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Evidence-based health care and health technology assessment
Evidence-based health care needs evidence, or more specifically, high quality research based evidence to answer the specific questions generated by clinicians and their patients in making diagnostic and therapeutic decisions. The problem is that research has traditionally not been focused on these needs. Hitherto, the main drivers of the research agenda have been:
The enquiring minds of clinical and non-clinical scientists, supported and guided by funders (in the UK, governmental organisations, such as the Medical Research Council, and charities are important)
Enthusiasts working in routine clinical practice (as the demands of work allow).
In the UK, the National Health Service's (NHS) research and development strategy, launched in 1991, sought “to create a knowledge-based health service in which clinical, managerial and policy decisions are based on sound information about research findings and scientific developments.”1 The health technology assessment (HTA) programme was established as part of this and has the aim:
“To ensure that high quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and work in the NHS.” 2
The term “health technologies,” although it may conjure up images of gleaming complex machinery attended upon by white coated technocrats, is used throughout the world in a broad way. In common with others, the HTA programme defines health technologies as:
“all methods used by health professionals to promote health, prevent and treat disease and improve rehabilitation and care.”
All mental health interventions (drugs, devices, procedures, and settings) therefore fall well within the remit of the programme. HTA is the evaluation of the costs, effectiveness, and broader impact of health technologies. The endpoints of evaluation should be patient centred outcomes and estimates of the cost effectiveness of technologies. HTA is therefore pragmatic. It aims to …
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