15/06/2013

HOW STATISTICS IMPACT

PHARMACY PRACTICE?
CPPD at NCCR
13th June, 2013

Mohamed Izham M.I., PhD

Professor in Social & Administrative Pharmacy

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Learning objective……..
• At the end of the presentation pharmacists
and pharmacy personnel should be able to:

1. explain the biostatistical concepts

2. explain the differences of statistical tests
3. discuss how these tests and its findings
can impact pharmacy practice

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Outline

 Overview of Biostatistical
Terms and Concepts
 Application of Statistical Tests

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The Research Process

OBSERVATION
Broad Area of
Research
Interest
PROBLEM THEORETICAL
DEFINITION FRAMEWORK GENERATION
Research Variables clearly OF
problem identified HYPOTHESES
delineated
PRELIMINARY
DATA
GATHERING
DEDUCTION DATA COLLECTION,
Interviews & ANALYSIS &
Hypotheses
Literature INTERPRETATION
substantiated?
review
Research Questions
answered?

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RESEARCH PROCES

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 Health Statistics provide information for

understanding, monitoring, improving and
planning the use of resources to improve the
lives of people, provide services and promote
their well being.

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• Numerical information (data) is everywhere

• Health statistics promote population health

and enhance societal well being

• Statistical techniques are used to make

decisions that affect our daily lives

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 Knowledge of statistical methods will help

you understand how decisions are made and
give you a better understanding of how they
affect you

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 No matter what line of work you select, you will find

yourself faced with decisions where an understanding of
data analysis is helpful.
 In order to make an informed decision, you will need to
be able to:
1. Determine whether the existing information is
adequate or additional information is required.
2. Gather additional information, if it is needed, in such a

way that it does not provide misleading results.

3. Summarize the information in a useful and informative

manner.
4. Analyze the available information.

5. Draw conclusions and make inferences while

assessing the risk of an incorrect conclusion.
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Why Use Statistics?

 Descriptive Statistics
• identify patterns
• leads to hypothesis generating
 Inferential Statistics
• distinguish true differences from random variation
• allows hypothesis testing

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Why Use Statistics?

1. "Credibility -- the ability to speak intelligently

is highly valued, use of numbers in a coherent
way is essential.“

2. Enable us to make informed, intelligent and

sometimes predictive decisions

e.g. quality testing, predicting diseases,

forecasting, diagnosis, treatment effectiveness

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HYPOTESIS TESTING

 Explain the nature of relationships

 Establish differences among groups or the

interdependence of two or more factor in a
situation

 Explain the variance in the dependent

variable or to predict organizational outcome.

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Research Variable Types

• Independent—comes first—influences or predicts
– Also called manipulated or experimental variable
– Can be an attribute
– Antecedent (precursor, originator)

• Dependent—comes second—if affected or

predicted by independent variable
– Consequence

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Independent Dependent
Variable Variable

Outcome
variable
e.g.:
Gender Blood pressure
Age Thinking ability
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Other Research Variable Types

• Control—type of IV that is measured

because it may influence the dependent
variable. Effect of variable accounted for by
inclusion in statistical analysis

• Confounding (extraneous)—not measured

but may have an influence on DV

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Which is IV, DV, Control, CV?

Alcohol
Smoking habit
intake

Cancer of larynx

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• People who drink alcohol, majority of them

smoke, but
• People who smoke not necessarily drink
alcohol
• Both alcohol and tobacco have been shown
have significant relationship with Ca of larynx
• So if we study the relationship between
Alcohol and Ca, we should control the 3rd
variable i.e. smoking habit
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Different Types of Statistics

 Descriptive statistics

 Pictorial statistics

 Inferential statistics

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Types of Data

 Numerical
 Continuous
 Discrete
 Categorical
 Ordinal
 Nominal

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Descriptive Statistics

 Identifies patterns in the data

 Identifies outliers
 Guides choice of statistical test

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The Normal Distribution

.
 Mean = median =
mode
 Skew is zero
Mean, Median, Mode

 68% of values fall

between 1 SD
 95% of values fall
between 2 SDs
 99% of values fall
between 3 SDs 1 2

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Skewness

Curve A Curve B
Mode
Median

negative
skew
Mean

Inferential Statistics

Used to determine the likelihood that a

conclusion based on data from a sample is
true

Making inference:

SAMPLE POPULATION

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Terms

p value: the probability that an observed

difference could have occurred by chance

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Terms

confidence interval:
The range of values we can be reasonably
certain includes the true value.

