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News - September 2015 

President's Message

By: Linda Wilhelm

Summer is drawing to a close and it’s been a busy few months for CAPA since our last newsletter! In May, I attended the KT Canada annual meeting and was able to showcase CAPA as an effective model for patient engagement, something everyone seems to be looking for these days but struggling with how to accomplish it. We have been doing this successfully for almost fifteen years.

The Best Medicines Coalition held its semi-annual meeting in June with plenty of discussion about National Pharmacare. The same day the Pan Canadian Pharmaceutical Alliance (PCPA) hosted a session for patient organizations. Dawn Richards, CAPA's VP and I were fortunate to be able to attend this in person. PCPA was formally called the Pan Canadian Pricing Alliance and was initially set up for the provinces to negotiate pricing with the pharmaceutical industry. The change in name signals a broadening of their mandate to look at issues that are national in scope. They now have an office located within The Ontario Ministry of Health and we are working toward patient representation on the Alliance to make the body more open and transparent.

CAPA received accolades from The Canadian Agency for Drugs in Technology in Health (CADTH) for our many years of providing them with patient input and our active participation in improving their process.

We are really excited about our Pregnancy and Parenting with Arthritis project. I encourage you to complete the survey that will help to inform the development of resources for parents living with arthritis who are trying to raise healthy, happy, well-adjusted kids despite living with a serious disease.

The fall 2015 is already looking to be a busy as usual, with the Arthritis Alliance of Canada's annual meeting, CAPA's annual meeting of our Board, Drug Information Association meetings and The Best Medicines Coalition Annual meeting, just to name a few.  Look for updates on these meetings in our Winter newsletter and look for us on Facebook for updates in between the quarterly newsletters! 

Consumers as partners in Research: Recruitment and retention a challenge

By:  Janet Gunderson, Colleen Maloney, Annette McKinnon
 
The 12th Annual Cochrane Canada Symposium in Calgary this May emphasized the entrenchment of patients/consumers in all aspects of Cochrane (and research decision-making in general) from consumer participation on the Cochrane Steering Committee to involvement in reviewing Protocols, Reviews and Plain Language Summaries. Some consumers are also partners on research studies and members of writing teams.  All of us work to find new pathways for knowledge dissemination. 
 
Our value is great but our numbers are few, a fact raised often throughout the Symposium.

In the early 2000s it wasn’t easy for patients/consumers to raise their questions, ideas, and concerns at scientific conferences.  We were unknown by most and considered interlopers by many. Champions within the scientific community like Dr. John Esdaile, Scientific Director, Arthritis Research Canada, and Dr. Peter Tugwell, Senior Scientist, Clinical Epidemiology Program, Ottawa Hospital Research Institute recognized our potential, encouraged our contribution, provided educational resources and ensured our attendance.  Confidence followed. Now, fifteen years later, we have a presence at most conferences, research scientists know us, and we are comfortable participating in discussions. 

As one challenge is overcome, another is presented.

Reaching New Heights, Measuring Success was the theme of this year’s symposium with many presentations and workshops focusing on recruiting, retaining and enhancing consumer involvement.  Presenters from COMET (Core Outcome Measures in Effectiveness Trials) and SPOR (Strategy for Patient Oriented Research) led the morning Plenary sessions on Thursday and Friday respectively.  

COMET presenters explained that clinical trial outcomes must be relevant to patients and caregivers as well as healthcare professionals, policy makers and the general public in order to influence health policy and practice.  They suggested that patients and caregivers be involved in developing core outcome sets (COS) that are most relevant to them – the patients.  Researchers, they acknowledged, face challenges when planning to involve patients in COS development.  They include: 

  • Finding patients and caregivers,
  • Keeping them involved over time, and
  • Determining their views on the most important outcomes.

 

SPOR presenters spoke about their mandate and the importance of ensuring that research funding be patient oriented. They cited a United Kingdom example where research focused on patient identified priorities, resulted in improved health and better access to the health care system.  Presenters also addressed the opportunities and challenges of patient engagement from inclusion in governance to research decision-making.

Focusing on consumer involvement in Cochrane Canada, Eileen Vilis, Cochrane Canada’s Knowledge Broker, led a consumer workshop that explored future opportunities for consumers acknowledging internal strengths and weaknesses. Strengths included:  

  • Consumer diversity, tenacity and expertise
  • Cochrane staff support. 

Weaknesses listed were: 

  • Lack of a formal recruitment process
  • Lack of a mentoring program. 

 

External opportunities for moving forward identified formal links to academic institutes as the most promising avenue for raising Cochrane Canada’s profile, consumer recruitment, and dissemination of Cochrane Reviews.
 
Everything you wanted to know about Cochrane Methods but were afraid to ask

One of my favourite learning sessions was about Cochrane Methods specifically PICO (Population, Interventions, Comparison, Outcomes).  It was a valuable refresher for me, a consumer, and for people like me who are involved in Peer Review activities related to Systematic Reviews.  We evaluate the relevance, outcomes, logic, flow and clarity of reviews or protocols and determine their value. Alain Mayhew, from the Cochrane Bias Methods group, led the workshop with support from Julia Worswick and Martie Muller. He explained Cochrane’s PICO approach used in Cochrane reviews.  The following is a brief overview of his presentation from my notes.
 
