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In search of professional consensus in defining and reducing low-value care

Ian A Scott and Stephen J Duckett
Med J Aust 2015; 203 (4): 179-181. || doi: 10.5694/mja14.01664

Summary

  • Care that confers no benefit or benefit that is disproportionately low compared with its cost is of low value and potentially wastes limited resources.
  • It has been claimed that low-value care consumes at least 20% of health care resources in the United States — the comparable figure in Australia is unknown but there is emerging evidence of overuse of diagnostic tests and therapeutic procedures.
  • Very few clinical interventions are of no value in every clinical circumstance, and efforts to label interventions as being so will meet with professional resistance.
  • In the context of complex and highly individualised clinical decisions, nuanced clinical judgements of experienced and well informed clinicians are likely to outperform any service-level measurement and incentive program aimed at recognising and reducing low-value care.
  • Public policy interventions should focus on supporting clinician-led efforts to seek professional consensus on what constitutes low-value care and the best means for reducing it.

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  • Ian A Scott1
  • Stephen J Duckett3

  • 1 Princess Alexandra Hospital, Brisbane, QLD
  • 2 University of Queensland, Brisbane, QLD
  • 3 Grattan Institute, Melbourne, VIC


Competing interests:

No relevant disclosures.

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access_time 04:58, 3 September 2015
Roxanne Wu

I have been practising in vascular surgery for over 25 years, and spent much of this time exhorting patients with claudication to do as you have suggested in scenario 3. It was very hard work, and few heeded my advice until they reached a stage of being crippled or developed life threatening vascular problems.
Since the availability of minimally invasive endovascular therapy has increased, I have been surprised at how much more responsive patients have become to suggestions that their health could be improved by more exercise, less smoking and taking anti-platelet therapy to enable them to walk normally.
I suggest that your scenario is based on as little evidence as my anecdote above, and that more research is required into the comparative long term benefits of risk factor management, as compared with risk factor management IN COMBINATION WITH minimally invasive revascularisation.

Competing Interests: No relevant disclosures

Dr Roxanne Wu
Cairns Hospital

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