Zarei Ehsan, Yousefi Iman, Shiranirad Saba, Poursaki Tahmineh, Zahmatkesh Mohamad Mehdi, Farrokhi Pouria
Department of Health Service Management, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Med J Islam Repub Iran. 2024 Jul 29;38:86. doi: 10.47176/mjiri.38.86. eCollection 2024.
Defensive medicine (DM) refers to taking or not taking clinical actions, mainly to prevent legal or reputational consequences. It increases patient and health system costs and threatens patient safety. This study aimed to provide policy options to reduce DM behaviors and was conducted in two phases.
First, a scoping review was conducted by searching the Web of Science, PubMed, ProQuest, and Scopus databases in 2000-2023, and interventions and strategies to control DM behaviors were identified. To recognize the advantages, disadvantages, and implementation considerations, one session of focus group discussion (FGD) with experts was designed. Finally, the policies, strategies, advantages, disadvantages, and implementation considerations were refined and categorized during two expert panel sessions.
During the search, 1774 articles were retrieved. Finally, after the screening process, 58 articles were included in the study. Four main policy options were formulated: "evidence-based medicine," "legal reforms," "promotion of professional ethics and a supportive environment," and "improving the doctor-patient relationship." In the following, 13 interventions and strategies, 18 advantages, 18 disadvantages, and 21 implementation considerations were identified.
To manage and reduce the effects of DM behaviors, different interventions at macro, organizational, and individual levels are needed. At the micro and individual levels, the enhancement of knowledge and skills is valuable. Organizational interventions that create a supportive culture and promote ethical behavior are also important.
防御性医疗（DM）是指采取或不采取临床行动，主要目的是防止法律或声誉方面的后果。它增加了患者和卫生系统的成本，并威胁到患者安全。本研究旨在提供减少防御性医疗行为的政策选择，并分两个阶段进行。
首先，通过检索2000年至2023年的科学引文索引、医学期刊数据库、ProQuest和Scopus数据库进行了一项范围综述，确定了控制防御性医疗行为的干预措施和策略。为了认识其优点、缺点和实施注意事项，设计了与专家进行的一轮焦点小组讨论（FGD）。最后，在两次专家小组会议期间对政策、策略、优点、缺点和实施注意事项进行了完善和分类。
在检索过程中，共检索到1774篇文章。最后，经过筛选过程，58篇文章被纳入研究。制定了四个主要政策选择：“循证医学”、“法律改革”、“促进职业道德和支持性环境”以及“改善医患关系”。随后，确定了13项干预措施和策略、18项优点、18项缺点和21项实施注意事项。
为了管理和减少防御性医疗行为的影响，需要在宏观、组织和个人层面采取不同的干预措施。在微观和个人层面，增强知识和技能很有价值。营造支持性文化并促进道德行为的组织干预也很重要。
