Where's the evidence for home care?
CMAJ 1998;159:135
See response from: S.M. MacLeod, B. Brossart, J.E. Mullens
See also:
The article "Evidence-based rationing: Dutch pragmatism or government insensitivity?" (CMAJ 1998;158[2]:213-4 [full text]), by Drs. Stuart M. MacLeod and John Bienenstock, raises cautionary flags. However, it also demonstrates the pitfalls of not using evidence-based rationing. MacLeod and Bienenstock call on conventional wisdom when they state that there are "services that everyone agrees should be provided, such as home care. . . ." I have recently reviewed the literature of controlled trials involving home care and find it difficult to convince myself that there are significant outcome or economic benefits from this type of care. My view is supported by a recent study by the Institute for Clinical Evaluative Sciences (ICES) that was reported in the Medical Post.1 Dr. Peter Coyte of ICES has pointed out that there are no studies showing that home care is a truly cost-effective alternative to hospital care. The ICES study itself stated that "In the absence of evidence-based decision making, health system restructuring may result in more, not less, costly patterns of practice, and erode, not enhance, health outcomes." It is clear that although evidence-based rationing is not perfect, rationing of limited resources must happen, and there is no better mechanism known.
Aidan Byrne, MSc, MD
Victoria, BC
byrne@gowebway.com
 |
Send a letter to the editor Envoyez une lettre à la rédaction |
Reference
- Wysong P. With Ontario hospitals closing, home care needs $91M: ICES. Med Post 1998;34(1):2.
