Health economy: evaluating the costs and benefits of occupational health programs.
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Biomedical subjects
Publications and source records attributed to N T Watts.
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Efforts to expand technology assessment in developing fields, such as physical therapy, face major obstacles. These impediments include scarcity of assessment tools, weak organizational structure for research, and clinicians' reluctance to assess economic factors. Risks that could accompany future work and strategies for reducing problems are discussed.
Orthopedic physical therapists' knowledge of pain mechanisms and methods of pain management and their attitudes toward working with patients with benign chronic pain were studied. A random sample of 500 members of the American Physical Therapy Association's Section on Orthopaedics received by mail a 36-item questionnaire. Statistical analysis of scores, using frequencies, means, and correlations was performed on the 119 (23.8%) usable returns. All but 4% of the respondents preferred to work with patients who are not likely to have chronic pain. Seventy-two percent believed their entry-level education in pain management and theory was very inadequate or less than adequate to deal with an orthopedic patient population. Pain knowledge scores were low (35.8 out of 46 points), and the scores on positive attitudes toward treating patients with benign chronic pain were lower (20.5 out of 36 points). The study suggests specific deficiencies in orthopedic physical therapists' knowledge of clinical pain mechanisms and management and potentially undesirable attitudes toward treating patients with chronic pain.
This condensed review of a complex method can provide only a general view of what clinical decision analysis is and why it might be useful. It also should help clarify, however, what decision analysis is not: This is not a practical method for making most decisions in everyday clinical practice. The process of carrying out all the steps in a full, formal analysis is much too time consuming to be applied to the dozens of important decisions clinicians make each day. The method should be used selectively to ensure that the time invested in analysis will pay off in a practical way in practice. Formal analyses should be attempted only for decisions that are made frequently, have important consequences, and provoke some sort of significant controversy, uncertainty, or discontent with the results less formal-decision making achieves. Decision analysis is not a substitute for all other methods of decision making. To suggest that this is the only tool clinicians need would be a little like suggesting that a balanced diet could consist exclusively of broccoli. Intuitive judgments, use of theoretical models, knowledge-problem coupling, and hypothesis-oriented algorithms for clinicians all provide important tools for improving patient care. Often these tools can be combined effectively with decision analysis, but at other times they will be superior on their own. Decision analysis is not an entirely unfamiliar method, and it does not always need to include all component steps to be useful.(ABSTRACT TRUNCATED AT 250 WORDS)
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