Evidence-based and value-based formulary guidelines

Health plans and hospitals have long used drug formularies, but the processes by which formulary committees made decisions have typically lacked transparency and scientific rigor. A growing number of organizations have begun implementing formulary guidelines issued by the Academy of Managed Care Pharmacy (AMCP). These guidelines call for health plans to request formally that drug companies present a standardized "dossier" that contains detailed information not only on the drug's effectiveness and safety but also on its economic value relative to alternative therapies. This paper describes the guidelines, reviews progress to date, and analyzes several critical issues for the future.     

浅述群医学与价值医疗

三次医疗卫生革命的兴起和四次医学思维方式的转变均对医疗卫生行业产生深远影响,极大改善了人类健康状况,但新型冠状病毒肺炎疫情的发生,暴露出医疗卫生体系建设中仍存在的隐患和问题。本文拟浅述群医学与价值医疗,为弥合临床医学和公共卫生与预防医学之间的裂痕以及医疗行业未来的发展路线提供新的思路和方向。     

Evidence-based healthcare in developing countries

Developing countries have limited resources, so it is particularly important to invest in healthcare that works. The case for evidence-based practice has long been made in the West. However, poor access to information makes this endeavour near impossible for health professionals working with vulnerable communities in low-income economies. This paper provides a call to action to create an evidence base for health professionals in developing countries and identify appropriate strategies for the dissemination of this information in realistic and meaningful ways.     

Evidence-based healthcare management competency evaluation: alumni perceptions

An ongoing concern of healthcare educators is how well students are prepared for practice after they are graduated. Curriculum design and pedagogical methods are central components for developing healthcare management and leadership competencies. Various stakeholders have identified competency domains and typologies that outline the requisite skills and expertise to manage and lead healthcare organizations. This study analyzes survey data over a ten-year period from alumni one-year post graduation to compare self-reported assessment of competency development. Trends across two graduate professional programs tailored to different students of healthcare administration are compared. A total of 302 alumni responded to the survey. A factor analysis is performed to evaluate how the skills, knowledge, and abilities of graduates fit into identified competency domains. Fourteen competencies on the survey load into four factor domains: leadership, communication, business skills, and technology.     

Advanced therapy medicinal products and health technology assessment principles and practices for value-based and sustainable healthcare

Background

Advanced therapy medicinal products (ATMPs) are beginning to reach European markets, and questions are being asked about their value for patients and how healthcare systems should pay for them.

Objectives

To identify and discuss potential challenges of ATMPs in view of current health technology assessment (HTA) methodology—specifically economic evaluation methods—in Europe as it relates to ATMPs, and to suggest potential solutions to these challenges.

Methods

An Expert Panel reviewed current HTA principles and practices in relation to the specific characteristics of ATMPs.

Results

Three key topics were identified and prioritised for discussion—uncertainty, discounting, and health outcomes and value. The panel discussed that evidence challenges linked to increased uncertainty may be mitigated by collection of follow-on data, use of value of information analysis, and/or outcomes-based contracts. For discount rates, an international, multi-disciplinary forum should be established to consider the economic, social and ethical implications of the choice of rate. Finally, consideration of the feasibility of assessing the value of ATMPs beyond health gain may also be key for decision-making.

Conclusions

ATMPs face a challenge in demonstrating their value within current HTA frameworks. Consideration of current HTA principles and practices with regards to the specific characteristics of ATMPs and continued dialogue will be key to ensuring appropriate market access.

Classification code

I.

     

Evidence-based healthcare and health informatics: derivations and extension of epidemiology

Epidemiology provides extremely valid information and evidence regarding human health.Epidemiologic findings with regard to major illnesses must be amassed, enhanced, and expanded further into related areas as a foundation for evidence-based medicine that is based on clinical practice, as well as for evidence-based healthcare that includes public health-related issues. Epidemiology should be recognized not only by epidemiologists but also by a variety of people, including specialists in other areas for healthcare and medicine, people in law and media, policy makers, and the general public. A system is needed that can create information for facilitating appropriate decision-making with issues related to clinical medicine and public health. The principles and methodology of epidemiology are used as a base for developing a field of health informatics. The objective of health informatics is to establish a system for facilitating the flow and circulation of health and medical information. Health informatics has potential applications for the creation, communication, and use of information, and the discipline is being expanded as a practical applied science in search of solutions. This report represents an effort to expand the scope of health informatics and extend the applications of epidemiology by working with individuals in other disciplines and the public.     

First steps in PROMs and PREMs collection in Wales as part of the prudent and value-based healthcare agenda

Quality of Life Research - Patients are experts in their own health and should be treated as equal partners in their care. Patient-reported outcome measures (PROMs) are an effective way of...     

循证医学和循证健康教育

目的 探讨循证健康教育的基本理论。方法 通过对循证医学的问题，研究循证健康教育的理论基础，通过对健康教育学及其相关学科的研究和对我国健康教育实践的研究，分析在我国开展循证健康教育的意义，特征，基本方法。结果 初步描述我国循证健康教育的概念，意义，特征，基本方法；提出了我国近期开展循证健康教育的重点问题。结论 开展循证健康教育，是发展我国健康教育的又一重要内容，对促进我国健康教育发展有一定意义。     

Detecting bad actors in value-based payment models

Health Services and Outcomes Research Methodology - The U.S. federal government is spending billions of dollars to test a multitude of new approaches to pay for healthcare. Unintended consequences...     

Assessing the evidence for value-based insurance design

High copayments for medical services can cause patients to underuse essential therapies. Value-based health insurance design attempts to address this problem by explicitly linking cost sharing and value. Copayments are set at low levels for high-value services. The Mercer National Survey of Employer-Sponsored Health Plans demonstrates that value-based insurance design use is increasing and that 81?percent of large employers plan to offer it in the near future. Despite this increase, few studies have adequately evaluated its ability to improve quality and reduce health spending. Maximizing the benefits of value-based insurance design will require mechanisms to target appropriate copayment reductions, offset short-run cost outlays, and expand its use to other health services.     

Evidence-based healthcare in practice: A study of clinician resistance,professional de-skilling,and inter-specialty differentiation in oncology

Evidence-based medicine (EBM) is strongly shaping the nature and direction of biomedical practice and organisational culture. Clinicians are now expected to adopt the principles of EBM and evidence-based practice (EBP) whilst also maintaining such things as professional autonomy, clinical judgement and therapeutic integrity. Little sociological work has been done on the implications of EBM in oncology contexts. Drawing on in-depth interviews with 13 oncology consultants and 12 oncology nurses in Australia, in this paper we explore how oncology clinicians utilise and/or critique types of evidence and statistical probabilities; the organisational systematisation of care; and, wider policies of EBM. The results illustrate significant variation in perception of EBM between the oncology sub-specialties examined, and the central role of organisational structures and intra-professional hierarchies in how evidence is viewed and utilised in practice. The interviews also capture the ways in which oncology specialists are negotiating the systematisation of care under the rubric of EBM, and the contradictory effects of professional de-skilling vis-à-vis the reinforcement of biomedical objectivity/power. Finally, we examine the experiences and perceptions of oncology nurses in relation to evidence and EBM, exploring the interplay of processes of professionalisation and distinction in shaping the evidence-based trajectories of nursing. We contrast these results with previous sociological writings on EBM, reflecting on the applicability and limitations of these theoretical positions when applied to the experiences of oncology clinicians.