Ávinningur af auknu aðgengi að upplýsingum
Sigurður Helgason
Ritstjóri klínískra leiðbeininga
Landlæknisembættinu
Upplýsingaflóð alla að drepa !!
- óljós spurning eða illa fram sett
- óljós hugmynd um hvar á að leita
- leitaraðferð ómarkviss
Fáum oft ónothæfar upplýsingar og eyðum miklum tíma
Misvísandi niðurstöður !!
Hver er sannleikurinn?
Greinar Leiðbeiningar
Endurmenntun
Sérfræðiálit Textabækur
Gagnreynd læknisfræði
-ofnotað sem orðatiltæki en vannotað í vinnu !!!!!
- litið á sem leið til að brúa bilið milli rannsókna og daglegrar vinnu.
-áherslan er á að besta vísindaleg þekking nýtist við m.a. klíníska ákvörðunartöku.
Að byggja á bestu upplýsingum
Getur leitt til:Gagnsærri ákvörðunartökuAukinnar ábyrgðar
rökstuðningur fyrir ákvörðunum verður aðgengilegur
Mats á óvissu ljóst er hve sönnun er mikil / eða lítil
Notkun vísindaniðurstaðna á kostnað reynslu og hyggjuvits
Nám - framhaldsmenntun
-hvernig við öðlumst þekkingu er jafn mikilvægt og vitneskjan sem við búum yfir. mikilvægara er að leggja áherslu á hvernig
við öflum þekkingar og förum með hana en skapa þekkingarílát sem gubba út upplýsingum eftir óskum
Kennsla með þetta í huga þarf að stóraukast á öllum stigum í námi heilbrigðisstétta
Vinna =HeimildaleitElta uppi gögnMat á gögnum (Appraisal)Heimfæra upp á vandamálið
Notagildi upplýsinga =
Relevance x Validity
VinnaVinna
Benjamin Rush 1797. Blóðtaka.
-óhemju upprifinn af árangri af blóðtöku. -fór sem eldur um sinu -mjög ótæpileg notkun á blóðtöku.
George Washington dó úr hálsbólgu eftir að tappað var af honum um 2 lítrum.
Mótbárur
-oft byggðar á misskilningi – Það þarf að sníða vísindalega þekkingu að
hverjum einstaklingi og það gerir sá læknir best sem til hans þekkir - eins og að troða ferköntuðum kubb í kringlótt gat!!
Við eigum ekki að vera svo barnaleg að halda að Evidence sé alltaf á hreinu. Það má ekki gera of mikið úr gagnreyndri
læknisfræði – við verðum að viðurkenna annmarka.
Hlutur stjórnenda
Það er langt í frá nóg að dreifa EBM efni – yfirvöld / stofnanir þurfa að skapa rétta umhverfið til að
þetta gangi upp. – með því hagnast heilbrigðiskerfið og sérlega sjúklingar.
Aðeins um þriðjungur af því sem við praktiserum er byggt á bestu upplýsingum
Bisbjerg audit. Ugeskr Læger 2000;162:4382
EBI
Forsendur betri heilsu í gegnum EBI:
Stjórnendur verða að að geta greint á milli góðra og lélegra upplýsinga
Breytt þekking þarf að leiða til breytinga í framkvæmd heilbrigðisþjónustu
Breytt þjónusta þarf að leiða til betri útkomu fyrir skjólstæðinga okkar
EBI
Upplýsingatækni sem stoð til betri heilsu þarf að búa yfir a.m.k þrem eiginleikum:Aðgengilegt – þægilegt
Réttur tími og staður
AðgreiningarhæfniGóðar og réttar upplýsingar eru aðgreindar frá
villandi eða ónauðsynlegum upplýsingum
SamtvinnunUpplýsingar frá mörgum stöðum
Economic? and influenza (33)
Zanamivir or oseltamivir (50)
Economic? and (zanamivir or oseltamivir) (1)
Economic analysis of influenza vaccination and antiviral treatment for healthy working adults; Patrick Y Lee; Annals of Internal Medicine Philadelphia; Aug 20,2002;Vol. 137, Iss. 4; pg. 225, 7 pgs
WWW.HVAR.IS
Proquest
Medline 1966-okt 2002
Influenza (27731)Economic? and influenza (196)Zanamivir or oseltamivir (352)Economic? and (zanamivir or oseltamivir) (7)
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Lee PY. Matchar DB. Clements DA. Huber J. Hamilton JD. Peterson ED. Economic analysis of influenza vaccination and antiviral treatment for healthy working adults. [summary for patients in .]. [Journal Article] Annals of Internal Medicine. 137(4):225-31, 2002 Aug 20.
