Ellen Tsaprailis, May 5, 2022

Carleton’s Mehdi Ammi is Looking into How Patients with Chronic Diseases were Affected by Health Resources Diverted to COVID-19 Care Instead

The multiple waves of COVID-19 has diverted considerable health-care resources away from patients who are dealing with chronic diseases since the spring of 2020.

Canadians who are trying to overcome or manage diseases such as cancer, heart disease and diabetes use a fair amount of health-care resources. The past two years have proven unprecedented in health-care resources being diverted to deal only with COVID-19 patients. How have those decisions impacted the health of patients with chronic diseases?

School of Public Policy & Administration Associate Professor Mehdi Ammi is the Nominated Principal Investigator of a two-year project that will try to pinpoint which multiple chronic conditions have been the most affected and at risk of long-term negative consequences because of the priority placed on COVID-19 care.

The project is titled, Wider Health Impacts of COVID-19 on Patients with Cancer and Other Multiple Chronic Conditions: A Parallel Mixed-Methods Study that was given a grant from the Canadian Institutes of Health Research (CIHR) of close to $500,000.

Ammi and his team will focus on the experiences of patients with chronic diseases living in Ontario for this study with the intent to understand how the pandemic impacted health-care in diseases that had nothing to do with COVID-19, including how clinicians adapted their care when faced with less than normal resources.

“We have to start somewhere,” says Ammi. “The choice we made was to start on the population that has multimorbidity. Approximately one quarter of Canadians across all ages have at least two chronic conditions. Because COVID-19 has taken so much of the resources in the health-care system, there was this trade-off essentially made between people who had COVID and resources were diverted from people who didn’t have COVID, such as surgeries being cancelled for example. We want to know how patients who didn’t have COVID at all were affected.”

School of Public Policy & Administration Associate Professor Mehdi Ammi will lead the two-year CIHR grant-funded study

Part of the study is going to process quantitative administrative health data and compare groups of patients in their disease trajectory and care outcomes. The team will compare patients in pre-pandemic time with similar characteristics of diseases to what patients experienced during the pandemic. They will follow each group for one year to see what happened to them and compare the two and the difference in trajectory of care between those treated during the pandemic and those treated before the pandemic. Factors such as if patients used emergency rooms instead of going to their general practitioner’s office, did their hospitalization take longer than necessary or had their disease become more severe will be considered.

In the quantitative analysis, Ammi and his team will also create subgroups of patients—those that have an affiliation with a single physician and those patients with multidisciplinary teams that include a specialist, a general practitioner, a nurse and a pharmacist. They will also explore equity implications as best as possible with administrative health data, for women and immigrants particularly.

The qualitative data in the second part of the project will come from two Ontario health centres, the Trillium Health Partners Hospital in the Peel Region and the Thunder Bay Regional Health Sciences Centre.

“We selected these two sites because in the Peel region, there is a high immigration, highly-ethnic diverse population who has been badly affected by high COVID cases,” says Ammi. “Thunder Bay was selected for its location in Northern Ontario which serves remote populations and where there is a higher share of Indigenous populations that seek treatment there. Both are also specialized cancer treatment centres and offer full services and will allow us to dig deeper into the equity implications.”

The team will interview patients, their families and clinicians to understand how they view the care they experienced during COVID. Ammi will also look at how the care system has adapted to the pandemic. “We are interested in interviewing clinicians and hospital managers because they have been the ones making changes with so many resources going to COVID. The first part of the project is trying to assess the effect of the pandemic. The second part is trying to see what impact the mitigation strategies and different models of care had. The two parts are done both through the quantitative and qualitative data.”

Midway through the project the team plans to bring together stories they gather from the quantitative and qualitative perspectives and present the findings with knowledge users in other provinces so they can tell them the Ontario experience, and the team can learn from experiences in other provinces as well.

“Let’s say in this project we figure out the situation has been OK for cancer patients as cancer treatment has been high on the list of priorities,” says Ammi. “But with diabetes, I am not sure what the data will say. If we see a lot of amputations, then disease management has not gone as well as that should not happen with careful monitoring and timely treatment. So, if we see diabetes as a big issue, then we will focus on it for the next study with more than one province.”

After this project is completed, Ammi plans to pursue more funding to study other provinces to get a better picture of the care experience across Canada.

“We are aware of the limit of what we are looking at, even though Ontario is the most populous province with 14.5 million people. We still think looking at just this province is an important first step and meaningful for decision-making in real time,” says Ammi. “The Ontario Science Table is doing an amazing job using mathematical models to make predictions but what we can do with this project is essentially feed in more precise information to help develop new models for the future and improve pandemic preparedness.

“Understanding and addressing issues related to treatment backlogs is one of the top priorities recently announced by the federal government and findings from our research will directly help inform this priority.”

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