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Torrini I, Grassetti L, Rizzi L. Under-spending, over-spending or substitution among services? Spatial patterns of unexplained shares of health care expenditures. Health Policy 2023; 137:104902. [PMID: 37688951 DOI: 10.1016/j.healthpol.2023.104902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 04/03/2023] [Accepted: 08/24/2023] [Indexed: 09/11/2023]
Abstract
Using individual-level administrative data, we investigate the spatial patterns of unexplained shares of health care expenditures (HCE) at the municipality level. The focus is on the elderly population in the Italian Region Friuli-Venezia Giulia observed over the period 2017-2019. The empirical analysis comprises two steps. First, random-effects two-part models are estimated to analyze the effect of age, morbidity, and death on the probability and amount of positive individual total HCE and its components. Second, the unexplained shares of HCE at the municipality level are examined to identify areas with under- or over-spending and substitution among services. Results confirm the existing findings on the determinants of HCE and reveal geographic patterns in the unexplained shares of expenditures. We identify clusters of municipalities with observed HCE higher than predicted for each type of service and clusters with substitution between home care and all other services. These findings are associated with the degree of urbanization of these areas and, consequently, with the ease of access to health care. This is crucial from a policy perspective, as it indicates specific policy targets for public health intervention.
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Affiliation(s)
- Irene Torrini
- Dept. of Economics and Statistics - University of Udine, Via Tomadini, 30/a, Udine, 33100, Italy
| | - Luca Grassetti
- Dept. of Economics and Statistics - University of Udine, Via Tomadini, 30/a, Udine, 33100, Italy
| | - Laura Rizzi
- Dept. of Economics and Statistics - University of Udine, Via Tomadini, 30/a, Udine, 33100, Italy.
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2
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Rozbroj T, Haas R, O'Connor D, Carter SM, McCaffery K, Thomas R, Donovan J, Buchbinder R. How do people understand overtesting and overdiagnosis? Systematic review and meta-synthesis of qualitative research. Soc Sci Med 2021; 285:114255. [PMID: 34391966 DOI: 10.1016/j.socscimed.2021.114255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/15/2022]
Abstract
RATIONALE The public should be informed about overtesting and overdiagnosis. Diverse qualitative studies have examined public understandings of this information. A synthesis was needed to systematise the body of evidence and yield new, generalisable insights. AIM Synthesise data from qualitative studies exploring patient and public understanding of overtesting and overdiagnosis. METHODS We searched Scopus, CINAHL, Ovid MEDLINE and PsycINFO databases from inception to March 18, 2020. We included published English-language primary studies exploring the perspectives of patients/the public about overtesting/overdiagnosis from any setting, year and relating to any condition. Only qualitative parts of mixed-methods studies were synthesised. We excluded studies that only examined overtreatment or sampled people with specialised medical knowledge. Two authors independently selected studies, extracted data, assessed the methodological quality of included studies using the CASP tool, and assessed confidence in the synthesis findings using the GRADE-CERQual approach. Data was analysed using thematic meta-synthesis, utilising descriptive and interpretive methods. RESULTS We synthesised data from 21 studies, comprising 1638 participants, from 2754 unique records identified. We identified six descriptive themes, all graded as moderate confidence (indicating they are likely to reasonably represent the available evidence): i) high confidence in screening and testing; ii) difficulty in understanding overuse; iii) acceptance that overuse can be harmful; iv) rejection or problematisation of overuse; v) limited impacts of overuse information on intended test and screening uptake; vi) desire for information and shared decision-making regarding overuse. The descriptive themes were underpinned by two analytic themes: i) perceived intrinsic value of information and information gathering, and; ii) differences in comprehension and acceptance of overuse concepts. CONCLUSIONS This study identified novel and important insights about how lay people interpret overuse concepts. It will guide the development of more effective public messages about overuse, highlighting the importance of interpretative frameworks in these communications.
