Overuse Of Medical Services Research Articles

Assessing data gathering of chatbot based symptom checkers - a clinical vignettes study

BackgroundThe burden on healthcare systems is mounting continuously owing to population growth and aging, overuse of medical services, and the recent COVID-19 pandemic. This overload is also causing reduced healthcare quality and outcomes. One solution gaining momentum is the integration of intelligent self-assessment tools, known as symptom-checkers, into healthcare-providers’ systems. To the best of our knowledge, no study so far has investigated the data-gathering capabilities of these tools, which represent a crucial resource for simulating doctors’ skills in medical-interviews. ObjectivesThe goal of this study was to evaluate the data-gathering function of currently available chatbot symptom-checkers. MethodsWe evaluated 8 symptom-checkers using 28 clinical vignettes from the repository of MSD-Manual case studies. The mean number of predefined pertinent findings for each case was 31.8 ± 6.8. The vignettes were entered into the platforms by 3 medical students who simulated the role of the patient. For each conversation, we obtained the number of pertinent findings retrieved and the number of questions asked. We then calculated the recall-rates (pertinent-findings retrieved out of all predefined pertinent-findings), and efficiency-rates (pertinent-findings retrieved out of the number of questions asked) of data-gathering, and compared them between the platforms. ResultsThe overall recall rate for all symptom-checkers was 0.32(2,280/7,112;95 %CI 0.31–0.33) for all pertinent findings, 0.37(1,110/2,992;95 %CI 0.35–0.39) for present findings, and 0.28(1140/4120;95 %CI 0.26–0.29) for absent findings. Among the symptom-checkers, Kahun platform had the highest recall rate with 0.51(450/889;95 %CI 0.47–0.54). Out of 4,877 questions asked overall, 2,280 findings were gathered, yielding an efficiency rate of 0.46(95 %CI 0.45–0.48) across all platforms. Kahun was the most efficient tool 0.74 (95 %CI 0.70–0.77) without a statistically significant difference from Your.MD 0.69(95 %CI 0.65–0.73). ConclusionThe data-gathering performance of currently available symptom checkers is questionable. From among the tools available, Kahun demonstrated the best overall performance.

‘Low-value’ clinical care in general practice: associations of low value care in GP trainees’ practice, including formative and summative examination performance – protocol for cross-sectional and retrospective cohort study analyses using the QUestionable In Training Clinical Activities (QUIT-CA) index

Introduction‘Low value’ clinical care and overuse of medical services are ‘questionable’ clinical activities that entail provision of medical services that are more likely to cause harm than good or whose...

A study on prescribing patterns in hemodialysis and renal transplantation patients

Background Patients treated with hemodialysis and renal transplant require complex therapy regimens that manage comorbid conditions such as diabetes, hypertension, and so on; as a result, they may develop drug-related issues. Inappropriate medication usage raises the risk of drug related problems, which can manifest as excessively extended hospital stays, higher expenses, and overuse of medical services. Prescribing pattern among the patients treated with hemodialysis and renal transplantation are not well characterized previously.Objectives The objective of the study is to investigate drug prescription trends in hemodialysis patients and to study the prescribing patterns of medications in kidney transplantation patients.Materials and methods The prospective observational study was conducted over a period of 8 months, i.e. from October 2021 to June 2022 in end stage CKD patients treating with maintenance hemodialysis and renal transplant. Different classes of drugs prescribed and percentage of drugs per prescription was estimated in this study. Data were analyzed descriptively.Results 105 patients recruited have been analyzed of which 76 (72.38%) were male and 29 (27.6%) were female. Polypharmacy (use of ≥5 medications) was observed in 91.5% in hemodialysis patients and 100% in renal transplant patients.The most prescribed drugs in hemodialysis patients were Cardiovascular Drugs 72 (100%), and in renal transplant patients, immunosuppressant were highly prescribed 33 (100%).Conclusion This study concludes that the cardiovascular agents and immunosuppressant were the most common drugs prescribed among the hemodialysis and renal transplant patients respectively. polypharmacy among overall patients were observed and it may initiate drug related problems.

A Practical Framework for Understanding and Reducing Medical Overuse: Conceptualizing Overuse Through the Patient-Clinician Interaction.

