Artichoke of Population Studies Clinical Practice. Part I

The Bone & Joint Decade India An IRACON 2003 Indian Rheumatology: New Horizons, New Hopes Artichoke of Population Studies & Clinical Practice Dr Rajesh Pandav, Dr. Denish Moorthy, Dr Binod Patro, Dr Hemant Shukla, Dr Chandrakant S Pandav Relationship between incidence & prevalence Incidence Prevalence Recovery Death Measurement Iterative Loop Burden of Illness (Assessment) Monitoring & Reassessment Synthesis & Implementation of Program Prognosis Diagnosis Etiology or Causation Therapy Community Effectiveness Policy Process Efficiency Outline of presentation 1) 2) 3) 4) 5) 6) 7) Key messages HFA Thoughtful physicians: Difficult Questions EBM Measurement Iterative Loop COPCORD / WHO / ILAR Studies In conclusion …… Clinical Practice Guidelines - Busy Clinician - Information overload - Wide variability in patient care - Need to develop CLINICAL PRACTICE GUIDELINES Practicing EBM: The Needs Evidence-based approach to patient care create the NEED for Clinical THERAPY Practice Guidelines Artichoke of Population Studies and Clinical Medicine – 1 Health of patients: - individual patient - patient groups Physicians need to identify & address factors: - patient’s family - community Community: - A resource for physicians Artichoke of Population Studies and Clinical Medicine - 2 To reduce burden of disease: Integration of disease prevention & health promotion into routine medical care Chronic diseases: - multiple causes or exacerbating factors variety of interventions at multiple levels helpful in chronic disease management A population-based perspective: Role of physicians in preventive interventions 1) 2) 3) Provision of direct preventive services Management & organization of preventive health services within medical care system Advocacy within clinical settings, communities & organized medicine Outline of presentation 1) 2) 3) 4) 5) 6) 7) Key messages HFA Thoughtful physicians: Difficult Questions EBM Measurement Iterative Loop COPCORD / WHO / ILAR Studies In conclusion …… Determinants of health Biological Human rights Behavioural Equity & social justice Communities Environmental Gender Families Health for All Individuals Societies Health system Information & communication Socio-economic Science & technology Socio-cultural Aging of the population Outline of presentation 1) Key messages 2) 3) HFA Thoughtful physicians: Difficult Questions EBM Measurement Iterative Loop COPCORD / WHO / ILAR Studies In conclusion …… 4) 5) 6) 7) Thoughtful Physicians : Difficult Questions - 1 1) How may I be thorough YET efficient when considering the possible causes of my patient’s problem? How do I characterize the information I have gathered during the medical interview & physical examination? (Probability - Utility) How should I interpret new diagnostic information? (Probability) 2) 3) Thoughtful Physicians : Difficult Questions - 2 4) 5) How do I select the appropriate diagnostic test? (Treatment, Threshold, Probability) How do I choose among several risky treatments? (Expected Value Decision Making) How do I know, how is my patient doing? 6)