Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
Stanford University School of Medicine, Stanford, CA, USA.
Am Fam Physician. 2019 Mar 15;99(6):376-382.
Underuse and overuse of medical interventions, failure to use interventions known to be effective, and provision of tests or interventions in which benefits do not exceed harms are types of low-value care. The Lown Institute's Right Care Alliance Children's Health Council identified five "do" recommendations that highlight underuse and five "don't" recommendations that highlight overuse in children's health care. The five "do" recommendations include: do provide access to long-acting reversible contraception for adolescents, do use nonpharmacologic interventions first for treatment of attention-deficit/hyperactivity disorder, do discuss quality of life for children with complex medical conditions using a shared decision-making model and access resources such as palliative care subspecialists, do promote childhood literacy development by providing free, age-appropriate books in clinical settings, and do screen for socioeconomic status of the patient and family and provide access to community health and wellness resources. The five "don't" recommendations include: don't routinely prescribe antibiotics in children two to 12 years of age with a middle ear infection, don't perform computed tomography of the head for children with minor head trauma, don't use albuterol in children with bronchiolitis, don't routinely screen for hyperlipidemia in children and adolescents, and don't routinely perform preparticipation sports evaluations. These 10 examples of underuse and overuse were identified with the intent of improving health care value and promoting "Right Care."
医疗干预措施的未充分使用和过度使用、未能使用已知有效的干预措施、以及提供收益不超过危害的测试或干预措施，这些都是低价值医疗的类型。Lown 研究所的正确护理联盟儿童健康委员会确定了五项“应该”的建议，这些建议强调了儿童保健中的未充分使用，以及五项“不应该”的建议，这些建议强调了过度使用。这五项“应该”的建议包括：为青少年提供长效可逆避孕措施、首先使用非药物干预治疗注意力缺陷/多动障碍、使用共同决策模型讨论患有复杂疾病的儿童的生活质量并利用姑息治疗专家等资源、通过在临床环境中提供免费、适合年龄的书籍来促进儿童的读写能力发展、以及筛查患者和家庭的社会经济状况并提供社区健康和健康资源。这五项“不应该”的建议包括：对于 2 至 12 岁患有中耳炎的儿童，不常规开抗生素处方、对于轻微头部创伤的儿童，不进行头部计算机断层扫描、对于患有细支气管炎的儿童，不使用沙丁胺醇、对于儿童和青少年，不常规筛查高血脂症、以及不常规进行运动前评估。这些 10 个过度使用和未充分使用的例子是为了提高医疗保健的价值并促进“正确护理”而确定的。
