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Alumni News - August 2004

Research Highlights

Raisa Deber on Taking Our Medicine: Who Should Pay for What?

In the most recent edition of Healthcare Papers (Vol.4 No.2), Professor Raisa Deber provides a Commentary on the proposal by Morgan and Willison funding pharmacare: "Taking Our Medicine: Who Should Pay for What?" (full-text). Morgan and Willison's "Post-Romanow Pharmacare: Last-Dollar First…First-Dollar Lost?" argues for the development of a pharmacare system that combines first-dollar coverage for required care with additional support for catastrophic costs. Deber supports Morgan and Willison's blended policy approach. However, Deber suggests that Morgan and Willison underestimate the difficulty of this task. First-dollar coverage requires defining which drugs are medically necessary and unlikely to cause more harm than good. First-dollar coverage may also drive up the demand for pharmaceuticals which produce marginal health benefits. How can policymakers decide when payment will improve health sufficiently to justify costs? Deber suggests that catastrophic drug coverage be implemented immediately while a program with the right blend of first and last-dollar coverage is developed. Raisa Deber is a full Professor in the Department of HPME and is the Director of the Medicare to Home and Community Research Unit (M-THAC).

Kevin Leonard Identifies Critical Success Factors for New Technology Adoption

Dr. Kevin J. Leonard, Associate Professor in the Department of HPME, published the article, "Critical Success Factors Relating to Healthcare's Adoption of New Technology: A Guide to Increasing the Likelihood of Successful Implementation" in Electronic Healthcare, Vol.2, No.4, 2004. In this article, he uses storytelling to illustrate the struggles in implementing information technology in healthcare, such as remote access to patient records, film-less radiology, telemedicine, electronic discharge summaries, and so on. Five vignettes capture the problem, the decision-making processes, the solution selected and the outcomes when organizations in healthcare or other industries attempt to adopt a technological innovation. Leonard identifies five Critical Success Factors for the adoption and implementation of new technologies, emphasizing the need to evaluate the outcomes of the adoption of the technology and whether it meets the objectives of different stakeholders. Finally, Leonard proposes a framework for the evaluation of healthcare technology innovations, based on its ability to meet user needs, a comparison of the current and new technologies, and the functionality of the new technology. This promises to be an important contribution to improving the ability of the healthcare sector to take advantage of new and emerging technologies and innovations.

Williams Warns of Problems Facing Community Support Agencies in Downtown Toronto

If community support agencies (CSAs) are unable to address current challenges, many seniors in Toronto, including those at the greatest risk of illness and dependency due to poverty and isolation, will have nowhere left to turn for the services they require, warn co-investigators Paul Williams (Professor, Department of HPME), Janet Lum (Associate Professor, Department of Politics and Public Administration, Ryerson University) and Fern Teplitsky (Senior Health Planner, Toronto District Health Council) in their recently published report: "Final Frontier: Impacts of Health Reforms and Population Change on the Community Support Sector in Toronto" (full-text).

Community support agencies play a vital role in the continuum of care in Toronto. They provide a wide range of health and social services including meals-on-wheels, supportive housing, friendly visiting, Alzheimer's day programs, adult day programs, crisis intervention and assistance, and transportation. “If hospitals reduce services, Community Care Access Centres and community agencies are often able to fill in the service gaps that result, but if the community support sector reduces service or is unable to meet client need, there is no further health ‘safety net'”, say the investigators. Care of elderly, disabled or ailing individuals will necessarily default to family members, although for many isolated seniors, even this is not an option.

Based on an analysis of the annual service plans that CSAs are required to submit to the provincial government, the report provides a snapshot of the demographic, economic and policy pressures at work within the sector. Despite fixed resources, CSAs are being asked to treat more clients with chronic illness and complex care needs than in previous years in part due to demographic changes, but also because of “upstream” policy shifts such as earlier hospital discharges, and caps on Community Care Access Centre budgets. Existing strategies aimed at holding down costs, increasing revenues and redesigning business practices to accommodate these changes are not enough to overcome the sector's declining ability to meet client needs, conclude the investigators.

The report lays the groundwork for additional solutions and strategies to be developed by the Toronto District Health Council in conjunction with sector providers; demonstrates the need for further investment into the sector from the Ministry of Health and Long-Term Care and other sources; and helps inform the city's ongoing health system planning process.

