Strategies for de-implementation of low-value care—a scoping review

Ingvarsson, Sara; Hasson, Henna; Schwarz, Ulrica von Thiele; Nilsén, Per; Powell, Byron J.; Lindberg, Clara; Augustsson, Hanna

doi:10.1186/s13012-022-01247-y

Cited by 29 publications

(30 citation statements)

References 106 publications

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“…Possible reasons for that could be that the information received from the participants about possible contingencies were not sufficiently comprehensive. Those identified in this study were only a few out of several suggested in the literature (7,10,49). Alternative contingencies with a stronger influence on behaviors related to using x-rays could potentially have maintained unnecessary use of LVC despite the two strategies.…”

Section: Discussionmentioning

confidence: 80%

“…The current state-of-the-art is that strategies should match the local factors impacting behavior rather than expecting particular implementation strategies to always be superior to others (9). With regard to de-implementation, numerous local factors have been found to influence the use of LVC, including care processes, financial incentives, and perceived pressure from patients, other professionals, or the system (7,(10)(11)(12). However, there is insufficient knowledge about which factors might be relevant for choosing effective strategies.…”

Section: Introductionmentioning

confidence: 99%

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Strategies to reduce low-value care – An applied behavior analysis using a single-case design

Ingvarsson¹,

Sandaker²,

Nilsén³

et al. 2023

Front. Health Serv.

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IntroductionImplementation science has traditionally focused on the implementation of evidence-based practices, but the field has increasingly recognized the importance of addressing de-implementation (i.e., the process of reducing low-value care). Most studies on de-implementation strategies have used a combination of strategies without addressing factors that sustain the use of LVC and there is a lack of information about which strategies are most effective and what mechanisms of change might underlie these strategies. Applied behavior analysis is an approach that could be a potential method to gain insights into the mechanisms of de-implementation strategies to reduce LVC. Three research questions are addressed in this study: What contingencies (three-term contingencies or rule-governing behavior) related to the use of LVC can be found in a local context and what strategies can be developed based on an analysis of these contingencies?; Do these strategies change targeted behaviors?; How do the participants describe the strategies' contingencies and the feasibility of the applied behavior analysis approach?Materials and methodsIn this study, we used applied behavior analysis to analyze contingencies that maintain behaviors related to a chosen LVC, the unnecessary use of x-rays for knee arthrosis within a primary care center. Based on this analysis, strategies were developed and evaluated using a single-case design and a qualitative analysis of interview data.ResultsTwo strategies were developed: a lecture and feedback meetings. The results from the single-case data were inconclusive but some of the findings may indicate a behavior change in the expected direction. Such a conclusion is supported by interview data showing that participants perceived an effect in response to both strategies.ConclusionThe findings illustrate how applied behavior analysis can be used to analyze contingencies related to the use of LVC and to design strategies for de-implementation. It also shows an effect of the targeted behaviors even though the quantitative results are inconclusive. The strategies used in this study could be further improved to target the contingencies better by structuring the feedback meetings better and including more precise feedback.

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Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Strategies to reduce low-value care – An applied behavior analysis using a single-case design

Ingvarsson¹,

Sandaker²,

Nilsén³

et al. 2023

Front. Health Serv.

Self Cite

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“…evidence of benefit and ease of use) 23 . A recent scoping review of strategies for de-implementation of low-value care found that with a few exceptions similar strategies are used for de-implementation and implementation 24 .…”

Section: Discussionmentioning

confidence: 99%

The impact of lidocaine plaster prescribing reduction strategies: a comparison of two national health services in Europe

Mattsson

Boland²,

Kirke³

et al. 2023

Preprint

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Introduction In 2017, two distinct interventions were implemented in Ireland and England to reduce prescribing of lidocaine medicated plasters. In Ireland, restrictions on reimbursement were introduced. In England, updated guidance on items not to routinely prescribe in primary care, including lidocaine plasters, was published. This study aims to compare how the interventions impacted prescribing of lidocaine plasters in these countries. Methods We conducted an interrupted time series study using general practice data. For Ireland, monthly dispensing data (2015-2019) from the means-tested General Medical Services scheme was used. For England, data covered all patients. Outcomes were the rate of dispensings, quantity and costs of lidocaine plasters, and we modelled level and trend changes from the first full month of the policy/guidance change. Findings Ireland had higher rates of lidocaine dispensings compared to England throughout the study period; this was 15.22/1,000 population immediately pre-intervention, and there was equivalent to a 97.2% immediate reduction following the intervention. In England, the immediate pre-intervention dispensing rate was 0.36/1,000, with an immediate reduction of 0.0251/1,000 (a 5.8% decrease), followed by a small but significant decrease in the monthly trend relative to the pre-intervention trend of 0.0057 per month. Interpretation Among two different interventions aiming to decrease low-value lidocaine plaster prescribing, there was a substantially larger impact in Ireland of reimbursement restriction compared to issuing guidance in England. However, this is in the context of much higher baseline rates of use in Ireland compared to England. Funding This study was funded by the Health Research Board (SDAP-2019-023).

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“…Of particular importance in deimplementation is deciding what practices to deimplement, which must involve considerations of equity, clinical effectiveness, cost‐effectiveness, and patient preferences. More studies are needed to understand methods for identifying deimplementation targets and to identify the most effective deimplementation strategies 12 …”

Section: Areas Of Interest For Implementation Sciencementioning

confidence: 99%

“…More studies are needed to understand methods for identifying deimplementation targets and to identify the most effective deimplementation strategies. 12…”

Section: And Concern For Omission (Or Missing a Diagnosis) Over Commi...mentioning

confidence: 99%

Methodological progress note: Implementation science contributions to healthcare research and practice

Tyler

Jolles

2023

Journal of Hospital Medicine

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Strategies for de-implementation of low-value care—a scoping review

Cited by 29 publications

References 106 publications

Strategies to reduce low-value care – An applied behavior analysis using a single-case design

Strategies to reduce low-value care – An applied behavior analysis using a single-case design

The impact of lidocaine plaster prescribing reduction strategies: a comparison of two national health services in Europe

Methodological progress note: Implementation science contributions to healthcare research and practice

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