Epidemiological study on gender bias and low-value practices in primary care: a study protocol.
Ontology highlight
ABSTRACT: Introduction
Evidence shows that gender has a substantial impact on health behaviours, access to and use of health systems and health system responses. This study aims to assess gender bias in patients subjected to low-value practices in the primary care setting and to develop recommendations for reducing adverse events that women experience for this reason.Methods and analysis
A Delphi study will be performed to reach a consensus on the 'Do Not Do' recommendations with a possible gender bias. A retrospective cohort study in a random selection of medical records will then be carried out to identify the frequency of adverse events that occur when the selected 'Do Not Do' recommendations are ignored. Qualitative research techniques (consensus conference and nominal group) will be carried out to develop recommendations to address any gender bias detected, considering barriers and facilitators in clinical practice.Ethics and dissemination
The study was approved by the ethics committee of San Juan de Alicante Hospital (San Juan de Alicante, Spain) Reference N. 21/061. We will disseminate the research findings via peer-reviewed articles, presentations at national and international scientific forums and webinars.Trial registration number
The study was registered at ClinicalTrials.gov (NCT05233852) on 10 February 2022.
SUBMITTER: Carrillo I
PROVIDER: S-EPMC10174026 | biostudies-literature | 2023 May
REPOSITORIES: biostudies-literature
Publications
Epidemiological study on gender bias and low-value practices in primary care: a study protocol.
Carrillo Irene I Lopez-Pineda Adriana A Pérez-Jover Virtudes V Guilabert Mercedes M Vicente María Asunción MA Fernández César C Gil-Guillen Vicente F VF Orozco-Bletrán Domingo D Chilet-Rosell Elisa E Luzon Oliver Lourdes L Astier-Peña Maria Pilar MP Tella Susanna S Carratalá-Munuera Concepción C Mira José Joaquín JJ
BMJ open 20230509 5
<h4>Introduction</h4>Evidence shows that gender has a substantial impact on health behaviours, access to and use of health systems and health system responses. This study aims to assess gender bias in patients subjected to low-value practices in the primary care setting and to develop recommendations for reducing adverse events that women experience for this reason.<h4>Methods and analysis</h4>A Delphi study will be performed to reach a consensus on the 'Do Not Do' recommendations with a possibl ...[more]
Similar Datasets
Project description:IntroductionPreventable injuries lead to 200 000 hospital stays, 60 000 disabilities, and 13 000 deaths per year in Canada with direct costs of $20 billion. Overall, potentially unnecessary medical interventions are estimated to consume up to 30% of healthcare resources and may expose patients to avoidable harm. However, little is known about overuse for acute injury care. We aim to identify low-value clinical practices in injury care.Methods and analysisWe will perform a scoping review of peer-reviewed and non-peer-reviewed literature to identify research articles, reviews, recommendations and guidelines that identify at least one low-value clinical practice specific to injury populations. We will search Medline, EMBASE, COCHRANE central, and BIOSIS/Web of Knowledge databases, websites of government agencies, professional societies and patient advocacy organisations, thesis holdings and conference proceedings. Pairs of independent reviewers will evaluate studies for eligibility and extract data from included articles using a prepiloted and standardised electronic data abstraction form. Low-value clinical practices will be categorised using an extension of the Agency for Healthcare Research and Quality conceptual framework and data will be presented using narrative synthesis.Ethics and disseminationEthics approval is not required as original data will not be collected. This study will be disseminated in a peer-reviewed journal, international scientific meetings, and to knowledge users through clinical and healthcare quality associations. This review will contribute new knowledge on low-value clinical practices in acute injury care. Our results will support the development indicators to measure resource overuse and inform policy makers on potential targets for deadoption in injury care.
