Dear Colleague,
A very good afternoon and warm greetings from the University town of
Cambridge.
You might recall my earlier message regarding evidence based disinvestment.
Available @
http://www.jiscmail.ac.uk/cgi-bin/webadmin?A2=ind0707&L=evidence-based-health&T=0&F=&S=&P=5979
Please find below the responses I have received from colleagues on the list.
Many thanks to all of you who responded. i am hoping to send my response to
NICE very soon.
Have a wonderful weekend,
Warm regards & very best wishes,
Badri
From
Adam Elshaug, BA, BSc(Hons), MPH
Lecturer and Doctoral Candidate
Discipline of Public Health
School of Population Health and Clinical Practice
Level 9, 10 Pulteney Street (Mail Drop 207)
THE UNIVERSITY OF ADELAIDE
Adelaide, SA, 5005, AUSTRALIA
My name is Adam Elshaug and I am in the very final stages of a PhD that has
focused specifically on policy approaches (and challenges) to disinvestment
from ineffective health care. My candidature was supervised by A/Prof John
Moss and Prof Janet Hiller of the Discipline of Public Health, University of
Adelaide (which incorporates the HTA group, Adelaide Health Technology
Assessment - AHTA)
http://www.health.adelaide.edu.au/publichealth/research/AHTA.html
In my work I have asked, and attempted to address, all of the questions that
you pose and more (from an Australian and international perspective). I have
presented my findings throughout Australasia and Canada, both at conferences
and to government health policy bodies as well as HTA, academic and clinical
groups. In the first instance I contextualised disinvestment using a case
study in surgery for obstructive sleep apnoea (OSA), see for examples:
Elshaug AG, Moss JR, Maddern GJ and Hiller JE. Upper airway surgery should
not be first-line therapy for adult obstructive sleep apnoea (OSA). British
Medical Journal Forthcoming: Accepted for publication July 19, 2007
Elshaug AG, Moss JR, Southcott A and Hiller JE. (2007) Redefining success in
airway surgery for Obstructive Sleep Apnea: A meta analysis and synthesis of
the evidence. Sleep, 30 (4), 461-467.
Elshaug AG, Moss JR, Southcott A and Hiller JE. (2007) An analysis of the
evidence-practice continuum: Is surgery for Obstructive Sleep Apnoea
contraindicated? Journal of Evaluation In Clinical Practice, 13 (1), 3-9.
However, in relation to your specific questions, currently I have two
manuscripts under editorial review that address the items you list. As I
have agreed to a copyright arrangement I cannot, at this stage, elaborate on
the content of the manuscripts until they are published however I would be
most interested in corresponding with you about disinvestment generally
should you wish to. Also, I offer to forward you the manuscripts the minute
I am able to do so under the copyright agreement.
I look forward to hearing from you and hopefully to fostering some
discussion and progress in this area.
With kind regards,
Adam
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From
Ahmed M. Abou-Setta, M.D.
5 El-Ashwal Street from Pyramids Road
Pyramids
Giza
Egypt
Hope all is well. Thank you for the posted question. In my field of
reproductive medicine, we have several proposed cost-effective analysis
regarding the NHS system. I would imagine that this will be the same in
many other branches of medicine. I can imagine that this is a good place to
start.
Best wishes,
Ahmed
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From
Ian Bown
A less obvious place to start is by looking at where the greatest resources
are spent, rather than at what's least effective.
Politically, there's little point in causing loads of conflict over
treatments that, whilst ineffective, may also be harmless and not consume
significant resources.
Then cross reference this with the evidence-base.
In practice, look at the latest Programme Budgeting data (talk to Peter
Brambleby who's just moved to York, as he was intimately involved with their
development), and look at prescribing data.
Then the evidence base for the ones where there's a high spend and an a
priori case against them.
Then comes the difficult bit - getting people to change their behaviour!
Just my thoughts, for what they're worth.
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From
David Evans
Hi Badri,
I have a limited scope of expertise (I am an osteopath, albeit with a PhD)
but the literature is clear that routine use of imaging for musculoskeletal
conditions is costly, potentially harmful (radiography) and may lead to
unnecessary intervention (MRI more than x-ray).
Only when there is a suspicion of serious pathology or acute tissue injury
is imaging recommended. I am not sure if this qualifies for a disinvestment,
however.
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Dr P Badrinath MD BS M.Phil MPH FFPH PhD (Cantab)
Consultant in Public Health Medicine & Affiliated Clinical Lecturer
Suffolk PCT & University of Cambridge
Rushbrook house, Paper mill lane, Bramford, Ipswich, IP8 4DE, Suffolk, UK
http://myprofile.cos.com/badrishanthi
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