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Affiliation(s)
- Tomas Rozbroj
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, 154 Wattletree Rd, Malvern, VIC 3144, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, VIC 3004, Australia.
| | - Romi Haas
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, 154 Wattletree Rd, Malvern, VIC 3144, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, VIC 3004, Australia
| | - Denise O'Connor
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, 154 Wattletree Rd, Malvern, VIC 3144, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, VIC 3004, Australia
| | - Stacy M Carter
- Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, NSW 2500, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Rae Thomas
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, QLD, Australia
| | - Jan Donovan
- Consumers Health Forum of Australia, 7B/17 Napier Close, Deakin, ACT 2600, Australia
| | - Rachelle Buchbinder
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, 154 Wattletree Rd, Malvern, VIC 3144, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, VIC 3004, Australia
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3
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Scott IA, Elshaug AG, Fox M. Low value care is a health hazard that calls for patient empowerment. Med J Aust 2021; 215:101-103.e1. [PMID: 34275155 DOI: 10.5694/mja2.51168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ian A Scott
- Princess Alexandra Hospital, Brisbane, QLD.,University of Queensland, Brisbane, QLD
| | - Adam G Elshaug
- Centre for Health Policy, University of Melbourne, Melbourne, VIC
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Wang T, Mott N, Miller J, Berlin NL, Hawley S, Jagsi R, Dossett LA. Patient Perspectives on Treatment Options for Older Women With Hormone Receptor-Positive Breast Cancer: A Qualitative Study. JAMA Netw Open 2020; 3:e2017129. [PMID: 32960279 PMCID: PMC7509630 DOI: 10.1001/jamanetworkopen.2020.17129] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/07/2020] [Indexed: 12/27/2022] Open
Abstract
Importance Women aged 70 years or older with hormone receptor-positive breast cancer have an excellent prognosis, but because of their age and comorbidities, they are at higher risk for treatment-related adverse events. Despite studies demonstrating the safety of omitting previously routine therapies, including sentinel lymph node biopsy (SLNB) and postlumpectomy radiotherapy, these treatments continue to be used at high rates. Physicians cite patient preference as one factor associated with overuse. However, little is known about how women view potential de-escalation of therapies. Objective To evaluate older women's preferences for SLNB and radiotherapy in the setting of guidelines recommending them or allowing for their omission. Design, Setting, and Participants This qualitative study was performed from October 2019 to January 2020. Midwestern women aged 70 years and older who had never received a diagnosis of breast cancer were recruited online and interviewed. Guided by an interpretive description approach, interviews were analyzed to produce a thematic description. Data analysis was performed from January to March 2020. Exposures Participants were presented with hypothetical scenarios in which they received a diagnosis of low-risk, hormone receptor-positive breast cancer and were given treatment options in accordance with current guidelines. Main Outcomes and Measures The interviews elicited perspectives on breast cancer treatment, including surgery, SLNB, chemotherapy, and postlumpectomy radiotherapy. Results The median (interquartile range) age of the 30 participants was 72.0 (71.0-76.5) years. Most of the women were White (26 participants [87%]), lived in metropolitan areas (29 participants [97%]), and were college educated (20 participants [67%] had a 4-year degree or higher). Overall, women expressed the belief that age-based guidelines were appropriate on the basis of decreased recurrence risk and increased frailty in older patients. However, many participants stated that these guidelines should not apply to healthy older women with a long life expectancy. Some participants struggled to understand that the basis for treatment de-escalation in older patients is a favorable, not poor, prognosis. Women who said they would undergo SLNB (12 participants [40%]) perceived the procedure as low risk and providing peace of mind. Most participants (22 participants [73%]) expressed a preference for omitting postlumpectomy radiotherapy because of the perceived risks, lack of benefit, and inconvenience. Conclusions and Relevance Positive reframing of the excellent prognosis driving national recommendations for de-escalation may reduce breast cancer overtreatment in older women. Strategies for reducing SLNB use will likely require education on the risks vs benefits and addressing patient preferences for peace of mind. In contrast, efforts to reduce radiotherapy use may need to address clinician or organizational factors.
