Exploring policy makers' perspectives on a clinical controversy: airway surgery for adult obstructive sleep apnoea

Elshaug, Adam G; Hiller, Janet E.; Moss, John

doi:10.1136/qshc.2008.028563

Cited by 4 publications

(5 citation statements)

References 18 publications

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“…In the same way that HTA can be used to decide whether a new technology should be adopted, it can also be used to assess whether existing treatments should continue to be funded on the basis of their cost effectiveness. Despite there being a number of practical and theoretical examples of HTA being used in an effort to deliver disinvestment (Elshaug et al 2009;Zechmeister and Schumacher 2012;Elshaug et al 2008), as well as political mandates (Pearson and Littlejohns 2007), the evidence base for re-engineering HTA for this purpose does require further development (Ibargoyen-Roteta et al…”

Section: Tackling Disinvestmentmentioning

confidence: 99%

Tackling disinvestment in health care services

Daniels

Williams

Robinson

et al. 2013

Journal of Health Organization and Management

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Purpose -The aims of this paper are to explore the experiences of budget holders within the English National Health Service (NHS), in their attempts to implement programmes of disinvestment, and to consider factors which influence the success (or otherwise) of this activity. Design/methodology/approach -Between 24 January and 15 March 2011 semi-structured, telephone interviews were conducted with representatives of 12 Primary Care Trusts in England. Interviews focussed on: understanding of the term "disinvestment"; current activities, and perceived determinants of successful disinvestment decision making and implementation. Data were organised into themes according to standard qualitative data coding practices. Findings -Findings indicate that experiences of disinvestment are varied and that organisations are currently adopting a range of approaches. There are a number of apparently influential determinants of disinvestment which relate to both health system features and organisational characteristics. According to the experiences of the interviewees, many of the easier disinvestment options have now been taken and more ambitious plans, which require wider engagement and more thorough project management, will be required in the future. Research limitations/implications -Findings from the research suggest that issues around understanding and usage of disinvestment terminology should be addressed and that a more in-depth and ethnographic research agenda will be of most value in moving forward both the theory and practice of disinvestment. Originality/value -This research suggests that, in the English NHS at least, there is a disjuncture between common usage of the term "disinvestment" and the way that it has previously been understood by the wider research community. In addition to this, the research also highlights a broader range of potential determinants of disinvestment than are considered in the extant literature.

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Section: Tackling Disinvestmentmentioning

confidence: 99%

Tackling disinvestment in health care services

Daniels

Williams

Robinson

et al. 2013

Journal of Health Organization and Management

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“…For specific technologies, including new drugs which must be assessed in Canada by the Common Drug Review, a demonstration of clinical value and cost-effectiveness is also required (2). However, once a technology enters the system, there is no standardized process for monitoring its use, nor managing its exit if it is superseded by advances in knowledge (1;3).…”

mentioning

confidence: 99%

“…In the past, HTR has been an implicit part of HTA as often usage of a competing technology will be affected by the adoption of a new technology. However, there is now a desire to see HTR become standard practice with a goal of optimizing the use of technologies in health care and achieving the greatest clinical benefit with our social dollars (1;3;7–9).…”

mentioning

confidence: 99%

Health Technology Reassessment: The Art of the Possible

MacKean¹,

Noseworthy²,

Elshaug³

et al. 2013

Int J Technol Assess Health Care

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Background: Health technology reassessment (HTR) is “a structured, evidence-based assessment of the clinical, social, ethical, and economic effects of a technology currently used in the healthcare system, to inform optimal use of that technology in comparison to its alternatives.” The purpose of this study is to describe the key themes in the context of current HTR activities and propose a way forward for this newly emerging field.Methods: Data were gathered from a workshop held as part of the 2012 Canadian Agency for Drugs and Technology in Health (CADTH) symposium. The workshop consisted of two panel presentations followed by discussion; data gathered, including presentations and rich audience discussion transcripts, were analyzed for key themes emerging in the field of HTR using constant comparative analysis.Results: The language chosen to describe HTR will set the tone for engagement. The identification of champions at multiple levels and political will are essential. Key lessons from international experience are: disinvestment is difficult, focus on clinical areas not specific technologies, identify clear goals of the HTR agenda. Six key themes were identified to move the HTR agenda forward: emphasize integration over segregation, focus on development of HTR methods and processes, processes are context-specific but lessons must be shared, build capacity in synergistic interdisciplinary fields, develop meaningful stakeholder engagement, strengthen postimplementation monitoring and evaluation.Conclusions: To move this field forward, we must continue to build on international experiences with a focus on developing novel methodological approaches to generating, incorporating, and implementing evidence into policy and practice.

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“…Recent publications 11,26 have been less than favorable with respect to upper airway surgery for OSA, without truly reflecting on the potential improvement and benefits achievable with contemporary surgical protocols. The controversy associated with measuring success, on the spectrum from improvement to complete cure, is eloquently outlined by Weaver in a recent sleep medicine review article 10 .…”

Section: Discussionmentioning

confidence: 99%

“…8,9 The lack of these trials does not automatically imply that surgical techniques do not work or that lower levels of clinical evidence are not instructive for clinical decisions that must be made immediately. 10 Regardless, in the medium to long term, high-quality clinical trials may be necessary to convince policy makers and nonsurgical clinicians 11 that surgery is a viable option in specified situations.…”

mentioning

confidence: 99%