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1.
Washington; Organización Panamericana de la Salud; jun. 8, 2020. 17 p.
Não convencional em Espanhol | LILACS | ID: biblio-1099669

RESUMO

En el marco de la emergencia producida por el nuevo Coronavirus, COVID-19, surgido en la ciudad de Wuhan, provincia de Hubei en la República Popular de China en el mes de diciembre del 2019 y declaración oficial de Pandemia el 11 de marzo de 2020 por el Director General de la Organización Mundial de la Salud (OMS), la Directora de la Organización Panamericana de la Salud (OPS), Dra. Carissa Etienne ha solicitado elevar el nivel de preparación de los servicios de salud. Ante este nuevo escenario el Centro de Operaciones de Emergencias (COE), activado desde enero, ha pasado a una fase en la cual es prioritario orientar esfuerzos a que los servicios de salud de los países en la región de las Américas puedan estar preparados para la respuesta a una trasmisión comunitaria sostenida. En respuesta a estas orientaciones el departamento de sistemas y servicios de salud (HSS), ha definido como lineamiento general responder a la emergencia del COVID-19 a través de las redes de servicios de salud y el enfoque estratégico de Atención Primaria en Salud en los países.


Assuntos
Humanos , Pneumonia Viral/prevenção & controle , Atenção Primária à Saúde/organização & administração , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Centro de Operações de Emergência , Pandemias/prevenção & controle , Betacoronavirus , América/epidemiologia , Pessoal de Saúde/organização & administração , Equipamento de Proteção Individual/provisão & distribução , Pesquisa sobre Serviços de Saúde/organização & administração
2.
Soins Gerontol ; 25(143): 24-25, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32444078

RESUMO

Healthcare research is developing. The oncogeriatrics team of the Toulouse University Hospital started from an innovative practice to think about a research protocol. It is an evolving, reflexive and complex approach for the caregivers with the hazards of responding to calls for research projects.


Assuntos
Cuidadores/psicologia , Geriatria , Pesquisa sobre Serviços de Saúde/organização & administração , Oncologia , Idoso , Difusão de Inovações , França , Hospitais Universitários , Humanos
5.
Arch Osteoporos ; 14(1): 110, 2019 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-31754810

RESUMO

To ensure meaningful results in a clinical audit, as many hospitals as possible should participate. To optimise participation, the data collection process should either be performed by additional staff or be automated. Active participation may be promoted by offering relevant external parties insight into the actual quality of care. PURPOSE: The aim of the study was to identify which facilitators and barriers experienced by hospital staff are associated with participation in the ongoing nationwide multidisciplinary Dutch Hip Fracture Audit (DHFA). METHODS: A survey including questions about the respondents' characteristics, hospital level of participation and factors of influence on DHFA participation was sent to hip fracture surgeons. The factors were based on results of semi-structured interviews held with hospital staff involved in hip fracture care. Univariable and multivariable logistic regression analyses were used to establish which respondent characteristics and factors were associated with participation and active participation (≥ 80% of patients registered) in the DHFA. Factors significantly increasing the (active) participation in the DHFA were classified as facilitators, and factors significantly decreasing the (active) participation in the DHFA as barriers. RESULTS: One hundred nine surgeons filled out the questionnaire. The factors most agreed on were availability of staffing capacity for data collection and automated data import. A lower intention to participate was associated with being an academic surgeon (odds ratio, 0.15; 95% confidence interval, 0.04-0.52) and an orthopaedic surgeon (odds ratio, 0.30; 95% confidence interval, 0.10-0.90). Data sharing with relevant external parties was associated with active participation (odds ratio, 3.19; 95% confidence interval, 1.14-8.95). CONCLUSIONS: To improve participation in a nationwide clinical audit, it seems that the data collection should either be performed by additional staff or be automated. Active participation is facilitated if audit data is made available to other parties, such as insurers, healthcare authorities or policymakers.


