systematic reviews from a policy perspective
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Systematic reviews from a policy perspective. Sara Hayes Director of Public Health, Abertawe Bro Morgannwg University Health Board Honorary Senior Lecturer, Swansea University. Background . Systematic reviews can be conducted on policy areas as well as defined health interventions - PowerPoint PPT PresentationTRANSCRIPT
Systematic reviews from a policy perspective
Sara Hayes
Director of Public Health, Abertawe Bro Morgannwg University Health Board
Honorary Senior Lecturer, Swansea University
Background Systematic reviews can be
conducted on policy areas as well as defined health interventions
In many countries, local interagency collaborations have been introduced to improve health outcomes and evidence is needed on their effectiveness
Collaboration between local health and local government agencies for health improvement
S Hayes, M Mann, F Morgan, H, Kitcher, M Kelly, A WeightmanPublished 2011
Aimed to evaluate the effects of interagency collaboration between local health and local government agencies on health outcomes
What were we looking for?Interventions delivered through
interagency collaboration between statutory health and local government agencies, where the level of partnership between collaborators could be clearly determined and where the interventions were aimed at improving health
How did we define collaboration?Two or more parties that pursue an
agreed set of goals and work cooperatively toward a set of shared health outcomes
Local collaboration was judged to have taken place if there was evidence that the partners had agreed local joint working arrangements and shared objectives
Search strategyTwenty-five databases Relevant websites Experts were contacted Reference lists followed up for relevant - randomized controlled trials (RCTs)- controlled clinical trials (CCTs)- controlled before-and-after studies
(CBAs) - interrupted time series (ITS)
ResultsEleven studies were identified,
representing a total of 26,686 participants
Owing to the heterogeneity between studies a narrative synthesis was undertaken
Six studies of mental health initiatives - 1 showed health benefit- 4 showed modest improvement in one or
more of the outcomes measured, but no clear overall health gain
- 1 showed no evidence of health gain
Two studies on lifestyle - 1 failed to show health gains - 1 showed more unhealthy lifestyle
behaviours persisting in the intervention population
Three studies on chronic disease management
- all 3 failed to demonstrate health gains
Six studies of mental health initiatives - 1 showed health benefit- 4 showed modest improvement in one or
more of the outcomes measured, but no clear overall health gain
- 1 showed no evidence of health gain
Two studies on lifestyle - 1 failed to show health gains - 1 showed more unhealthy lifestyle
behaviours persisting in the intervention population
Three studies on chronic disease management
- all 3 failed to demonstrate health gains
Six studies of mental health initiatives - 1 showed health benefit- 4 showed modest improvement in one or
more of the outcomes measured, but no clear overall health gain
- 1 showed no evidence of health gain
Two studies on lifestyle - 1 failed to show health gains - 1 showed more unhealthy lifestyle
behaviours persisting in the intervention population
Three studies on chronic disease management
- all 3 failed to demonstrate health gains
Six studies of mental health initiatives - 1 showed health benefit- 4 showed modest improvement in one or
more of the outcomes measured, but no clear overall health gain
- 1 showed no evidence of health gain
Two studies on lifestyle - 1 failed to show health gains - 1 showed more unhealthy lifestyle
behaviours persisting in the intervention population
Three studies on chronic disease management
- all 3 failed to demonstrate health gains
ConclusionsThe review did not identify reliable evidence that
interagency collaboration, compared to standard services, leads to health improvement
A few studies identified some benefits but these were not reflected in overall outcomes and could have resulted from the use of significant additional resources
Methodological flaws and incomplete implementation of initiatives have prevented the development of a strong evidence base in this field
RecommendationsHealth and local government services
should ensure their standard services work well together
Pilot projects and new interventions should include health outcome measurement and evaluation in the study design from the start
http://summaries.cochrane.org/CD007825/collaboration-between-local-health-and-local-government-agencies-for-health-improvement
What did I learn from the results of this review?
I have always worked in multidisciplinary settings. Am I now saying it’s all been a waste of time?
Port health officers, CsCDC and related agencies across Wales meet regularly and run exercises
Consider the limitations of the reviewProjects and new programmes
were compared to mainstream services
No evaluation of mainstream services themselves
Statutory partnerships were not included
What else might we want to know?
It is not yet clear how much resource should be spent supporting partnership working (eg through team meetings, joint training, shared staffing) compared to that used to deliver the required service
Our update will look for evidence on partnership evaluation in our included studies
How do we present these findings to policy makers?
This is a difficult message to give. The findings can be expressed
more positively ..... .......routine services perform as well as one-off projects and consideration needs to be given to maximising their effectiveness
How can we help policy makers?Encourage links between public health advocates and policy makers Help decision makers understand that not all evidence is of equal value
Improve the quality of published papers
Disseminate key findings
Rigour is as important as enthusiasm in any new development
Help is at hand for the policy maker
Conclusions for policy makersJoint working between local services needs to
be supported in line with local priorities and resulting health outcomes should be monitored
New service developments need to be evidence-based, evaluated at implementation and applied to the whole service if successful
Pilot projects should not be funded if there is no prospect of them being adopted across the whole service
The systematic review process can be a useful tool to assess the effectiveness of policy implementation
What might Archie say about this review?
Would he accept that the effectiveness of collaborative partnership working could be tested through the systematic review process?
Would he accept the principle of combining information from such diverse trials?
How should such information be analysed?
What did I learn from conducting this review?It is possible to be a systematic reviewer
while in a service postI aim to be the advocate for the
systematic use of evidence in service development
It is important to negotiate a commitment to the review in the job plan to be able to take part in group work in the working week
However...
...one summer holiday
Introduction
Aim
Background
Methods
Results
Discussion
Conclusion
Thank you for listening.
Any questions?