How is the use of research evidence in health policy perceived? A comparison between the reporting of researchers and policy-makers.

BACKGROUND: The use of health policy and systems research (HPSR) to inform health policy-making is an international challenge. Incorporating HPSR into decision-making primarily involves two groups, namely researchers (knowledge producers) and policy-makers (knowledge users). The purpose of this study was to compare the perceptions of Israeli health systems and policy researchers and health services policy-makers regarding the role of HPSR, factors influencing its uses and potential facilitators and barriers to HPSR, and implementation of knowledge transfer and exchange (KTE) activities. METHODS: A cross-sectional survey was administered to researchers and policy-makers in Israel. The survey consisted of seven closed questions. Descriptive analyses were carried out for closed-ended questions and comparative analysis were conducted between groups using the χ2 test. RESULTS: A total of 37 researchers and 32 policy-makers responded to the survey. While some views were in alignment, others showed differences. More policy-makers than researchers perceived that the use of HPSR in policy was hindered by practical implementation constraints, whereas more researchers felt that its use was hindered by a lack of coordination between knowledge producers and users. A larger percentage of policy-makers, as compared to researchers, reported that facilitators to the KTE process are in place and a larger percentage of researchers perceived barriers within the KTE environment. A larger percentage of policy-makers perceived KTE activities were in place as compared to researchers. Results also showed large differences in the perceptions of the two groups regarding policy formulation and which organisations they perceived as exerting strong influence on policy-making. CONCLUSIONS: This research demonstrated that there are differences in the perceptions of knowledge producers and users about the process of KTE. Future work should focus on minimising the challenges highlighted here and implementing new KTE activities. These activities could include making the researchers aware of the most effective manner in which to package their results, providing training to policy-makers and assuring that policy-makers have technical access to appropriate databases to search for HPSR. These results underscore the need for the groups to communicate and clarify to each other what they can offer and what they require.

Making Wise Choices in Health Provision: Initial Exploration of Nurse Perceptions in Israel.

Overuse of health services drives up costs while affecting quality of care. It can also harm patients physically and psychologically through invoking duplicate testing, unnecessary procedures, and psychological stress. The purpose of this study was to understand nurses' perceptions of health care overuse. Nurses perceived that physicians' main considerations when ordering tests are to get additional data to strengthen the diagnosis and "just to be safe." Fear of litigation and patients' desires were important factors. Implementing interventions to reduce overuse will create a more efficient and effective system.

Is There Justification for Total Thyroidectomy in Low-Risk Papillary Thyroid Carcinoma? A Decision-Analysis Model.

BACKGROUND: Low-risk papillary thyroid carcinoma is commonly treated surgically. However, uncertainties exist in regard to the optimal extent of surgery. We approached this question using a decision-analysis model. METHODS: A Markov model was used to compare outcome between patients with small (1-2 cm) low-risk PTC treated by hemithyroidectomy or total thyroidectomy. Probabilities and utilities were derived from the literature. The model was evaluated with Monte Carlo simulation. Sensitivity analysis was used to determine which variables most affected the model. RESULTS: Hemithyroidectomy was associated with a minor increase in mortality risk. After incorporation of mortality risk, complications, and quality-of-life measures, hemithyroidectomy was found to be superior to total thyroidectomy, with an increasing benefit over time. Quality-of-life measures, especially disutility of disease recurrence and undergoing surgery, had the greatest effect on the incremental benefit of hemithyroidectomy. CONCLUSION: Based on our decision-analysis model, hemithyroidectomy is the preferred option in low-risk PTC.

The patient-perceived difficulty in diabetes treatment (PDDT) scale identifies barriers to care.

OBJECTIVE: The objective of this study is to describe the design and validation of a newly developed brief, treatment-focused scale for use with type 1 and type 2-diabetes, exploring patient-perceived difficulties that are associated with treatment. METHODS: The content of the construct was derived from consultation with experts, from existing instruments and the literature, as well as from diabetic patients. The original draft was comprised of 11 attributes. Based on an interim analysis, an additional 12th attribute was added. The final scale was tested on 988 diabetic patients from 25 practices in Israel. Respondents also completed a diabetes-specific quality of life (QoL) questionnaire and indicated their current perceived overall health status. RESULTS: The patient-perceived difficulty of diabetes treatment (PDDT) scale contains 12 items reflecting diabetes-treatment characteristics: adherence to self-monitoring of glucose schedule, frequency of self-monitoring of glucose, adherence to medication administration schedule, frequency of medication administration, multiple number of medications, synchronization between meals and medications, dependence on the medications, pain associated with treatment, diet restrictions, self-care, multiple healthcare providers, and costs of treatment. Response rate to all attributes was very high. Construct validity was shown by significant correlations between PDDT attributes and diabetes-specific quality of life (r = 0.31-0.46) and self-report adherence to recommended treatment (r = 0.14-0.28), as well as between overall perceived difficulty and diabetes-specific quality of life (r = 0.60). Furthermore, the PDDT items showed discriminant capabilities with respect to known groups of patients. CONCLUSIONS: The PDDT scale is a simple and valid instrument that may assist in identifying potential barriers in adherence to recommended treatments and to new treatment options.