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Affiliation(s)
- Ton Wang
- Department of Surgery, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Nicole Mott
- University of Michigan Medical School, Ann Arbor
| | - Jacquelyn Miller
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Nicholas L. Berlin
- Department of Surgery, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Sarah Hawley
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Reshma Jagsi
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Lesly A. Dossett
- Department of Surgery, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
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Olry de Labry Lima A, Marcos Marcos J, Marquina Marquez A, González Vera MDLÁ, Matas Hoces A, Bermúdez Tamayo C. Evidence for deprescription in primary care through an umbrella review. BMC FAMILY PRACTICE 2020; 21:100. [PMID: 32513110 PMCID: PMC7278115 DOI: 10.1186/s12875-020-01166-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/14/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is a high prevalence of potentially inappropriate prescriptions in primary care. This is associated with more frequent adverse events, lower quality of life and more frequent visits to hospital accident & emergency departments. The aim of the present study is to summarise available evidence on the effectiveness of deprescription interventions in primary care, and to describe the barriers and enablers of the process from the point of view of patients and healthcare professionals. METHODS We designed an umbrella review which includes nine systematic reviews. More than 50% of included studies were performed with adults in primary care. Two reviewers independently performed data extraction and analysis. RESULTS In considering studies of the effectiveness of interventions, it can be observed that the educational component of deprescription procedures is a key factor, whilst procedures tailored towards the patient's situation offer better results. With regards to studies involving healthcare professionals, the main explored areas were the balance between risks and benefits, and the need to improve communication with patients as well as other colleagues involved in patient care. Amongst the identified barriers we found lack of time, inability to access all information, being stuck in a routine, resistance to change and a lack of willingness to question the prescription decisions made by healthcare colleagues. With regards to patients, it is clear that they have worries and doubts. In order to overcome these issues, a good relationship with healthcare professionals and receipt of their support is required during the process. CONCLUSIONS Optimizing medication through targeted deprescribing is an important part of managing chronic conditions, avoiding adverse effects and improving outcomes. The majority of deprescription interventions in primary care are effective. Good communication between healthcare professionals is a key element for success in the deprescription process.
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Affiliation(s)
- Antonio Olry de Labry Lima
- Andalusian School of Public Health (Spanish acronym EASP), Granada, Spain. .,Instituto de Investigación Biosanitaria ibs, GRANADA, Granada, Spain. .,CIBER en Epidemiología and Salud Pública (CIBERESP), Madrid, Spain.
| | - Jorge Marcos Marcos
- Andalusian School of Public Health (Spanish acronym EASP), Granada, Spain.,Public Health Research Group, University of Alicante, Alicante, Spain
| | - Alfonso Marquina Marquez
- Faculty of Education and Social Work, University of Valladolid, Valladolid, Spain.,GIESA, Applied Sociocultural Studies (SEJ208), University of Granada, Granada, Spain
| | | | - Antonio Matas Hoces
- Andalusian School of Public Health (Spanish acronym EASP), Granada, Spain.,Centro Andaluz de Información del Medicamento (CADIME), Campus Universitario de Cartuja, Granada, Spain
| | - Clara Bermúdez Tamayo
- Andalusian School of Public Health (Spanish acronym EASP), Granada, Spain.,Instituto de Investigación Biosanitaria ibs, GRANADA, Granada, Spain.,CIBER en Epidemiología and Salud Pública (CIBERESP), Madrid, Spain
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Lown M, Wilcox CR, Hughes S, Santer M, Lewith G, Moore M, Little P. Patients' views about screening for atrial fibrillation (AF): a qualitative study in primary care. BMJ Open 2020; 10:e033061. [PMID: 32193260 PMCID: PMC7150591 DOI: 10.1136/bmjopen-2019-033061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES There has been increased interest in screening for atrial fibrillation (AF) with commissioned pilot schemes, ongoing large clinical trials and the emergence of inexpensive consumer single-lead ECG devices that can be used to detect AF. This qualitative study aimed to explore patients' views and understanding of AF and AF screening to determine acceptability and inform future recommendations. SETTING A single primary care practice in Hampshire, UK. PARTICIPANTS 15 participants (11 female) were interviewed from primary care who had taken part in an AF screening trial. A semistructured interview guide was used flexibly to enable the interviewer to explore any relevant topics raised by the participants. Interviews were recorded, transcribed verbatim and analysed using inductive thematic analysis. RESULTS Participants generally had an incomplete understanding of AF and conflated it with other heart problems or with raised blood pressure. With regards to potential drawbacks from screening, some participants considered anxiety and the cost of implementation, but none acknowledged potential harms associated with screening such as side effects of anticoagulation treatment or the risk of further investigations. The screening was generally well accepted, and participants were generally in favour of engaging with prolonged screening. CONCLUSIONS Our study highlights that there may be poor understanding (of both the nature of AF and potential negatives of screening) among patients who have been screened for AF. Further work is required to determine if resources including decision aids can address this important knowledge gap and improve clinical informed consent for AF screening. TRIAL REGISTRATION NUMBER ISRCTN 17495003.
