Evidence Based Health Policy in Brussels

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Evidence Based Health Policy in Brussels

• What works?

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Research 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

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Brussels 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

4
Public Health (Information)Monitoring system on
400 Health Indicators, Determinants,
Interventions
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Purpose of the monitoring and information
programme

• to make national evidence based policy
• 10 years of work gathering these data
• Why dont they use it?

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Evidence Based Medicine

• Integration of the best research evidence with
  clinical expertise and patient values (Sackett DL
  et al, 2000).
• Driving forces
• Characteristics
• What works?

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Meta 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

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Meta 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

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Critics EBM

• Danger of rigidity
• Hierarchy of methods can lead to therapeutic
  nihilism

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Public Health (Information)Monitoring system on
400 Health Indicators, Determinants,
Interventions
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Evidence 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

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Why 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

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Why dont they use it?Continuation Criticism
within EBPH

• applicability of RCTs in Public Health
• complex
• representativeness
• process evaluations

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Why dont they use it?Pawson on Meta Analysis in
social programs

• misleading and articifial

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Why 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

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Example 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

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Continuation RCT study

• Results
• Authors conclusions
• What do we know after this study?

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Pawson on Evidence Based Policy

• Social interventions are active.
• no hierarchy in evidence
• First ask how the theory works before testing if
  it works

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What should have been done?

• Pawson
• context and mechanisms give outcome
• Steps
• Conclusion

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Back 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?