Chronic disease
The increasing incidence of diabetes, chronic kidney disease, high blood pressure, and vascular disease is a sign of what many health observers are calling a "quiet epidemic" of non-communicable chronic diseases in developed countries. These chronic diseases commonly occur together and predispose people to more serious cardiovascular conditions such as heart attack and stroke. Although chronic diseases don't get the same attention as cardiovascular conditions and major infectious diseases, they are leading causes of death and disability worldwide, not to mention a huge drain on national economies and family incomes.
"This situation with chronic diseases isn't new, and governments and healthcare organizations have put a lot of time and effort into trying to improve how they manage chronic diseases," notes Dr. Braden Manns, who researches health economics at the University of Calgary. "However, it's fair to say that progress has been slow."
The Interdisciplinary Chronic Disease Collaboration plans to look at chronic diseases from a broader perspective. "Many researchers have investigated such underlying risk factors for chronic diseases as obesity, smoking, and lack of exercise. As a result, we have a lot of tools to manage people with chronic diseases—we should be doing a lot better than we actually do. We don't necessarily need another discovery from basic research; rather we need to understand the barriers that prevent people from better managing their health. And that requires studies that address the root causes of these risk factors. For example, we need to look at economic factors, the social environment, geography, education, and more. This is what our group aims to do."
The first phase of the research will involve analyzing existing administrative and laboratory data collected on all patients in Alberta. Working with this data, the team will gather information about the prevalence of various diseases in certain areas, for instance, or how different medications are prescribed in urban and rural regions. The main objective in this phase is to identify where changes in health or public policy could most improve the health of Albertans. In the second phase, the team will use surveys to get a more detailed picture of people with known chronic diseases. "The exciting thing here is that we will be able to look more closely at root causes," says Dr. Manns. "For example, what is it about certain patients that makes their blood pressure difficult to control? Is the medication too expensive? Are their diets unhealthy? Are they unemployed? We'll be able to look beyond medical factors."
In the third phase, the researchers will test new ways to overcome the most significant barriers to better care of chronic diseases. One such study is already underway in rural Alberta. Patients with high blood pressure were assigned to one of two groups: one group is prescribed blood pressure medication by a pharmacist, the other group by a physician. The researchers want to find out whether having a pharmacist prescribe drugs—compared to having a physician prescribe the same drugs—makes a difference in controlling blood pressure. Although pharmacists in Alberta are now authorized to prescribe some drugs, Dr. Manns notes that few of them do. "And yet prescribing by pharmacists has the potential to address the gap in access to certain healthcare services in rural areas. We need to figure out how to make this service more successful."
Dr. Manns, is one of the team's three principal investigators; the others are AHFMR Population Health Investigator Dr. Brenda Hemmelgarn, from the University of Calgary, and AHFMR Health Scholar Dr. Marcello Tonelli, from the University of Alberta. All three are nephrologists (doctors who treat people with kidney problems) and collaborators in the Alberta Kidney Disease Network. As Dr. Manns says, "Moving beyond nephrology is a stretch for us but that's the beauty of the team. We've assembled a group of experts that will allow us to make an impact beyond nephrology." The team comprises 23 researchers, clinicians, and decision-makers from the University of Calgary, the University of Alberta, the University of Toronto, Queen's University, the University of Aberdeen, Alberta Health Services, the Canadian Agency for Drugs and Technologies in Health, Statistics Canada, and the University of Alberta Hospital.
Including decision-makers in the team is vital to better translating research findings into health policy and planning. In the long term, Dr. Manns envisions the team as a resource for Alberta Health and Wellness. "I hope we can develop a two-way relationship with policy-makers, where they forecast to us the types of policy changes they are considering, and we provide data to inform policy. In this way, we can prevent situations where new programs are implemented without incorporating the best evidence, or where marginally effective programs continue for years without any evaluation of their impact on health outcomes or costs. By getting information to the policy-makers, better decisions can be made."