Guest post by Vinayak K. Prasad, MD, MPH, and Adam S. Cifu, MD For doctors, it is common to have some doubt about a new medical test, procedure or drug—even one which is widely hailed as remarkable…
For doctors, it is common to have some doubt about a new medical test, procedure or drug—even one which is widely hailed as remarkable or a game changer. It is not cynicism but a healthy skepticism towards marketing over substance. Doctors want to see the evidence that a drug actually works rather than just a good story about why it should work.
Often, however, this skepticism does not last. After a few months, still without any evidence, the doctor finds herself buying in, just a little, to the hype. OK, let me just see what everyone is talking about, she thinks. She begins recommending the drug herself. She still thinks of herself as cautious and conservative—while her colleagues use the treatment widely, she thinks it has a more narrow and defined role. Probably the pill does not work for everyone, but in a select group of people.
A few more years go by, and she gets comfortable with the once-hyped treatment. She now knows how to manage its complications; she thinks she has a good sense of who it benefits; and she considers it a part of her practice.”
Source: Ending medical reversal
Photo credit: Cindy Funk via Flickr
A paper in Health Affairs (subscription required for access) shows what can be done with decision aids in clinical practice in what the authors describe as “the largest (observational study) to date of the implementation of patient decision aids in the context of quality improvement for elective surgery.”
A team from Group Health Cooperative in Seattle reports:
“Decision aids are evidence-based sources of health information that can help patients make informed treatment decisions. However, little is known about how decision aids affect health care use when they are implemented outside of randomized controlled clinical trials. We conducted an observational study to examine the associations between introducing decision aids for hip and knee osteoarthritis and rates of joint replacement surgery and costs in a large health system in Washington State. Consistent with prior randomized trials, our introduction of decision aids was associated with 26 percent fewer hip replacement surgeries, 38 percent fewer knee replacements, and 12–21 percent lower costs over six months. These findings support the concept that patient decision aids for some health conditions, for which treatment decisions are highly sensitive to both patients’ and physicians’ preferences, may reduce rates of elective surgery and lower costs.”
Group Health says it has distributed more decision aids than any other single health care organization in the world. More than 25,000 Group Health patients have received decision aids, and is now distributing at the rate of about 900 more each month.
It should also be noted that 5 years ago, Washington passed the first state legislation recognizing the use of patient decision aids and “shared decision making” as a higher standard of informed consent.
The study was funded by the Commonwealth Fund. The implementation of decision aids was funded in part by the Informed Medical Decisions Foundation, which has been the sole supporter of this website for its entire existence. However, no one at that Foundation influences what I publish on this site. First author Dr. David Arterburn has also reviewed stories for HealthNewsReview.org.