RESUMO

En esta editorial, la autora aborda la problemática de las prácticas de bajo valor en la medicina contemporánea: aquellas intervenciones terapéuticas o diagnósticas carentes de respaldo científico, que aumentan la probabilidad de daños, generan desperdicio de recursos y amenazan la eficiencia del sistema de salud. En un contexto de preocupación global por el exceso médico y las consecuencias del sobreuso de intervenciones inefectivas, resalta la relevancia del concepto de prevención cuaternaria en la atención sanitaria, y señala la iniciativa internacional Choosing Wisely como una estrategia para identificar y revertir las prácticas de bajo valor, destacando la importancia del cambio cultural y la participación activade los pacientes. Finalmente, la autora presenta el lanzamiento de Choosing Wisely Argentina, una colaboración entre asociaciones científicas locales con el compromiso de transformar la práctica médica en este país, priorizando el bienestar del paciente y adoptando un enfoque integral hacia la atención sanitaria. (AU)

In this editorial, the author addresses the problem of low-value practices in contemporary medicine: those therapeutic or diagnostic interventions that lack scientific support and increase the probability of damage, generate waste of resources,and threaten the efficiency of the health system. In a context of global concern about medical excess and the consequences of the overuse of ineffective interventions, she highlights the relevance of the concept of quaternary prevention in healthcare, and points to the international Choosing Wisely initiative as a strategy to identify and reverse low-value practices, highlighting the importance of cultural change and active patient participation. Finally, the author presents the launch of Choosing Wisely Argentina, a collaboration amongst local scientific associations with the commitment to transform medical practice in this country, prioritizing patient well-being and adopting a comprehensive approach to health care. (AU)

Assuntos

RESUMO

The number of patients with cancer requiring intensive care unit admission is increasing around the world. The improvement in the pathophysiological understanding of this group of patients, as well as the increasingly better and more targeted treatment options for their underlying disease, has led to a significant increase in their survival over the past three decades. Within the organizational concepts, it is necessary to know what adds value in the care of critical oncohematological patients. Practices in medicine that do not benefit patients and possibly cause harm are called low-value practices, while high-value practices are defined as high-quality care at relatively low cost. In this article, we discuss ten domains with high-value evidence in the care of cancer patients: (1) intensive care unit admission policies; (2) intensive care unit organization; (3) etiological investigation of hypoxemia; (4) management of acute respiratory failure; (5) management of febrile neutropenia; (6) urgent chemotherapy treatment in critically ill patients; (7) patient and family experience; (8) palliative care; (9) care of intensive care unit staff; and (10) long-term impact of critical disease on the cancer population. The disclosure of such policies is expected to have the potential to change health care standards. We understand that it is a lengthy process, and initiatives such as this paper are one of the first steps in raising awareness and beginning a discussion about high-value care in various health scenarios.

Assuntos

RESUMO

The Choosing Wisely initiative has become a significant benchmark as a strategy to reduce low value tests and therapies. An original initiative of the American Board of Internal Medicine (ABIM) which has been growing gradually and is now present in over 18 countries, with the support of more than 80 scientific societies around the world. In Colombia, the strategy is being accepted by the Colombian Association of Scientific Societies (ACSC), which with the support of six pioneer Colombian scientific societies, have encouraged the development and implementation of "do not do recommendations", with a view to fulfil the right to self-regulation of human resources in healthcare, reducing those medical behaviors that could be ineffective or harmful to the patient. This article is an overview of the most significant items of the initiative which has been conducted by the ACSC, with the support of the Colombian Society of Anesthesiology and Resuscitation (S.C.A.R.E.) as a pioneer.

La iniciativa Choosing Wisely se ha convertido en un significativo referente como estrategia para reducir pruebas y tratamientos de bajo valor. Planteada originalmente por la American Board of Internal Medicine (ABIM), ha ido creciendo gradualmente y ya se encuentra en más de 18 países, y cuenta con el apoyo de más de 80 sociedades científicas del mundo. En Colombia, la estrategia está siendo adaptada por la Asociación Colombiana de Sociedades Científicas (ACSC), quienes, con el apoyo de seis sociedades científicas colombianas como pioneras, han motivado la elaboración e implementación de "recomendaciones de no hacer", con el objetivo de materializar el derecho a la autorregulación del talento humano en salud, reduciendo aquellas conductas médicas que pueden ser inefectivas u ocasionar daño al paciente. En este artículo hacemos un recuento de los puntos más importantes de la iniciativa, cuál ha sido la labor de la ACSC, y el papel que la Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.) ha tenido como sociedad pionera.