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Types of Errors

Truth
No Difference
difference
No TYPE II
Conclusion difference ERROR ()
Difference TYPE I
ERROR ()

Power = 1-

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Inferential Statistics

General Explore Relationships Description

Purpose between Variables (only)

Specific Compare Find strength of Summarize data

Purpose groups relationship, relate
variables

Type of Differences Associational Descriptive

Qs/Hypothesis

General Type Difference Associational Descriptive

of Statistics Inferential Inferential Statistics Statistics (e.g.
Statistics (e.g. correlation, mean, SD, %,
(e.g. t-test, regression, Chi- range)
ANOVA) Square)

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What Test Should I Use?

1. What type of data?

2. Are the data normally distributed?

3. How many groups/samples?

4. Are the groups independent or dependent?

5. What is the sample size?

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When Should I Use Regression

Analysis?
 Regression analysis can be used to identify
the explanatory variables that can most
effectively influence or control the value of
the outcome variable.

 Regression analysis can also be used to

estimate the future value of a variable.
 forecast

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 Simple linear regression

 Outcome variable is affected by a single factor
 Is this realistic? Is this true?
 “Omitted variables bias”

 Multiple regression
 Outcome variable is affected by variety of factors

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When Should I Use Correlation

Analysis?
 Correlation analysis measures the
relationship between two items (x and y
variables)

 The 2 variables are continuous measurement

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When Should I Use Chi-Square Test ?

 You would like to see if there is a relationship

between two variables

 Both variables are categorical

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When Should I Use Independent

t-test ?
 You have 2 groups of subjects or programs
or services

 You would like to compare the means

outcome (dependent) variable for two
independent groups

 Outcome variable: continuous measurement

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When Should I Use Paired t-test ?

 A paired (samples) t-test is used when you

have two related observations (i.e. two
observations per subject)

 You want to see if the means on these two

normally distributed interval variables differ
from one another.

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When Should I Use One-way ANOVA?

 You have 3 or more groups

 You wish to test for differences in the means

of the outcome (dependent) variable

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What Test Do I Use?

1. What type of data?
• Quantitative vs Qualitative (Interval & ratio vs Nominal &
Ordinal)
2. Are the data normally distributed?
• Normal distribution vs Skewed
3. How many groups/samples?
• One group/sample vs 2 groups/samples vs more than 2
groups/samples
4. Are the groups independent or dependent?
• Separate groups (not related) vs pre-post (before and after)
5. What is the sample size?
• Large vs small

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Process in Choosing
Statistical Tests
• Statistical objective
• Level of measurement
• Number of groups compared
• Dependent observation (data) or independent
observation
• Statistical tests
Parametric test
 Non-parametric test
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METHODS TO TEST HYPOTHESES

2 treatment Before and after
Multiple Association
Scale of groups, 3+ groups, diff a single
treatments, same between 2
Measurement different individuals treatment in
individuals variables
individuals same individuals
Interval (and Linear regression
drawn from Analysis of and Pearson
Unpaired t- Repeated-
normally variance Paired t-test product-moment
test measures ANOVA
distributed (ANOVA) correlation; Bland-
populations)* Altman analysis
Chi-square Chi-square
analysis-of- analysis-of- Contingency
Nominal McNemar's test Cochrane Q **
contingency contingency coefficients **
table table
Mann-
Whitney Kruskal-Wallis Wilcoxon signed- Spearman rank
Ordinal Friedman statistic
rank-sum statistic rank test correlation
test
Log-rank test
Survival time or Gehan's
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Take Home Message

• Pharmacists should acquire the knowledge in
– Research methods
– Statistics (or biostatistics)

• For some, you need to have the skill in these 2

areas

• For a few, you need to master in these areas

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• What are the impact on practice?

– Aware the standard or level of current practice
– Identify barriers in order to improve practice
– What kind of services should pharmacists focus on?
– Is there any significant difference between methods,
between interventions or between procedures?
– Is drug, intervention, procedure or method ‘A’
superior than drug, intervention, procedure or
method ‘B’

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• What are the impact on practice? (cont.)

– Any observed link between drug and disease?
– Identifying determinants for a disease, drug-
related problem etc.
– Which drug, regimen, protocol is more cost-
effective?
– Making rational decisions and recommendations
– Making informed-decisions
– Evidence-based medicines and practice
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Lessons learned…………..

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