Assuntos
Fraturas do Quadril/cirurgia , Auditoria Médica/organização & administração , Recursos Humanos em Hospital , Engajamento no Trabalho , Competência Clínica , Feminino , Pesquisa sobre Serviços de Saúde/organização & administração , Humanos , Masculino , Países Baixos , Razão de Chances , Complicações Pós-Operatórias , Inquéritos e Questionários
7.
Nurs Res ; 68(6): 488-493, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31693555

RESUMO

BACKGROUND: Certain research principles, framed within an indigenous context, are helpful guideposts to practice ethical, relevant, and sensitive inquiries. It is essential to further adapt research approaches based on the unique geographical, sociopolitical, and cultural attributes of partnering tribal communities. These adaptations are largely shaped by trial and error. OBJECTIVES: The purpose of this article is to offer the prospective novice nurse researcher lessons that we learned when entering Indian country to conduct research for the first time. As indigenous and nonindigenous researchers, we are not seeking to set down a methodology but rather offer a list of processes, environments, timelines, and barriers that we never learned in didactic, seminar, clinical, practicum, or any other academic setting. METHODS: We organized a set of memories and thoughts through a series of semistructured iterative sessions specific to our first encounters as researchers in Indian country. We compiled our written responses and field notes from our dialogue, interpreted these data, and organized them into themes. We have reported what we felt would be the most surprising, frequent, or important information to note. RESULTS: We identified three overarching themes in our collective experience: orientation and negotiation, situating ourselves and our work, and navigating our way. Subthemes included perceiving ourselves as outsiders, negotiating distance and time realities, relying on the goodness of gatekeepers, shaping research questions per community priorities, honing our cross-cultural and intercultural communication skills, discovering the many layers of tribal approval processes, and developing sensibilities and intuition. DISCUSSION: Our previous experiences as novices leading research projects in Indian country have produced unique sensibilities that may serve to guide nurse researchers who seek to partner with tribal communities.


Assuntos
Pesquisa sobre Serviços de Saúde/organização & administração , Índios Norte-Americanos , Pesquisa em Enfermagem/organização & administração , Nativos do Alasca , Humanos
9.
PLoS Med ; 16(10): e1002935, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31613898

RESUMO

BACKGROUND: Although women at all career stages are more likely to leave academia than men, early-career women are a particularly high-risk group. Research supports that women are less likely than men to receive research funding; however, whether funding success rates vary based on research content is unknown. We addressed gender differences in funding success rates for applications directed to one or more of 13 institutes, representing research communities, over a 15-year period. METHODS AND FINDINGS: We retrospectively reviewed 55,700 grant and 4,087 personnel award applications submitted to the Canadian Institutes of Health Research. We analyzed application success rates according to gender and the primary institute selected by applicants, pooled gender differences in success rates using random effects models, and fitted Poisson regression models to assess the effects of gender, time, and institute. We noted variable success rates among grant applications directed to selected institutes and declining success rates over time. Women submitted 31.1% and 44.7% of grant and personnel award applications, respectively. In the pooled estimate, women had significantly lower grant success (risk ratio [RR] 0.89, 95% confidence interval [CI] 0.84-0.94; p < 0.001; absolute difference 3.2%) compared with men, with substantial heterogeneity (I2 = 58%). Compared with men, women who directed grants to the Institutes of Cancer Research (RR 0.86, 95% CI 0.78-0.96), Circulatory and Respiratory Health (RR 0.74, 95% CI 0.66-0.84), Health Services and Policy Research (RR 0.78, 95% CI 0.68-0.90), and Musculoskeletal Health and Arthritis (RR 0.80, 95% CI 0.69-0.93) were significantly less likely to be funded, and those who directed grants to the Institute of Aboriginal People's Health (RR 1.67, 95% CI 1.0-2.7) were more likely to be funded. Overall, women also had significantly lower personnel award success (RR 0.75, 95% CI 0.65-0.86; p < 0.001; absolute difference 6.6%). Regression modelling identified that the effect of gender on grant success rates differed by institute and not time. Study limitations include use of institutes as a surrogate identifier, variability in designation of primary institute, and lack of access to metrics reflecting applicants, coapplicants, peer reviewers, and the peer-review process. CONCLUSIONS: Gender disparity existed overall in grant and personnel award success rates, especially for grants directed to selected research communities. Funding agencies should monitor for gender differences in grant success rates overall and by research content.


