aphcri anu edu by R6tO8p

VIEWS: 3 PAGES: 35

									GP & PHCRED Conference July 2005
Australian Primary Health Care Research Institute

               Nicholas Glasgow
                                Aims


 By the end of this session:
   • Reflected more on the nexus between evidence and
     policy
   • Clearer about APHCRI’s focus and approach
   • Had opportunity to ask questions
                                   Overview


 Professor Nicholas Glasgow
   • Overview of the research evidence and policy
 Mr Robert Wells
   • Research Evidence and Policy – Reflections on a career
 Dr Bev Sibthorpe
   • Research Evidence and Policy - Case studies
 Professor Nicholas Glasgow
   • Research Evidence and Policy – The Evidence and APHCRI’s
     Response
 Professor Jonathan Lomas
   • Commentary
  Because what
  you told me is
     Yes,
The problem
    absolutely
  how did
 You must but
   correct
Wherea
   beyou
   completely
    I?
amknow?
researcher           Because you
      useless
                   don’t know where
                     you are, you 30
                         YouYou’re
                              Yes.
                             must
                              where
                   don’t knowmetres
                              How
                        be a policy
                   you’re going, and
                            above the
                             did
                          maker you
                      now you’re in a
                           ground
                             know?
                     blaming me
                             balloon
                   GP & PHC Research activity


 Welcome announcement by Parliamentary Secretary to the
  Minister for Health and Ageing, Christopher Pyne for
  continued support of PHCRED
 Increasing research and evaluation activity
   •   Growth of this conference
   •   PHCRED activities
   •   RACGP developments
   •   Success in competitive grant rounds such as NHMRC
 APHCRI
   • Primary health system level focus
   • Policy relevance important
   • Complex (non linear) relationships between evidence and policy
 How do we engage with this complexity?
Use of Research Evidence by Policy
             Makers

          Nicholas Glasgow
                              Method


 Comprehensive search of the black and grey
  literature relating to research dissemination, uptake
  and utilisation in primary health care policy
 Supplemented by personal communications with
  key contributors to this literature including:
   • Professor Jonathan Lomas at the Canadian Health
     Services Research Foundation
   • Professor John Lavis and
   • Professor Nicholas Mays
 Relevant systematic reviews were identified
                                                                        Method


    A publication was judged to be a systematic review
     if there were explicit statements within the paper
     which:
           • articulated the question
           • clearly summarised the strategy used to identify relevant
             studies
           • indicated how the identified studies were assessed for
             inclusion/exclusion
           • summarised and synthesized the results
Greenhalgh AT, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of Innovations in Service Organisations: Systematic Review and
Recommendations Milbank Quarterly 2004; 82: http://www.milbank.org/quarterly/8204feat.html (Accessed April 2005)
                        July 2005 Supplement
                   J Health Services Research & Policy


• Synthesizing evidence for management
  and policy-making
• Volume 10 Number 3 Supplement July 2005



• http://select.ingentaconnect.com/rsm/13558
  196/v10n3x1/contp1-1.htm
                          Key review before the
                               supplement


 Innvaer S, Vist G, Trommald M, Oxman A. Health policy-
  makers perceptions of their use of evidence: a systematic
  review J Health Serv Res Policy 2002; 7:239-244h

 Facilitators
   •   Personal contact between researchers and policy makers
   •   Timeliness and relevance of the research
   •   Research that included a summary and clear recommendations
   •   Good quality research
   •   Research that confirmed current policy or endorsed self-interest
   •   Community pressure or client demand for research
   •   Research that included effectiveness data
 Barriers
   • Absence of personal contact between researchers and
     policy-makers
   • Lack of timeless or relevance of research
   • Mutual distrust, including perceived political naivety or
     scientists and scientific naivety by policy-makers
   • Power and budget struggles
   • Poor quality research
   • Political instability and high turnover of policy-making
     staff
A policy maker reflects on evidence and
                 policy

             Mr Robert Wells
                             Policy


   Evidence-based            Reactive
   Rational process          Ad hoc
   Balancing of interests    responding to specific
   Long term perspective      interests
   Open & accountable        Short term horizon
   Objectively evaluated     Secretive
                              Spin
                 Research


   Systematic      Curiosity driven
   Methodical      Irrelevant
   Accurate        Slow
   Objective       Technical
   Analytical      Narrowly focussed
   Detailed
A researcher reflects – case studies from
                 APHCRI

             Dr Bev Sibthorpe
                          Key review before the
                               supplement


 Innvaer S, Vist G, Trommald M, Oxman A. Health policy-
  makers perceptions of their use of evidence: a systematic
  review J Health Serv Res Policy 2002; 7:239-244h

 Facilitators
   •   Personal contact between researchers and policy makers
   •   Timeliness and relevance of the research
   •   Research that included a summary and clear recommendations
   •   Good quality research
   •   Research that confirmed current policy or endorsed self-interest
   •   Community pressure or client demand for research
   •   Research that included effectiveness data
 APHCRI’s approach

Professor Nicholas Glasgow
                          Overview


 Getting past “two communities”
 What is evidence?
 What does “use” of evidence mean?
 How do systematic reviews and synthesis fit in?
 What does APHCRI see as an applied research
  cycle?
 What does this mean for APHCRI's work?
                      Key Stakeholders
                      (“communities”)

                                 Providers of Primary
    Australian
                                 Health Care services
   Government
                                       and their
Policy and Decision                 organisations
      Makers




                       APHCRI
                       Hub and
                       Spokes




                                  Consumers of Primary
    Research                       Health Care Services
   Community                      and their organisations
Getting past “two communities”
                                               The nature of “evidence”


