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Borst RA, Wehrens R, Bal R. Sustaining Knowledge Translation Practices: A Critical Interpretive Synthesis. Int J Health Policy Manag 2022; 11:2793-2804. [PMID: 35279039 PMCID: PMC10105179 DOI: 10.34172/ijhpm.2022.6424] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 02/19/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The health policy and systems research literature increasingly observes that knowledge translation (KT) practices are difficult to sustain. An important issue is that it remains unclear what sustainability of KT practices means and how it can be improved. The aim of this study was thus to identify and explain those processes, activities, and efforts in the literature that facilitate the sustaining of KT practices in health policy-making processes. METHODS We used a critical interpretive synthesis (CIS) to review the health policy and systems research and Science and Technology Studies (STS) literature. The STS literature was included as to enrich the review with constructivist social scientific perspectives on sustainability and KT. The CIS methodology allowed for creating new theory by critically combining both literatures. We searched the literature by using PubMed, Google Scholar, Web of Science, and qualitative sampling. Searches were guided by pre-set eligibility criteria and all entries were iteratively analysed using thematic synthesis. RESULTS Eighty documents were included. Our synthesis suggests a shift from sustainability as an end-goal towards sustaining as actors' relatively mundane work aimed at making and keeping KT practices productive. This 'sustaining work' is an interplay of three processes: (i) translating, (ii) contexting, and (iii) institutionalising. Translating refers to activities aimed at constructing and extending networks. Contexting emphasises the activities needed to create contexts that support KT practices. Institutionalising addresses how actors create, maintain, and disrupt institutions with the aim of sustaining KT practices. CONCLUSION The 'sustaining work' perspective of our CIS emphasises KT actors' ongoing work directed at sustaining KT practices. We suggest that this perspective can guide empirical study of sustaining work and that these empirical insights, combined with this CIS, can inform training programmes for KT actors, and thereby improve the sustainability of KT practices.
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Affiliation(s)
- Robert A.J. Borst
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Douglas CMW, Aith F, Boon W, de Neiva Borba M, Doganova L, Grunebaum S, Hagendijk R, Lynd L, Mallard A, Mohamed FA, Moors E, Oliveira CC, Paterson F, Scanga V, Soares J, Raberharisoa V, Kleinhout-Vliek T. Social pharmaceutical innovation and alternative forms of research, development and deployment for drugs for rare diseases. Orphanet J Rare Dis 2022; 17:344. [PMID: 36064440 PMCID: PMC9446828 DOI: 10.1186/s13023-022-02476-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/13/2022] [Indexed: 11/10/2022] Open
Abstract
Rare diseases are associated with difficulties in addressing unmet medical needs, lack of access to treatment, high prices, evidentiary mismatch, equity, etc. While challenges facing the development of drugs for rare diseases are experienced differently globally (i.e., higher vs. lower and middle income countries), many are also expressed transnationally, which suggests systemic issues. Pharmaceutical innovation is highly regulated and institutionalized, leading to firmly established innovation pathways. While deviating from these innovation pathways is difficult, we take the position that doing so is of critical importance. The reason is that the current model of pharmaceutical innovation alone will not deliver the quantity of products needed to address the unmet needs faced by rare disease patients, nor at a price point that is sustainable for healthcare systems. In light of the problems in rare diseases, we hold that re-thinking innovation is crucial and more room should be provided for alternative innovation pathways. We already observe a significant number and variety of new types of initiatives in the rare diseases field that propose or use alternative pharmaceutical innovation pathways which have in common that they involve a diverse set of societal stakeholders, explicitly address a higher societal goal, or both. Our position is that principles of social innovation can be drawn on in the framing and articulation of such alternative pathways, which we term here social pharmaceutical innovation (SPIN), and that it should be given more room for development. As an interdisciplinary research team in the social sciences, public health and law, the cases of SPIN we investigate are spread transnationally, and include higher income as well as middle income countries. We do this to develop a better understanding of the social pharmaceutical innovation field's breadth and to advance changes ranging from the bedside to system levels. We seek collaborations with those working in such projects (e.g., patients and patient organisations, researchers in rare diseases, industry, and policy makers). We aim to add comparative and evaluative value to social pharmaceutical innovation, and we seek to ignite further interest in these initiatives, thereby actively contributing to them as a part of our work.
