23.03.2012

Ein Leitfaden für evidenzbasierte Entscheidungen in Gesundheitssystemen. Was können politische Entscheidungsträger von Klinikern lernen?

Xavier Bosch-Capblanch vom Swiss TPH veröffentlicht in PLoS Medicine zusammen mit weiteren Autoren zwischen dem 6. und dem 20. März eine Serie von drei Artikeln über die Entwicklung von Leitfäden für Gesundheitssysteme. Die Artikel befassen sich mit dem Thema, wie Forschungsergebnisse in Leitfäden für evidenzbasierte Entscheidungen in Gesundheitssystemen übersetzt werden sollten, um damit sowohl Interventionen im klinischen Bereich als auch im öffentlichen Gesundheitswesen zu verbessern. Zusammenfassungen der drei Artikel werden hier verlinkt, sobald sie in PloS Medicine verfügbar sind.

The articles in this series have been led by three authors from the Swiss TPH (Xavier Bosch-Capblanch), the MacMaster University (John Lavis) and the Norwegian Knowledge Centre for Health Services (Simon Lewin), together with a group of distinguished collaborators from the Task Force on Developing Health Systems Guidance, chaired by Andy Haines. These are open access articles and can be accessed here at PLoS Medicine site.

Particular attention is given to the issues raised during meetings of the Task Force on Developing Health Systems Guidance, which was grounded following a request from the WHO for advice. The first article makes a case for developing guidance to inform decisions on health systems-level questions based on an analysis of strategic health sector documents. It also explores specific challenges in producing such guidance and identifies options for addressing these challenges. The second article explores the links between health systems guidance development and policy development at global and national levels, and examines the range of factors that can influence policy development. The third paper focuses on assessing how much confidence can be placed on health systems research evidence in both guidance and policy development processes.
 

LINKS

To view the articles visit:


To view the Handbook visit:

http://www.swisstph.ch/fileadmin/user_upload/Pdfs/SCIH/WHOHSG_Handbook_v04.pdf


SUMMARY POINTS OF THE THREE ARTICLES


1 - Summary points of article one

  • Weak health systems hinder the implementation of effective interventions; policies to strengthen such systems need to draw on the best available evidence
  • Health systems evidence is best delivered in the form of guidance embedded in policy formulation processes but health systems guidance is poorly developed at present
  • The translation of research on problems, interventions and implementation into decisions and policies that affect how systems are organised is one challenge facing the development of health systems guidance
  • The development of guidance that is timely and usable by the broad range of health systems stakeholders, and of methods to appraise the quality of health systems guidance, are additional challenges
  • Further research is needed to adapt existing approaches (e.g. those used in clinical guidelines) to produce meaningful advice that accounts for the complexity of health systems, political systems, and contexts



 2 - Summary points of article 2

  • Contextual factors are extremely important in shaping decisions about health systems and policy makers need to work through all the pros and cons of different options before adopting specific health systems guidance
  • Division of labour between global guidance developers, global policy developers, national guidance developers and national policy developers is needed to support evidence-informed policymaking about health systems
  • A panel charged with developing health systems guidance at the global level could best add value by ensuring that its output can be used for policy development at the global and national level, and for guidance development at the national level
  • Rigorous health systems analyses and political systems analyses are needed at the global and national level to support guideline and policy development
  • Further research is needed into the division of labour in guideline development and policy development and on frameworks for supporting system and political analyses


 
3 - Summary points of article 3

  • Assessing how much confidence to place in different types of research evidence is key to informing judgements regarding policy options to address health systems problems
  • Systematic and transparent approaches to such assessments are particularly important given the complexity of many health systems interventions
  • Useful tools are available to assess how much confidence to place in the different types of research evidence needed to support different steps in the policymaking process; those for assessing evidence of effectiveness are most developed
  • Tools need to be developed to assist judgements regarding evidence from systematic reviews on other key factors such as the acceptability of policy options to stakeholders, implementation feasibility and equity
  • Research is also needed on ways to develop, structure and present policy options within global health systems guidance
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