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Flashcards in Evidence Based Practice and Resource Allocation Deck (51)
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1

what are inequities

how different people have different experiences in treatment

2

what are randomised control trials

experiment which reduces bias when testing a new treatment. The people participating in the trial are randomly allocated to either the group receiving the treatment under investigation or to a group receiving standard treatment (or placebo treatment) as the control

3

what is evidence based practice

treatment based on clinical expertise as well as the best available external clinical evidence

4

what is the evidence based on

effectiveness and cost effectiveness

5

what is the best avaliable evidence

findings from rigorously conducted research

6

What did Cochrane's book set out

principles of evidence based practice and criticism of medical professionals for failing to take into account research

7

what is a systematic review

collection and analysis of multiple reviews

8

what is a Cochrane centre

where RCTs are collected and systematic reviews take place analysing the evidence from the RCTs

9

why are systematic reviews useful

increases certainty, offer conclusions, save clinicians from having to locate studies for themselves

10

true or false systematic reviews prevent biased decisions being made

true

11

what is used to assess the quality of evidence

critical appraisal tool

12

what do critical appraisal tools do?

suggest things to look for, questions to ask

13

what are the 2 types of criticisms of evidence based practice

practical and philosophical

14

give examples of practical criticisms (3)

1. may be impossible to create systemic reviews for all specialities
2. may be challenging and expensive to implement findings
3. they are not always necessary

15

give examples of philosophical criticisms (4)

1. to what extent should doctors use them to make decisions
2. just because an RCT shows a positive effect doesn't mean it will for an individual patient
3. where does responsibility lie if doctors are just following guidelines
4. doctors may just follow guidelines and not do what best for the patient

16

what problems are there with getting the evidence into practice (4)

1. doctors don't know the evidence exists
2. doctors don't know how to use the evidence
3. don't have the drugs or equipment to implement
4. patients may not want that treatment

17

why are priorities for resources set

there are not enough resources as demand outstrips supply

18

what is resource allocation driven by

1. demographics (the population of elderly is increasing giving increases of certain conditions)
2. cost

19

what are the 2 forms of rationing when determining resource allocation

explicit and implicit

20

what is implicit rationing

the allocation of resources through individual clinical decisions

21

what are the disadvantages to implicit rationing

leads to inequalities, open to abuse

22

what is explicit rationing

systematic allocation of resources within health care system

23

what are the advantages of explicit rationing

evidence based, less inequality, transparent

24

what are the disadvantages of explicit rationing

very complex, patient distress if the NHS cant fund a drug, less clinical freedom as you cant prescribe whats in the patients best interest

25

what does NICE stand for

national institute for health and care excellence

26

what does NICE do

looks at clinical and cost effectiveness of treatments to decide whether or not they can be recommended for use in the NHS

27

what is scarcity

when the need outstrips the resources so prioritisation is inevitable

28

what is efficiency

getting the most out of limited resources

29

what is equity

the extent to which distribution of resources is fair

30

what is effectiveness

the extent to which an intervention produced desired outcomes

31

what is utility

the value an individual places on health state

32

what is opportunity cost

once you've spent money on one treatment you no longer have that money to spend on another treatment

33

what is opportunity cost measured in

benefits foregone

34

what is technical efficiency

when you are interested in the most efficient way of meeting a need (e.g. whether a treatment should be in the community or hospital)

35

what is allocative efficiency

you are choosing between many needs to be met (e.g. by choosing which treatment to fund)

36

what does an economic analysis compare

the inputs (resources) and outputs of alternative interventions to see which intervention is the best value

37

how can you measure benefits?

by looking at:
1. impact on health status
2. saving in resources (e.g. will the patient no longer need drugs)
3. improved productivity of the patient

38

what are the 4 types of economic evaluation

1. cost minimisation analysis
2. cost effectiveness analysis
3, cost benefit analysis
4. cost utility analysis

39

what do all 4 types of economic evaluations do

consider costs

40

what do the 4 types of economic evaluations differ in

the extent to which they attempt to measure and value benefits

41

what is cost minimisation analysis

where the outcomes are assumed to be equivalent so only look at costs (e.g. all hit replacements give equal improvement so choose the cheapest one)

42

what is cost effectiveness analysis

compare drugs with a common health outcome in terms of cost per unit outcome

43

what is cost benefit analysis

where the inputs and outputs are valued in monetary terms

44

what is a cost utility analysis

analysis focussing on the quality of health outcomes produced

45

what is the most frequently used measure in cost utility analysis

Quality adjusted life year (QALY)

46

why are QALYs used

as they combine survival and quality of life as a guide to decision making

47

what does 1 QALY equal

1 year of perfect health

48

how is quality of life measured

generic (EQ-5D commonly used) and specific instruments

49

what are 3 alternatives to QALYs

1. health year equivalents
2. saved young life equivalents
3. disability adjusted life years

50

what does NICE use to assess cost effectiveness

QALYs

51

what are some criticisms of QALYs

1. don't distribute resources according to need but according to benefit gained per cost
2. may not embrace all dimensions of benefit
3. don't asses impact on family or carers