Tag Archives: Evidence Based

Prescribing cannabis based drugs: response from NICE and Health Education England

I thought I would include this response from NICE and HEE as it is an important message. Click the link below to access the letter or read it below.

https://www.bmj.com/content/363/bmj.k4940

Further to Hamilton’s recommendation that general practitioners consult Google Scholar and ask their colleagues if they are unsure about prescribing cannabis,1 we write to remind readers in England that they have 24/7 access to reliable sources of evidence to inform clinical decisions.

The National Institute for Health and Care Excellence’s evidence search (https://www.evidence.nhs.uk) provides access to authoritative evidence on health, social care, and public health. It focuses on synthesised secondary evidence, including content from over 800 sources, including the British National Formulary, Clinical Knowledge Summaries, SIGN, the Cochrane Library, the royal colleges, Public Health England, and GOV.UK. Information and knowledge specialists at NICE add further good quality systematic reviews. This service is openly available to everyone in the UK; here you will find reviews on the use of cannabis in treatment of epilepsy, neuropathic pain, fibromyalgia, HIV/AIDS, and asthma.

Healthcare staff in England can access a vital, core collection of healthcare databases and full text journals for no charge at https://hdas.nice.org.uk. Purchased by Health Education England on behalf of the NHS in England, these are provided online in partnership with NICE. You simply need an NHS OpenAthens account. Register at https://www.nice.org.uk/about/what-we-do/evidence-services/journals-and-databases/OpenAthens.

NHS funded librarians and knowledge specialists are skilled in helping colleagues find information and search for evidence. They can offer summarised evidence searches and help teams keep up-to-date.

Health is a knowledge industry. We encourage practices to contact their local healthcare library. Check http://hlisd.org for details. Health Education England is committed to work with NHS organisations to ensure that all staff can access knowledge for healthcare23 and benefit from the expertise of healthcare librarians. We know that only a third of Clinical Commissioning Groups currently have such arrangements in place for their staff and member practices. For advice on improving your organisation’s access to knowledge services please contact your regional Health Education England library lead.3

 

Development of measurable indicators to enhance public health evidence-informed policy-making

Tudisca, V. et al. Health Research Policy and Systems, 2018: 16:47

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Background
Ensuring health policies are informed by evidence still remains a challenge despite efforts devoted to this aim. Several tools and approaches aimed at fostering evidence-informed policy-making (EIPM) have been developed, yet there is a lack of availability of indicators specifically devoted to assess and support EIPM. The present study aims to overcome this by building a set of measurable indicators for EIPM intended to infer if and to what extent health-related policies are, or are expected to be, evidence-informed for the purposes of policy planning as well as formative and summative evaluations.

Methods
The indicators for EIPM were developed and validated at international level by means of a two-round internet-based Delphi study conducted within the European project ‘REsearch into POlicy to enhance Physical Activity’ (REPOPA). A total of 82 researchers and policy-makers from the six European countries (Denmark, Finland, Italy, the Netherlands, Romania, the United Kingdom) involved in the project and international organisations were asked to evaluate the relevance and feasibility of an initial set of 23 indicators developed by REPOPA researchers on the basis of literature and knowledge gathered from the previous phases of the project, and to propose new indicators.

Results
The first Delphi round led to the validation of 14 initial indicators and to the development of 8 additional indicators based on panellists’ suggestions; the second round led to the validation of a further 11 indicators, including 6 proposed by panellists, and to the rejection of 6 indicators. A total of 25 indicators were validated, covering EIPM issues related to human resources, documentation, participation and monitoring, and stressing different levels of knowledge exchange and involvement of researchers and other stakeholders in policy development and evaluation.

Conclusion
The study overcame the lack of availability of indicators to assess if and to what extent policies are realised in an evidence-informed manner thanks to the active contribution of researchers and policy-makers. These indicators are intended to become a shared resource usable by policy-makers, researchers and other stakeholders, with a crucial impact on fostering the development of policies informed by evidence.

Does access to a demand-led evidence briefing service improve uptake and use of research evidence by health service commissioners? A controlled before and after study

Wilson, P.M. et al. BMC Implementation Science, 2017; 12(20)

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Abstract
Background
The Health and Social Care Act mandated research use as a core consideration of health service commissioning arrangements in England. We undertook a controlled before and after study to evaluate whether access to a demand-led evidence briefing service improved the use of research evidence by commissioners compared with less intensive and less targeted alternatives.

Methods
Nine Clinical Commissioning Groups (CCGs) in the North of England received one of three interventions: (A) access to an evidence briefing service; (B) contact plus an unsolicited push of non-tailored evidence; or (C) unsolicited push of non-tailored evidence. Data for the primary outcome measure were collected at baseline and 12 months using a survey instrument devised to assess an organisations’ ability to acquire, assess, adapt and apply research evidence to support decision-making. Documentary and observational evidence of the use of the outputs of the service were sought.

Results
Over the course of the study, the service addressed 24 topics raised by participating CCGs. At 12 months, the evidence briefing service was not associated with increases in CCG capacity to acquire, assess, adapt and apply research evidence to support decision-making, individual intentions to use research findings or perceptions of CCG relationships with researchers. Regardless of intervention received, participating CCGs indicated that they remained inconsistent in their research-seeking behaviours and in their capacity to acquire research. The informal nature of decision-making processes meant that there was little traceability of the use of evidence. Low baseline and follow-up response rates and missing data limit the reliability of the findings.