Assuntos
Pesquisa Biomédica/organização & administração , Pesquisa sobre Serviços de Saúde/organização & administração , Pesquisadores , Apoio à Pesquisa como Assunto , Distribuição por Sexo , Academias e Institutos , Adulto , Distinções e Prêmios , Canadá , Escolha da Profissão , Feminino , Organização do Financiamento , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Saúde Pública , Análise de Regressão , Estudos Retrospectivos , Resultado do Tratamento
10.
Prog Community Health Partnersh ; 13(3): 273-282, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31564668

RESUMO

BACKGROUND: Collaborations between community health and academic partners hold promise for improving community health through research. OBJECTIVES: To develop, implement, and evaluate a partnership to build capacity for community-based research. METHODS: Development of the partnership was based on a participatory model that aimed to nurture strong infrastructure, clear communication, and trust between partners. Research training was individualized to assessed needs. Methods of evaluation included online surveys of partnership members comparing years 1 and 2 and appreciative inquiry (AI) interviews in year 3.Results and Lessons Learned: Course corrections from year 1 responses were implemented, and reflected in improvements on the second survey. Interviews highlighted mutual benefits of infrastructure developed in partnership; threats to sustainability were identified. Lessons learned included the importance of early course correction based on feedback, opportunities for communication, and building trust and a shared language. CONCLUSIONS: Partnerships develop through commitment and trust. Routine assessments and course correction may enable productive research partnerships.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Pesquisa Participativa Baseada na Comunidade/organização & administração , Relações Comunidade-Instituição , Pesquisa sobre Serviços de Saúde/organização & administração , Universidades/organização & administração , Serviços de Saúde Comunitária/métodos , Pesquisa Participativa Baseada na Comunidade/métodos , Acesso aos Serviços de Saúde/organização & administração , Pesquisa sobre Serviços de Saúde/métodos , Humanos , Relações Interinstitucionais , Cidade de Nova Iorque , Qualidade da Assistência à Saúde/organização & administração
11.
Eur J Gen Pract ; 25(4): 179-189, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31597502

RESUMO

Primary care is challenged to provide high quality, accessible and affordable care for an increasingly ageing, complex, and multimorbid population. To counter these challenges, primary care professionals need to take up new and innovative practices, including eHealth. eHealth applications hold the promise to overcome some difficulties encountered in the care of people with complex medical and social needs in primary care. However, many unanswered questions regarding (cost) effectiveness, integration with healthcare, and acceptability to patients, caregivers, and professionals remain to be elucidated. What conditions need to be met? What challenges need to be overcome? What downsides must be dealt with? This first paper in a series on eHealth in primary care introduces basic concepts and examines opportunities for the uptake of eHealth in primary care. We illustrate that although the potential of eHealth in primary care is high, several conditions need to be met to ensure that safe and high-quality eHealth is developed for and implemented in primary care. eHealth research needs to be optimized; ensuring evidence-based eHealth is available. Blended care, i.e. combining face-to-face care with remote options, personalized to the individual patient should be considered. Stakeholders need to be involved in the development and implementation of eHealth via co-creation processes, and design should be mindful of vulnerable groups and eHealth illiteracy. Furthermore, a global perspective on eHealth should be adopted, and eHealth ethics, patients' safety and privacy considered.


Assuntos
Assistência à Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Telemedicina/organização & administração , Pesquisa sobre Serviços de Saúde/organização & administração , Humanos , Segurança do Paciente
12.
Bull Hist Med ; 93(3): 365-400, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31631071

RESUMO

An influential policy network emerged from two overlapping developments of the 1970s and 1980s: new research programs focusing on tropical diseases and debates about how to implement the concept of primary health care at the World Health Organization. Participating actors came together in an informal network that, by the late 1980s, expanded advocacy to include the promotion and reorganization of all forms of research that might improve health in the Global South. This goal became associated with a search for new research methods for determining priorities, a quest that reached a peak in the early 1990s when the World Bank entered the picture. The bank brought money, economic analyses, and neoliberal ideology to the research advocacy movement and helped stimulate an upsurge of cost-effective forms of economic thinking in global health (GH) circles. This expanded research network provided some of the conceptual foundations and leadership for several of the most emblematic institutions of the new GH. These included new organizations to bring together and coordinate public and private actors in pursuit of common aims and new forms of economic rationality. The network's advocacy work contributed as well to a massive expansion of GH research at the turn of the century.