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Affiliation(s)
- Conor M W Douglas
- Department of Science, Technology and Society, 307 Bethune College, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
| | - Fernando Aith
- University of São Paulo Public Health School, Health Law Research Center of the University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, Brazil
| | - Wouter Boon
- Copernicus Institute of Sustainable Development, Universiteit Utrecht, Princetonlaan 8a, 3584 CB, Utrecht, The Netherlands
| | - Marina de Neiva Borba
- São Camilo Medical School, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, Brazil
| | - Liliana Doganova
- Mines ParisTech, Université PSL in Paris, 60 Boulevard Saint Michel, 75272, Paris Cedex 06, France
| | - Shir Grunebaum
- Department of Science and Technology Studies, 307 Bethune College, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Rob Hagendijk
- Faculty of Social and Behavioural Sciences, International School of Social Sciences and Humanities, University of Amsterdam, Spui 2, 1012 WX, Amsterdam, The Netherlands
| | - Larry Lynd
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Alexandre Mallard
- Center for Social Innovation, Université PSL in Paris, Mines ParisTech60 Boulevard Saint Michel, 75272, Paris Cedex 06, France
| | - Faisal Ali Mohamed
- Faculty of Health Policy and Equity, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Ellen Moors
- Innovation and Sustainability, Copernicus Institute of Sustainable Development, Universiteit Utrecht, Princetonlaan 8a, 3584 CB, Utrecht, The Netherlands
| | - Claudio Cordovil Oliveira
- Public Health at the Sergio Arouca National School of Public Health (ENSP/Fiocruz), Av. Brazil, 4365 - Manguinhos, Rio de Janeiro, Brazil
| | - Florence Paterson
- Mines ParisTech, Université PSL in Paris, 60 Boulevard Saint Michel, 75272, Paris Cedex 06, France
| | - Vanessa Scanga
- Osgoode Hall Law School of York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Julino Soares
- The Federal University of Sao Paulo (UNIFESP), School of Public Health at the University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, Brazil
| | - Vololona Raberharisoa
- Mines ParisTech, Université PSL in Paris, 60 Boulevard Saint Michel, 75272, Paris Cedex 06, France
| | - Tineke Kleinhout-Vliek
- Geosciences, Innovation Studies, Innovation and Sustainability Institute, Universiteit Utrecht, Princetonlaan 8a, 3584 CB, Utrecht, The Netherlands
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Kleinhout-Vliek TH, De Bont AA, Boer A. Under careful construction: combining findings, arguments, and values into robust health care coverage decisions. BMC Health Serv Res 2022; 22:756. [PMID: 35672735 PMCID: PMC9175321 DOI: 10.1186/s12913-022-07781-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 03/09/2022] [Indexed: 11/22/2022] Open
Abstract
Background Health care coverage decisions deal with health care technology provision or reimbursement at a national level. The coverage decision report, i.e., the publicly available document giving reasons for the decision, may contain various elements: quantitative calculations like cost and clinical effectiveness analyses and formalised and non-formalised qualitative considerations. We know little about the process of combining these heterogeneous elements into robust decisions. Methods This study describes a model for combining different elements in coverage decisions. We build on two qualitative cases of coverage appraisals at the Dutch National Health Care Institute, for which we analysed observations at committee meetings (n = 2, with field notes taken) and the corresponding audio files (n = 3), interviews with appraisal committee members (n = 10 in seven interviews) and with Institute employees (n = 5 in three interviews), and relevant documents (n = 4). Results We conceptualise decisions as combinations of elements, specifically (quantitative) findings and (qualitative) arguments and values. Our model contains three steps: 1) identifying elements; 2) designing the combinations of elements, which entails articulating links, broadening the scope of designed combinations, and black-boxing links; and 3) testing these combinations and choosing one as the final decision. Conclusions Based on the proposed model, we suggest actively identifying a wider variety of elements and stepping up in terms of engaging patients and the public, including facilitating appeals. Future research could explore how different actors perceive the robustness of decisions and how this relates to their perceived legitimacy.
