Medical Overuse in the Iranian Healthcare System: A Systematic Scoping Review and Practical Recommendations for Decreasing Medical Overuse During Unexpected COVID-19 Pandemic Opportunity

doi:10.2147/RMHP.S262908

. 2020 Aug 11:13:1103-1110.

doi: 10.2147/RMHP.S262908. eCollection 2020.

Medical Overuse in the Iranian Healthcare System: A Systematic Scoping Review and Practical Recommendations for Decreasing Medical Overuse During Unexpected COVID-19 Pandemic Opportunity

Mohammad Zakaria Pezeshki¹, Ali Janati², Morteza Arab-Zozani^{3

4}

Affiliations

¹ Social Determinants of Health Research Center, Department of Community and Family Medicine, Tabriz Medical School, Tabriz University of Medical Sciences, Tabriz, Iran.
² Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
³ Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran.
⁴ Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.

PMID: 32848487
PMCID: PMC7429239
DOI: 10.2147/RMHP.S262908

Medical Overuse in the Iranian Healthcare System: A Systematic Scoping Review and Practical Recommendations for Decreasing Medical Overuse During Unexpected COVID-19 Pandemic Opportunity

Mohammad Zakaria Pezeshki et al. Risk Manag Healthc Policy. 2020.

. 2020 Aug 11:13:1103-1110.

doi: 10.2147/RMHP.S262908. eCollection 2020.

Authors

Mohammad Zakaria Pezeshki¹, Ali Janati², Morteza Arab-Zozani^{3

4}

Affiliations

¹ Social Determinants of Health Research Center, Department of Community and Family Medicine, Tabriz Medical School, Tabriz University of Medical Sciences, Tabriz, Iran.
² Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
³ Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran.
⁴ Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.

PMID: 32848487
PMCID: PMC7429239
DOI: 10.2147/RMHP.S262908

Abstract

Purpose: To perform an inclusive search for original studies that report medical overuse in the Iranian healthcare system and discovering the area of overuse.

Patients and methods: A systematic search of the literature is conducted in bibliographic databases including PubMed, Embase, Scopus, Web of Sciences, Cochrane and Scientific Information Database using a comprehensive search strategy without time limit until the end of 2018, updated by 1 July 2020, accomplished by reference tracking, author contacting and expert consultation to identify studies on the overuse of medical care.

Results: We reviewed 4124 published articles based on predetermined inclusion criteria. The author's consensus included a total of 41 articles. Of these, 32 were in English and 9 in Farsi, published between 1975-2019. The result categorized into two distinct clinical areas: treatment (18 articles) and diagnostic (23 articles) services. Almost all of the studies only described the magnitude of unnecessary overuse. Unnecessary overuse of antibiotics, MRI, and CT-scan were the most reported topics. The ranges of their overuse proportion were as follows: antibiotic (31 to 97%); MRI (33 to 88%), and CT-scan (19 to 50%).

Conclusion: Our review showed, even so, the magnitude of unnecessary overuse of medical services is high but there are only a few interventional studies in clinical and administrative level for finding effective methods for decreasing these unnecessary services. Researchers should be encouraged to conducting interventional studies. We suggest the ministry of health to use the golden opportunity of COVID-19 epidemic for designing Iran national policy and action plan for controlling and preventing unnecessary healthcare services and including a section for "Interventional Research" in the action plan.

Keywords: COVID-19; Iran; healthcare system; medical overuse.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

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References

1. Arab-Zozani M, Pezeshki MZ, Khodayari-Zarnaq R, Janati A. Medical overuse in the Iranian healthcare system: a systematic review protocol. BMJ open. 2018;8(4):e020355. - PMC - PubMed
1. Brownlee S, Chalkidou K, Doust J, et al. Evidence for overuse of medical services around the world. Lancet. 2017;390(10090):156–168. - PMC - PubMed
1. Morgan DJ, Dhruva SS, Coon ER, Wright SM, Korenstein D. 2017 update on medical overuse: a systematic review. JAMA internal med. 2018;178(1):110–115. - PMC - PubMed
1. Korenstein D, Chimonas S, Barrow B, Keyhani S, Troy A, Lipitz-Snyderman A. Development of a conceptual map of negative consequences for patients of overuse of medical tests and treatments. JAMA Intern Med. 2018;178(10):1401. doi:10.1001/jamainternmed.2018.3573 - DOI - PMC - PubMed
1. Korenstein D, Falk R, Howell EA, Bishop T, Keyhani S. Overuse of health care services in the United States: an understudied problem. Arch internal med. 2012;172(2):171–178. - PubMed

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[1] Arab-Zozani M, Pezeshki MZ, Khodayari-Zarnaq R, Janati A. Medical overuse in the Iranian healthcare system: a systematic review protocol. BMJ open. 2018;8(4):e020355. - PMC - PubMed

[2] Arab-Zozani M, Pezeshki MZ, Khodayari-Zarnaq R, Janati A. Medical overuse in the Iranian healthcare system: a systematic review protocol. BMJ open. 2018;8(4):e020355. - PMC - PubMed

[3] Brownlee S, Chalkidou K, Doust J, et al. Evidence for overuse of medical services around the world. Lancet. 2017;390(10090):156–168. - PMC - PubMed

[4] Brownlee S, Chalkidou K, Doust J, et al. Evidence for overuse of medical services around the world. Lancet. 2017;390(10090):156–168. - PMC - PubMed

[5] Morgan DJ, Dhruva SS, Coon ER, Wright SM, Korenstein D. 2017 update on medical overuse: a systematic review. JAMA internal med. 2018;178(1):110–115. - PMC - PubMed

[6] Morgan DJ, Dhruva SS, Coon ER, Wright SM, Korenstein D. 2017 update on medical overuse: a systematic review. JAMA internal med. 2018;178(1):110–115. - PMC - PubMed

[7] Korenstein D, Chimonas S, Barrow B, Keyhani S, Troy A, Lipitz-Snyderman A. Development of a conceptual map of negative consequences for patients of overuse of medical tests and treatments. JAMA Intern Med. 2018;178(10):1401. doi:10.1001/jamainternmed.2018.3573 - DOI - PMC - PubMed

[8] Korenstein D, Chimonas S, Barrow B, Keyhani S, Troy A, Lipitz-Snyderman A. Development of a conceptual map of negative consequences for patients of overuse of medical tests and treatments. JAMA Intern Med. 2018;178(10):1401. doi:10.1001/jamainternmed.2018.3573 - DOI - PMC - PubMed

[9] Korenstein D, Falk R, Howell EA, Bishop T, Keyhani S. Overuse of health care services in the United States: an understudied problem. Arch internal med. 2012;172(2):171–178. - PubMed

[10] Korenstein D, Falk R, Howell EA, Bishop T, Keyhani S. Overuse of health care services in the United States: an understudied problem. Arch internal med. 2012;172(2):171–178. - PubMed

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Medical Overuse in the Iranian Healthcare System: A Systematic Scoping Review and Practical Recommendations for Decreasing Medical Overuse During Unexpected COVID-19 Pandemic Opportunity

Affiliations

Medical Overuse in the Iranian Healthcare System: A Systematic Scoping Review and Practical Recommendations for Decreasing Medical Overuse During Unexpected COVID-19 Pandemic Opportunity

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Conflict of interest statement

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