Health Care and Pharmacoepidemiology

Health Care Epidemiology Program Health care epidemiology can be defined as the study of health care variables, together with biological, social, behavioral, and environmental factors, that influence the health states of populations. The implication for public policy and clinical decision making are encompassed in this area of inquiry. Health care epidemiology rests on the theoretical formulation that the distributions of health states (good health, disease, disability, and death) in populations are not random. Health states are determined by many factors that are found in the host, agent, or environment including biological, social, and environmental factors. One important determinant of the health of populations is the accessibility and use of health services. Because health care epidemiology is a field defined mainly by the type of exposure, it is to be expected that it overlaps with fields defined by disease such as cancer, cardiovascular diseases, and infectious diseases. Similarly, it overlaps with fields defined by the age or sex of the exposed subjects: pediatric epidemiology, epidemiology of aging, perinatal epidemiology, reproductive epidemiology, and women's health. Environmental and occupational epidemiology, fields defined by the setting in which the exposure occurs, also share some attributes with health care epidemiology. The study of outcomes of medical care has become known as Outcomes Research. The area of Outcomes Research draws heavily on the core disciplines of epidemiology, health economics, and health services research. Health care epidemiology is indeed intertwined with both outcomes and health services research because it is concerned with studying how the use of health services affects the health outcomes of patients and populations. An observation...   Over the past decade there has been an international trend toward increased emphasis on judging the results of medical interventions in terms of their ability to improve medical outcomes. That is, the focus is on the effects of medical care on the health status of patients and populations, rather than exclusively in terms of ability to improve laboratory tests or physiological parameters. This is coupled with an interest not only in efficacy, as measured in randomized clinical trials, but also in effectiveness of new medical interventions, as measured by the extent to which application of the interventions in clinical practice can prevent or reduce morbidity, relieve symptoms, increase patient satisfaction with care, improve quality of life and functional status, decrease medical care utilization, and increase years of healthy life. Pharmacoepidemiology A sub-discipline of health care epidemiology is Pharmacoepidemiology, which has been described as "the study of the distribution and determinants of drug-related events in populations and the application of this study to efficacious drug treatment." The pharmacoepidemiology area of concentration is modeled after the ideals and vision of the late Dr. Harry Guess. Traditionally, pharmacoepidemiology was primarily concerned with studying how medications affect the health status of patients and populations. It is now evolving away from a single focus on etiologic observational studies of adverse drug reactions and toward a broader focus on epidemiologic questions arising in health services research. This change in emphasis has been reflected throughout the UNC program, in the content of courses, the types of courses taught, the types of students interested in this area of epidemiology, and the career paths of students. Training Program in Health Care Epidemiology The Training Program in Health Care Epidemiology, including outcomes research, is primarily housed in the Department of Epidemiology, but the full array of activities is spread throughout the university. It draws heavily on resources from other centers and institutes at UNC. The program is partially supported by a grant from the Health Resources and Services Administration (HRSA), which is aimed at promoting partnership among academic medicine, academic public health, and managed care organizations in order to bring a population perspective to medical practice. Collaborative research efforts for the management of chronic diseases are already underway.

Last updated December 06, 2007