Understanding the public’s role in reducing low-value care: a scoping review

Abstract

Background: Low-value care initiatives are rapidly growing; however, it is not clear how members of the public should be involved. The objective of this scoping review was to systematically examine the literature describing public involvement in initatives to reduce low-value care. Methods: Evidence sources included MEDLINE, EMBASE, and CINAHL databases from inception to November 26, 2019, grey literature (CADTH Tool), reference lists of included articles, and expert consultation. Citations were screened in duplicate and included if they referred to the public's perception and/or involvement in reducing lowvalue care. Public included patients or citizens without any advanced healthcare knowledge. Low-value care included medical tests or treatments that lack efficacy, have risks that exceed benefit, or are not cost-effective. Extracted data pertained to study characteristics, low-value practice, clinical setting, and level of public involvement (i.e., patient-clinician interaction, research, or policy-making). Results: The 218 included citations were predominantly original research (n = 138, 63%), published since 2010 (n = 192, 88%), originating from North America (n = 146, 67%). Most citations focused on patient engagement within the patient-clinician interaction (n = 156, 72%), using tools that included shared decision-making (n = 66, 42%) and patient-targeted educational materials (n = 72, 46%), and reported both reductions in low-value care and improved patient perceptions regarding low-value care. Fewer citations examined public involvement in low-value care policy-making (n = 33, 15%). Among citations that examined perspectives regarding public involvement in initiatives to reduce low-value care (n = 10, 5%), there was consistent support for the utility of tools applied within the patient-clinician interaction and less consistent support for involvement in policy-making. Conclusions: Efforts examining public involvement in low-value care concentrate within the patient-clinician interaction, wherein patient-oriented educational materials and shared decision-making tools have been commonly studied and are associated with reductions in low-value care. This contrasts with inclusion of the public in lowvalue care policy decisions wherein tools to promote engagement are less well-developed and involvement not consistently viewed as valuable.

Engaging patients in de-implementation interventions to reduce low-value clinical care: a systematic review and meta-analysis

“…This systematic review and meta-analysis is a follow-up to a scoping review that mapped the literature exploring the public's role in reducing low-value care [18], the protocol for which was registered with Open Science Framework (https://osf.io/6fsxm). Methodology was guided by the Joanna Briggs Institute Reviewer's Manual [19], and the reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist [20].…”

‘Give me something meaningful’: GPs perspectives on how to improve an audit and feedback report provided by health insurers – an exploratory qualitative study

“…14 Quality improvement strategies are necessary in many Western countries, as they struggle with the provision of low-value care (LVC), that is, care is not effective or not cost-effective. 15 16 The provision of LVC reduces the overall quality of care, potentially causes patient harm and is ineffective use of scarce healthcare resources. In primary care, LVC entails prescribing of ineffective medications and unnecessary referrals, diagnostics and interventions.…”

The frequency of medical reversals in a cross-sectional analysis of high-impact oncology journals, 2009–2018

“…The identification of medical reversals or low-value practices is an important first step in eliminating their use. Their identification can then lead to clinical decision support tools and better communication between healthcare providers and patients, including educating patients about the value and effectiveness of medical practices, which have been identified as other important steps in reducing the usage of low-value practices [ 71 ]. The identification of these practices provides an opportunity for healthcare administrators, physicians and other healthcare providers to re-evaluate the care they provide, thus improving patient care and outcomes.…”