Improving the evidence base for primary care using evidence synthesis

Carl Heneghan, Director NIHR School of Primary Care Evidence Synthesis Working 

This innovative approach to evidence synthesis production is, we believe, the most extensive formal collaboration of shared evidence synthesis expertise in primary care in the world."

Evidence synthesis increasingly informs National Guidance, provides high impact research outputs and ensure healthcare is based on the best evidence of efficacy and cost-effectiveness. The importance of evidence synthesis has been outlined by Professor Chris Whitty, Chief Scientific Adviser for the Department of Health and Social Care, who, in 2015, reported that “the accurate synthesis of existing information is the most important single offering by academics to the policy process.”

As a group, we are, therefore, aiming to provide relevant evidence for current practice and become a world-leading collaboration in novel evidence synthesis methods. Our four workstreams and reviews within these set out to position the School of Primary Care at the forefront of policy by providing high-quality, timely reviews in important NHS priority areas. We are acutely aware of the pressure primary care is under to meet the demands of an ageing population and to transform care with more done in the community, against a backdrop of ensuring new technologies are taken up - or not as may be the case - while maintaining budgets. 

How do we work together?

At the outset, our systematic prioritisation process included peer reviewers’ consideration of the following questions: “Is this question of relevance to NHS clinical primary care?” and “Is this the right synthesis design to answer the question?” Both the relevance of the question to the NHS and the methods chosen were reflected upon during the developmental process.

The complex nature of the problems in primary care requires a variety of methods to be used to inform policy better. Our collaboration has the infrastructure and expertise to deliver reviews of routine data, individual patient level data, reviews of qualitative data, realist reviews, reviews of prognostic studies, diagnostic test accuracy reviews, network meta-analysis, and reviews of nonrandomized studies and clinical study reports.

This innovative approach to evidence synthesis production is, we believe, the most extensive formal collaboration of shared evidence synthesis expertise in primary care in the world.

One of the objectives of our group is to share this capability across the nine school members to support future capacity building in the field. The addition of information specialists in our group means we have a unique resource to further develop and improve searching techniques in primary care, including the identification of unpublished sources in the grey literature.

What are we hoping to achieve? 

We aim to produce high-quality reviews that determine through the use of novel evidence synthesis methods (such as realist reviews and complex reviews) what works, in what situations, for whom.

We are aiming to deliver 20 evidence synthesis reviews under four different workstreams. These four workstreams are the urgent care interface; end of life care and bereavement; assessment of new drugs and technologies in chronic disease patients using unpublished data sources; and health service redesign in primary care.

Impacting on health policy and improving patient care is a crucial objective of our collaborative group. We are aiming to develop short policy briefing document for each review and circulate this to appropriate policy leads at local and national levels.  Regarding PPI, we have a robust strategy that prioritises and enhances our outputs. We are also extending our plan to engage with policy–we refer to this as PPPI (patients, public and policy).

We also have a dedicated training group, whose key objectives is to provide training and propagate best practice, in aspects of the more complex methods needed for evidence synthesis. One of our aims is to build capacity in evidence synthesis. We are achieving this by creating capacity building activities (SPCR ESWG training and capacity development). 

Find out more and keep to date with each of our workstreams:

 URGENT CARE INTERFACE

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Carl Heneghan is Director of the NIHR SCPR Evidence Synthesis Working Group, Professor of EBM at the University of Oxford, Director of CEBM and Editor in Chief of BMJ EBM

Follow on twitter @carlheneghan

Competing interests

Carl has received expenses and fees for his media work including BBC Inside Health. He holds grant funding from the NIHR, the NIHR School of Primary Care Research, The Wellcome Trust and the WHO.

Reference

Whitty, C. J. M. What makes an academic paper useful for health policy? BMC Med. 13, 301 (2015).