B.C. Office of Health Technology Assessment

Office clears confusion of conflicting studies

A scientific study published one day states carrots should be eaten in great quantities. The next day, a different study states carrots should be avoided at all costs.

Conflicting research findings affect not only carrot consumption but also health-care spending, policy decisions and clinical practice.

That's where the British Columbia Office of Health Technology Assessment (BCOHTA) comes in.

Established in 1990, this UBC-based organization provides detailed assessments on a wide range of research studies.

Evaluating other people's research takes a lot of commitment, the ability to ask the right questions and no fear of confrontation, says Arminée Kazanjian, founding chair of BCOHTA.

"We work with clinicians, academics and researchers and bringing those camps together can be a challenge," says Kazanjian, an associate professor of Health Care and Epidemiology at UBC and associate director of the Centre for Health Services and Policy Research.

"We are asked to probe, challenge and critique research results and that can make some individuals uncomfortable," she says.

Administrators without access to a lot of scientific resources, such as vice-presidents of smaller hospitals, are grateful to have the research information synthesized and at their fingertips, she says. Reports from BCOHTA help them to allocate scarce funds, she adds.

Health technology assessment is part of the move to evidence-based medicine and is a relatively new field according to Kazanjian.

Evidence-based medicine uses a synthesis of rigorously appraised research as a basis for health decisions that range from policy changes to clinical practice.

The field got its start in the United Kingdom and is gaining momentum internationally as countries try to manage escalating health-care costs.

BCOHTA has received requests from Pacific Rim countries and Latin America on how to set up similar technology assessment offices.

"We're unique in that we are university-based and work at arm's length from government," says Kazanjian, who is also the UBC representative to the Canadian Cochrane Network/Centre which is part of an international body that promotes evidence-based medicine. UBC's international consultation is conducted as part of this international academic collaboration.

"BCOHTA is the only centre in Canada where technology assessment work is conducted using the original methodology developed in the United Kingdom," says Kazanjian.

She points to a recent assessment of the research on bone mineral density screening as one of BCOHTA's greatest challenges and accomplishments.

A number of hospitals and the B.C. College of Physicians and Surgeons Clinical Practice Guidelines Committee requested the assessment. Many different sectors and constituents were involved with the study including the Medical Service Plan, clinicians, and Children's and Women's Health Centre of British Columbia.

The review took two and a half years to complete. After it was published, the provincial Ministry of Health set up a committee with representatives from various sectors to offer advice on bone health and fracture prevention strategies.

Kazanjian and colleagues actively promote the systematic review methodology used at BCOHTA.

One of the office's aims is to build into organizations the capacity to ask the right questions and to encourage structures that are able to include research in their decision-making.

Carolyn Green, research associate at BCOHTA, has been working with the technological assessment committee at the Workers' Compensation Board to review evidence on the clinical effectiveness of craniosacral therapy.

The therapy involves manual manipulation of areas of the skull to stimulate healing via the cerebral spinal fluid.

"We needed BCOHTA's help in assessing this unconventional form of therapy," says Dr. Craig Martin of the WCB. "They led us through a systematic review of research which helped us refine our policy and practice related to this technique."

The review showed that the therapy couldn't be considered of proven benefit on the basis of scientific research.

"Our mandate is to promote the use of research," says Kazanjian. "We have increased our efforts to collaborate with the requestor, to disseminate research and to educate practitioners, policy makers and the public."

BCOHTA sends its reports and newsletters to more than 8,000 B.C. physicians and decision-makers.

Staff members also serve on regional health board committees and make presentations at national and international conferences.

Kazanjian emphasizes that the office has no agenda except to provide research on effectiveness. She says practitioners and the public need to know as much as they can about health-care policies and technology to understand what their taxes are buying and to make better-informed health-care decisions.

Kazanjian, who holds a doctorate in sociology, originally researched the equality of opportunity in education and labour markets. She then examined health human resources, which led to her current interest in health systems and health policy research.

BCOHTA, with nine employees and an annual budget of $500,000 is a program within UBC's Centre for Health Services and Policy Research.

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