Publications (5)0 Total impact
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Article: Systematic review to determine whether participation in a trial influences outcome.
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ABSTRACT: To systematically compare the outcomes of participants in randomised controlled trials (RCTs) with those in comparable non-participants who received the same or similar treatment. Bibliographic databases, reference lists from eligible articles, medical journals, and study authors. RCTs and cohort studies that evaluated the clinical outcomes of participants in RCTs and comparable non-participants who received the same or similar treatment. Five RCTs (six comparisons) and 50 cohort studies (85 comparisons) provided data on 31,140 patients treated in RCTs and 20,380 comparable patients treated outside RCTs. In the five RCTs, in which patients were given the option of participating or not, the comparisons provided limited information because of small sample sizes (a total of 412 patients) and the nature of the questions considered. 73 dichotomous outcomes were compared, of which 59 reported no statistically significant differences. For patients treated within RCTs, 10 comparisons reported significantly better outcomes and four reported significantly worse outcomes. Significantly heterogeneity was found (I2 = 89%) among the comparisons of 73 dichotomous outcomes; none of our a priori explanatory factors helped explain this heterogeneity. The 18 comparisons of continuous outcomes showed no significant differences in heterogeneity (I2 = 0%). The overall pooled estimate for continuous outcomes of the effect of participating in an RCT was not significant (standardised mean difference 0.01, 95% confidence interval -0.10 to 0.12). No strong evidence was found of a harmful or beneficial effect of participating in RCTs compared with receiving the same or similar treatment outside such trials.BMJ (Clinical research ed.). 06/2005; 330(7501):1175. -
Article: The effect of how outcomes are framed on decisions about whether to take antihypertensive medication: a randomized trial.
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ABSTRACT: BACKGROUND: We conducted an Internet-based randomized trial comparing three valence framing presentations of the benefits of antihypertensive medication in preventing cardiovascular disease (CVD) for people with newly diagnosed hypertension to determine which framing presentation resulted in choices most consistent with participants' values. METHODS AND FINDINGS: In this second in a series of televised trials in cooperation with the Norwegian Broadcasting Company, adult volunteers rated the relative importance of the consequences of taking antihypertensive medication using visual analogue scales (VAS). Participants viewed information (or no information) to which they were randomized and decided whether or not to take medication. We compared positive framing over 10 years (the number escaping CVD per 1000); negative framing over 10 years (the number that will have CVD) and negative framing per year over 10 years of the effects of antihypertensive medication on the 10-year risk for CVD for a 40 year-old man with newly diagnosed hypertension without other risk factors. Finally, all participants were shown all presentations and detailed patient information about hypertension and were asked to decide again. We calculated a relative importance score (RIS) by subtracting the VAS-scores for the undesirable consequences of antihypertensive medication from the VAS-score for the benefit of CVD risk reduction. We used logistic regression to determine the association between participants' RIS and their choice. 1,528 participants completed the study. The statistically significant differences between the groups in the likelihood of choosing to take antihypertensive medication in relation to different values (RIS) increased as the RIS increased. Positively framed information lead to decisions most consistent with those made by everyone for the second, more fully informed decision. There was a statistically significant decrease in deciding to take antihypertensives on the second decision, both within groups and overall. CONCLUSIONS: For decisions about taking antihypertensive medication for people with a relatively low baseline risk of CVD (70 per 1000 over 10 years), both positive and negative framing resulted in significantly more people deciding to take medication compared to what participants decided after being shown all three of the presentations. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number Register ISRCTN 33771631. -
Article: Evidence-Informed Health Policy: using research to make health systems healthier
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ABSTRACT: A review of organisations that support the use of research evidence in developing guidelines, technology assessments, and health policy. Prepared for the WHO Advisory Committee on Health Research. A Final Report and Video Documentary Series Background: • Over the past two years there has been a great deal of international discussion about how to harness health research more effectively in order to achieve the United Nations’ Millennium Development Goals as well as other national health goals in low- and middle-income countries. • Our objective was to identify organisations around the world, and especially in low- and middleincome countries, that are in some way successful or innovative in supporting the use of research evidence in the development of clinical practice guidelines, health technology assessments, and health policy, and to describe their experiences. Key messages from the report: • The study presents seven main implications for those establishing or administering organisations to produce clinical practice guidelines or health technology assessments, or organisations to support the use of research evidence in developing health policy: • 1. Collaborate with other organisations • 2. Establish strong links with policymakers and involve stakeholders in the work • 3. Be independent and manage conflicts of interest among those involved in the work • 4. Build capacity among those working in the organisation • 5. Use good methods and be transparent in the work • 6. Start small, have a clear audience and scope, and address important questions • 7. Be attentive to implementation considerations even if implementation is not a remit. • The study presents four main implications for the World Health Organisation and other international organisations: • 1. Support collaborations among organisations • 2. Support local adaptation efforts • 3. Mobilize support • 4. Create knowledge-related global public goods, including methods and evidence syntheses. Client: The report is prepared for the WHO Advisory Committee on Health Research. • Links to a Video Documentary Series about the cases described in the study are found in the appendix, page 104. WHO Advisory Committee on Health Research -
Article: Integrated health care for people with chronic conditions. A policy brief.
