Hi-lights from the In-Person Workshop for Citizens Finding & Using Research Evidence and Understanding the Ontario Health System

[Annette McKinnon]

Hi-lights from the In-Person Workshop for Citizens Finding & Using Research Evidence and Understanding the Ontario Health System, McMaster Health Forum - Dec. 1, 2018

The forum was presented by Dr. Cristina Mattison and James McKinlay (McMaster Health Forum).

The workshop was a culmination of a 2-year project:

• Year 1 was focused on finding and using research evidence for citizens (online instructional course + webinars)

• Year 2 was focused on understanding the Ontario Health System for citizens In-Person Workshop for Citizens Finding & Using Research Evidence and Understanding the Ontario Health System

The following book: Ontario's Health System: Key insights for Engaged Citizens, Professional and Policymakers - was recommended. The reading is available for download at https://www.mcmasterforum.org/learn-how/ontarios-health-system  Taxpayers who finance much of the health system

 Patients who receive care in the health system

 Family and caregivers who support patients receiving care in the health system

:

 Take aspects from both the ‘finding and using' content and the ‘understanding the health system' content

 Combine the two together to demonstrate, using a real-world example, how they can be used together to advocate for change

 The value of research evidence

 Where to look for research on specific topics

 The value of systematic reviews

 The internet and media

:

 Research findings

 Clinical knowledge

 Expert opinion

 Lived Experience

All of these are valid and all can be used to change the way we do things and they work together to inform decision-making and policy. Evidence informs decision-making! However, practices based on research findings are more likely to result in the desired patient outcomes across various settings and geographic locations.

 EIDM is the backbone of most decisions

 Involves the incorporation of valid and relevant external evidence

 You can find evidence typically in high-quality research studies and there is a clear benefit to have patient engagement ‘involvement' and evaluating the system!

 There is a lot of it and because of the volume of evidence available, you need to be systematic in what you are searching for and how you go about searching

 Always remember that just because it is published evidence, does not mean it is good evidence

 Single studies are frequently done poorly

 Systematic reviews attempt to answer the bigger question that single studies are unable to answer

 Systematic reviews combine all studies conducted on a specific clinical question into one large ‘artificial' study

 Draw up a list of words that capture each feature of the problem (or each potential cause of the problem)

• Synonyms for each word (where applicable)

 Alternative formulations or spellings for each word or synonym (e.g., singular / plural, American / British)

 Consider whether using a wildcard (*) can help to reduce duplication in each list of words, synonyms and alternative formulations or spellings (e.g., nurs* instead of nurse OR nurses OR nursing)

 Connect words in each list using Boolean operators (AND, OR, NOT), brackets and quotation marks

 e.g., (doctor AND nurse) OR pharmacist ≠doctor AND (nurse OR pharmacist)

• e.g., "user fees" ≠user fees

 When citizens and patients want answers to questions about their own individual health (i.e., when making personal health decisions), the Cochrane Library has established a one-stop shop for Evidence Summaries

 Browse by health topics to quickly look for relevant evidence

 Declarative titles to help highlight messages that are actionable for citizens and patients

 Cochrane only produces high-quality systematic reviews, meaning citizens and patients can feel confident getting their evidence from this resource

 Can also do more specific searches using keywords, and filter their searches by new evidence

 Also provides other ways in that may be better for citizens and patients, such as podcasts about the latest evidence

 2002: Royal Commission on the Future of Health Care in Canada

 2004: First Minister's Meeting on the Future of Health Care: 10-year plan to strengthen health care

 Ontario began working on programs and services that were the focus of this 10 year plan

 2016: Council's 2nd annual report recommended to the gov't: "to adopt a set of core mental health and addictions services across Ontario that have dedicated funding support, are available to all Ontarians, and are accessible in all regions of the province"

 The gov't asked the McMaster Health Forum to define the province's mental health and addictions ‘core services' and the McMaster Health Forum started by reviewing all of the research evidence.

 The McMaster Health Forum produced a 172-page document summarizing 143 sources of evidence plus input from experts in the field to create a summary (of mental health services). The McMaster Health Forum convened a dialogue of experts in the field to discuss the results of the evidence and to consider how to define core services for the general population; those with mild to moderate mental health problems; and those with severe and persistent mental health problems,

 2016: the Council's final annual report recommended that "Ontarians need access to a consistent and coordinated set of mental health and addictions services - and a more consistent and mental health and addictions services - and a more consistent and seamless service experience - regardless of where they live. In order to achieve this, and to align with the transformations that have taken place in the community-based child and youth mental health sector, the Council continues to emphasize the importance of moving toward implementation of a set of core services along with standardization, streamlining and centralization of data. This will enable improved service coordination across the province - reducing gaps and inefficiencies in services, and improving transitions across services - as well as supporting better cross-sector integration."

 In regards to psychotherapy across the province, the first steps in a structured provincial program are:

o Funding

o https://news.ontario.ca/mohltc/en/2017/10/ontario-improvingmental-health-services-for-people-across-the-province.html

o https://news.ontario.ca/opo/en/2018/03/ontario-makinghistoric-investment-in-mental-health-care.html

o Governance

o http://www.health.gov.on.ca/en/news/bulletin/2017/hb_20171221.aspx

o http://www.crpo.ca/

 The McMaster Health Forum can be reached at https://www.mcmasterhealthforum

 Click on ‘PLAYLIST'

Visit the McMaster Health Forum

Applying Evidence to the Health System and Example & Timeline:

Cochrane Summaries for ‘my health'

How to Search Appropriate Sources of Research Evidence

Single studies vs. Systematic reviews

Problem with Research Evidence

Evidence Informed Decision Making (EIDM)

Evidence means

The agenda covered:

The purpose of the workshop is to

The definition of citizen (for the purpose of the workshop) includes

[Kathy Smith]

Thanks for this Annette