Dear list,
I asked a question about prioritisation in healthcare a couple of weeks ago.
I had some very useful repsonses and here is a summary of articles,
websites, contacts etc that were suggested. If I get any more I'll post
those to the list as well.
* Hadorn, D and Holmes, A (1997), 'the New Zealand priority criteria
project', BMJ 314:131-8, in two parts). Patients whose score does not reach
a certain level will not be booked for an operation. Clinicians have agreed
to work within this threshold, whilst voicing their opinion that it is set
is too low and people are being excluded from potentially beneficial
treatment. [Louise Locock]
* The National Health Committee in New Zealand have sponsored a number
of clincial practice guidelines, the best known of which are those on
assessing cardiovascular risk and treating mild hypertension and blood
lipids on the basis of a person's absolute risk:
(http://www.nzgg.org.nz/library/gl_complete/bloodpressure/table1.htm)
[Ashley Bloomfield]
* The New Zealand National Health Committee website,
http://www.nhc.govt.nz/ contains a lot of useful information on decsions
made in NZ regarding prioritisation [Barbara Nicholas, Gay Wood and Wendy
Edgar]
* The Pharmaceutical Benefits Scheme in Australia considers some
issues of prioritisation:
1. There is a list of government funded medications (a subset of all
available medications)
2. The list includes some restrictions on who you can prescribe it
- e.g., guidelines on who should get cholesterol lowering medications
3. For the past 5 years, to get a new listing or a change of
indication requires two things: a. evidence of (comparative
effectiveness b. a cost-effectiveness analysis showing acceptable value for
money.
The system certainly has flaws: a lot of pharmaceuticals were
"grandfathered" into the system; some prescirbing occurs outside the
accepted indications; the evidence often is incomplete; etc. But I think it
is an interesting attempt to tackle the inevitable problems of the
rise in technologically driven costs. Plans are underway to extend this to
new procedures and diagnostic devices. [Paul Glasziou]
* One project in Oxfordshire Health Authority, known as the Oxford
Priorities Forum, which has used specific criteria and evidence to decide
which treatments should be included or should not be included in the health
services in their county. The contact person is the Director of Public
Health, Sian Griffiths, Sian Griffiths
<[log in to unmask]> There has also been work completed
by Homa Hasan and Prof. Jan Helge Solbakk in the University of Oslo on
prioritisation and genetic screening in connection with the recommendations
for prioritisation with the Norwegian framework. Homa Hasan can be
contacted on homa hasan <[log in to unmask]> A book, 'Ethics and
Public Health' containing chapters from these authors will be published by
Routledge Press later this year. [Peter Bradley]
* North Wales Health Authority is undertaking a Prioritisation
Demonstration Project to help inform its new Cancer strategy. The
Prioritisation Demonstration Project is exploring the potential of a
prioritisation model successfully used by Gwynedd Health Authority between
1992 and 1996. [Richard Keatinge]
* A paper by Feek et al in the BMJ discusses rationing in New Zealand.
http://www.bmj.com/cgi/content-embargo/full/318/7194/1346 [Wendy Edgar]
A number of people asked about the Norwegian prioritisation document. The
full reference is 'Prioritering på ny', NOU 1997: 18, Statens
forvaltningstjeneste, Statens trykning, Oslo. The full document is
available (in Norwegian) on the Norwegian Government's website:
http://odin.dep.no/html/nofovalt/offpub/nou/1997-18/index.htm
Thanks again to all those who responded.
Regards,
Shaun Treweek
Dr Shaun Treweek, Research Fellow
Health Services Research Unit (SAHT)
National Institute of Public Health
PO Box 4404 Torshov
0403 Oslo
Norway
Tel.: +47 22 04 22 71
Fax.: +47 22 04 25 95
e-mail (work): [log in to unmask]
e-mail (home): [log in to unmask]
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