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ANALYSE ET ÉVALUATION DES INTERVENTIONS EN SANTÉ
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Programme de formation interdisciplinaire
Potential Roles for
Health Technology Assessment Agencies:
Opportunities and Challenges for an
Effective Health Technology Assessment
Practice at the Meso Level
Chantale Lessard, BPharm, MSc, PhD (Cand)
Anaîs Tanon, MSc, PhD (Cand)
2005 Joint CES/AEA Conference
Toronto, Ontario, Canada
October 24-30, 2005
AnÉIS
Overview
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Health technology assessment (HTA)
Current situation
Objectives and Methods
Analysis
Proposed roles for HTA agencies
Conclusion
Analyse et évaluation des interventions en santé
santé
Programme de formation interdisciplinaire
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Health technology assessment (HTA)
 Health technology
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Pharmaceutical and devices
Vaccines
Medical and surgical procedures
Prevention and rehabilitation
Health services and organization
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Health technology assessment (HTA)
 Multidisciplinary field of policy analysis
 Medical, economic, social, and ethical
implications of development, introduction,
diffusion, and utilization of health technology
 Provide rigorous and objective data to
inform and improve the health care
decision-making process
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HTA Agencies
 Support their Minister of Health and
decision makers in their healthcare system
by means of HTAs
 Macro (policy) level
 Meso (administrative) level
 Micro (clinical) level
 International Network of Agencies for
Health Technology Assessment (INAHTA)
 41 member agencies in 21 countries
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Current situation
 With the growth of healthcare costs, policy
makers and managers have begun to turn
towards HTA
 HTA agencies have focused on the macro
level
 Use and diffusion of health technologies
occur primarily in hospitals
 Little evidence at the meso level
 Use of HTA in the decision-making process
 Potential roles for HTA agencies
Analyse et évaluation des interventions en santé
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Objectives
 Propose roles for HTA agencies at the meso
(hospital) level
 Highlight opportunities and challenges for
an effective HTA practice
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Methods
 Literature review
 Hospital-based HTA programs
 Determinants influencing hospital work
environments
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Organizational and professional
cultures in hospitals
 Many professionals bring their skills to the
task
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Community
Managers
Physicians
Nurses and other health professionals
 Critical role of expertise and values
 Significant differences between hospitals
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Decision-making process in hospitals
 Various competing arguments can influence
the decision-making process
 Power is a determining factor in medical
decisions
 Opinions of peers, prevailing positions at a
given hospital, influence of leaders, and
ability of physicians to reconcile clinical and
administrative perspectives also influence
the decision-making process
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Decision-making process in hospitals
 Lack of available information may force an
intuitive decision-making approach inspired
by
 The hospital's history, vocation and technology
 Changes in the composition of the medical staff
 Political arguments and lobbying by interest
groups bring influence to bear in the
decision-making process
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Management of health technologies in
hospitals
 Introduction, diffusion, utilization and
withdrawal of health technologies
 Ethical debates
 New technologies focus on the patient's
individual needs
 New technologies also call for society's
responsibilities to act in its citizens' interest
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Management of health technologies in
hospitals
 Lack of structure in technology
management
 Technology management is embedded in an
organizational dynamic
 Decisions made in a context of limited
rationality
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HTA in hospitals
 Few arguments describing how HTA
practice should be adopted, implemented
and sustained
 No investment made in the financial, human
and physical resources necessary
 Hospitals have always operated otherwise
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HTA in hospitals
 Players have divergent views of the
professional and organizational issues
underlying the rationalization of the use of
technologies
 Weak impact of HTA reports on decisions
and practices in hospital settings
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Potential roles for HTA agencies Development of a HTA culture in
hospitals
 Identify key players
 On a priority basis in university hospitals
 HTA agencies should be proactive in
promoting their functions and activities, and
disseminating their reports
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Potential roles for HTA agencies Development of a HTA culture in
hospitals
 Promote the rational dissemination of new
technologies
 Institute incentives for using HTA
information in the decision-making process
 Seek a consensus among the players
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Potential roles for HTA agencies Development of a HTA culture in
hospitals
 Institute exchange and discussion
mechanisms enabling managers, physicians,
nurses and other health professionals, and
the community to develop a better
understanding of HTA
 “Infiltrate” the users’ exchange forums
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Potential roles for HTA agencies Development of HTA services tailored
to the needs of hospitals
 Recognize the complexity of health care
 HTA agencies should be resolutely oriented
toward a transdisciplinary knowledge
production mode
 Oriented toward applying complex knowledge
 Multidisciplinary team
 Sensitive to its impact on several types of
stakeholders
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Potential roles for HTA agencies Development of HTA services tailored
to the needs of hospitals
 Identify HTA users and their needs
 Deliver HTA information that is accessible,
relevant, reliable, credible, useful, and
available in a timely manner
 Achieve a balance in the information
included in HTA reports
 Disseminate HTA information effectively
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Potential roles for HTA agencies Development of HTA services tailored
to the needs of hospitals
 Make greater investments
 Human, physical and financial resources
needed for the activities and tasks relating to
adapting the disseminated results to the users'
needs
 Dissemination efforts
 Exchange mechanisms between HTA
researchers and users
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Conclusion
 The development of a HTA culture in
hospitals is a sine qua non
 HTA agencies must turn towards a
transdisciplinary knowledge production
mode
 Particularly relevant for contextual knowledge,
which is often ignored or marginalized in HTA
 Extension of stakeholders involvement in the
production, evaluation and application of HTA
knowledge
 Policy role of HTA
Analyse et évaluation des interventions en santé
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Programme de formation interdisciplinaire
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ANALYSE ET ÉVALUATION DES INTERVENTIONS EN SANTÉ
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Programme de formation interdisciplinaire
Université de Montréal
Faculté de médecine
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