In the modern world of medicine, doctors' time is precious both in terms of cost and the huge and varying demands placed on them. Strategies that have evolved to reduce these demands include the development of specialist nurse roles and greater involvement of patients in their own care. Of course, this is accepted and good practice as doctors should not have a monopoly in healthcare provision.
However, like all medical treatment and interventional strategies, they should be subject to the rigours of research and peer review. Bearing this in mind, I read with interest a recent article in the univadis GP News service (click here). The article reports: "A trial of education and self-management in patients with chronic obstructive pulmonary disease has had to be stopped early because of excess deaths in the group receiving the intervention." Indeed, it continued: "Three times as many patients were found to have died in the self-management group as in the usual care group after 8 months."
I must say I was surprised to read this, as we are used to devolving some aspects of care to patients and encouraging self-care, particularly with respect to chronic disease management. A good example is patient self-monitoring of blood glucose in the management of diabetes.
What are the implications of this particular study? Firstly, it is important to assess the research. It may need to be substantiated and analysed further to see if certain groups of patients can safely self-manage, while others may need more detailed medical supervision. This will help to improve safety, guide further management and give doctors and patients confidence that they are following the correct pathway. It should also enable us to deliver more cost-effective care, which is increasingly important in these difficult economic times.
But the big take-home message here is how important it is to do research then publish and disseminate it. It is critical that we always question what we do and continue to look for the evidence base that substantiates our daily clinical practice.
By Dr Harry Brown