Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen
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Z Evid Fortbild Qual Gesundhwes · Jan 2014
Comparative StudyRevolution then evolution: the advance of health economic evaluation in Australia.
All governments face immense challenges in providing affordable healthcare for their citizens, and the diffusion of novel health technologies is a key driver of growth in expenditure for many. Although important methodological and process variations exist around the world, health economic evaluation is increasingly seen as an important tool to support decision-making around the introduction of new health technologies, interventions and programmes in countries of varying stages of economic development. In Australia, the assessment of the comparative cost-effectiveness of new medicines proposed for subsidy under the country's national drug subsidy programme, the Pharmaceutical Benefits Scheme, was introduced in the late 1980s and became mandatory in 1993, making Australia the first country to introduce such a requirement nationally. Since then the use of health economic evaluation has expanded and been applied to support decision-making across a broader range of health technologies, as well as to programmes in public health.
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Z Evid Fortbild Qual Gesundhwes · Jan 2014
The NICE process for developing quality standards and indicators.
This paper describes the core principles and processes used by the National Institute for Health and Care Excellence (NICE) to develop quality standards and quality indicators from evidence based guidelines.
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The American Board of Internal Medicine (ABIM) Foundation launched the Choosing Wisely campaign in 2012 and until today convinced more than 50 US specialist societies to develop lists of interventions that may not improve people's health but are potentially harmful. We suggest combining these new efforts with the already existing efforts in clinical practice guideline development. Existing clinical practice guidelines facilitate a more participatory and evidence-based approach to the development of top 5 lists. In return, adding top 5 lists (for overuse and underuse) to existing clinical practice guidelines nicely addresses a neglected dimension to clinical practice guideline development, namely explicit information on which Do or Don't do recommendations are frequently disregarded in practice.
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Z Evid Fortbild Qual Gesundhwes · Jan 2014
[Reflections on 20 years of clinical practice guideline programmes in Germany: what is their impact?].
Following a recommendation of the National Advisory Council for the Concerted Action in Health Care, the Association of the Scientific Medical Societies (AWMF) have promoted, supported and coordinated the development of clinical practice guidelines in Germany since 1995. The allocation of the responsibility for guideline development in the scientific societies corresponded to the principle of subsidiarity, in contrast to other countries counting on government-organised guideline programmes. ⋯ The next challenging goal is to establish a theory-driven framework allowing for a systematic implementation and evaluation of guidelines in Germany on the basis of existing approaches. However, success in this endeavour will require further research and funding.
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Z Evid Fortbild Qual Gesundhwes · Jan 2014
[Dealing with uncertainty--the hypermodernity of general practice].
The general practitioner is fundamentally dealing with uncertainty. On the one hand, we want to demonstrate that uncertainty cannot simply be stipulated as a matter of fact. Instead, we will show that this uncertainty is a performative effect of the primary care setting. On the other hand, we want to point out that the general practitioner's ability to bear uncertainty is a genuinely hypermodern way of productively dealing with uncertainty.