440 likes | 656 Views
The First International Conference for Evidence-based Healthcare. First International Conference on Evidence-based healthcare The Inaugural Conference of the International Society of Evidence-based Health Care India International Centre, New Delhi Workshops: 6 October 2012
E N D
The First International Conference for Evidence-based Healthcare
First International Conference on Evidence-based healthcare The Inaugural Conference of the International Society of Evidence-based Health Care India International Centre, New Delhi Workshops: 6 October 2012 (Pre-Conference workshops on topics related to EBHC) Conference: 7-8 October 2012 www.isehcon2012.com
Who should attend? • Physicians, nurses, pharmacists, chiropractors, naturopaths, involved in the implementation of evidence including frontline healthcare professionals • Educators involved in teaching and training in evidence based healthcare • Speakers • Kameshwar Prasad, Paul Glasziou, Gordon Guyatt, Luz Letelier, Victor Montori • www.isehcon2012.com
The second principle of evidence-based medicine changes everything Victor M. Montori, MD, MSc Professor of Medicine KER UNIT - Mayo Clinic montori.victor@mayo.edu @vmontori
Disclosures • Relevant Financial Relationships • None • Off Label Usage • None
Our confidence in estimates of risk and benefit from the body of evidence contributes to our confidence in making decisions.
Our confidence in estimates of risk and benefit from the body of evidence contributes to our confidence in making decisions.
Confidence in the estimates of risk and benefit Bias Imprecision Inconsistency Indirectness Biased reporting
Our confidence in estimates of risk and benefit from the body of evidence contributes to our confidence in making decisions.
body of evidence Trelle et al. BMJ 2011;342:c7086
Our confidence in estimates of risk and benefit from the body of evidence contributes to our confidence in making decisions.
Appropriate care
Care < Need Underuse Appropriate care
Care < Need Care > Need Overuse Underuse Appropriate care
Geographic variation in overuse Variation in overuse by procedure (n=172) Preventive services PSA 16-36% Urinalysis 37% Follow-up colonoscopy: 61% Pap smear: 58% Shah ND et al. NEJM 2012 Korenstein D, et al. Arch Intern Med 2012: 172: 171-8
Sources of waste and their projected growth to 2020 Berwick, D. M. et al. JAMA 2012;307:1513-1516
Care < Need Care > Need Overuse Underuse Appropriate care
Guidelines Every patient with diabetes is a ‘coronary heart disease risk equivalent’ Every patient with diabetes should take a statin and achieve LDL < 100 mg/dL ATP III, 2004
% who opted for treatment >90% ~50% <20% % who should take statins based on ATP III >90% >90% >90%
The evidence alone is never sufficient to make a decision. Context and patient values, preferences and goals should be considered.
Care < Need Care > Need Overuse Underuse Appropriate care
Care < Want Care > Want Overtreatment Undertreatment Desirable care
A survey of 627 US primary care clinicians 50% of my patients get too much care 50% of primary care docs are too aggressive 60% of specialists are too aggressive 35% practice much more aggressively than what they would like Sirovich BE et al. Arch Intern Med 2011
Statin Choice Weymiller et al. Arch Intern Med 2007
55 3 2 1 Get a ride Dietitian Numbers don’t add up Take off work Deadline is now Endocrinologist 108 kg take work home Obese High cholesterol perform! LDL high Avoid salt, fats, carbs insurance Metformin A1c 8.2% Diabetes mortgage Check sugars Glipizide debt Hypertension Dizzy HCTZ Take pills Wasted! Beta-blocker Daughter back at home Depression Can’t sleep Exercise 2 beautiful girls Bad back Neuropathy Pain Podiatrist Check his feet
Care < Need Care > Need Overuse Underuse Appropriate care
Care < Want Care > Want Overtreatment Undertreatment Desirable care
Care < Can Care > Can Overtreatment Undertreatment Feasible care
WORKLOAD CAPACITY
DESIRABLE Encounter Research WANT CAN NEED FEASIBLE APPROPRIATE
Need http://www.gradeworkinggroup.org Want http://shareddecisions.mayoclinic.org Can http://minimallydisruptivemedicine.org
7th International Shared Decision Making Conference Lima, Perú - June 16-19 2013 www.isdm2013.org
Our confidence in the research contributes to our confidence in making decisions. The evidence alone is never sufficient to make a decision.