Posters
Using HTA methods to support evidence based medical standards for motor vehicle driver licensing in the UK.
Moore D, Fry-Smith A, Bayliss S, Hyde C, Lee B, Major H, West Midlands Health Technology Assessment Collaboration, Drivers Medical Group - Driver and Vehicle Licensing Agency. Poster. Montreal. V Annual Meeting of Heath Technology Assessment International (HTAi) 6th – 9th July 2008. View Poster Here
Objective: The implementation of evidence-based driving licence legislation is important in protecting public health. Since 2005, the West Midlands Health Technology Assessment Collaboration (WMHTAC) has worked with the Drivers Medical Group and Medical Advisory Panels (MAPs) within the UK Driver and Vehicle Licensing Agency. The specialty specific MAPS advise the Secretary of State for Transport on the medical standards required for safe driving, including recommendations to withdraw licences on grounds of health-related impairment.
Methods: WMHTAC: (i) assists MAPs in defining research questions in areas where medical standards need defining or revising, (ii) undertakes systematic literature searches, (iii) screens citations for relevance using defined inclusion criteria, (iii) pragmatically identifies and critically appraises the key relevant literature, (iv) extracts/analyses data, (v) writes reports that include assessment of the quality of the evidence (vi) supplements reports by presentations to MAPS and aids subsequent discussion. Evidence from a wide range of study designs is used (e.g. cohort and cross-sectional studies) where methods are not as well developed as those for systematic reviews and RCTs.
Results: Twenty-two reports have been completed on a wide range of topics including dementia, visual deficits, cardiac disorders, seizure, drink driving and diabetes. The types of research questions answered include (commonest first) prognosis, diagnosis, prevalence, aetiology and effectiveness.
Conclusions: The application of the principles of HTA are important in helping to ensure that driving policy relating to medical disorders is based on the best available evidence so that drivers are given sound advice and the general public receive appropriate protection.
Identifying evidence on the effects of medical impairment on driving: adapting search strategies using a HTA framework.
Fry-Smith A, Bayliss S. Poster. Montreal. V Annual Meeting of Heath Technology Assessment International (HTAi) 6th – 9th July 2008. View Poster Here
Objective: In 2005 the West Midlands Health Technology Assessment Collaboration started working with the Medical Drivers Group of the UK Driver and Vehicle Licensing Agency to produce rapid evidence summaries on topics related to medical standards for safe driving, which are based on HTA methods. Approaches to literature searching required for HTAs where sources and methods of retrieving appropriate studies (systematic reviews and RCTs) are well developed, do not apply here.
Methods: Most of the research questions addressed relate to prognosis, diagnostic test accuracy, prevalence or etiology, where study designs are mainly cohort and cross sectional studies. This poses particular challenges to searching which has to be carried out following systematic and comprehensive methods within a short timescale (2 months). For example, terms used to describe the above study designs are limited and ill defined and broader searches are needed to minimize the risk of missing key references which yields large numbers of references.
Results: Examples will illustrate our approaches to searching and methods used to harness the potentially vast amount of literature. A search protocol will be presented which includes sources for systematic reviews, driving specific sources and general databases and the contribution made by each evaluated. Methods used to control the large volume of literature from bibliographic databases will be described as well as what strategies proved to be most successful in improving specificity of searches.
Conclusions: Answering research questions relating to medical impairment and effects on fitness to drive requires alternative, more pragmatic approaches to searching compared to standard methods.