Low-value care in musculoskeletal health care: is there a way forward?

Review written by Dr Sandy Hilton info

Key Points

  1. Low-value care describes health services that have little to no benefit to patients, or where harm is greater than the probable benefit.
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BACKGROUND & OBJECTIVE

Low-value care is prevalent across all healthcare systems and all health professions. It is defined as health care that provides little to no benefit to the patient or care that carries more risk of harm than probability of benefit (1). A 2020 study showed that 60% of health services are in line with best available evidence, 30% waste/duplication/low value, and 10% is harmful (2). Unfamiliarity/lack of use of clinical practice guidelines, financial incentives, and clinical bias all play a role in the prevalence of low value care.

The authors of this paper presented the arguments for the need for behavior change in clinical decisions and in healthcare organizational policies. They presented models for the delivery of high value care and to facilitate the de-adopting of low value care including changing healthcare organizational systems to stop rewarding low value care.

Low-value care is prevalent across all healthcare systems and all health professions.
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It is our responsibility as clinicians to question the inherent biases, personal beliefs, organizational structures, and practice habits that underpin the prevalence of low-value care.

METHODS

This is not a systematic review, although there were repeated literature searches to identify recommended guidelines. The focus was on back pain, neck pain, and osteoarthritis.

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