Monday, 27 October 2014

More material against low value clinical practices

Dr. Joan Escarrabill is the Chronic Care Program Director of the Clínic Hospital. As a pulmonologist, he trained and developed his career in Bellvitge Hospital, where he had the opportunity to exercise various responsibilities in the field of clinical management. And now he has given us the selected tweet that leads to "Mayo Clinic Proceedings".

If you click on the two links from Dr. Escarrabill’s tweets, you’ll reach a project (and the introductory editorial) which reviewed over two thousand articles published over 10 years in the New England Journal of Medicine with the rank of "Originals". This work has identified 146 studies that advise stopping certain medical practices that are failing to demonstrate expected clinical outcomes.

Therefore, Dr. Escarrabill with his tweet, offers us a new key to strengthen programs calling for clinical practice to focus only on the actions that are known to add value to the health of people (see posts from: "Too much medicine", "Less is more", "Choosing Wisely", "Do not do" and "Projecte Essencial"). This movement of clinical containment led by professionals is taking shape in the United States under the name "The Right Care Alliance".

Monday, 20 October 2014

New diseases: new?

Enrique Gavilán is a family physician who has a habit of providing good professional quality "material" on Twitter, especially with regards to evidence in overdiagnosis and overtreatment.

On this occasion, I have chosen a tweet from Dr Gavilán which refers to a work published in "PLOS Medicine" that analyzes 16 studies where there have been criteria changes in the diagnostic definitions of common diseases such as: hypertension, asthma, attention deficit hyperactivity disorder (ADHD), COPD and dementia, among others.

One finding of the study was that these changes in criteria were mainly in three directions: creation of pre-conditions, lowering superior analytical values ​​and introduction of methods of early diagnosis. Another discovery is that these changes in criteria, which only serve to increase the legion of people affected by supposedly pathological conditions, are not accompanied by evaluations of the negative or even harmful impact to the health of "new patients". And there's a final finding: many of these studies have been developed by researchers with an economic interest linked to pharmaceutical companies directly involved in the proposed criteria changes.

Jordi Varela

Monday, 13 October 2014

Rethinking the doctor’s appointment

Thomas Goetz, the author of the this tweet, has been executive director of "Wired" magazine (a reference in the world of technology and futurism), and he has joined the Robert Wood Johnson Foundation (RWJF). According to him, he now intends to implement innovative concepts that he has been promoting from "Wired" to see the intellectual production of RWJF, surely he will succeed.

The chosen tweet refers us to the RWJF Blog where he writes that the doctor's office is a place where the real value activity is being conducted and recognizes that the doctor's office is the most important resource of the health system. But then he adds from his particular vision, that in fact this resource has many details yet to be improved: the information between the parties is asymmetric, the communication is full of misunderstandings and as a result, often the patient leaves the office having heard, but not having understood some fact that then reduces a lot the effectiveness of the subsequent planned clinical procedure.

As he states in the blog, Thomas Goetz will devote his energy and knowledge to encourage improvements in this field. Therefore we’re looking forward to it.

Jordi Varela

Monday, 6 October 2014

Clinical safety: "The Leapfrog Group" and other benchmarkings

The Hospital Safety Score is a scaled assessment (A / B / C / D / E / F) of American hospitals that aims to provide that insurers and citizens have access to proven clinical safety information offered by each hospital in the system. The Hospital Safety Score is a summary of 26 parameters that feed on both a voluntary survey and official sources: AHRQ (Agency for Healthcare Research and Quality), CDC (Centre for Disease Control and Prevention), CMS (Centres for Medicare and Medicaid Services) and "American Hospital Association Annual Survey."