Eva Draborg

Time-trends in health technology assessments: an analysis of developments in composition of international health technology assessments from 1989 to 2002.

OBJECTIVES Health Technology Assessment (HTA) as a method for producing evidence in the health-care sector has been used for more than 25 years but has grown in extent during the past years. The objective of this study is to explore a possible evolution in these HTAs, in type of assessed technologies, in type of assessors, and in its methods. METHODS A structured literature review was conducted of 433 HTA reports from the period 1989 to 2002 by eleven leading HTA institutions worldwide. The review focused on the methodology used, the assessors, and the assessed technologies and was designed to elucidate general time-trends in the practical application of HTA. RESULTS The study shows that literature reviews are still the most often used method of assessment and accounts for a relatively stable fraction of assessments. The fraction of economic evaluations shows a slightly decreasing trend in contrast to randomized controlled trials and modeling/evaluations, which are applied more frequently. The data also demonstrate a more frequent use of external partners as assessors and a shift between devices and pharmaceuticals as assessed technologies. CONCLUSIONS The study shows an increase in the number of HTAs but no major developments in assessment methods used and, therefore, no widespread spillover from the development in research methods in general to the field of HTA methodology.

Interprofessional clinical training improves self-efficacy of health care students

Background: Interprofessional collaboration potentially enhances patient safety and satisfaction, and reduces tensions and conflicts among health professionals. However, health professionals often lack sufficient knowledge of other professional roles and competences to engage in interprofessional teamwork. The aim of this study was to assess the impact of an interprofessional training programme on students’ perceived self-efficacy. Methods: A quasi-experimental study with an intervention group (239 students) and a control group (405 students). The intervention was an interprofessional clinical study (ICS) unit including students from nursing, medicine, physiotherapy, occupational therapy, laboratory technology and radiography. Data on students’ perceived self-efficacy were collected through web-based questionnaires. Aspects of self-efficacy measured were: (1) collaboration with other professions in planning goals and actions for patients; (2) collaboration with other professions for rehabilitation; (3) identifying the functions of other professions and (4) assessing and describing patients’ needs and problems. Results: All scores of perceived self-efficacy for the ICS group improved over time although one score change was non-significant (p = 0.08). After adjustment for baseline differences and the score change for the control group, the ICS groups self-efficacy score gain remained statistically significant. Conclusion: The study showed that interprofessional training improved students’ perception of self-efficacy more than traditional clinical training.

Providing information about prenatal screening for Down syndrome: a systematic review

In recent decades there have been advances in the options for prenatal screening. Screening programmes for Down syndrome are well established in many countries. It is important that pregnant women are well informed about the benefits and risks of screening. A variety of interventions has been introduced to support pregnant women in their choice of prenatal screening.

Adaptation and reliability of the Readiness for Inter professional Learning Scale in a Danish student and health professional setting

BackgroundShared learning activities aim to enhance the collaborative skills of health students and professionals in relation to both colleagues and patients. The Readiness for Interprofessional Learning Scale is used to assess such skills. The aim of this study was to validate a Danish four-subscale version of the RIPLS in a sample of 370 health-care students and 200 health professionals.MethodsThe questionnaire was translated following a two-step process, including forward and backward translations, and a pilot test. A test of internal consistency and a test–retest of reliability were performed using a web-based questionnaire.ResultsThe questionnaire was completed by 370 health care students and 200 health professionals (test) whereas the retest was completed by 203 health professionals. A full data set of first-time responses was generated from the 570 students and professionals at baseline (test).Good internal association was found between items in Positive Professional Identity (Q13–Q16), with factor loadings between 0.61 and 0.72.The confirmatory factor analyses revealed 11 items with factor loadings above 0.50, 18 below 0.50, and no items below 0.20. Weighted kappa values were between 0.20 and 0.40, 16 items with values between 0.40 and 0.60, and six items between 0.60 and 0.80; all showing p-values below 0.001.ConclusionStrong internal consistency was found for both populations. The Danish RIPLS proved a stable and reliable instrument for the Teamwork and Collaboration, Negative Professional Identity, and Positive Professional Identity subscales, while the Roles and Responsibility subscale showed some limitations. The reason behind these limitations is unclear.

