Stop This Low-Value Program! I Want to Get Off.

by Jon Scaccia January 3, 2024

The concept of “less is more” is gaining traction, especially when it comes to low-value care (LVC). The article Strategies for de-implementation of low-value care—a scoping review published in Implementation Science provides a comprehensive overview of strategies to reduce the use of LVC, a crucial step towards more effective and efficient healthcare systems. For those unfamiliar with the term, LVC refers to medical practices that offer little to no benefit to patients, considering the potential harm, costs, and alternatives available.

Understanding the Problem of Low-Value Care

Low-value care includes practices like unnecessary antibiotic prescriptions, unneeded imaging, and inappropriate medications for the elderly. Such practices are not only costly but can also lead to potential harm to patients. The review’s findings are pivotal in understanding how to effectively “de-implement” such practices. De-implementation, in this context, means systematically reducing or completely stopping the use of low-value care.

The Study’s Approach

The researchers conducted an extensive review of multiple scientific databases, analyzing studies that focused on strategies to reduce LVC. They mapped these strategies onto the Expert Recommendation for Implementing Change (ERIC) and found 71 unique de-implementation strategies in the literature.

Key Findings and Their Implications

1. Overlap with Implementation Strategies:

A significant revelation is the overlap between de-implementation and implementation strategies. About half of the ERIC implementation strategies were also used for de-implementation. This suggests that the tools and approaches used to introduce new medical practices can also be effective in phasing out outdated or harmful ones.

2. Unique De-implementation Strategies:

The study identified strategies like “accountability tool” and “communication tool,” which are unique to de-implementation. These tools focus on making healthcare professionals think critically before continuing a low-value practice and on enhancing communication with patients about not receiving such care.

3. A Call for More Tailored Strategies:

The review points out that the choice of de-implementation strategies often lacks a tailored approach based on research findings. For effective de-implementation, strategies need to be more context-specific and evidence-based.

4. Educational Strategies:

The most common category of strategies was related to training and educating stakeholders. However, the review also cautions that education alone might not be sufficient for successful de-implementation, advocating for a combination of educational strategies with other approaches like audit and feedback.

Why This Matters

Understanding and applying these findings is crucial for public health practice. By effectively de-implementing LVC, healthcare systems can reduce unnecessary costs and focus resources on more beneficial, value-based care. This shift not only saves money but also improves patient outcomes and satisfaction.

Moving Forward

This scoping review is a stepping stone towards a more rational, patient-centered healthcare system. It highlights the need for more research in this area, particularly in finding tailored strategies for different types of low-value care and understanding the applicability of various implementation strategies in the context of de-implementation.

For healthcare policymakers and practitioners, these insights offer a roadmap for improving care quality by eliminating practices that do not add value. For the general public, this represents a move towards a healthcare system that prioritizes effective, necessary, and patient-focused care.

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