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 approach...
Main Authors: | , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2018-06-01
|
Series: | Health Research Policy and Systems |
Subjects: | |
Online Access: | http://link.springer.com/article/10.1186/s12961-018-0325-x |
id |
doaj-94be86d554bb4127ad3bf4e8386c1ee1 |
---|---|
record_format |
Article |
spelling |
doaj-94be86d554bb4127ad3bf4e8386c1ee12020-11-25T00:45:15ZengBMCHealth Research Policy and Systems1478-45052018-06-0116111410.1186/s12961-018-0325-xAddressing overuse of health services in health systems: a critical interpretive synthesisMoriah E. Ellen0Michael G. Wilson1Marcela Vélez2Ruth Shach3John N. Lavis4Jeremy M. Grimshaw5Kaelan A. Moat6Synthesis working groupDepartment of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the NegevMcMaster Health Forum, McMaster UniversityMcMaster Health Forum, McMaster UniversityBrown School of Social Work, Washington University in St LouisMcMaster Health Forum, McMaster UniversityClinical Epidemiology Program, Ottawa Hospital Research InstituteMcMaster Health Forum, McMaster UniversityAbstract 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.http://link.springer.com/article/10.1186/s12961-018-0325-xOveruse of health servicesWasteLow-value careHealth policy |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Moriah E. Ellen Michael G. Wilson Marcela Vélez Ruth Shach John N. Lavis Jeremy M. Grimshaw Kaelan A. Moat Synthesis working group |
spellingShingle |
Moriah E. Ellen Michael G. Wilson Marcela Vélez Ruth Shach John N. Lavis Jeremy M. Grimshaw Kaelan A. Moat Synthesis working group Addressing overuse of health services in health systems: a critical interpretive synthesis Health Research Policy and Systems Overuse of health services Waste Low-value care Health policy |
author_facet |
Moriah E. Ellen Michael G. Wilson Marcela Vélez Ruth Shach John N. Lavis Jeremy M. Grimshaw Kaelan A. Moat Synthesis working group |
author_sort |
Moriah E. Ellen |
title |
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_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 |
publisher |
BMC |
series |
Health Research Policy and Systems |
issn |
1478-4505 |
publishDate |
2018-06-01 |
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. Systematic review registration PROSPERO CRD42014013204. |
topic |
Overuse of health services Waste Low-value care Health policy |
url |
http://link.springer.com/article/10.1186/s12961-018-0325-x |
work_keys_str_mv |
AT moriaheellen addressingoveruseofhealthservicesinhealthsystemsacriticalinterpretivesynthesis AT michaelgwilson addressingoveruseofhealthservicesinhealthsystemsacriticalinterpretivesynthesis AT marcelavelez addressingoveruseofhealthservicesinhealthsystemsacriticalinterpretivesynthesis AT ruthshach addressingoveruseofhealthservicesinhealthsystemsacriticalinterpretivesynthesis AT johnnlavis addressingoveruseofhealthservicesinhealthsystemsacriticalinterpretivesynthesis AT jeremymgrimshaw addressingoveruseofhealthservicesinhealthsystemsacriticalinterpretivesynthesis AT kaelanamoat addressingoveruseofhealthservicesinhealthsystemsacriticalinterpretivesynthesis AT synthesisworkinggroup addressingoveruseofhealthservicesinhealthsystemsacriticalinterpretivesynthesis |
_version_ |
1725271237945458688 |