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Alvaro Nagib Atallah*
E fficacy an d effectiv en ess o f treatm en t
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e a s p h y s ic ia n sd ia g n o s tic h y p o th e s isu s u a lly fe e l re w a rd e dis c o n firm e d .w h e n o u rT h e a n s w e r to th e q u iz w a s c o rre c t. S o th e n e x t s te p is to d e fin e th e tre a tm e n t, u s u a lly in v o lv in g th e p re s c rip tio n o f a p p ro p ria te m e d ic a tio n . N a tu ra lly , a fte r th a t w e h a v e th e fe e lin g th a t a g o o d jo b h a s b e e n d o n e ; b u t th is is o n ly a lm o s t c o rre c t.A lth o u g h th e d ia g n o s is a n d th e th e ra p e u tic a re c o rre c t th e m o s t im p o rta n t a im is to im p ro v e th e p a tie n t's h e a lth . O b v io u s ly to re a c h s u c h a n o b je c tiv e th e d ia g n o s is m u s t b e c o rre c t a n d th e p re s c rib e d d ru g n e e d s to h a v e g o o d e ffic a c y , b u t th e tre a tm e n t m u s t h a v e e ffe c tiv e n e s s . E ffic a c y is tre a tm e n t's d e fin e d a s th e tre a tm e n t's e ffe c t u n d e r id e a l c o n d itio n s . In o th e r w o rd s , u s u a lly th e p a tie n t is in th e
hospital,
u n d e r rig o ro u s c o n tro l a n d d e fin itily re c e iv e s th e tre a tm e n t a s it s h o u ld b e a p p lie d .E ffe c tiv e n e s s is d e fin e d a s th e tre a tm e n t's e ffe c t in th e re a l w o rld o f m e d ic a l p ra c tic e . T h e tre a tm e n t is p re s c rib e d , th e p a tie n t re tu rn s to h is p la c e o f o rig in o n h is o w n . A t th is p o in t th e e ffe c t o f th e tre a tm e n t is a t m a n y ris k s . T h e e ffe c tiv e n e s s o f th e tre a tm e n t w ill d e p e n d o n th e a c c e s s h e h a s to , fo r in s ta n c e , th e d ru g .
H e n e e d s to b e to a b le to o b ta in it (th e d ru g ) o r o th e r ty p e o f tre a tm e n t (u s u a lly re q u irin g c a s h ), a ls o th e p a tie n t n e e d s to c o m p ly w ith th e tre a tm e n t. T h is a s p e c t d e p e n d s o n m a n y fa c to rs s u c h a s , c o n fid e n c e th a t th e p a tie n t m a y h a v e in th e d o c to r w h o p re s c rib e d th e tre a tm e n t, th e
* MD, PhD, MSc
Department of Internal Medicine, Escola Paulista de Medicina Chairman, Editor, Sao Paulo Medical Journal.
a d v e rs e e ffe c ts o f th e d ru g , d is c ip lin e , s e lf e s te e m , re lig io u s b e lie f e tc .
T h e d o c to r m a y im p ro v e th e p a tie n t's a d h e re n c e o r c o m p lia n c e , b y s p e n d in g s o m e tim e e x p la in in g w h a t a re th e e x p e c te d e ffe c ts o f th e tre a tm e n t a n d w h a t to d o to p re v e n t p itfa lls in th e tre a tm e n t.
S u p p o s e th a t fo r o n e s p e c ific tre a tm e n t in a p a rtic u la r g ro u p o f p a tie n ts e ffic a c y is 9 0 % , a d h e re n c e o f d o c to r is 9 0 % , a n d a c c e s s to tre a tm e n t is 8 0 % , a t th e e n d o f th e d a y , th e p ro b a b ility o f s u c h p re s c rip tio n s h a v in g b e e n e ffic a c io u s is e q u a l to 0 ,9 x 0 ,9 x 0 ,8 x 0 ,8
=
5 1 .9 % .W e m u s t e m p h a s iz e th a t th e a b o v e e x a m p le fo r c h ro n ic d is e a s e s is a v e ry o p tim is tic o n e .
F o r in s ta n c e , m o re th a n 5 0 % e ffe c tiv e n e s s is s e ld o m o b ta in e d in th e tre a tm e n t o f p a tie n ts w ith p rim a ry h y p e rte n s io n s .
T h is m e a n s th a t a fte r th e c o rre c t d ia g n o s is h a s b e e n g i v e n a n d th e m o s t e ffic a c io u s p re s c rip tio n fo r th e tre a tm e n t p re s c rib e d , a n e w c h a lle n g e a w a its th e d o c to r; th e tre a tm e n t e ffe c tiv e n e s s . P ro b a b ly th a t e x p la in s w h y th e m e d ic a l p ra c tic e is s o e x c itin g .
In th is c a s e th e in te n tio n to tre a t is n o t e n o u g h . C o m p re h e n s iv e e v o lu tio n o f p a tie n t's life a s a w h o le a n d c a re fu l e x p la n a tio n o f th e w h y a n d h o w o f th e tre a tm e n t m a y b e o f h e lp . R e s e a rc h in g h o w to im p ro v e p a tie n ts a d h e ra n c e to tre a tn ie n t is b a d ly n e e d e d in o rd e r to o b ta in m o re b e n e tits fro m th e a lre a d y e x is te n t th e ra p e u tic s re s o u rc e s .
