Internal medicine journal
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Internal medicine journal · Oct 2020
ReviewAn Overview of Healthcare Improvement: Unpacking the Complexity for Clinicians and Managers in a Learning Health System.
Given the pace of technological advancement and government mandates for healthcare and system transformation, there is an imperative for change. Health systems are highly complex in their design, networks and interacting components, and experience demonstrates that change is very challenging to enact, sustain and scale. Policy-makers, academics and clinicians all need better insight into the nature of this complexity and an understanding of the evidence-base that can support healthcare improvement (HCI), or quality improvement, interventions and make them more effective in driving change. ⋯ We aim to address these issues by summarising theories, frameworks, models and success factors for improvement in complex health systems to assist clinicians and others to engage and lead change. We integrate the field of HCI into the learning health system highlighting the key role of the clinician. We seek to inform stakeholders; clinicians and managers to guide the planning, enacting, sustaining and scaling of HCI.
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Internal medicine journal · Oct 2020
ReviewDeprescribing long-term opioid therapy in patients with chronic pain.
Proposed regulatory changes will limit the access to opioids by Australian patients with chronic pain, many of whom are under the care of consultant physicians. This review summarises points of consensus on opioid deprescribing that emerged from the interaction of an expert panel and the audience at a symposium on the topic held in Sydney in 2019. Each of these consensus points speaks to the need for an individualised, patient-centred approach. In other words, 'treat the patient, not the pill count'.