RESUMO

BACKGROUND: Choosing Wisely recommendations could reduce physical therapists' use of low-value care. OBJECTIVE: To investigate whether language influences physical therapists' willingness to follow the Australian Physiotherapy Association's (APA) Choosing Wisely recommendations. DESIGN: Best-worst Scaling survey METHODS: The six original APA Choosing Wisely recommendations were modified based on four language characteristics (level of detail, strength- qualified/unqualified, framing, and alternatives to low-value care) to create 60 recommendations. Physical therapists were randomised to a block of seven choice tasks, which included four recommendations. Participants indicated which recommendation they were most and least willing to follow. A multinomial logistic regression model was used to create normalised (0=least preferred; 10=most preferred) and marginal preference scores. RESULTS: 215 physical therapists (48.5% of 443 who started the survey) completed the survey. Participants' mean age (SD) was 38.7 (10.6) and 47.9% were female. Physical therapists were more willing to follow recommendations with more detail (marginal preference score of 1.1) or that provided alternatives to low-value care (1.3) and less willing to follow recommendations with negative framing (-1.3). The use of qualified ('don't routinely') language (vs. unqualified - 'don't') did not affect willingness. Physical therapists were more willing to follow recommendations to avoid imaging for non-specific low back pain (3.9) and electrotherapy for low back pain (3.8) vs. recommendation to avoid incentive spirometry after upper abdominal and cardiac surgery. CONCLUSION: Physical therapists were more willing to follow recommendations that provided more detail, alternatives to low-value care, and were positively framed. These findings can inform the development of future Choosing Wisely recommendations and could help reduce low-value physical therapy.

Assuntos

RESUMO

RATIONALE: Preoperative care is one of the main areas in which to address low-value care. A detailed definition of what low-value care is in this period of the surgical care journey paves the way for new scientific research, clinical improvements, and reduction of unnecessary costs in this field. AIMS AND OBJECTIVE: To identify how low-value care in low-risk preoperative population has been defined in the scientific literature and propose a low-value care framework with potential consequences in this setting. METHODS: Scoping review of theoretical studies and peer-reviewed papers, including reviews, commentaries, or expert opinions, were considered eligible for inclusion. The following databases were consulted: MEDLINE (via PubMed), EMBASE, and SCOPUS (from inception to July 24, 2021), using a structured search with the keywords "low value care", "clinical waste", "preoperative", and "elective procedures." Two independent reviewers performed study selection and data extraction. The definition of low-value care in the preoperative period and their consequences were described after extracting previous low-value care concepts and summarising the contents. Also, a visual framework was built with this information. RESULTS: From 1519 publications identified in the initial searches, 22 underwent full-text assessment, and 11 conceptual studies were included in the review. A total of four studies (36%) presented a general low-value care definition, and all studies report some situations considered low-value care in the preoperative field of low-risk surgeries. The most common example of preoperative low-value care, listed in nine studies (81%), was having asymptomatic patients undergo screening tests before surgery. The main clinical and nonclinical consequences of low-value care in the preoperative phase included false-positive results from exams as well as psychological distress, increased costs, and delay in surgery. CONCLUSIONS: Revisiting and integrating previous definitions of low-value care in low-risk surgery into a scoping review is a starting point for de-implementing unnecessary care and promoting improvements in surgical pathways.

Assuntos

RESUMO

ABSTRACT The number of patients with cancer requiring intensive care unit admission is increasing around the world. The improvement in the pathophysiological understanding of this group of patients, as well as the increasingly better and more targeted treatment options for their underlying disease, has led to a significant increase in their survival over the past three decades. Within the organizational concepts, it is necessary to know what adds value in the care of critical oncohematological patients. Practices in medicine that do not benefit patients and possibly cause harm are called low-value practices, while high-value practices are defined as high-quality care at relatively low cost. In this article, we discuss ten domains with high-value evidence in the care of cancer patients: (1) intensive care unit admission policies; (2) intensive care unit organization; (3) etiological investigation of hypoxemia; (4) management of acute respiratory failure; (5) management of febrile neutropenia; (6) urgent chemotherapy treatment in critically ill patients; (7) patient and family experience; (8) palliative care; (9) care of intensive care unit staff; and (10) long-term impact of critical disease on the cancer population. The disclosure of such policies is expected to have the potential to change health care standards. We understand that it is a lengthy process, and initiatives such as this paper are one of the first steps in raising awareness and beginning a discussion about high-value care in various health scenarios.

RESUMO O número de pacientes oncológicos com necessidade de internação em unidades de terapia intensiva está aumentando em todo o mundo. A maior compreensão fisiopatológica desse grupo de pacientes, bem como opções de tratamento cada vez melhores e mais direcionadas à doença subjacente, tem levado a um aumento significativo da sobrevida nas últimas três décadas. Dentro dos conceitos organizacionais é necessário saber o que agrega valor ao cuidado de pacientes onco-hematológicos graves. As práticas terapêuticas não benéficas aos pacientes e possivelmente causadoras de danos são chamadas práticas de baixo valor, enquanto as práticas de alto valor são definidas como cuidados de alta qualidade a um custo relativamente baixo. Neste artigo discutimos dez domínios com evidências de alto valor no cuidado de pacientes com câncer: (1) políticas de internação na unidade de terapia intensiva; (2) organização da unidade de terapia intensiva; (3) investigação etiológica da hipoxemia; (4) manejo da insuficiência respiratória aguda; (5) manejo da neutropenia febril; (6) tratamento quimioterápico de urgência em pacientes graves; (7) experiência do paciente e da família; (8) cuidados paliativos; (9) cuidados com a equipe da unidade de terapia intensiva; e (10) impacto a longo prazo da doença grave na população oncológica. Esperase que a divulgação dessas políticas traga mudanças aos padrões atuais do cuidado em saúde. Entendemos que é um processo longo, e iniciativas como o presente artigo são um dos primeiros passos para aumentar a conscientização e possibilitar discussão sobre cuidados de alto valor em vários cenários de saúde.