Piggott Thomas, Moja Lorenzo, Garcia Carlos A Cuello, Akl Elie A, Banzi Rita, Huttner Benedikt, Kredo Tamara, Lavis John N, Schünemann Holger J
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Department of Family Medicine, Queens University, Kingston, ON, Canada.
PLOS Glob Public Health. 2024 Jan 11;4(1):e0002723. doi: 10.1371/journal.pgph.0002723. eCollection 2024.
Essential medicine lists (EMLs) are important medicine prioritization tools used by the World Health Organization (WHO) EML and over 130 countries. The criteria used by WHO's Expert Committee on the Selection and Use of Essential Medicines has parallels to the GRADE Evidence-to-Decision (EtD) frameworks. In this study, we explored the EtD frameworks and a visual abstract as adjunctive tools to strengthen the integrate evidence and improve the transparency of decisions of EML applications. We conducted user-experience testing interviews of key EML stakeholders using Morville's honeycomb model. Interviews explored multifaceted dimensions (e.g., usability) on two EML applications for the 2021 WHO EML-long-acting insulin analogues for diabetes and immune checkpoint inhibitors for lung cancer. Using a pre-determined coding framework and thematic analysis we iteratively improved both the EtD framework and the visual abstract. We coded the transcripts of 17 interviews with 13 respondents in 103 locations of the interview texts across all dimensions of the user-experience honeycomb. Respondents felt the EtD framework and visual abstract presented complementary useful and findable adjuncts to the traditional EML application. They felt this would increase transparency and efficiency in evidence assessed by EML committees. As EtD frameworks are also used in health practice guidelines, including those by the WHO, respondents articulated that the adoption of the EtD by EML applications represents a tangible mechanism to align EMLs and guidelines, decrease duplication of work and improve coordination. Improvements were made to clarify instructions for the EtD and visual abstract, and to refine the design and content included. 'Availability' was added as an additional criterion for EML applications to highlight this criterion in alignment with WHO EML criteria. EtD frameworks and visual abstracts present additional important tools to communicate evidence and support decision-criteria in EML applications, which have global health impact. Access to essential medicines is important for achieving universal health coverage, and the development of essential medicine lists should be as evidence-based and trustworthy as possible.
基本药物清单（EMLs）是世界卫生组织（WHO）及130多个国家使用的重要药物优先排序工具。WHO基本药物遴选与使用专家委员会所采用的标准与GRADE证据到决策（EtD）框架有相似之处。在本研究中，我们探索了EtD框架和可视化摘要作为辅助工具，以加强综合证据并提高EML应用决策的透明度。我们使用莫维尔的蜂巢模型对EML的关键利益相关者进行了用户体验测试访谈。访谈探讨了2021年WHO EML的两个应用方面的多维度内容（如可用性），即用于糖尿病的长效胰岛素类似物和用于肺癌的免疫检查点抑制剂。我们使用预先确定的编码框架和主题分析，对EtD框架和可视化摘要进行了迭代改进。我们对来自13名受访者的17次访谈记录进行了编码，涉及用户体验蜂巢的所有维度，共103个访谈文本位置。受访者认为EtD框架和可视化摘要为传统的EML应用提供了互补的、有用且易于查找的辅助工具。他们认为这将提高EML委员会评估证据的透明度和效率。由于EtD框架也用于包括WHO在内的卫生实践指南，受访者明确表示EML应用采用EtD是使EML与指南保持一致、减少工作重复并改善协调的切实机制。我们进行了改进，以明确EtD和可视化摘要的说明，并完善其设计和所含内容。增加了“可及性”作为EML应用的一项额外标准，以使其与WHO EML标准保持一致并突出该标准。EtD框架和可视化摘要为在具有全球健康影响的EML应用中传达证据和支持决策标准提供了额外的重要工具。获得基本药物对于实现全民健康覆盖很重要，基本药物清单的制定应尽可能基于证据且值得信赖。
