A decision aid is a web-enabled set of slides designed to inform a patient about a particular health topic. As an example, take a look at one developed by AHRQ focusing on the risk for post-menopausal women of developing osteoporosis. For the total impact, you will need to navigate through 21 slides in order. If the reader doesn't understand any of the words or concepts presented, she can branch to other slides.
In my opinion, an educated patient will usually make better health care decisions. It should come as no surprise then that a recent article concluded that the use of decision aids reduced the rates of elective hip and knee surgeries (see: Introducing Decision Aids At Group Health Was Linked To Sharply Lower Hip And Knee Surgery Rates And Costs). Here's an excerpt from it:
Decision aids are evidence-based sources of health information that can help patients make informed treatment decisions. However, little is known about how decision aids affect health care use when they are implemented outside of randomized controlled clinical trials. We conducted an observational study to examine the associations between introducing decision aids for hip and knee osteoarthritis and rates of joint replacement surgery and costs in a large health system in Washington State. Consistent with prior randomized trials, our introduction of decision aids was associated with 26 percent fewer hip replacement surgeries, 38 percent fewer knee replacements, and 12–21 percent lower costs over six months. These findings support the concept that patient decision aids for some health conditions, for which treatment decisions are highly sensitive to both patients’ and physicians’ preferences, may reduce rates of elective surgery and lower costs.
Any patient faced with the prospect of elective surgery needs to go to a quiet place at home and research the topic on the web or using quality print materials. I understand that some patients are unable to do such in-depth investigative work so a professionally-developed decision aid can be extremely helpful instead of, or in addition to, a web search. It should come as no surprise that the use of a decision aid resulted in "26 percent fewer hip replacement surgeries [and] 38 percent fewer knee replacements" in one healthcare setting over six months. Criteria of many orthopedic elective procedures are quite broad and depend, in part, on the patient's toleration for some discomfort and also the degree of activity.
I have posted a number of previous notes about overutilization of services/procedures and overdiagnosis (see, for example: Physician Campaign Against Unnecessary Tests and Procedures; When Not to Treat Cancer Patients). In many of these notes, I stress the importance of working with a physician who has an objective perspective on operating or treating a patient. I think that a physician who does not have a strong financial incentive to perform an operation is often the most objective guide.
During the discussion about an elective orthopedic procedure, the patient should pay particular attention in to whether it is balanced, stressing the reasons for having and not having the surgery. The patient should always ask about the consequences of delaying the surgery/treatment or avoiding it entirely. There is no question in my mind that the use of a sophisticated decision aids can assist in educating a patient. If a surgeon does not discuss the availability of a relevant decision aids, a patient facing elective surgery or treatment would do well to search the web for relevant education tools.
You are right that when money is involved, perceptions sometimes become a little skewed. Patients often forget this and may think that their doctor always has their best interests at heart.
Decisions like that should be made slowly.
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Posted by: Cosmetic Surgeries | January 31, 2013 at 07:06 AM