Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Karen Sepucha, Massachusetts General Hospital
Dale Collins Vidal, The Dartmouth Institute for Health Policy & Clinical Practice
Copyright 2014 American Medical Association. All rights reserv.docxbobbywlane695641
Copyright 2014 American Medical Association. All rights reserved.
The Connection Between Evidence-Based
Medicine and Shared Decision Making
Evidence-based medicine (EBM) and shared decision
making (SDM) are both essential to quality health care,
yet the interdependence between these 2 approaches
is not generally appreciated. Evidence-based medicine
should begin and end with the patient: after finding
and appraising the evidence and integrating its infer-
ences with their expertise, clinicians attempt a deci-
sion that reflects their patient’s values and circum-
stances. Incorporating patient values, preferences, and
circumstances is probably the most difficult and poorly
mapped step—yet it receives the least attention.1 This
has led to a common criticism that EBM ignore s
patients’ values and preferences—explicitly not its
intention.2
Shared decision making is the process of clinician
and patient jointly participating in a health decision af-
ter discussing the options, the benefits and harms, and
considering the patient’s values, preferences, and cir-
cumstances. It is the intersection of patient-centered
communication skills and EBM, in the pinnacle of good
patient care (Figure).
One Without the Other?
These approaches, for the most part, have evolved in
parallel, yet neither can achieve its aim without the other.
Without SDM, authentic EBM cannot occur.3 It is a
mechanism by which evidence can be explicitly brought
into the consultation and discussed with the patient.
Even if clinicians attempt to incorporate patient prefer-
ences into decisions, they sometimes erroneously
guess them. However, it is through evidence-informed
deliberations that patients construct informed prefer-
ences. For patients who have to implement the deci-
sion and live with the consequences, it may be more per-
tinent to realize that it is through this process that
patients incorporate the evidence and expertise of the
clinician, along with their values and preferences, into
their decision-making. Without SDM, EBM can turn into
evidence tyranny. Without SDM, evidence may poorly
translate into practice and improved outcomes.
Likewise, without attention to the principles of EBM,
SDM becomes limited because a number of its steps are
inextricably linked to the evidence. For example, discus-
sions with patients about the natural history of the con-
dition, the possible options, the benefits and harms of
each, and a quantification of these must be informed by
the best available research evidence. If SDM does not in-
corporate this body of evidence, the preferences that pa-
tients express may not be based on reliable estimates
of the risks and benefits of the options, and the result-
ing decisions not truly informed.
Why Is There a Disconnect?
A contributor to the existing disconnect between EBM
and SDM may be that leaders, researchers, and teach-
ers of EBM, and those of SDM, originated from, and his-
torically tended to practice, research, publish, and col-
labo.
Angela Coulter: Getting the best value for patientsThe King's Fund
Dr Angela Coulter, Director of Global Initiatives, Foundation for Informed Medical Decision Making, spoke at The King's Fund's 'Reducing unwarranted variations in health care' conference, giving her expert opinion on how to give the best value for patients: with the right intervention, in the right place, at the right time with the right level of involvement.
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Karen Sepucha, Massachusetts General Hospital
Dale Collins Vidal, The Dartmouth Institute for Health Policy & Clinical Practice
Copyright 2014 American Medical Association. All rights reserv.docxbobbywlane695641
Copyright 2014 American Medical Association. All rights reserved.
The Connection Between Evidence-Based
Medicine and Shared Decision Making
Evidence-based medicine (EBM) and shared decision
making (SDM) are both essential to quality health care,
yet the interdependence between these 2 approaches
is not generally appreciated. Evidence-based medicine
should begin and end with the patient: after finding
and appraising the evidence and integrating its infer-
ences with their expertise, clinicians attempt a deci-
sion that reflects their patient’s values and circum-
stances. Incorporating patient values, preferences, and
circumstances is probably the most difficult and poorly
mapped step—yet it receives the least attention.1 This
has led to a common criticism that EBM ignore s
patients’ values and preferences—explicitly not its
intention.2
Shared decision making is the process of clinician
and patient jointly participating in a health decision af-
ter discussing the options, the benefits and harms, and
considering the patient’s values, preferences, and cir-
cumstances. It is the intersection of patient-centered
communication skills and EBM, in the pinnacle of good
patient care (Figure).
