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Opinion
Ten recommendations to foster healthcare resource stewardship in knowledge translation
  1. Rene Wittmer1,
  2. Guylene Theriault1,2,
  3. Frantz-Daniel Lafortune3,
  4. Samuel Boudreault4,
  5. Marc-Antoine Turgeon4,
  6. Pascale Breault1,
  7. Genevieve Bois1,
  8. Lisa Hannane4,
  9. Amanda Try5
  1. 1Department of Family Medicine and Emergency Medicine, Université de Montréal, Montréal, Quebec, Canada
  2. 2Department of Family Medicine, McGill University, Montréal, Quebec, Canada
  3. 3Department of Family Medicine, Laval University, Quebec City, Quebec, Canada
  4. 4Université Laval, Quebec City, Quebec, Canada
  5. 5Choisir avec soin Québec, Montréal, Quebec, Canada
  1. Correspondence to Dr Rene Wittmer, Department of Family Medicine and Emergency Medicine, Université de Montréal, Montréal, Quebec, Canada; rene.jr.wittmer{at}umontreal.ca

https://doi.org/10.1136/bmjebm-2024-112914

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    Providing healthcare services with little to no benefit represents an important issue in healthcare worldwide. It is estimated that between 20% and 40% of prescribed tests and treatments are not useful in patient management.1 These unnecessary tests and treatments can lead to psychological and physical harm2 and have downstream consequences such as reduced quality of care, opportunity costs and negative environmental impacts.3

    Unfortunately, tackling unnecessary care is rarely seen as a pressing agenda. To start with, guideline developers often do not consider the necessity to include aspects related to the judicious use of healthcare resources in their recommendations.4 There are many examples of guideline panels widening disease definitions by lowering thresholds (eg, attention deficit hyperactivity disorder - ADHD) or transforming a risk factor into a disease (eg, pre-diabetes). Most panels did not consider the impact of these decisions on the balance of benefits and harms for patients and the health system.5 There are also healthcare professionals’ training programmes that mostly focus on the thoroughness and exhaustiveness of diagnosis instead of focusing on the value of the proposed tests.6 It seems that concepts of resource stewardship or elements that can enhance transparency (eg, absolute values) are seldom part of what is taught in medical school7–9 and the same is true for most of the continuous professional development offered to practising professionals. As argued recently, this issue should be embedded in development offerings to improve efficiency and safety in healthcare.9 Regrettably, not much information is available about what is happening in other professionals’ training curricula. Without making appropriateness of care a longitudinal priority, high-value care will continue to be an unreachable goal.

    While it is clear we need recommendations to foster healthcare resource stewardship in clinical practice guidelines, knowledge translation tools, scientific presentations and …

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    Footnotes

    • X @rwittmer3, @ebmgatineau

    • Contributors This article is a collaborative effort. The authors contributed in various capacities to the conceptualisation, writing and revision of the work. All authors have read and agreed to the proposed version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.