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Avoiding low-value practices:
Implementation of ESSENCIAL
Project in Catalonia
Aim
ESSENCIAL Project is a public policy
initiative to identify low-value clinical
practices and elaborate recommendations
to avoid unnecessary care
Low-value clinical practices includes: ineffective or lack of evidence on their effectiveness
negative risk-benefit balance
more cost-effective alternatives exists
1. Identification of low-value practices
Scientific
events
Regional
meetings
Clinical
specialty
societies
Social
networks
Website
Consumers
35 recommendations. 64% primary care
2. Implementation of recommendations in clinical practice
To promote change in clinical practice in primary
care, to improve the quality of care and
sustainability of the healthcare system
Assessing the impact of recommendations
Objective
Catalan health primary care system
Implementation process
Feedback
Indicators monitoring
3
Impact
Before-after
4
Identification of Clinical Leader
Primary Care Team
Plan of Action
21
Collaboration, communication, transparency
Clin
ical L
ead
er
1
1. Identification of clinical leaders
Selected by Primary Care Team and
healthcare managers
To promote the project and to be the
contact person
Participate in focus group to identify
barriers to implement
recommendations
2. Plan of Action
Include:
Recommendations selected
by PCT to be implemented
Reasons why these low-value
practices occur
Proposal of actions to avoid
unnecessary care
Listing tools needed to
implement recommendations
3. Feedback-monitoring indicators
•Measurement and
monitoring indicators of
recommendations
•Providing information
monthly (feedback to PCT)
•Source of information: EHR
4. Impact assessment
Cross sectional
studyImplementation
Cross sectional
study
Beginning End
Before-after comparisons:
• Use rates
• Physician attitudes, behaviours
ResultsPilot implementation
PCT Lleida 4 Pardines
PCT Seu d’Urgell
PCT Castelldefels 2 (Can Bou)
PCT Cerdanyola
PCT Deltebre
PCT Falset
PCT Figueres
PCT Gran Sol
PCT Llefià
DAP Metropolitana Nord (69 PCTs)
Primary Care Teams of Institut Català de la Salut (ICS)
21% of all PCT and 28% of population covered
http://essencialsalut.gencat.cat/ca/implementacio/
Implemented recommendations
Dinamiques pròpies
Dona confortabilitat al pacient
Manca de coordinació entre diferents nivells
assitèncials
Pressió industria
Falta de recursos
15 /22 (68%) recommendations
Preliminary impact assessment at 6, 12 and 18 months follow-up
Barriers – Focus group
Related to physicians: uncertainty-inertia
Related to patients: influence of media and industry- to keep patients satisfied
Related to organisation: lack of time-incoherence between primary and secondary care
Conclusions /Lessons learned so far…
Pilot implementation of the Essencial at the primary care level is the first experience in Catalonia and Spain with a high participation rate.
We use the best information available to elaborate indicators for each recommendations (EHR) but we lack information to measure the impact for some recommendations
Broad number of recommendations were selected by the PCTs including screening, diagnostic test and treatment procedures
Conclusions /Lessons learned so far…
Future challenges is to design a communication campaignaddressed to all citizens and to initiate closer work withhospitals
Results provided by this pilot we will help us to improve current implementation strategy and expand it to the whole primary care system
Barriers identified by clinical leaders needed a multidisciplinary approach reaching broad stakeholder commitment for collaboration
Essencial- avoiding low-value practices is a project of theAgency of Health Quality and Assessment (AQuAS)
Catalan Health Ministry of the Generalitat de Catalunya of Catalonia
More information in http://essencialsalut.gencat.cat/en http://aquas.gencat.cat
© About this presentation. 2015, Generalitat de Catalunya. Departament
de Salut. Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS)
The contents of this presentation are under a Creative Commons license for Attribution-
NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0)
The license can be accessed in:
http://creativecommons.org/licenses/by-nc-sa/4.0/deed.en