| S-EPMC5726053 | biostudies-literature
Project description:BackgroundPreventive and curative medical interventions can reduce child mortality. It is important to assess whether there is gender bias in access to these interventions, which can lead to preferential treatment of children of a given sex.MethodsData from Demographic and Health Surveys carried out in 57 low- and middle-income countries were used. The outcome variable was a composite careseeking indicator, which represents the proportion of children with common childhood symptoms or illnesses (diarrhea, fever, or suspected pneumonia) who were taken to an appropriate provider. Results were stratified by sex at the national level and within each wealth quintile. Ecological analyses were carried out to assess if sex ratios varied by world region, religion, national income and its distribution, and gender inequality indices. Linear multilevel regression models were used to estimate time trends in careseeking by sex between 1994 and 2014.FindingsEight out of 57 countries showed significant differences in careseeking; in six countries, girls were less likely to receive care (Colombia, Egypt, India, Liberia, Senegal and Yemen). Seven countries had significant interactions between sex and wealth quintile, but the patterns varied from country to country. In the ecological analyses, lower careseeking for girls tended to be more common in countries with higher income concentration (P = 0.039) and higher Muslim population (P = 0.006). Coverage increased for both sexes; 0.95 percent points (pp) a year among girls (32.9% to 51.9%), and 0.91 pp (34.8% to 52.9%) among boys.ConclusionThe overall frequency of careseeking is similar for girls and boys, but not in all countries, where there is evidence of gender bias. A gender perspective should be an integral part of monitoring, accountability and programming. Countries where bias is present need renewed attention by national and international initiatives, in order to ensure that girls receive adequate care and protection.
| S-EPMC5460396 | biostudies-literature
Project description:IntroductionOveruse of medical services is a challenge worldwide, posing a threat to the quality of care, patient safety and the sustainability of healthcare systems. Some data suggest that females receive more low-value practices (LVPs)-defined as medical interventions that provide little or no benefit to patients and can even cause harm-than males. This study aims to evaluate and compare the occurrence of LVPs in primary care among both males and females.DesignA retrospective study was conducted.SettingPrimary care in the Alicante province (Spain) during 2022.ParticipantsData were extracted from the digital medical records of 978 936 patients attended by 1125 family physicians across 262 primary healthcare centres in the Alicante province.Outcome measuresData on age, sex, diagnosis and treatment were extracted. The primary outcome measure was the frequency of 12 selected LVPs prescribed to male and female patients. These LVPs were expected to be relatively frequent occurrences with the potential to cause harm.ResultsA total of 45 955 LVPs were identified, of which 28 148 (5.27% of 534 603, CI95% 5.20-5.32) were prescribed to female patients and 17 807 (4.00% of 444 333, CI95% 3.95-4.06) to male patients (x², p value <0.0001). The most common LVPs were prescribing treatment for overactive bladder without excluding other pathologies that may cause similar symptoms (30.87%), using hypnotics without having a previous aetiological diagnosis in patients with difficulty maintaining sleep (14%) and recommending analgesics (NSAIDs, paracetamol and others) for more than 15 days per month in primary headaches that do not respond to treatment (13.33%).ConclusionsFuture clinical training, management and research must consider biological differences or those based on gender factors when analysing the frequency and causes of LVP.Trial registration numberNCT05233852.