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Affiliation(s)
- Mark Lown
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Christopher R Wilcox
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Stephanie Hughes
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Miriam Santer
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - George Lewith
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Michael Moore
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Paul Little
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
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7
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Pickering AN, Hamm ME, Dawdani A, Hanlon JT, Thorpe CT, Gellad WF, Radomski TR. Older Patient and Caregiver Perspectives on Medication Value and Deprescribing: A Qualitative Study. J Am Geriatr Soc 2020; 68:746-753. [PMID: 32067226 DOI: 10.1111/jgs.16370] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Shared decision making is essential to deprescribing unnecessary or harmful medications in older adults, yet patients' and caregivers' perspectives on medication value and how this affects their willingness to discontinue a medication are poorly understood. We sought to identify the most significant factors that impact the perceived value of a medication from the perspective of patients and caregivers. DESIGN Qualitative study using focus groups conducted in September and October 2018. SETTING Participants from the Pepper Geriatric Research Registry (patients) and the Pitt+Me Registry (caregivers) maintained by the University of Pittsburgh. PARTICIPANTS Six focus groups of community-dwelling adults aged 65 years or older, or their caregivers, prescribed five or more medications in the preceding 12 months. MEASUREMENTS We sought to identify (1) general views on medication value and what makes medication worth taking; (2) how specific features such as cost or side effects impact perceived value; and (3) reactions to clinical scenarios related to deprescribing. RESULTS We identified four themes. Perceived effectiveness was the primary factor that caused participants to consider a medication to be of high value. Participants considered a medication to be of low value if it adversely affected quality of life. Participants also cited cost when determining value, especially if it resulted in material sacrifices. Participants valued medications prescribed by providers with whom they had good relationships rather than valuing level of training. When presented with clinical scenarios, participants ably weighed these factors when determining the value of a medication and indicated whether they would adhere to a deprescribing recommendation. CONCLUSION We identified that perceived effectiveness, adverse effects on quality of life, cost, and a strong relationship with the prescriber influenced patients' and caregivers' views on medication value. These findings will enable prescribers to engage older patients in shared decision making when deprescribing unnecessary medications and will allow health systems to incorporate patient-centered assessment of value into systems-based deprescribing interventions. J Am Geriatr Soc 68:746-753, 2020.
