TY - JOUR
T1 - Barriers and facilitators to reduce low-value care
T2 - a qualitative evidence synthesis
AU - van Dulmen, S A
AU - Naaktgeboren, C A
AU - Heus, Pauline
AU - Verkerk, Eva W
AU - Weenink, J
AU - Kool, Rudolf Bertijn
AU - Hooft, Lotty
N1 - Funding Information:
Funding This study was funded by “To do or not to do” a project of the Citrien Fonds, a grant from the Dutch Government. http://www.nfu.nl/patientenzorg/citrien. ‘To do or not to do. Reducing low-value care’. Grant number: 80-83920-98-101. Competing interests None declared. Patient consent for publication Not required.
Publisher Copyright:
©
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/10/30
Y1 - 2020/10/30
N2 - OBJECTIVE: To assess barriers and facilitators to de-implementation.DESIGN: A qualitative evidence synthesis with a framework analysis.DATA SOURCES: Medline, Embase, Cochrane Library and Rx for Change databases until September 2018 were searched.ELIGIBILITY CRITERIA: We included studies that primarily focused on identifying factors influencing de-implementation or the continuation of low-value care, and studies describing influencing factors related to the effect of a de-implementation strategy.DATA EXTRACTION AND SYNTHESIS: The factors were classified on five levels: individual provider, individual patient, social context, organisational context, economic/political context.RESULTS: We identified 333 factors in 81 articles. Factors related to the individual provider (n=131; 74% barriers, 17% facilitators, 9% both barrier/facilitator) were associated with their attitude (n=72; 55%), knowledge/skills (n=43; 33%), behaviour (n=11; 8%) and provider characteristics (n=5; 4%). Individual patient factors (n=58; 72% barriers, 9% facilitators, 19% both barrier/facilitator) were mainly related to knowledge (n=33; 56%) and attitude (n=13; 22%). Factors related to the social context (n=46; 41% barriers, 48% facilitators, 11% both barrier/facilitator) included mainly professional teams (n=23; 50%) and professional development (n=12; 26%). Frequent factors in the organisational context (n=67; 67% barriers, 25% facilitators, 8% both barrier/facilitator) were available resources (n=28; 41%) and organisational structures and work routines (n=24; 36%). Under the category of economic and political context (n=31; 71% barriers, 13% facilitators, 16% both barrier/facilitator), financial incentives were most common (n=27; 87%).CONCLUSIONS: This study provides in-depth insight into the factors within the different (sub)categories that are important in reducing low-value care. This can be used to identify barriers and facilitators in low-value care practices or to stimulate development of strategies that need further refinement. We conclude that multifaceted de-implementation strategies are often necessary for effective reduction of low-value care. Situation-specific knowledge of impeding or facilitating factors across all levels is important for designing tailored de-implementation strategies.
AB - OBJECTIVE: To assess barriers and facilitators to de-implementation.DESIGN: A qualitative evidence synthesis with a framework analysis.DATA SOURCES: Medline, Embase, Cochrane Library and Rx for Change databases until September 2018 were searched.ELIGIBILITY CRITERIA: We included studies that primarily focused on identifying factors influencing de-implementation or the continuation of low-value care, and studies describing influencing factors related to the effect of a de-implementation strategy.DATA EXTRACTION AND SYNTHESIS: The factors were classified on five levels: individual provider, individual patient, social context, organisational context, economic/political context.RESULTS: We identified 333 factors in 81 articles. Factors related to the individual provider (n=131; 74% barriers, 17% facilitators, 9% both barrier/facilitator) were associated with their attitude (n=72; 55%), knowledge/skills (n=43; 33%), behaviour (n=11; 8%) and provider characteristics (n=5; 4%). Individual patient factors (n=58; 72% barriers, 9% facilitators, 19% both barrier/facilitator) were mainly related to knowledge (n=33; 56%) and attitude (n=13; 22%). Factors related to the social context (n=46; 41% barriers, 48% facilitators, 11% both barrier/facilitator) included mainly professional teams (n=23; 50%) and professional development (n=12; 26%). Frequent factors in the organisational context (n=67; 67% barriers, 25% facilitators, 8% both barrier/facilitator) were available resources (n=28; 41%) and organisational structures and work routines (n=24; 36%). Under the category of economic and political context (n=31; 71% barriers, 13% facilitators, 16% both barrier/facilitator), financial incentives were most common (n=27; 87%).CONCLUSIONS: This study provides in-depth insight into the factors within the different (sub)categories that are important in reducing low-value care. This can be used to identify barriers and facilitators in low-value care practices or to stimulate development of strategies that need further refinement. We conclude that multifaceted de-implementation strategies are often necessary for effective reduction of low-value care. Situation-specific knowledge of impeding or facilitating factors across all levels is important for designing tailored de-implementation strategies.
KW - organisation of health services
KW - public health
KW - quality in health care
UR - http://www.scopus.com/inward/record.url?scp=85094983904&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2020-040025
DO - 10.1136/bmjopen-2020-040025
M3 - Article
C2 - 33127636
SN - 2044-6055
VL - 10
SP - 1
EP - 9
JO - BMJ Open
JF - BMJ Open
IS - 10
M1 - e040025
ER -