RÉSUMÉ
OBJECTIVE: To synthetize the state of the art of methods for identifying candidate technologies for disinvestment and propose an evidence-based framework for executing this task. METHODS: An interpretative review was conducted. A systematic literature search was performed to identify secondary or tertiary research related to disinvestment initiatives and/or any type of research that specifically described one or more methods for identifying potential candidates technologies, services, or practices for disinvestment. An iterative and critical analysis of the methods described alongside the disinvestment initiatives was performed. RESULTS: Seventeen systematic reviews on disinvestment or related terms (health technology reassessment or medical reversal) were retrieved and methods of 45 disinvestment initiatives were compared. On the basis of this evidence, we proposed a new framework for identifying these technologies based on the wide definition of evidence provided by Lomas et al. The framework comprises seven basic approaches, eleven triggers and thirteen methods for applying these triggers, which were grouped in embedded and ad hoc methods. CONCLUSIONS: Although identification methods have been described in the literature and tested in different contexts, the proliferation of terms and concepts used to describe this process creates considerable confusion. The proposed framework is a rigorous and flexible tool that could guide the implementation of strategies for identifying potential candidates for disinvestment.
Sujet(s)
Surmédicalisation/prévention et contrôle , Évaluation de la technologie biomédicale/organisation et administration , Budgets , Recherche comparative sur l'efficacité/organisation et administration , Coûts et analyse des coûts , Prise décision institutionnelle , Environnement , Pratique factuelle/organisation et administration , Humains , Surmédicalisation/économie , Satisfaction des patientsSujet(s)
Rationnement des services de santé , Surmédicalisation , Relations médecin-patient/éthique , Confiance , Rationnement des services de santé/éthique , Rationnement des services de santé/législation et jurisprudence , Rationnement des services de santé/méthodes , Humains , Surmédicalisation/économie , Surmédicalisation/statistiques et données numériques , Programmes nationaux de santé , Opinion publique , Perception sociale , Enquêtes et questionnairesRÉSUMÉ
Seventy five percent or more of a diagnosis comes from a proper medical history along with an excellent physical examination. This leaves to the clinical laboratory the function of supporting the findings, determining prognosis, classifying the diseases, monitoring the diseases and, in the minimum of cases, establishing the diagnosis. In recent years there has been a global phenomenon in which the allocation of resources to health care has grown in an excessive way; the Instituto Mexicano del Seguro Social is not an exception with an increase of 29 % from 2009 to 2011; therefore, it is necessary to set containment and reduction without compromising the quality of patient care.
El 75 % o más del diagnóstico de una entidad nosológica proviene de una adecuada historia clínica junto con una exhaustiva exploración física, lo cual le deja al laboratorio clínico la función de apoyar los hallazgos, establecer pronóstico, clasificar una enfermedad, dar seguimiento y establecer en el mínimo de los casos un diagnóstico. En los últimos años se ha presentado un fenómeno global en el que la erogación de recursos para la atención a la salud ha aumentado de forma desmedida y el Instituto Mexicano del Seguro Social no ha sido la excepción con un aumento del 29 % del 2009 al 2011, por lo que es necesario el establecimiento de medidas de contención y reducción sin que se comprometa la calidad de la atención a los pacientes.