Coinvolgere i clinici per identificare e dare priorità alle opportunità di disinvestimento nel trattamento delle malattie neurodegenerative: uno studio qualitativo

Translated title of the contribution: Engaging clinicians to identify and prioritize disinvestment opportunities in the treatment of neurodegenerative diseases: a qualitative study.

Anna Ciannameo, Antonio Chiarenza, Graziella Filippini, Roberto D'Amico, Roberto Grilli

Research output: Contribution to journalArticlepeer-review

Abstract

INTRODUCTION: The overuse of health care interventions is a problem which has clinical and economic implications. On a clinical level this means that ineffective interventions or effective interventions in inappropriate clinical indications are used. On an economic level it refers to allocative inefficiency which implies that these resources could possibly be used for interventions of major clinical utility. The contribution of health professionals in the context of reallocation disinvestment policies is still little investigated. This study involved 25 neurologists in the process of identifying low value interventions in the management of stroke, dementia, Parkinson's disease, amyotrophic lateral sclerosis and multiple sclerosis.

METHODS: The Nominal Group Technique was applied in the context of 5 Focus Groups (FG) in order to reach a consensus to identify and prioritize disinvestment opportunities in the treatment of the 5 neurodegenerative diseases. Qualitative data were coded, categorised, and analysed, applying the six-phase approach to thematic analysis, with the support of Atlas Ti7.

RESULTS: Within 5 categories of "low value intervention", 25 clinical interventions were identified: 6 pharmacological, 16 diagnostic, 3 clinical-therapeutic. FG findings describe: how clinicians view the issue of disinvestment, both in absolute and relative terms; the factors which contribute to the use of low-value interventions; the explicit link between the disinvestment process and the reallocation of resources.

DISCUSSION: This study revealed that factors that hinder the disinvestment of inappropriate practices involve elements that are not only technical or clinical, but also relational and care-related contexts.

Translated title of the contributionEngaging clinicians to identify and prioritize disinvestment opportunities in the treatment of neurodegenerative diseases: a qualitative study.
Original languageItalian
Pages (from-to)503-514
Number of pages12
JournalRecenti Progressi in Medicina
Volume111
Issue number9
DOIs
Publication statusPublished - Sep 2020

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