David is a health services researcher with particular interest in the areas of inequities in care delivery for chronic diseases. He is a specialist in internal medicine who is specializing in Endocrinology & Metabolism. He has a diverse research background that started with an MSc in Anthropology of Health and Illness from the University of Edinburgh (Scotland). He then obtained his PhD in Community Health Sciences (Health Services Research Stream) from the University of Calgary.
Working with: Dr. Stephen Hwang and Dr. Gillian Booth
Contact David at: campbelldavi@smh.ca
What did you do for your PhD?
I used a mixed methods approach to investigate the role of financial barriers in the care and outcomes for patients with cardiovascular-related chronic diseases, like diabetes and heart disease. Using national survey data we found that approximately 10 to 15 per cent of people living in Canada* with chronic diseases report struggling financially to access the goods and services they require to optimally manage their conditions. The goods and services that people struggle to access include medications, healthy food, and rehabilitation, among others.
Through detailed interviews with some of these individuals, and using a grounded theory approach, I developed a proposed model to understand how a patient’s experience of financial barriers might be related to adverse clinical outcomes.
Finally, using a unique dataset comprising ten cycles of the Canadian Community Health Survey linked to health care, census and vital statistics data, we demonstrated that individuals who perceive a financial barrier related to any aspect of their chronic disease care were 36 per cent more likely to suffer adverse events, including death and chronic-disease hospitalizations (such as those related to diabetes, stroke or heart disease). Furthermore, we found that those who perceive financial barriers incurred higher inpatient health care costs.
We then designed and are currently running a large pragmatic randomized trial to test whether reducing financial barriers to medication access will, in fact, result in improved outcomes for patients at high risk of cardiovascular disease (ACCESS trial).
What are you doing at C-UHS?
During my time at C-UHS, I will be working with Drs. Booth and Hwang on a number of projects related to diabetes in individuals experiencing homelessness. It has already been shown that those who experience homelessness have worse clinical outcomes than those who are stably housed, and that they are less likely to access services.
I will be working collaboratively, taking a participatory approach, with stakeholders in the homeless-serving community, as well as those with lived experience to better understand their experience and the challenges that they face. Ultimately, my hope is that together we can pursue research objectives and projects that will lead to the development of a novel model of care, or policies that address the needs of this underserved population.
What would you like to see happen?
In an ideal world, I would like to see an overall reduction in poverty and inequality within our society. However, given that this is a long term objective, in more immediate terms, I would like to see our public dollars better used to address the needs of those within our society who are not well-served by the services that are currently offered. Particularly in health care, I think we must do a better job understanding the needs of those we care for and work collaboratively with them to design how care is provided.
Selected Publications:
Feng, X., Manns, B., Campbell, D. (2018). Affordability of Medications for Canadian Patients with Diabetes & What Providers Can Do About It. Diabetes Communicator. 2018: 12
Campbell, D., Soril, L., Manns, B., Clement, F. (2017). Differences in Canadian public medication insurance plans and the impact on out-of-pocket costs. CMAJ Open, 5(4): e808-813.
Campbell, D., Manns, B., Weaver, R., Hemmelgarn, B., King-Shier, K., Sanmartin, C. (2017). The association between financial barriers and adverse clinical outcomes among patients with cardiovascular-related chronic diseases: A cohort study. BMC Medicine, 15(33): 1-13.
Campbell, D., Tam-Tham, H., Dhaliwal, K., Manns, B., Hemmelgarn, B., Sanmartin, C., King-Shier, K. (2017). Use of Mixed Methods Research in Coronary Artery Disease Research: A Scoping Review. Circulation: Cardiovascular Quality and Outcomes. Epub ahead of print.
Campbell, D., Manns, B., Hemmelgarn, B., Sanmartin, C., Edwards, A., King-Shier, K. (2017). Understanding Financial Barriers to Care for Patients with Diabetes: An Exploratory Qualitative Study. The Diabetes Educator, 43(1).
Campbell, D., Manns, B., Leblanc, P., Hemmelgarn, B., Sanmartin, C., King-Shier, K. (2016). Finding resiliency in the face of financial barriers: Development of a conceptual framework for people with cardiovascular-related chronic disease. Medicine, 95(49): 1-8.
Campbell, D., Tonelli, M., Hemmelgarn, B., Mitchell, C., Tsuyuki, R., Ivers, N., et al. (2016). Assessing outcomes of enhanced Chronic disease Care through patient Education and a value-baSed formulary Study (ACCESS) – study protocol for a 2×2 factorial randomized trial. Implementation Science, 11(131).
