Barriers and opportunities for evidence-based health service planning: The example of developing a Decision Analytic Model to plan services for sexually transmitted infections in the UK

Catherine R.H. Aicken, Nigel T. Armstrong, Jackie A. Cassell, Neil MacDonald, Angela C. Bailey, Sandra A. Johnson, Catherine H. Mercer

Research output: Contribution to journalArticle

Abstract

Background: Decision Analytic Models (DAMs) are established means of evidence-synthesis to differentiate between health interventions. They have mainly been used to inform clinical decisions and health technology assessment at the national level, yet could also inform local health service planning. For this, a DAM must take into account the needs of the local population, but also the needs of those planning its services. Drawing on our experiences from stakeholder consultations, where we presented the potential utility of a DAM for planning local health services for sexually transmitted infections (STIs) in the UK, and the evidence it could use to inform decisions regarding different combinations of service provision, in terms of their costs, cost-effectiveness, and public health outcomes, we discuss the barriers perceived by stakeholders to the use of DAMs to inform service planning for local populations, including (1) a tension between individual and population perspectives; (2) reductionism; and (3) a lack of transparency regarding models, their assumptions, and the motivations of those generating models. Discussion. Technological advances, including improvements in computing capability, are facilitating the development and use of models such as DAMs for health service planning. However, given the current scepticism among many stakeholders, encouraging informed critique and promoting trust in models to aid health service planning is vital, for example by making available and explicit the methods and assumptions underlying each model, associated limitations, and the process of validation. This can be achieved by consultation and training with the intended users, and by allowing access to the workings of the models, and their underlying assumptions (e.g. via the internet), to show how they actually work. Summary. Constructive discussion and education will help build a consensus on the purposes of STI services, the need for service planning to be evidence-based, and the potential for mathematical tools like DAMs to facilitate this.

Original languageEnglish
Article number202
JournalBMC Health Services Research
Volume12
Issue number1
DOIs
Publication statusPublished - 17 Dec 2012

Bibliographical note

© Aicken et al.; licensee BioMed Central Ltd. 2012
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Keywords

  • Decision Analytic Model
  • Evidence-synthesis
  • Model
  • Service planning

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