How do recommendations reach clinical decision makers? Implementation of the MUMM programme (Managed Uptake of Medical Methods)

Transcription

1 How do recommendations reach clinical decision makers? Implementation of the MUMM programme (Managed Uptake of Medical Methods) Sinikka Sihvo, PhD, Research Manager, Finohta (Finnish Office for Health Technology Assessment)

2 Managed Uptake of Medical Methods (MUMM) A joint venture of Finnish Office for Health Technology Assessment (Finohta) at THL (National Institute for Health and Welfare) and the 20 hospital districts providing specialized care Started in 2007 The aim is to use critical appraisal and joint decisions in uptake of new methods Finohta: responsible for practical operations, responsible for reviews Hospitals districts: MUMM Board give recommendations, provide expertise for review groups Sinikka Sihvo 2

3 Finohta does preliminary work on suggested topics "mini-hta forms from hospitals, physicians societys MUMM Advisory Council prioritizes MUMM Board selects 4-10 topics /year Finohta/ Review groups: searches and assesses literature When review is ready Advisory Council prepares recommendation to the Board Publication -Finnish Medical J -MUMM website MUMM Board: National recommendation on the uptake Other publications Sinikka Sihvo 3

4 Traffic light model of the recommendations Traffic light Effectiveness Safety Costs Green Adequate Adequate Reasonable Should be used - may have limitations Yellow Red Promising, but evidence scarce Obviously adequate Reasonable Adequate Adequate High Adequate Known insufficiently Reasonable Information inadequate Adequate Reasonable Poor or unknown Adequate Reasonable Adequate Poor or unknown Reasonable Use while gathering information research, registry, literature Should not be used Adequate Adequate Overly expensive Sinikka Sihvo 5

5 Gene profiling assays for planning breast cancer treatment Current commercial breast cancer gene profiling tests do not provide substantial additional information to support clinical decision-making Sinikka Sihvo 6

6 Earlier studies on implementation of MUMM recommmendations 1) A structured webpropol questionnaire study for chief physicians in hospital districts in 2012, n=199. Knowledge, reported use and acceptability of the recommendations 2) A semi-structured interview study for chief physicians (gynecology, radiology) in hospitals 2013, n= 8 Views about appropriateness of recommendations, barriers and facilitators in implementation of recommendations Sinikka Sihvo 7

7 Results indicated that: MUMM recommendations were not well known Commitment to follow recommendations was low Current way of informing about recommendations was not adequate or appropriate Need to find out what the spesific target groups for recommendations (chief physicians in the departments having budget responsibility) think of the recommendation + Get fresh feedback on success of the implementation Sinikka Sihvo 8

8 Targetted surveys on recommendations Chief physicians of the departments related to the topic of the recommendation were send the link to web based survey 6 months after the recommendation was given Send by Chief Medical Officers (members of the MUMM Board) 11 questions, time taken to respond < 5 minutes Sinikka Sihvo 9

9 Studied recommendations Response rate *) n November 2014 Gene profiling assays for planning breast cancer treatment The effectiveness, safety and costs of collagenase injection treatment of Dupuytren s contracture 50% 17 50% 13 May 2015 Role of fractional exhaled nitric oxide (FeNO) 70% 27 measurement in the management of asthma with corticosteroids Sutureless valve replacement for aortic valve stenosis 53% 9 Total 66 *) counted from responses received from each hospital district Sinikka Sihvo 10

10 Familiarity with recommendation Geneprofiling test Collagenase injection FeNo measurement Sutureless valve Sinikka Sihvo 11

11 Information sources Finnish Medical Journal Superior MUMM web page Colleague Meetings in the clinic Other sources Sinikka Sihvo 12

12 Assessment of the recommendations, n=66 Somewhat agree Totally agree Up to date/relevant topic Clear and understandable Expertly prepared Useful for practice Sinikka Sihvo 13

13 Assessment of the recommendations, % who disagree Gene profiling Collagenase injection Feno Sutureless valve Up to date/relevant topic Clear and understandable Expertly prepared Useful for practice Sinikka Sihvo 14

14 Assessment of recommendations: School degree, range 4 poor to 10 excellent Mean (range) Gene profiling assays for planning breast cancer treatment The effectiveness, safety and costs of collagenase injection treatment of Dupuytren s contracture Role of fractional exhaled nitric oxide (FeNO) measurement in the management of asthma with corticosteroids Sutureless valve replacement for aortic valve stenosis 8.8 (6-10) 8.5 (7-10) 8.4 (6-9) 8.0 (6-9) Sinikka Sihvo 15

15 Has recommendation been usefull for desicion making in the unit? Recommendation Yes No Not yet, possibly later Gene profiling tests for breast cancer Collagenase injection treatment of Dupuytren s contracture Fractional exhaled nitric oxide (FeNO) measurement in the management of asthma Sutureless valve replacement for aortic valve stenosis Sinikka Sihvo 16

16 Obstacles: Why the recommendation has not been used Recommendation : is not known, 12% published too late, 8% not usefull for decision making, 8% cannot be put in action, 6% Lack of time, 6% Sinikka Sihvo 17

17 Conclusions Most had seen the recommendation (improvement to situation in 2012) Recommendations were considered relevant.. But they were not systematically used (for example in clinic meetings) Only 1/3 found them usefull for decision making -> is the timing right? Many stated that they could be used later Some specialty related differences: Perceptions about sutureless valve recommendation were more critical Sinikka Sihvo 18

18 Implications for the future More attention to the relevance of the topics of the reviews and recommendations More emphasis on timing Surveys will be continued = part of the implementation process -> new ways of distributing the survey will the tried (hospital registries instead of Medical Directors) Sinikka Sihvo 19