In favour of the variability

19 Mar

Joan EscarrabillJoan Escarrabill. Director Chronic Care Program at Hospital Clínic Barcelona

John Wennberg explained to us how difficult it is to justify the variability in clinical practice. The health care that people receive, is more determined by where they live (zip code) than by their overall health. This variability is influenced more by local clinical practice (the features and character of each place, i.e. zip code) than the prevalence of disease or patient preferences. Furthermore, in places with greater health services and activity, the satisfaction, quality and the survival rates are often worse. As this variability (chaotic, according to Wennberg) is not explained by sanitary reasons, it also constitutes an element that leads to greater health inequalities.

There are many examples. The “Observatori de Teràpies Respiratòries a Domicili” analyzes annually the performance of these home treatments. There are paradoxes related to the number of treatments. In Catalonia there are over 65,000 people who receive treatment with continuous positive airway pressure (CPAP) in order to treat sleep apnoea. On the other hand there are just over 2,000 people who need home mechanical ventilation. There is less variability in the patient group treated with CPAP (the difference is 2.5 times between the territory with the lowest and the highest prevalence) than in the group of patients using ventilators (the difference is 22 times). The home oxygen therapies’ variability maps show the differences in use of these treatments among different districts of Barcelona. Continue reading