Addressing overuse of health services in health systems: A critical interpretive synthesis

Moriah E. Ellen, Michael G. Wilson, Marcela Vélez, Ruth Shach, John N. Lavis, Jeremy M. Grimshaw, Kaelan A. Moat

Research output: Contribution to journalReview articlepeer-review

13 Scopus citations

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.

Original languageEnglish
Article number48
JournalHealth Research Policy and Systems
Volume16
Issue number1
DOIs
StatePublished - 15 Jun 2018

Keywords

  • Health policy
  • Low-value care
  • Overuse of health services
  • Waste

ASJC Scopus subject areas

  • Health Policy

Fingerprint

Dive into the research topics of 'Addressing overuse of health services in health systems: A critical interpretive synthesis'. Together they form a unique fingerprint.

Cite this