Tag Archives: Evidence Based

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.

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Public Health e-Learning toolkit

By UK Health Forum

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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.

Evidence-based policymaking is not like evidence-based medicine, so how far should you go to bridge the divide between evidence and policy?

Cairney, P. et al.  Health Research Policy & Systems, 2017; 15: 35

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There is extensive health and public health literature on the ‘evidence-policy gap’, exploring the frustrating experiences of scientists trying to secure a response to the problems and solutions they raise and identifying the need for better evidence to reduce policymaker uncertainty. We offer a new perspective by using policy theory to propose research with greater impact, identifying the need to use persuasion to reduce ambiguity, and to adapt to multi-level policymaking systems.

We identify insights from secondary data, namely systematic reviews, critical analysis and policy theories relevant to evidence-based policymaking. The studies are drawn primarily from countries such as the United States, United Kingdom, Canada, Australia and New Zealand. We combine empirical and normative elements to identify the ways in which scientists can, do and could influence policy.

We identify two important dilemmas, for scientists and researchers, that arise from our initial advice. First, effective actors combine evidence with manipulative emotional appeals to influence the policy agenda – should scientists do the same, or would the reputational costs outweigh the policy benefits? Second, when adapting to multi-level policymaking, should scientists prioritise ‘evidence-based’ policymaking above other factors? The latter includes governance principles such the ‘co-production’ of policy between local public bodies, interest groups and service users. This process may be based primarily on values and involve actors with no commitment to a hierarchy of evidence.

We conclude that successful engagement in ‘evidence-based policymaking’ requires pragmatism, combining scientific evidence with governance principles, and persuasion to translate complex evidence into simple stories. To maximise the use of scientific evidence in health and public health policy, researchers should recognise the tendency of policymakers to base judgements on their beliefs, and shortcuts based on their emotions and familiarity with information; learn ‘where the action is’, and be prepared to engage in long-term strategies to be able to influence policy; and, in both cases, decide how far you are willing to go to persuade policymakers to act and secure a hierarchy of evidence underpinning policy. These are value-driven and political, not just ‘evidence-based’, choices.

Evidence-based medicine meets democracy: the role of evidence-based public health guidelines in local government

Kelly, M.P. et al (2017) Journal of Public Health. pp. 1–7 doi:10.1093/pubmed/fdx002

In 2013, many public health functions transferred from the National Health Service to local government in England. From 2006 NICE had produced public health guidelines based on the principles of evidence-based medicine. This study explores how the guidelines were received in the new environment in local government and related issues raised relating to the use of evidence in local authoritites.

Methods

In depth, interviews with 31 elected members and officers, including Directors of Public Health, from four very different local government organizations (‘local authorities’).

Results

Participants reported that (i) there were tensions between evidence-based, and political decision-making; (ii) there were differences in views about what constituted ‘good’ evidence and (iii) that organizational life is an important mediator in the way evidence is used.

Conclusions

Democratic political decision-making does not necessarily naturally align with decision-making based on evidence from the international scientific literature, and local knowledge and local evidence are very important in the ways that public health decisions are made.

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