Population - he explained, must be clear so that the reader knows who is being represented:  adults, children, seniors (age range), females and males (gender), disease/condition, i.e., rheumatoid arthritis.
 
Interventions - must be described.  For example in drug therapy is the type, dose, frequency, place of administration, combinations, length of intervention and so on included.

Comparison – what are the categories being compared, i.e., those who received treatment (intervention) and those who either did not receive the treatment or received the “usual care” (control). 

Outcomes - are the important outcomes included?  Are they relevant to patients and care providers?  Adverse events/harms?

The knowledge exchange at all Cochrane events generates an energy among most patient/consumers that demands deeper involvement.  Fortunately we know our desire to be involved will be welcomed.  

Cochrane in Canada: What’s your story?

Another session, different from all others, introduced the results of the "What's Your Story" competition.  In April 2014, Cochrane asked Canadians to share how Cochrane Reviews helped them make clinical, personal and policy-related decisions. Over 80 submissions were received.  Some were from medical students who were writing research papers, others were from clinicians who discovered better practices for senior care, and still others from allied health care professionals.  

Denise Harrison, a nurse from Ottawa, Ontario was the first place winner.  She turned to a Cochrane Review that in turn sparked a research program. 

Suzanne Tedrick a nurse from Shawinigan Lake, British Columbia, the second place winner became an advocate for herself “thanks to Cochrane”.  

And a consumer, caregiver and patient advocate, Marilyn Walsh from Hamilton, Ontario was the third place winner.  Ms Walsh who, in need of a second opinion in an emergency situation, turned to The Cochrane Library for answers and reassurance about the treatment intervention being proposed.
 
Cochrane Canada is now faced with severe funding cuts.  To raise its profile and attract funders, Cochrane wants and needs to hear from us.  Let’s roll up our sleeves and tell everyone how Cochrane has impacted our work or life?  Submit your story online.  It’s time for us to give back.
 
SPOR:  http://www.aihealthsolutions.ca/media/SPOR-Brochure-2015_5.pdf 
 
COMET: http://www.comet-initiative.org 
 
COCHRANE Canada: http://ccc.cochrane.org 
 
What’s Your Story:  http://ccc.cochrane.org/cochrane-canada-whats-your-story / http://ccc.cochrane.org/cochrane-canada-whats-your-story
 
Submit your story online: http://ccc.cochrane.org/how-can-i-help-savecochranecanada
 

The Arthritis Society's Resources on Medical Cannabis

By: Jeff Jurmain

Due to the fact that arthritis pain is the biggest reason why Canadians are taking medical cannabis, The Arthritis Society has for the past year been closely examining this treatment and taken a leadership role in the health care community.

In June, The Society announced a three-year grant to one of the world’s leading medical cannabis investigators who will see how and why it may alleviate osteoarthritis pain. That investigator, Dr. Jason McDougall, is featured in this new video about what you need to know about how medical cannabis works.

To launch Arthritis Awareness Month, The Society released a 12-page guide that details how interested Canadians can access medical cannabis in the new federal system – including such subjects as pricing, licensed providers, privacy and working with your doctor. That, and all future resources, can be accessed at www.arthritis.ca/medicalcannabis.

Two additional videos were released in September. In this two-part video, a Toronto doctor and licensed provider walks you through working with your doctor and a licensed provider. And here, a 31-year-old woman describes the impact of rheumatoid arthritis on her life and why she is choosing to try medical cannabis. 

It Wasn’t All Good News - The Cochrane Symposium, Calgary, May 21 and 22, 2015

By: Janet Gunderson, Colleen Maloney, Annette McKinnon

Many of our CAPA members are familiar with Cochrane Canada and its mandate to “… bring the use of evidence into healthcare policy and practice … by promoting the use and accessibility of Cochrane Reviews through the Cochrane Library.” Indeed people from all walks of life use Cochrane as a resource to find answers to enable them to make informed decisions about health related questions. In fact over the past two years, 231 Cochrane Reviews from 37 Cochrane Review Groups have been used in 65 Canadian clinical practice guidelines. Whether we know it or not, Cochrane Reviews are guiding the delivery and best health practices from the research bench to the patient/consumer bedside.

What subscribers may not know is that effective September 2015, the Canadian Institutes of Health Research (CIHR) will no longer fund Cochrane Canada. The loss amounts to approximately $2 million per year and signals the end to Cochrane Canada unless new funding can be found. Dr. Jeremy Grimshaw, Director of Cochrane Canada, made the announcement at the Cochrane Symposium held in Calgary, Alberta, in mid-May this year. He explained that he was informed of the CIHR decision two years ago and has been working with CIHR and other funding agencies in an attempt to keep Cochrane afloat. Dr. Grimshaw is hopeful that short-term funding can be found until long-term funding is secure.

At this point you may be asking yourself, What can I do about the funding loss?

Cochrane is asking all stakeholders who know of funding sources that might be interested in supporting Cochrane Canada to contact the Cochrane Centre. For further information see: The future of funding for Cochrane Canada

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