I want to introduce you to Peter Attia MD. His voice was one of the first that encouraged me to look beyond the headlines, and profit machines to better understand and quantify the true needs and gaps in effective clinical decision making.
In the modern healthcare ecosystem there are thousands of healthcare guidelines to direct what we are to assume is model care and improved patient outcomes. In that vast number there are certainly conflicting reports and stakeholder influence to add to the confusion.
Let's consider the new class of cholesterol drugs and how we might design an educational intervention framework--from a content perspective.
I don't have answers. What I hope I can present here are better questions. I will pull actual content from their original sources--all fully referenced but the context and discussion will be my own. I hope you will engage and enrich the engagement with your own voice, insights, and expertise.
This assessment will attempt to answer the key issues that patients, providers, and payers face when making decisions about the PCSK9 inhibitors. The primary limitation to the evidence on PCSK9 inhibitors is that they were approved based on their lowering of LDL-cholesterol. The clinical trials evaluating their effect on clinical outcomes such as myocardial infarction, stroke, and death from cardiovascular disease are still in progress with results expected in 2017. The drugs are also very expensive at a proposed cost of $14,600 annually. This assessment will address the following questions:
- What evidence exists to support decisions regarding the risks and benefits of initiating PCSK9 inhibitor therapy?
- Are there specific populations in whom the benefits of PCSK9 inhibitors outweigh the risks?
If therapy is considered, what is the potential cost effectiveness and budgetary impact of different strategies to target therapy?
- The purpose of this assessment is to help patients, providers, and payers address these important questions and to support dialogue needed for successful action to improve the quality and value of health care for all patients.
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We read about health literacy and initiatives to improve the understanding of complicated language reserved for discussing medicine. Patients are becoming shared-decision makers and we need to foster and clarify dialogue to improve the translation of research findings, health policy, medical education, and healthcare.
Health literacy measures the ability to comprehend, evaluate, and negotiate the data to make informed healthcare decisions. Although we tend to think of health literacy as central to societal concerns, numeracy crosses both professional and patient populations. For example, peer-reviewed clinical research often discusses risk-benefit analyses without the clarification that “risk” is defined as both benefits and harms. How do we calculate the harms of treatment to arrive at an informed clinical decision central to the patient’s best interests, values, and wishes?
How does numeracy influence standard care? What does the data show us about screening healthy individuals upstream from actual medical necessity? What do the “results” in technical medical literature really tell us? Is the message scrambled by the media? We can’t consistently blame the pharmaceutical industry. They don’t write the prescriptions—doctors do. Let’s improve numeracy in medicine.