|
Dana Farber/Harvard Cancer Center Community Practice Core - Linking investigators to real-life clinical settings for cancer research
Larissa Nekhlyudov
The Community Practice Core provides Dana Farber/Harvard Cancer Center investigators outside of the DACP an opportunity to conduct translational cancer research within the populations of Harvard Vanguard Medical Associates, Harvard Pilgrim Health Care and the Cancer Research Network, a consortium of 12 HMOs across the country with a membership of over 10 million enrollees. Through the Community Practice Core, researchers are able to conduct studies in real-life clinical settings with patients across all ages, ethnicities, risks and co-morbidities. This is especially well suited for research questions on primary and secondary prevention, risk communication, patient and clinician behavior change, quality of care and cost-effectiveness. The Community Practice Core is funded by the National Cancer Institute. Larissa Nekhlyudov is Director of the Core. Jane Cologiavanni provides staff support.
For an overview of the Cancer research programs at DACP please click here
HMO Research Network Center for Education and Research in Therapeutics (CERT) -
Richard Platt
DACP/HPHC leads the HMO Research Network Center for Education and Research on Therapeutics (CERTs), one of 11 centers created by Congressional mandate to serve as a trusted national resource regarding treatments with drugs, biological agents, and devices. The CERTs are administered by the U.S. Agency for Healthcare Research and Quality in conjunction with the Food and Drug Administration. They study a wide array of topics, ranging from drug safety and effectiveness to improving the ways drugs are used. Recent studies have evaluated trends in the use of prescription drugs during pregnancy and ways to improve long- term adherence to medical therapy.
The HMO Cancer Research Network - Using delivery systems to conduct population-based research on cancer
The HMO Cancer Research Network (CRN) includes 12 HMO members of the HMO Research Network, with a combined population of 10 million enrollees, funded by the National Cancer Institute (NCI). The CRN's mission is to perform research on cancer detection, prevention and treatment. CRN investigators collaborate on research that uses the geographically and ethnically diverse health plan populations, delivery systems, and data systems. They have conducted studies on topics ranging from increasing smoking cessation counseling to cancer care at the end of life. Ed Wagner, at Group Health Cooperative in Seattle is the overall principal investigator. Suzanne Fletcher is the HPHC site-Principal Investigator. Fourteen HPHC and HVMA personnel participate in the CRN. DACP's main local collaborations in this work include HPHC, Harvard Vanguard Medical Associates, and the Dana Farber / Harvard Cancer Center (DF/HCC). Larissa Nekhlyudov is Director of the DF/HCC community practice core and is the liaison between the CRN and the DF/HCC.
Click here to see selected CRN abstracts
Finding: Women who are active decision makers for preventive breast surgery are more satisfied but also have more concerns Larissa Nekhlyudov, Suzanne Fletcher and others evaluated the relationship between a woman's role in deciding to have her unaffected breast removed after cancer has been diagnosed in one breast (contralateral prophylactic mastectomy, or CPM*) and her postoperative level of satisfaction and concern. This Cancer Research Network study examined information provided by 431 women in six health plans who had undergone CPM. Women who took the lead in deciding for CPM were more likely to be satisfied with their decision than women who shared the decision-making with their clinicians. They were also more likely to continue to be concerned about breast cancer. Larissa believes it is important to understand better whether this persistent concern might be reduced if clinicians provide more information to women who are the lead decision makers.
* An earlier CRN study found this preventive surgery was highly effective in preventing cancer in the second breast. CPM is a consideration for 10,000-20,000 women in the US each year.
Click here to see citation and abstract
Medicines and Insurance Coverage (MedIC) Initiative - improving access to medications for poor populations around the world.
