CIHR Institute of Health Services and Policy Research (IHSPR) Fellowship - Winter 2009 Priority Announcement

The Ontario Ministry of Health and Long-Term Care (MOHLTC) in partnerships with the CIHR Institute of Health Services and Policy Research (CIHR-IHSPR) will fund applications that are determined to be relevant to the research priority area described below:

For more information on the research priorities of the IHSPR and the December 2008 Funding Opportunities please visit the Funding Opportunity Database.

Please select the following link to go back to the Fellowship: Priority Announcement (Specific Research Areas).

CIHR's contribution to these initiatives is subject to availability of funds voted annually to CIHR by parliamentary appropriations, and the conditions that may be attached to them.

1. Ontario Drug Policy (CIHR/Ontario Ministry of Health and Long-Term Care)

IHSPR has identified drug policy as a priority research area. Prescription medications are a vital part of the Canadian health care system. They save lives, treat diseases and improve the quality of life for many. As well as improving lives, in some cases drugs may ease the burden on the healthcare system by reducing hospital stays. However, prescription drug use presents several challenges to the health care system. For example, drugs are the fastest growing and second largest category of health care expenditures in Canada, they are sometimes used inappropriately, and there can be poor adherence to drug therapy. Governments across Canada are endeavouring to address the challenges and ensure both good health outcomes and system sustainability.

To inform evidence-based policy making, improved "real-world," population-based evidence is needed on the impact of drug utilization on costs and outcomes. Greater evidence is required with regard to the impact of the use of new drugs (those recently approved for marketing and sale) on both patient and health system outcomes related to the treatment of a particular condition within a patient population. Innovative methodologies are needed to conduct such evaluations and greater use of public, administrative and private data sources is required.

The CIHR Institute of Health Services and Policy Research, in partnership with the Ontario Public Drug Programs (OPDP) of the Ontario Ministry of Health and Long Term Care, will support up to four (4) Fellowships in Drug Policy. The OPDP is funding these Fellowships through the Drug Innovation Fund, a key initiative of the Ontario Government's plan to reform the provincial drug system. The OPDP's main area of interest is the impact of drugs on health outcomes, non-drug health system outcomes and costs. Areas of focus could include:

Impact of Drug Access and Utilization

  • Assess the association between the use of drugs, and health and health system outcomes (including non-drug expenditures)
  • Assess the impact of the use of newer drugs (for a particular health condition) on:
    • patient health outcomes (e.g., reduced risk of complications, improved survival)
    • health system outcomes (e.g., inpatient hospital stays, ambulatory care, home care and associated costs)
    • cost (i.e., the impact on the overall cost of treating a given disease)
    • cost effectiveness/cost benefit (i.e., a comparison of drug costs to outcomes or potential cost savings in other parts of the healthcare system)
  • Assess the relationship between the number of drugs a patient has access to and drug age (the length of time a drug has been on the market since approval) on health outcomes and other (non-drug) health expenditures, including hospital costs
  • Evaluate health outcomes and costs among those with differential access to newer drugs through private and public drug plans or for those with no drug coverage

Optimal Use of Drugs

  • Determine the factors that impact on safe, appropriate, and effective drug use
  • Assess the infrastructure and organizational influences on optimal drug use
  • Determine effective ways to improve prescribing and patient safety related to prescription drugs, including physical, procedural, behavioural, technical and system innovations
  • Develop methods for uptake of best practices among healthcare providers
  • Identify key sources of influence in patients' decisions to seek a prescription drug, including the influence of direct marketing efforts such as direct-to-consumer advertising, toll-free lines, patient forums and patient support groups, free equipment (pens, monitoring devices, etc.), third-party support for accessing public or private coverage, etc.
  • Assess the impact of disease management programs (e.g., for asthma, hypertension or diabetes) and/or direct pharmacist involvement in drug therapy on patient and system outcomes and other (non-drug) expenditures

Drug Adherence

  • Evaluate adherence among those with differential access to prescription medications
  • Assess the impact of financial barriers on drug adherence
  • Assess the impact of drug non-adherence on healthcare costs and health outcomes - including disease-related work-day absences and disabilities - and on other healthcare-related expenditures
  • Assess the causes of poor adherence in the treatment of chronic conditions, including the impact of limited access to certain drugs, side effects, and ineffective therapy

Funding for these Fellowships is provided by the Ontario Public Drug Programs (OPDP), Ontario Ministry of Health and Long-Term Care. The OPDP's objectives and mandate are listed in the Description of Partners section below.

