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CJ: UoL Medicine Semester Two (ESA2) > ASBHDS - Session 1 > Flashcards

ASBHDS - Session 1 Flashcards

1
Q

Give some arguments in favour of using evidence-based healthcare.

A
  • evidence of effectiveness and cost-effectiveness required in a system with finite resources
  • variations in treatment cause inequities
  • practices influenced too much by professional opinion, clinical fashion, culture etc.
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2
Q

What is the Cochrane Collaboration?

A

A global group of all the Cochrane Centres, which register and analyse all RCTs

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3
Q

What is the standard definition of evidence-based practice?

A

Evidence based practice involves the integration of individual clinical expertise with the best available external clinical evidence from systematic research

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4
Q

Why are systematic reviews required?

A
  • Traditional reviews may be biased/subjective
  • Not easy to see how studies were identified for review
  • quality of reviewed studies is variable
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5
Q

Give some reasons why systematic reviews are useful to clinicians.

A
  • offer quality control and increased certainty
  • save clinicians from having to locate/appraise studies for themselves
  • may reduce delay between research discoveries and implementation
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6
Q

Give some PRACTICAL criticisms of the evidence-based practice movement

A
  • may be an impossible task to maintain systematic reviews across all specialities
  • challenging and expensive to disseminate/implement findings
  • not always feasible/necessary
  • requires ‘good faith’ from pharmaceutical companies
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7
Q

Give some PHILOSOPHICAL criticisms of evidence-based practice.

A
  • does not align with most doctors’ modes of reasoning
  • population-level outcomes don’t mean an intervention will work for an individual
  • could relate ‘unreflective rule followers’ from professionals
  • might be seen as way of legitimising rationing
  • professional responsibility/autonomy
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8
Q

Give some problems with getting evidence into practice

A
  • evidence exists but doctors don’t know about it
  • doctors know about evidence but don’t use it
  • organisational systems cannot support innovation
  • commissioning decisions reflect different priorities
  • resources not available to implement change
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9
Q

Define scarcity

A

Need outstrips resources, prioritisation is inevitable

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10
Q

Define efficiency

A

Getting the most out of limited resources

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11
Q

Define equity

A

The extent to which distribution of resources is fair

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12
Q

Define effectiveness

A

The extent to which an intervention produces desired outcomes

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13
Q

Define utility

A

The value an individual places on a heath state

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14
Q

Define opportunity cost

A

Once a resource has been used in one way, it can no longer be used in another way

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15
Q

What is the difference between technical and allocative efficiency?

A

Technical efficiency - the most efficient way of meeting a need
Allocative efficiency - choosing between the many needs to be met

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16
Q

What does an economic analysis do?

A

Compares the inputs (resources) and outputs (benefits and value attached to them) of alternative interventions, allowing better decisions to be made about investment values.

17
Q

How are costs measured?

A

Identify, quantify and value resources needed

18
Q

How are benefits measured?

A
  • impacts on health status
  • savings in other healthcare resources
  • improved productivity if patient/family returns to work earlier
19
Q

What are the four types of economic evaluation?

A
  • cost minimisation analysis
  • cost effectiveness analysis
  • cost benefit analysis
  • cost utility analysis
20
Q

What is cost minimisation analysis?

A
  • outcomes assumed to be equivalent
  • focus is on costs only
  • not relevant very often
  • eg. All prostheses for hip replacement improve mobility equally; choose cheapest one
21
Q

What is cost effectiveness analysis?

A
  • used to compare drugs/interventions with a common health outcome
  • compared in terms of cost per unit outcome (eg per reduction in blood pressure of 5 mm Hg)
22
Q

What is cost benefit analysis?

A
  • all inputs and outputs valued in monetary terms

- allows comparisons with interventions outside healthcare

23
Q

What is cost utility analysis?

A
  • sub-type of cost effectiveness analysis

- measured in ‘cost per QALY’ terms

24
Q

If there is good evidence about the effectiveness of the interventions and they are equally effective, which study should be used?

A

Cost minimisation study

25
Q

If outcomes cannot be measured in monetary terms or QALYs, what study should be used?

A

Cost-effectiveness analysis

26
Q

What is a QALY?

A

A Quality Adjusted Life Year adjusts life expectancy for quality of life, so one year of perfect health = 1 QALY

27
Q

Give an example of a way of measuring quality of life.

A

The EQ-5D

28
Q

Up to what monetary value will NICE approve technology?

A
  • below £20k per QALY, technology approved
  • at £20k-30k it will be evaluated
  • above £30k needs a ‘strong case’ to be accepted
29
Q

Give some criticisms of QALYs

A
  • controversy about values they embody
  • may disadvantage common conditions
  • do not distribute resources according to need, but according to benefit gained
  • technical problems with calculation
  • do not assess impact on careers/family
  • RCT evidence can not always be relied upon
30
Q

Why must priorities must be set in healthcare?

A

Due to scarcity of resources - demand outstrips supply

31
Q

What is the difference between explicit and implicit rationing?

A

Implicit - allocation of resources through individual clinical decisions without the criteria for decisions being explicit

Explicit - the use of institutional procedures for the systematic allocation of resources within a health care system

32
Q

Give some disadvantages of implicit rationing

A
  • can lead to inequities and discrimination
  • open to abuse
  • decisions based on perceptions of ‘social deserving-ness’
  • doctors increasingly unwilling to do it
33
Q

Give some advantages of explicit rationing

A
  • transparent and accountable
  • opportunity for debate
  • more clearly evidence-based
  • more opportunities for equity in decision-making
34
Q

Give some disadvantages of explicit rationing

A
  • very complex
  • heterogeneity of patients and illnesses makes it difficult
  • patient/professional hostility
  • impact on clinical freedom
  • evidence of patient distress
35
Q

What does NICE stand for?

A

National Institute for Health and Care Excellence

36
Q

What is the purpose of NICE?

A

Enables evidence of clinical and cost effectiveness to be integrated to form a judgement on the value of a treatment

37
Q

Why is the role of NICE in approving/rejecting expensive treatments sometimes seen as controversial?

A
  • if not approved, patients effectively denied access to treatment
  • if approved, NHS organisations must fund them, even if with adverse consequences for other priorities

CJ: UoL Medicine Semester Two (ESA2) (87 decks)

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