The effect of priority setting decisions for new cancer drugs on medical oncologists' practice in Ontario: a qualitative study

<p>Abstract</p> <p>Background</p> <p>Health care policies, including drug-funding policies, influence physician practice. Funding policies are especially important in the area of cancer care since cancer is a leading cause of death that is responsible for a significant level of health care expenditures. Recognizing the rising cost of cancer therapies, Cancer Care Ontario (CCO) established a funding process to provide access to new, effective agents through a "New Drug Funding Program" (NDFP). The purpose of this study is to describe oncologists' perceptions of the impact of NDFP priority setting decisions on their practice.</p> <p>Methods</p> <p>This is a qualitative study involving semi-structured, in-depth interviews with 46 medical oncologists in Ontario. Oncologists were asked to describe the impact of CCO's NDFP drug funding decisions on their practice. Analysis of interview transcripts commenced with data collection.</p> <p>Results</p> <p>Our key finding is that many of the medical oncologists who participated in this study did not accept limits when policy decisions limit access to cancer drugs they feel would benefit their patients. Moreover, overcoming those limits had a significant impact on oncologists' practice in terms of how they spend their time and energy and their relationship with patients.</p> <p>Conclusion</p> <p>When priority setting decisions limit access to cancer medications, many oncologists' efforts to overcome those limits have a significant impact on their practice. Policy makers need to seriously consider the implications of their decisions on physicians, who may go to considerable effort to circumvent their policies in the name of patient advocacy.</p

Systematic monitoring of heathy woodlands in a Mediterranean climate - a practical assessment of methods

Practical and useful vegetation monitoring methods are needed, and data compatibility and validation of remotely sensed data are desirable. Methods have not been adequately tested for heathy woodlands. We tested the feasibility of detecting species composition shifts in remnant woodland in South Australia, comparing historical (1986) plot data with temporal replicates (2010). We compared the uniformity of species composition among spatially scattered versus spatially clustered plots. At two sites, we compared visual and point-intercept estimation of cover and species diversity. Species composition (presence/absence) shifted between 1986 and 2010. Species that significantly shifted in frequency had low cover. Observations of decreasing species were consistent with predictions from temperature response curves (generalised additive models) for climate change over the period. However, long-term trends could not be distinguished from medium-term dynamics or short-term changes in visibility from this dataset. Difficulties were highlighted in assessing compositional change using historical baselines established for a different purpose in terms of spatial sampling and accuracy of replicate plots, differences in standard plot methods and verification of species identifications. Spatially clustered replicate plots were more similar in species composition than spatially scattered plots, improving change detection potential but decreasing area of inference. Visual surveys detected more species than point-intercepts. Visual cover estimates differed little from point-intercepts although underestimating cover in some instances relative to intercepts. Point-intercepts provide more precise cover estimates of dominant species but took longer and were difficult in steep, heathy terrain. A decision tree based on costs and benefits is presented assessing monitoring options based on data presented. The appropriate method is a function of available resources, the need for precise cover estimates versus adequate species detection, replication and practical considerations such as access and terrain.Greg R. Guerin & Andrew J. Low