The answer to everything wrong in health care

TOP Alberta has released a beautiful infographic Evidence Summary: The Benefits of Continuity in Primary Care, and the document also serves as an overview of the 112 publications they reviewed.

It speaks for itself. Maybe the title of this post is a bit grandiose, but as a shameful hypocrite [I have very little continuity in my clinical practice, something I'm working to remedy] I cannot underscore how important this idea is.

Every physician, nurse, administrator (yes, you!), health policy person, and their uncle needs to not only know this but act on it. Continuity is what we need.

It's not a fad. It's something that we used to have. And it has slowly been eroded, without too many people noticing, as we kept focussing on the newest technology and the latest pharmaceuticals as if they would solve everything.

In BC, the essential nature of continuity has been recognized particularly with the work of Marcus Hollander and was implemented in the GP for Me/Attachment Initiative. Unfortunately (some might dispute this), changing physician incentives to try to encourage more attachment hasn't made much of a difference for patients. So while we know that we need continuity, we don't know how to 'make' the system or the providers do it.

It's a perfect storm for patients: Can't find a GP, or if you can it's hard to build a relationship with them because they are so busy/unavailable/don't have enough time to spend with you; the GP doesn't know all the details of your care as pharmacists/naturopaths and others expand their scope and don't communicate with the GP; the medical records at the hospital or from the specialist in the other city don't link with those of the GP so no one knows what is going on; when a referral or requisition is sent, there is no confirmation that is was received so it might be that you are just waiting, or it might be that it has been lost and you will never hear back about the appointment; when a home care support worker or nurse comes, it is a different person each day and they don't know you or your needs, and they aren't allowed to do the things you need help with most.

Health care really is about caring for people, and how can we do this when we do not build robust and lasting relationships?

The review did not cover provider satisfaction but personally and in BC studies so far, physician satisfaction is improved by continuity with patients. However, this is not how most young graduates are practicing; Yet another great reason that we need to look more into this.

Is it too good to be true? Before we rush ahead and try to force the "magic pill" of continuity, we need to know more about why it's being eroded, and if we can save it, then how?

 

Source: http://www.topalbertadoctors.org/file/top-...

Other Blogs: Less Is More | An index of evidence-based, “less-medical” patient care

More "Less is More"!

Dr Bill Cayley Jr has started a Wordpress Blog, "Less is More EBM" to review studies that explore situations in which less involved/invasive/expensive/difficult/novel/etc. care is actually best for patients.

He writes, "This index is currently a personal (and extremely part-time!) project aiming to catalog literature documenting when “less is more” in a searchable and accessible format." It has just started, but there are already insights on papers about overuse of arthroscopy, the best treatment for paediatric upper respiratory infection, and creative solutions for low resource areas (eg. mosquito nets instead of mesh for hernia repair).

It's great to see interest booming. More people are writing books and blogs, talking at conferences, changing the care they deliver, and asking questions of their health care provider. The movement – still known by many names, a few of which are highlighted in the glossary – is growing!

If you are particularly interested in blogs, look at the left sidebar column, and under 'Similar Blogs' you'll find others writing about similar issues as you'll find on this site. Check 'em out!

Source: https://lessismoreebm.wordpress.com/

The one chart you need to (begin to) understand any health study

Jullia Belluz, common-sense and evidence-oriented journalist (known to me from her great "Science-ish" Maclean's column) and Trudeau Scholar and Assistant Professor of Law at the University of Ottawa, Steven Hoffman, team up in their Burden of Proof column for Vox.

This week, in "The one chart you need to understand any health study" they help readers with a simple approach to understanding how to evaluate levels of evidence. Not all research is created equally:

This is a chart from the article, modified slightly. It has been beautifully "enhanced" with the added last line by Peter Cook,  @DoodlePeter . I couldn't resist sharing Peter's version!

This is a chart from the article, modified slightly. It has been beautifully "enhanced" with the added last line by Peter Cook, @DoodlePeter. I couldn't resist sharing Peter's version!

I think the chart it is a good start, and I wish it were as simple as this. Some sneaky (or inept) researchers are good at making trials look randomized, blinded, and so on but the controls, conflicts of interest, low study numbers, etc. mean that the data they gather is not very useful at all. Sometimes, the way the papers are written, it's easy to think of the conclusion as groundbreaking and accurate, but digging deeper into the methods it becomes clear that the authors did a little.... 'creative interpretation'.

Even the highest form of evidence comes in different flavours:

Not all systematic reviews are created equally, either.

And while some evidence is stronger than other evidence, it doesn't necessarily mean anything when it comes to applying it to you, the individual. Fortunately, Ms Belluz and Mr Hoffman get it.

Even with the best available evidence from around the world at our disposal, we have to analyze it and apply it to our particular circumstances. A personal experience with the success or failure of a drug, like an allergic reaction, is more informative for you than the most rigorous study on the drug ever could be. 

It can be challenging to spot issues with quality amongst the jargon and statistics. It is so refreshing to see journalists like Julia Belluz who get this and who are raising the bar for colleagues to be responsible with their science reporting.

Follow @JuliaOfToronto and @SHoffmania on Twitter

 

Source: http://www.vox.com/2015/1/5/7482871/types-...