Expanding the Reach of Evidence in Nova Scotia Can we get the Evidence to Everyone? CADTH Symposium 2016 Lisa Farrell- Chair of DEANS ( NS Liaison CADTH)

Drug Evaluation Alliance of Nova Scotia (DEANS) Multidisciplinary, multi-sectoral alliance to optimize drug use in Nova Scotia Responsible and accountable to the Minister of Health and Wellness (DHW) Management committee includes: Representatives from DHW, health professionals, administrators, and researchers and their trainees Dalhousie University (Faculty of Medicine, College of Pharmacy), Drug Evaluation Unit Nova Scotia Health Authority, Canadian Agency for Drugs and Technology in Health (CADTH), First Nations and Inuit Health, Pharmacy Association of Nova Scotia, Nova Scotia Prescription Monitoring Program.

Science Practice Policy DEANS

Mission To contribute to the health of Nova Scotians by encouraging appropriate medication use. Obtains and analyses information. Provides relevant information to Nova Scotian decision- makers, practitioners and consumers. Evaluates the impact of the information and the methods of dissemination on policy making, practitioner behaviour and consumer outcomes.

History Began in 1998 Commitment by Nova Scotia Department of Health to fund a new initiative to complement existing drug management systems Pilot different ways to encourage appropriate prescribing Two years of behind the scenes work by many groups (including the Pharmacy Association of Nova Scotia, the Nova Scotia Pharmaceutical Society and the College of Pharmacy) to establish the structural and funding framework to launch the program

Early projects Chlorpropamide Initiative: Over 1,500 seniors in NS were taking chlorpropamide, despite evidence that it should not be used in this population. Initiative included target date for delisting chlorpropamide, education targeting chlorpropamide prescribers, general educational initiatives for pharmacists and diabetes educators in the 33 Diabetes Care Centres across NS Asthma initiative: Respiratory medications can be delivered as effectively, more portably and at less cost than via the use of wet nebulization solutions. Target date to restrict access to wet nebulization solutions Multi-faceted educational interventions targeted at hospital staff, patients, pharmacists, physicians and respiratory technologists

Resources Funding through Department of Health and Wellness Dedicated staff coordinator Volunteer, with dedicated time commitment Funding supports Drug Evaluation Unit Nova Scotia Health Authority Continuing Pharmacy Education Continuing Medical Education Academic detailing service Academic Family medicine group Project support

Objectives Encourages appropriate drug use by: identifying areas where optimization of drug use is needed developing interventions to provide targeted, evidence- informed knowledge to health care patients and providers evaluating the impact of the interventions. Work closely with Dalhousie continuing professional development programs and academic detailing service.

Products The use of direct acting oral anticoagulants in atrial fibrillation Incorporating the evidence into Academic Detailing Service topic Liaise with cardiology specialties Presentations at Continuing Medical and Pharmacy Education Conferences Live webinars for physicians and pharmacists Self-monitoring of blood glucose Province wide live interactive sessions, “Are we singing from the same song sheet?” With leadership from Diabetes Care Nova Scotia Web sessions

Products Proton Pump Inhibitors Evidence incorporated into Academic Detailing Service topic Live webinar sessions Pharmacare policy change Evaluation demonstrated decrease in double dosing Statins for primary prevention Evidence incorporated into Academic Detailing Service topic Live webinar sessions Presented at Continuing Medical and Pharmacy Education conferences

Products “Managing Drug Diversion” Inter-professional province wide interactive program Partnered with Nova Scotia Prescription Monitoring Program and provincial Addictions Services SleepWell NS Multi-stakeholder initiative to promote non-pharmacological resources to manage sleep difficulties Developed website and ‘sleep kits’ Promoted at professional conferences Phase 2 under development

Why does it work? Collaboration Long-standing personal and professional relationships Building of trust Sharing of ideas Ongoing support from the Executive within the DHW Real deliverables with measurable outcomes Identifying manageable components of a larger concept Listening to and responding to the needs of primary care practitioners

“Don’t let what you can’t do stop you from what you can do.” (John Wooden)

Questions? Contact info ( Coordinator of DEANS) ( current Chair of DEANS )