Book contents
- Frontmatter
- Contents
- List of tables and figures
- Acknowledgements
- Prologue: Stephen’s story
- Introduction
- Section 1 Introducing personal health budgets
- Section 2 Implementing personal health budgets
- Section 3 Personal health budgets and organisational change in the NHS
- Conclusion
- Epilogue: Jonathan’s story
- References
- Index
five - How well do personal health budgets work?
Published online by Cambridge University Press: 03 February 2022
- Frontmatter
- Contents
- List of tables and figures
- Acknowledgements
- Prologue: Stephen’s story
- Introduction
- Section 1 Introducing personal health budgets
- Section 2 Implementing personal health budgets
- Section 3 Personal health budgets and organisational change in the NHS
- Conclusion
- Epilogue: Jonathan’s story
- References
- Index
Summary
The question of what constitutes evidence is not a straightforward one. In healthcare, a hierarchy of evidence has tended to operate which sets systematic reviews and randomised controlled trials (RCTs) as the gold standard, as illustrated in Table 5.1. A controlled study or trial compares outcomes for two groups: a treatment group that gets the intervention and a control group that does not. An RCT assigns individuals to one group or the other on a random basis and thereby tries to eliminate any biases within the two groups to isolate the impact of the intervention. The reliance on controlled studies in healthcare reflects the dominance of drug trials that are usually RCTs in shaping notions of evidence, and has been accelerated by the work of the National Institute for Health and Clinical Excellence (NICE) on evidence-based care.
However, questions are now being raised about the applicability of RCTs to evaluations of healthcare interventions and the dominance of this form of evidence (Cesar et al, 2004). First, it can take many years for the findings from an RCT study to be reported. This can slow down the rate of adoption of the intervention and, even when the results are positive, there is no guarantee that the intervention will be implemented in day-to-day practice (Steventon, 2012). Second, many clinical procedures and pharmaceuticals are recommended within clinical practice on the basis that they work for 50 per cent of people in the trial. This means that they do not work for the other 50 per cent. The incomplete nature of the clinical evidence base to inform decisions about care for any one specific individual highlights the need for other forms of evidence to fill in the gaps and is discussed further in Section 3 (Hasnain-Wynia, 2006). Third, certain academics have challenged the very existence of a hierarchy of evidence, arguing that different types of evidence are required to assess the impact of health interventions because each assesses different dimensions and can add value to the overall picture. For example, a controlled evaluation may be most appropriate when looking at clinical effectiveness, but patient interviews may be better placed to tell you whether or not the experience of the intervention was positive (Glasby et al, 2007; Glasby, 2011a).
- Type
- Chapter
- Information
- Delivering Personal Health BudgetsA Guide to Policy and Practice, pp. 57 - 70Publisher: Bristol University PressPrint publication year: 2014