Welcome to the July newsletter of the Cochrane Consumers and Communication Group. We deliver e-newsletters every three months, outlining our latest reviews and other activities. We welcome your feedback.
Our warmest congratulations go to our Managing Editor, Megan Prictor, and her family on the birth, on Wednesday 21 May, of a healthy son, Leo William John, weighing 3.6 kg.
It is with considerable sadness that we announce that Brian McKinstry is leaving the editorial team. We are extremely grateful for Brian’s participation, both as editor and author, in the work of the CCCRG.
Brian led, and cared for, an important review on improving patients’ trust in doctors, which was recently updated (Rolfe A, Cash-Gibson L, Car J, Sheikh A, McKinstry B. Interventions for improving patients' trust in doctors and groups of doctors. Cochrane Database of Systematic Reviews 2014, Issue 3: http://bit.ly/1cyI8QW ).
We have also greatly benefited from Brian’s sage advice on many difficult editorial issues and his practical approach to problem solving.
We wish him all the best for his future endeavours.
We are, however, pleased to welcome Melanie Charity, BBiolSc, MSc, who has recently joined us as a casual researcher, who will assist in data checks of systematic reviews.
Melanie works as a research assistant at Federation University in Ballarat where her responsibilities include data management, statistical analysis and reporting. She has held similar positions in health research at The University of Melbourne and Monash University. She also has extensive experience working in the health sector including clinical coding, data management and reporting.
Publication: ‘Vaccination blow from a baffling budget’
CCCRG author Jessica Kaufman’s article on the probable impact on vaccination rates of the $7 GP co-payment announced in the recent Australian federal budget was published on the ABC website, The Drum (www.abc.net.au/news/thedrum/), and generated a lively debate, with over 200 comments.
Jessica points out that full vaccination requires six separate GP visits in the first 18 months of a child's life, each of which will incur the $7 fee. While free vaccines are offered by some councils, the new fee could lead to more delayed vaccinations, leaving some children ‘under-vaccinated’, and susceptible to diseases. Other children will miss vaccinations all together.
And this will potentially have widespread consequences. Vaccines protect all of us by offering herd immunity: when most people in a population are vaccinated (generally more than 90 per cent, though for particularly infectious diseases like measles this number is more like 95 per cent), vaccine-preventable diseases can't get a foothold among the isolated unprotected people.
There will always be some people who are unprotected – very young babies, those with allergies and other health conditions that prevent or limit the effectiveness of vaccinations – and they come from all income levels.
What this budget does, ultimately, is remove access to vaccination for those who cannot afford the co-payment, and punish vulnerable people in our population when vaccine-preventable diseases return.
It means that instead of moving towards a model of informed decision-making where communication can engage parents, communities and health professionals to improve vaccination rates, we are putting financial barriers on basic vaccine access. That is not universal health care, and it's not wise health policy.
Vaccines save lives - is this really the place for budget cuts?
The full article can be found at http://ab.co/1gIB3Vw
Jessica is the lead author of a review of Face to face interventions for informing or educating parents about early childhood vaccination (Cochrane Database of Systematic Reviews 2013, Issue 5), and is a researcher at the Centre for Health Communication and Participation at La Trobe University, the home of the CCCRG.
Details of all our Review Group staff and editors can be found at http://cccrg.cochrane.org/staff-and-editors
Recent Reviews and updates
Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews
by Ryan R, Santesso N, Lowe D, Hill S, Grimshaw J, Prictor M, Kaufman C, Cowie G, Taylor M.
This is an update of an overview first published in 2011. The authors reviewed the evidence from systematic reviews about the effects of interventions to improve safe and effective medicines use by consumers, irrespective of disease, medicine type, population or setting.
Medicines are a cornerstone of treatment for many health problems. Many strategies exist to help people to use medicines safely and effectively, but research in the area is poorly organised across diseases, populations and settings. This can make it difficult for policy makers, health professionals and others to find and use the evidence about what works and what does not.
