International overview of health technology assessment training tools and materials for patients and consumers.

OBJECTIVES: The study, conducted by the French National Authority for Health (HAS), aimed to identify available online health technology assessment (HTA) training tools for patients, specifically those used by HTA bodies (HTAbs) and major selected European and international patient and consumer groups (PCGs), to inform an HTA training approach for HAS. METHODS: A literature search, a review of selected websites, semi-structured interviews with HTAbs and patient groups, and discussion within a dedicated working group to help target the needs and preferences of patients and consumers were conducted. Online HTA training tools relating to HTA and patient and public involvement (PPI), published or translated into English or French, were included in the study results. RESULTS: Eighty-two online HTA training tools for patients and consumers were selected according to the specified inclusion criteria coming from sixteen international HTAbs, nine European and international PCGs, and thirteen other organizations. Two main categories emerged: the first relating to HTA and the second relating to PPI in HTA. The formats of these tools ranged from interactive and non-interactive formats with varying accessibility and assessment methods. No journal articles mentioned explicitly the content and format of PCG training tools. CONCLUSIONS: This research served as a basis for HAS to develop their own HTA training tools and materials for patients and consumers. Two training tools were subsequently developed, guided by the needs and preferences of a patient and consumer working group, and were published on the HAS website in November 2022.

The contribution of French patient and consumer groups to health technology assessments over a 2-year period: an observational retrospective study.

BACKGROUND: In 2017, The French National Authority for Health (HAS) created an open, online, systematic contribution process to enable patient and consumer groups (PCGs) to contribute to health technology assessment (HTA) carried out to aid public authorities in reimbursement and pricing decision making. OBJECTIVES: This retrospective study analyzes how French PCGs contributed to the HTA process within the HAS for the first 2 years of this new mechanism. METHODS: PCG contributions received between 01 January 2017 and 31 December 2018 and the recording of deliberations leading to reports of the corresponding HTAs were included. Analysis grids were designed by the investigators with 5 rounds of refinement tests on 10 random PCG contributions and the reports. Systematic data extraction was then performed separately by two investigators. PCG answers to the open-question templates and the related final HTA report published by the HAS were analyzed. RESULTS: Seventy-nine contributions from 44 PCGs were received and analyzed by the HAS for 78 out of the 592 HTAs performed for drugs or medical devices during the 2-year period. Twenty-five percent of the HTAs performed for drugs received at least one contribution. The contributions covered quality-of-life aspects, access to care, and personal and family impact. Membership and budget of the contributing PCGs varied greatly. CONCLUSIONS: The experience gained in the first 2 years demonstrates the feasibility of the process and the fact that PCG contribution actually provides relevant input on the patient perspective for HTAs used for reimbursement decisions. The challenges identified on the side of PCGs were time constraints and human resources.

[Shared decision-making, dialogue and mutual agreement between the patient and health professionals]. / La décision partagée, un dialogue et un accord mutuel entre le patient et les professionnels de santé.

Shared decision-making corresponds to a medical decision-making model whereby the patient and health professionals discuss the available options and prioritise them according to the patient's preferences. Patient decision aids can be useful in this dialogue. They can help to improve the quality of care.

Non-drug treatment (excluding surgery) in rheumatoid arthritis: clinical practice guidelines.

OBJECTIVES: Because drugs do not halt joint destruction in rheumatoid arthritis (RA), non-drug treatments are an important adjunct to drug treatment. Establishing rules governing their use is difficult because treatment is multidisciplinary, complex, and difficult to assess. The aims of these guidelines were to (a) establish the indications for physical therapies and for educational, psychological, and other non-drug interventions, (b) address social welfare, occupational, and organizational issues. METHODS: A systematic literature search (MEDLINE, EMBASE, CINAHL, Pascal, Cochrane Library, HTA database) (1985-2006) was completed with information obtained from specialty societies and the grey literature. A review of the studies meeting inclusion criteria, with evidence levels, was used by a multidisciplinary working group (18 experts) to draft guidelines. Consensus was reached when evidence was lacking on key topics. The draft guidelines were scored by 60 peer reviewers, amended when necessary, and then validated by the HAS Board. RESULTS: Of the 1819 articles retrieved, 817 were analysed and 382 cited in the report. Low-power randomized clinical trials constituted the highest level of evidence. Grade B guidelines (intermediate evidence level) concerned aerobic activities, dynamic muscular strengthening, and therapeutic patient education. Grade C (low evidence level) concerned use of rest orthoses or assistive devices, balneotherapy and spa therapy, self-exercise programmes, and conventional physiotherapy. Professional agreement (no scientific evidence) was reached for orthotic insoles and footwear, chiropody care, thermotherapy, acupuncture, psychological support, occupational adjustments, and referral to social workers. CONCLUSION: Aerobic activities, dynamic muscular reinforcement, and therapeutic patient education are valuable in non-drug management of RA.