Evidence on the Front Line of Health

Care: What Counts?

ASSOCIATION OF REGISTERED NURSES OF NEWFOUNDLAND AND

LABRADOR

NOVEMBER 17TH, 2015

SHEILA TUCKER, M.L.I.S., B.ED., B.A.(HON), CPAD.

LIAISON OFFICER FOR NEWFOUNDLAND AND LABRADOR - CADTH

Disclosure – Sheila Tucker

Relationship with Commercial Interest:

•Grant/Research Support: None

•Speaker Bureau/Honoraria: None

•Consulting fees: None

•Memberships on advisory committees, boards: None

Other Affiliations:

I am a CADTH employee independently based in

Newfoundland.

Learning Objectives

After attending this event, participants will be able to:

• Define health technology assessment (HTA) and its role in

healthcare decision-making;

• Explain specific examples of how HTA has been applied in

clinical practice;

• Access sources of HTA evidence to help guide clinical

practice.

What are health technologies?

• Improve health

• Prevent, diagnose or treat disease

• Help in rehabilitation and long-

term care

Include:

• Devices and equipment

• Medical and surgical procedures

• Drugs, vaccines and blood

products

Health Technology Assessment (HTA)

• Evaluations of the clinical effectiveness, cost-effectiveness,

ethical, legal, and social implications of a health technology.

• Designed to support various aspects of healthcare decision-

making

• Includes new and existing:

• prescription drugs

• diagnostic tests;

• surgical/medical/dental devices and procedures

• Does NOT include:

• broad health system issues, such as information

technology, program delivery, staffing and finance.

CADTH Products and Process

Horizon Scanning – early evidence on new technologies

• Health Technology Update

• Emerging Technologies

Health Technology Assessment

• Technology Reports – comprehensive reviews

• Rapid Response – more narrow, shorter time frame

Optimal Use – comprehensive reviews + tools

Drug Formulary Recommendations

• Common Drug Review

• Pan-Canadian Oncology Drug Review

Therapeutic Reviews – drug class reviews

Engaging With Health Professionals

• Health professional feedback on draft evidence reviews

(subscribe to receive “CADTH Alerts” at www.cadth.ca )

• Development of clinical practice tools based on health

technology assessments – accessible through CADTH’s

website and by request.

• Liaison with health professional associations

• Newsletter articles

• Conference participation

• True or false quizzes

• Support for continuing education on various topics

including, but not limited to:

• Blood glucose monitoring

• Anticoagulants in stroke management

CADTH Website - Highlights

Content

• Evidence-based reports and recommendations

• Implementation support tools,

• Resources – help to find, interpret, implement evidence

• Corporate news, special events information.

Public accessibility

• All reports and tools are posted upon completion.

• Reports and tools can be downloaded free of charge.

• Free webinars posted.

• Interactive – facilitates feedback on reports and new

requests.

CADTH Website – Highlights Continued

• Various search filters:

• Body systems

• Disease and conditions

• Target population

• Technologies, therapies and systems

• Testing and diagnostics

• Publication date

• Evidence bundles

• Common Drug Review Table

• Pan-Canadian Oncology Drug Review Table

• Pan-Canadian HTA Database Interface - allows users to

search databases of other HTA organizations in Canada

and internationally.

Evidence Bundles

• Current evidence bundles include:

• Anticoagulants

• Diabetes management

• Optimizing use of laboratory tests

• Prescription drug abuse

• Primary care

• Treatment of Chronic Hepatitis C Virus Infection

• Long term care

• Medical imaging

Evidence on Anticoagulants

Evidence on Anticoagulants Continued

Health Professional Newsletter

Preventing Stroke – Patient Pamphlet

Debate Slides

From Evidence to Practice

Case Study: Self-Monitoring of

Blood Glucose in Diabetes

Estimated Number of Canadians with Diabetes

The Cost of Self-Monitoring of Blood Glucose

Approach to identifying optimal practice of SMBG

clinical-effect iveness data

cost-effect iveness data

recommendations

pract ice and

knowledge gaps

4 key messages

tools to

support

uptake

current pract ice and

ut ilizat ion

Systematic Reviews

Economic Report

Optimal Therapy

Recommendations

Current Pract ice and

Utilizat ion Reports

Gap Analysis &

Key Messages

Report

Intervent ion Tools

Stak

eh

old

er

Fee

db

ack

Bu

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etw

ork

s an

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artn

ers

hip

s

Expert Review Committee

Endocrinologist

Endocrinologist

Pharmacist

Nephrologist/Health Economist

General Internist

Family Physician

Pediatric Endocrinologist

Pharmacist/Epidemiologist

Family Physician/Practice Support

Public Member

Family Physician/CME

Public Member

BC Dr. M. Dahl

BC Dr. E. Ur

BC Dr. A. Virani

AB Dr. S. Klarenbach

AB Dr. A. Colbourne

SK Dr. M. Caughlin

MB Dr. H. Dean

ON Dr. L. Dolovich

ON Dr. M. Evans

ON Panos Petrides

NS Dr. M. Allen

NS Cathy MacNutt

Systematic Review

Included studies:

RCTs, observational

studies (cohort,

case-control, time

series)

• Patient problem or population:

patients with type 1, type 2, and

gestational diabetes

• Intervention: SMBG

• Comparison: no SMBG & ∆ frequency

of SMBG

• Outcome: effect on A1C,

health-related quality of life, patient

satisfaction, long-term complications,

or mortality

Adults With Type 2 Diabetes Who Do Not Use

Antidiabetes Drugs

• Given a lack of evidence, women in this patient

population who are considering a pregnancy may

benefit from SMBG.

