Knowledge Transfer & ExchangePresentation Transcript
Knowledge Transfer & Exchange: Doing what we know, knowing what to do
Jennifer Verma, Director, Policy
February 2-3, 2011
Barriers & Facilitators to Using Research Evidence
Systematic review of 24 studies that asked over 2000 policymakers what facilitated or prevented their use of research evidence
#1 facilitator of research use : personal contact between researchers between researchers and policy-makers (13/24)
#1 barrier to research use : absence of personal contact between researchers and policy-makers (11/24)
Innvaer S. et al. 2002. Health policy-makers’ perceptions of their use of evidence:
A systematic review . Journal of Health Services Research and Policy 7(4): 239-244.
Factors Facilitating Use of (Research) Evidence
Senior Management / CEO leadership
Champions at all levels
“ Culture of enquiry”
Critical mass of professionals with higher education
Link with strategic directions
Funds / Time
Use of evidence required as part of all decisions
Ease of access to evidence
University / research institute linkages
Lack of timeliness of research
Lack of (real or perceived) relevance of research
General mistrust and little personal contact between researchers and policymakers
Lack of political will
Interpersonal links, spread through the life of a given study, are the key to research use. They allow non-researchers to find their niche and their voice while a study is still young … There are reciprocal effects, such that we are no longer in a conventional research-to-practice paradigm, but in more of a conversation among professionals, each bringing different expertise to bear on the same topic
Huberman, M. 1994. Research Utilization: The State of the Art. Knowledge ,Technology & Policy 7(4): 13-33.
Collaboratively set agendas
Communicate different ‘realities’
Create a common language and frame of reference
Help to establish realistic expectations, roles and responsibilities
Helpful workbooks. . .
Lavis J. et al. 2009. SUPPORT Tools for evidence-informed health Policymaking (STP) . Health Research Policy & Systems 7(Suppl 1). http://www.health-policysystems.com/content/7/S1/I1
Sorting the Evidence
Not all research is created equal, and it requires some skill to sort the wheat from the chaff before making the ‘summary loaf’ from the best ingredients…
… the nature of the relevant research for management and policy was sharply different from that of clinical medicine.
Lomas, J. 2007. “Decision support: A new approach to making the best healthcare management and policy choices.” Healthcare Quarterly ; 10(3): 14-16.
There are enormous potential benefits to be derived from health and wellness promotion, disease and injury prevention, public health and health protection and population health strategies, measured primarily in terms of improving the health of Canadians, but also in terms of their positive long-term financial impact on the health care system.
Senator Michael Kirby, Senate Standing Committee on Social Affairs, Science and Technology
Example: Do we spend too much on treatment, and not enough on prevention?
Myth: An ounce of prevention is worth a pound of cure (2003)
Critics say: If we spend more on prevention, then the savings in treatment would be large enough to reduce the rising share of national income devoted to medical care.
Research says: Despite savings in treatment, prevention usually increases medical spending.
Bottom line: With prevention as with treatment, better health comes at a higher price most of the time.
Myth: Early detection is good for everyone (2006)
Critics say: Screening of healthy people is good practice for “early detection” of illness.
Research says: Good screening tests have a low error rate, reduce the number of deaths from the disease being tested for, and do not subject people to undue harm.
Bottom line: Before any specific test is put into widespread use, patients and practitioners need to consider whether it is worthwhile and accurate, and whether they would be empowered to do something with the results.
Myth: Whole-body screening is an effective way to detect hidden cancers (2009)
Critics say: Whole-body screening is a one-stop shop to detect hidden cancer and prevent cancer-related deaths.
Research says: It does not improve life expectancy and is tied to significant risks, costs and anxiety for patients, as well as to substantial costs and unnecessary service use on the healthcare system.
Bottom line: Cancer screening recommendations and decisions should be based on reliable data and careful weighing of all potential benefits and harms.
The Issue: Chronically ill patients are not partners in their own healthcare >>> Self-management education to optimize health and reduce hospital admissions for chronically ill patients (2007)
The Issue: Limited health human resources leave some patients underserved >>> Incorporate lay health workers to promote health and prevent disease (2007)
The Issue: Chronic health conditions are often poorly managed in traditional primary care >>> Interdisciplinary teams in primary healthcare can effectively manage chronic illnesses (2005)
Easier said than done…
In a review of World Health Organization (WHO) and World Bank recommendations on five topics (contracting, healthcare financing, HHR, tuberculosis control and tobacco control):
2/8 publications cited systematic reviews;
5/14 WHO and 2/7 World Bank recommendations were consistent with both the direction and nature of effect claims from systematic reviews.
Hoffman SJ, Lavis JN, Bennett S. 2009. The use of research evidence in two international organizations’ recommendations about health systems. Healthcare Policy 9(1): 66-86.