mercredi 20 janvier 2016

Prohibition of drugs and illegal black market versus regulated selling of pharmaceuticals: opting for a rational choice

It is obvious that state prohibition of drugs is a failure.

Prevention policy and illness insurance: two quite different worlds

Prevention policy is quite efficient as far as it is not a care provider mechanism:

tobacco smoking cessation
alcohol drinking should be limited to zero or a minimal amount per a day
exercise as frequently as possible
maintain a normal body weight through life
keeping a healthy eating pattern of whole foods
use drugs, hormones as less as possible

These decisions could be implemented in schools, universities, enterprises and communities. They are not relevant of insurance.

Illness is an event which is potentially treatable and relevant to insurance

Firstly illness needs a diagnosis
Secondly it needs a treatment whose benefit does not outweighs the risks
Screening is a research of illness and should obey to the same ratio of benefit/risk.

A major paper that requires major changes in everyday practice of medicine

High-Value Care Advice 1Clinicians should not perform testing or initiate antibiotic therapy in patients with bronchitis unless pneumonia is suspected.
High-Value Care Advice 2Clinicians should test patients with symptoms suggestive of group A streptococcal pharyngitis (for example, persistent fevers, anterior cervical adenitis, and tonsillopharyngeal exudates or other appropriate combination of symptoms) by rapid antigen detection test and/or culture for group A Streptococcus. Clinicians should treat patients with antibiotics only if they have confirmed streptococcal pharyngitis.
High-Value Care Advice 3Clinicians should reserve antibiotic treatment for acute rhinosinusitis for patients with persistent symptoms for more than 10 days, onset of severe symptoms or signs of high fever (>39 °C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or onset of worsening symptoms following a typical viral illness that lasted 5 days that was initially improving (double sickening).
High-Value Care Advice 4Clinicians should not prescribe antibiotics for patients with the common cold.

How to improve quality and efficiency of care: kill the length of stay in hospitals

Enhanced Recovery After Surgery (ERAS) protocols improve substantially the outcomes of surgery.