Boletim do Instituto de Saúde - BIS

Knowledge translation mechanisms for Evidence-Informed Policies formulation

Evelina Chapman — Fri, 01 Jul 2016 00:00:00 -0300

This paper discusses and proposes some methodological concepts of knowledge translation for policy and decision making processes, the evolution over time of key concepts, models and strategies to facilitate these processes. Also discusses the importance of implementation, considerations of equity and the need for monitoring and evaluation of these courses of action.

Consolidation for Evidence-Informed Policy Network - EVIPNet Brazil

Roberta Moreira Wichmann, Eliana Carlan, Jorge Otávio Maia Barreto — Fri, 01 Jul 2016 00:00:00 -0300

This article examines the implementing of the action plan for Evidence-Informed Policy Network (EVIPNet Brazil), describing its activities from January/2013 to March/2016 and discussing its relevance to the consolidation of the initiative as a knowledge translation platform for the Brazilian Public Healthcare System (SUS). A case study was written using a descriptive approach. The data were collected by the Executive Secretary of EVIPNet Brazil, by analyzing the annual reports and directly consulting the coordination of the Network in the Brazilian Ministry of Health. The study identifies activities in four categories: training activities, support to the development of the network, knowledge translation products and diffusion and dissemination activities. The most relevant activities include capacity building for implementation of the SUPPORT tools, lato-sensu graduate and online courses, public call press-release to support projects, building summaries (Evidence Brief for Policy), deliberative dialogues organizations, scientific articles publication, website maintenance, performance in virtual social networks and participation in scientific and management events. The results showed sustained growth of the activities of EVIPNet Brazil and suggest that the network is becoming a robust instrument of knowledge translation in Brazil.

Rapid response for evidence-informed health policy

Michelle M. Haby, Rachel Clark — Fri, 01 Jul 2016 00:00:00 -0300

It is widely accepted that health interventions underpinned by research evidence will be more effective than those that are not. However, in health policy making, with its non-linear decision making processes and competing political drivers, the use of research evidence to inform decisions is not straightforward. Often cited barriers include limited access to high quality research and poor relevance and timeliness of research; whilst improved collaboration and relationships between academics and decision makers have been cited as important facilitators of the use of research evidence. Rapid response programs have been initiated in order to overcome these barriers. They seek to facilitate the use of research evidence by ensuring timely and relevant provision of research and through close working relationships between researchers and decision makers. A program typically works to provide synthesized research evidence in a short timeframe. Rapid reviews of the literature are key products. At present there is wide variation in how such products are developed and little empirical evidence on how shortcuts in the review process might impact on review findings. Whilst rapid response programs and their products are potentially an important mechanism for supporting evidence-informed health policy decisions, these strategies need to be tested empirically

Methodological approach in EVIPNet Brazil

Jorge Otávio Maia Barreto, Tereza Setsuko Toma — Fri, 01 Jul 2016 00:00:00 -0300

We present the main points of SUPPORT (Supporting Policy Relevant Reviews and Trials) Tools for evidence-informed health policy making. SUPPORT Tools was presented in a series of articles published in 2009 in journal Health Research Policy and Systems. The series of 18 articles were translated into Portuguese and is available on the Internet. The SUPPORT Tools are very useful for teams in rigorous production of knowledge translation products on options to address a particular health problem, known as evidence brief for policy. EVIPNet Brazil adopts the SUPPORT Tools as main reference of methods for develop its institutional activities.

Where to find the evidence to inform health policy?

Carmen Verônica Mendes Abdala — Fri, 01 Jul 2016 00:00:00 -0300

The issue of access and use of evidence to support policy-making and decision-making processes in health is present in important strategies and recommendations of international and national organizations, as an element that contributes to meet the health priorities. The challenge facing policy and decision makers is where to seek this evidence in a universe of millions of documents, ranging from Google to more structured search systems, as are the Virtual Health Library and PubMed. This study presents the main information sources where that evidence could be finding.

Systematic review of complex public health interventions

Marcus Tolentino Silva, Taís Freire Galvão — Fri, 01 Jul 2016 00:00:00 -0300

Complex interventions are groups of interventions that usually involve changing behaviors. Such interventions are especially relevant to solve public health problems that require different strategies to be solved, as obesity and violence, for example. They offer support for decision making process. Present paper discusses concepts and methods to interpret scientific evidence of complex interventions assessed in systematic reviews. To context the processes of searching and critical assessment, we illustrated a scenario of strengthening the culture of patient safety in the hospital setting. The example is discussed from the definition of a wellstructured research question, which consists in defining the target population, characterization of intervention, comparison, outcome and context. Then we present the data sources to identify systematic reviews of complex interventions. We also present critical assessment criteria to help certifying the reliability of the systematic review. Ultimately, the interpretation of findings from weak evidence is discussed facing other parameters uses in decision making process. The practice of using systematic reviews about public health interventions is a strategy to allow to the process of policy-making in public health to identify the most effective intervention. This method is prone to contribute to health promotion to the population.