Assuntos
Saúde Global/história , Política de Saúde/história , Pesquisa sobre Serviços de Saúde/história , Pesquisa sobre Serviços de Saúde/economia , Pesquisa sobre Serviços de Saúde/organização & administração , História do Século XX , Humanos , Internacionalidade
13.
Health Res Policy Syst ; 17(1): 83, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31511008

RESUMO

BACKGROUND: Canada has been referred to as the land of 'perpetual pilot projects'. Effective innovations often remain small in scale, with limited impact on health systems. Several innovations have been developed in Canada to tackle important challenges such as poor access to services and excessive wait times - one of the most promising innovations that has been piloted is eConsult, which is a model of asynchronous communication that allows primary care providers to electronically consult with specialists regarding their patients' medical issues. eConsult pilot projects have been shown to reduce wait times for specialist care, prevent unnecessary referrals and reduce health system costs. eConsult has been spread throughout Ontario as well as to certain regions in Manitoba, Quebec, and Newfoundland and Labrador. Our aim is to understand and support the scale-up process of eConsult in Ontario, Quebec, Manitoba, and Newfoundland and Labrador. Our specific objectives are to (1) describe the main components of eConsult relevant to the scale-up process in each province; (2) understand the eConsult scale-up process in each province and compare across provinces; (3) identify policy issues and strategies to scaling up eConsult in each province; and (4) foster cross-level and cross-jurisdictional learning on scaling up eConsult. METHODS: We will conduct a qualitative multiple case study to investigate the scaling up of eConsult in four Canadian provinces using a grey literature review, key stakeholder interviews (10 interviews/province), non-participant observations, focus groups and deliberative dialogues. We will identify the main components of eConsult to be scaled up using logic models (obj. 1). Scaling up processes will be analysed using strategies adapted from process research (obj. 2). Policy issues and strategies to scale-up eConsult will be analysed thematically (obj. 3). Finally, a symposium will foster pan-Canadian learning on the process of scaling up eConsult (obj. 4). DISCUSSION: This study will likely increase learning and support evidence-based policy-making across participating provinces and may improve the capacity for a pan-Canadian scale-up of eConsult, including in provinces where eConsult has not yet been implemented. This work is essential to inform how similar innovations can reshape our health systems in the evolving information age.


Assuntos
Pesquisa sobre Serviços de Saúde/organização & administração , Atenção Primária à Saúde/métodos , Encaminhamento e Consulta/organização & administração , Consulta Remota/organização & administração , Especialização , Canadá , Acesso aos Serviços de Saúde/organização & administração , Humanos , Desenvolvimento de Programas
14.
Prof Inferm ; 72(2): 152-161, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31550432

RESUMO

In this first part of the article, we aim to provide health researchers with an understanding of how to design a qualitative health research study, including: topic identification, design selection, and engagement in reflexivity. We offer practical guidance for writing an overarching question using a novel framework that helps develop a clearly articulated question that includes the following elements: emphasis, purposeful sampling, phenomenon of interest, and context. We then expand on specific methodological issues: study designs, contexts, sampling, and recruitment. Finally, we provide examples of qualitative health research studies that illustrate the application of different research designs. In part two of this article, we will discuss how to prepare for going into the field, how to generate, manage and analyse data, and plan for the dissemination of qualitative health research.


Assuntos
Pesquisa sobre Serviços de Saúde/organização & administração , Pesquisa Qualitativa , Projetos de Pesquisa , Coleta de Dados/métodos , Humanos
15.
J Nurs Adm ; 49(10): 496-502, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31517757

RESUMO

OBJECTIVE: The purpose of this research study was to develop an innovative, standardized taxonomy for leader demographic data to gather consistent and comparable data across healthcare leadership studies. BACKGROUND: Minimum data sets help ensure consistent data collection strategies for standardized comparison among similar variables across settings. A standardized approach to collecting demographic data of healthcare workforce leadership will provide the structure necessary for researchers to more adequately compare the role of demographic characteristics in research outcomes. METHODS: This study was conducted using systematic literature review methodology with comparative analysis across demographic data sets. Two separate literature reviews were conducted: the 1st for studies of approaches to establishing minimum data sets and another for studies of healthcare leadership. RESULTS: The outcome of this study is the Shillam-Clipper Leadership Minimum Demographic Data Set tool that includes a comprehensive list of minimum demographic variables applicable to healthcare leadership research, a glossary of operational definitions for the identified demographic variables, and a clearly articulated set of instructions for consistent and accurate data collection. CONCLUSION: This standardized taxonomy will result in a consistent data set that will improve the effectiveness of comparative research.


