ASBHDS - Session 1 Flashcards Preview

CJ: UoL Medicine Semester Two (ESA2) > ASBHDS - Session 1 > Flashcards

Flashcards in ASBHDS - Session 1 Deck (37):
1

Give some arguments in favour of using evidence-based healthcare.

- evidence of effectiveness and cost-effectiveness required in a system with finite resources
- variations in treatment cause inequities
- practices influenced too much by professional opinion, clinical fashion, culture etc.

2

What is the Cochrane Collaboration?

A global group of all the Cochrane Centres, which register and analyse all RCTs

3

What is the standard definition of evidence-based practice?

Evidence based practice involves the integration of individual clinical expertise with the best available external clinical evidence from systematic research

4

Why are systematic reviews required?

- Traditional reviews may be biased/subjective
- Not easy to see how studies were identified for review
- quality of reviewed studies is variable

5

Give some reasons why systematic reviews are useful to clinicians.

- offer quality control and increased certainty
- save clinicians from having to locate/appraise studies for themselves
- may reduce delay between research discoveries and implementation

6

Give some PRACTICAL criticisms of the evidence-based practice movement

- may be an impossible task to maintain systematic reviews across all specialities
- challenging and expensive to disseminate/implement findings
- not always feasible/necessary
- requires 'good faith' from pharmaceutical companies

7

Give some PHILOSOPHICAL criticisms of evidence-based practice.

- does not align with most doctors' modes of reasoning
- population-level outcomes don't mean an intervention will work for an individual
- could relate 'unreflective rule followers' from professionals
- might be seen as way of legitimising rationing
- professional responsibility/autonomy

8

Give some problems with getting evidence into practice

- evidence exists but doctors don't know about it
- doctors know about evidence but don't use it
- organisational systems cannot support innovation
- commissioning decisions reflect different priorities
- resources not available to implement change

9

Define scarcity

Need outstrips resources, prioritisation is inevitable

10

Define efficiency

Getting the most out of limited resources

11

Define equity

The extent to which distribution of resources is fair

12

Define effectiveness

The extent to which an intervention produces desired outcomes

13

Define utility

The value an individual places on a heath state

14

Define opportunity cost

Once a resource has been used in one way, it can no longer be used in another way

15

What is the difference between technical and allocative efficiency?

Technical efficiency - the most efficient way of meeting a need
Allocative efficiency - choosing between the many needs to be met

16

What does an economic analysis do?

Compares the inputs (resources) and outputs (benefits and value attached to them) of alternative interventions, allowing better decisions to be made about investment values.

17

How are costs measured?

Identify, quantify and value resources needed

18

How are benefits measured?

- impacts on health status
- savings in other healthcare resources
- improved productivity if patient/family returns to work earlier

19

What are the four types of economic evaluation?

- cost minimisation analysis
- cost effectiveness analysis
- cost benefit analysis
- cost utility analysis

20

What is cost minimisation analysis?

- outcomes assumed to be equivalent
- focus is on costs only
- not relevant very often
- eg. All prostheses for hip replacement improve mobility equally; choose cheapest one

21

What is cost effectiveness analysis?

- used to compare drugs/interventions with a common health outcome
- compared in terms of cost per unit outcome (eg per reduction in blood pressure of 5 mm Hg)

22

What is cost benefit analysis?

- all inputs and outputs valued in monetary terms
- allows comparisons with interventions outside healthcare

23

What is cost utility analysis?

- sub-type of cost effectiveness analysis
- measured in 'cost per QALY' terms

24

If there is good evidence about the effectiveness of the interventions and they are equally effective, which study should be used?

Cost minimisation study

25

If outcomes cannot be measured in monetary terms or QALYs, what study should be used?

Cost-effectiveness analysis

26

What is a QALY?

A Quality Adjusted Life Year adjusts life expectancy for quality of life, so one year of perfect health = 1 QALY

27

Give an example of a way of measuring quality of life.

The EQ-5D

28

Up to what monetary value will NICE approve technology?

- below £20k per QALY, technology approved
- at £20k-30k it will be evaluated
- above £30k needs a 'strong case' to be accepted

29

Give some criticisms of QALYs

- controversy about values they embody
- may disadvantage common conditions
- do not distribute resources according to need, but according to benefit gained
- technical problems with calculation
- do not assess impact on careers/family
- RCT evidence can not always be relied upon

30

Why must priorities must be set in healthcare?

Due to scarcity of resources - demand outstrips supply

31

What is the difference between explicit and implicit rationing?

Implicit - allocation of resources through individual clinical decisions without the criteria for decisions being explicit

Explicit - the use of institutional procedures for the systematic allocation of resources within a health care system

32

Give some disadvantages of implicit rationing

- can lead to inequities and discrimination
- open to abuse
- decisions based on perceptions of 'social deserving-ness'
- doctors increasingly unwilling to do it

33

Give some advantages of explicit rationing

- transparent and accountable
- opportunity for debate
- more clearly evidence-based
- more opportunities for equity in decision-making

34

Give some disadvantages of explicit rationing

- very complex
- heterogeneity of patients and illnesses makes it difficult
- patient/professional hostility
- impact on clinical freedom
- evidence of patient distress

35

What does NICE stand for?

National Institute for Health and Care Excellence

36

What is the purpose of NICE?

Enables evidence of clinical and cost effectiveness to be integrated to form a judgement on the value of a treatment

37

Why is the role of NICE in approving/rejecting expensive treatments sometimes seen as controversial?

- if not approved, patients effectively denied access to treatment
- if approved, NHS organisations must fund them, even if with adverse consequences for other priorities

Decks in CJ: UoL Medicine Semester Two (ESA2) Class (87):