Academic Staff
Colleen Metge, Ph.D.
Associate Professor

Evaluation of Drug Therapy Effectiveness

Program Overview

Drug effectiveness research tries to answer the question: "Can the benefits of pharmaceutical use be improved and, if so, how?"

The research focuses on obtaining an explicit understanding of how pharmaceuticals contribute to better health. Primarily, the program undertakes studies using the Manitoba's Drug Programs Information Network (DPIN) database and a synthesis of other research findings to determine how drugs really perform when prescribed by an average physician for a typical patient.

For example, new prescription drugs are safe and work for their intended purpose(s) under very controlled conditions. However, rarely is there information on their safety and effectiveness in the long term, and especially when prescribed in select groups such as the elderly.

Findings from this research program will result in interventions based on the evidence and targeted at improving both patient use and physician prescribing.

Program Support

This program of research is supported by a five-year grant from Bristol-Myers Squibb $250,000), a three-year Establishment Grant ($88,000) and a two-year Operating Grant ($97,270) from the Manitoba Health Research Council, and a Research Fellowship from the Centre on Aging ($10,000).

Researchers, graduate and undergraduate researchers have the use of state-of-the-art computers and analysis software. Population-based pharmaceutical use data is available through the Manitoba Centre for Health Policy and Evaluation where Dr. Metge is a Research Associate.

Current Studies

Manitoba Health Research Council / Social Sciences and Humanities Research Council of Canada funded:

    Describe the rates of pharmaceuticals by the entire population of Manitoba elderly.
    Literature syntheses to evaluate drug therapy effectiveness in the elderly, specifically to answer:
      What is the rate of underuse of antidepressants in the elderly?
      What is the rate and risks of overuse of long-acting benzodiazepines in the elderly?
      Has there been an increase in NSAID use since the introduction of gastric mucosal protective agents?
      Are beta-blockers used appropriately post-acute myocardial infarction?
    Develop a means of defining medication nonadherence using DPIN
    Examine the relationship between social determinants and nonadherence to pharmaceuticals.
    Determinants of Chronic Good Health and Chronic Ill Health in a Longitudinal Aging Population (SSHRC)
    Supporting self-care for the community dwelling older adult (Can Nurses Assoc and SSHRC)
    An evaluation of the provision and impact of pharmaceutical care on physicians and elderly patients (NHRDP)
Canadian Institutes for Health Research and Health Sciences Foundation (Winnipeg) funded:
    Epidemiology of Hip Fracture in the Aboriginal Population:  This study will describe the incidence of fractures among Manitoba’s First Nations as a marker of the burden of osteoporosis in this population.  This study is being accomplished through an examination of the Manitoba Health registry and computerized linkages between the Manitoba Health hospital separation, physician claims and DPIN (similar to the investigation of fracture rates undertaken in individuals with inflammatory bowel disease].
    First Nations Bone Health Survey:  This survey-based study represents a unique opportunity for evaluating skeletal health in Manitoba First Nations by bringing together both the CaMos (Canadian Multicentre Osteoporosis Study) and the MFNRHS initiatives (Manitoba First Nations Regional Health Survey.  A random sample of urban First Nations women, non-urban First Nations women with unmatched and neighborhood-matched urban non-First Nations women serving as the control population.  The cohort will have three age strata (25-39, 40-59 and 60-75) for studying differences in peak bone mass, bone loss during the perimenopause and bone loss during late menopause.
Miscellaneous funders (often multisource):
    Maximizing Osteoporosis Management in Manitoba (the MOMM project):  a joint initiative by the Faculties of Pharmacy & Medicine, Merck Frosst Canada Inc. and the Minister of Health, Province of Manitoba to (1) determine the prevalence (rate of identification and diagnosis) of women with or at high risk for osteoporosis and fracture; (2) improve the appropriate use of evidence-based prevention and treatment strategies by developing and implementing patient and physician interventions to close gaps in the treatment and prevention options used by women with or at high risk of osteoporosis and fracture; (3)  assess changes in practice and adherence to evidence-based therapies following patient and physician intervention; (4) assess the impact of the MOMM project on patients’ quality of life, education and health care outcomes
    Integrated approach to improving the appropriate utilization of anti-inflammatory/analgesic medications in Manitoba (MB Health & Merck Frosst)
    Inflammatory Bowel Disease:  A description of pharmaceutical use.  In this project, we describe the burden of pharmaceutical use on IBD patients in Manitoba.  Indicators of access to pharmaceuticals, intensity of use (number of prescriptions per IBD patient) and total expenditures were used to describe pharmaceutical use in a population-based cohort of Manitoba IBD patients.
    Epidemiology of warfarin use in the general population:  We will describe the epidemiology of warfarin use in the general population of Manitoba.  Specifically, we will describe the prevalence of warfarin use over the years 1995 to 1999, and the incidence of new warfarin use in the general population over these same years.  We also plan to determine the duration of warfarin use in the community.  This study is funded by the Manitoba Medical Services Foundation
    Willingness to pay (WTP) for increased regulation on natural health products (funded by an AACP New Investigator’s grant). This project is using willingness-to-pay (contingent valuation) to answer the following three research questions:  (1) Are natural products substitutes or complements of prescription-only pharmaceuticals? (2) What is the relationship between price and quantity of natural products demanded in Canada’s relatively unregulated herbal products market?   (3) What are consumers willing to pay for the added benefits of safety standards in the manufacture of herbal products and an increase in balanced, credible information subsequent to regulatory changes regarding the sale of natural products in Canada?
    A comparison of drug consumption between Iceland residents and people of Icelandic descent living in the Interlake region of Manitoba.
Future Directions

This program of research builds on the province's international reputation for research in the treatment of the elderly. Two Aging in Manitoba studies have been proposed using the Manitoba Longitudinal Study in Aging survey data to:

  1. describe the changing patterns of pharmaceutical utilization for elderly persons in good and poor health in an era of reform
  2. develop the means to relate patient morbidity measures, physician characteristics and drug use.

In addition, methods to improve the way we describe pharmaceutical use need to be developed. We plan to develop a method to control for severity of illness in our description of the population's use of pharma-ceuticals.

Collaboration with other researchers at the University of Manitoba (specifically, the Manitoba Centre for Health Policy and Research and the Centre on Aging), the Government of Manitoba and between researchers at McGill, Dalhousie, UBC, McMaster and the University of Montreal is ongoing.

Specifically, projects which encompass the methods of pharmacoepidemiology and pharmacoeconomics are being developed and funded on an ongoing basis.

We invite applications from prospective graduate students for placement in the program and from academic, industry and government for collaborative projects.

For additional information, please contact:
Email: Dr. Colleen Metge