Assuntos
Coleta de Dados/normas , Pesquisa sobre Serviços de Saúde/organização & administração , Projetos de Pesquisa/normas , Terminologia como Assunto , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Liderança , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos
16.
Value Health ; 22(8): 942-952, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31426936

RESUMO

BACKGROUND: Many investment cases have recently been published intending to show the value of new health investments, but without consistent methodological approaches. OBJECTIVES: To conduct a scoping review of existing investment cases (using vaccines and immunization programs as an example), identify common characteristics that define these investment cases, and examine their role within the broader context of the vaccine development and introduction. METHODS: A systematic search was conducted from January 1980 to November 2017 to identify investment cases in the area of vaccines and immunization programs from gray literature and electronic bibliographic databases. Investment case outcomes, objectives, key variables, target audiences, and funding sources were extracted and analyzed according to their reporting frequency. RESULTS: We found 24 investment cases, and most of them aim to provide information for decisions (12 cases) or advocate for a specific agenda (9 cases). Outcomes presented fell into 4 broad categories-burden of disease, cost of investment, impact of investment, and other considerations for implementation. Number of deaths averted (70%), incremental cost-effectiveness ratios (67%), and reduction in health and socioeconomic inequalities (54%) were the most frequently reported outcome measures for impact of investment. Health system capacity (79%) and vaccine financing landscape (75%) were the most common considerations for implementation. A sizable proportion (41.4%) of investment cases did not reveal their funding sources. CONCLUSIONS: This review describes information that is critical to decision making about resource mobilization and allocation concerning vaccines. Global efforts to harmonize investment cases more broadly will increase transparency and comparability.


Assuntos
Programas de Imunização/organização & administração , Investimentos em Saúde/organização & administração , Alocação de Recursos/organização & administração , Vacinas , Pesquisa Biomédica/organização & administração , Análise Custo-Benefício , Tomada de Decisões , Pesquisa sobre Serviços de Saúde/organização & administração , Disparidades nos Níveis de Saúde , Humanos , Programas de Imunização/economia , Investimentos em Saúde/economia , Alocação de Recursos/economia , Alocação de Recursos/normas , Fatores Socioeconômicos , Vacinas/economia
18.
Health Res Policy Syst ; 17(1): 76, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31391057

RESUMO

BACKGROUND: WHO has recognised the need to ensure that guideline processes are transparent and evidence based, and that the resulting recommendations are relevant and applicable. Along with decision-making criteria that require findings from effectiveness reviews, WHO is increasingly using evidence derived from qualitative evidence syntheses (QES) to inform the values, acceptability, equity and feasibility implications of its recommendations. This is the first in a series of three papers examining the use of QES in developing clinical and health systems guidelines. METHODS: WHO convened a group of methodologists involved in developing recent (2010-2018) guidelines that were informed by QES. Using a pragmatic and iterative approach that included feedback from WHO staff and other stakeholders, the group reflected on, discussed and identified key methods and research implications from designing QES and using the resulting findings in guideline development. Our aim in this paper is to (1) describe and discuss how the findings of QES can inform the scope of a guideline and (2) develop findings for key guideline decision-making criteria. RESULTS: QES resulted in the addition of new outcomes that are directly relevant to service users, a stronger evidence base for decisions about how much effective interventions and related outcomes are valued by stakeholders in a range of contexts, and a more complete database of summary evidence for guideline panels to consider, linked to decisions about values, acceptability, feasibility and equity. CONCLUSIONS: Rigorously conducted QES can be a powerful means of improving the relevance of guidelines, and of ensuring that the concerns of stakeholders, at all levels of the healthcare system and from a wide range of settings, are taken into account at all stages of the process.


Assuntos
Medicina Baseada em Evidências/organização & administração , Pesquisa sobre Serviços de Saúde/organização & administração , Guias de Prática Clínica como Assunto/normas , Pesquisa Qualitativa , Organização Mundial da Saúde/organização & administração , Aborto Induzido/normas , Comunicação , Tomada de Decisões , Medicina Baseada em Evidências/normas , Conhecimentos, Atitudes e Prática em Saúde , Pesquisa sobre Serviços de Saúde/normas , Humanos , Serviços de Saúde Materno-Infantil/normas , Cuidado Pré-Natal/normas , Papel Profissional , Revisões Sistemáticas como Assunto , Vacinação/métodos
19.
Health Res Policy Syst ; 17(1): 74, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31391071

