Health Cards (7)
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Dear Bill,
Thank you for that extra detail. It sounds like a very thoroughly thought
through system, but I am afraid my concerns remain. In fact, given the
enormous amount of information which you plan to collect, my concerns have
deepened.
Is there any evidence that this collection of information impacts
positively on the health status of individuals or their communities?
Although we are not used to seeing data collection as a potentially
dangerous act, it might well be if it diverts staff attention from
potentially more fruitful activity, such as communicating with their
patients.
A pilot study in a single site obviously does not give you a controlled
answer. Anyway, an enthusiastic project leader may be the intervention
responsible (through routes outside of the card, such as good general
leadership) for any improvements in health that are detected.
No, I am afraid that in regard to interventions like this one, we ought to
seek more reliable evidence than small scale single site pilot studies
before local, regional, national, or even international implementation of
new interventions.
We will not easily succeed in doing large scale, double blind, randomised
controlled trials, but there are feasible evaluation designs that will not
take a fortune or a lifetime to implement, and that will give a clear
answer to my original question: do we know that the card does more good
than harm?
And of course such a trial should be preceded by a Systematic review, or,
if CCEPP have already directed you to a completed one, your trial should be
aiming to fill any remaining gaps indicated by that review.
Thanks again for your detailed response, and good luck.
Merrick Zwarenstein
Division Head,
Health Systems Division,
Centre for Epidemiological Research in Southern Africa
Medical Research Council
PO BOX 19070, Tygerberg, South Africa, 7505
STREET ADRESS:
Fransie van Zyl Drive, Parow, South Africa, 7500
Tel. +27-21-938-0247
Fax +27-21-938-0342
mailto:mzwaren@eagle.mrc.ac.za
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