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ABSTRACT: 1-page key messages * Uncoordinated care can affect the quality and efficiency of health care, access to care, participation in and satisfaction with care, and health outcomes for chronically ill patients. However, there is a paucity of data in Norway that provide a basis for estimating the size of the problem or clarifying the underlying reasons for inadequate coordination. * The impact of many changes in delivery, financial and governance arrangements that could be made to improve the coordination of care for people with chronic conditions is uncertain; evaluation is critical when such changes are made. * Components of the Chronic Care Model and disease management programs, alone or in combination, can improve quality of care, clinical outcomes and health care resource use, but the effects are not consistent and a number of obstacles may hinder their use. * The impacts of delivery arrangements that have been shown to be effective (e.g. patient education and motivational counselling, provider education, feedback, reminders, and multidisciplinary team work) are generally modest, but important. There is uncertainty about the impacts of other arrangements (e.g. care pathways, case management, and shared care). * Targeted financial incentives with the aim of achieving specific changes in how care is delivered probably influence discrete individual behaviours in the short run, but are less likely to influence sustained changes, and they can have unintended effects, including motivating unintended behaviours, distortions, gaming, cream skimming or cherry-picking, and bureaucratisation. Therefore, they require careful design and monitoring. * Similarly, changes in the basic payment methods that are used for both clinicians and institutions in order to offset the inherent limitations of each require careful design and monitoring. A long-term perspective with continual adjustments is more likely to be successful, than dramatic one-off changes. * There is not evidence to support any one governance model as being better than others. However, specific structures are likely needed at different levels to improve coordination: * o Clinical governance (healthcare professionals' accountability for quality of care) for both primary and secondary care o Boards at the local level that conduct detailed oversight and monitoring for both primary and secondary care o A regional board that coordinates different local networks in the region o A central governance structure that sets broad standards, which the regional and local boards are responsible to adhere to and implement * Consumer and stakeholder involvement in governance arrangements at all levels is a strategy for achieving better coordination of care and other health goals, as well as a goal in itself, but there is little evidence of how to best to achieve this. * Because there are multiple barriers to organisational and professional change, simple approaches to implementing change are unlikely to be effective, change is likely to occur incrementally and to require ongoing attention. There are many tools that may be useful for implementing organisational changes, including analytic models, tools for assessing why change is needed, such as SWOT analysis, and tools for making changes, such as organisational development and project management. However, there is almost no evidence of their effectiveness -
Article: An overview of research on the effects of results-based financing
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ABSTRACT: Background: Norway is the lead promoter of results-based financing (RBF) as one of five actions being taken as part of the Global Campaign for the Health Millennium Development Goals and plans to support the use of RBF through the World Bank and in bilateral agreements with selected countries focusing on achieving the Millennium Development Goals (MDGs) of reducing child and maternal mortality (MDG 4 and 5).RBF-schemes can be targeted at different levels: recipients of healthcare, individual providers of healthcare, healthcare facilities, private sector organisations, public sector organisations, sub-national governments, and national governments. • Method: This report consists of an overview of systematic reviews and a critical appraisal of four evaluations of RBF schemes in the health sector in low and middle-income countries (LMIC). Results: • Ten systematic reviews that met the inclusion criteria for this report were summarised. In addition, four evaluations of RBF schemes in LMIC were critically appraised, including fi nancial incentives targeted at patients, individual providers, organisations, and governments. There are few rigorous studies of RBF and overall the evidence of its effects is weak. • Financial incentives targeting recipients of healthcare and individual healthcare professionals appear to be effective in the short run for simple and distinct, well-defi ned behavioural goals. There is less evidence that fi nancial incentives can sustain long-term changes. • The use of RBF in LMIC has commonly been as part of a package that may include increased funding, technical support, training, changes in management, and new information systems. It is not possible to disentangle the effects of RBF and there is very limited quantitative evidence of RBF per se having an effect, other than in the context of conditional cash transfers to poor and disadvantaged groups in Latin America to motivate preventive care. Norwegian Agency for Development Cooperation (Norad)
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Institutions
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2005
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Norwegian Knowledge Centre for the Health Services
Oslo, Oslo, Norway
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