Counterpoint: Rationing on the Fly: The Opportunity Cost of Clinical Guidelines

Culpepper, Larry

doi:10.3122/jabfm.2014.04.140137

The Journal of the American Board of Family Medicine

2014

DOI: 10.3122/jabfm.2014.04.140137

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Counterpoint: Rationing on the Fly: The Opportunity Cost of Clinical Guidelines

Larry Culpepper

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“…Unfortunately, physicians are forced to calculate these tradeoffs without an evidence base because reliable information to compare the effect of various guidelines on patient outcomes is still needed. Culpepper 8 provides an equally thoughtprovoking counterpoint to these thoughts; he does not share the view that care is de facto rationed when more clinical guidelines are applicable than there is time to address those required. Atlas et al 9 report a study in which primary care providers (PCPs) were incorporated into an information technology-based population management strategy that automatically generated reminder letters to encourage timely cancer screening.…”

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Context and Trade-offs in Family Medicine

Seehusen¹,

Bowman²,

Neale³

2014

The Journal of the American Board of Family Medicine

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Context and Trade-offsFamily physicians regularly take context into consideration. We learn early in our training that no 2 clinical situations, no 2 patients are exactly the same. Sex, age, cultural background, social circumstances, sexual preference, and a host of other factors can affect patient care in a profound way. Family physicians also understand inherently that trade-offs are a routine function of medical practice. Life-saving medications often cause unwanted side effects. Cancer screening may lead to incidental findings that lead to unrewarding testing or treatment. If you administer enough routine vaccinations, you may encounter an adverse event. This issue of the Journal of the American Board of Family Medicine contains several articles that highlight the effect of context and trade-offs encountered in the practice of family medicine.For example, Solberg et al 1 demonstrate that context matters for patient-centered medical home (PCMH) implementation. In this study, using a survey of 120 Minnesota clinics that recently undertook practice transformation to become certified as medical homes, the authors attempted to find common change characteristics and associate them to improved clinical performance measures. While some common change themes emerged, each practice had specific local factors that were influential, and the changes could not be attributed to performance outcomes. As suspected, each practice must take a unique path to PCMH certification based on multiple local factors; there is no proven formula for successful PCMH implementation.A trade-off associated with PCMH implementation involves the type of patient-provider interactions. With the increasing emphasis on non-faceto-face interactions, the composition of workload in primary care is changing. Arndt et al 2 use both survey results and electronic health record data to evaluate the contribution of these non-face-to-face patient-provider interactions on overall workload. The authors conclude that non-face-to-face patient care activities contribute significantly to overall provider workload. The percentage of workload attributable to these interactions will only increase over time as technology makes non-face-to-face encounters more practical and productivity demands encourage these types of encounters. The results of this study have important implications for workforce planning, productivity measurement, and physician reimbursement reform.Peterson et al 3 report that 6.7% of US family physicians spend at least 80% of their time provid- Conflict of interest:The authors are editors of the JABFM.

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confidence: 99%

Context and Trade-offs in Family Medicine

Seehusen¹,

Bowman²,

Neale³

2014

The Journal of the American Board of Family Medicine

View full text Add to dashboard Cite

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Counterpoint: Rationing on the Fly: The Opportunity Cost of Clinical Guidelines

Cited by 1 publication

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Context and Trade-offs in Family Medicine

Context and Trade-offs in Family Medicine

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