We have moved along a path that no one has laid out, yet it leads the way without a missed beat. Evidence based medicine and evidence based whatever is barreling down the track with no notice of the myriad patients that do not fit the mold. A long time ago, we passed the point where the lack of relevance of standardized treatment for the outcast and downtrodden was lost in the hubub of the departing train. The highly specialized, evidence based approach is greatly needed for those conditions that fit the mold, but a new, interprofessional approach is needed for all the other conditions that do not fit the mold. A road map is needed that shows the way to achieve this integrated care system, and this road map exists. Managed Care in a public setting gives a clear and usable set of guidelines for moving forward to mobilize resources to make this possible. When shall we start?
I agree with the urgent need for mobilization of resources for treatment outside the orthodox "evidence-based medicine". Indeed well documented case studies are level 4 evidence. Clinical Practice Guidelines can be written based on best available evidence.
With Comparative Effectiveness Research including Cost Effectiveness Analysis, we could demonstrate to policy makers that the "integrated care" model is going to cost less. Each country has to work out their own system. For UK, the NHS is moving along this path. In Hong Kong, we have the added challenge of Chinese medicine which has great potential to help lower the healthcare cost through prevention, early treatment and patient empowerment at the community level.
Rick, this is a very interesting question that many health care managers try to solve worldwide. This is an issue that applies worldwide. I have some comments:
1. first the interprofessional approach: there is already research that shows that health care organizations working in well-structured interprofessional teams have better performance (amongst which lower mortality rates for hospitals). Please refer to research by West et al. from UK. Clarity in patient pathways will help in defining roles to avoid interprofessional overlap, turf wars etc... Unfortunately, we do not have enough evidence to support interprofessional guidelines that would give us more confidence in avoiding litigation.
2. Guidelines are guidelines....different countries have different definitions of guidelines, in that for some guidelines are not binding unless they become protocols.
3. there needs to be a balance between the use of technology and more humane care. It is not the first time that patients complain that their doctors spend more time sing the computer rather than listening attentively to their problems. The traditional art of clinical consultation is to some extent being eroded by too many technical processes...perhaps in terms of patient satisfaction point of view...wasteful.
I am impressed that answers to my question are answered with generalities that clearly show that the author has not read my book, Managed Care in a Public Setting. This clearly is the game changer that everyone has been waiting for! Moving along the path is fine, but so slow! A revolution is needed, a new paradigm, and this book has the roadmap.
Rick, Can you provide details of book please ?
- Badges
- Science topic
- Similar topics
- Journal Impact Factor