One Without the Other?
These approaches, for the most part, have evolved in
parallel, yet neither can achieve its aim without the other.
Without SDM, authentic EBM cannot occur.3 It is a
mechanism by which evidence can be explicitly brought
into the consultation and discussed with the patient.
Even if clinicians attempt to incorporate patient prefer-
ences into decisions, they sometimes erroneously
guess them. However, it is through evidence-informed
deliberations that patients construct informed prefer-
ences. For patients who have to implement the deci-
sion and live with the consequences, it may be more per-
tinent to realize that it is through this process that
patients incorporate the evidence and expertise of the
clinician, along with their values and preferences, into
their decision-making. Without SDM, EBM can turn into
evidence tyranny. Without SDM, evidence may poorly
translate into practice and improved outcomes.
Likewise, without attention to the principles of EBM,
SDM becomes limited because a number of its steps are
inextricably linked to the evidence. For example, discus-
sions with patients about the natural history of the con-
dition, the possible options, the benefits and harms of
each, and a quantification of these must be informed by
the best available research evidence. If SDM does not in-
corporate this body of evidence, the preferences that pa-
tients express may not be based on reliable estimates
of the risks and benefits of the options, and the result-
ing decisions not truly informed.
Why Is There a Disconnect?
A contributor to the existing disconnect between EBM
and SDM may be that leaders, researchers, and teach-
ers of EBM, and those of SDM, originated from, and his-
torically tended to practice, research, publish, and col-
labo.
Angela Coulter: Getting the best value for patientsThe King's Fund
Dr Angela Coulter, Director of Global Initiatives, Foundation for Informed Medical Decision Making, spoke at The King's Fund's 'Reducing unwarranted variations in health care' conference, giving her expert opinion on how to give the best value for patients: with the right intervention, in the right place, at the right time with the right level of involvement.
Module 5 (week 9) - InterventionAs you continue to work on your .docxroushhsiu
Module 5 (week 9) - Intervention
As you continue to work on your assignment, you will be pulling in some information from your work throughout this course. For one part of this presentation, you will be identifying the current problem (or opportunity for change). This was part of your discussion in the week 2 assignment PowerPoint.
You will also propose an evidence-based intervention to address this particular problem. This intervention should be derived from the literature you have found and presented in your critical appraisal template.
As you have seen, these assignments have provided you the ability to identify a problem, develop a PCIOT question, search for evidence related to this PICOT, critically appraise the evidence for a solution to the problem, and now you will identify the solution and disseminate the results.
You are well on your way to becoming evidence-based practitioners!
Week 9!
Nice work on last week’s discussion. As you have discovered, decision aids can be very helpful when providing information for patients and families.
This week, you will continue to work on your assignment for this module. This will be an 8-9 slide PowerPoint presentation in which you will recommend an evidence-based practice change. Review the 4 articles you critiqued to determine what practice change is supported by the literature.
Some of the content for this assignment will be taken from your previous work and some will be new. This PowerPoint is a total of 8-9 slides.
Please review the full assignment details located under the learning resources for module 5.
Please let me know if you have questions
David
Provider perspectives on the utility of a colorectal
cancer screening decision aid for facilitating shared
decision making
Paul C. Schroy III MD MPH,* Shamini Mylvaganam MPH� and Peter Davidson MD�
*Director of Clinical Research, Section of Gastroenterology, Boston Medical Center, Boston, MA, �Study Coordinator, Section of
Gastroenterology, Boston Medical Center, Boston, MA and �Clinical Director, Section of General Internal Medicine, Boston
Medical Center, Boston, MA, USA
Correspondence
Paul C. Schroy III, MD MPH
Boston Medical Center
85 E. Concord Street
Suite 7715
Boston
MA 02118
USA
E-mail: [email protected]
Accepted for publication
8 August 2011
Keywords: decision aids, informed
decision making, shared decision
making
Abstract
Background Decision aids for colorectal cancer (CRC) screening
have been shown to enable patients to identify a preferred screening
option, but the extent to which such tools facilitate shared decision
making (SDM) from the perspective of the provider is less well
established.
