Medical overuse in the Iranian healthcare system: a systematic scoping review and practical recommendations for decreasing medical overuse during unexpected COVID-19 pandemic opportunity

Abstract

Background: Overuse of medical care is a major problem across health systems as well as in Iran. By our knowledge, this is the first scoping review in which medical overuse in the Iranian healthcare system was investigated.Objective: To perform an inclusive search for original studies that report medical overuse in the Iranian healthcare system. Methods: A systematic search of the literature conducted in bibliographic databasesincluding PubMed, Embase, Scopus, Web of Sciences, Cochrane and Scientific Information Database using a comprehensive search strategy without time limit until the end of 2018, accomplished by reference tracking, author contacting and expert consultation to identify studies on the overuse of medical care. Results:We reviewed 4124 published articles based on predetermined inclusion criteria. The author's consensus included a total of 40 articles. Of these, 31 were in English and 9 in Farsi, published between 19975-2018. The result categorized into two distinct clinical areas: treatment (17 articles), and diagnostic (23 articles) services. Almost all of the studies only described the magnitude of unnecessary overuse. Unnecessary overuse of Antibiotics, MRI, and CT-scan were the most reported topics. The ranges of their overuse proportion were as follows; Antibiotic (31 to 97%); MRI (33 to 88%), and CT-scan (19 to 50%). Conclusions:Our review showed, even so, the magnitude of unnecessary overuse of medical services is high but there are only a few interventional studies in clinical and administrative level for finding effective methods for decreasing these unnecessary services. Researchers should be encouraged to conducting interventional studies. We suggest the ministry of health to use the golden opportunity of COVID-19 epidemic for designing Iran national policy and All rights reserved. No reuse allowed without permission. : medRxiv preprint action plan for controlling and preventing unnecessary health care services and including a section for "Interventional Research" in the action plan.

Ethical issues with geographical variations in the provision of health care services

“…Many such well-documented geographical variations cannot be explained by demographical differences or in epidemiological terms and appear to be iatrogenic or systemic. Accordingly, it has been claimed that such geographical variations indicate underuse and overuse [62][63][64][65][66][67][68][69][70][71] and pose challenges to clinical practice, health services provision, and health policy making. This has spurred a series of initiatives, such as the Choosing Wisely Campaign, Too Much Medicine (BMJ) series, Smarter Medicine movement, Prudent Health Care, Slow Medicine, Do Not Do (NICE), just to mention a few [72].…”

Cost-Effectiveness Analysis of Rapid Test Compared to Polymerase Chain Reaction (PCR) in Patients with Acute Respiratory Syndrome

“…Therefore, determining an efficient diagnostic method with the lowest cost and with the highest accuracy is one of the most important concerns of health professionals. In this regard, diagnostic studies with comparative design are of special importance in which the reliability or validity of a test in different ways is examined (14)(15)(16).…”