Improving understanding of public drug purchasing ...

Improving Understanding of Public Drug Purchasing Decisions through

Brokered Dialogue

The case of LANTUS® Insulin

Jim Lavery, Janet Parsons, Wendy Rowland, Lineke Heus

CADTH Symposium 2009April 6, 2009

Ottawa

Centre for Research on Inner City HealthCentre for Global Health Research

Li Ka Shing Knowledge InstituteSt. Michael's Hospital

Overview & Aims

• Introduce the Brokered Dialogue method

• Report on a pilot project related to public drug purchasing (LANTUS® Insulin Glargine)– Emphasis on technical aspects of the Brokered Dialogue method– Some preliminary insights about use of Brokered Dialogue for public

engagement

• 13 min Brokered Dialogue film presentation

• “Brainstorming” next steps

• Discussion

Dialogue

• Dialogue = “through words”

• Foundations of social and political life

• How we come to know one another

• How we come to appreciate and value the interests and perspectives of others

• Mode of operation of deliberative democracy– how we confront and accommodate diverse interests in a range

of public contexts

Absence of Dialogue on socially important issues

•Risk increased homogeneity of acceptable views/perspectives•Lose potentially valuable knowledge/insights•Get impoverished accounts of complex social phenomena and their stakes•Undermines democratic ideals

Power/influence determine who’s perspectives are taken into

consideration

•Dialogue becomes less common across socio-economic and “cultural” divides•Normalizes absence of dialogue

Lack of appropriate contexts for dialogue

•Marginalization (gated communities)•Lose experience with different perspectives•“Alienation”

Social Distance (both a barrier and consequence--self-perpetuating)

•Reluctance/inability to articulate perspective•Intimidation•Under-estimation of the value of one’s own perspective

Disparities in language skills

•Avoidance of others•Avoidance of opportunities for dialogue

Fear of confrontation/Establishing relationships

ConsequencesBarriers

Can we develop a methodto address these issues?

Can we develop a methodto address these issues?

The Brokered Dialogue method

Brokered Dialogue Method

• Research method AND intervention– We learn through the process– Participants are confronted by other perspectives– The exchange of perspectives is captured for use in public

engagement

• Process:– Select an issue– Identify potential participants– Data collection and analysis / “Brokering”– Produce films and/or “creative applications”– Use these for public engagement

Filmed interview with Participant 1

Interview viewed and edited with Participant 1

Review/further editing

Participant 2 views Participant 1 ’s filmed

interview

Participant 2 ’s reactions are filmed

Brokered Dialogue Method: Data Collection and Analysis

1





interview



1

2


Film Cut “A”Review/further

editing





interview



1

2


3

Participant 1views Cut “A”

Film Cut “A”

+Participant 2views Cut “A”

Film Cut “B”

reactions are filmed







interview



1

2


3

Participant 1views Cut “A”

Film Cut “A”

+Participant 2views Cut “A”

4

Film Cut “B”

Participant 1views Cut “B”

+Participant 2views Cut “B”

+Participant 3views Cut “B”

Film Cut “C”






etc.5

Brokered Dialogue Method: “ Brokering”

•BD provides context for dialogue, but does not require face to face confrontation•Film enhances realism of experience of dialogue•Participants have full control of final content•“multiplier effect”--resulting films and “creative applications” can take dialogue out to the public in various forms/contexts

Advantages

•“brokering” dialogues that do not naturally occur•Participatory qualitative research design•Use of film=unique opportunities for PE, Education and “creative apps”

Key elements and innovation

•Generate important insights by addressing barriers to dialogue•Bridge communication gaps / differences in perspective in important social issues/contexts•Produce original films and “creative applications” as tools for public engagement

Main goals

•Dialogue can reveal aspects of social phenomena that other research methods can’t•Participating in, or observing dialogue, can “transformational” in some ways•Can be applied in a wide range of social issues/contexts

Underlying assumptions

Brokered Dialogue Method: Overview

The LANTUS® case

The LANTUS® (Insulin glargine) case

• Purpose :– to explore the feasibility of applying the Brokered Dialogue method in

the context of a controversial public drug funding decision

• Controversy :– disagreement among “stakeholders” about the decision not to fund– Disagreement arises from very different perspectives on the decision– Ideal for focus on dialogue– Selected LANTUS® case in consultation with CADTH

• Context:– Recent and “live”– Diabetes high prevalence disease– Large market, therefore public cost implications and public stewardship

implications are considerable

Potential

The Brokered Dialogue Concept

Potential Current Reality

The Brokered Dialogue Concept

QuickTime™ and aDV/DVCPRO - NTSC decompressor

are needed to see this picture.

Lessons: LANTUS® decision

Selected findings highlighted in the video• Range of values relevant to public drug purchasing

decisions• CEA does not incorporate the full range of relevant

values/perspectives– CEA is necessary, but not sufficient in itself

• Agreement among all the participants that the fair inclusion of these perspectives in the decision-making process is important

• These are fundamentally questions of how we agree on the value of each proposed addition to our public drug formularies

• What expertise is required to determine value?

Lessons: Brokered Dialogue

• The method is feasible, though currently inefficient• Difficult to simulate natural dialogue

– Technically

– Temporally/immediacy/dynamic

• “Brokerage” role is more complicated than we anticipated– Simply an impartial/indifferent vehicle for the dialogue of others?

– More active shaping of dialogue through analysis?

• Our view of what “problems” need to be fixed may be different than the participants’

• Research ethics issues are complex and there is limited guidance

Research Questions Preview• What is the most effective role for “brokering”?• Should film of the “brokering” process be included in

the final film?• What is the most realistic filming/editing approach to

create dialogue?• Is it important for individual participants to change or

reflect evolution of their positions?– Is this necessary for PE to be effective?

• What are the implications if some perspectives are missing?

• What impact do different lengths/edits/versions of the film have for public engagement?

Next steps?

• “Build” a custom film for a specific public forum?

• Use film as training/background material for pilot citizens’ council?– Study impact

QuickTime™ and a decompressor


QuickTime™ and a decompressor


Next steps?• Expand the LANTUS® Brokered Dialogue to

include other interested parties:– Patients– Drug manufacturer– Government and political dimensions– Pharmacists– Others?

• Continue to study and refine method• Develop funding strategy

Acknowledgements

• CADTH• Our dialogue participants• Alison Thompson• Andreas Laupacis• Judy Kopelow

Improving understanding of public drug purchasing ...

Documents

Transcript of Improving understanding of public drug purchasing ...