Evidence based health care and poverty
Today the buzz word in the field of medicine is evidence based health care.As many argue it is the only ethical care which can be given to the patient no matter what the circumstances are.But is it really possible in Indian health care scenario is what no one is willing to engage with.
I would like to narrate two incidents which i came across recently.The first one was a middle aged patient who has been suffering from severe psoriasis with Psoriatic arthropathy for the past few years and he finally landed up in the hospital where i work with severe skin lesions and arthropathy.The drug which was commonly used to treat such patients was methotrexate in the indian setting .But there has been definite evidence against the use of methotrexate as it does not prevent the worsening of the lesions in these patients.The preferred drugs which has soon significant improvement in morbidity and mortality was the biological agents.But the cost is out of reach for the common man and he is left at the mercy of a drug which has been proven in research to be not beneficial!
Another common scenario which we come across is management of myocardial infarction.The current practice in mission hospitals or rural hospitals is to thrombolyse them and refer them to a tertiary center for further intervention such as angiography.But the current evidence is shifting in the favor of a primary coronary intervention which has a significant mortality benefit for the patient.Again the cost and logistics stand in the way for the common man to accrue the benefits of the evidence generated.This list can go on and on as the field of medicine progresses.
These kind of scenarios raises some hard questions for us to answer.In mission hospitals we always aim for 'quality' in our care given to patients and one important dimension in the quality aspect is evidence based care.As the above examples show has evidence based care(EBM) has any relevance in the mission hospital setting?How to we define "quality"care in settings where evidence based care is lacking?Will EBM remain in the domain of the affordable wealthy corporates or can rural hospital write a different script?
This is not to say that evidence is completely lacking in clinical care and there are many areas of care where evidence based guidelines are being utilised.But also the question remains will wee keep up with the pace of the rapidly changing evidence and guidelines?Of course all efforts are made in utilising teh beast availabale resources.But how to take steps when the "best available" are really inadequate in addressing the disease.There are also serious attempts made to venture into the areas of research but it remains as an observational study at the most which may not generate rigorous evidence for clinical practice except fro some intelligent observations whin may not be relevant in other settings or geographical areas.Atleast a move has been made to leap from expert opinion to observations made on research.Will a rigorous research pave way for a more cost effective treatment benefits for the patients in resource limited setting is yet to be seen.I hope one day it will become a reality.
Is there scope and hope for evidence based health care in rural setting?What do you think?
I would like to narrate two incidents which i came across recently.The first one was a middle aged patient who has been suffering from severe psoriasis with Psoriatic arthropathy for the past few years and he finally landed up in the hospital where i work with severe skin lesions and arthropathy.The drug which was commonly used to treat such patients was methotrexate in the indian setting .But there has been definite evidence against the use of methotrexate as it does not prevent the worsening of the lesions in these patients.The preferred drugs which has soon significant improvement in morbidity and mortality was the biological agents.But the cost is out of reach for the common man and he is left at the mercy of a drug which has been proven in research to be not beneficial!
Another common scenario which we come across is management of myocardial infarction.The current practice in mission hospitals or rural hospitals is to thrombolyse them and refer them to a tertiary center for further intervention such as angiography.But the current evidence is shifting in the favor of a primary coronary intervention which has a significant mortality benefit for the patient.Again the cost and logistics stand in the way for the common man to accrue the benefits of the evidence generated.This list can go on and on as the field of medicine progresses.
These kind of scenarios raises some hard questions for us to answer.In mission hospitals we always aim for 'quality' in our care given to patients and one important dimension in the quality aspect is evidence based care.As the above examples show has evidence based care(EBM) has any relevance in the mission hospital setting?How to we define "quality"care in settings where evidence based care is lacking?Will EBM remain in the domain of the affordable wealthy corporates or can rural hospital write a different script?
This is not to say that evidence is completely lacking in clinical care and there are many areas of care where evidence based guidelines are being utilised.But also the question remains will wee keep up with the pace of the rapidly changing evidence and guidelines?Of course all efforts are made in utilising teh beast availabale resources.But how to take steps when the "best available" are really inadequate in addressing the disease.There are also serious attempts made to venture into the areas of research but it remains as an observational study at the most which may not generate rigorous evidence for clinical practice except fro some intelligent observations whin may not be relevant in other settings or geographical areas.Atleast a move has been made to leap from expert opinion to observations made on research.Will a rigorous research pave way for a more cost effective treatment benefits for the patients in resource limited setting is yet to be seen.I hope one day it will become a reality.
Is there scope and hope for evidence based health care in rural setting?What do you think?
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