This thesis is about UK healthcare decision-makers’ responses to guidance that a new interventional procedure is safe and efficacious, and whether additional information would be helpful. The aims were to conceptualise how evidence could be used to best inform decision-making; investigate the ways in which decision-makers currently respond to such guidance; identify types of additional useful information, and assess the feasibility and value of providing these. The study was based on the UK Interventional Procedures Programme (IPP). A multidimensional framework for categorising evidence (explanatory vs. pragmatic) was developed and tested using IPP-evaluated procedures. A qualitative study explored how local NHS decision-makers respond to IPP guidance and whether additional information might be useful to them. A range of approaches – from simple descriptive data, through evidence syntheses, to economic models of cost-effectiveness – were explored in a case study of radiofrequency ablation (RFA) for snoring. NHS decision-makers’ responses to IPP guidance varied and they indicated additional information would be helpful. Available evidence on the effects of procedures went beyond ‘efficacy’. The case study showed it was possible, within limitations, to provide useful additional information but at increasing costs as complexity increased. Decision-makers vary in their responses to IPP guidance. Additional information (such as prevalence, incidence, costs and likely cost-effectiveness), which they indicated would be useful, is potentially available but the feasibility of providing this varies depending on the nature of the evidence available and the related costs. The thesis indicates that the quality of decision-making would be improved if guidance that a new procedure is safe and efficacious were to be contextualised through specific extra information.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:521334 |
| Date | January 2010 |
| Creators | Lourenço, Tânia P. C. |
| Publisher | University of Aberdeen |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=131530 |
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