Development of a complex intervention to improve health literacy skills

Background Providing insight into the developmental processes involved in building interventions is an important way to ensure methodological transparency and inform future research efforts. The objective of this study was to describe the development of a web portal designed to improve health literacy skills among the public. Methods The web portal was tailored to address three key barriers to obtaining information, using the conceptual frameworks of shared decision-making and evidence-based practice and based on explicit criteria for selecting the content and form of the intervention. Results The web portal targeted the general public and took the form of structured sets of tools. Content included: an introduction to research methods, help on how to find evidence-based health information efficiently based on the steps of evidence-based practice, an introduction to critical appraisal, information about patient participation rights in decision-making, and a decision aid for consultations. Conclusions The web portal was designed in a systematic and transparent way and address key barriers to obtaining and acting upon reliable health information. The web portal provides open access to the tools and can be used independently by health care users, or during consultations with health professionals

Minimal-invasiv glaukomkirurgi (MIGS) for individer med glaukom. En metodevurdering

Source at https://www.fhi.no/en/publ/2021/Minimally-Invasive-Glaucoma-Surgery-MIGS-for-individuals-with-glaucoma/Key messages: This health technology assessment (HTA) summarises and supplements a 2019 Canadian HTA on the effectiveness and safety of micro-invasive glaucoma surgery (MIGS) versus other treatment options. Further, it contains cost-effectiveness analysis based on the Canadian HTA, in addition to patient partners’ considerations, organizational and ethical considerations relevant to discussions of MIGS’ role in Norwegian routine care. The Canadian evidence, which included 32 studies and 24 comparisons, was inconclusive due to very low to low certainty. Our supplementary findings show that: • MIGS with Hydrus Microstent combined with cataract surgery reduces intraocular pressure (IOP) at 24 months, compared with cataract surgery alone (high-certainty evidence) • MIGS with iStent inject combined with cataract surgery probably reduces IOP at 24 months, compared with cataract surgery alone (moderate-certainty evidence) • For other techniques there is either no or little difference between the MIGS and control interventions, or it is uncertain whether there is a difference in effectiveness • Neither MIGS procedures, nor alternative surgical strategies appear to be at high risk of adverse events • Lifetime total cost for glaucoma treatment ranged from NOK 30 000 to NOK 83 000 per patient, depending on treatment strategy and baseline disease stage. The incremental Quality adjusted life years (QALYs) for MIGS between comparators ranged between – 0.080 and 0.057 • MIGS is suitable as a outpatient surgery without hospital admission. Clinicians need training. Clear criteria for patient selection shuld be developed. Experts predict that the number of MIGS procedures may increase to twice as many in 2024 than today • The clinical evidence on MIGS is limited. The main reason for this is the lack of comparative studies. Our health economic evaluation shows some scenarios where MIGS may be cost-effective, depending on comparator and disease stage. Our analysis puts individuals with glaucoma in severity class 1.Hovedbudskap: Denne metodevurderingen (HTA) oppsummerer og supplerer en kanadisk HTA fra 2019 om effekt og sikkerhet ved minimal-invasiv glaukomkirurgi (MIGS). Videre gjorde vi kost-nytteanalyser basert på den kanadiske HTAen, i tillegg til brukerperspektiv, organisatoriske og etiske vurderinger som er relevante i en diskusjon om hvorvidt MIGS bør være et rutinetilbud i norsk praksis. Det kanadiske kunnskapsgrunnlaget, som omfattet 32 studier og 24 sammenlikninger, var usikkert på grunn av svært lav til lav tillit til resultatene. Våre supplerende funn viser at: • MIGS med Hydrus Microstent kombinert med kataraktkirurgi reduserer intraokulært trykk (IOP) etter 24 måneder, sammenliknet med kataraktkirurgi alene (høy tillit til resultatet) • MIGS med iStent inject og kataraktkirurgi reduserer trolig IOP etter 24 måneder, sammenliknet med kataraktkirurgi alene (middels tillit til resultatet) • Det er usikkert hvorvidt det er noen forskjell i effekt mellom MIGS og kontrollgruppene for andre sammenligninger • Det ser ikke ut til å være noen betydelig forskjell mellom MIGS og kontrollgruppene i risiko for uønskede hendelser/skader • Total livstidskostnad per pasient for glaukombehandling ble estimert mellom 30 000 norske kroner og 83 000 norske kroner avhengig av behandlingsstrategi og sykdomsstadie ved start. Inkrementell QALY for MIGS sammenlignet med komparatorer var mellom – 0.080 og 0.057 • MIGS egner seg for poliklinisk kirurgi. Øyeleger må ha opplæring for å utføre MIGS. Det bør utvikles klare kriterier for pasientseleksjon. Eksperter predikerer en dobling av antall MIGS prosedyrer i 2024 enn antallet i dag • Kunnskapsgrunnlaget for effekt og sikkerhet om MIGS er begrenset. Hovedgrunnen er mangel på sammenliknende studier. Vår helseøkonomiske vurdering viser at MIGS kan være kostnadseffektive, avhengig av sammenliknng og sykdomsutvikling. Vår analyse setter individer med glaukom i gruppe for alvorlighetsgrad 1