Towards a Communication Framework for Empowerment in Osteoarthritis Care.

Anaesthetic agents have various financial and environmental impacts. Climate change is one of the biggest threats to human health, and anaesthetic gases contribute to global heating by acting as greenhouse gases. The primary aim of this study was to quantify the financial and environmental impacts of anaesthesia maintenance agents used during surgery in an Australian university teaching hospital. The volume of desflurane, sevoflurane, isoflurane and propofol purchased by a university teaching hospital between 2010 and 2020 was analysed and described in terms of financial and environmental impact. Estimated carbon emissions and financial costs of each agent per annum were calculated using the volumes purchased for each agent. A model of ideal anaesthetic agent usage was used to hypothesise the financial and environmental impact of replacing desflurane (the most environmentally damaging and expensive agent) with alternative agents. Using 2019 as an example year at our health service, replacing desflurane with low flow sevoflurane would save greenhouse gas emissions equivalent to driving over 1.4 million kilometres in an average petrol car. Removing desflurane from machines at our institution could save an estimated A$14,630 per annum through reduced machine testing alone. Our findings and calculations indicate that reducing the use of desflurane would have both financial and environmental benefits for healthcare. 

The financial and environmental impact of purchased anaesthetic agents in an Australian tertiary hospital

Many initiatives to guide prescribing focus only on ‘drugs to use’ and not those to avoid. These include treatment guidelines, formularies, and national and regional lists of reimbursed drugs. The aim is to guide clinicians towards the most effective treatments and the most cost-effective of equivalent alternatives. However, this guidance can be incomplete, distorted by commercial interests1 and does not always adequately address harmful outcomes of medicines use. Criteria targeting inappropriate use also often focus on single drug classes such as opioids or specific demographics such as older patients for the Beers and STOPP/START criteria.

The French independent drug bulletin Prescrire has developed a unique initiative aiming to improve prescribing appropriateness: an annual list of ‘drugs to avoid’ across all treatment indications and patient populations. These lists are based on Prescrire’s evaluations …

'Drugs to avoid': can we improve prescribing appropriateness?

As Professor Gerben Keijzers et al. have previously explored, ‘deliberate clinical inertia’ is ‘the art of doing nothing as a positive response’. Deliberate clinical inertia is proposed to have the capacity to reduce low-value care, and avoid overdiagnosis, the purpose of which is to avoid patient harm. This form of practice is more difficult in metropolitan settings with cultural pressure which accepts little diagnostic uncertainty, seemingly limitless resources, and a lack of individual autonomy in clinical decision-making. Although working in a less-resourced rural ED, particularly out-of-hours, the practitioner is forced to accept more diagnostic uncertainty. When time, specialty availability and investigation modalities are not freely available, the clinician must cater their decision-making accordingly. This can be uncomfortable for the clinician but may not necessarily mean inferior health outcomes. I present two scenarios for comparison.

Risk and reward in the resource deplete setting: Lessons from rural, regional and remote emergency medicine

Directly or indirectly, medical practitioners influence health-care policy and spending through their clinical decision-making. As medical expertise and technology has grown, and patient choice has been empowered by the consumer movement, there are now many more medical interventions than can be accommodated in a finite national health-care budget. We reviewed the Australian Medical Council, Medical School and Medical Specialist curricula. In Australia, medical students, doctors and medical specialists do not appear to have specific health economics education that would improve skills to select beneficial and cost-effective care. We propose a framework for medical practitioner health economics education. 

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/1467-8462.12520

Under‐ and Postgraduate Education in Health Economics for Australia's Medical Practitioners: Time for Change?

To protect themselves from the potential harms of low value care, patients must take an active role in clinical decision making

Low value care is a health hazard that calls for patient empowerment

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Low value care is a health hazard that calls for patient empowerment