Health policy trials can improve health and health-care decisions

We often have a poor understanding of the risks and benefits of a policy when it is put into place, says Dr. Amity Quinn, PhD, a senior research associate at the O’Brien Institute for Public Health at the Cumming School of Medicine (CSM). “Policy changes need to be evaluated more regularly and more rigorously to ensure we know if a policy is doing what we hope it is, or there are unintended consequences,” she says.

In response to the need for scientifically backed evidence around health policy, the Centre for Health Policy at the O’Brien Institute recently launched the Health Policy Trials Unit (HPTU). Co-led by Quinn and Dr. David Campbell, MD, PhD, the HPTU will conduct rigorous health policy evaluations to inform health and health-care decisions.

As the world experienced in 2020, when a public health crisis hits, such as the COVID-19 pandemic, policymakers must move quickly to protect the health and well-being of the public. However, policymakers can lack scientifically backed evidence when it comes to the effectiveness of urgent policy decisions.

“We absolutely need to develop capacity to rigorously evaluate the intended and unintended consequences of policies on health. Otherwise, we are left guessing as to the impacts of the most important decisions made in society,” says Dr. Tom Stelfox, MD, PhD, scientific director of the O’Brien Institute. “The HPTU is one-of-a-kind infrastructure in Canada that can help us develop this critical national capacity.”

The HPTU was funded as part of the pan-Canadian Accelerating Clinical Trials (ACT) Canada Consortium. The goal of ACT Canada is to create a new platform to strengthen co-ordination between domestic and international clinical trial networks and units.

“Through the establishment of the Health Policy Trials Unit and our links to ACT Canada, the University of Calgary is able to provide leadership and guidance to other investigators across Canada who are interested in conducting policy trials,” says Dr. David Campbell, an assistant professor in the departments of Medicine, Community Health Sciences, and Cardiac Sciences, CSM.

“With this unit, we will enable rigorous policy evaluation and contribute to more evidence-informed policies being enacted in our health-care systems.”

How quality evidence can inform impactful solutions to health-care challenges

Led by researchers from McMaster and McGill University, ACT Canada was awarded $39 million for three years from the Canadian Institutes of Health Research to advance equitable access to, build capacity in, and improve the impact of clinical trials.

HPTU is one of 11 trial units within ACT Canada from across the country. Most trial units are focused on various forms of clinical trials. HPTU is unique in its focus on policy trials.

While clinical trials are used to determine which drugs and other treatments are safe and effective, a policy trial tests which social, economic, and health-care interventions have the strongest influence on health outcomes.

HPTU will contribute to identifying the most effective health-care coverage and delivery strategies and will also play a major role communicating trial results to decision-makers in Alberta and across Canada.

“To date, HPTU has focused on interventions that provide a financial incentive to improve the health of people with low-incomes and chronic diseases. However, HPTU has a wide range of research expertise,” says Campbell. 

For example, lead researchers within the HPTU recently completed a trial that tested a combination of strategies to improve adherence to chronic disease medications, including eliminating prescription drug copayments and providing self-management education and support, he says.

Future studies the HPTU plans to lead will test similar types of policies in addition to approaches to improve the uptake of public health strategies such as vaccines and preventive medications.

Researchers at the University of Calgary and across Canada are invited to reach out to the HPTU to discuss ideas for new trials, tips for running successful policy trials, and to connect with other ACT Canada resources.