Clinical priority setting

Publisher Website
Google Scholar
Abstract
Clinical prioritiesClinical priority setting means choosing whom to investigate and what diagnostic tests to perform; sorting the flow of patients so some are diagnosed or treated before others; allocating patients to surgery, medical treatment, or watchful observation; and selecting or excluding patients for a given treatment.6 7 Justice requires a fair distribution of the benefits and burdens of priority setting.8Clinicians’ decisions rest on two types of information: the patient’s severity of disease (prognosis without the intervention) and the expected outcome (prognosis with the intervention). The evidence underlying their judgment is also important.9 Clinicians can help support priority setting by stopping procedures that have little evidence of effectiveness.Priority setting is an integral part of daily practice in many clinical specialties. Cardiology is but one example. Firm evidence supports sorting patients with risk of a cardiovascular event into prognostic priority groups.10 European clinical guidelines, for instance, distinguish between three prognostic groups (graded from high to low priority): patients with established cardiovascular disease; asymptomatic patients with a 10 year risk of cardiovascular death ≥5%; asymptomatic patients with a 10 year risk of cardiovascular death ≤5%.11 Patients in the first two groups almost always get preventive treatment, but those in the third group may not because the evidence of effectiveness is weaker (but not absent) and the risk is low. There is therefore a lively debate about the marginal value of preventive treatment for this group.

This publication has 0 references indexed in Scilit: