Transcript The value of Cochrane Reviews in developing health system

The value of Cochrane Reviews in
developing health systems guidance
Plenary session: How to ensure a safe and evidence-based health system
19th Cochrane Colloquium
Madrid
October 21th 2011
Tomás Pantoja Calderón
Escuela de Medicina
Pontificia Universidad Católica de Chile
Outline
• Are Cochrane reviews of health systems
interventions being used?
• Where in Cochrane are these reviews
produced?
• Challenges in developing Cochrane reviews of
health systems interventions
• Conclusion: some thoughts for Cochrane
COCHRANE REVIEWS OF HEALTH
SYSTEMS INTERVENTIONS AND THEIR
USE IN POLICYMAKING
Health systems interventions?
• What are the best
solutions to the most
burdensome health
problems?
• What are the best ways to
fit these solutions into
complex health systems
• What are the best ways to
bring about the desired
changes in health
systems?
Effectiveness of drugs, services or
programs
Health systems arrangements
•Governance
•Financial
•Delivery
Implementation strategies
•Consumers (patients)
•Health care professionals
•Health care organizations
Source: Lavis et al. Use of research to inform public policymaking. Lancet 2004;364:1615-21
WHERE IN COCHRANE ARE THESE
REVIEWS PRODUCED?
Production of health-systems
intervention reviews in Cochrane
The Cochrane Effective Practice and
Organisation of Care Group (EPOC)
• EPOC aims to undertake systematic reviews of interventions to
improve health care delivery and health care systems
including:
– Professional interventions (e.g. continuing
medical education, audit and feedback)
– Financial interventions (e.g. professional
incentives)
– Organisational interventions (e.g. the
expanded role of pharmacists)
– Regulatory / governance interventions
(e.g. interventions to reduce corruption
in the health sector)
• Spans all clinical areas
Bero L, Eccles M, Grimshaw J, Gruen RL, Mayhew A, Oxman AD, Tavender E, Zwarenstein M, Shepperd S, Paulsen E, Pantoja T, Lewin S, Ballini L. Cochrane
Effective Practice and Organisation of Care Group. About The Cochrane Collaboration (Cochrane Review Groups (CRGs)) 2009, Issue 4. Art. No.: EPOC
The Cochrane Effective Practice and
Organisation of Care Group (EPOC)
Progress to date – reviews, protocols &
overviews
• 79 reviews, 44 protocols
• Overviews of reviews (e.g. guidelines,
pharmaceutical policies)
• Collaborating with over 300 researchers
globally
• Base in Ottawa, Canada
• 3 satellites: Australia, UK, Norway
Objectives of the EPOC Satellite Oslo
• Support to review teams in low- & middle-income countries
(LMICs) to undertake and update relevant EPOC reviews
• Provide support to WHO and LMICs to access and use the
results of EPOC reviews through:
– AHPSR (Alliance for Health Policy and Systems
Research)
– EVIPNet (Evidence-Informed Policy Network)
– WHO ACHR (Advisory Committee on Health Research)
and GRC (Guideline Review Committee)
– Norwegian MDG 4&5 Initiative
– Stipends, training & support for reviewers in
LMIC
• Support to NORAD (Norwegian Overseas Aid)
• Expand EPOC’s editorial capacity
Support available to EPOC review
authors in LMICs
• Support to develop a review protocol, including:
– Designing a search strategy
– Statistical support for design of the analysis
– General guidance and technical training
• Similar support for conducting the review +
– Running database searches
– Retrieving full text copies of relevant papers
• Stipends for researchers from LMICs to travel to Oslo (or other
locations) to work on their review/s
• Links to the relevant Cochrane Centre and / or experienced
EPOC review authors in their country
Examples of Cochrane EPOC systematic reviews of
health systems interventions relevant to LMICs
• The impact of contracting out on
health outcomes and use of health
services in LMICs
• Interventions for increasing the
proportion of health professionals
practising in rural and other
underserved areas
• Strategies for integrating primary
health services in LMICs at the point of
delivery
• Substitution of doctors by nurses in
primary care
• Supervision outreach visits to improve
the quality of primary health care in
LMICs (protocol)
THE CHALLENGES
Some challenges in producing health
systems intervention reviews (in Cochrane)
• The timeliness of available evidence and the timeliness
of decision making
• The methodological challenges
–
–
–
–
Incorporating different types of evidence
Where to look for studies?
What synthesis methods?
the quality of evidence on health systems (GRADE in
health systems interventions)
• users experience:
– Review-derived products (e.g. SUPPORT summaries)
– incorporating judgments about relevance: applicability,
equity, cost-effectiveness, M&E (SUPPORT Tools for
policymakers)
How can we present (summarized)
evidence
so that it is useful and usable
for health policy makers
in low and middle-income
countries?
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Integrating different developments
Summary of
Findings tables
Suggested format for
Plain Language
Summaries
Thanks to Sarah Rosenbaum
SUPPORT
Summaries
Structured summary –”1:3:25”
approach
1
3
25
key
messages
exec.
summary
report
full
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Key messages and information about
the information:
“Who is this summary for?...”
“This summary includes…”
“Not included...”
“This summary is based on
the following systematic
review...”
“What is a systematic
review?...”
19
Information about the information:
“How this summary was
produced…”
“Knowing what’s not known
is important…”
20
Summary of findings and information
about the information:
“About quality of evidence
(GRADE)…”
21
More information on last page
“Additional information…”
Including other important
reviews, books, articles
on this topic
22
Information about the information:
Information about
SUPPORT Collaboration,
partners, newsletter,
glossary of terms, etc.
July 16, 2015
23
Judgments about relevance
Judgments about relevance (2)
Help with those judgments
Help with those judgments
Conclusions
• Cochrane reviews of health-systems
interventions could be a valuable resource to
inform policymaking
• They are being currently produced by different
Cochrane groups
• However, some challenges should be
addressed in order to increase their value for
health systems guidance
Challenges
• Production:
– The incorporation of other kinds of evidence (e.g.
qualitative research) and other synthesis methods
(e.g. realist synthesis)
– Capacity building strategy to conduct reviews of
health-systems interventions
– How Cochrane is planning to collaborate with other
partners in synthesizing evidence of health systems
interventions? (e.g. WHO)
• Use of evidence (translation)
– Dissemination vs users’ experience
– Is users’ experience within the scope of Cochrane?
Thanks to:
• Partners of the SUPPORT Collaboration
• Sarah Rosenbaum & Claire Glenton – Norwegian
Centre for the Health Services
• Simon Lewin, Andy Oxman, Liz Paulsen, Susan MunabiBabigumira – Oslo EPOC satellite
• John Lavis – McMaster University
• Jeremy Grimshaw, Al Mayhew – EPOC editorial base
• Evelina Chapman & Luis Gabriel Cuervo – Research
Promotion & Development, Pan American Health
Organization