Effectiveness of de-implementation strategies for low-value prescribing in secondary care: a systematic review

Author:

Dunsmore JenniferORCID,Duncan Eilidh,MacLennan Sara,N’Dow James,MacLennan Steven

Abstract

Abstract Background/aims Considerable efforts have been made to improve guideline adherence in healthcare through de-implementation, such as decreasing the prescription of inappropriate medicines. However, we have limited knowledge about the effectiveness, barriers, facilitators and consequences of de-implementation strategies targeting inappropriate medication prescribing in secondary care settings. This review was conducted to understand these factors to contribute to better replication and optimisation of future de-implementation efforts to reduce low-value care. Methods A systematic review of randomised control trials was conducted. Papers were identified through CINAHL, EMBASE, MEDLINE and Cochrane register of controlled trials to February 2021. Eligible studies were randomised control trials evaluating behavioural strategies to de-implement inappropriate prescribing in secondary healthcare. Risk of bias was assessed using the Cochrane Risk of Bias tool. Intervention characteristics, effectiveness, barriers, facilitators and consequences were identified in the study text and tabulated. Results Eleven studies were included, of which seven were reported as effectively de-implementing low-value prescribing. Included studies were judged to be mainly at low to moderate risk for selection biases and generally high risk for performance and reporting biases. The majority of these strategies were clinical decision support at the ‘point of care’. Clinical decision support tools were the most common and effective. They were found to be a low-cost and simple strategy. However, barriers such as clinician’s reluctance to accept recommendations, or the clinical setting were potential barriers to their success. Educational strategies were the second most reported intervention type however the utility of educational strategies for de-implementation remains varied. Multiple barriers and facilitators relating to the environmental context, resources and knowledge were identified across studies as potentially influencing de-implementation. Various consequences were identified; however, few measured the impact of de-implementation on usual appropriate practice. Conclusion This review offers insight into the intervention strategies, potential barriers, facilitators and consequences that may affect the de-implementation of low-value prescribing in secondary care. Identification of these key features helps understand how and why these strategies are effective and the wider (desirable or undesirable) impact of de-implementation. These findings can contribute to the successful replication or optimisation of strategies used to de-implement low-value prescribing practices in future. Trial registration The review protocol was registered at PROSPERO (ID: CRD42021243944).

Funder

Cancer Research Aberdeen and North East Scotland

Publisher

Springer Science and Business Media LLC

Subject

General Medicine

Reference54 articles.

1. Brownlee S, Chalkidou K, Doust J, Elshaug AG, Glasziou P, Heath I, et al. Evidence for overuse of medical services around the world. Lancet. 2017;390:156–68. https://doi.org/10.1016/S0140-6736(16)32585-5.

2. Department of Health & Social Care. Good for you, good for us, good for everybody: a plan to reduce overprescribing to make patient care better and safer, support the NHS, and reduce carbon emissions. 2021;85.

3. NICE. Our principles | Who we are | About [Internet]. NICE. NICE; 2022 [cited 2022 Aug 9]. Available from: https://www.nice.org.uk/about/who-we-are/our-principles.

4. Choosing Wisely UK. About Choosing Wisely UK [Internet]. Choosing Wisely UK. 2022. Cited 2022 June 10. Available from: https://www.choosingwisely.co.uk/about-choosing-wisely-uk/.

5. Rosenberg A, Agiro A, Gottlieb M, Barron J, Brady P, Liu Y, et al. Early Trends Among Seven Recommendations From the Choosing Wisely Campaign. JAMA Intern Med. 2015;175:1913–20. https://doi.org/10.1001/jamainternmed.2015.5441.

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3