Conclusions
Access to a demand-led evidence briefing service did not improve the uptake and use of research evidence by NHS commissioners compared with less intensive and less targeted alternatives. Commissioners appear well intentioned but ad hoc users of research. Further research is required on the effects of interventions and strategies to build individual and organisational capacity to use research.

Public Health e-Learning toolkit

By UK Health Forum

Click here to use the toolkit

Public Health eLearning Toolkit (PHeLT) has been developed by qualified information professionals at the UK Health Forum, to support the public health workforce in using and appraising information in their work.
The PHeLT toolkit brings together a suite of resources to help you improve your skills in the areas of critical appraisal, understanding copyright, and ethical use of information, including correct referencing.

The aim of PHeLT is to save the public health workforce time in making effective use of the evidence by providing a single point of call for accessing resources to support the use of evidence. PHeLT is different from other elearning resources because it includes information on critical appraisal of grey literature, something that is not covered by other resources. An explanation of grey literature and it’s importance in public health is available in the FAQs section of the website.
PHeLT contains links only to existing, high quality resources on information skills such as referencing and critical appraisal. The majority of resources linked to from PHeLT have been made freely available by their publishers. However, the toolkits do contains some resources that are paid for, or require registration. This is indicated in the resource summary.

Social systems evidence – a free to search repository of research evidence across a broad range of government sectors

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Social Systems Evidence is the world’s most comprehensive, continuously updated repository of syntheses of research evidence about the programs, services and products available in a broad range of government sectors and program areas (e.g., community and social services, culture and gender, economic development and growth, education, and transportation) as well as the governance, financial and delivery arrangements within which these programs, services and products are provided, and the implementation strategies that can help to ensure that these programs, services and products get to those who need them. The content contained in Social Systems Evidence covers most of the Sustainable Development Goals, with the exceptions of the health part of goal 3 (which is already well covered by Health Systems Evidence), most of goal 7 (energy), and all of goals 13-15 (climate, water and land).

The types of syntheses in Social Systems Evidence include evidence briefs for policy, overviews of systematic reviews, systematic reviews, systematic reviews in progress (i.e. protocols for systematic reviews), and systematic reviews being planned (i.e. registered titles for systematic reviews). Social Systems Evidence also contains a continuously updated repository of economic evaluations in these same domains. Documents included in Social Systems Evidence are identified through weekly electronic searches of online bibliographic databases (EBSCOhost, ProQuest and Web of Science) and through manual searches of the websites of high-volume producers of research syntheses relevant to social system program and service areas (see below acknowledgements). For all types of documents, Social Systems Evidence provides links to user-friendly summaries, scientific abstracts, and full-text reports (if applicable and when freely available). For each systematic review, Social Systems Evidence also provides an assessment of its methodological quality, and links to the studies contained in the review.

While SSE is free to use and does not require that users have an account, creating an account will allow you to view more than 20 search results, to save documents and searches, and to subscribe to email alerts, among other advanced features. You can create an account by clicking ‘Create account’ on the top banner (for desktop and laptop computers) or in the menu on far right of the banner (for mobile devices).

Social Systems Evidence can save social system policymakers and stakeholders a great deal of time by helping them to rapidly identify: a synthesis of the best available research evidence on a given topic that has been prepared in a systematic and transparent way, how recently the search for studies was conducted, the quality of the synthesis, the countries in which the studies included in the synthesis were conducted, and the key findings from the synthesis. Social Systems Evidence can also help them to rapidly identify economic evaluations in these same domains.

The need for a complex systems model of evidence for public health

The Lancet, Vol 390, Issue 10112 Pages 2527-2604

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Evidence based policy making and the ‘art’ of commissioning – how English healthcare commissioners access and use information and academic research in ‘real life’ decision-making: an empirical qualitative study

Wye, L. et al. BMC Health Services Research, 2015; 15: 430

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Abstract

Background
Policymakers such as English healthcare commissioners are encouraged to adopt ‘evidence-based policy-making’, with ‘evidence’ defined by researchers as academic research. To learn how academic research can influence policy, researchers need to know more about commissioning, commissioners’ information seeking behaviour and the role of research in their decisions.

Methods
In case studies of four commissioning organisations, we interviewed 52 people including clinical and managerial commissioners, observed 14 commissioning meetings and collected documentation e.g. meeting minutes and reports. Using constant comparison, data were coded, summarised and analysed to facilitate cross case comparison.

Results
The ‘art of commissioning’ entails juggling competing agendas, priorities, power relationships, demands and personal inclinations to build a persuasive, compelling case. Policymakers sought information to identify options, navigate ways through, justify decisions and convince others to approve and/or follow the suggested course. ‘Evidence-based policy-making’ usually meant pragmatic selection of ‘evidence’ such as best practice guidance, clinicians’ and users’ views of services and innovations from elsewhere. Inconclusive or negative research was unhelpful in developing policymaking plans and did not inform disinvestment decisions. Information was exchanged through conversations and stories, which were fast, flexible and suited the rapidly changing world of policymaking. Local data often trumped national or research-based evidence. Local evaluations were more useful than academic research.

Discussion
Commissioners are highly pragmatic and will only use information that helps them create a compelling case for action.Therefore, researchers need to start producing more useful information.

Conclusions
To influence policymakers’ decisions, researchers need to 1) learn more about local policymakers’ priorities 2) develop relationships of mutual benefit 3) use verbal instead of writtencommunication 4) work with intermediaries such as public health consultants and 5) co-produce local evaluations.