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Looking for lower value and overuse

Professor Carl Heneghan Director CEBM University of Oxford

Administrative or other business processes add costs without creating value.

Clinical care is considered inappropriate, including Overuse, Misuse or Under-use of particular tests or interventions.

Prevention

Individual behaviors are shown to lead to health problems, and potential opportunities for earlier intervention exists.

Clinical care Operational

People invited to participate in weight watchers

Take up the invitation 1

Attend all classes 2

Weight loss 5.4 kg 3

At 2 years people maintain their goal weight 4

At 5 years 4

(9 women and 1 man) maintain their goal weight

6

Do not attend the first class 2

Do not attend all of the classes

At 1 year lose an average of 2.5 kg

Don’t take up an invitation

1. Jolly et al (BMJ): the response rate to the invitation was 11.5%2. Ahern et al (BMC Public Health): 54% of courses were completed3. Ahern at al (BMC Public Health): median weight change was 5.4kg in those that completed the course 4. Lowe MR (BJN) The percentage of participants who remained below their goal wait at 2 and 5 years was 20.5% and 16.2% respectively

Weight Watchers

Most intervention don’t apply to the people we see in practice?

Insufficient evidence exist around most current interventions to determine if they are effective

• There were 14 studies (16 comparisons) with extractable data, of which 10 examined TCAs, 2 examined SSRIs and 2 included both classes, all compared with placebo.

• The nos. of participants in the intervention groups was 1364 and in the placebo groups 919.

• Nearly all studies were of short duration, typically 6-8 weeks. • There was no dose information on SSRIs, and the authors

were unable to comment on the appropriate duration of treatment for either TCAs or SSRIs.

For every 1000 patients treated 65 more will be alive at 1 month if treatment is administered in the first hour – the ‘golden hour’ – after symptom onset, compared with not giving thrombolysis 37 lives are saved for every 1000 patients treated in the 1–2 hour interval after symptom onset

26 lives are saved for every 1000 patients treated in the 2–3 hour interval after symptom onset

29 lives are saved for every 1000 patients treated in the 3–6 hour interval after symptom onset

20 lives are saved for every 1000 patients treated in the 7–12 hour interval after symptom onset.

There is a constant need to re-evaluate interventions

“Aspirin for everyone older than 50?”

‘If you don't know where you are going, then you probably won't end up there.’

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