Measuring impact
Intuitively it may seem obvious that access to essential healthcare information is as important as access to essential medicines to support safe, effective health care. However, demonstrating the impact of healthcare information on knowledge, practice and health outcomes is not straightforward. The links are complex and incompletely understood.
There is a lack of research in this area, particularly in developing countries. For example, the quote below from WHO (2006) ‘Experience clearly shows that simply disseminating guidelines is ineffective’ is based on six studies, all of which were carried out in information-overloaded industrialized countries. That said, the experience of HIFA2015 members confirms that ‘pushing’ health information without an understanding of information needs is a recipe for failure.
What HIFA2015 members say
[Content in preparation]
Quotes from the literature
‘Evidence shows that having information does help health workers to do their jobs better, as long as certain provisos are met: the information must be relevant to the job and available when needed, and workers must have a degree of confidence in the information’s quality and understand what it is ‘saying’.’
World Health Organization 2006
‘Experience clearly shows that simply disseminating guidelines is ineffective (99-104). If guidelines are passively distributed, few people read them, even if they are followed by reminder visits. When guidelines are distributed during a training course, however, and supported by peer groups to discuss the content and to provide audit and feedback to participants or associated with subsequent supervisory visits, they are significantly more likely to be implemented.’
World Health Organization 2006
‘The impacts of countless activities such as training courses, in-service seminars, formularies, drug supply improvements, drug bulletins, or standard treatment guidelines designed to improve drug use are simply not known.’
Ross-Degnan D et al 1997
‘Current evidence for the effectiveness of interventions to change health professionals’ behaviour in developing countries is either scanty or flawed due to poorly designed research. Given the recent drive to improve quality of care, this should be a priority area for researchers and international agencies supporting health systems development in developing countries.’
Siddiqi K et al. 2005
‘Two studies in Peru and China showed significant improvement [in compliance with clinical guidelines] following the introduction of an educational package which was informed by educational needs assessment of the primary and secondary health professionals, respectively.’
Siddiqi K et al 2005
‘There is a dearth of evidence indicating whether and how the provision of up-to-date medical information can lead to change in practice in developing country settings.’
Geyoushi et al 2003
‘Ability to evaluate the impact of knowledge translation strategies was lacking in all agencies.’
Cordero C et al 2008
‘More research is needed to demonstrate unequivocally the cost-effectiveness of continuing medical education in resource-poor settings, the most appropriate ways of providing and supporting it, and ways of ensuring long-term sustainability.’
Kamran Siddiqi & James Newell 2005
‘Health workers in the developing world are starved of the information that is the lifeblood of effective health care. As a direct result, their patients suffer and die.’
Pakenham-Walsh N, Priestley C & Smith R 1997
‘Providing access to reliable health information for health workers in developing countries is potentially the single most cost effective and achievable strategy for sustainable improvement in health care.’
Pakenham-Walsh N, Priestley C & Smith R 1997
‘An overall trend towards a decrease in proportion of patients prescribed antibiotics in the two intervention groups was seen, although the difference was not significant… The weaker than expected effect of information may be due to lower overall antibiotic prescribing than in other Asian countries, and that information was not targeted at identified misuse.’
Angunawela I et al 1991
‘No study explored why printed materials were ineffective, but it is not surprising that passive distribution of printed materials does not automatically change behaviour: information may have been difficult to access when it was needed, may have been difficult to understand, or may have been irrelevant.’ Barton S 2001
‘It is difficult to quantify benefits and to assign monetary values because the benefits often are not direct. The benefit may be a long way off, geographically or in time, from the actual point of use. A university student who has used the services at the library may well benefit throughout the rest of his life. However, it will be almost impossible to quantify the benefits that result from the investment in the university library. It is almost impossible to disaggregate causes and effects and to attribute quantifiable benefits back to the information service.’
Rasmussen A 2001
References
Barton S. Using clinical evidence. BMJ 2001;322:503-4
Geyoushi et al. Pathways to evidence-based reproductive healthcare in developing countries. Br J Obs and Gynae 2003; 110: 500-507
Ross-Degnan D et al 1997. Improving pharmaceutical use in primary care in developing countries: a critical review of experience and lack of experience. International Conference on Improving Use of Medicines. Chiang Mai, Thailand.
Siddiqi K & Newell J 2005. WHO Bulletin 2005, 83 (12), 882
World Health Organization. World Health
Report 2006: working together for health.
