Parallel Session 2.2 Health Technologies: Making Choices, Spending Wisely

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  • 1. Health Technologies: Making Choices,Spending WiselyNHSScotland Event Thursday 21 June2012

2. Health technologies: makingchoices, spending wisely andpublic involvement 3. Public Involvement in making choices and spending wisely Helen CaddenChair, Public Involvement Collaborative Public Partner, Scottish Medicines ConsortiumMember, Scottish Health Council Richard Norris Director, Scottish Health Council 4. Overarching Medicines and TechnologiesGroup To provide strategic oversight of all assessment andadvice for health technologies activity within theorganisation. To facilitate synergy and joint working. To ensure that Healthcare Improvement Scotlandshealth technologies work is aligned with the NHSScotland Quality Strategy and the Scottish Governmentsstrategic approach to health technologies. 5. Public Involvement Collaborative Brings together patient and public representatives Representative on Overarching Medicines andTechnologies Group Developing two-way dialogue and identifying publicinvolvement issues not just about shadowingOverarching Medicines and Technologies Group Agree areas of good practice in patient and publicinvolvement Identify any gaps in involvement activities within thecurrent areas of work 6. Public involvement collaborative structure 7. Scottish Health Council Set up in 2005 to support, ensure and monitor patientfocus and public involvement in the NHS 14 local offices across Scotland, National Chair andCommittee Developed and implemented the Participation Standard Part of Healthcare Improvement Scotland and supportswider organisation to meet Duty of User Focus Publications and case studies on website: 8. Involving patients in assessing medicinesfor use in the NHS Scottish Medicines Consortium Patient and Public Involvement Group ensure that theneeds of patients and the wider public are brought intofocus during the Scottish Medicines Consortium decision-making process Integral part of the process - need a perspective fromthose who have experience of the disease or condition Three Patient and Public Involvement Grouprepresentatives on Scottish Medicines Consortium Summarise submissions from Patient Interest Groups 9. Patient interest groups submissions 2010 8 8 7 666 55 55 5 4 4 4 3 3 333 2 22 111 10 JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DECNumber of Drugs with Patient Interest Groups submissionsactual number of patient interest groups submissionsnumber of drugs submission to SMC(FULL & RE) 10. Patient Interest group submissions 2011Number of Drugs with Patient Interest Groups submissionsactual number of patient interest groups submissions8Number of submission to SMC(FULL & RE)6 6 645 5 7 6 6 655 552 43 3 4 311 1122 12 2 3 4 112 2 4 4 220JANFEBMARCH APRILMAY JUNEJULYAUG SEPTOCT NOV DEC 11. Scottish Medicines ConsortiumEvaluation: Impact of Public Involvement October 2003 to December 2007, 117 Patient InterestGroup submissions presented for 97 new medicines 63% of those submissions supported by a PatientInterest Group were accepted or accepted withrestrictions2008 data 12. Patient Interest Group submissions January - June 201298876 6655554 44444 3332 222111 000000 000 000 0000000jan feb marchApril MayJune July AugSeptOctNovDecTotal Drug Submission to SMCNumber of Drug Submission with a PIGActul Number of PIGs received 13. SMC decisions Jan 2010 - Dec 2011 Full and re submission only accepted 26%not accepted42% accepted restricted 32% 14. Area Drug and Therapeutic Committees One in each board makes local decisions on whatmedicines are made available Individual Patient Treatment Requests Event in March bringing together Committee membersfrom across Scotland Confusion over different terminology in different boards Variation in how and if members of public are involved Variation in understanding about decision making Agreed that Public Involvement Collaborative wouldproduce Good Practice Toolkit 15. Disinvestment What does it mean? What questions do we ask the public? How do we ask the public? Does the public speak with a single voice? Do we accept what the public say? Work with National Institute for health and ClinicalExcellence (NICE) 16. Karen GrahamPatient Involvement Officer, SIGN 17. What is SIGN? Scottish Intercollegiate Guidelines Network Set up in 1993 to produce guidelines for NHSScotland Initiative from medical Royal Colleges and otherprofessional organisations SIGN has evolved over time to include other healthcareprofessionals, patients and lay representatives at allstages of our work 18. SIGN methodology Guidelines are developed by multidisciplinary nationallyrepresentative groups A systematic review is undertaken to identify and criticallyappraise the literature Recommendations are explicitly linked to the supportingevidence 19. Health technology : patient versions of guidelines 20. What is the purpose of patient versions of guidelines? To help patients and carers understand what the latestevidence supports around:diagnosis, treatment and self-care to empower patients to participate fully in decisionsaround management of their condition in discussion withhealthcare professionals highlight for patients where there are areas of uncertainty 21. Developing patient versions with patientsand carers Sub-group formed from main clinical guideline Highlight recommendations where there is a choice forpatients or specific actions they may take Form a question, word an answer Additional content Simple language Draft edited by SIGN 22. Translation of recommendations into plainEnglishRecommendation Patients with diabetes and CKD stages 3-5 should have theirhaemoglobin checked at least annually. Erythropoiesis stimulatingagents should be considered in all patients with anaemia of chronickidney disease, including those with diabetic kidney disease.Translation If you have advanced chronic kidney disease, you must have your haemoglobin levels checked at least once a year. You may get medication to help your body to make red blood cells. 23. Consultation with patients, carers and members of the public Draft distributed to relevant voluntary groups andmembers of the SIGN patient network for comment Draft edited and improved based on comments 24. Ensuring quality of patient versions Evidence based SIGN editorial group accurate translation of theevidence? Plain English Campaign 25. The end result 26. Ensuring our patient versions are accessible 27. How can patient versions of guidelines help to promote patient choice? Allows priorities to become clear to patients and carers highlight to patients (and healthcare professionals!) thoseinterventions which have the greatest evidence of benefit clearly identify treatments for which there is no evidence potentiallyreducing the use of/demand for unproven therapies identify lifestyle interventions and ways in which the patient can takesteps to manage their condition potentially reducing unnecessaryconsultations 28. What have clinicians said about our patient versions?Give patients clear, unbiased information in relation totherapies available and their effectivenessUsing the patient version serves to let people know thatthere are nationally agreed interventions availableThe patient version of the ASD guideline is very useful, we aim to give each family a copy. It is reassuring for families to have this information based on the latest evidence. We wouldnt use anything else. 29. What have patient groups said about our patient versions?it answers questions that people go away with but do notactually ask, plus you can go back to it to recap, plus iteven answers questions professionals have when askeda question by a carer or patient which can sometimesmeet a oh I dont know and the patient, carer leavingwith worryif we were given these, we would need to see our GP lessbecause we would know how to look after ourselves 30. Group Task Work in groups to identify from the 4 patient versionsprovided: An area of clinical uncertainty An intervention with no evidence An intervention with no evidence of safety Some indications for self- care Some well established effective therapies An area where the patient has a clear choice to make


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