About Effective care

Effective care is a term used in the health care industry to describe healthcare strategies that have proven to be helpful for most patients of a certain condition most of the time.

Best practices might be a comparable term from the business world. A website bestpractices.org shares some examples of corporations who have successfully established business practices that support the environment and reuse or reduce use of natural resources.

A definition of the term best practices by businessdictionary.com also mentions that they are used as a benchmark – something to compare new strategies with to see if they are as helpful as the current best practices.

“A method or technique that has consistently shown results superior to those achieved with other means, and that is used as a benchmark.”

Read more: http://www.businessdictionary.com/definition/best-practice.html

Health care strategies that have been shown to be effective with many clinical research studies may also become benchmarks that newer research may use as a comparison. Unfortunately however best practices in the medical world don’t always make it to the patient and the reason is not cost – lack of profit might be more of the problem. Research in the use of effective care practices in the medical industry have found that more health spending is correlated with less use of the most effective care strategies. The problem may be associated with too many physicians and too many specialists being involved without adequate coordination of the whole system – recommendations or prescriptions given by one specialist may interact with a prescription or treatment being given by another specialist and an underlying problem may have been missed by both specialists because it wasn’t within their area of focus.

Effective care refers to services that are of proven value and have no significant tradeoffs — that is, the benefits of the services so far outweigh the risks that all patients with specific medical conditions should receive them.” -The Dartmouth Atlas of Healthcare – effective_care.pdf

The Dartmouth Atlas Project has found that there is no correlation between higher spending and more widespread use of effective care. The causes of underuse include fragmented care (which tends to grow worse when more physicians are involved in the patient’s care) and the lack of systems to ensure that all eligible patients receive these treatments.” – dartmouthatlas.org

The U.S. Department of Health and Human Services (HHS) has an agency dedicated to reviewing medical research and summarizing results by levels of proven effectiveness. The HHS, Agency for Healthcare Research and Quality (AHRQ) Effective Health Care Program  website, effectivehealthcare.ahrq.gov, provides research summaries for consumers, clinicians and policymakers on medical topics or conditions that have already been reviewed by the agency. Topics that are under review by the agency can also be viewed and comments about the findings or other recommendations regarding the topic can be submitted by members of the public.

The more general term effective care is also used in the nursing care and residential care facilities regarding best practices in daily care of patients or residents that is less medical in nature but which might help support good health.

  • The Alzheimer’s Association, alz.org offers a pdf of their guide, Dementia Care Practice Recommendations for Assisted Living and Nursing Homes, which provides recommendations for effective dementia care for residential facilities or for patients with dementia and caregivers.
  • An Executive Summary regarding the effective use of psychiatric residential facilities and what best practices to look for when assessing a facility is available in a pdf  the Appropriate and Effective Use of Psychiatric Residential Treatment Services by Dave Ziegler, Ph.D. for Jasper Mountain.
  • A more colorful infographic regarding best practices for residential youth care is available from casey.org. The infographic titled Elements of Effective Practice for Children and Youth Served by Therapeutic Residential Care, includes statistics on foster care.
  • A review of residential facilities and their use of ten different evidence based interventions concluded that incorporating interventions found helpful in other research was possible and did have some beneficial results. Effectiveness and Implementation of Evidence-Based Practices in Residential Care Settings, by Sigrid James, PhD, MSW, Qais Alemi, MPH, MBA, and Veronica Zepeda, BA, published in Child Youth Serv Rev. 2013 Apr 1; 35(4): 642–656.

There are also best practices in research and use of statistical analysis of results. Math can be used to increase apparent significance of results and may not be able to be repeated by future studies or when attempted to be used in real world applications.

  • A discussion of variables in research and statistical analysis is available here.
  • A free/low cost university level course on understanding the statistics used in clinical research papers without focusing on the math itself is available online here.
  • Errors in research that is used to make government or corporate policy can result in increased costs as well as reduce effectiveness of the policy. Inaccuracy in research may result from how data is categorized and then use of the research can result in potentially life threatening and costly policy decisions, Errors contained in Federal Reports Used for Health Policy and Funding Decisions, Beth Waldron.

My own interest in best practices and effective care started early, during childhood.

My first job as a teenager was as a water safety instructor, life guard and camp counselor for groups of children at a summer camp. In order to qualify for the position I had previously spent many hours of my life going to swimming classes each year. I enjoyed them and slowly advanced up through the levels of training and tests of skill and knowledge until eventually I achieved certification as a water safety instructor and swimming life guard – two different sets of training and testing, and it also required CPR certification and training with a different organization. I had to understand and remember safety and emergency procedures in real life training drills for a variety of scenarios and repeat them under timed test conditions.

