Research

RCT Results Garner NEJM Editorial

Local members of the International Natalizumab Multiple Sclerosis Trial Group, led by Paul O'Connor, HPME Associate Professor, recently published the results of a randomized controlled trial in the New England Journal of Medicine (2003; 348: 15-23). Dr. O'Connor is also Co-ordinator of the University of Toronto MS Program and Chief of the Division of Neurology at St. Michael's Hospital. His research focuses on clinical trials involving multiple sclerosis.

Patients in the group treated with natalizumab had significantly fewer inflammatory brain lesions (mean 9.6 lesions per patient in the placebo group versus 0.7 lesions per patient in the treatment group, p<0.001) and fewer relapses (27 patients relapsed in the placebo group versus 13 in the treatment group, p=0.02) over a six-month period compared with patients in the placebo group.

The results were highlighted in an editorial within the same issue of the journal examining the use of this drug as a potential new treatment for autoimmune diseases including MS and Crohn's diesease.

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 organizations. Success of the HPME Knowledge Transfer initiative is dependent on presenting our stakeholders with a unified, clear image of the depth and breadth of Departmental expertise. To promote greater internal awareness of the knowledge developed through HPME, faculty research profiles will be included as a regular feature of this newsletter.

This issue of the HPME newsletter features a research profile for:

• Paul Williams, an Associate Professor in HPME, Adjunct Research Scientist at the Hospital for Sick Children Research Institute, and consultant for the Canadian International Scientific Exchange Program. His research focuses on the public-private mix in the funding and delivery of home care, long-term care and community-based services.
  
  

+ + PROFILE OF THE MONTH + +

A. Paul Williams, PhD

Paul Williams is an Associate Professor in HPME. His teaching and research focus on Canadian health policy and health care systems, with particular emphasis on the public-private mix in the funding and delivery of home care, long-term care and community-based services.

Education and Work Background

Dr. Williams obtained a PhD in political science from York University in Toronto with the benefit of doctoral fellowships from the Social Sciences and Humanities Research Council of Canada (SSHRCC). Following a stint as Research Fellow at York University's Institute for Social Research, he completed an SSHRC Post-Doctoral Fellowship with HPME (then Health Administration). Before joining HPME in 1993, he was founding Director of the undergraduate degree program in Health Services Management at Ryerson University.

In addition to his HPME faculty position, Dr. Williams is an Adjunct Research Scientist at the Hospital for Sick Children Research Institute and consultant for the Canadian International Scientific Exchange Program (CISEPO) based at the University of Toronto and Mount Sinai Hospital. He maintains cross-appointments with the University of Toronto Collaborative Program in Aging and the Life Course, and the Institute of Medical Science.

Internationally, Dr. Williams has been a visiting professor at De Montfort University (United Kingdom), Al Quds University (Palestinian Authority), and the Academy of Public Administration (Office of the President of Ukraine). Closer to home, he is actively involved with local planning bodies and community service agencies.

Research Activities

Dr. Williams currently leads a number of multi-year, multi-disciplinary research projects examining the implications for consumers, providers and governments of ongoing health system restructuring initiatives which shift care from hospitals to home and community.

One current project (funded by the Hospital for Sick Children Research Institute) assesses home care services for children with long-term care needs; another (funded by SSHRC) investigates the role played by voluntary, community-based service agencies in meeting health and social needs "downloaded" from other parts of the health care system; a third project (also funded by SSHRC) looks at rehabilitation services and the rehabilitation professions as more care shifts out of hospitals and out of public coverage. Other ongoing projects examine home care resources allocation in the Maritime provinces and hospital involvement in community action. Dr. Williams is Co-Director of the M-THAC (From Medicare to Home and Community) Research Unit, a research infrastructure initiative based in HPME.

Teaching and Supervisory Responsibilities

Dr. Williams currently supervises seven MSc/PhD students. He teaches graduate courses (HAD 5010/5011 and HAD 5020) which develop a policy analysis "toolkit" to critically analyze key issues and trends in Canada's health care system including changes in the public-private mix, the roles of doctors and hospitals, and the shift toward home and community care.

Future Research

Key research directions include: elaboration of a model of community capacity which estimates the variable impact on different needs groups (e.g. children and ethno-racial minorities) of policy changes affecting the funding and delivery of health and social services; and continuing exploration of the politics of the health care professions and their responses to health system restructuring initiatives.

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