Burls A. Clark W. Stewart T. Preston C. Bryan S. Jefferson T. Fry-Smith A. Zanamivir for the treatment of influenza in adults: a systematic review and economic evaluation. [Review] [89 refs] [Journal Article. Review. Review Literature] Health Technology Assessment (Winchester, England). 6(9):1-87, 2002.
Cram P. Blitz SG. Monto A. Fendrick AM. Influenza. Cost of illness and considerations in the economic evaluation of new and emerging therapies. [Journal Article] Pharmacoeconomics. 19(3):223-30, 2001.
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EBM ovid
Influenza (1256)Economic? and influenza (12) (neðan)Zanamivir or oseltamivir (57)Economic? and (zanamivir or oseltamivir) (1) (neðan) EBM Reviews - ACP Journal Club Influenza vaccination of healthy adults was effective during the 1998 to 1999 flu season but not the 1997 to
1998 season [Therapeutics] ACP Journal Club. v134(3):90, May/June, 2001. EBM Reviews - ACP Journal Club Vaccination against influenza had both health and economic benefits for healthy, working adults
[Therapeutics] ACP Journal Club. v124:52, Mar-April, 1996. EBM Reviews - Database of Abstracts of Reviews of Effectiveness Center for Reviews and Dissemination Reviewers. The efficacy of influenza
vaccine in elderly persons: a meta-analysis and review of the literature. [Prevention] Database of Abstracts of Reviews of Effectiveness. Issue 4, December 2002
EBM Reviews - Database of Abstracts of Reviews of Effectiveness Center for Reviews and Dissemination Reviewers. Oseltamivir for the treatment of suspected influenza: a clinical and economic assessment. [Miscellaneous] Database of Abstracts of Reviews of Effectiveness. Issue 4, December 2002
EBM Reviews - Cochrane Controlled Trials Register Bridges CB, Thompson WW, Meltzer MI, Reeve GR, Talamonti WJ, Cox NJ, Lilac HA, Hall H, Klimov A, Fukuda K Effectiveness and cost-benefit of influenza vaccination of healthy working adults: A randomized controlled trial. [see comments]. [Clinical Trial. Journal Article. Randomized Controlled Trial] JAMA. 284(13):1655-63, 2000 Oct 4
EBM Reviews - Cochrane Controlled Trials Register Nexoe, J., Kragstrup, J., and Ronne, T. [The impact of postal invitations and user fee on influenza vaccination among the elderly. A randomized controlled trial in general practice] [CLINICAL TRIAL. JOURNAL ARTICLE. RANDOMIZED CONTROLLED TRIAL] Ugeskrift for Laeger. 159(27):4270-3, 1997
EBM Reviews - Cochrane Controlled Trials Register Nichol KL, Lind A, Margolis KL, Murdoch M, McFadden R, Hauge M, Magnan S, Drake M The effectiveness of vaccination against influenza in healthy, working adults. [see comments]. [Clinical Trial. Journal Article. Randomized Controlled Trial] New England Journal of Medicine. 333(14):889-93, 1995 Oct 5.
EBM Reviews - Database of Abstracts of Reviews of Effectiveness Center for Reviews and Dissemination Reviewers. Oseltamivir for the treatment of suspected influenza: a clinical and economic assessment. [Miscellaneous] Database of Abstracts of Reviews of Effectiveness. Issue 4, December 2002. ( COMMENT Husereau D R, Brady B, McGeer A. )
http://agatha.york.ac.uk/welcome.htm
HTA - Guidelines
HTA - Guidelines
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Zanamivir or oseltamivir (12) (næsta)
Economic? and (zanamivir or oseltamivir) (0) Cost-effectiveness of influenza vaccine in The Netherlands. Reinders A, Postma M J,
Govaert T M, Sprenger M J. Nederlands Tijdschrift voor Geneeskunde 1997; 141(2): 93-97 A pharmacoeconomic model for the treatment of influenza.
Mauskopf J A, Cates S C, Griffin A D. Pharmacoeconomics 1999; 16(Suppl 1): 73-84. Pharmacoeconomic model to evaluate new influenza treatments.
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Cost effectiveness of zanamivir for the treatment of influenza in a high risk population in Australia. Mauskopf J A, Cates S C, Griffin A D, Neighbors D M, Lamb S C, Rutherford C. Pharmacoeconomics 2000; 17(6): 611-620.
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