All the training helped me perform better as a life guard and water safety instructor for the children at the summer camp during normal routine and during emergency situations. Summer storms can roll in rapidly and if you are out in the middle of the lake in a metal boat then you need to get to shore quickly and calmly. In an emergency, panic is not helpful in oneself or as a role model for others. Fortunately we all got to shore safely. It helped me stay calm leading a small group on my own, to have first been part of a larger group with other more experienced camp counselors guiding the group through a dangerous situations.

Happily I’ve never been in a situation where I had to try to save a drowning person but I am still prepared to jump in the deep end if a situation calls for it, however if possible, first I would also ask someone to call 911 and look for a life preserver, and I would probably have kicked off my shoes and jacket at the same time. Having experienced the training situations I know that every advantage can help in a dangerous situation and bulky clothing or backpacks would be a disadvantage in the water, especially with a struggling person who might be panicking.

Recognizing that a risk exists allows strategies to be developed to better cope with the risk or to help prevent the risk from occurring. Learning from the experience and reliable research of others can help save time and lives and can be more cost effective than paying for the research independently or having to learn from an accident or emergency.

  • The American Red Cross offers training courses throughout the U.S. for in person training and certification for emergency care for a variety of situations.  Representatives from the organization can also be scheduled to offer courses for groups at business locations.
  • Downloadable copies of the written material used in their CPR and other training courses is available for no charge online. Their website also has a store area with print copies available for purchase.  redcross.org/participantmaterials The participant materials are available for course manuals or for skill sheets on the following topics:
  1. Administering Emergency Oxygen; 
  2. Babysitter’s Training;
  3. Basic Life Support for Healthcare Providers;
  4. Bloodborne Pathogens Training; 
  5. CPR/AED for Professional Rescuers (CPRO); 
  6. First Aid, CPR and AED (Spanish versions available); 
  7. Life-guarding;
  8. Wilderness and Remote First Aid.

The American Red Cross training for water safety instructors includes basic boating safety information however more frequent boaters would benefit from a more focused course. Courses for a variety of types of boating is available from the U.S. Coast Guard: uscgboating.org/recreational-boaters/boating-safety-courses.php

Land bound outdoor recreational vehicles can also be dangerous and safety programs for snowmobiling and other off road vehicles likely exist. At a state level, the Michigan Department of Natural Resources offers a training program for volunteers to be certified as Recreational Safety Instructors. michigan.gov/dnr

Preventing an accident in the first place can save time, money, and lives.

Preventing disease by preserving the body’s ability to protect itself or a developing fetus can also save lives or preserve the quality of life and save time and money.

Some strategies do work better for some people or in some situations better than for others. Effective care ideally includes ways to assess whether a strategy is working for a specific individual instead of suggesting that a research average will produce average results for all individuals.

Self care is not an official medical term, to my knowledge, and it can involve emotionally supportive strategies that may not also be the ‘ideal’ effective care recommendation. Strategies that are both emotionally and physically healthy would be the ideal for daily habits for health maintenance and save the less physically healthy but emotionally satisfying treats for less frequent use, but that suggests we have the research or the personal experience to know which strategies are less physically healthy. It might be more obvious that drinking too much alcohol has short term negative consequences but research and personal anecdote also supports the idea that regularly drinking a lot of alcohol can have long term negative health consequences. Add a high speed vehicle whether on land or on water and alcohol can lead to negative consequences for anyone in the vicinity of an accident.

Effective self care can involve learning both the recommendations from research and others’ experiences and learning to recognize internal signals from the body – queasy stomach, wobbly walk, slurred speech, — give the keys to the bartender or close friend and sleep it off. Excess alcohol may also cause a depressed mood or a more aggressive mood so recognize that violence or self injury in oneself or a friend may be more of a risk when under the influence of alcohol. Sleeping it off is the safest strategy because coffee or other methods suggested for rapid sobering up have not been found to be truly effective. Roughly, it takes the body about one hour to process an ounce equivalent of hard liquor (5-6 ounce wine, 12 ounce beer) so if it was a twelve pack plan ahead and call in absent from the next day’s work, and then maybe turn off the phone to prevent making any other calls. For more information see: servingitright.com/alcohol_effects

Effective self care involves a combination of learning the general best practice/evidence research based recommendations and learning to listen to one’s own body for signals of pain or the positive feeling of energy and wellness. Effective self care strategies, doing more of what seems to lead to the feelings of energy and wellness and less of what seems to lead to feeling pain, might help prevent chronic illness from developing or help maintain health better when a chronic illness or congenital birth issue is already present.

