An Investigation of the Factors Reducing the Use of Hospital Services: A Systematic Review

Hospital service utilization has declined in many health systems due to policy shifts, limited resources, and alternative care approaches. This study aimed to systematically review the factors contributing to a reduction in the use or volume of hospital services.

In this systematic review, articles published from 2018 to 2023 were reviewed by searching relevant keywords based on the PRISMA guidelines. The systematic search was conducted using English-language texts related to the research question, "What are the factors reducing hospital services?" and electronic databases such as PubMed, Scopus, Science Direct, ProQuest, and Web of Science. The CASP checklist was used to evaluate the methodological quality of the included studies. Two researchers performed all the stages; finally, the selected articles were summarized in tables.

The database search yielded a total of 3705 articles, of which 30 were included in the review. The results of extracting the findings from the articles indicated four main concepts of factors reducing hospital services: "therapeutic factors," "administrative-support factors," "preventive factors," and "technological factors." The studies assessed the impact of medications, treatment pathways, guidelines and standards, and treatment methods as effective therapeutic factors. Regulations were considered administrative or support factors, while health measures to control the spread of COVID-19 and various vaccines were shown as preventive factors. Additionally, remote care and the use of new tools were categorized as technological factors influencing the reduction of hospital services.

Therapeutic factors such as medications, managerial factors like regulations, preventive factors like vaccines, and factors related to new tools such as artificial intelligence were shown to be among the factors which reduce the use of hospital services. Therefore, if the focus on reducing services is hospital-centered, these factors should be considered in policy-making related to health service delivery.