Managing Managed Care

Our inequitable, inefficient, oftentimes uncaring health care "system," revealed. -- Jeffrey G. Kaplan, M.D., M.S.

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Evidence-Based Medicine

Apr 5, 2017

Patient-Centered Caring

Achieving patient-centered care is difficult, but essential; since paternalism is out, the patient has a greater role to play. The editorial, "Patient-Centered Care; What Is the Best Measuring Stick?" by Drs. Lin and Dudley (Archives of Internal Medicine), begins with an apropos quote of Sir William Osler: "The good physician treats the disease; the great physician treatsthe patient who has the disease."  It continues by establishing a... Read more Tags: Patient-Centered Care, communication, medication adherence, paternalism, Hawthorne effect, outcome, type II diabetic, adherence, compliance, non-fulfillment, medication adherence, non-compliance, higher risk of morbidity, higher risk of mortality, death rate, financial implications, failure to reach treatment goals Read more articles about: compliance / adherence
Jan 4, 2017

What is Evidence Based Medicine?

The Best Available Evidence Does Not Dictate How Medicine is Practiced. In other words, the average patient does not dictate a rule, a protocol or a practice standard. Clinicians are hyper-individualistic to a fault, only sometimes following peer-reviewed, published guidelines. Guideline developers need to be sensitive to that and to achieve buy-in, they should rethink their goals and objectives. "In addition to summarizing the evidence,... Read more Tags: evidence-based medicine, Precision Medicine, race, evidence bassed medicine, Personalized Health Care, intention to treat, meta-analyses Read more articles about: Evidence-Based Medicine
Dec 29, 2016

Costly Chronic Conditions

2/5 of the population has one or more chronic conditions that, collectively, consumes 3/4 of all health care dollars. For TB and HIV and "other chronic diseases, from diabetes to epilepsy to major mental illness and many cardiovascular diseases — and for many acute conditions, from trauma to obstructed labor (and most other conditions requiring surgical intervention), and most cancers. The development of new therapeutic agents has outpaced our... Read more Tags: population, chronic conditions, chronic, coordinate, untreatable, public health, collectively, consume, disproportionate, health care dollars Read more articles about: chronic disease management
Dec 21, 2016

Caring When Conditions are Complex/Chronic/Both

Are we prepared to care for people with chronic or complex conditions like those with comorbidities? The more chronic conditions, the greater the likelihood of the following: "unnecessary hospitalizations; adverse drug events; duplicative tests; conflicting medical advice; and, most important, poor functional status and death.1-5 Approximately 65% of total health care spending is directed at the approximately 25% of US population who have... Read more Tags: drug, cost, drug expiration date, chronic disease, functional status, death, adverse drug events, care management, coordination, incentive, surgical rates, Deyo, spinal fusion, back, fee-for-service Read more articles about: chronic disease management
Sep 12, 2016

Practices Must Change for Cost Effectiveness Research to Work

It is unclear in the U.S. if Cost Effectiveness Research (CER) studies are compelling enough to overturn insurer's coverage decisions or reduce well-established procedures--Beware the status quo "if a procedure has spread widely, large, well-designed studies must show that it’s clearly ineffective or harmful before payers and providers will abandon it; for a new procedure, the assumption is that effectiveness has not been established, so good... Read more Tags: Cost Effectiveness Research, bundled payments, shared savings programs, outcomes-based payments Read more articles about: cost-effectiveness
Aug 1, 2016

Quality Assessment--First, Is the Recommended Diagnostic Test or Treatment Efficacious?

Would you care to see efficacy in new product development where the reduction in mortality for patients so treated takes a back seat to 'The cheaper is first" rule.  In this example, metformin is standard therapy; the more efficacious Lilly product, must wait in the wings. Macrovascular Efficacy:  Microvascular Efficacy: Why doesn't Dr. Jones' opinion about therapeutic efficacy really matter? What if the patient won't or can't take the test or... Read more Tags: efficacy, compliance, adherence, outcomes, affordability Read more articles about: efficacy
Jun 6, 2016

Not Just an Apple a Day...

“There’s no such thing as alternative medicine [when it comes to "fighting" cancer]. There’s only medicine that works and medicine that doesn’t."   Complementary and Alternative Medicine (CAM) is inviting and has such promise but it is unproved and it can be dangerous. As Paul Offit (Chief Infectious Diseases, Children’s Hospital of Philadelphia) states, “There’s no such thing as alternative medicine. There’s only medicine that works and... Read more Tags: diet, nutrition, antioxidants, alternative medicine, yoga, Fight Song, Dr. Offit, supplements, vitamins, preventive medicine, omega-3, cancer, prostate, breast Read more articles about: complementary and alternative medicine (CAM)
Feb 16, 2016

Antibiotics, Sensible Use; Injudicious Overuse

It's easier to prescribe antibiotics in a cold, sinsitis or bronchitis than to explain why not. (It takes less time, it's expected, it's someone else's money and diagnostic confusion from partial or inappropriate treatment will likely be someone else's problem.) Advisory "If you're suffering from a cold, the flu, or another virus, there are things you can do to help relieve the symptoms, but taking antibiotics will not help. Antibiotics only... Read more Tags: antibiotic, indiscriminate use, antibiotic resistance, antibiotic pressure, treat to target, ESKAPE pathogens, antibiotic overuse, need for an antibiotic, the number one problem facing the medical community Read more articles about: antibiotic use/overuse
Dec 27, 2015

Yoga Therapy Prevents or Helps Treat Orthopedic Conditions

Bone fide alternative medicine approaches to common orthopedic problems. [Note: no controls] Regardless.... Loren Fishman, MD of Manhattan Physical Medicine and Rehabilitation is a personal friend and a Physiatrist, par excellence. Brody, Jane E. "Ancient Moves for Orthopedic Problems." Published, NY Times; August 1, 2011 Jane E. Brody, "12 Minutes of Yoga for Bone Health." NY Times, 12/21/15 [Dr. Lauren Fishman: in essence, yoga adherents... Read more Tags: alternative medicine, orthopedics, pain, relief, bone health, fractures, osteoporosis, meds Read more articles about: complementary and alternative medicine (CAM)
Oct 22, 2015

Timely or Delayed Breast Cancer Decision-Making

"[Is] it true that early detection/screening will save your life? The answer to this is complicated, in part, because not all cancers are the same. In general, it is likely that screening will detect slow growing tumors better than fast growing ones. My favorite analogy is of a building with a security guard that takes an hour to circle the building. A robber who can be in and out in five minutes will most likely not be caught unless he is very... Read more Tags: breast cancer screening, denial, delay, access, screening, early detection, cancer, breast cancer, tertiary prevention, becoming better informed Read more articles about: Evidence-Based Medicine

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