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The proposed new NHS England MS Prescribing Guidelines will stop the current wide variation in DMT prescribing across England
NO
Gavin Giovannoni
NO Gavin Giovannoni CRA (2014) Access to medicines for multiple - - PowerPoint PPT Presentation
NO Gavin Giovannoni CRA (2014) Access to medicines for multiple - - PowerPoint PPT Presentation
The proposed new NHS England MS Prescribing Guidelines will stop the current wide variation in DMT prescribing across England NO Gavin Giovannoni CRA (2014) Access to medicines for multiple sclerosis: Challenges and opportunities Specialised
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CRA (2014) Access to medicines for multiple sclerosis: Challenges and opportunities
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Specialised Services: Recommendations for an NHS England algorithm to use disease- modifying drugs to treat multiple sclerosis
https://www.engage.england.nhs.uk/consultation/specialised-services-algorithm/
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Why measure?
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Prof G in preparation for REF2021
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NHSE MS DMT Treatment Algorithm, 28 August 2017
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Humans struggle to think statistically; we either arrive at binary decisions or fail to precisely associate reasonable probabilities with outcomes (the theory of heuristics) Anchoring: our tendency to be influenced by irrelevant numbers and/or recent experiences; e.g. a recent case of natalizumab-related PML. Availability: a mental shortcut that occurs when people make judgments about the probability of events on the basis of how easy it is to think of examples or anecdotes; e.g. a recent case of autoimmune hepatitis on interferon-beta. Optimism and loss aversion: the pervasive optimistic bias generates the illusion of control; e.g. the gambler’s dilemma - this patient is more likely to end-up having benign disease. Framing: Framing is the context in which choices are presented. A person with MS is asked whether they would opt for alemtuzumab if the "long-term remission” rate is >60%, while another is told that the secondary autoimmune rate on alemtuzumab is 45%. The first framing would increase acceptance, even though the situations are no different. Kahneman and Tversky. Judgment under Uncertainty: Heuristics and Biases. Science 1974; 185(4157):1124-1131.
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Images courtesy of Dr Varun Sethi
The Problem
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The proposed new NHS England MS Prescribing Guidelines will not stop the current wide variation in DMT prescribing across England
- NHS is under-resourced
– too few MSologists; we need meat on the skeleton & bandwidth to change things
- Guidelines are too complex
– hangover from NICE; ideally we need the Australian solution – MDTs not necessarily a solution (group think)
- Blueteq is primitive
– no granularity and not quality driven
- Metrics and behavioural/cognitive biases
– unconscious biases will result in us gaming the system – a guideline is not enough, we need a political solution, e.g. stroke
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