Sometimes when new guidelines for medical practice are unveiled — such as for screening certain types of cancer — controversy ensues. Doctors differ over what really is the best course of action to prevent disease progression.
But frequently experts point out adoption of practices — like appropriately limiting antibiotics in treating bacterial infections — is slow for other reasons. As with non-health professions, in medicine it can take time to shift practice from what was initially taught or has become habit. And in health care, providers are often inundated with new information, while having limited time to process it all and see patients.
“I think that part of it is just the overload of new research that’s coming out — new findings — and most clinicians are somewhat overwhelmed,” says Dr. Quyen Ngo-Metzger, scientific director of the U.S. Preventive Services Task Force program at the Agency for Healthcare Research and Quality. Sorting through new studies and staying up on new guidelines is an ongoing challenge for health providers. “It takes many years for this new clinical information to go from publication — scientific publication — into clinical practice,” Ngo-Metzger says.
With fewer doctors having solo practices, health care groups or systems play a larger role in determining the standard of care. This can certainly have the advantage of keeping clinicians on the cutting edge, but incorporating changes at an organization- or system-wide level can also take time. Insurance plans often lag, too, covering services based on older guidelines but not newer ones. And patients — whether by choice or due to access issues — may also forgo recommended care or prevention services, from blood pressure checks to colon cancer screening. Still, even as patients face their own challenges and allowing for some disagreement among doctors on certain clinical recommendations, experts say it’s important that the latest, evidence-based standards of care are adopted in practice in a timely fashion.
[See: 10 Questions Doctors Wish Their Patients Would Ask.]
Sharing the Latest Recommendations
Among others, the Agency for Healthcare Research and Quality has taken steps to expedite this process. That includes providing at no charge so-called clinical decision support: in this case, updated guideline information that can be incorporated into health organizations’ electronic medical records. In addition, the agency offers a free app health providers can use that’s based on the latest recommendations from the U.S. Preventive Services Task Force, called the electronic Preventive Services Selector, or ePSS. Clinicians can download it, and put in age of their patients, their sex, whether or not they’re pregnant and health status information — like whether that individual smokes, Ngo-Metzger explains. Then it returns individualized recommendations to help guide primary care providers and health care teams on what a particular patient needs.
Generally speaking, the vast majority of patients don’t get all recommended preventive care, which — depending upon a person’s age and risk — can range from screening for colon cancer and other cancers to taking low-dose aspirin to prevent cardiovascular disease in a person at increased risk. “Only 8 percent of adults 35 years and older were getting all of the highly recommended preventive services that offer the greatest potential for improving health,” Ngo-Metzger says. That’s according to research she co-authored published this month in the journal Health Affairs looking at preventive services that were evidence-based, according to the USPSTF or a recommendation from the Advisory Committee on Immunization Practices, and considered “clinically important.”
Doctors’ organizations also take steps to disseminate their latest recommendations as well as guidelines put forth by other organizations they deem to be backed by sufficient evidence. The American College of Physicians does this through a wide variety of channels: The group publishes guidelines in its journal the Annals of Internal Medicine, highlights recommendations in newsletters, provides information on new guidelines at its annual meetings and broadcasts guidelines through social media to not only doctors but patients, says Dr. Davoren Chick, ACP’s senior vice president for medical education. “We know that physicians need to access that information in different ways, at different times, and with different preferences for learning. So we really have to get the word out using numerous, different avenues,” she says. That’s in addition to patient education resources it provides on its website.
Patients can also use the governmental resource HealthFinder.gov to learn more about prevention and the right preventive services for them, Ngo-Metzger says. Like the doctor app, there’s a “calculator” into which patients can plug their age and sex to return specific recommendations for health prevention. Then patients can come into their appointment with an idea of preventive services recommended for them based on their age and health risk, and ask the provider about those.
[See: 5 Solid Lifestyle Changes to Help Prevent Cancer.]
Continuing Education
Along with having that discussion, patients sizing up a new doctor should take into account that physician’s affiliations and ongoing education to get a sense of how they might incorporate guidelines into care. If, for example, a doctor practices at a center for excellence, is a member of a physician organization and is board certified, experts say, that may increase the likelihood that provider will be up to date on new medical recommendations — though it’s no guarantee. “Clinicians who are board-certified tend to have to keep up with their continuous medical education, and they have to do a certain level of continuous medical education and quality improvement in order to be board-certified,” Ngo-Metzger notes.
To help doctors adapt more quickly to a fast-paced, ever-changing health care landscape, some medical schools have changed their approaches to educating tomorrow’s doctors. To support these efforts, the American Medical Association has, to date, awarded $12. 5 million in grants to 32 medical schools it’s collaborating with as part of its Accelerating Change in Medical Education Consortium.
While the AMA is not setting the curriculum — each school is making its own changes — the organization is involved in moving things forward, even writing a textbook on “health system sciences.” “That covers areas that are not strictly clinical, like health care structure, health care policy and economics, clinical informatics and health information technology, population health, value-based care,” says AMA president Dr. David Barbe. “These health system sciences are being incorporated into curriculum at an increasing number of medical schools across the country to broaden and deepen the knowledge of medical students, to perform the way our health system and our patients need them to perform.”
Another way medical schools are making students more nimble is by increasing the clinical experience they get earlier in their education. “The idea is that since students are getting patient exposure while they’re learning basic science, that they are able to more closely relate those basic science sessions or facts to patient care — which is something they’re going to need to do as a practitioner,” says Dr. Blaine Takesue, an assistant professor of clinical medicine at Indiana University School of Medicine, and a research scientist at the health care innovator Regenstrief Institute in Indianapolis.
IU School of Medicine is one of five medical schools that have been in the consortium long enough to graduate students this year who have had curriculum changes in place for all four years of their education. IU worked with Regenstrief Institute to develop and incorporate a platform to provide students with comprehensive training on using electronic health records. This involved using real patient data that didn’t identify patients to virtually care for patients with multiple, complex health conditions by navigating records, documenting those encounters and placing orders within an application similar to the EHRs used in practice, the AMA noted. This is part of a larger ongoing effort and focus on ensuring today’s medical students graduate proficiently skilled at using EHRs, which experts say is a normal part of everyday reality for most doctors today.
Just as AHRQ is providing the latest guidelines data (in the form of electronic codes) to be incorporated into health systems’ medical records, increasing emphasis is being placed on ensuring clinicians are adept at using EMRs to make care decisions based on the latest evidence.
[See: How Hospitals Are Using Technology to Become More Patient-Centered.]
Of course, the comparatively low tech conversation between doctor and patient remains central to making sure patients get the best care possible. Whether the physician is following a new guideline, or recommending something different based on your individual circumstances, you’ll want to know — and to talk it over. That includes being proactive in asking about what guidelines the doctor is following, where those come from and if they’re up to date, even if it feels a bit forward — and especially if you’re considering seeing a new doctor. “I think if you’re interviewing a doctor and you’re still trying to figure out if this is the right doctor for you,” Ngo-Metzger says, “I think it’s reasonable to ask if they’re board certified in their field, and if they follow guidelines.”
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How Well-Equipped Is Your Doctor to Adapt to Medical Practice Changes? originally appeared on usnews.com
