Monday, 24 June 2019

Integrated care or person centred care?

At the 6th "Right Care" Conference of the Clinical Management Section of the Societat Catalana de Gestió Sanitària we had the opportunity to get to know Don Redding, director of Policy and Partnerships for National Voices of the National Health Service and a well known promoter of the involving people in their own clinical processes. Redding said that the integration of services doesn’t make any sense if it’s intended only as an exercise of resource rationalization. On the contrary, he argued that coordination must be conceived based on the specific needs of each person, stating that every patient can be involved in their own care plan in agreement with close involved professionals and working as a team to achieve outcomes perceived as valuable by the patients themselves.

Monday, 17 June 2019

The excesses of image diagnostics

The practice of modern medicine is subject to much pressure from the use of diagnostic imaging technologies, many of which are truly dazzling for the eyes of clinicians and patients and, as a result, health budgets are constantly increasing. This being the case, everyone agrees that more professional debate should be generated to put the matter in its place and avoid the excesses that damage resources, irradiate people and don’t add value to clinical reasoning.

Monday, 10 June 2019

Cancer research: little science, big data or big science

Apparently, the duration and costs of clinical trials of new oncological drugs could be reduced if surrogate measures, such as tumour reduction or time to progression, were to be used instead of survival, but a meta-analysis of 146 clinical trials of colorectal cancer and 191 of lung cancer found that only 10-16% of survival was explained by these variables; obviously a poor correlation. On the other hand, there is the question of the methodology used. A review of 43 studies found that, in 81% of the cases, promising results from phase II (without a control group) failed to transfer to phase III (double-blind randomized trial). The latter is another finding unfavourable to the rush with which many oncological drugs are introduced in the market. Perhaps it’s for this reason that, in an observation of 94 articles on the subject, Abola and Prasad have discovered that in half of them, the editors had resorted to adjectives of the type: miraculous, revolutionary, innovative, wonderful, transformative, etc...

Monday, 3 June 2019

The future of primary care: "Build the plane while it flies"

Josep M. Picas

Recently, The King's Fund, based on a study by the National Centre for Social Research (BSA), reported a significant decline (7%) in the assessment of satisfaction with English primary care by its citizens. This is probably due to the difficulties of access, caused by the scarcity of resources and the increasing complexity of patients. We do not know this information in other countries and especially in Spain, but it would surely be very similar, since the problems are global.