Family Medicine Update

Interprofessionalism and shared decision-making in primary care: a stepwise approach towards a new model.

J Interprof Care. 2010 Aug 26;

Authors: Légaré F, Stacey D, Pouliot S, Gauvin FP, Desroches S, Kryworuchko J, Dunn S, Elwyn G, Frosch D, Gagnon MP, Harrison MB, Pluye P, Graham ID

Most shared decision-making (SDM) models within healthcare have been limited to the patient-physician dyad. As a first step towards promoting an interprofessional approach to SDM in primary care, this article reports how an interprofessional and interdisciplinary group developed and achieved consensus on a new interprofessional SDM model. The key concepts within published reviews of SDM models and interprofessionalism were identified, analysed, and discussed by the group in order to reach consensus on the new interprofessional SDM (IP-SDM) model. The IP-SDM model comprises three levels: the individual (micro) level and two healthcare system (meso and macro) levels. At the individual level, the patient presents with a health condition that requires decision-making and follows a structured process to make an informed, value-based decision in concert with a team of healthcare professionals. The model acknowledges (at the meso level) the influence of individual team members’ professional roles including the decision coach and organizational routines. At the macro level it acknowledges the influence of system level factors (i.e. health policies, professional organisations, and social context) on the meso and individual levels. Subsequently, the IP-SDM model will be validated with other stakeholders.

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– Interprofessionalism and shared decision-making in primary care: a stepwise approach towards a new model.

Comparative effectiveness studies of medications.

Curr Opin Investig Drugs. 2010 Sep;11(9):987-8

Authors: Lane DM

Comparative effectiveness studies of medications or, more appropriately, studies comparing the safety and efficacy of drugs have been conducted for decades, particularly for cancer chemotherapy. Research oncologists can stratify individuals participating in studies using prognostic criteria based on tissue diagnosis and disease staging. Conversely, research cardiologists, in particular those evaluating drugs for atherosclerotic vascular disease, have had to stratify individuals using criteria based on the risk of having a vascular event (ie, coronary heart disease risk). During the past 20 years, new imaging techniques, such as coronary calcium scoring, that are able to screen asymptomatic populations for atherosclerosis have been developed. In the future, studies comparing drugs for cardiovascular disease should be based on the presence of disease, such as atherosclerosis, rather than on the risk of a vascular event.

20730692

– Comparative effectiveness studies of medications.

Premature deaths in Switzerland from 1995-2006: causes and trends.

Swiss Med Wkly. 2010;140:w13077

Authors: Savidan A, Junker C, Cerny T, Ess S

PURPOSE: Mortality expressed as potential years of life lost (PYLL) underscores premature and preventable mortality. We analysed causes of and trends in premature death in Switzerland to highlight the areas which provide the greatest potential outcome for preventive measures. METHODS: Premature mortality rates and trends from 1995-2006 were examined by reviewing potential years of life lost between age 1 and 70, as the upper age limit, considering 4 main categories: circulatory diseases, cancer, external causes of mortality and other causes, and 19 specific causes of death. Trends were assessed using join point analysis with PYLL expressed as age-standardised rate. The analysis was based on the official death certification files provided by the Swiss Federal Statistical Office. RESULTS: Age adjusted PYLL rates decreased for all categories of causes, but the decline in cancers was modest compared to circulatory diseases and external causes. The strongest downward trends were observed for AIDS, traffic accidents and ischaemic heart disease. In women breast cancer contributed most to the decline of premature mortality but remains the first cause of early death. Lung cancer in women is the only cause of premature mortality with rising trends. CONCLUSIONS: Past efforts in prevention, early detection and treatment, but also a healthier lifestyle and other factors, have very probably contributed to the considerable reduction in the rate of potential years of life lost, but the rising rate of premature mortality caused by lung cancer in women is of concern. Persistent efforts in prevention and early detection are required to further reduce premature death and its burden on society.

20734281

– Premature deaths in Switzerland from 1995-2006: causes and trends.