What medical specialists like and dislike about health technology assessment reports

Abstract

Objective: To examine how medical specialists view health technology assessment (HTA) and its role in policy-making. Methods: Semi-structured interviews with 28 medical specialists practising in Quebec and Ontario (Canada) to examine their views on an HTA report relevant to their specialty (prostate-specific antigen screening, electroconvulsive therapy and prenatal screening for Down's syndrome). Results: Medical specialists represent a particularly demanding audience for HTA producers because they are knowledgeable about current studies in their field and often contribute to the evidence base that HTA seeks to synthesize. In all three cases, specialists not only challenged specific points in the content of the HTA reports but also offered different and sometimes conflicting appraisals of the clinical relevance and policy implications. More than just the timeliness and usefulness of HTA findings are at issue. The views of specialists are grounded in a clinical understanding of what counts as evidence and how decisions should be made, a view that contrasts with the societal perspective of HTA. Conclusions: HTA producers cannot afford to overlook medical specialists who play a key role in the adoption of health technologies. Establishing a transparent dialogue between producers and users of HTA reports could enrich policy recommendations.