Using a Café to Demystify Recommendations, Engage Audiences, and Address Barriers
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1 Using a Café to Demystify Recommendations, Engage Audiences, and Address Barriers
2 Kristen Chelak Program Development Officer and Theme Lead Canadian Agency for Drugs and Technologies in Health
3 Outline About the Café Scientifique Findings on Self-Monitoring of Blood Glucose Why the Café Scientifique? Results The Expert s Experience Role on the panel Reflections on the Café experience Is it effective? Jurisdictional Perspective Multi-faceted educational strategy How a Café informs our work Advantages and disadvantages
4 Objectives To introduce the concept of a café To illustrate the use of a café as a knowledge exchange tool To describe the successes and challenges of using the cafés to engage a variety of audiences To describe how the cafés can be used to inform policy
5 CADTH: Providing What Decision Makers Need Independent, evidence-based information Relevance answering the real policy and clinical practice questions Timeliness Messaging concise, understandable Context around decisions social, legal, ethical, political, patient, public Support to interpret and apply the information
6 Why Study Self-Monitoring Blood Glucose? Diabetes Prevalence Utilization Efficacy of SMBG uncertain Expenditure ($)
7 Intervention Tools 4 key messages practice and knowledge gaps current practice and utilization Gap Analysis & Key Messages Report Current Practice and Utilization Reports recommendations Optimal Therapy Recommendations cost-effectiveness data Economic Report clinical-effectiveness data Systematic Reviews Feedback tools to support uptake Stakeholder Build Networks and Partnerships How?
8 T2DM No Oral Antidiabetes Drugs or Insulin Routine practice of SMBG is not recommended for most adults with T2DM who do not use diabetes pharmacotherapy. * Pregnant women or women considering pregnancy may benefit from SMBG. 8
9 T2DM Using Oral Antidiabetes Drugs (No Insulin) Routine practice of SMBG is not recommended for most adults with T2DM using oral antidiabetes drugs. Periodic testing may be beneficial for patients: using insulin secretagogues (i.e. sulfonylureas) at risk of hypoglycemia experiencing acute illness undergoing changes in pharmacotherapy or significant changes in routine with poorly controlled or unstable glucose levels pregnant or planning a pregnancy 9
10 Challenges to Dissemination Message complexity Variation of coverage policies across Canada Variation in capacity to implement policy change Contrary to current practice Varying points of view from professional and advocacy groups Timing
11
12 What is a Café Scientifique? Informal and casual Food and drink Hot topic Small audience Panel of experts Led by a moderator Free and open to the public Experts engage and discuss with audience
13 Why the Café Scientifique? Raise awareness about CADTH s recommendations Demystify recommendations Allow for patient participation Bring affected providers and patients/public together in one room Create opportunities for discussion about: Role of SMBG in T2DM Diabetes self-management it s more than just SMBG Challenges of limited health care resources Value for money what does it mean?
14 Overview of the Café Scientifique Project Pan-Canadian series Funding in partnership with PHAC Goals Collaboration and Partnerships Evaluation City Province Date Halifax Nova Scotia February 17, 2010 Halifax Nova Scotia February 18, 2010 Regina Saskatchewan March 2, 2010 Regina Saskatchewan March 3, 2010 Charlottetown Prince Edward Island September 21, 2010 Moncton New Brunswick September 23, 2010 Edmonton Alberta October 26, 2010 Vancouver British Columbia October 28, 2010 Ottawa Ontario November 30, 2010 Toronto Ontario December 1, 2010 Surrey British Columbia February 28, 2011 St. John s Newfoundland & Labrador March 8, 2011
15 Results from the Café Scientifique Project Attendance Health Care Providers (n=291) People with diabetes, caregivers, public (n=242) Audience Feedback Health Profession Total Family Physician 9 Registered Nurse 70 Dietician 34 Medical specialist 3 Nurse practitioner 5 Pharmacist 87 Student 29 Other 53 Did Not Answer 1 TOTAL 291
16 Impact of Key Themes - Providers 1) Routine self-monitoring of blood glucose is not required for most patients with type 2 diabetes not treated by insulin. 60% - will change how they practice 2) Effective self-management of diabetes involves consideration of more than just blood glucose results. 78% - agreement with this theme
17 Provider Comments This is the first time I've attended an educational event with people from so many different backgrounds. It was interesting to see different opinions and experiences. Moderator did a great job. I think you need to have consumers presenting this to the public. It cannot be seen as taking control from the people that ultimately have to live with this disease. Information will challenge me in my practice to consider why I recommend a specific type of self-monitoring and understanding how it will impact the bigger picture.
18 Impact of Key Themes - Public 1) Routine self-monitoring of blood glucose is not required for most patients with type 2 diabetes not treated by insulin. 54% - agree with the theme 38% - will change how they manage their diabetes 2) Effective self-management of diabetes involves consideration of more than just blood glucose results. 72% - agree with the theme 67% - very or somewhat likely to speak to provider about how often to test
19 Public Comments Even with the cost of test strips this gives me self-awareness because I had no symptoms. Consider the astronomical cost of dealing with diabetes complications of those who have uncontrolled diabetes and blood pressure. Education is more economic in the long run. Agree with the ideas presented, but needed to hear it. Nice to have local professionals invited. Since I pay for my own stuff, too much talk about the money.