Elaboração e adaptação de Protocolos Clínicos informados por evidência na América Latina e Caribe

Fri, 01 Jul 2016 00:00:00 -0300

Objetivo: Identificar e descrever os componentes, vantagens e desvantagens dos Protocolos Clínicos, assim como o processo de desenvolvimento e o efeito deste nos países da América Latina e do Caribe (ALC). Métodos: Realizou-se uma revisão narrativa da literatura, com análise bibliométrica descritiva dos processos de elaboração dos Protocolos Clínicos na ALC. Resultados: O processo de elaboração de Protocolos Clínicos é sistemático, válido e reprodutível. Grading of Recommendations Assessment, Development and. Evaluation (GRADE) é a estratégia metodológica que se definiu como padrão em nível mundial para o desenvolvimento de Protocolos Clínicos, a partir da avaliação da qualidade de evidência científica. Na ALC o processo de elaboração de Protocolos Clínicos fortaleceu-se durante a última década com implantação institucional por parte do setor público, com efetividade na padronização da prestação de serviços de saúde, estabelecimento da governança do processo e fonte de informação para outras funções do sistema de saúde.

Relações entre medicina baseada em evidências e jornalismo

Patrícia Aline dos Santos, Maria Conceição da Costa — Fri, 01 Jul 2016 00:00:00 -0300

In this work we analyze changes in the medical field that interrelate with health journalism taking as a reference the Social Studies of Science and Technology (SSST). Our focus is the Evidence-Based Medicine (EBM), a set of practices in which clinical studies based on population samples are used for decision making in the medical field. EBM has been incorporated globally, including in Brazil, as part of medical practices, public policies, organizational management and other health frameworks. EBM practices go beyond the production and use of scientific knowledge in medicine. It reaches also activities for knowledge popularization about health and that includes journalism as we could observe in this study. Through interviews, we analyze work processes of journalists to identify relations with the changes brought by EBM. In our analyses, journalism contributes to the public acknowledgement of EBM practices, to comprehend its rationality and also to a critical view on how this knowledge has been built.

Policy options for controlling type 2 diabetes mellitus in the city of Franco da Rocha-SP

Fri, 01 Jul 2016 00:00:00 -0300

It is estimated that diabetes mellitus prevalence in Brazilian population is about 8%, and around 85 to 90% of all cases are type 2 diabetes mellitus (DM2). The disease arises insidiously having heredity, obesity, inadequate dietary habits, stress and sedentary lifestyle as predisposing factors. Economic and social burden of the disease are substantial due to acute and chronic complications, hospitalizations, disablements and premature deaths. Diabetes is considered as a sensitive condition to primary health care, being health teams in charge of improving patients’ compliance to treatment, including lifestyle changes. In Franco da Rocha, a city in São Paulo State, premature deaths regarding diabetes have increased in the last years, more frequently amongst men. A Policy Brief was elaborated with the aim to support the formulation of a public policy to control DM2 in that city. Following the proposed methodology of Evidence Informed Policy Network (EVIPNet) five options to manage DM2 were identified, from the search in the main scientific database for systematic reviews. These options, as well as their barriers to implement actions were discussed with the health team.

Evidence Brief for Policy about Strategies to Reduce Maternal Mortality in the Municipality of Franco da Rocha, Sao Paulo.

Fri, 01 Jul 2016 00:00:00 -0300

Brazil is still far from achieving the Millennium Development Goals undertaken in 1990 to reduce maternal mortality (MM). Currently, in the country about 69 women die per 100 thousand live births, but by the goals of the United Nations, that number should be a maximum of 35 women. In this context, it is possible to emphasize that the main causes of these deaths are hypertension, hemorrhage, complications of abortion in unsafe conditions and postpartum infections. Moreover, we note high rates of MM in Brazil in remote areas, where access to health networks is almost non-existent and / or precarious. In the city of Franco da Rocha, the high MM rates have been worrying policy makers, especially because it is related to causes considered preventable. This article presents some of the results of a Policy Brief prepared by students of the Professional Program in Public Health at Instituto de Saúde, with the support of its Evidence Center, which is part of the Evidence Informed-Policy Network - EVIPNet Brazil in order to support municipal policy makers in Franco da Rocha in decision making for reducing MM.

Health policy options aimed at reducing inappropriate prescriptions of antidepressant drugs

Fri, 01 Jul 2016 00:00:00 -0300

Mental disorders generate high social and economic costs, leading to decreased quality of life for those people affected by them. Although there are different therapeutically approaches to these diseases, in the last 10 years, there has been a significant increase in consumption and use of psychoactive drugs in the world. Technicians and managers of Franco da Rocha’s municipal Secretary of Health expressed concern about the medicalization of mental suffering in their municipality. A data survey was conducted, and the results confirmed the existence of high rates of prescribed antidepressants and inappropriate prescriptions of those drugs. A synthesis of scientific evidence of health policies was produced to propose options to reduce inappropriate and/or unnecessary prescription of antidepressants in Franco da Rocha. Evidence-Informed Policy Network (EVIPNet) methodology was used. From the reading of systematic reviews, four options were identified to respond to the problem posed. The evidence brief for health policy will be presented to professionals and managers of the Health Department of Franco da Rocha’s City by conducting a deliberative dialogue.