Bronskill, Anderson and Team Find High Use of Antipsychotics in Nursing Homes

A recent study of the use of neuroleptic drug therapy in nursing homes found that neuroleptic drugs (antipsychotics) were dispensed to 17% of older adults who had no previous history and to 24% of patients within one year of admission to a nursing home; in addition, 10% of patients received doses that exceeded thresholds. The study examined the medical records of 20,000 people aged 66 and over who entered a nursing home in Ontario between 1998 and 2000. Susan Bronskill (ICES, HPME) and Geoff Anderson (ICES, HPME) were lead authors of the article "Neuroleptic Drug Therapy in Older Adults Newly Admitted to Nursing Homes: Incidence, Dose and Specialist Contact", published in the May 4, 2004 Journal of the American Geriatrics Society. Other members of the research team included Kathy Sykora (ICES), Walter P. Wodchis (Toronto Rehabilitation Institute and HPME), Sudeep Gill (ICES, Baycrest Centre for Geriatric Care), Kenneth I. Shulman (Sunnybrook and Women's College Health Science Centre) and Paula A. Rochon (ICES, Baycrest Centre for Geriatric Care, HPME).

Antipychotics, typically given for major psychiatric illnesses, are being prescribed for older adults with dementia. In an interview with CBC News on May 5, 2004 , Dr. Paula Rochon noted that, "These therapies have been associated with problems like instability and falls and some problems like Parkinson-type symptoms". The use of antipsychotics has been steadily increasing since the 1990's without conclusive evidence of their effectiveness and with the potential to cause harm, such as increased risk of stroke. Unlike the US, Canada does not have legislation restricting the use and dosage of these types of drugs for older adults.

HPME Faculty Research and Teaching Profiles

Faculty associated with the Department of Health Policy, Management and Evaluation (HPME) are involved in a broad range of research activities with a variety of organization. To promote a greater awareness of the knowledge developed through HPME, faculty research profiles will be included as a regular feature of this newsletter.

This issue features a research profile for Professor Audrey Laporte.

+ + Faculty Profile + +

Audrey Laporte, PhD

Audrey Laporte is an Assistant Professor in the Department of HPME, and is cross-appointed to both the Faculties of Law and Dentistry at the University of Toronto. Dr. Laporte is an economist with expertise in microeconomic analysis of resource allocation issues in healthcare. Her research interests include access to health care services; nurse retention and turnover across sectors; the operational efficiency of long-term care facilities, CCACs and hospitals; and the impact of socio-economic status on health.

Education and Work Background

Dr. Laporte completed her BA in Economics and Political Science at the University of Toronto in 1993 and her MA and PhD in Economics at the University of Guelph, graduating in 2001. Between 2000 and 2002, Laporte held a status-only appointment as an assistant professor with HPME. She was awarded a Lupina Foundation, Munk Centre for International Studies, Post-Doctoral Fellowship (2001-2002) and a Canadian Health Services Research Foundation (CHSRF) Post-Doctoral Training Award (2001-2003). As a post-doctoral fellow, Dr. Laporte benefited from the mentorship of the Health Care, Technology and Place (HCTP) program under the supervision of Professor Peter Coyte of the Department of HPME. Audrey joined HPME as a full-time tenure-track faculty in January 2003.

In addition to her research and teaching responsibilities, Dr. Laporte is currently also serving as:

Research Activities

Dr. Laporte is currently a co-investigator and mentor in the Health Care Technology and Place (HCTP) program, a participant in the CHSRF/CIHR Chair in Health Care Settings and Canadians research program, a member of the From Medicare to Home and Community (M-THAC) research unit, and a research associate with the Institute for Policy Analysis (IPA). She is the principal or co-investigator of research grants totaling over $2.5 million. As principal investigator, Laporte is leading a number of studies which include: research on the operational efficiency of long-term care facilities in Canada (co-PI W. Berta), an inquiry into the impact of work setting and work choice on nurse retention and turnover across care settings (co-PI R. Deber), and an analysis of the relationship between health status, health behaviour and income inequality. She is also equally involved in studies that assess mechanisms for introducing cost effective interventions to improve the dental health of Aboriginal children (PI: H. Lawrence) and an economic analysis of the costs and quality of life in prostate cancer survivors (PI: M. Krahn).

A sample of recent publications (2002-4) include:

Teaching and Supervisory Responsibilities

Dr. Laporte teaches Health Economics I (HAD5730) and Health Economics II (HAD5760), supervises Master's level students and is a thesis committee member for six doctoral students. She provides encouragement to students to prepare and submit conference abstracts and journal manuscripts. Under Dr. Laporte's mentorship, HPME students presented 4 papers at the CAHSPR conference in Montreal and five manuscripts based on their work are in preparation for journal submission.

Future Research and Training

Building on current research, Dr. Laporte is presently developing funding proposals to explore the operational efficiency and quality of care in Ontario's acute care hospitals, performance evaluation in home and community care and a comparative analysis of access to primary care services in the Canadian and US health care systems. More information on research programs Dr. Laporte is affiliated with can be found on the following websites: