The case for reassessment of health care technology: once is not enough
Article Abstract:
Although reassessments of the cost and quality of health care technology are important, they are performed too infrequently, while new technology continues to grow. A review is provided of the concept of technology reassessment and its application to electronic fetal monitoring (EFM), episiotomy (an incision of the tissue between the vagina and rectum during delivery), electroencephalography (EEG, measuring the brain's electrical activity), and hysterectomy (removal of the uterus). Medical technology includes drugs, devices, and medical and surgical procedures, and the individuals and organizations that provide. Assessment means evaluating the long- and short-term consequences of a particular technology. Brief histories of medical technology assessment and reassessment are provided. Some leaders in reassessment have been Blue Cross/Blue Shield, the American College of Radiology, the American College of Physicians, and the National Perinatal Epidemiology Unit in Oxford, England, aided by the World Health Organization. These groups have made recommendations regarding useless or questionable procedures. In general, the elimination of obsolete technology benefits patient, doctor, and payer; yet, opposition to reassessment exists, fueled chiefly by inertia. Establishing priorities helps assessment to proceed, and the Agency for Health Care Policy and Research, established in 1989, plans to approach this issue. Different approaches for setting priorities are described. EFM has been reassessed and found to be no better than auscultation (listening with a stethoscope). Routine episiotomies were performed on 62.5 percent of women in the United States in 1979, and on 8 percent of women in the Netherlands in 1975; studies have indicated that episiotomy is damaging and useless. EEG is indicated in some clinical conditions, but far fewer than the number of machines in use represents. Finally, hysterectomy rates have been shown to be the result of patient and physician practice style, not medical need. Overall, it is estimated that only about one-fifth of current practices and technologies have actually been shown to be beneficial. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1990
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WHO meeting targets AIDS, other issues
Article Abstract:
The fifty-seventh World Health Assembly, which met during the month of May focused on the AIDS epidemic and access care for HIV infected patients and some time was also devoted to obesity, which is also assuming alarming proportions. There are around six-million affected individuals all over the world, with less than half-a-million in the developed world, and a resolution was passed to improve care facilities for the affected.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 2004
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