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Barriers and facilitators to reduce low-value care: a qualitative evidence synthesis.

ABSTRACT: OBJECTIVE:To assess barriers and facilitators to de-implementation. DESIGN:A qualitative evidence synthesis with a framework analysis. DATA SOURCES:Medline, Embase, Cochrane Library and Rx for Change databases until September 2018 were searched. ELIGIBILITY CRITERIA:We included studies that primarily focused on identifying factors influencing de-implementation or the continuation of low-value care, and studies describing influencing factors related to the effect of a de-implementation strategy. DATA EXTRACTION AND SYNTHESIS:The factors were classified on five levels: individual provider, individual patient, social context, organisational context, economic/political context. RESULTS:We identified 333 factors in 81 articles. Factors related to the individual provider (n=131; 74% barriers, 17% facilitators, 9% both barrier/facilitator) were associated with their attitude (n=72; 55%), knowledge/skills (n=43; 33%), behaviour (n=11; 8%) and provider characteristics (n=5; 4%). Individual patient factors (n=58; 72% barriers, 9% facilitators, 19% both barrier/facilitator) were mainly related to knowledge (n=33; 56%) and attitude (n=13; 22%). Factors related to the social context (n=46; 41% barriers, 48% facilitators, 11% both barrier/facilitator) included mainly professional teams (n=23; 50%) and professional development (n=12; 26%). Frequent factors in the organisational context (n=67; 67% barriers, 25% facilitators, 8% both barrier/facilitator) were available resources (n=28; 41%) and organisational structures and work routines (n=24; 36%). Under the category of economic and political context (n=31; 71% barriers, 13% facilitators, 16% both barrier/facilitator), financial incentives were most common (n=27; 87%). CONCLUSIONS:This study provides in-depth insight into the factors within the different (sub)categories that are important in reducing low-value care. This can be used to identify barriers and facilitators in low-value care practices or to stimulate development of strategies that need further refinement. We conclude that multifaceted de-implementation strategies are often necessary for effective reduction of low-value care. Situation-specific knowledge of impeding or facilitating factors across all levels is important for designing tailored de-implementation strategies.

SUBMITTER: van Dulmen SA

PROVIDER: S-EPMC7604848 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Barriers and facilitators to reduce low-value care: a qualitative evidence synthesis.

van Dulmen S A SA Naaktgeboren C A CA Heus Pauline P Verkerk Eva W EW Weenink J J Kool Rudolf Bertijn RB Hooft Lotty L

BMJ open 20201030 10

<h4>Objective</h4>To assess barriers and facilitators to de-implementation.<h4>Design</h4>A qualitative evidence synthesis with a framework analysis.<h4>Data sources</h4>Medline, Embase, Cochrane Library and Rx for Change databases until September 2018 were searched.<h4>Eligibility criteria</h4>We included studies that primarily focused on identifying factors influencing de-implementation or the continuation of low-value care, and studies describing influencing factors related to the effect of a ...[more]

PMID: 33127636

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Project description:BackgroundAdverse perinatal health outcomes are notably high among African-born women living in Australia. This problem is partly attributed to their lower engagement in maternity care services as compared to Australian-born women. Various barriers might limit African-born women's access to and use of services; however, these barriers are not well documented. Therefore, this review aimed to synthesise current qualitative evidence on barriers and facilitators of access to maternity care for African-born women living in Australia.MethodsThe search was conducted in MEDLINE, CINAHL, Embase, PsychInfo, and Maternity and Infant Care databases on 16 April 2023. All articles retrieved were meticulously screened for eligibility by two independent reviewers with any disagreements resolved through discussion. The quality of the included articles was evaluated using the Mixed Methods Appraisal Tool. Studies were screened in Covidence and analysed in NVivo. The findings were organised and presented using Levesque's framework of healthcare access.ResultsOut of 558 identified papers, 11 studies comprising a total of 472 participants met the eligibility criteria. The review highlighted provider-side barriers such as shortage of information, unmet cultural needs, long waiting times, low engagement of women in care, discrimination, and lack of continuity of care. User-side barriers identified include communication issues, difficulty navigating the health system, and lack of trustful relationships with healthcare providers. In contrast, the review pinpointed provider-side facilitators including positive staff attitudes, service availability, and the proximity of facilities to residential homes, while user-side facilitators such as cultural assimilation and feeling valued by healthcare providers were noted.ConclusionsThis review identified barriers and facilitators of access to maternity care for African-born women living in Australia. Empirical evidence that would inform potential changes to policy and practice to address African-born women's unique health needs was highlighted. Designing and implementing a culturally safe service delivery model could remove the identified access barriers and improve African-born women's engagement in maternity care. Moreover, reinforcing factors associated with positive healthcare experiences is essential for improving maternity care access for this priority population.Systematic review registrationPROSPERO CRD42023405458.

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Barriers and facilitators to reduce low-value care: a qualitative evidence synthesis.

Publications

Barriers and facilitators to reduce low-value care: a qualitative evidence synthesis.

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