Dr. Garrison & team have been awarded a 4 year CIHR SPOR Innovative Clinical Trials grant for the BedMed Initiative to expand into Manitoba and BC!
Who We Are
The Pragmatic Trials Collaborative is a group of practicing primary care providers (including family physicians, nurse practitioners, registered nurses and pharmacists) coming together to improve the care of our own patients and answer pivotal healthcare questions along the way. We are a western Canadian initiative with members in British Columbia (BC) and Alberta (AB) and we are looking to expand our quality improvement network to other provinces as we grow.
What we do
Working behind the scenes, we enable practitioners (with little or no impact on practice workflow) to evaluate whether practice changes they are introducing affect important patient-oriented outcomes. For example:
- Does reducing polypharmacy in older adults lessen mortality? ... or prolong independence?
- Does changing blood pressure medication to bedtime reduce heart attacks and strokes? (A single study that needs confirmation suggests a better than 50% reduction in cardiovascular events if blood pressure meds are taken at bedtime)
- Should we be treating according to home blood pressures? (Instead of office readings)
How we do it
The outcomes that matter to patients and providers (e.g. death, nursing home admission, hospitalization, hip fracture, stroke) are already reliably collected and held in electronic Ministry of Health databases. We have an arrangement with the Alberta SPOR Support Unit's data platform to analyse such outcomes (for consenting patients and providers in Alberta) and we are working on a similar partnership with government in other provinces. This removes the burden of data collection from care providers. We additionally perform (behind the scenes) all patient dialog, consenting and treatment allocation so that the health care team need only focus on implementing and managing the intervention. How this works is best demonstrated by example.
Example: Timing of Blood Pressure (BP) Medication
(Is it true that taking BP meds at bedtime reduces mortality?)
- We assist primary care providers by providing patient information which:
- Describes what is known about the timing of blood pressure medication
- Lets them know their provider is contemplating making this practice change; and
- Provides OUR contact number for more information if patients are interested in being part of their provider's evaluation group.
- We dialog with interested patients, ensure they are eligible, and obtain written consent.
- Patients make a regular BP follow-up appointment with their provider and we allocate them beforehand to either 1) change to bedtime antihypertensive use, or 2) delay making that change (i.e. continue with AM medication use) until the evaluation period is finished.
- The primary care provider is told of the allocation when they enter the exam room. They make any necessary medication changes and follow-up as appropriate.
- Ministry of Health data is accessed at a later date (e.g. 2 years later) to determine differences in outcomes such as mortality / hospitalization / stroke / MI / hip fracture / and nursing home admission.
It’s really that simple!