[How to] Explore Your Treatment Options

 

The US Agency for Healthcare Research and Qualtiy (AHRQ) publishes a wealth of information for consumers and patients on staying healthy, choosing medical care, understanding diseases and conditions, and comparing medical treatments.

For example, Explore Your Treatment Options gives sound advice on

• Why one should explore treatment options
• Tips on how to start the conversation about treatment options with doctors
• Rating health priorities through a  check list type tool. The questions ask you to rate ease of every day activities, concerns about treatment side effects, and basic questions about treatment time, cost, and effort. Results may be printed to share with your doctor.
• Links to Treatment Guides (cancer, diabetes, heart conditions, and more)

What can we do about death? Reinventing the American medical system

From the 31 May 2011 Eureka News Alert

(Garrison, NY) In a feature article in The New Republic,(subscription only, check your local public library for availability)  Daniel Callahan and Sherwin Nuland propose a radical reinvention of the American medical system requiring new ways of thinking about living, aging, and dying. They argue that a sustainable—and more humane— medical system in the U.S. will have to reprioritize to emphasize public health and prevention for the young, and care not cure for the elderly.

An interesting twist on their argument, which would aim to bring everyone’s life expectancy up to an average age of 80 years but give highest priority for medical treatment to those under 80, is that Callahan and Nuland are themselves 80 years old. Daniel Callahan, Ph.D., is cofounder and president emeritus of The Hastings Center and author most recently of Taming the Beloved Beast: How Medical Technology Costs Are Destroying Our Health Care System. Sherwin Nuland, M.D., is a retired Clinical Professor of Surgery at the Yale School of Medicine and author of How We Die and the Art of Aging. He is also a Hastings Center Fellow and Board member.

“The real problem is that we have medicine excessively driven by progress, which aims to rid us of death and disease and treats them as the targets of unlimited medical warfare,” said Callahan and Nuland. “That warfare, however, has come to look like the trench warfare of World War I: great human and economic cost for little progress. Neither infectious disease nor the chronic diseases of an aging society will soon be cured. Cancer, heart disease, stroke, and Alzheimer’s disease are our fate for the foreseeable future. Medicine and the public must adapt it to that reality, one that has mainly brought us lives that end poorly and expensively in old age.”

The article notes that the Affordable Care Act might ease the financial burden of this system, but not eliminate it. It reports, for example, that the cost of Alzheimer’s disease is projected to rise from $91 billion in 2005 to $189 billion in 2015, and to $1 trillion in 2025 – twice the cost of Medicare expenditures for all diseases now.

“We need to change our priorities for the elderly. Death is not the only bad thing that can happen to an elderly person,” the authors write. “An old age marked by disability, economic insecurity, and social isolation are also great evils.” They endorse a culture of care, not cure, for the elderly, with a stronger Social Security program and a Medicare program weighted toward primary care that supports preventative measures and independent living.

Callahan and Nuland point the way to a more sustainable path that reprioritizes the entire system. Among their recommendations:

• improve medicine at the level of public health and primary care, while reducing its use for expensive high-tech end-of-life care;
• shift resources for the elderly to greater economic and social security and away from more medical care;
• subsidize the education of physicians, particularly those who go into primary care, and decrease medical subspecialization;
• train physicians better to tell the truth to patients about the way excessively aggressive medicine can increase the likelihood of a poor death;
• shift the emphasis in chronic disease to care rather than cure;
• conduct a top-down, bottom-up, long-range study of the entire American system of health care, including the training of physicians, with a view toward reconstituting it along systematic lines that take science, humanistic concerns, economics, and social issues into account.

Related articles

• Andrew Reinbach: Health Care Could Kill Us: We Don’t Have to Let It (huffingtonpost.com)
• New at Reason: Ronald Bailey on Health Care Reform (reason.com)

What’s The Use Of Health Economic Evaluations?

From the 10 May 2011 Medical News Today article

The production of health economic evaluations of pharmaceuticals is a multibillion dollar industry globally. Nevertheless, little is known about uptake by medical decision makers.

Dr. Sandra Erntoft has investigated whether there are differences in use across decision makers and to what extent these patterns can be explained by contextual factors?

The review – “Pharmaceutical priority setting and the use of health economic evaluations – A systematic literature review”, published in Value In Health identifies differences in the use between decision makers and contexts. Health Economic evaluations are not only used in order to inform decisions, but also serves the purpose of rationalize decisions, structuring the priority setting process or requesting additional budgets. Factors that seem to support an increased use of health economic evaluations are a general awareness and acceptance of limited health care resources, demands for an explicit priority setting process, the lack of budgetary responsibilities and the presence of health economic skills.

Dr. Sandra Erntoft, Research Director of the Swedish Institute for Health Economics says “When these preconditions are not in place, it is difficult for a decision maker to use health economic evaluations directly in medical decision making. In order to increase the use these cultural and institutional barriers need to be removed.”

Related articles

• FDA could analyze public health consequences of its decisions better (medicalxpress.com)

NLM announces MedlinePlus Connect

From a posting by  GMRLIST – email list for the National Network of Libraries of Medicine-Greater Midwest Region (NN/LM-GMR) members. Written by Samanthi Hewakapuge, MA, MLS, Consumer Health Coordinator

Today NLM [US National Libraries of Medicine) announces MedlinePlus Connect (http://medlineplus.gov/connect), a free service that allows electronic health records (EHR) systems to link users to MedlinePlus (http://medlineplus.gov), an authoritative up-to-date health information resource for patients, families and health care providers. MedlinePlus provides information about conditions and disorders, medications, and health and wellness.

MedlinePlus Connect accepts requests for information on diagnoses (problem codes) and medications. NLM mapped MedlinePlus health topics to two standard diagnostic coding systems used in EHRs: ICD-9-CM and SNOMED CT CORE Problem List Subset.

When an EHR submits a request to MedlinePlus Connect, the service returns the closest matching health topic as a response.  MedlinePlus Connect also links EHR systems to drug information written especially for patients. For medication codes, MedlinePlus Connect accepts RXCUIs and NDCs. The API for using this service conforms to the HL7 Context-Aware Knowledge Retrieval (Infobutton) Knowledge Request URL-Based Implementation specification.

MedlinePlus responds to problem code requests in either English or Spanish. Currently, it supports requests for drug information in English only.  NLM is working on adding laboratory test responses to MedlinePlus Connect. We will also support an XML-based Web service at a future date.

You can find more background and technical information at http://medlineplus.gov/connect. If you are an EHR owner or developer interested in staying up-to-date on technical developments with MedlinePlus Connect, or talking to other organizations that are using it, join the free email list athttp://www.nlm.nih.gov/medlineplus/connect/emaillist.html. To send questions or feedback, use the MedlinePlus Contact Us link athttp://apps.nlm.nih.gov/medlineplus/contact/index.cfm.

 

Research, evidence and analysis for health-care decision-makers: The READ Portal

The Centre for Health Care Management at UBC has created a new resource to help health-care managers keep up with evidence from peer-reviewed journals, the grey literature (reports from government, NGOs and other organizations), as well as commentary in the media. The beta version of this new portal, called READ, is now being updated regularly.

From the About page

This site is run by the Centre for Health Care Management at the University of British Columbia and aims to provide health care decision-makers with current articles, news items, reports, and publications that are of professional interest. Our focus is on Canadian gray literature (articles that are not published in peer-reviewed articles or publishing firms, such as: government reports, corporate reports, studies conducted by private organisations), however we will also post original book reviews and links to items of particular interest in peer-reviewed journals and the mass media.

One may keep up with new items via Twitter, Facebook, and RSS feeds.