Presentation on theme: "In the 1930s the idea of a National Health Service (NHS) was not then the source of my greatest enthusiasm. Anti- fascist activities (and in particular."— Presentation transcript:
In the 1930s the idea of a National Health Service (NHS) was not then the source of my greatest enthusiasm. Anti- fascist activities (and in particular Spain) headed the list, but the NHS ranked high. A. Cochrane Effectiveness and Efficiency, p. 1
FIGURE 5.2. Clinical and epidemiological interpretations of distributions of quantitative biological characteristics Characteristic measured Clinical E pidemiological
Eficiencia:El uso óptimo de personal y materiales para obtener estos efectos. Equidad:Diferencias en el cuidado médico entre ricos y pobres. Efectividad: Efecto de una actuación médica en alterar la historia natural de la enfermedad (entendidos como los resultados de investigación, en lugar de los resultados obtenidos en la práctica clínica rutinaria).
Information of importance to patient choice which is not even potentially of evidence-based type. E.g. Information about the process of delivery of health care A B C Area where there is currently good evidence-based information which is of importance to patients in making choices Information of importance to patient choice which is potentially of evidence-based type A Information which is currently based on good evidence B Information for which good quality evidence-based information could be available in due course C Information which is potentially of importance to patients in making health care choices FIGURE 1. The relationship between evidence-based medicine and patient-centred medicine Source: Hope T. Evidence-based patient choice and the doctor-patient relationship. In: But Will it Work, Doctor? Kings Fund, London 1997,
I believe that cure is rare while the need of care is widespread and that the pursuit of cure at all costs may restrict the supply of care, but the bias has at least been declared. A. Cochrane Effectiveness and Efficiency, p. 7
I was brought up in an older tradition. I was told before ordering a test decide what you will do if it is a) positive, or b) negative, and if both answers are the same dont do the test. At the other end of the scale is the most recent innovation whereby a package of results of a dozen tests arrive at the bedside almost before the signs and symptoms have been elicited. A. Cochrane Effectiveness and Efficiency, p. 43
The inverse care law The availability of good medical care tends to vary inversely with the need for it in the population served Julian Tudor Hart Lancet 1971; i: 405