Balance and moderation are helpful for food and activities. Overloading a schedule can be a stress that can add to ill health. A university program has been established at Yale University to help students with learning balance and self compassion. Over achievers are common and are encouraged along the way as successes accrue however without balance, and basic self care of food and rest, eventually some crash is likely to occur in mental or physical health. Read more about Yale’s Emotional Intelligence Program:  qz.com/986966/overachieving-ivy-league-students-are-learning-the-wrong-lesson-about-what-it-takes-to-be-successful

However when a disease or a medical issue is already present it is important to discuss any symptoms or problems with a medical treatment with the health care team before discontinuing a medication or treatment plan or adding new medications or supplements. Abruptly stopping a treatment or adding other treatments without checking for interactions can sometimes cause a negative reaction or medical emergency to occur. See a health professional or a few seeking more information on a diagnosis or symptom can be self protective or simply make it easier to discuss with a doctor.

Physicians are given little time to spend with patients in the current system and errors can be made in diagnosis which could lead to treatments that may be dangerous for a person without the condition. Seeking a second opinion is within a patient’s rights if unsure about a recommendation or treatment. Insurance may provide some coverage, it is always a good idea to check with the insurance policy before scheduling an appointment if finances are limited.

  • Is Poor Diagnosis a Leading Cause of Inefficiency in the Health System?linkis.com/com.au/HxXWW
  • Listening effectively is suggested to be important by the actor Alan Alda in a book he wrote about communication techniques for sharing scientific information with non-scientists, If I Understood You, Would I Have This Look On My Face? My Adventures In The Art And Science Of Relating And Communication. In order to understand how the other person is feeling it can be as important to use our eyes to “listen” to the other person’s body language in addition to using our ears to listen to the words being spoken.
    • An interview with Alan Alda about the book is available on npr.org: Alan Alda’s Experiment: Helping Scientists Learn to Talk to the Rest of Us
    • And an excerpt from the book is also available on npr.orgIf I Understood You Would I Have This Look On My Face?

Pharmacists are also helpful medical experts when seeking more information regarding potential negative interactions between medications, or herbal supplements and vitamins. However they are also busy people, and research has shown that some may miss as many as 50% of potential drug interactions.  chicagotribune.com/news/watchdog/druginteractions/ct-drug-interactions-pharmacy-met-20161214-story.html

A couple services are available online for entering a person’s prescriptions into a software application to check for possible interactions.

  • The CVS pharmacy website offers a drug/supplement interaction checker application. The information is for reference purposes and as a starting point for further conversation with a pharmacist or physician but is not intended to provide recommendations: cvs.com/drug/interaction-checker

Effective self care can serve as a safety warning when someone recognizes that what they are feeling is similar to what they felt in their body during a previous experience that had negative consequences. An example would be the medication Xanax/Valium/benzodiazepine which may be prescribed as an anti-anxiety medication however it affects the brain and body very similarly to alcohol and combining the two can make the “drunk” feelings much worse.

Not all conditions or situations have evidence based recommendations available or don’t have research from double blind human clinical trials available. Rare diseases may not have enough funding or profit motive to support the expense of research trials or there might be so few people with the condition that little information is known about it. In such cases I was trained as a dietitian to look for what research I could find regarding the disease or condition and see if there were any recommendations or clinical findings suggesting what nutrients might be helpful or harmful. Interviewing the patient regarding their usual habits might also provide suggestions regarding which might be known to be more harmful or helpful of health in general or for the condition in question.

An educated guess is speculation about what might help or harm that is based on experience or the research that is known about a condition rather than simply saying no evidence-based recommendations are available. Not everyone has common diseases with evidence-based recommendations available but everyone needs to eat or be fed regular meals anyway.

Returning to the idea of effective health care recommendations and their use as a benchmark for comparison of new research or a medical hypothesis (an educated guess, neatly written up with citations): the U.S. Department of Health and Human Services has an agency dedicated to reviewing medical research and summarizing results by levels of proven effectiveness. The website, effectivehealthcare.ahrq.gov, provides research summaries for consumers, clinicians and policymakers on medical topics or conditions that have already been reviewed by the agency.

One of the topics is on alcohol use disorder and medications that have been used in research trials for treating adults with the condition: Pharmacotherapy for Adults With Alcohol Use Disorder in Outpatient Settings,  effectivehealthcare.ahrq.gov

Medications without adequate research regarding their use for treating adults with alcohol use disorder were not included in the table. Medications that were reviewed are rated based on the strength of the research trials that were performed with their use as an experimental treatment. The rating scale is provided at the end of the US HHS, AHRQ Effective Health Care Program report; a copy of the Strength of Evidence Scale, for educational purposes:

Strength of Evidence Scale

High: evidence high
High confidence that the evidence reflects the true effect. Further research is very unlikely to change our confidence in the estimate of effect.

