Transcript Document

GP & PHCRED Conference July 2005
Australian Primary Health Care Research Institute
Nicholas Glasgow
Aims
 By the end of this session:
• Reflected more on the nexus between evidence and
policy
• Clearer about APHCRI’s focus and approach
• Had opportunity to ask questions
Overview
 Professor Nicholas Glasgow
• Overview of the research evidence and policy
 Mr Robert Wells
• Research Evidence and Policy – Reflections on a career
 Dr Bev Sibthorpe
• Research Evidence and Policy - Case studies
 Professor Nicholas Glasgow
• Research Evidence and Policy – The Evidence and APHCRI’s
Response
 Professor Jonathan Lomas
• Commentary
Because what
you
told me is
Yes,
absolutely
how
did
Youcorrect
must
but
Where
you
be
a
completely
am
I?
know?
researcher
useless
The problem
Because you
don’t know where
you are,
you 30
You’re
You must
Yes.
don’t know
where
metres
be
a
policy
How
you’re going,
and
above
the
maker
did
you
now you’re
ground
in a
know?
blamingballoon
me
GP & PHC Research activity
 Welcome announcement by Parliamentary Secretary to the
Minister for Health and Ageing, Christopher Pyne for
continued support of PHCRED
 Increasing research and evaluation activity
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Growth of this conference
PHCRED activities
RACGP developments
Success in competitive grant rounds such as NHMRC
 APHCRI
• Primary health system level focus
• Policy relevance important
• Complex (non linear) relationships between evidence and policy
 How do we engage with this complexity?
Use of Research Evidence by Policy
Makers
Nicholas Glasgow
Method
 Comprehensive search of the black and grey
literature relating to research dissemination, uptake
and utilisation in primary health care policy
 Supplemented by personal communications with
key contributors to this literature including:
• Professor Jonathan Lomas at the Canadian Health
Services Research Foundation
• Professor John Lavis and
• Professor Nicholas Mays
 Relevant systematic reviews were identified
Method
 A publication was judged to be a systematic review
if there were explicit statements within the paper
which:
• articulated the question
• clearly summarised the strategy used to identify relevant
studies
• indicated how the identified studies were assessed for
inclusion/exclusion
• summarised and synthesized the results
Greenhalgh AT, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of Innovations in Service Organisations: Systematic Review and
Recommendations Milbank Quarterly 2004; 82: http://www.milbank.org/quarterly/8204feat.html (Accessed April 2005)
July 2005 Supplement
J Health Services Research & Policy
• Synthesizing evidence for management
and policy-making
• Volume 10 Number 3 Supplement July 2005
• http://select.ingentaconnect.com/rsm/13558
196/v10n3x1/contp1-1.htm
Key review before the
supplement
 Innvaer S, Vist G, Trommald M, Oxman A. Health policymakers perceptions of their use of evidence: a systematic
review J Health Serv Res Policy 2002; 7:239-244h
 Facilitators
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Personal contact between researchers and policy makers
Timeliness and relevance of the research
Research that included a summary and clear recommendations
Good quality research
Research that confirmed current policy or endorsed self-interest
Community pressure or client demand for research
Research that included effectiveness data
 Barriers
• Absence of personal contact between researchers and
policy-makers
• Lack of timeless or relevance of research
• Mutual distrust, including perceived political naivety or
scientists and scientific naivety by policy-makers
• Power and budget struggles
• Poor quality research
• Political instability and high turnover of policy-making
staff
A policy maker reflects on evidence and
policy
Mr Robert Wells
Policy
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Evidence-based
Rational process
Balancing of interests
Long term perspective
Open & accountable
Objectively evaluated
 Reactive
 Ad hoc
 responding to specific
interests
 Short term horizon
 Secretive
 Spin
Research
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Systematic
Methodical
Accurate
Objective
Analytical
Detailed
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Curiosity driven
Irrelevant
Slow
Technical
Narrowly focussed
A researcher reflects – case studies from
APHCRI
Dr Bev Sibthorpe
Key review before the
supplement
 Innvaer S, Vist G, Trommald M, Oxman A. Health policymakers perceptions of their use of evidence: a systematic
review J Health Serv Res Policy 2002; 7:239-244h
 Facilitators
•
•
•
•
•
•
•
Personal contact between researchers and policy makers
Timeliness and relevance of the research
Research that included a summary and clear recommendations
Good quality research
Research that confirmed current policy or endorsed self-interest
Community pressure or client demand for research
Research that included effectiveness data
APHCRI’s approach
Professor Nicholas Glasgow
Overview
Getting past “two communities”
What is evidence?
What does “use” of evidence mean?
How do systematic reviews and synthesis fit in?
What does APHCRI see as an applied research
cycle?
 What does this mean for APHCRI's work?
