The informed medical decision making

In this post, I’ll discuss some initiatives that began in the U.S. long before the emergence of the internet, but now, with the explosion of communication channels and social networks, these have taken on an impressive dimension that I’d like to bring to your knowledge and appreciation because, as we stand today in our environment, we are very far from these advances.

Healthwise is a U.S. company offering all kinds of solutions helping healthy people to better preserve their health and patients to better understand their disease. Many assurances, such as Kaiser Permanente, are offering Healthwise products and solutions to their members, with the aim of supporting policies of empowerment.

Femur fractures. Could its incidence be reduced?

Femur fractures represent a major health issue burden for healthcare systems as it is estimated that one in 20 people will have a femur fracture throughout their lives. According to the 2005 issue of the Atlas de Variaciones en la Práctica Clínica and a subsequent document linked to the same organism (Bernal 2009), the incidence of femur fractures in Spain is 511 new cases per year per 100,000 inhabitants, with a gender distribution clearly tilted towards women (2.6 times). The incidence in Catalonia is the highest, 623, while in Galicia is the lowest, 317.

Although it’s believed that the incidence of femur fracture has little variability, note that the autonomous region that has the highest figure is almost twice of the lowest and on the other hand, if we carefully analyse the Bernal document, we can see that there are certain lifestyles that have a clear impact on the frequency of  femur fractures, such as the following finding: if older people are living in a residence, they are three times more likely to break their femur that if living in their own house.

The incidence correlates with hospitalisation in 99% of cases

Preference sensitive health care: the causes of variations

There is a case-mix part (25% according to Wennberg) such as inguinal hernia, cataracts, metrorrhagia or knee osteoarthritis, for which modern medicine has an effective surgical response, although in the application of the technique there is often a margin for the doctor’s interpretation, another margin for the subjectivity of the patient, such as pain perception or adaptation to the lack of visual acuity, as well as a very important factor: the decision of the patient himself. There are men who prefer to wear a brace to hernia surgery and women who prefer to live with their uterus, provided that the degree of the discomfort and metrorrhagy allows them to.

After this introduction, let’s see the Variations in Health Care, the good, the bad and the inexplicable report by John Appleby and his collaborators, published by King's Fund in 2011, which states that variations in hospitalization rates are pervasive and persistent, and even affect common interventions known to be effective such as hip replacement for advanced osteoarthritis cases.

                Distribution rates of hip replacement in England 2009/10