This overview summarised the evidence from 75 systematic reviews on consumers' medicine use published to March 2012. Reviews covered acute and chronic diseases in diverse populations and settings; and evaluated a wide range of strategies to improve medicines use, including support for behaviour change, risk minimisation and skills acquisition. Medicines adherence was the most commonly-reported outcome, with others such as knowledge and clinical outcomes also reported. Adverse events were identified less often.
Collectively, the results suggest that there are many different potential pathways through which consumers' use of medicines could be targeted to improve outcomes. However, no single strategy improved all medicines-use outcomes across all diseases, populations or settings.
For more information and a podcast about this overview, see: http://summaries.cochrane.org/CD007768/strategies-to-improve-safe-and-effective-medicines-use-by-consumers-an-overview-of-systematic-reviews
Cultural competence education for health professionals
by Horvat L, Horey D, Romios P, Kis-Rigo J
This review assessed the effects of cultural competence education for health professionals. Five studies were included involving 337 health professionals (including general practitioners, primary care teams and counsellors) and 8400 patients. Three studies were conducted in the USA, one in Canada and one in The Netherlands. At least 3000 patients were from culturally and linguistically diverse (CALD) backgrounds and some of the health professional groups were also from CALD backgrounds. Due to differences in terminology and their cultural meanings, and the evolving nature of concepts and practices in this area, in this review we use the term 'CALD participants' when referring to minority, CALD populations as a whole. When referring to participants in included studies we describe them in the terms used by the relevant study authors.
The studies differed in how the education was provided and which outcome measures were used. Involvement in care improved in one study in The Netherlands measuring mutual understanding between minority CALD background patients and their doctors. Health behaviour also changed in one small study in the USA, in which women whose counsellors had received education were three times more likely to attend planned counselling sessions. However there was no evidence of an effect on a range of treatment outcomes or evaluations of care. None of the five included studies examined the effect of cultural competence education on healthcare organisations, or assessed adverse outcomes.
The review findings showed some support for cultural competence education for health professionals. These findings are tentative, however, as the quality of the evidence was low and more data are needed. Future research on cultural competence education for health professionals should seek greater consensus on the core components of cultural competence education, how participants are described and the outcomes assessed.
Audio-visual presentation of information used in the informed consent process for people considering entering clinical trials
by Synnot A, Ryan R, Prictor M, Fetherstonhaugh D, Parker B. Updated on the Cochrane Database of Systematic Reviews 2014, Issue 5. Art. No.: CD003717. DOI: 10.1002/14651858.CD003717.pub3.
This is an update of a review first published in 2008. The authors reviewed the evidence about the effect of audio-visual presentation of information used in the informed consent process for people considering entering a clinical trial. They compared this with the usual informed consent information (either written and/or verbal) and placebo (sham) audio-visual information.
Before taking part in a clinical trial, potential participants must be provided with detailed information, such as what they will be asked to do and any possible benefits or harms. Once they understand what is involved, and if they are happy to take part, they usually sign a consent form. This process is known as 'informed consent'. The problem is that consent forms use technical language that can be hard to for the average person to understand. Sometimes people agree to take part in a clinical trial even though they are unsure what is involved. Presenting the consent form information in an audio-visual format (for example, on a computer or DVD) might improve the informed consent process.
The authors searched for studies of audio-visual informed consent interventions and found 16 studies, involving a total of 1884 people. People were considering (or imagined considering) participation in a range of different clinical trials, including those testing cancer treatments and drugs for mental health problems. The audio-visual informed consent information was presented on computers, DVDs, videos and CD-ROMs. In some studies, people also received the usual written informed consent forms and/or a face-to-face explanation by the study staff.
There is low to very low quality evidence that audio-visual consent interventions may slightly improve knowledge or understanding of the parent trial, but may make little or no difference to rate of participation or willingness to participate. Audio-visual presentation may improve participation satisfaction with the information provided, but its effect on satisfaction with other aspects of the process is not clear.
Africa Evidence Network
The Africa Evidence Network has launched its new website (www.africaevidencenetwork.org). The Network provides a forum for sharing information, experiences and ideas around evidence production and use, in particular systematic reviews. We include researchers, practitioners and policy-makers from universities, NGOs and governments.
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