Specific requirements that relate to this funding opportunity are:

  • Since funding is provided by Ontario's Drug Innovation Fund, this specific funding opportunity is only open to candidates from universities or affiliated institutions in Ontario.
  • The successful applicant and the host institution must work with the Ministry to ensure that its reporting requirements are met.
  • The successful applicant's university must provide financial reports on a quarterly basis to the Research Unit at the MOHLTC using the Ministry's template.
  • The interim and final reports required by CIHR must also be submitted to the Research Unit at the MOHLTC.
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Description of Partners

Ontario Ministry of Health and Long-term Care - Ontario Public Drug Programs (OPDP): Through the Transparent Drug System for Patients Act (formerly known as Bill 102), the Ontario Government has committed to provide annual funding for innovative health system research through the establishment of the Drug Innovation Fund. Short-term and multi-year funding will be provided to eligible researchers and organizations in Ontario to support evidence-based research on the impact of drugs on patient outcomes and health system outcomes (including non-drug expenditures) in Ontario in order to support drug policy decision making in the province. Capacity building and knowledge transfer are also important objectives of the Fund. The mandate of the funding program is to:

  • generate strong, high-quality, independent scientific evidence on the impact and value of new and existing drugs across the healthcare system, by linking drug interventions to health or system outcomes
  • support linkages between researchers, clinicians and drug policy decision makers to ensure the timely and effective application of relevant evidence-based scientific information and to support the objectives and priorities of Ontario's Public Drug Programs
  • support and develop research capacity in the area of drugs and health outcomes in Ontario

CIHR Institute of Health Services and Policy Research (IHSPR) Fellowship - Fall 2007 Priority Announcement (Archive)

The CIHR Institute of Health Services and Policy Research (IHSPR) will fund applications that are determined to be relevant to the research priority areas described below. In the area of Drug Policy, the Ontario Ministry of Health and Long-Term Care (MOHLTC) will fund applications that are determined to be relevant to the specified research priority areas. Separate funding pools will be established to ensure that at least one meritorious application (top-ranked and deemed relevant by the funding partners) is funded in each of the four areas listed below:

  1. Ontario Drug Policy (CIHR/Ontario MOHLTC)
  2. Public Involvement/Citizen Engagement (CIHR)
  3. Chronic Disease Prevention and Management (CIHR)
  4. Listening for Direction III Theme Areas (CIHR)

For more information on the research priorities of the IHSPR and the July 2007 Funding Opportunities please visit the IHSPR Website.

Please select the following link to go back to the Fellowship: Priority Announcement (Specific Research Areas).

CIHR's contribution to these initiatives is subject to availability of funds voted annually to CIHR by parliamentary appropriations, and the conditions that may be attached to them.

1. Ontario Drug Policy (CIHR/Ontario Ministry of Health and Long-Term Care)

IHSPR has identified drug policy as a priority research area. Prescription medications are a vital part of the Canadian health care system. They save lives, treat diseases and improve the quality of life for many. As well as improving lives, in some cases drugs may ease the burden on the healthcare system by reducing hospital stays. However, prescription drug use presents several challenges to the health care system. For example, drugs are the fastest growing and second largest category of health care expenditures in Canada, they are sometimes used inappropriately, and there can be poor adherence to drug therapy. Governments across Canada are endeavouring to address the challenges and ensure both good health outcomes and system sustainability.

To inform evidence-based policy making, improved "real-world," population-based evidence is needed on the impact of drug utilization on costs and outcomes. Greater evidence is required with regard to the impact of the use of new drugs (those recently approved for marketing and sale) on both patient and health system outcomes related to the treatment of a particular condition within a patient population. Innovative methodologies are needed to conduct such evaluations and greater use of public, administrative and private data sources is required.

The CIHR Institute of Health Services and Policy Research, in partnership with the Drug System Secretariat of the Ontario Ministry of Health and Long Term Care, will support up to four (4) Fellowships in Drug Policy. The Drug System Secretariat is funding these Fellowships through the Drug Innovation Fund, a key initiative of the Ontario Government's plan to reform the provincial drug system. The Secretariat's main area of interest is the impact of drugs on health outcomes, non-drug health system outcomes and costs. Areas of focus could include:

Impact of Drug Access and Utilization

  • Assess the association between the use of drugs, and health and health system outcomes (including non-drug expenditures)
  • Assess the impact of the use of newer drugs (for a particular health condition) on:
    • patient health outcomes (e.g., reduced risk of complications, improved survival)
    • health system outcomes (e.g., inpatient hospital stays, ambulatory care, home care and associated costs)
    • cost (i.e., the impact on the overall cost of treating a given disease)
    • cost effectiveness/cost benefit (i.e., a comparison of drug costs to outcomes or potential cost savings in other parts of the healthcare system)
  • Assess the relationship between the number of drugs a patient has access to and drug age (the length of time a drug has been on the market since approval) on health outcomes and other (non-drug) health expenditures, including hospital costs
  • Evaluate health outcomes and costs among those with differential access to newer drugs through private and public drug plans or for those with no drug coverage

