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A decision aid for cancer drugs, antibiotics for appendicitis, and the role of transparency in patient safety

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June 25, 2015

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.

Join the conversation: Post your comments in our new section at the bottom of this page.

 

Features:

Cancer drugs are bankrupting some patients, even those who have optimal health coverage and lower co-pays. Yet many new expensive drugs—some that cost $100,000 a year—have not been proven effective; and some older drugs considered effective have skyrocketed in cost. While common sense dictates that only the drugs that work should cost more, that’s just not so. Patients and doctors have more questions than answers regarding cancer drugs. Now the American Society of Clinical Oncology, as reported in its Journal, Los Angeles Times and The New York Times, is working on a decision-making aid known as Value Framework, a resource to compare drug safety and efficacy with a score, or “net health benefit,” for some cancers. The tool also separately provides cost estimates for treatments— a refreshing extra, considering patients often lack this information. Last week, 60 Minutes reported that industries basically can charge whatever they want because Medicare will pay it. But there’s more: In addition to high costs are conflicts of interest for private practice oncologists who are incentivized by pharma-paid commissions when they buy drugs wholesale and then sell them retail to patients.

 

Investigators in Finland conducted a large randomized controlled trial to assess whether antibiotic treatment of appendicitis can be as safe and effective as standard surgical treatment. The findings, published in JAMA, offer strong evidence that broad-spectrum antibiotics may be a viable alternative to appendectomy. The researchers found that 72.7% of patients with uncomplicated, CT-confirmed acute appendicitis recovered with antibiotics alone and did not require appendectomy after one year of follow-up. However, the authors determined prior to the study that the acceptable rate of failure in the group receiving antibiotics (i.e. the proportion of people who received antibiotics but eventually needed an appendectomy) was 24%. The failure rate of 27.3% exceeded that, and the authors are not able to establish the advantage of antibiotic treatment over appendectomy. Aaron Carroll in the Incidental Economist  lauds the scientists for adhering to their a priori definitions, but argues, “This is progress. Care has improved so that we can be less invasive and less costly… We should reconsider how we treat appendicitis.”

 

Robert Wachter, et al. contend in a Health Affairs blog post this week that transparency is the single most important feature of a culture of safety. When clinicians and organizations are more transparent with each other, patients, and the public, they will be better able to drive improvements and facilitate patient choice. In The New York Times, Allison Bond highlights one example of what can transpire in the absence of transparency. Bond recounts instances of miscommunication between providers that significantly compromised care. To avoid future failures and insults to patients, the Health Affairs writers encourage acknowledging errors when they occur, learning from the event, making changes, and sharing lessons with peer organizations. The Sun describes how two hospitals in Baltimore are addressing patient safety from all angles and have instituted programs that provide clinicians with support in the aftermath of medical errors. Changing culture and allowing providers the space to be human while also changing the system to minimize the likelihood of human error will allow healthcare to make further progress toward a culture of safety.

 

Announcements:

  • Only five days left! The Lown Institute is accepting applications from incoming chief residents for the new RightCare Educator Program. Help shape a more rational medical culture by implementing RightCare Rounds in your institution. Deadline for applications is Tuesday, June 30. A small stipend will be provided. For more information, see here.

 

  • Have you signed up for RightCare Action Week? It’s our grassroots initiative that engages people across the country to take action to show what our healthcare system should look like. On the RightCareActionWeek.org, you’ll find an Action Forum, where you can submit, vote on, and discuss Action Ideas with your friends and colleagues. Sign up today.

 

Headlines:

 

End-of-life care

 

Community health

 

Practice

 

Health reporting

 

Elder care

 

Primary care

 

Research

 

Health insurance

 

Tax regulations

 

Patient safety

 

Cost of care

 

Evidence-based medicine

 

Overtreatment

 

Social determinants of health

 

Medical education

 

Environmental health

 

Tech & innovations

 

RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.