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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
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RecoveryDeath
Incidence
Relationship between incidence & prevalence
Prevalence
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Burden of Illness (Assessment)
Etiology or Causation
Community Effectiveness
Efficiency
Synthesis & Implementation
of Program
Monitoring & Reassessment
Policy Process
Measurement Iterative Loop
Diagnosis
Therapy
Prognosis
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Outline of presentation
1) Key messages
2) HFA
3) Thoughtful physicians: Difficult Questions
4) EBM
5) Measurement Iterative Loop
6) COPCORD / WHO / ILAR Studies
7) In conclusion ……
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Clinical Practice Guidelines
- Busy Clinician
- Information overload
- Wide variability in patient care
- Need to develop CLINICAL PRACTICE GUIDELINES
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Practicing EBM: The Needs
Evidence-based
approach to patient
care create the
NEED for Clinical
Practice
Guidelines
THERAPY
DIAGNOSI
SPROGNOSIS
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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
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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
A population-based perspective:
- helpful in chronic disease management
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Role of physicians in preventive interventions
1) Provision of direct preventive services
2) Management & organization of preventive health services within medical care system
3) Advocacy within clinical settings, communities & organized medicine
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Outline of presentation
1) Key messages
2) HFA
3) Thoughtful physicians: Difficult Questions
4) EBM
5) Measurement Iterative Loop
6) COPCORD / WHO / ILAR Studies
7) In conclusion ……
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Health for All
Communities
Families Societies
Individuals
Health system
Aging of the
population
Science & technolog
y
Information & communicatio
n
Equity & social
justice
Dete
rmin
an
ts o
f h
ealt
h
Gender
Human rights
Biological
Environmental
Behavioural
Socio-economic
Socio-cultural
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Outline of presentation
1) Key messages
2) HFA
3) Thoughtful physicians: Difficult Questions
4) EBM
5) Measurement Iterative Loop
6) COPCORD / WHO / ILAR Studies
7) In conclusion ……
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1) How may I be thorough YET efficient when considering the possible causes of my patient’s problem?
2) How do I characterize the information I have gathered during the medical interview & physical examination? (Probability - Utility)
3) How should I interpret new diagnostic
information? (Probability)
Thoughtful Physicians : Difficult Questions - 1
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4) How do I select the appropriate diagnostic test? (Treatment, Threshold, Probability)
5) How do I choose among several risky treatments? (Expected Value Decision Making)
6) How do I know, how is my patient doing?
Thoughtful Physicians : Difficult Questions - 2