Optimal Use of Drugs

  • Determine the factors that impact on safe, appropriate, and effective drug use
  • Assess the infrastructure and organizational influences on optimal drug use
  • Determine effective ways to improve prescribing and patient safety related to prescription drugs, including physical, procedural, behavioural, technical and system innovations
  • Develop methods for uptake of best practices among healthcare providers
  • Identify key sources of influence in patients' decisions to seek a prescription drug, including the influence of direct marketing efforts such as direct-to-consumer advertising, toll-free lines, patient forums and patient support groups, free equipment (pens, monitoring devices, etc.), third-party support for accessing public or private coverage, etc.
  • Assess the impact of disease management programs (e.g., for asthma, hypertension or diabetes) and/or direct pharmacist involvement in drug therapy on patient and system outcomes and other (non-drug) expenditures

Drug Adherence

  • Evaluate adherence among those with differential access to prescription medications
  • Assess the impact of financial barriers on drug adherence
  • Assess the impact of drug non-adherence on healthcare costs and health outcomes - including disease-related work-day absences and disabilities - and on other healthcare-related expenditures
  • Assess the causes of poor adherence in the treatment of chronic conditions, including the impact of limited access to certain drugs, side effects, and ineffective therapy

Funding for these Fellowships is provided by the Drug System Secretariat, Ontario Ministry of Health and Long-Term Care. The Secretariat's objectives and mandate are listed in the Description of Partners section below.

Specific requirements that relate to this funding opportunity are:

  • Since funding is provided by Ontario's Drug Innovation Fund, this specific funding opportunity is only open to candidates from universities or affiliated institutions in Ontario.
  • The successful applicant and the host institution must work with the Ministry to ensure that its reporting requirements are met.
  • The successful applicant's university must provide financial reports on a quarterly basis to the Research Unit at the MOHLTC using the Ministry's template.
  • The interim and final reports required by CIHR must also be submitted to the Research Unit at the MOHLTC.

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2. Public Involvement/Citizen Engagement (CIHR)

The amount that Canada allocates towards the provision of health care services and treatments demonstrates the value placed on health and well-being. Limited health care budgets and competing demands for resources, however, constrain the ability of decision makers to provide public coverage for all potentially effective treatments and services. Thus, healthcare decision makers must often make difficult resource allocation decisions that fall under close public scrutiny and can quickly become highly politicized. These decisions affect the lives of Canadians, and they are becoming increasingly interested in participating in the decision-making processes that directly affect their health (at the micro or individual level with their own care, including chronic disease management and end-of-life care, at the provincial level with drug formulary decision-making committees and primary care reform initiatives; and at the macro or national level with such processes as the Western Canada Wait List Project). Rigorous research that examines frameworks and strategies for engaging/involving the public in health care decision-making processes, and that produces evidence that can be used by decision makers, is needed.

Questions that arise when considering the role for public participation/citizen engagement include: Who is the public? What is the underlying rationale for involving the public? Is there a legitimate role for the public? How can we engage the public (i.e., in which processes, at what stages, and through what mechanisms)? Do the approaches for involving the public differ depending on the context or issue at hand? How can the impact of public participation in health care decision-making be evaluated?

The CIHR Institute of Health Services and Policy Research will fund a Fellowship in Public Involvement and Citizen Engagement. Potential areas of research include:

  • Evaluating alternative ways to engage the public and consumers in effective and informed decision-making processes
  • Developing and evaluating a framework or model for improving public participation into health policy formulation (and health technology assessment processes) that clearly delineates the roles and responsibilities of the public and that considers process and result outcomes
  • Evaluating the impact of increased publicity of the rationale behind health care priority setting and resource allocation decisions
  • Evaluating the linkages between public involvement/citizen engagement and quality health care and health care outcomes
  • Cross-country comparative analyses of frameworks for involving the public in health care decision-making processes in order to identify best practices
  • Assessing the levels of familiarity among the public with well-understood evidence-based facts about the safety, effectiveness and cost-effectiveness of health care alternatives
  • Assessing the impact of enhanced public participation on government accountability
  • Identifying the key sources of influence in patients' decisions to seek care including, the influence of efforts such as direct-to-consumer advertising, toll-free lines, patient forums and patient support groups, and the media

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3. Chronic Disease Prevention and Management (CIHR)

Chronic diseases are the leading causes of death in Canada. They contribute greatly to the burden of illness and the ensuing social and economic costs (approximately $80 billion annually), and negatively impact on quality of life of Canadians. The healthcare system was designed to manage acute, not chronic illness, and a physician rather than system focus has led to a lack of integrated and coordinated care, and competing, disparate chronic disease management initiatives. Given the health and economic effects of chronic diseases across the country, coupled with an ageing population, research focus on best practices for chronic disease management is warranted.

