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| EDITORIAL |
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| Year : 2017 | Volume
: 1
| Issue : 3 | Page : 55 |
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High-value care in developing countries: Reducing overuse and waste
Abdel-Naser Elzouki
Department of Medicine, Hamad General Hospital, HMC, College of Medicine, Qatar University, Weill Cornell Medical College, Doha, Qatar
| Date of Web Publication | 26-Dec-2017 |
Correspondence Address:
Prof. Abdel-Naser Elzouki
Department of Medicine, Hamad General Hospital, HMC, P. O. Box: 3050, Doha
Qatar
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/2588-9044.221499
How to cite this article:
Elzouki AN. High-value care in developing countries: Reducing overuse and waste. Libyan J Med Sci 2017;1:55 |
Medical students during their study in medical school are expected to learn all tests and treatments relevant to manage the patients' care. Over time and when they start practicing, they become acquainted with what is appropriate. In our training, the high-value care principles are central to the way we practice. We always ask ourselves, what will we get from these test results? Will it change the treatment and potentially the outcome? Nevertheless, variations in the amount and intensity of care provided across physicians, hospitals, and countries have been well illustrated.[1] In 2011, high-value care defined by the American College of Physicians as “care that balances the potential benefits, harms, and costs of tests and treatments.”[2] Subsequently, in 2012, the American Council for Graduate Medical Education incorporated the practice of cost-effective care into the competencies and milestones of the Internal Medicine Residency Program,[3] but optimal methods for teaching and assessing these skills were not specified.[4]
High-value care perhaps looks the same in developing countries as it does in developed countries. Its visage is so recognizable: unnecessary tests, redundant workups, inappropriate procedures, needless drug prescriptions, and ineffective treatments.[5] However, conceivably, one should not be surprised by the global dimensions and commonality of overuse and misuse.[6] Physicians are, after all, more alike, than they are different. Anyone of them will respond similarly when presented with the same incentives and function similarly if they are practicing in similar systems. We heard over and over again about the pernicious effects of financial reward for procedures performed; how difficult it is to practice high-value care in the absence of data and interpretative Electronic Medical Record System, and the challenges posed by fragmented care and overspecialization.
We did hear positive global reports about “Choosing Wisely,” “Global Ratings Scales,” and other similar ideas.[7] In developing countries, it is expected that the high-value care costs are continuing to rise to unsustainable level.[8] Such care is not necessary to be accompanied with high-quality care and is usually related to health system “wastes” that does not benefit the patient but adds more cost.[9] Recently, few initiatives in this direction have been started in some Arab and Middle East countries, which has been addressed through WHO-EMRO.[5],[6] We believe that such initiatives need to be strengthened and extended to other countries in the region to provide support to challenge the concept that “more is better,” to be introspective about the care we provide and to think critically and wisely.
| References | |  |
| 1. | Donohue JM, Morden NE, Gellad WF, Bynum JP, Zhou W, Hanlon JT, et al. Sources of regional variation in medicare part D drug spending. N Engl J Med 2012;366:530-8.  |
| 2. | Owens DK, Qaseem A, Chou R, Shekelle P; Clinical Guidelines Committee of the American College of Physicians. High-value, cost-conscious health care: Concepts for clinicians to evaluate the benefits, harms, and costs of medical interventions. Ann Intern Med 2011;154:174-80. |
| 3. | Caverzagie KJ, Iobst WF, Aagaard EM, Hood S, Chick DA, Kane GC, et al. The internal medicine reporting milestones and the next accreditation system. Ann Intern Med 2013;158:557-9. |
| 4. | Ryskina KL, Smith CD, Weissman A, Post J, Dine CJ, Bollmann K, et al. U.S. Internal medicine residents' knowledge and practice of high-value care: A National survey. Acad Med 2015;90:1373-9. |
| 5. | Kronfol NM. WHO-EMRO: Delivery of health services in Arab countries: A reviewed. East Mediterr Health J 2012;18:1229-38. |
| 6. | Kronfol NM. WHO-EMRO: Access and barriers to health care delivery in Arab countries: A review. East Mediterr Health J 2012;18:1239-46. |
| 7. | Klein S, Mayer D. Choosing wisely Canada recommendations. Can Fam Physician 2017;63:e473. |
| 8. | Dyer SJ, Patel M. The economic impact of infertility on women in developing countries – A systematic review. Facts Views Vis Obgyn 2012;4:102-9. |
| 9. | Boronat F, Barrachina I, Budia A, Vivas Consuelo D, Criado MC. Costs and hospital procedures in an urology department of a tertiary hospital. Analysis of groups related by their diagnosis. Actas Urol Esp 2017;41:400-8. |
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