Our Rapid Response Unit has generated a substantial body of high-quality comprehensive research in a wide breadth of areas that has informed policy decisions for the benefit of Canadians. Some major areas of impact include work in the area of prescription opioids, blood glucose test strips, and cardiovascular health:
Physicians commonly prescribe opioids to patients with chronic pain. However, over the past 20 years, the escalating use of prescription opioids has created a major public health crisis across North America. A series of ODPRN studies investigating the escalating opioid dose and growing numbers of overdose deaths have been used to inform and support Ontario’s Narcotic Strategy.
This research is cited as a key factor in the development and passage of Bill 101, the Narcotics Safety and Awareness Act (NSAA), which received Royal Assent in November 2010. The findings have been incorporated into briefing materials and policies at the local, national and international level, including a presentation to Canada’s Minister of Health in 2014, programming by several Public Health Units across the province, and opioid labeling requirements by the United States Food and Drug Administration (FDA). ODPRN has also worked closely with the Canadian Institute for Health Information (CIHI) to inform methodology that will be used in national surveillance of opioid toxicity.
Blood Glucose Test Strips
Blood glucose test strips (BGTS) are typically prescribed to patients with diabetes, but have limited clinical benefit among certain groups of individuals, leading to potential overuse and significant costs to the healthcare system. The ODPRN analyzed potential cost avoidance that might be achieved by establishing maximum reimbursement policies for test strips in various groups of patients who may not require frequent monitoring.
Since the publication of these findings, the Canadian Diabetes Association (CDA) has recognized that limits on government-funded testing are reasonable in some patients, and has changed their recommendations on optimal testing frequency. Subsequently, the OPDP widely implemented new quantity limits for BGTS in 2013. In a 2016 evaluation of this policy, the ODPRN reported nearly $25 million in cost reductions in the year following the introduction of the policy. Furthermore, this evaluation indicated no negative impact on patient outcomes, including hypoglycemia, hyperglycemia and HbA1c.
Recently, these analyses were replicated in 7 other provinces across Canada, and found that considerable savings would be achieved annually if a quantity limit policy were introduced in public drug programs across Canada. These results have been shared with policy-makers across Canada, including the pan-Canadian Pharmaceutical Alliance (pCPA), and quantity limits have now been introduced in British Columbia and by Health Canada’s Non-Insured Health Benefits, with other provinces considering similar changes.
Proton Pump Inhibitors and Antiplatelet Drugs
Proton pump inhibitors (PPIs) are among some of the most widely prescribed medications for the management of gastrointestinal symptoms. Previous published guidelines recommend PPI therapy for the majority of patients treated with aspirin after acute myocardial infarction, many of whom also take clopidogrel, an antiplatelet drug whose metabolism may be affected by use of some PPIs. In 2009, the ODPRN examined whether concomitant use of PPIs and clopidogrel was associated with adverse outcomes among older patients discharged from hospital after acute myocardial infarction. Study findings suggested that among patients prescribed clopidogrel following acute myocardial infarction, concomitant therapy with PPIs other than pantoprazole was associated with a loss of the beneficial effects of clopidogrel and an increased risk of reinfarction. The study suggested that unlike other PPIs, pantaprazole could be used safely with clopidogrel.
An evaluation of the impact of ODPRN’s study subsequent to its publication demonstrated a significant shift in utilization of PPIs immediately following publication – the use of pantoprazole in Ontario increased from 24% of all PPI prescription issued to patients receiving clopidogrel prior to publication to 53% following publication. This change was mirrored by a corresponding decrease in all other PPIs. The ODPRN’s original publication has been cited 385 times (based on Scopus), and received the CMAJ Bruce Squires Award as the study published in 2009 that was deemed by the CMAJ to have the greatest impact on clinical practice.
Pulmonary Arterial Hypertension
Pulmonary arterial hypertension (PAH) is a rare and potentially life-threatening condition. Prior to 2010, the Ontario Public Drug Programs only funded PAH monotherapy (i.e. one drug at one time) due to the lack of evidence on the effectiveness and safety of PAH combination therapy (i.e. multiple drugs at one time). Clinicians and patients advocated to the MOHLTC that this was an impediment to optimal care. The ODPRN conducted multiple studies on the prescription and utilization of PAH drugs in Ontario; this information contributed to PAH drug funding changes, which were enacted in June 2010. Funding was expanded to include combination therapy of selected PAH drugs, and PAH drug initiation was restricted to Ontario’s five Centres of Excellence.