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Developing health technology assessment capacity : a five-step approach to disseminating the evidence. Kazanjian, Arminée, 1947-; Green, C. J. (Carolyn Joanne), 1956- 1997

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Developing health technologyessment capacity:A five-step approach todisseminating theevidenceKazanjian A, Green CJPRESENTED AT THE 2ND INTERNATIONAL CONFERENCE SCIENTIFICBASIS OF HEALTH SERVICES 5-8 OCTOBER, 5TH COCHRANECOLLOQUIUM 8-12 OCTOBER 1997.BCOHTA 97:14CB.C. Office of Health Technology AssessmentCentre for Health Services & Policy Research5-184 - Koerner Pavilion, 2211 Wesbrook MallThe University of British ColumbiaVancouver, B.C. V6T 1Z3.------ - - - - - - - - - - - - - - - -.....--..-..- ---......-......."'"....--...~--~,~-""~.>O.._'_~.""-~~.."A'. '--. c;".;INTRODUCTIONRegional and local expertise in producing scientifically rigorous reviews of clinicalevidence is uncommon in British Columbia. In fact, almost no one outside of variousdepartments associated with the Faculty of Medicine at the University of British Columbiacontributes to, or acts as local champions of, these systematic review products.As government departments, health institutions, and professional associations becomemore supportive of what has been loosely termed evidence-based medicine, they arebecoming increasingly interested in scientifically rigorous reviews of clinical evidence.In addition, they are beginning to recognize the importance of having a local personwho both conducts and defends these often controversial reviews .Provincial, national, and to a growing extent international, resources and recognitionhave been awarded to experts who review clinical evidence. These experts, many ofwhom are also clinicians, undertake these reviews more or less full time, train highlyskilled research staff, and often hold university appointments. Health TechnologyAssessment (HTA) offices such as the BC Office of Health Technology Assessment(BCOHTA) are one example of this emerging field. Although gaining academicimportance, these experts are too few to meet even a fraction of the growing demandsfor their services and too distant to contribute to most local debates.To influence policy and decision-making, the effective dissemination of technologyassessment products is a necessary step. Like many other HTA groups, BCOHTA hasbeen working to develop a successful dissemination strategy. The goal of thedissemination strategy is to introduce effectiveness evidence, for example, in funding oracquisition decisions, in a format which is preferred by the user of the product and isreceived at the most opportune time. Therefore, when a single product is beingdisseminated to different stakeholders, researchers need to appreciate the varyingusefulness of the information they have produced to the potential users and be responsiveto the specific needs of each of the stakeholders.WHO? BCOHTABCOHTA is a government funded, university-based, provincial technology assessmentprogram of research which began in 1990.• Purpose: to promote and encourage the use of assessment research among decision­makers at all levels.• Objectives: research, education and communication are all objectives of the Office.B.C. Office of Health Technology AssessmentDeveloping health technology assessment capacity:A five-step approach to disseminating the evidence1-·-~·""" """'_~."" · ~ ""'''''-:~_'''u·" """",· ._"",,,, ,,, · ,,,·. "' ~" ·I · · ,.. . , ~ : - .,. ' 1. _ ~ ,:; " ." ""._~ • •~ _~ ....BCOHTA contributes written and oral presentations to a wide range of local and nationalclinical-effectiveness debates . The strength of the BCOHTA method of systematic reviewand critical appraisal lies in the process of explicitly detailing the methodology and criteriaused to produce recommendations which are based solely on the research evidence. Thistransparent process allows for interaction between the technology assessment expert anddecision-makerWHAT? MULTITUDE PRODUCTS & EFFECTSAn interactive approach to dissemination is optimal. BCOHTA has developed apreliminary strategy based on five key components:1. One-on-one discussions with leaders2. Research reports, discussion papers3. Research publications4. NewslettersS. Media coverageCritical Product vs Critical Thinking!AppraisalThe decision makers need to be engaged in the critical thinking processfrom the outset of the project. Their personal experiences in the researchprocess, from framing the questions through to appraising the scientificevidence, provides a strong platform for becoming supporters and likelyusers of HTA.A key factor in the success of this strategy appears to be theimplementation of the dissemination strategy at specific moments in thetechnology acquisition/funding time frame.It is usual to focus on the health technology assessment report as "theanswer." In fact, research uptake is unlikely unless the requestor has anevidence-based approach to decision making. It can be equally important totransmit to the requestor a critical thinking approach, as well as the specificevidence pertaining to the particular question under study .B.C. Office of Health Technology AssessmentDeveloping health technology assessment capacity:A five-step approach to disseminating the evidence2BCOHTA participates in a number of endeavors where we bring to the table not just aproduct but a critical approach to assessing the evidenceWHERE?Policy context• the clinical practice guideline panels of the CPG Council- the body responsible forguideline development in British ColumbiaProgram context• a hospital society's technology assessment committee which deliberates all acquisitiondecisions for a group of hospitalsPractice setting• a therapeutics initiative which establishes recommendations for appropriate drugprescription behaviorPublic communication• the science reporter of the local daily newspaper who draws extensively on BCORTAreportsWHAT WORKS BEST?Understanding the context of the request is instrumental for providing the mostappropriate product; therefore, developing capacity for critical appraisal (and/or it'sappreciation) in different health settings (policy, program, practice) is, ultimately, aneffective approach to promoting HTA.Disseminating HTA products involves, in addition to knowledge transfer, the ability todefend the findings in often contentious committee debate. Printed material falls short inthis respect, yet a local expert/advocate can contribute effectively to such debates.B.C. Office of Health Technology AssessmentDeveloping health technology assessment capacity:A five-step approach to disseminating the evidence3

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