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

RecoveryDeath

Incidence

Relationship between incidence & prevalence

Prevalence

Burden of Illness (Assessment)

Etiology or Causation

Community Effectiveness

Efficiency

Synthesis & Implementation

of Program

Monitoring & Reassessment

Policy Process

Measurement Iterative Loop

Diagnosis

Therapy

Prognosis

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 ……

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

Practice

Guidelines

THERAPY

DIAGNOSI

SPROGNOSIS

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

A population-based perspective:

- helpful in chronic disease management

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

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 ……

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

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 ……

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

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