Elderly: too much for too little

Can we find ways to get more value from what we spend on health and social care for the elderly? http://t.co/AcIgeSkeGl
— Richard Smith (@Richard56) June 22, 2013

Richard Smith, former editor of the British Medical Journal, author of the selected tweet this week, asks: "Can we find ways to get more out of the costs of health and social services for older people?"

This tweet links back to his own blog where we can read about his mother’s case, a lovely woman who has lost her immediate memory and is drinking too much alcohol. The point is that his mother is no longer able to live alone, but is very stubborn and refuses to leave her home, so he and his mother are forced to make a pilgrimage to the health and social services in order to obtain the case assessment: diagnostic tests, questionnaires, specialist consultations, etc..

At the end, Richard Smith concludes that all the professional activities that have happened have contributed very little to the real needs of his mother. Finally a person from a voluntary agency who visits her each day was the one who actually provided solutions to their everyday life problems.

At the end of the post, the former editor asks: "Perhaps for these lonely older people, we need community revitalization rather than so many professionals."


Jordi Varela
Editor

Minimally Disruptive Medicine

"With regards to the chronic diseases, less can be more." The Wall Street Journal published that statement on the 8th of April last in an interview with Dr. Victor Montori, a diabetologist and Director of "Health Care Delivery Research Program" at a Mayo Clinic in Rochester. Dr. Montori told the journalist that one of the best strategies for the clinical management of patients with more than one chronic disease is to know how to slow down, namely how to give clinical practice some rest.

Reporter: What is minimally disruptive medicine?

Dr. Montori: Is the health care designed to achieve objectives of improved health for patients with various chronic conditions leaving the smallest possible footprint in their lives? To achieve this, patients and clinicians should jointly make decisions about which treatments are best suited to the patient’s lifestyle.

More access to family doctor, fewer emergency room visits

More primary care access->fewer ED visits (at least in UK). http://t.co/gmpMNrsKvB (I'm co-author w/ @ImperialCollege colleagues) @PLOSONE
— Bob Wachter (@Bob_Wachter) June 18, 2013

This tweet from Professor Robert Watcher UCSF (San Francisco) refers us to an article of which he is a co-author, framed in the English NHS. This is a wide-ranging population study, with the population corresponding to 7,856 family doctors and a full year of monitoring.

To assess the access to a family doctor a survey was used from which the following parameters have been chosen: seeing the family doctor within two days of the request, having the option of talking on the phone with the family doctor or the percentage of people who get to see the family doctor of their choice.

The study has shown that the quality of access to a family doctor reduces the number of spontaneous visits to hospital emergency departments.


Jordi Varela
Editor

The parsimonious medicine

I started the last Mondays’ post with the "Too much medicine" campaign from the British Medical Journal but in this one I want to talk about the "Less is more" article from "JAMA Internal Medicine" that began in April 2010 with the aim of bringing to our attention the side effects of diagnostic tests and treatments that from the outset are not expected to add any value.

Parsimonious medicine versus spending cuts

Dr. Jon Tilburt, an internist and researcher in biomedical ethics at the Mayo Clinic, and Dr. Christine Cassel, president of ABIM Foundation (see the Video that presents the "Choosing Wisely” campaign), in an article published in JAMA, attempt to differentiate between the ethics of "no budget and therefore I can’t request a test" and those of "this test does not suit you, it will not contribute anything new to what we already know, and additionally, the test itself carries risks that do not outweigh the expected benefits". According to the authors, as at the moment the two ethics are competing on the same stage, an effort must be made to explain them better from a professional point of view.