A two day workshop by
Dr Geoff Wong
24 - 25 February 2010
Attended by Rachel Katterl and
Eleanor Jackson-Bowers, PHC RIS
The Australian Government is heavily emphasising the use of evidence in policy development. To support this there is much interest in methodologies for synthesising evidence in ways that are most useful.
In our complex health system many of the research questions we ask become challenging due to the interconnectedness of the environments in which variables, people, programs and services operate. Realist Synthesis seeks to grapple with these issues of complexity. It is a logic, or set of principles to organise the process of a systematic review. Rather than addressing only the question of ‘what works’, it also seeks to discover ‘how, why and for whom’.
Realist Synthesis starts by proposing a model of causal relationships between variables in the program under review based on the given program logic and further explained by middle range theory (integrating theory and empirical research). True to the real world experience, these models are complex, non-linear, and have multiple stages or components. This model is tested and retested iteratively by examining the research and other literature in a particular area. The output is a tested program theory which can be applied in other contexts.
What is refreshing about the realist approach is its willingness to acknowledge multiple sources of evidence, which makes it particularly suitable for use in a policy context. What evidence is applicable will depend on the nature of what is being asked. In addition, its attempt to acknowledge and use context, rather than viewing it as a source of bias makes the findings from these syntheses more generalisable to real life contexts.
This approach shows much promise and is generating a great deal of interest.
The method is fully outlined by Ray Pawson in his book:
Pawson R. (2006). Evidence-Based Policy: A Realist Perspective. London: SAGE Publications.
And more information can be found in the following article:
Wong G, Greenhalgh T, Pawson R. (2010). Internet-based medical education: A realist review of what works, for whom and in what circumstances. BMC Med Educ. Feb 2;10(1):12.
 APHCRI National Health Reform Series
24 February 2010
Attended by Libby Kalucy and
Ellen McIntyre, PHC RIS
An expert panel of speakers facilitated by the Director of APHCRI, Mr Bob Wells, provided the setting for this second forum in the National Health Reform Series. With the topic Are GP super clinics the answer to the access problems? participation at the Forum was spirited.
Professor Mark Harris, (University of NSW) in his opening comments, indicated that access problems are more of an issue in rural and remote areas. In addition, there are major problems in accessing allied health workers in relation to affordability, however super clinics may not necessarily be the answer if they are merely a co-location of services. What is more important is that the services a superclinic provides are integrated, affordable and available. According to the evidence, size does matter – when a centre becomes too large, patient satisfaction falls.
Mr Russell McGowan (health consumer advocate) described superclinics as supermarkets – they are accessible and competitive but his concerns were that they need to provide high quality cost effective services, something that has yet to be evaluated.
Dr Rashmi Sharma (GP) and Dr Steve Hambleton, (Australian Medical Association) both expressed concern that superclinics would be competing against established general practices in the same area. While it is anticipated that bulk billing would be a feature in the superclinics, there was concern that this may not be sustainable.
Discussion covered several areas such as concerns the superclinics will provide optimal care that includes continuity of care, affordability and accessibility to allied health workers, and a commitment to clinical placements for both medical and allied health students along with ongoing monitoring and evaluation.
For the podcast and transcripts of this second forum see <www.anu.edu.au/aphcri/national_health_reform_series/>
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