Extracting Key Messages from Systematic Reviews

The Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, NC 27599-7590, USA.
Journal of psychiatric practice 03/2008; 14 Suppl 1:28-34. DOI: 10.1097/01.pra.0000333585.83365.cb
Source: PubMed


Systematic reviews have become a common method of synthesizing literature to examine the comparative effectiveness of medical interventions. Groups such as the Cochrane Collaboration and the U.S. Agency for Healthcare Research and Quality (AHRQ) conduct dozens of such reviews each year. However, these documents are often hundreds of pages long and the intended audiences, including medical providers and payers, may have difficulty interpreting the often technical terminology used in these reports. In this article, we describe the derivation of "key concepts" on the efficacy of antiepileptic drugs (AEDs) in the treatment of bipolar disorder from a pre- viously published systematic review of the use of AEDs (AED Review) for multiple indications, including mood disorders and chronic pain. With the aid of a multidisciplinary science panel, we derived the key concepts from the source report and subsequent updates of that report. Because we found that the key concepts were still quite technical, we subsequently derived four less technical "key messages" and revised these through multiple additional iterations. The concepts and messages were then tested with key informants and focus groups. At all stages of the process, we found that it was critical to maintain fidelity to the initial systematic review. The structured approach used in the derivation process described here proved to be very helpful in developing key messages and concepts.

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Available from: Cathy Melvin, May 12, 2014
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    ABSTRACT: Evidence from drug class reviews is often not accessible to practicing clinicians nor is it presented in a way that allows clinicians to use the information to guide treatment and prescribing decisions. Nevertheless, information from such reviews can be very helpful to clinicians as they evaluate the "evidence" provided to them through marketing strategies implemented, primarily, by the pharmaceutical industry and designed to influence their prescribing behavior. Unfortunately, these marketing strategies can be used to promote the off-label use of drugs that may not be efficacious. One example is the pharmaceutical marketing to promote off-label use of gabapentin (Neurontin) for the treatment of bipolar disorder, the legality of which was later addressed in a major lawsuit by the National Association of Attorneys General. We describe an effort to use counter-marketing strategies to compete with those implemented by the pharmaceutical industry and to help clinicians, principally psychiatrists, make use of available evidence to inform their prescription of antiepileptic drugs (AEDs) in the treatment of bipolar disorder. A growing body of literature describes industry marketing practices designed to influence prescriber behavior. This literature suggests that use of competing approaches involving the same underlying strategies to deliver highly credible information from trusted sources can inform prescriber knowledge and prescribing practice. We describe our use of existing evidence to develop accurate and convincing messages and materials to be disseminated nationally to counter industry misinformation and promote evidence-based prescription of AEDs.
    Full-text · Article · Mar 2008
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    ABSTRACT: Off-label use of medications is the subject of great debate. Prescribing is influenced by a number of factors, including peer recommendations, pharmaceutical industry marketing, and evidence-based drug effectiveness reports. Understanding prescribing patterns for a particular drug class can inform efforts to provide fair and balanced information to prescribers. This study investigated four dimensions of psychiatrists' prescribing practices for antiepileptic drugs (AEDs) for bipolar disorder: 1) psychiatrists' current use of AEDs, 2) their actual and preferred sources of information on AEDs, 3) their knowledge about the Neurontin lawsuit, and 4) their reactions to sample marketing campaign materials, including key messages from an evidence-based report on the topic. Qualitative methods, including telephone and in-person focus groups and in-depth interviews, were used to explore these dimensions. We found that psychiatrists prescribe AEDs for off-label use, but that they are not using gabapentin as a primary treatment for bipolar disorder. The psychiatrists also reported that they obtained their information about AEDs from professional journals, colleagues, and pharmaceutical representatives. The psychiatrists were asked to review a set of four key messages derived from an evidence-based report on the use of AEDs to treat bipolar disorder. They had misconceptions about the efficacy of the draft messages as they were written, stating that they were oversimplified and erroneous. The messages were revised based on the participants' feedback. However, the core findings from the evidence-based report remained unchanged. Recommendations for developing and disseminating messages and materials for a future corrective marketing campaign to provide fair and balanced information to physicians about gabapentin and other AEDs are discussed.
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