Hospital emergencies: the refugee camp of the healthcare system

@varelalaf

The society witnesses the emergence of population groups with social and health care needs that are difficult to fit in the current model of service offer. Thus, we see how fragile and vulnerable people are picked up by ambulances and go to hospital emergency rooms, which become like refugee camps, as Sara Kreindler, head of health systems innovation research at the University of Manitoba (Canada), likes to call them. Many initiatives, observed everywhere, aim to put an order in these refugee camps of healthcare: implantation of triage, observation units, geriatric units, new case management nurses, nurses trained in geriatric evaluation. To help us analyze a problem that we don’t know how to address, Sara Kreindler has developed a qualitative study in the framework of a region of Canada. The study has concluded that partial interventions aiming to improve the flow of urgent care for patient’s complex show three paradoxes:

Lost in translation: five parachutes for the "jumping into the void" at hospital discharge

Marco Inzitari

As in Sofia Coppola's melancholic and visual film of 15 years ago, the disorientation that is experienced during a phase of transition, which in the movie was a life transition whereas in our case a transition between care levels, could be converted into an opportunity to rethink the present and face the future with a renewed perspective. Especially if we are lucky enough to partner with good travel companions with whom we can share the same concerns.

A new clinical visit format: shared medical appointments (SMA)

Glòria Galvez

The model of patient-centred care suggests the need to redefine some models of care and look for others that respond at the same time to the needs of patients and professionals. An example of innovative care is that which affects the traditional medical consultation, which is insufficient to address certain diseases with a prominent psychosocial component.

The shared decision making through a behavioural economics view

Pedro Rey

Last year I participated in a session on shared clinical decisions between doctors and patients during the XXXVIII Conference on Health Economics of the AES, which this year was focused on shared decisions making, including a plenary talk by Alistair McGuire. As a behavioural economist, I find that informed decision-making in an area with as much uncertainty as health is precisely one of the fields in which a more interesting and, hopefully, more productive dialogue can be generated among health and behavioural economists. As I have commented in other posts, behavioural economics departs from the traditional economics assumption that which individuals are rational beings that always know what is best for them and make optimal decisions according to established and well-defined preferences. It’s obvious that this theoretical ideal is rarely met, especially in a context such as health where asymmetries of information, uncertainty about our own preferences or the difficulty in interpreting the risks associated with the multiple decisions that must be made makes it very difficult to choose well, and even evaluate ex post if the decision was optimal. Therefore, the premise from which the movement claims for more shared decision making between doctors and patients produces both hope and doubts.

Vertebroplasty and knee arthroscopy: two interventions questioned by the evidence

@varelalaf

The measurement of the clinical effectiveness of surgical interventions is, regrettably, not too frequent. In this field, the design of rigorously and well executed clinical trials has its complexities, especially when the control group undergoes sham surgery. For this reason, it’s worth disseminating the conclusions of consistent studies that arouse doubts about the effectiveness of the decisions made every year by the operating rooms to thousands of citizens, who must accept the risks, not negligible, inherent in surgical intervention. In this regard, I already mentioned the poor results that a clinical trial had shown for coronary angioplasties with stenting in patients with stable angina and, in the same vein, today I have selected two clinical trials related to orthopaedic interventions.