By. Published by Churchill Livingstone Elsevier , UK . Paperback, 403pp plus index . ISBN 9780443101236 RRP $87.00
Reviewed by Stephen Duckett
Alberta Health Services, Edmonton, Alberta, Canada
Muir Gray's third edition of his book about the application of evidence-based medicine to healthcare and public health is an easy to read, well set out guide to this topic. For academics, it has numerous diagrams and dot points which would be useful in explaining relevant concepts to public health students. It provides a good overview of a range of topics useful for management and planning in the health sector including the expected chapter on appraising the quality of research (hints about randomised controlled trials, case control studies, cohort studies and qualitative research) as well as chapters on outcomes (including patient satisfaction, safety, cost effectiveness), moving on to chapters on evidence-based approached to health service management, including policy and public health.
Muir Gray is a practitioner (both public and private) as well as an academic. The book straddles the needs of both types of worlds well. The book has extensive ‘margin notes’ which provide foot note style explications of the text, in an easily accessible way. Boxes throughout provide additional detail and vignettes addressed to the ‘gentle reader’ are also used to highlight and give practical application to some of the concepts in the text.
As would be expected in a book of just over 400 pages, it cannot do justice to each of the disciplines and ideas over which it skates. To give some examples: the section on patient satisfaction (220.127.116.11) highlights the importance of the interaction between prior expectations of service quality and experience of care. This issue is dealt with in two sentences in contrast to whole books on service quality and the importance of the expectations-experience gap.1 As an economist, I particularly looked at the section on cost effectiveness, which while technically correct, in my view doesn't emphasise sufficiently the fact that these techniques are designed to assess benefits and costs at the margin, with the critical measure being the incremental cost effectiveness ratio.
The book's section on public health practice and legislation (8.1.5) states authoritatively that “there is an inverse relationship between the magnitude of a health problem and the strength of opposition”, this accompanied by figure 8.7, a simple diagram illustrating this point. Although this assertion may well be true, there is no citation of evidence in its support. There are many instances of a similar kind throughout the book, where practical guidance is given, apparently based on the author's experience, the antithesis of the theme of the book.
I read this book in the weeks before taking up a new role as Chief Executive of a major health service and particularly looked for guidance and advice which I could adopt in my new role. Interestingly, there are definitely ideas and thoughts in the book of relevance to my new role.
The book is recommended for reading by senior health policy makers, as well as public health academics.