31 January 2019

A national research program conducted by the university medical centers (UMCs) has shown that it is both feasible and responsible to reduce inappropriate healthcare – because more care is not always better care. If care providers are motivated to eliminate inappropriate healthcare and patients are informed, then the quality of care can be improved and costs can be reduced by millions of euros. The measures included the reduction of inappropriate laboratory tests, drugs, urinary catheters, periodic checkups after certain forms of cancer and arthroscopy and gastroscopy procedures.

For example, by providing information, education and feedback to their patients, 26 GP practices reduced the number of blood tests for vitamin levels – which some patients request but usually do not need – by 20%. This is one of the eight projects that started in 2015 as part of the program To do or not to do? Reducing inappropriate care. More than 200 GPs and 38 hospitals and independent treatment centers across the country participated in the program.

No added value
Inappropriate care is defined as care that has no added value for the patient and is therefore unnecessarily burdensome for the patient, creates risks and entails additional costs. As a result, it can jeopardize the quality of care. The results of the program show that inappropriate care can be reduced with relatively simple measures. In addition to healthcare providers, patients play an important role in this process.
Although the measures are relatively simple, reducing inappropriate care is still challenging. Important reasons for this are the lack of cooperation between care providers, the lack of time for patient consultations, patient expectations and the difficulty of changing established routines. The results of the program indicate that hospitals and GPs can save many millions of euros by reducing inappropriate care.

Successful examples
In another project, patients who had been referred for a costly and often unnecessary gastroscopy were given an e-learning module to learn more about their stomach complaints. After completing the e-learning module, 76% of the patients decided to cancel the gastroscopy. Another example concerns urinary catheters, which are often used for an unnecessarily long period. Through feedback, training and other measures, employees from seven hospitals reduced the inappropriate use of urinary catheters by 25%. Four other hospitals realized an 11% reduction of requests for lab tests by actively giving feedback on the request behavior, training physicians and residents and modifying the systems for requesting such tests.

Final conference
The results were presented during the final conference of the program on 25 January. In the coming years, the To do or not to do? program will continue to reduce inappropriate care and increase awareness about being more cautious with some forms of care. A more active role of care providers and patients is urgently needed to bring about behavioral change. To do or not to do? is a program of the Citrienfonds. This fund is part of the NFU and ZonMw and helps to develop sustainable and widely deployable solutions in health care.

Go to the website www.doenoflaten.nl and read the full report for more information (available in Dutch only).

Responsible researchers: Simone van Dulmen, Tijn Kool and Eva Verkerk.
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