Dr Stephen Child South/Fri_Plenary_1150_Stephen Child... · Darbepoetin alfa Treatment of type 2...

Dr Stephen ChildChief Medical Officer

Southern Cross Health Society

Auckland

11:50 - 12:10 Things That Matter - The Human Side of Medicine

Human side of technology

Healthy Partnerships


Stephen Child

Chief Medical Off icer

M.D. FRACP(C) , FRACP



191 conditions



General practice – top 10 (Australia)

1. Hypertension 2. Immunisation 3. Upper respiratory

tract infection4. Depression

5. Diabetes 6. Lipids

7. General check 8. Osteoarthritis 10. Prescription9. Back pain



Contract with society?

1938-41

Erosion of doctor-patient relationship

$Third-party

funder



What’s changed?

• Growing patient expectations

• Funder wants value

• State suspicious of self-regulation

= reduced autonomy and wellbeing



Customer is always right



Expectations

Patient (customer )

• “Diagnosis”

• Personalised

• Empowerment

• Quality

Funder (customer representation)

• Quality outcome at low cost (value)

• ROI: Productivity, brand, etc



New Zealand find ‘game changer’ for bowel cancer (NZ Herald article)



Elizabeth Anne Holmes

Wanted to be a billionaire but faces decades in jail



Other therapy



Cancer therapy

Aromatherapy Ayurvedic RykeHerbalism Homeopathy

Shamanistic Naturopathy Urotherapy Diets +++ Macrobiotics

Probiotics Bioresonance Magnet Therapy Light Therapy Orgone

Polarity Therapeutic Touch Zoetron Aloe Cannabis Capsicum Castor Oil Ginseng Grapes Kombucha Milk Thistle

Mushrooms Acupuncture Chiropractic Craniosacral Colonics Cupping Ear Candling Reiki

Shiatsu Hypnosis Faith-based Meditation NLP Qigong

Bee Venom Caesium Salt Chelation Colloidal Silver Emu Oil

Hyperbaric OrthomolecularOxygen Shark Cartilage

Vitamins


The medicalised smartphone

Source: ‘The Patient Will See You Now’, Eric Topol



Google is tackling specific diseases

Source: CB Insights



If technology is the solution, what was the problem?



1. Not informed

2. Ill informed

3. Imbalanced information

4. “At risk” – fear - pain

Vulnerable



Condition X

30% placebo

always effective

20 people take

treatment A

20 people take

treatment B or

placebo

Evidence based or biased?



Background

Wang MT, Gamble G, Grey A. JAMA Internal Medicine. 2015;175(5):845-848.

Oestrogen and progestin replacement Prevention of cardiovascular disease in post menopausal women

Tympanostomy tube insertion Treatment of persistent otitis media

Vitamin D and calcium Prevention of fractures

Vitamin E Prevention of cardiovascular disease and cancer

Mammography screening Detection of breast cancer from 40 years

Percutaneous coronary intervention Treatment of stable coronary artery disease

Rosiglitazone Treatment of type 2 diabetes

Arthroscopic surgery Treatment of osteoarthritis of the knee

PSA screening Detection of prostate cancer

Vertebroplasty Treatment of osteoporotic vertebral fractures

Rosuvastatin Treatment of haemodialysis patients

Intensive glucose control Treatment of type 2 diabetes

Prednisolone Treatment of wheezing in preschool children

Darbepoetin alfa Treatment of type 2 diabetes and chronic kidney disease

Renal artery revascularisation Treatment of renal-artery stenosis

Calcium Prevention and treatment of osteoporosis

Intensive BP control Treatment of critically ill patients

Aspirin and heparin Women with recurrent miscarriage

Fish oils Prevention of cardiovascular disease

Type 2 diabetes screening Detection of type 2 diabetes

Established Practices and Indications



Paternalistic approach Patient-centric approach “The Patient Will See

You Now”



Likely future?

