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Ávinningur af auknu aðgengi að upplýsingum
Sigurður Helgason
Ritstjóri klínískra leiðbeininga
Landlæknisembættinu
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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
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Misvísandi niðurstöður !!
Hver er sannleikurinn?
Greinar Leiðbeiningar
Endurmenntun
Sérfræðiálit Textabækur
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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.
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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
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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
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Vinna =HeimildaleitElta uppi gögnMat á gögnum (Appraisal)Heimfæra upp á vandamálið
Notagildi upplýsinga =
Relevance x Validity
VinnaVinna
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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.
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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.
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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
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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
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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
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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
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Medline 1966-okt 2002
Influenza (27731)Economic? and influenza (196)Zanamivir or oseltamivir (352)Economic? and (zanamivir or oseltamivir) (7)
Anonymous. Summaries for patients. Influenza vaccination or antiviral treatment for healthy working adults: an economic analysis. [original report in .]. [Journal Article. Patient Education Handout] Annals of Internal Medicine. 137(4):I22, 2002 Aug 20.
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.
Calza L. Briganti E. Manfredi R. Chiodo F. [Influenza]. [Review] [48 refs] [Italian] [Historical Article. Journal Article. Review. Review, Tutorial] Recenti Progressi in Medicina. 91(12):657-66, 2000 Dec.
van Loon FP. Voordouw AC. Simonian S. Koopmans PP. [Critical review of anti-influenza drugs]. [Review] [22 refs] [Dutch] [Journal Article. Review. Review, Tutorial] Nederlands Tijdschrift voor Geneeskunde. 144(4):165-7, 2000 Jan 22.
Demicheli V. Jefferson T. Rivetti D. Deeks J. Prevention and early treatment of influenza in healthy adults. [Review] [37 refs] [Journal Article. Review. Review, Tutorial] Vaccine. 18(11-12):957-1030, 2000 Jan 6.
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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. )
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http://agatha.york.ac.uk/welcome.htm
HTA - Guidelines
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HTA - Guidelines
Influenza (129)
Economic? and influenza (9) (neðan)
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.
Armstrong E P, Abarca J. Hospital Formulary 2000; 35(2): 169-181. Cost-benefit evaluation of routine influenza immunization in subjects 65-74 years of
age - primary research (project). UK NHS National Coordinating Centre for Health Technology Assessment (NCCHTA).
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The cost effectiveness of zanamivir and oseltamivir for influenza treatment. Armstrong E P, Khan Z M, Perry A S, Perri L R. Formulary 2000; 35(12): 979-989.
Oseltamivir for the treatment of suspected influenza: a clinical and economic assessment. Husereau D R, Brady B, McGeer A. Ottawa, ON, Canada: Canadian Coordinating Office for Health Technology Assessment 2001: i-89.
An assessment of oseltamivir for the treatment of suspected influenza. Husereau DR, Brady B, McGeer A. Canadian Coordinating Office for Health Technology Assessment (CCOHTA) 2002 (Technology Overview Issue 7): 12.
Zanamivir for the treatment of influenza in adults: a systematic review and economic evaluation. Burls A, Clark W, Stewart T, Preston C, Bryan S, Jefferson T, Fry-Smith A. UK NHS National Coordinating Centre for Health Technology Assessment (NCCHTA) 2002: 87.
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.
Economic evaluation of zanamivir (relenza) for the treatment of influenza. Brady B, McAuley L, Shukla V K. Canadian Coordinating Office for Health Technology Assessment (CCOHTA) 2001 (Technology Report Issue 13): 63.
Guidance on the use of zanamivir (Relenza) in the treatment ofinfluenza. National Institute for Clinical Excellence. National Institute for Clinical Excellence (NICE) 2000 (Technology Appraisal Guidance - No.15): 12.
Treating influenza by medication - zanamivir - early assessment briefs (ALERT). Swedish Council on Technology Assessment in Health Care. Swedish Council on Technology Assessment in Health Care (SBU) 2000.
Cost-effectiveness analysis of inhaled zanamivir in the treatment of influenza A and B in high-risk patients. Griffin A D, Perry A S, Fleming D M. Pharmacoeconomics 2001; 19(3): 293-301.
Evidence-based drug reviews: Zanamivir. No noticeable progress against influenza.. . Canadian Family Physician 2000; 46: 2003-2008.
Do neuraminidase inhibitors prevent influenza?. Husereau D R. Canadian Coordinating Office for Health Technology Assessment (CCOHTA) 2001 (Issues in Emerging Health Technologies Issue 27): 4.