Monday, 24 August 2015

When less is more: a strategic agenda

Dr. Joan Figueres, expert in the evaluation of health services, announces with his tweet, of the publication of a post signed by Shannon Brownlee and Vikas Saini, Vice President and respectively President of Lown Institute, along with Christine Cassel, President of ABIM Foundation. This post was published on the blog of Health Affairs on 25 April and in total agreement with Dr. Figueres, I also find it remarkable as I believe that the article does a good overview of the current grade of clinical waste outbreaks and suggests some strategies for engaging physicians, patients and the media in improving the situation, and I will focus on the latter:

  1. Rethinking preventive policies that lead to overdiagnosis and involve more every citizen in the decision making when presented with certain evidence.
  2. Applying more benchmarking to the variations in the use of resources, particularly in terms of elective surgery.
  3. Promoting the practice of shared clinical decision with more practical materials and more training.
  4. Promoting the integration of services to continuously meet the needs of complex chronic patients and frail elderly patients in a customized manner.
  5. Expanding the practice of palliative medicine in all areas where it is believed that can provide comfort to the patient.
  6. Reviewing the clinical practice guidelines from a perspective of evidence that is as independent as possible. Introducing the practice of moderate medicine in the teaching and the practice of patient involvement when training new doctors and nurses.
  7. Determining the public research funding agencies to establish a research agenda for the overuse of health services.
  8. Reviewing the financing models based on activity payment and redirecting them towards promoting the value that the vendors bring to the health of people.
  9. Involving the media to help change the perception of health services and to redirect the focus from scandals and scientific findings towards true stories that help people become more involved in decisions that affect their health.
Dr. Howard Brody said in the first Right Care lecture: "The overuse of health services is not just a technical problem; it’s in the air we breathe."

In conclusion: we must create a strategic agenda to change culture of the more the better with the culture of: we decide together what’s the best route to take.

Jordi Varela


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