Transcript Describe the problem in terms of whether it relates to one or more of

Program in Policy Decision-Making
McMaster University
27 October 2009
Policy Briefs Workshop:
Defining the Problem - Roundtable
EVIPNet Policy Briefs Workshop
Santiago, Chile
John N. Lavis, MD, PhD
Professor and Canada Research Chair in Knowledge Transfer and Exchange
McMaster University
Q1: What Is the Problem? (CAN)
Describe the problem in terms of whether it relates to one or more of
• A risk factor, disease or condition
- High and rising prevalence of diabetes (esp. type 2)
• A program, service or drug currently being used
- Many diabetics’ blood sugar and cardiovascular risk factors are
not being well monitored and controlled (esp. in comparison)
• Current health system arrangements within which programs,
services and drugs are provided
- Few supports to enable effective self-management
- About 1/20 diabetics don’t have a primary care physician, and
most physicians have few decision supports, no patient roster
and no financial incentives for coordinated, proactive care
• Current degree of implementation of agreed policies
- Diabetes Registry has not yet been implemented
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Q1: What Is the Problem? (COR)
Describe the problem in terms of whether it relates to one or more of
• A risk factor, disease or condition
- High prevalence of type 2 diabetes (esp. among older citizens)
• A program, service or drug currently being used
- Many diabetics’ blood sugar is not being well controlled (HbA1c)
• Current health system arrangements within which programs,
services and drugs are provided
- Few supports to enable effective self-management (pt/family)
- Poorly functioning interface between first and second levels and
few decision supports that influence practice (norms and
guidelines, information systems)
• Current degree of implementation of agreed policies
- Networked multidisciplinary teams
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Q1: What Is the Problem? (MEX)
Describe the problem in terms of whether it relates to one or more of
• A risk factor, disease or condition
- High prevalence of diabetes, risk factors (overweight/obesity) and
complications from diabetes (amputation)
• A program, service or drug currently being used
- Poor adherence to diabetes guidelines among PHC physicians
- Many diabetics’ blood sugar is not being well controlled (HbA1c)
• Current health system arrangements within which programs,
services and drugs are provided
- Lack of decision supports for PHC physicians, many of whom are
new graduates, and more generally a lack of resources (staff)
• Current degree of implementation of agreed policies
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Q1: What Is the Problem? (PAR)
Describe the problem in terms of whether it relates to one or more of
• A risk factor, disease or condition
- High prevalence of type 2 diabetes, risk factors (overweight) &
complications, with urban/rural and ethno-cultural differentials
• A program, service or drug currently being used
- Secondary prevention programs don’t reach many patients, esp.
those: 1) in rural areas and from particular ethno-cultural groups,
2) who don’t seek care in formal healthcare sector, and 3) who
rely heavily on self-medication
• Current health system arrangements within which programs,
services and drugs are provided
- Few ethno-culturally appropriate supports (esp. communication
strategies) to enable effective self-management and appropriate
engagement with formal sector
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Q1: What Is the Problem? (ARG)
Describe the problem in terms of whether it relates to one or more of
• A risk factor, disease or condition
- Higher prevalence of gestational diabetes than in US/Chile and
high rates of related hospital admissions and mortality
• A program, service or drug currently being used
- Many indicators proposed but no diagnosis based on their
current levels or on changes over time
• Current health system arrangements within which programs,
services and drugs are provided
- Many indicators proposed but no diagnosis based on their
current levels or on changes over time
• Current degree of implementation of agreed policies
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Q1: What Is the Problem? (FEP)
Describe the problem in terms of whether it relates to one or more of
• A risk factor, disease or condition
- High prevalence of diabetes, risk factors (overweight/obesity
and a poor diet and lack of physical activity) and complications
from diabetes (amputation)
• A program, service or drug currently being used
- Health promoters, whose role is to support primary prevention,
are offering programs and services that are ineffective or are
not offering programs are services that are effective?
• Current health system arrangements within which programs,
services and drugs are provided
- Health promoters are not reaching many citizens? Why?
• Current degree of implementation of agreed policies
- Health promoters are not using agreed norms & guidelines?
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Q1: What Is the Problem? (BRA)
Describe the problem in terms of whether it relates to one or more of
• A risk factor, disease or condition
- High prevalence of gestational diabetes and related neonatal
mortality, and high prevalence of type 2 diabetes among
women of child-bearing age, particularly in the northeast
• A program, service or drug currently being used
- Ministry’s program provides a treatment protocol but adherence
to the protocol is low (20%)
- Only 16% of diabetics are diagnosed and followed in the formal
healthcare sector
• Current health system arrangements within which programs,
services and drugs are provided
- ?
• Current degree of implementation of agreed policies
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Other Observations
Most aspects of problem definition require local data
Two types of research evidence can be helpful
•
Administrative database studies and community surveys that help
to put problems in comparative perspective (e.g., urban/rural and
ethnocultural groups in Paraguay, Argentina/Chile & US)
•
Qualitative studies that help to understand how different groups
view and experience the problem (e.g., health promoters)
Your choice of options hinges on using data and research evidence
to clarify a problem in a systematic way, and the options have to
match the problem
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