Centre for Studies in Family Medicine
Merrick Zwarenstein M.B.B.Ch., M.Sc., Ph.D.
Director, Centre for Studies in Family Medicine
& Director of Research, Department of Family Medicine
Non-Peer Reviewed Publications
Merrick Zwarenstein is a health services researcher, who trained at the Karolinska Institute in Sweden, the London School of Hygiene in the UK and Witwatersrand University Medical School in South Africa. He worked briefly as a family doctor in Cape Town, South Africa, and still wishes he had not given up clinical work.
He has helped to bring together partners from over a dozen countries, half of them low or middle income, in a number of European Union funded programmes to promote the conduct and use of health systems research, especially pragmatic randomised trials in healthcare decision-making. As well as supporting the development of more than 20 research projects, many of which have been published, this group also produced a number of tools for health services researchers, including web based training tools for randomized trials. (www.practihc.org) This network is helping to establish, in Africa and in Latin America, a tradition and capacity in HSR.
He was the PI for a network of Canadian health services and policy researchers to focus on overcoming limitations to the use of randomized trials in support of policy decision-making. This group has developed a new guideline for the design of pragmatic randomized trials. This guideline, which forms part of the internationally recognized Consolidated Standards on Reporting of Randomized Trials (CONSORT) statement has influenced the way they are described and published.
He developed new uses for routine administrative databases in Ontario for large-scale implementation and rigorous evaluation of quality of care interventions. He is the principal investigator for three randomized trials, covering all Ontario primary care physicians, of knowledge translation interventions. Currently being submitted, these studies will establish greater certainty around the use of printed educational messages, a widely used approach to changing physician behaviour, providing guidance for Ministries of Health on how to achieve physician behaviour change for improving quality of care.
He has studied nurse-physician collaboration and routinised patient care, in South Africa and in Canada, as a threat to safety and quality of hospital care, and efficiency of resource use. He has helped to quantify this problem and led systematic reviews of effects of interventions for collaboration. He recently co-authored a book on Teamwork in the Health professions.
He led the establishment at his hospital of an evidence based hospital quality improvement program. Among the innovative projects are randomized trials of hand held computer based physician order entry for prescriptions, knowledge translation interventions to deploy evidence based Intensive Care Unit clinical guidelines, of new nurse/doctor triage teams in the emergency room, and of time countdown interventions as a strategy for promoting rapid thrombolysis for stroke patients. The unit was closed in cutbacks.
He has acted as a consultant to WHO and a number of bilateral development organizations on research for programme development and evaluation, a process which he hopes will lead to redesign of implementation and evaluation strategies for complex health care intervention rollout- not only in low and middle income countries.
He has worked in the development of new approaches to primary care provider support and education for HIV/AIDS and ART care, which in expanded form, are now being implemented as South African national policy.