Tag Archives: Practice Guidelines

Patient Engagement

I believe in the principle behind practice guidelines. That is, I believe there is value in compiling the best available evidence related to treatment options for a particular condition and synthesizing it into a series of recommendations for clinicians. There are certainly potential pitfalls in developing guidelines, but I still think that a high quality guideline, applied critically and with respect for patient preferences, can improve care.

One objection that clinicians often raise about guidelines is really not about the guidelines themselves, but rather about being judged on the extent to which their management matches guideline recommendations. The argument is pretty straightforward: management depends both on the physician’s recommendations and the patient’s adherence, and physicians can’t control the latter. I have argued that physicians have more influence on adherence than they may care to be accountable for, but the point is well taken. There are limits to how much physicians can influence patients’ behavior. Are there other means for improving adherence?

A novel collaboration between the American College of Cardiology (ACC) and Google is based on the assumption that patients can be engaged and activated if they have easier access to high quality information.

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Rethinking a No-Brainer

What does someone having a heart attack look like? I think the New York Times captured what many of us probably have in mind, when they published this picture as part of a recent series on advances in cardiovascular care:

Nash_Blog_ImageMark Makela for The New York Times. Retrieved from http://www.nytimes.com/2015/06/21/health/saving-heart-attack-victims-stat.html

Here is the iconic middle-aged guy, in extremis, pointing to his chest, with a team of health care professionals at the bedside. There are also signs of initial management – he has ECG electrodes on his chest, an IV in his left arm, what looks like monitor/defibrillator pads on his right chest and below his left arm and, of course, an oxygen mask.

What is wrong with this picture?
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Practice Guidelines and Quality Care

As I have noted previously I have a “love-hate” relationship with practice guidelines. Love because it is often helpful to refer to a set of evidence-based recommendations as part of clinical decision-making; hate because of all of the shortcomings of the guidelines themselves, as well as the evidence upon which they are based. Continue reading Practice Guidelines and Quality Care