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Martin Underwood
Martin Underwood
Martin Underwood
Martin Underwood
Martin Underwood
Martin Underwood
Martin Underwood
Martin Underwood
Martin Underwood
Martin Underwood
Martin Underwood
Martin Underwood
Martin Underwood
Martin Underwood
Martin Underwood
Martin Underwood
Martin Underwood
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Martin Underwood

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Transcript

  • 1. Supporting Informed Choices Martin Underwood
  • 2. Talking about Arthur
  • 3. Decision making in arthritis? • Decision making is complex • and poorly understood • Big Decisions • Surgery • Disease Modifying Anti-Rheumatic Drugs • ‘Small’ Decisions • Exercises • Appliances • Drugs
  • 4. Drugs for osteoarthritis • Small everyday decision in GP’s surgery & the pharmacy • >1,000,000 GP consultations per year for OA • >17,000,000 prescriptions for anti-inflammatory drugs • >4,000,000 topical preparations
  • 5. Big consequences • Consultations, prescriptions, and treating side effects cost >£400,000,000 PA. • Drug side effects • Gastric Bleeding • Raised Blood Pressure • Cardiovascular Disease • Risk for an individual is not clear • Comparative risks are different for different drugs
  • 6. Preferences • Most people with arthritis prefer anti-inflammatory drugs to paracetamol • More effective? • Studies suggest that many people might prefer a less effective but safer medication • Many people prefer topical preparations to oral medications
  • 7. Decision making • More benefit if made jointly with clinician that they trust • Take into account, benefits, risks and availability of alternative treatments • Information quality? • Risk evaluation affected by perceived severity of condition
  • 8. Where does patient information come from? • Past experience • Theirs and that of friends/relatives • Tradition • Medical advisors • Written material (traditional & modern) • Folk models of illness
  • 9. Do patients make the correct choices? • Effectiveness relatively easy • Adverse events harder • Poor data • Most people not affected • Topical or Oral Ibuprofen study (TOIB) • People who chose oral medication had fewer side effects than those randomised to oral medication
  • 10. Perception of risk and benefit High risk •(Oral) Beneficial High tolerance to adverse effect effects Little effect Low risk Low tolerance to adverse •(Topical) effects
  • 11. How did they decide GP knows best Uncritical acceptance of various information sources Nature of pain - -constant /transient – Regular or as required Trade off between pain relief, side effects and, improved function.
  • 12. Types of pain and medication use Regular NSAID use Constant pain More pain more Regular NSAID use with reserve medication As required Transient pain Pre-emptive
  • 13. A balanced decision making process?
  • 14. Factors influencing patient preferences for topical or oral ibuprofen Carnes, D. et al. BMJ 2008;336:142-145 Copyright ©2008 BMJ Publishing Group Ltd.
  • 15. On the other hand Normalisation of – arthritis pain • not aspiring to improvement – minor side effects • possible increased risk of serious side effects
  • 16. Supporting Informed Choices
  • 17. Conclusions • Most patients are pretty good at making informed choices • Shared informed decision making key to getting right balance of risks/benefits • Practitioners - data on risks and benefits • Patients – relative values of risk and benefits

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