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Health Research Policy and Systems
Published in: Health Research Policy and Systems 1/2018

Open Access 01-12-2018 | Review

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

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

Published in: Health Research Policy and Systems | Issue 1/2018

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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.
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Metadata
Title
Addressing overuse of health services in health systems: a critical interpretive synthesis
Authors
Moriah E. Ellen
Michael G. Wilson
Marcela Vélez
Ruth Shach
John N. Lavis
Jeremy M. Grimshaw
Kaelan A. Moat
Synthesis working group
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Health Research Policy and Systems / Issue 1/2018
Electronic ISSN: 1478-4505
DOI
https://doi.org/10.1186/s12961-018-0325-x

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