RESUMO

BACKGROUND: This is the third in a series of three papers describing the use of qualitative evidence syntheses (QES) to inform the development of clinical and health systems guidelines. WHO has recognised the need to improve its guideline methodology to ensure that decision-making processes are transparent and evidence based, and that the resulting recommendations are relevant and applicable to end users. In addition to the standard data on effectiveness, WHO guidelines increasingly use evidence derived from QES to provide information on acceptability and feasibility and to develop important implementation considerations. METHODS: WHO convened a group drawn from the technical teams involved in formulating recent (2010-2018) guidelines employing QES. Using a pragmatic and iterative approach that included feedback from WHO staff and other stakeholders, the group reflected on, discussed and identified key methods and research implications from designing QES and using the resulting findings in guideline development. As members of WHO guideline technical teams, our aim in this paper is to explore how we have used findings from QES to develop implementation considerations for these guidelines. RESULTS: For each guideline, in addition to using systematic reviews of effectiveness, the technical teams used QES to gather evidence of the acceptability and feasibility of interventions and, in some cases, equity issues and the value people place on different outcomes. This evidence was synthesised using standardised processes. The teams then used the QES to identify implementation considerations combined with other sources of information and input from experts. CONCLUSIONS: QES were useful sources of information for implementation considerations. However, several issues for further development remain, including whether researchers should use existing health systems frameworks when developing implementation considerations; whether researchers should take confidence in the evidence into account when developing implementation considerations; whether qualitative evidence that reveals implementation challenges should lead guideline panels to make conditional recommendations or only point to implementation considerations; and whether guideline users find it helpful to have challenges pointed out to them or whether they also need solutions. Finally, we need to explore how QES findings can be incorporated into derivative products to aid implementation.


Assuntos
Medicina Baseada em Evidências/organização & administração , Pesquisa sobre Serviços de Saúde/organização & administração , Guias de Prática Clínica como Assunto/normas , Pesquisa Qualitativa , Organização Mundial da Saúde/organização & administração , Aborto Induzido/normas , Comunicação , Tomada de Decisões , Medicina Baseada em Evidências/normas , Conhecimentos, Atitudes e Prática em Saúde , Pesquisa sobre Serviços de Saúde/normas , Humanos , Serviços de Saúde Materno-Infantil/normas , Cuidado Pré-Natal/normas , Papel Profissional , Revisões Sistemáticas como Assunto , Vacinação/métodos
20.
Health Res Policy Syst ; 17(1): 75, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31391119

RESUMO

BACKGROUND: WHO has recognised the need to improve its guideline methodology to ensure that guideline decision-making processes are transparent and evidence based, and that the resulting recommendations are relevant and applicable. To help achieve this, WHO guidelines now typically enhance intervention effectiveness data with evidence on a wider range of decision-making criteria, including how stakeholders value different outcomes, equity, gender and human rights impacts, and the acceptability and feasibility of interventions. Qualitative evidence syntheses (QES) are increasingly used to provide evidence on this wider range of issues. In this paper, we describe and discuss how to use the findings from QES to populate decision-making criteria in evidence-to-decision (EtD) frameworks. This is the second in a series of three papers that examines the use of QES in developing clinical and health system guidelines. METHODS: WHO convened a writing group drawn from the technical teams involved in its recent (2010-2018) guidelines employing QES. Using a pragmatic and iterative approach that included feedback from WHO staff and other stakeholders, the group reflected on, discussed and identified key methods and research implications from designing QES and using the resulting findings in guideline development. RESULTS: We describe a step-wise approach to populating EtD frameworks with QES findings. This involves allocating findings to the different EtD criteria (how stakeholders value different outcomes, equity, acceptability and feasibility, etc.), weaving the findings into a short narrative relevant to each criterion, and inserting this summary narrative into the corresponding 'research evidence' sections of the EtD. We also identify areas for further methodological research, including how best to summarise and present qualitative data to groups developing guidelines, how these groups draw on different types of evidence in their decisions, and the extent to which our experiences are relevant to decision-making processes in fields other than health. CONCLUSIONS: This paper shows the value of incorporating QES within a guideline development process, and the roles that qualitative evidence can play in integrating the views and experiences of relevant stakeholders, including groups who may not be otherwise represented in the decision-making process.


Assuntos
Medicina Baseada em Evidências/organização & administração , Pesquisa sobre Serviços de Saúde/organização & administração , Guias de Prática Clínica como Assunto/normas , Pesquisa Qualitativa , Organização Mundial da Saúde/organização & administração , Aborto Induzido/normas , Comunicação , Tomada de Decisões , Medicina Baseada em Evidências/normas , Conhecimentos, Atitudes e Prática em Saúde , Pesquisa sobre Serviços de Saúde/normas , Humanos , Serviços de Saúde Materno-Infantil/normas , Cuidado Pré-Natal/normas , Papel Profissional , Revisões Sistemáticas como Assunto , Vacinação/métodos
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