s drug programs and policies depend on proven research evidence.

ODPRN is unique in its mission to address this challenge. Established in 2008, the ODPRN works with the Ontario Public Drug Programs branch of the Ministry of Health and Long-Term care to rapidly provide the high-quality scientific research needed by government to inform pressing policy decisions.

Leveraging the large, population-based data repository housed by the Institute for Clinical Evaluative Sciences (ICES), ODPRN researchers are able to study health care interventions for all 13 million residents of Ontario without risk to privacy or security. With that data, researchers are able to rapidly generate evidence for policy-makers.

 

Quick Impact History: Some examples of how ODPRN has made a difference for Ontario

To date, the ODPRN has more than 85 academic publications and 104 policy reports related to drug safety, utilization and effectiveness. Since receiving HSRF support in 2013, they have conducted 12 drug class reviews and 25 rapid response projects at the request of the Ministry of Health and Long-Term Care and other ministries. The following examples demonstrate exactly how the research evidence at ODPRN has gone from the lab to the real world—informing Ontario drug formulary policy and clinical practice and improving quality of care and health outcomes for Ontarians.

Safety and efficacy of opioids

Over the past 20 years, the escalating use of prescription opioids has created a major public health crisis across North America. A series of ODPRN studies investigating the prescribing and safety of opioids informed the Ontario Public Drug Programs’ decision on how to restrict funding for long-acting oxycodone. Their studies also informed Ontario’s Narcotics Safety and Awareness Act, which was developed to promote more appropriate prescribing of narcotics in the province.  Furthermore, the ODPRN has been invited to present this research to federal policy-makers in Canada and the United States, including the US Food and Drug Administration and the US Department of Transportation.

Pulmonary arterial hypertension (PAH)

Prior to 2010, the Ontario Public Drug Programs exclusively funded PAH monotherapy (one drug at one time) due to the lack of evidence on the effectiveness and safety of PAH combination therapy (multiple drugs at one time). In collaboration with drug policy makers, the ODPRN conducted studies evaluating the use of PAH drugs in Ontario, resulting in drug funding changes and expanded access to combination therapy.

Diabetes drugs

In 2009, the ODPRN published research on the adverse cardiovascular effects of thiazolidinedione drugs for the treatment of diabetes. The findings were critical to the delisting of these drugs from the Ontario formulary, an action estimated to have saved Ontario hundreds of hospitalizations each year.

 

Today’s research promises value for future policy needs

The clinicians and researchers at the ODPRN continue to generate evidence and inform solutions for tomorrow’s health challenges. Provincial investment promises to show value in the future by supporting important work in policy-relevant areas such as appropriate prescribing for the elderly.

“An ODPRN study requested by Ontario policy-makers found a concerning trend towards high rates of antipsychotic prescribing in long-term care homes,” said Gomes, co-principal investigator of the ODPRN and scientist with the Li Ka Shing Knowledge Institute of St. Michael’s and the Institute for Clinical Evaluative Sciences. “This research was used to inform a broader review of these antipsychotic drugs by the Ministry of Health in Ontario.”

With support from the Health System Research Fund, the ODPRN is currently involved in a Ministry of Health-led evaluation of a novel educational outreach program designed to improve antipsychotic prescribing in long-term care homes. The program uses an academic-detailing approach: an innovative way of educating front-line clinicians using evidence developed by the ODPRN and others through interactive, one-on-one communications.

The ODPRN’s past research will inform the educational component of this outreach program as it is implemented in a number of long-term care homes across the province, and the network will evaluate its impact on patient outcomes in this vulnerable population.

Gomes identified other key research areas to support the health system today and tomorrow, including a need to examine the use of health services by high needs users and patients with complex illnesses.

 

Tara Gomes Dr. Muhammad Mamdani
Tara Gomes and Dr. Muhammad Mamdani

 

Listening to the patient voice in drug policy development

Gomes and Dr. Mamdani submitted a proposal for the Health System Research Fund 2015/16 call to support the continuation of their valuable work with ODPRN. Aligned with the Ministry’s Patients First priorities, their work will continue to ensure that the patient voice is being heard.

Over the past 3 years, the ODPRN has substantially enhanced the integration of patients into its research process by creating the ODPRN Citizen’s Panel, a group of 14 members of the general public who have been involved in 12 projects to date. The panel was created in order to gauge the societal acceptability of various reimbursement recommendations that resulted from each of the ODPRN’s drug class reviews. Feedback from Citizen’s Panel members is incorporated into the policy recommendations made by the ODPRN to government.

In addition, the ODPRN has integrated patient representatives into its research teams for drug class reviews, ensuring that the scope of the review incorporates not only policy and clinical outcomes but patient perspectives.

Because research at the ODPRN is driven by the needs of policy makers, patients, public and clinicians, their work has high strategic value for driving policy direction and improving outcomes for patients and the health care system.

“The ODPRN is well positioned to work closely with patients and assist the government in advancing a sustainable drug program that maximizes patient care and outcomes,” said Dr. Mamdani. “And we look forward to meeting that challenge.”

 

The ODPRN is supported through the Ontario SPOR Support Unit and the Health System Research Fund. Their work is an example of how policy-relevant health research—at St. Michael’s, ICES, and across Ontario—contributes to a healthier, wealthier, smarter province. To read more about the ODPRN, click here.