Improving Adequacy in Endocrine Practice: Reducing Low-Value Care and Advancing Value-Based Medicine

Low-value care represents a major and under-recognized threat to quality, safety, and sustainability in clinical endocrinology. This review aims to critically examine the role of overdiagnosis and overtreatment as key drivers of low-value care and to identify strategies to support the transition towards value-based endocrine practice.

We conducted a narrative review integrating current evidence on low-value care, overdiagnosis, and overtreatment in endocrinology. We also analyzed major international initiatives (e.g., Choosing Wisely, Right Care) and national programs, with particular focus on the "do not do" recommendations developed by the Spanish Society of Endocrinology and Nutrition (SEEN), as well as emerging frameworks from implementation and deimplementation science.

Low-value practices are highly prevalent in endocrinology, driven by extensive use of diagnostic testing, evolving disease definitions, and uncertainty in clinical decision-making. These factors contribute to overdiagnosis and overtreatment, often triggering diagnostic-therapeutic cascades that increase patient harm, psychological burden, and healthcare costs without improving clinically meaningful outcomes. Although "do not do" recommendations and guideline-based initiatives provide actionable tools, their impact remains limited due to clinical inertia, cultural norms favoring intervention, and systemic barriers to deimplementation.

Reducing low-value care is essential to advancing high-quality, patient-centered endocrinology. This requires not only evidence-based recommendations but also transformative changes in clinical culture, clinician behavior, and healthcare systems, ensuring that care consistently maximizes benefit while minimizing harm.