Effective "chronic disease management programs offer systematic care for the chronically ill, through assessment, diagnosis, treatment, education and follow-up. They can improve the quality of life of those affected…and help sustain the health care system by reducing demand for acute care and acting as a link between primary and secondary care" (Wong et al. 2004). The essential components of chronic disease management programs are: leadership, financial support, patient and physician involvement, partnerships among organizations, good information technology, regular evaluation and incentives for following best practice guidelines. A delivery system that provides effective chronic disease prevention and management would focus on prevention (of disease initiation and progression), access and continuity of care, and the seamless movement of people through the system. Patients would have access to providers with appropriate expertise, a care plan that reflects their unique needs and self-management training and support.

An effective healthcare system also provides support to its healthcare providers in terms of education and training about evidence-based best practices in chronic disease prevention and management, clinical management tools (like practice guidelines and case management programs), access to specialist expertise and feedback about their performance. It is also important that information about best practices and effective interventions flows to the providers, patients, community members and policy makers who need it to support their decision making through common information technologies. In addition to breaking down silos between services and providers, effective chronic disease interventions must break down and cross the boundaries between disease-specific approaches to build on the commonalities and knowledge base, and bridge the gap between prevention and treatment. As well, commonalities among chronic diseases and best practices need to be adequately documented and disseminated, and evidence from the multitude of chronic disease initiatives throughout Canada and internationally synthesized.

The CIHR Institute of Health Services and Policy Research will fund a Fellowship in Chronic Disease Prevention and Management. The following are possible areas of investigation:

  • Evaluation of the effectiveness of coordination and delivery processes associated with various chronic disease prevention and management models
  • Evaluation of the impact on quality of care, health and quality of life outcomes of the various delivery models of chronic disease prevention and management
  • Assessment of the impact of team-based approaches and team composition on quality of care, health outcomes and overall quality of life
  • Determination of the critical success factors and health professionals' requirements for effective chronic disease prevention and management teams
  • Documentation of the information critical to supporting and facilitating effective chronic disease prevention and management programs (e.g., clinical guidelines, clinical indicators, prompts, reminders and warnings of potential adverse events)
  • Investigation of the prerequisites for effective patient education and self-management programs
  • Determination of the support to team members necessary to ensure effective delivery of integrated, quality care for chronic diseases
  • Identification of effective ways to integrate primary prevention with secondary and tertiary prevention and management strategies
  • Appraisal of incentive models (e.g., funding models that promote teamwork, or that are based on performance) that could improve the quality and coordination of care
  • Assessment of the regulatory requirements (public and private) that promote or limit the delivery of interdisciplinary, coordinated, quality care

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4. Listening for Direction III Theme Areas (CIHR)

CIHR Institute of Health Services and Policy Research will support up to three Fellows conducting work in any of the national priority areas identified in the Listening for Direction III (LfD III) national consultations. At the time of writing, the LfD III theme areas have not been finalized. A draft list of themes can be found online and the final list will be included as soon as possible. Applicants will not be penalized for working from the draft as opposed to the final consultation document.

Please select the following link to go back to the Fellowship: Priority Announcement (Specific Research Areas).

Description of Partners

Ontario Ministry of Health and Long-Term Care - Drug System Secretariat. Through the Transparent Drug System for Patients Act (formerly known as Bill 102), the Ontario Government has committed to provide annual funding for innovative health system research through the establishment of the Drug Innovation Fund. Short-term and multi-year funding will be provided to eligible researchers and organizations in Ontario to support evidence-based research on the impact of drugs on patient outcomes and health system outcomes (including non-drug expenditures) in Ontario in order to support drug policy decision making in the province. Capacity building and knowledge transfer are also important objectives of the Fund.

The mandate of the funding program is to:

  •  generate strong, high-quality, independent scientific evidence on the impact and value of new and existing drugs across the healthcare system, by linking drug interventions to health or system outcomes
  • support linkages between researchers, clinicians and drug policy decision makers to ensure the timely and effective application of relevant evidence-based scientific information and to support the objectives and priorities of Ontario's Drug System Secretariat
  • support and develop research capacity in the area of drugs and health outcomes in Ontario