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循证采购:理解临床试验和系统评价的结果

Evidence based purchasing: understanding results of clinical trials and systematic reviews.

作者信息

Fahey T, Griffiths S, Peters T J

机构信息

Department of Public Health Medicine and Health Policy, Oxfordshire Health, Oxford.

出版信息

BMJ. 1995 Oct 21;311(7012):1056-9; discussion 1059-60. doi: 10.1136/bmj.311.7012.1056.

Abstract

OBJECTIVE

To assess whether the way in which the results of a randomised controlled trial and a systematic review are presented influences health policy decisions.

DESIGN

A postal questionnaire to all members of a health authority within one regional health authority.

SETTING

Anglia and Oxford regional health authorities.

SUBJECTS

182 executive and non-executive members of 13 health authorities, family health services authorities, or health commissions.

MAIN OUTCOME MEASURES

The average score from all health authority members in terms of their willingness to fund a mammography programme or cardiac rehabilitation programme according to four different ways of presenting the same results of research evidence--namely, as a relative risk reduction, absolute risk reduction, proportion of event free patients, or as the number of patients needed to be treated to prevent an adverse event.

RESULTS

The willingness to fund either programme was significantly influenced by the way in which data were presented. Results of both programmes when expressed as relative risk reductions produced significantly higher scores when compared with other methods (P < 0.05). The difference was more extreme for mammography, for which the outcome condition is rarer.

CONCLUSIONS

The method of reporting trial results has a considerable influence on the health policy decisions made by health authority members.

摘要

目的

评估随机对照试验和系统评价结果的呈现方式是否会影响卫生政策决策。

设计

向一个地区卫生当局内的所有卫生当局成员邮寄问卷调查。

地点

东安格利亚和牛津地区卫生当局。

研究对象

13个卫生当局、家庭健康服务当局或卫生委员会的182名行政和非行政成员。

主要观察指标

根据呈现相同研究证据结果的四种不同方式,即相对风险降低、绝对风险降低、无事件患者比例或预防不良事件所需治疗的患者数量,所有卫生当局成员在为乳房X光检查项目或心脏康复项目提供资金意愿方面的平均得分。

结果

为两个项目提供资金的意愿受到数据呈现方式的显著影响。与其他方法相比,两个项目的结果以相对风险降低表示时得分显著更高(P<0.05)。乳房X光检查的差异更为明显,其结果情况更为罕见。

结论

试验结果的报告方法对卫生当局成员做出的卫生政策决策有相当大的影响。

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本文引用的文献

1
The framing effect of relative and absolute risk.相对风险和绝对风险的框架效应。
J Gen Intern Med. 1993 Oct;8(10):543-8. doi: 10.1007/BF02599636.
4
Purchasing clinically effective care.购买临床有效护理。
BMJ. 1994 Oct 1;309(6958):823-4. doi: 10.1136/bmj.309.6958.823.
6
Understanding clinical trials.了解临床试验。
BMJ. 1994 Sep 24;309(6957):755-6. doi: 10.1136/bmj.309.6957.755.

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