Understanding the Role of the Public in Reducing Low-value Care

Sypes, Emma Elizabeth

Understanding the Role of the Public in Reducing Low-value Care

dc.contributor.advisor	Stelfox, Henry Thomas
dc.contributor.advisor	Niven, Daniel J.
dc.contributor.author	Sypes, Emma Elizabeth
dc.contributor.committeemember	Parsons-Leigh, Jeanna
dc.contributor.committeemember	Clement, Fiona M.
dc.date	2019-11
dc.date.accessioned	2019-06-25T13:57:11Z
dc.date.available	2019-06-25T13:57:11Z
dc.date.issued	2019-06-21
dc.description.abstract	Low-value care consists of medical tests and treatments that are unnecessary, potentially harmful, or not cost-effective and contribute to rising healthcare costs, adverse events, and poor quality of care. In recent years there has been a surge in initiatives aiming to identify and reduce low-value care. However, the role of the public in reducing low-value care remains unclear. The research reported in this thesis aimed to understand the role of the public in reducing low-value care through a systematic and comprehensive review of the literature. A scoping review identified 151 relevant articles. The majority of these articles described or evaluated a strategy for involving the public in reducing low-value care; articles that explored stakeholder perspectives about the role of the public were less common. Public involvement most commonly occurred at the level of the patient-clinician interaction, followed by administrative and policy decision-making and low-value care research. Shared decision-making and patient-oriented education were the most frequent and best supported strategies. There was considerably less support for public involvement at the level of administrative and policy decision-making. A follow-up systematic review and meta-analysis was conducted to estimate the impact of patient-targeted interventions to reduce low-value care. This study found a statistically significant association between patient-targeted interventions (i.e., shared decision-making, patient-oriented education) and a decrease in use of the low-value practices (RR 0.75; 95% CI 0.66-0.84), which remained significant when the meta-analysis was restricted to randomized clinical trials with low risk of bias (RR 0.69; 95% CI 0.58-0.83). Collectively, these two studies show a considerable amount of support for engaging the public in reducing low-value care at the level of the patient-clinician interaction through strategies including shared decision-making and patient-oriented education. There is comparably less evidence to support public involvement in research or administrative and policy decision-making. Additional research to explore stakeholder perspectives and evaluate strategies for public involvement within varying contexts is required to further understand the role of the public in reducing low-value care.	en_US
dc.identifier.citation	Sypes, E. E. (2019). Understanding the Role of the Public in Reducing Low-value Care (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.	en_US
dc.identifier.doi	http://dx.doi.org/10.11575/PRISM/36657
dc.identifier.uri	http://hdl.handle.net/1880/110526
dc.language.iso	eng	en_US
dc.publisher.faculty	Cumming School of Medicine	en_US
dc.publisher.institution	University of Calgary	en
dc.rights	University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.	en_US
dc.subject.classification	Epidemiology	en_US
dc.title	Understanding the Role of the Public in Reducing Low-value Care	en_US
dc.type	master thesis	en_US
thesis.degree.discipline	Medicine – Community Health Sciences	en_US
thesis.degree.grantor	University of Calgary	en_US
thesis.degree.name	Master of Science (MSc)	en_US
ucalgary.item.requestcopy	true