January 15, 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.
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In a Boston Globe op-ed, Angelo Volandes, MD, describes the deep failures in American end-of-life care, through his experiences as a physician and his research on helping patients make more informed treatment decisions. By using videos, patients can get a much better understanding of what different end-of-life treatment options, including CPR, intubation, and hospice care, will look and feel like. Dr. Volandes’s new book, The Conversation, expands on the importance of end-of-life decision-making through more stories, and argues that ultimately, rethinking the doctor-patient relationship is essential to helping patients make the best decisions for them.
A new paper in The BMJ, with authors including Jeanne Lenzer and John Ioannidis, MD, takes reporters and physicians to task for overstating the importance of new hepatitis C drugs like sofosbuvir (Sovaldi). The authors point out that while large numbers of people are infected with hepatitis C virus (HCV) and the consequences of hepatitis C can be severe, many people infected with HCV don’t ever develop serious liver disease. Given that, and the substantial side effects caused by drugs like sofosbuvir, which have been downplayed by the manufacturer and in the press, it may not be worth pursuing aggressive screening and treatment for people who are unlikely to have serious symptoms. Moreover, saying the drug offers a “cure,” as many press accounts have done, is premature: the benefits of new antiviral treatments have been oversold. Most of the clinical trials have showed benefits only in surrogate outcomes like levels of HCV in the blood, rather than in improving clinically meaningful patient outcomes.
As the new governor of Massachusetts comes into office, Lown Institute Vice President David Martin, recommends ways to reorient healthcare systems in the Bay State. In his op-ed on WBUR’s ideas and opinion page, Cognoscenti, Martin advocates shifting healthcare models from incentivizing more care, to one of keeping people healthy by eliminating overtreatments, creating healthy communities and bolstering primary and preventive care. “Accountable Care Organizations, under which providers earn more if they keep their patients healthy, are a good start,” Martin says. “But before ACOs can devote money to the kinds of services that create healthy communities, they will have to root out the services that are overused and unnecessary. To do this, they will need the support and input of the community they serve.”
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Practice design and primary care
Shared decision making
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