Objective Our goal was to elicit provider feedback regarding the
impact of a CRC screening decision aid on SDM in the primary care
setting.
Methods Cross-sectional survey.
Participants Primary care providers participating in a clinical trial
evaluating the impact of a novel CRC screening d ...
How evidence affects clinical practice in egyptWafaa Benjamin
Evidence based medicine is the gold standard for clinical care.
It implies the integration of best research evidence with clinical expertise and patient values.
There is still a wide gap between availability of evidence and its incorporation into routine practice in our country.
Barriers to implementation could be personal, social, institutional, financial and legal barriers.
True practice of evidence based care can only occur where evidence based decisions coincide with patients’ beliefs and clinicians’ preferences.
Continuing medical education programs should be set with integrating evidence based medicine teaching and learning within clinical training.
The importance of presence of local national guidelines which need to take into account variation in expertise, resources and patient preferences across our geographical and cultural contexts .
Customisation of a guideline to meet the local needs of a target patient population is critical to successful implementation.
Digital communications bring opportunity and risk to the therapeutic relationship. Doctors and other health professionals can learn to collaborate in person and online to protect informed decision making. Modified slightly from a talk August 8 2019 at Brigham & Women's Hospital/Dana-Farber Cancer Institute.
Presented in:
Pre-Conference Workshop on Communication Skills in Management of Cancer Patients,
World Cancer Day Conference & Expo 2015
by National Cancer Society of Malaysia
Talk on how learning healthcare systems can aid the responsible implementation of genomics into the clinic, with a focus on the debate over universal BRCA1/2 screening. ELSI Congress, UConn, Farmington, CT, June 5, 2017.
Shared Decision Making, Decision Support and Breast Conservation TherapyMatthew Katz
Shared Decision Making, Decision Support and Breast Conservation Therapy explores how breast cancer patients interpret decisions around making decisions about mastectomy vs. lumpectomy.
Cancer Clinical Trials_ USA Scenario and Study Designs.pdfProRelix Research
Clinical trials in oncology are vital for the advancement of cancer treatments and
care. The US is at the forefront of these clinical trials, with many different study
designs being used to assess the efficacy and safety of new treatments. This article
will explore the current state of oncology clinical trial services in the US, as well as
discuss different types of study designs that are commonly used. It will provide
insight into how these trials are conducted, what data is collected, and how this
information can be used to improve patient care.
The United States Food and Drug Administration (FDA) has released
several guidance documents over the years through the Oncology Center
of Excellence to support the development of oncologic treatments and
diagnoses. Furthermore, information on the clinical trials for the treatment
of different types of cancer or specific interventions can be found on the
National Cancer Institute (NCI) website and Clinical Trials. Currently,
ClinicalTrials.gov, a website maintained by the National Library of
Medicine (NLM) and the National Institutes of Health (NIH) contains
listings of publicly and privately sponsored trials and includes information
on 91,937 studies related to cancer indicating the high volume of
research being conducted in this field.According to the World Health Organization (WHO), cancer is the leading
cause of death worldwide, with a death rate of one in six in 2020 (1).