Understanding Physicians' Perceptions of Overuse of Health Services in Oncology.

Overuse rates in oncology are high, but areas of possible improvement exist for reducing it and improving quality of care. This study explores perceptions and experiences of oncologists in Israel regarding overuse of health services within oncology. In-depth, semistructured interviews were conducted focusing on causes of overuse, facilitators for reduction, and suggestions for improvement. Interviews were audio recorded, transcribed, coded, and thematically analyzed. Physicians reported patient-level causes including "well-informed" and "demanding" patients; physician-level causes including desire to satisfy patients, lack of confidence, time, and skills; and system-level causes like ease of access, and lack of alignment and coordination. Physicians can reduce overuse through patient dialogue, building trust and solidifying patient-physician relationships, and further reduce overuse with better teamwork. Improvements can be made through educational initiatives, and bottom-up solutions. Policy makers and decision makers should develop appropriate interventions addressing health service overuse, including improving patient education and instilling confidence and knowledge in physicians.

EQ-5D as a generic measure of health-related quality of life in Israel: reliability, validity and responsiveness.

BACKGROUND: The European Quality of Life 5-Dimensions questionnaire is one of the most commonly used measures of health-related quality of life. OBJECTIVES: To present the feasibility, reliability and validity of the Hebrew version of the EQ-5D. METHODS: We conducted face-to-face interviews with a representative sample (n = 1666) of the Israeli Jewish population. The data collected included demographic and medical information, and self-valuation of health using the EQ-5D descriptive system, Visual Analogue Scale and Time Trade-Off. Construct validity was assessed by assuming that older individuals, those with a greater burden of diseases, and those reporting experience with their own severe illness would have lower EQ-5D indexes, VAS and TTO values. Test-retest reliability was assessed in a small sample (n = 50) that was reevaluated after a 3 week interval. RESULTS: Test-retest reliability of the EQ-5D and VAS was very high (r > or = 0.85). Reliability of the TTO was moderate (r = 0.48). There were significant differences in the EQ-5D index, profiles, VAS and TTO between healthy and sick respondents and younger and older respondents, indicating good validity of the instrument. CONCLUSIONS: The Hebrew translation of the EQ-5D is a practical, reliable and valid instrument for assessing the health-related quality of life of the general Israeli Jewish population.

[Assessment of health related quality of life--Part 1--Direct measures].

Assessment of the impact of medical interventions on patient's quality of life is becoming a major aspect in evaluating the effectiveness of these interventions. Based on the concept of combining life expectancy and quality of life in a single value, many tools for measuring this effect have been developed in the last few decades. Quality-adjusted life years (QALYs) are calculated by multiplying life expectancy by a factor representing the quality of life during that period. Health related quality of life may be measured directly by several methods. The most commonly used are Visual Analogue Scale (VAS), Standard gamble (SG) and Time Trade-Off (TTO). This article reviews these three methods, their applications and their advantages and disadvantages. It also addresses some of the problems characteristic of each measure, their theoretical and practical differences and the implications of those differences on the values obtained from each one. Finally, the article discusses the attempts to map the relationships between the three measures, in order to be able to convert values from one to another.

[Assessment of health related quality of life--part 3--preference based measures].

Preference Based questionnaires are instrumental in the use of Health Related Quality of Life in economic analyses in medicine. These questionnaires combine the features of Health State Measures with those of direct methods of valuations, and therefore link between a profile, which describes a certain health state, to the utility of living in that state. Using statistical models, which are based on values to a sample of profiles, a complete table of utilities for all profiles may be constructed. These utilities serve to evaluate the effectiveness, and cost-effectiveness, of medical interventions. This article describes the method of creating and valuing preference based questionnaires and discusses the problems inherent in using the utilities they produce. The article also covers four of the most common questionnaires- Health Utility Index (HUI), Quality of Well Being (QWB), EuroQoL 5 Dimensions (EQ-5D) and Short Form 6 Dimensions (SF-6D). Finally, it briefly mentions the subject of specific preference based questionnaires.

[Assessment of health related quality of life--part 2--health state measures].

Health State Measures (HSMs) are one of the existing methods for assessing Health Related Quality of Life. These measures provide a quantitative description of the quality of life across different aspects of living--physical, emotional and social. They allow us to determine the effects of diseases and medical interventions on each of those aspects. Health state measures may be generic--applicable to all conditions and populations, or focus on the unique features of a specific disease, state or group. This article discusses the differences in scope and responsiveness between generic and specific HSMs, with an emphasis on Minimal Clinically Important Difference, and their significance in regard to the selection and use of these questionnaires. The article also provides a short overview of the most commonly used HSMs--Sickness Impact Profile (SIP), Nottingham Health Profile (NHP) and Medical Outcome Study 36-Item Short Form (SF-36).

Views of health system policymakers on the role of research in health policymaking in Israel.

