Evidence Based Practice and Resource Allocation Flashcards
what are inequities
how different people have different experiences in treatment
what are randomised control trials
experiment which reduces bias when testing a new treatment. The people participating in the trial are randomly allocated to either the group receiving the treatment under investigation or to a group receiving standard treatment (or placebo treatment) as the control
what is evidence based practice
treatment based on clinical expertise as well as the best available external clinical evidence
what is the evidence based on
effectiveness and cost effectiveness
what is the best avaliable evidence
findings from rigorously conducted research
What did Cochrane’s book set out
principles of evidence based practice and criticism of medical professionals for failing to take into account research
what is a systematic review
collection and analysis of multiple reviews
what is a Cochrane centre
where RCTs are collected and systematic reviews take place analysing the evidence from the RCTs
why are systematic reviews useful
increases certainty, offer conclusions, save clinicians from having to locate studies for themselves
true or false systematic reviews prevent biased decisions being made
true
what is used to assess the quality of evidence
critical appraisal tool
what do critical appraisal tools do?
suggest things to look for, questions to ask
what are the 2 types of criticisms of evidence based practice
practical and philosophical
give examples of practical criticisms (3)
- may be impossible to create systemic reviews for all specialities
- may be challenging and expensive to implement findings
- they are not always necessary
give examples of philosophical criticisms (4)
- to what extent should doctors use them to make decisions
- just because an RCT shows a positive effect doesn’t mean it will for an individual patient
- where does responsibility lie if doctors are just following guidelines
- doctors may just follow guidelines and not do what best for the patient
what problems are there with getting the evidence into practice (4)
- doctors don’t know the evidence exists
- doctors don’t know how to use the evidence
- don’t have the drugs or equipment to implement
- patients may not want that treatment
why are priorities for resources set
there are not enough resources as demand outstrips supply
what is resource allocation driven by
- demographics (the population of elderly is increasing giving increases of certain conditions)
- cost
what are the 2 forms of rationing when determining resource allocation
explicit and implicit
what is implicit rationing
the allocation of resources through individual clinical decisions
what are the disadvantages to implicit rationing
leads to inequalities, open to abuse
what is explicit rationing
systematic allocation of resources within health care system
what are the advantages of explicit rationing
evidence based, less inequality, transparent
what are the disadvantages of explicit rationing
very complex, patient distress if the NHS cant fund a drug, less clinical freedom as you cant prescribe whats in the patients best interest
what does NICE stand for
national institute for health and care excellence
what does NICE do
looks at clinical and cost effectiveness of treatments to decide whether or not they can be recommended for use in the NHS
what is scarcity
when the need outstrips the resources so prioritisation is inevitable
what is efficiency
getting the most out of limited resources
what is equity
the extent to which distribution of resources is fair
what is effectiveness
the extent to which an intervention produced desired outcomes
what is utility
the value an individual places on health state
what is opportunity cost
once you’ve spent money on one treatment you no longer have that money to spend on another treatment
what is opportunity cost measured in
benefits foregone
what is technical efficiency
when you are interested in the most efficient way of meeting a need (e.g. whether a treatment should be in the community or hospital)
what is allocative efficiency
you are choosing between many needs to be met (e.g. by choosing which treatment to fund)
what does an economic analysis compare
the inputs (resources) and outputs of alternative interventions to see which intervention is the best value
how can you measure benefits?
by looking at:
- impact on health status
- saving in resources (e.g. will the patient no longer need drugs)
- improved productivity of the patient
what are the 4 types of economic evaluation
- cost minimisation analysis
- cost effectiveness analysis
3, cost benefit analysis - cost utility analysis
what do all 4 types of economic evaluations do
consider costs
what do the 4 types of economic evaluations differ in
the extent to which they attempt to measure and value benefits
what is cost minimisation analysis
where the outcomes are assumed to be equivalent so only look at costs (e.g. all hit replacements give equal improvement so choose the cheapest one)
what is cost effectiveness analysis
compare drugs with a common health outcome in terms of cost per unit outcome
what is cost benefit analysis
where the inputs and outputs are valued in monetary terms
what is a cost utility analysis
analysis focussing on the quality of health outcomes produced
what is the most frequently used measure in cost utility analysis
Quality adjusted life year (QALY)
why are QALYs used
as they combine survival and quality of life as a guide to decision making
what does 1 QALY equal
1 year of perfect health
how is quality of life measured
generic (EQ-5D commonly used) and specific instruments
what are 3 alternatives to QALYs
- health year equivalents
- saved young life equivalents
- disability adjusted life years
what does NICE use to assess cost effectiveness
QALYs
what are some criticisms of QALYs
- don’t distribute resources according to need but according to benefit gained per cost
- may not embrace all dimensions of benefit
- don’t asses impact on family or carers
