Research

Primary Care Team Presents Study Findings

The Primary Care Practice Management and Performance Indicators Project research team presented study findings at two conferences in the Fall 2004:

• A paper entitled “What Needs Improvement – Performance or Performance Indicators: A Field Test of Family Practice Performance Indicators in Ontario Canada” was presented by Jan Barnsley (Principal Investigator) at the North American Primary Care Research Group 2004 Meeting in Orlando, Florida.
  
• A poster presentation entitled “Performance Indicators and Benchmarks in Primary Health Care Study” was presented by Judith MacPhail (Project Coordinator) at the Annual Nurse Practitioner Association of Ontario Conference held in Toronto, Ontario.

For more study progress reports, and the latest primary health care performance measurement news, please visit our website located at: www.utoronto.ca/hpme/primarycare/.

Ian Tannock Heads Practice-Changing Trial for Prostate Cancer

Dr. Ian Tannock, Professor in the Department of Medical Oncology and Hematology and cross-appointed to HPME, led an international study of a new treatment for hormone-resistant prostate cancer. Published in the October 7 issue of the New England Journal of Medicine, the study found that men with advanced, incurable prostate cancer can survive an average of three months longer and experience less symptoms when offered the new treatment. Over 1,000 patients in 24 countries participated. The study compared mortality, pain, quality of life and amount of cancer present in the body in patients receiving mitoxantrone, the standard chemotherapy treatment, with docetaxel.

"The new treatment of docetaxel results in many patients feeling better and living a few months longer," said Dr. Ian Tannock. "As a result, we are recommending docetaxel every three weeks with daily prednisone as the new standard of treatment for many patients with advanced hormone-refractory prostate cancer." In addition to his appointments with UofT, Dr. Tannock is a medical oncologist at Princess Margaret Hospital and senior scientist with Ontario Cancer Institute.

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 HMPE, faculty research profiles are a regular feature of the newsletter.

This issue of the HPME newsletter features a research profile for Pascale Lehoux.

+ + PROFILE OF THE MONTH + +

Pascale Lehoux, PhD, MScA

The department of HPME is pleased that Dr. Pascale Lehoux, Associate Professor with the Department of Health Administration at l'Université de Montréal, will be spending her 2004-2005 sabbatical as a Visiting Scholar. Dr. Lehoux has held a cross-appointment in HPME since 2003 and has been involved as an investigator in the Health Care, Technology and Place program (HCTP). Her primary research interests lie with Health Technology Assessment (HTA), the sociology of innovation, and knowledge utilization. During her eight-month tenure in the department, she will build links between HPME and the International Master's Program in Health Technology Assessment and Management (www.hta-master.com), maintain her collaboration with HCTP, and work on a book.

Education and Work Background

Dr. Lehoux obtained an MScA in Urban Planning in 1992 and a PhD in Public Health in 1996, both from l'Université de Montréal. She completed one post-doctoral fellowship at the University of Amsterdam (1997), a second at the Quebec Health Technology Assessment Council ( AETMIS ) (1998), and was appointed as a Researcher at the Department of Health Administration at l'Université de Montréal in 1998 before being promoted to Assistant Professor in 2001. Dr. Lehoux is a Researcher with the Groupe de Recherche Interdisciplinaire en Santé (GRIS) at l'Université de Montréal and a consultant researcher for the Quebec Health Services and Technology Assessment Council. She is the Canadian Coordinator of the International Master's Program in Health Technology Assessment and Management, a project involving five universities ( University of Montreal, McGill University, University of Ottawa, University of Barcelona, Catholic University of Rome) and five health technology assessment agencies in Canada and Europe. Dr. Lehoux is also a Board Member of the Canadian Association for Health Services and Policy Research (CAHSPR).

Research Activities

Dr. Lehoux's current research program seeks to contribute to the field of health technology assessment by improving the understanding of how knowledge and technology are currently employed, and by identifying ways to improve the use of health information and technology. To this end, she obtained a National Scholar Award from Health Canada 's National Health Research and Development Program (1998-2003) and a New Investigator Award from the CIHR Institute of Health Policy and Services Research (2003-2008).

Dr. Lehoux is currently the Principle or co-Investigator on grants totaling close to $3 million. As Principle Investigator, she is studying the utilization of health technology assessment and health services research by patient associations, medical specialists and the media; evaluating satellite and mobile hemodialysis units; and building research capacity in health technology assessment and management. Dr. Lehoux is a co-Investigator in the Health Care, Technology and Place program (PI: Peter Coyte) and in studies of health technology decision-making and the balanced integration of innovative surgical technologies.

In 2002, Dr. Lehoux completed an important piece of work for the Romanow Commission. It was published in 2004 as a chapter in The Governance of Health Care in Canada: The Romanow Papers Volume 3 . The paper develops the idea that a new way of regulating the design, management and use of technology has to be adopted. It analyses the tensions between the market value of technologies (i.e. their return once they are introduced on the market), their clinical value (what they allow clinicians to know and do) and their social value (the positive and negative changes they can bring). It also stresses the importance of creating “upstream” regulatory instruments in order to promote the marketing and utilization of technologies that more clearly contribute to the collective well-being. She was recently awarded a Canada Research Chair to further explore these issues (starting June 2005).

Dr. Lehoux has published more than 30 papers examining the use of computerized medical records, telemedicine, scientific knowledge, and home care equipment in journals such as Social Science and Medicine, the International Journal of Technology Assessment in Health Care, the Journal of Health Politics, Policy and Law and the Canadian Medical Association Journal.

Teaching and Supervisory Responsibilities

Dr. Lehoux has developed and taught five new graduate courses in the Department of Health Administration at l'Université de Montréal: Health Technology Assessment; Knowledge and Practice in Health Organizations (with Dr. Jean-Louis Denis); Ethical and Social Issues in Health Technology Assessment and Dissemination; Sociopolitical Dimensions of Health Technology; and Qualitative Research. She currently supervises 2 PhD students and 4 International Master's Program students as well as serving on thesis committees.

Future Research and Training

Dr. Lehoux's Canada Research Chair program is aiming to develop an in-depth understanding of the relationships between the opportunities and constraints that shape R&D processes (upstream), and the technical, clinical and organizational characteristics of technologies when introduced into the market (downstream). Underpinning this research program is the recognition that many choices that are made upstream: 1) largely determine the costs, the types of settings where technologies are used, and the levels of skills required to use them appropriately; and 2) that systematically examining them will open a unique and useful research avenue, since most industrialized countries are facing enormous challenges in terms of priority-setting due to the rising costs of health technologies.

The following specific research themes will be investigated over the next five years: Theme 1: Defining “best practices” in health technology design; Theme 2: Understanding the Canadian biomedical equipment market; Theme 3: Profiling health technology trajectories; and Transversal Theme: Bridging upstream and downstream perspectives. The pursuit of these research themes requires bringing together three main bodies of knowledge: sociology of science and technology, engineering design and HTA. It also calls for the development of collaborative relationships with designers, manufacturers, clinicians, patient associations, HTA producers and decision-makers from both the health and industry branches. Dr. Lehoux's dual training in industrial design and public health will enable her to conceptually articulate these bodies of literature and to navigate between the designer's and the technology user's perspective while contributing to health research.

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