BACKGROUND: The use of research evidence in health policymaking is an international challenge. Health systems, including that of Israel, are usually characterized by scarce resources and the necessity to make rapid policy decisions. Knowledge transfer and exchange (KTE) has emerged as a paradigm to start bridging the "know-do" gap. The purpose of this study was to explore the views of health system policymakers and senior executives involved in the policy development process in Israel regarding the role of health systems and policy research (HSPR) in health policymaking, the barriers and facilitators to the use of evidence in the policymaking process, and suggestions for improving the use of HSPR in the policymaking process. METHODS: A survey and an interview were verbally administered in a single face-to-face meeting with health system policymakers and senior executives involved in the policy development process in Israel. The data collection period was from July to October 2014. The potential participants included members of Knesset, officials from Israel's Ministry of Health, Ministry of Finance, health services organizations, and other stakeholder organizations (i.e., National Insurance Institute). The close-ended questions were based on previous surveys that had been conducted in this field. Interviews were tape recorded and transcribed. Descriptive statistics were conducted for close ended survey-questions and thematic analysis was conducted for open-ended interview questions. RESULTS: There were 32 participants in this study. Participants felt that the use of HSPR helps raise awareness on policy issues, yet the actual use of HSPR was hindered for many reasons. Facilitators do exist to support the use of HSPR in the policymaking process, such as a strong foundation of relationships between researchers and policymakers. However, many barriers exist such as the lack of relevance and timeliness of much of the currently available research to support decision-making and the paucity of funding to support research use. Suggestions to improve the use of HSPR focused on improving dissemination of research findings and ensuring that the research was more relevant and timely. CONCLUSIONS: This research demonstrated that health systems policymakers in Israel perceive having strong relationships and collaborations with researchers however there is room for improvement, e.g. partnering in research projects to ensure relevance and use. Furthermore, health system policymakers seem to be interested in receiving relevant research in a more useable format and are open to using research in decision making.

Off-label use of sodium valproate for schizophrenia.

BACKGROUND: Off-label use of a drug not according to its regulatory labeling has become common in medicine, especially in the field of psychiatry. Mood stabilizers are intended to be used to attenuate mood fluctuations in bipolar disorder, but their use has spread to patients with schizophrenia, as it provides greater control of impulsivity and aggressiveness. Sodium valproate is one of the most frequently used mood stabilizers in psychiatry. This study determined the prevalence of off-label use of sodium valproate for schizophrenia and schizoaffective disorder in Abarbanel Psychiatric Hospital and the demographic and clinical characteristics associated with its use. METHODS: Retrospective study of patients hospitalized in 2011-2012 with a diagnosis of schizophrenia or schizoaffective disorder in one of three general psychiatric wards. RESULTS: Valproate use was significantly lower in the geriatric group (11.6% vs. 20.1%, chi square  = 4.7, p = .03), in patients with schizophrenia (14.1% vs. schizoaffective disorder (35.2%), chi square  = 29, p<.001) and in patients receiving both atypical and typical antipsychotics (23.3% vs. 16.4%, p = .04). In multivariate logistic regression analysis, diagnosis and the combination of atypical and typical antipsychotics predicted the use of sodium valproate. The number of other medications prescribed did not predict sodium valproate use. CONCLUSIONS: Off-label use of sodium valproate in psychiatric patients with schizophrenia or schizoaffective disorder is extensive, especially in younger patients and those with schizoaffective disorder. More research is needed to determine whether it is being prescribed appropriately.

Is there a role for elective neck dissection with salvage laryngectomy? A decision-analysis model.

OBJECTIVES/HYPOTHESIS: Elective neck dissection for the clinically negative neck is often a matter of debate. A decision-analysis model that was published in 1994 established the widely accepted principle that neck dissection is warranted when the risk for occult metastases is higher than 20%. The aim of the present study was to build a specific and up-to-date decision-analysis model to determine the need for elective neck dissection during salvage laryngectomy after chemoradiation failure and to identify the variables that effect the decision. STUDY DESIGN: Decision-analysis model. METHODS: A decision-analysis model was performed to compare the outcome of patients after salvage total laryngectomy with and without an elective neck dissection. Probabilities and expected utilities were derived from available literature to construct the model. Monte Carlo simulation and sensitivity analysis were used to calculate our models' outcomes and to identify the variables that influence the model most, respectively. RESULTS: When calculating our model results with published data, we found that elective neck dissection is not warranted during salvage total laryngectomy. Optimal decision was found to be sensitive by two variables: 1) the probability for cure with neck dissection, and 2) the probability for regional-only recurrence after salvage laryngectomy without neck dissection. In multiway sensitivity analysis, only when cure rate with neck dissection exceeded 82%, adding neck dissection was the preferred decision. In practice, cure rates for patients after salvage total laryngectomy are around 50% to 65%. CONCLUSIONS: Based on our decision-analysis model, we do not recommend routine elective neck dissection during salvage total laryngectomy after failure of chemoradiation.