Evidence brief for policy

Emiliana Maria Grando Gaiotto, Sonia Isoyama Venancio — Fri, 01 Jul 2016 00:00:00 -0300

This article presents some of the main results of an Evidence Brief for Health Policy, developed in the Professional Master’s Program in Public Health of the Instituto de Saúde , in which four viable options were identified to address the problem about perinatal mortality at Porto Feliz city: a) qualification of pre -natal through risk rating for pregnant and adequacy of management of examinations; b) development of prevention and treatment protocol respiratory distress of newborn; c ) implementation of family planning with a focus on prevention of teenage pregnancy and prevention and treatment of illicit drug use during pregnancy d) structure and organization of education actions in health and home visits in prenatal and puerperium. Each identified option also took up issues related to equity and possible barriers to implementation of interventions. The analysis of equity related to the implementation of the options, especially considering access to health services, the identification of the training needs of teams to work on specific themes and the development of health education to the community were included so that options do not produce different results for different groups in the city

Experience report of a working group on evidence brief for policy in a medium-sized municipality of the São Paulo State, Brazil

Emiliana Maria Grando Gaiotto, Sonia Isoyama Venancio — Fri, 01 Jul 2016 00:00:00 -0300

The Evidence Informed Policy Network (EVIPnet) proposes a focused approach to participatory planning and aims to promote sustainable partnerships between policy makers, researchers and civil society to use the best scientific evidence, contextualizing the reality of the country on public health issues The purpose of this article 1) describe the implementation experience of Evidence Group in a medium-sized city of State of Sao Paulo and 2) describe the development stages next to a multidisciplinary team for the definition and characterization of a priority health problem the development of an evidence synthesis. For the initial discussions of the evidence group, we used the technique of brainstorming, having been appointed the main organizational problems of municipal health area. Through this study, we contribute to the production of knowledge, in order to overcome some challenges in Public Health practices and it may serve as a basis for the use of evidence for decision-making and preparation of action plans municipalities with similar characteristics

A rapid review on rapid reviews

Tereza Setsuko Toma, Amanda Cristiane Soares — Fri, 01 Jul 2016 00:00:00 -0300

Rapid reviews in the context of health decisions have been widely used and gained legitimacy over time. Under various names, rapid reviews have been employed as in the process of incorporation, change and exclusion of health technologies in the macro and meso levels of the health system, as in clinical decisions and even in supporting the development of health policies. The purpose of this rapid review was to analyze the scientific literature on rapid reviews, with emphasis on methodological aspects. From a search performed in five scientific literature databases twelve studies were selected for analysis. It was found that, despite the growing discussion about the rapid reviews in recent years, there is still no consensus of the international community regarding their definition, the time of execution of this type of study, the standardization of a methodology and its applications. Seminar held in Canada in 2015 highlighted the growing importance of rapid reviews, their practices and gaps. Three key areas that emerged in the discussion were: how to conduct a rapid review and understand their validity and utility, and how to improve access to them. Given the nature of rapid reviews they often are not published, so it is important to create opportunities to share this information. Brazil, as example of some countries, developed methodological guidelines for the preparation of quick review, which is in its fourth edition.

The cost-minimization analysis of the Top Maternal and infant radiant warmer for temperature maintenance of healthy newborns in the first hour of life

Fri, 01 Jul 2016 00:00:00 -0300

Introduction: Systematic reviews and a clinical study conducted at the Maternity Hospital Leonor Mendes de Barros (HMLMB) found that healthy newborns exposed to infant radiant warmer (IRW) or skin to skin contact favored by TOP Maternal (TOP) in the first hour of life, have an equivalent thermoregulation. Objective: To analyze the cost of the infant radiant warmer and TOP Maternal to serve the healthy newborns in the first hour of life in order to maintain their temperature. Method: The cost-minimization analysis on assistance to newborns with use of TOP Maternal and infant radiant warmer. Results: It was identified that the cost of care on average to newborns in IRW is R$ 3.39, while the TOP is R$ 0.75. Conclusion: It can be identified by studying the amount spent on the TOP is more than four times lower when compared to IRW. Both the infant radiant warmer, as the TOP Maternal keeps the recommended temperature for thermoregulation, but the use of TOP can provide other benefits such as: calm the baby, breastfeeding success and mother-child bond already described in literature. The infant radiant warmer is still recommended equipment for newborns with limited temperature adaptation to the environment, such as premature and low-birth-weight infants.