Research

HPME Researchers Report to Romanow Commission

Several HPME researchers have contributed reports to the Romanow Commission. Colleen Flood and Sujit Choudry, both cross-appointed to HPME and members of the Faculty of Law, co-authored a report for the Romanow Commission calling for several changes to the Canada Health Act and warning of "passive privatization". The Flood/Choudry report recommends that:

• the Act be expanded into diagnostic services
• separate legislation be introduced for universal coverage for prescription drugs and home care
• the federal government acknowledge the Act does not preclude for-profit firms from delivering services if they are 100% publicly funded
• the difference between the delivery of health care and the funding of health care be highlighted
• the definition of "reasonable access" in the Act be expanded to include the concept of timely access.

Raisa Deber, HPME Professor, prepared a report for the Romanow Commission to identify the appropriate role for private delivery within Canada's health care system. The report reveals that the majority of all health care delivered in Canada is already privatized. Dr. Deber was referring to the large number of physicians who are paid from the public sector but are, in fact, operating private companies. The report concludes that:

• Comparisons of public, not-for-profit and for-profit services are difficult, but not impossible
• Competition and cooperation must be balanced to ensure coordination across health care providers
• Measuring and monitoring of performance is essential, particularly in contracting arrangements
• Measuring and monitoring performance can be costly and difficult
• Changing delivery structures also changes power relationships and, hence, how resources are allocated
• Experiments should not be irreversible, particularly given international trade agreements
• Health human resources issues must be addressed
• For-profit delivery requires predictable revenue streams
• Barriers to meeting patient demands must be immediately addressed.

Both documents, with 38 other studies commissioned from Canadians researchers, will be incorporated into the Romanow report to be released in the Fall of 2002. All reports are available on the Romanow Commission website.

Recommended Clinical Practice Guidelines

The Ontario Guidelines Advisory Committee (GAC) invites you to visit their newly updated website (www.gacguidelines.ca) to search for recommended guidelines on common medical conditions by keyword or guideline title. Formed in 1997 and chaired by Dr. Dave Davis, HPME Professor and Associate Dean of Continuing Education at the University of Toronto, the Guideline Advisory Committee (GAC) is a joint body of the Ontario Medical Association and the Ontario Ministry of Health and Long-Term Care with additional ex-officio representation from the Institute for Clinical Evaluative Sciences in Ontario. The GAC assesses the clinical relevance of existing clinical practice guidelines and the rigour of the process used by guideline developers according to the AGREE instrument, then prepares summaries of the guideline recommendations which are available on the GAC website.

Guidelines are independently assessed a minimum of three times by trained teams of Family and Community Medicine residents at the University of Toronto and groups of community based physicians in active medical practice across the province. The Guideline Advisory Committee invites physicians to become guideline assessors in a number of clinical areas. Workshops on reviewing clinical practice guidelines will be held in Toronto, London and Sudbury throughout September and October. More details are available on the website.

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 research profiles for the joint recipients of the Eugenie Stuart Award for Best Instructor, decided on the basis of student evaluations and contribution to the Department's teaching programs, bestowed at the Annual Student Research Day on May 1, 2002.

• Gillian Hawker is an Associate Professor in HPME, Director of the Osteoporosis Research Program at the Sunnybrook and Women's College Health Sciences Centre, and holds several additional research appointments. Her research focuses on clinical and health services research in osteoporosis and osteoarthritis.
  
  
• Mary Hannah is a Professor in HPME and Director and Scientist at the University of Toronto’s Maternal, Infant and Reproductive Health Research Unit (MIRU) at the Centre for Research in Women’s Health. Her research involves the study of obstetrics, labour and delivery, and multicentre clinical trials to investigate the care of childbearing women and reproductive health.
  
  

+ + PROFILES OF THE MONTH + +

Gillian Hawker, MD, MSc

Dr. Hawker is an Associate Professor in the Department of Medicine, University of Toronto and the Director of the Clinical Epidemiology and Health Care Research Program, Department of Health Policy Management and Evaluation, University of Toronto. Her research focus in arthritis is on reducing disparity in provision of health care to individuals with osteoarthritis living in the community. Her research focus in osteoporosis is on determinants of attainment and maintenance of peak bone mass in young women and health services research in osteoporosis.

Education and Work Background

Dr. Hawker acquired her M.D. from the University of Toronto in 1984. In 1995 she became a Medical Research Council of Canada Scholar. She was presented with the Young Investigator Award by the Canadian Rheumatology Association in 1998 and then became a Medical Research Council of Canada Scientist in 2000. Dr. Hawker is a Staff Rheumatologist at the Women's College Campus of Sunnybrook and Women's College Health Sciences Centre, where she is also Director of the Osteoporosis Research Program. In 2001 she was appointed the FM Hill Professor in Academic Women's Medicine.

