Promise and perils of patient decision aids for reducing low-value care

Promise and perils of patient decision aids for reducing low-value care
BMJ Quality & Safety : 24 December 2020. doi: 10.1136/bmjqs-2020-012312

• A discussion of patient decision aids which aim to reduce the use of care considered of low value.

Understanding the public’s role in reducing low-value care: a scoping review.

Understanding the public’s role in reducing low-value care: a scoping review.
Implementation Sci 15, 20 (7 April 2020). https://doi.org/10.1186/s13012-020-00986-0

• The objective of this scoping review was to systematically examine the literature describing public involvement in initiatives to reduce low-value care.The majority of included citations were published following inception of Choosing Wisely in 2012. 
• Of the 218 studies identified 156 (72%) focused on patient engagement within the patient-clinician interaction, using tools that included shared decision-making (n = 66, 42%) and patient-targeted educational materials (n = 72, 46%), and reported both reductions in low-value care and improved patient perceptions regarding low-value care. Thirty three studies (15%) examined public involvement in low-value care policy-making. Forty one studies were from Europe.

Abstract

De-implementing wisely: developing the evidence base to reduce low-value care

De-implementing wisely: developing the evidence base to reduce low-value care
BMJ Quality & Safety 06 February 2020. doi: 10.1136/bmjqs-2019-010060

• This paper describes the Choosing Wisely De-Implementation Framework (CWDIF), a novel framework that builds on previous work in the field of implementation science and proposes a comprehensive approach to systematically reduce low-value care in both hospital and community settings and advance the science of de-implementation.

Evidence based interventions programme – support resources

Evidence based interventions programme – support resources
NHS England

• NHS England have created a series of resources (leaflets and videos) to help health professionals, patients and the public understand the Evidence-Based Interventions Programme and the interventions that are currently included in the guidance.
• The programme runs alongside the NHS England and NHS Clinical Commissioners’ programme focused on items that should not be routinely prescribed in primary care.

A review of patient access to inguinal hernia surgery in England

A dangerous waiting game? A review of patient access to inguinal hernia surgery in England
Royal College of Surgeons, British Hernia Society 17 July 2018

• This report sets out the scale of CCG restrictions around access to access to groin (inguinal) hernia (based on FOI request to CCGs), the impact these are having on patients, and what needs to be done at a local and national policy level to address this.
• Of the 184 CCGs that responded to the RCS’s FOI request, 105 (57%) had policies in place that either restricted access to surgery or increased the risk of poorer outcomes (including adverse events and mortality).
• A full breakdown as follows: 
• 8 CCGs (5%) require patients to demonstrate a history of incarceration and/or their hernia increasing in size from month to month (named in report)
• 95 CCGs (52%) require evidence that the patient is suffering from pain or discomfort sufficient to impede their day-to-day activities or working life before surgery can be commissioned (a ‘watchful waiting’ approach is commonly required until this criterion is met) 
• 44 CCGs (24%) have policies that meet RCS/BHS guidelines 
• 35 CCGs (19%) have no commissioning policy relating to inguinal hernia surgery

Breast reconstruction in England - variation in CCG policies

Rebuilding my body: Breast reconstruction in England
Breast Cancer Now, 18 June 2018

• Evidence from FOI requests conducted in 2017 shows that 47 out of 208 CCGs (22.6%) have established policies to restrict reconstruction services for non-clinical reasons, with a further nine CCGs (4.3%) having draft policies or informal restrictions in place (see p18/19). The report makes recommends for CCGs to support shared decision making, availability of surgery and patient expectations. 
• At the same time new guidelines have been published by the Association of Breast Surgery Guidance for the Commissioning of Oncoplastic Breast Surgery