| S-EPMC11590792 | biostudies-literature
Project description:ImportanceReducing low-value care has the potential to improve patient experiences and outcomes and decrease the unnecessary use of health care resources. Research suggests that low-value practices (ie, the potential for harm exceeds the potential for benefit) in adult trauma care are frequent and subject to interhospital variation; evidence on low-value practices in pediatric trauma care is lacking.ObjectiveTo estimate the incidence of low-value practices in pediatric trauma care and evaluate interhospital practice variation.Design, setting, and participantsA retrospective multicenter cohort study in a Canadian provincial trauma system was conducted. Children younger than 16 years admitted to any of the 59 provincial trauma centers from April 1, 2016, to March 31, 2022, were included.Main outcomes and measuresLow-value practices were identified from systematic reviews of clinical practice guidelines on pediatric trauma. The frequencies of low-value practices were evaluated by estimating incidence proportions and cases per 1000 admissions (low if ≤10% and ≤10 cases, moderate if >10% or >10 cases, and high if >10% and >10 cases) were identified. Interhospital variation with intraclass correlation coefficients (ICCs) were assessed (low if <5%, moderate if 5%-20%, and high if >20%).ResultsA total of 10 711 children were included (mean [SD] age, 7.4 [4.9] years; 6645 [62%] boys). Nineteen low-value practices on imaging, fluid resuscitation, hospital/intensive care unit admission, specialist consultation, deep vein thrombosis prophylaxis, and surgical management of solid organ injuries were identified. Of these, 14 (74%) could be evaluated using trauma registry data. Five practices had moderate to high frequencies and interhospital variation: head computed tomography in low-risk children (7.1%; 33 per 1000 admissions; ICC, 8.6%), pretransfer computed tomography in children with a clear indication for transfer (67.6%; 4 per 1000 admissions; ICC, 5.7%), neurosurgical consultation in children without clinically important intracranial lesions (11.6%; 13 per 1000 admissions; ICC, 15.8%), hospital admission in isolated mild traumatic brain injury (38.8%; 98 per 1000 admissions; ICC, 12.4%), and hospital admission in isolated minor blunt abdominal trauma (10%; 5 per 1000 admissions; ICC, 31%).Conclusions and relevanceIn this cohort study, low-value practices appeared to be frequent and subject to interhospital variation. These practices may represent priority targets for deimplementation interventions, particularly as they can be measured using routinely collected data.
| S-EPMC11522939 | biostudies-literature
Project description:BackgroundA diagnosis of depression is common in primary care practices, but data are lacking on the prevalence in Canadian practices. We describe the prevalence of the diagnosis among men and women, patient characteristics and drug treatment in patients diagnosed with depression in the primary care setting in Canada.MethodsUsing electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network, we examined whether the prevalence of a depression diagnosis varied by patient characteristics, the number of chronic conditions and the presence of the following chronic conditions: hypertension, diabetes, chronic obstructive pulmonary disease, osteoarthritis, dementia, epilepsy and parkinsonism. We used regression models to examine whether patient characteristics and type of comorbidity were associated with a depression diagnosis.ResultsOf the 304 412 patients who had at least 1 encounter with their primary care provider between Jan. 1, 2011, and Dec. 31, 2012, 14% had a diagnosis of depression. Current or past smokers and women with a high body mass index had higher rates of depression. One in 4 patients with a diagnosis of depression also had another chronic condition; those with depression had 1.5 times more primary care visits. About 85% of patients with depression were prescribed medication, most frequently selective serotonin reuptake inhibitors, followed by atypical antipsychotics.InterpretationOur data provide information on the prevalence of a depression diagnosis in primary care and associations with being female, having a chronic condition, smoking history and obesity in women. Our findings may inform research and assist primary care providers with early detection and interventions in at-risk patient populations.
| S-EPMC4251512 | biostudies-literature
Project description:BackgroundA large number of practices used in health care lack evidence of effectiveness and may be unnecessary or even cause harm. As such, they should be de-implemented. While there are multiple actors involved in de-implementation of such low-value care (LVC) practices, ultimately, the decision to abandon a practice is often made by each health care professional. A recent scoping review identified 6 types of factors affecting the utilization vs. abandonment of LVC practices. These factors concern health care professionals, patients, outer context, inner context, processes, and the characteristics of LVC practice itself. However, it is unclear how professionals weigh these different factors in and how these determinants influence their decisions about abandoning LVC practices. This project aims to investigate how health care professionals account for various factors as they make decisions regarding de-implementation of LVC practices.MethodsThis project will be carried out in two main steps. First, a factorial survey experiment (a vignette study) will be applied to empirically test the relevance of factors previously identified in the literature for health care professionals' decision-making about de-implementation. Second, interactive workshops with relevant stakeholders will be carried out to develop a framework for professionals' decision-making and to offer suggestions for interventions to support de-implementation of LVC practices.DiscussionThe project has the potential to contribute to improved understanding of the decision-making involved in de-implementation of LVC practices. We will identify which factors are more important when they make judgments about utilizing versus abandoning LVC practices. The results will provide the basis for recommendations concerning appropriate interventions to support de-implementation decision-making processes.
