Cargando…
Addressing overuse of health services in health systems: a critical interpretive synthesis
BACKGROUND: Health systems are increasingly focusing on the issue of ‘overuse’ of health services and how to address it. We developed a framework focused on (1) the rationale and context for health systems prioritising addressing overuse, (2) elements of a comprehensive process and approach to reduc...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003114/ https://www.ncbi.nlm.nih.gov/pubmed/29907158 http://dx.doi.org/10.1186/s12961-018-0325-x |
_version_ | 1783332309220458496 |
---|---|
author | Ellen, Moriah E. Wilson, Michael G. Vélez, Marcela Shach, Ruth Lavis, John N. Grimshaw, Jeremy M. Moat, Kaelan A. |
author_facet | Ellen, Moriah E. Wilson, Michael G. Vélez, Marcela Shach, Ruth Lavis, John N. Grimshaw, Jeremy M. Moat, Kaelan A. |
author_sort | Ellen, Moriah E. |
collection | PubMed |
description | BACKGROUND: Health systems are increasingly focusing on the issue of ‘overuse’ of health services and how to address it. We developed a framework focused on (1) the rationale and context for health systems prioritising addressing overuse, (2) elements of a comprehensive process and approach to reduce overuse and (3) implementation considerations for addressing overuse. METHODS: We conducted a critical interpretive synthesis informed by a stakeholder-engagement process. The synthesis identified relevant empirical and non-empirical articles about system-level overuse. Two reviewers independently screened records, assessed for inclusion and conceptually mapped included articles. From these, we selected a purposive sample, created structured summaries of key findings and thematically synthesised the results. RESULTS: Our search identified 3545 references, from which we included 251. Most articles (76%; n = 192) were published within 5 years of conducting the review and addressed processes for addressing overuse (63%; n = 158) or political and health system context (60%; n = 151). Besides negative outcomes at the patient, system and global level, there were various contextual factors to addressing service overuse that seem to be key issue drivers. Processes for addressing overuse can be grouped into three elements comprising a comprehensive approach, including (1) approaches to identify overused health services, (2) stakeholder- or patient-led approaches and (3) government-led initiatives. Key implementation considerations include the need to develop ‘buy in’ from stakeholders and citizens. CONCLUSIONS: Health systems want to ensure the use of high-value services to keep citizens healthy and avoid harm. Our synthesis can be used by policy-makers, stakeholders and researchers to understand how the issue has been prioritised, what approaches have been used to address it and implementation considerations. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42014013204. |
format | Online Article Text |
id | pubmed-6003114 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-60031142018-07-06 Addressing overuse of health services in health systems: a critical interpretive synthesis Ellen, Moriah E. Wilson, Michael G. Vélez, Marcela Shach, Ruth Lavis, John N. Grimshaw, Jeremy M. Moat, Kaelan A. Health Res Policy Syst Review BACKGROUND: Health systems are increasingly focusing on the issue of ‘overuse’ of health services and how to address it. We developed a framework focused on (1) the rationale and context for health systems prioritising addressing overuse, (2) elements of a comprehensive process and approach to reduce overuse and (3) implementation considerations for addressing overuse. METHODS: We conducted a critical interpretive synthesis informed by a stakeholder-engagement process. The synthesis identified relevant empirical and non-empirical articles about system-level overuse. Two reviewers independently screened records, assessed for inclusion and conceptually mapped included articles. From these, we selected a purposive sample, created structured summaries of key findings and thematically synthesised the results. RESULTS: Our search identified 3545 references, from which we included 251. Most articles (76%; n = 192) were published within 5 years of conducting the review and addressed processes for addressing overuse (63%; n = 158) or political and health system context (60%; n = 151). Besides negative outcomes at the patient, system and global level, there were various contextual factors to addressing service overuse that seem to be key issue drivers. Processes for addressing overuse can be grouped into three elements comprising a comprehensive approach, including (1) approaches to identify overused health services, (2) stakeholder- or patient-led approaches and (3) government-led initiatives. Key implementation considerations include the need to develop ‘buy in’ from stakeholders and citizens. CONCLUSIONS: Health systems want to ensure the use of high-value services to keep citizens healthy and avoid harm. Our synthesis can be used by policy-makers, stakeholders and researchers to understand how the issue has been prioritised, what approaches have been used to address it and implementation considerations. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42014013204. BioMed Central 2018-06-15 /pmc/articles/PMC6003114/ /pubmed/29907158 http://dx.doi.org/10.1186/s12961-018-0325-x Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Review Ellen, Moriah E. Wilson, Michael G. Vélez, Marcela Shach, Ruth Lavis, John N. Grimshaw, Jeremy M. Moat, Kaelan A. Addressing overuse of health services in health systems: a critical interpretive synthesis |
title | Addressing overuse of health services in health systems: a critical interpretive synthesis |
title_full | Addressing overuse of health services in health systems: a critical interpretive synthesis |
title_fullStr | Addressing overuse of health services in health systems: a critical interpretive synthesis |
title_full_unstemmed | Addressing overuse of health services in health systems: a critical interpretive synthesis |
title_short | Addressing overuse of health services in health systems: a critical interpretive synthesis |
title_sort | addressing overuse of health services in health systems: a critical interpretive synthesis |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003114/ https://www.ncbi.nlm.nih.gov/pubmed/29907158 http://dx.doi.org/10.1186/s12961-018-0325-x |
work_keys_str_mv | AT ellenmoriahe addressingoveruseofhealthservicesinhealthsystemsacriticalinterpretivesynthesis AT wilsonmichaelg addressingoveruseofhealthservicesinhealthsystemsacriticalinterpretivesynthesis AT velezmarcela addressingoveruseofhealthservicesinhealthsystemsacriticalinterpretivesynthesis AT shachruth addressingoveruseofhealthservicesinhealthsystemsacriticalinterpretivesynthesis AT lavisjohnn addressingoveruseofhealthservicesinhealthsystemsacriticalinterpretivesynthesis AT grimshawjeremym addressingoveruseofhealthservicesinhealthsystemsacriticalinterpretivesynthesis AT moatkaelana addressingoveruseofhealthservicesinhealthsystemsacriticalinterpretivesynthesis AT addressingoveruseofhealthservicesinhealthsystemsacriticalinterpretivesynthesis |