Self-regulation (and sanction) Super-specialisation

Corporatisation/competition

“Protocolisation” of

medicine

Self-regulation (and

sanction)Super-specialisation

Corporatisation/

competition



Medically Unexplained Diagnosis (MUD)

Germany n=620

consecutive

66% MUD

By 12 months:

Somatoform 22.9%

Affective 12.4%

Anxiety 11.4%



MUD: GP

UK: 18% MUD

Chest pain, fatigue, dizziness,

headache, swelling, back pain,

SOB, insomnia, abdominal pain,

numbness

26% biological cause

IBS, Fibromyalgia, BDS, chronic

pain etc.



Will patients be better ?

• Vulnerable to exploitation

• Solutions without problems

• Increased “worried well “

• Who will they trust?



Will people trust Google?

Source: CB insights (morning consult + politico national tracking poll)

“How much do you trust Google to keep your personal

data private?”8%

Don’t know/ no opinion

53%Not at all/ Not very much

39%A great deal/ a fair amount



Achieving value in healthcare

OUTCOMES

COST

VALUE



How ethical is the business model?

1. Define “value” offered

2. Transparency:

price, quality

3. Trustworthiness


What do you think?


SouthernCross

nib Sovereign Unimed PartnersLife

Accuro Others

New Zealand’s private health insurance market

62%

15%

7% 5%

3%2%

6%

Source: HFANZ March 2018



Who is Southern Cross Health Society?

Biggest customer

62% of market, pays 73% of NZ’s health insurance claims

Not standard insurance – friendly society

For every $1 received in premiums, 90c paid in claims

Doctor initiated 1961


Relative change of health insurance claims paid and

New Zealanders with health insurance

Source: HFANZ



GP research November 2017

Over 20 in-depth

interviews

140 GP survey

responses


GPs interested in accessing patient feedback

Interested in feedback

about specialists

Interested in feedback about

other healthcare providers

(eg physiotherapists)


Need a plumber?

• Quality?

• Qualifications?

• Recommendations?

• Ability to understand the job?

• Invoice is visible

• Cost comparison



Outcomes and Experience Questionnaire (OEQ)

49,000 responses*

Patient Reported Outcome Measures Survey (PROMS)

5,300 responses*

*May 2018 figures



Patient outcomes and experience programme results

• highly likely to refer their friend or family member to see the provider who treated them

• Average of 94% for Experience and 88% for Outcomes


Patient outcomes and experience programme: provider portal dashboard


PROMS: Shift in pain score, pre-op versus post-op

Pain is

static


Patient outcomes and experience programme results: Detractors

Misogynist. Couldn’t talk

to me, or gave me

contradictory information.

So I took my husband

along, and he talked to my

husband instead of me,

that way I could find out

what was happening.

He is very blunt and

did upset me by the

manner in which he

assessed my low pain

threshold.

I could have

been better

informed.

Technically brilliant

but would be good

to know how to deal

with people at their

most vulnerable.



Presentation titlestyle exampleIf there’s a subheading, it can be entered here

Thank you

Thank You



191 conditions


Public information

and campaigns

Personalised

automated

advice

Online

interaction

Personal

interactionF2F

Website self-help

Social media channels

Media

Assessments

Symptom checkers

Monitoring

Targeted marketing

Apps

Chat

Email

Txt

Social messaging

Phone

Picture

Video

Referral to

F2F provider

Increasing clinical richness and cost

Patient’s

Healthcare

Home



Healthline

5% to ambulance (postural dizzy)

23% to GP

22% self-care

0.02% complaints/compliments (1/6 clinical)

for mental health/addiction

40,000 calls per month

10,000 calls per month



FIT= 5% positive

95% test within 45 days

60% adenoma

30% dysplasia

5-8% cancer

1-3% normal

1/10,000 death with colonoscopy

Screening



Health technology assessment process

01 02 03 04

Rapid

assessment

Full

assessment

Prioritisation Implementation


Health technology assessment process

Application Safety Efficacy

1. 2. 3. 4. 5.QALY benefit Business decision

Quality

Adjusted

Life

Years



Trustworthiness = Honesty

Competency

Reliability

Dr Stephen Child South/Fri_Plenary_1150_Stephen Child... · Darbepoetin alfa Treatment of type 2...

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