Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario L8N 1E9, Canada.
J Health Serv Res Policy. 2010 Apr;15(2):98-105. doi: 10.1258/jhsrp.2009.009105. Epub 2010 Feb 10.
In formulary committee deliberations, evidence for the efficacy of medications is often based on changes in the scale scores of patient-reported outcome measures. Our aim was to examine whether clinician judgement about the efficacy of medications for Alzheimer's disease, when added to scale score evidence, affects formulary committee members' recommendations about providing these medications under public insurance.
The study was conducted using mixed methods. In a survey of formulary committee members in Canada, 32 participants were presented with scenarios that outlined different levels of efficacy for a medication. For each scenario, participants were asked to specify their likelihood of recommending that the medication be provided under public insurance. Of the 32 participants, 23 agreed to take part in an interview to explain the survey results. Content analysis was used to elicit recurrent themes across the interviews.
When a medication was disease modifying, use of clinician judgement increased the mean likelihood of recommending that the medication be provided under public insurance. Despite this, some participants felt formulary committees should not use clinician judgement because of risks of subjectivity and bias. However, other participants believed the addition of clinician judgement would enhance the clinical relevance of evidence that might otherwise be based entirely on changes in scale score.
Clinician judgement about the efficacy of medications can influence formulary committee recommendations. This suggests the need for a new approach to govern the consideration of expert evidence during formulary committee deliberations.
在处方委员会的审议中，药物疗效的证据通常基于患者报告的结果测量量表评分的变化。我们的目的是研究当加入药物疗效的临床医生判断时，是否会影响处方委员会成员对提供这些药物的建议，这些药物是通过公共保险提供的。
该研究采用混合方法进行。在对加拿大处方委员会成员的调查中，32 名参与者收到了概述药物不同疗效水平的情况。对于每个方案，参与者被要求指定他们推荐该药物通过公共保险提供的可能性。在 32 名参与者中，有 23 名同意接受采访以解释调查结果。内容分析用于从访谈中引出反复出现的主题。
当一种药物具有疾病修饰作用时，使用临床医生的判断会增加推荐该药物通过公共保险提供的平均可能性。尽管如此，一些参与者认为处方委员会不应该使用临床医生的判断，因为存在主观性和偏见的风险。然而，其他参与者认为，添加临床医生的判断将增强证据的临床相关性，而这些证据可能完全基于量表评分的变化。
药物疗效的临床医生判断可以影响处方委员会的建议。这表明需要一种新的方法来管理处方委员会审议中专家证据的考虑。
