Evidence Based Practice and Resource Allocation

Question 1

what are inequities

Answer 1

how different people have different experiences in treatment

Question 2

what are randomised control trials

Answer 2

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

Question 3

what is evidence based practice

Answer 3

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

Question 4

what is the evidence based on

Answer 4

effectiveness and cost effectiveness

Question 5

what is the best avaliable evidence

Answer 5

findings from rigorously conducted research

Question 6

What did Cochrane’s book set out

Answer 6

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

Question 7

what is a systematic review

Answer 7

collection and analysis of multiple reviews

Question 8

what is a Cochrane centre

Answer 8

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

Question 9

why are systematic reviews useful

Answer 9

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

Question 10

true or false systematic reviews prevent biased decisions being made

Answer 10

true

Question 11

what is used to assess the quality of evidence

Answer 11

critical appraisal tool

Question 12

what do critical appraisal tools do?

Answer 12

suggest things to look for, questions to ask

Question 13

what are the 2 types of criticisms of evidence based practice

Answer 13

practical and philosophical

Question 14

give examples of practical criticisms (3)

Answer 14

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

Question 15

give examples of philosophical criticisms (4)

Answer 15

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

Question 16

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

Answer 16

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

Question 17

why are priorities for resources set

Answer 17

there are not enough resources as demand outstrips supply

Question 18

what is resource allocation driven by

Answer 18

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

Question 19

what are the 2 forms of rationing when determining resource allocation

Answer 19

explicit and implicit

Question 20

what is implicit rationing

Answer 20

the allocation of resources through individual clinical decisions

Question 21

what are the disadvantages to implicit rationing

Answer 21

leads to inequalities, open to abuse

Question 22

what is explicit rationing

Answer 22

systematic allocation of resources within health care system

Question 23

what are the advantages of explicit rationing

Answer 23

evidence based, less inequality, transparent

Question 24

what are the disadvantages of explicit rationing

Answer 24

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

Question 25

what does NICE stand for

Answer 25

national institute for health and care excellence

Question 26

what does NICE do

Answer 26

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

Question 27

what is scarcity

Answer 27

when the need outstrips the resources so prioritisation is inevitable

Question 28

what is efficiency

Answer 28

getting the most out of limited resources

Question 29

what is equity

Answer 29

the extent to which distribution of resources is fair

Question 30

what is effectiveness

Answer 30

the extent to which an intervention produced desired outcomes

Question 31

what is utility

Answer 31

the value an individual places on health state

Question 32

what is opportunity cost

Answer 32

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

Question 33

what is opportunity cost measured in

Answer 33

benefits foregone

Question 34

what is technical efficiency

Answer 34

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)

Question 35

what is allocative efficiency

Answer 35

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

Question 36

what does an economic analysis compare

Answer 36

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

Question 37

how can you measure benefits?

Answer 37

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

Question 38

what are the 4 types of economic evaluation

Answer 38

1. cost minimisation analysis 2. cost effectiveness analysis 3, cost benefit analysis 4. cost utility analysis

Question 39

what do all 4 types of economic evaluations do

Answer 39

consider costs

Question 40

what do the 4 types of economic evaluations differ in

Answer 40

the extent to which they attempt to measure and value benefits

Question 41

what is cost minimisation analysis

Answer 41

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)

Question 42

what is cost effectiveness analysis

Answer 42

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

Question 43

what is cost benefit analysis

Answer 43

where the inputs and outputs are valued in monetary terms

Question 44

what is a cost utility analysis

Answer 44

analysis focussing on the quality of health outcomes produced

Question 45

what is the most frequently used measure in cost utility analysis

Answer 45

Quality adjusted life year (QALY)

Question 46

why are QALYs used

Answer 46

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

Question 47

what does 1 QALY equal

Answer 47

1 year of perfect health

Question 48

how is quality of life measured

Answer 48

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

Question 49

what are 3 alternatives to QALYs

Answer 49

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

Question 50

what does NICE use to assess cost effectiveness

Answer 50

QALYs

Question 51

what are some criticisms of QALYs

Answer 51

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