Article type
Year
Abstract
Background: The decision of health insurance companies (HC) and governments to adopt or not new technologies should be made ideally according to evidence-based information. Formal evidence based programs are rarely used by HC in Brazil. The decisions are mostly based on opinions. The majority of practitioners in Brazil lack the proper training in evidence based medicine (EBM). In order to facilitate the decision making process for the adoption of new technologies, an EBM program was established in one of the largest HC in Brazil, which insures half a million people.
Objectives: To describe the development and implementation of an EBM program in a private HC in Campinas, Sao Paulo, Brazil.
To evaluate the requests on new procedures sent by the specialist committee or by physicians per se, the quality of the literature sent as bibliographic support for those requests and to compare the latter with evidence found by EBM specialists.
Methods: A group of three EBM trained physicians reviewed all the requests for the adoption of new technologies from July 2003 until February 2004.
Each request form should be accompanied by proper literature, selected by the requesters. For each request, a systematic search of literature on electronic databases (Cochrane Library, MEDLINE, LILACS and DARE) was performed, followed by critical appraisal of the retrieved information. Based on the grade of evidence found, we agreed or not with the adoption of the new technology. The request, attached with the adequate bibliography and reviewers' evidence based recommendation, was then sent to the requesters and to the specialists committee, for their appreciation.
Results: 49 requests for new technologies were evaluated (July 2003- February 2004). Of those, 13 (26.5%) were considered effective, and so recommended for adoption. Fourteen (28.5%) were considered ineffective and thus denied and, 22 (45%) were labeled experimental and therefore denied. Of the original 49 procedures requests, 21 (43%) did not contain any bibliography. Eighteen (37%) had as main source advertisement material provided by pharmaceutical companies and opinion-based literature. Evaluating these 39 requests that were made based on low quality literature, the EBM team was able to retrieve high quality articles (systematic reviews or randomized trials) for 32 (82%) of them. From these 32 requests, the EBM program recommendation was coincident with the request in 12 (38%) of them; the other 20 (62%) were considered ineffective or experimental.
Two of the initial 49 requests were based on published guidelines, and only 8 (16%) were based on randomized controlled trials or systematic reviews.
Conclusions: There is still an important gap between physicians and the practice of EBM. The majority of specialist is not trained to retrieve and appraise information and most of the times they have not the ability to properly back up new procedures' requests with adequate literature.
A formal training in EBM can help physicians and HC in the decision making process for adopting new technologies.
Objectives: To describe the development and implementation of an EBM program in a private HC in Campinas, Sao Paulo, Brazil.
To evaluate the requests on new procedures sent by the specialist committee or by physicians per se, the quality of the literature sent as bibliographic support for those requests and to compare the latter with evidence found by EBM specialists.
Methods: A group of three EBM trained physicians reviewed all the requests for the adoption of new technologies from July 2003 until February 2004.
Each request form should be accompanied by proper literature, selected by the requesters. For each request, a systematic search of literature on electronic databases (Cochrane Library, MEDLINE, LILACS and DARE) was performed, followed by critical appraisal of the retrieved information. Based on the grade of evidence found, we agreed or not with the adoption of the new technology. The request, attached with the adequate bibliography and reviewers' evidence based recommendation, was then sent to the requesters and to the specialists committee, for their appreciation.
Results: 49 requests for new technologies were evaluated (July 2003- February 2004). Of those, 13 (26.5%) were considered effective, and so recommended for adoption. Fourteen (28.5%) were considered ineffective and thus denied and, 22 (45%) were labeled experimental and therefore denied. Of the original 49 procedures requests, 21 (43%) did not contain any bibliography. Eighteen (37%) had as main source advertisement material provided by pharmaceutical companies and opinion-based literature. Evaluating these 39 requests that were made based on low quality literature, the EBM team was able to retrieve high quality articles (systematic reviews or randomized trials) for 32 (82%) of them. From these 32 requests, the EBM program recommendation was coincident with the request in 12 (38%) of them; the other 20 (62%) were considered ineffective or experimental.
Two of the initial 49 requests were based on published guidelines, and only 8 (16%) were based on randomized controlled trials or systematic reviews.
Conclusions: There is still an important gap between physicians and the practice of EBM. The majority of specialist is not trained to retrieve and appraise information and most of the times they have not the ability to properly back up new procedures' requests with adequate literature.
A formal training in EBM can help physicians and HC in the decision making process for adopting new technologies.