Overuse of medical services is an increasingly recognized driver of poor-quality care and high cost. A practical framework is needed to guide clinical decisions and facilitate concrete actions that can reduce overuse and improve care. We used an iterative, expert-informed, evidence-based process to develop a framework for conceptualizing interventions to reduce medical overuse. Given the complexity of defining and identifying overused care in nuanced clinical situations and the need to define care appropriateness in the context of an individual patient, this framework conceptualizes the patient-clinician interaction as the nexus of decisions regarding inappropriate care. This interaction is influenced by other utilization drivers, including healthcare system factors, the practice environment, the culture of professional medicine, the culture of healthcare consumption, and individual patient and clinician factors. The variable strength of the evidence supporting these domains highlights important areas for further investigation. Journal of Hospital Medicine 2017;12:346-351.

Defensive medicine in the emergency department. The clinicians’ perspective

The overuse of medical services is regarded as a growing problem in Western countries, accounting for up to 30% of all delivered care, and carrying a higher risk of morbidity and mortality. One of the leading drivers toward medical overuse is the so-called defensive medicine, which is commonly defined as ordering of tests, procedures, and visits, or, at variance, avoidance of high-risk patients or procedures, aimed to reduce exposure to malpractice liability. Defensive medicine may increase the amount of care provided to the patients (<em>i.e.</em>, additional tests or therapies), change care or setting of care (<em>i.e.</em>, patients referred to another specialist or another healthcare facility), or impair the optimal care (<em>i.e.</em>, refusing risky patients). Some studies seem to confirm a large utilization of defensive medicine in the emergency departments. This article tries to analyze some key points capable to pave the way to a consistent reduction of defensive medicine, thus defining a hierarchical list of priorities, keeping the patient’s health always at the center of the matter.

Strategic re-design of team-based patient-focused health care services.

This paper proposes an organizational change process to prepare physicians and other health professionals for their new roles in patient-centered medical homes (PCMHs). It provides physician-centered tools, models, concepts, and the language to implement transformational patient-centered medical care. To improve care delivery, quality, and patient engagement, a systems approach to care is required. This paper examines a systems approach to patient care where all inputs that influence patient interactions and participation are considered in the design of health care delivery and follow-up treatment plans. Applying systems thinking, organizational change models, and team-building, we have examined the continuum of this change process from ideation through the diffusion of new methods and behaviors. PCMHs make compelling business sense. Studies have shown that the PCMH improves patient satisfaction, clinical outcomes and reduces underuse and overuse of medical services. Patient-centered care necessitates transitioning from an adversarial to a collaborative culture. It is a transformation process predicated on strong leadership able to align an organization toward a vision of patient-centered care, creating a collaborative culture committed to health-goal achievement. This paper proposes that the PCMH is a rigorous team-building transformational organizational change, a radical departure from the current hierarchical, silo-oriented, medical practice model. It requires that participants within and across health care organizations learn new skills and behaviors to achieve the anticipated quality and efficiency improvements. It is an innovative health care organization model of the future whose success is premised on teams supplanting the individual as the building block and unit of health care performance.

Emotional Consequences of Nuclear Power Plant Disasters

The emotional consequences of nuclear power plant disasters include depression, anxiety, post-traumatic stress disorder, and medically unexplained somatic symptoms. These effects are often long term and associated with fears about developing cancer. Research on disasters involving radiation, particularly evidence from Chernobyl, indicates that mothers of young children and cleanup workers are the highest risk groups. The emotional consequences occur independently of the actual exposure received. In contrast, studies of children raised in the shadows of the Three Mile Island (TMI) and Chernobyl accidents suggest that although their self-rated health is less satisfactory than that of their peers, their emotional, academic, and psychosocial development is comparable. The importance of the psychological impact is underscored by its chronicity and by several studies showing that poor mental health is associated with physical health conditions, early mortality, disability, and overuse of medical services. Given the established increase in mental health problems following TMI and Chernobyl, it is likely that the same pattern will occur in residents and evacuees affected by the Fukushima meltdowns. Preliminary data from Fukushima indeed suggest that workers and mothers of young children are at risk of depression, anxiety, psychosomatic, and post-traumatic symptoms both as a direct result of their fears about radiation exposure and an indirect result of societal stigma. Thus, it is important that non-mental health providers learn to recognize and manage psychological symptoms and that medical programs be designed to reduce stigma and alleviate psychological suffering by integrating psychiatric and medical treatment within the walls of their clinics.Introduction of Emotional Consequences of Nuclear Power Plant Disasters (Video 2:15, http://links.lww.com/HP/A34).

