Contents (for this page)
A Case Study Workshop in Dermatology
DEVELOPED BY FAMILY PHYSICIANS
In the primary care setting, dermatological conditions rank as one of the most common disease presentations, alongside GI disorders, respiratory tract infections, and so forth. On a typical day a clinician may see and treat a wide array of skin diseases ranging from a simple, infected wound to a widespread cellulitis or psoriasis.
But, although they are common, the management of skin conditions is seldom routine; each case can present distinct challenges in terms of diagnosis, treatment and overall patient care. This dermatology workshop sets the scene to address many of these challenges in light of the types of medical decisions, socioeconomic issues and patient-related concerns that occur in todays clinical practice.
To set the stage for this practice-based learning session, close attention was paid to the methodology behind the development of the program materials themselves:
Overall, we hope that you find this to be a fruitful learning experience, and a stimulus for provocative discussions among peers and colleagues.
Elliot Halparin MD, CCFP, FCFP
In this online course, you will find the following components, intended to be utilized in a 2 hour session:
This workshop program in dermatology has been designed to improve the skill and knowledge of participants in the following areas:
Family Physician Editor
|Elliot Halparin MD
|Peter Hull MD
FRCPC FFDerm (SA)
Associate Professor of Medicine
Head, Division of Dermatology
University of Saskatchewan
Royal University Hospital
Marie-Christine Roy MD FRCP(C)
|Nancy Austin MD
Sam Racanelli MD CCFP
Suleman Remtulla MD
Optimal Drug Therapy in Dermatology
THE ROLE OF CONTEMPORARY CLINICAL GUIDELINES
The contemporary emphasis on cost-control has compelled health caregivers both individually and as professional groups to re-evaluate their attitudes and practices regarding patient care. Essentially, the current dilemma can be summarized as follows: How do we continue to provide quality care, while keeping costs under control?
The concept of Optimal Drug Therapy is basically a response to this conundrum; under this concept, the efficacy, safety and cost-effectiveness of a particular therapy are carefully weighed and balanced according to each patient and his/her clinical situation. In other words, clinical consideration is given to the needs of society at large (cost-effectiveness), while ministering to the needs of individual patients (efficacy, safety).
Todays clinical guidelines have crystallized these criteria (efficacy, safety and cost-effectiveness) by formulating algorithms with indications for first-, second- and third-line therapies. Although these indications would appear to be clear-cut, in practice the application of clinical guidelines is often a complex and highly individualized process.
As an illustration of this individualized process, consider the way cost-effectiveness of therapy is assessed.
It is well known that cost of treatment is an important factor for government (formularies), group (insurance companies) and individual (patients) payors. However, it should be noted that the pharmacoeconomics of a drug does not merely take into account its purchase value; of equal importance is its efficacy and safety. In other words, a drug may be inexpensive but:
Thus, cost-effectiveness of therapy can only be determined by weighing its actual cost, along with the other criteria involved namely efficacy and safety and assessing their impact on the patient and his/her clinical situation.
There is a fourth factor implicit within this Optimal Drug Therapy pyramid: compliance or patient acceptance. Once again, therapeutic compliance is related to all the preceding factors: If a drug is efficacious, safe and affordable, there is a higher likelihood of compliance. On the other hand, if a drug does not satisfactorily meet one or more of these criteria, it needs to be asked: What is the cost of noncompliance?
Emergency room visits, return visits to the physician, new drug prescriptions, and secondary complications may all result from noncompliance with the initial therapy. Apart from the human consequences, the cost of noncompliance from a macroeconomic standpoint ranges from 7 to 9 billion dollars a year, according to recent estimates.*
In the following program, discussions surrounding Optimal Drug Therapy are aimed chiefly at promoting comprehensive care of our patients that is, administering the right treatment, with the right dose, for the right amount of time and at the right price.
* Coambs RB, Jensen P, Her MH, et al. Review of the scientific literature on the prevalence, consequences, and health costs of noncompliance & inappropriate use of prescription medication in Canada. Pharmaceutical Manufacturers Association of Canada, Ottawa, Ontario, 1995.
This program has been designed to run for 2 hours; however, it can be adapted to conform to timeframes ranging from 1-3 hours. The following briefly describes the program flow and possible implementation by program moderators:
The suggested timing of the program is roughly as follows (based on a 2-hour session):
|0 - 20 mins:||Differential diagnosis visual skills test|
|21 - 1 hr 40 mins:||Case studies (not yet available)|
|1 hr 41 mins - 2 hrs:||Self-assessment quiz|
|Prev||Next||Hosted by DermWeb||Top|