Health Services Research

144 College Street
Toronto ON M5S 3M2

My major research to date is on socioeconomic status (ses) and work/employment status as a determinant of health, on ses and aging, and on the influence of social context on the meaning of health and on health care decision-making (for example, the effect of a patient’s interpersonal environment, of the patient-professional interaction, and the effect of social policy and the institutional environment on the interpretation of health, illness symptoms and treatment decisions). These areas have particular relevance for social pharmacy.

I have several programs of research in progress or under development at the Faculty of Pharmacy. Among others, these include:

1. Research on Medicine Use by the Elderly: In a series of studies, my collaborators and I are examining profiles and patterns of medicine use by the elderly, including the selection and relative distribution of prescription, over-the-counter and “alternative” or complementary medicines. Using the National Population Health Surveys, analyses of both cross-sectional and longitudinal data are being conducted. Medicine-use patterns of individuals with particular diseases or conditions such as cardiovascular disease, arthritis, and depression and anxiety are of particular interest. Further, the implications of type of medicine used for economic assessment (ie: the relative costs of drugs to public/private insurers or to individuals) is of central importance in this work.

A related project, under development, will focus on medicine use decision-making among the elderly, using a qualitative research design. Here, the focus will be on identifying the various health care/medicine use informants (such as the physician, the pharmacist, lay informants, and “alternative” practitioners) and understanding the basis of their legitimacy for individual consumers of medicines.

2. Research on Workplace Health, Work-place Related Disability and Health Care Utilization: I have recently completed a qualitative study examining the meaning of ability/disability status among clients of the Workplace Safety and Insurance Board receiving long term disability pensions. The aim of the study was to describe client’s needs, based on changes and losses experienced as a result of workplace injury—ie: changes in health and ability status, change in capacity to work and in income status, change related to family and social network. Additionally, clients’ need for and access to health services, including medicines, was assessed. This project has provided me with an excellent opportunity to examine the trajectories of disability, health care decision-making and health outcomes in a disabled population. Three areas related to medication use were identified in my qualitative study: 1) problems related to access to prescription medications among long term disabled claimants; 2) individuals’ negotiation of long-term use of medications for pain and psychological distress (particularly around the theme of avoiding addiction to pain and other CNS medications); and 3) the use of illicit drugs/alcohol in the self-care strategies of long term disabled claimants. Currently, these are significant issues for public health, especially given the growing numbers of individuals who are aging with disabilities (in Ontario, there are approximately 155,000 claimants registered with the WSIB Pre-1990s claims unit alone; these are aging, disabled workers who are experiencing health declines at an accelerated pace).

The themes of medicine access among vulnerable populations (such as injured workers), and that of self-care/information sources and the negotiation of the use of medicines will feature prominently in my future research in the Faculty.