8 Drivers and potential solutions for overdiagnosis: perspectives from the low and middle income countries

Pathirana, Thanya; Yu, Matthew Wang; Martiny, Frederik; Rupasinghe, Maithri; Kottahachchi, Dulani; Wijewickrama, Ananda; Copp, Tessa; Kumar, Raman; Mendis, Kumara

doi:10.1136/bmjebm-2019-pod.13

Cited by 9 publications

(15 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Evidence of excess population mortality, in addition to deaths from COVID-19, and related phenomena such as increases in out-of-hospital cardiac arrests and contacts with emergency phone lines 33 34 make these calls to action even more urgent. Conversely, the review's finding that reductions often tended to be greater for milder or less severe forms of illness, combined with existing evidence about too much medicine, [11][12][13][14][15][16][17] suggests that for some people, missing care may not have caused harm.…”

Section: Discussionmentioning

confidence: 99%

“…8 Concurrently, the pandemic may also have resulted in some people being spared unnecessary or inappropriate care which has the potential to cause harm. 9 10 The problem of too much medicine is well documented, [11][12][13][14][15][16][17] and multiple global campaigns are addressing this challenge, such as Choosing Wisely, which is active in more than 20 countries. 18 As some nations are forced to Strengths and limitations of this study ► The review is the first broad synthesis of global studies of pandemic-related changes in utilisation across all categories of healthcare services.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review

et al. 2021

View full text Add to dashboard Cite

ObjectivesTo determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic.DesignSystematic review.EligibilityEligible studies compared utilisation of services during COVID-19 pandemic to at least one comparable period in prior years. Services included visits, admissions, diagnostics and therapeutics. Studies were excluded if from single centres or studied only patients with COVID-19.Data sourcesPubMed, Embase, Cochrane COVID-19 Study Register and preprints were searched, without language restrictions, until 10 August, using detailed searches with key concepts including COVID-19, health services and impact.Data analysisRisk of bias was assessed by adapting the Risk of Bias in Non-randomised Studies of Interventions tool, and a Cochrane Effective Practice and Organization of Care tool. Results were analysed using descriptive statistics, graphical figures and narrative synthesis.Outcome measuresPrimary outcome was change in service utilisation between prepandemic and pandemic periods. Secondary outcome was the change in proportions of users of healthcare services with milder or more severe illness (eg, triage scores).Results3097 unique references were identified, and 81 studies across 20 countries included, reporting on >11 million services prepandemic and 6.9 million during pandemic. For the primary outcome, there were 143 estimates of changes, with a median 37% reduction in services overall (IQR −51% to −20%), comprising median reductions for visits of 42% (−53% to −32%), admissions 28% (−40% to −17%), diagnostics 31% (−53% to −24%) and for therapeutics 30% (−57% to −19%). Among 35 studies reporting secondary outcomes, there were 60 estimates, with 27 (45%) reporting larger reductions in utilisation among people with a milder spectrum of illness, and 33 (55%) reporting no difference.ConclusionsHealthcare utilisation decreased by about a third during the pandemic, with considerable variation, and with greater reductions among people with less severe illness. While addressing unmet need remains a priority, studies of health impacts of reductions may help health systems reduce unnecessary care in the postpandemic recovery.PROSPERO registration numberCRD42020203729.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The case for tackling too much medicine was clear before covid-19 1234567. Reports from the US and the Organisation for Economic Cooperation and Development suggest that at least a fifth of routine healthcare spending may be wasted, including on overdiagnosis and overuse 34.…”

mentioning

confidence: 99%

“…In Canada, patients receive more than a million potentially unnecessary tests and treatments each year, according to recent estimates 5. The threats from overuse and overdiagnosis may be even more serious in low and middle income countries 6…”

mentioning

confidence: 99%

Covid-19: an opportunity to reduce unnecessary healthcare

Moynihan

Johansson

Maybee³

et al. 2020

BMJ

View full text Add to dashboard Cite

show abstract

“…The WHO has observed that the global move towards universal health coverage is making the problems of overdiagnosis and overuse of healthcare services more pressing, 14 15 and a recent World Bank report makes clear that providing ‘high-quality health services’ means minimising harm and waste. 52 To achieve universal health coverage, especially in the post-pandemic recovery, there is a clear need for health systems to focus more on what matters most, and direct resources to where they are most needed.…”

Section: Discussionmentioning

confidence: 99%

Overdiagnosis and overuse of diagnostic and screening tests in low-income and middle-income countries: a scoping review

et al. 2022

Self Cite

View full text Add to dashboard Cite

ObjectiveOverdiagnosis and overuse of healthcare services harm individuals, take resources that could be used to address underuse, and threaten the sustainability of health systems. These problems are attracting increasing attention in low-income and middle-income countries (LMICs). Unaware of any review of relevant evidence, we conducted a scoping review of the evidence around overdiagnosis and overuse of diagnostic and screening tests in LMICs.DesignScoping review.MethodsWe searched PubMed, Embase, PsycINFO, Global Index Medicus for relevant studies published until 24 May 2021, with no restrictions on date or language. We categorised included studies by major focus (overdiagnosis, overuse of tests, or both) and main themes (presence or estimates of extent; drivers; consequences and solutions).ResultsWe identified 2763 unique records and included 162 articles reporting on 154 studies across 55 countries, involving over 2.8 million participants and/or requests for tests. Almost half the studies focused on overdiagnosis (70; 45.5%), one-third on overuse of tests (61; 39.6%) and one-fifth on both (23; 14.9%). Common overdiagnosed conditions included malaria (61; 39.6%) and thyroid cancer (25; 16.2%), estimated to be >70% in China. Overused tests included imaging (n=25 studies) such as CT and MRI; laboratory investigations (n=18) such as serological tests and tumour markers; and procedures (n=14) such as colonoscopy. Drivers included fear of conflict with patients and expanding disease definitions. Common consequences included unnecessary treatments such as antimalarials, and wasted resources, with costs of malaria overdiagnosis estimated at US$86 million in Sudan in 1 year alone. Only 9% of studies discussed solutions, which included addressing inappropriately lowered diagnostic thresholds and reforming test-ordering processes.ConclusionsOverdiagnosis and overuse of tests are widespread in LMICs and generate significant harm and waste. Better understanding of the problems and robust evaluation of solutions is needed, informed by a new global alliance of researchers and policy-makers.

show abstract

8 Drivers and potential solutions for overdiagnosis: perspectives from the low and middle income countries

Cited by 9 publications

References 0 publications

Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review

Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review

Covid-19: an opportunity to reduce unnecessary healthcare

Overdiagnosis and overuse of diagnostic and screening tests in low-income and middle-income countries: a scoping review

Contact Info

Product

Resources

About