Balancing overuse and underuse in the Iranian healthcare system: a force field theory analysis

BACKGROUND: Overuse and underuse of healthcare services occure within population, organizations and even patients around the world. Producing a balance between these two can increase efficiency, service quality and patient satisfaction. It also decrease extra costs. The aim of this study was to identify forces for change and forces against change for generating balance between overuse and underuse to achieve right care. METHODS: This study was conducted in five steps: 1) describe our plan or proposal for change; 2) identify forces for change; 3) identify forces against change; 4) assign forces; and 5) analyze and apply. We used purposive sampling strategy. The number of participants in the expert panel were eight. Each participant signed informed consent form before starting the study (Ethical code: IR.TBZMED.REC.1396.908). RESULTS: The driving factors for balancing overuse and underuse were education, preparing clinical guideline and standard protocols, resource allocation, using evidence-based medicine, evidence-based management and evidence-informed policy making approaches and social prescribing. The restraining factors for balancing overuse and underuse were conflict of interest issues, payment systems, paternalism and medicalization, patients and physicians' side problems and culture of consumerism in the community. The total scores for and against change were 14 and 17, respectively. CONCLUSION: It seems that the emphasis on education and training in this field is essential for physicians, patients and all people in the community. Also, making reforms in payment systems and changing the rules and regulations in this area could be major drivers

Unnecessary Overtreatment Index: a useful tool in family practice / Índice de Sobretratamento Desnecessário: uma ferramenta útil para a medicina de família / Índice de Sobretratamiento Innecesario: una herramienta útil para la medicina familiar

One of the most important aspects of quaternary prevention is avoiding the exposure of the patients to unnecessary overtreatment. In this commentary we explain how a valid and reliable double blinded randomized controlled clinical trial (RCT) with a good external validity may help a physician to estimate the magnitude of unnecessary overtreatment.