Medical research has local and international impact

Helping the patient is priority

(November 12, 1998)
By Sonia B. Glover

Researcher Dr. Patrick Parfrey of Memorial's Faculty of Medicine is involved in several different projects these days, but there is one thing that each of them has in common Dr. Parfrey's fervor to create knowledge to better a patient's well-being.

Most of Dr. Parfrey's research is nephrology-related, including work in inherited renal diseases and studying cardiac disease in dialysis patients. He is also involved in examining health care in our province, particularly in the areas of restructuring acute and long-term care.

"We are involved in work that goes from the basic science with genetics, to identifying risk factors for disease in longitudinal studies, to doing scientific experiments of treatments with clinical trials, to applied research in terms of how to improve health care delivery," he explained during an interview with the Gazette.

Studies on cardiac disease in dialysis patients by Dr. Parfrey's research group have had enormous international impact. He said there are a large number of dialysis patients who die from cardiac disease, and do so much more rapidly when compared to the general population.

"What we've been trying to determine is what it is about the heart that makes the patient die more quickly and whether it's possible to do something that would delay their death."

One of the things that causes cardiac disease is anemia which results from a lack of hormone called Erythropoetin so, in an attempt to find the best way to use the hormone to increase a patient's hemoglobin level, Dr. Parfrey and his colleague Dr. Robert Foley conducted a nationwide study involving 140 patients in 11 centres across Canada.

The $3-million, three-year randomized controlled clinical trial wrapped up recently, and according to Dr. Parfrey, the results demonstrate that using Erythropoetin to normalize a patient's hemoglobin can indeed prevent one type of cardiac disease.

These findings are of great interest to nephyrologists around the world. And as a result of the clinical trial, which was sponsored by Janssen-Ortho Inc., Dr. Parfrey said the obvious next step is to conduct a global study to try and determine at what phase of a patient's life this intervention should be used.

"When we gathered our information and we made our conclusions, it appeared to us that we were trying to treat patients with this intervention too late in their lives and that we would need to treat them earlier, before they develop endstage cardiac disease or when they start dialysis."

He added, "For another study we are hoping to  enrol about 300 patients, and it will have to be done in several countries.  These types of studies are very intricate and expensive and for this one we are looking at a cost of about six million (dollars)."
Dr. Parfrey hopes the new study will get under way within the next year.

Another major project that Dr. Parfrey is involved in isn't as expensive or relevant internationally, but is of great importance locally.  It's a study on delivering long-term health care for the elderly in our province.

This project has been ongoing for the past couple of years; it involves assessing the needs of people who are just entering long-term care and the needs of those already in nursing homes, and gathering data that will help the provincial government with its policy making. The information will also be used to predict what the needs will be for long-term care in the future and a cost-effective way to meet those needs.

Dr. Parfrey said an assessment of St. John's was recently completed and the research will now expand to other centres around the province.

"What we will do is integrate the data that's been obtained in St. John's with data from places outside the city and give it to government; this will help them come up with a plan for the province in terms of the best way to provide long-term care for the elderly."

With a lot of pressures in the health care system from the community these days, Dr. Parfrey said the provincial government is looking for ways to effectively meet patients' long-term care needs, especially those with modest disabilities; and he believes data from this research project will allow government to make more informed decisions in the future.

Dr. Parfrey has his own theory about how to deal with problems surrounding long-term care in our province. "I think the best way to deal with it is by creating an environment where the elderly are independent and can receive support so that they are able to continue in the community.

"But ultimately, when they need professional care, they want to get that care in an environment that they would like to live in. And how one produces those facilities and pays for this is a good question."

Dr. Parfrey said information from the St. John's assessment shows there are not enough facilities in the capital city to look after people with modest disability and, therefore, most people end up in nursing homes.

"I believe it's likely that if you provide opportunities for people to stay independent, there would be a lower amount of people in nursing homes and then this should give you the opportunity to improve the quality of care in the home."

Dr. Parfrey says assessing the long-term care needs in centres around the province should be completed by next year at which time a report will be presented to government.

While there are many other areas that Dr. Parfrey is researching in a multi-disciplinary manner, he contends that each of  them are important; creating new knowledge that deal with changing the way things are done to improve a patient's care.