Reporting of costs and economic impacts in randomized trials of de-implementation interventions for low-value care: a systematic scoping review.

BACKGROUND: De-implementation of low-value care can increase health care sustainability. We evaluated the reporting of direct costs of de-implementation and subsequent change (increase or decrease) in health care costs in randomized trials of de-implementation research. METHODS: We searched MEDLINE and Scopus databases without any language restrictions up to May 2021. We conducted study screening and data extraction independently and in duplicate. We extracted information related to study characteristics, types and characteristics of interventions, de-implementation costs, and impacts on health care costs. We assessed risk of bias using a modified Cochrane risk-of-bias tool. RESULTS: We screened 10,733 articles, with 227 studies meeting the inclusion criteria, of which 50 included information on direct cost of de-implementation or impact of de-implementation on health care costs. Studies were mostly conducted in North America (36%) or Europe (32%) and in the primary care context (70%). The most common practice of interest was reduction in the use of antibiotics or other medications (74%). Most studies used education strategies (meetings, materials) (64%). Studies used either a single strategy (52%) or were multifaceted (48%). Of the 227 eligible studies, 18 (8%) reported on direct costs of the used de-implementation strategy; of which, 13 reported total costs, and 12 reported per unit costs (7 reported both). The costs of de-implementation strategies varied considerably. Of the 227 eligible studies, 43 (19%) reported on impact of de-implementation on health care costs. Health care costs decreased in 27 studies (63%), increased in 2 (5%), and were unchanged in 14 (33%). CONCLUSION: De-implementation randomized controlled trials typically did not report direct costs of the de-implementation strategies (92%) or the impacts of de-implementation on health care costs (81%). Lack of cost information may limit the value of de-implementation trials to decision-makers. TRIAL REGISTRATION: OSF (Open Science Framework): https://osf.io/ueq32 .

Salud intercultural y el modelo de salud propio indígena / Intercultural health and the indigenous health model

RESUMEN La población indígena tiene condiciones de vida inferiores al resto, reflejadas en mayor morbilidad y mortalidad a pesar de la cobertura del Sistema de Salud. Por ello, es importante conocer las causas de estas diferencias. Para esto, se hace uso de la interculturalidad como puente entre la cultura occidental y la cultura indígena. En este encuentro de saberes se identifica el modelo de salud indígena como respuesta cultural a la necesidad de mantener la salud y tratar la enfermedad, un modelo organizado jerárquicamente en el que la salud del individuo depende además de sus hábitos, de la armonía con la naturaleza, el espíritu, los dioses y su comunidad. Este modelo había sido menospreciado hasta hace poco tiempo por la comunidad científica; pero, gracias a los estudios en interculturalidad, se sabe que la salud también debe ser intercultural y que las políticas públicas deben incluirla para poder obtener los resultados esperados en la comunidad objetivo. Para hacer realidad estas políticas públicas debe haber voluntad y agenda política, una adecuada estructura en los servicios de salud y formación de los profesionales de la salud en interculturalidad desde sus estudios técnicos, tecnológicos, profesionales y de posgrado. Esas políticas públicas deben contener: capacitación, empleo de la lengua indígena local, alimentación y equipamiento con elementos tradicionales, diálogo respetuoso con los médicos tradicionales, atención humanizada, entre otros. Así se brinda una atención en salud de calidad que respeta las diferencias culturales de toda la población.(AU)

ABSTRACT The indigenous population has lower living conditions reflected in higher morbidity and mortality despite the coverage of the Health System, so it is important to know the causes of these differences. For this, Interculturality is used as a bridge between western culture and indigenous culture. In this meeting of knowledge, the indigenous health model is identified as a cultural response to the need to maintain health and treat disease, a hierarchically organized model in which the health of the individual also depends on their habits, on harmony with nature, the spirit, the gods and their community. Until recently, this model had been undervalued by the scientific community, but thanks to studies in Interculturality, it is known that health must also be intercultural and that public policies must include it in order to obtain the expected results in the target community. To make these public policies a reality, there must be a will and a political agenda, an adequate structure in the health services and training of health professionals in interculturality from their technical, technological, professional and postgraduate studies. These public policies must contain training, use of the local indigenous language, food and equipment with traditional elements, respectful dialogue with traditional doctors, humanized care, among others. This provides quality health care that is respectful of cultural differences to the entire population.(AU)

[Intercultural health and the indigenous health model]. / Salud intercultural y el modelo de salud propio indígena.

The indigenous population has lower living conditions reflected in higher morbidity and mortality despite the coverage of the Health System, so it is important to know the causes of these differences. For this, Interculturality is used as a bridge between western culture and indigenous culture. In this meeting of knowledge, the indigenous health model is identified as a cultural response to the need to maintain health and treat disease, a hierarchically organized model in which the health of the individual also depends on their habits, on harmony with nature, the spirit, the gods and their community. Until recently, this model had been undervalued by the scientific community, but thanks to studies in Interculturality, it is known that health must also be intercultural and that public policies must include it in order to obtain the expected results in the target community. To make these public policies a reality, there must be a will and a political agenda, an adequate structure in the health services and training of health professionals in interculturality from their technical, technological, professional and postgraduate studies. These public policies must contain training, use of the local indigenous language, food and equipment with traditional elements, respectful dialogue with traditional doctors, humanized care, among others. This provides quality health care that is respectful of cultural differences to the entire population.

La población indígena tiene condiciones de vida inferiores al resto, reflejadas en mayor morbilidad y mortalidad a pesar de la cobertura del Sistema de Salud. Por ello, es importante conocer las causas de estas diferencias. Para esto, se hace uso de la interculturalidad como puente entre la cultura occidental y la cultura indígena. En este encuentro de saberes se identifica el modelo de salud indígena como respuesta cultural a la necesidad de mantener la salud y tratar la enfermedad, un modelo organizado jerárquicamente en el que la salud del individuo depende además de sus hábitos, de la armonía con la naturaleza, el espíritu, los dioses y su comunidad. Este modelo había sido menospreciado hasta hace poco tiempo por la comunidad científica; pero, gracias a los estudios en interculturalidad, se sabe que la salud también debe ser intercultural y que las políticas públicas deben incluirla para poder obtener los resultados esperados en la comunidad objetivo. Para hacer realidad estas políticas públicas debe haber voluntad y agenda política, una adecuada estructura en los servicios de salud y formación de los profesionales de la salud en interculturalidad desde sus estudios técnicos, tecnológicos, profesionales y de posgrado. Esas políticas públicas deben contener: capacitación, empleo de la lengua indígena local, alimentación y equipamiento con elementos tradicionales, diálogo respetuoso con los médicos tradicionales, atención humanizada, entre otros. Así se brinda una atención en salud de calidad que respeta las diferencias culturales de toda la población.