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Influence of expert clinical adviser characteristics on opinions about interventional procedures

Published online by Cambridge University Press:  09 April 2008

Georgios Lyratzopoulos
Affiliation:
National Institute for Health and Clinical Excellence
Andrew R. Hoy
Affiliation:
National Institute for Health and Clinical Excellence
Darmarajah Veeramootoo
Affiliation:
Royal Devon and Exeter NHS Foundation Trust
Nava V. Shanmuganathan
Affiliation:
Royal Devon and Exeter NHS Foundation Trust
Bruce Campbell
Affiliation:
National Institute for Health and Clinical Excellence

Abstract

Objectives: The aim of this study was to examine potential associations between the professional background and experience of expert clinicians and their opinions about the clinical utility of interventional procedures.

Methods: A retrospective survey of expert clinician characteristics and their opinions was conducted. Information was collected on expert clinical adviser self-declared “operator,” “researcher,” and conflict of interest status. Associations were sought between expert clinical adviser characteristics and their opinions on whether procedures were “established,” “efficacious,” and “safe.” The setting was the Interventional Procedures Programme of the UK's National Institute for Health and Clinical Excellence (NICE). A total of 598 expert clinician questionnaires relating to 182 different interventional procedures were analyzed.

Results: Expert clinical advisers with operative experience of procedures were significantly more likely to consider them as established (odds ratio [OR] 3.93; 95 percent confidence interval [CI], 2.43 to 6.36; p < .001), efficacious (OR 1.76; 95 percent CI, 1.00 to 3.08; p = .049), and safe (OR 2.28; 95 percent CI, 1.43 to 3.65; p = .001). Once adjusted for other characteristics, there was no association between either researcher or conflict of interest status and opinions about the clinical utility of procedures.

Conclusions: Expert clinical advisers are an important source of information for decision makers producing guidance about the use of procedures, especially when published evidence is sparse or of poor quality. This study suggests that those who are operators, but not those who are researchers or declare a conflict of interest, are more likely to have a favorable opinion of a procedure's clinical utility. Use of expert clinical advisers with a variety of experience and backgrounds seems a reasonable approach to obtaining authoritative opinions about interventional procedures, to supplement and help interpret evidence from published data.

Type
GENERAL ESSAYS
Copyright
Copyright © Cambridge University Press 2008

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References

1. Campbell, WB, Barnes, SJ, Kirby, RA, Willett, SL, Wortley, S, Lyratzopoulos, G. Association of study type, sample size, and follow-up length with type of recommendation produced by the National Institute for Health and Clinical Excellence Interventional Procedures Programme. Int J Technol Assess Health Care. 2007;23:101107.CrossRefGoogle ScholarPubMed
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5. Kjaergard, LL, Als-Nielsen, B. Association between competing interests and authors' conclusions: Epidemiological study of randomised clinical trials published in the BMJ. BMJ. 2002;325:249.CrossRefGoogle ScholarPubMed
6. National Institute for Health and Clinical Excellence. Interventional Procedures Programme Methods Guide. June 2007. Available at: http://www.nice.org.uk/page.aspx?o=ipmethodsguide. Accessed October 2007.Google Scholar
7. National Institute for Health and Clinical Excellence. The Interventional Procedures Programme — Programme Manual. September 2004. Available at: http://www.nice.org.uk/page.aspx?o=IPprogrammemanual. Accessed October 2007.Google Scholar
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