RT Journal Article
T1 Prioritization of non-recommended clinical activities in Primary Care
A1 Garcia Mochon, L.
A1 de Labry Lima, A. Olry
A1 Bermudez Tamayo, C.
K1 "Do not do" recommendations
K1 Disinvestment
K1 Resource allocation
K1 Primary Care
K1 Health
K1 Guidelines
K1 Physicians
K1 Overuse
K1 Consumers
K1 Providers
K1 Barriers
AB Background: To prioritize non-recommended clinical activities in Primary Care (PC), from "Do not do" recommendations listed by the Sociedad Espanola de Medicina de Familia y Comunitaria (Semfyc), according to expert consensus (physicians, nurses and pharmacists).Methods. The consensus for the prioritization of non-recommended practices in PC was performed through an online procedure. We used as a base the list of "do not-do" recommendations of the SEMFYC. We asked the experts to prioritize practices that should be de-adopted in PC, based on four prioritization criteria: frequency of occurrence, cost of the activity, ease of disposal and damage caused, which were scored from one to five, according to their recommendation. Scores were summarized in median and quartile values. Two rounds were necessary to obtain a consensus. A modified e-Delphi technique was used.Results. 34 experts (62%) participated in the first consultation round and prioritized 19 recommendations with a score >= 3.5. These recommendations were again analyzed in a second round, in which 32 panelists agreed to prioritize 17 practices (13 related to prescription, three diagnostic tests, and one clinical analysis). The high priority list included seven practices with values >= 4.1) Prescription of a new drug in elderly patients without having reviewed the previous treatments; 2) Lipid-lowering drugs without calculating the overall cardiovascular risk; 3) Not systematically prescribing gastric protection with proton pump inhibitors to patients consuming Nonsteroidal anti-inflammatory drugs (NSAIDs); 4) Glucose self-analysis in non-insulinized type 2 diabetics; 5) Benzodiazepines in the long term; 6) Bisphosphonates in patients with low risk of fracture; and 7) Antibiotics in lower respiratory tract infections.Conclusion. This study provides information for the prioritization of 17 non-AP activities in which short-term de-adoption would significantly increase the efficiency of the public health system.
PB Gobierno de navarra
SN 1137-6627
YR 2017
FD 2017-09-01
LK http://hdl.handle.net/10668/19488
UL http://hdl.handle.net/10668/19488
LA es
DS RISalud
RD Apr 8, 2025