      “Research” and “evidence” are words that are value laden
       and differently understood
      What is being sought is valid and reliable knowledge, and
       wisdom in its application
      If innovations within primary health care are going to be
       conceived, tested and implemented there must be
       willingness on the part of all players to understand research
       and evidence through different lenses
      Helpful insights will be derived from different research
       traditions.*

*Greenhalgh AT, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of Innovations in Service Organisations: Systematic R eview and
Recommendations Milbank Quarterly 2004; 82: http://www.milbank.org/quarterly/8204feat.html (Accessed April 2005)
                                                The nature of “use”


    Direct (engineering, instrumental) use
       •    Research feeds directly into decision making for policy and practice
    Symbolic use (mobilisation of support)
       •    to add weight to a particular policy direction
       •    an instrument for persuasion. Findings – or simply the act of research – can be used
            as a political tool and can legitimate particular courses of action or inaction
    Conceptual use (enlightenment)
       •    Even if policy makers or practitioners are blocked from using findings, research can
            change their understanding of a situation, provide new ways of thinking and offer
            insights into the strengths and weaknesses of particular courses of action. New
            conceptual understandings can then sometimes be used in instrumental ways.
    Wider influence
       •    influence beyond the institutions and events being studied. Evidence may be
            synthesised. It might come into currency through networks of practitioners and
            researchers, and alter policy paradigms or belief communities

Nutley S, Davies H, Walter I. Evidence Based Policy and Practice: Cross Sector Lessons From the UK. ESRC UK Centre for Evidence
Based Policy and Practice: Working Paper 9. 2002. ESRC UK Centre for Evidence Based Policy and Practice; Research Unit for Research
Utilisation
                                     Systematic reviews and
                                           synthesis


     Cogent argument for systematic reviews to be given
      greater profile as evidence of value to policy
      makers
     There is an emerging science of systematic reviews
      and synthesis




*Lavis JN, Posada FB, Haines A, Osei E. Use of research to inform public policymaking Lancet 2004; 364: 1615-21
*Lavis JN, Davies HTO, Oxman A, Denis JL, Golden-Biddle K, Ferlie E. Towards Systematic Reviews That Inform
Healthcare Management and Policymaking JHSRP 2005; v10 Number 3 Supplement
                 Economic assumptions


 How you pay (reward) people contains incentives to
  do (or not do) particular things
 Economists speak of the need to align incentives to
  ensure that that inherent incentives encourage the
  behaviour needed to achieve desired goals
 Are producers of research evidence rewarded for
  addressing policy questions?
                                             Research
                                             •Primary
                                             •Secondary




Pre Research                                                                Dissemination
•Priority setting/review
•Questions
• Methodologies
• Funding
• Research training (not just researchers)




                           Evaluation                     Adoption
                                                          (Use
                                                          •Direct
                                                          •Symbolic
                                                          •Enlightenment)
                      Key Stakeholders


                                 Providers of Primary
    Australian
                                 Health Care services
   Government
                                       and their
Policy and Decision                 organisations
      Makers




                       APHCRI
                       Hub and
                       Spokes




                                  Consumers of Primary
    Research                       Health Care Services
   Community                      and their organisations
                    Who’s question(s)?


 Policy makers and decision makers in both the
  Commonwealth and States/Territories;
 Providers of primary health care services and the
  various organisations with which they are linked;
 Researchers; and/or
 Users of primary health care services and the
  various organisations with which they are linked
                    Aim for Stream Four


 “to systematically identify, review, and synthesise
  knowledge about primary health care organisation,
  funding, delivery and performance and then
  consider how this knowledge might be applied in
  the Australian context”
                       Seven Topic Areas


1. Chronic disease management;
2. Integration, co-ordination and multidisciplinary care;
3. Prevention and early intervention;
4. Innovative models for comprehensive primary health care
   delivery;
5. Innovative models for the management of mental health in
   primary health care settings;
6. Older Australians and health promotion, prevention and
   post-acute care; and
7. Children and young Australians, health promotion and
   prevention
               APHCRI questions within topics


 Questions of two general types
   • “What do we know about….?” and
   • “What are the possible options?”
 The “What do we know about…?” questions are the focus of
  the systematic review and synthesis, while the “What are the
  possible options?” questions build on the results to develop
  ways forward for Australia’s primary health care system
 APHCRI is interested in specific questions being addressed
  in each topic area, including questions about funding
  arrangements (existing and alternative), delivery
  arrangements and governance arrangements, and
  performance - i.e. system level questions
                           Why Stream Four?


 This systematic processing of knowledge will provide:
   • A strong basis on which national primary health care policy can be
     informed,
   • Clear insights into important knowledge gaps, and
   • The foundation on which APHCRI can build subsequent streams of
     activity
 The process for Stream Four will:
   • Strengthen the hub and spoke model – we mean it!
   • Build capacity in the policy and research communities with regard to
     primary health care policy relevant research
                         Stream Four Workshops


   Four workshops occur during Stream Four
   At least one CI from each group
   Attendance by members of the DoHA
   Allows
    •   Iteration of the questions
    •   Reflection on the results as they start to emerge
    •   New direction to occur
    •   Researchers to focus on the research, policy analysts to focus on
        policy analysis and both to learn more of the other
                Miscommunication is real


ATTORNEY: Is your appearance here this morning pursuant
to a deposition notice which I sent to your attorney?

WITNESS: No, this is how I dress when I go to work.



ATTORNEY: What gear were you in at the moment of the
impact?

WITNESS: Gucci sweats and Reeboks.
Professor Lomas Comments
END

								
To top