Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Evidence-based illness?
- Chris Manning (7 June 1999)
-
Evidence Based Medicine in General Practice
- Derek Mitchell (8 June 1999)
-
EVIDENCE BASED MEDICINE SKILLS & GPs
- Khalid Alkhouly, Riyadh 11481, KSA (21 May 2002)
|
|
|||
|
Chris Manning, GP Teddington
Send response to journal:
|
Dear Sir, Dr. Michael O'Donnell once wrote that the problem with evidence-based medicine (apart from the innate threat that words beginning with capital letters can suggest) was that patients in primary care often do not present with evidence-based illness. We spend so much of our training being prepared for a model of clinical behaviour that often bears little resemblance to reality. With governments morphing patients into consumers, many GPs will cease to debate issues other than the fairly straightforward ones that can be subjected to a governance process. As GPs are moved towards Level 4 Trust employee status and beyond, they would be foolish to err from centrally agreed protocols, either by commission or omission. To do otherwise will be to invite the inevitable visit from a ChiMP or a llitigious lawyer. Patient-consumers will find that GPs will want increasingly to practice evidence-based medicine (which is not always synonymous with best-practice, which often has to be far more holistic), and there will be nothing else on offer, at least within the NHS. The block to the practice of it will be mostly from patients anyway. GPs need quality time and space and the chance to build up a working understanding of their clientele if they are going to make their stand (on anything from antibiotics to pointless secondary referrals). Anyway, most of the medical evidence I have read over the years leads me to the conclusion that the best doctors are those who simply listen constructively and direct people towards generating their own solutions, rather than create thousands of illness/medicine dependents. Time and a supportive and experienced attitude does for most of our afflictions most of the time. I lecture to the 'now' generation of GP registrars - they do not seem to have any will to shape the future, rather taking the view that it will be thrust upon them and that, by the time they are in practice, much will have changed anyway. This is the current coping mechanism for living in a world where little time is allowed for consolidation; we seem to concentrate on hunger, rather than satiety. Yours Sincerely Dr. Chris Manning |
|||
|
|
|||
|
Derek Mitchell, Clinical Governance Manager East Kent HA Dover, Kent
Send response to journal:
|
Sir, On the subject of implemtning evidence basde medicine in general practice we currently have a successful scheme called thePrimary Care Clinical Effectiveness Project (PRICCE)which directly addresses this issue, and which is proving very succesful. The object of the scheme is to encourage evidence based practice and clinical effectiveness in general practice. The scheme sets out crtieria and standards in thirteen disease areas, these are; Asthma, Diabetes, Angina, Hypertension, Heart Failure, Lipid lowering, Use of anticoagulants and aspirin in heart disease, treatment of myocardial infarction, Dyspepsia, Epilepsy, Leg ulcers, Depression, and Urinary Tract Infections in children. Participating GPs qualify for financial support at £3,000 per year. Each participating practice must demonstrate, through the use of clinical audit, that it has met all the project standards at the end of each year, in order to qualify for payment. All of the disease management outcomes being implemented have national or international guidelines attached and are clearly evidence based. Entry to this scheme is entirely voluntary and is a decision for each practice. The project began in 1998/99 and will run for three years. In the first year 102 out of 312 GPs (33%) in East Kent joined the scheme. A further 73 have joined from 1st April 1999. The scheme now includes 56% of GPs in East Kent and all types of practice are represented. The scheme forms a major plank in the Health Authority Clinical Governance Framework. A number of key lessons and success factors have been learned from the project including: The project is demonstrating that evidence from large scale clinical trials can be successfully implemented in primary care. Success in the project depends on the effective and consistent use of information technology and systems. A multi-disciplinary team approach provides the most effective platform for success. In practices where all members of the team, including Nurses, Managers, Pharmacists and other practice staff, as well as GPs, are involved in working towards the standards their efforts are being met with considerable success. Participation in the project is changing the ways in which practice teams work together and placing a greater emphasis not only on teamwork but also on clinical quality. The project provides a secure environment in which GPs are comfortable in acknowledging their own shortcomings and in changing their practise where appropriate. The project has invigorated discussions between GPs and hospital clinicians in the areas of the project in which co-ordinated shared care is necessary to achieve the standards. It is already obvious from discussions with participating GPs that significant improvements in outcomes for patients are being secured and that, with appropriate adaptations to the environment of general practice, the benefits of evidence based medicine can be brought to patients in primary care. On the basis of this work it would be unwise to underestimate the willingness and the ability of general practitioners, and their teams, to deliver important benefits for their patients. Yours sincerely, Derek Mitchell. Clinical Governance Manager |
|||
|
|
|||
|
Khalid Alkhouly, specoialist in Gen Surgery Security Forces Hospital, P.O.Box 3643, Riyadh 11481, KSA
Send response to journal:
|
Dear Sir: GPs are bound by their terms and conditions of service to refer patients to different subspecialties. Focusing on a balance between the stressful GP’s workload, GP’s experience and the backup from expert colleagues is the best tool to improve quality of patient’s care. GP's awareness & training with a feedback on using skills and guidelines of evidence based medicine would be expected to be beneficial. I am fully satisfied that GPs can cope effectively with evidence based medicine , provided that they are given enough support to practising it in a clinical setting with supervision. |
|||