20 Dr. Adil Virani Café Scientifique Panelist Moncton Charlottetown Surrey Core Member COMPUS Expert Review Committee Canadian Agency for Drugs and Technologies in Health Director, Pharmacy Services Professional Practice, Education & Burnaby Hospital Fraser Health Providence Health Care Provincial Health Services Authority Vancouver Coastal Health Associate Professor Faculty of Pharmaceutical Sciences University of British Columbia
21 Disclosure Statement I have no financial relationships with any manufacturers of test strips, test strip machines or pharmaceutical companies I receive honoraria for work related to rational drug use from: CADTH Therapeutics Initiative Patented Medicine Price Review Board
22 Panel of Experts Physician (Endocrinologist, GP) Certified Diabetes Educator (RN) CERC Panel Member My Role: Set the stage (describe the process) Clinical findings Cost-effectiveness findings Formulating recommendations considering clinical and cost implications
23 My Reflections 1. More relaxed environment (vs traditional educational settings) 2. Informal tone - No slides or visual aids 3. Limited speaking time (5 min intro each) 4. More inviting opportunity for participants to explore the possibilities and consider the disconnect between the evidence and practice
24 My Reflections 5. Panel members didn t always share the same opinions good thing 6. Opportunity to listen more to the audience, who were an active part in driving the discussion and the night s success 7. Location and ambience are important factors to set the mood 8. Having time for round table discussions help formulate questions for Panel
25 My Reflections: 9. Discussions seemed to flow well (moderator helped) 10.Some participants came to the event with an agenda 11.Several opportunities to add in humour and use real case examples from the audience 12.People with DM had different kinds of questions than did some Health Care Professionals
26 Diverse Audiences Pros and Cons
27 Café Scientifique s are a great Tool for Knowledge Exchange!
28 Dr. Suzanne Taylor Executive Director Drug Use Optimization Pharmaceutical Services Division BC Ministry of Health Member Drug Policy Advisory Committee, Optimal Use Working Group Canadian Agency for Drugs and Technologies in Health
29 Café Scientifique : Jurisdictional/Policy Perspective Suzanne C. Malfair Taylor, BSc(Pharm), ACPR, PharmD, BCPS, FCSHP Executive Director, Drug Use Optimization Branch Pharmaceutical Services Division BC Ministry of Health 2011 CADTH Symposium 5Apr
30 Financial Disclosure All presented work is funded by the BC Ministry of Health, Pharmaceutical Services Division 30
31 Outline Pharmaceutical Services Division and Drug Use Optimization (DUO) Branch relationships with CADTH Who wants a Café? BC Cafés How Cafés inform us More Cafés? 31
32 PSD, DUO, CADTH relationships (PDF) DI Best drugs FWG CADTH DPAC PSD OUWG Information POER Best policies Therapeutically oriented pharmaceutical management system DUO Best prescribing Evaluation Utilization BMSRS Best deals 32
33 Drug Use Optimization mission Best prescribing Educate the province (prescribers, other healthcare professionals, patients and public) on: the optimal use of drugs to achieve improved health outcomes in a fiscally responsible manner Support pharmacists to work to full scope of practice Evaluate impact of programs and services Facilitate evaluation of real world safety and effectiveness and real world cost-effectiveness 33
34 Evidence to practice BGTS = 3rd $$ health care sustainability evidence CADTH review CDA guidelines health care delivery target groups 34
35 Multi-faceted education strategy live presentations to diabetes educators networking with all diabetes education centres networking with HealthLink BC, home care and residential care nurses live presentations to health authority executives and staff public forum (providers & patients): CADTH Café Scientifique print materials articles, e-blasts, existing educational initiatives 35
36 Who wants a Café? 36
37 Vancouver 28 Oct 2010 Vancouver Aquarium BC Cafés Surrey 28 Feb 2011 Surrey Arts Centre 37
38 How Cafés inform us arm s length hear the evidence presented panelist expertise and views hear the audience reaction comments, questions, concerns inform beliefs, values, gaps, styles inspire 38
39 More Cafés? advantages genuine, on-the-spot input from people real-time interaction information for consideration tool for education inspire ideas disadvantages genuine, on-the-spot input from people real-time interaction information for response 39
40 Thank-you 40
41 Where Do We Go From Here? The dialogue continues Video and audio of select cafés will be available Final Report: Evaluations of all 12 events Café Casebook: Sharing lessons learned Picking up where the Cafés left off Participants continue to share the message in their settings Jurisdictions determine if, when, and how to implement Other Cafés? Potentially
42 Summary / Key Messages A Café Scientifique can: Be used and adapted by anyone Successfully spark dialogue on contentious issues Create a platform to openly share research findings with the public Effectively bring multi-disciplinary audiences together Be a useful tool for decision-makers to inform policy But it s also challenging Can be difficult to adapt presentations for a variety of audiences Discussion can go off topic Needs dedicated resources to be successful
43 Questions?
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