Evidence-based medicine (EBM) and practice guidelines have been embraced by increasing numbers of scholars, administrators, and medical journalists as an intellectually attractive solution to the dilemma of improving health care quality while reducing costs.
However, certain factors have thus far limited the role that EBM might play in resolving cost-quality trade-offs.
Factors for success of EBM recommandations and guidelines : Beyond the quality of the guideline and the evidence base itself, critical factors for success include local clinician involvement, a unified or closed medical staff, protocols that minimize use of clinical judgment and that call for involvement of so-called physician extenders (such as nurse practitioners and physician assistants), and financial incentive.
Troublesome issues related to cost-quality trade-offs : Rationing presents many dilemmas, but for physicians one critical problem is determining what is the physician's responsibility.
Is the physician to be the patient's advocate, or should the physician be the advocate of all patients (the patients'advocate) ?
How do we get physicians out of potentially conflicted roles ?
EBM guidelines are needed to help minimize the number of instances physicians are asked to ration care at the bedside.
If the public can decide to share and limit resources-presumably based on shared priorities-physicians would have a basis to act as advocates for all patients. (...)
Mots-clés Pascal : Protocole thérapeutique, Guide, Médecin, Pratique professionnelle, Médecine, Technologie, Qualité, Soin, Coût, Santé
Mots-clés Pascal anglais : Therapeutic protocol, Guide, Physician, Professional practice, Medicine, Technology, Quality, Care, Costs, Health
Notice produite par :
ORS Auvergne - Observatoire Régional de la Santé d'Auvergne
Code Inist : 002B30A11. Création : 14/12/1999.