30th January 1999
Medical Journal Focus

Sharing decisions with patients: is the information good enough?

We will occasionally feature, under the heading Medical Journal Focus, an article recently published in the medical journal press. While not necessarily having specific references to polio, the content of the articles will in our opinion be relevent to the interests of users of this web site.

Today's article from the BMJ discusses the advantages of medical professionals working in partnership with their patients and in particular the importance of availability of "sufficient and appropriate information" regarding their treatment options. In the opening paragraphs the authors write:

Shared decision making, in which patients and health professionals join in both the process of decision making and ownership of the decision made, is attracting considerable interest as a means by which patients' preferences can be incorporated into clinical decisions. When there are several treatment options which may have different effects on the patient's quality of life, there is a strong case for offering patients choice. Their active involvement in decision making may increase the effectiveness of the treatment.

Trials are currently under way to test this hypothesis formally, but there are good grounds for optimism. Patients with hypertension benefit if they are allowed to adopt an active rather than a passive role in treatment, patients with breast cancer suffer less depression and anxiety if they are treated by doctors who adopt a participative consultation style, and patients who are more actively involved in discussions about the management of their diabetes achieve better blood sugar control. Patients whose doctors are ignorant of their values and preferences may receive treatment that is inappropriate to their needs.

Patients cannot express informed preferences unless they are given sufficient and appropriate information, including detailed explanations about their condition and the likely outcomes with and without treatment. Yet many report considerable difficulties in obtaining relevant information. There are various reasons for this. Health professionals frequently underestimate patients' desire for and ability to cope with information. Consultation times are limited, there is often insufficient time to explain fully the condition and the treatment choices. Health professionals may themselves lack knowledge of treatment options and their effects. A solution to this problem is to ensure that patients have access to written or audiovisual material, to inform themselves and to use in discussion with health professionals.

The full text is available online:

Sharing decisions with patients: is the information good enough?
Editorial by Richards and Coulter
Angela Coulter, director of policy and development, a Vikki Entwistle, senior research fellow, b David Gilbert, research officer. a
a King's Fund, London W1M 0AN, b Health Services Research Unit, University of Aberdeen, Aberdeen AB25 2ZD
BMJ 1999;318:318-322 ( 30 January )
http://www.bmj.com/cgi/content/full/318/7179/318

26th January 1999
Consumer Assessments and Performance of MEDICARE Health Plans Now Available on Internet (U.S.A.)

HCFA Press Release 25th January 1999

From the Press Release:

For the first time in Medicare's history, beneficiaries and their families can now examine information assessing the quality of care provided by health plans contracting with the program as rated by other beneficiaries. The Health Care Financing Administration (HCFA) today began posting on the World Wide Web (http://www.medicare.gov/) the results of a survey of more than 100,000 Medicare beneficiaries enrolled in managed care plans that participate in Medicare.

HCFA also is posting the results of a new assessment of the quality of care as demonstrated in seven audited performance measures, the measures most important to beneficiaries.

The new measures, part of the Consumer Assessment of Health Plans (CAHPS) and the Health Plan Employer Data and Information Set (HEDIS) provide Medicare beneficiaries and the public with information to help them make decisions about how they want to get their health care.

At the time of writing the press release had not as yet appeared on the HHS site. Eventually the full text should be available at http://www.hhs.gov/news/press/1999.html

The Health Care Financing Administration (HCFA) administers Medicare, the USA's largest health insurance program, which covers 39 million Americans.

For other Health Insurance related resources see our directory Disability

6th January 1999
OPV is no longer recommended for the first two doses of the polio series,
except in special circumstances. (U.S.A.)

The following report appeared in IAC EXPRESS, a newsletter of the Immunization Action Coalition. It parallels the earlier reported changes in the American Academy of Pediatrics recommendations (see NewsBites 16th December 1998) and refers to changes in ACIP recommendations which at the time of writing do not appear to have filtered through to sites such as CDC. Here is the report.

OPV is no longer recommended for the first two doses of the polio series, except in special circumstances such as a child whose parents do not accept the recommended number of injections, or a child who will be traveling to a polio-endemic area. This recommendation was made by the Advisory Committee on Immunization Practices (ACIP) at its October 21-22, 1998, meeting. The ACIP voted to continue recommending that the first two doses of polio vaccine should be IPV at 2 and 4 months of age, followed by a dose of OPV at 12-18 months and another dose of OPV at 4-6 years of age. Use of IPV for all doses is also acceptable.

An article on the ACIP's changes in the polio vaccination schedule, which appeared in the November 26, 1998, issue of CDC's National Immunization Program's "Polio Vaccine UPDATE," stated that implementation of this recommendation will begin January 1, 1999, with release of the Recommended Childhood Immunization Schedule. The entire article is reprinted as follows:

ACIP MODIFIES POLIO VACCINATION SCHEDULE

"The Advisory Committee on Immunization Practices (ACIP) voted to recommend a change in the polio vaccination schedule during its meeting held in Atlanta, Georgia, October 21-22, 1998. The ACIP voted to continue recommending that the first two doses of polio vaccine should be IPV at 2 and 4 months of age, followed by two doses of OPV at 12-18 months and 4-6 years of age. Use of IPV for all doses is also acceptable.

"The change from the 1997 ACIP recommendation is that OPV is no longer recommended for the first two doses except in special circumstances, such as a child whose parents do not accept the recommended number of injections, or a child who will be traveling to a polio-endemic area.

"OPV continues to be recommended as the most effective vaccine for mass immunization campaigns to control outbreaks due to wild polio virus. IPV is the only poliovirus vaccine recommended for children who are immunocompromised, who have close contact with immunocompromised persons, or who have an increased risk of developing polio.

"Implementation of the recommendation will begin January 1, 1999, with release of the revised Recommended Childhood Immunization Schedule. A revised Vaccine Information Statement will be provided to states for distribution in the near future.

"The recommendation was made to address continued concerns related to VAPP and OPV. There were four confirmed cases of VAPP reported during 1997-98, all associated with the first or second dose of an all-OPV schedule. Three suspected cases of VAPP are being investigated. There has been no confirmed VAPP reported with the sequential schedule. Expanded use of IPV has not been associated with increased risk or unexpected adverse events, according to data from the Vaccine Adverse Events Reporting System (VAERS).

"The ACIP also expressed a strong desire to set a date for transition to an all-IPV schedule and will form a working group to consider how such a transition would be implemented. The process would involve working in conjunction with a wider group of partners, including State and local health departments, immunization coalitions, private providers, and national minority and community-based organizations."

The above appeared in Issue 40 of IAC EXPRESS, a newsletter of the Immunization Action Coalition, a 501(c)3 nonprofit organization, which works to boost immunization rates. The Coalition promotes physician, community, and family awareness of, and responsibility for, appropriate immunization of all people of all ages against all vaccine-preventable diseases. Their web site URL is http://www.immunize.org/

For other Polio Vaccine related resources see our directory Polio Virus, Vaccine and Eradication