Aside from the high mortality rate and morbidity associated with cancer, it
also negatively impacts the quality of life and poses a significant financial
burden on patients and payers making it imperative to develop effective
treatments for the disease. According to Global Cancer Observatory
(GLOBACAN), the United States accounted for 13.3% of all estimated
new cases of cancer in 2020 (2). In 2020, the single leading type of
cancer in the United States was breast cancer (11.1%) followed by lung
cancer (10%), prostrate (9,2%), colorectum (6.8%), and melanoma of the
skin (4.2%). Despite the significant prevalence of cancer and numerous
clinical trials conducted for oncology treatments, data have shown an
almost 95% attrition rate for anticancer drugs from Phase I trials until
marketing authorization. Various factors such as inaccurate preclinical
models, lack of suitable biomarkers in clinical trials, and a disconnect
between industry, academia, and regulators are responsible for the high
attrition rate (3). Therefore, it is vital to develop suitable study designs
and protocols for candidate molecules such that they obtain regulatory
approval and can be marketed. In addition to these challenges, the
development of anti-cancer agents comes at a monumental cost of an
estimated $2.8 billion. Several factors such as the choice of relevant
endpoints, the choice of appropriate biomarkers that are guided by tumor
biology, and careful patient selection are expected to improve the overall
fate of oncologic agents in the clinical trial phase
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Reducing opioid prescribing, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
Pharmacist Interventions and Medication Reviews at Care Homes - Improving Med...Health Innovation Wessex
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Pharmacist Interventions and Medication Reviews at Care Homes - Improving Medication Safety and Patient Outcomes, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
More Related Content
Similar to Working with patients to support transformational healthcare
Module 5 (week 9) - InterventionAs you continue to work on your .docxroushhsiu
Module 5 (week 9) - Intervention
As you continue to work on your assignment, you will be pulling in some information from your work throughout this course. For one part of this presentation, you will be identifying the current problem (or opportunity for change). This was part of your discussion in the week 2 assignment PowerPoint.
You will also propose an evidence-based intervention to address this particular problem. This intervention should be derived from the literature you have found and presented in your critical appraisal template.
As you have seen, these assignments have provided you the ability to identify a problem, develop a PCIOT question, search for evidence related to this PICOT, critically appraise the evidence for a solution to the problem, and now you will identify the solution and disseminate the results.
You are well on your way to becoming evidence-based practitioners!
Week 9!
Nice work on last week’s discussion. As you have discovered, decision aids can be very helpful when providing information for patients and families.
This week, you will continue to work on your assignment for this module. This will be an 8-9 slide PowerPoint presentation in which you will recommend an evidence-based practice change. Review the 4 articles you critiqued to determine what practice change is supported by the literature.
Some of the content for this assignment will be taken from your previous work and some will be new. This PowerPoint is a total of 8-9 slides.
Please review the full assignment details located under the learning resources for module 5.
Please let me know if you have questions
David
Provider perspectives on the utility of a colorectal
cancer screening decision aid for facilitating shared
decision making
Paul C. Schroy III MD MPH,* Shamini Mylvaganam MPH� and Peter Davidson MD�
*Director of Clinical Research, Section of Gastroenterology, Boston Medical Center, Boston, MA, �Study Coordinator, Section of
Gastroenterology, Boston Medical Center, Boston, MA and �Clinical Director, Section of General Internal Medicine, Boston
Medical Center, Boston, MA, USA
Correspondence
Paul C. Schroy III, MD MPH
Boston Medical Center
85 E. Concord Street
Suite 7715
Boston
MA 02118
USA
E-mail: [email protected]
Accepted for publication
8 August 2011
Keywords: decision aids, informed
decision making, shared decision
making
Abstract
Background Decision aids for colorectal cancer (CRC) screening
have been shown to enable patients to identify a preferred screening
option, but the extent to which such tools facilitate shared decision
making (SDM) from the perspective of the provider is less well
established.
Objective Our goal was to elicit provider feedback regarding the
impact of a CRC screening decision aid on SDM in the primary care
setting.
Methods Cross-sectional survey.
Participants Primary care providers participating in a clinical trial
evaluating the impact of a novel CRC screening d ...
How evidence affects clinical practice in egyptWafaa Benjamin
Evidence based medicine is the gold standard for clinical care.
It implies the integration of best research evidence with clinical expertise and patient values.
There is still a wide gap between availability of evidence and its incorporation into routine practice in our country.
Barriers to implementation could be personal, social, institutional, financial and legal barriers.
