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Some recommended reading: on research, policy, healthcare and the media

Below are short summaries of recent journal and other articles that may be of interest, investigating:

• Trends in Indigenous health research
• What policy makers really want from researchers
• An evidence-based analysis of GP super clinics
• Some suggestions for media reporting from US health policy expert Don Berwick  

(Links to the papers are provided but if you’d like a copy, please leave your details below or email me direct.)

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Indigenous health research deserves greater priority

If the volume of research into a health issue is an indicator of its importance, then Indigenous health is not the priority for Australia that it should be.

That’s one implication of a recent study that identified all publications (820 in total) referring to the health of Indigenous Australians that were authored by Australian researchers between 1972 and 2008.

The study, published by the Australian and New Zealand Journal of Public Health, found that research publications referring to Indigenous health, while remaining relatively small in number, grew at an average annual rate of 14.1%, compared with 8.2% across all fields of Australian research.

The growth rate shown was equal second highest in the study’s seven categories of health and medical research. However, Indigenous publications were cited significantly less than the Australian average. As well, almost 25% of the Indigenous health related publications included in the study were not exclusively related to Indigenous health, but included data on Indigenous health as part of a wider population study.

The researchers from University of Sydney and University of Melbourne say:“Research concentration and impact can be seen as an index of the importance of a health problem to a nation. The low visibility of Australian Indigenous health-related research does not demonstrate a level of concern commensurate with the gravity of Indigenous health problems. While there has been positive growth in publications referring to Indigenous health, the attention paid to this research through citations remains disappointingly low.”

The study did not include “grey literature” such as government and non-government organisation reports, books, and websites. But it’s not only the volume of research that counts – also the quality. We know from a previous study that researchers have tended to concentrate on describing the problems in Indigenous health, rather than testing interventions.

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What policy makers want from public health researchers: independence and media savvy

This study, titled Galvanizers, Guides, Champions, and Shields: The Many Ways That Policymakers Use Public Health Researchers is a must-read for those interested in the intersections between evidence, researchers, the media and policy.

Researchers interviewed 32 Australian civil servants, parliamentary ministers, and ministerial advisers who had been identified as “research-engaged” by public health researchers questioned in an earlier phase of the project.

The public servants, who were the largest group in the study, were middle- to high-ranking career employees in state government agencies that develop and administer health-related policies and programs. Other interviewees were from regulatory agencies or were elected officials.

It’s one of those studies where it would be interesting to read the transcripts of the entire interviews.

Conducted by researchers from The Sax Institute, University of Sydney, Menzies Centre for Health Policy, University of Queensland, Institute of Public Goods and Policies, the study is published in Milbank Quarterly.

It investigates, amongst other things, how research-engaged policymakers use researchers (as adjuncts or alternatives to published research; as colleagues, informants, allies, or champions, or some mix of these roles).

The study found that how researchers were used depended on their role and position, the stage of policy development in which they were engaged,  the level of contention about the policy, and the policy makers’ assessment of the researchers’ academic credentials, trustworthiness, communicative expertise, and understanding of research-to-policy processes.

The findings might surprise cynics who believe that policymakers only want researchers to tell them what they want to hear.

“In fact, there was a sense that politicians in particular appreciated researchers who were robust, creative thinkers who understood the policy environment but were unadulterated by bureaucratic acculturation,” the researchers reported.

“Indeed, the credibility of researchers for policymakers, stakeholders, and the public alike was contingent on their being seen as independent representatives of science and, by implication, nonpartisan, dispassionate, and thus antithetical to politics.”

The most consistently described attribute of researchers who were effective agents of persuasion was their ability to make research-based assertions in the public sphere, especially in the media. Their value lay not only in their authority as experts but also in their perceived independence.

As one policymaker said: “We have a few contacts that we use who speak to the media when we can’t. So it’s of benefit to us to have people that can speak independently and boldly.”

Policymakers relied on the independence of researchers to combat what they saw as profound public scepticism about political expediency and dishonesty in policymaking. For example, a ministerial adviser talked about the importance of researchers “being known for being independent at a time when governments have decreasing levels of legitimacy in terms of being trusted.”

The policymakers widely agreed that researchers had greater credibility than policymakers did.  As one adviser put it, “For good or for evil, people out there will trust a scientist before they trust a politician.”

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What do we know about GP super clinics? (Not enough)

Croakey has often wondered what to make of GP super clinics – it’s been difficult to gain a clear picture amid the noise created by various interests.

It’s useful to have this analysis from the Primary Health Care Research &  Information Service, giving an overview of the background, goals and current state of knowledge. Overall, the paper concludes that the jury is still out, hence the importance of proper evaluation.

It notes that the Australian Government expects that bringing primary care professionals under one organisational structure is expected to significantly facilitate the integration and coordination of care.

However, their funding model is likely to ensure their focus is on providing health care to individual patients who present to the centre, rather than a focus on improving health of a defined population; explicitly addressing equity; or a focus on social determinants of health.

The paper says that the limited number of clinics means they will not achieve population level change on their own, but may act as a stimulus to the development of more comprehensive and integrated primary health services elsewhere in the private, non-government and public sectors.

GP Super Clinics and their state-based cousins, GP Plus and HealthOne NSW, are still in their formative stages. It is therefore too early to judge their success in improving health care, and it is also unclear whether they will prove to be the best way of integrating primary care, or whether other types of networks of services may be more appropriate under some circumstances.

The review says the overseas evidence is limited but stronger for broader primary health care rather than extended general practice services. However this reflects the scarcity of evaluations and the difficulty of showing an effect.

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A health story that deserves more exposure: Don Berwick

Charles Ornstein, an investigative journalist with Pro Publica and president of the Association of Health Care Journalists, recently interviewed Don Berwick, an international guru on healthcare quality, for the AHCJ.

The interview, canvassing issues ranging from the quality of health reporting to the the importance of transparency in health services, is worth a read.

Berwick, described by the AHCJ as “one of the most thoughtful and powerful forces in US health care”, would like to see less “gotcha”, superficial journalism, and more media focus on ways to improve health care while reducing costs.

He tells Ornstein: “This is an urgent time to find ways to reduce health care costs without harming people at all – and it’s clearly possible. There are improvements in care that I am absolutely certain, not from my administration experience, but from my 30 years before, reduce expenses and improve care. I have not seen that grappled with in the way that it really needs to in the media. It’s a social necessity but it’s an important intellectual endeavour. Shannon Brownlee [at New America Foundation] has done a very good job. I don’t think the media has gotten into the “more-is-better” myth enough.”

Berwick, whose recent politically forced departure from the Centers for Medicare and Medicaid Services is lamented in this NYT piece, says he is now in “a contemplative period” and remains on a mission to help health care get better globally. “I’m giving speeches and want to speak out and have many thoughts I want to share,” he says.

Sounds like the timing may be right for those interested in enlisting Berwick in like-minded causes.

 

 

 

 

 

 

 

 

 

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