Monday, 28 September 2015

Research and Health Policy "to blog or not to blog"

By Tino Martí

That is the question. The strength of the link between research and health policy looks different depending on the perspective. Health services researchers expect a lot more feedback regarding their work in political decisions while the politicians need to be informed about the most effective way to ease the configuration of health policies based on scientific evidence. It’s a difficult transition bridge where the surface is eminently communicative.

In the "Web first" section of the influential Health Affairs, a study on the use of social media and perceptions of researchers has been published and is well worth reviewing (Grande D et al, 2014). During the Academy Health Annual Research Meeting, 215 investigators were interviewed using a mix of techniques (cases, assessment of broadcasting effectiveness and open qualitative questions). In the cases’ section, three ways of communicating research results to policy makers were presented: traditional media, social media and direct contact with decision-makers. Social media includes the blogosphere and the different social networks, particularly Twitter.

Monday, 21 September 2015

ICU: the elasticity of demand

The intensive care units are the most expensive health system resources, and it’s logical that both the funders and the general public wonder whether the way these are used meets their full potential. But, despite this interest the data in this area are sadly rather scarce. Of the few that I have had access to, I will highlight two: a) the variations are impressive: in the US the cost of ICU represent 1% of GDP, while in the UK only 0.1%, ten times less b) misuse, or if you prefer - therapeutic obstinacy towards the end of life of people with chronic diseases- is detected; continuing in the United States, it’s estimated that between 13% and 35% of chronic patients die in an ICU, or they die in a hospital bed after being admitted to the critical care unit (J. Wennberg. Tracking Medicine. Oxford University Press, 2010).

Two intensive carers at the University of Pittsburgh, Dr. Rebecca Gooch and Dr. Jeremy Kahn, published in JAMA a conceptual model on the elasticity of demand for ICU admissions. In a 2x2 table they’re showing the severity of the disease crossed with  the chances of survival.

Monday, 14 September 2015

Integration of social and health services: a must!

King's Fund, through this tweet, offers us access to an interim report of an independent commission that is working for the unification of the social and health services for complex chronic patients and patients with disabling degenerative processes. The report's proposal is clear: one organization and one budget with the aim of promoting access to social and health services tailored to the needs.

According to the Commission, in the UK, with regard to chronic disease care, there’s a misuse due to different barriers to access to services, with little public money on social services and waste in health services. The question is whether it’s possible to redistribute public funds to meet the real needs of this ever-growing population group.

Monday, 7 September 2015

"Patient Centred Coordination" a CCM evolution

Edward Wagner, the creator of the Chronic Care Model (CCM), when asked why he promoted a new system, responds. "The initiative came from my own clinical practice. For me, it was frustrating to see how well prepared and well-meaning doctors, were not achieving good results when dealing with the care of chronic patients, while we were starting to see evidence that by doing things differently, patients could better understand what happened to them and clinical outcomes could improve. And for this reason I thought it appropriate to communicate these new findings with the doctors "(The full interview can be found in the post "The chronic model: The Wagnerian Keys").

The current care model for complex chronic patients is usually based on individualized care plans developed for each sector: the primary care teams generally have individualized plans (ICP-PCT in the graphic), the municipal social services also work with customized plans (ICP-MSS) linked to the service portfolio of the dependence law; the long-term centers, meanwhile, develop their specific plans for each admitted patient (ICP-LTC), whereas in nursing homes, healthcare professionals who work there tend to write different plans for each resident (ICP-NH).