The role (or not) of economic evaluation at the micro level: Can Bourdieu’s theory provide a way forward for clinical decision-making?

Lessard, Chantale; Contandriopoulos, André‐Pierre; Beaulieu, Marie-Dominique

doi:10.1016/j.socscimed.2010.03.013

Cited by 20 publications

(7 citation statements)

References 53 publications

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“…Health systems investments are typically conceptualised as investments in health care infrastructure, clinical guidelines, technology or human resources, with less emphasis on how the relational aspect of health systems [ 23 ] may affect the costs and outcomes of an investment. Clinical discretionary decision-points in patient care can be conceptualised as transactions between patients and providers, occurring within a given organisational system.…”

Section: Methodsmentioning

confidence: 99%

Strengthening health systems to improve the value of tuberculosis diagnostics in South Africa: A cost and cost-effectiveness analysis

et al. 2021

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Background In South Africa, replacing smear microscopy with Xpert-MTB/RIF (Xpert) for tuberculosis diagnosis did not reduce mortality and was cost-neutral. The unchanged mortality has been attributed to suboptimal Xpert implementation. We developed a mathematical model to explore how complementary investments may improve cost-effectiveness of the tuberculosis diagnostic algorithm. Methods Complementary investments in the tuberculosis diagnostic pathway were compared to the status quo. Investment scenarios following an initial Xpert test included actions to reduce pre-treatment loss-to-follow-up; supporting same-day clinical diagnosis of tuberculosis after a negative result; and improving access to further tuberculosis diagnostic tests following a negative result. We estimated costs, deaths and disability-adjusted-life-years (DALYs) averted from provider and societal perspectives. Sensitivity analyses explored the mediating influence of behavioural, disease- and organisational characteristics on investment effectiveness. Findings Among a cohort of symptomatic patients tested for tuberculosis, with an estimated active tuberculosis prevalence of 13%, reducing pre-treatment loss-to-follow-up from ~20% to ~0% led to a 4% (uncertainty interval [UI] 3; 4%) reduction in mortality compared to the Xpert scenario. Improving access to further tuberculosis diagnostic tests from ~4% to 90% among those with an initial negative Xpert result reduced overall mortality by 28% (UI 27; 28) at $39.70/ DALY averted. Effectiveness of investment scenarios to improve access to further diagnostic tests was dependent on a high return rate for follow-up visits. Interpretation Investing in direct and indirect costs to support the TB diagnostic pathway is potentially highly cost-effective.

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Section: Methodsmentioning

confidence: 99%

Strengthening health systems to improve the value of tuberculosis diagnostics in South Africa: A cost and cost-effectiveness analysis

et al. 2021

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“…The use of economic evaluations at the local decision-making level in healthcare remains limited ( Searles et al , 2018 ; Baghbanian and Torkfar, 2012 ; Eddama and Coast, 2008 ). This is problematic because most of Australia's health budget, 70%, is spent at the “local level” through hospitals, community care and through primary care ( Searles et al , 2018 ; Australian Institute of Health and Welfare, 2017 and Lessard et al , 2010 ). The number of published economic evaluations applied to the field of improvement and implementation research is, however, modest ( Roberts et al , 2019 ).…”

Section: “Slow Science” In Practice: “The Embedded Economist”mentioning

confidence: 99%

“Slow science” for 21st century healthcare: reinventing health service research that serves fast-paced, high-complexity care organisations

Jorm¹,

Iedema

Piper

et al. 2021

JHOM

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PurposeThe purpose of this paper is to argue for an improved conceptualisation of health service research, using Stengers' (2018) metaphor of “slow science” as a critical yardstick.Design/methodology/approachThe paper is structured in three parts. It first reviews the field of health services research and the approaches that dominate it. It then considers the healthcare research approaches whose principles and methodologies are more aligned with “slow science” before presenting a description of a “slow science” project in which the authors are currently engaged.FindingsCurrent approaches to health service research struggle to offer adequate resources for resolving frontline complexity, principally because they set more store by knowledge generalisation, disciplinary continuity and integrity and the consolidation of expertise, than by engaging with frontline complexity on its terms, negotiating issues with frontline staff and patients on their terms and framing findings and solutions in ways that key in to the in situ dynamics and complexities that define health service delivery.Originality/valueThere is a need to engage in a paradigm shift that engages health services as co-researchers, prioritising practical change and local involvement over knowledge production. Economics is a research field where the products are of natural appeal to powerful health service managers. A “slow science” approach adopted by the embedded Economist Program with its emphasis on pre-implementation, knowledge mobilisation and parallel site capacity development sets out how research can be flexibly produced to improve health services.

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“…However, Bourdieu recognises creativity and transformative agency leading to change (i.e. changes to habitus, structural and social conditions) when he argues that actions are adapted to the social setting and practices are generated through interactions of various forms of capital with habitus by entering the fields of action (Bourdieu 1990;Lessard et al 2010).…”

Section: Some Theoretical Considerationsmentioning

confidence: 99%

Understanding behaviour change in context: examining the role of midstream social marketing programmes

Luca

Hibbert

McDonald

2019

Sociology Health & Illness

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This research examines how midstream social marketing programmes that adopt a relational and community‐based approach create opportunities for individuals to make incremental changes to health behaviour. Specifically, it applies Bourdieusian theory to explore how interactions between community healthcare workers (CHWs) and members of the public generate impetus for change and foster individual agency for improved health. Qualitative interviews were carried out with members of the public and CHWs engaged in a Smokefree home and cars initiative. The findings suggest that although CHWs are challenged by resource constraints, their practices in working with individuals and families build trust and enable dialogue that bridges smoking‐related health insight with home logics. These interactions can promote individual agency with a transformative effect through small changes to smoking‐related dispositions, norms and practices. However, tensions with the habitus of other household members and other capital deficits can inhibit progress towards embedding new practices. The study concludes that interventions built upon community relationships show potential for addressing limitations of information‐focused campaigns but there is a need to also respond to key social structures relating to the field of action for new health dispositions to become embedded in practice.

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The role (or not) of economic evaluation at the micro level: Can Bourdieu’s theory provide a way forward for clinical decision-making?

Cited by 20 publications

References 53 publications

Strengthening health systems to improve the value of tuberculosis diagnostics in South Africa: A cost and cost-effectiveness analysis

Strengthening health systems to improve the value of tuberculosis diagnostics in South Africa: A cost and cost-effectiveness analysis

“Slow science” for 21st century healthcare: reinventing health service research that serves fast-paced, high-complexity care organisations

Understanding behaviour change in context: examining the role of midstream social marketing programmes

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