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ENGAGING CLINICIANS IN EVIDENCE-BASED DISINVESTMENT: ROLE AND PERCEPTIONS OF EVIDENCE

Published online by Cambridge University Press:  14 September 2012

Amber M. Watt ,
Cameron D. Willis ,
Katherine Hodgetts ,
Adam G. Elshaug  and
Janet E. Hiller
Amber M. Watt
Affiliation:
The University of Adelaide
Cameron D. Willis
Affiliation:
The University of Adelaide
Katherine Hodgetts
Affiliation:
The University of Adelaide
Adam G. Elshaug
Affiliation:
The University of Adelaide; Harvard Medical School email: elshaug@hcp.med.harvard.edu
Janet E. Hiller
Affiliation:
Australian Catholic University
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Abstract

Objectives: The aim of this study was to determine how evidence from systematic review (SR) is perceived and negotiated by expert stakeholders in considering a technology for potential disinvestment.

Methods: An evidence-informed stakeholder engagement examined results from a diagnostic accuracy SR of vitamin B12 and folate tests. Pathologists deliberated around the SR findings to generate an informed contribution to future policy for the funding of B12 and folate tests. Deliberations were transcribed and subject to qualitative analysis.

Results: Pathologists did not engage with findings from the SR in depth; rather they sought to contest the terms of the problem driving the review and attempted to reframe it. Pathologists questioned the usefulness of SR outcomes given the variable definitions of B12 deficiency and deferred addressing disinvestment options specifically pertaining to B12 testing. However, folate testing was proffered as a potential disinvestment candidate, based upon pathologists' definition of “appropriate” evidence beyond the bounds of the SR.

Conclusions: The value of SR to informing disinvestment deliberations by expert stakeholders may be a function of timing as well as content. Engagement of stakeholders in co-produced evidence may be required at two levels: (i) Early in the synthesis phase to help shape the SR and harmonize expert views with the available evidence (including gaps); (ii) Collaboration in primary research to fill evidence-gaps thus supporting evidence-based disinvestment. Without this, information asymmetry between clinically engaged experts and decision makers may preclude the collaborative, informed, and technical discussions required to generate productive policy change.

Keywords

DisinvestmentQualitative researchSystematic reviewEvidence-based practiceHealth policy
Type
MINITHEME: DISINVESTMENT
Information
International Journal of Technology Assessment in Health Care , Volume 28 , Issue 3 , July 2012 , pp. 211 - 219
Copyright
Copyright © Cambridge University Press 2012

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