Dennis Ross-Degnan
Many countries still lack access to essential medicines to treat major illnesses, especially among the poor. The Medicines and Insurance Coverage (MedIC) Initiative is a new program that will help existing and expanding insurance programs in low and middle-income countries to develop policies that make medicines more available and more effectively used. These might include expanded coverage for important medicines, programs to improve quality of care for key illnesses, or better ability to track use of needed medicines by the poor. MedIC will form long-term partnerships with insurance organizations to support all stages of this process, from policy development to evaluation. Anita Wagner and Dennis Ross-Degnan lead this global initiative. Working with other DACP faculty and fellows, the World Health Organization's Medicines Program and Health Financing Programs, and Boston University's Center for International Health and Development (BUCIHD) , they will lend both technical and practical expertise to these efforts and develop the capacity of local policy-makers to identify which policies work best in specific environments. In 2004, in recognition of their longstanding work on pharmaceutical policy and use of medicines in developing countries, DACP and BUCIHD jointly became a WHO Collaborating Center in Pharmaceutical Policy.
The MedIC Initiative arose from the Second International Conference on Improving use of Medicines (ICIUM2004), which was led by several DACP faculty. That conference brought together experts from over 70 countries to devise strategies to promote appropriate use of essential medicines all over the world through large-scale and sustainable programs.
Finding: Prohibiting doctors from dispensing medication reduces inappropriate antibiotic use Sylvia Park, a former DACP Pharmaceutical Policy Fellow, Dennis Ross-Degnan, Steve Soumerai, Alyce Adams, and Jon Finkelstein collaborated on a study that found a Korean policy prohibiting doctors from dispensing medications reduced inappropriate antibiotic prescribing for viral illness. Before 2000, Korean doctors were able to dispense as well as prescribe medication, which offered a financial incentive for over-prescribing. Using data from the Korean National Health Insurance Corporation, the study team analyzed over 50,000 viral and bacterial illness visits in primary care clinics in Korea. After the policy was initiated antibiotic prescribing decreased by 8% for viral illness, but by less than 2% for bacterial illness. Non-antibiotic drugs were also prescribed less under this policy.
Click here to see citation and abstract
WHO Collaborating Center for Pharmaceutical Policy: Improving pharmaceutical policy in developing nations
Dennis-Ross Degnan
The Drug Policy Research Group (DPRG) within the Department of Ambulatory Care and Prevention (DACP), in association with the Center for International Health and Development (CIHD) at Boston University, has been designated as a World Health Organization (WHO) Collaborating Center in Pharmaceutical Policy (CCPP). Dennis Ross-Degnan, ScD, who leads DPRG's international work, co-directs the Center with Jon Simon, ScD at CIHD. These organizations have worked extensively with the WHO Dept. of Medicines Policy and Standards and Dept. of Technical Cooperation for Essential Drugs and Traditional Medicine for over two decades. Their cooperative endeavors have included training and research intended to improve access to and use of essential medicines. This work is particularly crucial since more than one-third of the world's population currently lacks access to high quality, affordable essential medicines. The CCPP's work is aligned with several of DACP's core themes involving evidence-based approaches to health; improving medical care for disadvantaged and high-risk populations; and promoting innovative health education and health care quality improvement.
The CCPP trains international fellows in pharmaceutical policy research; works with WHO and other international partners on joint research to improve use of medicines; develops, tests, and disseminates innovative approaches to medicine-related policy and behavior change; and provides a global forum for exchanging research results and identifying new issues in the field. One priority activity of the CCPP is to lead a global initiative on Medicines and Insurance Coverage (MedIC) following the recommendation of the 2004 International Conference on Improving Use of Medicines. The goal of MedIC is to improve health in developing and transitional countries by expanding access to and improving use of medicines in health insurance programs. MedIC activities include technical cooperation with individual insurance systems in policy research, development of medicines-related performance standards, building human capacity in insurance systems through longitudinal training programs, and facilitating regional networking and sharing of experience. Dennis Ross-Degnan leads this program. Click here for other DACP faculty and staff members who participate in this program (Anita Wagner, Stephen Soumerai, Alyce Adams, Jeanne Madden, Mai Manchanda, Fang Zhang, Robert LeCates, Joyce Cheatham, Ann Payson)
National Bioterrorism Syndromic Surveillance Demonstration Program:
Richard Platt
|