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Key Stakeholders
(“communities”)
Providers of Primary
Health Care services
and their
organisations
Australian
Government
Policy and Decision
Makers
APHCRI
Hub and
Spokes
Research
Community
Consumers of Primary
Health Care Services
and their organisations
Getting past “two communities”
The nature of “evidence”
 “Research” and “evidence” are words that are value laden
and differently understood
 What is being sought is valid and reliable knowledge, and
wisdom in its application
 If innovations within primary health care are going to be
conceived, tested and implemented there must be
willingness on the part of all players to understand research
and evidence through different lenses
 Helpful insights will be derived from different research
traditions.*
*Greenhalgh AT, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of Innovations in Service Organisations: Systematic R eview and
Recommendations Milbank Quarterly 2004; 82: http://www.milbank.org/quarterly/8204feat.html (Accessed April 2005)
The nature of “use”
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Direct (engineering, instrumental) use
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Symbolic use (mobilisation of support)
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to add weight to a particular policy direction
an instrument for persuasion. Findings – or simply the act of research – can be used
as a political tool and can legitimate particular courses of action or inaction
Conceptual use (enlightenment)
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Research feeds directly into decision making for policy and practice
Even if policy makers or practitioners are blocked from using findings, research can
change their understanding of a situation, provide new ways of thinking and offer
insights into the strengths and weaknesses of particular courses of action. New
conceptual understandings can then sometimes be used in instrumental ways.
Wider influence
•
influence beyond the institutions and events being studied. Evidence may be
synthesised. It might come into currency through networks of practitioners and
researchers, and alter policy paradigms or belief communities
Nutley S, Davies H, Walter I. Evidence Based Policy and Practice: Cross Sector Lessons From the UK. ESRC UK Centre for Evidence
Based Policy and Practice: Working Paper 9. 2002. ESRC UK Centre for Evidence Based Policy and Practice; Research Unit for Research
Utilisation
Systematic reviews and
synthesis
 Cogent argument for systematic reviews to be given
greater profile as evidence of value to policy
makers
 There is an emerging science of systematic reviews
and synthesis
*Lavis JN, Posada FB, Haines A, Osei E. Use of research to inform public policymaking Lancet 2004; 364: 1615-21
*Lavis JN, Davies HTO, Oxman A, Denis JL, Golden-Biddle K, Ferlie E. Towards Systematic Reviews That Inform
Healthcare Management and Policymaking JHSRP 2005; v10 Number 3 Supplement
Economic assumptions
 How you pay (reward) people contains incentives to
do (or not do) particular things
 Economists speak of the need to align incentives to
ensure that that inherent incentives encourage the
behaviour needed to achieve desired goals
 Are producers of research evidence rewarded for
addressing policy questions?
Research
•Primary
•Secondary
Pre Research
Dissemination
•Priority setting/review
•Questions
• Methodologies
• Funding
• Research training (not just researchers)
Evaluation
Adoption
(Use
•Direct
•Symbolic
•Enlightenment)
Key Stakeholders
Providers of Primary
Health Care services
and their
organisations
Australian
Government
Policy and Decision
Makers
APHCRI
Hub and
Spokes
Research
Community
Consumers of Primary
Health Care Services
and their organisations
Who’s question(s)?
 Policy makers and decision makers in both the
Commonwealth and States/Territories;
 Providers of primary health care services and the
various organisations with which they are linked;
 Researchers; and/or
 Users of primary health care services and the
various organisations with which they are linked
Aim for Stream Four
 “to systematically identify, review, and synthesise
knowledge about primary health care organisation,
funding, delivery and performance and then
consider how this knowledge might be applied in
the Australian context”
Seven Topic Areas
1.
2.
3.
4.
Chronic disease management;
Integration, co-ordination and multidisciplinary care;
Prevention and early intervention;
Innovative models for comprehensive primary health care
delivery;
5. Innovative models for the management of mental health in
primary health care settings;
6. Older Australians and health promotion, prevention and
post-acute care; and
7. Children and young Australians, health promotion and
prevention
APHCRI questions within topics
 Questions of two general types
• “What do we know about….?” and
• “What are the possible options?”
 The “What do we know about…?” questions are the focus of
the systematic review and synthesis, while the “What are the
possible options?” questions build on the results to develop
ways forward for Australia’s primary health care system
 APHCRI is interested in specific questions being addressed
in each topic area, including questions about funding
arrangements (existing and alternative), delivery
arrangements and governance arrangements, and
performance - i.e. system level questions
Why Stream Four?
 This systematic processing of knowledge will provide:
• A strong basis on which national primary health care policy can be
informed,
• Clear insights into important knowledge gaps, and
• The foundation on which APHCRI can build subsequent streams of
activity
 The process for Stream Four will:
• Strengthen the hub and spoke model – we mean it!
• Build capacity in the policy and research communities with regard to
primary health care policy relevant research
Stream Four Workshops
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Four workshops occur during Stream Four
At least one CI from each group
Attendance by members of the DoHA
Allows
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Iteration of the questions
Reflection on the results as they start to emerge
New direction to occur
Researchers to focus on the research, policy analysts to focus on
policy analysis and both to learn more of the other
Miscommunication is real
ATTORNEY: Is your appearance here this morning pursuant
to a deposition notice which I sent to your attorney?
WITNESS: No, this is how I dress when I go to work.
ATTORNEY: What gear were you in at the moment of the
impact?
WITNESS: Gucci sweats and Reeboks.
Professor Lomas Comments
END