¿Por qué resulta cada vez más complicado “hacer lo que hay que hacer” y “dejar de hacer lo que no hay que hacer”? Estrategias para revertir las prácticas de bajo valor

Abstract

This manuscript describes the factors that have led to the spread of low-value practices (LVP) and the main initiatives to reverse them. The paper highlights the strategies that have proven to be most useful over the years, from the alignment of clinical practice with “do not do” recommendations, to quaternary prevention and the risks associated with interventionism. Reversing LVP requires a planned process with a multifactorial approach engaging the different actors involved. It considers the barriers to de-implementation of low-value interventions and incorporates tools that facilitate adherence to “do not do” recommendations. Family doctor has an especially relevant role in LVP prevention, detection and de-implementation, due to their coordinating and integrating nature in the patients’ healthcare, and because most of the citizens’ healthcare demands are managed and resolved at the first level of care.