Thursday, 1 December 2011

Patients do better if they know their results.

A meta-analysis of anticoagulation studies by researchers from Oxford say that self-management is safe and can improve the quality of care.
"Patients who monitor their own treatment with warfarin or other blood-thinning drugs reduce their risk of developing blood clots by half, an Oxford University study has found. ...Taking charge of their own treatment can empower patients, improve the quality of treatment and be more convenient. The researchers say their findings confirm that self-monitoring of warfarin is safe for suitable patients of all ages." http://www.ox.ac.uk/media/news_stories/2011/110112.html
"Our [meta] analysis showed that self-monitoring and self-management of oral coagulation is a safe option for suitable patients of all ages. Patients should also be offered the option to self-manage their disease with suitable health-care support as back-up." http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61294-4/abstract
I note the recent JAMA editorial advising caution about a proposed rule to allow access to investigations by patients,
"The current policy of allowing state laws to limit patient access to test results could deter patient engagement, thereby contradicting the intention of transparency in health care reform. However, offering patients direct and potentially immediate access to laboratory results has potential consequences that must be addressed. Without involvement of physicians, delivery of abnormal test results will be a major concern. For example, patients having access to abnormal test results before physicians have had the opportunity to interpret and counsel patients may create unnecessary anxiety." http://jama.ama-assn.org/content/early/2011/11/22/jama.2011.1797.full
OK so anticoagulation monitoring is not the same as diagnostic interventions but it makes sense to assume that the person most likely to act quickly and efficiently on their results is the patient - the one with the most to gain. Access to results may generate 'extra' work for staff when patients prompt them into action (or reassurance) but isn't that work which would be done anyhow? It might change the scheduling of work and might just stimulate a more efficient system.

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