背景:循证临床实践指南(CPG)是为透明的医疗保健决策提供信息的有用工具。在CPG开发过程中以结构化方式考虑健康经济证据(HEE)仍然是全球和本地的挑战。本研究探讨了观点,目前的做法,在南非,CPG开发人员在生产和使用HEEforCPG时面临的培训需求和挑战。
方法:这项混合方法研究包括在线调查和焦点小组讨论。该调查进行了试点,随后发送给CPG角色扮演者-证据审查员,CPG小组成员,参与卫生经济学和公共卫生等相关学科培训的学者,实施者和资助者。焦点小组参与者在全国范围内的CPG发展和卫生经济活动中发挥战略作用。调查评估了平均值,变异性的度量,和李克特量表的百分比,而叙事成分是进行主题分析的。焦点小组数据是手动编码的,进行了专题分析和验证。
结果:该调查(分布的245项调查中,n=55名受访者)和一个焦点小组(n=5名参与者,来自10人的邀请)发生在2018年10月至2019年2月之间。我们发现,HEE应告知CPG决策的最一致原因是“更有效地利用有限的财务资源”。许多背景和方法障碍都解释了这一点。焦点小组参与者指出,如果不加强应用循证医学原则的技能,就无法考虑复杂的HEE。进一步的担忧包括标准方法缺乏明确性;私营和公共部门的主题选择不公平和不透明;CPG小组成员使用HEE的技能不足;以及卫生经济学家以可访问的方式传达结果的能力。总的来说,在过程和方法不清楚的情况下,政治和利益可能会推动CPG决定实施哪些干预措施。
结论:在南非的CPG决策中,最好考虑HEE。然而,在CPG社区就在CPG中使用HEE的方法和过程达成一致之前,这将一直受到阻碍。随着国家健康保险的发展,国家政府为应对研究确定的挑战而进行的重点投资对于提高投资回报至关重要。
BACKGROUND: Evidence-informed clinical practice
guidelines (CPGs) are useful tools to inform transparent healthcare decision-making. Consideration of health economic evidence (HEE) during CPG development in a structured manner remains a challenge globally and locally. This study explored the views, current practice, training needs and challenges faced by CPG developers in the production and use of HEE for CPGs in South Africa.
METHODS: This mixed-methods study comprised an online survey and a focus group discussion. The survey was piloted and subsequently sent to CPG role players - evidence reviewers, CPG panellists, academics involved with training in relevant disciplines like health economics and public health, implementers and funders. The focus group participants hold strategic roles in CPG development and health economic activities nationally. The survey evaluated mean values, measures of variability, and percentages for Likert scales, while narrative components were thematically analysed. Focus group data were manually coded, thematically analysed and verified.
RESULTS: The survey (n = 55 respondents to 245 surveys distributed) and one focus group (n = 5 participants from 10 people invited) occurred between October 2018 and February 2019. We found the most consistent reason why HEE should inform CPG decisions was \'making more efficient use of limited financial resources\'. This was explained by numerous context and methodological barriers. Focus groups participants noted that consideration of complex HEE are not achievable without bolstering skills in applying evidence-based medicine principles. Further concerns include lack of clarity of standard methods; inequitable and opaque topic selection across private and public sectors; inadequate skills of CPG panel members to use HEE; and the ability of health economists to communicate results in accessible ways. Overall, in the absence of clarity about process and methods, politics and interests may drive CPG decisions about which interventions to implement.
CONCLUSIONS: HEE should ideally be considered in CPG decisions in South Africa. However, this will remain hampered until the CPG community agree on methods and processes for using HEE in CPGs. Focused investment by national government to address the challenges identified by the study is imperative for a better return on investment as National Health Insurance moves forward.