Evidence & Health Policy Flashcards
Evidence-Based Medicine
Movement within medicine and related professions to base clinical practice on the most rigorous scientific basis, principally informed by the results of randomized controlled trials of effectiveness of interventions
- The trend in medicine is to guide clinical practice based on scientific evidence, from the outcomes of studies (ie. randomized controlled trials) that assess the effectiveness of interventions.
What is the problem with evidence based medicine today?
- Research produced by evidence based medicine may not be relevant to every individual - underrepresented in research, may create distorted view of whether a treatment should work or not on a certain person
- evidence cannot address every clinical question
- Research can be influenced by bias - questions and research we generate are based on what the most advantaged populations have/want to be researched
- It is hard to keep up with the amount of articles and research, and hard to implement new evidence fast
Evidence-Based Health Policy
Movement within public policy to give evidence greater weight in shaping policy decisions
- Apply principles of evidence based medicine to health policies
Evidence-Informed Health Policy
The integration of experience, judgement and expertise with the best available external evidence from systematic research
- Closer to how physicians actually operate
On average, how long does it take for new clinical evidence to change clinical practice?
~ 17 years
Why was the COVID vaccine/research an exception to how long it takes to change clinical practice?
As a result of funding and global focus on an issue
Steps to evidence informed health policy
1) Knowledge creation and distillation - What is the key thing we want to focus on?
2) Dissemination and diffusion - Share research with the world; doesn’t always happen because its only published on academic journal websites, how do we diffuse to stakeholders effectively
3) Organizational adoption and implementation - How does research evidence get taken up? What are barriers? How do we make this happen more often?
Types pf Evidence
Audits
Monitoring
Polling
Community consultations
Evaluation
Research
Evidence for analysis OF policy
1) Formative evaluation
2) Summative evaluation
Formative evaluation
Evaluation designed to assess how a programme or policy is being implemented with a view to modifying or developing the programme or policy in order to improve its implementation
- currently being implemented, making edits
Summative evaluation
Evaluation designed to produce an overall verdict on a policy or programme in terms of the balance of costs and benefits
- already implemented , did it achieve its aims?, what were some burdens?
Research
Systematic process for generating new knowledge and relating it to existing knowledge in order to improve understanding about the natural and social world
What is the ‘gold standard’ for research
randomized clinical trials - people believe more validity, more proactive
Pyramid of Research
- top represents ‘best and most accurate’ research
- people misunderstand, thinking that the top of the pyramid is always right and disregard bottom of pyramid
PSA Test
- measures prostate specific antigen in your blood
- When psa are high, it may indicate risk of prostate cancer is high
What is the problem with regulated PSA testing?
- Research found that men that are screened with PSA test, 1 death will be prevented, 3 will be prevented from cancer spreading
- 1 in 5 men have PSA test false positive
- 17% of the false positives have false biopsy
- Cancer misdiagnosed because of this
–> Harms associated with screening outweigh benefits for many people
What is tamiflu, what is the controversy surrounding it?
- Brand name of an antiviral used to treat influenza
- Only 2 of 10 research article about Tamiflu medicine were published
- Decisions were based on only 2 articles bc the others are not available to public
- Are they hiding negative effects?
Why isn’t all health policy evidence informed?
- hard to read scientific literature
- hard for policymakers to analyze
- hard to access (people have to pay to access)
- fear influencing policy decisions
- value influencing policy decisions
- false info spread by media
- effects on the economy if banning certain procedures/goods
What is the role of fear in policy?
- people prioritize fear over evidence in times of stress
ex. ebola - canada closed its borders, even though it had already spread to Canada
Example of abortion laws and how values influence them
- Legalize and regulated abortion = abortion rates going down, and are done more safely
- Evidence says more abortions may occur when banned
- Many politicians prohibit abortions, despite the evidence
- Core values and ideologies trump evidence in this case
Knowledge Transition
- dynamic and iterative process that includes synthesis, dissemination, exchange and ethical application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system
translating knowledge so policy makers nderstajnd and see as legitimate - ## ‘middleman’ job
Evidence is ____ but not _____ in policy making
necessary, sufficient
What are strategies to bridge policy making community with those publishing scientific evidence?
- linkage and exchange - scientists ask what knowledge is required by the policy makers to understand the issue, and to make policy
- coproduction of knowledge - involve physicians, patients, policy in trials
- advocacy coalitions - groups of people pushing for a certain change, involving these groups in policy making