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Affiliation(s)
- T H Kleinhout-Vliek
- Erasmus School of Health Policy & Management, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands. .,Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, the Netherlands.
| | - A A De Bont
- Erasmus School of Health Policy & Management, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands
| | - A Boer
- Erasmus School of Health Policy & Management, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands
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Oortwijn W, Husereau D, Abelson J, Barasa E, Bayani DD, Canuto Santos V, Culyer A, Facey K, Grainger D, Kieslich K, Ollendorf D, Pichon-Riviere A, Sandman L, Strammiello V, Teerawattananon Y. Designing and Implementing Deliberative Processes for Health Technology Assessment: A Good Practices Report of a Joint HTAi/ISPOR Task Force. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:869-886. [PMID: 35667778 PMCID: PMC7613534 DOI: 10.1016/j.jval.2022.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Deliberative processes for health technology assessment (HTA) are intended to facilitate participatory decision making, using discussion and open dialogue between stakeholders. Increasing attention is being given to deliberative processes, but guidance is lacking for those who wish to design or use them. Health Technology Assessment International (HTAi) and ISPOR-The Professional Society for Health Economics and Outcomes Research initiated a joint Task Force to address this gap. METHODS The joint Task Force consisted of 15 members with different backgrounds, perspectives, and expertise relevant to the field. It developed guidance and a checklist for deliberative processes for HTA. The guidance builds upon the few, existing initiatives in the field, as well as input from the HTA community following an established consultation plan. In addition, the guidance was subject to 2 rounds of peer review. RESULTS A deliberative process for HTA consists of procedures, activities, and events that support the informed and critical examination of an issue and the weighing of arguments and evidence to guide a subsequent decision. Guidance and an accompanying checklist are provided for (i) developing the governance and structure of an HTA program and (ii) informing how the various stages of an HTA process might be managed using deliberation. CONCLUSIONS The guidance and the checklist contain a series of questions, grouped by 6 phases of a model deliberative process. They are offered as practical tools for those wishing to establish or improve deliberative processes for HTA that are fit for local contexts. The tools can also be used for independent scrutiny of deliberative processes.
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Affiliation(s)
- Wija Oortwijn
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Don Husereau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Julia Abelson
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Edwine Barasa
- Health Economics Research Unit (HERU), KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Diana Dana Bayani
- Health Intervention and Policy Evaluation Research (HIPER), Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Vania Canuto Santos
- Department of Management and Incorporation of Health Technology, Executive Secretariat of National Committee Health Technology Incorporation (CONITEC), Ministry of Health, Brasilia, Brazil
| | - Anthony Culyer
- Centre for Health Economics, University of York, York, United Kingdom
| | - Karen Facey
- Evidence Based Health Policy Consultant, Drymen, Scotland
| | | | - Katharina Kieslich
- Department of Political Science, Centre for the Study of Contemporary Solidarity, University of Vienna, Vienna, Austria
| | - Daniel Ollendorf
- Center for the Evaluation of Value and Risk in Health (CEVR), Tufts University Medical Centre, Boston, MA, USA
| | - Andrés Pichon-Riviere
- Institute for Clinical Effectiveness and Health Policy (IECS), University of Buenos Aires, Buenos Aires, Argentina
| | - Lars Sandman
- National Centre for Priorities in Health, Linköping University, Linköping, Sweden
| | | | - Yot Teerawattananon
- Health Intervention and Technology Assessment Programme (HITAP), Ministry of Health, Bangkok, Thailand
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Kleinhout-Vliek T, de Bont A, Boer B. Necessity under construction - societal weighing rationality in the appraisal of health care technologies. HEALTH ECONOMICS, POLICY, AND LAW 2021; 16:457-472. [PMID: 32955010 PMCID: PMC8460450 DOI: 10.1017/s1744133120000341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 06/29/2020] [Accepted: 07/31/2020] [Indexed: 11/26/2022]
Abstract
Health care coverage decisions may employ many different considerations, which are brought together across two phases. The assessment phase examines the available scientific evidence, such as the cost-effectiveness, of the technology. The appraisal then contextualises this evidence to arrive at an (advised) coverage decision, but little is known about how this is done.In the Netherlands, the appraisal is set up to achieve a societal weighing and is the primary place where need- and solidarity-related ('necessity') argumentations are used. To elucidate how the Dutch appraisal committee 'constructs necessity', we analysed observations and recordings of two appraisal committee meetings at the National Health Care Institute, the corresponding documents (five), and interviews with committee members and policy makers (13 interviewees in 12 interviews), with attention to specific necessity argumentations.The Dutch appraisal committee constructs necessity in four phases: (1) allowing explicit criteria to steer the process; (2) allowing patient (representative) contributions to challenge the process; (3) bringing new argumentations in from outside and weaving them together; and (4) formulating recommendations to societal stakeholders. We argue that in these ways, the appraisal committee achieves societal weighing rationality, as the committee actively uses argumentations from society and embeds the decision outcome in society.
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Affiliation(s)
- Tineke Kleinhout-Vliek
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands
| | - Antoinette de Bont
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands
| | - Bert Boer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands
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