Informed Choice for Participation in Down Syndrome Screening: Development and Content of a Web-Based Decision Aid

Background In Denmark, all pregnant women are offered screening in early pregnancy to estimate the risk of having a fetus with Down syndrome. Pregnant women participating in the screening program should be provided with information and support to allow them to make an informed choice. There is increasing interest in the use of Web-based technology to provide information and digital solutions for the delivery of health care. Objective The aim of this study was to develop an eHealth tool that contained accurate and relevant information to allow pregnant women to make an informed choice about whether to accept or reject participation in screening for Down syndrome. Methods The development of the eHealth tool involved the cooperation of researchers, technology experts, clinicians, and users. The underlying theoretical framework was based on participatory design, the International Patient Decision Aid Standards (IPDAS) Collaboration guide to develop a patient decision aid, and the roadmap for developing eHealth technologies from the Center for eHealth Research and Disease Management (CeHRes). The methods employed were a systematic literature search, focus group interviews with 3 care providers and 14 pregnant women, and 2 weeks of field observations. A qualitative descriptive approach was used in this study. Results Relevant themes from pregnant women and care providers with respect to information about Down syndrome screening were identified. Based on formalized processes for developing patient decision aids and eHealth technologies, an interactive website containing information about Down syndrome, methods of screening, and consequences of the test was developed. The intervention was based on user requests and needs, and reflected the current hospital practice and national guidelines. Conclusions This paper describes the development and content of an interactive website to support pregnant women in making informed choices about Down syndrome screening. To develop the website, we used a well-structured process based on scientific evidence and involved pregnant women, care providers, and technology experts as stakeholders. To our knowledge, there has been no research on the combination of IPDAS standards and the CeHRes roadmap to develop an eHealth tool to target information about screening for Down syndrome.

Informed choice about Down syndrome screening - effect of an eHealth tool: a randomized controlled trial.

The aim of this study was to evaluate the effect of an eHealth intervention (interactive website) on pregnant womens ability to make an informed choice about Down syndrome screening.

Reflections on two years after establishing an orthogeriatric unit: a focus group study of healthcare professionals’ expectations and experiences

BackgroundFor decades hospitals have been “vertically” organized, with the risk that specialization leads to fragmented and one-sided views of patient care and treatment that may cause poor communication and coordination of care and treatment. Two years after the introduction of an orthogeriatric unit for elderly patients admitted with fragility fractures, we studied the involved healthcare professionals’ perspectives and experiences with working in an interprofessional organization.MethodsWe performed four focus groups interviews with 19 healthcare workers representing different professions. The interviews were analysed using systematic text condensation (STC).ResultsThree themes were identified: 1) A patient-centred approach, 2) An opportunity for professional growth and 3) The benefits of interprofessional collaboration. The interviewees emphasized in particular the systematic and frequent face-to-face communication enabled by the interprofessional team meetings as essential to their feeling of enhanced collegial solidarity. All groups expressed their respect for other groups’ competences and their vital contributions to good orthogeriatric care. However, collaboration was challenged by the groups’ divergent views of the patients and of the relevance of the information given in the weekly meetings. Heavy workloads were also mentioned. The opportunity for professional growth was also felt to be imperilled by some professionals.ConclusionsAll participants indicated their view that the orthogeriatric organization had improved the quality of care and treatment. Furthermore, good communication, mutual respect for other professional competences and shared goals were found to have enhanced interprofessional collaboration and improved the sense of having a shared mission. However, differences in approaches and expectations continued to challenge the orthogeriatric model after 2 years. Neither did all professionals find orthogeriatric care professionally challenging.

The Cost-Effectiveness of Conventional Discectomy Compared to Other Surgical Techniques for Lumbar Disk Herniation. A Systematic Review

Background: The current study reviews the literature on the cost-effectiveness of conventional diskectomy compared to other surgical techniques, by assessing studies with economical evaluation and studies using proxy measures of cost-effectiveness. Methods: In April 2016, a comprehensive search was conducted in Medline, Embase and the Cochrane Database. Reference lists of retrieved articles were perused for further relevant publications. Randomized controlled trials and comparison studies, comparing conventional diskectomy to other surgical interventions for patients with lumbar disk herniation, were included and reviewed by the authors. Data were gathered on the methodology of the studies, including study design, randomization, follow-up period, cost-estimation, etc. and the quality of the published studies was quantified using a modified version of the Drummond checklist. Results: Twenty-four articles were included in the review, 9 retrieved from the original search, and an additional 15 from reference lists. Four studies included an economical evaluation and 20 reported proxy measures of cost-effectiveness. The quality of studies varied considerably and results were ambiguous; the four economic studies favored conventional diskectomy, but none were randomized trials. Of the twenty proxy studies some favored the alternatives, and some reported no clear difference. Conclusions: The available literature does not allow for strong conclusions due to the sparsity of high quality economic studies. The available evidence, however, suggests that any cost-effectiveness difference between conventional diskectomy and the alternatives is unlikely to be great. Correspondence to: Thorsen MTH, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5000 Odense M, Denmark, Tel: +47 936 18 222; E-mail: Mayt101@yahoo.no