Erschienen in:
01.07.2010 | Editorial
Moving Medical Advances from Prototype into Practice
verfasst von:
Bruce L. Rollman, MD, MPH
Erschienen in:
Journal of General Internal Medicine
|
Ausgabe 7/2010
Einloggen, um Zugang zu erhalten
Excerpt
Improving health care outcomes is difficult, and we have known for many years that successful efforts are more likely to involve a blend of approaches rather than a single “silver bullet.”
1 Over the past 15 years, dozens of published trials have supported use of the multipronged “collaborative care” model as an effective strategy for improving treatment outcomes for depression
2‐
4 as well as for a variety of other chronic medical conditions.
5 Based on the Wagner Chronic Care Model, collaborative care involves active follow-up by a non-physician allied health professional “care manager” who supports patients with the time and frequency of contacts necessary to educate them about their illness and evidence-based treatment options; involves primary care physicians as active participants in their patients’ care; and proactively monitors patients’ response to therapy and suggests adjustments in care when indicated. Yet despite the proven efficacy and cost-effectiveness of this approach, collaborative care strategies have yet to be implemented widely into routine practice beyond a few large integrated health care delivery organizations.
6 This lack of implementation may be due to factors ranging from the complexity, effort, and costs associated with the change (e.g., electronic medical records); reluctance by health plans to pay for new treatments and modalities of care delivery (e.g., telehealth); development of novel treatments in isolation from the real world of patient care and attention towards financial profits and losses (e.g., unbillable care manager time); lack of demand for services, particularly by patients who may be stigmatized by their condition (depression); and investigator lack of follow-through or skill with the science of implementation.
7 …