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Systematic reviews from a policy perspective. Sara Hayes Director of Public Health, Abertawe Bro Morgannwg University Health Board Honorary Senior Lecturer, Swansea University. Background . Systematic reviews can be conducted on policy areas as well as defined health interventions
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Systematic reviews from a policy perspective Sara Hayes Director of Public Health, Abertawe Bro Morgannwg University Health Board Honorary Senior Lecturer, Swansea University
Background • Systematic reviews can be conducted on policy areas as well as defined health interventions • In many countries, local interagency collaborations have been introduced to improve health outcomes and evidence is needed on their effectiveness
Collaboration between local health and local government agencies for health improvement S Hayes, M Mann, F Morgan, H, Kitcher, M Kelly, A Weightman Published 2011 • Aimed to evaluate the effects of interagency collaboration between local health and local government agencies on health outcomes
What were we looking for? • Interventions delivered through interagency collaboration between statutory health and local government agencies, where the level of partnership between collaborators could be clearly determined and where the interventions were aimed at improving health
How did we define collaboration? • Two or more parties that pursue an agreed set of goals and work cooperatively toward a set of shared health outcomes • Local collaboration was judged to have taken place if there was evidence that the partners had agreed local joint working arrangements and shared objectives
Search strategy Twenty-five databases Relevant websites Experts were contacted Reference lists followed up for relevant • randomized controlled trials (RCTs) • controlled clinical trials (CCTs) • controlled before-and-after studies (CBAs) • interrupted time series (ITS)
Results • Eleven studies were identified, representing a total of 26,686 participants • Owing to the heterogeneity between studies a narrative synthesis was undertaken
Six studies of mental health initiatives - 1 showed health benefit - 4 showed modest improvement in one or more of the outcomes measured, but no clear overall health gain - 1 showed no evidence of health gain Two studies on lifestyle - 1 failed to show health gains - 1 showed more unhealthy lifestyle behaviours persisting in the intervention population Three studies on chronic disease management - all 3 failed to demonstrate health gains
Six studies of mental health initiatives - 1 showed health benefit - 4 showed modest improvement in one or more of the outcomes measured, but no clear overall health gain - 1 showed no evidence of health gain Two studies on lifestyle - 1 failed to show health gains - 1 showed more unhealthy lifestyle behaviours persisting in the intervention population Three studies on chronic disease management - all 3 failed to demonstrate health gains
Six studies of mental health initiatives - 1 showed health benefit - 4 showed modest improvement in one or more of the outcomes measured, but no clear overall health gain - 1 showed no evidence of health gain Two studies on lifestyle - 1 failed to show health gains - 1 showed more unhealthy lifestyle behaviours persisting in the intervention population Three studies on chronic disease management - all 3 failed to demonstrate health gains
Six studies of mental health initiatives - 1 showed health benefit - 4 showed modest improvement in one or more of the outcomes measured, but no clear overall health gain - 1 showed no evidence of health gain Two studies on lifestyle - 1 failed to show health gains - 1 showed more unhealthy lifestyle behaviours persisting in the intervention population Three studies on chronic disease management - all 3 failed to demonstrate health gains
Conclusions • The review did not identify reliable evidence that interagency collaboration, compared to standard services, leads to health improvement • A few studies identified some benefits but these were not reflected in overall outcomes and could have resulted from the use of significant additional resources • Methodological flaws and incomplete implementation of initiatives have prevented the development of a strong evidence base in this field
Recommendations • Health and local government services should ensure their standard services work well together • Pilot projects and new interventions should include health outcome measurement and evaluation in the study design from the start http://summaries.cochrane.org/CD007825/collaboration-between-local-health-and-local-government-agencies-for-health-improvement
What did I learn from the results of this review? • I have always worked in multidisciplinary settings. Am I now saying it’s all been a waste of time?
Port health officers, CsCDC and related agencies across Wales meet regularly and run exercises
Consider the limitations of the review • Projects and new programmes were compared to mainstream services • No evaluation of mainstream services themselves • Statutory partnerships were not included
What else might we want to know? • It is not yet clear how much resource should be spent supporting partnership working (eg through team meetings, joint training, shared staffing) compared to that used to deliver the required service • Our update will look for evidence on partnership evaluation in our included studies
How do we present these findings to policy makers? • This is a difficult message to give. • The findings can be expressed more positively ..... .......routine services perform as well as one-off projects and consideration needs to be given to maximising their effectiveness
How can we help policy makers? Encourage links between public health advocates and policy makers Help decision makers understand that not all evidence is of equal value Improve the quality of published papers Disseminate key findings Rigour is as important as enthusiasm in any new development
Conclusions for policy makers • Joint working between local services needs to be supported in line with local priorities and resulting health outcomes should be monitored • New service developments need to be evidence-based, evaluated at implementation and applied to the whole service if successful • Pilot projects should not be funded if there is no prospect of them being adopted across the whole service • The systematic review process can be a useful tool to assess the effectiveness of policy implementation
What might Archie say about this review? • Would he accept that the effectiveness of collaborative partnership working could be tested through the systematic review process? • Would he accept the principle of combining information from such diverse trials? • How should such information be analysed?
What did I learn from conducting this review? • It is possible to be a systematic reviewer while in a service post • I aim to be the advocate for the systematic use of evidence in service development • It is important to negotiate a commitment to the review in the job plan to be able to take part in group work in the working week • However...
