Debating the benefits of home care
CMAJ 1998;159:918-9
In response to: J.E. Mullens
Dr. Mullens is seeking a black-and-white view on evidence-based rationing that would be inappropriate to a complex situation. A reading of the original editorial "Evidence-based rationing: Dutch pragmatism or government insensitivity?" (CMAJ 1998;158[2]:213-4 [full text]) together with my recent response to Dr. Byrne's letter should demonstrate that I am not a proponent of evidence-based medicine. Without denigrating the importance of scientific evidence in medical decision-making, I am concerned by the potential misuse of evidence-based medicine by politicians seeking support for rationing policies. If health care is to be rationed on the basis of research, governments should be expected to fund appropriate outcome studies that ask meaningful questions likely to yield answers that go beyond obvious issues of patient choice. Home care is a case in point. Although elaborate prospective studies are feasible, there is no routine need for evidence from cost-effectiveness studies to show that home care is preferable to hospital care in some situations. Furthermore, it is a basic premise of outcome research that the right of patients to participate in treatment decisions must be respected as a component of quality of care and as a determinant of quality of life.
Stuart M. MacLeod, MD, PhD
Professor
Clinical Epidemiology and Biostatistics,
Medicine and Paediatrics
McMaster University
Hamilton, Ont.
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