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Phase 1 - ASBHDS > Evidence Based Practice and Resource Allocation > Flashcards

Evidence Based Practice and Resource Allocation Flashcards

1
Q

what are inequities

A

how different people have different experiences in treatment

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2
Q

what are randomised control trials

A

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

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3
Q

what is evidence based practice

A

treatment based on clinical expertise as well as the best available external clinical evidence

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4
Q

what is the evidence based on

A

effectiveness and cost effectiveness

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5
Q

what is the best avaliable evidence

A

findings from rigorously conducted research

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6
Q

What did Cochrane’s book set out

A

principles of evidence based practice and criticism of medical professionals for failing to take into account research

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7
Q

what is a systematic review

A

collection and analysis of multiple reviews

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8
Q

what is a Cochrane centre

A

where RCTs are collected and systematic reviews take place analysing the evidence from the RCTs

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9
Q

why are systematic reviews useful

A

increases certainty, offer conclusions, save clinicians from having to locate studies for themselves

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10
Q

true or false systematic reviews prevent biased decisions being made

A

true

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11
Q

what is used to assess the quality of evidence

A

critical appraisal tool

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12
Q

what do critical appraisal tools do?

A

suggest things to look for, questions to ask

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13
Q

what are the 2 types of criticisms of evidence based practice

A

practical and philosophical

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14
Q

give examples of practical criticisms (3)

A
  1. may be impossible to create systemic reviews for all specialities
  2. may be challenging and expensive to implement findings
  3. they are not always necessary
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15
Q

give examples of philosophical criticisms (4)

A
  1. to what extent should doctors use them to make decisions
  2. just because an RCT shows a positive effect doesn’t mean it will for an individual patient
  3. where does responsibility lie if doctors are just following guidelines
  4. doctors may just follow guidelines and not do what best for the patient
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16
Q

what problems are there with getting the evidence into practice (4)

A
  1. doctors don’t know the evidence exists
  2. doctors don’t know how to use the evidence
  3. don’t have the drugs or equipment to implement
  4. patients may not want that treatment
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17
Q

why are priorities for resources set

A

there are not enough resources as demand outstrips supply

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18
Q

what is resource allocation driven by

A
  1. demographics (the population of elderly is increasing giving increases of certain conditions)
  2. cost
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19
Q

what are the 2 forms of rationing when determining resource allocation

A

explicit and implicit

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20
Q

what is implicit rationing

A

the allocation of resources through individual clinical decisions

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21
Q

what are the disadvantages to implicit rationing

A

leads to inequalities, open to abuse

22
Q

what is explicit rationing

A

systematic allocation of resources within health care system

23
Q

what are the advantages of explicit rationing

A

evidence based, less inequality, transparent

24
Q

what are the disadvantages of explicit rationing

A

very complex, patient distress if the NHS cant fund a drug, less clinical freedom as you cant prescribe whats in the patients best interest

25
Q

what does NICE stand for

A

national institute for health and care excellence

26
Q

what does NICE do

A

looks at clinical and cost effectiveness of treatments to decide whether or not they can be recommended for use in the NHS

27
Q

what is scarcity

A

when the need outstrips the resources so prioritisation is inevitable

28
Q

what is efficiency

A

getting the most out of limited resources

29
Q

what is equity

A

the extent to which distribution of resources is fair

30
Q

what is effectiveness

A

the extent to which an intervention produced desired outcomes

31
Q

what is utility

A

the value an individual places on health state

32
Q

what is opportunity cost

A

once you’ve spent money on one treatment you no longer have that money to spend on another treatment

33
Q

what is opportunity cost measured in

A

benefits foregone

34
Q

what is technical efficiency

A

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)

35
Q

what is allocative efficiency

A

you are choosing between many needs to be met (e.g. by choosing which treatment to fund)

36
Q

what does an economic analysis compare

A

the inputs (resources) and outputs of alternative interventions to see which intervention is the best value

37
Q

how can you measure benefits?

A

by looking at:

  1. impact on health status
  2. saving in resources (e.g. will the patient no longer need drugs)
  3. improved productivity of the patient
38
Q

what are the 4 types of economic evaluation

A
  1. cost minimisation analysis
  2. cost effectiveness analysis
    3, cost benefit analysis
  3. cost utility analysis
39
Q

what do all 4 types of economic evaluations do

A

consider costs

40
Q

what do the 4 types of economic evaluations differ in

A

the extent to which they attempt to measure and value benefits

41
Q

what is cost minimisation analysis

A

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)

42
Q

what is cost effectiveness analysis

A

compare drugs with a common health outcome in terms of cost per unit outcome

43
Q

what is cost benefit analysis

A

where the inputs and outputs are valued in monetary terms

44
Q

what is a cost utility analysis

A

analysis focussing on the quality of health outcomes produced

45
Q

what is the most frequently used measure in cost utility analysis

A

Quality adjusted life year (QALY)

46
Q

why are QALYs used

A

as they combine survival and quality of life as a guide to decision making

47
Q

what does 1 QALY equal

A

1 year of perfect health

48
Q

how is quality of life measured

A

generic (EQ-5D commonly used) and specific instruments

49
Q

what are 3 alternatives to QALYs

A
  1. health year equivalents
  2. saved young life equivalents
  3. disability adjusted life years
50
Q

what does NICE use to assess cost effectiveness

A

QALYs

51
Q

what are some criticisms of QALYs

A
  1. don’t distribute resources according to need but according to benefit gained per cost
  2. may not embrace all dimensions of benefit
  3. don’t asses impact on family or carers

Phase 1 - ASBHDS (7 decks)

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