ASBHDS: Evidence Based Practice, Recourse Allocation, Healthcare Economics Flashcards
What is evidence based practice?
It involves the integration of individual clinical expertise with the best available external clinical evidence from systematic research.
What are some problems with evidence based practice?
- challenging and expensive to disseminate findings
- RCTs often have ethical implications
- requires good faith of pharmaceutical companies
Name some of the difficulties of getting evidence into practice.
- Doctors don’t know about evidence
- Doctors choose not to use evidence
- Organisational systems may not be able to support change (i.e. they don’t have the equipment)
- Patients might want something else
How does scare resources impact doctors?
Patients may disagree with the NICE guidelines, however doctors much remain ethical (clear and explicit) in their practice
Name and describe the 2 forms of rationing.
- Explicit: based on defined rules of entitlement, i.e. uses institutional procedures for systematic allocation
- Implicit: the allocation of resources through individual clinical decisions without the criteria for those decisions to be explicit
Why is there a need to priortise in healthcare?
Because recourse are so scarce, demand outstrips supply.
Name 4 ways in which cost and benefits are compared.
- Cost effectiveness
- cost benefit
- cost utility
- cost minimisation
What is cost minimisation?
- Out comes are assumed to be equivalent and therefore the focus is on cost
What is cost effectiveness?
Used to compare drugs or treatments with a common health outcomes
What is cost utility?
Focuses on quality of health outcomes
What is cost benefit?
When all incomes and outcome are valued in monetary terms. This allows comparison with interventions outside of healthcare. (i.e. transport and education)
Why are cost minimisation analyses rarely relevant?
outcomes are rarely equivalent
How is cost effectiveness usually compared?
cost per unit outcome (i.e. is extra benefit worth extra cost?)
What is the most frequently used measure for cost utility?
QALY (Quality adjusted life year)
What are the advantages of using QALYs?
- Maximise the benefits from health care spending.
- Overcome regional variations in access.
- Contain costs and manage demand.
- Provide bargaining power with suppliers of health care products.
