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Ellen M, Perlman S, Horowitz E, Shach R, Catane R. Understanding Physicians' Perceptions of Overuse of Health Services in Oncology. Med Care Res Rev 2020; 78:511-520. [PMID: 32321339 DOI: 10.1177/1077558720915112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Overuse rates in oncology are high, but areas of possible improvement exist for reducing it and improving quality of care. This study explores perceptions and experiences of oncologists in Israel regarding overuse of health services within oncology. In-depth, semistructured interviews were conducted focusing on causes of overuse, facilitators for reduction, and suggestions for improvement. Interviews were audio recorded, transcribed, coded, and thematically analyzed. Physicians reported patient-level causes including "well-informed" and "demanding" patients; physician-level causes including desire to satisfy patients, lack of confidence, time, and skills; and system-level causes like ease of access, and lack of alignment and coordination. Physicians can reduce overuse through patient dialogue, building trust and solidifying patient-physician relationships, and further reduce overuse with better teamwork. Improvements can be made through educational initiatives, and bottom-up solutions. Policy makers and decision makers should develop appropriate interventions addressing health service overuse, including improving patient education and instilling confidence and knowledge in physicians.
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Affiliation(s)
- Moriah Ellen
- Ben-Gurion University of the Negev, Beersheba, Israel.,University of Toronto, Toronto, Ontario, Canada.,McMaster University, Hamilton, Ontario, Canada
| | | | | | - Ruth Shach
- Washington University in St Louis, St Louis, MO, USA
| | - Raphael Catane
- Tel Aviv University, Tel Aviv, Israel.,Chaim Sheba Medical Center, Tel Hashomer, Israel
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Ellen ME, Shach R, Kok MC, Fatta K. There Is Much to Learn When You Listen: Exploring Citizen Engagement in High- and Low-Income Countries. ACTA ACUST UNITED AC 2019; 17:31-42. [PMID: 29400272 DOI: 10.12927/whp.2017.25307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The need for engaging citizens in healthcare policy making is critical, and different approaches are gaining traction internationally. However, citizen engagement seems more difficult to implement in low- and middle-income countries because of political, practical and cultural reasons. Despite this, countries such as India, Malawi, Tanzania, Ethiopia, Rwanda, Mozambique, Egypt have initiated community engagement initiatives, which are contextually unique, and can be used as examples to learn from for the future. Overall, community voices need to play a bigger role in forming policy; they hold the key to improve health and forward growth. Evidence needs to move out of communities and districts through broader communication and knowledge translation avenues to influence and shape national and global level policies and strategies.
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Affiliation(s)
- Moriah E Ellen
- Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev Beer-Sheva, Israel; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON; McMaster Health Forum, McMaster University Hamilton, ON
| | - Ruth Shach
- Jerusalem College of Technology, Jerusalem, Israel
| | - Maryse C Kok
- KIT Health, Royal Tropical Institute, Amsterdam, NL
| | - Katherine Fatta
- University Research Co., LLC/USAID Applying Science to Strengthen and Improve Systems Project (ASSIST)
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Ellen ME, Shach R, Balicer RD. Helping patients help themselves: Supporting the healthcare journey. Patient Educ Couns 2018; 101:1708-1711. [PMID: 29691111 DOI: 10.1016/j.pec.2018.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/25/2018] [Accepted: 04/11/2018] [Indexed: 06/08/2023]
Abstract
Patients often feel lost when navigating the health care system, and poor care coordination leads to negative patient outcomes, consumes resources and makes diseases more difficult to treat. Patients and citizens have become eager to take health care decision making into their own hands. To this end, solutions have been proposed which assist patients by providing them with more information and enabling them to take a more active role in their care. These include enlisting a patient navigator, consumer engagement, process mapping, decision aids, and clinical pathways. However, as the global penetration of mobile devices approaches 100%, it is timely to update and optimize health system support technologies and information dissemination pathways. There is much room for improvement and health systems are beginning to echo other industries in asking "what do consumers want?" in their applications. We believe that now is the time to address emergent gaps and supplement the irreplaceable human elements of patient navigation with a mobile or computer application. It would be able to automate parts of the process, and consolidate important information, to serve as a broad-reaching, real-time companion for healthcare consumers and their families to accompany them on their journey from diagnosis to follow up.