Why Lowering Health Costs Should Be A Key Adjunct To Slowing Health Spending Growth

If U.S. health care spending growth continues unchecked, the nation will have far less in the future to purchase other essentials, including education, infrastructure, and consumer goods. The point at which nonhealth spending could begin a precipitous decline was previously projected in a paper by Michael Chernew and colleagues to be 2050, unless the rate of health cost growth can be lowered (that is, "bending the curve"). This paper evaluates alternative approaches. First, it looks at the effect on health and nonhealth spending of a one-time reduction in health costs--for example, through a sharp reduction in overuse of medical services in higher-cost regions of the country. It concludes that a one-time reduction in the range of 20-35 percent would delay Chernew's projected decline in nonhealth spending by ten to twenty years. Second, it looks at the effect of combining up-front spending reductions of this size with a longer-range cut in the rate of growth of health spending from 2 percentage points to 1.5 percentage points annually. It finds that this scenario would postpone a major drop in nonhealth spending almost until the twenty-second century. The paper argues that substantial up-front reductions in health spending are therefore worth pursuing to protect the nation's long-term economic growth.

Evolución de la relación entre atención primaria y especializada 1992-2001: estudio Delphi

To evaluate the trends in the inter-professional relationship between primary health care (PHC) and secondary care (hospital) at 2 different moments of the health reform, at its start in 1992 and after a phase of consolidation (2001). Observational study based on modified Delphi technique. Valencia Community, Spain. One hundred and ninety six professionals from Valencia Community were selected (103 PH centre administrators, 43 hospital and PC medical directors, and 50 heads of internal medicine or emergency services). One hundred and ninety six questionnaires were sent out, with a response rate of 38%. In PHC problems remained the same, but the following got worse: "lack of motivation" (+1.34), "lack of overall vision of patients" (+1.10), and "overuse of medical services" (+1.06). The existence of non-integrated out-patient specialists got better (-1.32). In hospitals, "lack of overall vision of patients" got worse (+0.51), but in general problems got better, especially in "lack of communication and dialogue" (-1.14). PC increased its demand for "a single computerized clinical record" (+1.50), drawing up of common protocols (+0.86), and periodic rotations of PC doctors through hospitals (+0.85), but bureaucratic referrals to PC (-0.60) and the need for specialists in PC as consultants (-0.36) diminished. In hospitals all solutions showed lower scores, particularly access of PC doctors to monitoring of admitted patients (-2.44) and PC doctors doing hospital cover (-2.30). Problems and solutions from PHC and hospitals remain the same, but there is a trend to the worse in PHC, whereas in hospitals the trend is more positive.

Abnormal illness behavior of patients with functional somatic symptoms: relation to psychiatric disorders

Functional somatic symptoms are highly associated with hypochondriasis, anxiety, and depressive disorders. Despite the absence of an organic disorder, underlying psychological distress of patients with functional somatic symptoms may result in abnormal illness behavior such as inadequate treatment seeking or overuse of medical services. Using the Illness Behavior Questionnaire (IBQ), we examined the illness behavior of Japanese patients visiting a general medicine clinic whose physical symptoms were considered functional. We used the General Health Questionnaire-30 to classify patients with functional somatic symptoms as those with and without psychological distress. Patients with distress ( n=35) reported more physical complaints and higher IBQ scores than did patients without distress ( n=22). The IBQ profile of patients with psychological distress was identical to that of patients diagnosed with either hypochondriasis or major depression. The illness behavior of patients without psychological distress was indistinguishable from that of patients whose physical symptoms were attributed to organic disease. These results further support the hypothesis that functional somatic symptoms may be associated with hypochondriasis and major depression, the pathology of which may contribute to the development of abnormal illness behavior.