Oncological Care: What does the IOM Report reveal?

Ten years after the first report, the Institute of Medicine has published a new study on the quality of cancer care in the United States, forced, according to experts, because the situation is far from improving. To better understand this work, we have to contextualize it in the United States, where they have serious problems of access to cancer care, coordination between professionals and exaggerated costs of clinical processes.

On the other hand, cancer care in our country is, obviously, more accessible and more coordinated than the United States, but nevertheless you will agree with me that we lack, by contrast, the evaluation and analytical capacity of Americans, and for this reason I believe that the findings presented in this report should teach us something with the intention of overcoming our own inefficiencies, because we do have them.

The IOM expert committee concluded that the model of cancer care in America is in crisis, mainly due to three factors: a) the clinical process too often does not focus on the patients’ preferences, b) many patients only receive palliative care at the end of life, and c) clinical decisions too often are not based on evidence.

"The Right Care Alliance" – The Statement of Principles

In 2012, The Lown Institute held a conference in Cambridge (Boston) with the motto "Avoiding Avoidable Care” which generated a statement aimed at creating a professional, academic and social movement in favour of a new health system that is sustainable, effective, rational, personalized and fair. You would think, of course, that the The Lown Institute refer only to the American system, which we all know is deeply unfair and expensive. And this would be so, if it wasn’t for the fact that, in a system like the Spanish, which is infinitely fairer than theirs, when we analyze it in detail we can also note the clinical practice’s undesirable variations of a scale comparable with the American’s.

For this reason, I think it's worth having a look at the statement promoted by The Lown Institute: "Declaration of Principles of the Right Care Alliance". Look at the following extract from the explanatory memorandum of the Declaration and judge whether they are timely or not:

• Modern medicine offers significant benefits, but at the same time also has a great ability to cause damage.
• The overuse of services is widespread and tacitly accepted by the modern healthcare system
• Overuse exposes patients to iatrogenic disease.
• Overuse distracts resources that could be used in real health needs or in investments in other non-health sectors that influence the health of people as social services, education, nutrition, etc.
• The health sector industry can distort clinical decisions to the point of betraying patients’ trust. 

Resident’s values and the hidden training program

What Kind of Physician Will You Be? | The Dartmouth Atlas of Health Care | "We look to you as med stud nearing grad" http://t.co/OFqonpPjxo
— Rafael Manzanera (@rafaelmanzanera) September 6, 2013

Dr. Rafael Manzanera, the author of this week’s selected tweet, is a doctor with a career related to the planning and management of public health. Now he is responsible for quality and "knowledge management" at MC Mutual.

Deprescribing: a Preventative Decalogue

Ten principles for using medicines | @NPSmedicinewise http://t.co/XpvoClaz4M
— Lluís Triquell (@TriquellBio) September 2, 2013

Lluís Triquell is a hospital pharmacist, doctor and PDG IESE. As a managing partner of Antares Consulting, he has focused his field of expertise towards the bio-industry and pharmacy, areas where he is particularly active, both in his professional life and on Twitter.

Lluís Triquell’s tweet brings us to a Decalogue published in the online magazine NPS Medicinewise, an Australian organization specializing in searching for evidence in the field of medicine and in diagnostic tests. In this Decalogue, NPS offers a number of tips that should be taken into account when prescribing drugs to the elderly. It is, therefore, to prevent de- prescribing with 10 simple criteria.

Thank you, Lluís, for giving us this opportune link.


Jordi Varela
Editor