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Thursday 25 October 2018

Understanding the treatment burden

Bret Scher, MD FACC writes:

"Every week we hear a new story about the burden of chronic diseases. Diabetes, heart disease, cancer and Alzheimer’s all have a direct financial burden on the patient, and they have an even larger indirect burden on society. 

But what about the burden of different therapeutic choices, the so-called “treatment burden”? Despite over 20 years as a physician, treatment burden is a term I had not heard until recently. Simply put, the treatment burden is “the workload of healthcare and its effect on patient functioning and well-being.” 

The BMJ: Treatment burden should be included in clinical practice guidelines

Our medical culture has become so obsessed with guidelines, performance metrics and drug trials that we have lost sight of possibly the most important question — how will this treatment impact our patient’s life? We chase statistical “p values” for benefits that amounts to a fraction of a percent and call it a breakthrough. But we forget to ask, “Will the benefits outweigh the costs and improve my patient’s life?”

One study referenced in The BMJ article estimated that an individual with a combination of three chronic diseases (such as emphysema, arthritis, heart disease or diabetes) spends 50 hours per month in health-related activities, takes 6-12 drugs per day and has to see his or her doctor 2-6 times per month. How can anyone be expected to do this while holding a job and taking care of a family?

Insulin therapy for type 2 diabetes is the perfect example. It requires multiple finger sticks per day, specific dosing and injection of the insulin, and constant communication with a provider to ensure proper dosing. Insulin therapy also has side effects: weight gain, fluid retention and the risk of dangerous hypoglycaemia. And I have not even mentioned the rising cost of insulin that has sent some people searching the black market to get it.

How does that treatment burden compare to a low-carb diet without the need for insulin? If we consider the burden of care, all of a sudden the benefit of “aggressive” lifestyle therapy seems clearer.

Fortunately, we have reason for optimism. Thought leaders like Dr. Victor Montori are leading the charge for a more patient-centred method of healthcare. In addition, some guidelines are starting to incorporate “acceptability and feasibility” sections.

Will that be enough? Short of a healthcare revolution, it is up to each of us as individuals to talk to our doctors about the burden of our treatment. Doctors need to know how our lives are impacted, and how that may change the relative benefits of certain treatment choices.

In the end, it may keep coming back to a healthy lifestyle as the best option with the fewest side effects and the lowest treatment burden."

Words and picture from article on Diet Doctor site here

All the best Jan


Tom said...

...complex to say the least. As our wonderful President said, 'who knew that health care was so complex.' EVERYONE!

Valerie-Jael said...

A healthy diet and lifestyle are always best. Valerie

DUTA said...

Healthy lifestyle is indeed the best and cheapest option. Dependance on doctors and meds is highly exaggerated.

Mary Kirkland said...

I take 14 medications per day. I see my doctor every 3 months. It's a big pain in the rear but I do feel better than before I started taking medication so something is working.

Elephant's Child said...

Treatment burden is a new term to me - but as someone with MS I so understand it. And wish that more doctors did.

Bill said...

A healthy lifestyle is the way to go always. Thanks for sharing.

Christine said...

Thanks for sharing.

Iris Flavia said...

I am very, very thankful indeed I have nothing to take but one pill a day for my hyperthyroidism...

chrissie said...

Fascinating post with lots ot think about.

A healthy and happy life is the best policy for sure

Love Chrissie xx

Teresa said...

Muy buen reportaje. Besitos.

Francisco Manuel Carrajola Oliveira said...

Um excelente artigo.
Um abraço e bom fim-de-semana.

Dedais de Francisco e Idalisa

Kezzie said...

I can imagine a great weariness with having to take medication every day in large quantities is extremely wearisome- even just one thing must be! I like the discussion and the empathy in this!

baili said...

very important topic that comes to mind hardly in busy routine of life jan

i felt as you are writer pointing towards me as all symptoms of a stuck patient sound familiar here

except one thing that until now i am not diabetic (may be in future :)

this is right that while bearing the side effects of medication it is tough job to keep up with all duties of normal daily life

Bob Bushell said...

It makes you think, necessary for some.

carol l mckenna said...

Informative post ~ 'the times they are achangin'

Happy Day to you,
A ShutterBug Explores,
aka (A Creative Harbor)

Magic Love Crow said...

A very good post Jan! Thank you! Big Hugs!