At 8:26 am +1100 7/3/06, Ken Harvey wrote:
What do others think about how best to achieve, "best-practice"
pathology ordering?
I can match every high profile story of "overinvesigating" with
several from my own personal experience of:
* underdiagnosis
* failing to investigate
* failing to act on test results
and all the consequences to people's lives over years/decades of
that. So where lies the truth in this story???
Solutions to system problems require system responses. No, it's not
rocket science.....and it's not consultancies....and it's not
committees.....and not religion....and not group hugs.
Any serious program needs:
A. systematic monitoring
B. ongoing research program, including aspects of science, economics,
marketing/business
C. dissemination of results of A and B
D. system policy adjustments
We are being shunted down the QA siding whilst the system problems are ignored.
While we appear to have a big black hole in B in medicine and health
informatics, the problem will not go away.
Ian.
Cheers
Ken
--
Dr. Ken Harvey
Adjunct Senior Research Fellow
School of Public Health, La Trobe University
http://www.medreach.com.au
VOIP: +61 (03) 9029 0634; Mobile +61 (04) 1918 1910
-------- Original Message --------
Subject: Re: [Haianz] Doctors to be queried over surge in lab tests
Date: Mon, 06 Mar 2006 06:33:55 +1100
From: Ken Harvey <[EMAIL PROTECTED]>
To: HAIANZ <[EMAIL PROTECTED]>
Les Toop wrote:
Without wishing to brag the 200 GTPs in CHCH have held lab expenditure
flat for a decade with huge effort into evidence based education..
[snip]
Les, can you tell us more about how you "flat-lined" lab expenditure in
N.Z.?
Cheers
Ken
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-------- Original Message --------
Subject: CHCH programme
Date: Mon, 06 Mar 2006 11:44:54 +1300
From: Les Toop <[EMAIL PROTECTED]>
To: Ken Harvey <[EMAIL PROTECTED]>
Same way we did with drugs, a mixture of small group peer led education
programmes, practice visits, case studies, distributing summarised
evidence, utilisation feedback, changed the lab form and importantly
incentivised the GPs by allowing them to decide how the savings are
spent on other patient services (eg subsidised smoking cessation,
subsidised palliative care at home, extended care at home, special
situation benefits, free contraceptive care for under 20s mammograms
prior to the national programme etc etc.
It really isn't rocket science, but persuading the funders to allow that
level of autonomy is difficult with those who stand to lose undermine
the process at every opportunity.
Les
Les Toop
Professor of General Practice
Head of Department of Public Health and General Practice
Christchurch School of Medicine and Health Sciences
PO Box 4345
Christchurch, New Zealand
Tel 0064 (0)3 3643604
Fax 0064 (0)3 3643637
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--
Dr Ian R Cheong, BMedSc, FRACGP, GradDipCompSc, MBA(Exec)
Health Informatics Consultant, Brisbane, Australia
Internet: [EMAIL PROTECTED]
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