The challenge of implementing Less is More medicine: A European perspective

Abstract

The concept of Less is More medicine emerged in North America in 2010. It aims to serve as an invitation to recognize the potential risks of overuse of medical care that may result in harm rather than in better health, tackling the erroneous assumption that more care is always better. In response, several medical societies across the world launched quality-driven campaigns ("Choosing Wisely") and published "top-five lists" of low-value medical interventions that should be used to help make wise decisions in each clinical domain, by engaging patients in conversations about unnecessary tests, treatments and procedures.However, barriers and challenges for the implementation of Less is More medicine have been identified in several European countries, where overuse is rooted in the culture and demanded by a society that requests certainty at almost any cost. Patients' high expectations, physician's behavior, lack of monitoring and pernicious financial incentives have all indirect negative consequences for medical overuse. Multiple interventions and quality-measurement efforts are necessary to widely implement Less is More recommendations. These also consist of a top-five list of actions: (1) a novel cultural approach starting from medical graduation courses, up to (2) patient and society education, (3) physician behavior change with data feedback, (4) communication training

Utility of hospitalization for elderly individuals affected by COVID-19

“…While the data examined apply to the current COVID-19 epidemic, it is possible that the observation that hospitalization does not positively affect elderly patients' prognosis may be true for other diseases, especially where effective therapy is lacking. The Choosing Wisely campaign has recently highlighted the need to reconsider the benefit(s) of hospital admission [23]. Indeed, over the past few years, the medical community has been more supportive of the concept that doing more does not always mean doing better.…”

Toma de decisiones clínicas basadas en evidencias durante la pandemia de COVID-19

“…Como hemos revisado en los conceptos previos, pocas intervenciones resultan ser beneficiosas, aun a pesar de tener plausibilidad fisiopatológica o estudios preclínicos favorables. Esta noción da lugar al concepto de «menos es más» en medicina, que ha llevado a la creación de iniciativas que buscan alertar sobre los peligros del sobreuso de las intervenciones médicas (Choosing Wisely, Slow Medicine, SMART Medicine, entre otros) [31] . De los fármacos que, según estudios preclínicos, cuentan con potenciales beneficios para el manejo de una enfermedad, aproximadamente el 7% tendrá un beneficio relevante en humanos [13] .…”

“…Asimismo, debemos tener en cuenta que los profesionales de la salud tienden a usar más intervenciones de las necesarias, debido a diversos factores que debemos identificar y combatir para poder tomar una decisión objetiva orientada al bienestar de los pacientes; como son [31,32] :…”

Precision medicine in follicular lymphoma: Focus on predictive biomarkers

“…It is essential that new tests are not entered into clinical practice without the proper evidence. [112][113][114] Challenges beyond the scientific and technological will also have to be resolved. Keeping general hematologist/ oncologists abreast of new developments in FL and making it possible (economically and logistically) for samples obtained in smaller community centers to access all required testing will be complex issues, analogous to the "last mile" concern in transportation and networkstructured fields.…”

“…The importance of establishing robust grounds for the use of these tests in clinical practice cannot be overemphasized. It is essential that new tests are not entered into clinical practice without the proper evidence 112‐114 . Challenges beyond the scientific and technological will also have to be resolved.…”