Heather Buchan

When financial incentives do more good than harm: a checklist

Financial incentives can sometimes improve the quality of clinical practice, but they may also be an expensive distraction. Paul Glasziou and colleagues have devised a checklist to help prevent their premature or inappropriate implementation

The ASTUTE Health study protocol: Deliberative stakeholder engagements to inform implementation approaches to healthcare disinvestment

BackgroundGovernments and other payers are yet to determine optimal processes by which to review the safety, effectiveness, and cost-effectiveness of technologies and procedures that are in active use within health systems, and rescind funding (partially or fully) from those that display poor profiles against these parameters. To further progress a disinvestment agenda, a model is required to support payers in implementing disinvestment in a transparent manner that may withstand challenge from vested interests and concerned citizens. Combining approaches from health technology assessment and deliberative democratic theory, this project seeks to determine if and how wide stakeholder engagement can contribute to improved decision-making processes, wherein the views of both vested and non-vested stakeholders are seen to contribute to informing policy implementation within a disinvestment context.Methods/designSystematic reviews pertaining to illustrative case studies were developed and formed the evidence base for discussion. Review findings were presented at a series of deliberative, evidence-informed stakeholder engagements, including partisan (clinicians and consumers) and non-partisan (representative community members) stakeholders. Participants were actively facilitated towards identifying shared and dissenting perspectives regarding public funding policy for each of the case studies and developing their own funding models in response to the evidence presented. Policy advisors will subsequently be invited to evaluate disinvestment options based on the scientific and colloquial evidence presented to them, and to explore the value of this information to their decision-making processes with reference to disinvestment.DiscussionAnalysis of the varied outputs of the deliberative engagements will contribute to the methodological development around how to best integrate scientific and colloquial evidence for consideration by policy advisors. It may contribute to the legitimization of broad and transparent stakeholder engagement in this context. It is anticipated that decision making will benefit from the knowledge delivered through informed deliberation with engaged stakeholders, and this will be explored through interviews with key decision makers.

The cycle of change: implementing best-evidence clinical practice

To improve health outcomes, effective and systematic mechanisms to foster the adoption of evidence-based guideline recommendations into routine practice need to be identified. A cyclical process for achieving this objective involving three key phases is suggested. Phase 1. Writing actionable best-evidence guidelines that prioritize key recommendations while indicating the levels of adoption needed for population health benefits to be accomplished. Phase 2. Developing implementation plans for the priority guideline recommendations. These should systematically consider skills training and accreditation; social influences including opinion leaders and patient influences; environmental factors; monitoring and feedback; and incentives for clinical change. Phase 3. Pilot testing the effectiveness of proposed approaches in producing the desired clinical changes. If implementation requires system changes and evaluation at an organizational level, the use of alternative research designs to the randomized controlled trial could be considered. The purpose evaluation would be to enable refinement of the implementation plans before widespread dissemination.

Effectiveness of strategies to encourage general practitioners to accept an offer of free access to online evidence-based information: a randomised controlled trial

BackgroundThis study examined the effectiveness of seven different interventions designed to increase the proportion of general practitioners (GPs) accepting an offer of free access to an online evidence-based resource.MethodsAustralian GPs (n = 14,000) were randomly selected and assigned to seven intervention groups, with each receiving a different letter. Seven different strategies were used to encourage GPs to accept an offer of two years free access to an online evidence-based resource (BMJ Clinical Evidence). The first group received a standard letter of offer with no experimental demands. Groups two to seven received a standard letter of offer outlining the requirements of the study. They were asked to complete an initial online questionnaire, agree to complete a 12-month follow-up questionnaire, and agree to having data about their usage of the online evidence-based resource provided to researchers. Groups three to seven also had additional interventions included in the letter of offer: access to an online tutorial in use of the resource (group three); provision of a pamphlet with statements from influential opinion leaders endorsing the resource (group four); offer of eligibility to receive professional development points (group five); offer of eligibility for a prize of

Use graduated compression stockings postoperatively to prevent deep vein thrombosis

500 for registration at a medical conference of their choice (group six); and a combination of some of the above interventions (group seven).ResultsIn the group with no research demands, 27% accepted the offer. Average acceptance across all other groups was 10%. There was no advantage in using additional strategies such as financial incentives, opinion leader support, offer of professional development points, or an educational aid over a standard letter of offer to increase acceptance rates.ConclusionThis study showed low acceptance rates of the offer of access to the online resource when there was an associated requirement of response to a short online questionnaire and non-obtrusive monitoring of GP behaviour in terms of accessing the resource. If we are to improve care and encourage evidence-based practice, we need to find effective ways of motivating doctors and other health professionals to take part in research that can inform our implementation efforts.

Seeking consumer views: what use are results of hospital patient satisfaction surveys?

Improvements in clinicians’ use of graduated compression stockings are needed, supported by consistent policies in hospitals and general practice