Sustainable healthcare for patients and populations Healthcare organisations should provide care that patients and populations need. This statement is so axiomatic that it hardly merits stating. And yet it is clear that much of the provision of healthcare is not as effective or efficient as it could be – at a patient or population level. Nor is it always based on population needs. Too much of healthcare is focused on hospital care. In many countries secondary and tertiary care centres are responsible for a disproportionate percentage of the healthcare spend. Medical education is still carried out predominantly in hospital settings and too many undergraduate and postgraduate trainees aspire to become hospital specialists rather than primary care generalists. The results are services that are expensive, inefficient and not sustainable - in healthcare, financial, or environmental terms. How can we fix things? The simple answer is that a system wide approach is needed to solve system wide problems. Fixing the medical education system on its own will not have a long-term effect if graduates of that system are still forced to work in the unchanged healthcare system. Simply put, our systems of education and care need to change together.One example is that both systems need to do much more to concentrate on the prevention and management of patients with chronic non-communicable diseases. These diseases used to be prevalent only in high income countries but in the past 20 years they have become common everywhere. Often, they occur together in the same person who might have a combination of comorbidities such as cardiac, respiratory and neurological conditions. Once again this used to be more common in older people; however today it is increasingly common in middle age. A high prevalence of comorbidities is more common in people from poor socio-economic groups. The result is a higher healthcare spend on patients with multiple chronic non-communicable conditions and an increased rate of hospitalisation. When these patients are hospitalised, they often have an increased length of stay or a higher rate of readmissions. BMJ Best Practice has recently launched a new Comorbidities tool to improve the management of such patients. More also needs to be done in the prevention of such conditions in the first place. In the case of concordant comorbidities, often simple interventions can help with prevention - for example stopping smoking will prevent heart and respiratory disease. Some interventions can also have a wider effect on environmental health - for example a vegetarian diet can result in improved health and is more likely to be sustainable in environmental terms. These problems occur in patients and populations in rural areas and in cities. Tackling pollution in cities will have an effect on lung health and will help prevent the effects of climate change. Cities that are friendly to pedestrians will also have the same dual effects. Sustainable healthcare for patients and populations by Gareth Presch, Founder and CEO, World Health Innovation Summit, Dr Kieran Walsh, Clinical Director, BMJ #SDGCities #BMJBestPractice #WHIS
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