Appropriateness of Care

What does this mean and why are we examining this issue now?

Appropriateness of care relates to making sure that individuals and their professionals have all the facts at their command when making decisions about interventions that have significant implications to the patient and the health care system. It is an important concept that is going to assume increasing relevance to clinical practice as evidenced by one simple statistic: funding for Capital Health is going to decrease by one per cent while patient treatments are rising by six per cent annually. How and where are the cuts going to be made so that we can continue to provide exemplary patient care? This debate started on the front lines, with a question about the appropriateness of operating on older patients when many of them had complications and a poorer rate of success from that intervention.

It was co-incidental that the Division of Geriatrics had initiated their own study of the frail elderly and had explored the issue of delivery of all available information to patients and their care givers, prior to any intervention, such as surgery. They have found that as all of the information about the procedure and the patient is presented to the patient and the caregiver, then often the patient and care givers decline risky interventions. The study is called Path and is run by Dr. Laurie Mallery and her team. This approach is an example of the patient centered care that is a thrust of this district.

However there are two potentially conflicting themes developing within CH that require physicians’ urgent attention. The first is to change from a focus on acute care to community care with an emphasis on Community Health Boards. In an arena of declining fiscal resources, budget cutbacks and a systematic lack of investment in infrastructure, how is CH going to achieve such a change in health care delivery? Appropriateness of care may imply that a reduction in the provision of services is going to occur when patients are more fully provided with the information about medical and surgical treatments. But this cannot be the only way that we can change health care delivery and we must as Physicians be prepared to be at the table when discussions take place about change within the health care system.

Throughout all of this I am always struck by the absolute dearth of information about outcomes; we provide a huge amount of interventions without any idea as to whether we actually make a difference in people’s lives and health care. Individually we are convinced that we make a difference, but I believe that we have to have more robust measurements of outcomes to justify ongoing funding of our clinical practices. Stay tuned!