Seminar Series: Kristy Coleman and Joshua Wiener

PhD Thesis Proposal Defense Public Lectures

Toward a Phase 3 Clinical Trial of Intranasal Oxytocin for Frontotemporal Dementia

Kristy Coleman, PhD Candidate

Program: Epidemiology and Biostatistics
Supervisor(s): Dr. GY Zou, Dr. Elizabeth Finger
Department of Epidemiology and Biostatistics
Schulich School of Medicine & Dentistry
Western University

Short Biography:
Kristy KL Coleman is a PhD candidate in Epidemiology and Biostatistics at Western University, with a focus on neurodegenerative diseases, particularly frontotemporal dementia (FTD) and related disorders. Her academic work includes contributions to understanding the cognitive and social processes affected by neurodegenerative diseases with an emphasis on improving clinical management and research design.

Area of research:
Frontotemporal dementia, clinical trials, RCT

Learn more about Kristy's work.

 

The role of primary care and family physicians in the ongoing care and treatment of first episode non-affective psychotic disorder in Ontario

Joshua Wiener, PhD Candidate

Program: Epidemiology and Biostatistics
Supervisor(s): Dr. Kelly Anderson
Department of Epidemiology and Biostatistics
Schulich School of Medicine & Dentistry
Western University

Short Biography:
Joshua C Wiener is a PhD candidate in Epidemiology and Biostatistics at Western University under the supervision of Dr. Kelly Anderson. His doctoral thesis explores the intersection of primary care and psychotic disorders, with respect to the role of family physicians in providing care to people after a first episode of psychosis in Ontario. He completed his Bachelor of Health Sciences at McMaster University, and has worked as clinical researcher in psychiatry, infectious diseases, and physical rehabilitation medicine. His current research interests include health services for mental illness, social determinants of mental health, and epidemiologic methods for causal inference.

Abstract:
Background : Psychotic disorders are a group of serious mental illnesses that affect 1% of the population over the lifecourse. People with psychotic disorders have a three-fold greater risk of mortality and an average fifteen-year reduction in life expectancy compared to the general population. These inequities are largely attributable to differences in physical health: people with psychotic disorders are more likely to have chronic physical health conditions and experience multiple co-occurring conditions. Physical illness among people with psychotic disorders is often a consequence of lifestyle factors associated with psychosis, including poor diet, physical inactivity, disrupted sleep, and substance misuse. These health issues are often exacerbated by side effects from prolonged use of antipsychotic medications, such as weight gain, impaired metabolism, and insulin resistance. The first episode of psychosis typically occurs in the late teens and early twenties, and the immediate period following diagnosis is crucial for determining the long-term trajectory of health outcomes. Thus, the early phase of psychosis provides a unique opportunity for health care providers to mitigate such health disparities. Primary care is well positioned to address the health concerns facing young people with psychotic disorders. Family physicians play a pivotal role in managing the overall physical health of their patients, which consists of health promotion, preventive screening, routine monitoring, and active treatment. However, international research has demonstrated that patients with psychotic disorders often fail to receive the standard of care from physicians in a variety of settings. In Ontario, where nearly 5000 new cases of psychosis are diagnosed each year, family physicians provide ongoing care for two-thirds of young people with early psychosis during the initial years after first diagnosis. Prior research from Ontario has focused on the role of psychiatric services for early psychosis, and more recently, the role of primary care prior to first diagnosis of psychotic disorder.

Objectives: Currently, there is a gap in knowledge regarding the utilisation, provision, and associated outcomes of primary care among young people following a first diagnosis of psychotic disorder in Ontario. Therefore, the objectives of the proposed project are to: (1) describe the use of primary care services among young people during the initial years after first diagnosis; (2) examine the care provided by family physicians to young people following first diagnosis; and (3) investigate the impact of service use and care provision in primary care on health outcomes after first diagnosis.

Methods: We constructed a retrospective cohort of people aged 14-35 years between 2005 and 2015 in Ontario using linked population-based health administrative data from ICES. Cases of newly diagnosed psychotic disorders were identified using a validated algorithm, and a comparison group from the general population was matched on age, sex, and neighbourhood at a 1:4 ratio. We linked administrative databases to the electronic medical records of 350 family physicians with over 500,000 patients in Ontario, as these clinical data provide more detailed clinical information than administrative data alone. For Objective 1, we will use administrative data to determine the frequency and reasons for visits in primary care among cases and the comparison group during the five years after first diagnosis. Multivariable regression modeling will be used to compare health service use between the cases and the comparison group, and growth curve analysis will be used to identify distinct subgroups of cases based on patterns of health service use. For Objective 2, we will use clinical data to evaluate the care provided by family physicians to cases and the comparison group, including health promotion, preventive screening, and routine monitoring. Multivariable regression modeling will be used to compare provision of care between cases and the comparison group, and latent class analysis will be used to identify distinct subgroups of physicians based on patterns of practice. For Objective 3, we will use administrative data to examine the occurrence of emergency department visits and inpatient hospitalizations among cases and the comparison group during the five years after first diagnosis. Multivariable regression modeling will be used to compare service outcomes between cases and the comparison group, and cluster analysis will be used to identify distinct subgroups of cases based on occurrence of outcomes.

Impact: This project will characterise potential inequities in service use, care provision, and outcomes among a marginalised population at high risk of poor health. The project outputs will help identify opportunities for quality improvement in primary care for patients requiring early intervention for various health conditions, and for physicians requiring additional support in their central role in caring for these patients. They will also provide information on using existing resources to build linkages between primary care and psychiatric services in order to improve collaboration and continuity of care. Ultimately, this research will elucidate patient-, physician-, and system-level factors that must be addressed when developing practices, programs, and policies to better meet the needs of young people following first diagnosis of psychotic disorders.

Area of research:
Mental health, Primary care, Psychotic disorders, Health services

Learn more about Joshua's work.

Date: Friday, November 14
Time: 1:30 pm - 2:30 pm
Location: PHFM 3015 (Western Centre for Public Health and Family Medicine) or via Zoom (Zoom link may be requestet at  EpiBio@uwo.ca )