Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-09T12:38:28.975Z Has data issue: false hasContentIssue false

Health technology assessment and ill-structured problems: A case study concerning the drug mebeverine

Published online by Cambridge University Press:  19 June 2007

Margriet Moret-Hartman
Affiliation:
Radboud University Medical Center
Gert Jan van der Wilt
Affiliation:
Radboud University Medical Center
John Grin
Affiliation:
University of Amsterdam

Abstract

Objectives: The practical significance of health technology assessment (HTA) in policy decisions or clinical practice has been challenged. Possibly, problem definitions underlying HTA do not concur sufficiently with the problem definitions held by policy makers or clinicians. We performed an in-depth case study on mebeverine, a drug prescribed to patients with irritable bowel syndrome, to explore this hypothesis.

Methods: The theoretical framework was provided by the theory of argumentative policy analysis. We analyzed documents and held semistructured interviews to collect data. We reconstructed interpretative frames to analyze actors' argumentation.

Results: The funding and usage problems relating to mebeverine were ill-structured. Actors disagreed on the information needed and the norms at stake. As a result, the problem definition shifted, and the resulting problem definitions failed to correspond with the problems perceived by the target populations.

Conclusions: To ensure that future studies on healthcare problems are useful, it is imperative that policy makers take the problem definitions of potential users into account.

Type
GENERAL ESSAYS
Copyright
© 2007 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Banta D. 2003 The development of health technology assessment. Health Policy. 63: 121132.Google Scholar
Camelleri M. 1999 Therapeutic approach to the patient with irritable bowel syndrome. Am J Med. 107: 27S32S.Google Scholar
Charatan F. 2000 Drug for irritable bowel syndrome taken off the market. BMJ. 321: 1429.Google Scholar
Chernichovsky D. 1995 What can developing economies learn from health system reforms of developed economies? Health Policy. 32: 7991.Google Scholar
College voor Zorgverzekeringen. 2002. Mebeverine. Samenvatting onderzoeksrapport “irritable bowel syndrome in primary care”. Amstelveen: College voor Zorgverzekeringen;
Connell AM. 1965 Physiological and clinical assessment of the effect of the musculotropic agent mebeverine on the human colon. BMJ. 2: 848851.Google Scholar
Dulmen van AM. 1996. Exploring cognitions in irritable bowel syndrome. Implications for the role of the doctor. Nijmegen, the Netherlands: Quickprint;
Dunn WN. 2004. Public policy analysis: An introduction. 3rd ed.
Farthing MJ. 1998 New drugs in the management of the irritable bowel syndrome. Drugs. 56: 1121.Google Scholar
Fischer F, Forester J. 1993. The argumentative turn in policy analysis and planning. Durham NC: Duke University Press;
Frankish CJ, Kwan B, Ratner PA, Higgins JW, Larsen C. 2002 Social and political factors influencing the functioning of regional health boards in British Colombia (Canada). Health Policy. 61: 125151.Google Scholar
Greenwood B, Mandel KG. 1992 Effect of mebeverine hydrochloride on jejunal motility and epithelial transport in the anaesthetized ferret. Eur J Pharmacol. 211: 143147.Google Scholar
Grin J, van de Graaf H. 1996 Implementation as communicative action. An interpretative understanding of interactions between policy actors and target groups. Policy Sci. 29: 291319.Google Scholar
Grin J, van de Graaf H, Hoppe R. 1997. Technology assessment through interaction: A guide. Den Haag, the Netherlands: Rathenau Instituut;
Heuvel van den WJA, Wieringh R, Heuvel van den LP. 1997 Utilisation of medial technology assessment in health policy. Health Policy. 42: 211222.Google Scholar
Hisschemoller MP. 1993. De democratie van problemen. De relatie tussen de inhoud van beleidsproblemen en methoden van politieke besluitvorming. Amsterdam, the Netherlands: VU Uitgeverij bv;
Hoppe R Peterse A. 1998. Bouwstenen voor Argumentatieve Beleidsanalyse (Building Blocks for Argumentative Policy Analysis). Den Haag, the Netherlands: Elsevier/VUGA;
Hoppe R, Grin J. 2000: Traffic problems go through the technology assessment machine. A culturalist comparison. Chap. 10. In: Vig NJ, & Passchen H, eds. Parliaments and technology: The development of technology assessment in Europe. New York: SUNY Press; 273324.
Horst van der HE. 1997. Irritable bowel syndrome in general practice. How effective is patient education and counselling? Wageningen, the Netherlands: Ponsen & Looyen;
Horwitz BJ, Fischer RS. 2001 Current concepts. The irritable bowel syndrome. N Engl J Med. 344: 18461850.Google Scholar
Hurst JW. 1991 Reforming health care in seven European nations. Health Aff (Millwood). 10: 721.Google Scholar
Janssen HAM, Muris JWM, Knottnerus JA. 1998 The clinical course and prognostic determinants of the irritable bowel syndrome: A literature review. Scand J Gastroenterol. 33: 561567.Google Scholar
Klein KB. 1988 Controlled treatment trials in the irritable bowel syndrome: A critique. Gastroenterology. 95: 232241.Google Scholar
Malcolm LA. 1989 Decentralisation trends in the management of New Zealand's health services. Health Policy. 12: 285299.Google Scholar
Okma KGH. 2001. Health care, health policies and health care reforms in the Netherlands. Den Haag, the Netherlands: Ministerie van Volksgezondheid, Welzijn en Sport;
Poynard T, Naveau S, Mory B, Chaput JC. 1994 Metaanalysis of smooth muscle relaxants in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 8: 499510.Google Scholar
Ragnarsson G, Bodemar G. 1999 Division of the irritable bowel syndrome into subgroups on the basis of daily recorded symptoms in two outpatient samples. Scand J Gastroenterol. 10: 9931000.Google Scholar
Rosen R, Gabbay J. 1999 Linking health technology assessment to practice. BMJ. 319: 12921294.Google Scholar
Sackett DL, Haynes RB, Guyatt GH, Tugwell P. 1991: Clinical epidemiology. A basic science for clinical medicine. Boston: Little, Brown and Company; 223238.
Schieber GJ. 1995 Preconditions for health reform: Experiences from the OECD countries. Health Policy. 32: 279293.Google Scholar
Schön D. 1983. The reflective practitioner. How professionals think in action. New York: Basic Books;
van de Graaf H, Grin J. 1999: Policy Instruments, pratiques réflichés et apprentisage. Implications pour la gouvernabilité à long terme et la démocratie. Espaces et Sociétés. 6390.Google Scholar
Wahnschaffe U, Ullrich R, Riecken EO, Schulzke JD. 2001 Celiac disease-like abnormalities in a subgroup of patients with irritable bowel syndrome. Gastroenterology. 121: 13291338.Google Scholar
Ziekenfondsraad. 1995. Advies toetsing van het geneesmiddelenpakket. Amstelveen: Ziekenfondsraad;
Ziekenfondsraad. 1998. Rapport Jaarplan Beleidsonderzoek Geneesmiddelen 1999. Amstelveen: Ziekenfondsraad;