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Sir, Tessa Richards asks whether cost effectiveness of patient care
can be improved by contracting our services to pharmaceutical companies in
the form of Disease Management Programmes (ref.1). She acknowledges some
potential problems such as fragmentation of care, sustainability of cost
savings and professional independence within commercially driven
enterprises. I am concerned that the conflict of interest that arises
when a pharmaceutical company is paid public money to be physician,
pharmacist and fund manager is potentially insurmountable.
She appears to state, without evidence, that commercial disease
management ventures provide higher quality care than existing shared care
programmes. Shared care programmes may, in fact, provide just as high
quality care (or higher) without the problems of fragmentation and
conflict of interest. (Ref. DICE).
Scarce resources might be better spent in supporting and continually
improving shared care programmes. Handling the patinets and the money
over to pharmaceutical companies may simply be an abrogation of health
managers and doctors responsibilities without proven benefit.
Ref.
1. Richards T, Disease Management in Europe. BMJ. 1998;317:426-427
2. DICE, Diabetes Integrated Evaluation Team. Integrated care of diabetes
clinical, psychosocial and economic evaluation. BMJ, 1994:308:1208-1212.
Yours sincerely
Dr Susan Smith
Lecturer in General Practice
Concerns re effectiveness of patient care
Sir, Tessa Richards asks whether cost effectiveness of patient care
can be improved by contracting our services to pharmaceutical companies in
the form of Disease Management Programmes (ref.1). She acknowledges some
potential problems such as fragmentation of care, sustainability of cost
savings and professional independence within commercially driven
enterprises. I am concerned that the conflict of interest that arises
when a pharmaceutical company is paid public money to be physician,
pharmacist and fund manager is potentially insurmountable.
She appears to state, without evidence, that commercial disease
management ventures provide higher quality care than existing shared care
programmes. Shared care programmes may, in fact, provide just as high
quality care (or higher) without the problems of fragmentation and
conflict of interest. (Ref. DICE).
Scarce resources might be better spent in supporting and continually
improving shared care programmes. Handling the patinets and the money
over to pharmaceutical companies may simply be an abrogation of health
managers and doctors responsibilities without proven benefit.
Ref.
1. Richards T, Disease Management in Europe. BMJ. 1998;317:426-427
2. DICE, Diabetes Integrated Evaluation Team. Integrated care of diabetes
clinical, psychosocial and economic evaluation. BMJ, 1994:308:1208-1212.
Yours sincerely
Dr Susan Smith
Lecturer in General Practice
Competing interests: No competing interests