Moderate: evidence medium
Moderate confidence that the evidence reflects the true effect. Further research may change our confidence in the estimate of effect and may change the estimate.

Low: evidence low
Low confidence that the evidence reflects the true effect. Further research is likely to change our confidence in the estimate of effect and is likely to change the estimate.

Insufficient:evidence insufficient
Evidence is either unavailable or does not permit a conclusion.

US HHS, AHRQ Effective Health Care Program  https://effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=2273

And a return to educated guesses;

So is one person’s guess likely to be as good as another’s, as the old saying goes?

Not necessarily. It would depend on (A) who is guessing; (B) about what topic; and (C) whether they had adequate high quality research available on the topic, and (D) adequate time to review the research articles — and (E) ideally, also the data and statistical analysis on which the research articles were based.

(A) Does the person have some sort of special knowledge of the condition or professional experience and credentials relevant to the condition?

(B) Is the educated guess/hypothesis within an area they specialize in and/or do they have some financial incentive that are motivating their work and possibly biasing their recommendations? or personal reasons or political motives?

(C, D, E) The amount of research that is funded and the quality of the research may be affected by corporate or political reasons and funding may also be affected by what type of population is most at risk from the condition. The open availability of data may be affected by corporate privacy concerns.

In the computer industry shareware and cooperative development of software has been a part of many advances.  Best practices from one industry can serve as helpful role models when considering the need for change, and what changes to make and how, in another industry.

A description of how open science research publishing might work and a discussion of the current scientific research system and what is available for authors interested in open science is available at openscholar.org.uk: openscholar.org.uk/academic-self-publishing-a-not-so-distant-future/

A more in depth discussion of how the accuracy and truthfulness of medical research could be improved is available here:  journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001747

An ORCID research ID can help identify an author and their work across a number of publishing formats and could help readers by providing an easy way to look up the biography of the authors of a published article or book.  service.elsevier.com/answers

PubMed.com (https://www.ncbi.nlm.nih.gov/pubmed/) is an open access service for looking up science articles, many of which provide the Abstract summary and some of which provide links to the full text article.

There are a lot of answers available but making the time available to read them all, interpret and collate them, and test them in real world situations is – daunting, or – it’s an exciting challenge we all can look forward to accomplishing together, in an open science system.

Effective care can save time  and money and improve quality of life for patients and save time and cost of ineffective treatments for health care systems. Sharing of health information in online chart systems has run into issues with privacy walls between different businesses and cybersecurity risks. Cybersecurity in the healthcare world affects not only computers and other devices that use internet connections, but also medical devices used by individual patients for cardiovascular or diabetic needs.

Individual patients can benefit from being their own patient advocate and reading more about any treatments that are recommended or they can seek out patient advocate assistance.

  • A few types of patient advocates are described at assertivepatient.org: assertivepatient.org/patient-advocate
  • The book “Prepare to Defend Yourself . . . How to Navigate the Healthcare System & Escape with Your Life,” (2014) by Matthew Minson, MD is a patient self – advocacy guide written with sensitivity and humor. preparetodefendyourself.com

The duties of data sharing for care coordination can be difficult and time consuming and are discussed in more detail in this article regarding the patient’s and the clinician’s role in a patient’s coordination of care between specialists:  patientengagementhit.com/news/exploring-patients-roles-in-chronic-illness-care-coordination

Patient’s may find after researching treatment options that less invasive physical therapy options are available to try before going to a surgical method for resolving a physical symptoms. Chiropractic care for some people with back pain has been found to be effective for reducing chronic pain, with a faster recovery time and for less cost to the patient than a back surgery would likely cost.  chironexus.net/2016/09/chiropractic-patients-recover-faster-spend-less-money/

Changing daily habits can be the key to better health. Our bodies change over the years as we age and our habits have to adapt with our capabilities, ideally before chronic illness has developed. Or starvation occurs. As infants we need help with self care but the goal of parenting is to help us learn how to take care of ourselves on our own. With the first breath we take as newborns we are learning to take care of ourselves. Shutting our eyes at the bright light is a reflex that is protective and might occur next along with a little rest after the work of being born. And if left to respond naturally, within an hour or two later hunger signals would have encouraged us inch our way up our mother’s belly to latch on and suckle for food.

The tiny newborn is precious, the rebellious teenager is also.

Learning to do the things on our own that are necessary to help us survive and thrive is the key to effective self care. Having adequate food, water, and a warm shelter with clean air to breath is necessary for basic survival, and having caring social connections and a sense of purpose can be necessary for thriving emotionally.

Life gets more exciting and amazing with each discovery we learn.

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.