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Affiliation(s)
- Aimee N Pickering
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Megan E Hamm
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Alicia Dawdani
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Joseph T Hanlon
- Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Center for Pharmaceutical Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for Health Equity Research and Promotion, Virginia Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Carolyn T Thorpe
- Center for Health Equity Research and Promotion, Virginia Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Walid F Gellad
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Center for Pharmaceutical Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for Health Equity Research and Promotion, Virginia Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Thomas R Radomski
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Center for Pharmaceutical Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for Health Equity Research and Promotion, Virginia Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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Tinetti ME, Naik AD, Dindo L, Costello DM, Esterson J, Geda M, Rosen J, Hernandez-Bigos K, Smith CD, Ouellet GM, Kang G, Lee Y, Blaum C. Association of Patient Priorities-Aligned Decision-Making With Patient Outcomes and Ambulatory Health Care Burden Among Older Adults With Multiple Chronic Conditions: A Nonrandomized Clinical Trial. JAMA Intern Med 2019; 179:1688-1697. [PMID: 31589281 PMCID: PMC6784811 DOI: 10.1001/jamainternmed.2019.4235] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/03/2019] [Indexed: 01/14/2023]
Abstract
Importance Health care may be burdensome and of uncertain benefit for older adults with multiple chronic conditions (MCCs). Aligning health care with an individual's health priorities may improve outcomes and reduce burden. Objective To evaluate whether patient priorities care (PPC) is associated with a perception of more goal-directed and less burdensome care compared with usual care (UC). Design, Setting, and Participants Nonrandomized clinical trial with propensity adjustment conducted at 1 PPC and 1 UC site of a Connecticut multisite primary care practice that provides care to almost 15% of the state's residents. Participants included 163 adults aged 65 years or older who had 3 or more chronic conditions cared for by 10 primary care practitioners (PCPs) trained in PPC and 203 similar patients who received UC from 7 PCPs not trained in PPC. Participant enrollment occurred between February 1, 2017, and March 31, 2018; follow-up extended for up to 9 months (ended September 30, 2018). Interventions Patient priorities care, an approach to decision-making that includes patients' identifying their health priorities (ie, specific health outcome goals and health care preferences) and clinicians aligning their decision-making to achieve these health priorities. Main Outcomes and Measures Primary outcomes included change in patients' Older Patient Assessment of Chronic Illness Care (O-PACIC), CollaboRATE, and Treatment Burden Questionnaire (TBQ) scores; electronic health record documentation of decision-making based on patients' health priorities; medications and self-management tasks added or stopped; and diagnostic tests, referrals, and procedures ordered or avoided. Results Of the 366 patients, 235 (64.2%) were female and 350 (95.6%) were white. Compared with the UC group, the PPC group was older (mean [SD] age, 74.7 [6.6] vs 77.6 [7.6] years) and had lower physical and mental health scores. At follow-up, PPC participants reported a 5-point greater decrease in TBQ score than those who received UC (ß [SE], -5.0 [2.04]; P = .01) using a weighted regression model with inverse probability of PCP assignment weights; no differences were seen in O-PACIC or CollaboRATE scores. Health priorities-based decisions were mentioned in clinical visit notes for 108 of 163 (66.3%) PPC vs 0 of 203 (0%) UC participants. Compared with UC patients, PPC patients were more likely to have medications stopped (weighted comparison, 52.0% vs 33.8%; adjusted odds ratio [AOR], 2.05; 95% CI, 1.43-2.95) and less likely to have self-management tasks (57.5% vs 62.1%; AOR, 0.59; 95% CI, 0.41-0.84) and diagnostic tests (80.8% vs 86.4%; AOR, 0.22; 95% CI, 0.12-0.40) ordered. Conclusions and Relevance This study's findings suggest that patient priorities care may be associated with reduced treatment burden and unwanted health care. Care aligned with patients' priorities may be feasible and effective for older adults with MCCs. Trial Registration ClinicalTrials.gov identifier: NCT03600389.
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Affiliation(s)
- Mary E. Tinetti
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Aanand D. Naik
- Houston Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas
- Department of Medicine (Health Services Research and Geriatrics), Baylor College of Medicine, Houston, Texas
| | - Lilian Dindo
- Houston Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas
- Department of Medicine (Health Services Research and Geriatrics), Baylor College of Medicine, Houston, Texas
| | - Darce M. Costello
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jessica Esterson
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mary Geda
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jonathan Rosen
- Connecticut Center for Primary Care, Farmington, Connecticut
| | | | - Cynthia Daisy Smith
- American College of Physicians, Philadelphia, Pennsylvania
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | | | - Gina Kang
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yungah Lee
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Caroline Blaum
- Department of Medicine, New York University School of Medicine, New York
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Older Adults' Perceptions of Healthcare Overuse. J Gen Intern Med 2019; 34:174. [PMID: 30402821 PMCID: PMC6374250 DOI: 10.1007/s11606-018-4726-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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10
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Scott IA. How much end-of-life care is of low value. Intern Med J 2018; 48:1173-1174. [DOI: 10.1111/imj.14054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 07/18/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Ian A. Scott
- Department of Internal Medicine and Clinical Epidemiology; Princess Alexandra Hospital; Brisbane Queensland Australia
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