True practice of evidence based care can only occur where evidence based decisions coincide with patients’ beliefs and clinicians’ preferences.
Continuing medical education programs should be set with integrating evidence based medicine teaching and learning within clinical training.
The importance of presence of local national guidelines which need to take into account variation in expertise, resources and patient preferences across our geographical and cultural contexts .
Customisation of a guideline to meet the local needs of a target patient population is critical to successful implementation.
Digital communications bring opportunity and risk to the therapeutic relationship. Doctors and other health professionals can learn to collaborate in person and online to protect informed decision making. Modified slightly from a talk August 8 2019 at Brigham & Women's Hospital/Dana-Farber Cancer Institute.
Presented in:
Pre-Conference Workshop on Communication Skills in Management of Cancer Patients,
World Cancer Day Conference & Expo 2015
by National Cancer Society of Malaysia
Talk on how learning healthcare systems can aid the responsible implementation of genomics into the clinic, with a focus on the debate over universal BRCA1/2 screening. ELSI Congress, UConn, Farmington, CT, June 5, 2017.
Shared Decision Making, Decision Support and Breast Conservation TherapyMatthew Katz
Shared Decision Making, Decision Support and Breast Conservation Therapy explores how breast cancer patients interpret decisions around making decisions about mastectomy vs. lumpectomy.
Cancer Clinical Trials_ USA Scenario and Study Designs.pdfProRelix Research
Clinical trials in oncology are vital for the advancement of cancer treatments and
care. The US is at the forefront of these clinical trials, with many different study
designs being used to assess the efficacy and safety of new treatments. This article
will explore the current state of oncology clinical trial services in the US, as well as
discuss different types of study designs that are commonly used. It will provide
insight into how these trials are conducted, what data is collected, and how this
information can be used to improve patient care.
The United States Food and Drug Administration (FDA) has released
several guidance documents over the years through the Oncology Center
of Excellence to support the development of oncologic treatments and
diagnoses. Furthermore, information on the clinical trials for the treatment
of different types of cancer or specific interventions can be found on the
National Cancer Institute (NCI) website and Clinical Trials. Currently,
ClinicalTrials.gov, a website maintained by the National Library of
Medicine (NLM) and the National Institutes of Health (NIH) contains
listings of publicly and privately sponsored trials and includes information
on 91,937 studies related to cancer indicating the high volume of
research being conducted in this field.According to the World Health Organization (WHO), cancer is the leading
cause of death worldwide, with a death rate of one in six in 2020 (1).
Aside from the high mortality rate and morbidity associated with cancer, it
also negatively impacts the quality of life and poses a significant financial
burden on patients and payers making it imperative to develop effective
treatments for the disease. According to Global Cancer Observatory
(GLOBACAN), the United States accounted for 13.3% of all estimated
new cases of cancer in 2020 (2). In 2020, the single leading type of
cancer in the United States was breast cancer (11.1%) followed by lung
cancer (10%), prostrate (9,2%), colorectum (6.8%), and melanoma of the
skin (4.2%). Despite the significant prevalence of cancer and numerous
clinical trials conducted for oncology treatments, data have shown an
almost 95% attrition rate for anticancer drugs from Phase I trials until
marketing authorization. Various factors such as inaccurate preclinical
models, lack of suitable biomarkers in clinical trials, and a disconnect
between industry, academia, and regulators are responsible for the high
attrition rate (3). Therefore, it is vital to develop suitable study designs
and protocols for candidate molecules such that they obtain regulatory
approval and can be marketed. In addition to these challenges, the
development of anti-cancer agents comes at a monumental cost of an
estimated $2.8 billion. Several factors such as the choice of relevant
endpoints, the choice of appropriate biomarkers that are guided by tumor
biology, and careful patient selection are expected to improve the overall
fate of oncologic agents in the clinical trial phase
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The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Reducing opioid prescribing, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
