The political contexts of evidence-based medicine: Policymaking for daily hemodialysis
The political contexts of evidence-based medicine: Policymaking for daily hemodialysis
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DOI：
10.1016/j.socscimed.2005.11.024
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发表时间：
2006-06-01
影响因子：
5.4
通讯作者：
Gordon, Elisa Jill
中科院分区：
文献类型：
--
作者：
Gordon, Elisa Jill
政策制定者和临床医生越来越依赖循证医学 (EBM) 来做出有关保险范围和临床治疗的决策。对证据的价值判断和利益相关者施加的压力相互矛盾，使得卫生政策制定成为一个政治过程。本文探讨了价值判断如何通过关注卫生政策制定而融入到改善医疗结果的过程中。具体来说，本文强调了如何根据政策制定者感知到的风险以及竞争议程上的内容，不同地使用 EBM 作为决策标准。我借鉴了最近美国法案 H.R. 1004：肾病患者每日透析法案的政策制定过程的案例研究，该法案将立法每日血液透析 (DHD) 作为一种新的肾脏替代治疗方式，并为每周 3 至 6 次的血液透析提供联邦医疗保险资金。 DHD 是探索 EBM 政治基础的理想案例研究。对显示 DHD 相对于传统透析的医疗、生活质量和假设经济改善的大量结果数据的解释目前在医学和政治领域存在争议。因此，通过随机临床试验寻求一些利益相关者认为更好的证据是辩论和政策制定过程的核心。本文强调了对证据的需求、解释、资助和使用如何使循证医学成为一项对临床护理具有重要伦理影响的政治努力。 (c) 2005 Elsevier Ltd. 保留所有权利。
Policymakers and clinicians increasingly rely on evidence-based medicine (EBM) to make decisions about insurance coverage and clinical treatment. Conflicting value judgments about evidence and pressures exerted by stakeholders render health policyrnaking a political process. This paper examines how value judgments become embedded in the process of improving medical outcomes by focusing on health policyrnaking. Specifically, this paper highlights how EBM is variably used as a standard for decision-making depending on perceived risks by policymakers and what is on the competing agenda. I draw upon the case study of the policyrnaking process for the recent US bill, H.R. 1004: Kidney Patient Daily Dialysis Act, which would legislate daily hemodialysis (DHD) as a new renal replacement therapy modality, and provide federal medicare funding of hemodialysis from 3 to 6 times per week. DHD constitutes an ideal case study with which to explore the political underpinnings of EBM. The interpretations of substantial outcome data showing medical, quality of life, and hypothetical economic improvements of DHD over conventional dialysis are currently being contested in the medical and political spheres. Accordingly, the drive for what some stakeholders view as better evidence through randomized clinical trials is central to the debate and policyrnaking process. This paper underscores how the demand for, the interpretations, the funding for, and the use of evidence render EBM a political endeavor with vital ethical implications for clinical care. (c) 2005 Elsevier Ltd. All rights reserved.