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Affiliation(s)
- Moriah E Ellen
- Senior Lecturer, Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben Gurion University of the Negev, P.O.B. 653, Beer-Sheva, 8410501, Israel; McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L6, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada.
| | - Ruth Shach
- Senior Lecturer, Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben Gurion University of the Negev, P.O.B. 653, Beer-Sheva, 8410501, Israel; Brown School, Washington University in St Louis, 1 Brookings Dr, St. Louis, MO, 63130, United States
| | - Ran D Balicer
- McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L6, Canada; Clalit Research Institute at Clalit Health Services, 101 Arlozorov Street, Tel Aviv, 6209804, Israel
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Ellen ME, Wilson MG, Vélez M, Shach R, Lavis JN, Grimshaw JM, Moat KA. Addressing overuse of health services in health systems: a critical interpretive synthesis. Health Res Policy Syst 2018; 16:48. [PMID: 29907158 PMCID: PMC6003114 DOI: 10.1186/s12961-018-0325-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 05/08/2018] [Indexed: 01/08/2023] Open
Abstract
Background Health systems are increasingly focusing on the issue of ‘overuse’ of health services and how to address it. We developed a framework focused on (1) the rationale and context for health systems prioritising addressing overuse, (2) elements of a comprehensive process and approach to reduce overuse and (3) implementation considerations for addressing overuse. Methods We conducted a critical interpretive synthesis informed by a stakeholder-engagement process. The synthesis identified relevant empirical and non-empirical articles about system-level overuse. Two reviewers independently screened records, assessed for inclusion and conceptually mapped included articles. From these, we selected a purposive sample, created structured summaries of key findings and thematically synthesised the results. Results Our search identified 3545 references, from which we included 251. Most articles (76%; n = 192) were published within 5 years of conducting the review and addressed processes for addressing overuse (63%; n = 158) or political and health system context (60%; n = 151). Besides negative outcomes at the patient, system and global level, there were various contextual factors to addressing service overuse that seem to be key issue drivers. Processes for addressing overuse can be grouped into three elements comprising a comprehensive approach, including (1) approaches to identify overused health services, (2) stakeholder- or patient-led approaches and (3) government-led initiatives. Key implementation considerations include the need to develop ‘buy in’ from stakeholders and citizens. Conclusions Health systems want to ensure the use of high-value services to keep citizens healthy and avoid harm. Our synthesis can be used by policy-makers, stakeholders and researchers to understand how the issue has been prioritised, what approaches have been used to address it and implementation considerations. Systematic review registration PROSPERO CRD42014013204.
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Affiliation(s)
- Moriah E Ellen
- Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 653, 84105, Beer-Sheva, Israel.,Institute for Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada.,McMaster Health Forum, McMaster University, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada
| | - Michael G Wilson
- McMaster Health Forum, McMaster University, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada. .,Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada. .,Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.
| | - Marcela Vélez
- McMaster Health Forum, McMaster University, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada.,Health Policy PhD Program, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.,Faculty of Medicine, University of Antioquia, Cra. 51d #62-29, Medellín, Antioquia, Colombia
| | - Ruth Shach
- Brown School of Social Work, Washington University in St Louis, 1 Brookings Dr, St Louis, MO, 63130, United States of America
| | - John N Lavis
- McMaster Health Forum, McMaster University, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.,Department of Political Science, McMaster University, Hamilton, Canada.,Department of Global Health and Population, Harvard School of Public Health, Cambridge, MA, United States of America
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Kaelan A Moat
- McMaster Health Forum, McMaster University, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
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Ellen M, Bin Nun G, Shach R. Maimonides' middle path in the use of health care. J Health Serv Res Policy 2017; 22:192-194. [PMID: 28429980 DOI: 10.1177/1355819616686387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Moriah Ellen
- Senior Lecturer, School of Business, Jerusalem College of Technology, Israel.,Investigator, McMaster Health Forum, Canada.,Assistant Professor, Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Gabi Bin Nun
- Professor, Department of Health System Management, Faculty of Management, Ben Gurion University of the Negev, Israel
| | - Ruth Shach
- Researcher, Israeli Center for Technology Assessment in Health Care, Gertner Institute for Epidemiology and Health Policy, Israel
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Affiliation(s)
- Moriah E Ellen
- Jerusalem College of Technology, Ha-Va'ad ha-Le'umi St 21, Jerusalem, 93721, Israel; McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L6, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada.
| | - Francis Hughes
- International Council of Nurses, Jean-Marteau 3, 1201, Genève, Switzerland
| | - Ruth Shach
- Jerusalem College of Technology, Ha-Va'ad ha-Le'umi St 21, Jerusalem, 93721, Israel
| | - Judith Shamian
- International Council of Nurses, Jean-Marteau 3, 1201, Genève, Switzerland
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