随机实验减少过度使用医疗保健:一个范围审查
Ravi Gupta1,2, Bingrui Emily Xie3, Meng Zhu4,5
1Division of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD.
Medical care
|February 5, 2024
概括
减少低价值医疗保健需要针对患者和临床医生的行为进行干预. 这次审查发现很少有研究有效地改变了心理过程,突出了对更有针对性的行为干预措施的需求.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 行为科学 行为科学
- 医学经济学 医学经济学
背景情况:
- 医疗保健过度使用是发达医疗保健系统的一个重要问题.
- 低价值的护理有助于增加成本和潜在的较差的患者结果.
- 了解行为驱动因素是减少不必要的医疗服务的关键.
研究的目的:
- 进行旨在减少低价值护理的实验性干预措施的范围审查.
- 确定针对影响患者和临床医生的行为心理和认知过程的干预措施.
- 分析这些干预的目标和特点.
主要方法:
- 对医疗保健过度使用干预措施的实验研究进行系统搜索.
- 专注于改变认知取向和情感状态的干预措施.
- 使用行为变化框架对干预和调解过程的分类.
主要成果:
- 27项研究符合纳入标准;大多数为患者或临床医生提供了信息 (例如,成本).
- 较少的研究使用了教育干预,反,咨询,推动,说服或奖励.
- 观察到的行为变化机制包括知识获取,信心和社会规范动机.
结论:
- 很少有实验直接针对心理/认知过程,以减少低价值护理.
- 许多干预措施在不评估调解行为因素的情况下提供信息.
- 未来的研究应该优先考虑过程驱动的设计,包括行为推动和患者与临床医生关系中的说服性沟通.
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