| S-EPMC8136038 | biostudies-literature
Project description:OBJECTIVE:To compare and contrast illustrative examples of the adoption of high value practices and the de-adoption of low value practices. DESIGN:(1) Retrospective, population-based audit of low molecular weight heparin (LMWH) for venous thromboembolism (VTE) prophylaxis (high value practice) and albumin for fluid resuscitation (low value practice) and (2) cross-sectional survey of healthcare providers. SETTING:Data were collected from nine adult medical-surgical intensive care units (ICUs) in two large Canadian cities. Patients are managed in these ICUs by a group of multiprofessional and multidisciplinary healthcare providers. PARTICIPANTS:Participants included 6946 ICU admissions and 309 healthcare providers from the same ICUs. MAIN OUTCOME MEASURES:(1) The use of LMWH for VTE prophylaxis (per cent ICU days) and albumin for fluid resuscitation (per cent of patients); and (2) provider knowledge of evidence underpinning these practices, and barriers and facilitators to adopt and de-adopt these practices. RESULTS:LMWH was administered on 38.7% of ICU days, and 20.0% of patients received albumin.Most participants had knowledge of evidence underpinning VTE prophylaxis and fluid resuscitation (59.1% and 84.2%, respectively). Providers perceived these practices to be followed. The most commonly reported barrier to adoption was insufficient knowledge/understanding (32.8%), and to de-adoption was clinical leader preferences (33.2%). On-site education was the most commonly identified facilitator for adoption and de-adoption (67.8% and 68.6%, respectively). CONCLUSIONS:Despite knowledge of and self-reported adherence to best practices, the audit demonstrated opportunity to improve. Provider-reported barriers and facilitators to adoption and de-adoption are broadly similar.
| S-EPMC6429967 | biostudies-literature
Project description:ImportanceThe use of quality indicators has been shown to improve injury care processes and outcomes. However, trauma quality indicators proposed to date exclusively target the underuse of recommended practices. Initiatives such as Choosing Wisely publish lists of practices to be questioned, but few apply to trauma care, and most have not successfully been translated to quality indicators.ObjectiveTo develop a set of evidence and patient-informed, consensus-based quality indicators targeting reductions in low-value clinical practices in acute, in-hospital trauma care.Design, setting, and participantsThis 2-round Research and Development/University of California at Los Angeles (RAND/UCLA) consensus study, conducted from April 20 to June 9, 2021, comprised an online questionnaire and a virtual workshop led by 2 independent moderators. Two panels of international experts from Canada, Australia, the US, and the UK, and local stakeholders from Québec, Canada, represented key clinical expertise involved in trauma care and included 3 patient partners.Main outcomes and measuresPanelists were asked to rate 50 practices on a 7-point Likert scale according to 4 quality indicator criteria: importance, supporting evidence, actionability, and measurability.ResultsOf 49 eligible experts approached, 46 (94%; 18 experts [39%] aged ≥50 years; 37 men [80%]) completed at least 1 round and 36 (73%) completed both rounds. Eleven quality indicators were selected overall, 2 more were selected by the international panel and a further 3 by the local stakeholder panel. Selected indicators targeted low-value clinical practices in the following aspects of trauma care: (1) initial diagnostic imaging (head, cervical spine, ankle, and pelvis), (2) repeated diagnostic imaging (posttransfer computed tomography [CT] and repeated head CT), (3) consultation (neurosurgical and spine), (4) surgery (penetrating neck injury), (5) blood product administration, (6) medication (antibiotic prophylaxis and late seizure prophylaxis), (7) trauma service admission (blunt abdominal trauma), (8) intensive care unit admission (mild complicated traumatic brain injury), and (9) routine blood work (minor orthopedic surgery).Conclusions and relevanceIn this consensus study, a set of consensus-based quality indicators were developed that were informed by the best available evidence and patient priorities, targeting low-value trauma care. Selected indicators represented a trauma-specific list of practices, the use of which should be questioned. Trauma quality programs in high-income countries may use these study results as a basis to select context-specific quality indicators to measure and reduce low-value care.