Routine use of blood glucose test strips for

SMBG is not recommended for most adults with type

2 diabetes who do not use diabetes pharmacotherapy.

Adults With Type 2 Diabetes Using Oral

Antidiabetes Drugs

Periodic testing may be beneficial for patients:

• using insulin secretagogues

• at risk of hypoglycemia

• experiencing acute illness

• undergoing changes in pharmacotherapy or significant changes in routine

• with poorly controlled or unstable glucose levels

• pregnant or planning a pregnancy

Routine use of blood glucose test strips for

SMBG is not recommended for most adults with

type 2 diabetes using oral antidiabetes drugs.

Practice and Knowledge Gaps

Type Of Gap Description

Practice Gap There is routine use of blood glucose test strips among

patients with type 2 diabetes not using insulin.

Practice Gap There is limited use of SMBG results in therapeutic

decisions by physicians.

Practice Gap SMBG is often seen to be synonymous with self-

management of diabetes by health care professionals.

Knowledge Gap There is a lack of awareness among health care

professionals about key evidence related to the efficacy

of SMBG in patients with type 2 diabetes not using

insulin.

Knowledge Gap There is a lack of awareness of opportunity costs

associated with widespread blood glucose testing by

patients with type 2 diabetes not using insulin.

Opportunity Cost

• Represents the value of benefits foregone as the result of

making a decision.

• Opportunity cost of funding test strips at current levels is

substantial.

• In a health care system with finite resources,

the resources spent on test strips are

no longer available to fund other

potentially beneficial interventions

or services.

* Public and private plans combined; type 1 and type 2 diabetic patients combined. Calculations based on 22% insulin

users vs. 78% non-insulin users.

Potential Savings for Canada

What Are the Other Opportunities??

• Give patients options to alter how often they self-test—in some cases,

saving time for patients and providers by reducing the frequency

• More focus on other aspects of diabetes self-management:

Blood pressure

Weight management

Healthy diet

Physical activity

Foot care

Dental and eye care

Quitting smoking

Mental health

CADTH Evidence on Blood Glucose Monitoring

Outreach in Newfoundland and Labrador

• Continuing education sessions

• Professional Development and Conference Service

• Pharmacists Association of NL Annual Conference

• Canadian College of Health Leaders – NL Chapter (2014)

• Café Scientific (2010)

• Conference presentations

• Primary Healthcare Partnership Forum (2012)

• Newsletter articles –

• NL Medical Association (2009)

• May 2015 edition of ACCESS (ARNNL)

• Fall 2015 edition of The Pulse (NL College of Licensed

Practical Nurses)

Quick Reference Prescribing Aid (Front)

Quick Reference Prescribing Aid (back)

Engaging with CADTH

Keep up to date on new products and services:

• Subscribe to CADTH newsletters:

https://www.cadth.ca/subscribe

Do you have questions about a drug/device/procedure in

your practice?

Are you developing or updating a policy/practice?

Are you faced with an acquisition decision?

If you need evidence to help inform these questions:

• Contact CADTH – Requests@cadth.ca

Email: Sheilat@cadth.ca

Upcoming Events and Advisories

Consultation to Increase Opportunities for Clinician Input and

Feedback in CADTH’s pan-Canadian Oncology Drug Review

Process - New Call for Feedback Deadline: November 30,

2015 at 5:00 p.m. ET via email to info@pcodr.ca

CADTH Lecture Series. Delivered via webinar at no cost to

participants. Learn more at: https://www.cadth.ca/news-and-

events/upcoming-events/cadth-lecture-series

CADTH Symposium. April 10-12th, 2016. Ottawa.

https://www.cadth.ca/2016-cadth-symposium

ReferencesOptimal Warfarin Management for the Prevention of Thromboembolic Events in

Patients with Atrial Fibrillation: Project in Brief. 2011, December. [Internet] Ottawa:

CADTH. (Optimal Use Tool) Available from:

https://www.cadth.ca/media/pdf/OP0508_Warfarin_PiB_e.pdf

Antithrombotic Therapy for Patients With Atrial Fibrillation: Project in Brief. 2013,

April. [Internet] Ottawa: CADTH. (Optimal Use Tool). Available from:

https://www.cadth.ca/media/pdf/KC0007_PiB_PreventingStrokeAF_e.pdf

What’s the Evidence? Preventing Stroke in Your Patients with Atrial Fibrillation.

2015, March. [Internet] Ottawa: CADTH. (Optimal Use Tool). Available from:

https://www.cadth.ca/evidence-bundles/clots/tools-resources/whats-evidence

Preventing Stroke When You Have Atrial Fibrillation: Information for Patients. March

23, 2015. [Internet] Ottawa: CADTH. (Optimal Use Tool). Available from:

https://www.cadth.ca/sites/default/files/pdf/Preventing-stoke-2sided_e.pdf

References

New Oral Anticoagulants: Breakthrough or Just Another Bleeding Mess? (Debate

Slides). March 23, 2015. Available from:

http://www.slideshare.net/CADTH-ACMTS/fmf2013-debate-cox-andcarrier

Blood Glucose Testing in Type 2 Diabetes. An infographic showing key data and

ideas [Internet]. Ottawa: CADTH; 2013. (Optimal Use Tool). [cited 2015 Aug 24].

Available from:

https://www.cadth.ca/sites/default/files/pdf/CADTH_Infographicv_eng_final.pdf

Prescribing Aid Card. [Internet]. Ottawa: CADTH; 2012 Mar. (Optimal Use Tool).

[cited 2015 Aug 24]. Available from:

https://www.cadth.ca/sites/default/files/pdf/Tools/SMBG/prescribing_aid_en.pdf