Transcript First International Conference on Evidence

The First International Conference for
Evidence-based Healthcare
First International Conference on
Evidence-based healthcare
The Inaugural Conference of the
International Society of
Evidence-based Health Care
India International Centre, New Delhi
Workshops: 6 October 2012
(Pre-Conference workshops on topics related to EBHC)
Conference: 7-8 October 2012
www.isehcon2012.com
Who should attend?
• Physicians, nurses, pharmacists, chiropractors,
naturopaths, involved in the implementation of evidence
including frontline healthcare professionals
• Educators involved in teaching and training in evidence
based healthcare
Speakers
• Kameshwar Prasad, Paul Glasziou, Gordon Guyatt,
Luz Letelier, Victor Montori
www.isehcon2012.com
The second principle of
evidence-based medicine
changes everything
Victor M. Montori, MD, MSc
Professor of Medicine
KER UNIT - Mayo Clinic
[email protected]
@vmontori
Disclosures
Relevant Financial Relationships
None
Off Label Usage
None
Our confidence in estimates of risk and benefit
from the body of evidence
contributes to
our confidence in making decisions.
Our confidence in estimates of risk and benefit
from the body of evidence
contributes to
our confidence in making decisions.
Confidence in the estimates of risk and benefit
Bias
Imprecision
Inconsistency
Indirectness
Biased reporting
Our confidence in estimates of risk and benefit
from the body of evidence
contributes to
our confidence in making decisions.
body of evidence
Trelle et al. BMJ 2011;342:c7086
Our confidence in estimates of risk and benefit
from the body of evidence
contributes to
our confidence in making decisions.
Appropriate
care
Care < Need
Underuse
Appropriate
care
Glasziou and Haynes ACP JC 2005
Care < Need
Care > Need
Overuse
Underuse
Appropriate
care
Geographic variation in overuse
Shah ND et al. NEJM 2012
Variation in overuse by procedure (n=172)
Preventive services
PSA 16-36%
Urinalysis 37%
Follow-up colonoscopy: 61%
Pap smear: 58%
Korenstein D, et al. Arch Intern Med 2012: 172: 171-8
Sources of waste and their projected growth to 2020
Berwick, D. M. et al. JAMA 2012;307:1513-1516
Care < Need
Care > Need
Overuse
Underuse
Appropriate
care
Guidelines
Every patient with diabetes is a ‘coronary
heart disease risk equivalent’
Every patient with diabetes should take a
statin and achieve LDL < 100 mg/dL
ATP III, 2004
Minnesota Community Measurement
Weymiller et al. Arch Intern Med 2007
Weymiller et al. Arch Intern Med 2007
Weymiller et al. Arch Intern Med 2007
% who opted for treatment
>90%
~50%
<20%
% who should take statins based on ATP III
>90%
>90%
>90%
The evidence alone is never sufficient to
make a decision.
Context and patient values, preferences and
goals should be considered.
Encounter Research
Care < Need
Care > Need
Overuse
Underuse
Appropriate
care
Care < Want
Care > Want
Overtreatment
Undertreatment
Desirable
care
A survey of 627 US primary care clinicians
50% of my patients get too much care
50% of primary care docs are too aggressive
60% of specialists are too aggressive
35% practice much more aggressively than
what they would like
Sirovich BE et al. Arch Intern Med 2011
Statin Choice
Weymiller et al. Arch Intern Med 2007
Statin Decision Aid
Web-based tool
34
Mullan et al Arch Intern Med 2009
321
Get a ride
Numbers don’t add up
Dietitian
Take
off
work
Deadline is now
Endocrinologist
108
kg
take work home ObeseHigh cholesterol
perform!
Avoid salt, fats, carbs LDL high
insurance
Metformin A1c 8.2%
mortgage
Diabetes GlipizideCheck sugars
debt
HCTZDizzy
Hypertension
55
Beta-blocker
Take
pills
Wasted!
Daughter back at home Exercise
DepressionCan’t sleep
2 beautiful girls Bad back Neuropathy
PainCheck his feet
Podiatrist
Care < Need
Care > Need
Overuse
Underuse
Appropriate
care
Care < Want
Care > Want
Overtreatment
Undertreatment
Desirable
care
Care < Can
Care > Can
Overtreatment
Undertreatment
Feasible
care
WORKLOAD
CAPACITY
DESIRABLE
Encounter Research
WANT
CAN
FEASIBLE
NEED
APPROPRIATE
Need
http://www.gradeworkinggroup.org
Want
http://shareddecisions.mayoclinic.org
Can
http://minimallydisruptivemedicine.org
7th International Shared Decision Making
Conference
Lima, Perú - June 16-19 2013
www.isdm2013.org
Our confidence in the research contributes to
our confidence in making decisions.
The evidence alone is never sufficient
to make a decision.
Want
Can
Need