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(2) OPEN
ACCESS FOLLOW UP IS COST EFFECTIVE
AND POPULAR
WITH GPS AND PATIENTS WITH
INFLAMMATORY
BOWEL DISEASE
(3) MOST
ASTHMA MANAGEMENT REVIEWS ARE
FLAWED, LIMITING
THEIR VALUE FOR HARD
PRESSED DOCTORS
(4) CAUTION
IS NEEDED IN COMMERCIAL
PARTNERSHIPS
IN CARE MANAGEMENT
(Qualitative study of interpretation
of reassurance among
patients attending rheumatology
clinics: "just a touch of
arthritis, doctor?")
http://www.bmj.com/cgi/content/full/320/7234/541
Providing reassurance to patients is a
key medical task, yet
there is little evidence about the best
ways to impart it
successfully. A qualitative study by Donovan
and Blake at the
University of Bristol's Department of
Social Medicine shows
that doctors' attempts to reassure rheumatology
patients that
their symptoms are mild or that the disease
is in its early
stages, can be counterproductive. Patients
can be left with the
feeling that the doctor has not understood
their problems and
with raised concerns about possible future
pain and disability.
Writing in this week's BMJ, a theme issue
devoted to the
management of chronic disease, the authors
acknowledge
other studies which have found that patients
and doctors
often have different perspectives on the
same clinical
encounter. Whilst efforts have tended
to focus on improving
the clarity of information provided to
patients, Donovan and
Blake argue that the key to successful
reassurance lies in the
doctor's ability to acknowledge patients'
pain and
difficulties. By means of a qualitative
study of tape recordings
of consultations and in-depth interviews
with 35 patients from
two major British cities, the authors
found that the doctors'
tendency to emphasise the non-seriousness
of the condition
contrasted with the patient's own perception
that their lives
had already been disrupted and led to
heightened fears about
pain and disability in the future. The
authors conclude that
doctors should avoid loaded terms such
as "mild" and "early
stages" and, at the same time, try to
understand and
acknowledge patients' views that their
difficulties are serious
and require attention.
Contact:
Jenny Donovan, Reader in Social Medicine,
Department of
Social Medicine, University of Bristol,
Bristol BS8 2PR
Email: jenny.donovan@bris.ac.uk
(2) OPEN ACCESS
FOLLOW UP IS COST EFFECTIVE
AND POPULAR WITH GPS AND PATIENTS WITH
INFLAMMATORY BOWEL DISEASE
(Open access follow up for inflammatory
bowel disease:
pragmatic randomised trial and cost
effectiveness study)
http://www.bmj.com/cgi/content/full/320/7234/544
Open access follow-up for patients with
stable inflammatory
bowel disease delivers the same quality
of care as routine
outpatient appointments, is preferred
by patients and general
practitioners and would save the average
consultant in
gastroenterology 25 - 50 outpatient visits
per year. This is the
conclusion of a two-year long randomised
trial and cost
effectiveness study conducted by J G Williams
et al at the
School of Postgraduate Studies in Medical
and Health Care,
at Morriston Hospital in Swansea, studying
patients from
Morriston and Neath hospitals.
The patients registered a strong preference
for open access,
feeling it appropriate to attend only
when ill. General
practitioners also preferred open access
but some patients
experienced difficulty in making urgent
appointments.
Effective methods are needed to overcome
this difficulty and
the favoured solution is the employment
of a specialist nurse
practitioner to organise patient access.
Contact:
J G Williams, Director, School of Postgraduate
Studies in
Medical and Health Care, Morriston Hospital,
Swansea SA6
6NL
Email: john.williams@pgms.wales.nhs.uk
(3) MOST ASTHMA
MANAGEMENT REVIEWS ARE
FLAWED, LIMITING THEIR VALUE FOR HARD
PRESSED DOCTORS
(Systematic reviews and meta-analyses
on treatment of
asthma: critical evaluation)
http://www.bmj.com/cgi/content/full/320/7234/537
Hard pressed doctors trying to cope with
the vast amounts of
information on new treatments for asthma
would do well to
turn to the Cochrane reviews rather than
those published in
peer-reviewed journals or funded by industry.
The Cochrane
reviews are more rigorous and better reported
than those
published in peer review journals, says
an article in this
week's BMJ. All six of the reviews sponsored
by industry
were found to have serious methodological
flaws and five out
of six had results that favoured interventions
related to the
companies sponsoring the reviews.
Alejandro Jadad et al of the Department
of Clinical
Epidemiology and Biostatistics at McMaster
University in
Hamilton, Canada subjected 50 clinical
reviews to critical
evaluation using the Oxman and Guyatt
index to measure
methodological quality. Of the 10 highest
scoring reviews,
seven were published in the Cochrane Library.
Dr Jadad,
who declares a competing interest as co-director
of the
Canadian Cochrane Network and Centre,
says most of the
reviews had methodological limitations
which could easily
have been avoided. He recommends that
peer reviewed
journals provide authors and peer reviewers
with clear
reporting criteria and use the Internet
to update or correct
previously published material. Industry
sponsored research
demands particular vigilance, the authors
conclude.
Contact:
A R Jadad, Department of Clinical Epidemiology
and
Biostatistics, McMaster University, Hamilton,
Canada L8N
3Z5
Email: jadada@fhs.mcmaster.ca
(4) CAUTION IS
NEEDED IN COMMERCIAL
PARTNERSHIPS IN CARE MANAGEMENT
(Commercial partnerships in chronic
disease management:
proceeding with caution)
http://www.bmj.com/cgi/content/full/320/7234/566
(Disease management in the American
market)
http://www.bmj.com/cgi/content/full/320/7234/563
In this week's BMJ, Trisha Greenhalgh and
colleagues from
Barnet Health Authority's Clinical Effectiveness
Review
Group set out draft standards for use
by public sector
organisations who are considering entering
a partnership with
companies offering disease management
packages. The
authors argue that in the "new Labour"
climate of
co-operation between commercial and NHS
interests, it may
be unrealistic to impose a blanket ban
on relationships with
companies. It may be better simply to
require all parties to be
explicit about potential conflicts of
interest and use a rigorous
checklist of quality standards to develop
a package which
attempts to meet the interests of all
parties.
Thomas Bodenheimer, Clinical Professor
at the Department
of Family and Community Medicine, University
of California
at San Francisco, School of Medicine argues
that commercial
disease management programmes may take
needed money
away from actual caregiving in order to
enhance companies'
profits.
Both the American and British papers conclude
that although
disease management programmes show promise
in improving
the care of patients with chronic illnesses,
commercial disease
management may have damaging, unintended
consequences
for healthcare systems. There is a transatlantic
consensus that
health care institutions should resist
the trend to outsource
disease management work to commercial
companies and
instead set up in house programmes that
help primary care
physicians do a better job.
Contact:
Trisha Greenhalgh, Senior Lecturer in primary
health care,
Department of Primary Care and Population
Sciences,
University College Medical School, London
N19 3UA
Email p.greenhalgh@ucl.ac.uk
or
Thomas Bodenheimer, Department of Family
and Community
Medicine, University of California at
San Francisco, School
of Medicine, 1580 Valencia Street, Suite
201, San
Francisco, CA 94110, USA
Email:
tbodie@earthlink.net
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