| S-EPMC9047751 | biostudies-literature
Project description:IntroductionThe challenge of implementing best evidence into clinical practice is a major problem in modern healthcare that can result in ineffective, inefficient and unsafe care. There is a growing body of literature which suggests that the removal or reduction of low-value care practices (ie, deadoption) is integral to the delivery of high-quality care and the sustainability of our healthcare system. However, currently very little is known about deadoption practices in Canada. We propose to map the current state of deadoption in Canadian intensive care units (ICUs). A key deliverable of this work will include development of an inventory of barriers, facilitators and potential implementation strategies for guiding the deadoption efforts.Methods and analysisWe will use Canadian adult general systems ICUs as our laboratory of investigation and employ a two-phased sequential exploratory mixed-methods approach: (1) semi-structured interviews with critical care stakeholders to develop an understanding of the structure (ie, healthcare context), process (ie, actions and events in healthcare) and outcomes (ie, effects on health status, quality, knowledge or behaviour) of deadoption (phase I) and (2) surveys with a broader sample of critical care stakeholders to further identify important barriers and facilitators, as well as potential implementation strategies (phase II). Interview data will be analysed through qualitative content analysis and survey data will be analysed through quantitative analyses to identify top barriers and facilitators, as well as top rated strategies.Ethics and disseminationEthical approval has been obtained through the University of Calgary Research Ethics Board (REB 17-2153). Participants involved will have the opportunity to provide feedback on the final written reports to support accurate representation of the data. The findings of this study will be disseminated through peer-reviewed publications and oral presentations with critical care stakeholders across Canada. Patient and family partners will receive an executive summary of the findings.
| S-EPMC6937030 | biostudies-literature
Project description:ImportanceThe rapid expansion of telehealth transformed how primary care practices deliver care; however, uncertainties about the quality of telehealth-delivered care compared with in-person care remain. While there are concerns that increased telehealth may introduce wasteful care, how telehealth affects the delivery of low-value care is unknown.ObjectiveTo examine whether a primary care practice's level of telehealth use is associated with changes in the rates of low-value care.Design, setting, and participantsThis retrospective cohort study using a difference-in-differences study design was conducted from January 1, 2019, to December 31, 2022, using Medicare fee-for-service claims data. Participants were Medicare beneficiaries attributed to primary care practices in Michigan.ExposuresLow, medium, or high tertile of practice-level telehealth use.Main outcomes and measuresLow-value care was assessed using 8 claims-based measures relevant to primary care, grouped into 4 main categories: office-based, laboratory-based, imaging-based, and mixed-modality services. Poisson regression models were used to estimate the association between practice-level telehealth use and rates of low-value care services, controlling for practice-level characteristics.ResultsA total of 577 928 beneficiaries (332 100 [57%] women; mean [SD] age, 76 [8] years) attributed to 2552 primary care practices were included in the study. After adjusting for practice-level characteristics and baseline differences in low-value care rates between telehealth use groups, high practice-level telehealth use was associated with lower rates of low-value cervical cancer screening (-2.9 [95% CI, -5.3 to -0.4] services per 1000 beneficiaries) and lower rates of low-value thyroid testing (-40 [95% CI, -70 to -9] tests per 1000 beneficiaries) compared with low practice-level telehealth use. Of the other 6 outcomes examined, there was no association between practice-level telehealth use and rates of low-value care services.Conclusions and relevanceIn this cohort study of Medicare fee-for-service beneficiaries who received care from primary care practices in Michigan, some low-value care services (ie, cervical cancer screening among women older than 65 years and low-value thyroid testing) were lower among practices with high telehealth use, and there was no association between practice-level telehealth use in rates of most other low-value care services not delivered in the office. As telehealth continues to be an important part of care delivery, evaluating how it may encourage or discourage low-value care services is critical to understanding its impact on quality of care.
| S-EPMC11544489 | biostudies-literature