Expanding disease definitions are causing more and more previously healthy people to be labelled as diseased, contributing to the problem of overdiagnosis and related overtreatment. Often the specialist guideline panels which expand definitions have close tis to industry and do not investigate the harms of defining more people as sick. Responding to growing calls to address these problems, an international group of leading researchers and clinicians is proposing a new way to set diagnostic thresholds and mark the boundaries of condition definitions, to try to tackle a key driver of overdiagnosis and overtreatment. The group proposes new evidence-informed principles, with new process and new people constituting new multidisciplinary panels, free from financial conflicts of interest.
The detailed analysis of the chronic care plans developed by the Spanish regional health services show a surprising level of uniformity in their design and deployment, despite differences between these services. The reviews about theoretical models that support it and tools they develop does not provide conclusive evidence to support the chronic care models achieve better results than another alternatives of care. Although the whole Spanish chronic care plans includes assessment proposals no rigorous studies on their effect have been published to date. Given that, on the contrary, there is a strong and repeated evidence that health systems with Primary Care high performance obtains better outcomes, it is necessary to ask about the need to look for alternative models, when the proposed goals could be reached strengthen Primary Care.
Rationale, aims and objectives: The available evidence on the existence
and consequences of the use of heuristics in the clinical decision
process is very scarce. The purpose of this study is to measure the use
of the Representativeness, Availability and Overconfidence heuristics in
real conditions with Primary Care physicians in cases of dyspnea and to
study the possible correlation with diagnostic error. Methods: A
prospective cohort study was carried out in 4 Primary Care centers in
which 371 new cases or dyspnea were registered. The use of the three
heuristics in the diagnostic process is measured through an operational
definition of the same. Subsequently, the statistical correlation with
the identified clinical errors is analyzed. Results: In 9.97% of the
registered cases a diagnostic error was identified. In 49.59% of the
cases, the physicians used the representativeness heuristic in the
diagnostic decision process. The availability heuristic was used by
82.38% of the doctors and finally, in more than 50% of the cases the
doctors showed excess confidence. None of the heuristics showed a
statistically significant correlation with diagnostic error. Conclusion:
The three heuristics have been used as mental shortcuts by Primary Care
physicians in the clinical decision process in cases of dyspnea, but
their influence on the diagnostic error is not significant. New studies
based on the proposed methodology will allow confirming both its
importance and its association with diagnostic error.
Health economics literature has demonstrated that physician motivation is related with three reasons—extrinsic motivation, intrinsic motivation, and prosocial motivation—and that this motivational structure is influenced by the type of organization in which they work. Yet this research proves insufficient to identify the origin of the physician's psychological motivations. To shed light on this gap, this chapter aims to outline a neuroimaging methodology which would prove useful to identify the neurocognitive motivational structures of hospital physicians with the proposes the design of several intrasubject laboratory experiments, using the functional neuroimaging technique magnetic resonance imaging (fMRI). Identifying the neuronal origin of doctors' motivational framework belonging to private or public health organizations would be a step forward in defining the most appropriate motivational plan for a medical profile working in different hospital environments.
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