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72 Sustainable healthcare starting at the GP office: a national innovation project to curb medical overuse
  1. Linn Okkenhaug Getz1,
  2. Bente Prytz Mjølstad1,
  3. Stefán Hjörleifsson2,3
  1. 1General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
  2. 2Research Unit for General Practice, Norce, Bergen, Norway
  3. 3Department of Global Public Health and Primary Care, Bergen, Norway


In a nutshell: This seminar focuses on the ‘ecology’ of healthcare: If we can curb an increasing tendency towards medical overuse in the offices of thousands of general practitioners (GPs), it will have important impact on the overall sustainability of the entire healthcare system. We aim to achieve such change by establishing a national alliance between the Norwegian GP college, Academia and other partners.

A challenging scenario: In high-income countries, the OECD estimates that 20% of all medical activity represents waste. Prime examples include overuse of radiological imaging and cascades of referrals to secondary care. Such low value care represents wrong allocation of limited resources and poses risk for unintended harm (side effects of unwarranted diagnostic/treatment procedures, etc.). Furthermore, low value care must be curbed to minimize the substantial carbon footprint of healthcare.

Nordic GPs handle up to 90% of patient contacts locally, carefully regulating access to specialist care and supplementary investigations in their capacity as gatekeepers. Although each particular gatekeeping decision might appear unremarkable, their sum has major system level impact. Example: A Norwegian GP might refer 3 patients to secondary care per working day. If this number increases to 3.5/day, it amounts to 2000 additional secondary care consultations in Norway/day (given 4000 GPs at fulltime work).

Interventions to curb medical overuse have so far mainly focused on changing clinician behaviour – with limited effects. Doctors compare the clinical task of curbing overuse in our contemporary consumer culture with ‘trying to stop a waterfall with your hands’. More citizen involvement and culturally sensitive interventions are needed.

Our innovation project Through a co-designed, multifaceted information campaign to counteract medical overuse at the GP office, we aim to 1) bolster the health literacy of the general population by evoking insight that ‘more medicine is not necessarily better’ for the individual, and 2) stimulate collective moral engagement, introducing sustainability and solidarity as strong societal values.

The ‘Sustainability at the GP office’ project team: GP clinician-academics, health secretaries, laboratory physicians, communication experts and patients/citizens. The project is hosted by the Norwegian College of General Practitioners, with co-creation engagement from the College’s board and sub-committees. Information about the project is being disseminated to the 9000 GP college members, officials in the health bureaucracy and patient organizations. Research anchored in general practice research units is planned to follow the innovation project.

How does the intervention look in practice? Carefully designed messages related to sustainable healthcare are being developed for GP practice waiting room screens, brochures, posters and podcasts. Other information channels will be included at later stages of the project. The messages are designed to gently and empathetically address patients’ ideas, concerns and expectations before the GP consultation, preparing them for discussions about effective, responsible and sustainable clinical practice.

Content of seminar We will introduce our innovation project and open for discussion about its moral, strategic and clinical aspects. We hope to see our activities in an international perspective, receive feedback to further develop the project, and, ideally, inspire us all.

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