Opportunistic evidence: evidence-based policy in the setting of the Australian Government’s chlamydia screening pilot
Simon R. CrouchA Department of Health and Ageing, GPO Box 9848, Melbourne, VIC 3001, Australia.
B La Trobe University, Faculty of Health Sciences, School of Public Health, Melbourne, VIC 3086, Australia. Email: simonrcrouch@hotmail.com
Australian Health Review 36(1) 57-60 https://doi.org/10.1071/AH10942
Submitted: 4 July 2010 Accepted: 29 April 2011 Published: 15 December 2011
Abstract
Objective. Chlamydia prevention and control form a significant part of the Australian Government’s sexual health policy. This paper examines the evidence for policy development and in particular the role of systematic reviews in evidence-based policy.
Methods. The author undertook a review of the literature on evidence-based policy. The major theories for evidence-based policy were then linked to the Australian Government’s main chlamydia policy.
Results. A systematic review on chlamydia screening has been influential in policy development, but like all systematic reviews its validity must be assessed. It has been suggested that methodological appropriateness and the question being asked are perhaps more important than study design per se. Partnerships between researchers and policymakers are important but it should be noted that experts have their own particular biases. Policymaking can also be determined by political ideologies.
Conclusions and implications. The publication of a systematic review has provided a good summative evaluation of chlamydia screening that has been built upon through partnerships with researchers. The resulting chlamydia screening pilot will provide further evidence for future policy; however, a variety of sources are required to develop robust policy directions.
What is known about the topic? Systematic reviews are often considered to be the best evidence on which to base policy decisions. In practice it is not always the case that best evidence is used to form policy. As well as systematic reviews, which are not always infallible, there are many other factors that affect the development of national health policy.
What does the paper add? This paper provides a consideration of the role of systematic reviews in policy-making, as well as some of the pitfalls to this approach. As an example, it provides the Australian Government’s policy on chlamydia control and looks at other factors that may have contributed to the development of this policy.
What are the implications for practitioners? All practitioners involved in policy decisions should consider the evidence-base from which their policies are derived. They should understand the sound basis of the systematic review while accepting that other pressures may affect the processes leading up to the formation of good health policy.
Additional keywords: health policy, review.
References
[1] National Sexually Transmissible Infections Strategy, 2005–2008. Canberra: Commonwealth Department of Health and Ageing; 2005.[2] National Notifiable Diseases Surveillance System. Commonwealth Department of Health and Ageing, Communicable Diseases Branch. Available at http://www9.health.gov.au/cda/Source/CDA-index.cfm [verified 30 Jun 2009].
[3] Second National Sexually Transmissible Infections Strategy, 2010–2013. Canberra: Commonwealth Department of Health and Ageing; 2010; p. 9.
[4] Low N, Bender N, Nartey L, Shang A, Stephenson JM. Effectiveness of chlamydia screening: systematic review. Int J Epidemiol 2009; 38 435–48.
| Effectiveness of chlamydia screening: systematic review.Crossref | GoogleScholarGoogle Scholar | 19060033PubMed |
[5] Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol 2007; 7 10
| Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews.Crossref | GoogleScholarGoogle Scholar | 17302989PubMed |
[6] Shea BJ, Bouter LM, Peterson J, Boers M, Andersson N, Ortiz Z, et al. External validation of a measurement tool to assess systematic reviews (AMSTAR). PLoS ONE 2007; 2 e1350
| External validation of a measurement tool to assess systematic reviews (AMSTAR).Crossref | GoogleScholarGoogle Scholar | 18159233PubMed |
[7] Mulrow CD. Rationale for systematic reviews. BMJ 1994; 309 597–9.
| Rationale for systematic reviews.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2cznt1OmtQ%3D%3D&md5=6d4e8f9cc4f07120d3a3c8eeb66b4626CAS | 8086953PubMed |
[8] Petticrew M, Roberts H. Evidence, hierarchies, and typologies: horses for courses. J Epidemiol Community Health 2003; 57 527–9.
| Evidence, hierarchies, and typologies: horses for courses.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3s3psVaqtw%3D%3D&md5=7efd7d8438ce8406d796c7c35c847889CAS | 12821702PubMed |
[9] Muir Gray J. Evidence-based healthcare. London: Churchill Livingstone; 1996.
[10] Lomas J. Using research to inform healthcare managers’ and policy makers’ questions: from summative to interpretive synthesis. Healthc Policy 2005; 1 55–71.
| 19308103PubMed |
[11] Pope C, Mays N, Popay J. Informing policy making and management in healthcare: the place for synthesis. Healthc Policy 2006; 1 43–8.
| 19305652PubMed |
[12] Mays N, Pope C, Popay J. Systematically reviewing qualitative and quantitative evidence to inform management and policy-making in the health field. J Health Serv Res Policy 2005; 10 6–20.
| Systematically reviewing qualitative and quantitative evidence to inform management and policy-making in the health field.Crossref | GoogleScholarGoogle Scholar | 16053580PubMed |
[13] Lavis JN, Davies HTO, Gruen RL, Walshe K, Farquhar CM. Working within and beyond the cochrane collaboration to make systematic reviews more useful to healthcare managers and policy makers. Health Policy 2006; 1 21–33.
[14] Mitchell P, Pirkis J, Hall J, Haas M. Partnerships for knowledge exchange in health services research, policy and practice. J Health Serv Res Policy 2009; 14 104–11.
| Partnerships for knowledge exchange in health services research, policy and practice.Crossref | GoogleScholarGoogle Scholar | 19299264PubMed |
[15] Innvaer S, Vist G, Trommald M, Oxman A. Health policy-makers’ perceptions of their use of evidence: a systematic review. J Health Serv Res Policy 2002; 7 239–44.
| Health policy-makers’ perceptions of their use of evidence: a systematic review.Crossref | GoogleScholarGoogle Scholar | 12425783PubMed |
[16] Lavis J, Davies H, Oxman A, Denis J, Golden-Biddle K, Ferlie E. Towards systematic reviews that inform health care management and policy-making. J Health Serv Res Policy 2005; 10 35–48.
| Towards systematic reviews that inform health care management and policy-making.Crossref | GoogleScholarGoogle Scholar | 16053582PubMed |
[17] Jewell CJ, Bero LA. ‘Developing good taste in evidence’: facilitators of and hindrances to evidence-informed health policymaking in state government. Milbank Q 2008; 86 177–208.
| ‘Developing good taste in evidence’: facilitators of and hindrances to evidence-informed health policymaking in state government.Crossref | GoogleScholarGoogle Scholar | 18522611PubMed |
[18] Brownson RC, Fielding JE, Maylahn CM. Evidence-based public health: a fundamental concept for public health practice. Annu Rev Public Health 2009; 30 175–201.
| Evidence-based public health: a fundamental concept for public health practice.Crossref | GoogleScholarGoogle Scholar | 19296775PubMed |