Pharmacist Interventions and Medication Reviews at Care Homes - Improving Med...Health Innovation Wessex
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Pharmacist Interventions and Medication Reviews at Care Homes - Improving Medication Safety and Patient Outcomes, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, SBAR Patient Engagement Tool, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
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For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
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Impact of an EMIS search to prioritise care home residents for a pharmacist l...Health Innovation Wessex
The Health Innovation Network Polypharmacy programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Impact of an EMIS search to prioritise care home residents for a pharmacist led medication review, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Identifying Orthostatic Hypotension caused by Medication, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, How do you best get that message across, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
3. 3
Working with patients to support
transformational health care
Professor Diana Eccles, Honorary Consultant and Professor of Cancer
Genetics
Kelly Kohut, PhD student and Senior Genetic Counsellor at St
George’s
Dr Kate Morton, Senior Research Fellow
Professor Claire Foster, Professor of Psycho-oncology
Lesley Turner, Chair of Patient Reference Panel
Gillian Crawford PhD Senior Genetic Counsellor – mainstreaming lead
Dr Lucy Side, Cancer Genetics Lead Wessex Genetics Service
Dr Becky Foster, Research Fellow
5. 5
Risk and uncertainty
Risk = probability x impact
Risk = probability x impact
Risk estimate/modelling
Personal experience
Health beliefs
Influencers
(perception)
7. 7
Risk Tolerance
Risk tolerance varies between individuals and circumstances
Risk aversion: more risk averse decision-makers’ tend to
discount the value of options that have greater uncertainty in
favour of options where uncertainty is minimized even if it
requires then to pay a premium to avoid such uncertainty.
Rules (guidelines) have the common effect of reducing patients’
and clinicians’ uncertainty about what to expect and how to act
and promote consistency of action in the face of uncertainty
Based on Uncertainty in Medicine: a framework for tolerance by Paul Hann
8. 8
Shared Decision Making
For many predictive genetic
tests there is clinical
equipoise regarding their net
value.
The “value” of a test may
depend on subsequent
actions/choices.
Choices will be preference-
sensitive and collaborative
deliberation is essential to
allow each person to make the
right choice
9. 9
Decision Aids
Decision aids are tools designed to facilitate shared decision
making and patient participation in healthcare decisions. They
help people think about choices they face, describe where and
why choice exists, and provide information about options. They
are best used when there is more than one reasonable option
for care.
Breast Cancer Choices: developed with patients and clinicians to
support women with breast cancer considering a genetic test.
Grimmett et al: Systematic review of the empirical investigation of resources to support decision-making regarding
BRCA1 and BRCA2 genetic testing in women with breast cancer. Patient Education and Counselling 2018: 779-788.
Grimmett et al: Development of Breast Cancer Choices: a decision support tool for young women with breast cancer
deciding whether to have genetic testing for BRCA1/2 mutations. Supportive Care in Cancer 2019; 297-309
10. 10
Implementation: Does use of the BCC decision improve the
“experience” of BRCA genetic testing?
Setting: Mainstream
Oncology
Design: Service Evaluation
Single arm
implementation study
assessing effect of DA on
decisional conflict
12. Work Package 4
Patient Tools
What do
patients want?
What do
clinicians need
to tell them?
‘A good
decision is one
that feels right
for me’
What is
deliverable in
clinical
practice?
↓ anxiety &
decisional
conflict
↑confidence with
(self) management
of genetic cancer
risks
Co-design of patient decision aids bridging the gap together
Kelly Kohut, Kate Morton, Claire Foster, Lesley Turner, Diana Eccles
13. What is important to people when
they make decisions?
https://doi.org/10.1111/hex.13844
14. Language + cultural translation
projects
Dr Raza Sayyed, Pakistan
Professor Ranjit Manchanda
& Quicksand India
Germany
Mev Domínguez-
Valentin &
colleagues in Peru
Finland
19. Challenges
Software – keep contemporary
Hardware – host platform
Accuracy - in a fast-moving field
Responsibility – for decisions
Endorsement – trusted Kite Mark and/or promotion by trusted HCP
Dollars – long term sustainable funding model