Ben-Gurion University of the Negev, Beersheba, Israel.
University of Toronto, Toronto, Ontario, Canada.
Med Care Res Rev. 2021 Oct;78(5):511-520. doi: 10.1177/1077558720915112. Epub 2020 Apr 23.
Overuse rates in oncology are high, but areas of possible improvement exist for reducing it and improving quality of care. This study explores perceptions and experiences of oncologists in Israel regarding overuse of health services within oncology. In-depth, semistructured interviews were conducted focusing on causes of overuse, facilitators for reduction, and suggestions for improvement. Interviews were audio recorded, transcribed, coded, and thematically analyzed. Physicians reported patient-level causes including "well-informed" and "demanding" patients; physician-level causes including desire to satisfy patients, lack of confidence, time, and skills; and system-level causes like ease of access, and lack of alignment and coordination. Physicians can reduce overuse through patient dialogue, building trust and solidifying patient-physician relationships, and further reduce overuse with better teamwork. Improvements can be made through educational initiatives, and bottom-up solutions. Policy makers and decision makers should develop appropriate interventions addressing health service overuse, including improving patient education and instilling confidence and knowledge in physicians.
肿瘤学领域的过度医疗现象较为普遍,但仍存在一些可能的改进措施,可以减少过度医疗并提高医疗质量。本研究旨在探讨以色列肿瘤学家对肿瘤学领域过度使用医疗服务的看法和经验。采用深入的半结构化访谈,重点关注过度医疗的原因、减少过度医疗的促进因素以及改进建议。访谈内容进行了音频录制、转录、编码和主题分析。医生报告了患者层面的原因,包括“知情”和“要求高”的患者;医生层面的原因包括满足患者的愿望、缺乏信心、时间和技能;以及系统层面的原因,如易于获得医疗服务、缺乏一致性和协调性。医生可以通过与患者对话、建立信任和巩固医患关系来减少过度医疗,通过更好的团队合作进一步减少过度医疗。可以通过教育举措和自下而上的解决方案来进行改进。政策制定者和决策者应制定适当的干预措施来解决医疗服务过度使用的问题,包括改善患者教育和增强医生的信心和知识。