The capacity of health service commissioners to use evidence: a case study

Clinical Commissioning Groups (CCGs) lead a network of organisations that plan and make decisions about what services to provide through the NHS. By examining decision-making about service interventions designed to reduce potentially avoidable elderly care admissions into acute hospitals, our study explores the capacity of CCG-led commissioning networks to make decisions that are based on evidence. Empirically, we study 13 cases of representative (region, size, urban/rural) commissioning networks in England, drawing on interviews with commissioning managers, general practitioners (GPs), patient and public involvement (PPI) representatives and other relevant stakeholders. CCGs can not only draw on evidence about what is most clinically effective or cost-effective, but can also consider patient experience and local knowledge held by doctors. However, the inclusion of GPs and PPI representatives is limited, so the local knowledge of doctors and the patient experience are not considered as fully as they might be in commissioning decisions. CCGs can use government agencies, such as commissioning support units, that provide external information about local population and existing service provision, but they fail to do so adequately. The voluntary sector can play a key role in providing local knowledge about individual patients and their needs. Finally, given the need for health and social care organisations to collaborate to support older people so that they do not experience potentially avoidable admissions to acute hospitals, there is a need for organisations to develop joint evidence-based strategies and work together in real time to exchange information. From our research, in collaboration with a PPI reference group, a self-assessment questionnaire for CCG-led commissioning networks was developed, which allows CCGs to assess and develop their capacity to acquire and use different types of evidence in their decision-making.questionnaire for CCG-led commissioning networks was developed, which allows CCGs to assess and develop their capacity to acquire and use different types of evidence in their decision-making

Statin-use and the adoption of healthy lifestyle choices: A cross-national comparison

Background: Statin-use and the adoption of healthy lifestyle choices are important components of cardiovascular disease prevention. The nature of the relationship between the former and the latter, and the influence of personal and social factors on this relationship remains unclear. Aim: This research aimed to examine whether statin-use influences the adoption of healthy dietary and exercise choices by changing the way people think of high cholesterol as a risk factor for cardiovascular disease in the context of their social world. Methods: Questionnaires were used to compare the dietary and exercise behaviours; perceptions of high cholesterol; and perceived future risk of cardiovascular disease of statin users and non-statin users recruited in Nigeria and in the UK. In-depth interviews were conducted in each country to explore between group differences and the influence of social factors on statin-use, adoption of a healthy lifestyle choices; perceptions of high cholesterol, future cardiovascular disease risk and availability of social support. Results: A similar proportion of the 148 participants recruited from Nigeria and the 89 participants recruited from the UK reportedly adopted a low-fat diet, 69% and 70% respectively. Reported adoption of healthy exercise behaviours was much lower and notably different between the country samples, 16% and 32% respectively. Statin-use was found to influence the adoption of healthy lifestyle choices in 3 ways: it was found to encourage, hinder, and work alongside the adoption of healthy lifestyle choices. The adoption of healthy lifestyle choices was also influenced by cause-control perceptions, gender, and social factors such as location, preferences and demands of other people, and societal norms such as body image ideals. Conclusion: Statin-use influenced the adoption of healthy lifestyle choices in 3 different ways. Dietary changes were preferred to exercise changes. Illness perceptions and preferences of the individual and their social world influenced statin-use and the adoption of healthy lifestyle choices