Mismatch between health priorities and publicly funded clinical research: The Chilean case

Article type
Authors
Meza N1, Bracchiglione J2, Franco J3, Escobar-Liquitay C4, Garnham R5, Sánchez A6, Dauvergne J7, Díaz Menai S8, Vaimberg O9, Carrera Fabia M10, Riva N11, Grandi D11, Flores N11, Cabrera C11, Cruzat B11, Briceño F11, Morales D11, Madrid E1
1Interdisciplinary Centre For Health Studies (ciesal), Universidad De Valparaíso, Viña Del Mar, Chile, Valparaiso, Chile; Iberoamerican Cochrane Centre, Barcelona, Spain
2Interdisciplinary Centre For Health Studies (ciesal), Universidad De Valparaíso, Viña Del Mar, Chile, Valparaiso, Chile; Iberoamerican Cochrane Centre, Institut de Recerca Sant Pau (IR Sant Pau), CIBERESP, Barcelona, Spain
3Institute of General Practice, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
4Research Department, Cochrane Associate Centre, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
5Interdisciplinary Centre For Health Studies (ciesal), Universidad De Valparaíso, Viña Del Mar, Chile, Valparaiso, Chile
6Pharmacy Unit, Regional Hospital, Rancagua, Chile; School of Medicine, Universidad de Santiago de Chile, Santiago, Chile
7Facultad de Medicina, Universidad de Los Andes, Santiago, Chile
8Residencia de Epidemiologia, Ministerio de Salud de Buenos Aires, Buenos Aires, Argentina; Research Department, Cochrane Associate Centre, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
9School of Medicine, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
10Critical Care Unit, Red de Salud UC Christus, Santiago, Chile
11School of Medicine, Universidad de Valparaiso, Viña del Mar, Valpraiso, Chile
Abstract
"Introduction:
Publicly funded research must be aligned with locally prioritised health topics, aiming to inform clinical practice guidelines (CPGs). In Chile, 85 health problems have been prioritised mainly based on the burden of disease (and other governance considerations), and the Chilean Ministry of Health is committed to developing CPGs for each of them. However, it is unclear whether the clinical research conducted in Chile addresses locally prioritised health topics.

Objective:
To characterise the Chilean clinical research published from 2000 onwards, and to estimate the proportion of publicly funded research addressing locally prioritised health conditions.

Methods:
We conducted a scoping review. We searched MEDLINE, Embase, PsycINFO, CINAHL, LILACS, and WoS and performed hand searches to retrieve studies conducted in Chile or by authors whose affiliations are based in Chile from 2000 onwards. We extracted bibliometric data, study design, area of study, authorship data, diseases or health conditions addressed, funding, and conflicts of interest.

Results:
After deduplication, we retrieved 56,233 references. To date, 32,000 studies have been excluded by title/abstract screening. Among 19,535 full-texts assessed for eligibility, 4,816 have been excluded for being conducted in other countries or having authors non-based in Chile, whereas 2,647 have been excluded due to other reasons (wrong publication type or no clinical topic). Preliminarily, we have identified a total of 12,072 Chilean studies, of which 7092 have been extracted. 2064 studies received public funding, among which 300 (14.53%) were randomised clinical trials, 503 (24.37%) cohort studies, 47 (2.27%) quasi-experimental studies, and 228 (11.04%) corresponded to systematic reviews. We have identified 1781 (86.28%) publicly funded studies not addressing any of the most burdensome diseases in Chile. We expect to complete the data extraction soon and to perform a detailed analysis of the alignment between clinical studies and the burden of disease, for each of the ten conditions with the highest burden of disease.

Conclusion:
Most of the Chilean clinical research receiving public funding do not address locally prioritised problems. Countries as Chile a need to strengthen the research agenda to assign public funds with cost-effectiveness criteria. This scoping review is part of a broader government-funded project (DOI:10.1136/bmjopen-2021-057555).
"