在发展中国家选择基本药物决策过程中证据的作用：以坦桑尼亚为例。
The role of evidence in the decision-making process of selecting essential medicines in developing countries: the case of Tanzania.
机构信息
Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway ; School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
出版信息
PLoS One. 2014 Jan 8;9(1):e84824. doi: 10.1371/journal.pone.0084824. eCollection 2014.
BACKGROUND
Insufficient access to essential medicines is a major health challenge in developing countries. Despite the importance of Standard Treatment Guidelines and National Essential Medicine Lists in facilitating access to medicines, little is known about how they are updated. This study aims to describe the process of updating the Standard Treatment Guidelines and National Essential Medicine List in Tanzania and further examines the criteria and the underlying evidence used in decision-making.
METHODS
This is a qualitative study in which data were collected by in-depth interviews and document reviews. Interviews were conducted with 18 key informants who were involved in updating the Standard Treatment Guidelines and National Essential Medicine List. We used a thematic content approach to analyse the data.
FINDINGS
The Standard Treatment Guidelines and National Essential Medicine List was updated by committees of experts who were recruited mostly from referral hospitals and the Ministry of Health and Social Welfare. Efficacy, safety, availability and affordability were the most frequently utilised criteria in decision-making, although these were largely based on experience rather than evidence. In addition, recommendations from international guidelines and medicine promotions also influenced decision-making. Cost-effectiveness, despite being an important criterion for formulary decisions, was not utilised.
CONCLUSIONS
Recent decisions about the selection of essential medicines in Tanzania were made by committees of experts who largely used experience and discretionary judgement, leaving evidence with only a limited role in decision-making process. There may be several reasons for the current limited use of evidence in decision-making, but one hypothesis that remains to be explored is whether training experts in evidence-based decision-making would lead to a better and more explicit use of evidence.
背景
发展中国家普遍面临基本药物可及性不足的问题。尽管标准治疗指南和国家基本药物清单对于促进药物可及性至关重要，但对于它们的更新过程却知之甚少。本研究旨在描述坦桑尼亚标准治疗指南和国家基本药物清单的更新过程，并进一步探讨决策中使用的标准和潜在证据。
方法
这是一项定性研究，通过深入访谈和文件审查收集数据。访谈了 18 名参与标准治疗指南和国家基本药物清单更新的主要利益相关者。我们使用主题内容分析方法来分析数据。
结果
标准治疗指南和国家基本药物清单由主要来自转诊医院和卫生部及社会福利部的专家委员会更新。在决策中，最常使用的标准是疗效、安全性、可及性和可负担性，尽管这些标准主要基于经验而非证据。此外，国际指南和药品推广的建议也影响了决策。尽管成本效益是药物目录决策的一个重要标准，但并未得到利用。
结论
坦桑尼亚最近关于基本药物选择的决策是由专家委员会做出的，他们主要使用经验和自由裁量权，证据在决策过程中仅发挥有限作用。目前证据在决策中的应用有限可能有多种原因，但一个有待探讨的假设是，对专家进行循证决策的培训是否会导致更好、更明确地使用证据。
Zotero 插件