Lessard Chantale, Contandriopoulos André-Pierre, Beaulieu Marie-Dominique
Department of Health Administration, Faculty of Medicine, University of Montreal, Quebec, Canada.
BMC Fam Pract. 2009 Feb 11;10:15. doi: 10.1186/1471-2296-10-15.
A considerable amount of resource allocation decisions take place daily at the point of the clinical encounter; especially in primary care, where 80 percent of health problems are managed. Ignoring economic evaluation evidence in individual clinical decision-making may have a broad impact on the efficiency of health services. To date, almost all studies on the use of economic evaluation in decision-making used a quantitative approach, and few investigated decision-making at the clinical level. An important question is whether economic evaluations affect clinical practice. The project is an intervention research study designed to understand the role of economic evaluation in the decision-making process of family physicians (FPs). The contributions of the project will be from the perspective of Pierre Bourdieu's sociological theory.
METHODS/DESIGN: A qualitative research strategy is proposed. We will conduct an embedded multiple-case study design. Ten case studies will be performed. The FPs will be the unit of analysis. The sampling strategies will be directed towards theoretical generalization. The 10 selected cases will be intended to reflect a diversity of FPs. There will be two embedded units of analysis: FPs (micro-level of analysis) and field of family medicine (macro-level of analysis). The division of the determinants of practice/behaviour into two groups, corresponding to the macro-structural level and the micro-individual level, is the basis for Bourdieu's mode of analysis. The sources of data collection for the micro-level analysis will be 10 life history interviews with FPs, documents and observational evidence. The sources of data collection for the macro-level analysis will be documents and 9 open-ended, focused interviews with key informants from medical associations and academic institutions. The analytic induction approach to data analysis will be used. A list of codes will be generated based on both the original framework and new themes introduced by the participants. We will conduct within-case and cross-case analyses of the data.
The question of the role of economic evaluation in FPs' decision-making is of great interest to scientists, health care practitioners, managers and policy-makers, as well as to consultants, industry, and society. It is believed that the proposed research approach will make an original contribution to the development of knowledge, both empirical and theoretical.
每天在临床诊疗过程中都会做出大量资源分配决策；尤其是在基层医疗中，80%的健康问题在此得到处理。在个体临床决策中忽视经济评估证据可能会对卫生服务效率产生广泛影响。迄今为止，几乎所有关于在决策中使用经济评估的研究都采用定量方法，很少有研究在临床层面调查决策情况。一个重要问题是经济评估是否会影响临床实践。该项目是一项干预性研究，旨在了解经济评估在家庭医生（FP）决策过程中的作用。该项目的贡献将从皮埃尔·布迪厄的社会学理论角度出发。
方法/设计：提出一种定性研究策略。我们将进行嵌入式多案例研究设计。将开展十个案例研究。家庭医生将作为分析单位。抽样策略将以理论概括为导向。所选的十个案例旨在反映家庭医生的多样性。将有两个嵌入式分析单位：家庭医生（微观分析层面）和家庭医学领域（宏观分析层面）。将实践/行为的决定因素分为两组，分别对应宏观结构层面和微观个体层面，这是布迪厄分析模式的基础。微观层面分析的数据收集来源将是对家庭医生进行的十次生活史访谈、文件和观察证据。宏观层面分析的数据收集来源将是文件以及对医学协会和学术机构的关键信息提供者进行的9次开放式重点访谈。将采用分析归纳法进行数据分析。将根据原始框架和参与者提出的新主题生成一份编码清单。我们将对数据进行案例内和跨案例分析。
经济评估在家庭医生决策中的作用问题，不仅对科学家、医疗从业者、管理人员和政策制定者，而且对顾问、行业和社会都极具吸引力。相信所提出的研究方法将在实证和理论知识发展方面做出原创性贡献。
