Addressing overuse of health services in health systems : a critical interpretive synthesis

ABSTRACT: 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 approac...

Full description

Autores:
Ellen, Moriah E.
Gordon Wilson, Michael
Vélez, Claudia Marcela
Shach, Ruth
Lavis, John N.
Grimshaw, Jeremy M.
Moat, Kaelan A.
Tipo de recurso:
Review article
Fecha de publicación:
2018
Institución:
Universidad de Antioquia
Repositorio:
Repositorio UdeA
Idioma:
eng
OAI Identifier:
oai:bibliotecadigital.udea.edu.co:10495/21554
Acceso en línea:
http://hdl.handle.net/10495/21554
Palabra clave:
Servicios de Salud
Health Services
Uso Excesivo de los Servicios de Salud
Medical Overuse
Política de Salud
Health Policy
Rights
openAccess
License
http://creativecommons.org/licenses/by/2.5/co/
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network_acronym_str UDEA2
network_name_str Repositorio UdeA
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dc.title.spa.fl_str_mv 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
spellingShingle Addressing overuse of health services in health systems : a critical interpretive synthesis
Servicios de Salud
Health Services
Uso Excesivo de los Servicios de Salud
Medical Overuse
Política de Salud
Health Policy
title_short 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_sort Addressing overuse of health services in health systems : a critical interpretive synthesis
dc.creator.fl_str_mv Ellen, Moriah E.
Gordon Wilson, Michael
Vélez, Claudia Marcela
Shach, Ruth
Lavis, John N.
Grimshaw, Jeremy M.
Moat, Kaelan A.
dc.contributor.author.none.fl_str_mv Ellen, Moriah E.
Gordon Wilson, Michael
Vélez, Claudia Marcela
Shach, Ruth
Lavis, John N.
Grimshaw, Jeremy M.
Moat, Kaelan A.
dc.subject.decs.none.fl_str_mv Servicios de Salud
Health Services
Uso Excesivo de los Servicios de Salud
Medical Overuse
Política de Salud
topic Servicios de Salud
Health Services
Uso Excesivo de los Servicios de Salud
Medical Overuse
Política de Salud
Health Policy
dc.subject.agrovoc.none.fl_str_mv Health Policy
description ABSTRACT: 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.
publishDate 2018
dc.date.issued.none.fl_str_mv 2018
dc.date.accessioned.none.fl_str_mv 2021-08-06T11:25:18Z
dc.date.available.none.fl_str_mv 2021-08-06T11:25:18Z
dc.type.spa.fl_str_mv info:eu-repo/semantics/article
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dc.type.redcol.spa.fl_str_mv https://purl.org/redcol/resource_type/ARTREV
dc.type.local.spa.fl_str_mv Artículo de revisión
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status_str publishedVersion
dc.identifier.issn.none.fl_str_mv 1478-4505
dc.identifier.uri.none.fl_str_mv http://hdl.handle.net/10495/21554
dc.identifier.doi.none.fl_str_mv 10.1186/s12961-018-0325-x
identifier_str_mv 1478-4505
10.1186/s12961-018-0325-x
url http://hdl.handle.net/10495/21554
dc.language.iso.spa.fl_str_mv eng
language eng
dc.relation.ispartofjournalabbrev.spa.fl_str_mv Health Res. Policy Syst.
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dc.format.extent.spa.fl_str_mv 14
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dc.publisher.spa.fl_str_mv BMC
dc.publisher.group.spa.fl_str_mv Grupo Académico de Epidemiología Clínica
dc.publisher.place.spa.fl_str_mv Londres, Inglaterra
institution Universidad de Antioquia
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http://bibliotecadigital.udea.edu.co/bitstream/10495/21554/2/license.txt
http://bibliotecadigital.udea.edu.co/bitstream/10495/21554/3/VelezClaudia_2018_AddressingOveruseHealthServices.pdf
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spelling Ellen, Moriah E.Gordon Wilson, MichaelVélez, Claudia MarcelaShach, RuthLavis, John N.Grimshaw, Jeremy M.Moat, Kaelan A.2021-08-06T11:25:18Z2021-08-06T11:25:18Z20181478-4505http://hdl.handle.net/10495/2155410.1186/s12961-018-0325-xABSTRACT: 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.COL000712114application/pdfengBMCGrupo Académico de Epidemiología ClínicaLondres, Inglaterrainfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttp://purl.org/coar/resource_type/c_dcae04bchttp://purl.org/coar/resource_type/c_2df8fbb1https://purl.org/redcol/resource_type/ARTREVArtículo de revisiónhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/openAccesshttp://creativecommons.org/licenses/by/2.5/co/http://purl.org/coar/access_right/c_abf2https://creativecommons.org/licenses/by/4.0/Addressing overuse of health services in health systems : a critical interpretive synthesisServicios de SaludHealth ServicesUso Excesivo de los Servicios de SaludMedical OverusePolítica de SaludHealth PolicyHealth Res. Policy Syst.Health Research Policy and Systems11416CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-8927http://bibliotecadigital.udea.edu.co/bitstream/10495/21554/1/license_rdf1646d1f6b96dbbbc38035efc9239ac9cMD51LICENSElicense.txtlicense.txttext/plain; charset=utf-81748http://bibliotecadigital.udea.edu.co/bitstream/10495/21554/2/license.txt8a4605be74aa9ea9d79846c1fba20a33MD52ORIGINALVelezClaudia_2018_AddressingOveruseHealthServices.pdfVelezClaudia_2018_AddressingOveruseHealthServices.pdfArtículo de revisiónapplication/pdf1274961http://bibliotecadigital.udea.edu.co/bitstream/10495/21554/3/VelezClaudia_2018_AddressingOveruseHealthServices.pdfda2e5d7ee947456f6d57be5728affeebMD5310495/21554oai:bibliotecadigital.udea.edu.co:10495/215542021-08-06 06:25:19.584Repositorio Institucional Universidad de Antioquiaandres.perez@udea.edu.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