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Identifying and prioritizing do-not-do recommendations in Dutch primary care.

Simone A van Dulmen1, Ngoc Hue Tran2, Tjerk Wiersma3

  • 1Radboud university medical center, Radboud Institute for Health Science, IQ healthcare, PO Box 9101 (160), 6500 HB, Nijmegen, the Netherlands. Simone.vandulmen@radboudumc.nl.

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|June 6, 2022
PubMed
Summary

This study identified 30 high-priority "do-not-do" recommendations for general practitioners to reduce low-value care. These evidence-based guidelines help minimize patient harm and optimize healthcare resource allocation.

Keywords:
Clinical guidelinesDe-implementationFamily practiceGeneral practitionersLow-value careNetherlandsPrimary health care

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Area of Science:

  • Primary Care Medicine
  • Health Services Research
  • Clinical Guideline Development

Background:

  • Low-value care offers minimal patient benefit, wastes resources, and can cause harm.
  • Explicit "do-not-do" recommendations are crucial for reducing low-value care.
  • General practice guidelines contain numerous "do-not-do" recommendations.

Purpose of the Study:

  • To identify and prioritize "do-not-do" recommendations in general practice guidelines for implementation.
  • To inform general practitioners (GPs) about high-priority interventions to avoid.

Main Methods:

  • A mixed-method design was employed in Dutch primary care.
  • Systematic assessment of 92 Dutch general practice guidelines identified 385 "do-not-do" recommendations.
  • An online survey of 440 GPs prioritized recommendations based on condition prevalence, low-value care, potential harm, and cost reduction.

Main Results:

  • 30 high-priority "do-not-do" recommendations were identified.
  • These recommendations cover drug treatments (12), diagnostics (10), referrals (5), and non-drug treatments (3).

Conclusions:

  • Dutch clinical guidelines contain many "do-not-do" recommendations highly relevant to GPs.
  • The prioritized list of 30 recommendations can raise awareness and guide strategies to reduce low-value care.
  • International evidence supports these recommendations, enabling global validation and implementation by healthcare professionals and policymakers.