Dr. Hawker conducts research with the Centre for Research in Women's Health, a joint initiative of Sunnybrook and Women's College Health Sciences Centre and the University of Toronto, as a Senior Investigator with the Arthritis Community Research and Evaluation Unit at The Toronto Hospital Research Institute and as a Senior Adjunct Scientist at the Institute for Clinical and Evaluative Sciences. She is a member of the Scientific Advisory Board of the Arthritis Society of Canada and has served on many operating and salary grant review panels. This past year, she chaired the Health Research Training Grant Review Panel of the Canadian Institute for Health Research (CIHR) and of the Epidemiology and Healthcare Outcomes Review Panel for the Arthritis Society of Canada.

Research Activities

Dr. Hawker's current research in osteoporosis includes a study funded by CIHR to examine the unique contributions of body composition, diet and exercise profiles, and menstrual function to the attainment and maintenance of peak bone mass in a group of over 250 premenopausal women between the ages of 21 to 38 years of age. Her research in the area of arthritis includes a study also funded by CIHR to investigate the determinants of arthritis disability and time to total joint replacement in a population-based cohort of individuals with arthritis.

Teaching and Supervisory Responsibilities

Dr. Hawker currently supervises three Masters and three Ph.D. students. Her teaching activities include undergraduate and postgraduate medical education as well as graduate teaching in clinical epidemiology in the department of HPME.

Future Research

Future research in arthritis will examine disparity in access to total joint arthroplasty of the hip and knee and determinants of arthritis disabilities among individuals with hip and knee osteoarthritis in a population-based cohort in the United States.

+ + + + +

Mary Hannah

Mary Hannah is Director and Scientist at the University of Toronto's Maternal, Infant and Reproductive Health Research Unit (MIRU) at the Centre for Research in Women's Health, located on the Women's College Campus of the Sunnybrook and Women's College Health Sciences Centre. Her combined expertise in obstetrics, labour and delivery, and multicentre clinical trials guides MIRU's involvement in international studies designed to answer important questions about the care of childbearing women and reproductive health care.

Education and Work Background

Mary Hannah obtained a BSc in chemistry and mathematics and an MDCM degree from McGill University in Montreal, with professional qualifications in obstetrics and gynaecology. She then completed an MSc in Clinical Epidemiology and Biostatistics from McMaster University in Hamilton. In addition to holding the position of Professor in HPME, she is a Professor in the Departments of Obstetrics and Gynaecology, Paediatrics, and in Public Health Sciences. Dr. Hannah also maintains an active appointment in Obstetrics and Gynaecology at Sunnybrook and Women's College Health Sciences Centre.

Research Activities

Mary Hannah has published extensively and is a Senior Scientist with funding from the CIHR. Her current largest research project (with Hilary Whyte) is a multicentre international randomised controlled trial to determine the effect of cesarean section as a method of delivery for the fetus in breech presentation, which is now following mothers and babies for two years following delivery. Two of her graduate students are leading CIHR funded projects on the timing of external cephalic version for breech presentation pregnancies (Eileen Hutton), and on the effect of exercise and diet for women with polycystic ovary syndrome (Sheila Laredo). Through close collaboration with other young investigators, she contributes to several other large MIRU - coordinated multicentre studies: the comparison of multiple versus single courses of antenatal corticosteroids for preterm birth (Principal Investigator: Kellie Murphy); the assessment of a policy of cesarean section as a method of delivery for twins in which twin A is presenting head first (Principal Investigator: Jon Barrett); and the evaluation of different target levels of blood pressure for women with hypertension in pregnancy (Principal Investigator: Laura Magee).

Additional professional activities include appointments to the editorial boards of the American Journal of Obstetrics and Gynecology, Evidence Based Obstetrics and Gynecology, American Journal of Perinatology, Obstetrical and Gynecological Survey, and Journal of the Society of Obstetricians and Gynaecologists of Canada. Dr. Hannah serves on several committees at the Centre for Research in Women's Health and the University of Toronto, the Clinical Trials Committee at the CIHR, the Research Committee for the Association of Professors of Obstetrics and Gynaecology, and the FIGO Expert Advisory Panel on Maternal and Perinatal Health and Obstetrics.

Teaching and Supervisory Responsibilities

Dr. Hannah is currently supervising two MSc and two PhD students. She has also served on several thesis committees and has supervised many medical residents on research rotation. She currently teaches two courses on clinical epidemiology and controlled clinical trials in the Department of Public Health Sciences.

Future Research

Future research will continue to focus on answering important clinical questions related to the reproductive health of women and their infants, using large, rigorously designed randomised controlled trials.

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