Title: Evidence Based Health Policy in Brussels
1Evidence Based Health Policy in Brussels
2Research voor Beleid
- Policy monitoring and evaluation
- Public sector, especially Health, Labour Markets,
Social Affairs and Education - Social Scientists, Economists, Statisticians
- Member of the Panteia group EIM (economic policy
research) NEA (transport research and training)
IOO (institute for Research on Public
Expenditure) - Commissioned by national and international
governments/European Commission/branches etc. - All sectors of health (mental health, hospitals,
nursing, homecare, disabled, elderly) and
subjects (prevention, quality, regulations,
patients, professionals, governance) - International cross-border health, tobacco
prevention, disabled, evaluation theories, health
systems in Europe. - Brussels
3Brussels and Evidence Based Health policy notes
from a small survey
- A small survey in Brussels
- Two types of reactions
- Similar Evidence Based Policy discussion in Health
4Public Health (Information)Monitoring system on
400 Health Indicators, Determinants,
Interventions
5Purpose of the monitoring and information
programme
- to make national evidence based policy
- 10 years of work gathering these data
- Why dont they use it?
6Evidence Based Medicine
- Integration of the best research evidence with
clinical expertise and patient values (Sackett DL
et al, 2000). - Driving forces
- Characteristics
- What works?
7Meta Analysis based on systematic reviews
- New revival of EBM
- The sum of all previous (high-quality) evidence
- Accumulating facts
- Strong RCT design with statistical (quantitative)
outcome gives strong evidence
8Meta Analysis based on systematic reviews (2)
- Hierarchy in evidence
- RCT
- (Quasi) experimental
- Before and after comparisons
- Cross sectional, random sample studies
- Process evaluation, formative studies and action
research - Qualitative case study and ethnographic research
- Descriptive guides and examples of good practice
- Professional and expert opinion
- User opinion
9Critics EBM
- Danger of rigidity
- Hierarchy of methods can lead to therapeutic
nihilism
10Public Health (Information)Monitoring system on
400 Health Indicators, Determinants,
Interventions
11Evidence Based Public Health(Kohatsu N.D, 2005)
- epidemiology.
- Relatively new
- Brownson 1999
-
- EBM and EBPH parallels
- State the scientific question of interest
- Identify the relevant evidence
- Determine what information is needed to answer
the scientific question - Determine the best course of action considering
the patient or population - Evaluate process and outcome
- knowledge databanks (e.g. Cochrane Collaboration,
WHO, Guide to Community Preventive Services
(Taskforce USA), OECD) - Taskforce 9 topic areas
12Why dont they use it?Criticism within EBPH
literature
- Disappointment about studies on effectiveness of
Public Health interventions - no information on reducing
- few evaluations on effectiveness
- not applicable to specific groups
- can widen health inequalities
13Why dont they use it?Continuation Criticism
within EBPH
- applicability of RCTs in Public Health
- complex
- representativeness
- process evaluations
14Why dont they use it?Pawson on Meta Analysis in
social programs
- misleading and articifial
15Why dont they use it?Realistic Evaluation by
Pawson
- Fundamental criticism black box
- The question isnt what works? But rather what
works and why? In what circumstances and for
whom? - internal validity
- medication versus a social program
16Example of RCT study
- A cluster randomised controlled trial to evaluate
a policy to make hip protectors available to
residents of nursing homes OHalloran P.D et
al, Age and Ageing Vol.33 No.6 582-588 2004 - Background
- Home as unit of randomisation
- 127 nursing and residential homes in Ireland
- 40 homes in intervention group and 87 in control
group - Intervention
17Continuation RCT study
- Results
- Authors conclusions
- What do we know after this study?
18Pawson on Evidence Based Policy
- Social interventions are active.
- no hierarchy in evidence
- First ask how the theory works before testing if
it works
19What should have been done?
- Pawson
- context and mechanisms give outcome
- Steps
- Conclusion
20Back to EU How can we stimulate EBPH in member
States?
- Best of both worlds
- Select the problem
- Combine methods
- All sources
- Answer the question what works for whom in what
circumstances?