In 2017, the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) was instructed by the Swedish Government to identify areas of strategic importance within health care and social services lacking substantial scientific evidence. This work should be based on SBU observations following the evaluation of evidence in various fields of health care and social services. In addition, a gender- and equality perspective should be considered when identifying these areas.
By analyzing the SBU database for evidence gaps, SBU herein highlights the areas where a significant need for more evidence of practice-based research has been identified. Furthermore, we suggest implementing measures that can facilitate the process of prioritizing and filling these evidence gaps.
Apart from aiming to answer the question posed by the Swedish Government, this report could also be of interest to research funding bodies, scientists, universities, policy makers within health care and social services and agencies operating under the Swedish law LSS, user organisations, and other governmental agencies.
Per the definition used at SBU, a scientific evidence gap exists when one or several systematic reviews of acceptable quality show an unsure effect of a method or an intervention, or when no systematic review of acceptable quality evaluating the method or intervention is to be found.
The SBU database includes evidence gaps for areas where the lack of evidence has been identified or for areas where SBU has not been able to identify a systematic review evaluating practice-based research regarding effects of different methods within the health care or interventions supported by the laws relevant to social care and LSS. However, the database does not include evidence gaps concerning pre-clinical research.
The evidence gaps in the database are categorized according to the topic (for example pharmaceuticals or medical devices), the type of evidence needed to fill the gap, and the source of evidence gap, as well as on the age and gender of the considered population.
Most of the evidence gaps listed in the SBU database have been identified through systematic reviews conducted by SBU or national guidelines provided by The National Board of Health and Welfare (Socialstyrelsen) between 2009 and 2016. Therefore, the content of the database reflects the areas investigated by SBU or Socialstyrelsen. It should thus be taken into consideration that this report does not include evidence gaps within areas that are not included in the SBU database.
Among the areas with evidence gaps in the SBU database, the project group working with this report has chosen those which SBU has identified to be of strategic importance for practice-based research and scientific evaluations. These areas have been chosen based on the SBU ethical guideline for prioritizing scientific evidence gaps, in addition to other factors associated with equity in health and social care. Ethical and economical perspectives are also discussed in the full report.
The contents of SBU´s database are described in this report. In total, there were 1733 scientific evidence gaps following the analysis conducted on the 20th of March 2017. A substantial number of gaps were observed in the categories pharmaceuticals, medical devices, prevention of diseases, psychiatry and psychology, and oral disease. The majority of these evidence gaps can be filled by undertaking practice-based studies.
The analyses of the SBU database did not show any clear difference in gender equality, since most gaps include both men and women.
Areas not evaluated or only partly evaluated by SBU and holding few or no evidence gaps in our database might need to be evaluated in future systematic
reviews or systematic maps.
The following areas that contain substantial amounts of evidence gaps were considered to be of strategic importance:
These areas were chosen based on the content of the database, as well as SBU´s ethical guidelines for prioritizing scientific evidence gaps and other factors associated with equity in health and social care. Within these strategic areas there are certain topics that exhibit a substantial amount of evidence gaps. These topics are listed in the full report.
Possible activities to increase the benefits of practice based research SBU believes that there is a need for a more distinct connection between identifying evidence gaps and the filling of those. For this to be achieved, a better collaboration between many different stakeholders is required (Figure 1). It is also of great importance that relevant bodies participate in the prioritization of the most relevant research. Important groups are users and their relatives, user organisations, governmental agencies, universities, research groups, research funding bodies, professionals within health care, social services and LSS, as well as representatives of county councils and municipalities. The strategies that could strengthen the use of practice-based research are:
SBU Policy support identifies and presents available scientific evidence to support policy and decision making, including the development of national guidelines, at other government agencies. In consultation with professional experts, SBU staff generates supporting documentation to address the various questions that have been posed.